December 2016

CommunityYour

atWorkA REPORT ON WHAT IT TAKES TO MAKE A HEALTHY COMMUNITY

One simple home visit from a health team makes a big di� erence for those with severe lung problems. Patients who had home health visits to see why they kept missing doctors appointments, signi� cantly improved their inhaler use and reduced emergency visits by 40%. � e e� ort is part of Community Regional Medical Center / UCSF Fresno Chronic Lung Disease Program – one of three such lung disease management programs in California.

The chronic disease m a n a g e m e n t t e a m i nt e n s e l y m o n i t o r s patients’ lung function, teaches them how to use their medications and inhalers more e� ectively, helps them quit smoking and visits their homes to see if environmental changes can help. The patients who participate in the program have seen signi� cant health improvements. A study published in 2014 showed that participating patients reduced their ER visits for respiratory problems by 79% and reduced hospitalizations at Community Regional by 65%. Community’s chronic lung program is one of the few integrated programs in the country with such success and was also found to be cost e� ective.

“Our patients feel special when we visit them and it helps establish a relationship,” said Richard Allison, a nurse practitioner at Community’s chronic lung program who leads home visits. cmc.news/access

PREEMIES STAY OFF VENTILATORS, LIVE A BETTER LIFE

UNIQUE ‘HEAT BLASTS’ GIVE LONG-TERM ASTHMA RELIEF

Every three hours a neonatal intensive care (NICU) nurse and a respiratory therapist at Community Regional Medical Center team up to coordinate care and change respiratory apparatus from a mask to nasal prongs on newborns struggling to breathe. � is ensures that the fragile skin on very premature babies isn’t rubbed raw. When the skin degrades, infants have to go back on a ventilator with a tube down the throat. � is simple routine, rarely used in other hospitals, makes a huge di� erence for these tiniest of babies – for the rest of their lives.

Because our preemies are able to stay o� ventilators, only two out of the 857 babies

at Community Regional’s NICU last year went home needing to use oxygen. Statewide, nearly 10% of very premature babies get discharged with oxygen tanks.

Community Regional also delivers critical lung medication to babies born between 22 and 29 weeks gestation faster than any other hospital in the state since respiratory care practitioners, neonatologists and pharmacists are part of the delivery team during high-risk and premature births. More than 82%

of Community Regional’s extremely low-weight babies

get this crucial lung treatment within the � rst 30 minutes of birth – nearly two times faster than the statewide average.

“We put babies on ventilators right a� er birth much more than other hospitals, but we get them o� much faster than anyone else,” said Hank Perry, clinical coordinator of the NICU respiratory care team at Community Regional. “� e quicker you can remove these infants from the ventilator, the better. It helps reduce possible damage to the lungs that causes chronic lung disease and asthma later in life.” cmc.news/quality

Maria Perez, born Aug. 18 at 23 weeks and 1 day, weighing only 1.18 lbs., gets an innovative treatment that uses percussive bursts of air to open up her lungs’ tiny air sacs and help keep her off a ventilator. Such respiratory care minimizes the chances of chronic lung problems later in life.

In a region with the highest asthma rates in California, Community Regional Medical Center is the only hospital between Sacramento and Los Angeles equipped to provide bronchial thermoplasty (BT) to improve lung function in adults. Two pulmonologists are trained to feed the thermoplasty device through patients’ mouth into their lungs to help deliver radiofrequency energy to burn away thickened muscle tissue and open airways.

Fewer emergency visits in the 12 months after Bronchial Thermaplasty (BT) and the effects can last for years

Terra Alexander, 34, a frequent visitor to the emergency room for breathing problems, said she had reduced her rescue inhaler use nearly 75% “and I’m almost completely o� the breathing machine.” Pulmonologist Vipul Jain at UCSF Fresno who manages Terra’s asthma, said a� er just two treatments, her lung function test showed she had 7% more capacity than her best ever previous lung test. cmc.news/quality

Fresno County asthma patients have 58% higher hospitalization rates and 52% more ER visits than those with asthma statewide

BT reduces asthma attacks

Constricted airway during an asthma attackContracted airway smooth muscle

BT reduces asthma attacks by reducing airway smooth muscle

Asthma Attack

Post BT Treatment

Nurse Practitioner Richard Allison teaches a patient with COPD how to use her oxygen tank during a home visit.

40%

190%

HELP AT HOME CLEARS OBSTACLES

ER visits down after home visits to patients who

miss doctors visits

that extremely premature babies at

Community Regional will improve enough

in the fi rst 4 hours of life to be removed

from ventilators, compared to the statewide NICU

average

3X MORE LIKELY

WHAT HAPPENS WHEN A HOSPITAL NETWORK AND ITS COMMUNITY ARE CONNECTED? FIND OUT AT cmc.news/dec2016

One Network. One Community.Clovis Community Medical Center | Community Behavioral Health Center | Community Regional Medical Center | Fresno Heart & Surgical Hospital

BREATHE EASIER

Community Regional is second in California for delivering high numbers of babies weighing under 3 lbs. 5 oz.

84%

Maintenance inhaler use increased