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“Getting Well, Being Well, Staying Well” As a hospital in a rural county, many of Ukiah Valley Medical Center’s (UVMC) patient population struggle with geographic isolation; language barriers; lack of health insurance; and/or lack of access to prevention and wellness services. During this past year, UVMC has been actively working with its local community partners to plan a community-based preventative health and wellness program, including health screening and education. UVMC’s plan is to continue to maintain its core prevention programs at its hospital in Ukiah, while working with its health care partners on this expanded focus for prevention education and community wellness. Despite the undeniable need for an expanded community focus on prevention and wellness, a major stumbling block for UVMC and its partners is the availability of funding for rural areas to support these types of critical programs and services.
UVMC Mission and Activities
UVMC’s goal is to promote a healthy community through comprehensive preventative, innovative and compassionate medical care that is efficient and cost effective. In 2006, Ukiah Valley Medical Center partnered with Ukiah Valley Primary Care Medical Group to begin providing care via hospital-based Rural Health Clinics (RHC) in Mendocino and Lake County. The RHCs are intended to increase primary health care services for MediCal and Medicare patients in this rural area. Each year, UVMC provides care for approximately 24,935 emergency room patients, 142,273 outpatients, and 3,950 hospital patients. In 2009, the organization had annual total revenues of $87.6 million, but experienced a significant drop in net income from 2008 to 2009. As a result, funding available to maintain its current prevention, self-management and wellness education programs and services, as well as develop an expanded community-based focus on wellness, is increasingly limited. Region and Population Served UVMC is located in Ukiah, a city of approximately 15,500 residents, but serves the Greater Ukiah area, including adjacent valleys and connecting communities that are home to more than 40,000. The county’s population is estimated to be 86,221, with a mix of approximately 70% Caucasian, 21% Hispanic/Latino, 5% Native American, and 4% of other ethnicities/races. The mean household income for the county is $43,307 (2008), with 42% of households making less than $35,000 per year. The age distribution for the county is: 25% age 19 and under; 31% age 20-44; and 44% age 45 and older. (American Community Survey for Mendocino County, 2006-2008, American Factfinder, U.S.Census) Mendocino is ranked 42rd in the state for its high rate of people on Medi-Cal; 12th for Medicare; 16th for those who are uninsured; and 11th for those with no usual source of care. Approximately 35% of the total adult population in the county is enrolled in Medicare or Medi-Cal. However, an estimated 24% of the county’s total adult population does not have health insurance, and 13% indicate they do not have a usual source of health care. About 48% of the Latino/Hispanic adult population in the county indicates they do not have health insurance, and 38% indicate they do not have a usual source of care. (Diabetes in California Counties, California Department of Public Health, University of California, San Francisco, Issued April 2009) Mendocino County is ranked poorly compared with other California counties based on the number of people (relative to its general population) with behavioral or other health risk factors. The county is ranked at almost the highest rate among the 58 counties in the state for people who are overweight (57th); 49th for heart disease; and 13th for those who eat less than 5-a-day of fruits and vegetables. Strong existing and emerging partnerships are working to address some of the health disparities in the county. For example, as a result of a Federal Health Resources and Services Administration (HRSA) directive, the rural health care clinics in the county have been part of a health disparity collaborative for the last 10 years focusing on diabetes. However, based on a recent series of discussions with a range of UVMC’s health care partners in the county, the greatest challenges cited were in the area of wellness and prevention services, especially around nutrition education for children and adults. None of the local clinics have a nutritionist/dietitian on staff. In addition, Mendocino County has a significant population of people who are not receiving preventative health screenings to check for risk factors and the presence of diabetes or pre-diabetes. The county is ranked: 25th among other counties in the state for the numbers of people receiving annual A1C tests, and 45th for annual cholesterol testing. (RHC patients are now being tested twice per year); 33rd for annual eye exams (Dilated retinal scans have been used by the clinics to screen for pre-diabetes, but this is limited); and 47th for annual foot exams (RHCs recently instituted foot exams with every diabetes patient exam). Impact of Prevention Education and Support Initial outside funding to expand UVMC’s prevention screening and education programs was received in 2009 from the Community Foundation of Mendocino County and Synod of the Pacific. This funding allowed UVMC to assist with Spanish translation services for the diabetes program outreach and screening activities. In addition, UVMC’s diabetes education team participated in several community events offering glucose fingerstick tests. Approximately 20% of those individuals receiving a screening had elevated blood sugar levels, and were referred to their physician for follow-up. As part of its core prevention programs and services, UVMC patients participate in a series of classes and support groups, learning about their disease and potential complications; medications; and ways they can manage their disease through their nutrition, physical activity, and other healthy behaviors. A recent survey of patients participating in prevention and disease self-management education indicated that: 90% of respondents believe that the information and support was helping them to manage their disease; 80% were receiving regular health care screenings for hypertension and lipids; and of the 30% who had been hospitalized for their disease before participating, none had been to the emergency room or hospitalized after participating in the classes and support groups. Conclusion About the Author: Comments or feedback? Email us at advocate@csrha.org. |
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