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MCMC Collaborates with OHSU to Increase Local Access to Specialized Care and Expertise

Published on 12/28/2008
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Mid-Columbia Medical Center in The Dalles, Ore., has announced that it is now working with Oregon Health & Science University to expand the availability of specialty physician and medical/surgical care in the Mid-Columbia region.
MCMC and OHSU will collaborate on two healthcare programs over the next six months and will continue to explore opportunities to bring new services to the area that fill gaps in specialty care.
In February 2009 OHSU will begin providing regular medical and surgical orthopedic coverage in The Dalles.  In late summer 2009, MCMC and the university will jointly bring a cardiologist to the area, the Mid-Columbia region's first full-time heart specialist.
Collaborating with OHSU provides MCMC with the unique opportunity to cost-effectively expand its specialty care offerings while also connecting residents of the Mid-Columbia to the expertise and resources of Oregon's only health and research university.
"We're excited to add this component of care to the array of skilled physicians, health professionals and comprehensive services that currently comprise our medical community," says Duane Francis, president/CEO of MCMC.  "Developing these types of collaborative agreements with OHSU, as needed, will enable us to improve access to care in underserved specialty areas and in other, more highly specialized areas where full-time physician coverage is not a practical option."
Francis says the two organizations targeted orthopedics as the first area to address because the need for this type of care in the Mid-Columbia far exceeds the available physician coverage.
"The current shortage of orthopedic coverage is what motivated us to explore creative, affordable ways to grow to our specialty care offerings," Francis says.  "This collaborative model is a great solution in areas, like orthopedics, in which there is pent-up demand for care.  This allows us to quickly bring in an orthopedist to begin meeting that demand while a full-time physician is being recruited."
Francis credits OHSU's orthopedic and cardiology leaders with having the vision and willingness to work with MCMC to help solve some of the hospital's pressing needs.  That sentiment is shared by OHSU's Director of Clinical Outreach, Dr. Mark O'Hollaren.
"This would not have come to fruition without the innovation, creative thinking and leadership of Dr. Jung Yoo and Dr. Joaquin Cigarroa," O'Hollaren says. "They conceived and developed the plan for bringing additional subspecialty care to The Dalles and have worked tirelessly to put all of the pieces in place."
Yoo is chairman of the OHSU Department of Orthopedics and professor in the School of Medicine. Cigarroa is associate professor of medicine, associate chief of clinical affairs for the OHSU Division of Cardiovascular Medicine and director of the Cardiac Catheterization Laboratory.
Through the orthopedic arrangement with OHSU, a physician member of the university medical staff and teaching faculty will practice in The Dalles a portion of every week.  That physician also will spend one weekend a month in The Dalles providing after-hours call coverage in support of existing orthopedic specialists.
A second component of the arrangement involves OHSU providing local physician coverage in orthopedic sub-specialty areas as needed.
Collaborating with MCMC allows OHSU to serve its mission of helping improve access to additional medical services in rural communities throughout the state, says O'Hollaren.
"We realize there is a significant shortage of physicians in many areas of the state, and that creates problems of access, especially for sub-specialty care that most rural areas are not able to support full-time," O'Hollaren says.  "This type of arrangement helps OHSU fulfill its mission of enabling residents of smaller communities to stay close to home for more of the care they need.  The goal is to improve access in ways that make sense for the communities we serve, and to help support the healthcare providers with whom we collaborate.
"OHSU has tremendous respect for the unbelievable job that our medical colleagues do in rural areas throughout the state.  We are happy to help support their important work when we can."
The first joint MCMC-OHSU project not only will facilitate more consistent physician coverage for more common orthopedic conditions, but will also provide access to orthopedic subspecialty expertise in areas such as complex revision spine surgery and bone tumors.
In addition, it will allow MCMC and OHSU to seamlessly move the practice from part-time to full-time once an orthopedic physician and surgeon has been successfully recruited to practice in The Dalles. That individual will live and practice in the Mid-Columbia area and spend one day per week at OHSU teaching medical students, working with colleagues, and providing patient care.
Dr. O'Hollaren says the new orthopedic specialist will be connected electronically with OHSU for consulting purposes, an arrangement that also will be implemented between the university and MCMC's Emergency Department staff.
MCMC ER physicians will benefit from real-time consultations with OHSU orthopedic specialists who will be able to view diagnostic images, help local staff make diagnoses and determine whether a patient can be treated locally or should be transferred to OHSU.
A similar arrangement already is in place between OHSU and St. John's Medical Center in Longview, Wash., and O'Hollaren cited a recent example of the dramatic difference such a connection can make in patient outcomes.
"A patient recently walked into the St. John's ER with chest pain," he says.  "The physicians there diagnosed the early stages of a heart attack and activated their STEMI protocol - a structured protocol for quickly managing patient care for a patient suffering a type of heart attack - which had been jointly developed by St. John's and OHSU. The patient was immediately transported to OHSU with the help of Life Flight, where the interventional cardiac team was waiting. Major heart damage was avoided by opening the coronary artery with balloon angioplasty and a placement of a stent to keep the vessel open.  Only 88 minutes elapsed from the time the patient walked into St. John's until his vessels were opened up by OHSU's cardiac team.  That can only happen if two organizations have protocols in place and a seamless system of coverage.  OHSU and MCMC will explore development of similar coordinated care."
Mid-Columbia area heart patients will be the next to benefit from an MCMC-OHSU collaboration.  The cardiology partnership between the two organizations will closely follow the orthopedic model with one significant exception - a cardiologist already has been identified who will live and practice full-time in The Dalles.
"In the past patients have had local access to heart specialists through visiting physicians, who have done an outstanding job of caring for our patients," Francis says.  "But this is another specialty area in which the need for care is far greater than we can serve on a part-time basis.  Heart disease is a major community health issue, and we are looking forward to being able to address this in a more comprehensive way with a full-time specialist closely tied to the comprehensive and state-of-the-art resources of OHSU."
Dr. David Guarraia will move to the area after completing a cardiology fellowship at OHSU in July or August.  "Dr. Guarraia grew up in a smaller town and he wanted to practice in one," says O'Hollaren.  "He loves the Mid-Columbia area and is anxious to be part of the community."
O'Hollaren says OHSU is equally anxious to help MCMC meet the health needs of the Mid-Columbia region, though he emphasizes the university is there only for the purpose of collaboration, a point Francis reinforces.
"This is not in any way, shape or form a merger of our organizations or an acquisition," Francis says. "OHSU is here at our invitation to help us expand access to care in comprehensive ways that would not have been feasible for us to pursue on our own.  We anticipate a long and growing relationship with OHSU, but we will continue to move forward as separate organizations."

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