Enduring Materials - March 1, 2024      
"Addressing Firearm Safety with Patients at Risk of Suicide"

Speaker: Christopher Wolsko, PhD, Elizabeth Marino.

Access the Course Materials

Objectives

1. Recognize key elements of rural culture that impact conversations about firearms.
2. Identify communication skills to use when speaking with patients at risk of suicide about firearm safety.
3. Create a suicide prevention safety plan specific to firearms.
4. Identify skills specific to working with a patient who becomes defensive.
5. Identify actions steps when a patient becomes hostile and won’t engage with the provider.
6. Understanding the contributions to suicide risk.
7. Awareness of emerging trends in suicide risk and prevention.

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 OSU. 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.

Starting July 26, 2024, the course is approved to meet Oregon Health Authority Cultural Competence Continuing Education (CCCE) training requirements for the following groups: Chiropractor, Counselor/Therapist, Dietitian, Emergency Medical Service Provider, Home Care Worker, Long Term Care Administrator, Massage Therapist, Midwife, Naturopathic Doctor, Nurse, Occupational Therapist, Pharmacist, Physical Therapist, Physician, Psychologist, Social Worker, Speech-Language Pathologist/Audiologist

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]. 

St. Charles has relocated its high-risk breast cancer clinic into the St. Charles Cancer Center, a move caregivers believe will help them identify more people at increased risk for developing cancer and give those people the tools they need to reduce their risk.

The clinic – a partnership between St. Charles and Central Oregon Radiology Associates (CORA) since 2015 – was previously located in CORA’s facility on the east side of Bend. Last year, when the CORA-employed provider who staffed the clinic retired, the decision was made to move the clinic into the Cancer Center and staff it with a St. Charles-employed provider.

That provider, Stephanie Henderson, started working in January and the clinic is now seeing patients.

“Because we were already collaborating closely with CORA, it made sense for us to bring it in-house,” said Dr. Linyee Chang, senior medical director of Cancer Services for St. Charles. “It’s important for our cancer program to provide this service as it allows our comprehensive breast program to encompass the full spectrum of breast care.”

On the surface, the move simply means that patients of the clinic will go to a different location for their appointments – crossing Neff Road from CORA to the Cancer Center. But bringing the clinic into the Cancer Center and under health system administration will also improve the care provided, both now and in the future, Chang said.

In addition to enjoying streamlined policies and procedures, the provider will have more options in terms of ordering MRI scans or ultrasounds than they would at CORA because of rules against self-referral, Chang said. Also, the move will bring the clinic into closer alignment with St. Charles’ existing menu of high-risk assessment and risk-reduction strategies.

Women identified to have greater than a 20% lifetime risk for developing breast cancer are considered at high risk. If they visit the clinic, they’ll receive general education about breast cancer, learn how to reduce their risk, discuss potential treatments, develop a personalized plan for surveillance and complete a familial risk questionnaire to identify whether they may benefit from a comprehensive genetic assessment.

The Cancer Center’s genetic counselor, Brigitte Cronier, said she expects to see an uptick in patients who come to her from the high-risk breast clinic now that it’s at St. Charles.

“Genetic counseling is a big part of risk assessment, and many of the people we meet are going to be candidates for it,” she said. “At the same time, there will be plenty of people we follow for high risk because of some other factor and not because of a genetic test result. Ultimately, we just want to capture as many high-risk people as possible and make sure they know what they can do to try to stay healthy.”

Jessica Keegan is the prevention and high-risk coordinator for the Cancer Center. She said the comprehensive screening process is designed to guide people into the program that’s right for them.

“When people come to me, I’m going through and building out pedigrees with them to really look and see where they are going to be best served,” she said. “That may be genetic counseling or it may be a more frequent screening regimen. We’re looking to make sure we are giving them the best possible resources.”

Last but certainly not least, Chang and her team see the breast cancer clinic as a next step on the path to a more robust high-risk cancer program at St. Charles.

“This is just the start. We want to have high-risk lung care, high-risk prostate care, high-risk colorectal care – we’ll be identifying those and rolling out comparable programs to this one,” Chang said.

“This clinic will serve as a sort of model for how we take care of people who are at higher risk for cancer and empower them to take control of their risk and their health,” she continued. “We’re here not just to take care of people who have cancer, but to help them never develop cancer at all.”

For more information or to schedule a consultation with the high-risk breast cancer clinic, call Jessica Keegan at 541-706-6729.

Above: St. Charles caregiver Jake Fries stands in front of his new home in Bend.

In March 2023, Jake Fries was reading the news when he spotted an advertisement for a new housing community in Bend called Rooted at Poplar. The concept: Seven 1,300-square-foot homes on the south end of town, with four of them prioritized for local workers thanks to partnerships between a developer, Rooted Homes, and local employers and organizations.

A year later, nearly half of the Rooted at Poplar’s residents are St. Charles caregivers, including Fries, a 29-year-old surgical tech in the Bend operating room.

“I can finally afford to live in my own place,” Fries says. “It’s changed everything.”

Like many local workers, Fries had trouble finding affordable housing in Bend, where the median price of a single-family home reached $800,000 last summer. It’s an issue that has contributed to workforce shortages at St. Charles, which is why the health system partnered last year with Rooted Homes, a nonprofit whose mission is to make buying a home more affordable.

“At St. Charles, we not only care about our people, we also depend on them to care for the communities we serve. We need great people to be able to live and work in Central Oregon,” said Rebecca Berry, vice president and chief Human Resources officer for St. Charles. “We knew we had to find creative ways to help attract and retain great caregivers.”

Rooted Homes works with a consortium of partners to build high-quality, affordable housing and pay part of the cost for homebuyers. To fund its Poplar project, Rooted Homes tapped a number of local and state organizations, banks, charitable foundations, the City of Bend and the Bend Chamber of Commerce, which secured financial support from some of its members. St. Charles Foundation provided $7,500 to cover closing costs for the three caregivers now living in the community.

“It really was a team effort,” said Berry. “Everyone knows how important it is that Central Oregon remains a place where people can afford to live, and we appreciate the partnership of the Bend Chamber, Rooted Homes and all the other entities involved in making this happen.”

The process starts with an application that places potential buyers in a lottery system, where essential workers and employees of partner organizations (such as St. Charles) are given additional weight made possible through private funds raised by the Bend Chamber. From a pool of around 300 applicants, Fries ended up fifth on the waitlist for a home, eventually landing a spot after another applicant dropped out. From there, the process was similar to buying any other house: loans, escrow, keys, furniture shopping. Fries moved into his new home in February.

“Now I feel like I’m able to build myself and my future family a better future,” he said.

The typical monthly mortgage for the Poplar homes is around $1,650, about 40% lower than average rent prices in the area. And it’s not just the mortgage that’s low — monthly utilities hover around $12. Rooted Homes communities are built with sustainability in mind, featuring solar panels and a net-zero design, said Jackie Keogh, vice president of the company. Residents also receive a free electric bike.

“The goal was that these folks become more long-term residents and, therefore, longer-term employees because they are not impacted by the cost of housing,” Keogh said.

Thanks to continued community support, more homes are on the horizon, including 40 new houses on Bend’s west side.

“It's been a great partnership,” Keogh said, “and we hope to continue it with St. Charles.”

You may have seen recently that St. Charles has been positively recognized by S&P Global Ratings and Moody’s Investors Service, two large and influential credit rating agencies, for the health system’s operating performance turnaround.

As a nonprofit health care organization, we issue bonds to reinvest in our facilities and infrastructure to continue providing high quality, critical care to Central Oregon communities. The affirmed ratings and improved outlooks from the two agencies strengthen the health system’s capacity to borrow additional capital dollars in the future. And it’s nice that others have recognized the improvements we’ve made over the past 18 months, stabilizing our workforce and our finances.

I want to tell you about another sign of stabilization at St. Charles – one that will be more visible to our patients, visitors and caregivers than a credit rating.

Late last year, the St. Charles Board of Directors approved a $74 million plan to fund deferred maintenance, facility improvements, equipment upgrades, growth initiatives and other projects. The total includes $30 million in bond funds for development of the Redmond Cancer Center and $44 million from last year’s earnings for existing needs.

This is another really strong signal that the organization is stabilizing financially. It comes after three years of limited spending on this kind of work across the health system, at first as a cautionary move near the beginning of the COVID-19 pandemic, and then because we simply didn’t have the financial strength to fund a lot of projects.

Now, with an improved financial outlook, the 2024 plan covers a number of facility projects that will be noticeable to patients and the visiting public, as well as equipment and infrastructure upgrades that will make a positive day-to-day impact on St. Charles caregivers. All projects in the plan were prioritized and selected by operational leaders across the system as part of an in-depth planning process.

This is great news, not only for our bottom line and the caregivers who work in our facilities every day, but for the health of the organization as a whole and our ability to continue to provide Central Oregon with excellent care, far into the future.

As always, thanks for reading,
Steve

Postpartum Depression

Postpartum depression (PPD) is more than just the "baby blues." It's a serious mental health condition that affects mothers after childbirth, often characterized by feelings of extreme sadness, anxiety and exhaustion. Unlike the typical fluctuations in mood that many new mothers experience, PPD persists and can significantly interfere with daily life and bonding with the newborn. Symptoms may include overwhelming fatigue, changes in appetite, difficulty sleeping, intense irritability, and a sense of detachment from the baby. It's crucial to recognize that PPD is not a reflection of a mother's ability to care for her child, but rather a biological and psychological response to the immense hormonal changes and new responsibilities of motherhood. With support, understanding and appropriate treatment, mothers can navigate through PPD and emerge stronger, healthier and more connected with their babies.

At St. Charles, we are committed to supporting mothers through their journey into motherhood and recognize the significant and often overlooked challenges that PPD presents. If you feel you're experiencing the effects of postpartum depression, please reach out to your obstetrician or primary care provider for help.

St. Charles Foundation’s annual Saints Gala co-sponsored by Genentech and CORA was a resounding success, raising nearly half a million dollars to enable St. Charles to continue providing world-class health care services. This year’s special appeal focused on the Three Sisters Rural Track Program (RTP), the first graduate level residency program in Central Oregon which will provide training for rural family medicine doctors.

“Watching our community come together from across Central Oregon to support this new program was inspiring and heartwarming,” said Jenny O’Bryan, executive director of the Foundation.

The theme for this year’s event was Puttin’ on the Ritz, with décor and music from the 1920s. The event includes a silent and live auction along with dinner. The Foundation received two significant matching gifts: an anonymous donor gave $50,000 in honor of the Sunriver Wood Chuckers volunteer program and the Bean Foundation from Madras gave $25,000.

Learn more about the RTP program and how it will impact Central Oregonians: Video, Website

About St. Charles Foundation
The mission of St. Charles Foundation is to support St. Charles Health System in the delivery and advancement of world-class health care in Central Oregon and in achieving its strategic goals. St. Charles Foundation works with the community to develop and steward philanthropic resources to fund programs and capital projects that improve health, prevent disease, enhance quality of life and provide the highest quality care possible for all St. Charles patients now and in the future. Learn more about the efforts of St. Charles Foundation: https://foundation.stcharleshealthcare.org/. 

February is American Heart Month, and a great time for everyone to review basic tips to keep their heart healthy. 

St. Charles' team of Heart Failure Nurse Navigators are leading several free classes throughout Central Oregon to share tips during the month of February. The events are all free and open to the community. Attendees at the Heart Health 101 classes will learn how to improve heart health while developing skills to prevent or manage cardiovascular conditions. The class will include information about how the heart works, how to recognize signs of a heart attack, nutrition tips and more. 

Classes take place at the following times and locations:

Feb. 15, Bend Larkspur Community Center noon to 1:30 p.m.

Feb. 15, Sisters Parks and Recreation, noon to 1 p.m.

Feb. 27, La Pine Senior Center 10 a.m. to noon

April 30, La Pine Senior Center 10 a.m. to noon

After several difficult years of COVID-19 pandemic response, staffing shortages and financial challenges, St. Charles Health System’s operating performance turnaround has been recognized positively by two large, influential credit-rating agencies.

S&P Global Ratings revised the organization’s outlook to stable from negative and affirmed its ‘A’ long-term rating assigned to bonds the health system issued in 2016 and 2020 under the Deschutes County Hospital Facilities Authority.

“The outlook revision from negative reflects our view of St. Charles’ meaningful rebound in operating performance and solid days’ cash on hand that have allowed it to withstand operating pressure and recent industry headwinds,” according to S&P Global Ratings.

Moody’s Investors Service revised St. Charles’ outlook to stable from negative and affirmed its ‘A2’ revenue bond rating to reflect the health system’s successful execution of financial turnaround plans.

“(St. Charles’) favorable credit profile is supported by (its) strong market position as the dominant system in central Oregon, its comprehensive array of strong clinical offerings, and its favorable location in a quickly growing, desirable region, which will continue to fuel strong revenue growth,” according to Moody’s.

As a nonprofit health care organization, St. Charles issues bonds to reinvest in its facilities and infrastructure to continue providing high quality, critical care to Central Oregon communities. The affirmed rating and improved outlook strengthen the health system’s capacity to borrow additional capital dollars in the future.

"We have been working incredibly hard for the past 18 months to stabilize the health system and it is nice that others recognize our improvement,” said St. Charles President and CEO Dr. Steve Gordon. “We have stabilized our workforce, stabilized our finances and are now able to lay the groundwork to better meet our region’s growing needs for essential services now and in the future.” 

About St. Charles Health System
St. Charles Health System, Inc., headquartered in Bend, Ore., owns and operates St. Charles Bend, Madras, Prineville and Redmond. It also owns family care clinics in Bend, Madras, Prineville, Redmond, La Pine and Sisters. St. Charles is a private, nonprofit Oregon corporation and is the largest employer in Central Oregon with more than 4,500 caregivers. In addition, there are more than 350 active medical staff members and nearly 200 visiting medical staff members who partner with the health system to provide a wide range of care and service to our communities.

Target audience: Although our educational content is primarily designed for MDs, DOs, and Advanced Practice Providers (APPs), Grand Rounds is open to all individuals with an interest in attending.

Teams link for 2025: (we recommend creating a free teams account for ease of use)

Microsoft Teams Need help?
Join the meeting now
Meeting ID: 279 927 922 198
Passcode: RC9Bf2KT 
Dial in by phone
+1 971-337-0188,,408466018# United States, Portland
Find a local number
Phone conference ID: 408 466 018#

Download Teams | Join on the web

Grand Rounds is on a Summer Break for August. Join us again September 5th!

You can watch past Grand Round recordings for credit! After watching be sure to follow the "claim credit" link to sign in and fill out your eval for credit.

• Portal - Enduring Materials

Interested in presenting at Grand Rounds or have a topic suggestion? Email us at [email protected] 

Maintenance of Certification (MoC)

MOC, or Maintenance of Certification/ Continuous Certification, credits are part of a continuing education process for physicians who are board-certified. The purpose of MOC is to ensure that physicians stay current with the latest medical knowledge and practices throughout their careers.

Here's a brief overview of how MOC credits work for boarded physicians:

1. Requirements: Physicians who are board-certified by organizations like the American Board of Medical Specialties (ABMS) or its member boards must participate in MOC programs to maintain their certification. These requirements typically include continuing medical education (CME), self-assessment, and sometimes participation in quality improvement activities.
2. Credit Categories: MOC credits often fall into several categories, including:
   • Professional Standing: Proof of a valid medical license and a clean record of professional behavior.
   • Medical Knowledge: Participation in CME activities or passing examinations that demonstrate up-to-date knowledge in their specialty.
   • Practice Performance: Engaging in activities that improve the quality of care, such as performance improvement projects or practice audits.
   • Patient Care: Involvement in activities that enhance patient care, such as patient safety or communication skills workshops.
3. Renewal Cycle: MOC requirements are usually part of a multi-year cycle, often spanning 10 years. Physicians must earn a certain number of MOC credits within this cycle to maintain their certification status.
4. Assessment and Documentation: Physicians must keep track of their MOC activities and submit documentation as required by their certifying board. They may also need to pass periodic exams or assessments to demonstrate their continued competency.

Currently, St. Charles CME has collaborations in place with:

American Board of Anesthesiology (ABA)
American Board of Internal Medicine (ABIM)
American Board of Orthopaedic Surgery (ABOS)
American Board of Otolaryngology–Head and Neck Surgery (ABOHNS)
American Board of Pathology (ABPath)
American Board of Pediatrics (ABP)
American Board of Surgery (ABS)
American Board of Thoracic Surgery (ABTS)

A board badge and statement will be present at event that is offering MOC. 
 

To claim MOC at CME activities:

1. Attend the CME event
2. Sign into your EEDS account with the event code and fill out the evaluation. 
3. Mark the box for "claim ____ MOC"
4. Take the post test for MOC credits

5. Make sure your EEDS account has the correct year for your DOB and full name listed on your NPI (this is how the system will find you and send credit info to your board on your behalf)

   Reach out to [email protected] if you need help claiming MOC or need to find options for specific MOC.