News Around Hahnemann Family Health Center
Dr. Katharine Barnard Honored for Community Service
by Worcester District Medical Society
Katharine Barnard, MD
The article below was reprinted with permission from writer Sandra Gray at "UMassMed Now" at www.umassmed.edu/news.
, assistant professor of family medicine & community health, was honored by the Worcester District Medical Society (WDMS) for her exceptional commitment to community service.
On Wednesday, Nov. 14, Dr. Barnard accepted the 22nd annual A. Jane Fitzpatrick Award for Community Service at the WDMS 2012 Fall District Meeting. The award recognizes a Central Massachusetts health care professional for contributions that go above and beyond usual professional duties to improve the health and well-being of the community.
Long affiliated with UMMS and UMass Memorial Medical Center, beginning as a medical student, then as a family medicine resident, Dr. Barnard now combines active engagement as a UMMS faculty member with her clinical practice as medical director of the Plumley Village Health Services Center. Plumley Village Health Services is an outreach practice in a Worcester public housing complex that is supported by the Hahnemann Family Health Center, which is also a UMMS Family Medicine Residency site for which Barnard is a faculty physician.
The Fitzpatrick Award is given in memory of the life-long community contributions of its namesake, who was a long-time Worcester pediatrician and pioneering woman in medicine. It honors individuals who demonstrate compassion and dedication to the medical needs of patients and/or the public and has made significant contributions to the practice of medicine, values exemplified by Barnard's focus on serving the underserved and training the next generation of primary care physicians.
An additional note from Dr. Barnard:
"Recent successes for Plumley have been collaborative work with community agencies to establish a community garden in Plumley Village housing, outreach programs promoting healthy cooking and exercise for residents of Plumley Village and our patients, and involvement in the Worcester Department of Public Health's CHIP assessment.
We strive to provide clinical care that is appropriate for our patient population including an emphasis on maternity care, office-based treatment for opiate addiction, and have integrated behavioral health and pharmacy students into our clinical team. We share space with Community HealthLink's program for at-risk youth, and have arranged for the UMass CareMobile to stop in Plumley once monthly to provide dental care for those without a dental provider."
Welcome to Our Newest Faculty Members!
Debbie Ordogh MD joined our residency in summer 2012. A native of Toronto, Debbie completed her residency at Ellis Hospital in Schenectady, NY and earned her medical degree from St. George's University. Her professional interests include resident education, dermatology and community medicine.
Prior to medical school, Debbie taught high school biology and physical education. About joining the Hahnemann faculty, Debbie says, "The wonderful people at UMass make this an ideal place to receive and give care. I am thankful to work with such a supportive group of colleagues and have so many resources available."
Kimberly Bombaci, MD, PGY-3 and our current chief resident, will be joining the faculty at Hahnemann upon her graduation from our residency this coming spring. Kim grew up in Rowley, MA and is a 2010 graduate of UMass Medical School and a 2006 graduate of Brandeis University. Kim's interests include women's health, geriatrics and preventive medicine.
"I decided to stay at HFHC and join the faculty because it is a place that is at the forefront of primary care," she says. "The health center has a mission of educating future physicians with a faculty and staff that are dedicated to that mission. It is also an innovative center that is working to improve its full specturm care of patients in a constantly changing medical world."
Behavioral Health Update
By Christine Runyan, PhD
Director of Behavioral Science (for Worcester residency)
On-site behavioral health providers continue to be a touchstone at HFHC. All residents and faculty have access to either behavioral science faculty members or one of several post-doctoral fellows to collaboratively treat patients with mental health needs or acute life stressors. Our behavioral science providers are also skilled in motivational interviewing and helping patients with lifestyle and behavioral changes to improve their overall health.
For example, they routinely help patients with weight management, quitting smoking, improving sleep disturbances, and all the changes that accompany coping with a chronic illness. As residents, the best part about having behavioral health providers on-site is learning how best to ask about and communicate with patients about mental and behavioral health issues and needs.
Team Base Care for Chronic Pain
For many PCPs, treating patients with chronic non-malignant pain can be, well ... painful! Often, all the appropriate diagnostic work-ups have been done, medications have been tried, and invasive interventions and surgeries have failed. Both patients and providers become frustrated. Starting in January, we are piloting a chronic pain program that will include structured group treatment and standardized processes for medication refills and toxicology screens.
Behavioral health providers will partner with PCPs who will identify appropriate patients for the 8 session group treatment. The groups will provide psycho-education to patients as well as behavioral activation, relaxation training, cognitive restructuring, distress tolerance skills and communication skills. Patients will be expected to attend the group in order to receive medication refills and PCPs will be regularly informed about their patients' progress."
Questions? Dr. Runyan can be reached at Christine.Runyan@umassmemorial.org.
Transforming How We Deliver Care
by David Gilchrist, MD
Education Director and Interim Medical Director
Hahnemann Family Health Center has been involved in an innovative redesign of how we deliver care utilizing the principles of the Patient Centered Medical Home (PCMH) model for the past three years. The faculty, residents and staff are involved in this transformation at every level of change. The prospect of change is not something most people look forward to, but this has provided an opportunity for our team to work more as a cohesive unit and deliver excellent patient care. It has also allowed us to think about the way we work and redesign this in a more efficient manner with the help of the front line staff doing the work every day.
While it is always nice to hear how someplace wants to change and do a better job, how does this really happen? As a health center, we are looking at our patient registries to see if patients are receiving the care they need (colonoscopy for colorectal cancer screening, A1C's for diabetics at least twice per year, etc) and if they have their chronic disease care optimized (all patients with persistent asthma are on controller meds, diabetics have an A1C of under 7, etc).
One of our front desk staff created a pilot for how we get women eligible for mammogram a same day appointment immediately following their appointment without the provider being involved in the process at all. Our nursing staff has taken the lead on educating patients on overdue health care services. Providers are reaching out to patients with chronic disease not optimally controlled. We are giving patients the care they need at the time they need it.
Another area that we have continued to work on is process improvement. We are educating are staff and utilizing PDSA (Plan-Do-Study-Act) cycles and principles of a process improvement model called LEAN. Everyone in the office can put forth an idea for how to improvement the way the office works to improve how we do our work and how we provide care for patients. The patient is at the center of all of this work.
So what does all of this have to do with your residency experience? Residents are involved in this process at multiple levels and put forth ideas for how to improve the way we do our work. Residents get to train in a model of care, the PCMH model that is becoming the standard of how care is delivered. Residents don't just hear about PDSA cycles and process improvement, they become part of the process and help lead that change. It prepares you to be an effective part of a health care team no matter where you go.
Come join us to become an integral part of this exciting change!
Contact Dr. Gilchrist with questions at David.Gilchrist firstname.lastname@example.org
It Takes A (Plumley) Village
by Katharine Barnard, MD
Plumley Village Health Services is a unique clinic offering continuity training experience in community health for Hahnemann Family Health Center residents. This small clinic was founded in 1992 to integrate public health and primary care medical services into low-income housing in downtown Worcester. Its original priorities were to provide immunizations to area children, wellness care and family planning services.
In addition to continuing to fulfill its original public health mission, the clinic now serves as a primary care site for close to 2000 patients who primarily live in Plumley Village housing and the surrounding neighborhood. Community outreach continues to be an essential component of our work. Recent programs have included cooking class for overweight children and their parents, and home visits to asthmatics. Plumley is also currently in the process of applying for NCQA Accreditation as a Patient Centered Medical Home.
Each year, one or two upper-level residents from Hahnemann elect to participate in a longitudinal elective at Plumley. HFHC residents have valued this experience for the volume of pediatric and OB-gyn care and procedures, exposure to a vulnerable patient population, and the chance to improve medical Spanish. From a practice management standpoint, residents have liked the exposure to a smaller clinical setting.
There are many opportunities available to design and implement a community-oriented project at Plumley. There also are opportunities to learn about community agencies and services by working one-on-one with our outreach worker and clients.
Questions about Plumley? Contact Katharine Barnard, MD, Medical Director (pictured top photo, right) at Plumley Village Health Services at Katharine.Barnard@umassmemorial.org.
"A longitudinal elective at Plumley Village was a great way for me to have a more concentrated experience with this patient population. It's also been a great way for me to do more continuity maternity care and women's health procedures, as well as improve my Spanish language skills.
This has been a unique experience working in a small office setting with two nurse practitioners and a supervising physician with a unique patient population. The office staff and providers are like a family, and when I'm seeing one patient, I often learn they're related to someone else I've just seen - true family medicine!"
Mary Flynn, MD
2012 UMass Worcester graduate
Attending physician at Plumley
A Day in the Life of a Hahnemann Intern
by Mary Cooper, MD, PGY-1
Coming into residency, I had typical concerns about working in an entirely new hospital system with a new medical record and ordering systems, and, most importantly, new and greater responsibilities. One of the things that makes the Worcester Family Medicine program unique, the month of Foundations, helped in the transition to internship and the protocols of the UMass system.
The first day, "A Day in the Life of an Intern," set the stage for the challenges to come in the rest of the month and intern year. Well thought-out exercises using the medical record and realistic simulations of the stresses of being first call gave us a chance to act and then to assess what had happened. We critiqued examples of sign-outs and clinic visits, again getting the chance to reflect on effective ways to communicate with coworkers and patients before having all the pressures of a full inpatient service or full clinic schedule on our shoulders.
Looking back on the day six months in, I can see how well it acclimated us to the daily work flow on the family medicine inpatient service. The work of the day encouraged patient safety and intern efficiency, and it showed me that this residency program is invested in making its residents feel confident on the floor, from day one.
College Health at Hahnemann
by Chris Purington, MD
HFHC residents have the opportunity to provide care for local college students at one of three college health centers, at the College of the Holy Cross, Clark University, and Worcester Polytechnic Institute (WPI). The student health centers are individually located on each college campus, and serve more than 9500 undergraduate and 1000 graduate students. The majority of students are late adolescent to early adult; many graduate students have returned to programs in their mid-20s through 30s. Over 15% of students are international, with all the colleges having extensive study abroad programs.
Physicians provide clinical care at each college health center for four hours each weekday during the academic year, supplementing the on-site full time clinical and administrative staffs. Clinicians handle a wide range of acute and chronic health problems, encompassing infectious diseases (including STI exposure and prevention), women's health, eating disorders, sports medicine, and substance abuse. Clinicians also provide psychological assessments and work closely with student counseling providers on each campus. The campus health model focuses not only on treatment, but also on health promotion and prevention through education and awareness.
College health patients are referred into Hahnemann for colposcopy and other procedures. Residents provide after-hour call triage. Upper-level Hahnemann residents have the opportunity to have a longitudinal experience providing patient care weekly at one of the college health centers throughout the academic year. After this exposure, many have incorporated college health into their future careers!
Questions about College Health in Worcester? Contact Chris Purington, MD, Director of College Health Programs, at email@example.com.
"Being a resident at Hahnemann affords many opportunities. I was able to work at Clark Health Center as part of a longitudinal elective in College Health. This experience is very rewarding because the college students are very receptive to advice and education about their health.
It also is a wonderful working environment with great nursing and support staff thereby affording me an experience that mimics a small office. In addition, working with one attending throughout the semester is nice because it makes for a congenial atmosphere where you learn from each other."
Ana George, MD, PGY-3
Resident Writing Opportunities: The 5 Minute Clinical Consult
by Jeremy Golding, MD, Associate Editor
I'm one of three associate editors of this evidence-based medicine publication. Residents at
Hahnemann (and at the other health centers) are offered the opportunity to author chapters for The 5 Minute Clinical Consult. This internationally known textbook is used around the world, translated into several languages, and is integrated into a number of E.H.R.'s. Residents may write on a wide variety of topics as first author with a faculty member as senior author.
Hahnemann faculty have especially strong representation in chapters pertaining to womens' health and reproductive medicine, oral health, and cardiovascular disease. Writing for a peer-reviewed publication serves the residency educational mission by improving the resident's ability to evaluate evidence and knowledge of the medical literature on a given topic, and by helping the resident understand the responsibility inherent in writing diagnostic and treatment recommendations that will be used by a vast audience. Frank Domino, MD, Professor of Family Medicine and Community Health, serves as Editor-in-Chief.
To learn more, contact Dr. Golding at Jeremy.Golding@umassmemorial.org.
A Final "Word About Worcester" for our Applicants
Sitting around our library table this fall on your interview day with us, you heard all about our "black hole theory" - that magnetic, hard-to-resist forcefield that pulls you back to live and work in our city after you train with us! Now that it's the end of your interview season, we can't resist the temptation to leave you with some parting thoughts about Worcester....
We bet you forgot that the typewriter, sewing machine, shredded wheat, the ballpoint pen and the "smiley face" were all invented in Worcester.
Can't locate where you put Dr. Ennis' highly popular list of all of Worcester's ethnic restaurants? Click here.
Did you know that Worcester was recently featured as one of CareerBliss.com's "happiest" cities to work in? Read all about it here.
Video Clip: A Faculty Feature with Dr. Gleich
Last but certainly not least, we would be remiss if we did not include a fun clip of our very own Gerry Gleich, MD. Many of you met Dr. Gleich on your interview day....but what you may not know is that he has musical talent, writes songs and plays guitar. Every year, he is asked to perform for our residents at our annual Resident Retreat.
We have unearthed this clip from our 2012 residency retreat. Click the arrow below to watch and hear him sing "It's a Zoo Without You." (It may take a second or two to load on the UMass Memorial Youtube channel.) Enjoy!
To pass on your kudos to Dr. Gleich (or maybe have him write a song for you) you can reach him at Gerald.Gleich@umassmemorial.org.