After using an “all hands on deck approach,” the White House Rural Council was able to produce a package of new job initiatives that were announced at the White House Rural Economic Forum. The Council’s recommendations, which leverage existing programs and funding, include making HHS loans available to help more than 1,300 Critical Access Hospitals recruit additional staff, and helping rural hospitals purchase software and hardware to implement health IT. The specifics are below:

Increasing Rural Access to Health Care Workers and Technology

Increasing Physician Recruitment at Critical Access Hospitals: HHS will issue guidance to expand eligibility for the National Health Service Corps loan repayment program so that Critical Access Hospitals (those with 25 beds or fewer) can use these loans to recruit new physicians. This program will help more than 1,300 CAHs across the country recruit needed staff.  The addition of one primary care physician in a rural community generates approximately $1.5 million in annual revenue and creates 23 jobs annually.  The average CAH creates 107 jobs and generates $4.8 million in payroll annually.

Expanding Health Information Technology (IT) in Rural America: USDA and HHS will sign an agreement linking rural hospitals and clinicians to existing capital loan programs that enable them to purchase software and hardware needed to implement health information technology (HIT). Under current conditions, rural health care providers face challenges in harnessing the benefits of HIT due to limited access to capital and workforce challenges.  Rural hospitals tend to have lower financial operating margins and limited capital to make the investments needed to purchase hardware, software and other equipment.

The health status of rural residents are intertwined with geography, economy, individual habits and genetics as well as access to care. The result of the dynamic interplay between these factors is a population that tends to experience a higher rate of: accidents, suicides, people with low income, public health insurance eligibility and uninsured than their metropolitan counter-parts.

Policy solutions for rural health have taken many forms including: loan repayment programs (Federal and State); construction of schools, hospitals and clinics; National Health Service Corps; J1 visas (non-US trained physicians); and telemedicine. While each of the policy solutions have its merits and effected rural health disparities to varying degrees, the basic mismatch of providers to residents still exist and create a very real access to care problem.

Hopefully this latest package combined with those provided by ACA will increase access to health care in rural areas.

Helpful Rural Health Terms to Know

Rural Health Clinics (RHCs): Clinics in official “rural designated” areas that provide a “safety net” for health care delivery.  There are approximately 3,800 Rural Health Clinics nationwide that provide access to primary care services in rural areas[i].

Federally Qualified Health Centers (FQHCs): “Safety net” providers such as community health centers, public housing centers, outpatient health programs funded by the Indian Health Service, and programs serving migrants and the homeless that meet the Centers for Medicare and Medicaid Services (CMS) criteria for FQHC designation. The main purpose of the FQHC Program is to enhance the provision of primary care services in underserved urban and rural communities[ii].

Health Professional Shortage Areas (HPSAs): These areas, designated by Health Resources and Services Administration (HRSA), have shortages of primary medical care, dental or mental health providers and may be geographic (a county or service area), demographic (low income population) or institutional (comprehensive health center, federally qualified health center or other public facility). [iii]

Medically Underserved Areas (MUA): Areas that are designated by HRSA in which residents have a shortage of personal health services.  They may be a whole county; a group of contiguous counties, a group of county or civil divisions; or a group of urban census tracts. [iv]

Medically Underserved Populations (MUPs): Groups of people who face economic, cultural or linguistic barriers to health care as defined by HRSA.[v]

Criteria for Rural and Urban Designation

Rural definitions are typically based on the following three concepts; administrative, land-use, or economic[vi]. Each definition provides considerable variation in socio-economic characteristics and well-being of the measured population[vii]. This process becomes more confusing when more than one definition is used during policy creation and evaluation.

However, one of the major criteria for Rural Health Clinics is to meet the Census Bureau’s standard of rural. The standard is straightforward- is a definition based on exclusion. Simply put, in order to meet the definition of rural an area cannot meet the Census Bureau’s definition of urban (see below)[viii].

The Census Bureau does not define suburban[ix].

Urban: All territory, population, and housing units located within an urbanized area (UA) or an urban cluster (UC). UA and UC boundaries encompass densely settled territory, which consist of: 1) core census block groups or blocks that have a population density of at least 1,000 people per square mile and 2) surrounding census blocks that have an overall density of at least 500 people per square mile[x].

Rural: The Census Bureau's classification of "rural" consists of all territory, population, and housing units located outside of urban areas (UAs and UCs). The rural component contains both place and non-place territories. Geographic entities, such as census tracts, counties, metropolitan areas, and the territory outside metropolitan areas, often are "split" between urban and rural territory, and the population and housing units they contain often are partly classified as urban and partly classified as rural[xi].

[i] Centers for Medicaid and Medicare Rural Health Clinic Fact Sheet (April 2009), available at http://www.cms.gov/MLNProducts/downloads/RuralHlthClinfctsht.pdf (last accessed August 2010)

[ii] Centers for Medicaid and Medicare Rural Health Clinic Fact Sheet (April 2009), available at  http://www.cms.gov/MLNProducts/downloads/fqhcfactsheet.pdf (last accessed August 2010)

[iii] U.S. Department of Health and Human Services, Health Resources and Services Administration Shortage Designation: HPSAs, MUAs & MUPs (May 28, 2010) http://bhpr.hrsa.gov/shortage/ (last accessed July 2010)

[iv] Ibid

[v] Ibid

[vi] Cormartie,J.; Bucholtz S.(Economic Research Service) Defining “Rural” in Rural America (2008) Volume 6 Issue 3 available at http://www.ers.usda.gov/AmberWaves/June08/Features/RuralAmerica.htm (last accessed August 2010)

[vii] Ibid

[viii] U.S. Census Bureau Census 2000 Urban and Rural Classification (2009)

http://www.census.gov/geo/www/ua/ua_2k.html last accessed August 2010

[ix] U.S. Census Bureau Census 2000 Urban and Rural Classification: Question and Answer (2009)

https://ask.census.gov/cgi-bin/askcensus.cfg/php/enduser/std_adp.php?p_faqid=623&p_sid=CSWjaK5k&p_created=1092150238&p_sp=cF9zcmNoPSZwX3NvcnRfYnk9JnBfZ3JpZHNvcnQ9JnBfcm93X2NudD0mcF9wcm9kcz0mcF9jYXRzPSZwX3B2PSZwX2N2PSZwX3BhZ2U9MQ!!&p_search_text=rural%20definition last accessed August 2010

[x] U.S. Census Bureau Census 2000 Urban and Rural Classification (2009)

http://www.census.gov/geo/www/ua/ua_2k.html (last accessed August 2010)

[xi] Ibid

This is the second day of the week long exploration of care transitions and medication errors. Knowing the importance and vulnerability surrounding care transitions I will present findings from the literature regarding checklists and Computer Order Entry that will illuminate their “true” impact in reducing medication errors. For another look at how Hope Street Group conceives to Improve the quality and cost of transitions between acute and other types of care, click here: http://www.hopestreetgroup.org/docs/DOC-2479

Checklists

A check list is an “algorithmic listing of actions to be performed in a given clinical setting” with the goal of ensuring steps of a given task are not forgotten(Agency for Healthcare Research and Quality). Checklists are a favored intervention in patient safety since the majority of errors in health care are due to “slips” or failures due to distractions, fatigue or lack of attention (Agency for Healthcare Research and Quality). The use of checklists has the potential to convey and delineate the critical thinking, collaboration and goal setting needed for a successful transition to the next environment (Halasyamani, et al., 2006). The Society of Hospital Medicine leveraged this potential by creating a basic but comprehensive checklist of the processes and elements considered necessary for optimal patient handoff at hospital discharge(Halasyamani, et al., 2006). One of the most important aspects identified by the Society is the need to treat discharges as important and time intensive as admissions, since in essence, a discharge from on place is an “admission” to another.

In theory, checklists should be easy to reproduce and bring to scale as a valid intervention. However, the literature suggests that checklists may not be successful where the “gold standard” safety practices have yet to be determined, when the preparatory work of creating a safety culture has not taken place and when relevant co-interventions are not used (Agency for Healthcare Research and Quality). Further, checklists are not proven to impact errors that primarily involve attentional behavior or adaptive situations(Agency for Healthcare Research and Quality). Checklists need to be created and implemented with an understanding of local needs, organizational buy-in and evidence for targeted problem in order to lower barriers for use (Bosk, Dixon-Woods, Goeschel, & Pronovost, 2009). For example, checklists do not perform well when used to track baggage for airlines(Bosk, Dixon-Woods, Goeschel, & Pronovost, 2009). Bosk et al, state that this is a reasonable comparison to patient transitions since they both require: a high degree of coordination (often done poorly), ability to deal with schedule changes, time-pressured decision making and heterogeneous populations(Bosk, Dixon-Woods, Goeschel, & Pronovost, 2009). According to these authors, this is what has led the U.S. Veterans Affairs to classify checklists as weak interventions based on the low probability that they will reduce risks(Bosk, Dixon-Woods, Goeschel, & Pronovost, 2009).

Computerized Order Entry and Clinical Decision Support Systems

Computerized Provider Order Entry (CPOE) generally refers to a system in which clinicians directly enter medication orders into a computer system (Agency for Healthcare Research and Quality). It has been reported that 90% of inpatient medication errors occurred at either the ordering or transcribing stage (Bates, et al., 1995). These systems are more common in the inpatient setting than in the outpatient setting (Agency for Healthcare Research and Quality). Often, CPOE is paired with clinical decision support systems (CDSS), which can help prevent errors of commission and omission(Agency for Healthcare Research and Quality).

There are drawbacks to CPOE despite the fact that it directly addresses issues such as handwriting; drug interactions; similar drug names; system communication and adverse drug event reporting.(Agency for Healthcare Research and Quality). In fact, CDSS may be the key intervention in reducing errors in conjunction with CPOE since it has been reported that together (CPOE and CDSS), they reduced serious medication errors by 81% (National Priorities Partnership, 2010). However, the immediate implications of these findings are unclear. Although nursing homes are leading the way in terms of electronic medical record use (43%) it is unclear what percentage of those use CPOE (Leading Age, 2008). Additionally, the Agency for Healthcare Research and Quality (AHRQ) reports that only 17% of U.S. hospitals have implemented a CPOE system in 2009(Agency for Healthcare Research and Quality). AHRQ also indicates that problems with CPOE include cost, time, onsite customization, resistance and interoperability. CPOE and CDSS appear to not be able to make a large impact based on the low and inconsistent penetration of these technologies.

I know there are dedicated supporters of each intervention. Let us hear what you have to say! Log in and share below.

Agency for Healthcare Research and Quality. (2011 February). Nursing Home Survey on Patient Safety Culture. Retrieved 2011 10-August from Agency for Healthcare Research and Qulaity: http://www.ahrq.org.gov/qual/patientsafetyculture/nhsurvindex.htm

Agency for Healthcare Research and Quality. (n.d.). PSNET, Patient Safety Primer, Checklists. Retrieved 2011 10-August from Agency for Healthcare Research and Quality: http://www.psnet.ahrq.gov/primer.aspx?[rimerID=14

Agency for Healthcare Research and Quality. (n.d.). PSNet, Patient Stafety Primer, Computerized Order Entry. Retrieved 2011 10-August from Agency for Healthcare Research and Quality: http://www.psnet.ahrq.gov/primer.aspx?primerID=6

Bosk, C., Dixon-Woods, M., Goeschel, C., & Pronovost, P. (2009). Reality Check for Checklists. The Lancet , 374 (9688), 444-445.

Halasyamani, L., Kripalani, S., Coleman, E., Schnipper, J., vanWalraven, C., Nagamine, J., et al. (2006). Transition of Care for Hospitalized Elderly Patients: Development of a Discharge Checklist for Hospitalists. Journal fo Hospital Medicine , 1 (6), 354-360.

Leading Age. (2008  7-November). Press Release: Research Shows Nursing Homes Lead the Way in Electronic Health Record Use. Retrieved 2011 10-August from Leading Age: http://www.leadingage.org/Article.aspx?id=952

National Priorities Partnership. (2011 10 August). National Qulaity Forurm, Overuse. Retrieved 2011 10-August from National Quality Forum: http://www.qualityforum.org/Topics/Overuse.aspx

Walmart changed the pharmaceutical retail industry forever by creating the $4 Prescription Program. In one fell swoop, a gargantuan company disrupted part of the health care ecosystem. Today it looks like they are taking a new angle on how to manage in store health clinics. In the past, Walmart utilized a separate company that ran health clinics within the store but these closed in 2008 after about 3 years in operation. By partnering with St. Dominic in Mississippi, Walmart has made a deliberate choice to support local health care professionals ability to provide care to their community.

This type of movement directly ties with Hope Street Group’s belief that using new places to deliver primary care can achieve greater capacity at lower cost.

You can read more about this here: Walmart to open clinics in stores , The Clinic at Walmart and Recommendation 3: Use new people, places, and tools to achieve greater capacity at lower cost.

In its 2001 seminal report “Crossing the Quality Chasm:  A New Health System for the 21rst Century”, the Institute of Medicine (IOM) described the current state of health care delivery.  The report described a health care system that was fragmented, poorly designed and most importantly not delivering quality care. It also outlined a plan with very specific performance objectives designed to close the quality gap and support the patient-provider relationship. These objectives called for a radical redesign of the health system to achieve six aims—safe, effective, patient-centered, timely, efficient, and equitable care.  A new phase in health care improvement is now emerging: one that focuses on value. Value considers providing safe, effective, and efficient care at the right cost. The Institute for Healthcare Improvement (IHI) has developed a model for optimizing health, care experience, and costs for populations -- The Triple Aim. This is a structure in which we know and care about:

1. Patient and Family experience,
   
2. The quality of care delivered, and
   
3. How our efforts impact the cost of care.
   

I would add from my own perspective that we care about our community and providing care for all.

My career started working as a nurse in a hospital system before I moved to the ambulatory care setting. As a nurse there are moments in my career that haunt me. These tragic events had catastrophic impact on patients and families. It was not the failure of caring and competent staff which led to these haunting memories--it was the lack of systems and process to support evidence based care. These experiences drive my passion for a healthier health care delivery system.

In my current position with Colorado Beacon Consortium as Director, Community Collaboratives and Practice Transformation, I have the pleasure of helping primary care practices in transformation and learning from their amazing efforts. In my 15 years working with primary care practices, I have never met a staff member clinical or non-clinical who came to work hoping not to deliver the best possible care. Practices need support for these transformational changes.  Having a “small test of change” fail has meaning for clinical staff because of our educational experience. Failure in the clinical training means that a patient is harmed. Clinical staff need to understand that failures in the quality improvement process mean that the team will not be wasting their time on processes that do not bring value to their patients or to the practice.

In an era of incentive programs such as Meaningful Use and system designs such as Accountable Care Organizations, now more than ever strong Primary Care delivery systems is necessary for creating a healthier health care system. Primary Care transformation is integral is achieving the goals articulated in Crossing the Quality Chasm.

Now more than ever Primary Care needs support to transform systems and processes to make their best better. Redesign efforts started with the development of the Chronic Care Model by Dr. Edward Wagner and the MacColl Institute. The Chronic Care Model serves as a structure to organize care delivery for patients with chronic disease by maximizing proactive team based care, implementing processes which deliver evidence based care, utilizing health information technology (HIT) and delivering proactive care. Through several national organizations such as Health Resources and Services Administration (HRSA) Health Disparities Collaboratives, the Institute for Healthcare Improvement (IHI), the MacColl Institute and more recent initiatives such as National Demonstration Project and Improving Performance in Practice (IPIP) best practices in primary care transformation have been developed.

The Patient-Centered Medical Home (PCMH) has been recognized as a catalyst to support Primary Care transformation that delivers on the expectations described in Crossing the Quality Chasm. Agency for Healthcare Research and Quality (AHRQ) describes PCMH as:

• Patient-Centered
  
• Comprehensive  & Coordinated care
  
• Superb access to care
  
• A systems-based approach to quality and safety
  

These attributes must be supported by a foundation of Health Information Technology and rich data which provides knowledge to drive outcomes.  The other structural change must come in the form of a payment structure that supports primary care and the attributes that will drive the value primary care delivery will bring to healthcare.

A comprehensive program to recognize practices who implement the attributes of PCMH has been developed by the National Committee for Quality Assurance (NCQA) Physician Practice Connections- Patient-Centered Medical Home (PPC-PCMH). NCQA has recently updated the recognition program.

The 2011 program includes the core components of primary care:

• PCMH 1: Enhance Access and Continuity
  
• PCMH 2: Identify and Manage Patient Populations
  
• PCMH 3: Plan and Manage Care
  
• PCMH 4: Provide Self-Care and Community Support
  
• PCMH 5: Track and Coordinate Care
  
• PCMH 6: Measure and Improve Performance
  

The transformation process for primary care is more than tinkering around the edges. This process of change requires a foundation of culture and leadership that is supportive of the efforts within the practice. This can be either through the leadership structure of a broader organization or within a small independent primary care practice. The Primary Care Practice team members are being asked to reconsider the hierarchical nature of medicine for a team based approach to patient-centered care. All members of the team to participate in the redesign process and in evidence based care delivery. Practices establish structures to make “small tests of change” that are reviewed to understand if the impact is positive in delivering safe, effective, evidence based care.  Implementing self-management support with primary care builds on the most intimate of relationships between patient & families and the care team. Self-management techniques utilized in the care setting build on patient activation and engagement in their care. Technology is a tool to be maximized and utilized meaningfully.

Clearly, we understand the role of Primary Care in supporting our current sick health care system to become healthier. This transformation takes time and requires support. As we establish principles, goals, care models and incentive programs to create a healthy health care system, it is important not to lose sight of the need to also transform the current payment model with is perfectly designed to assure that our fragmented, ineffective, dysfunctional and harmful health care system continues.

Crossing the Quality Chasm

http://www.iom.edu/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx

Institute for Healthcare Improvement

http://www.ihi.org/IHI/Programs/StrategicInitiatives/IHITripleAim.htm

Improving Chronic Illness Care

http://www.improvingchroniccare.org/

HRSA Healthcare Communities

http://www.healthcarecommunities.org/

Agency for Healthcare Research and Quality

http://www.pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/1483/what_is_pcmh_

National Committee for Quality Assurance

http://www.ncqa.org/tabid/631/default.aspx

Office of the National Coordinator for HIT (ONC)

http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__home/1204

Colorado Beacon Consortium

http://www.coloradobeaconconsortium.org/

Center for Medicare and Medicaid (CMS)

https://www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp

Partnership with Patients

http://www.healthcare.gov/center/programs/partnership/index.html

Where does the healthcare continuum really begin?

With prevention?

In the home?

With the Primary Care Provider?

In the Emergency Department?

Although an argument can certainly be made for any of the four choices above, I’d like to challenge your opinion and perspective with a different answer…the continuum for many begins with Emergency Medical Services (EMS).

This past year I had the privilege to be included in two standard setting and forward thinking discussion forums-- AHRQ’s 2010 Annual Conference and HCIE Innovators Event as well as Hope Street Group’s Policy 2.0: Using Open Innovation to Reinvent Primary Care Project. Both of these events offered diverse perspectives from diverse participants in academia, corporations and all levels of government and localities who gathered to discuss and make recommendations to improve the health care system. Interestingly, the first responder perspective of EMS was only a footnote in these discussions. I believe that policy makers and leaders within healthcare all too often fail to look outside their sphere of influence and familiarity for answers or more importantly the critical questions. That said, I know this minimalization was not intended or planned, but a result of historical processes and comfort levels.

The numbers…

EMS contributes 15% or 17.25 million patients to the nations 123.8 million annual Emergency Department (ED) visits (CDC, 2008), yet Fire, EMS or Law Enforcement respond to over 240 million 911 calls per year (NENA, 2009). It’s difficult to accurately breakdown the national percentages of 911 call types, but upwards of 60% of EMS calls are generally considered low-acuity or non-emergent. To put this into a local perspective, the City of Tucson AZ with a population of approximately 530,000 (2005) generates approx. 79,000 Fire and EMS 911 calls per year, 84% or ~67,000 of these are medical in nature and 60% of those, ~46,000 require only Basic Life Support (BLS) care (TFD, 2009).

So what does that really mean? It means that the 911 system provides a substantial safety net for the Nation’s healthcare system. While this should come as no surprise, the volume of patients utilizing EMS, Emergency Departments and the 911 system continues to grow. Over 15 years ago, the National Highway Traffic Safety Administration and the Health Resources and Services Administration joined with leaders from the EMS community to put forth an EMS plan that would require significant collaboration with acute care, primary care and public health. This provided one of the earliest, nationwide, use of the scale-up-and spread model and was published as the1996 EMS Agenda for the Future (NHTSA, 1996).

The past…

To implement that vision and professional template, EMS has continued to grow it’s service provision model from one that was historically created for stabilization and transport of the acutely ill and injured; one that was set-up to intervene only when patients needed emergent support; one that operated in relative isolation from other health care and community resources; one that was not involved in the business of ensuring social service follow-up and one that did not have a working knowledge of community health care providers and regional health care organizations (NHTSA, 1996).

The present…

Today, EMS is integrated with other health care providers, public health and public safety agencies to provide community-based healthcare and management. EMS agencies and providers are involved in activities related to prevention education, illness and injury risk, acute illness and injury care, follow-up, treatment of chronic conditions and community health monitoring. This vision is also shared by the Injury Response Division of the National Center for Injury Prevention and Control/Centers for Disease Control and Prevention (NCIPC/CDC) and the American College of Emergency Physicians (ACEP) who have called for a better understanding of roles and collaboration between Public Health and EMS through their Appleseed Project initiative (CDC, 2004).

The reality …

As you can see, EMS has developed into more than a group of fire departments, rescue services and ambulance companies. While providing these additional and collaborative services, EMS remains the public’s emergency medical safety net.  Looking back to those 240 million 911 calls and the 17.25 million EMS-to-ED admissions, it’s clear that a significant amount of health assessment, care and triage occurs outside the hospital walls. In fact, there are no other healthcare providers that see patients in their own home or living environment quite like EMS. The “scene assessment” which is a fundamental EMS skill reveals more information about a person, their living conditions, their health, their support system and their coping mechanisms than any other assessment tool.  How many Primary Care providers, case managers or health plan administrators have this perspective into their own patient’s lives?

From where I sit with over 30 years of experience as an RN in Maternal-Child Health and EMS, I see several important questions that need further discussion and clarification before we can begin to understand how to move forward in improving the healthcare of our Nation.

• How can we better educate individuals to utilize the 911 system for acuity appropriate reasons?
  
• How do we encourage the use of Primary Care practitioners for non-emergent and urgent medical and injury complaints instead of defaulting to the approach of “if this is a medical emergency, please hang up and dial 911?
  
• How do we share the burden of after-hours and weekend low-acuity patient needs?
  
• How do we facilitate better communication and collaboration between EMS, public health, acute and chronic care case management, behavioral health and community services?
  
• How do we move patients calling 911 for non-emergent or non-healthcare reasons into a public or human services system that will better meet their needs?
  

Communication, collaboration, connectivity, consistency and caring are all functions of healthcare, yet as the patient numbers and range of patient complaints increase, we all need to utilize each others skills, knowledge and expertise to meet the needs of our patient population. Reaching out to our colleagues may be the first step toward improvement, integration and understanding of our healthcare system.

http://www.911dispatch.com/info/fact_figures.html

http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/nhamcsed2008.pdf

http://cms3.tucsonaz.gov/sites/default/files/imported/data/demographic/eecpop00_05.pdf

http://www.nena.org/911-statistics

http://www.cdc.gov/injury/publications/index.html

http://www.nremt.org/nremt/about/emsAgendaFuture.asp

http://www.tucsonaz.gov/fire/AnnualReport.pdf

Recently, two of our key advisors have been featured in the media due to their success in providing direct health care services using both innovative and underutilized methods.

A recent New Yorker article by Atul Gawande highlights one of our advisors and panelists for the primary care event, Rushika Fernandopulle, MD. His practice in Atlantic City, New Jersey recruits and trains frontline health workers to serve the functions of both health coaches and medical assistants for 1,200 patients with multiple chronic illnesses.

The New York Times just featured advisor Tom Lee, MD as one of the pioneers of affordable concierge practices in the country. Lee, also a co-founder of Epocrates, has been able to extend visit times, engage in email communication and additional services provided by personalized “concierge” medical practices, but at a much lower price: $150 to $200 a year.

Access the full articles:

http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande

http://www.nytimes.com/2011/02/01/health/01medical.html

Nova Scotia Premier Darrell Dexter has announced in a speech earlier this month plans for a $16-million collaborative primary care clinic in Queens County. The overarching goal is to bring Better Care Sooner to Nova Scotia residents by reshaping how emergency care is delivered.

The collaborative care clinic will have space for five  family  physicians, a nurse practitioner, family practice nurses and  other  health professionals.The new plans also call for an upgraded 22-bed  inpatient unit.

Additionally the Better Care Sooner is poised to:

-improve access to primary care, especially in smaller communities.

-make emergency care more patient-centered and streamlined.

-provide care that is better tailored to those whose needs are more complex (i.e. seniors).

-increase public awareness of 911 and the healthlink nurse line 811.

-make changes to the way health care is funded (reward better, patient-centered care).

The government states that roughly 84 percent of ER visits at the hospital would be better addressed by primary care.

Dexter says the province is committing $2.5 million to the project while the Region of Queens Municipality has committed $1 million.

About $11 million comes from the Queens Foundation and private donors, and another $1.5 million still needs to be raised.

Check out the whole story at http://www.canadaviews.ca/2010/12/23/improvements-will-ease-er-overcrowding-access-to-care/

On May 3, 2010, Hope Street Group convened our Bipartisan Working Group of business, political and civic sector leaders to address the urgent need to reinvent primary care.  The Working Group looked at opportunities to maximize innovation in addressing resource shortages and acute, preventative, and chronic care delivery.

Once again, Hope Street Group leveraged the tremendous expertise and knowledge base of our community of advisors.  Participating in the discussions on the night were:

Byron Auguste | Director, McKinsey & Company

Dr. Sree Chaguturu | Attending Physician, Massachusetts General Hospital; Manager, McKinsey & Company

Aaron Doty | Health Care Advisor, Hope Street Group

Susan Edgman-Levitan, PA | Executive Director ,The John D. Stoeckle Center for Primary Care Innovation, Massachusetts General Hospital

Dr. Paul Grundy, MPH | IBM's Global Director of Healthcare Transformation; President, Patient-Centered Primary Care Collaborative

Dr. Jeff Harris | Former President, American College of Physicians

Dr. Matthew Hunsaker | Director, RMED, National Center for Rural Health Professions, University of Illinois, College of Medicine at Rockford

David Javdan | Manager Director, Alvarez & Marsal, LLC;

Dr. Bob Kocher | Special Assistant to the President, National Economic Council

Peter Lee | Executive Director, National Health Policy Pacific Business Group on Health

Monique Nadeau | Executive Director, Hope Street Group

John Podesta | CEO, Center for American Progress

Diane Rowland, ScD | Executive Vice President, Henry J. Kaiser Family Foundation; Chair, MACPAC

Andy Slavitt | CEO, Ingenix

Simon Stevens | Executive Vice President, UnitedHealth Group

Dr. Kate Tulenko | Deputy Director, CapacityPlus (USAID)

David Walker | President and CEO, Peter Peterson Foundation

Dr. Steven Weinberger, FACP | Deputy Executive Vice President, Senior Vice President for Medical Education & Publishing American College of Physicians

Participants considered the impact of the lack of a coordinated market in primary care, and the impediments to take up of innovation. They discussed the way in which geographic distribution and variation in the distribution of types of practitioners exacerbates the impact of workforce shortage in primary care.  They also looked at how other players in the complex health care market may react when changes to primary care begin to take effect.  Participants agreed that it was important to address the barriers to the spread of innovation (including drawing on the experiences of other countries), rather than duplicating the efforts of existing innovation leaders.

You can view a copy of the full Executive Summary here.