Community Oriented Primary Care A Practical Assessment, Vol. 2: Case Studies (1984) / Chapter Skim
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Crow Hill Family Medicine Center
Crow Hill Family Medicine Center
Pages 51-70
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From page 51... ...
While on the faculty, Dr . Reed was active in the development of a family medicine information system, an encounter-based patient care management information system serving the dual purposes of monitoring the business aspects of family practice and monitoring several of the important indices of medical care.
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From page 52... ...
Having the desire to meet the health needs of the community, a zeal for family practice, an educational background and experience based solidly in high quality primary care, and a data System capable of monitoring both the health status and health care utilization of his active patients, Or . Reed began a con~unityoriented pr unary care practice .
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From page 53... ...
They are transcribed and will appear in the medical record within 24 hours. Data Sys tem Until September of 1983 the practice subscribed to the Family Medicine Information System (nlIS)
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From page 54... ...
Organization of Financing Crow Hill Family Medicine Center is a private, for-profit, fee-forservice family practice very much in the traditional mode of American medical care. Revenues for the practice are generated exclusively from provision of patient services.
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From page 55... ...
Currently the only third party reimbursement the practice receives is from Medicaid and Comprecare.
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From page 56... ...
Me geographic community, on the other hand, consists of the 14, 000 people living along the Highway 285 corridor. The age and sex distribution of the two communities differ considerably, with the notable absence of representation in the practice community of individuals over the age of 65 years.
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From page 57... ...
At the present time, it consists of eight members who are for the most part the original members who have remained active, in addition to the school nurse of the Platte Canyon School System, the nutritionist for the county health department, as well as one member each from the two senior groups in the community. Although the health council acts in an advisory capacity to both the Crow Hill Family Medical Center and the several health related agencies of the county government, the health council has no governance function in either case.
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From page 58... ...
The f i rat two examples descr ibe activities directed primarily at the practice community, but including elements intending to reach the larger geographic community as well. In these two efforts, the data system (FMIS ~ allowed relatively close monitoring of program impact on the practice community, but monitoring the impact of the program in the larg er com~.unity was incomplete and costly .
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From page 59... ...
, but that many individuals were concerned about the potential side effects of the vaccine and were confusing the current effort with the swine f lu campaign and its adverse publicity. Bared on the previous exper fence and the data, the practice in 1983 decided to try to reach the high-risk people in the larger geographic community by collaborating with the public health nurse of the county health department.
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From page 60... ...
According to the practice impressions of the county health nurse, there is a s izable subset of geographic population served by the county health program who cannot afford or are hesitant to pay for an of f ice visit for a throat culture, and subsequently pay for an of f ice vis it for treatment if the culture is positive. Many of these people are eligible to receive cultures f tom the county health nurse, but the log istics of process ing the cultures often require an unavoidable delay in treating those with pos itive results.
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From page 61... ...
In an effort to reach a population-based group of the larger geographic community, Crow Hill has turned frequently to the Platte Canyon School. Each year one of the physicians volunteers time to teach at the school on various topics of mutual interest to the school and the practice.
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From page 62... ...
The Crow Hill practice has made use of the census data of 1980 and has noted in particular that the age and sex distribution of the geographic community is considerably different from that of either the active patients of the practice or the practice community. In general the practice feels that there are a large number of elderly in the geographic community who are not involved with the practice.
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From page 63... ...
the high-risk group, collaborating with other community agencies {county health department, senior citizens groups) , and mounting an active outreach ef fort (mailings to all high-risk individuals within the practice community)
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From page 64... ...
Rather, it prefers to collaborate with community programs, especially the county health department and the school health program, to be an advocate for needed programs, and to be supportive of current programs by providing medical back-up and consultation for health issues and cononunity-based programs. Monitor ing the Ef festiveness of Program Modif ications Through the use of the EMIS, the practice was able to monitor its success in reaching the target groups for the school child inununization and influenza vaccination campaigns within the practice community.
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From page 65... ...
While the practice has no directed outreach program as such, this coordination proves to be extremely vital an a linkage between the primary care activities of the practice itself and the comounitybased activi ties of the school and county health programs. The use of the FKIS made a tremendous difference in the ability of the practice to characterize the practice community, identify problems, create a list of high risk or high priority patients, monitor the Impact of the effort in terms of the process of care.
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From page 66... ...
Although the practice community contains elements of each of the subsets of the larger community noted above, the practice can enumerate them, he '3 had at least indirect contact with them, and feels more justified in communicating with them and in reaching out to offer Services. Crow Hill is the only local source of primary care for the residents of this geographically def ined area.
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From page 67... ...
However, the practice has considerable cliff iculty in achieving the same level of COPC practice in the larger geographic community. At this level, many of the environmental variables inherent in the small size of the practice group, the organization of financing, and the variability and dispersion of the unity make the practice of COPC a difficult undertaking.
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From page 68... ...
Second, Dr. Reed points out that the success of program modification was largely the result of serious efforts at consensus building, both within the practice and within the community.
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From page 69... ...
N Charlotte Johnson, Platte Canyon Rescue Squad Lynn Wadleigh, Platte Canyon Rescue Squad Terry Hardley, Platte Canyon Rescue Squad Mary Soucie , R.N., school nurse and member of Health Council Mary Dewey, R.N., Park County Health Department Cliff Lamaster, Silver Set Senior Group Lois Davis, The Bank of Park County Joel Edelmann, Rose Medical Center Mike Bernstein, Pose Medical Center .
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From page 70... ...
Paper prepared by Romed Corporation for Crow Hill Family Medicine Center. JRB Associates, Inc .
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