Community Engagement: Creating The Nation’s First School of Community Medicine

1. Community Engagement: Creating The Nation’s First School of Community Medicine

2. Established as a branch campus in 1972 using community based model. Purpose – workforce and service for northeast OK. OU Clinics 250,000 visits / year OU Departments / Divisions 186 OU employed faculty Pediatrics, Psychiatry, Surgery Internal Medicine, OB/Gyn Family Medicine, Emergency Medicine, Geriatrics, Dermatology, Physician Assistant, Sports Medicine Additional OU Programs Nursing, Pharmacy, Public Health, Allied Health, Social Work, Human Relations, Engineering, Telecommunications, Computer Science, Organizational Dynamics, Knowledge Management Community Partners Specialist Physicians 3 Large Private Hospitals Residencies 200 residents in 13 Residencies / Fellowships Medical Students Average 40 students each in the 3rd and 4th year classes. 50 Physician Assistant Students OU College of Medicine, Tulsa Structure

3. We thought we were doing fine….OU College of Medicine, Tulsa alumni practicing InOklahoma 0 1- 5 6- 10 11- 35 36-150 151-779

4. …fine until we saw the death curve….

5. 1,100 Age Adjusted Death Rates Over the Past 25 Years 1,000 Tulsa County 950 900 While the death rate of most U.S. residents is declining, that of Tulsans is not – and the trend is going in the wrong direction United States 850 800 1980 1990 2000

6. If you ask the public, what should a medical school do?? AAMC – 2000 Survey • Educate the next generation of physicians. • Advance care through research. • Take care of complex patients. • Take care of the poor. • LEAD IN SOLVING HEALTH CARE PROBLEMS.

7. We needed a plan….. OU College’s of Public Health and Medicine came together. More data on health parameters, workforce, student satisfaction / trends. Pilot Projects - Access. Critical Mass – Clinical Services and Students External Consultants Prepared for Next Transformation * Note – these are not real OU Football Players

8. Health Status

9. COMMONWEALTH FUND State Scorecard Summary of Health System Performance

10. HEART DISEASE MORTALITY IN THE UNITED STATES

11. MENTAL ILLNESS PREVALENCE IN THE UNITED STATES

12. Tulsa Area Health Status Varies Dramatically By Income

13. Tulsa Area Health Status Varies By Race: Years of Productive Life Lost Per Death

14. Tulsa Area Health Status Varies By Zip Code: AGE ADJUSTED DEATH RATES IN TULSA COUNTY Red = very poor health status Zip Codes Yellow = worsening health status Zip Codes Green = good health status Zip Codes Although north, east and west Tulsa have 40% of the region’s population, they have only 4% of the region’ physicians

15. Rationale for Change Responsibility to Improve Health (continued) Access to and equity in healthcare are key health determinants. Health status is variable across the Tulsa region. NORTH TULSA Shorter Life Expectancy 14 Year difference in Life Expectancy Across Tulsa County SOUTH TULSA Longer Life Expectancy

16. Tulsa County Prenatal Care and Infant Mortality Rates

17. Initial Pilot Efforts:Focus on Access

18. Primary Care 2005 - New 60,000 sq ft Family Medicine. 2007 – New 100,000 sq ft multispecialty clinic 2003 – 2008 Network of 35 Bedlam Outreach Clinics, free pharmacy program, nursing and social work case management Schools / Head Starts Housing Authority Apartments Mobile Clinics Specialty Care 2003 - Mobile Psychiatric Team 2007 - New 10,000 sq ft Diabetes Center 2008 – Perinatal Outreach Initiative 2008 New 22,000 sq ft Cancer Center satellite 2008 - New 10,000 sq ft Surgery Clinic 2010 - 50,000 sq ft North Tulsa Specialty Clinic. Access to Care Expansion

19. 20 School-based OU Clinics Serving 32 Schools

20. EXAM ROOMS

21. OU PACT Team and Community Mental Health • PACT Team provides mobile psychiatric care and rehabilitation to those with the most severe forms of mental illness (e.g homeless mentally ill). Pre PACT1 Year in PACT Hospital Days / year 2898 Days 671 Days Jail Days / year 1196 Days 535 Days

22. Emerging Workforce Trends

23. TOTAL PHYSICIANS IN 2005PER 100K POPULATION IN THE UNITED STATES Oklahoma ranks 45th in the number of physicians per capita Created by Michael Lapolla, OU College of Public Health, December 2007

24. PRIMARY CARE PHYSICIANS IN 2005PER 100K POPULATION IN THE UNITED STATES Oklahoma ranks 39th in number of primary care physicians per capita Created by Michael Lapolla, OU College of Public Health, December 2007

25. SPECIALIST PHYSICIANS IN 2005PER 100K POPULATION IN THE UNITED STATES Oklahoma ranks 47th in number of specialists per capita Created by Michael Lapolla, OU College of Public Health, December 2007

26. Access to Health Care Varies Dramatically By Tulsa Zip Code: • For every 1 physician in north, east and west Tulsa, there are 26 in mid-town and south Tulsa. • 40% of the population and 4% of the clinicians.

27. Combine Workforce and Health Status Data

28. Physicians are not practicing in the Tulsa metro areas where healthcare is needed most. Age-Adjusted Death Rate in Tulsa Physician Density in Tulsa - Partner hospital - Partner hospital The age-adjusted death rate is highest in those areas with the fewest physicians.

29. Student and Resident Attitudes and Skills

30. Resident Physician Skill Sets: System-based Practice Core Competencies 151 OU Resident Physicians: Wrote the Dean a paper on the worst health care problems in the region. • Excellent at identifying health system problems. • Excellent at innovative solutions to these problems. • No skills for researching, testing theories, developing a plan, implementation, financing strategies to carry out their unique interventions.

31. Medical Students: Perceptions of and Needs of the Poor

32. Medical Students: Student’s Professional Obligation to the Health of the Poor

33. AAMC Graduation Questionnaires “ The experiences in community medicine, particularly the Bedlam Clinics (student run free clinics), rekindled the spirit of why I wanted to be a physician.”

34. In 2006 – 2 Driving Factors for a Dramatic Transformation…. • Physician Work Force Trends: • Future National Shortage • Existing Oklahoma Shortage • Expansion of medical education would happen. • Oklahoma Health Status: • Although access to care was improving, much more needed to be done. • A different type of physician was needed.

35.  http/:”Community Medicine” • Many academic… • Divisions • Departments • Centers • Institutes • 1 “School of Community Medicine” in New South Wales Australia

36. School of Community Medicine • Vision • Leveraging our leadership, service, education and research expertise, we will be successful at “Improving the Health of Entire Communities”. • Strategies • Expanded Education Platforms – Start a physician assistant program. Expanded medical student, residency and fellowships in Tulsa. • Unique Aspects of Curriculum – close alignment with the OU College of Public Health. Educational themes include excellence in individual patient care as well as improving the health of entire communities, at risk populations, the underserved, complex problem solving skills, complex project management, translational research, physician character development and medical informatics. • Health Services Delivery: creating community partnerships to expand healthcare access to targeted populations. • Research: Targeted …not comprehensive research programs: services, outcomes and translational in focus.

37. Nuts and Bolts of what we think may be the Nation’s First School of Community Medicine….. • Transform ourselves from branch campus status to a School with a unique purpose within the OU College of Medicine. • Renamed as OU College of Medicine’s School of Community Medicine – “improving the health of entire communities.” • Tulsa Public Schools shadowing programs and Undergraduate pre-med fast-track at University of Tulsa and OU. • National recruitment of students with dedication to the underserved to this specific medical education track that merges traditional medical education with public health curriculum  MD + Public Health Certificate or MD + MPH. • Creative use of “Summer Institutes” for in-depth work. • If possible and funding available, expand medical student class size from 40 to 70 per year, add Physician Assistant students – initial class of 25, expand residents from 201 to 251. • New scholarship program with incentives to establish career serving underserved and at-risk.

38. February 2008 Announcement “With this health data known, it is morally offensive not to act.” George Kaiser, February 2008.

39. The Gift….”The Grand Experiment” $ 50,000,000 from the George Kaiser Family Foundation: • $ 35,000,000 dedicated to new endowed chairs. Matched with $ 35,000,000 from state funds to create $ 70,000,000 endowment for faculty expansion. • $ 7,500,000 for school infrastructure expansion. • $ 7,500,000 for student scholarships.

40. 6 Lessons Learned • Physicians in training are very smart but need additional skills to tackle the toughest problems out there…. • Altruism can be preserved with the right teaching / clinical environment. • Public health data and physician manpower data drove our planning and influenced philanthropy. • Important for us to create something complementary and not competitive with existing medical education and clinical services. • Planning: • Intimately involved students and philanthropy in planning. • Everyone Involved - Primary Care, Specialty Care, Bio-medical Researchers, Community Partners, DO and MD….and other Colleges….because team care works. • At the end of the day – one writer of the master plan. 180 pages and a 15 page executive summary.

41. 6. Had to create a “Business Plan for our Social Contract” Mission (+) Finance (-) Finance (+) Mission (-) Student scholarships Physician assistant program After-hours free clinics Children’s Village Private support Endowment expansion Expanding primary care network Expanding specialty access Native American partnerships Corporate partnerships 90% FTE time as clinicians Practice plan efficiency initiative Patient Satisfaction JCAHO accreditation of OU Clinics THE NO-FLY ZONE

42. 1,100 Age-adjusted Death Rates 1,000 Our Goal: Improve the Health of Entire Communities 950 Tulsa County 900 850 United States 800 1980 1990 2000 2010 2020 2030