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Parkside Care Team: A year of transforming care

06 Aug 2017

By: Christine Clarke, MD, QOC Chair, and Shannon Priem, Marketing and Communications

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Welcome to a new series in Common Ground on improvements we’re making through Salem Health’s Quality Operations Committee (QOC). I’m excited about our progress and this opportunity to share how our medical staff, Salem Health staff, administrators and trustees are improving patient care together.

Addressing a huge need: access

One of our community’s greatest needs is increased access to primary care. With this goal in mind, the Salem Health Parkside Clinic launched the care team model a year ago, transitioning from the traditional model where patients are treated exclusively by their primary care provider at each appointment.

This team includes the PCP, certified medical assistant, pharmacist, nurse care manager, licensed clinical social worker, certified diabetes educator and psychiatric nurse practitioner. For example, the Parkside team includes Jessi Peterson, CDE; Brandi Libby, RN care manager; Melody Klug, psychiatric mental health NP; Charlene Clemmons, LCSW; and Andrew Sowles, clinical pharmacist.

Everyone loves a success story!

A long-term patient who had chronic challenges controlling his diabetes joined the diabetes support group Jessi started several months ago at Parkside.

With our more frequent contact – and peer influence -- he started feeling more empowered and engaged in his own diabetes management. Encouraged by others who face the same challenges, he ended up getting a new insulin pump that was quickly arranged through the clinical pharmacist. Within just a few months, he’s seen a dramatic improvement in his A1c levels.

PCP Emily Zheng, MD, calls it “the best thing in the world.” She says she wouldn’t treat complex patients anywhere else because her team is the key to excellent, timely and cost-effective care.

Wrap-around care removes barriers

Patients love the quick access this new model provides. For example, it used to take several weeks to see a PCP. Having a team with multiple disciplines such as care management, diabetes, mental health and pharmacy, patients have prompt access to wrap-around care that addresses many upstream barriers to their well-being, such as transportation, food security and medication education. 

Because the PCP doesn’t need to see the patient each time, their time is freed to see other patients, expanding access to more patients who often wait weeks, even months, to see a doctor.

The model also increases access for under-served patients, so we can do more charity care. No patient, regardless of ability to pay, is turned away.

Key improvements after one year

  • ED visits: ED visits averaged two percent among the patients Parkside treated in 2015. After one year using the team approach, the average was 0.1 percent.
  • Access to care: Baseline averaged 28 days to first available appointment. After a year, access increased to ranges of two to 11 days, with one peak of 25 days during flu season (November to January) that flattened out to five days through March 2017.
  • Hospital admissions: A baseline of four percent of the clinic’s patients had been admitted to the hospital in the past year. After one year in the new model, less than one percent were hospitalized (0.7 percent).
  • Re-admissions: The baseline averaged eight patients per month. After one year it was one patient per month.
  • Cost of care: With 11,000 patients, provider cost under the PCP model was $730,000; under the team model it was $531,802. Savings totaled $198,198 after one year while increasing access to new patients.
  • Patients with previously uncontrolled LDL: 80 percent now controlled.

As our pharmacist Andrew Sowles observed, “This is the future of health care. Medicine is too complicated to know everything. The model allows us to specialize while all working together.”


We are rethinking what health care means and broadening our teams to improve our care as we meet our patients’ needs, today and in the future.

We hope this update adds to the conversation. I look forward to continuing the transformation and integration of care in our community – together. Please contact me with questions, suggestions or about how you can join this collaboration.