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Population health is not too different from preparing for a hike. Let’s do some research.
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Dispatches from Las Vegas: Preparing for Population Health Improvement

By IHI Open School | Thursday, January 29, 2015
Eva2
For the next four weeks, Eva Luo, an Open School student and an MD/MBA candidate at the University of Michigan Medical School and Harvard Business School, is doing a rotation at Iora Health in Las Vegas to learn about their model of primary care. While there, she’s also going to be working on a population health project through the Open School’s new initiative, the Improvement Change Agent Network, or I-CAN. Below is her second dispatch for our blog (read the first here). Look for more of her posts on our blog, and contact us at openschool@ihi.org if you want to write your own post.

While there are plenty of entertainment options in Las Vegas, it’s also a fantastic launch point to some of the best national parks in the US! Since this is my first time in the southwest United States, I plan to take advantage of these places. After doing some research on the various trails and challenges I may face, preparing for a fun hike isn’t too difficult. In my backpack, I need to pack sneakers, plenty of water, sunscreen, and a light snack. With these resources, I can prevent twisting my ankle, becoming dehydrated, getting a sunburn, and getting low blood sugar.

Population health is not too different from preparing for a hike. Let’s do some research. A snapshot of Clark County, where Las Vegas is located, shows the following:

 

Clark County

Top US Performers

% Reporting Poor or Fair Health

18%

10%

% Adults who smoke >= 100 cigarettes a year

21%

14%

% Adults who report BMI >=30

25%

25%

% Adults report binge drinking

17%

10%

Chlamydia rate per 100,000

423

123

Hospitalization rate for ambulatory-care sensitive conditions per 1,000 Medicare enrollees

58

46

% Diabetic Medicare enrollees that receive HbA1c monitoring

77%

90%

% adults > 20 with diabetes

9%

N/A

Price adjusted Medicare spending per enrollee

$10,712

N/A

% Adults who could not see a doctor in the past 12 months because of cost

16%

N/A

 

One of the first exercises of the I-CAN course is “Five Whys.” The exercise helps to uncover the root causes to any particular observation. The Iora Health team clearly conducted a root cause analysis in the creation of their primary care model to better treat the patients in Las Vegas.

The clinicians and health coach team care for roughly 1,000 patients at Culinary Extra Clinic and see between 40-60 patients a day. Culinary Extra Clinic treats some of the most challenging patients who require management of several chronic diseases including diabetes, congestive heart failure, asthma, hypertension, and chronic kidney disease. Without a primary care delivery system like Iora Health, these patients were bouncing in and out of emergency rooms and hospitals with no overall improvement of their health. The Iora Health primary care model at Culinary Extra Clinic has already achieved some incredible population health outcomes. My I-CAN project this month will focus on fine-tuning Culinary Extra Clinic’s management of diabetes. The goal is to achieve well-controlled blood sugar levels, as defined by an HbA1c test of less than 8 percent, for at least 70 percent of its patients.

What would you pack into your health care “backpack” to care for the population in Las Vegas? What kind of clinical and infrastructural support systems do your patients need? Here are a few broad areas where an intervention can impact diabetes management:

Clinical Support

Infrastructural Support

  • Frequency of clinic visits
  • Frequency and types of lab tests
  • Frequency and type of communication with health coaches
  • Adherence to medication regimen and appropriate adjustment of medications
  • Training of health coach staff for more intensive care model

  • Access to healthy foods
  • Culturally sensitive diabetic diet
  • Diabetes and wellness education
  • Regular exercise
  • Flexibility of diet and medication regimen for busy job schedule
  • Engagement of family and community

 

What else would you add to your “backpack” to treat the patients at Culinary Extra Clinic? How would you prepare for the hike?

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