Milwaukie Family Medicine 2025

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  Patient Forms in Their Native Written Languages

  Bin Chen and Monica DeMasi

  Problem Statement: Patients who speak languages other than English lack access to forms in their preferred language. Current translation methods (using interpreters) are time-consuming and may influence patient responses. At our clinic in Southeast Portland, approximately half of our visits involve translators for non-English-speaking patients. While we strive to use translators to assist patients with their English forms, this creates a disparity in the care we can provide for the following reasons. Firstly, the in-person translators we employ are part of the same small communities as most of our patients, leading to potential inaccuracies in describing social or sexual health concerns. As a large health system, we should aim for inclusivity and in accommodating patients’ diverse language skills. Written forms in patient’s native language is a good first step toward alleviating the language barrier all our patients face 1. Providing written information in the patient’s native language in addition to translators help with discussion of care can enhance the care received from providers.2 Objectives: Project Objective: How to obtain wellness forms, PHQ-9 and GAD-7 in our top 5 languages and exploring a clinic workflow to ensure these are appropriately given out. Methods: 1. Translate standard adult wellness forms ages 18-64 to written Chinese, Spanish, 2. Vietnamese, and Russian. AI translation services was used instead of Linguava due to the cost of about $200 per page. 3. Obtaining approved PHQ-9 form translations in Chinese, Spanish, Vietnamese, and Russian. Found this on OR Dial. 4. Explore workflow for optimization so that language congruent written forms are given to non-English speakers appropriately. Made protopage that links to Sharepoint 5. documents for all the forms we routinely use in other languages. Results: See Figures in the poster for website created and forms translated. Survey to show staff of this new website showed that having a clinic discussion in about 5 minutes increased awareness by > 40% (see Figure 3 and 4) Discussion/Conclusions/Next Steps: An overview of SE clinic patient population demographics and visit types indicated a potential for making care provided more equitable by having forms in patient’s native language. This is important because studies have shown that having these forms increases response rates3 and quality of information to allow the clinician to provide better care2. It is currently not cost effective for a single clinic such as PMG Southeast to pay for human translation of all the forms regularly used, but preliminary translation with the use of readily available AI translation such as Deep L showed that this technology can be fairly accurate and cost effective. Future Plans: • Consider adding more forms such as patient education documents, pediatric forms, and instructions for FIT tests • Dual language forms for MA interpretation of all the forms • Work with local leadership in getting formal translation of all forms • Consider piloting AI translation for After Visit Summaries • Formalizing a workflow in Southeast for PRRs and medical assistants to find the necessary forms for our patients.

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  Developing a Hospital Medicine Elective for a Family Medicine Residency

  Alissa Kummer and Justin Osborn

  Background: Inpatient medicine is a key area of family medicine training, providing experiences in both triage and management of decompensated illness and building skills in safe transitions back to outpatient care. There is a growing trend of FM-trained physicians providing inpatient care (3-7% growth in some studies), but the training in many FM programs lacks the volume of hospital medicine that is needed for comfort with independent hospital work. Despite our FM residency including more hospital medicine training than many FM programs, and more than required of FM residencies per ACGME guidelines, there were still deficits in our volume of inpatient day coverage and critical care training when compared to two local IM residencies. Purpose: We aimed to design a hospital medicine elective experience that FM residents could take in the PGY2 or PGY3 years to augment the inpatient medicine experiences and help residents gain further proficiency in acute and critical patient care. Design: The elective was designed as a 4-week experience. The residents taking any elective rotations were surveyed in July of the 2024-2025 academic year, and again in February. Setting & Participants: Participants were PGY3 family medicine residents at a small, academic community hospital. Intervention: The 4-week elective implemented during the 2024-2025 academic year included 2 weeks of critical care time, a one-week rotation with a community hospitalist training residents to manage a higher volume of hospitalized patients, and one week focused on training in hospital-based procedures and POCUS. Main outcome measures: Residents evaluated their level of confidence with management of critical care cases, a high hospital census, and selected hospital procedures and POCUS skills at the beginning of the 2024-2025 academic year and in February 2025. Residents taking the hospital medicine elective also completed qualitative evaluations on the elective experience. Results: While the N of this study is underpowered for meaningful quantitative analysis (only two PGY3 residents chose to take this elective in the 2024-2025 academic year), key stakeholder interviews show success with POCUS training in the ED with 1:1 precepting, working directly with hospitalists, and gaining intubation experience with anesthesia providers. Areas for improvement included the ability to rotate at larger medical centers for medical ICU training, timing of hospital rotations to be during high-census seasons, and improvement in procedure training opportunities. Administrative staff gave feedback that the rotation was challenging to schedule given many preceptors and locations. Conclusions: Key learning points in the development of this elective were the challenges of coordinating complex elective experiences with multiple subspecialty partners and ensuring that residents are having high-value learning experiences. Key lessons from the post-elective stakeholder interviews include a need for a simplified schedule structure, improved procedural and ICU experiences, and ensuring residents can rotate in high hospital census seasons (although, this is unpredictable). Next steps are to discuss options for ICU and procedural experiences with program administration and work to develop ties with high-value learning opportunities.

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  Building Climate Resilience in Primary Care by Preparing Patients for Extreme Heat

  Tiffany Nguyen

  Background • Extreme heat is the leading cause of weather-related deaths in the US and extreme heat events are projected to become more frequent and severe with climate change. • Extreme heat can lead to illness or death through exacerbation of chronic illnesses. • Populations at higher risk include older adults, pregnant patients, young children, and those with chronic medical conditions such as cardiovascular disease, lung conditions, substance use, chronic kidney disease, mental health conditions. • It also disproportionately affects marginalized residents and those who face systemic inequities • Access to air conditioning (AC) is a life-saving intervention for preventing heat-related illness and mortality. • Community initiatives, such as the Cooling Portland program, were developed to connect low-income Portland residents with cooling devices. Some insurance plans, such as the Oregon Health Plan, also have a climate benefit that provides coverage of climate devices. However, not all patients are aware of these programs. • Primary care clinics are uniquely positioned to assess patients who are at increased risk for heat-related illness, provide education on safety interventions, and bring awareness about programs offering climate resources. Objectives • Primary Objective: Identify patients with increased risk of heat-related illness to screen for access to air conditioning and offer additional patient information for staying safe during extreme heat. • Secondary Objective: Identify the most effective approach for outreach to high-risk patients. Methods • Epic SlicerDicer was used to help identify patients on my panel who had a medical condition that increased their risk of heat-related illness. The risk factors used in-clude: age over 65 years, history of asthma or COPD, history of CHF, history of CAD, history of substance use disorder. • Data collection: I directly performed outreach to all patients with risk factors either through office visit or phone call throughout the months of February and March in order to provide adequate time to apply and receive an AC device prior to the sum-mer. • During each encounter, patients were screened by asking if they had a working air conditioner and if they wanted additional resources. • Patients who did not have access to AC were then connected to the clinic care coordinator who provided information on which program they would be eligible for based on health insurance. Results • Out of the patients on my panel who had risk factors for heat-related illness, 46% were able to be contacted to screen for access to AC (24.3% during an office visit, 75.7% contacted by phone call). • Out of the patients who were screened, 13.5% reported not having access to AC and 29.7% requested to have additional information about resources sent to them.

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  Implementation and Assessment of a Novel Family Medicine Residency Geriatrics And Palliative Care Selective Curriculum

  Mary Parker and Jessica Valls Burness

  Background: Family medicine physicians are integral to delivering personalized care for elderly patients and those with severe illnesses, who often encounter high symptom burdens, challenging treatment decisions, and end-of-life circumstances. The Geriatrics and Palliative Care Selective at Providence Oregon Family Medicine Residency is de-signed to enhance resident expertise in geriatric care by immersing them in multidisci-plinary settings. Through a blend of ambulatory clinical visits, home visits, and facility engagements, residents provide comprehensive palliative and hospice care. Educational components include practical experiences supplemented by online modules, articles, and videos. Methods: The selective aims to build competencies in several areas: prescribing appro-priate medications considering age-related changes, managing end-of-life symptoms, utilizing screening tools for delirium, dementia, depression, and substance abuse, fos-tering evidence-based practices, improving shared decision-making and patient advoca-cy, promoting professionalism, and enhancing communication skills. Residents engage in home visits, clinic sessions, and nursing home rotations, supported by online educational resources, fostering practical skills in real-world settings. The hypothesis posited that participation in the selective would enhance residents' compe-tency assessments in geriatrics and palliative care. Assessment methods include pre and post surveys for residents and qualitative evaluations after rotations. Results: Results showed residents who participated in the selective reported higher self-reported competency levels in specific geriatrics and palliative care topics. Statistical analysis revealed a significant improvement in confidence, with those having complet-ed the selective scoring an average of 59.4 compared to 47.7 for non-participants, (p-value of 0.0004). Pre and post survey comparisons of all residents indicated improve-ment, with scores increasing from 40.6 to 53.6, (p-value 0.01). Discussion: While the study demonstrated increased comfort and competence in geriat-rics and palliative care for participants, limitations included small sample size, non-randomized groups, and reliance on subjective survey data. The study scored 6 out of 18 on the Medical Education Research Study Quality Instrument (MERSQI), impacted by incomplete response rates and lack of matched survey data. Despite these con-straints, the selective shows promise as a model for enhancing family medicine residen-cy programs' approach to geriatric and palliative care training. Future improvements involve refining assessment methodologies to incorporate objec-tive evaluations, increasing response rates, and integrating randomized sampling to enhance statistical analysis rigor. Addressing these challenges with further study may help us to improve the selective's cultivation of residents' skills navigating geriatric and palliative care complexities.

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  Ambulatory Pediatric Fluoridation

  Kristine Park, Stephanie Rodriguez, Mary Parker, Alissa Kummer, and Daniel Ruegg

  Context: Dental health is an important part of pediatric wellness. Early childhood caries represents the most common childhood chronic health condition. As such, dental health screening and intervention are crucial in primary care. Oral health disparities exist among children from low-income families, low family education status and Black and Hispanic children. These inequities are evidenced in a higher prevalence of cavities, lower treatment rates, and less access to preventative dental care. Fluoride varnish is a simple yet highly effective method of preventing dental decay in children- reducing the incidence of cavities by 30-50%. Americal Academy of Pediatrics recommends applying fluoride every 3-6 months until age 5 for all children, and every 3 months for high-risk children. USPFTF gives this a “B” recommendation. Goal: At PMG Milwaukie, there were 28 opportunities to apply fluoride varnish in September 2024. Only 4 patients received this treatment (14%). The goal of this project is to increase fluoride varnish rates during well child checks (WCC) for children ages 1-5 to 50% by March 31, 2025. Methods: Topical fluoride treatments during routine WCC for children ages 1 until age 6 were initiated through a workflow including clinic providers, medical assistants, and clinic leadership. In this workflow, the lead medical assistant will chart scrub and place the note “fluoride” in office visit notes. The rooming medical assistant will place a fluoride kit and toothbrush in the room, which also acts as a visual cue for the provider. The provider will educate the family on the importance of pediatric fluoride varnish, apply the fluoride varnish during the visit, and complete the billing, documentation, and after care instructions. For this project, the CPT code, documentation dot phrase, and after care instruction dot phrase were made clearly visible at each provider desk. Results: The baseline rate of pediatric fluoride varnish application in the clinic was 14%. PDSA cycles included following an idealized workflow, described above, provider reminders at individual desks including fluoridation coding instructions and dot phrases, a recommitment to the basic workflow after a downturn in rate of fluoridation around the holidays, and finally the most effective intervention; targeted reminders to providers seeing high numbers of children ages 1-5 resulting in a final fluoridation rate of 61%. Discussion: This project highlighted some of the challenges of implementing a new workflow in a busy primary care clinic in addition to obstacles in recommending new treatments and interventions to families. Barriers to providing higher rates of fluoride varnish at WCCs included providers remembering to discuss these recommendations, adequate time to focus on counseling around the importance of pediatric dental fluoride, and parents declining the service. Chart scrubs of the visit notes where fluoride was discussed but not applied highlighted the latter obstacle, as many possible varnish opportunities documented parental refusal. We noticed that the greatest improvement in rates of applying fluoride varnish came with focusing varnish application reminders on those providers in the clinic seeing the highest volume of pediatric patients. This finding also reinforces the small N number of this intervention. The overall goal of meeting a pediatric fluoride varnish application rate of 50% was met. Possible next steps include both improving high pediatric volume providers implementation of these recommendations and working long-term to address familial fluoride varnish hesitancy.

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  Prescription Gardening: A Pilot Group Medical Visit for Spanish-Speaking Patients With Chronic Conditions

  J. Stephanie Rodriguez, Jill Christensen, and Heidi David

  Background Group medical visits (GMVs) have demonstrated benefits for patients with chronic conditions, including diabetes, obesity, and mental health disorders, by fostering peer support, improving health literacy, and enhancing patient engagement (Edelman et al., 2015; Riley et al., 2018). Community-based settings, such as gardens and teaching kitchens, offer additional advantages by promoting hands-on learning, stress reduction, and improved nutrition (Soga et al., 2017; Wolf & Zilverberg, 2018). However, Spanish-speaking patients often face barriers to accessing these services due to language limitations, lack of insurance coverage for certain providers (e.g., dietitians for obesity), and limited availability of bilingual healthcare professionals. This project aimed to assess patient satisfaction, build community, evaluate the financial feasibility of GMVs, and bridge gaps in care for Spanish-speaking patients by providing culturally and linguistically appropriate resources. Objectives • To evaluate the impact of garden-based group medical visits on patient satisfaction, health engagement, and perceived well-being. • To explore the financial and logistical feasibility of implementing GMVs as a sustainable model for primary care. • Assess interest in GMVs among bilingual patients with chronic conditions. • To assess potential collaborations with ancillary health services such as dietitians and community health workers. • Address healthcare gaps for Spanish-speaking patients by providing non-covered services. Methods: Setting: Community garden environment & community teaching kitchen Participants: Spanish-speaking patients with chronic conditions Structure: The GMV was 3 hours and was structured as a Level 3 billable visit with vitals collected at the beginning of the visit and group visits lead by a bilingual physician and a bilingual community health worker and conducted primarily in Spanish. Time was split between two locations the community garden and community kitchen. Participants engaged in multiple activities mindfulness exercises, group discussions on mental health, nutrition, and chronic disease, horticultural therapy, movement activities, and preparation of herbal and floral salves after harvesting. Data Collection: Patient testimonials, qualitative feedback, and provider observation Results • High patient satisfaction, with participants reporting increased confidence in managing chronic conditions and appreciation for culturally relevant care. • Positive community engagement, with participants expressing interest in ongoing GMVs. • Financial feasibility confirmed, as sessions could be billed similarly to in-clinic visits while incorporating services not typically covered by insurance (e.g., dietitian counseling for obesity). • Improved access to care, particularly for marginalized patients who otherwise would not qualify for certain services. • Initial group visit had projected to have 7 patients but due to heat wave patients were rescheduled. At the end of this, there were 3 participants that took part in this pilot group visit.