CitySquare Community Health Services receives highest rating as "medical home"!

Great news for CitySquare's Community Health Services!  The National Committee for Quality Assurance, a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality recently released the results of the following practices as receiving the organization's highest quality ranking:

Baylor Family Medicine at Legacy
Family Medical Center at Terrell
Baylor Occupational and Family Health Center at TI
City Square
City Square- Pediatrics

Since 1997, our Community Health Services department has partnered with the Baylor Health Care System and Health Texas Provider Network to bring extremely high quality medical services to inner city Dallas.  The following letter tells the wonderful story:

Congratulations!

We have not only completed the application process for NCQA Patient Centered Medical Home recognition for all of our adult, geriatric, residency and pediatric practices, but have now received the results. All practices received the highest possible level of recognition. Level 3 is the highest level for Electronic Health Record (EHR) practices and the highest for paper practices is Level 2. Out of a possible 100 points, our EHR clinics scored in the mid-90s on average. This means that we now have 60 practices, 271 physicians, and 59 non-physician providers (APRNs and PAs) in recognized medical homes. This is the second highest total of any system in the nation.

During this implementation and application process we have seen engagement in new discussions around topics like pre-visit planning, ambulatory care coordination, patient/family activation and patient access. More practices have extended hours than ever before. Heart failure readmissions have dropped significantly. Diabetes scores have improved. Guidelines have been standardized across our practices including many specialty practices. Insurers are coming to us asking for PCMH contracts that allow for new funded resources and opportunities for shared savings.

The journey started many years ago with the Quality committee's work on quality standards and measurement of preventive services and diabetes metrics. It continued with the work of the Service Excellence committee, the Ambulatory EHR committee, Patient Safety committee, Disease Management and EHR Content Committee, and then the PCMH Task Force. The medical home applications included work from all of these committees.

Join me in thanking the chairwomen/chairmen and members of these committees for their hard work as well Sarah Gahm and David Winter for their leadership. Of course we should especially thank Pat Link, the PCMH Director, and her team of consultants, writers and contributors: Endia Kendrick, Michell Martin, Niki Shah, Patrice McConnell, Ashley Wood, Vivian Plumlee, Joe Brumbelow, Nancy Trinh, Kelly Risinger, Beulah Casey, Cynthia Granade and Tim Houtchens. We also need to thank our physician auditor team who gave personal time to audit over 2,300 patient records, Drs. Hickl, Astbury, Aponte, Molen, Massey, Stroud, Thompson, Bassel, Berry, Caudill, Garcia, De Leon, Holbrook, McMillin and Sharp.

The journey of course never ends. We are already implementing the new PCMH criteria into our practices. Many of these are meaningful use criteria. We are also preparing to apply for NCQA recognition for our new practices under these new guidelines as well as preparing to support BQA non-HTPN practices.

We are blessed to have a group of physicians, nurse practitioners, physician assistants, administrators and staff who strive to provide safe, effective, efficient, equitable, timely and patient centered care. It makes our work more enjoyable and meaningful.

Thank You All,

Cliff Fullerton, M.D., M.Sc.
VP Chronic Disease Baylor Health Care System
Chief Quality Officer HTPN

What a privilege to be working in tandem with our partners at Baylor and Health Texas!  CitySquare continues to help provide the highest quality care possible to low income neighbors in the inner city of East and South Dallas. 

Way to go, CitySquare team!

SNAP now works at Dallas Farmers' Market

CitySquare has led the way in opening the Dallas Farmers' Market to low-income customers by helping negotiate the use of Supplemental Nutrition Assistance Program benefits (SNAP, fomerly known as "food stamps") to purchase fresh fruits and vegetables from local producers.

The new policy delivers a true win-win to the market and those who trade there.

Farmers now have a larger market for their produce. Customers now have a grocery venue that supplies fresh, healthy food. Profits and health status both improve!

Rev. Gerald Britt, VP of Public Policy, and his associate, Keilah Jacques worked hard to see this new policy implemented!

Here's a video report from Channel 8!

Pain and class

This from TIME magazine and CNN:

Millions of Americans in Chronic Pain
Friday, May. 02, 2008 By KATHLEEN KINGSBURY

Nursing a migraine today? New research shows you're not alone. More than a quarter of Americans suffer daily pain, a condition that costs the U.S. about $60 billion a year in lost productivity. And how often you're in pain depends largely on the size of your paycheck.

Americans in households making less than $30,000 a year spend nearly 20% of their lives in moderate to severe pain, compared with less than 8% of people in households earning above $100,000, according to a landmark study on how Americans experience in pain. The findings, published Thursday in the British journal The Lancet, also found that participants who hadn't finished high school reported feeling twice the amount of pain as college graduates. "To a significant extent, pain does separate the classes," says Princeton economist Alan Krueger, who authored the study along with Dr. Arthur Stone, a psychiatry professor at Stony Brook University.

Krueger notes that the type of pain people reported typically fell on either side of the rich-poor divide. "Those with higher incomes welcome pain almost by choice, usually through exercise," he says. "At lower incomes, pain comes as the result of work." Indeed, Krueger and Stone found that blue-collar workers felt more pain, from physical labor or repetitive motion, while on the job than off, which at least offers hope that the problem can be mitigated. This finding "emphasizes the need for pain preventing measures [in the workplace] such as better ergonomics," wrote Juha H.O. Turunen, a professor of social pharmacy at Finland's University of Kuopio, in an accompanying commentary to the report.

People with chronic pain also worked less, the new study found, costing U.S. businesses as much as $60 billion annually. These conclusions are in line with previous studies on productivity lost to common pain conditions, including a 2003 report finding that nearly 15% of the U.S. workforce's output was diminished by ailments such as headaches and arthritis. What's new in Kruger and Stone's study, however, is the level of detail with which the researchers were able to chronicle the lives of Americans in pain. With the help of the polling firm Gallup, they asked nearly 4,000 survey participants to diarize their daily activities over a 24-hour period. From these personal accounts, the researchers saw the impact pain had on people's emotional states. Though participants said interacting with a spouse or friend lowered their pain, those suffering chronic pain tended to socialize much less. They also spent a lot more time watching television�about 25% of their day compared with 16% for the average person.

Pain also appeared to be a major driver of healthcare costs. Krueger and Stone found that Americans spent about $2.6 billion in over-the-counter pain medications and another nearly $14 billion on outpatient analgesics in 2004, the most recent data available. But in these numbers, too, there may be a distinction between the haves and the have-nots. A 2005 study in Michigan showed that minorities and the poor have less access to such drugs than wealthier Americans because local pharmacies don't stock enough pain medications such as oxycodone or morphine.

"Those [pharmacies] in white ZIP codes were more than 13 times more likely to have sufficient supplies," says lead researcher Dr. Carmen Green, an anesthesiology professor at the University of Michigan. "I have patients who have to drive 30 miles or more just to get their pain medications."

One characteristic that pain doesn't seem to distinguish is gender: according to Krueger and Stone's study, men and women were nearly equally likely to find themselves in pain. Another is age. People reported more aches and pains as they got older, though surprisingly that pain tended to plateau from ages 45 to 75. "Maybe people reach a point in their career where they move up the ladder into a desk job," Krueger says. "Or maybe they've just learned how to cope with the pain."

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Is inequality making us sick?

Most of us take our advantages for granted.

I expect most reading here today have never experienced "oppression" and its side effects.

But, sadly, many have and do today.

Yesterday morning I saw the segment below on The Today Show. It describes new research and an upcoming 4-part television series based on this research documenting the fact that race, socioeconomic standing, education and other social factors determine length of life and health status. In short, inequality is making us sick. Injustice has very real, practical, life and death consequences.

You will be able to catch the entire report by checking your local listings for PBS programming or by visiting the website at www.pbs.org.

Watch the segment. Tell me what you think.

Below is a video from The Today Show called "Is inequality making us sick?"

Obesity and poverty. . .

Diet and nutrition continue to be incredible challenges for people who don't have much money.

On the one hand, access to affordable and healthy food products remains very limited in many inner city neighborhoods in Dallas simply because there are almost no full-service grocery markets.

On the other, the food products that prove to be affordable and available usually turn out to be very unhealthy.

Our Community Health Services clinic recently prepared a report on a segment of its patients battling dietary challenges that are resulting in dangerous health status outcomes.

Of the 1,291 patients screened. . .

. . .14 were underweight.

. . .187 were judged at a healthy weight.

. . .391 were overweight.

. . .571 were obese.

. . .128 were very obese.

Terrifying results from a public health standpoint.

Income levels dramatically affect health outcomes, as do neighborhood environments and resources.

So, how do we change things? What do you think?

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