public health, pimps and pit bulls - aha! process · overall health physical inactivity diabetes...

Public Health, Pimps and Pit BullsFrom the OU-TU School of Community Medicine

Created by Dr. Gerard Clancy MDDean, The University of Tulsa Oxley College of Health

SciencesPresented by Angela Martindale PhD(c), RN Clinical

Assistant Professor, The University of Tulsa Oxley College of Health Sciences

Dr. Gerard Clancy MDDean of College of Health Sciences

Vice President of Health Affairs Professor of Community MedicineOxley College of Health Sciences

Community Medicine

Presented at aha! Process 2016 Addressing the Challenges of Poverty International Conference

www.ahaprocess.com of 26

PUBLIC HEALTH DATA POINTED US IN THE RIGHT DIRECTION…..

650$

700$

750$

800$

850$

900$

950$

1,000$

1,050$

1,100$

1,150$

1,200$

1,250$

1968

$

1972

$

1976

$

1980

$

1984

$

1988

$

1992

$

1996

$

2000

$

2004

$

2008

$

1968 Iowa (11)

Florida (12) Wisconsin (13)

Montana (14) OKLAHOMA (15) COLORADO (16)

Arizona (17) Connecticut (18) Washington (19)

Texas (20)

2010 Minnesota (4) New York (5)

Massachusetts (6) COLORADO (7)

New Hampshire (8) New Jersey (9)

Washington (10)

2010 Arkansas (45) Louisiana (46) Kentucky (47)

OKLAHOMA (48) West Virginia (49)

Alabama (50) Mississippi (51)

1968 Years 2008

Age-adjusted Death Rates



5

Clinical Services Distribution Age-Adjusted Death Rate in Tulsa

14 year difference in Life Expectancy, 4 Miles - Cancer and Heart Disease

North, East and West Tulsa: 40% of population has ready access to 4% of physicians

5

2005 - HOT SPOTTING TULSA COUNTY

A Shiny New $20,000,000 Clinic Would Save the Day and We Would Be The Heroes!



Two Pit Bulls Showed Us How Hard This Work Would Be….

I was pretty sure the loud crack I had just heard was from my son’s bicycle helmet hitting the pavement of the bike trail. As I rolled over, I could see that I was right as the helmet was now in pieces although still strapped to his head.

He had already sprung to his feet and was using his bicycle to shield me from the two angry pit bulls.


Just an hour earlier, I had noticed what a beautiful evening we had in store. May is a month in Oklahoma where all Oklahomans are on guard for tornadoes. But not this evening for it was clear and cool with a brilliant sunset on the way. My 19-year old son Sam had just returned home from his first year in college. “What should we do this evening?” Sam had asked. “Let’s take a bike ride through north Tulsa. I want to show you the progress we have made on our new Wayman Tisdale Clinic,” I responded.

So off we rode to our destination five miles away. When we reached the clinic, I could not help but to beam from pride as the gleaming $20 million clinic began to take shape. “I think things are going really well right now in north Tulsa. Things are changing for the better and this clinic helps,” I proclaimed.




As we headed back home from the construction site, I noticed the two pit bulls asleep on either side of the bike trail just 50 yards ahead. “Sam, we are going to need to speed it up a bit and fly by those pit bulls ahead,” I warned. As we approached the sleeping dogs, the extra speed had become a bad idea. The dogs were on to us, both of them lunging for my thighs. I steered to the left, catching my rear wheel on Sam’s front wheel resulting in both of us flying head first over our handlebars on to the pavement. Scrambling to stand up, I followed Sam’s lead and used my mangled bicycle to shield the angry dogs from getting any closer.

Two Pit Bulls Showed Us How Hard This Work Would Be….Within seconds, the dog’s owner was on the scene and called off the dogs. He was immediately apologetic. “I am so sorry guys. But I gotta’ say, I need these dogs. They are my protection. This neighborhood can be rough and these dogs let people know I mean business. You gonna’ be ok?” he asked.

We assured him that despite our bruises, scrapes and torn cloths, we were fine and began to walk our now useless bicycles down the trail.



Two Pit Bulls Showed Us How Hard This Work Would Be….We both were remarkably calm. I called my wife to pick us up. She too was remarkably calm. For all of us, it seemed as if this was just another lesson on our long road to understanding north Tulsa.

As we sat on the curb of the next cross street, waiting for our ride back home, Sam summed up this next lesson. “Even with a new bike trail, its hard to begin to be healthy in north Tulsa if it is unsafe to simply ride your bike,” he said softly.

THEN WE WERE CALLED PIMPS……



Is Tulsa North Being Pimped By OU?

“To Tulsa north’s “rescue,” Oklahoma University has come. Unquestionably, medical care is needed in Tulsa north. Why then, pose such a negative question when OU appears to be doing the right thing?

Our answer….Pimps use the bodies of women to make money. For whatever reason, the women are vulnerable. The residents of Tulsa north are very vulnerable because of their poor health outcomes. Hundreds of millions of dollars will be spent ostensibly for better health care for Tulsa north residents. Who gets the money for such an endeavor? OU will. Who receives $20 million dollars for building the facility? Manhattan Construction has been selected as the contractor.



If a healthy community is the goal of OU, does it not recognize that a healthy community involves more than improving traditional healthcare facilities and services? A healthy community must have a good economy and a chance for good jobs for its residents.

Tulsa north’s personal sense of well-being and its ability to thrive socially and economically are tied together. It is impossible to have a healthy community without a strong educational and economic engine in its midst.

Why do we pose the question, “Is Tulsa north being pimped by OU?” Do not pimps use bodies to get income? OU will receive income from treating sick bodies. When will OU learn that the elimination of healthcare disparities among population groups is not a zero sum game?”

History is Always Relevant (1921) to Understanding and Solving Our Current Health Disparities



TULSA’S HEALTH DISPARITIES ARE NOT UNIQUE……

Overall Health Physical Inactivity Diabetes

Cardiovascular Events Cardiovascular Death

High School Graduation Health System Performance

Mortality

The US Culture of Health“Continental Divide”

2



Life Expectancy Changes: Past 25 Years

Commonwealth Fund 2012

HEALTH RANKING OF 306 US CITIES:# 281 = Tulsa# 286 = Lawton# 298 = OKC



Geographic Differences in Life Expectancy in the Same Town

New York, NY = 9 years Richmond, VA = 20 years

Life Expectancy : 2005

67 YRSIn 2005

THE START OF A LONG ROAD

2005 REPORT: North Tulsa had

3 times the national rate of cardiovascular and cancer deaths.

North Tulsa had 40% of region’s population but only 4% of region’s health programs.

Focused efforts on access to care.



Life Expectancy : 2015

70 YRSIn 2015

DECADE’S WORK: 4 new clinics

added. Multiple new

clinical programs added.

37 new physicians added.

Poverty rates worsened in North Tulsa.

CV Dz, DM, infant mortality rates improved the most.

3 years of life expectancy added for 20,000.



OUR NEXT DECADE OF WORK:

Different parts of Tulsa have different health disparities:

Zip Codes with 3 to 4 Times the National Average Death Rates

Suicide Cardiovascular

and Cancer Narcotics

Overdose

TULSA HEALTH HOT SPOTS



Bridges to Health and Healthcare in OklahomaAngela Martindale PhD(c), RNThe University of Tulsa Oxley College of Health Sciences

Oklahoma Health



Oklahoma Rankings

• #47th in the nation for• Children in Poverty• Infectious Diseases• Violent Crime• Occupational Fatalities• Air Pollution• 3 places from the bottom…

Oklahoma Health

• Poverty similar to that of a 3rd world country

• War (on those in) poverty



What can we do about it?

• Advocate for policy change

• Get to know your elected officials

• Tell stories

Community and Public Health

• Prevention

• Education

• Integrated curriculum



Education

• Nursing Students• Medical Students• Nurses• Hospital staff• Seminars

Community Clinic

• Good Samaritan

• Community clinic at TU



Creating Change

• Easier said than done…• Begin where you are with what you have• Ask for forgiveness rather than permission• Enroll and graduate more students from

under-resourced backgrounds

Future Ideas

• Poverty simulation in nursing school curriculum

• Student research opportunities• School of Community Medicine (only one

in the nation)• Change a generation



Don’t give up…

Discussion and Questions



Amy Thomas MSN, RN |OKWU MSN Program

Bridges to Health and Healthcare Capstone

Capstone Selection

What am I passionate about?

Grand Rounds at TU

“We need this Training at Hillcrest!”

How do I do it?!

“He who oppresses the poor reproaches, mocks and insults his Maker, but he who is kind and merciful to the needy honors Him”(Prov 17:5, AMP)



PICOT Question-“Does Bridges to Health and Healthcare training improve the interactions, attitudes, and communication of nurses that care for patients in generational poverty, as compared to pre-training interactions, attitudes, and communication and continue to have a positive effect on their practice, post-training and beyond?”

Target Population- Nurses at a safety-net hospital

Introduction- PICOT

Literature Review

Identified Five ThemesPoverty in Primary CarePsychological Factors and

Poverty Low Socioeconomic Status and

Chronic DiseaseHospital Discharge and Low

Socioeconomic StatusTraining for Poverty Awareness



Lewin’s Change Theory

Theoretical Framework

Strategic PlanPhase One- Provide training to a small group of ED nurses

Training conducted on May 4, 2016

• 11 attendees- 9 ED nurses, 1 ED social worker, Women’s Center Director

• Angela Martindale- Certified trainer

• Pre-test and Post-test

Quote from attendee: “After working in the ER for over a year, it opened

my eyes to what I have forgotten, seeing patients in their life struggles”

Method



Present a proposal to the executive council

Explain the basic concepts of Bridges training

Present the impact of Bridges training on a facility

Disseminate results of training on a group of ED nurses

Strategic timeline of training

Cost analysis and resources(Valenti, 2013)

Phase 2

Hardwiring Bridges Framework and Concepts into Hillcrest Training for all staff New Employee Orientation Refresher courses Incorporate into Patient Experience andPEARLS training

Phase 3



Phase 1- completed May 4

Phase 2- After approval:

Training in November 2016- Three trainers

750 nurses at Hillcrest- class size of 25

Goal-3-4 months to train all nurses

Phase 3- Goal-- implement to all staff by end of 2017

Implementation

Pre and Posttest Interview Class evaluation HCAHPS scores- measure indicators that involve

nursing communication and interactions

Readmission Rates- especially in first 30 days

(HCAPHS website, n.d.)

Evaluation



Adepoju, O. E., Preston, M. A., & Gonzales, G. (2015). Healthcare disparities in the post-affordable care act era. American

Journal of Public Health, 105, S665-S667. http://dx.doi.org/10.2105/AJPH.2015.302611

Anakwenze, U., & Zuberi, D. (2013). Mental health and poverty in the inner city. Health & Social Work, 38, 147-157.

http://dx.doi.org/10.1093/hsuw/hr013

Atal, S., & Cheng, C. (2016). Socioeconomic health disparities revisited: coping flexibility enhances health-related quality of

life for individuals low in socioeconomic status. Health and Quality of Life Outcomes, 14, 1-7.

http://dx.doi.org/10.1186/s12955-016-0410-1

Bashinskaya, B., Nahed, B. V., Walcott, B. P., Coumans, J. C., & Onuma, O. K. (2012). Socioeconomic status correlates with

the prevalence of advance coronary artery disease in the United States. PLOS one, 7, 1-7. Retrieved from

www.plosone.org

References

Bernheim, S. M., & Ross, J. S. (2013). Hospital discharge and the transition home for poor patients: “I knew I couldn’t do what they

were asking me”. Journal of General Internal Medicine, 29(2), 269-270. http://dx.doi.org/10.1007/s11606-013-2698-4

Evans-Agnew, R. A. (2011). Asthma management: an ecosocial framework for disparity. Journal of Health Disparities Research and

Practice, 5(1), 1-19.

HCAPHS website. (n.d.). http://www.hcahpsonline.org/home.aspx

Institute of Medicine. (2000). America’s health care safety net: Intact but endangered. Retrieved from www.nap.edu.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Retrieved from

http://www.nap.edu/read/10027

Kangovi, S., Barg, F. K., Carter, T., Levy, K., Sellman, J., Long, J. A., & Grande, D. (2013). Challenges faced by patients with low

socioeconomic status during the post-hospital transition. Journal of General Internal Medicine, 29(2), 283-289.

http://dx.doi.org/10.1007/s11606-013-2571-5



Lee, W., Nelson, R., Mailey, B., Duldulao, M. P., Garcia-Aguilar, J., & Kim, J. (2012,). Socioeconomic factors impact colon cancer outcomes in diverse patient populations.

Journal of Gastrointestinal Surgery, 16, 692-704. http://dx.doi.org/10.1007/s11605-011-1809-y

Lix, L. M., Hobson, D. E., Azimaee, M., Leslie, W. D., Burchill, C., & Hobson, S. (2010). Socioeconomic variations in the prevalence and incidence of parkinson’s

disease: a population-based analysis. Journal of Epidemiol Community Health, 64, 335-340. http://dx.doi.org/10.1136/jech.2008.084954

Loignon, C., Haggerty, J. L., Fortin, M., Bedos, C. P., Barbeau, D., & Allen, D. (2010). What makes primary care effective for people in poverty living with multiple

chronic conditions?: Study protocol. BMC Health Services Research, 10. Retrieved from http://www.biomedcentral.com/1472-6963/10/320

Loignon, C., Hudson, C., Boudreault-Fournier, A., Dupere, S., Macaulay, A. C., Pluye, P.... Champagne, L. (2013). Transforming primary healthcare by including the

stakeholders involved in delivering care to people living in poverty: EQUIhealThy study protocol. BioMed Central, 13. Retrieved from

http://www.biomedcentral.com/1472-6963/13/92

Mercer, S. W., Higgins, M., Bikker, A. M., Fitzpatrick, B., McConnachie, A., Lloyd, S. M. ... Watt, G. C. (2016). General practitioners empathy and health outcomes: A

prospective observational study of consultations in areas of high and low deprivation. Annals of Family Medicine, 14(2), 117-124. Retrieved from

www.annafammed.org

Payne, R. K., DeVol, P. E., & Smith, T. D. (2009). Bridges out of poverty. Highlands, TX: aha! Process.

Payne, R. K., Dreussi-Smith, T., Shaw, L. Y., & Young, J. (2014). Bridges to health and healthcare: New solutions for improving access and services. Highlands, TX: aha!

Process.

Petiprin, A. (2016). Lewin’s change theory. Retrieved from http://www.nursing-theory.org/theories-and-models/Lewin-Change-Theory.php

Readmissions reduction program. (n.d.). Retrieved from https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-

program.html

Sapolsky, R. (2005). Sick of poverty. Scientific American, 293. Retrieved from http://0-

search.ebscohost.com.library.utulsa.edu/login.aspx?direct=true&db=18752259&site=ehost-live

Smith, L. (2009). Enhancing training and practice in the context of poverty. Training and Education in Professional Psychology, 3(2), 84-93.

http://dx.doi.org/10.1037/a0014459

Valenti, K. (2013). From vision to action: Best practices to reduce the impact of poverty in communities, education, healthcare, and more. Retrieved from

http://ahaprocess.directfrompublisher.com/catalog/book/vision-action

Vu, C., & Austin, M. J. (2007). The explosive nature of the culture of poverty: A teaching case based on an agency-based training program. Journal of Human Behavior in the

Social Environment, 16. http://dx.doi.org/10.1300/J137v16n01_11

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nursing. Nurse Education in Practice, 14, 680-685. http://dx.doi.org/10.1016/j.nepr.2014.09.001



public health, pimps and pit bulls - aha! process · overall health physical inactivity diabetes...

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