A presentation on healthcare for the Wahiawa Center for Community Health public hearing, 2015

1. Health Care in Transition
Lee Ellen Buenconsejo-Lum, MD, FAAFP
Board Member, Wahiawa Center for Community Health
Associate Professor, Department of Family Medicine & Community Health
John A. Burns School of Medicine
University of Hawaii

2. Physical
(Body)
Spiritual
(Spirit)
Emotional
(Mind)
CHANGING CONCEPTS OF HEALTH

3. LIVE
WORK
PLAY
EAT
VALUES

5. Hospitalization Rates ≠ quality of outpatient
care
Hospital Service Area
REASON FOR HOSPITALIZATION State Rate Honolulu Rate Wahiawa Rate
96712 96786 96789 96791 96857
Lower leg amputation (2009) 20.6 19.6 30.4
High blood pressure (2011) 26.1 24.9 30.5
Heart failure (2011) 267.4 199.7 405.3
COPD or asthma in adults 40+ (2011) 293.4 236.3 339.8
Chronic Composite Rate (2011): diabetes-related, leg amputation,
hypertension, heart failure, angina without procedures, COPD/adult asthma,
asthma in younger adults
1019.4 834.3 1221.7
Rates were provided by HHIC, and are defined by the Agency for Healthcare Research and Quality (AHRQ) as a set of measures that can be
used to identify quality of outpatient care, which can potentially prevent the need for hospitalization. Rates are risk -adjusted based on the
Healthcare Cost and Utilization Project’s State Inpatient Databases. The table includes risk-adjusted hospitalization rates with 95%
confidence intervals for Honolulu County and all contained hospital Service Areas for 2011. State values are also provided for comparison.
https://www.adventisthealth.org/castle/Documents/CMC-CHNA-13-Report.pdf

7. O’Gurek D, et al. AAFP Integration of Primary Care and Public Health Work Group. Integration of
Primary Care and Public Health (Position Paper). American Academy of Family Physicians. December
2014. Accessed online: February 12, 2015
http://www.aafp.org/about/policies/all/integprimarycareandpublichealth.html.
Patient
Context
Values?
Barriers?
Support?Goals of
care?
Under-
standing
THE EVOLUTION OF
HEALTH CARE

8. Patient
• Physician / Nurse
• Dentist
• Mental Health
Family
• Physician
• Mental Health
Support Services
• Social work
• Transportation
• Insurance / Case Manager
Community
• Safe environments
• Skills for health and wellness
• Enables healthy choices
• Educated
• Empowered
Division of Cancer Prevention and Control, National Center for Chronic
Disease Prevention and Health Promotion, Centers for Disease Control
(CDC) and Prevention. (2011). Social Ecological Model. Retrieved
September 21, 2012. From http://www.cdc.gov/cancer/crccp/sem.htm.
Quality
Care

9. • Patient-Driven
• Enhanced Access to
Care
• Team-based Delivery
• Care Coordination
• Integrated and Holistic