Grand Rounds - September 15, 2023  
"Artificial Intelligence in Medicine"

Speaker: Geoffrey Tso, MD. Clinical Assistant Professor, Stanford University School of Medicine.

Objectives

1. Discuss how artificial intelligence is changing the landscape of medical science.
2. Examine the benefits and risks of established artificial intelligence applications in clinical practice on physicians, healthcare institutions, medical education, and bioethics.
3. Assess the challenges and future directions of artificial intelligence in medicine.

Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)^TM.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].

Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].

This is a joint press release from Mosaic Community Health, St. Charles Health System and Deschutes County: 

Sisters, Oregon, Sept. 13, 2023 – The Sisters School-Based Health Center, located adjacent to Sisters High School, will soon expand its operations from two days a week to four days a week, thanks to a partnership between Mosaic Community Health, St. Charles Health System and Deschutes County. On Oct. 18, Mosaic will assume operations of the health center, which is currently operated by St. Charles Health System, in a building owned by Deschutes County. 

“We are thrilled to be able to provide additional access to pediatric patients in Sisters by offering expanded hours for the health center,” said Tamarra Harris, pediatrics manager for Mosaic. “In addition to a pediatric-trained medical provider, we also plan to have a full-time behavioral health consultant on site. We want to thank our community partners, St. Charles and Deschutes County, for supporting this transition, which will benefit our community.” 

Under Mosaic, which operates six additional SBHCs throughout Central Oregon, the health center will provide a pediatric-trained medical provider, a full-time behavioral health consultant, a community health worker, plus clinical pharmacy, Oregon Health Plan enrollment and nutritionist support. Deschutes County Behavioral Health staff will also be located on site.

“We believe this transition will benefit the Sisters community and shows the exceptional partnership the medical community has in Central Oregon,” said Emily Salmon, vice president for whole person care and community health at St. Charles. “Ultimately, our goal is to provide the best access possible to medical care in our community and, in this case, that means transitioning the clinic to Mosaic, which has access to federal funding to expand services.”

Since 2015, the Sisters SBHC, located at 535 N. Reed St. in Sisters, has been providing convenient access to quality healthcare for local pediatric patients—one of the primary goals of SBHCs, according to the Oregon Health Authority. Other goals for SBHCs include:

• Providing patient-centered care for all students, regardless of insurance status
• Reducing costs related to unnecessary hospital stays and use of emergency rooms
• Improving education outcomes—because healthy kids learn better
• Saving parents time by reducing hours of missed work to transport children to appointments

Utilizing unique public-private partnerships, SBHCs have been operating in the state of Oregon since 1986. There are currently 85 certified SBHCs across Oregon. Mosaic and their school district and county health partners currently operate six of those in Central Oregon, including at Bend High, Mountain View High, Madras High, Redmond High, Lynch Elementary and Crook Kids in Prineville. La Pine Community Health Center operates one SBHC in La Pine.

“School-Based Health Centers provide a great service within Deschutes County, helping eliminate barriers for our youngest residents to receive health care. Together, Mosaic and St. Charles are helping to create a healthier Central Oregon and we applaud our continued partnerships,” said Holly Harris, Deschutes County behavioral health director. 

In addition to medical and behavioral health care, providers at Mosaic SBHCs emphasize prevention, early intervention, risk reduction and the development of healthy habits with their young patients. Mosaic SBHCs are open to anyone from birth through age 18; patients do not need to be a student at the school where the SBHC is located. 

“We appreciate St. Charles, Deschutes County Health Services and all of our local partners for working together with us to improve the health of everyone in Central Oregon,” said Elaine Knobbs-Seasholtz, Mosaic director of strategy and development. 

Grand Rounds - September 8, 2023
"Psychosis and Comorbid Substance Use Disorder: Dual Diagnosis"

Speaker: Joseph M. Pierre, MD. Health Sciences Clinical Professor, Department of Psychiatry and Behavioral Sciences, UCSF School of Medicine.

Objectives

1. Identify rates of comorbidity between psychotic disorders like schizophrenia and substance use disorders.
2. Identify illicit drugs that can cause psychosis.
3. Describe evidence-based components of dual diagnosis treatment programs.

Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)^TM.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].

Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].

Enduring Materials - Sept 6, 2023
"Gender Affirming Care: Treatment, Care, and Services"

Speaker: Kerry Gillette, PA. Mosaic Community Health.

Objectives

1. Differentiate gender-affirming care and trans-inclusive healthcare across a wide spectrum of provider types, including primary, Behavioral, pharmacy and dental providers.
2. Illustrate the many diverse pathways of gender-affirming care for trans and non-binary patients/clients.
3. Recognize and manage personal and potential implicit bias to help reduce healthcare inequities.
4. Report Oregon specific data and trends of suicide within LGTBQ+ population.
5. Utilize WPATH criteria tool to help identify gender dysphoria.
6. Select treatment options that supports patients care plan such as common HRT, risk/side effects, labs, monitoring, and follow-up care.
7. Address special considerations for the Pediatric population.
8. Provide additional resources, references in and around Central Oregon.
9. Address provider-specific concerns about gender-affirming and trans-inclusive care.

Accreditation: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of St. Charles Health System and Mosaic Medical. St. Charles Health System is accredited by the ACCME to provide continuing medical education for physicians. St. Charles Health System designates this live virtual activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected]. 

Grand Rounds - September 1, 2023
"Mobility is Medicine"

Speakers: Kelly Plunkett, MSN, RN, CCRN, Timothy Preston, DO, Theresa Kramer, Lisa Rodriguez. St. Charles Health System

Objectives

1. Describe the theories behind MIM.
2. Practice the paradigm shift; every patient moves unless there is a clinical reason for bedrest.
3. Employ mobility approach in interdisciplinary teams to improve patient outcomes .

Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)^TM.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].

Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].

At St. Charles, one of my responsibilities as president and CEO is to keep our community informed about health care services, access to care and other topics that could impact local residents. That’s why we recently shared the news that St. Charles is reevaluating its participation in all Medicare Advantage plans, which are operated by private insurance companies and are different from traditional Medicare, which is funded and operated by the federal government.

To hopefully alleviate some of the concerns that have been raised, I’d like to share a few facts about why we are evaluating our participation in Medicare Advantage plans and where we are in our negotiations.

Please know that all of us at St. Charles are listening and we understand your concerns about possibly having to change plans or incurring increased costs. We take these concerns seriously and are certainly weighing potential impacts on community members in our decision-making. But we have also seen and felt for years the impact of not publicly acknowledging these problems, and the burden often lands on the shoulders of our sickest patients and our caregivers.

Every day, I hear stories of Medicare Advantage patients who have trouble getting the care they need. Recently, a patient in the St. Charles Cancer Center was diagnosed with prostate cancer. As a routine next step, the treating physician ordered a PET scan to see if the cancer had spread. It was denied by the patient’s Medicare Advantage plan. The patient had to wait and wonder if the cancer was spreading while three different physicians ordered the test and all three times it was denied, even though it is nationally accepted best practice care for this type of case. Eventually, the scan was approved.

As a physician, I have firsthand knowledge of how delays in care can impact a patient both emotionally and physically. I started out in my career when managed care plans were just coming into existence. I’m struck now by how dramatically the administrative burden has piled up on the backs of my colleagues, our caregivers and our patients since those early days.

It is increasingly clear that Medicare Advantage plans do a pretty good job of providing coverage for outpatient visits and procedures, and some plan members rave about their experience. For patients sick enough to need hospitalization or high levels of specialty care, however, the plans too often fall short. Patients on Medicare Advantage plans frequently end up staying in the hospital longer than traditional Medicare patients. In many cases, these patients also wait longer for approval of necessary care and experience a high rate of denials for care that has already happened.

From my perspective, it’s important for people to understand that we do not believe the current system under Medicare Advantage is working effectively for the interests of all patients.

We, like many other health care organizations across the nation, are asking insurance providers to do better through ongoing contract negotiations. Here is where we stand today:

• St. Charles Health System is currently in contract negotiations with four Medicare Advantage plans.
• Contract negotiations between health care providers and insurance companies are routine.
• We are asking for proposals that address our concerns about delays in patient care, denials for treatments that have already been provided and administrative burdens on our care teams.
• Since our recent announcement, we are pleased to share that some insurers have responded with their intention to continue negotiating. We believe some are willing to work with us to find creative solutions to these complex problems.
• Regardless of where we land in negotiations, we anticipate St. Charles will continue participating in some Medicare Advantage plans in Central Oregon in 2024.
• We want people to be aware that these negotiations are taking place so they have plenty of time to research options and consult with insurance experts before the annual open enrollment period for Medicare beings on Oct. 15.

If you have continued concerns, your insurance provider is the best source of information about the plans they will continue to provide to Central Oregonians into the future. We are also committed to providing updates once negotiations are complete.

Sincerely,
Steve

In the hospital, most of a patient's time is spent in bed. And during that time, muscle function can quickly ebb away. That's why movement and mobility are vital to recovery, whether a patient is resting during an extended treatment or recovering from surgery.

But mobility must be maintained in a way that is safe for patients and their providers. That's why St. Charles launched its Mobility is Medicine initiative last year.

"Mobility is part of medicine that you receive in the hospital," said Kelly Plunkett, a nurse manager in St. Charles' Intermediate Care Unit. "That's just as important as the pills and the treatment that you're getting here."

Inspired by a Johns Hopkins Medicine conference about mobility in hospitals, Plunkett and the health system’s injury prevention coordinator, Theresa Kramer, started infusing St. Charles with best practices for safe mobility in the spring of 2022. These practices center around preventing falls, decreasing pressure injuries in patients, and teaching providers how to aid patients' mobility without injuring themselves. (For example, if a nurse lifts a patient without the proper equipment, they can hurt their back.)

Made possible by several generous grants from the St. Charles Foundation, Plunkett and Kramer have secured numerous equipment upgrades that make movement safer and easier, such as bed slings.

“A lot of people think of a hospital stay as bedrest,” Kramer said, “but if you come to stay at St. Charles, you will be asked to move in a way that is safe for you.”

Across the organization, more than 600 nurses have been trained in safe mobility practices so far. In addition to training, the program also introduced a new bedside mobility assessment tool nurses can use to determine patients' mobility needs and the best ways to meet them.

Movement is a vital part of preventing secondary debilities that arise from patients spending more than 97% of their hospital time in bed, Kramer said.

"One of the themes we have been training is, 'Has my patient had their mobility medicine at least three times today?'" she said. "We’re trying to consciously put it in everybody's brain that there is an actual prescription for mobility so they get that it's just as important as a medication."

In the best-case scenario, mobility as medicine might be a patient getting up to walk three times in a day. But that isn't always possible, particularly if a person has suffered an extreme injury or trauma to the spine. In that case, providers may need to manually move patients' limbs to maintain muscles and promote blood flow.

While the training phase of the initiative recently wrapped up, it was just the beginning of the work, Plunkett said. In the coming months, the team will have enough preliminary data to track how effectively the program reduces patient and caregiver harm. Anecdotally, it seems to be making a dent in nurse injuries – a promising trend, given that health care workers are five times more likely to get hurt on the job than other professions.

"If we can get somebody assessed at the beginning and get them mobilized to their full potential every single day, that'll help get them out of the hospital sooner," Kramer said. "It's just so important."

Our Acute Care Rehabilitation Services

At St. Charles, we offer a comprehensive range of acute care rehabilitation services designed to support patients recovering from surgeries, injuries and acute medical conditions. Our expert team of rehabilitation specialists collaborates closely with medical professionals to create individualized treatment plans that align with your medical needs, recovery goals and timeline.

Our acute care rehabilitation services include:

Physical Rehabilitation: Our expert physical therapists are skilled in helping patients regain strength, mobility, and function after a medical event or surgery.

Occupational Rehabilitation: Our occupational therapists focus on equipping you with the skills and techniques needed to perform daily activities independently.

Speech and Swallowing Therapy: Our speech-language pathologists assist patients in recovering speech and swallowing abilities after stroke, surgery, or other medical conditions.

Neurorehabilitation: For patients with neurological conditions, our neurorehabilitation programs are designed to promote neurological recovery and improve quality of life.

Why Choose St. Charles for Acute Care Rehabilitation?

Specialized Care: Our team specializes in acute care rehabilitation, ensuring that you receive the most effective and targeted treatment for your condition.

Collaboration: We work closely with your medical team to ensure a seamless continuum of care, from acute treatment to rehabilitation.

Patient-Centered Approach: Your unique needs and goals are at the center of our rehabilitation programs. We create personalized treatment plans to maximize your recovery potential.

State-of-the-Art Facilities: Our modern facilities are equipped with the latest technology and equipment to support your rehabilitation journey.

Start Your Journey to Healing Today

Recovery is possible, even in the face of acute medical challenges. Begin your journey to healing and restoration with the compassionate and expert care provided by St. Charles Health System. Contact us today to schedule a consultation and take the first step toward a brighter, healthier future.

Welcome to St. Charles Outpatient Rehabilitation, where we are dedicated to helping you achieve a full and active life through our comprehensive outpatient rehabilitation services. Whether you're recovering from surgery, managing a chronic condition, or seeking support to regain your mobility and independence, our team of experienced therapists is here to guide you on your journey to recovery.

Our Outpatient Rehabilitation Services

At St. Charles, we offer a wide range of outpatient rehabilitation services designed to address your unique needs. Our highly trained and compassionate therapists work closely with you to create personalized treatment plans, ensuring that your path to recovery is tailored to your specific goals and requirements.

Our outpatient rehabilitation services include:

Physical Therapy: Our physical therapists are experts in helping you regain strength, flexibility, and mobility, whether you're recovering from surgery or managing a musculoskeletal condition.

Occupational Therapy: Our occupational therapists focus on improving your ability to perform daily activities, enhancing your independence and quality of life.

Speech-Language Pathology: Our speech-language pathologists help individuals of all ages overcome communication and swallowing challenges.

Why Choose St. Charles Outpatient Rehab?

Expertise: Our team of therapists comprises experts in their respective fields, ensuring that you receive the highest standard of care.

Personalized Care: We understand that every patient is unique. That's why we create customized treatment plans to meet your individual needs and goals.

Convenience: Our outpatient services allow you to receive care without the need for an overnight hospital stay, making it more convenient for you to fit therapy into your schedule.

Compassionate Support: We are committed to not only treating your physical symptoms but also providing emotional support throughout your rehabilitation journey.

Get Started Today

Your path to recovery begins at St. Charles Outpatient Rehab. Contact us today to schedule an appointment with one of our experienced therapists and take the first step towards a healthier, more active life. We look forward to partnering with you on your journey to wellness.

Andy Davidson

Andy Davidson, president of Gallagher Healthcare, joined the board in 2023, bringing with him three decades of experience working with leaders from community hospitals, health systems, physician practices, payers, and health care technology companies.

From 2005 to 2019, Davidson served as president and CEO of the Oregon Association of Hospitals and Health Systems. He was also a founding board member of the Oregon Health Leadership Council and the Oregon Health Network, and he recently completed 12 years on the board of Central City Concern, one of Oregon’s largest Federally Qualified Health Centers and providers of low-income housing.

Davidson earned his degree in English literature from the University of New Hampshire and participated in the first Executive Leadership Program on Healthcare Policy and Reform at Harvard University’s Kennedy School of Government.

Reason for service: “St. Charles exists to serve our patients and we have an obligation to consistently strive to meet them where they are. I see the work of the board and the health system as an extension of the communities we serve.”