MyWhole Person Care Curriculum

Part I: About Community Health Network

Welcome to Community Health Network

Community Health Network (CHN) is excited to welcome our clinical learners and medical providers, and we are excited to be a part of your whole person care medical education journey! Our preceptors are enthusiastic about teaching and mentoring students. They are accessible and genuinely care about the students they teach. Our clinic rotations currently include Pediatrics, Family Medicine, and Women’s Health. All rotations have a whole person care focus and are patient centered. It is our hope that after completing their rotations at Community Health Network our clinical learners leave with a since of purpose to provide quality care to those who need it most. We hope that you have a fulfilling experience at Community Health Network!

Mission of CHN

Our mission is to provide quality care that uplifts, supports, and shapes, healthy communities while addressing financial and social barriers.

Vision of CHN

The vision of Community Health Network is to be a leader in providing quality services and programs that enhance the lives of the people in our community.

About CHN

· Community Health Network started in 2008 in Alvin, TX with the goal of providing access to quality healthcare to patients.

· It started with one provider and three exam rooms and has experienced rapid growth over the last decade. · Community Health Network is a fully fledged Federally Qualified Health Center (FQHC).

What is an FQHC?

· An FQHC is a federally funded not for profit health center that serves medically underserved areas and populations.

· All FQHC’s must have an independent governing board.

· An FQHC must have a robust quality improvement program.

· All patients are welcome including Medicaid, Medicare, underinsured, and uninsured patients.

· Must have an integrated care model that includes preventative health services, behavioral health services, and dental services.

There are multiple benefits for future medical providers to practice at an FQHC that include the ability to participate in the National Health Service Corp Scholarship and loan repayment program

· CHN will see patients regardless of ability to pay, and CHN has developed an affordable sliding scale model for patients without insurance.

· CHN now has a total of twelve integrated whole person care centers and current students rotate at the following sites:

· Freeport Community Health Center

· MyCHN League City

· MyCHN Silverlake (Pearland)

· Scarsdale Family Health Center (Houston)

· Women and Children’s Center in (Alvin)

· Our clinics service Harris, Brazoria, and Galveston counties

· Community Health Network provides the following services to our patients

· Medical – Internal medicine, family medicine, pediatrics, and OB/GYN

· Behavioral Health – Adult and child psychiatry, counseling, and peer support groups

· Podiatry and wound care

· Dental services

· Laboratory services

· Pharmacy services

· Our pharmacy is a participant in the 340b program that allows patients to receive lifesaving medications at significantly discounted rates

· Clinical research trials

· Transportation services

· In-home health program where we bring care to the patient

· In-person and virtual services

· Medication assisted treatment for addiction

· CHN was on the frontline of the Covid-19 pandemic and provided thousands of Covid-19 tests and vaccines at no cost to our patients

· Access to multiple subspecialty services through e-consultations with 24 hour turn around

· To sum this all up at CHN we do whole-person integrated care!

Part II: Patient Centered Medical Home

The concept of the patient-centered medical home (PCMH) is not a new concept! It was adopted by the American Academy of Pediatrics in 1967. The PCMH model took off in the last 2000’s when four major professional organizations endorsed the model including:

· American Academy of Pediatrics

· American Academy of Family Physicians

· American College of Physicians

· American Osteophathic Association

The goal of the patient centered medical home model is to creates a partnership between medical providers, patients, and their family. It is patient-focused and provider-driven and has a strong emphasis on patient quality and safety. This is our goal for each patient at Community Health Network, and we are proud that we have reached PMHC status.

The foundations of PCMH are:

Patient-centered

· At CHN we have a whole-person care patient centered model

· We recognize that every person has their own unique set of health challenges and concerns

· CHN views the provider-patient relationship as a partnership

· A dedicated patient portal for patients to find their medical information in one place

· Dedicated language line available to provide services to patients regardless of their background

Comprehensive

· At CHN we strive to practice evidence-based medicine with an emphasis on preventative medicine

· CHN providers have also received training in integrative medicine with an emphasis on holistic care

· CHN provides services that include (but not limited to) to dental services, behavioral health services, medication assisted treatment, and has a laboratory on site

Coordinated

· CHN providers work together to make sure care is coordinated across specialties

· CHN utilize an electronic health record so each member of the medical care team knows the relevant clinical history of each patient

· CHN also coordinates with other outside organizations and hospitals to make sure care is coordinated between medical organizations

· CHN providers have access to subspecialists through e-consultation

Accessible

· CHN prides itself on access to care

· Dedicated same-day spots are available in all provider schedules

· Patients have the option to do both in-person or virtual visits

· CHN is open for care seven days a week

· CHN also provides transportation and does home visits to help close medical are caps

Commitment to Quality and Safety

· Dedicated monthly quality improvement meetings with an emphasis on quality metrics

· Dedicated risk management team that is dedicated to minimizing and preventing medical errors

· Each medical provider has dedicated continuing medical education

· Patient driven surveys that focus on quality and patient satisfaction

Part III: The Whole Person Care Model

The world of medicine is constantly changing, and this is an exciting time to be a student. Previous ways to teaching have evolved from a symptom-medical condition approach (“the diabetic patient”) to a more broad-based mind, body, and spirit integrated approach.

According to the National Institutes of Health (NIH), “Whole person health involves looking at the whole person—not just separate organs or body systems—and considering multiple factors that promote either health or disease.” The factors that cause disease can be medical or non-medical factors known as social determinants of health (SDOH).

Social determinants of health are:

· Economic stability

· Education access and quality

· Access to healthcare

· Neighborhood and Environment

· Social and community context

Case Study

Mr. Smith is a 25-year-old veteran who presents to the Adoue clinic for dental pain. He appears unkempt and on a social determinants of health screening indicates that he is homeless. PHQ-9 is significant for severe depression. He reports a history of opioid addiction that started after he was injured in Iraq. Dental exam reveals a dental abscess with several missing and broken teeth. How would you approach this patient to maximize his health outcomes?

Conventional approach:

· Mr. Smith has a dental abscess ➢ treat with antibiotics ➢ discharge Mr. Smith

An integrated whole person care approach:

· SDOH questionnaire reveals homelessness ➢ Mr. Smith is put in contact with a local shelter that provides temporary housing

· Depression questionnaire is positive for severe depression ➢ the front desk alerts the behavioral health coordinator, and a same day appointment is scheduled with an in-house counselor

· Mr. Smith discusses his opioid addiction with the dental hygienist ➢ during the appointment the hygienist informs Mr. Smith about the medication assisted therapy at Community Health Network ➢ Mr. Smith enters the MAT (Medication Assisted Treatment) program

· The dentist prescribes Mr. Smith an antibiotic for his dental abscess ➢ the dentist is aware that Mr. Smith has limited funds ➢ prescription is sent to CHN pharmacy and is picked up at a lower cost than a traditional retail pharmacy

This case illustrates the type of situations and medical complexities that the clinical learner will see at Community Health Network.

Part IV: Clinical Learner and Whole Person Care

Core Competencies

The Accreditation Council on Graduation of Medical Education (ACGME) has established core competencies that are expected of future physicians. These competencies align with both the University of Houston Tilman J. Fertitta Family College of Medicine and the Sam Houston State College of Osteopathic Medicine curriculum. The core competencies are adapted directly from ACGME.

Medical Knowledge:

· Clinical learners must demonstrate knowledge about established and evolving biomedical, clinical, social-behavioral sciences, and the application of this knowledge to patient care.

Patient Care:

· Clinical learners are expected to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Interpersonal and Communication Skills

· Clinical learners must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, families, and other medical professionals.

Professionalism

· Clinical learners must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Systems Based Practice

· Clinical learners must demonstrate an awareness of and responsiveness to the larger context of health care, and the ability to effectively call on system resources to provide care that is optimal value.

Practice Based Learning and Improvement

· Clinical learners must be able to investigate and evaluate their patient care practices, appraise, and assimilate scientific evidence, and improve their patient care practices.

Whole Person Care Provider Expectations

· Whole Person Care providers are expected to provide care that is

· Quality Based

· Value Based

· Patient Centric

· Data driven

· As an FQHC Community Health Network adheres to all UDS measures that include · Whole person care providers are expected to see an average of 20 patients per day

· Diabetes control (A1c > 9.0%)· Value Based

· Hypertension control (BP < 140/90)

· Childhood immunizations

· Cervical and Breast cancer screenings

· Dental sealants for children

· Adult and child body mass index screening

· Depression screening

· Tobacco cessation

· Whole person care providers are expected to address these measures during appointments (when appropriate)

· Whole person care providers are expected to see an average of 20 patients per day

· Charts should be closed in timely fashion based on Community Health Network policy

· If total patient encounters is < 10 patients ➢ charts should be closed within 24 hours

· If total patient encounters is 10-15 patients ➢ charts should be closed within 48 hours

· If total patient encounters is 16 or more ➢ charts should be closed within 72 hours

· Whole person care providers have 36 hours of direct clinical care and 4 hours of administrative time used for charting

· Participate in provider meetings, quality improvement meetings, supervision and delegation meetings, and peer review.

· Family medicine whole person care providers will receive on-boarding in chronic and acute adult care, pediatrics, women’s health, and medication assisted treatment (MAT)

· Disposition of labs within 48 hours and practice within CHN standard of care guidelines

· Participate in provider weekend rotation as designated by the chief medical officer and chief operating officer

· Providers are expected to provide both in-person and virtual care

· Community Health Network currently observes the following days:

· New Year’s Day

· July 4th

· Thanksgiving Day

· Christmas Day

· Additional PTO is given in lieu of other recognized holidays – more information is provided by human resources at orientation

Onboarding Expectations

• The provider on-boarding experience will consist of multiple rotations through family medicine, pediatrics, women’s health, and behavioral health with an established CHN provider

• The on-boarding experience is designed to have the provider hit the ground running and is not merely a “shadowing” experience

• Whole person care providers are expected to see patients and chart in the EHR during the on-boarding process

Part V: Pediatric Whole Person Care Curriculum

Clerkship Objectives:

A. Clinical skills

· Perform a history and physical on a newborn baby, toddler, school-aged child, and an adolescent

· Perform a HEADDS exam on an adolescent

· Interpreting growth charts in pediatric patients

· Interpreting developmental questionnaires

B. Medical Knowledge

· Formulate an assessment and plan for common pediatric conditions within a whole-person care framework

· Suggest appropriate lab testing for common pediatric conditions

· Interpreting common pediatric labs

· Provide age-appropriate anticipatory guidance

Complete History and Physical

Exam including differential and plan in pediatric patient

Acute Injury

Autism Screening

Bronchial Asthma

Child Abuse Evaluation

Chromosomal abnormality

Congenital Heart Disease

Dehydration and/or Electrolyte

Abnormality

Developmental Delay

Diabetes Mellitus

Ear Pain

Failure to Thrive or Growth

Abnormality

Fever Evaluation

Gastroenteritis

Headaches

Leg Pain

Obesity

Pediatric Hospital Discharge

Process

C. Communication Skills

Premature infant – Follow – up

Rashes Seizure Disorder

Severely Handicapped

Sore Throat

Thyroid Disease

Urinary Tract Infection

Birth to One Year

1 – 4 Years

Well child visit with Immunizations

· Demonstrate patient appropriate language to communicate clinical findings with patients’ family

· Demonstrate appropriate cultural sensitivity towards patients and their family

· Effectively present to preceptor using traditional “SOAP” format

· Document appropriately in the patient electronic health record

D. Professionalism

· Demonstrate honesty and integrity in all interactions with patients, preceptors, and other medical staff

· Maintain patient confidentiality in accordance with HIPAA guidelines and regulations

· Demonstrate an interest in continued growth and development including asking for feedback and areas for improvement

· Complete any preceptor assigned readings in timely fashion

· Arrive on time and inform the preceptor of any planned absences

· Dress professionally – business casual with white coat or badge

Part VI: Family Medicine Whole Person Care Curriculum

A. Clinical Skills

· Perform a complete history and physical examination on a pediatric, adult, and geriatric patient

· Observe or perform common outpatient procedures that may include:

· Simple laceration repair/suture removal

· Biopsies

· In-grown toenail removal

· Diabetic foot exam

· Trigger point/Joint injections

· Incision and drainage

· Perform a complete history and physical examination on a patient with substance use disorder

B. Medical Knowledge

· Formulate a differential diagnosis, assessment, and plan for common medical conditions in the context of a whole person care framework

· Demonstrate appropriate knowledge of screening guidelines of common medical conditions based on the United States Preventative Service Taskforce (USPSTF)

· Perform high-quality literature review to generate clinical questions about common medical conditions seen in the family medicine setting

· Interpreting common laboratory results

· Identify barriers to care that affect patient adherence to care plan

Complete History and Physical

Exam including Assessment and Plan

Acid Base Disorder

Altered Mental Status

Acute Kidney Failure

Anemia

Arrhythmia

Bacteremia

Cancer

Chest Pain

Chronic Kidney Disease

Cough

Coronary Artery Disease

Congestive Heart Failure

C. Communication Skills

Dementia

Diabetes Mellitus

Diarrhea

Dyspnea

Fever

Gastrointestinal Bleeding

GERD

Headache

Hepatobiliary & Pancreatic disease

HIV/AIDS

Hospital Admission/Discharge

Hyperglycemia

Hyperlipidemia

Hypertension

Nausea and/or Vomiting

Nosocomial Infection

Obesity

Obstructive Lung Disease

Palliative Care

Pneumonia

Rash

Rheumatic Complaints

Substance Use Disorder

Smoking Cessation Counseling

Thyroid Disease

Upper Respiratory Infection

Urinary Tract Infection

Venous Thromboembolism

· Demonstrate patient appropriate language to communicate clinical findings with patients and their family

· Demonstrate appropriate cultural sensitivity towards patients and their family

· Effectively present to preceptor using traditional “SOAP” format

· Document appropriately in the patient electronic health record

D. Professionalism

· Demonstrate honesty and integrity in all interactions with patients, preceptors, and other medical staff

· Maintain patient confidentiality in accordance with HIPAA guidelines and regulations

· Demonstrate an interest in continued growth and development including asking for feedback and areas for improvement

· Complete any preceptor assigned readings in timely fashion

· Arrive on time and inform the preceptor of any planned absences

· Dress professionally – business casual with white coat or badge

Part VII: Women’s Health Whole Person Care

Curriculum

A. Clinical Skills

· Perform a complete reproductive history and physical examination

· Obtain menstrual and sexual history

· Obtain birth control history and counsel patients on birth control options

· Perform physical exam and prenatal services at each trimester of pregnancy

· Observe and/or perform:

· Intrauterine device (IUD) insertion and removal

· Nexplanon insertion and removal

· Cervical polyp resection

· Endometrial biopsy

· Incision and Drainage of Bartholin cyst

· Genital wart chemical cauterization (TCA treatment)

· Papanicolaou smear (PAP smear)

· Breast exam

· Obtaining fetal heart tones

· Obtaining fundal height measurement

· GBS specimen collection

B. Medical Knowledge

· Formulate a differential diagnosis, assessment, and plan for common women’s health conditions in the context of a whole person care framework

· Formulate a plan of care during each trimester of pregnancy

· Be familiar with common contraceptive methods

· Know appropriate screening and prevention guidelines based on ACOG, ASCCP, ASC, and USPSTF recommendations

Annual Well – Women Exam 1st Trimester Bleeding

Abnormal Pap/Colposcopy

Abnormal Uterine Bleeding

Acute Pelvic or Abdominal Pain

Advanced Maternal AgeCounseling

Cervical Dysplasia Treatment

Amenorrhea

Benign Gyn Neoplasm

Breast Mass/Breast Pain

Chronic/Recurrent Pelvic Pain

Contraception Counseling and Management

Fetal Malpresentation

C. Communication Skills

Gestational Diabetes

Gestational Hypertension/Preeclampsia

Infertility

Irregular Menses

Menopause Symptoms

Multiple Gestation

Post-Cesarean Care Initial 24h

Postpartum Care 4–6-week visit

Postpartum Care Initial 24h

Prenatal Care-Continuation

Visit: 1st, 2nd, 3rd Trimester

Prenatal Care – Initial Visit w/ Complete History and Management Plan

Prenatal Care Continuation –

Normal and High-Risk Pregnancy

Preterm Labor

Spontaneous Abortion

STD Screening/Treatment

Third Trimester Bleeding

Urinary Incontinence/Pelvic Floor Dysfunction

Vaginitis/Vaginal Discharge

VBAC Counseling

Vulvar Lesion

· Demonstrate patient appropriate language to communicate clinical findings with patients and their family

· Demonstrate appropriate cultural sensitivity towards patients and their family

· Effectively present to preceptor using traditional “SOAP” format

· Document appropriately in the patient electronic health record

D. Professionalism

· Demonstrate honesty and integrity in all interactions with patients, preceptors, and other medical staff

· Maintain patient confidentiality in accordance with HIPAA guidelines and regulations

· Demonstrate an interest in continued growth and development including asking for feedback and areas for improvement

· Complete any preceptor assigned readings in timely fashion

· Arrive on time and inform the preceptor of any planned absences

· Dress professionally – business casual with white coat or badge

Part VIII: Psychiatry/Behavioral Health Whole Person Care Curriculum

A. Clinical Skills

· Perform a complete mental status assessment

· Obtain an appropriate psychiatric history

· Conduct a substance use disorder history and physical

B. Medical Knowledge

· Formulate a differential diagnosis, assessment, and plan for common psychiatric conditions in the context of a whole person care framework

· Formulate a plan for a crisis and/or suicidal patient

· Be familiar with indications, contraindications, and side effects of common psychiatric medications

· Interpret and order appropriate laboratory studies

Complete History and Physical exam including differential and plan as appropriate

ADHD

Behavioral Disorder with patient less than 18 years of age

Bipolar disorder

Depression Initial dx with patient 18-60 years old

Depression – follow up with patient greater than 60 years old Depression – follow up visit with 18–60-year-old

Depression – initial dx greater than 60 years old

C. Communication Skills

Eating Disorder

Panic/other anxiety disorder

Psychosis, acute

Schizophrenia follow up

Substance use disorder

Suicide/Homicidal Ideation assessment

Medication assisted treatment

Crisis management/hospitalization

· Demonstrate patient appropriate language to communicate clinical findings with patients and their family

· Demonstrate appropriate cultural sensitivity towards patients and their family

· Effectively present to preceptor using traditional “SOAP” format

· Document appropriately in the patient electronic health record

D. Professionalism

· Demonstrate honesty and integrity in all interactions with patients, preceptors, and other medical staff

· Maintain patient confidentiality in accordance with HIPAA guidelines and regulations

· Demonstrate an interest in continued growth and development including asking for feedback and areas for improvement

· Complete any preceptor assigned readings in timely fashion

· Arrive on time and inform the preceptor of any planned absences

· Dress professionally – business casual with white coat or badge

Part IX: Whole Person Care Provider Resources

A. Meetings

· Provider Quality Collaborative Meeting

· Monthly meeting with a focus on provider quality

· Use of data driven measures and metrics to improve patient outcomes

· Examples: A1c measurements in diabetics, blood pressure management, and body mass index screenings

· Provider Supervision and Delegation Meeting

· Presentation of a monthly interesting case with key learning points that all providers can benefit from

· Provider lead meeting and providers rotate presentations

· This provides and interactive environment and an opportunity to ask questions

· CHN Monthly Town Hall Meeting

· Meeting that is done monthly for all staff members

· Get updates from CEO and CMO about new projects and events happening at CHN

· Monthly empathy champion award for dedicated staff members that go above and beyond

B. E-consultations

· CHN has partnered with ConferMed a subspeciality consult service with 24 hour turnaround time

· Specialties include the following:

C. Learning Resources

· Continuing Medical Education (CME)

· CHN provides an annual stipend and five days of CME for medical providers

· This can be used to attend conferences, purchase books and journals, or to attend courses

· Training opportunities in functional and integrative medicine

· Dedicated Microsoft Teams Provider Chat

· Allows providers to ask questions or present cases in real time

· Other providers can respond with suggestions and help answer any questions that a provider may have

· Includes both adult and pediatrics

· Free Access to Uptodate

Part X: Closing

Our patient centered approach to care, our goals providing access to and removing barriers to care, as well as our dedicated preceptors make Community Health Network an ideal place to do your clinical rotations. We are excited to have you, and we look forward to working you!