The Heroes Among Us:

DAYTON–Local multi-disciplinary Population Health Team has been launched to better service the community.

In the heart of Columbia County, the local health system is tackling a growing challenge with a blend of innovation and compassion. With 28.6% of the county's residents aged 65 or older-a figure expected to rise to 32% by 2030-the Columbia County Health System is prioritizing the needs of its aging population. This critical access hospital district in Dayton has launched a multi-disciplinary Population Health Team to address healthcare challenges and improve patient outcomes.

"Our community's aging presents challenges for us related to access to care, specialty services, chronic disease management, and social determinants of health," said Dawn Meicher, ARNP, and Population Health Provider Champion. "In response, we have enacted an innovative Population Health Team that is multi-disciplinary and consistently thinks 'outside the healthcare box,' to provide holistic care."

This dedicated team comprises of registered nurses, community health workers, a social worker, and an advanced registered nurse practitioner. They collaborate closely with various departments within the health system, including the CCHS Clinics, Emergency Department, Wound Clinic, and Physical Therapy, as well as local agencies, non-profits, and specialists.

"Population health is about taking care of the whole person," said Melissa Peterson, RN, Rural Health Clinics Manager. "It's not just the care that happens in the provider's office; it is the 'in between care.' This 'in between care' is what our team tirelessly provides day in and day out to our most complex patients and is tailored to what our community needs."

The Population Health Team tackles knowledge deficits, add healthcare access concerns, medication management, and compliance issues while addressing social determinants of health, all with the goal of improving patients' quality of life. They understand that many factors affecting health occur in the home, and as such, bring compassionate care into the community.

Supported by CCHS executive leadership, this team meets weekly to discuss challenges, which can range from resource limitations to staffing issues. These meetings, as described by Melanie Gagnon, Community Health Worker, are "vital to case management but also serve as therapy for the Team because of all the difficult things we see in our community."

The Team goes above and beyond, supporting patients not only in their health journeys but also in dealing with homelessness, life changes, and end-of-life care. Paul Ihle, MSW-Community Health Worker, Social Worker, remarked, "We get in some pretty sketchy scenarios and there's safety in our Team. There's no doubt that we're all for one and one for all."

Team members embody superpowers of compassion and empathy. But navigating these strengths requires balance, as Meicher highlighted, "They support each other in very difficult situations and barriers in which they find patients. They celebrate the wins and support in the grief at the end of a patient's life whom they have come to know so closely."

Becky Lynch, Chronic Care Management RN, emerges as a superhero among them, known for her "powers of fierceness, strength, resilience, selflessness, logical thinking, and compassion." Her ability to soothe anxious patients in a single call is indicative of the quiet strength felt by both the team and the community.

The Columbia County Health System's Population Health Team stands as a testament to the power of holistic, community-focused care, tackling the challenges of an aging population with unwavering dedication and empathy. For that, we are pleased to announce that on 11/21/24, this Team has been awarded by the WA Dept of Health as the 2024 Team Rural Health Heroes of WA by Breaking Barriers and Leading the Way!