RX for Change: Confronting the health care crisis in Kansas

Dec. 9, 2005

By Sarah Hill

Hutchinson News

Sometimes it's difficult to measure success.

It can be measured in units as small as preventing infection in patients during their stay in a hospital.

It can be measured in the number of patients aided by staff at a small clinic in reversing the potentially deadly effects of hypertension and diabetes.

And, it can be measured by small hospitals taking part in national efforts to reduce patient mortality.

There are programs and projects in Kansas that aim to tell the ultimate success stories about helping people stay healthy and alive.

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In seven years, the Community Health and Wellness Center in northeast Wichita has combined clinical care for the insured, underinsured and uninsured with a comprehensive health and wellness program.

Community need drives the clinic's success, said Bev White, chief executive officer for the organization.

“No. 1, we had buy-in from the community,” she said. “There was a lot of footwork done to ask the community, ‘what do you need, and what would you like?' The community donated to the center and helped the vision come to fruition.”

The center is funded by private donations, foundation grants and health grants from the state, as well as individual payment for services. About 42 percent of those who use the center are not insured.

Payment plans are available for those without insurance. The center also accepts volunteer hours at the center as credit — each hour is worth $10 toward a patient's bill.

The center has served more than 45,000 patients since opening. The staff works toward treating conditions that can be improved or reversed — such as diabetes, hypertension and some kidney problems — with diet and exercise classes combined with notes from doctors.

“We've worked with doctors who write prescriptions for our classes,” White said. “If you walk out of the doctor's office with a signed note, you're much more likely to come in and register because they told you that you need to.”

White stresses the importance of tailoring programs to the specific needs of the community.

“Then it's up to you to see if you can deliver what they need,” she said.

Successful programs not only look at needs but prioritize them as well, said Karla Finnell, executive director for the Kansas Association for the Medically Underserved in Topeka.

“Does that mean, do you need extended hours?” she asked. “What is considered affordable in your community can be critical. You have to look at what are the greatest needs and concerns.”

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The Flint Hills Community Health Center/Lyon County Health Department combines a range of services to give patients a one-stop shop for their health care needs.

The community health center was founded in response to a mass of underserved patients in Emporia and Lyon County, said Executive Director Lougene Marsh.

“For many years, there was just an unmet need for primary health care services for the uninsured, for people who maybe were on Medicaid but didn't have access to health care,” she said. “The community looked around and said, ‘We need to do something.' ”

As a community health center, the Flint Hills organization is qualified to receive federal funds, which make up about a quarter of their budget. The remainder comes from state grants, county support and patient fees.

Marsh says the community board that oversees the center — 51 percent of the board uses the center's services — is the “bedrock” for the successful health center.

“You need to find those consumers interested and willing to give their time and really care about sustaining a model of care for the community,” she said.

The model of having a community health care center combined with a county health department allows patients to access health care and other programs, such as the Women, Infants and Children program, at one location.

It also helps in reducing competition for limited state and federal dollars and improves communication, Marsh said.

“Obviously, there are downsides in everything, with competing expectations between state and federal grants,” she said. “Most of those have been worked through and overcome since we started.”

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A program in southeast Kansas paired the dental hygiene program at Fort Scott Community College with a community health care center in Pittsburg, resulting in a 12-chair dental clinic.

“There are other models that we can look at for system reform and system change that we can replicate in Kansas,” Finnell said.

“But there's also good old-fashioned ingenuity. That program makes sense for so many issues — it addresses both a workforce shortage in that area and increased access to dental care.”

Attention also must be paid to future needs, Finnell said.

“I think as we move forward, we really want to look at promoting a model for care with a certain level of integration between services. Even if it's not possible to get those services under one roof, like the Flint Hills program, we still need to collaborate to increase access to health care.”

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As one of the largest medical centers in the state, the University of Kansas Hospital in Kansas City, Kan., has programs and departments most hospitals don't have — a Level I trauma center, a relationship with a state medical school and research center.

It also has something in common with the smallest hospitals in the state.

The “100,000 Lives” campaign is a challenge to save that many lives of patients in hospitals by June 14, 2006.

More than 40 Kansas hospitals large and small joined the campaign, which has more than 2,000 participants nationwide.

Bob Page, senior vice president and chief operating officer, and Tammy Peterman, vice president and chief nurse executive for the KU hospital, say they've already seen success.

The new initiative means paying closer attention to standard practices of fighting infection, pneumonia and heart attacks before there's even a chance they could affect a patient.

Rapid response teams, implemented earlier this year at the hospital, are called at the first sign of a problem by those who work with patients.

Since implementation of response teams, code blue patients — those who face imminent threat of death — have recovered at a rate of 5 times higher than before, Page said.

Response teams at smaller hospitals might have a different look than those at KU's hospital.

“Each hospital needs to look at its resources and determine what they have that will work,” Peterman said. “But can you have this program at a small hospital? Absolutely.”

The Kiowa District Hospital in Kiowa, in south-central Kansas, has 24 beds and a medical staff of two doctors and a physician's assistant, said Chief Executive Officer Bryan Stacey.

Hospital staff learned about the campaign earlier this year at a Kansas Hospital Association meeting.

Not all of the goals are pertinent to every hospital, Stacey said. The Kiowa hospital doesn't have ventilators, so preventing ventilator-associated pneumonia isn't a possibility.

But the medical staff looked at the campaign's “best practices” for treating heart attacks and other maladies and implemented those.

“It just made sense,” Stacey said.

The response rate from hospitals that joined the campaign is greater than expected, Peterman said, giving the program a better chance of meeting the goal of saving 100,000 lives.

“We've set a very aggressive timeframe for this,” Peterman said. “We're still working on trigger points. We can tweak it as we go, but we'd rather start somewhere than not start at all.”