From Tulsa to Colorado Springs:
A Tale of Two Cities
University of Colorado School of Medicine, Colorado Springs Branch
Background
Tulsa vs Colorado Springs
The University of Oklahoma, Tulsa, has served as a
branch campus of the University of Oklahoma College of
Medicine in Oklahoma City since 1974.
In 2008, the George Kaiser Family Foundation donated
$50 million to the University of Oklahoma to help
address community health care disparities in Tulsa that
were described as “morally offensive.” The branch
campus in Tulsa was thus renamed as The University of
Oklahoma School of Community Medicine in 2008.
For a community that is similar to Tulsa, how can
Colorado Springs improve the health of its community?
Tulsa County Demographics
Health Disparities
Data reviewed from death certificates from the Tulsa
Health Department showed up to a 14-year difference in
life expectancy between North and South Tulsa based
on zip code (see below)
Population
Land (sq. miles)
Persons/sq. mile
Age >65
White
African American
American Indian
Hispanic
Veterans
Median household
income
% below poverty
Tulsa
391,906
196.75
1,991.9
12.5%
57.9
15.9%
5.3%
14.1%
28,584
$40,781
CS
416,427
194.54
2,140.6
10.9%
70.7%
6.3%
1.0%
16.1%
52,282
$54,351
19.7%
13.7%
Tulsa County vs El Paso County
Data from the year 2000 United States Census shows
that the areas of lower life expectancy in Tulsa county
correspond with a high percentage of minority residents
(see above) and higher rates of poverty (see below).
Population
Land (sq. miles)
Persons/sq. mile
Age >65
White
American Indian
African American
Hispanic
Veterans
Median household
income
% below poverty
Tulsa County
603,403
El Paso
622,263
570.25
1,058.1
12.5%
64.6%
6.5%
10.9%
11.4%
44,958
$47,845
2,126.8
292.6
10.7%
71.3%
1.3%
6.8%
15.6%
79,897
$57,531
15.4%
12.5%
Reference: http://www.census.gov
The Summer Institute: Understanding the
Health and Culture of the Community
University of Colorado School of Medicine, Colorado Springs Branch
Background
Prototype 0.8 Examples
The following are examples of initiatives that developed
from Prototype 0.8 projects created by the collaborative
efforts of faculty, students, and the community:
Following the renaming of The University of Oklahoma,
Tulsa branch campus as The University of Oklahoma
School of Community Medicine (OU-SCM) in 2008, OUSCM established its first “Summer Institute” in 2008.
MyHealth Access Network
Health Information Exchange (HIE) developed for the
greater Tulsa area, established through a $12 million
Beacon Community grant from the Office of the National
Coordinator of Health. One of 15 communities in US to
receive this grant.
Through generous community support, the Summer
Institute was designed to provide faculty and students on
campus a week-long community immersion experience to
learn more about available community resources and
barriers that people face in regards to health and access to
high-quality and affordable health care.
Participants
Each year since 2008, there have been over 100
participants in each Summer Institute. In addition leaders
of community organizations and community stakeholders,
participants have included faculty and students from
following schools and departments at the OU-SCM (see
below).
•
•
•
School of Medicine
School of Social Work
School of Library and Information Studies
•
Physician Assistant Program
•
•
College of Allied Health – Physical and Occupational Therapy
College of Nursing
Curriculum
Anchoring Lectures
Brief daily topics that ground thinking in potentially
unfamiliar concepts
Community Interviews/PhotoVoice4
Student-led interviews along with faculty of community
stakeholders to learn what is needed for change to
improve the health of the community
Poverty Simulation5
This 3-hour activity requires participants to work as a
“family” to live the life of poverty for a simulated month.
•
•
•
College of Pharmacy
College of Public Health
College of Architecture – Urban Design Studio
Prototypes 0.86
Faculty and students form self-selected teams to develop
projects to find answers and create solutions for complex
problems
•
•
•
•
Department of Psychology – Organizational Dynamics
Department of Human Relations
Department of Educational Leadership and Policy Studies
Department of Instructural Leadership and Academic Curriculum
Debriefing/World Café7/Professional Meaning Groups8
Structured sessions to reflect upon challenging topics and
experiences
Comprehensive Primary Care Initiative (CPCi)
Tulsa community (NE Oklahoma) one of 7 regions in US
selected by Centers for Medicare and Medicaid Services
to improve care coordination through innovative payment
models.
Quotes
“The Summer Institute was a tremendously rewarding experience.
The close interaction with both faculty and staff was an excellent
way to start medical school.
-Stephen Twyman, 1st year medical student
“If you are passionate about improving the health of your patients,
then you have the ability to become an effective leaders at
improving the health of your community.”
-Erik Wallace, MD, FACP
Methodologies/References
1.
2.
3.
4.
5.
6.
7.
8.
Scharmer, C. Otto (2007) Theory U: Leading from the Future as it Emerges. The Society for Organizational Learning,
Cambridge, USA.
Community: The Structure of Belonging. San Francisco: Berrett-Koehler, 2008
Cooperrider, D.L. & Srivastva, S. (1987) Appreciative inquiry in organizational life. In Woodman, R. W. & Pasmore, W.A.
(eds) Research In Organizational Change And Development, Vol. 1 (129-169). Stamford, CT: JAI Press.
PhotoVoice: http://www.photovoice.org
Poverty Simulation: Missouri Association for Community Action. Community action poverty simulation.
http://communityaction.org/poverty%20simulation.aspx
Prototypes 0.8: http://Tulsa.ou.edu/socm/2008/prototypes.htm
The World Café: http://www.theworldcafe.com
Professional Meaning Conversations: http://Tulsa.ou.edu/socm/pdf/curriculum5.pdf
Going “All In” to Transform the Tulsa Community’s
1
Health and Health Care Workforce
University of Colorado School of Medicine, Colorado Springs Branch
A. Transformation of regional health care delivery
1. Providing better primary care
•  Adoption of Patient-Centered Medical Home (PCMH)
model with NCQA Level 3 accreditation
•  Tulsa became one of the first seven demonstrations sites
for the Comprehensive Primary Care initiative (CPCi)
which provides additional financial support for PCMH
teams
•  Initiatives have led to reduced ER and hospital utilization,
increased medication adherence, and increased use of
generic medications
2. Moving from fragmentation of care to care
coordination
•  Care coordination entities (CCEs), through increased
specialist participation, has shown a $22 per month
reduction in overall cost of care per patient
3. Providing specialized care teams for highrisk populations
•  Improved outcomes and reduced service utilization for
patients with severe mental illness, terminal illness, victims
of child abuse, homeless teens, children in foster care
•  OU Integrated Multidisciplinary Program of Assertive
Community Treatment (IMPACT) team provides care to
patients with severe mental illness. After 1 year,
psychiatric hospitalizations dropped >60% with annual
savings of $15,000 per patient
4. Moving from fragmented communication to a
regional exchange for health information
•  $12 million Beach Community Program grant for Health
Information Exchange (HIE): MyHealth Access Network
•  Online consultation service (Doc2Doc), has replaced
patient-specialist visits by 35%, generating $100-150
savings per online consultation
CONCLUSIONS AND REFLECTIONS
ON “ALL IN” APPROACH
•  Momentum for big change based on dismal health ranking
leads to support from business and government leaders
and discussions regarding the moral and ethical
imperatives for dramatic system changes.
•  Must work collaboratively across competitive boundaries to
achieve significant change.
•  When a critical level of community participation is reached,
the few health care entities remaining who have not
participated don’t want to be left out.
•  Early successes lead to greater financial support and
investment from philanthropic foundations, granting
agencies, and payers.
B. Transformation of workforce education
1. Summer Institutes and Academies
•  Summer Institute – see other poster
•  Academies – one day per month for faculty and students to
learn application of community medicine, team-based care
and health management for underserved populations, use
of medical informatics
2. Student-led free Clinics
•  Twice-weekly free evening clinics for uninsured for acute
problems
•  Weekly interdisciplinary PCMH model continuity clinics for
uninsured with chronic medical problems; led by faculty
and medical, physician assistant, nursing, pharmacy, and
social work students
3. New health professions training partners
•  Students are increasingly interested in new and innovative
models of care, public health, health systems, and health
economics.
•  Student-led clinics can provide core educational
experiences in quality improvement, systems-based
practice, health care delivery efficiency, and
interdisciplinary teamwork. Patient outcomes can mirror
those of other clinics in the community.
•  Students have greater appreciation for challenges that poor
patients face and a stronger interest in providing patientcentered care and culturally competent care to the poor.
•  “All-in” approach trumps incremental change. Incremental
changes are less taxing on leadership and staff. However,
each initiative depends on the success of the other
initiatives. Success of initiatives that depended on each
other led to development of new payment models to
sustain the transformation.
•  Expansion of physician-assistant led PCHM clinic sites and
residency training at local Federally Qualified Health
Center (FQHC) through Affordable Care Act’s (ACA)
Teaching Health Center Initiative
4. Medical informatics
•  Students and residents can access clinical information on
patients across health care systems through HIE.
•  Can use analytic tools within HIE to identify populations of
patients in greatest need and track their team’s clinical
performance measures
Reference
1.  Clancy GP, Duffy FD. Going “All In” to Transform the Tulsa
Community’s Health and Health Care Workforce. Acad Med.
2013;88.