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University of Vermont

ScholarWorks @ UVM

Family Medicine Clerkship Student Projects Larner College of Medicine

2019

An exploration of the benefits and challenges

associated with introducing point-of-care

ultrasound to a rural primary care setting

Daniel Bak

University of Vermont

Follow this and additional works at:https://scholarworks.uvm.edu/fmclerk

Part of theFamily Medicine Commons,Medical Education Commons, and thePrimary Care Commons

This Book is brought to you for free and open access by the Larner College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion in Family Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contact

donna.omalley@uvm.edu.

Recommended Citation

Bak, Daniel, "An exploration of the benefits and challenges associated with introducing point-of-care ultrasound to a rural primary care setting" (2019). Family Medicine Clerkship Student Projects. 463.

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An exploration of the benefits and challenges associated with

introducing point-of-care ultrasound to a rural primary care

setting

DAN I E L BAK

M A RCH - A PR IL , 2 0 1 9

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Problem Identification

Castleton Family Health Center (CFHC) serves the western portion

of Rutland County, which is designated as both rural and medically

underserved by the Health Resources & Services Administration.

The 2018-2020 Rutland regional Community Health Needs

Assessment set goals to increase primary care visits, decrease

inappropriate utilization of the emergency department, and work

towards seamless care transitions without loss of information or

gaps in care.

Additionally, the Vermont Department of Health (Rutland region)

identified both transportation limitations and a shortage of

medical specialists as significant barriers to accessing care in the

region.

Point-of-care ultrasound (POCUS) may serve to improve the quality

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Cost Considerations

CFHC is a Federally Qualified Health Center

which receives an annual budget and bills

a flat rate for each patient encounter

Ultrasound machines range in price from

$2,000-$45,000

POCUS intensive training courses may cost $1,495

per provider to attend

POCUS may lead to fewer out-of-office referrals, resulting in fewer patient visits and

decreased cost-to-patient

An FQHC can reimburse at a higher rate if it meets certain quality

metrics

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Community Perspective and Support for

Project

Renee Bousquet

Rutland Regional Director of the Vermont Department of Health

Renee explained that both transportation and a shortage of medical specialists in the Rutland area

represented significant barriers to care. She also expressed that improving continuity of care was an ongoing

goal.

Jennifer Hanson, MD

Third year family medicine resident training in rural medicine, originally from the Castleton area and

returning to CFHC after residency

Dr. Hanson explained that POCUS is an emerging trend in primary care that makes providers more confident in

their clinical decisions. She explained how it is particularly useful in triage, and why this is important at CFHC

given its many high acuity patients. Dr. Hanson hopes ultrasound will be part of her practice.

Cat Cota

Castleton Family Health Center Practice Manager

As an expert on the FQHC healthcare model, Cat explained the “determination of need” process, existing

incentives and budgetary constraints. She also outlined the structure of the Community Health Centers of the

Rutland Region.

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Intervention and Methodology

Interview

Interview local community health experts, family medicine doctors who are aware of emerging trends in primary care, and business experts who are experienced in FQHC budgeting and

reimbursement

Explore

Explore the utility, cost, and logistics of introducing POCUS to CFHC

Report

Prepare a report for Castleton Family Health Center summarizing findings

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Response Data

POCUS has the potential to:

Streamline care by decreasing time to diagnosis

Refine clinical decision making

Increase provider confidence and patient satisfaction

As POCUS grows in popularity, provider training is becoming more readily available and

machines are becoming more affordable. However, there is significant cost associated with the

implementation of POCUS which is uniquely challenging in an FQHC setting.

The utility of POCUS continues to expand, suggesting that it may represent the future of

diagnostic medicine. Continued quality improvements at CFHC would ensure that the greater

Castleton area continues to receive exceptional medical care.

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Evaluation of Effectiveness and

Limitations

This project seeks to inform Castleton Family Health Center of the benefits and challenges

associated with POCUS. If CFHC implements POCUS, then a study assessing efficacy would be

appropriate.

A two pronged study comparing relevant quality of care measures (time to diagnosis of new

problems, number of out-of-office referrals, provider confidence in triage, patient satisfaction,

cost to patient, etc.) before and after introduction of POCUS would assess the effect of the

technology.

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Future Work

If POCUS is successfully implemented in Castleton, and shown to benefit the practice, POCUS

could then be introduced to other practices within the Community Health Centers of Rutland

Region.

Piloting POCUS at CFHC would allow CHCRR to explore the functionality of the technology,

identify challenges, and develop solutions before expanding the technology to the remainder of

its seven practices.

A small scale introduction would address the real-world utility and cost of ultrasound, while

mitigating financial risk.

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References

Bhagra, A., Tierney, D. M., Sekiguchi, H., & Soni, N. J. (2016, December). Point-of-care ultrasonography for primary care physicians and general internists. In Mayo Clinic Proceedings (Vol. 91, No. 12, pp. 1811-1827). Elsevier.

Health Resources & Services Administration. Medically Underserved Areas/Populations. Data.HRSA.gov

Kelly, C. E. (2004). Evaluation of voiding dysfunction and measurement of bladder volume. Reviews in urology, 6(Suppl 1), S32.

Rutland County Map. National Atlas. Retrieved 4/22/19 from Nationalmap.gov

Rural Health Information Hub. Small Health Care Provider Quality Improvement Grant Program. Accessed 4/22/19 at https://www.ruralhealthinfo.org/funding/1222

Rutland Regional Medical Center. Community Health Needs Assessment 2018-2020. Retrieved 4/10/19 from https://www.rrmc.org/app/files/public/2544/2018-Community-Health-Needs-Assessment-Report.pdf

Smallwood, N., & Dachsel, M. (2018). Point-of-care ultrasound (POCUS): unnecessary gadgetry or evidence-based medicine?. Clinical Medicine, 18(3), 219-224.

U.S. Preventative Services Task Force. Abdominal Aortic Aneurysm: Screening. Accessed 4/22/19 from:

https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/abdominal-aortic-aneurysm-screening

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Interview Consents

Thank you for agreeing to be interviewed. This project is a requirement for the Family Medicine clerkship. It will be stored on the Dana Library ScholarWorks website. Your name will be attached to your interview and you may be cited directly or indirectly in subsequent unpublished or published work. The interviewer affirms that he/she has explained the nature and purpose of this project. The interviewee affirms that he/she has consented to this interview.

Consented _X___ Name: _Jenifer Hanson, MD_______________________

Did NOT Consent_____ Name: ________________________________________

Consented _X___ Name: _ Cat Cota_______________________________

Did NOT Consent_____ Name: ________________________________________

Consented _X___ Name: _Renee Bousquet_________________________

References

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