On a Mission

Internship puts student at the vanguard of changes in primary care

Rachel Carson came to UNC Asheville with an eye toward a career in healthcare, but she didn’t expect to begin that career quite so soon.

“When I heard about this internship opportunity, I got really excited,” said Carson, a junior from Winchester, Va., majoring in health and wellness promotion. “This is an experience within a highly respected health system, and it involves helping medical practices put more focus on preventive care for their patients.”

Last July, Carson began a paid internship program at the Mission Hospital Research Institute. The Institute is a part of Mission Health, the region’s largest hospital and healthcare system.  She is the youngest member of Mission Health’s team helping primary care providers adopt a new model of care – the “patient-centered medical home” (PCMH).

The PCMH model involves the redesign of primary care practices in order to emphasize better care management for patients with chronic diseases and improve health outcomes while reducing costs.  “This is the future of primary care – the medical home model – there’s no question about that,” said Alan Baumgarten, MD, an Asheville family physician and director of Mission Health’s PCMH project. “With changes in healthcare, almost all primary care practices will be striving to function in a medical home model.”

Carson goes with the PCMH project team when it meets with primary care providers as they begin to change their practice model. “Rachel’s right in there,” according to Karen Hyman, PCMH project manager at Mission Health. “She has an opinion, she has suggestions, Rachel’s totally engaged in the process. You wouldn’t necessarily expect that from an intern, but she doesn’t sit back.”

“There are a lot of goals of the patient-centered medical home,” said Carson. “One is to increase access. Often when providers are at capacity and patients can’t get appointments, they end up going to the emergency room. Another goal is to help patients learn to manage chronic conditions like diabetes, obesity and pulmonary disease, so they feel in better control of their health and don’t have as many incidences where they need to see someone right away.”

In class, we’ve talked about issues of communication and access to health care, and through this project, we’re putting those things into practice.
– Rachel Carson, Health and Wellness Promotion major

“One thing I’ve realized during this internship is the importance of primary care physicians and the significant demand for their services,” said Carson. “I feel bad going to these meetings because you can tell they’re so busy; they’re trying really hard. Once they make the transition to the medical home model, it should help them in their practice. This project gives them resources to make that change. But during the transition, it can be stressful.”

Carson too is incredibly busy. She is an honor student, a member of UNC Asheville’s cross-country and track teams, and is participating in an undergraduate research project.

That research experience has served her well in her internship, where she spends a portion of her 10 hours a week inputting survey and health data and creating reports that include doctor and patient satisfaction, frequency of visits to the doctor and to the hospital, correlated with health indicators and outcomes. “The nicest thing was, from the first day, I didn’t need to worry about Rachel’s work,” said Karen Finch, data analyst for the Mission Health Research Institute. “She knew what she was doing.”

The internship also reflects a natural synergy between UNC Asheville and Mission Health. The two organizations formally recognized the strong working relationship established more than a decade ago with an affiliation agreement signed last year. Together, they hope to develop new research opportunities for students and connect the university with Mission Health’s research projects.

Carson is experiencing this connection firsthand.  “There’s an overlap between the internship and my coursework,” she said. “In class, we’ve talked about issues of communication and access to health care, and through this project, we’re putting those things into practice. We’re helping the doctors’ offices focus more on helping individual patients get control of chronic conditions – this goes along with promoting health and wellness.”

Carson’s strong passion for health care comes from her family. “My mom was a nurse,” said Carson. “She was always so passionate about her work, and she always used research in deciding how to best care for patients – she’s my role model.” Carson’s mother passed away less than a year ago, and Carson, while still grappling with that loss, has not lost any of her zeal for wellness promotion. She says she wants to dive right into that work as soon as she graduates.

“While I’m not exactly sure what I want to do, I have a lot of ideas, and I’m dreaming really big,” said Carson. “I would love to start a summer camp for adolescents that focuses on wellness in general and making healthy lifestyle choices. It’s really important to start healthy habits at a young age, and summer camp is fun! Who wouldn’t want to come?”

In the meantime, Carson will continue her studies, her running, her research and her work on the PCMH project. This spring will bring early data on how well the medical home model is working, as the first data arrives from primary care providers who have made the transition. If the new model truly can improve care while lowering health care costs, Carson will be among the first to see the evidence, as she compares the before and after data, preparing reports for the project team.

For more information on the Western North Carolina Patient Centered Medical Home Project, visit the website.