1. A Narrative Account of the Fond du Lac Partnership with the Mayo CTSA W. Michael Hooten, MD Department of Anesthesiology Division of Pain Medicine

2. “I know not any thing more pleasant, or more instructive, than to compare experience with expectation, or to register from time to time the difference between idea and reality. It is by this kind of observation that we grow daily less liable to be disappointed.” “I know not any thing more pleasant, or more instructive, than to compare experience with expectation, or to register from time to time the difference between idea and reality. It is by this kind of observation that we grow daily less liable to be disappointed.” Samuel Johnson 1709-1784

3. Set the bar low...

4. Objectives To provide a narrative account of the Fond du Lac led partnership with the CTSA.To provide a narrative account of the Fond du Lac led partnership with the CTSA. Identification of important themes that have characterized this partnership.Identification of important themes that have characterized this partnership. To highlight the key role of the CTSA in this partnership.To highlight the key role of the CTSA in this partnership.

9. The risks and perils of “celebrityhood.”

13. Research Literature 2003 2007 2009

14. Research Literature 2009 2007 2003

17. FDL identification of a health care problem.FDL identification of a health care problem.

19. FLD-led Action Plan Summer 2007.Summer 2007. Members of the Health Services Division initiated a visit to PRC.Members of the Health Services Division initiated a visit to PRC. Two physicians and one PA.Two physicians and one PA.

20. Invited Site Visit Mid-2008.Mid-2008. Leaders of the HSD invited PRC clinical staff for a site visit.Leaders of the HSD invited PRC clinical staff for a site visit. They talked about their need to improve chronic pain care.They talked about their need to improve chronic pain care.

22. Fond du Lac HSD Integrated health deliver system.Integrated health deliver system. Owned & administered by FDL.Owned & administered by FDL. Provide health services for approximately 7,000 American Indians.Provide health services for approximately 7,000 American Indians. Electronic medical record.Electronic medical record.

24. On-site pharmacy services

25. FDL led solution(s) that would provide direct and immediate benefits to the community.FDL led solution(s) that would provide direct and immediate benefits to the community.

26. Chronic Pain Clinical ServicesResearch Grants

27. Delivery of On-Site Health Services Scheduled by FDL providers.Scheduled by FDL providers. FDL providers identified patients for participation.FDL providers identified patients for participation. Gained approval and support of Mayo including malpractice coverage.Gained approval and support of Mayo including malpractice coverage.

28. Cynthia O. Townsend, PhD Assistant Professor Department of Psychiatry and Psychology Director of Clinical Research Mayo Pain Rehabilitation Center

29. Min-No-Aya-Win Clinic and Mayo Clinic Pain Rehabilitation Executive Program The Impact of Pain… and the Process of Regaining Control Over your Life Again

30. Three Different Types of Pain Acute Chronic or Persistent Terminal Pain associated with dying process.Pain associated with dying process. Care focuses on comfort and quality of life rather than treatment/cure.Care focuses on comfort and quality of life rather than treatment/cure. Opioids/narcotics provide comfort during end of life.Opioids/narcotics provide comfort during end of life.

31. Wellness Concepts Elimination of Pain Behaviors Stress Management Relaxation Moderation No Analgesic Medications for Chronic Pain Distraction/DiversionDistraction/Diversion Sleep HygieneSleep Hygiene Exercise (Stretching, Strengthening, and Aerobic Activities)Exercise (Stretching, Strengthening, and Aerobic Activities) Awareness of Emotional Impact of Chronic PainAwareness of Emotional Impact of Chronic Pain

32. Pain is in Control Illness/Injury Fear & Concern Offer Support Decreased activity & pain Hope & Trust Increase attentiveness, Help with daily tasks. Seek medical attention Loss of control Continue to Do More, Care-taking Increased activity & pain Anger, frustration Attempt to Re-establish Roles Loss of strength & endurance Guilty & withdrawn Do it All, Over-invest Withdrawal & Isolation Sadness & depression Ignore, Withdraw Cycle of Chronic Pain Cycle of Chronic Pain (Behaviors, Emotions, Family Response)

33. Goal : Break the Cycle of Pain Learn adaptive ways to cope with painLearn adaptive ways to cope with pain Strategies for applying wellness principles to pain managementStrategies for applying wellness principles to pain management Improve quality of lifeImprove quality of life

34. What is Wellness? A way of life that you design, by making informed healthy choices to achieve your optimal health.A way of life that you design, by making informed healthy choices to achieve your optimal health.

35. FDL led research that would build clinical capacity, provide education to tribal members and could be disseminated to other tribal communitiesFDL led research that would build clinical capacity, provide education to tribal members and could be disseminated to other tribal communities

36. Research Component Fall 2008. Healthier Minnesota Community Clinic Fund grant. Not funded but… Demonstrated feasibility. Rough draft for a NARCH grant.

37. NARCH January 2009 Meeting at the HSD included: Mayo CTSA representatives Great Lakes NARCH FDL staff U MN-Duluth Medical School

38. FDL Visit to Mayo CTSA February 2009.February 2009. Chuck Walt identified as NARCH PI.Chuck Walt identified as NARCH PI. Presented CTSA Grand Rounds.Presented CTSA Grand Rounds. Disussed basic role(s) of CTSA in the NARCH grant.Disussed basic role(s) of CTSA in the NARCH grant.

40. Dr. Dorscher

41. Take Home Points FDL identification of a clinical problem.FDL identification of a clinical problem. Action plan developed by FDL.Action plan developed by FDL. FDL led partnership with the CTSA and the U MN-Duluth….FDL led partnership with the CTSA and the U MN-Duluth….