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?
