OWhN Focus Areas
On August 31st, 2015, the Oregon Washington health Network completed its five year strategic health plan. This plan included 20 goals to be completed by 2020. Individual goals were established by calendar year. These were integrated with the scope of work of the network’s three year outreach grant that was funded by the Health Resources Services Administration starting in May of 2015. The current initiatives of the network are described below.
1. Chronic Disease Management
Improving chronic disease management is an ongoing priority of the network. Elevated rates of cancer, heart disease, and stoke have been long standing health concerns in the service area of the network for decades. Based on its strategic plan, the network plans to carry out the following initiatives over the next five years.
2. Implementation of Evidence Based Practices for Chronic Diseases
In March of 2015, YTHC established an evidence based practice protocol team with the support of the Oregon Health and Science University Evidence Based Practice Institute. Evidence based practice training was held for the network in February of 2015 and for the staff of YTHC in March of 2016. The EBP protocol team will work with members of the network over the next two years to implement evidence based practices for cancer, heart disease, and stroke.
3. Heart Disease Community Education
The Outreach Nurse of OWhN arranges and coordinates community education presentations on heart disease. These presentations which are based on evidenced based practices for heart disease will be expanded in 2016 with community education presentations to be held at various locations in Umatilla, Union, Morrow, and Walla Walla Counties.
4. Heart Disease and Cancer Coaching
In June of 2015, the network’s Outreach Nurse began providing heart disease and cancer coaching services to patients of Yellowhawk Tribal Health Center. Chronic disease coaching activities will be expanded in 2016 and 2017 based on approved evidence based practices for the network. By April of 2018, the network will fully implement evidence based cancer coaching services for all of its members. These efforts will be added through the completion of quality improvement studies to assess the impact of coaching activities and a small market media campaign for which funding is being sought.
5. Cancer Intervention Plan
In March of 2016, Yellowhawk Tribal Health Center in collaboration with OWhN completed the first updated study of cancer in the four county service area of the network. During 2012, Oregon experienced the highest cancer death rates of eleven Western states. Based on the results of the study, the four counties served by OWhN had even higher cancer deaths rates than did the State of Oregon for a number of diagnoses. These included prostate, kidney, stomach, and thyroid cancer. Based on this information, the network developed a cancer intervention plan that calls for expanded cancer prevention, screening, and treatment. Radon testing is also encouraged for Union County with expanded mammography screening for Morrow County. The network is currently in the process of seeking funding to address these needs.
6. Health Professions Recruitment
Access to care due to a lack of health professionals is the largest single barrier to quality health care being delivered in the four counties served by OWhN. As a result, recruiting and retaining health professional in Northeast Oregon is considered to be one of the highest priorities of the network. In order to address the continuing shortage of health professionals in the region, OWhN is currently in the process of carrying out the following initiatives.
7. Residency Programs with Oregon Health and Science University (OHSU)
OWhN is working with Oregon Health and Science University (the state’s only medical school) to establish residency programs within OWhN member hospitals and at Yellowhawk Tribal Health Center. These would include family practice and internal medicine. Residencies for specialty care are also being discussed with the OHSU and it is hoped these can be implemented over the next two to three years.
8. Arranging Training for Nurse Practitioners, Psychiatric Nurse Practitioners and other advanced practice nurses through OHSU
OWhN is working with the OHSU School of Nursing to arrange training opportunities for nurse practitioners and other advanced practice nurses in Northeast Oregon. These would include Advanced Practice Nurse Practitioners (ARNP’s), psychiatric nurse practitioner, and pediatric nnurse practitioners among others.
9. Expansion of Health Related Training Programs with Blue Mountain Community College (BMCC) of Pendleton
Staff of OWhN is currently working with BMCC to initiate or expand health professions training opportunities in the network’s service area. Potential training areas would include lab and radiology technologists, medical records professionals, and substance abuse counselors.
10. Establishing Social Work Placements to Implement Value Based Care
OWhN is currently working with Walla Walla University of Walla, Walla Washington to place Master’s level social workers within the provider agencies of the network. These individuals would be trained to assist with crisis management teams to be implemented for the network and as coordinators for value based care services. The network hopes to implement these services over the next three years.
11. Increase the Number of Preceptors available in the Network’s Service Area
The availability of preceptors is important to increasing training opportunities in Eastern Oregon. Many existing preceptors are retiring or are no longer interested in participating in student or resident training. As a result, the network is working with its members and OHSU to increase the number of preceptors available in the OWhN service area.
12. Training of Network Members and Collaborators
Since OWhN was established, training of member organizations and their staffs has been a high priority. During the past 18 months, the network has sponsored cultural sensitivity, quality improvement, and evidence based practice training. In March of 2016, the network completed a training survey of its members. Areas of training recommended for the network were:
- Expand Evidence Based Practices training for local medical providers
- Outcome measurement and benchmarking
- Program Evaluation
- Value Based Care
- Team Management/Team Building
Staff of the network is currently in the process of arranging this training that will be held in 2016 and 17.
13. Establish a Regional Telemedicine Network
One of the initial goals established by the network during the OWhN strategic planning process was to establish a regional telemedicine network. This was seen as important for improving access to specialty care, hosting member training, and reducing travel for meetings. In January 2016, teleconferencing equipment was purchased for all member organizations of the network. In May of 2016, Yellowhawk Tribal Health Center was award a two year grant from the Cambia Foundation of Portland to implement a regional telemedicine system in all four counties in the network. As of 6/1/15, OWhN is carrying out the following activities to fully implement a regional telemedicine network by May 1, 2018.
14. Arrange contracts with regional providers including transfer center services
The network is currently in the process of arranging telemedicine contracts with all three regional providers. These are Providence Kedlac of Richland, WA; Legacy Health System of Portland, and OHSU. Agreements to provide ongoing telemedicine services with one or more of these organizations are anticipated by October 1, 2016.
15. Provide Training for Users of Telemedicine to include IT Support
Staff of OWhn is currently investigating options for the training of medical users of the telemedicine network. Training will also be provided for information technology staff to resolve technical issues with the system once it is fully implemented. This training is expected to be held in the fall or winter of 2016 once a decision is made regarding the telemedicine equipment to be used by the network and purchased through the Cambia grant.
16. Determine Management Responsibilities and Telemedicine Billing Procedures
Management of the telemedicine network to include accessing services through provider transfer centers and billing are issues currently under consideration by the network. These will be determined as part of the contracting process for implementation of the telehealth network over the next two years.
17. Work to Achieve Expanded Access to Quality Mental Health and Substance Abuse Treatment Services
Similar to a lack of primary health care services within the OWhN service area, behavioral health and substance abuse treatment service are in short supply. Although behavioral health and primary care integration are recognized goals of the network, the immediate need is to provide adequate staffing for existing programs and to develop new services so that a full continuum of behavioral health services can be accessed by patients. In 2015, the network implemented a process to ensure all patients were screened for depression. This is expected to be fully implemented for all network partners by the end of 2017. Other mental health and substance abuse initiatives being carried out by OWhN are described below.
18. Support the implementation of Crisis Mental Health Service Teams
During 2016, OWhN completed an assessment of crisis mental health services within the network’s service area. This study found that numerous activities needed to be carried out to ensure adequate crisis mental health services were available on a 24 hour, 7 day per week basis. These included training, establishing crisis team in all counties, and working to reduce emergency room usage in local hospital. The network is currently working with its member county health departments and regional mental health provider (Lifeways, Inc.) to ensure effective crisis management and response within the OWhN service area.
19. Improve Access to Mental Health Services in Area Schools
During 2016, staff of OWhN contacted schools in Umatilla County to determine the adequacy of mental health services being provided within local school districts. It found that these services were lacking in many cases due to a lack state funding. The network is in the process of assessing the availability of mental health counseling in all four counties in the OWhN service area and upon completion of this assessment will be seeking funding to expand services especially at the junior and high school grade level.
20. Access to Substance Abuse Treatment
Oregon counties in the OWhN service area lack many of the needed components for comprehensive substance abuse treatment. These include adult and youth residential treatment, shelter homes, and recovery half way houses. Staff of OWhN is currently working with the YTHC behavioral health program and county health departments to develop a plan for expanding substance abuse treatment across the region.
21. Develop the network’s organizational structure and plan for long range operation and sustainability
As has been documented in a number of studies, long term sustainability is the most important element in the success of a rural health network. Over the next two years, the network plans to implement by-laws to formalize the governance structure of the organization and to complete a long range sustainability plan. This will include recommendations for establishing for profits services and related funding raising activities to sustain the operation of the network on a long term basis.