Session topics

1. What Haiti Can Teach the US about Providing Healthcare to the UninsuredStan Shaffer, MDFounder, Healthy Mothers, Healthy BabiesKendra WyattStrategist, Community Access, Cerner

2. Session topics • Delivering Care in Haiti • Medical Pathology – Social Pathology • Community Focus – Community Engagement • Measuring Outcome – Measuring Impact • The Principles and Comparisons • Medical Home Theory • Kansas City, Missouri: Jackson Country Free Clinic • Lasso the Power of Community and Information Technology • Austin, Texas: Indigent Care Collaboration • JaxCare, Jacksonville, Florida • Health Banks- Privacy, Portability with Purpose • Live from the WHO Standards Meeting, Kenya

3. Maternal Mortality

5. Percent of deliveries with skilled birth attendant

6. Child Mortality ● = 5,000 child deaths / year

7. Child Mortality - Haiti(< 5 years)

8. Neonatal Mortality - Haiti(< 28 days)

9. Potential for Basic Interventions Jones, Child Survival II, 2003; Lancet 362:65-71 • Clean delivery, breast feeding, antibiotics → Sepsis deaths ↓94% • Prenatal tetanus vaccine → Tetanus deaths ↓81% • Malaria prevention → Low birth weight deaths ↓59% • Neonatal resuscitation → asphyxia deaths ↓39%

22. Community Survey Results

23. Why didn’t you go to the hospital? 1. Too far 2. Too expensive 3. Untrustworthy Underlying Medical pathology is Social pathology Community Survey Results

26. Why didn’t you go to the hospital? 1. Too far → Community services 2. Too expensive →Free care 3. Untrustworthy → Quality Consistency Hospitality The need

27. Models of Maternity Care Obstetricians Nurse Midwives Matrones Hospital Comprehensive Expensive Remote Birthing Home Home Limited care Inexpensive Convenient

28. Pregnancy planning Prenatal care and triage Prevention of infections Syphilis, HIV, Malaria Safe birth Clean delivery Skilled birth attendants Breast feeding support Vaccinations Nutrition and micro-nutrient supplementation Child development Road to Health Continuity of Care

29. Health Information Technology • Outcome monitoring • Quality assurance • Performance improvement • Communication • Resource sharing • Health mapping • Community health atlas

31. Community Health Atlas

32. Home visits Santé Communautaire Vit A Education HIV - DOT

33. Santé Communautaire Elimination of Intestinal Parasites

36. 2005-2006 delivery data

37. Maison de Naissance Primary Outcome Measures

39. Community Engagement • Employment • Mothers clubs • Community activism • Vaccination campaigns • Seeking water, housing, micro-loan programs

40. The value of a society is increased only as it cares for its most vulnerable. John Rawls not just for the countries with high child mortality, but also for countries that could have changed the situation. William Foege Child survival…a measure of civilization…

41. This isn’t charity work, it’s social justice. Paul Farmer

42. Childbirth in a Haitian Village Implications for the Un and Under-insured in the States

43. Partners In HealthHealthcare as a Right vs Commodity “Anywhere you have extreme poverty and no national health insurance, no promise of health care regardless of social standing, that's where you see the sharp limitations of market-based health care.” Paul Farmer

44. A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.  A medical home addresses how a primary health care professional works in partnership with the family/patient to assure that all of the medical and non-medical needs of the patient are met.  The physician should be known to the person/family and should be able to develop a partnership of mutual responsibility and trust with them. Definition: Medical Home

45. Maison de Naissance Providing a Physical Birth Home Virtual Consults Outreach Via Football Clubs Virtual Consults Data Center Drinking Water Waste Management Faith Partnerships Agriculture Productivity Community Health Workers MN Health Bank Haitian School of Midwifery MN Baby,Mama, Family Home Cement Floor Tile Roof Government Education (BTI)Business Technology Institute Les Cayes Hospital Cell Phone Connectivity Power Entrepreneurism Midwives

46. Medical Home Theory

47. So what do they do in Texas?

48. AUSTIN/TRAVIS COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT AUSTIN TRAVIS COUNTY MENTAL HEALTH MENTAL RETARDATION CENTER (ATCMHMR) AUSTIN WOMEN'S HOSPITAL CENTRAL TEXAS MEDICAL CENTER CITY OF AUSTIN COMMUNITY CARE SERVICES DEPARTMENT JOHNS COMMUNITY HOSPITAL LONE STAR CIRCLE OF CARE PEOPLE'S COMMUNITY CLINIC PLANNED PARENTHOOD OF THE TEXAS CAPITAL REGION ROUND ROCK HEALTH CLINIC ST. DAVID'S HEALTH CARE SETON FAMILY OF HOSPITALS TRAVIS COUNTY HEALTHCARE DISTRICT TRAVIS COUNTY MEDICAL SOCIETY UT SCHOOL OF NURSING VOLUNTEER HEALTHCARE CLINIC WILLIAMSON COUNTY AND CITIES HEALTH DISTRICT All Members of the Safety Net Community Participate Community Health Record Community Health Workers The Mother of them all….Indigent Care Collaboration, Austin Texas

49. Virtual Medical Home Framework Community Foundation Philanthropy Health Plan Government Faith Health Ministry Employer Public Health Birth Center Education Hospice Affordable Housing Appropriate Clothing Environment Person Family Specialist Mobile Clinic Medical Home FQHC, Safety Net Nutrition Community Health Worker Community Center Hospital Health System Pharmacy Grandmothers Sports Clubs

50. Shands Jacksonville McKesson Duval County Health Department Med Claims Baptist Health System SMS Cerner JaxCare Claims Mayo Clinic Hospital Cerner St. Vincent’s Medical Center IDX .csv Files Cerner Memorial Hospital MediTech • Community Electronic Health Record HL7 Interfaces, Data Extracts University of Florida IDX AllScripts .M. Sulzbacher (FQHC) Med Mgr Brooks Rehabilitation Hospital MediTech Jacksonville Health Information Network Accessible via a secure internet site (SSL 128-bit encryption) Jacksonville Health Information Network Community Health RecordA Virtual Medical Home HMS Duval County Health Department