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Medical Center Develops Innovative Approaches to Bridge Health Care Between Rich and Poor E-mail
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Across the country in urban and rural settings, there is a gap between the health status of blacks and whites and between wealthy and poor. It is accentuated in Mississippi, where blacks make up 37 percent of the population and nearly 20 percent of all families live below the poverty level. But the University of Mississippi has committed resources to several innovative programs that are lifting the state's health care profile and improving the lives of thousands of people.

"I couldn't see. I couldn't move anymore. My mouth was twisted, so I couldn't even yell loudly," said the 45-year-old native of Durant, Miss. "I do remember I fell and hit the floor. I'm not sure if my sister heard me calling or falling, but she came running."

Lowe's brother-in-law called an ambulance, and a quick ride to University Hospital and Clinics-Holmes County in nearby Lexington brought Lowe face-to-face with rural health care of the future.

Like many small hospitals, the 84-bed Lexington hospital has limited staff. When Lowe arrived shortly after 3 a.m., no doctor was on duty in the ER. But the hospital is equipped with a TelEmergency System, which allows physicians in the emergency department at University of Mississippi Medical Center in Jackson to consult with on-site nurse practitioners about patients' immediate health care needs.

"Time is a huge factor in cases like Glenda's, who is also a diabetic," said Mickey Aldridge, the nurse practitioner on duty when Lowe arrived. "You can preserve body function if a patient is treated quickly. Cells die the longer you wait."

That's why the University of Mississippi commits resources on its Oxford and Medical Center campuses to programs that could play a role in narrowing the divide between the health of rich and poor, black and white. The programs are credited with reducing costs, improving outcomes for long-term chronic conditions and making the most of limited resources.

"The thinking is that if it works in Mississippi, it can work anywhere," said Dr. Dan Jones, vice chancellor for health affairs at the Medical Center and CEO of the state's only academic health center.

With growing concern about the costs of health care and the steady increase in the number of people without health insurance - 15.8 percent of Americans in 2006 - health care is sure to play a pivotal role in upcoming presidential debates.

Across the country in urban and rural settings, there is a gap between the health status of blacks and whites and between wealthy and poor. It is accentuated in Mississippi, where blacks make up 37 percent of the population and nearly 20 percent of all families live below the poverty level - $20,000 annually for a family of four. Beyond that, median household income in Mississippi is $34,000, compared to the national median of $44,000. Twenty percent of Mississippians have no health insurance, and most Mississippians live in rural areas poorly served by the medical establishment.

Despite this dismal snapshot of Mississippi's health, change and progress are palpable.

From a small room in the Medical Center's emergency department in Jackson, physicians can view patients in 12 rural hospitals through the TelEmergency system, which includes flat-screen televisions, webcams and high-speed data networks. The program is designed to stretch medical resources for emergency treatment in areas where physician coverage is slight.

Dr. Robert Galli, chairman of emergency medicine at the Medical Center, says his team created a protocol that allows nurse practitioners to assess and treat patients and quickly know which ones need immediate consultation with an MD at the Medical Center.

In Lowe's case, Aldridge worked with Dr. John McCarter at the Medical Center to rule out diabetic complications and confirm that she was having a stroke. Soon, Aldridge and Lowe were on a helicopter headed to the Medical Center to get the specialized care she required.

"Glenda's case is a classic example of all the pieces working," Aldridge said. "Everyone understood that time is muscle, and in this case, time is function. The longer it took to get Glenda to a higher level of care, the more body function she could lose."

The TelEmergency program is a feasible alternative to traditional staffing choices and is the only one like it in the county, he said. "It falls short of the ideal of hands-on emergency care delivered by a residency-trained, board-certified emergency physician, but it is a means of delivering care with real-time input from such physicians. It could easily be duplicated by the emergency departments of other academic medical centers."

The program pays for itself with reimbursement set higher than the usual rate for a nurse practitioner but less than most physicians.

"In a lot of our rural hospitals, you might have two physicians covering the hospital, with one of them also covering the emergency service on weekends," Galli said. "They would almost never get a break. Twenty-four-hour physician coverage just isn't possible in most areas of the state."
Since the program's inception in 2003, some 66,000 patients have benefitted from the technology, an average of 1,500 patients a month.

Thousands more have received expert medical care at the Pharmaceutical Care Clinic operated by UM's School of Pharmacy at the Jackson Medical Mall. Headquartered in Oxford and operating clinical programs in Jackson, the school established the clinic in 1998 to help patients better comply with treatments by helping them understand the role of their medications in their illnesses and how best to administer them.

A collaboration between the School of Pharmacy and the Medical Center's pharmacy administration department, the clinic is recognized for its innovation and success. It has proven especially effective in teaching chronically ill patients with diabetes, asthma and high cholesterol, as well as patients taking anticoagulants (blood thinners), to manage their conditions. The clinic gives patients - many of whom are Medicaid patients or uninsured - more power over their illnesses, enjoys high compliance rates and has improved the quality of patient care.

While the Pharmaceutical Care Clinic and TelEmergency system address access to health care, other programs seek to end the disparity in health status between black and white Mississippians, and put more black physicians and researchers into the pipeline.

Studies have linked poor care among blacks to the dearth of black physicians to treat them. The Medical Center is committed to correcting that deficit by vigorously recruiting blacks into its health professions programs. In 1999, former Netscape CEO Jim Barksdale and his late wife, Sally, established the Barksdale Scholarship endowment, which funds three full-ticket medical school scholarships for talented black students every year.

"In the past, we were recruiting African-American medical students with our hands tied," Jones said. "We just didn't have the money to compete with older established schools who also wanted African-American students to increase the diversity of their campuses. We need to train them here so they will be more inclined to practice here."

Since 2000, 24 students have received Barksdale Scholarships. Fifteen have graduated, and nine others are in the pipeline.

The Herrin Foundation also has funded six full-ticket scholarships for black students, three in medicine and three in dentistry. The Rural Health Scholars program identifies high school students from rural areas and guides and assists them through college. Up to 15 students a year will be granted scholarships in return for a commitment to practice in rural Mississippi.

"We also are incrementally increasing our medical school class size to 150 to put more physicians into practice in the state," Jones said.

Through the Mississippi Institute for Improvement of Geographic Minority Health and Health Disparities, the Medical Center is partnering with 11 institutions and organizations in Mississippi to improve the quality of health care for minorities and the rural disadvantaged.

Dr. Warren Jones, director of the institute, said, "If every Mississippian had a medical home and built a longitudinal relationship with a health care provider - clinic, nurse practitioner, or physician - and engaged in prevention, the chronic disease burden would go down dramatically."

Another piece in the health disparity puzzle is the reluctance of blacks to engage in research studies, even when the study examines diseases prevalent in their community. Officials at the National Heart, Lung and Blood Institute of the National Institutes of Health feared recruitment would be a problem in a decades-long examination of a large black population to determine why heart disease is such a killer of black people.

The Jackson Heart Study - a collaboration of Jackson State University, Tougaloo College and the UM Medical Center - has been continuously funded since 1999. With a well-known black cardiologist as the principal investigator (Dr. Herman Taylor) and a strong community involvement, the study has attracted ample participants.

"Our understanding of the cardiovascular disease process in African-Americans will help us reduce the staggering death rate among our black citizens," Jones said. One component of the study is a set of courses introducing black students to public health and epidemiological research, so they can pursue careers as investigators in studies like the JHS.

Disparity in health status is, of course, only one issue facing the future president as he shapes the nation's health care plan. Baby boomers, who are living longer and demanding more care, will push the system to its limits. Upcoming debates promise to feature dueling candidates' plans with probably only one thing in common - the need for a quick, but lasting, fix.

Glenda Lowe thinks Mississippi can provide some answers. In her third month of speech and physical therapies, Lowe had regained about 85 percent of her mobility, thanks to the quick treatment she received.

"My speech is not as good as before, and I have to think harder to say what I want to say, but I do know that he [Aldridge] saved my life," she said. "I'm blessed, and I thank the Lord for him. I'd tell anyone to come here for treatment."

Aldridge credits the TelEmergency system for her recovery.

"TelEmergency is cutting edge," he said. "In Mississippi, we're always listed as last, but in this case, we're first. It's important in small communities that we're able to work expediently. Time is not money. Time is muscle, function and brain cells, or a life. This system gives us time."

For more information on programs at the UM Medical Center, visit http://www.umc.edu/. For more information on the UM School of Pharmacy, visit http://www.pharmacy.olemiss.edu/.

 
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