Health Survey Seeks Broad Profile of Medical Needs to Strengthen Delivery of Care to All Islanders

By JULIA WELLS
Gazette Senior Writer

Marking the first-ever study of its kind on the Island, a wide-ranging scientific health survey will be launched this winter that is aimed at developing a comprehensive health report for the Vineyard.

Called The Health Report of Martha's Vineyard, the pioneering project is a collaborative venture supported by virtually every health care organization on the Vineyard, including the Martha's Vineyard Hospital, Martha's Vineyard Community Services, the Dukes County Health Council, Hospice of Martha's Vineyard and the Foundation for Island Health.

The six-month project, which will include a professional random sampling of both seasonal and year-round residents, interviews with every Island health provider and a summary of all existing health data on the Vineyard, will be directed by Diane Becker, a professor of medicine and director of the Center for Health Promotion at Johns Hopkins University.

"What we are planning to do is as thorough a profile of health status - both the good and the bad - as possibly can be done for both permanent residents and seasonal residents," said Ms. Becker from her office in Baltimore this week.

The project will begin in January and will include four phases. The first phase is a 10 to 12 per cent weighted random sampling aimed at reaching some 4,000 year-round and seasonal residents. The Wampanoag Tribe and the Brazilian community will also be surveyed.

The second phase will take place in the late winter and early spring and will include a summary of data from every health care organization on the Island, including the hospital, Community Services, hospice and the visiting nurse organizations.

The third phase will take place in March and will include an in-person interview with every Island health provider - including all of the alternative practitioners - to examine health factors such as illness, practice demands and access issues.

The fourth and final phase of the project will be the health report itself, which will be written in April.

All the data will be anonymous.

The actual survey will be adapted with permission from the government of Canada and First Nations, a recently completed comprehensive Canadian and Inuit health survey. The Canadian survey has been widely used for strategic planning.

Ms. Becker is chairman of the Health Report Committee along with Dr. Russell Hoxsie, a respected Vineyard physician, and Fred Rundlet, the health care administrator for the Wampanoag Tribe of Gay Head (Aquinnah).

The project was spearheaded by Dr. Charles Silberstein, who is founder, chairman and president of the Foundation for Island Health, a local group dedicated to creating a model health care system on the Vineyard.

Ms. Becker is a longtime seasonal resident of the Vineyard. Her involvement in the health report began two summers ago when she wandered into a summer symposium sponsored by the Foundation for Island Health. She said bluntly that she was somewhat taken aback at the discussion she heard in the Old Whaling Church that summer evening.

"I'll be totally frank, there was a lot of what I thought was very esoteric discussion. What I have learned over the years is you have to get down to tangibles. We can have all these talks and pat ourselves on the back and go home, but this sort of over-intellectualization of health and health issues bothers me," she said. "I was sitting in on this discussion and I was expecting to hear some good old grass-roots discussion of health, but I heard more of what I hear every day here in academia. I thought, ‘What is happening here, this is the Vineyard, a place where you can see things, feel them, touch them. People are real here - why do we have to have an intellectual discussion when we know what the issues are?' " She continued:

"One person on the panel said the only issue relative to health and wellness and illness on the Vineyard were those experienced by the full-time residents who were underinsured, and the way to solve it was to tax everybody who got off the boat."

That was when Diane Becker got out of her chair.

"I've been coming to the Vineyard for years and years, and I come here to get away from this. But the way we take care of it is we become Robin Hood. My husband said don't do it, don't get involved, but I did anyway. I made a statement; I said there are ways to approach this systematically and if our goal is to be the healthiest rural area in the country, we need to know some things," she said.

Put the story on fast forward and the result is the health report project now under way.

Ms. Becker took a preliminary look at existing health care data for the Vineyard and found there was very little.

A quick check of state and county data revealed that among 48 peer counties, Dukes County was the most lacking in health data, and other queries produced similar results. "I asked what we knew about the medical conditions and the health status of the Vineyard; what I got from people were really piecemeal things, little pieces of surveys, nothing that would give me a picture of what you would need to know to construct a hospital or primary care services - how do you plan for something when you don't really know what you need?" Ms. Becker said.

"I came to the conclusion after querying everything I could get my hands on that we really don't know what the issues are on the Vineyard, and the issues have to include both seasonal and part-time residents - it's very naive to think this is simply an issue of an underinsured population."

But Ms. Becker said she was also impressed with the number of services on the Vineyard. "I thought there are so many players at the table; this is the first time I have had an opportunity to do something right, to pull together all the strengths," she said.

It is estimated the health report would cost about $1 million in the regular market, but because the work by Ms. Becker and every other professional involved on the survey team is voluntary, the report will cost the Vineyard nothing.

"It's really a $1 million gift to this Island," said Community Services executive director Ned Robinson Lynch during a recent interview with a group of Vineyard health care leaders involved with the report.

"Too much of what we do is about CEOs and directors and too much of what we are involved with is reacting - we're reacting to the legislature, to the federal regulations - we don't ever have the time to step back and do an objective study. It's going to really help my services and hopefully the whole Island," he added.

Dr. Hoxsie recalled a story from many years ago, when there was a traffic jam in the operating room at the Martha's Vineyard Hospital. The prognosis called for building an expensive new suite of operating rooms. But when a team of staff, including nurses and doctors, sat down to examine the problem, it turned out to be a simple scheduling problem, because doctors were not arriving on time for scheduled surgeries. The problem was fixed without spending millions of dollars on new operating rooms.

He said the story is a lesson.

"We all have impressions about what's broken about medical care, not only on the Vineyard but everywhere - I'm not sure we are always right about it - but if we ask the right questions we may find out some things," he said.

"The main thrust and goal is to maintain our health status," said Mr. Rundlet.

"I think this is a unique opportunity for the hospital and a unique opportunity for health care on the Island," said Michael Dutton, who is the development director for the hospital.

"Just the fact of doing this changes us and empowers us," said Dr. Silberstein.

"I have nothing but praise for Diane Becker; she has literally struck the themes here," said Tad Crawford, who is chairman of the Dukes County Health Council.

Ms. Becker has a long background in community health research and health policy; among other things she has led a number of projects funded by the Nationals Institutes for Health and Centers for Disease Control. She also did a health policy fellowship in the United States Senate about five years ago and worked with the late Sen. John Chafee of Rhode Island.

She said the health report will be more than text on paper. "The health report will be not just be a published document, because we all have those that sit on the shelf - it will have information that can be used to do planning," Ms. Becker said.

She concluded simply that her work is meant to give something back to the Vineyard. "I felt the one thing I could bring to the table is my skills, not my opinion. There are lots of think tanks, but I found almost no work tanks - I was not willing to have a dialogue unless I could work," she said.