The past six months have been the busiest in our eight-year history! While continuing to offer services as usual, we got ready to launch a whole new model of care in January so we could serve our patients and other community members once they got health insurance. Everything from ordering women’s health supplies to setting up an after-hours phone system and hiring/training new staff and volunteers has really kept us on our toes. We have expanded our clinical hours to four half days a week and will be adding more time over the coming months. Our partnership with CareOregon has allowed us to implement an innovative payment model that builds on our strengths and recognizes the value of our Community Health Worker program and other care coordination services.
We are excited by the opportunities provided by the Affordable Care Act to bring health services to so many who have gone without for so long. Most of our patients qualify for the Oregon Health Plan, and we will continue to be their primary care home. As we offer assistance with health insurance enrollment, expand our services and further our outreach this year we will continue our focus on advancing health equity for those most at risk.
In the meantime, we are very proud of our quality outcomes from last year.
In 2013 we provided 1,503 visits, similar to 2012. Our staff also provided over 200 blood pressure checks at community events. We added 130 new patients to our Chronic Disease Registry of patients with high blood pressure, diabetes, asthma, high cholesterol and/or depression. This high “churn” rate really keeps us busy, as we strive to provide needed “catch-up” services to all of our new patients.
Since our founding we have been committed to serving the African American community of North and inner Northeast Portland with a goal of reducing the health inequities that cause illness and early death among this population. African Americans are at greater risk of high blood pressure and complications like stroke and heart attack. Our staff and volunteers are making a difference. 72% of our patients with high blood pressure were African American in 2013, and 81% had their blood pressure at goal by the end of 2013. Word is getting out about our success in helping our African American patients reach their blood pressure goals, and our program is a model for others.
Our patients with diabetes are seeing their health improve as well, getting blood sugar and blood pressure under control as well as receiving recommended preventive services. 93% of our diabetic patients had good or excellent blood sugar control in 2013 (an increase from 78% from 2012). Overall, 72% of our diabetic patients had blood pressure at goal and 87% of our African Americans with diabetes reached blood pressure targets. Over 97% received the immunizations recommended by the CDC for all adults with diabetes, and 100% of our patients with diabetes were offered the recommended statin to reduce the risk of heart attack and stroke.
Jill Ginsberg, MD, MPH