Texas | 50 states of population health

Kelly Gooch -

JANET HURLEY, MD. Medical Director of Population Health at Christus Trinity Mother Frances Health System (Tyler, Texas)

On the top challenge

"It has been said that only 10 to 20 percent of what makes a person healthy is based on access to medical care, and about 50 percent is based upon their health behaviors. Our population health department will continue our efforts in providing patients with practical tools to make a meaningful difference in their health behaviors. Our emphasis in 2018 will be on tobacco cessation initiatives, chronic pain management improvements and obesity management."

On the hospital's response  

"With regard to tobacco cessation initiatives, we have leveraged the power of our EHR to create best practice advisories and SmartSets, which make it easier for clinicians to refer to one of three tobacco cessation programs in our area. One of these programs is sponsored by our organization, and includes a one-hour seminar with follow-up contact by our health coach. We also have an electronic interface with a state-based program that will provide free nicotine replacement products to smokers who agree to telephonic counseling. The SmartSet enables clinicians to quickly prescribe proper doses of tobacco cessation medications and make these referrals.

With regard to chronic pain management, our neuroscience department has compiled many support tools on a shared drive to provide support to clinicians. In 2018, we hope to make support documents easier to use by creating clinical decisions support tools within our EHR. We have narcotic management contracts and opioid risk questionnaires embedded within the EMR, as well as documentation support tools to enable providers to meet documentation recommendations for these patients. We also plan to have the Texas prescription drug monitoring program information fed directly into our office visit workflows.

Lastly, we plan to create an obesity management program to which our clinicians can refer patients, which will likely be in the form of group visits and include peer support services, dietary education and health promotion activities."

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