Crossroad Health Center - OTR

Thomas Damhoff, Summer 2012

There were no routine days at Crossroad. Instead of spending my time working on one large project, I spent my time working on a number of small projects, and I also spent a considerable amount of time providing patient care. While Crossroad has always believed in a medical home model and designed the practice as such, they are in the process of obtaining National Committee for Quality Assurance certification as a Patient Centered Medical Home. In order to receive certification, Crossroad has to monitor many outcomes and has recently implemented an electronic medical record to both improve patient care and track these outcomes. Many projects that I worked on were in some way directed towards the goal of becoming a Patient Centered Medical Home.

I was quickly trained on the computer systems and put to work doing intake with patients. I would generally take a history and vital signs, and do routine screening tests such as blood sugar or depression screenings. I learned so much from my patients. Barriers to health became overwhelmingly real to me, as many patients faced obstacles I cannot comprehend. I enjoyed the challenges that came with working with this unique population: overcoming the barriers to communication and lack of resources to solve problems in a collaborative way. I enjoyed sharing in the joy of victories with patients, victories that outsiders may mistakenly describe as small. I learned that the smallest accomplishment on paper can be monumental if it inspires the patient or gives them hope. I have no doubt that the lessons these patients taught me will stick with me throughout my career.

Specific projects included doing groundwork for a "Hot Spot Medicine" program. Hot Spot Medicine identifies patients that overutilize the healthcare system and changes the way care is provided to these patients. These "ambulatory intensive care" programs have been shown to improve outcomes and reduce overall costs to the healthcare system. I compiled data on a particular patient and met with her in order to put together a comprehensive picture of what her healthcare looks like. The goal in doing this was to see if the patient would be a good fit for such a program, and to begin telling a story which can be used to demonstrate both the need for and effectiveness of such programs.

Crossroad began fully using an electronic medical record at the beginning of 2012 and continues to roll out new features. I helped implement a Chronic Disease Management Module. This module serves as a hub for important information related to the management of chronic disease, and allows for easy tracking of important metrics. The module includes questions related to the patient's understanding of their conditions and medications, a risk stratification tool, and a convenient way to document and follow up on treatment and self-management goals that are set by both patient and provider. I helped implement this module by working out technical issues and by training staff on the proper use of the module.