News From Grace Cottage

What is a Patient-Centered Medical Home?

| Graceful Health

By Elaine Swift, Grace Cottage Family Health Practice Director
as originally appeared in the Brattleboro Reformer’s Graceful Health series May 5, 2017

Sometimes the language used by government agencies obscures the goal. The term “Patient-Centered Medical Home” is like that. People ask me all the time, “What does it mean, and why is it important?” I’d like to explain some of the ways that being a Patient-Centered Medical Home (PCMH) helps Grace Cottage provide the best care for our patients.

First, it’s helpful to know that, while all of the various services offered at Grace Cottage are important, the PCMH designation applies specifically to primary care practices. It is Grace Cottage Family Health, the part of Grace Cottage where patients go for their regular checkups and other primary care needs, that has received the PCMH designation. In fact, Grace Cottage Family Health was recently awarded Level 3 PCMH recognition, the highest level possible.

What does that mean for our patients? The National Committee for Quality Assurance (NCQA) has established five crucial elements that are required in order for a medical practice to become a PCMH. These are:

  1. Patient-Centered Care
  2. Comprehensive Care
  3. Coordinated Care
  4. Accessible Services
  5. Quality and Safety

I’ll explain each of these one by one.

“Patient-centered care” means just what it says. At Grace Cottage, the main focus is always the patient. Countless testimonials have been received to prove that we are fulfilling our vision to be the standard for patient care, and Grace Cottage was recently ranked in the Top 20 in the nation for Patient Satisfaction among the 1,339 Critical Access Hospitals.

Beyond that, in the primary care setting, patient-centered also means partnering with patients and their families, making sure patients are fully informed about their care plans, and supporting patients’ choices about how to approach, manage, and organize their own care.

The easiest way to explain “comprehensive care” is to say that it is a team approach. PCMHs must offer a range of services, including medical and mental health care, prevention and wellness services, acute care, and chronic care. All of these are available at Grace Cottage.

Grace Cottage Family Health uses a team approach and offers a variety of services. Its family medicine, pediatric, geriatric, and mental health providers work together with each other and with the Grace Cottage Community Health Team, a group of professionals offering diabetes education; nutrition, exercise and stress-management coaching; crisis counseling; and care coordination (phone calls and visits with patients to make sure they have the medicines and equipment they need and that they understand their medical providers’ instructions). In addition, a resource advocate links patients to social services and support from other agencies.

“Coordinated care” means that PCMHs work to coordinate a patient’s care, whether it is provided at the PCMH or elsewhere. One way we do that is by helping with referrals and appointments with specialists. Another is by coordinating care among providers at Grace Cottage.

“Accessibility” is another key element for PCMHs. Grace Cottage patients benefit greatly by being able to access a wide range of services at one location.

To increase the accessibility of services, the Grace Cottage Family Health offers same-day appointments when available, for medical needs that are urgent but do not require an emergency department visit. The clinic is open for appointments Monday through Friday, 7:00 a.m. to 5:00 p.m., and until 6:00 p.m. on Tuesdays. When acute care is needed, Grace Cottage Hospital also has an always-open Emergency Department.

Another way that Grace Cottage offers increased access is through the Patient Portal. A patient who has signed up for an account through the Patient Portal can access his or her medical records anywhere there is internet access, so the records can easily be shared during a visit with a provider elsewhere. Grace Cottage’s Patient Portal also allows around-the-clock electronic messaging. Patients can email questions to their providers and be assured of a quick response. (This is not for medical emergencies; for those situations, you should still call 9-1-1.)

“Quality and safety” of patient care have always been of paramount importance at Grace Cottage. This is also required with the PCMH model. Quality initiatives and outreach are important aspects of the PCMH model, and we take these efforts very seriously.

All of this work leads to better coordination of care and better patient experiences and outcomes, while reducing medical care costs. Being a Level 3 PCMH proves we are not only doing the right thing, but doing it very well. We are always accepting new patients into our practice. Call 802-365-4331.

Bio: Elaine Swift, CHC, CPHRM, RHIT, is a Certified Healthcare Compliance Officer, a Certified Professional in Health Risk Management, and a Registered Health Information Technician. She joined the Grace Cottage staff 23 years ago and has served as Health Information and Billing Coordinator, Compliance Manager, and Director of Quality, Compliance, Risk Management, and Credentialing before becoming the Grace Cottage Family Health Practice Director in 2015.  

Alcohol and Your Health

| Graceful Health

By Louise McDevitt, Nurse Practitioner, Grace Cottage Family Health
as originally appeared in the April 21 Brattleboro Reformer Graceful Health column

Let’s start by looking at some common beliefs about alcohol. How would you answer the following questions, true or false? A moderate amount of alcohol each day is good for your health. The United Nations has established a standard portion size for alcoholic drinks that is honored in most countries worldwide. Drinking may decrease the risk of heart attack and strokes. Drinking decreases a woman’s risk for getting breast cancer. Women who are pregnant should not drink.  Wine is better for you than other alcoholic beverages. Your chances of having a car accident are doubled even if your blood alcohol limit is only half the legal limit.

You can find a variety of opinions out there. As a medical provider, I review the scientific evidence. One source that I rely on is www.uptodate.com, which offers detailed articles for medical providers, by subscription, and free articles for the general public. I recommend it.

First, is it healthy to drink a moderate amount of alcohol every day? It depends. Some people should abstain completely, especially those with liver disease, gastritis, esophagitis, pancreatitis, hepatitis C, patients taking sedating medications, and those who identify as alcoholics or who have a strong family tendency of alcoholism.

Second, there is no recommended daily dose of alcohol, nor is there any standard portion size worldwide. One study found that drinks served in the U.S. tend to have nearly twice as much alcohol than those served in Great Britain, most notably when people prepare their own “standard-size” drinks at home.

In the U.S., standard sizes served at restaurants and bars are a 12-ounce beer, a five-ounce glass of wine, or a 1.5-ounce shot of 80-proof liquor. Moderate drinking is defined as one to two drinks a day, or three to nine servings a week, using these standard sizes. Women and those of smaller stature should stick to the lower range.

Next, while it is true that some studies show that moderate amounts of alcohol consumption on a regular basis may lower one’s risk of heart attacks and the type of strokes caused by blockages, they also show that even a minimal amount of alcohol seems to increase the risk of other types of strokes.

Drinking several alcoholic beverages at once can increase the risk of atrial fibrillation (rapid and irregular heart rate), even among those who usually drink moderately. Also, those who regularly consume more than two drinks a day are twice as likely to have high blood pressure, excessive weight, high triglycerides, and high-risk behavior, compared to nondrinkers. Regular drinking above the recommended level cited above can also cause cardiomyopathy (enlarged heart), a serious condition affecting the heart’s ability to pump blood.

Men who drink regularly have an especially increased risk for certain types of cancer. In a large European study, the alcohol-related risk for men and women, respectively, was 44 and 25 percent for upper gastrointestinal cancer, 33 and 18 percent for hepatocellular cancer, and 17 and 4 percent for colorectal cancer. The increased risk was largely found in individuals who drank more than the recommended upper limit.

Regarding breast cancer, studies have consistently shown that it occurs more often in women who drink moderately or heavily. As little as one to two drinks a day appears to increase this risk, and the risk increases with the amount consumed.

Is it safe for a pregnant woman to drink alcohol? Alcohol consumption during pregnancy is common, which highlights the importance of educating women about the potential harms to the developing fetus. Heavy drinking can lead to fetal alcohol syndrome, causing developmental delay and other birth defects. The general consensus is that no amount of alcohol in pregnancy is recommended. My best advice is avoid it.

Wine versus beer? There is no conclusive evidence proving that wine is healthier for you than other alcohol. The so-called “French paradox,” based on the fact that death from chronic heart disease is lower than expected in France, considering the high rate of smoking and the amount of saturated fats in the diet, is often attributed to regular consumption of red wine. Other studies, however, do not support this conclusion, and researchers tend to conclude there is no difference.

How much can you safely drink before driving? Most states, including Vermont, have a legal blood alcohol concentration (BAC) limit of 0.08 percent. However, the risk of having an accident while driving doubles at half that amount, and driving ability is impaired with a BAC as low as 0.02 percent. So the correct answer is: do not drink and drive, fly a plane, operate a snowmobile, ride a bike, operate machinery, tweet, or go on a dating website!

One last idea: the best way to avoid abusing alcohol is by being involved with your community.

Two very significant behavioral studies were done using rats. In the first, a group of rats were separated into different cages, then offered two sources of liquid: regular water and water infused with cocaine. They had nothing else in their cages, no fellow rats, no mazes or toys for diversion. These rats invariably chose the cocaine water.

In the second study, the rats were caged as a community and were given exercise wheels and other engaging activities to do. They too had a choices of liquids, but they preferred the regular water and avoided the cocaine water. Social connections and pleasant activities made all the difference. Something to think about as we approach the issue of addiction.

Having a sense of community, mutual support, and purpose can help people overcome addictions and all kinds of unhealthy habits. Grace Cottage offers several health-related support groups and wellness activities. We’re here to help!

Bio: Louise McDevitt has been a certified Nurse Practitioner since 1989 and has practiced at Grace Cottage since 2003. She is triple certified as an Adult Nurse Practitioner, a Family Nurse Practitioner, and an Acute Care Nurse Practitioner, and is a Fellow in the American Academy of Nurse Practitioners. She is also a Senior Lecturer for Fitzgerald Health Education Associates, offering licensing preparation and continuing education for NPs, and she is an assistant clinical instructor at the UVM Medical School and its Graduate School of Nursing FNP Program.

Grace Cottage Hospital Ranks in Top 20 Nationally

| Featured, News
NRHA Top 20 Seal

Grace Cottage Hospital has been named a Top 20 Critical Access Hospital (CAH) for “Best Practice – Patient Satisfaction.” The National Rural Health Association (NRHA) has chosen Grace Cottage for this exclusive “Top 20” list out of all 1,339 CAH facilities throughout the U.S. It is the only CAH in the Northeast to receive this designation.

An awards ceremony marking this honor will be held during the NRHA’s CAH Conference this September in Kansas City, Mo.

The Top 20 Critical Access Hospitals “Best Practice—Patient Satisfaction” winners, including Grace Cottage, scored best among CAHs on iVantage Health Analytics’ Hospital Strength Index™. These Top 20 CAHs have achieved top percentile rank on independently collected patient surveys which measure “Overall Rating” and “Highly Recommend.”

“I am extremely proud that Grace Cottage Hospital has been ranked in the Top 20 in the nation for Patient Satisfaction. This is an extraordinary achievement,” said Grace Cottage CEO Roger Allbee. “This does not happen without the involvement and support of all staff in their interactions with patients and their families. These results help to prove what has always been true—that our community can count on us to deliver the services they need, now and into the future, in a compassionate and friendly way.”

The National Rural Health Association is a nonprofit organization working to improve the health and wellbeing of rural Americans and providing leadership on rural health issues through advocacy, communications, education and research. For more information, visit www.ruralhealthweb.org.

iVantage Health Analytics, Inc.™ is a privately held healthcare business intelligence and technology company, and a leading provider of information products for the healthcare industry. For more information, visit www.ivantagehealth.com.

Complete List of All 2017 Top 20 Critical Access Hospitals

NRHA Top 20 Criteria

Grace Cottage Family Health Earns National Recognition for Patient-Centered Care

| Featured, News
PCMH Award

Grace Cottage Family Health of Townshend, VT, has received Level 3 Patient-Centered Medical Home (PCMH) recognition from the National Committee for Quality Assurance (NCQA). This certifies that Grace Cottage’s Rural Health Clinic has achieved the highest level of evidence-based, patient-centered, coordinated care.

The NCQA PCMH model of primary care combines teamwork and information technology to improve access, communication and patient involvement, and to reduce costs. Medical homes use systematic, patient-centered, coordinated care to foster ongoing partnerships between patient and provider, rather than approaching medical care as a series of episodic office visits.

Research shows that medical homes can lead to higher quality and lower costs, and can improve patient and provider reported experiences of care.

In PCMHs, primary care providers oversee a team of professionals who can help with everything from patient and family education, to mental health care, to self-management support, to follow-up calls to answer questions and help ensure that necessary resources are in place. The primary care provider also oversees referrals to specialists and care by providers in multiple settings. This team approach helps to ensure that patients have better access to services across the health care system.

“At the core of each patient’s care is the provider-nurse team who together evaluate, educate and initiate any necessary treatment. As a Patient-Centered Medical Home, we can expand on that medical care and offer additional, coordinated services with other Grace Cottage professional staff,” says Grace Cottage Family Health Medical Director Dr. Timothy Shafer. “That might mean bringing in a health coach, a physical therapist, a mental health counselor, or a financial assistant. All members of a patient’s team have access to a confidential ‘Shared Care Plan,’ which allows primary care provider oversight, and coordinated efforts to help patients achieve optimum health.”

This NCQA Level 3 recognition is valid for three years. In order to receive it, Grace Cottage Family Health had to demonstrate the ability to meet the NCQA’s program standards, which are aligned with the joint principles of the PCMH established with the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics and the American Osteopathic Association.

NCQA is a private, non-profit organization dedicated to improving healthcare quality. NCQA accredits and certifies a wide range of healthcare organizations. See the NCQA web site (ncqa.org) for more information.

Full-time Mental Health Counselor Added To Grace Cottage Staff

| Featured, News
Eileen Arama, MSW LICSW

Grace Cottage Family Health welcomes Mental Health Counselor Eileen Arama to its team of 12 medical providers. Arama is a Licensed Independent Clinical Social Worker, offering counseling appointments for adults as well as children ages seven and up.

Trained at the Gallaudet University School of Social Work in Washington, D.C., Arama received her Masters of Social Work degree with Honors in May 2003. She has worked locally at Brattleboro’s Austine School for the Deaf, at Sunderland Elementary School, and at the Brattleboro Retreat, in addition to other positions in Vermont, Connecticut, and Israel.

Grace Cottage’s other full-time mental health medical provider is Benjamin Wright, a board-certified Psychiatric Mental Health Nurse Practitioner. In addition to providing therapy, Wright manages prescriptions for patients with mental health conditions.

“Too often people with the need for counseling or psychiatric care go without because they cannot find a provider,” says Elaine Swift, Practice Director for Grace Cottage Family Health. “With the addition of Eileen, we are pleased to welcome new patients to our behavioral health practice.”

To make an appointment with Arama or Wright, call 802-365-7381. Most insurances accepted.

Tips for Relieving Stress

| Graceful Health

By Elizabeth Harrison, Grace Cottage Health Coach
as originally appeared in the Brattleboro Reformer’s Graceful Health column, April 7, 2017

You probably know already that too much stress can make you sick. Chronic stress puts a tremendous load on our bodies, increasing our risk of getting a whole host of diseases, including high blood pressure, diabetes, and digestive troubles, to name a few.

And no doubt, you have direct experience with stress. We all lead busy lives, and it can be challenging to take time for self-care. It’s important, though, and I would like to offer a few simple stress reduction techniques that can make a huge difference. None of these are time-consuming or costly, and they don’t require any special equipment. Read more

How Do You Know if You Have Diabetes?

| Graceful Health

By Deborah Brown, Grace Cottage Family Health Diabetes Educator
as originally appeared in the Brattleboro Reformer’s Graceful Health column, March 24, 2017

Do you have diabetes? If you said no, how do you know?

As many as 8 million Americans have this disease without knowing it. And even without obvious symptoms, undiagnosed diabetes can still be ruining your health.

Diabetes is the 7th leading cause of death in the U.S. Heart disease and stroke are two-to-four times more common in those with diabetes. It is the leading cause of new cases of blindness in adults, and of end-stage kidney disease. More than half of the amputations of feet and legs are due to diabetes; 60-70 percent of those with diabetes have some nerve damage; and diabetes contributes to serious infections and gum disease. Read more

Caring for Your Heart

| Graceful Health

By Dr. Maurice Geurts, Grace Cottage Family Health
as originally appeared in the Brattleboro Reformer’s Graceful Health series, February 24, 2017

February is the month of Valentine’s Day, when we focus on emotions of the heart. February is also American Heart Month, a time when we are encouraged to consider the mechanics of this important organ.

Fortunately, most of the time, our hearts do their work silently and reliably, without any effort on our part. We shouldn’t take them for granted, though. Our hearts do need our attention, as certain lifestyle behaviors do often lead to malfunction.

The most common disease of the heart is the one over which we have the most control. Read more

Chiropractor Doucette Joins Grace Cottage

| Featured, News

Chiropractor Michele Doucette now offers appointments at Grace Cottage on Tuesday mornings.

Dr. Doucette also practices chiropractic medicine at her office in Wilmington three days a week. By adding appointments in Townshend, her goal is to provide easier access for some people.

“I see patients from all over southern Vermont, and some of them travel quite far for the combination of services I offer. I’m happy for this opportunity to offer a new location to existing patients and to see new patients as well,” she said. “I really appreciate Grace Cottage for their openness to provide patients with alternatives in complementary medicine and integrative care.”

Dr. Doucette received her training at the Los Angeles College of Chiropractic, earning her doctorate in 1989 with summa cum laude distinction. Her continuing education has included courses in nutrition, pediatrics, neurology, craniosacral therapy, and zero balancing, among others. She is also a Zero Balancing instructor and teaches classes to health care professionals internationally.

She has been certified by the National Board of Chiropractic Examiners and the Vermont Board of Chiropractic since 1989 and has maintained a private practice in Wilmington for over 27 years.

“We are very excited to offer this new service in the Grace Cottage Rehabilitation Center,” said Crystal Mansfield, Director of Rehabilitation, Community Wellness, and Community Initiatives. “This allows our patients a greater range of health care choices.”

To make an appointment with Dr. Doucette at Grace Cottage, call 802-365-3637.

Challenge Yourself: Get Ready for the 5K

| Graceful Health

By Jorda Daigneault, Grace Cottage Family Health Nurse Practitioner
as originally appeared in the Brattleboro Reformer, March 10, 2017.

Think you can’t run a 5K? You’re not alone. And yet, there’s plenty of evidence to suggest otherwise.

Take, for example, this story from the home page of the “Couch to 5K” website:

“With the help of the Couch to 5K program, in less than seven months, I went from a 47-year-old, 104kg, 30 cigarettes a day sort of guy, to an 82kg, 0 cigarettes, running 45 to 50 kilometers a week sort of guy. Ten months after finishing C25K I completed my first marathon. Since then I have run another 5 marathons, as well as 9 ultra-marathons including three over 100km.”

Maybe you think this is all hype, some marketer’s made-up story to sell the program. I know otherwise—because I’m a success story too.

A decade ago, friends were signing up to run the Reach the Beach Relay race and asked me if I wanted to run it with them. Being up for any challenge, and naïve about the race, I said yes!

Reach the Beach (RTB) starts at Cannon Mountain in Franconia, NH, and ends at Hampton Beach, some 200 miles away. The race takes place at the beginning of foliage season in the beautiful New Hampshire landscape—through the White Mountains, small NH towns, along lake fronts and streams, for about 24 hours. There are 12 team members, and each team member runs 3 legs of the 36-leg course. Some legs are short—3 miles, other legs are over 9 miles long; you get whatever leg is assigned to your runner number, no swapping for shorter runs. I ran over 22 miles total in the race.

I am not a natural runner, so I started preparing several months in advance by using the Couch to 5K plan. My favorite time to run is with a gentle rain in the middle of the night because it’s dark and quiet. The race was not easy, but I did participate, I did pretty well, and later I participated in 3 other RTB races! The first year we placed 354 out of 355 teams—we were excited we weren’t last. The last year I participated, my team finished 200 out of 388 teams. Not too shabby!

Grace Cottage Family Health and Hospital is hosting a 5K in Townshend, VT, on Saturday, May 13. Want to run it with me? I will be leading a C25K preparation/support group for eight weeks in March and April to help us all get ready.

The C25K program helps the potential runner get in shape without a great deal of pain. The participant starts by walking 5 minutes, then running for 30 seconds, walking for 90 seconds, and repeating this for 20 minutes, then walking for 5 minutes to cool down. It is recommended to do this three times a week. Each week the running time is increased while the walking time is decreased. By the end of the 8 weeks the participant should be able to run a 5K.

Our C25K group will meet Wednesdays at 5 p.m. in the Grace Cottage cafeteria, March 22 through May 10. The group is offered free of charge. Bring your get-up-and-go, your running gear, and a positive attitude. We’ll train together once a week, and you can train on your own two more days each week.

You can find lots of C25K information at the website www.c25k.com. All of the website resources are free. The website organizer is the person whose story is told above. He was so energized by his success that he decided to collect all of the information he could find in one place, making it easier to access. There are running logs, podcasts, inspirational stories, discussion forums, and more on this site.

It’s easy to read about all of this and to dream, but if you truly are ready for a self-transformation, why not join my group, and we’ll all do it together? Just show up at the Grace Cottage Hospital cafeteria on Wednesday, March 22 at 5 p.m. I’ll be happy to have you join us!

You can register for the Grace Cottage “Spring into Health” 5K at www.gracecottage.org/events. For more information on the C25K group or 5K itself, call 802-365-9109.

Bio: Jorda Daigneault received a diploma from the St. Elizabeth’s Hospital School of Nursing, a BSN from the University of the State of New York, her Family Nurse Practitioner Master’s degree from the University of Vermont, and an MS in Disaster Medicine and Management from Philadelphia University. She worked at Dartmouth-Hitchcock for 27 years and joined the staff of Grace Cottage in 2015.