Health Care in Transition

Lee Ellen Buenconsejo-Lum, MD, FAAFPBoard Member, Wahiawa Center for Community Health

Associate Professor, Department of Family Medicine & Community HealthJohn A. Burns School of Medicine

University of Hawaii

Physical (Body)

Spiritual (Spirit)

Emotional (Mind)

CHANGING CONCEPTS OF HEALTH

Physical (Body)

Spiritual (Spirit)

Emotional (Mind)

LIVE

WORK

PLAY

EAT

HEALTH

VALUES

STRESS

UNHEALTHY

Hospitalization Rates ≠ quality of outpatient care

Hospital Service Area

REASON FOR HOSPITALIZATION State Rate Honolulu Rate Wahiawa Rate96712 96786 96789 96791 96857

Lower leg amputation (2009) 20.6 19.6 30.4

High blood pressure (2011) 26.1 24.9 30.5

Heart failure (2011) 267.4 199.7 405.3

COPD or asthma in adults 40+ (2011) 293.4 236.3 339.8

Chronic Composite Rate (2011): diabetes-related, leg amputation, hypertension, heart failure, angina without procedures, COPD/adult asthma, asthma in younger adults

1019.4 834.3 1221.7

Rates were provided by HHIC, and are defined by the Agency for Healthcare Research and Quality (AHRQ) as a set of measures that can be used to identify quality of outpatient care, which can potentially prevent the need for hospitalization. Rates are risk -adjusted based on the Healthcare Cost and Utilization Project’s State Inpatient Databases. The table includes risk-adjusted hospitalization rates with 95% confidence intervals for Honolulu County and all contained hospital Service Areas for 2011. State values are also provided for comparison. https://www.adventisthealth.org/castle/Documents/CMC-CHNA-13-Report.pdf

OBESITYHEART DISEASE

DIABETESHIGH BLOOD PRESSURE

ARTHRITIS

O’Gurek D, et al. AAFP Integration of Primary Care and Public Health Work Group. Integration of Primary Care and Public Health (Position Paper). American Academy of Family Physicians. December 2014. Accessed online: February 12, 2015 http://www.aafp.org/about/policies/all/integprimarycareandpublichealth.html.

Patient Context

Values?

Barriers?

Support?Goals of care?

Under-standing

THE EVOLUTION OF HEALTH CARE

Patient• Physician / Nurse

• Dentist• Mental Health

Family• Physician

• Mental Health

Support Services• Social work

• Transportation• Insurance / Case Manager

Community• Safe environments

• Skills for health and wellness• Enables healthy choices

• Educated• Empowered

Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control (CDC) and Prevention. (2011). Social Ecological Model. Retrieved September 21, 2012. From http://www.cdc.gov/cancer/crccp/sem.htm.

Quality Care

• Patient-Driven• Enhanced Access to

Care• Team-based Delivery• Care Coordination• Integrated and Holistic