Nestled in the northwest corner of Mississippi, the 18-county region known as the Mississippi Delta is home to the crossroads, Blues music and fertile farmland. The Delta is also home to some of the nation's worst health problems, where the prevalence of diabetes reaches 13 percent, and approximately 70 percent of all adults are overweight or obese. The Delta Health Alliance (DHA) changes healthcare in the Delta by improving access to healthcare and providing education for healthier lifestyles. Despite the socio-economic challenges that present in the Delta, or perhaps because of them, clinicians in the Delta have readily adopted new innovations in care.
The DHA BLUES (Better Living Utilizing Electronic Systems) Beacon Community focuses on addressing the effects of diabetes and its complications through the use of innovative care programs infused with technology. The immediate goal is simple: Make use of the latest in direct care practices and information technologies to improve healthcare in the Delta. The long-term goal is more profound: Transform the healthcare system by redirecting more of the existing resources into patient care and out of administration and recordkeeping.
Through one BLUES Beacon initiative, the Pharmacy Medication Therapy Management and Adherence project, a systematic assessment of the patient's drug-related needs and previous medication experience is conducted to identify, resolve and prevent medication-related problems. An individualized care plan is developed, and a follow-up evaluation is completed. The program utilizes transitions of care methods and collaborates with other disease management programs in the community. The program builds upon infrastructure in private practice and existing community disease management programs.
In this model, a pharmacist is embedded in the clinic and is a member of the patients' treatment team. The embedded pharmacist works directly with patients to provide education, screenings and medication management. To maximize adherence, bi-monthly telephonic assessments are performed to assess and document adherence within the clinic electronic health record. All members of the healthcare team use the electronic health record (EHR) to improve communication among providers. The pharmacist receives an e-referral for high-risk patients and follows a prescribed template of care, individualizing it to each patient's situation.
To illustrate this key economic component, consider that one inpatient hospital day costs $1,853 for a patient with diabetes. An office visit where diabetes is the primary diagnosis costs $132. Therefore the potential exists to save $1,721 by avoiding a hospital admission and directing care to the primary care provider's clinic.1 This type of savings is of tremendous benefit to the resource-poor Delta, where most counties are designated health professional shortage areas.
By including the pharmacist as a member of the healthcare team and the EHR as a means for communication, the clinic takes a step toward being a patient-centered medical home. By measuring outcomes related to quality, cost and efficiency, the full picture of how medication adherence projects affect patients’ quality of care is realized.
The Delta BLUES Beacon Community compliments and leverages infrastructure development currently underway to connect the region's health systems through health information exchange (HIE) powered by Medicity. Successful integration of health information technology into existing care delivery systems is considered by the BLUES Beacon Team to be one of three critical components to achieving patient centric care with a patient-centered IT system.
1. American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2007
Karen C. Fox, PhD, is president and CEO of the Delta Health Alliance. Anna Lyn Whitt, LMSW, MPH, is project director of HIT grants for DHA. Leigh Ann Ross, Pharm D, is associate dean for Clinical Affairs, associate professor and chair of the Department of Pharmacy Practice at the University of Mississippi Medical Center. Lauren Bloodworth, Pharm D, is an associate professor in the Department of Clinical Pharmacy Practice at the University of Missippi Medical Center.
