Community Oriented Primary Care A Practical Assessment, Vol. 2: Case Studies (1984) / Chapter Skim
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The Checkerboard Area Health System
The Checkerboard Area Health System
Pages 25-50
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From page 25... ...
The Checkerboard program became an entity within the PMS organization in 1971, and was funded in 1972 as a demonstration project by the Social and Rehabilitation Service of the Department of Health, Education and Welfare to develop anew and innovative methods of providing health care to an economically depressed area.. After 197S, it continued to be supported in part by federal grants from U.S.
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From page 26... ...
He served as a physician with the Indian Health Service and the National Health & rvices Corps prior to his residency years. Bmmediately before coming to Checkerboard he worked for the New Mexico State Health Agency as district health officer for San Juan and McKinley counties.
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From page 27... ...
TABLE 3.1 Major Personnel and Facility Resources Available at Checkerboard Area Health System Type of Resource Personnel Medical/Dental Nursing Ancillary and support Administrative Visiting medical consultants Facilities Limited hospital Satellite clinics Emergency room Ambulances Outpatient examination rooms Dental chairs Pharmaceutical dispensaries Diagnostic laboratory Radiologic facility Radio communications system Quantity 17 16 42 19 8 10 beds 6 24 hours~day 2 20 10 7 1 1
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From page 28... ...
A director of nursing services located at the Cuba facility supervises a nurs ing stat f of 10. One of the services, school health nursing, is financed through contracts with the three public school districts in the Checkerboard area.
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From page 29... ...
Dr. Richard Rozoll is the director of the Checkerboard program and is directly assisted in his management responsibility by a business manager and an administrative assistant jointly supervising an administrati~re support staff of 11.
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From page 30... ...
Recently, Checkerboard reinstituted a series of computer-generated chronic disease registries (they were previously inconsistently kept manually) , which include CVA, hypertension, diabetes mellitus, syphillis, arthritis, Parkinson disease, alcoholism, blindness, child abuse, prenatal care, and mental retardation.
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From page 31... ...
Of the 75 percent, 88 percent come n from federal sources, specifically the Indian Health Service and the Bureau of Health Care Delivery and Assistance. The Indian Health Service contracts with Checkerboard for outpatient, inpatient.
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From page 32... ...
The other contractual funds came from a few categorical state grants, contracts with local school districts to provide the school health program, and a grant from the Robert Wood Johnson Foundation for a swing bed demonstration project. Direct payment and third-party reimbursement represent a smaller, but nonetheless substantial proportion of the revenues from patient services.
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From page 33... ...
In addition to securing another source of revenue, this arrangement resulted in an immediate doubling of public health encounters for the same expenditure. Similarly, Checkerboard has negotiated contracts with three of the local school systems to coordinate and administer a school health program.
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From page 34... ...
Within the Checkerboard program, there are three guidance councils, one for each of the constituent ies served including Navajo, Jemez Valley, and Cuba area. Each of the guidance councils exists specifically to provide consumer input into the day-to-day operation of the health care program.
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From page 35... ...
Occasionally, all three guidance councils meet jointly with the board of directors specifically to provide grass roots input into ma jor policy issues confronting EMS. The guidance councils individually meet bimonthly with the director of Checkerboard and other key staff.
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From page 36... ...
The school screening program is accomplished through the school health program and BHCDA grant at an estimated cost of $2 per child screened. Although there has been no systematic effort to document the impact of the school-based program, it can be estimated from the practice impressions and subsequent screening results.
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From page 37... ...
Within the first six months of the program, there was suggestive evidence of program success, particularly in terms of program participation and completion of adequate prenatal care for the subset of the pregnancies identified at risk. Using data from the EMS system, the Impact of the program continues to be monitored each quarter and has suggested several important trends: · an increase in breast feeding rates among all ages · an increase in birth weight in infants of mothers of all ages · a decrease in rate of both premature and small for gestational age births.
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From page 38... ...
A printout is obtained from the data system that lists all individuals in the data base who are: -- over age 65 years -- diagnosed with one of a specified set of conditions that placed them in a high-risk category (e.g., emphysema, chronic bronchitis, diabetes, congestive heart failure, rheumatic heart disease) m e public health nurses all receive a list of the high-risk patients, sorted by area of residence, and an appropriate portion of the listing was provided to each satellite clinic.
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From page 39... ...
An evaluation is planned for 1986 that will involve reexa~ination of al' medical records of child deaths in the community, based on a listing from the Office of the Medical Investigator. In the meantime, it is planned to continue monitoring the road-specific statistics from the Highway Department.
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From page 40... ...
A printout was also generated listing all children who had not had a well child contact with the health program In the last six months. When the state cut back the WIC program, the case load among the Checkerboard child community dropped from 1,050 to 450.
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From page 41... ...
Visit and immunization data will be cross-referenced from the original master list, enabling the program not only to compute well child care and immunization rates, but also to identify the cohort of children who have not responded to the postcard reminders. Screening in School Children Between 1973-1976, the community and the Checkerboard program participated in an EPSDT demonstration project.
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From page 42... ...
The monthly operating summaries that are routinely received sort the total registered population into several categories that is useful for characterizing social/economic status of the community (Presbyterian Medical Services, 19833. The evidence of routine use of this capability of the data system by the Checkerboard program places them at stage IV in the development of this function.
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From page 43... ...
Identifying the Community Health Needs Rather than routinely engaging in new data collection activities, in general, the Checkerboard program makes maximal use of existing data, particularly data that is available from the Indian Health Service and from the State Health Department. Checkerboard has not made any specific study of the total community for the purpose of identifying health problems since the early 1970s; however, it appears that the program has excellent documentation of the extent and sever ity of its major health problems.
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From page 44... ...
GAS TRo and CAR SEAT refer to the activities that addressed infant gastroenteritis and pushed auto infant seat restraints e SCREEN refers to the efforts to address the appropriate level of screening for a var iety of problems in the school population. WEIL CHILD refers to the effort to improve the well child care after _ .
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From page 45... ...
It was interesting to note that most of the clinical personnel interviewed were quite involved in a particular health issue well beyond their primary care health service delivery responsibilities. In general, the Checkerboard program operates at stage III in the development of the function of modifying the health program to address pr iority community health problems.
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From page 46... ...
While not necessarily showing a positive cost-benefit ratio if examined in isolation, the inpatient service does provide the additional revenues to maintain a higher quality of several of the ancillary services, including laboratory, radiology, nursing, and emergency room services. The inpatient service provides the momentum to attract, hire, and retain adequate numbers and quality of staff in these critical areas, which, in turn, improve the quality of the ambulatory care program as well.
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From page 47... ...
This may be due in large part to the combination of their well documented knowledge of the community 's health problems, their health program incorporating both primary care and community health services, and their growing reputation as a health care program capable of initiating, sustaining, and car ry ing out to successf ul conclus ions innovative prog rams in health services delivery. Organization of the Community me relative isolation of the community that the practice serves has offered several "captive.
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From page 48... ...
In developing a source of funds and a commitment to serve as the school health program and as the local health department, Checkerboard further solidif fed its foundation as an active COPC program.
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From page 49... ...
Bonner Dates, DDS, Staff Dentist for Cuba and Torreon William Morningstar, DDS, Dental Director Phillip Frey, DDS, Staff Dentist for Nazeezi Elsie Otero, Nurse Aide at Torreon Millie Antonio, Secretary at Torreon Eleanor Begay, P.A., Physician' s Assistant at Torreon Anna Marie Tomlinson, R.N., Coordinator of School Health Programs Martha Barbe, M.S.N., F.N.C., Director of Nursing Elizabeth Burleigh, M.P.H., Health Educator
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From page 50... ...
Santa Fe, New Mexico : Presbyterian Medical Services. Reid, R.A., Bartlett, E.E., and Kozoll, R
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