Novel Interventions in Children's Healthcare (NICH) - Portland, Oregon.
Dr. Michael Harris is the psychologist who heads the NICH program at Oregon Health & Sciences University. I have had the pleasure of attending to his talk a couple months ago when I still working on my comp. From what I have gathered, NICH is a program that assigns a health worker ("interventionist") to pediatric patients with complex health needs and barriers to quality care because of social constraints. Just a side note - these are patients who are in and out of the hospital frequently due to medical complications. After initial intake, the health worker then spends the next several months establishing a trusting and therapeutic relationship with the patient and family. Whenever the family needs help in something, whether it is to fill out job applications, social security, or getting rides to the hospital, the health worker is their man/woman. While my description does not do this program justice, what is impressive about this program is that patients and their family have 24/7 telephone access to their health worker. It sounds so simple, but it works. It has long been shown social determinants such as poverty and lack of access to care negatively impact health, and NICH has figured out a way to help these vulnerable patients by meeting where they are at and getting exactly what they need. In fact, NICH has data showing that children who enter their program are significantly less likely to be re-admitted (d/t complications) or less likely to stay hospitalized as their counterparts. Needless to say, we need more programs like NICH.
Public Health Institute & Center for Digital Health Innovations
Here is a truly innovative idea for reaching out to farmworkers and migrant workers - use text messaging as a way to promote public health. Through rounds of focus groups, Iana Simeonov has figured out a way to connect with the seasonal & migrant workers via SMS.
Here is my rant that no one wants to read (including myself):
The current primary care system is not ideal and very frustrating for both patients and clinicians alike. In 15 minutes, you are supposed to take a focused history, perform relevant physical exams, and diagnose as well as offer sound, evidence-based recommendations. Not only that, you are expected to make sure that the patient understands your frantic rambling and gets why treatment is being provided a certain way. And document important historical as well as physical findings in the so-not-user-friendly-and-counterintuitive EMR your clinic uses. What ends up happening is that you parse patient's concerns down to one and try to scramble for as much time as you can (e.g., maybe talk faster, interrupt more, or request the patient to make another appointment for other complaints). In response, the patient learns that asking questions is futile and just smile/nod to make you think that every word you say is crystal clear. The patient then goes home confused and without a single clue about what just went on in the clinical encounter. Also a bit miffed about not having all of his or her questions addressed. Honestly, a 15-minute visit really doesn't really get anywhere. It's frustrating.
Because I am super green and am just starting out with my career, I don't want to be burned out by this system so soon. The 15-minute constraint is such a downer. All I care about is being able to establish a genuine relationship with my patients. I want them to feel safe with me and be honest with me. And I do enjoy listening to my patients' stories, even the ones that don't have a plot or a clear goal.
