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Respiratory Care Clinics: How Dedicated Exam Spaces Limit the Spread of Viruses

Posted on May 26, 2020 in Carousel, Expanding Access, Innovation, Palo Alto Medical Foundation, Quality, Safety, Scroll Images, Uncategorized

BAY AREA, Calif. – Its second nature for people visit their doctor’s office or an urgent care center when they’re sick — or are worried they might be. In early March doctors across the Sutter Bay Medical Foundation prepared for patient demand at these locations by developing Respiratory Care Clinics (RCCs); an outdoor exam experience that keeps potentially contagious people distanced from those that aren’t, while allowing all who need in-person care to receive it.

“We always knew patients would have concerns that were serious enough to need an in-person exam, but not urgent enough for a trip to the emergency room,” said Kurt Vandevort, M.D., inter-regional medical director for the Palo Alto Foundation Medical Group, part of the Sutter Medical Network. “As community-based providers this middle level of care is our core competency, so it was incumbent on us to find a way to keep providing it, safely.”

By March 16th the Sutter Bay Medical Foundation had established fifteen RCCs in cities across the Bay Area, each seeing patients with COVID-19 concerning symptoms (or who reported a potential exposure to the coronavirus), outside of a nearby medical building that needed to stay open and clean for patients with urgent or medically necessary needs unrelated to COVID.

A month into their operation reporters from The Mercury News and San Francisco Chronicle took notice and wrote about these MASH-like clinics. Now, as Sutter Health resumes more routine patient visits, the RCCs will continue to separate patients with respiratory symptoms from those without, to reduce the risk of exposure to viruses, including the novel coronavirus. Read below to learn more about how the RCCs work and what to expect if you are directed to one.

Call First 

Sutter Health is focused on helping ensure patients have access to the right level of care to match their medical need, but we also understand that sometimes that’s hard for people to gauge. That’s why Sutter Health set up the COVID-19 Advice Line at 1-866-961-2889.

Staffed by a team of nurses from 8 a.m. – 6 p.m., seven days a week, every caller is screened for symptoms linked to coronavirus. Callers are then directed to the most appropriate level of care based on the severity of their symptoms. Patients may be directed to self-monitor at home, to see a provider by video visit or to come to an RCC location where they can receive an in-person exam.

“By linking the RCCs to a pre-screening process (by phone or after a video visit) we can ensure patients coming to RCC do need to be seen in-person, and aren’t ill enough to go straight to the emergency room,” said Dr. Vandevort, who is also the medical director of the RCCs established throughout the Palo Alto Medical Foundation footprint. “When patients arrive at the RCC we also have some information about their chief concerns, thanks to notes entered in our electronic medical record.”

Different, by design 

A physical exam in a parking lot or garage is strange, but the safety that these setting offer is worth the weird-factor. “To protect patients, staff and the community we designed the RCCs to first and fore-most prevent transmission of any virus from a contagious person; that’s why most of them are outdoors and anyone who comes within six feet of the patient is in full personal protective equipment” said Dr. Vandevort. “At the same time we took great pains to try to make the experience similar to what patients are used to when they go to the doctor or urgent care.”

The outdoor RCCs all have a contact-free arrival process, allowing patients to drive-up and call a phone number to “check-in” for their appointment. At every stage of the visit the patient is distanced from others by either staying in their car or in a marked off space within an exam bay.

In addition to an initial temperature check, patients will have their lungs listened to with a stethoscope, have their blood oxygen saturation checked, have their medical history and medications reviewed, and may be tested for coronavirus or the flu if symptoms indicate they should be. Depending on medical need, patients will also receive additional tests and procedures, including imaging scans, blood draws, heart monitoring and more.

The few indoor RCCs are all in buildings, or sections of buildings, that can safely be separated from other areas where patients who don’t have respiratory symptoms are being seen. The indoor RCCs have implemented all the necessary transmission precautions to ensure that spread of a virus from patient to patient or patient to staff is prevented.

Not Just COVID Care

In addition to screening and treating respiratory complaints, the RCCs have filled another important role; addressing non-respiratory related issues reported by patients who have symptoms linked to COVID (fever, cough, shortness of breath). “Just because COVID-19 is here, that doesn’t mean that other illnesses and injuries go away,” said Dr. Vandevort. “One of the best things about the RCCs is that you are being evaluated by a physician who can treat a wide variety of minor illnesses or injuries, prescribe medications or make a dosage change to an existing medication, and otherwise address a whole host of concerns. It’s what we do every day, and in these safe settings, we can keep doing our job even for patients who may have a virus and be contagious.”

In the short time the RCCs have been up and running, doctors staffing them have made unexpectedly important diagnoses and delivered increasingly complex care. “We’ve seen and treated conditions ranging from an appendicitis, to a swallowed fish bone, to an infection requiring IV antibiotics. We’ve done a lot of good.”

Twice the Team 

It’s not easy to run two clinics (one regular and one RCC), simultaneously, just feet apart, but for the safety of our patients and providers that is what we’ve done. “We had to reassign doctors and nurses so we had coverage in both the RCC and the regular urgent care at the same time, some staff now act as a front-door attendants making sure that patients are directed to the right clinic based on their symptoms, and others are runners shuttling supplies between the two spaces.”

All this investment was made for one reason: to prevent the spread of illness. But the RCCs have had several secondary benefits too.

“We’re also helping to preserve hospital capacity by keeping patients from going to the emergency department unnecessarily.” You wouldn’t normally go to the ER for a fever, and the RCCs make sure our smart use of resources stays intact, even during a pandemic.

At the same time, the RCCs have helped refer patients to a higher level of care when that was needed. “Our job is to help stabilize people so they can safely return home, but when their symptoms are serious we help get them to the hospital.”

Sutter Santa Rosa Regional Hospital Family Medicine Residency Program Announces Incoming Class of 2023

Posted on May 26, 2020 in Affiliates, People, Scroll Images, Sutter Santa Rosa Regional Hospital

SANTA ROSA, Calif. (May 26, 2020) – The Sutter Santa Rosa Regional Hospital (SSRRH) Family Medicine Residency Program today announced its incoming class of 2023. The 12 new residents were selected from among 850 applicants representing the nation’s top medical schools. SSRRH’s three-year program, one of 450 family medicine training programs in the United States, has trained hundreds of family physicians since its inception in 1938.

SSRRH’s Family Medicine Residency is a critical strategic asset with which to combat the emerging physician shortage in Sonoma County. The residency has been the largest single source of family physicians to Sonoma County for over 80 years. Residency graduates comprise nearly half of family physicians in Sonoma County, filling openings in private practices, community clinics, and large medical groups such as Sutter Medical Group of the Redwoods, The Permanente Medical Group, local community health centers, Sonoma County Health Services and leadership positions throughout the medical community.

“One of the amazing things about the specialty of Family Medicine is that we continue to adapt our training in order to provide the services that are needed by the particular community and the time in which we serve. After the last three years filled with fires and a SARS-CoV2 pandemic, it is becoming increasingly clear that we need to train doctors who are flexible and can adapt to, and even lead, in disaster,” says Tara Scott, M.D., program director of the residency.

“The Sutter Family Medicine Residency has fortified its position as a key part of the disaster response in the community and we have recruited an amazing class of soon-to-be Family Physicians from all over the country who are attracted to our brand of community-based training and service, says Dr. Scott. “We are thrilled to welcome these 12 amazing young physicians to the county. We know from experience that many will stay here in our community and provide Primary Care for the residents of Sonoma County for years to come.”

The eleven women and one man who will begin the training program in June came from medical schools across the country including: College of Osteopathic Medicine of the Pacific at Western University of Health Science; Frank H. Netter School of Medicine – Quinnipiac University; Edward Via College of Osteopathic Medicine of the Carolinas; George Washington University School of Medicine and Health Sciences; University of California, Davis; University of Kansas School of Medicine; University of Minnesota Medical School; University of Texas Southwestern Medical School; Virginia Commonwealth University School of Medicine; Warren Alpert Medical School – Brown University. They each come with an impressive background of academic achievement and community service.

(Click here for details about each resident.)

The new residents will graduate the program in 2023; they will begin on June 1, 2020.

The Santa Rosa Family Medicine Residency is under the sponsorship of Sutter Santa Rosa Regional Hospital (SSRRH). To provide a broader base of support for the residency and optimize learning experiences for residents, SSRRH engaged Santa Rosa Community Health Centers and Kaiser Permanente in 2006 and continues its affiliations with partners in the community today.

About the Sutter Health Family Medicine Residency Program

With the initiation of formal training in general practice dating back to 1938, Sutter Santa Rosa Regional Hospital (and formerly Sutter Medical Center of Santa Rosa) has an established tradition of excellent training of family physicians with the strong support of community physicians and specialists. In 1969, the program became affiliated with what has since become the Department of Family and Community Medicine at the University of California, San Francisco (UCSF).

About Sutter Santa Rosa Regional Hospital

Sutter Santa Rosa Regional Hospital, part of the not-for-profit, integrated Sutter Health network, has a long, proud history of providing high quality care in Sonoma County and beyond. Because of an unwavering focus on health and healing the hospital is consistently ranked as one of the top hospitals in the region.

Study Shines Light on COVID-19 Racial Disparities

Posted on May 21, 2020 in Expanding Access, Research, Scroll Images, Uncategorized

Differences in How People Access Care Contribute to Inequalities

SACRAMENTO, CALIF. – As the COVID-19 pandemic spreads throughout the U.S., evidence is mounting that racial and ethnic minorities and socioeconomically disadvantaged groups are bearing a disproportionate burden of illness and death. Here in California, African Americans are about 6% of the California population, but make up 10.3% of COVID-19 deaths where race/ethnicity is documented.

To better understand how this issue impacts patients in Sutter Health’s network, and to help develop solutions, Sutter’s Advancing Health Equity team undertook a thorough data analysis of the not-for-profit system’s COVID-19 patients. The resulting study, published today by the journal Health Affairs, revealed that African American COVID-19 patients are 2.7 times more likely to be hospitalized than their Non-Hispanic White counterparts, and they tend to arrive at Sutter healthcare facilities sicker and with more severe symptoms.

The findings underscore the fact that race and ethnicity still play a pivotal role in determining how and when care is accessed. Despite having health coverage, African American COVID-19 patients may not seek testing and care until it is an emergency requiring hospitalization.

Stephen Lockhart, M.D., Ph.D.

“The COVID-19 pandemic has ripped a Band-Aid off of the structural inequities that exist within our society – we must address these disparities right away because the cost of not addressing them is measured in human life,” said Stephen Lockhart, M.D., Ph.D., chief medical officer at Sutter Health. “With lives on the line, we as a state can and should do better in connecting minority patients to culturally competent care – that is why Sutter Health has committed to advancing health equity and this study is just one part of our mission and work. We have a moral obligation to do so and must work together to meet this moment and lean into the opportunity to advance health equity for generations to come.”

The study, “Disparities In Outcomes Among COVID-19 Patients In A Large Health Care System In California,” was conducted using Sutter’s electronic health record (EHR) data to characterize COVID-19 tested and confirmed cases by key sociodemographic and clinical characteristics, including self-reported race and ethnicity, across the 22 Northern California counties served by Sutter’s network.

A number of factors uniquely position Sutter to offer early insights into the reasons for the disparities in health outcomes that have been noted nationally. As an integrated healthcare delivery network serving more than 3.5 million patients a year, Sutter had been studying healthcare disparities for close to three years when it became one of the first in the nation to treat patients with COVID-19. And Sutter’s integrated system-wide electronic EHR includes race/ethnicity data throughout its service area, which is one of the most diverse regions of the country.

Sutter Health also operates in an environment that is one of the closest to universal healthcare coverage of any state in the U.S., mitigating one of the known causes of healthcare disparities – unequal rates of medical coverage – and making other factors driving disparities more visible. But coverage is not the same as access, and the higher hospital admissions and mortality rates for African American COVID-19 patients in California revealed by the study illustrate that expanded healthcare coverage is not enough to resolve health disparities.

Kristen M.J. Azar, RN, MSN/MPH

“The real value of the study lies not in the disparities it reveals but in its utility to inform our work to develop solutions that will address the equity gaps we are seeing with programs such as community outreach and engagement in at-risk neighborhoods,” said Kristen M.J. Azar, RN, MSN/MPH, Sutter Health’s lead author for the study and research scientist within the Sutter Health Center for Health Systems Research. “This pandemic underscores the need to develop innovative solutions that are specifically tailored to address the unmet needs of those at highest risk.”

Sutter has extensive experience looking for and analyzing disparities within its own network and beyond.

The results of the COVID-19 study mirror the patterns Sutter observed in a 2017 study about African American patients with asthma and how they access care. The asthma study found 72% of patients drove up to eight miles to a hospital emergency department to access care, even though they lived within one mile of a primary care clinic. We observed they were doing so because of a lack of culturally competent care.

After reviewing the findings of the 2017 study, Sutter developed its Advancing Health Equity Adult Asthma Program. Since the program began in April 2017, nearly 600 African American patients suffering from asthma attacks have been connected to a respiratory therapist to participate in the asthma program. As a result, very few have returned to the emergency room. The asthma program serves as a model for trusted outreach, education and treatment in a public health crisis – and how they can reduce health disparities.

Provider organizations like Sutter Health are on the front lines and, while not able to address all of the complex societal factors at issue, can play a unique role in developing solutions. For example, as part of its commitment to advancing health equity, Sutter developed a novel metric, the Health Equity Index (HEI), to identify and quantify disparities in outcomes across patient groups and develop targeted interventions to enhance equity. Through the HEI, our Advancing Health Equity team is taking major steps, like those detailed here, to build on the benefits of our integrated network of care to further health equity within the Sutter system and across the country.

Our health equity work and the findings of the study released today highlight the importance of community-based outreach and access to culturally competent care within the African American community, which hold the promise of reducing disparities. Additional research is needed to understand where healthcare disparities exist, what drives them, and what targeted interventions work best to address them. Sutter remains committed to continued advancement and leadership in this field.

Intelligently Ramping Up In-Person Care

Posted on May 20, 2020 in Scroll Images, Uncategorized, Wellness

SANTA ROSA, Calif. – Sutter physicians are moving into the clinical phase of recovery amid COVID-19, with in-person visits resuming with greater frequency.

While fears over contracting the virus persist, Sutter is working hard to communicate to patients the many safety measures in place so they feel comfortable coming in.

“Thanks to residents who continue to practice physical distancing and other responsible public health practices, we are starting to bring back our patients who deferred time-sensitive or preventative care in March and April,” said Gary McLeod, M.D., president of Sutter Medical Group of the Redwoods.

Opening Up, Gradually

California Governor Gavin Newsom said that re-opening the state will not happen all at once.

“There’s no light switch here. It’s more like a dimmer,” he told reporters during an April press conference, where he outlined six indicators, including the ability of hospitals and health systems to handle surges.

Sutter is taking a similar phased approach to reintegrating its operations. According to Bill Isenberg, M.D., Sutter’s Chief Quality and Safety Officer, “We anticipate that full resumption of our operations is likely months away.”

“We are taking a phased approach, not only because we want those patients most in need to be seen first, but also to allow us to continually monitor PPE inventory and testing capability to ensure we can provide care safely and remain prepared for a surge should the number of COVID-19 patients begin to increase again,” Isenberg said.

As patients begin to navigate the new normal of receiving care, it’s important they coordinate closely with their primary care provider to discuss timing and options.

Facilities Going the Extra Mile

Sutter hospitals, outpatient clinics and doctors’ offices are open and have the following safety measures in place:

• Each staff member, patient and visitor are screened for COVID-19 symptoms
• Temperatures are taken for all staff, patient and visitors at every building entrance
• Visitors are limited
• Masks are required and provided for everyone entering any Sutter building
• Lobbies and waiting areas are modified to support social distancing
• Enhanced cleaning of every exam room between visits

“We are continuing to open up and work through measures to ensure safe patient care, which is especially important for our vulnerable patients with complex health issues like heart disease, lung disease, and cancer. These patients really need to see us,” McLeod said.

“At this time, the public can rest assured that medical care is available and safer than ever.”

Sutter’s Alta Bates Summit Medical Center Welcomes New CEO

Posted on May 18, 2020 in Affiliates, Alta Bates Summit Medical Center, Uncategorized

OAKLAND, Calif. – David D. Clark, FACHE, begins a new role as chief executive officer of Alta Bates Summit Medical Center, part of the Sutter Health not-for-profit integrated network of care, on May 18. Clark served as interim CEO at Alta Bates Summit for the past year.

David D. Clark

“David Clark is an engaged and tireless leader who quickly immersed himself into all levels of the medical center’s operations when he assumed the interim CEO role at Alta Bates Summit a year ago. Since joining Sutter, David has built a diverse, cohesive, and values-driven team focused on strategy development and deployment, community relations, and operations improvement with a focus on patient-centered care,” said Julie Petrini, president and CEO of Sutter Bay Hospitals.

Clark is an accomplished healthcare executive with more than 25 years of leadership, including 15 years as CEO in various hospitals and health systems spanning rural, urban, academic medical centers, and integrated health systems.

Prior to joining Sutter, Clark served in executive roles at three different integrated health systems: Intermountain Healthcare as regional vice president and CEO in Provo, Utah; Trinity Health as regional president and CEO in Philadelphia, Pennsylvania; and CHRISTUS Health as senior vice president/chief administrative officer in Corpus Christi, Texas. Clark has provided interim healthcare leadership, executive coaching and consulting for hospitals, health systems, physician groups, and other organizations. Before his interim CEO position at Alta Bates Summit, Clark was interim chief operating officer for El Camino Health in Mountain View.

Clark grew up in Chico, California. He earned an MBA in Health Organization Management from Texas Tech University and a B.S. in Finance from Brigham Young University.

Program Designed to Attract Docs to Rural Areas Receives Accreditation

Posted on May 15, 2020 in Community Benefit, Expanding Access, Scroll Images, Sutter Amador Hospital, Sutter Medical Center, Sacramento, Uncategorized

The Sutter Rural Residency Program received a U.S. grant last year and this week was accredited and is ready to screen applicants. Leaders involved in the program include, from left, Dineen Greer, M.D., program director of the Sutter Family Medicine Residency Program; Sutter Amador Hospital CEO Tom Dickson; HRSA regional administrator Capt. John Moroney, M.D; Jackson Mayor Robert Stimpson; Sutter Valley Area Chief Medical Officer Ash Gokli, M.D.; former Sutter Amador CEO Anne Platt; and Robert Hartmann, M.D., longtime Amador County internal medicine physician and an instructor in the Rural Residency Program.

JACKSON, Calif. – Sutter Amador Hospital’s Rural Residency Program this week received accreditation from ACGME (Accreditation Council for Graduate Medical Education), the organization responsible for accrediting all graduate medical training programs for physicians in the United States. This Sutter Health program is designed to bring more primary-care physicians to rural regions, which have been hampered throughout the country by a shortage of family doctors.

The ACGME accreditation allows the Sutter Health Rural Residency Program to begin screening and selecting residency applicants. Those selected – two each year for six total in the program – will complete core inpatient training in Sacramento during the first year, with their next two years on the campus of Sutter Amador Hospital and in community medical offices.

The goal of the Sutter Health program is to develop a sustainable, accredited rural training track in Amador County and to ultimately expand the area’s rural primary-care workforce. In Amador County, there is a high need for primary-care physicians (PCPs) in the area as the ratio of the population to one PCP is 1,760-to-1; the ratio throughout the state of California is 1,280-to-1, according to the County Health Rankings and Roadmaps website.

“This is welcome news for Amador County, as it will provide an influx of bright, young physicians into our community to care for our families and should give us a steady supply of primary-care physicians for years to come,” said longtime Amador County internal medicine physician Robert Hartmann, M.D., who will be one of the instructors in the Rural Residency Program. “This is a major collaborative accomplishment between Sutter Amador Hospital, Sutter Medical Group physicians and the Sutter Family Medicine Residency Program.”

The Rural Residency Program was made possible through a grant from the U.S. Health Resources and Services Administration (HRSA), which allows not-for-profit Sutter Health to expand its successful Sacramento-based physician residency program to Amador County as part of the federal agency’s efforts to provide better access to quality medical care in rural areas.

Since its inception in 1995, the Sutter Family Medicine Residency Program has graduated 139 physicians, all of whom passed their Board Certification assessments on the first effort. Currently there are 21 residents in the program, and the Amador County program will expand the program to 27 residents.

“We are working to strengthen the physician pipeline throughout our integrated network so our patients receive the same high-quality care no matter where they live,” said Dineen Greer, M.D., program director of the Family Medicine Residency Program. “We have combined a strong, dedicated core faculty, community preceptors, innovative curriculum and access to Sutter hospitals so that our residents develop the skills needed to be outstanding family physicians and leaders in their communities.”

The accreditation was welcome news for the state legislators who serve the Gold Country. State Sen. Andreas Borgeas said: “The physician shortage continues to be a prevalent issue in Amador County and many rural areas of California. I offer my sincere congratulations and gratitude to Sutter Health on the program’s latest achievement, and for its targeted effort to bring much-needed family practice physicians to our community. This is a significant step to help expand access to quality care for our communities in the beautiful, remote areas of our state.”

State Assemblyman Frank Bigelow echoed Sen. Borgeas’ sentiment. “Sutter Health has long supported hospitals in more rural regions of California and they understand how family doctor shortages can have a negative impact on a community’s health,” Bigelow said. “I am so pleased they are pursuing this program and continuing their investment in bringing needed primary care physicians to Amador communities.”

Drs. Greer and Hartmann expect the program to be successful in filling the need for well-trained, community-minded primary-care physicians in Amador County and the greater Mother Lode region.

“The medical students applying for this residency opportunity will enter the program with a strong desire to serve in rural communities,” said Dr. Hartmann, “so their career focus will be the health and well-being of families in our towns and smaller cities. This is great for the future of health care in our community.”

For more on the Sutter Family Medicine Residency Program, go to www.suttermd.com/education/residency/family-medicine