January 13, 2014

Learning From West Cost Innovation

by Alexandra D. Urban

As part of TRI-Lab, students in the Health Early Childhood Development seminar were given the opportunity during winter break to conduct research, visit best practice sites, or pursue other learning activities.  Work sponsored by TRI-Lab was driven by research needs and learning opportunities emerging from focused interdisciplinary work teams and the larger TRI-Lab cohort of faculty, community practitioners, and students. 

Alexandra D. Urban ’15, who studies Educational Neuroscience, reflects on her experience over winter break visiting a best practice site in California. Her working group is investigating how hospitals and partner organizations work to ensure continuity of maternal and pediatric care for outpatients.  

Just this past week, I found myself with health care leaders at Valley Medical Center in San Jose, California.  This impressive medical complex cares for one in four of Santa Clara county residents and houses the only trauma response center in the area.

It was incredible to witness their passion for delivering the best care possible, even after decades in the industry.  Many questions were touched upon, including: How can we effectively address mental health issues?  One step they have taken is to have trained nurses act as the telephone operators so that triage can happen immediately, successfully connecting patients with the services they need.

Another issue they recently tackled was: what can we do to reduce outrageous wait times in the Emergency Room?  They have since implemented “Express Care,” where patients who need, for example, splints and anti-inflammatory medicine for their sprained ankles are directed to the help they need without hours and hours of waiting in the busy ER.  Meanwhile, patients requiring more extensive tests and a longer hospital stay, those with suspected appendicitis for instance, can then be taken more quickly in the actual Emergency Room.  Not only does this streamline care delivery for doctors, but patients are assisted without such delays and end up far more satisfied.

What about prenatal care?  And how are we addressing continuity of care for new mothers and their infants at Valley Medical? A crucial step they are in the midst of implementing is moving all medical information online.  With this new system, patients and doctors can access the most up-to-date information, all in one place.  Also, as with many large hospitals, this medical center has faced difficulties with communications between departments, meaning that if a soon-to-be mother is diagnosed with depression by her OB, this information might never makes it to her primary care physician.  However, once this patient and all her doctors are able to access and update information on the same online portal, communication will improve and diagnoses will be less likely to fall through the cracks between departments and sectors of the hospital.

Valley Medical has also started a new program entitled “Baby Gateway.”  This initiative connects new mothers with their babies’ pediatricians, face to face, while the mother and baby are still at the hospital immediately following birth.  The idea is that if mothers have already met and heard the importance of their children’s upcoming pediatric appointments from the pediatricians themselves, they will be more likely to bring their infants to these crucial check-ups and immunizations.  The early results are exciting: mothers served by “Baby Gateway” have shown higher rates of attendance at their children’s pediatric appointments, thereby effectively lowering DNKA [Did Not Keep Appointment] rates for the hospital overall.  Since Valley Medical serves a large population of immigrants and low-socioeconomic patients, a demographic in which DNKA rates have been shown to be particularly high, this type of intervention is extremely important.  In fact, Greg Price, Deputy Director of Ambulatory Care at Valley Medical, estimated the DNKA rate to be 20% across departments, and he stressed that any programs aimed at improving no-shows from the current one-in-five ratio would be very welcome.

Lastly, in response to the question of how to address the larger issue of continuity of care, Chris Wilder of the Valley Medical Foundation stated, “we’re the largest hospital in Silicon Valley and we still haven’t figured it out.”  This is a crucial area in medicine currently, one that is gaining both attention and traction at hospitals nationwide.   Many programs are being implemented, some of which are yielding promising results, but much research remains to be done.

This is where our TRI-Lab group comes in.  The more we can learn about why mothers do not bring their infants to pediatric appointments and how we can enhance these doctor appointments themselves, the more effective our future interventions will be to improve the continuity of care for low-income mothers in Rhode Island.  Only then, will we be able to share our knowledge and initiatives with others.

Wilder ended our meeting with a smile: “so let us know what you figure out in Providence – we always want to hear what’s working, near and far!”


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