A Narrative Account of the A Narrative Account of the Fond du Lac Partnership Fond du Lac Partnership

with the Mayo CTSAwith the Mayo CTSA

W. Michael Hooten, MDW. Michael Hooten, MDDepartment of AnesthesiologyDepartment of Anesthesiology

Division of Pain MedicineDivision of Pain Medicine

““I know not any thing more I know not any thing more

pleasant, or more instructive, pleasant, or more instructive,

than to compare experience than to compare experience

with expectation, or to register with expectation, or to register

from time to time the from time to time the

difference between idea and difference between idea and

reality. It is by this kind of reality. It is by this kind of

observation that we grow daily observation that we grow daily

less liable to be less liable to be

disappointed.”disappointed.”Samuel Johnson

1709-1784

Set the bar low...

ObjectivesObjectives• To provide a narrative account of To provide a narrative account of

the Fond du Lac led partnership the Fond du Lac led partnership with the CTSA.with the CTSA.

• Identification of important themes Identification of important themes that have characterized this that have characterized this partnership.partnership.

• To highlight the key role of the To highlight the key role of the CTSA in this partnership. CTSA in this partnership.

The risks and perils of The risks and perils of ““celebrityhoodcelebrityhood.”.”

Research LiteratureResearch Literature

2003

2007

2009

Research LiteratureResearch Literature

2009

2007

2003

• FDL identification of a FDL identification of a health care problem.health care problem.

FLD-led Action PlanFLD-led Action Plan

• Summer 2007.Summer 2007.

• Members of the Health Services Members of the Health Services Division Division initiatedinitiated a visit to PRC. a visit to PRC.

• Two physicians and one PA.Two physicians and one PA.

Invited Site VisitInvited Site Visit

• Mid-2008.Mid-2008.

• Leaders of the HSD invited PRC Leaders of the HSD invited PRC clinical staff for a site visit.clinical staff for a site visit.

• They talked about their need to They talked about their need to improve chronic pain care.improve chronic pain care.

Fond du Lac HSDFond du Lac HSD

• Integrated health deliver system.Integrated health deliver system.

• Owned & administered by FDL.Owned & administered by FDL.

• Provide health services for Provide health services for approximately 7,000 American approximately 7,000 American Indians.Indians.

• Electronic medical record.Electronic medical record.

On-site pharmacy services

• FDL led solution(s) that FDL led solution(s) that would provide direct and would provide direct and immediate benefits to the immediate benefits to the community.community.

Chronic Pain

Clinical Services Research Grants

Delivery of On-Site Delivery of On-Site Health ServicesHealth Services

• Scheduled by FDL providers.Scheduled by FDL providers.

• FDL providers identified patients FDL providers identified patients for participation.for participation.

• Gained approval and support of Gained approval and support of Mayo including malpractice Mayo including malpractice coverage.coverage.

Cynthia O. Townsend, PhD

Assistant Professor

Department of Psychiatry and Psychology

Director of Clinical Research

Mayo Pain Rehabilitation Center

Min-No-Aya-Win Clinic and Mayo Clinic Pain Rehabilitation

Executive Program

The Impact of Pain…The Impact of Pain…

and the Process of Regaining and the Process of Regaining Control Over your Life AgainControl Over your Life Again

Three Different Types of Pain• Acute

• Chronic or Persistent

• Terminal• Pain associated with dying process.Pain associated with dying process.

• Care focuses on comfort and quality of life Care focuses on comfort and quality of life rather than treatment/cure.rather than treatment/cure.

• Opioids/narcotics provide comfort during end of Opioids/narcotics provide comfort during end of life.life.

Wellness Concepts

• Elimination of Pain Behaviors

• Stress Management

• Relaxation

• Moderation

• No Analgesic Medications for Chronic Pain

• Distraction/Diversion Distraction/Diversion

• Sleep HygieneSleep Hygiene

• Exercise (Stretching, Exercise (Stretching, Strengthening, and Strengthening, and Aerobic Activities)Aerobic Activities)

• Awareness of Emotional Awareness of Emotional Impact of Chronic PainImpact of Chronic Pain

Pain isin

Control

Illness/InjuryFear & ConcernOffer Support Decreased activity & pain

Hope & TrustIncrease attentiveness,Help with daily tasks.

Seek medical attentionLoss of control

Continue to Do More, Care-taking

Increased activity & painAnger, frustration

Attempt to Re-establish Roles

Loss of strength & enduranceGuilty & withdrawn

Do it All, Over-invest

Withdrawal & IsolationSadness & depression

Ignore, Withdraw

Cycle of Chronic PainCycle of Chronic Pain(Behaviors, Emotions, Family Response)

Goal : Break the Cycle of Pain

• Learn adaptive ways to cope with Learn adaptive ways to cope with painpain

• Strategies for applying wellness Strategies for applying wellness principles to pain managementprinciples to pain management

• Improve quality of lifeImprove quality of life

What is Wellness?What is Wellness?

• A way of life that A way of life that you design, by you design, by making informed making informed healthy choices healthy choices to achieve your to achieve your optimal health.optimal health.

• FDL led research that would build FDL led research that would build clinical capacity, provide clinical capacity, provide education to tribal members and education to tribal members and could be disseminated to other could be disseminated to other tribal communities tribal communities

Research ComponentResearch Component

• Fall 2008.

• Healthier Minnesota Community Clinic Fund grant.

• Not funded but…• Demonstrated feasibility.

• Rough draft for a NARCH grant.

NARCHNARCH

• January 2009

• Meeting at the HSD included:• Mayo CTSA representatives

• Great Lakes NARCH

• FDL staff

• U MN-Duluth Medical School

FDL Visit to Mayo CTSAFDL Visit to Mayo CTSA

• February 2009.February 2009.

• Chuck Walt identified as NARCH Chuck Walt identified as NARCH PI.PI.

• Presented CTSA Grand Rounds.Presented CTSA Grand Rounds.

• Disussed basic role(s) of CTSA in Disussed basic role(s) of CTSA in the NARCH grant.the NARCH grant.

Dr. Dorscher

Take Home PointsTake Home Points

• FDL identification of a clinical FDL identification of a clinical problem.problem.

• Action plan developed by FDL.Action plan developed by FDL.

• FDL led partnership with the FDL led partnership with the CTSA and the U MN-Duluth….CTSA and the U MN-Duluth….