Central Oregon Project Targets ER Visits

A goal of reducing emergency room visits involves coordination

March 9, 2011 -- Larry Kite’s a former U.S. Ski Team coach who’s had 22 surgeries – some for sports injuries, some for the pancreatic cancer he’s currently fighting.
“My biggest issue is taking care of the pain I go through every day,” said Kite who lives in Bend. Like many people living with chronic pain, Kite’s relied on emergency room visits to manage his pain.
Now he’s among 274 participants in a demonstration project run by the Central Oregon Health Authority that focuses on people who’ve visited the emergency room at least ten times within the last year and live in Jefferson, Deschutes or Crook counties.
“People get frustrated; it's a frustrating system,” said Kristin Powers, the health integration project manager. They dislike relying on emergency room doctors to treat minor issues or flare-ups for chronic conditions, and the medical staff feels frustrated having to provide primary care.
“On average, these folks cost $27,000 a year,” said Robin Henderson, director of behavioral health services for St. Charles Health Care. Of the participants, 60 percent are enrolled in the Oregon Health
Plan. By contrast, the annual cost for OHP patients who don’t frequent the emergency room is $2,700. 
When this project was created, one of the first steps was to bring together mental health and physical health providers to talk about how to improve the delivery of care, said Jane Ellen Weidanz, government affairs manager for the Office of Addiction and Mental Health. “They often don't even speak the same language,” she said, which can lead to a misdiagnosis of a mental condition.
For example, it's not uncommon for chronic pain sufferers to be perceived as drug-seekers, which means they may not receive appropriate care, Powers said.

“The idea here isn't just to sweep them out of the emergency room,” said James Stalker, an intern, who’s a student at Portland State University's School of Social Work. “We're actually trying to meet patient's needs.”

That can mean something as simple as educating emergency room staff about writing more realistic discharge instructions. Kite’s often been told upon discharge to see his primary care physician within two or three days – when, in reality, his physician schedules appointments weeks in advance.
“This is much more massive than any of us thought,” Weidanz said, calling the project an interesting laboratory for public health. “It’s really showing the things that are possible.”
Kite was skeptical when he first met Becky Wilkinson, a community health worker who accompanies him to appointments. “I figured, this girl isn't going to be able to do anything for me,” he said.
Wilkinson, who taught health classes at Oregon Health & Science Univesity before joining the project, said the community health workers have a case load of about five patients each. “What I've seen is huge relief on behalf of the patient,” she said.
The Authority was created to reduce healthcare costs, particularly in the area of behavioral health. Central Oregon has become a test site to focus on public health and bring together experts to talk about improving the coordination of care – mental, physical and behavioral health. The result was the emergency room project.
An upcoming project will deal with children identified as having specialized healthcare needs – bringing together mental, physical and behavioral practitioners, along with projects on the health needs of children born prematurely, and projects on geriatrics and long-term care.


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The Central Oregon Health Authority is just now coming to the table to do what the OHP managed care plans have been dong for the last 15 years. Rather than innovative ideas, they have just adopted the standard pracrtices used by OHP.

Ms. McCurdy: Please explain more about the community health worker role. Was she able to assist the patient during the ER visit, or afterward, to get more timely PCP care? Are the CHWs the ones involved in "educating emergency room staff"?