People Centered Primary Care Shifting the focus of medical encounters from

episodic, disease based, body part specific,

specialized emphasis

to

wholistic, coordinated, patient centered

Extent of Problem in U.S.

• 4,000 occupational fatalities each year

• 3 million occupational injuries

• 160,000 cases of occupational illness

• A need for better diagnosis and treatment plans for intervention and prevention for improving the overall health of the working population

People who might benefit from OH at primary care level

• About three quarters of all U.S. business firms have no payroll. Most are self-employed persons operating unincorporated businesses (over 23 million people) (US Census Bureau)

• Over 3.6 million small businesses have 9 or fewer employees

• Informal sector –day laborers

Access to Services in the U.S. for low income and uninsured

• Community and Migrant Health – 18 million people seen through this network – 1,400 clinics with over 8,000 sites

• NIOSH needs assessment found that based on current trends, future national demand for occupational safety and health services will significantly outstrip the number of professionals with the necessary training, education, and experience to provide such services.

• Patient centered primary care model leads to: – equity (less disparity) – opportunities for increasing prevention and case management

of work related, work exacerbated, and non-work related recovery

Barriers

• Small pilot project looking at family practice residency training programs and physicians at community health centers

• Distribution of services

• Nature of practices

– Time (workers’ compensation, ADA)

– Knowledge of content or support networks

– Focus on issues of violence, smoking, food deserts, immunizations, other vertical program emphasis areas

Opportunities

• Networks of Settings – Public sector provided

• Veterans Administration • DOD • Indian Health Service • Bureau of Prisons

– Private sector supported by public sector funding • Centers for Medicare and Medicaid Services • Health Resources and Services Administration

• Networks of providers – American Academy of Pediatrics – American College of Physicians – American Academy of Family Physicians – American College of Obstetrics and Gynecology

• Patients – American Association of Retired Persons – National Partnership for Families and Children

Opportunities

• EHS (phase 1 now, phase 2 2013, and Phase 3 completed 2015) – Financial incentives for medical practices and

hospitals

– Clinical decision support tools

– Requires providers to take data into consideration

– Builds in preplanning support services and continuity

– Opportunities to add key work related questions to all medial records

– Opportunities to add tools for case management

Opportunities

• The medical home is a model of primary care that delivers care that is:

– Patient centered

– Comprehensive

– Coordinated

– Accessible, and

Objectives: • Increase awareness of occupation and work as social determinants of health in primary care practice in CHC. • Include occupation and work as part of the electronic medical record. Integrate work history into medical history in CHC. • Improve diagnosis, treatment and prevention of work related illness and injury in CHC. • Increase referrals to appropriate medical service specialties, advocacy groups and government agencies to address

systemic problems. • Increase the ability of occupational safety and health institutions to respond effectively and competently to the education,

training, and service needs of CHC and their constituents.

Stakeholders: • CHC staff- administrative, clinical, volunteer • OSH community-ERCs, COSH, professional associations, cooperative extension service • Worker groups-worker centers, unions • Government-HHS, HRSA, state & local health departments, OSHA, EPA • Advocacy groups-state primary health care associations, National Association of Community Health Centers • Non-governmental organizations—Migrant Clinician’s Network, National Center for Farmworker Health, others

Existing Networks: • EPA • Federal Interagency Partnership for Colonias, Farmworkers, and Rural Populations • Federal Promotores Work Group/ HHS Promotores Initiative Steering Committee • State Network on Medical Records

NIOSH Research and Products: • Medical records/work history-DRDS • Black lung-DRDS • Immigrant materials and curriculum-EID and OD • Electronic Medical Records-DRDS

How to strengthen collaboration

• National and regional partnerships

• Local partnerships with occupational health and primary care networks

• EHR questions and tools to support risk assessment, management and communication

Next Steps

What actions should be undertaken to mover to people centered care..

• community based participatory research and action research

• research out to nurses, community health workers, allied health professionals