January 25, 2021
In a Community with Higher-than-Average Smoking Rates, Allen Parish Healthcare is Committed to Smoking Cessation Measures

Allen Parish Healthcare, part of the Caravan Health Crouse ACO, serves a rural community in Louisiana, a state with the third highest smoking rate in the nation. Only West Virginia and Kentucky report higher rates of smoking. According to the CDC, tobacco smoking remains the leading cause of preventable death and disease in the U.S. Cigarette smoking kills nearly 500,000 Americans every year.

In Louisiana, 22% of adults smoke. Aware of their higher-than-average rates, staff and providers at Allen Parish are committed to the Tobacco Screening and Cessation Intervention quality measure to help reduce smoking rates in their patients and community.

As part of an ongoing quality improvement effort, Meaningful Use incentive, the staff communicates with patients and asks about their smoking status and informs them of tobacco cessation counseling, educational resources, and enhanced wellness visits to help encourage them to stop smoking or to reduce their usage. With the goal of having fewer active smoking patients, the staff implemented a way to capture each patient’s status in order to flag their provider to discuss the merits of tobacco counseling. They rely on their EMR to track their visits and increase the productivity and efficiency of their conversations – continuing to convey the importance of smoking cessation. With the EMR, each team member is able to see prompts to follow up and include specific measures as part of their workflows. Together, staff, providers and patients work toward achieving the collective goal of reducing or stopping smoking.
Despite being in an area with a high rate of smokers, Allen Parish patients have been cooperative and open to utilizing the resources to help them stop or reduce their smoking and have expressed an openness to screenings and cessation interventions. Today, Allen Parish reports that 92.9% of their patients have been screened and received intervention materials.
“Tobacco cessation and counseling reduces risk for many adverse health effects, including poor reproductive health outcomes, cardiovascular diseases, COPD, and cancer. Our clinic and providers have adopted a new vision for our clinic to promote wellness and educate our patients on the importance of being healthy in all aspects. It truly is a team effort in providing wellness care and promoting healthy living to our patients, and our team at Allen Parish Community Healthcare continues to strive to keep our patients healthy.”
Alex Courville, M.D.
ACO Provider Champion
Allen Parish Community Healthcare

January 13, 2021
Mammoth Hospital Uses Patient Engagement Techniques to Help Patients with Depression 

Since 2016, Mammoth Hospital (“Mammoth”), which serves the largely dispersed, rural communities of Mammoth Lakes, has been a part of a Caravan ACO. Rural residency is commonly cited as a risk factor for depression and providers at Mammoth, well-versed in population health practices, routinely take proactive measures to screen, prevent, and treat depression in their rural area.

Recently, during the COVID-19 pandemic and in the midst of social distancing and quarantining measures, a patient presented with a PHQ-9 score of 20 and a GAD-7 score of 3. He was diagnosed with a Major Depressive Disorder, ingle episode, severe with noted relationship problems and nicotine dependence. Mammoth providers initiated treatment that included a combination of in-person and telehealth visits. After four visits his symptoms had notably decreased and his PHQ9 score was a 6 – in the mild depression range.

The symptoms of depression including low motivation and energy often preclude patients from continuing treatment. As is common, this patient stopped attending visits. Mammoth staff, however, using best practice methodologies, re-engaged the patient and noted his scores had fallen to the moderately severe range with a score of 18. Mammoth staff continued to engage the patient, this time with a psychiatric consultation and medication assessment. Staff also encouraged the patient to attend in-person visits to help offset the isolation.

In a relatively short period of time with consistent visits and enhanced engagement, the patient’s PHQ-9 scores returned to the mild range and he was effectively weaned from medication. Population health nurses have worked with the patient to identify his goals to help him find more meaning in his life. The staff have helped him improve his communication style, increase self-compassion, decrease his nicotine use, and establish healthy habits and behaviors. His depression score continues to improve and today is near the normal range. 

The Top 3 Takeaways from this Patient Success Story
1. Continue to contact a patient with depression, engage and re-engage as much as necessary.
2. Despite the health and safety benefits of telehealth, patients with depression may require more in-person visits to help keep them engaged and motivated to get better.
3. Population health best practices such as helping a person with depression set goals and find meaning will help create new patterns of behavior and thinking.

“When a patient has depression, it is important to understand that the symptoms of their illness often prevent them from returning calls and/or engaging in appointments. We knew his depression impacted his motivation and we took steps to reach out to him and worked to encourage him to attend virtual appointments. Eventually the appointments transitioned to in-person. Our efforts helped keep him be more engaged, especially through his lowest points.”

Dr. Jacob Eide, Behavioral Health Clinical Supervisor

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