The truth is in the numbers, whether it’s attendance figures or lab test results. When attendance at the Barton Memorial Health Fair grew from 300 to 1,500 in just three years, it was clear there was a hunger for healthcare information. The fair’s focus on osteoporosis this past year could not have happened without an organized effort from its already busy clinical laboratory.

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“The health fair takes a lot of hard work,
but it’s an invaluable service to the community.”
– Robert Johnson, MT
Laboratory Manager,
Barton Memorial Hospital

For Barton Memorial Hospital in South Lake Tahoe, Calif., a commitment to public awareness and education on healthcare issues is more than just words in the mission statement, it’s a way of doing business. The hospital is committed to delivering quality care and educating patients about its many capabilities and programs, not the least of which is our laboratory services.

Our hospital serves a local population of approximately 20,000, but during the winter ski season, the patient base climbs to 80,000. Thus, the facility is equipped with 81 acute care beds and a 50-bed skilled nursing facility. Departments include Medical/Surgical, Orthopedics, ICU/CCU and complete maternity care. Since Barton is the only facility on the south shore of Lake Tahoe, it is equipped with five surgical suites and an ambulatory surgery center. The nearest hospital is in Carson City, Nev., 35 miles away.

Excellent staff and state-of-the-art equipment means South Lake Tahoe is not such a bad place to be if you happen to get sick or injured. The laboratory does its share to help. It is equipped to perform more than 300,000 clinical tests annually and is accredited by the College of American Pathologists (CAP).

Community Outreach
The hospital’s annual community health fair is our way of raising awareness about particular healthcare issues and spotlighting a few of our laboratory’s capabilities. In addition to lab resources, medical staff members offer educational programs on skin cancer, bone loss, hormone replacement, nutrition and general health. The casual environment of the health fair provides an effective forum for communicating the value of testing for the early detection of disease. It’s a perfect time for healthcare service providers to leverage our technological capabilities and research knowledge to deliver leading edge services to the community. We’re able to talk to large audiences about our initiatives to reduce healthcare costs, increase scientific and health-related knowledge and provide expanded consumer access to healthcare.

Fortunately, our efforts have met with a great response. Over the past three years, attendance at the health fair has grown from about 300 in 1996 to more than 1,500 participants in 1999. We like to think that this increase is a reflection of our efforts to expand and improve the fair’s program each year.

Each year the theme of the fair has focused on one or two major healthcare issues facing our community. Women’s health issues have always proven to be a popular topic in our educational outreach programs and community newsletters so a woman’s health issue, osteoporosis, was a natural choice for the fair. We see the fair is another opportunity to get the word out to women about early detection on many diseases and how our laboratory and hospital can serve them. Despite the theme, not all our health fair initiatives were specific to women’s health. We also provided screening tests along with educational materials for prostate cancer and diabetes.

Osteoporosis, a chronic, debilitating bone disease that turns strong supple bones, brittle and breakable, was the focus of last year’s fair. Although the disease does affect men, it affects women in much larger numbers. For example, the National Osteoporosis Foundation estimates that more than 28 million American women are at risk of developing osteoporosis. Women are at four times more risk than men, with an estimated half of all post-menopausal women in the United States likely to develop the disease. It leads to 1.5 million bone fractures annually. The consequence of osteoporosis-related fractures are deadly and serious; 12 to 20 percent of hip fracture patients die within one year.

Given the enormous impact of osteoporosis, we decided that a program focusing on it would be an ideal fit for our community. In addition to lab tests for bone reabsorption markers, we also tested for thyroid disfunction, glycohemoglobin, EKG/ECG and general chemistry panels.

Since it would be difficult to tests large numbers of people in one day, we promoted the fair and had people come to the hospital in advance for testing.

le01.jpg (16544 bytes)Heidi Phillips (left), a chief technologist at Barton Memorial, coordinated the Vitros tests for the health fair screening. Dr. Diane Oliver (right) is a pathologist and medical director of the laboratory

Laboratory Implementation
The health fair requires hospital and lab management to coordinate many activities. Along with deciding which health issues to feature and selecting the test menu to support those programs, many other tasks must be executed to ensure good turnout and smooth execution. For example, in advance of the fair, the hospital launched a radio and print advertising promotional campaign that featured extensive information on the tests available. This advertising campaign promoted the health fair and drew attention to our laboratory capabilities. Advertising materials ranged from general announcements of the health fair, to detailed brochures outlining the available tests, what they mean, and any nominal costs associated with them. Patients were only charged for the laboratory’s cost associated with the tests.

The promotional campaign helped make sure that patient test results were ready before the actual fair date. To do this, we had to collect patient specimens, run the tests and produce reports of the results in advance of the fair itself.

Sample-gathering was conducted during the four weeks prior to the actual health fair. Testing days were spread out as much as possible to minimize their impact on daily lab operations. Participants registered for their tests in a wing of the hospital set aside for that purpose. At the registration, they received literature on the tests offered, and, in return, gave us some demographic information along with their name, address and physician’s name. After choosing a test or tests and paying the nominal fees, patient urine or blood samples were taken. Urine sample patients were given a collection kit and directed to a bathroom while a draw area was set up for blood collection. During this phase of the fair, we ran 1,563 tests.

The extra volume from the health fair did not disrupt our normal testing workflow because most of the tests were run on automated random-access, continuous process instruments such as the VitrosÆ ECi Immunodiagnostic System from Ortho-Clinical Diagnostics. The instrument’s fast time-to-result and reliability made it possible for us to take on the extra volume.

We used the Vitros ECi System to offer several health fair tests. One was TSH, a test for measuring thyroid stimulating hormone that features third-generation sensitivity. We also offered an NTx assay that measures cross-linked N-telopeptides of type I collagen in human urine.

Throughout life, bone is formed and resorbed, or degraded in a dynamic process called bone remodeling. NTx, a bone resorption marker, appears in urine as a result of the bone resorption process. Elevated levels of this marker may therefore indicate that a patient’s bones are breaking down faster than they are rebuilding — a state that can indicate disease, including osteoporosis.

Bone density imaging exams are the only FDA approved tool for osteoporosis screening. However, offering an imaging exam was not possible in the context of the health fair. As a simple urine test, the NTx assay gave us another way to identify patients who are most likely to need bone density exams. It was also an educational tool our physicians could use to raise awareness about hone health issues.

When patients arrived at the health fair two or three weeks later, their results were ready. A technologist and a pathologist were on hand to review each test result with each patient. Any results deemed clinically significant were also called to the attention of an attending physician for further evaluation and patient counseling. Patients, who had been tested but were unable to attend the health fair, had results mailed to them or to their primary care physicians.

Improving Patient Care
Planning and implementing our annual community health fair takes a lot of hard work and planing, but Barton Memorial believes the program provides an invaluable service to the community. For example, a number of physicians have told us that the laboratory test results provided during the fair allowed them to better address the healthcare needs of their patients. The tests not only increased patient awareness of their conditions but also helped their physicians identify areas requiring treatment. We believe this can only result in improved outcomes among our patient base.

Just as important as the information we give out at the fair is the information we receive from the community. The fair is a great way for us to learn more about our patient population and capture that in our information systems. This will help us continue to set priorities and shape our healthcare programs to serve our community even better in the years to come.

Robert Johnson, M.T., received his training at the University of of Wisconsin, OshKosh. He worked at Miriam Hospital in Providence, R.I., and owned a private laboratory for 13 years before joining Barton Memorial as lab manager.