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Growing the Health Workforce: Community Based Residency Training Allen L. Hixon, MD Associate...
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Transcript of Growing the Health Workforce: Community Based Residency Training Allen L. Hixon, MD Associate...
Growing the Health Workforce: Community Based Residency
Training
Allen L. Hixon, MDAssociate Professor and Vice Chair
University of HawaiiDepartment of Family Medicine and
Community Health
Social Determinants of Health
Social determinants of health are:
• the conditions in which people are born, grow, live, work and age, including the health system.
• these circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices.
• mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries.
» WHO CSDH
How we receive care
N Engl J Med 2001; 344:2021-2025 June 28, 2001
Neighbor Island Health
• Poor health outcomes• Access to care • Drastic shortage of primary care
– Current shortage 150 primary care physicians to meet national physician to population ratios
– With aging/retirement of workforce demand will increase
• Withy/Sakamoto
Hawaii Island Rural Residency Program
• Problem – Physician/provider shortage, limited access to care, rural neighbor island focus
• Proposed solution – Increase physician/provider pipeline by developing a rural interdisciplinary FM residency program and collaborative training site
• 12 residents (four per year) based in Hilo Hawaii• Collaboration
– Hilo community/Hilo Medical Center– UH SONDH– UH College of Pharmacy
Hawaii Island Rural Residency
• Principles– Meet real needs of community– Interdisciplinary team based – Financially sustainable– High quality teaching and patient outcomes
Collaboration
• Needs Assessment – SHPDA– Workforce Data– NHHS– FQHC– Alliance– Mayor’s Office– Others
• Planning– Academic partnersJABSOMSchool of Nursing and Dental
HygieneCollege of Pharmacy
• Funding– CMS– HRSA– HMSA– Tri-West– State of Hawaii– HMC Foundation– Shipper’s Wharf– Individuals
• Implementation– HMC– UCERA– JABSOM– Steering Committee with
community partners
Residents
Foundation
Rural Residency
Family MedicineFaculty School of Nursing
JABSOM
Hilo Medical Center
Medical Students/Learners
Medical Staff
CMS
HMSA
TriWest
HRSA
Hawaii State Legislature
Patients/Community
College of Pharmacy
Progress to date
• Collaborative clinical practice site
• 2 family physicians (one more coming)
• 1 APRN
• 1 PharmD
• 1 RN
• 1 GYN consultant
• Telepsychiatry program
Next steps
• ACGME FM accreditation
• Build clinical practice and teaching
• Develop interdisciplinary curriculum
• Patient Centered Medical Home
• Quality initiatives
What we did well
• Solution oriented
• Messaging re: workforce shortage and critical need
• Created public-private partnership for funding
Barriers to collaboration
• Underestimated level of complexity• Created expectations
– Timeline– Cost
• Did not fully understand objectives, expertise or limitations of the various partners
• At times communicated poorly with partners
Engaging the Community
• Social determinants are the conditions that exist in the community that promote or undermine good health
• Program success linked to level of community support
• Be informed
• Advocate with lawmakers