Tuesday, December 05, 2000

Clinics' aim: Improve care

New medical standards to be adopted

By Tim Bonfield
The Cincinnati Enquirer

        Even an uninsured diabetic should be getting eye exams every year to prevent blindness.

        Even the poorest person with moderate to severe asthma should have and know how to use a peak flow meter to prevent a health emergency.

        These are just some of the medical standards to be adopted today by more than a dozen Greater Cincinnati health clinics to improve care for four common problems: asthma, diabetes, hypertension and depression.

        Adopting the standards is part of a regional effort to streamline health services for the uninsured through a coalition called the Southwest Ohio Community Access Program. It's an effort some say could serve as a national model of care for the poor.

        “What we're doing here isn't happening any place in the country,” said Dr. T.J. Redington, medical director of the Cincinnati Health Network, one of the clinic groups that formed the Southwest Ohio program.

        In September, the Community Access Program was awarded nearly $900,000 from the federal Health Resources and Services Administration as one of 23 programs nationwide seeking better ways to serve the un insured. The Greater Cincinnati program, which includes clinics serving nearly 100,000 people in Hamilton, Butler and Clermont counties, is among the largest of its kind.

        “We do consider this to be one of the models in the nation,” said Dr. Eric Baumgartner, director of community access and state planning for HRSA. “The Cincinnati collaborative is rich in several ways, including the number of partners involved and the capacity of patients that can be served. It's one of the larger efforts.”

        Starting today, the new standards will begin for clinics run by the Cincinnati Health Network, the Lincoln Heights Health Center, the Clermont County services of the Southern Ohio Health Network, and two clinics at University Hospital. Negotiations continue to add clinics run by the Cincinnati Health Department.

        Among the standards:

        • For depression: Patients will begin taking a standard questionnaire to measure the extent of their problem and the impact of medications and psychotherapy.

        • For asthma: Patients would be checked to see whether they have the peak flow meters and medications they need.

        • For diabetes: Patients would be expected to get annual eye exams. A sometimes-used urine test to monitor kidney function would become routine.

        • For hypertension: Patients should expect more education about medications that can control high blood pressure as well as more promotion of proper diet and exercise.

        The standards themselves are not new. Neither is the concept of disease management.

        Many national health agencies have spent years recommending standards for chronic disease care. More recently, many HMOs have adopted disease management programs to help control costs.

A model for others

               Be it the public or private sector, such standards are not followed consistently, Dr. Redington said.
        To the Health Resources and Services Administration, lessons learned in Greater Cincinnati and other cities could have wide application as federal and state policy makers look at ways to reform Medicare and Medicaid health programs.

        The key will be whether the disease management programs can be measured, and whether the effort can be sustained, Dr. Baumgartner said.


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