The Partnership secured a 3 year $2.1 million Community Access Program Grant in September of 2001 from the Health Resources and Services Administration a division of the United States Department of Health and Human services. The overall goal of this grant is to utilize a consortia of health care providers and organizations to strengthen the integrated community health delivery and social service system in Richmond County, Georgia and to improve the health status of individuals who are underserved, uninsured or underinsured. This overall goal is currently being achieved through the objectives of the grant, which are explained below:

Objective 1: Implementation of Management Information Systems (MIS) across a cross section of agencies that provide healthcare and social services to residents of Richmond County. The installed Information Systems include:

• Enterprise Practice Management (NextGen EPM®) and Electronic Medical Record (NextGen EMR®) systems which provide computerized patient records for patients who receive care at health centers located in the 30901 and 30906 zip code areas and at University Hospital (safety net hospital in Richmond County) where most patients receive their in-patient and some specialty care. Patient records are available at all these locations. All locations have business associate agreements with each other, which is reguired for adherence to HIPAA (Health Insurance Portability and Accountability Act of 1996) rules and regulations.
  
• ScriptPro® Prescription Robot that can dispense or fill 200 prescribed solids per day with a 99.5% accuracy, thereby releasing Pharmacists to counsel patients about prescription use. This Robotic system will be installed at Barney's Pharmacy by the fall of 2004. Barney's Pharmacy serves indegent care patients particularly in the 30906 zip code area of Richmond County.
  
• Client Callback system was successfully implemented at two health centers in the fall of 2003 and spring of 2004. These callback system have been beneficial by reducing the no-show rates at both clinics
  
• Women Infant and Children (WIC) Call Center is fully operational and was implemented at the Richmond County Health Department in the spring of 2003. This system has tremendously helped by increasing the Call Center's capacity to handle WIC appointment calls.
  
• A Video Teleconferencing system was implemented at three Richmond County Health Department locations for health nutritionist. This system now provides additional access to nutrition classes for 120 clients.

Objective 2: Implement wellness and disease management programs in conjunction with staff from the University Hospital's Information Systems Department, staff of the Partnership, and outside technical support to develop software interfaces for wellness and disease management protocols. Some of the activities involved under this objective include:

• Primary care teams were formed, September 2001-January, 2002.  A practice model was developed, approved and implemented in February 2002. Protocols for seven leading needs were developed, presented, discussed, and prepared for template development with NextGen EMR®. The seven leading needs are Wellness- health promotion and disease prevention; Hypertension; Diabetes mellitus; Congestive heart failure; Asthma-COLD-pneumonia; HIV/AIDS as a co-morbidity; anticoagulation as a co-therapy. Project Access an innovative collaboration between physicians, hospitals and county government to provide comprehensive health care to uninsured Richmond County residents was started on July 1, 2002 with 88 volunteer enrolled MD specialists and over 600 visits planned. Project Access currently accepts Richmond County patients whose incomes are below the 150% Federal Poverty Level and who are uninsured.
  
• Provide Follow-up to “high risk” Clients : Follow-up to “high risk” clients by Registered Nurse Care Managers hired by the Partnership was fully and successfully implemented in 2002 at two Community Health Centers in Richmond County. Before coming to the Health Centers, the patients’ chronic diseases and conditions were uncontrolled and patients frequently ended up in the hospital ER. Since receiving care form the care managers, patients state that the quality of care they receive has improved and as a result their health status has improved.
  

Objective 3: Implement the Information Network for Community Access (INCA) with links to four data bases to facilitate patient screening, application, and enrollment in health and social services. Some of the activities involved under this objective include:

• Medical College of Georgia Information Technology Department (MCG ITD) staff developed INCA, a web portal that includes a health and social service resource directory, a link to PATHWAYS COMPASS and an automated indigent care application system. The web portal is also the basis of information for the United Way of the CSRA's 211 telephone and referral system. The INCA resource directory pulls information from two databases that belong to the following agencies, Ask-A-Nurse and the Augusta Richmond County Community Partnership for Children and Families. Any one with internet access can vist the website to search for health and social service resources in Richmond county and surrounding counties. For those without internet access a simple phone call dailing 211 will connect them to a live operator that can search for resource information.

 

The Partnership secured an 18 month $99,000 grant from the Healthcare Georgia Foundation in January of 2004. The purpose of this grant is to support two Registered Nurses (RN) providing enhanced health education and chronic disease case management for patients in Richmond County and surrounding rural areas. The grant's objectives are as follows:

• Provide RN navigation services to a minimum of 230 patients to increase current patient levels by 28% on or before July 2005
  
• Provide education and navigation services to a minimum of 100 patients with diabetes, with at least 25 patients whose average blood glucose levels is reduces by 3 points on or before July 2005.
  
• Provide education and navigation services to at least 100 patients with hypertension, with at least 20 patients whose disease becomes controlled as indicated by a constant blood pressure reading of 140/90 or less or is indicated by their providers to be under control by July 2005.
  
• Replicate the RN navigator model in the Tri-county area of Warren, Hancock, Glascock and Taliaferro Counties with a minimum of 140 new rural visits on or before July 2005