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HOSPITAL CORNER

Once again Washington experienced a very dry month, in fact a record dry month at many locations. Due to the lack of precipitation and lots of sunshine, many SNOTEL sites on the east side melted out 1-2 weeks early. Higher elevation sites and the sites along the western Cascades seem to have fared better and exhibited normal melt rates. The North Puget Basin was the only area to increase snow percentages, more due to slow melt than anything. The most recent forecast through mid-May shows a high probability for above normal temperatures and below normal precipitation, with a return to near normal conditions later in the month. National Weather Service 3-month forecast, beginning May 1, indicates above normal temperatures and below normal precipitation. The latest US Drought Monitor indicates an expansion of D0 (Abnormally Dry) to Western Washington following the lack of rainfall over the last two months. D1 & D2 (Moderate and Severe) have also expanded their grip on the east side. (see maps on page 4) Snowpack The May 1 statewide SNOTEL readings were 122% of normal, slightly lower than last month. Snow sites in the central belt have begun to meltout, many 1-2 weeks early. The Tolt River Basin held the most snow with 198%. Westside medians from SNOTEL and May 1 snow surveys, included the North Puget Sound river basins with 115% of normal, the Central and South Puget river basins with 174% and 131% respectively, and the Lower Columbia basins with 112% of normal. Snowpack along the east slopes of the Cascade Mountains included the Yakima area with 96% and the Wenatchee area with 115%. Snowpack in the Spokane River Basin was at 86% and the Upper Columbia river basins had 112% of the long-term median. Precipitation May precipitation accumulation from SNOTEL was much below normal across the entire state. Individual stations ranged from 53% to a low of 14%. Many sites recorded record low rainfall last month. Statewide water-year average was near normal as of May 1. SNOTEL collects all form of precipitation including, rain, snow or sleet and hail. Reservoir Seasonal reservoir levels in Washington can vary greatly due to specific watershed management practices required in preparation for irrigation season, fisheries management, power generation, municipal demands and flood control. May 1 Reservoir storage in the Yakima Basin was 583,100-acre feet, 96% of average for the Upper Reaches and 175,300-acre feet or 98% of average for Rimrock and Bumping Lakes. The power generation reservoirs included the following: Coeur d'Alene Lake, 154,300-acre feet, 68% of average and 65% of capacity; and Ross lake within the Skagit River Basin at 81% of average and 42% of capacity. Recent climate impacts and management procedures may affect these numbers on a daily or weekly basis. Streamflow While seasonal forecasts this time of year are generally quite robust abnormal climate conditions can still affect final outcomes. The lack of or unavailability of certain data sets can also reduce accuracy (Example: failure to continue monthly measurements at historic long term manual snow courses can effect calculated runoff from major drainages of a large basin) Volumetric forecasts are developed using current, historic, and average snowpack, precipitation and streamflow data collected and coordinated by organizations cooperating with NRCS. The lack of precipitation last month highly effected normal runoff throughout the region, however irrigation releases and a mid-month temperature spike helped bolster some recorded flows.

 

May 13, 2021



Columbia County Health System has been focused on patient centered and population health care for several years. Within the healthcare industry, these terms are definitive programs that have specific goals and objectives. Patient Centered Medical Home (PCMH) is a designation earned through survey and is best described as being accountable for meeting the large majority of each patient's physical and mental health-care needs, including prevention and wellness, acute care, and chronic care. Think of it in terms of comprehensive care using a team of providers.

Population Health is described as the health outcomes of a group of individuals, including the distribution of such outcomes within the group. These groups are often defined within a specific geographical region. Population health is not just about the overall health of a population but is also focused on the distribution of health.

There is a lot of effort in our clinics to identify populations by disease types. For example, identification of all our diabetic patients defines our diabetic population. This population could be further broken down into subgroups: Diabetics whose diabetes are controlled, those who have uncontrolled diabetes, and diabetics who have other complications like kidney issues, are additional examples. This is important because it helps us apply resources to each of the defined populations and then measure to see if our intervention is improving the health of those individuals. It also helps us to understand the increased risk of patients who are included in multiple populations: Diabetics with depression have a greater risk of adverse outcome than those who do not.

In late 2020, we applied for a grant provided by the Health Resources & Services Administration, commonly known as HRSA. The grant was defined as a Rural Health Care Services Outreach Program and is meant to reduce rural disparities related to five leading causes of avoidable death which are: Heart disease, cancer, unintentional injury/substance use, chronic lower respiratory disease, and stroke. According to the CDC, in 2017 approximately 61% of all deaths in the United States were related to the five leading causes of death and the number of potentially excess deaths from the five leading causes in rural parts of the country was higher than those in urban areas.

This grant essentially defined a population and is meant to enable rural organizations to create an intervention and create better outcomes for people diagnosed with these diseases. We felt that elements of our patient centered medical home program that includes the creation of patient lists by disease type, along with our mature population health initiatives, put us in a competitive position for this grant. Our team put together and submitted our grant application and we were notified in April of the award.

We were one of 16 hospitals in the nation to receive an award letter having scored a 97/100 on our submission. This means that our grant response was competitive on a national level and that alone is worth celebrating, but what this $1.2-million-dollar intervention will mean for our community is the real reward. The first year of the grant is for planning and the clinic teams are excited to get started.

We want to much more than to just erase the disparity gap between us and our urban counter parts, we want to be a leader in care and better outcomes for our patients and residents that have been diagnosed with one or more of these life-ending diseases.

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