Daniel Derksen

The impact on rural New Mexico of a family medicine residency

Purpose To determine the impact on rural New Mexico of the large, decentralized University of New Mexico (UNM) family medicine residency. Method A cross-sectional study was conducted of all 317 residency’s graduates from 1974 to 2004. Location of current practice was correlated with the residents’ gender, ethnicity, medical school of origin, and whether most training took place in the urban program or one of three rural programs. The residency’s impact on rural communities was assessed. Results There was no significant gender difference between graduates who went into urban or rural practice. Compared with nonminority graduates, a significantly greater percentage of ethnic minority graduates were in rural and urban New Mexico practices and fewer in out-of-state practices. A greater percentage of graduates who had been medical students in New Mexico practiced in both rural and urban New Mexico areas compared with graduates of out of state medical schools. Finally, a greater percentage of graduates from the three rural family medicine residencies remained in the state and practiced in rural areas compared with graduates from the urban program. The graduates’ contributions to the school of medicine and to rural New Mexico are described. Conclusions Graduates of UNM’s family medicine residency have contributed significantly to the state’s rural health workforce. Ethnic minority status, graduation from New Mexico’s medical school, and training in one of the three rurally based residencies favored in-state and rural retention, while gender had no significant effect. The rural orientation of the residencies offered rural communities economic benefits.

Fostering the health of communities: a unifying mission for the University of New Mexico Health Sciences Center

Fostering the health of communities can serve as a unifying mission of the academic health center (AHC), which can set the AHC apart from other health providers in the community. To achieve this mission, the University of New Mexicos AHC is increasingly focusing education, research, and service upon the identified health and service needs of communities in its state. Since major health problems in our society have social, behavioral, and economic roots, New Mexicos AHC has tapped into the broad expertise of its different components as well as that of its state and community partners to adequately address health problems in the community. Its hospitals offer financing and management resources, its colleges offer innovative approaches to community-based education, and the state department of health offers expertise in health policy development. To adequately respond to the complexity of community health needs, the different colleges and departments at New Mexicos AHC are increasingly merging into integrated governance units. Measures of community outreach success include evidence of strengthened community development, increased health care access, and improved indices of community health. New Mexicos AHC formed an interdisciplinary rural outreach task force, which has demonstrated its ability to form partnerships with state and local agencies and to mobilize institutional resources in education, research, and service from the AHCs different departments, colleges, and hospitals to respond promptly to unique community health needs. Evidence shows that such an integrated, coordinated AHC intervention can generate strong and lasting AHC-community alliances, improve the quality and economic viability of community health systems, and enhance the financial resources of the AHC.

The Health Commons and Care of New Mexico’s Uninsured

PURPOSE A seamless system of social, behavioral, and medical services for the uninsured was created to address the social determinants of disease, reduce health disparities, and foster local economic development in 2 inner-city neighborhoods and 2 rural counties in New Mexico. METHODS Our family medicine department helped urban and rural communities that had large uninsured, minority populations create Health Commons models. These models of care are characterized by health planning shared by community stakeholders; 1-stop shopping for medical, behavioral, and social services; employment of community health workers bridging the clinic and the community; and job creation. RESULTS Outcomes of the Health Commons included creation of a Web-based assignment of uninsured emergency department patients to primary care homes, reducing return visits by 31%; creation of a Web-based interface allowing partner organizations with incompatible information systems to share medical information; and creation of a statewide telephone Health Advice Line offering rural and urban uninsured individuals access to health and social service information and referrals 24 hours a day, 7 days a week. The Health Commons created jobs and has been sustained by attracting local investment and external public and private funding for its products. Our department’s role in developing the Health Commons helped the academic health center (AHC) form mutually beneficial community partnerships with surrounding and distant urban and rural communities. CONCLUSIONS Broad stakeholder participation built trust and investment in the Health Commons, expanding services for the uninsured. This participation also fostered marketable innovations applicable to all Health Commons’ sites. Family medicine can promote the Health Commons as a venue for linking complementary strengths of the AHC and the community, while addressing the unique needs of each. Overall, our experience suggests that family medicine can play a leadership role in building collaborative approaches to seemingly intractable health problems among the uninsured, benefiting not only the community, but also the AHC.

Managed Care for Uninsured Patients at an Academic Health Center: A Case Study

In 1997, the University of New Mexico Health Sciences Center (“the Center”) created a managed care plan (“the Plan”) for its uninsured patients who were county residents. The Plans features include pooling the resources of existing county safety-net providers, enrolling patients with primary care providers at easily accessible neighborhood-based clinics, and investing in social support services, case management, and 24-hour telephone triage. After two years of the Plans operation, the utilization of ambulatory care services by Plan enrollees, the number of discharges per 1,000 enrollees from the Center-affiliated University Hospital, and the number of hospital days per 1,000 enrollees had all dropped significantly (p <.001 for all). For the 13,114 enrollees in the Plan, University Hospital saved an estimated

Making sense of hypothyroidism. An approach to testing and treatment.

1,904,872 per year in costs. The replacement of unpaid hospital days with paying patients is estimated to have yielded over

Academic models for practice relief, recruitment, and retention at the University of New Mexico Medical Center and East Carolina University School of Medicine.

695,000 in additional revenues per year. The authors conclude that managing the care of uninsured patients in an academic health center can reduce ambulatory care and inpatient utilization and reduce the cost of care. To achieve these favorable outcomes requires the organization of services to meet the unique needs of the uninsured and underserved population.

A "health commons" approach to oral health for low-income populations in a rural state

Development of the newer, sensitive assay for thyrotropin (thyroid-stimulating hormone [TSH]) has simplified the diagnosis and management of hypothyroidism. Serum free thyroxine (T4) levels measured by analogue techniques or free T4 index may be used in conjunction with TSH test results to confirm the diagnosis. Treatment consists of daily doses of levothyroxine sodium (Levothroid, Levoxine, Synthroid), which are increased slowly to achieve an optimal dose. Close monitoring with TSH assay is important to ensure adequate treatment. In euthyroid sick syndrome, results of thyroid function tests are abnormal in patients with nonthyroidal illness; treatment is indicated if symptoms of hypothyroidism are present. Patients with subclinical hypothyroidism also may benefit from treatment.

Strengthening the Oral Health Safety Net: Delivery Models That Improve Access to Oral Health Care for Uninsured and Underserved Populations

Locum tenens programs were independently developed by the University of New Mexico Health Sciences Center and East Carolina University School of Medicine to address health care needs within their states. The programs represent distinct models to provide locum tenens services for practices in rural and medically underserved regions through collaboration with stage government representatives and agencies. Differences between programs include years of operation, days of coverage provided, types of learners and providers involved, sources of funding, costs of the programs, and extent of institutional support. Common beneficial outcomes of the programs include coverage for struggling practices, training in rural medicine for locum tenens providers, recruitment of physicians to rural practice sites, and improved relationships with program partners. Adequate funding and institutional support are essential for success of locum tenens programs.