Quality Improvement in WV

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Our spacious house resides in the woods of West Virginia with a beautiful view of the New River Bridge down the street. There is no address which made finding the house difficult at first, but something we are getting used to as we spend more time on the country back roads.

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After a day of visiting the company store and coal mines, we got started early at the health centers we were assigned to. We are working with primary care providers at two Federally Qualified Health Center consortiums with clinics throughout the area. These clinics see patients of every age and of a wide variety of health states. In most states, about 5% of their population uses FQHCs for their primary care, however, in West Virginia it is increased to 20%. Unfortunately, despite being home to thousands of coal mines, the state of West Virginia sees very little of the profit from the mines and has been consistently ranked as the 2nd poorest state in the U.S.

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Each of us are assigned to a primary care provider and shadow them during the morning. In the few days we’ve been here, we’ve already seen many patients and been able to apply the skills we’ve learned in class to clinical. One of us assisted our preceptor with a colposcopy, another provided diet education to diabetic patients and others helped out with the pulmonary rehab program.

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In the afternoon, we have started to work on our quality improvement project. The clinics we are working with recently started a pulmonary rehab program. Pulmonary rehab is a combination of education and exercise aimed at improving lung function and mobility in patients with COPD and black lung. Patients spend 12 weeks, meeting twice a week, with a group of other patients with similar conditions learning and exercising together. By the end of the program, the patients have improved lung function and are able to complete their activities of daily living. So far, the patients who have graduated from the program, have greatly enjoyed the program, getting to know other patients and being more mobile than they ever thought they’d be able to.
Despite the marked improvements in patients’ conditions and the large amount of eligible patients, few patients have participated in the program. The program has capacity for many more patients to join and to benefit from the program. The groups have room for 6 to 8 patients, however, currently there are about 3 patients per group.

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We have been tasked with exploring this area; what drives patients to join pulmonary rehab? We will be conducting interviews with stakeholders to assess the access and barriers to pulmonary rehab. Interviewing staff, providers, patients in the program, patients who declined to participate and others will give us insight to our questions. And by gaining this insight we will be able to report back to these clinics and provide them the information necessary to improve the participation rate and thereby improve the health of many more West Virginians.

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