Public Health, Pimps and Pit BullsFrom the OU-TU School of Community Medicine
Created by Dr. Gerard Clancy MDDean, The University of Tulsa Oxley College of Health
SciencesPresented by Angela Martindale PhD(c), RN Clinical
Assistant Professor, The University of Tulsa Oxley College of Health Sciences
Dr. Gerard Clancy MDDean of College of Health Sciences
Vice President of Health Affairs Professor of Community MedicineOxley College of Health Sciences
Community Medicine
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PUBLIC HEALTH DATA POINTED US IN THE RIGHT DIRECTION…..
650$
700$
750$
800$
850$
900$
950$
1,000$
1,050$
1,100$
1,150$
1,200$
1,250$
1968
$
1972
$
1976
$
1980
$
1984
$
1988
$
1992
$
1996
$
2000
$
2004
$
2008
$
1968 Iowa (11)
Florida (12) Wisconsin (13)
Montana (14) OKLAHOMA (15) COLORADO (16)
Arizona (17) Connecticut (18) Washington (19)
Texas (20)
2010 Minnesota (4) New York (5)
Massachusetts (6) COLORADO (7)
New Hampshire (8) New Jersey (9)
Washington (10)
2010 Arkansas (45) Louisiana (46) Kentucky (47)
OKLAHOMA (48) West Virginia (49)
Alabama (50) Mississippi (51)
1968 Years 2008
Age-adjusted Death Rates
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5
Clinical Services Distribution Age-Adjusted Death Rate in Tulsa
14 year difference in Life Expectancy, 4 Miles - Cancer and Heart Disease
North, East and West Tulsa: 40% of population has ready access to 4% of physicians
5
2005 - HOT SPOTTING TULSA COUNTY
A Shiny New $20,000,000 Clinic Would Save the Day and We Would Be The Heroes!
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Two Pit Bulls Showed Us How Hard This Work Would Be….
I was pretty sure the loud crack I had just heard was from my son’s bicycle helmet hitting the pavement of the bike trail. As I rolled over, I could see that I was right as the helmet was now in pieces although still strapped to his head.
He had already sprung to his feet and was using his bicycle to shield me from the two angry pit bulls.
Two Pit Bulls Showed Us How Hard This Work Would Be….
Just an hour earlier, I had noticed what a beautiful evening we had in store. May is a month in Oklahoma where all Oklahomans are on guard for tornadoes. But not this evening for it was clear and cool with a brilliant sunset on the way. My 19-year old son Sam had just returned home from his first year in college. “What should we do this evening?” Sam had asked. “Let’s take a bike ride through north Tulsa. I want to show you the progress we have made on our new Wayman Tisdale Clinic,” I responded.
So off we rode to our destination five miles away. When we reached the clinic, I could not help but to beam from pride as the gleaming $20 million clinic began to take shape. “I think things are going really well right now in north Tulsa. Things are changing for the better and this clinic helps,” I proclaimed.
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Two Pit Bulls Showed Us How Hard This Work Would Be….
As we headed back home from the construction site, I noticed the two pit bulls asleep on either side of the bike trail just 50 yards ahead. “Sam, we are going to need to speed it up a bit and fly by those pit bulls ahead,” I warned. As we approached the sleeping dogs, the extra speed had become a bad idea. The dogs were on to us, both of them lunging for my thighs. I steered to the left, catching my rear wheel on Sam’s front wheel resulting in both of us flying head first over our handlebars on to the pavement. Scrambling to stand up, I followed Sam’s lead and used my mangled bicycle to shield the angry dogs from getting any closer.
Two Pit Bulls Showed Us How Hard This Work Would Be….Within seconds, the dog’s owner was on the scene and called off the dogs. He was immediately apologetic. “I am so sorry guys. But I gotta’ say, I need these dogs. They are my protection. This neighborhood can be rough and these dogs let people know I mean business. You gonna’ be ok?” he asked.
We assured him that despite our bruises, scrapes and torn cloths, we were fine and began to walk our now useless bicycles down the trail.
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Two Pit Bulls Showed Us How Hard This Work Would Be….We both were remarkably calm. I called my wife to pick us up. She too was remarkably calm. For all of us, it seemed as if this was just another lesson on our long road to understanding north Tulsa.
As we sat on the curb of the next cross street, waiting for our ride back home, Sam summed up this next lesson. “Even with a new bike trail, its hard to begin to be healthy in north Tulsa if it is unsafe to simply ride your bike,” he said softly.
THEN WE WERE CALLED PIMPS……
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Is Tulsa North Being Pimped By OU?
“To Tulsa north’s “rescue,” Oklahoma University has come. Unquestionably, medical care is needed in Tulsa north. Why then, pose such a negative question when OU appears to be doing the right thing?
Our answer….Pimps use the bodies of women to make money. For whatever reason, the women are vulnerable. The residents of Tulsa north are very vulnerable because of their poor health outcomes. Hundreds of millions of dollars will be spent ostensibly for better health care for Tulsa north residents. Who gets the money for such an endeavor? OU will. Who receives $20 million dollars for building the facility? Manhattan Construction has been selected as the contractor.
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If a healthy community is the goal of OU, does it not recognize that a healthy community involves more than improving traditional healthcare facilities and services? A healthy community must have a good economy and a chance for good jobs for its residents.
Tulsa north’s personal sense of well-being and its ability to thrive socially and economically are tied together. It is impossible to have a healthy community without a strong educational and economic engine in its midst.
Why do we pose the question, “Is Tulsa north being pimped by OU?” Do not pimps use bodies to get income? OU will receive income from treating sick bodies. When will OU learn that the elimination of healthcare disparities among population groups is not a zero sum game?”
History is Always Relevant (1921) to Understanding and Solving Our Current Health Disparities
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TULSA’S HEALTH DISPARITIES ARE NOT UNIQUE……
Overall Health Physical Inactivity Diabetes
Cardiovascular Events Cardiovascular Death
High School Graduation Health System Performance
Mortality
The US Culture of Health“Continental Divide”
2
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Life Expectancy Changes: Past 25 Years
Commonwealth Fund 2012
HEALTH RANKING OF 306 US CITIES:# 281 = Tulsa# 286 = Lawton# 298 = OKC
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Geographic Differences in Life Expectancy in the Same Town
New York, NY = 9 years Richmond, VA = 20 years
Life Expectancy : 2005
67 YRSIn 2005
THE START OF A LONG ROAD
2005 REPORT: North Tulsa had
3 times the national rate of cardiovascular and cancer deaths.
North Tulsa had 40% of region’s population but only 4% of region’s health programs.
Focused efforts on access to care.
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Life Expectancy : 2015
70 YRSIn 2015
DECADE’S WORK: 4 new clinics
added. Multiple new
clinical programs added.
37 new physicians added.
Poverty rates worsened in North Tulsa.
CV Dz, DM, infant mortality rates improved the most.
3 years of life expectancy added for 20,000.
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OUR NEXT DECADE OF WORK:
Different parts of Tulsa have different health disparities:
Zip Codes with 3 to 4 Times the National Average Death Rates
Suicide Cardiovascular
and Cancer Narcotics
Overdose
TULSA HEALTH HOT SPOTS
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Bridges to Health and Healthcare in OklahomaAngela Martindale PhD(c), RNThe University of Tulsa Oxley College of Health Sciences
Oklahoma Health
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Oklahoma Rankings
• #47th in the nation for• Children in Poverty• Infectious Diseases• Violent Crime• Occupational Fatalities• Air Pollution• 3 places from the bottom…
Oklahoma Health
• Poverty similar to that of a 3rd world country
• War (on those in) poverty
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What can we do about it?
• Advocate for policy change
• Get to know your elected officials
• Tell stories
Community and Public Health
• Prevention
• Education
• Integrated curriculum
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Education
• Nursing Students• Medical Students• Nurses• Hospital staff• Seminars
Community Clinic
• Good Samaritan
• Community clinic at TU
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Creating Change
• Easier said than done…• Begin where you are with what you have• Ask for forgiveness rather than permission• Enroll and graduate more students from
under-resourced backgrounds
Future Ideas
• Poverty simulation in nursing school curriculum
• Student research opportunities• School of Community Medicine (only one
in the nation)• Change a generation
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Don’t give up…
Discussion and Questions
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Amy Thomas MSN, RN |OKWU MSN Program
Bridges to Health and Healthcare Capstone
Capstone Selection
What am I passionate about?
Grand Rounds at TU
“We need this Training at Hillcrest!”
How do I do it?!
“He who oppresses the poor reproaches, mocks and insults his Maker, but he who is kind and merciful to the needy honors Him”(Prov 17:5, AMP)
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PICOT Question-“Does Bridges to Health and Healthcare training improve the interactions, attitudes, and communication of nurses that care for patients in generational poverty, as compared to pre-training interactions, attitudes, and communication and continue to have a positive effect on their practice, post-training and beyond?”
Target Population- Nurses at a safety-net hospital
Introduction- PICOT
Literature Review
Identified Five ThemesPoverty in Primary CarePsychological Factors and
Poverty Low Socioeconomic Status and
Chronic DiseaseHospital Discharge and Low
Socioeconomic StatusTraining for Poverty Awareness
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Lewin’s Change Theory
Theoretical Framework
Strategic PlanPhase One- Provide training to a small group of ED nurses
Training conducted on May 4, 2016
• 11 attendees- 9 ED nurses, 1 ED social worker, Women’s Center Director
• Angela Martindale- Certified trainer
• Pre-test and Post-test
Quote from attendee: “After working in the ER for over a year, it opened
my eyes to what I have forgotten, seeing patients in their life struggles”
Method
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Present a proposal to the executive council
Explain the basic concepts of Bridges training
Present the impact of Bridges training on a facility
Disseminate results of training on a group of ED nurses
Strategic timeline of training
Cost analysis and resources(Valenti, 2013)
Phase 2
Hardwiring Bridges Framework and Concepts into Hillcrest Training for all staff New Employee Orientation Refresher courses Incorporate into Patient Experience andPEARLS training
Phase 3
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Phase 1- completed May 4
Phase 2- After approval:
Training in November 2016- Three trainers
750 nurses at Hillcrest- class size of 25
Goal-3-4 months to train all nurses
Phase 3- Goal-- implement to all staff by end of 2017
Implementation
Pre and Posttest Interview Class evaluation HCAHPS scores- measure indicators that involve
nursing communication and interactions
Readmission Rates- especially in first 30 days
(HCAPHS website, n.d.)
Evaluation
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Adepoju, O. E., Preston, M. A., & Gonzales, G. (2015). Healthcare disparities in the post-affordable care act era. American
Journal of Public Health, 105, S665-S667. http://dx.doi.org/10.2105/AJPH.2015.302611
Anakwenze, U., & Zuberi, D. (2013). Mental health and poverty in the inner city. Health & Social Work, 38, 147-157.
http://dx.doi.org/10.1093/hsuw/hr013
Atal, S., & Cheng, C. (2016). Socioeconomic health disparities revisited: coping flexibility enhances health-related quality of
life for individuals low in socioeconomic status. Health and Quality of Life Outcomes, 14, 1-7.
http://dx.doi.org/10.1186/s12955-016-0410-1
Bashinskaya, B., Nahed, B. V., Walcott, B. P., Coumans, J. C., & Onuma, O. K. (2012). Socioeconomic status correlates with
the prevalence of advance coronary artery disease in the United States. PLOS one, 7, 1-7. Retrieved from
www.plosone.org
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