Community Engagement: Creating The Nations First School of Community Medicine

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Community Engagement Creating The
Nations First School of Community Medicine
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OU College of Medicine, Tulsa Structure

• Established as a branch campus in 1972 using
  community based model.
• Purpose workforce and service for northeast OK.
  
• OU Clinics
• 250,000 visits / year
• OU Departments / Divisions
• 186 OU employed faculty
• Pediatrics, Psychiatry, Surgery
• Internal Medicine, OB/Gyn
• Family Medicine, Emergency Medicine, Geriatrics,
  Dermatology, Physician Assistant, Sports Medicine

• Additional OU Programs
• Nursing, Pharmacy, Public Health, Allied Health,
  Social Work, Human Relations, Engineering,
  Telecommunications, Computer Science,
  Organizational Dynamics, Knowledge Management
• Community Partners
• Specialist Physicians
• 3 Large Private Hospitals
• Residencies
• 200 residents in 13 Residencies / Fellowships
• Medical Students
• Average 40 students each in the 3rd and 4th year
  classes.
• 50 Physician Assistant Students

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We thought we were doing fine.OU College of
Medicine, Tulsa alumni practicing In Oklahoma
0 1- 5 6- 10 11- 35 36-150 151-779
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fine until we saw the death curve.
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1,100
Age Adjusted Death Rates Over the Past 25 Years
1,000
Tulsa County
950
900
While the death rate of most U.S. residents is
declining, that of Tulsans is not and the trend
is going in the wrong direction
United States
850
800
1980 1990 2000
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If you ask the public, what should a medical
school do?? AAMC 2000 Survey

• Educate the next generation of physicians.
• Advance care through research.
• Take care of complex patients.
• Take care of the poor.
• LEAD IN SOLVING HEALTH CARE PROBLEMS.

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We needed a plan..

• OU Colleges of Public Health and Medicine came
  together.
• More data on health parameters, workforce,
  student satisfaction / trends.
• Pilot Projects - Access.
• Critical Mass Clinical Services and Students
• External Consultants
• Prepared for Next Transformation

Note these are not real OU Football Players
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Health Status
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COMMONWEALTH FUND State Scorecard Summary of
Health System Performance
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HEART DISEASE MORTALITY IN THE UNITED STATES
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MENTAL ILLNESS PREVALENCE IN THE UNITED STATES
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Tulsa Area Health Status Varies Dramatically By
Income
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Tulsa Area Health Status Varies By Race Years of
Productive Life Lost Per Death
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Tulsa Area Health Status Varies By Zip Code AGE
ADJUSTED DEATH RATES IN TULSA COUNTY
Red very poor health status Zip Codes Yellow
worsening health status Zip Codes Green good
health status Zip Codes
Although north, east and west Tulsa have 40 of
the regions population, they have only 4 of the
region physicians
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Rationale for Change Responsibility to Improve
Health (continued)
Access to and equity in healthcare are key health
determinants. Health status is variable across
the Tulsa region.
NORTH TULSA
Shorter Life Expectancy
14 Year difference in Life Expectancy Across
Tulsa County
SOUTH TULSA
Longer Life Expectancy
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Tulsa County Prenatal Care and Infant Mortality
Rates
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Initial Pilot EffortsFocus on Access
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Access to Care Expansion

• Primary Care
• 2005 - New 60,000 sq ft Family Medicine.
• 2007 New 100,000 sq ft multispecialty clinic
• 2003 2008 Network of 35 Bedlam Outreach
  Clinics, free pharmacy program, nursing and
  social work case management
• Schools / Head Starts
• Housing Authority Apartments
• Mobile Clinics

• Specialty Care
• 2003 - Mobile Psychiatric Team
• 2007 - New 10,000 sq ft Diabetes Center
• 2008 Perinatal Outreach Initiative
• 2008 New 22,000 sq ft Cancer Center satellite
• 2008 - New 10,000 sq ft Surgery Clinic
• 2010 - 50,000 sq ft North Tulsa Specialty Clinic.
  

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20 School-based OU Clinics Serving 32 Schools
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EXAM ROOMS
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OU PACT Team and Community Mental Health

• PACT Team provides mobile psychiatric care and
  rehabilitation to those with the most severe
  forms of mental illness (e.g homeless mentally
  ill).
• Pre PACT 1 Year in PACT
• Hospital Days / year 2898 Days 671 Days
• Jail Days / year 1196 Days 535 Days

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Emerging Workforce Trends
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TOTAL PHYSICIANS IN 2005PER 100K POPULATION IN
THE UNITED STATES Oklahoma ranks 45th in the
number of physicians per capita
Created by Michael Lapolla, OU College of Public
Health, December 2007
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PRIMARY CARE PHYSICIANS IN 2005PER 100K
POPULATION IN THE UNITED STATES Oklahoma ranks
39th in number of primary care physicians per
capita
Created by Michael Lapolla, OU College of Public
Health, December 2007
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SPECIALIST PHYSICIANS IN 2005PER 100K POPULATION
IN THE UNITED STATES Oklahoma ranks 47th in
number of specialists per capita
Created by Michael Lapolla, OU College of Public
Health, December 2007
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• Access to Health Care Varies Dramatically By
  Tulsa Zip Code
• For every 1 physician in north, east and west
  Tulsa, there are 26 in mid-town and south Tulsa.
• 40 of the population and 4 of the clinicians.
  

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Combine Workforce and Health Status Data
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Physicians are not practicing in the Tulsa metro
areas where healthcare is needed most.
Age-Adjusted Death Rate in Tulsa
Physician Density in Tulsa
- Partner hospital
- Partner hospital
The age-adjusted death rate is highest in those
areas with the fewest physicians.
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Student and Resident Attitudes and Skills
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Resident Physician Skill Sets System-based
Practice Core Competencies

• 151 OU Resident Physicians Wrote the Dean a
  paper on the worst health care problems in the
  region.
• Excellent at identifying health system problems.
• Excellent at innovative solutions to these
  problems.
• No skills for researching, testing theories,
  developing a plan, implementation, financing
  strategies to carry out their unique
  interventions.

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Medical Students Perceptions of and Needs of the
Poor
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Medical Students Students Professional
Obligation to the Health of the Poor
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AAMC Graduation Questionnaires

• The experiences in community medicine,
  particularly the Bedlam Clinics (student run free
  clinics), rekindled the spirit of why I wanted to
  be a physician.

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In 2006 2 Driving Factors for a Dramatic
Transformation.

• Physician Work Force Trends
• Future National Shortage
• Existing Oklahoma Shortage
• Expansion of medical education would happen.
• Oklahoma Health Status
• Although access to care was improving, much more
  needed to be done.
• A different type of physician was needed.

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? http/Community Medicine

• Many academic
• Divisions
• Departments
• Centers
• Institutes
• 1 School of Community Medicine in New South
  Wales Australia

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School of Community Medicine

• Vision
• Leveraging our leadership, service, education
  and research expertise, we will be successful at
  Improving the Health of Entire Communities.
• Strategies
• Expanded Education Platforms Start a physician
  assistant program. Expanded medical student,
  residency and fellowships in Tulsa.
• Unique Aspects of Curriculum close alignment
  with the OU College of Public Health. Educational
  themes include excellence in individual patient
  care as well as improving the health of entire
  communities, at risk populations, the
  underserved, complex problem solving skills,
  complex project management, translational
  research, physician character development and
  medical informatics.
• Health Services Delivery creating community
  partnerships to expand healthcare access to
  targeted populations.
• Research Targeted not comprehensive research
  programs services, outcomes and translational in
  focus.

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Nuts and Bolts of what we think may be the
Nations First School of Community Medicine..

• Transform ourselves from branch campus status to
  a School with a unique purpose within the OU
  College of Medicine.
• Renamed as OU College of Medicines School of
  Community Medicine improving the health of
  entire communities.
• Tulsa Public Schools shadowing programs and
  Undergraduate pre-med fast-track at University of
  Tulsa and OU.
• National recruitment of students with dedication
  to the underserved to this specific medical
  education track that merges traditional medical
  education with public health curriculum ? MD
  Public Health Certificate or MD MPH.
• Creative use of Summer Institutes for in-depth
  work.
• If possible and funding available, expand medical
  student class size from 40 to 70 per year, add
  Physician Assistant students initial class of
  25, expand residents from 201 to 251.
• New scholarship program with incentives to
  establish career serving underserved and at-risk.

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February 2008 Announcement

• With this health data known, it is morally
  offensive not to act.
• George Kaiser,
• February 2008.

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The Gift.The Grand Experiment

• 50,000,000 from the George Kaiser Family
  Foundation
• 35,000,000 dedicated to new endowed chairs.
  Matched with 35,000,000 from state funds to
  create 70,000,000 endowment for faculty
  expansion.
• 7,500,000 for school infrastructure expansion.
• 7,500,000 for student scholarships.

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6 Lessons Learned

• Physicians in training are very smart but need
  additional skills to tackle the toughest problems
  out there.
• Altruism can be preserved with the right teaching
  / clinical environment.
• Public health data and physician manpower data
  drove our planning and influenced philanthropy.
• Important for us to create something
  complementary and not competitive with existing
  medical education and clinical services.
• Planning
• Intimately involved students and philanthropy in
  planning.
• Everyone Involved - Primary Care, Specialty Care,
  Bio-medical Researchers, Community Partners, DO
  and MD.and other Colleges.because team care
  works.
• At the end of the day one writer of the master
  plan. 180 pages and a 15 page executive summary.
  

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6. Had to create a Business Plan for our Social
Contract

• Mission ()
• Finance (-) Finance ()
• Mission (-)

Private support Endowment expansion Expanding
primary care network Expanding specialty
access Native American partnerships
Student scholarships Physician assistant
program After-hours free clinics Childrens
Village
Corporate partnerships 90 FTE time as
clinicians Practice plan efficiency
initiative Patient Satisfaction JCAHO
accreditation of OU Clinics
THE NO-FLY ZONE
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1,100
Age-adjusted Death Rates
1,000
Our Goal Improve the Health of Entire Communities
950
Tulsa County
900
850
United States
800
1980 1990 2000 2010 2020 2030