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Diabetes And Community Medicine. Patrick Chen, M.D. Share Our Selves January 30, 2010. Objectives. Highlight services at a community clinic Characterize a diabetic patient population Describe a multi-disciplinary approach . Share Our Selves (SOS). 1550 Superior Avenue

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diabetes and community medicine

DiabetesAnd Community Medicine

Patrick Chen, M.D.

Share Our Selves

January 30, 2010

objectives

Objectives

Highlight services at a community clinic

Characterize a diabetic patient population

Describe a multi-disciplinary approach

share our selves sos
Share Our Selves (SOS)

1550 Superior Avenue

Costa Mesa, CA 92627

(949) 650-0640

www.shareourselves.org

what is sos
What is SOS?
  • 501(c)(3) non-profit organization
  • Health services for OC’s poor and uninsured
  • All services are free of charge
  • 2009 operational budget $6.6 million
  • More than 100,000 patients/clients annually
  • 45 employees
  • 400 volunteers
our mission statement
Our Mission Statement

We are servants who

provide free care and assistance

to those in need and

act as advocates for systemic change

sos a brief history
SOS – A Brief History
  • Founded in 1970 to provide for OC’s poor
      • Food
      • Clothing
      • Financial aid
  • Evolution
      • 1984 Medical Clinic
      • 1987 Dental Clinic
      • 2005 Comprehensive CARE Center
      • 2009 SOS Family Center
5 core services
5 Core Services
  • Social Services
  • Comprehensive CARE Center
  • Family Center
  • Dental Clinic
  • Medical Clinic
social services
Social Services
  • Food
  • Financial Aid
  • Clothing
  • Legal aid
  • Education Classes
  • Fundraising Drives
comprehensive care center
Comprehensive CARE Center
  • Counseling - individual, group therapy
  • Advocacy - case management
  • Resources - linkage to benefits/programs
  • Emergency Services - crisis intervention
family center
Family Center
  • Pregnant women, families with kids 0-5 y.o.
  • Education and in-home support:
    • Prenatal
    • Breastfeeding
    • Parenting
    • Diabetes prevention
dental clinic
Dental Clinic
  • Hygiene, x-rays, extractions, restorations
  • 2 dentists
  • 8124 visits annually
medical clinic
Medical Clinic
  • 15,000 visits annually
  • Chronic program
    • 2200 patients
  • Walk-in clinic
    • ER diversion rate: 29%
  • Specialty clinics
sos hoag partnership
SOS – Hoag Partnership
  • Symbiotic collaboration between two independent non-profit healthcare institutions
  • Hoag provides $1.5 million in-kind support: two physicians, meds, diagnostics, services
  • SOS provides primary care, ER diversion, and follow-up for discharged patients
socioeconomic profile
Socioeconomic Profile
  • Federal Poverty Level
    • Single: $10,800
    • Family of 4: $22,000
socioeconomic profile1
Socioeconomic Profile
  • Medical Services Initiative (MSI)
    • OC’s safety net program
    • < 200% FPL
employed providers
Employed Providers
  • 1.5 FTE Internists
  • Family Physician
  • Physician Assistant
  • Nurse Practitioner
  • 1.5 FTE Pharmacists
volunteer on site providers
Volunteer On-site Providers
  • Internist
  • Cardiologist
  • Nephrologist
  • Optometrist
  • Diabetic Educator
  • Gynecologist
  • Uro-Gynecologist
  • Physician Assistant
  • Nurse Practitioner
  • Physical Therapist
sos diabetes program
SOS Diabetes Program
  • 393 patients
  • 4.4 average visits/yr
  • MSI and Uninsured
  • Geographic focus
  • Demand is increasing
sos diabetes program1
SOS Diabetes Program
  • Labs
  • Specialty Care
  • Medications
  • Education
  • Mental Health
  • Case Management
a multi disciplinary team
A Multi-disciplinary Team
  • Primary care
  • Specialty care
  • Pharmacists
  • Diabetes educators
  • LCSW/MFT
  • Case Managers
ada guidelines
ADA Guidelines
  • Targets:
    • Hb A1C
    • BP
    • HDL, LDL
  • Medications:
    • Statins
    • Antiplatelet
    • Immunizations
  • Screening:
    • Neuropathy
    • Retinopathy
    • Nephropathy
  • Lifestyle Changes:
    • Physical Activity
    • Smoking Cessation
first encounter
First Encounter
  • How do patients get into the program?
    • Walk-in patient
    • Referral from a hospital
    • Our patient develops diabetes
first encounter1
First Encounter
  • Patient Contract
  • Financial Screening
  • Depression screening
  • Medications
  • Referral to a diabetes educator
medications
Medications
  • SOS purchases
  • $4 Pharmacy programs
  • Patients Assistance Program (PAP)
  • Hoag Pharmacy
medications1
Medications
  • Oral diabetic agents
  • Insulin
  • Statins
  • Fibrates
  • Antiplatelets
  • ACE Inhibitor / ARB
  • BP therapy
  • Antidepressants
  • Vaccines
  • ED meds
medications2
Medications

Value Dispensed 2009

  • SOS - Metformin $167,984
  • PAP – Atorvastatin $372,740
  • Hoag – Insulin $74,852
diabetic education
Diabetic Education
  • Latino Health Access
  • SOS Medication Therapy Management
  • Hoag Diabetes Center
diabetic education1
Diabetic Education
  • Pathophysiology
  • Glucometer Training
  • Nutrition
  • Exercise
  • Medications
  • Insulin Instruction
integrative behavioral health
Integrative Behavioral Health
  • Counselors are Providers
  • Collaboration (“Our patient”)
  • High-risk for depression
  • Behavioral change is critical
integrative behavioral health1
Integrative Behavioral Health
  • Depression Screening
    • PHQ-9 each visit
  • Depression Management
    • Counseling
    • Antidepressants
integrative behavioral health2
Integrative Behavioral Health

PHQ-2 Depression Screen

  • Score of 3: 83% Sensitivity, 90% specificity

- Administer PHQ-9

integrative behavioral health3
Integrative Behavioral Health
  • Case Management
    • Care coordination
    • Special needs
  • Family Conference
    • Patient / Family members
    • Provider
    • LCSW / Case Manager
family center1
Family Center
  • Target families of diabetic patients
  • Diabetes Prevention Classes
  • Exercise Classes
specialty care
Specialty Care
  • Nephrology
  • Optometry
  • Cardiology
eye care
Eye Care
  • Bimonthly eye clinic
  • Prescription lenses
  • Retinopathy screening
  • Referral to Ophthalmology
foot care
Foot Care
  • “Feet and Finger sticks” each chronic visit
  • Providers perform microfilament exam
  • Referral to podiatry
  • Hoag Wound Care Clinic
nephropathy
Nephropathy
  • BUN/Cr, Ur. Microalbumin Qyr
  • ACE Inhibitor / ARB
  • Referral to Nephrology
dental care
Dental Care
  • Referral to Cypress College Dental Hygiene Program
  • Referral to SOS Dental Clinic
challenges to care
Challenges to Care
  • Patient resources
  • Transportation
  • Clinical Space
  • Volunteer staff
  • Access to specialists
  • Increasing demand
the future
The Future
  • Electronic Health Records
  • Standardized management algorithms
  • Group Visits
  • Self-analysis (targets, outcomes)
  • Open another site
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