By JULIE MINDA
An institute in Bellingham, Wash., is helping its backers to marshal local talent and to secure funding to delve into some of the area's most pressing health care concerns.
"We are responding to human need in a way that is in collaboration with the community," said Chris Phillips, director of community affairs for Bellingham's PeaceHealth St. Joseph Hospital, a backer of the institute. "We're trying to bring the right people to the table" to take on public health concerns.
Dubbed the Critical Junctures Institute, the organization resulted from a 2007 conversation between Dr. Marcus Pierson, who is vice president of quality and clinical information at St. Joseph, and Jay Teachman, a sociologist at Bellingham's Western Washington University. The two men had said that Bellingham needed a central organization that could corral community members and engage them in developing solutions for health care delivery problems.
Phillips noted that at first glance, Whatcom County and Bellingham, its county seat, may appear to be relatively affluent and healthy. The county has a per capita income of more than $35,000. And studies consistently show Whatcom is a generally healthy county with relatively open access to health care services. But, what statistics may not reflect, according to Phillips, is that some people fall behind in health access and outcomes. They include migrant workers, Hispanic and Russian immigrants, people in tribal communities and people in rural areas.
Teachman said that at the time he and Pierson began talking about delivery system concerns, the two "were — and are — very much concerned about the quality of health and health care in the community. We wanted to make Whatcom County one of the healthiest counties in the country."
The men escalated their discussion to St. Joseph and Western Washington University. These early planners recognized they needed an organization that could provide nimble administration and that could draw in organizations with resources and people with ideas. Their solution: Create a separate institute linked to both St. Joseph and Western Washington.
Launched in 2008, Critical Junctures is housed at Western Washington and backed financially by both the hospital and university. Each backer is paying $275,000 over four years. The institute has a staff of three including Executive Director Dr. R. Michael Massanari. Much of the organization's work is driven by an eight-member board that includes Pierson and Teachman.
So far, Critical Junctures has investigated in earnest about a dozen ideas related to health care delivery, with each idea bubbling up from someone at the hospital, university or from elsewhere in the community.
Four ideas have evolved into full-scale projects: a community needs assessment, a study of the medical home model of care, a palliative care program and a pilot program on care transitions.
To conduct a community-wide health needs assessment, the institute harnessed the brainpower of the university, the hospital, local government entities including the public health department, the city of Bellingham, private foundations and community members.
University researchers gathered all of the community assessments of Bellingham over a several-year period, including studies on land use, water quality and other determinants that impact health. Originating agencies presented the highlights of their assessments at a conference convened by the university. Academics listened for themes and top takeaways. Following an action model from the Centers for Disease Control and Prevention, the institute and its partners engaged community organizations and individuals in discussions about local health concerns.
The institute's board and other Bellingham leaders now are reviewing what they've learned, and they expect to decide on strategies by the end of the year. They are not ready to announce their health priorities or talk about specific tactics.
Phillips said the assessment "should help us to identify the people most at risk (for poor health), understand what's driving the problem of health disparities and identify how to help people in need."
Critical Junctures also supported a yearlong study of the medical home concept, a project initiated by the Bellingham area's Family Care Network, a family medicine practice that is affiliated with St. Joseph and that has 70 physicians and other care providers. Funded by the Whatcom Community Foundation and Mt. Baker Imaging, the project looked at how to adapt the medical home concept employed by the Family Care Network to better serve patients whose complex health conditions are amplified by other stressors.
Beginning around June 2009, a project team made up of representatives of the Family Care Network, Critical Junctures and the Department of Family Medicine at Seattle's University of Washington School of Medicine worked on strategies for improving care to patients who have multiple chronic illnesses coupled with other concerns, like financial distress and unemployment.
Their efforts resulted in a plan for a pilot program. Under the plan, physicians, nurses and other staff build up their communication and other skills they need to manage patients with comorbidities. The team members also improve how they share responsibility, for instance, for inputting both medical and sociological information into the patients' health record. Team members also learn to develop an individualized care plan for such patients.
Two lead physicians and their clinical teams have trained on the model and are just beginning to implement some of the new ideas. The collaborative is seeking grant funding so they can expand the pilot.
Critical Junctures is helping St. Joseph to create the hospital's first formal palliative care program using funding from Washington's RiverStyx Foundation.
The three partners spent 2010 designing a multidisciplinary palliative care program and just hired a palliative care physician in April to formally launch the program in the fall at St. Joseph.
In the future, the partners plan to apply their palliative care concepts outside of the inpatient environment.
The Stepping Stones Project aims to reduce hospital readmissions among Medicare recipients by encouraging them and their informal caregivers to pay increased attention to medication regimens, to watch carefully for red flags that their condition is worsening, to be diligent about scheduling follow-up care, to communicate closely with clinicians and to evaluate their home for safety hazards.
To help patients do this, the Stepping Stones model has nurses coach patients and their loved ones prior to and after patients are discharged from the hospital and head back home or to another care environment like a nursing home.
Stepping Stones is a pilot program from the Centers for Medicare and Medicaid Services. The Bellingham-area partners that began their three-year pilot of the program in 2009 are Critical Junctures; St. Joseph; the PeaceHealth Whatcom, Wash., Region; a private nonprofit organization called Qualis Health; and the Northwest Regional Council, an association of county governments in Washington State.
Since the four institute projects are still building up momentum, it is too early to talk about specific, measurable results, said Phillips and Massanari.
The institute is facing many barriers in its struggle to gain traction.
Teachman explained, "The recession and the drying up of sources of financial support have been the most challenging hurdles."
While the coalitions the institute has built have been successful in securing start-up grant funding for their work, it's been difficult for them to find funding to sustain the projects.
Also, Western Washington University is in the crosshairs as Washington state looks to address a budget crisis. This could threaten the institute's funding, and so institute leaders are exploring whether another long-term partner — probably a nonprofit organization, according to Phillips — could sustain the work.
As the leaders work out the practicalities, they remain optimistic about the institute's promise.
Teachman noted the institute "is a great, community-wide effort that we hope will stimulate future discussions about how (everyone) in the community can participate in making the county a healthier place."
The institute's work could help St. Joseph to better understand and address the barriers that people face in improving their health, Phillips said.
Massanari said, "The projects the institute is working on — they deal with significant needs in the health care delivery system. They deal with helping people who are on the margins. That's why they are important."
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