This August, NW HERON and IREACH team members were fortunate to have the rare opportunity – mid-pandemic – to attend and present findings at the 23rd Annual National Indian Council on Aging (NICOA) Conference in Reno. Safely vaccinated, masked, and distanced, the team was able to immerse themselves in the greater community, sharing and connecting around the topic of aging in Indian Country.
To engage Tribal conference participants, the NW HERON team manned a booth, hosted a lunch for Elders from Washington state who attended the conference, and held 8 separate listening sessions. Preliminary themes that emerged from the Alzheimer’s disease sessions include the importance of allowing participants to select among research activities (which can entail MRI, blood and saliva tests, and lumbar puncture), honoring the belief that no body part should exist beyond death, promoting community-based education to raise dementia awareness, and educating researchers about traditional medicine and prayer practices used to complement Western medicine.
In addition to conducting and presenting research on cognitive impairment, the team also collected data on lung cancer screening and on COVID-19’s impact on Tribal elders; assisted Cole Allick – PhD student in Indigenous studies and member of NW HERON – in gathering data for his dissertation project; and presented at a youth panel discussion.
The NW HERON team is incredibly grateful they were able to attend the conference in person and returned with a renewed sense of purpose and energy. Being immersed in the community served as a great reminder as to why we do what we do!
Substance use disorders are one of the top clinical concerns for primary care facilities in Washington, according to a recent NW HERON survey of state healthcare administrators (view survey summary here.) The Washington Department of Health currently reports an average of 2 opioid overdose deaths per day in the state, while nationally there has been a 300% increase in opioid-related deaths over the last 2 decades.
To better understand why some rural counties in Washington experience higher rates of opioid overdose mortality than others, WSU graduate student Sam Castonguay has prepared a report that explores characteristics unique to Clallam, Chelan, and Walla Walla counties. Under the supervision of Dr. Justin Denney – Scientific Co-Director of NW HERON and Associate Professor of Sociology – Castonguay takes an in-depth look at the factors underlying geographic variation in opioid overdose deaths across Washington.
Castonguay’s interest in substance use disorders grew out of her prior work with a harm reduction nonprofit agency in upstate New York. As a doctoral student in WSU’s Sociology Department, she saw an opportunity to work with Dr. Denney to examine opioid overdose mortality using methods sensitive to intra-rural context. “I was originally trying to map opioid overdose mortality risk based on a few spatial factors, like distance to the nearest hospital and Naloxone access points,” Castonguay says. “I reached out to Justin (Denney) to help brainstorm overdose risk factors. We were really surprised by all the data available!”
Castonguay and Denney hope the report, which aligns with several initiatives presented in the Washington State Opioid Response Plan, will prove useful for understanding and combatting the opioid epidemic in rural areas of Washington. They intend for the data to provide local practitioners and clinics affiliated with NW HERON with insights to help tailor individualized plans to beat opioid addiction and mortality.
Click here to read “Washington State Opioid Overdose Mortality: A Comparison of Three Rural Counties.”
The Northwest Health Education & Research Outcomes Network (NW HERON) survey, conducted in the fall of 2020, is an important tool to identify the main concerns of healthcare facilities. Together, we can develop constructive strategies to improve clinical care and reduce health disparities for NW residents in rural, tribal, and urban medically underserved areas. Compiled from 35 facilities across the region, the 2020 survey data show that behavioral health and COVID-19 are the top two clinical concerns.
NW HERON is an emerging practice-based research network (PBRN) that currently includes 15+ primary care practices working in partnership with IREACH, WSU’s Elson S. Floyd College of Medicine, and the Health Equity Research Center at WSU. NW HERON’s purpose is to link providers with each other and with WSU faculty and healthcare students. We invite primary care practices to partner with us in research activities that address clinic priorities.
Look here for a visual summary of the 2020 survey results.
Granted: COVID’s Impact on Cancer Patients
NW Heron Survey: Seeing Results
From the Beginning
On the Road
WSU Scientists Develop COVID-19 Tracking Tool for Rural Areas
New WSU Asthma Study Issues Call for Participants
Win-Win: Community Projects Underway
GRANTED | COVID’S IMPACT ON CANCER PATIENTS
Patrik Johansson, MD, MPH, Director
We are proud to announce that the Andy Hill Care Fund has awarded NW HERON a COVID-19 Response Grant to research the impact of COVID-19 on the well-being of rural and American Indian cancer patients in Washington state.
Leveraging the reach of our research network, the NW HERON team will examine the impacts of COVID-19 on selected measures of health, health care, personal, socio-cultural, and economic outcomes among cancer patients from 15 clinics serving rural residents and American Indians. Specifically, we will:
Conduct focus groups with rural and American Indian cancer patients and family members to solicit their unique perspectives on the effects of the COVID-19 pandemic on their well-being and health.
Create an instrument to assess rural and American Indian cancer patients’ perceptions of the impact of COVID-19 on health-related quality of life, emotional well-being, resilience, access to social and community support and health care, lifestyle factors, employment and financial stressors, food and housing security, knowledge about COVID-19, COVID-19-related health literacy, and participation in community and cultural practices and events.
Survey 150 cancer patients seen at rural and American Indian-serving clinics that participate in NW HERON.
Why this study? Rural and American Indian patients face many challenges in receiving care. These include limited access to cancer treatments and cancer support providers, such as oncologists, mental health professionals, palliative care specialists, and social workers. In the absence of published studies or reliable data from the 30 rural counties and 29 federally recognized tribes in Washington state, it is imperative to directly hear from rural and tribal community members who are personally experiencing the impact of the COVID-19 pandemic. Only from them can we understand the true impact of COVID-19 among rural and American Indian cancer patients living in our state.
Findings from this study will provide preliminary data to participating health care systems, allowing them to adapt existing programs or identify new approaches to best meet the long-term needs of cancer patients during the pandemic.
Exploring future research opportunities
To address the urgent need for behavioral health care among our region’s primary care clinics, we are pursuing grants to support suicide prevention programs. We aim to develop and test suicide prevention interventions that 1) identify, prevent, and treat suicide risk within well-defined target populations, primarily high-risk and underserved groups, including rural and American Indian populations;and 2) are delivered within real-world settings where at-risk individuals are served.
NW HERON SURVEY | SEEING RESULTS
Justin Denney, PhD, Scientific Co-director
In December 2019, we launched a survey of 31 health care facilities to gather operational, programmatic, and clinical information as well as demographic data on their service populations. Using an online survey format and follow-up via email, we have achieved an 83% response rate to date. Among the most pressing and intractable clinical concerns reported by these facilities were management of patients with chronic conditions and those from vulnerable populations, in addition to behavioral health. Administrative concerns centered on ongoing challenges around attracting and retaining health care professionals.
Responding facilities were 80% public or federally qualified health centers; 20% were members of health care networks that employed between 1 and 100 physicians. All facilities provided primary care (e.g., family medicine, internal medicine, geriatrics). The total annual outpatient visits ranged from ~2,000 to ~180,000. Of the facilities providing inpatient hospital services (55%), the number of annual hospitalizations ranged from ~100 to ~4,000. Sixty percent of all facilities served a patient population that was primarily covered by public insurance.
We are further refining this survey and gathering data from additional partners to identify pressing concerns for NW HERON facilities and to partner in developing strategies to address them.
WHO WE ARE | NW HERON
Cole Allick, MHA, Outreach Coordinator and Tribal Liaison (Turtle Mountain Band of Chippewa Indians)
NW HERON is a transdisciplinary partnership of Washington State University’s Elson S. Floyd College of Medicine, the Institute for Research and Education to Advance Community Health, the Health Equity Research Center, and primary care clinics in Washington state and the surrounding region. The NW HERON team first reached out to primary care sites that had signed clinical affiliation agreements with the College of Medicine.
In December 2019, the NW HERON team initiated introductory conversations with a variety of primary care sites, including critical access hospitals, community health centers, tribally operated health care organizations, and Indian Health Service sites.
Initial outreach focused on introducing NW HERON and soliciting input via a brief intake survey of the needs and concerns of partner sites, including suggestions for virtual conference topics. The outreach team continues to focus on introducing NW HERON to partners with existing clinical affiliation agreements as well as launching an additional survey to the outstanding potential partners.
Ken Roberts, PhD
Washington State University’s Elson S. Floyd College of Medicine is charged with developing affiliations with hospitals and clinics across Washington in both urban centers and rural communities. Our affiliate partners provide the opportunities where our medical students receive their clinical training, an important and necessary benefit to the College of Medicine. To date, we have established affiliation agreements with 145 clinical partners in over 40 towns across the state.
In 2020 alone, we have added almost 40 new affiliate partners. These relationships also benefit our clinical partners by providing resources and the expertise of College of Medicine faculty. NW HERON, our practice-based research network, is a key example of one such partnership where we work together to solve challenging problems in health care.We look forward to continuing to develop additional productive partnerships.
As a Professor and Director of the Institute for Research and Education to Advance Community Health at the Elson S. Floyd College of Medicine, and NW HERON Scientific Co-director, Dr. Buchwald applies her background in public health, community-based research, and culturally competent primary care to the singular goal of improving the health and health care of underserved populations.
For over 30 years, Dr. Buchwald has worked with refugees, immigrants, and racial, ethnic, and cultural minorities to achieve this goal. Supported by more than 72 federally funded grants over her career, Dr. Buchwald’s research focuses on designing community-based interventions that target health disparities and the social determinants of health.
Dr. Buchwald’s first exposure to practice-based research networks (PBRNs) was at the University of Washington, but when she joined Washington State University, she saw unique opportunity to create a PBRN by building on the College of Medicine’s 200 affiliated clinical sites in rural, tribal, and underserved regions in central and eastern Washington. She realized the existing education affiliations and connections could serve as a foundation for a PBRN that partnered with WSU in research, education, and health care.
From this vision, NW HERON was born. Today, NW HERON provides valuable opportunities to WSU students in the medical and health professions, exposing them to sites in the network and further solidifying the PBRN infrastructure. Trainees learn about conducting research in a “real-world” setting and building ties with the communities that WSU serves as a land grant institution. Students are eager to associate with NW HERON; members of the first training cohort are now mentoring new cohorts of students and some have been engaged to work directly with their clinical sites, subject to the constraints of the pandemic.
ON THE ROAD
Director Patrik Johansson took to the road – leaning heavily on mask, sanitizer, and social distancing guidelines – to visit with clinics and practices that had expressed interest in joining the NW HERON PBRN.Since August, Ferry County Health; Palouse Medical, P.S.; Columbia County Health System; Garfield County Health District; Camas Center Clinic; and Newport Hospital & Health Services have signed affiliation agreements to join NW HERON.
More trips will be underway soon. If you’d like to schedule a visit to discuss or formalize participation of your clinic or practice in the PBRN, contact Patrik at Patrik.Johansson@wsu.edu.
“We are extremely happy to be part of the NW HERON. We are looking forward to partnering with WSU to improve the health of our community and other communities outside of ours through the collaboration.” -Aaron Edwards, CEO
Ferry County Memorial Hospital
“Here we are, a small medical community, but we’re right here in the back door of WSU and we should take advantage of each other in doing research and furthering health care. We’re your back-door neighbor so we should have strong liaisons with each other to support this work.” -Stephen Hall, MD, President
Palouse Medical. P.S.
“The more we can quantify rural health disparities with data, particularly for small communities, the better off we will be, because it’s been a missed opportunity. We are very supportive of working with the NW HERON on research projects.” -Shane McGuire, CEO Columbia County Health System
“We’re more than happy to be a part of the COVID study in cancer survivors to find out what if any gaps we may fill. We look forward to future endeavors as well with the NW HERON.” -Tom Wilbur, CEO
Newport Hospital & Health Services
“The Kalispel Tribe is truly excited to partners with WSU on the NW Heron project. This partnership will hopefully identify health care needs of tribe members and begin problem solving to meet thosehealth care needs. The Camas Center Clinic has enjoyed having WSU medical students train in the clinic. Patients and staff learn from the students as they gain valuable experience from being in a tribal medical clinic setting!” -Clayton Kersting, MD, Medical Director
Kalispel Tribe of Indians, Camas Center Clinic
SPOKANE, Wash. – Scientists at Washington State University Elson S. Floyd College of Medicine have launched one of the first tracking tools that provides a daily snapshot into COVID-19 cases in rural communities across the country. Using data from The New York Times and other sources, the COVID Urban Rural Explorer (CURE) focuses specifically on highlighting rural urban inequities in COVID trends by county and provides a weekly roundup of rural areas experiencing spikes in COVID-19 cases. More specifically, the CURE tracker enables users to identify rural counties with both limited hospital capacity and where cases are rapidly growing.
“There are several data dashboards out there showing COVID-19 cases and deaths across the country, but we noticed that few if any are focused on rural-urban disparities,” said Ofer Amram, lead developer of the tool and assistant professor in the Department of Nutrition and Exercise Physiology at the WSU College of Medicine. “Rural communities have far fewer resources and many unique challenges to preventing and treating COVID-19 such as few intensive care beds at critical access hospitals and insufficient contact tracing, so it’s critically important that we pay better attention to what’s happening in these communities.”
In this new study funded by the National Institute of Nursing Research, young adults ages 18-26 in the Pacific Northwest will test a phone app to help them manage their condition during wildfire season.
Julie Postma, PI and associate dean for research at WSU’s College of Nursing is recruiting 60 participants who will complete questionnaires and agree to track their lung function using a spirometer for two months. She expects to use the study results to propose a future larger clinical trial. Participants could earn between $100 and $200 in Amazon gift cards depending on group assignment.
Be 18-26 years old
Have been diagnosed with asthma by a health care provider
A cornerstone of NW HERON is to provide a training ground for the next generation of medical professionals who will address the most pressing issues facing our rural, tribal, and urban medically underserved clinics and communities. To best support our WSU Elson S. Floyd College of Medicine students and our clinical partners, we bring student and clinic leadership together to answer research questions and address ever-changing clinical needs.
Each student is required to complete 320 hours of scholarly research that will benefit our partnering clinics by addressing a community concern. Our students are tasked with employing a community-oriented primary care approach, defined as the practice of primary care with a focus on population responsibility. This approach is oriented to improving the health of a defined community served by the health care organization by relying on the participation of the community and coordinating all services involved with the health of the community.
This student and clinic relationship is a win-win. Our students gain problem-solving skills and sharpen critical reasoning as they prepare to enter the medical field. In turn, our partnering clinics benefit from having dedicated, focused, and driven student researchers on their team to address challenging topics and seek positive solutions.
It has been a rewarding eight months as we’ve met online with CEOs and executive leadership from across Washington state, hearing their COVID-19 concerns, discussing delivery systems, and exploring new approaches. We appreciate our partners’ warm welcome of our students as our teams conduct scholarly projects in their clinics.
An impressive number of sites have already signed on and we welcome more! Please contact firstname.lastname@example.org or email@example.com with any questions about joining the student research partnership.
Clinic Partner Site
Camas Center Clinic
Coulee Medical Center
Klickitat Valley Health
Ferry County Health
Columbia County Health
Why Should Your Site Join NW HERON?
Joining NW HERON is free for your primary care clinic. One of the primary goals is toshare medical research with affiliated or similar clinics in your area.
NW HERON can link providers and practices with one another as well as with WSU faculty and students. By doing so, we can collectively address local health priorities and create and disseminate shared best practices.
The research and education activities of NW HERON are founded in Washington State University’s public, land grant tradition of service to community stakeholders, with an emphasis on meeting the needs of rural, tribal, and urban underserved communities.
SPOKANE, Wash. – American Indian and Native Alaskan populations have been hit hard by the pandemic—exactly how hard, no one can say for sure, since there is a lack of information and testing in these communities.
A new project led by Dr. Dedra Buchwald, a physician and professor with WSU’s Elson S. Floyd College of Medicine, has received a $4.4 million National Institutes of Health grant to help address that knowledge gap and bring resources to curb the COVID-19 crisis within these populations.
“Many things come together to make American Indians and Native Alaskans particularly vulnerable to COVID-19, and at the same time, make them hesitant to participate in efforts to get tested and get vaccinated,” said Buchwald, who is also the director of the Institute for Research and Education to Advance Community Health or IREACH.
This grant is one of four recently received by College of Medicine researchers to help deal with aspects of COVID-19 crisis. The others include:
A competitive effort headed up by April Needham of the University Center for Innovation will challenge entrepreneurs from Eastern Washington and Northern Idaho to come up with ideas to improve the personal protective equipment (PPE) manufacturing process. The project received a $300,000 grant from the federal CARES (Coronavirus Aid, Relief and Economic Security) act and administered by the Economic Development Administration.
A project led by Dr. Patrik Johansson, an associate professor in the Elson S. Floyd College of Medicine’s Department of Medical Education and Clinical Sciences and an IREACH faculty member, received nearly $100,000 from Empire Health Foundation to study the impact of COVID-19 pandemic on the well-being of rural and American Indian cancer patients in Washington state.
Ofer Amram, assistant professor in nutrition and exercise physiology, will lead an effort to evaluate the impact of deferred preventative care for cancer in the era of COVID-19. This project also received a grant from Empire Health Foundation of nearly $100,000.
The National Institutes of Health grant is intended to help address health disparities among underserved and especially vulnerable Native populations in urban settings. An estimated 71% of American Indians and Native Alaskans live in urban areas. Buchwald said these populations have many risk factors, including a high prevalence of diabetes, hypertension, obesity, multi-generational households and poor living conditions. Many also struggle with poverty and limited access to quality health care and education.
This is complicated by a distrust in the federal government and health care systems, given the long history of atrocities committed against Native peoples, such as the deliberate dispersal of blankets laden with smallpox and sterilization of Native women without true consent.
In the new project, called COVID-19 Epidemiology, Research, Testing and Services or CONCERTS, researchers from WSU, University of Colorado and University of Minnesota will partner with Urban Indian Health Programs in six major cities with large Native populations: Albuquerque, N.M.; Anchorage, Ala.; Denver, Minneapolis, Seattle and Wichita, Kan.
The partners will work to understand who has been tested already and what challenges exist to getting people tested and ultimately vaccinated. The grant will also fund new resources for each site to help promote testing depending on their locally determined needs. Some sites might need PPE or testing kits while others may want to establish a testing drive-through site or send out case workers or COVID navigators to make contact with individuals.
Most of the people working on this project at the health programs will be from the tribal communities they serve, Buchwald said.
“American Indian and Native Alaskan people are more knowledgeable about what is going on in their communities than outside researchers, and we want to make sure that we have good trusting relationships,” she said. “Our partners are really key to encouraging more people to get tested, and in the future, vaccinated, if determined to be desirable.”