Continuing quality improvement work in WV

 

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This week, we continue to shadow primary care providers in the clinics and work on our quality improvement project in the afternoons. We’ve begun interviews with patients, providers and staff in and out of the clinic. Today, two of us went on a home visit to interview a patient who is eligible for pulmonary rehab and is willing to go but is unable to afford it. He lost his insurance at the end of last month and is not eligible for Medicare at this time. Although West Virginia opted to extend Medicaid and despite the fact that these health clinics did a significant amount of outreach to patients about the Affordable Care Act, it seems that some patients did not sign up or were unable to pay the fees for the insurances offered to them through the exchanges. The patient we visited today stated that his provider mentioned “some Obamacare thing” to him but that he didn’t know anything about it. To me, this really illuminates how rural this area really is and how isolated these communities are.

Without insurance and with no job, the patient is not able to afford going to pulmonary rehab. (He is still able to see his medical provider as these are FQHCs and they cannot turn away people, and therefore offer a sliding scale for provider visits). In visiting him, we learned how great his need for rehab is. At this point, he said he can’t even trim his toe nails without getting out of breath. He spends most of the day napping, and rarely goes out. He is able to drive himself places such as the store or the clinic. He doesn’t have any family in the area anymore and he said he didn’t have anyone to help him around the house. He is a great example of someone who would benefit from this program. By slowly improving his lung function under the supervision of medical providers and by learning how to organize his daily activities in a way to avoid fatigue, he would be able to do so much more. Perhaps he could continue a favorite hobby of his or be more social by attending church or community events.

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We’ve also been calling patients and talking to providers in the clinic. We are talking to patients who have declined or refused to go to the rehab program and have discovered the multitude of reasons why patients are unable to attend. Lack of insurance, lack of transportation, lack of motivation, lack of social support are just a few of the examples causing people to not attend this program. By talking to providers, we’ve been able to learn about the education they are receiving about the new program and how they are “selling” it to patients.

As the week goes on, we plan to finish up the interviews and put together a presentation for the health clinics we are working at. With a formal write up and presentation, we hope to give them the tools and information necessary to improve the program so that more patients can benefit from it.

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Despite the hard work, we were able to squeeze in a little bit of fun this weekend. This area of West Virginia is great for outdoor enthusiasts and has some great whitewater rafting opportunities. Our classmate Lauren, who works as a whitewater raft guide in Tennessee, was able to set up a rafting trip with some local guides. We floated down the river past new and old coal mines, while trains on both sides of the river carried coal to the shipping center. We overcame our fears and jumped off a 12 ft cliff into the welcoming river. As a special treat, Lauren played some music for us on the guitar. The beautiful river, a beautiful voice, and a beautiful sunset made for a magical afternoon rafting trip.

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