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What Haiti Can Teach the US about Providing Healthcare to the Uninsured
Stan Shaffer, MDFounder, Healthy Mothers, Healthy Babies
Kendra WyattStrategist, Community Access, Cerner
Session topicsDelivering Care in Haiti
Medical Pathology – Social Pathology
Community Focus – Community Engagement
Measuring Outcome – Measuring Impact
The Principles and Comparisons
Medical Home TheoryKansas City, Missouri: Jackson Country Free Clinic
Lasso the Power of Community and Information Technology Austin, Texas: Indigent Care Collaboration
JaxCare, Jacksonville, Florida
Health Banks- Privacy, Portability with PurposeLive from the WHO Standards Meeting, Kenya
Lifetime risk of death from pregnancy
Sweden 1:30,000
United States of America 1:4000
World average 1:75
Haiti 1:16
Afghanistan 1:6
Maternal Mortality
Percent of deliveries with skilled birth attendant
Child Mortality
● = 5,000 child deaths / year
Child Mortality - Haiti(< 5 years)
Neonatal Mortality - Haiti(< 28 days)
Potential for Basic Interventions
Jones, Child Survival II, 2003; Lancet 362:65-71
• Clean delivery, breast feeding, antibiotics → Sepsis deaths ↓94%
• Prenatal tetanus vaccine → Tetanus deaths ↓81%
• Malaria prevention→ Low birth weight deaths ↓59%
• Neonatal resuscitation → asphyxia deaths ↓39%
HaitiCountry wide
(WHO statistics)
Baseline Community
Survey
Prenatal Care(percent of total)
79 51
Births Attended by Skilled Health Staff(percent of total)
24 13
Neonatal Mortality Rate(deaths per 1,000 live births)
34 40
Community Survey Results
Why didn’t you go to the hospital?
1. Too far
2. Too expensive
3. Untrustworthy
Underlying Medical pathologyis Social pathology
Community Survey Results
Why didn’t you go to the hospital?
1. Too far → Community services
2. Too expensive → Free care3. Untrustworthy → Quality
Consistency Hospitality
The need
Models of Maternity Care
Obstetricians
Nurse Midwives
Matrones
HospitalComprehensiveExpensiveRemote
Birthing Home
HomeLimited careInexpensiveConvenient
Pregnancy planning Prenatal care and triage Prevention of infections
Syphilis, HIV, Malaria Safe birth
Clean delivery Skilled birth attendants
Breast feeding support Vaccinations Nutrition and micro-nutrient
supplementation Child development
Road to Health
Continuity of Care
Health Information Technology
• Outcome monitoring• Quality assurance• Performance improvement• Communication• Resource sharing• Health mapping• Community health atlas
Community Health Atlas
Home visitsSanté Communautaire
Education
HIV - DOT
Vit A
Santé Santé CommunautaireCommunautaire
Elimination of Intestinal Parasites
Maternal Transfers Number
Vaginal bleeding 21*
Postdates 19
Hypertension/Pre-eclampsia 17
Preterm labor 12
Repeat C-Section 9
Prolonged labor 8
Abnormal fetal position 2
Prolonged ROM 2
Eclampsia 2*
Large uterine size 1
Fetal death 1
2005-2006 delivery data
HaitiCountry wide
(WHO statistics)
Baseline Community
Survey
MNCommunity 2005-2006
Prenatal Care(percent of total)
79 51 99
Births Attended by Skilled Health Staff(percent of total)
24 13 91
Maternal Mortality Ratio(pregnancy related maternal deaths per 100,000 live births)
680 ---- 498
Neonatal Mortality Rate(deaths per 1,000 live births)
34 40 9
Maison de NaissancePrimary Outcome Measures
Community Engagement
Employment
Mothers clubs
Community activism
Vaccination campaigns
Seeking water, housing, micro-loan programs
The value of a society is increased only as it cares for its most
vulnerable.John Rawls
not just for the countries with high child mortality, but also for countries that could have changed the situation.
William Foege
Child survival…a measure of civilization…
This isn’t charity work, it’s social justice.Paul Farmer
Childbirth in a Haitian Village
Implications for the Un and Under-insured
in the States
Partners In HealthHealthcare as a Right vs Commodity
“Anywhere you have extreme poverty and no
national health insurance, no promise
of health care regardless of social
standing, that's where you see the sharp
limitations of market-based health care.”
Paul Farmer
A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and
culturally effective. A medical home addresses how a
primary health care professional works in partnership with the family/patient to assure that all of the medical and non-medical needs of the patient are met.
The physician should be known to the person/family and should be able to
develop a partnership of mutual responsibility and trust with them.
Definition: Medical Home
Agriculture Productivity
Government
Entrepreneurism
Outreach
Via Football Clubs
Faith Partnerships
Community Health Workers
Baby,Mama,
Family
Cell PhoneConnectivityPower
HomeCement
FloorTile Roof
Virtual Consults
Education(BTI)Business Technology
Institute
Drinking WaterWaste
Management
MN Health Bank
Les Cayes Hospital
Haitian School of Midwifery
Maison de NaissanceProviding a Physical Birth Home
Data CenterVirtual Consults
Midwives
MN
Medical Home Theory
So what do they do in Texas?
The Mother of them all….Indigent Care Collaboration, Austin Texas
AUSTIN/TRAVIS COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT
AUSTIN TRAVIS COUNTY MENTAL HEALTH MENTAL RETARDATION CENTER (ATCMHMR)
AUSTIN WOMEN'S HOSPITALCENTRAL TEXAS MEDICAL CENTER CITY OF AUSTIN COMMUNITY CARE
SERVICES DEPARTMENT JOHNS COMMUNITY HOSPITAL LONE STAR CIRCLE OF CARE PEOPLE'S COMMUNITY CLINIC PLANNED PARENTHOOD OF THE TEXAS
CAPITAL REGION ROUND ROCK HEALTH CLINIC ST. DAVID'S HEALTH CARE SETON FAMILY OF HOSPITALS TRAVIS COUNTY HEALTHCARE
DISTRICTTRAVIS COUNTY MEDICAL SOCIETY UT SCHOOL OF NURSINGVOLUNTEER HEALTHCARE CLINIC WILLIAMSON COUNTY AND CITIES
HEALTH DISTRICT
All Members of the Safety Net Community ParticipateCommunity Health RecordCommunity Health Workers
Virtual Medical Home Framework
Nutrition
Pharmacy
Government
Health Plan
Employer
Community Foundation
Philanthropy
Sports Clubs
Grandmothers
FaithHealth Ministry
Community Health Worker
Education
Affordable Housing
Appropriate Clothing Medical Home
FQHC, Safety Net
Hospital Health System
Specialist
Public Health
Community Center
Mobile Clinic
HospiceBirth Center
PersonFamily
Environment
Jacksonville Health Information Network
Community Health RecordA Virtual Medical Home
JaxCareClaims
•Communit
y
Electronic
Health
Record
ShandsJacksonville
Baptist Health System
SMS
Mayo Clinic Hospital Cerner
St. Vincent’sMedical Center
IDX
MemorialHospital
MediTech
University of Florida
IDX
.M. Sulzbacher(FQHC)
Med Mgr
Brooks Rehabilitatio
nHospital
MediTech
HL7 Interfaces,Data Extracts
.csv Files
McKesson
Cerner
Duval County Health Department Med
Claims
Jacksonville Health Information NetworkAccessible via a secure internet site (SSL 128-bit encryption)
Cerner
AllScripts
Duval County Health Department
HMS
Person Controlled Health Record BankThe Virtual Medical Home
A New Healthcare Transaction: Health BanksH.R.2991Independent Health Record Trust Act of 2007
Charter for not-for-profit, cooperative institutions with member-owned accounts
IHRBs could save money and livesSale of data with revenue considered tax-free incomeGives providers access to data in emergencies
Vision for a “New Transaction”
Saving money and lives using non-centric, consumer-driven independent health record banks
•"By offering member-owned accounts, independent health record banks have one focus—the patient.”
•- U.S. Sen. Sam Brownback, R-Kan.
Paul RyanU.S. Rep, R-Wis
Dennis MooreU.S. Rep, D-Kan
Kansas City Employer Initiative
Live From Kenya & the WHO
Speaker will update attendees on results of the WHO Health Information Standards Conference Held December 4-7, 2007
Finance Health & Medical Homes Not Sickcare
Information Technology is like
Clean Water
Global Lessons
Resources
Stan Shaffer, MDMaison de [email protected]
Kendra WyattCerner [email protected]
Partners In HealthPIH.org
Bridget McCandless, Medical Director, Jackson County Free [email protected]
Ann Kitchen, Executive Director, Indigent Care [email protected]
Rhonda Poirier, Executive Director, [email protected]
