Branch Health Care Clinic China Lake Leads the Way in Patient Care

By Dan Barber, Robert E. Bush Naval Hospital

In December the Branch Health Clinic China Lake (BHCCL) received recognition by the National Committee for Quality Assurance (NCQA) achieving Level III recognition by demonstrating compliance and scoring high in all “must pass” elements of the nine respective NCQA standards.

Those standards are:

·         Access and Communication;

·         Patient Tracking and Registry Functions;

·         Care Management;

·         Patient Self-Management and Support;

·         Electronic Prescribing;

·         Test Tracking;

·         Referral Tracking;

·         Performance Reporting and Improvement; and

·         Advanced Electronic Communication

Included in these standards are 6 “must-pass” elements.  To get the achievement Level II recognition, practices must be validated in at least five of the elements.  Achieving Level II or III depends on overall scoring and compliance with all 6 “must-pass” elements.

Lt. Cmdr. Richard Stacey, Officer in Charge of the Clinic located at the Naval Air Weapons Station, China Lake, Calif., credits Lt. Cmdr. Christina Lumba, NC and staff for this achievement.  “Lieutenant Commander Lumba and many staff here worked many long hours including a lot of overtime to put together our successful presentation for the NCQA evaluation.”

In 2011, the Robert E. Bush Naval Hospital started offering “Medical Home Port” … Navy speak for “Medical Home”…to enroll patients in to Primary Care at the Branch Health Clinic China Lake.

This model of health care delivery was mandated by the Bureau of Medicine and Surgery (BUMED) so the very best possible health care could continue to be given to eligible beneficiaries in an efficient and cost effective way.

This health care delivery method was relatively new to some Navy health care providers at the time and to make sure that clinics were operating their Medical Home Port, according to standards set by BUMED, a tool was selected to measure those standards.  The tool selected was the National Committee for Quality Assurance (NCQA) for Patient Centered Medical Home.

The Medical Home Port model allows patients to see the same team of providers each time they come in for medical appointments which allows the patients and the assigned team of providers and support staff to develop a patient-centered relationship which replaced a system where patients could be directed to any available health care provider.

The ultimate goal of the Medical Home Port is to allow continuity between patients and the assigned Primary Care Manager (PCM) as often as possible.  However, if the main provider is not available, another provider on the same team will deliver the care.    

In addition to medical providers, the team of healthcare professionals is also be made up of nurses, clerks, and Hospital Corpsman.  Patients are given the opportunity to know everyone on the team as well as they know their provider.  Many staff  at the hospital and at the BHCCL, believe this method of patient care provided by the Medical Home Port teams has established a patient-centered health care environment, which provides patients with more access to primary care and allows for longer appointments and better management of the patients medical issues.

 Medical Home Ports add continuity of care for patients even when the active duty providers deploy or transfer.  The combination of both civilian and military team members cultivates stability for the teams and patients when military members are transferred or deployed.

In addition to assigning patients to one of three teams at the hospital and at Branch Health Clinic China Lake, Naval Hospital Twentynine Palms offers Relay Health™ to all patients for an additional secure communications tool they can use to communicate directly with their health care team.

 Relay Health contributes to the success of meeting NCQA standards because it allows patients to request their lab results; request a medication refill; access health care information and allows them to create their own health care record to help manage their own care, all from the comfort of home.  Patients can also use Relay Health to request appointments with their Medical Home Port team.  

Congratulations to the Branch Health Clinic staff for this well deserved recognition in their efforts to provide patients with the highest standards in patient care.

Naval Hospital Twentynine Palms Receives Baby Friendly Certification

By Lt.j.g. Ashley Robertson, NC

Robert E. Bush Naval Hospital

            Naval Hospital Twentynine Palms joins Naval Hospital Jacksonville as the only two Baby Friendly Certified hospitals in the Navy.  At present, 150 U.S. hospitals and birthing centers in the United States hold the Baby-Friendly designation, which represents 5.8 percent of all hospitals in the US.

Currently, scientific evidence overwhelmingly indicates that breastfeeding is the optimal method of infant feeding and should be promoted and supported to ensure the best health for American women and their children.  Breastfeeding is the single most powerful and well documented preventive modality available to health care providers to reduce the risk of common causes of infant morbidity.  Breastfeeding can significantly lower rates of diarrhea, otitis media, lower respiratory tract infections, diabetes, childhood leukemia, and Sudden Infant Death Syndrome (SIDS).  Women who breastfeed have a lower risk of Type 2 diabetes, breast, and ovarian cancer.  Recent evidence suggests that reduction in the risk for cardiovascular and other related diseases may be added to the benefits of breastfeeding for women.

The diverse benefits of breastfeeding translate into hundreds of dollars of savings at the family level, and millions of dollars at the national level through decreased hospitalizations and pediatric visits.  

In 1991 the United Nations Child the World Health Organization (WHO) established the Baby-Friendly Hospital Initiative (BFHI).  The BFHI is a global program to encourage and recognize hospitals and birthing centers that offer an optimal level of care for breastfeeding. The

core components of the BFHI are the WHO Ten Steps to Successful Breastfeeding, which are designed to facilitate the role of the hospital/birthing center in providing women the choice and opportunity to breastfeed, regardless of the method of birth.

The Ten Steps to Successful Breastfeeding are:

1.      Have a written breastfeeding policy that is routinely communicated to all health care staff.

2.      Train all health care staff in skills necessary to implement this policy.

3.      Inform all pregnant women about the benefits and management of breastfeeding.

4.      Help mothers initiate breastfeeding within one hour of birth.

5.      Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.

6.      Give newborn infants no food or drink other than breast-milk, unless medically indicated.

7.      Practice “rooming in” to allow mothers and infants to remain together 24 hours a day.

8.      Encourage breastfeeding on demand.

9.      Give no pacifiers or artificial nipples to breastfeeding infants.

Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital.  HE GUIDELINES AND EVALUATION CR

Family History & Your Health: National Family History Day

By Martha Hunt, MA CAMF

Robert E. Bush Naval Hospital

Each year since 2004, the US Surgeon General has declared Thanksgiving to be National Family History Day. Over the holiday or whenever families gather together, the Surgeon General encourages Americans to talk about and write down the health problems that seem to run in their family. Learning about your family's health history may help ensure a longer, healthier future for you and your loved ones.

Why create your own family health portrait? Knowing your family’s health history can save your life and the lives of those you love. By knowing what illnesses blood relatives suffered can help your doctor predict some of the health problems that may face you or your family.

To help you organize your family’s health information, the U.S. Surgeon General has developed an online tool called “My Family Health Portrait”, which is available at https://familyhistory.hhs.gov/. You may use this tool online or it can be printed and used as a paper record of your family’s health. If you chose to use the online tool to record your family medical history, the information you place there is private. Before you start using this tool, however, you will need to talk with your family members to gather more details about their health histories. Here are some suggestions on how talk to your family about their health.

Make a list of relatives. Write down the names of the blood relatives that you need to include in your family health history. Talking to people who are related to you by marriage and not by blood doesn’t help you plan your health history. The most important relatives to talk to are your parents, brothers and sisters, and your children. Next should be your grandparents, uncles and aunts, nieces and nephews, and any half-brothers or half-sisters. It is also helpful to talk to great uncles and great aunts, as well as cousins if they are available.

Prepare your questions ahead of time. Writing out your questions ahead of time will help you to remember what you need to ask and will keep you on track during the conversation. Among the questions to ask are - Do you have any chronic illnesses, such as heart disease, high blood pressure or diabetes? Have you had any other serious illnesses, such as cancer or stroke? How old were you when you developed these illnesses? Have you or your partner had any difficulties with pregnancies, such as miscarriages? What medications are you currently taking?

Also ask questions about other relatives, both living and deceased, such as - What is our family’s ancestry? What country did we come from? Has anyone in the family had learning or developmental disabilities? What illnesses did our late grandparents have? How old were they when they died? What caused their deaths?

Find a good time to talk. Consider talking with your family when you are together in a relaxed setting such as family reunions, cookouts or holidays such as Thanksgiving. If it’s not possible to talk to your family in person, you talk with them over the telephone or send them questions by mail or e-mail.

Explain to your family what you are doing. Begin your conversation by explaining that learning more about your family health history can help save lives. When you are aware of what diseases or conditions run in your family you may be able to avoid the health problem by taking preventive measures. Let your family know that the information they share about their individual health histories will help you create a Family Health Portrait that will benefit the entire family.

Keep a record. Remember to bring along a pencil and paper, voice recorder or a laptop so you can take down the information that your family members tell you. That way you will have their health information handy when you sit down to create My Family Health Portrait online or to fill out the paper version.

Ask one question at a time. It will be easier for your family members to provide you with useful information if you keep your questions short and to the point. If you need more details, ask follow-up questions such as “why,”“how” or “when.” Try to get as much specific information as possible. This will be especially important for your elderly family members who may have memory issues.

Respect your family’s feelings. Some family members may not want to share their health information. Be sensitive to their feelings and let them know that whatever information they wish to provide will be helpful. Your family member has the right to privacy and may choose not to participate.

Take one step at a time. If during your talks, you find out about a serious health problem that you didn’t know existed in your family don’t panic. Create your Family Health Portrait, print it off if you created it online and then take it to your health care provider who can help you understand what the information means for you and your family.

Filling in the gaps. For family members who are deceased or for whom you have incomplete health information, try asking other family members for information. If it is possible, get copies of medical records, birth records or death certificates as added documentation. Different states have different regulations as to who has access to birth and death records.

Keep your family’s health history up-to-date. As children are born and family members develop illnesses, remember to add that information to your Family Health Portrait. Your family will thank you!

The #1 Way to Survive Breast Cancer

By Shari Lopatin

TriWest Healthcare Alliance

One woman is diagnosed with breast cancer every three minutes.*

And every 13 minutes, a woman will die from this disease. Yet, more than 2 million survivors of breast cancer are living in the U.S. today.* Do you know what that means?

Even if you’ve been diagnosed, there is still hope.

Mammograms Save Lives; TRICARE Covers Them

The sooner you detect breast cancer, the better your chance of survival. And a mammogram is one of the best ways to detect it early enough for successful treatment. The Centers for Disease Control and Prevention say having regular mammograms can lower your risk of dying from breast cancer, in general.

Just remember to also follow up with your doctor for a clinical breast exam and continue your monthly self-exams.

TRICARE covers mammograms for women starting at age 40. For those considered at high risk for breast cancer, TRICARE begins covering mammograms at 35 years old. Best of all, these screening mammograms are at no cost to you.

Early Warning Signs of Breast Cancer

Breast cancer is the most common type of cancer in American women, other than skin cancer, according to the CDC. So, what are some of the earliest warning signs?

·         A new lump in the breast or armpit

·         Thickening or swelling of the breast

·         Nipple discharge, other than breast milk, including blood

·         Change in size or shape of the breast

·         Pain in any area of the breast

If you are concerned about any of these symptoms, visit your doctor immediately.

Where Can You Get Your Mammogram?

Your doctor can give you some options where you can conveniently get a mammogram. Your closest option might be at a military clinic or a local imaging center—sometimes these are called radiology centers. To have your mammogram at no cost, make sure that:

·         Your mammography center is TRICARE-authorized.

·         If you’re on TRICARE Prime, your mammography center is in the TRICARE network. If not, you will need a referral from your primary doctor.

For more information on breast cancer prevention, visit TriWest.com/Prevention.

* Information pulled from Susan G. Komen Race for the Cure.

Not showing up or being late for an appointment is never fashionable

 By Dan Barber, Public Affairs Officer

Robert E. Bush Naval Hospital

Showing up late or not showing up at all for medical appointments is an ongoing challenge for Naval Hospital Twentynine Palms in trying to manage a productive clinic schedule. The hospital’s clinics are run on an appointment basis, and they try to stay on schedule. At times there may be an opportunity for a patient to walk-in and be seen... usually because someone else failed to show up for their appointment.

Occasional emergencies arise, or a procedure takes longer than anticipated which delays some appointments. However, over the years, it has been shown that when patients are kept waiting beyond their appointed time, it is usually because a previous patient showed up late. If this happens the clinics can both see the late patient and keep everyone after them waiting, rush through the appointment which our providers have indicated they will not do, or reschedule the appointment for another time.

If late for an appointment, the clinic will see you if the schedule permits but you may have to wait and/or see another provider. If this is not possible for you or the clinic, you will be asked to reschedule. If you or your family member’s condition is deemed serious, arrangements will be made to be seen in the Emergency Department, and if it does not negatively impact other patient care. If the provider feels that seeing you late will cause an inconvenience for others, then you will be asked to reschedule.

If unable to keep an appointment, please give the hospital as much notice as possible. This is in consideration of the hospital staff that has scheduled their time around your expected visit.

Here are some tips that will help you become more punctual; Give yourself extra time, just in case you are delayed by weather, traffic or other circumstances. Keep only one planner; carry it between your home, workplace, or daily appointments. Use a watch, or an electronic organizer with a beeper to provide you with reminders.

If you know that an appointment can’t be kept, give the clinic as much notice as possible by calling 760-830-2752 or visit the hospital web site at http://www.med.navy.mil/sites/nhtp/Pages/default.aspx

Hospital IT Team uses Technology to Improve Lives and Save Money, Time

By Dan Barber

Public Affairs Officer

Robert E. Bush Naval Hospital

             Naval Hospital Twentynine Palms, Calif., has set a goal to significantly decrease overall command operations cost and increase productivity with the latest technology.

            “Our goal is to leverage technology in different areas making peoples jobs easier and faster,” said Craig Palmer, Chief Information Officer of the Naval Hospital.

            One example of this technology innovation is with the addition of virtual computer log-on for Medical Home (Med Home) providers. “In the case of the Med Home providers, the IMD staff has been very sensitive to their needs,” Palmer said. “It used to be that the patient was moved around to our staff, now our staff is moved to the patients,” Palmer said. “We figured that it was conceivable that there would be about three people trying to log into a computer in a 20-minute exam in the same exam room. Normally, the log in time on each computer takes roughly 3-minutes. We tried to figure out what we could do to help. We basically did a technology insertion for our Med Home staff, which has worked out so well that it is being incorporated in other parts of our hospital and clinics,” Palmer added.

            “We were able to get the log in time on Exam Room computers, down from about 3-minutes to approximately 18-seconds… our ultimate goal is to get that time down to 3-seconds. Based on feedback we have received there are two other sites that are conducting virtual log-on trials.”

            Palmer added, “If a provider logs on 14 times a day (which is typical) and they are saving two and a half minutes per log on, the time saved can add up pretty quickly.  A real big bonus is before, because of computer log-on times, they weren’t always able to enter their clinic notes in CHSC and AHLTA records while in the exam room. This technology now empowers the providers to be able to enter their notes while in with the patients.”

            Palmer pointed out that providers report that they are now able to get out of the hospital in the an hour or more earlier then they did before. “This technology not only allows for better patient care, but it is adding to the quality of life for our providers,” said Palmer.

            Commander Raul Carrillo, NC, Medical Services Deputy Director and Department Head, Emergency Medicine Department was the key clinical contact for the project. Carrillo reports, “Virtual log-on for providers has increased productivity, it also gives the staff the ability to pull out their CAC [Common Access Card] from one station and move to the next. The clinic staff calls it ‘follow me CAC’ allowing staff to move from exam room to exam room.”

            “The time saved with virtual log-on will also allow our people to be able to work on Relay Health, a secure web-based program to provide better communications with our patients, and to allow the providers more time to complete their charts,” said Carrillo.

            The bottom line is, with the technological advances taking place at the hospital, it will improve patient care, decrease overall costs, work-hours and add to the quality of life for staff, which will lend itself to making this command a health care facility of choice, and a work place of choice for staff.

Summer Heat and Your Meds -- What's The Link?

Summer Heat and Your Meds – What’s The Link?
Martha Hunt, MA CAMF

      According to the Substance Abuse and Mental Health Services Administration (SAMHSA) certain medications such as psychotropic medications, antidepressants, or alcohol can change how your body responds to heat and how well you recognize that you are in danger of overheating. Heatstroke occurs when the body unable to cool itself and internal body temperatures rise to levels that may cause irreversible brain damage and death.
      Psychotropic medications are medications used to treat the symptoms of mental disorders such as schizophrenia, depression, bipolar disorder, anxiety disorders, and attention deficit-hyperactivity disorder (ADHD). These medications can interfere both with your ability to regulate your body temperature and your awareness that you are overheating.
      According to the Centers for Disease Control and Prevention (CDC) the risk for heat-related illness and death may also increase among people who use medications for Parkinson’s disease (because they can inhibit perspiration), those who use tranquilizers and users of diuretic medications or "water pills" that affect fluid balance in the body. Certain antihistamines can also lead to heat stroke
      Also watch out for nutrition supplements that boost your metabolism or advertise that you will lose weight or build muscle. These supplements increase the risk of heat stroke by revving up metabolism. This can produce extreme amounts of body heat and can lead to death or brain injury.
      For more information on heat injury, visit the CDC's “Extreme Heat: A Prevention Guide to Promote Your Personal Health and Safety” (http://www.bt.cdc.gov/disasters/extremeheat/) for information on how to prevent, recognize, and treat heat-related illnesses.