June 16, 2006

Outreach key to Cookeville clinic’s success

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Mathew Ninan, M.D., examines Tony Landers, a patient from Monterey, Tenn., after he had surgery last month. Landers was originally seen in the Cookeville clinic.
Photo by Dana Johnson

Outreach key to Cookeville clinic’s success

Vanderbilt University Medical Center's Department of Thoracic Surgery has teamed up with Highland Rim Respiratory Specialists in Cookeville, Tenn., to offer a unique service to the patients of the Cumberland Plateau.

This partnership has been a true life-saver.

For years the medical staff at the Cookeville clinic, run by pulmonary critical care specialists Douglas Kane, M.D., and Carlos Baleeiro, M.D., watched as many of their patients chose to forgo additional treatment because it meant driving to VUMC in Nashville.

“Most of our patients come from very rural parts of the county,” said Kane. “Traveling to Nashville is very intimidating and unfamiliar. They would rather let their disease progress. It was very difficult to watch that.”

But Mathew Ninan, M.D., assistant professor Thoracic Surgery and director of Vanderbilt's Lung Failure Program, saw the benefits of developing a community outreach program that fulfilled several goals and dovetailed with elevate, VUMC's wide ranging organizational improvement effort.

“Tennessee has one of the worst problems with tobacco,” said Ninan. “The largest burden of tobacco-related illnesses comes from the Cumberland Plateau area. And from a public health standpoint, we can offer education about a disease that commonly affects a majority of residents in that area.

“We began the Cookeville Lung Failure Clinic in 2005 and it has been incredibly successful. A lot of these patients would never get in a car to travel to Nashville. If we wanted to care for this population of patients, we would need to go to them.”

The clinic was started with the support of Bill Putnam, M.D., chair of Thoracic Surgery.

In Cookeville, Ninan attends a pulmonary conference, a multi-disciplinary group of nearly 20 area physicians, to discuss cases. He also holds clinic the first Thursday afternoon of every month. His appointment schedule is booked through summer.

“Many of the doctors in these communities have become more familiar with us, which makes it easier for their patients to trust me,” said Ninan.

“Having connections with the local physicians has been a key part of this strategy. Patients look to their physicians for guidance.”

Since opening the clinic, Ninan's team has seen a tremendous response in referrals, as well as patients' willingness to come to Vanderbilt for further treatment.

Commonly seen ailments include emphysema, bullous lung disease, combinations of severe emphysema and lung cancer and other lung failure disorders.

Vanderbilt is the only center in the state and one of a few in the Southeast offering comprehensive services in lung failure, Ninan said. Treatment options include lung volume reduction surgery (LVRS), lung cancer resection in patients with poor lung function and lung transplantation, among other procedures.

Jean Barnes, R.N., serves as the liaison for the outreach clinic, which has been eye-opening, she said.

“There were a few patients with a smoking history that began as young as 5 years old,” she said. “At first it shocked me, but I later found that it's not uncommon. Lung cancer is the largest cancer killer in men and women.

“Once they enter the VUMC community and meet the team, they realize their fears are unsubstantiated. This is a huge community service. We are being proactive in dealing with one of Tennessee's biggest health issues.”

Ninan and Kane hope that their outreach program can serve as a model for other areas of Vanderbilt seeking to serve semi-urban and rural areas of Tennessee.