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Toward A New System of Community Health

by Stephen Moore

January 4,2005

Healthcare stories inundate our lives. Whether in daily media and monthly magazines, or the personal interactions that we experience or share through our loved ones, healthcare, from a systems perspective, is stressed – falling short of delivering safe and comprehensive care. Much like politics, health care is local, dependent upon our medical systems to provide quality and value to the community.

As informed citizens, we must be able to digest the issues and understand what the medical leaders in our region are doing to address them.

Briefly, what do we know about healthcare today?

Diversity: Women, African-Americans, or Hispanics have 25-50% less of a chance to receive state-of-the-art health care than a Caucasian male. One’s chances do not appear to improve when your physician is a woman or African American.

HIV: New cases of HIV rose to 325 in Charlotte/Mecklenburg in 2003. Fewer than 200 cases were reported fives years ago.

Obesity: 26% of Americans have achieved the designation of morbidly obese. This compares to 12 % two decades ago and 6% four decades ago. Among those impoverished, the rate reaches 40%. Less than forty years ago, Lyndon Johnson, behind Food Stamps legislation, aimed specifically at improving the health of the undernourished poor in this country. Our poor are now sicker and dying earlier compared to 1965.

Alice in Wonderland Syndrome: In 2004 America spent $ 231 billion on prescription drugs, an average of $809 for every man, woman, and child living today.

Anxiety: The average teenager today scores higher on standard anxiety scales than did their psychiatric hospitalized peers forty years ago.

Quality: The cost to care for a Medicare enrollee annually ranges from $3500 in Hawaii to $9500 in Florida. The quality of that care, as measured by death rates from heart disease and key medical interventions known to improve life, are inversely related.

This information is rather overwhelming, even for those familiar with health care delivery. I believe it may be more constructive to detail what Carolinas Medical Center (CMC) and HealthCare System (CHS) are doing to address the issues of access and quality.

As a regional referral center, CMC provides unrestricted access to care for all people in a 29 county area, extending from South Carolina to the western mountains. CHS cares for 85% of the Medicaid population in Mecklenburg County and the overwhelming majority of indigent care as well. CMC provides services in the outpatient arena as well as complex care settings, including heart and liver transplants.

CHS is currently investing heavily in patient safety in both the inpatient and outpatient settings. Simply put, CHS expects to provide the best care for every unique patient in our system by understanding the risks to care for each individual, investing millions of dollars in computer systems to deliver medications as safely as possible, and analyzing and developing systematic approaches to better care. CMC has led the way in clinical improvements in 2004 with some of the following:

? Cardiovascular medical and surgical outcomes equal to and better than the best 15th percentile hospitals in the nation.

? A certified Comprehensive Stroke Unit with death rates from stroke more than 50% below the national average and 25% better than the best 15th percentile hospitals in the nation.

? An innovative approach to congestive heart failure patient care at CMC has led to a mortality rate amongst the lowest in the nation, and thirty day readmissions to hospital have fallen by greater than 50% over the past six months.

? Infection rates (from invasive vein access lines utilized for very ill patients) have fallen by 40%, now some of the lowest in our national benchmark database.

Our lives tumble along a linear beginning and end, short in some instances, prolonged in others. In contrast, community health exists in a multidimensional continuum spanning the fabric of our entire urban setting. Our systematic decisions surrounding finance, education, arts, transportation, safety, government and diversity have implications for the health of our community. The modern epidemics of anxiety, obesity, and HIV threaten our vision of urban revitalization. A new vision of healthcare and its delivery must become a “common language.” We must become attuned to the impact of our current actions upon the community health of Charlotte/Mecklenburg. Let us begin to shape the vision together.

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