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System Overview & Contacts
University of Utah Health
System Overview:
Contacts: Research Lead
Dominik Ose – Dr PH, MPH, Research Assistant Professor
dominik.ose@hsc.utah.edu  801-581-7564
Clinical Lead
Nadia Cobb – PA-C, Phd, Associate Professor (PA)
nadia.m.cobb@utah.edu 801-703-8084
QI Lead
Susan Pohl – Associate Professor (MD)
Susan.Pohl@hsc.utah.edu 801-652-8310
IT Analytics Lead
Jonathan Godfrey
Business Analyst
Jonathan.Godfrey@hsc.utah.edu
Dan Clawson
Associate IT Director
dan.clawson@utah.edu  801-581-????
Clinic Contacts Sugarhouse: Bern Kiraly, bernadette.kiraly@utah.edu
Jennifer Leiser, Jennifer.Leiser@hsc.utah.edu
Madsen: Susan Pohl, susan.pohl@hrc.utah.edu
Centerville: Charles White, chas.white@hrc.utah.edu
Farmington: David Anisman, David.Anisman@hsc.utah.edu
Liaison Consultants Primary: Mark Stephens, mark.r.stephens@comcast.net 425-970-3170
Secondary: Leigh Mathias, Leigh_Mathias@abtassoc.com 904-993-9905
How do you characterize your systems ownership? An academic medical center
Number of primary care clinics in your system? 1,400 physicians; 5,000 other health professionals
Number of clinician employees in your system? How many FTE? 50 physicians; 150 other health professionals, ???
Number of Primary Care clinician employees in your system? How many FTE?
Number of primary care providers with buprenorphine waivers? 10
Please describe the clinics participating in the CDC Opioid QI Collaborative. The University of Utah Community Clinics (CC) are a network of twelve multidisciplinary primary care practices with diverse patient populations, settings, and organizational cultures. As outpatient community practices, the individual clinics are conveniently located to serve their patient populations. All clinics have equivalent facilities and resources and have been part of a Practice Based Research Network for many years. They are accustomed to participating in and assisting with research projects involving their patients, personnel, and facilities. Out of these twelve practices, three are academic clinical training sites for family physicians and physician assistants. These are Madsen, Sugarhouse, and Centerville. All the clinics use the EPIC electronic medical record (EMR) for patient registration, billing, and medical records. The Madsen Family Practice is located near the University of Utah Hospital in Salt Lake City. The clinic offers a variety of health care services including acute care, immunizations, integrative medicine, management of chronic illness, preventive care, and screening tests. The clinic has providers specializing in sports medicine, family medicine, behavioral health, nutrition, and women’s health. The Sugarhouse Family Practice is located in Sugarhouse, an urban neighborhood in Salt Lake City. The clinic provides treatment and care in family medicine, nutrition, behavioral health, sports medicine, and women’s health. Caring for LGBTQ (Lesbian, Gay, Bisexual, Transgender, and Queer) patients is an important focus of this clinic. The Centerville Health Center serves the communities of Davis County. It provides family medicine services, obstetrics, fertility, urgent care, pharmacy, and women’s health services. As of January 2019, a total of 56 providers work in these three academic clinical training sites. The provider workforce includes 19 physicians, 9 advanced practice clinicians, 26 family medicine residents, and 2 family medicine sports fellows. At each site, the providers are supported by an interprofessional care team, which includes 5 care managers, 42 medical assistants, 7 behavioral health specialist, and 13 administrative staff. Madsen and Sugarhouse Family Practices are located in Salt Lake City, UT. The city has a population of 191K people with a median age of 31.8 and a median household income of $50K. The population of Salt Lake City is 65.0% White, 21.6% Hispanic, and 5.6% Asian (18). Compared to the general population, the clinic population we serve is markedly older and comprises more white or Caucasian people. At the Sugarhouse Family Practice, the population is 82.7% white, with a mean age of 46.0. At the Madsen Family Practice, the population is 83.4% white, with a median age of 47.9. Various social determinants of health create vulnerabilities in our patient population. At Sugarhouse, 9.1% of patients are insured by Medicaid and 24.8% by Medicare, many of whom live alone (41.4%). About 27% of patients have a mental health diagnosis, averaging 3.0 different diagnoses. Sugarhouse operates 300 business days per year, and every day 12.5 patients with a mental health diagnosis (including 2.1 with SUD) were seen in 2018. The Sugarhouse clinic cares for a large populations of LGBTQ patients, who have associated higher risks of mental health and SUD diagnoses (19). In 2018, 693 patient visits were for transgender care. University Health undertook a concerted outreach effort to the LGBTQ community to develop our program of care. Madsen clinic patients also display distinctive vulnerabilities. The median age is higher than Sugarhouse, at 47.9 years. The practice sees increased numbers of female patients, at 66.6%. While most are white and fewer live alone (30.3%) than at Sugarhouse, a larger number are on Medicare (26%) compared to Sugarhouse (24.8%). Madsen sees fewer Medicaid patients (3.7%) than Sugarhouse (9.3%). While Sugarhouse sees more patients for transgender care than Madsen, Madsen sees a significantly higher number of patients with mental health diagnoses (22.85 visits per day). Madsen’s overall load of patients with mental health diagnosis is 28.4 % and 6,855 patients, compared to Sugarhouses’s 26.8 % and 3,744 patients total. Though the percentage isn’t radically different, the actual number of mental health patients at Madsen is almost double that of Sugarhouse. Further, Madsen deals with a larger number of patients with substance abuse diagnosis at 1,374 (Sugarhouse = 637) and sees 4.6 such patients per day. The Centerville clinic is a young practice with 8,420 patients. It is expected to grow to the level of Sugarhouse and Madsen in the next two years. Centerville, UT is located in the Ogden-Clearfield Metropolitan Statistical area, approximately 14 miles north of Salt Lake City. In the 2010 census, the population was 15,335. The median age of the city was 33.7, significantly above Salt Lake City’s 31.8. The racial demographics differ significantly from Salt Lake City: Centerville is 92.4% White, 4.7% Hispanic or Latino, Asian 1.1% and African American 0.5%. While the number of Hispanic or Latino patients is currently low, the clinic is geographically close to a Latino urban community. We have added a Latina physician from the community, with future hires of Spanish-speaking physicians and staff in process. Data on Centerville clinic shows a disproportionately female client base, at 60.7%. The mean age is younger than Sugarhouse and Madsen at 39.5 years. This clinic has the highest proportion of Caucasian patients, at 86.6%. A relatively high number of these patients live alone, at 38.8%, and the numbers of Medicare and Medicaid recipients are also relatively high, at 19.2% (Medicare) and 8% (Medicaid). Data does show fewer patients overall with mental health issues (12.9% ), and fewer mental health patients per day (3.63), compared to our other clinics. This clinic sees the fewest substance abuse patients, at 0.4%. Centerville’s rate of visits for transgender care is slightly higher than Salt Lake’s Madsen clinic, at 36 visits per year. Our transgender practice has been built by outreach to patients in Davis County and more rural areas who cannot commute to Salt Lake City for transgender medical care.
Is behavioral health integrated into your primary care clinics? If so, please describe. In our primary care clinics IBH has been continuously advanced over the last years. Today, in all of our clinic behavioral health specialists (BHS) and primary care providers are co-located in the same facility. The close distance makes referrals easier for our patients, although the number of referrals vary by the individual provider. Overall, our BHS’s are part of a larger team, but the collaboration is not well defined, leaving most decisions about patient care to the provider. In the framework for levels of integrated healthcare, this situation is described as Level 3. With the planned advancements during this project, we are aiming to reach Level 6 of the framework for levels of integrated healthcare.
Are other clinical services integrated into your primary care clinics (e.g. PT, pharmacy, social work)? If so, please describe. Social workers are part of the care team in each community clinic. PharmD are part of the team in the Madsen Primary Care Clinic and the Sugarhouse Primary Care Clinic.
Please briefly describe your system’s current/past opioid QI efforts. We received a grant in March 2018 from the State of Utah Division of Substance Abuse and Mental health to implement SBIRT. Within this grant, the screening process, brief interventions and referral procedures have been developed. We have completed the technical infrastructure, procedure and materials, and have piloted SBIRT screening in 3 of our primary care clinics. Additional work is needed to review and improve the initial SBIRT implementation. Additionally, a guideline for opioid use and the treatment of chronic pain has been implemented three years ago. Gladly, we can provide a copy.
Please briefly describe your primary care clinics current/past QI efforts. As part of the University of Utah Health System, a broad range of quality improvement activities have been implemented over the years. If you are interested more in details, we can provide more information as needed.