Blog Archives
By Amanda Jepson | Categories: | Comments Off on Increasing Birth Equity in Washington, D.C.
Black families in Washington, D.C., account for 50 percent of all births in the city and 90 percent of all pregnancy-related deaths. More than 65 percent of all pregnancy-related deaths occur in D.C.’s Black-majority wards 7 and 8, where infant mortality rates are twice the city’s average. Data from MedStar Washington Hospital Center’s Women’s and Infants’ Services (WIS) patients and needs assessments indicated that multiple social determinants of health (SDOH), including access to medical care, housing, food, and transportation, also disproportionately affect wards 7 and 8.
WIS aims to increase early interventions for adverse SDOH, decrease the number of patients experiencing birthing complications, and mitigate risk factors associated with higher mortality rates. This includes upstream efforts, such as preconception health assessments, and prenatal SDOH screenings. WIS provides trauma-informed clinical services and connects prenatal patients to resources, including support for substance use disorder; food banks; legal aid; assistance obtaining Supplemental Nutrition Assistance Program and Special Supplemental Nutrition Program for Women, Infants, and Children benefits; and more.
A key partner in the D.C. Safe Babies Safe Moms initiative, WIS collaborates with fellow partner Mamatoto Village, a nonprofit that provides lactation consulting and other perinatal support services to primarily Black patients in wards 7 and 8. WIS also partners with Community of Hope to increase service accessibility and improve continuity of care on-site at Community of Hope’s Ward 8 location, allowing patients to see a high-risk obstetrician in the same location where they schedule their maternal and fetal medicine appointments. Additionally, MedStar Washington Hospital Center partnered with the Georgetown University Health Justice Alliance to launch the Perinatal Legal Assistance & Well-being project in 2021, which provides no-cost legal assistance to pregnant and postpartum individuals to address health-harming unmet legal needs, including employment, housing insecurity, and public benefits.
WIS has seen a clear increase in patients accessing interdisciplinary services focused on treating hypertensive disorders, anemia, depression, anxiety, and diabetes. For example, the number of patients receiving diabetes support has nearly tripled in 2020, and now, 92 percent of high-risk patients receive services for diabetes control—a nearly 30 percent increase. The rate of babies born with very low birth weights (less than 1,500 grams) decreased by more than 15 percent and rate of babies with low birth weights (less than 2,500 grams) decreased by more than 7 percent.
By Amanda Jepson | Categories: | Comments Off on Multi-Visit Patient Initiative Supports High-Risk Patients
In 2019, boarding and left-without-being-seen rates at Harris Health’s Ben Taub Hospital were above goal, and executive leaders grew concerned about quality of care, patient safety, and staff burnout. Data analysis showed that Multi-Visit Patients (MVPs)—defined as patients with 10 or more emergency department (ED) visits in the past 365 days—accounted for 0.7 percent of all ED patients and 8 percent of all ED visits. High utilizers of the emergency department often visit hospitals because of multiple behavioral, social, and medical conditions. To decrease avoidable utilization, improve throughput and safety, and help an under-resourced population obtain care, Harris Health in 2020 leveraged the Multi-Visit Patient Method.
Harris Health trained ED physicians, along with nursing, psychiatry, and care management staff, to become program champions. The program employs community health workers (CHWs) in the ED to communicate with MVPs, identify their root cause of frequent visits, and link them to necessary care and community resources. The team tracks key process measures on a weekly and monthly basis: percent of MVP ED visits with a face-to-face assessment, percent of MVP ED visits with a linkage to resources, and percent of unique MVPs with an MVP note in the electronic health record.
Partnering with more than 11 community organizations, including the Houston Recovery Center and Coalition for the Homeless of Houston/Harris County, the MVP team has successfully built pathways to support MVPs with substance use disorder, end-stage renal disease (ESRD), behavioral health, and housing insecurity. Recognizing that a simple referral is not enough for MVPs, the team developed closed-loop communication procedures, including dedicated staff contacts, phone numbers, and MVP-specific operating hours and transportation services.
The MVP team has reunited at least 10 MVPs with their families, obtained routine dialysis treatment for 26 MVPs with ESRD, connected 15 MVPs with substance use disorder to rehabilitation services, and helped 22 MVPs receive housing. In three years, the annual MVP visit count decreased by 23.2 percent (more than 1,500 annual visits), and total length of stay hours decreased by 36 percent (16,000 annual hours). MVPs who were engaged by CHWs on at least three-fourths of their visits showed a 57 percent decrease in ED visits during a 12-month follow-up.
By Amanda Jepson | Categories: | Comments Off on Healing and Opportunities with Psychotic Experiences (HOPE) Program
About 100,000 people in the United States each year experience a psychotic episode. Longer durations of untreated psychosis correlate with more severe symptoms, including less likelihood of remission and poorer vocational, academic, and social functioning. Hennepin Healthcare’s Healing and Opportunities with Psychotic Experiences (HOPE) Program provides early intervention for patients ages 15 to 40 experiencing an illness on the schizophrenia spectrum.
HOPE launched in 2016 through a federal mental health block grant. Program staff educate and collaborate with local organizations to provide referrals. An interdisciplinary team comprising a director, psychiatrists, nurse, individual and family psychotherapists, employment and education specialists, peer and family support specialists, and a psychiatric case worker provides empirically based treatment. Patients set treatment goals and participate in HOPE programming for an average of 18 months. Employment and education specialists collaborate with schools to build accommodations for HOPE patients. Since 2017, staff have taught local law enforcement agencies about psychosis and de-escalation techniques. Staff also developed educational materials for patients and families on safely managing crises in the community.
Since 2016, HOPE has treated 329 patients. Reduction in symptom severity from time of enrollment to time of discharge increased from 60 percent in 2021 to 65 percent in 2023. Planned discharges increased from 60 percent of total caseload in 2020 to 79.3 percent in 2023. From 2017 to 2023, patients involved in work and/or school activities increased from 47 to 63 percent, and representation of people of color in the program increased from 55 percent to 76 percent.
By Amanda Jepson | Categories: | Comments Off on Memorial Mobile Health Center
Memorial Healthcare System has been a leader in mobile health since 2000. The mobile health program runs both pediatric and adult health vans, all with the goal of increasing access to care and intervention services for community members.
The mobile vans operate 21 days a month and offer free services and social needs screenings to community members, most of whom are under- or uninsured. The pediatric van offers immunizations, behavioral health services, well and sick visits, follow-up visits, and counseling events. The adult van also offers vaccines and sick visits but emphasizes helping patients apply for public assistance benefits, such as Medicaid and the Supplemental Nutrition Assistance Program, if they are eligible. All vans are equipped with Memorial Healthcare staff, including two medical assistants, a nurse practitioner, and occasional residents.
To ensure the program meets patients’ needs, Memorial partners with many community organizations, including early learning services, homeless services, migrant services, food pantries, local universities, and local government to help identify locations to set up the clinics.
Memorial’s Mobile Health Center has built a trustful relationship with the community through its efforts. By caring for patients in the community, the vans also have reduced the burden on local emergency departments. The pediatric mobile van sees about 220 patients per month, and the adult mobile van sees about 490 patients per month.
By Amanda Jepson | Categories: | Comments Off on Mobile Wellness Clinic
The Casey Foundation, an organization that works to improve the well-being of children, youth, and families in the United States, conducted an analysis of the Opelika community in 2017 that revealed areas with a lack of access to care. The foundation engaged the City of Opelika and East Alabama Health to begin a mobile medicine program to increase access to primary care within the community. First Transit donated the mobile bus in 2017, and the program officially launched in December 2022.
The mobile wellness clinic visits communities in the greater Opelika area once a week. Staff provide disease prevention resources and screen patients for chronic conditions at the designated site each week. mobile unit social worker connects patients to resources within the community through screening for social determinants of health. The clinic is funded through multiple sources, including the Casey Foundation and the local housing authority, which allows the clinic to prioritize communities with the most need.
Beyond the City of Opelika and the Casey Foundation, mobile wellness clinic partners include charitable clinics that allow referrals for patients to be seen more quickly, local schools and universities from which students work and learn in the bus , and other local community-based organizations that help the program build trust with community members.
The mobile clinic has served community members with all-encompassing care since beginning operations in December 2022. Many personal stories illustrate the clinic’s importance to the community; for example, a care-reluctant patient sought care at the mobile wellness clinic and discovered dangerously high blood sugar levels. Fortunately, the clinic staff were able to quickly intervene and saved the patient’s life.
By Amanda Jepson | Categories: | Comments Off on Pediatric Mobile Health
Hennepin Healthcare’s Pediatric Mobile Health program started during the COVID-19 pandemic with the goal of ensuring that children receive preventative care such routine childhood immunizations. The racial awakening occurring adjacent to the pandemic, which highlighted the long-standing lack of access to care in the community, also fueled the momentum behind the clinic. The mobile clinic team achieved its goal by going door-to-door providing well child checks and immunizations to children. The program since has implemented additional services, including primary pediatric care, partum care for the birthing dyad, referrals back to a medical home, specialty care or community resources for social needs.
The mobile clinic brings pediatric care to families who are hesitant and/or unable to visit the hospital or off-site clinic. Full-time staff, including a nurse practitioner or pediatrician, pediatric provider trainee, and an emergency medical technician, operate the clinic. Staff also screen each family for social determinants of health. Patients who screen positive are referred to clinics or community organizations and resources to help families with their needs.
The program is grant-funded and bills insurance when appropriate. The program collaborates with other departments within the hospital, including the information technology department, to ensure the clinic has the bandwidth to document in electronic health records. The mobile clinic also partners with local schools and community organizations, such as Second Harvest Heartland to help families facing food insecurity and school districts and Head Start Centers to help with childcare resources.
The Pediatric Mobile Health Program has successfully increased access to care by ensuring continuity of care. When families are screened for social needs, community health workers ensure that patients follow through with referrals and applications are completed if necessary. The program also decreased Emergency Department visits, which helps lower costs and provider burnout.
By Amanda Jepson | Categories: | Comments Off on Street Health Outreach and Wellness
During the COVID-19 pandemic, NYC Health + Hospitals recognized that New Yorkers experiencing unsheltered homelessness faced unique challenges accessing COVID-19 testing and vaccination. As the city’s public hospital system and the largest municipal health care system in the nation, the health system had a unique opportunity to leverage its size and spread to bring street medicine services across New York City. NYC Health + Hospitals launched the Street Health Outreach and Wellness (SHOW) program, which quickly evolved to include basic medical care, harm reduction education, and links to other care and services.
SHOW aims to meet patients where they are, build trust, and use longitudinal care relationships to drive positive outcomes in both health and housing. NYC Health + Hospitals currently operates five mobile street medicine units, each connected to one of the system’s facilities and staffed by providers from within those facilities’ primary care safety net (PCSN) clinics. Mobile units, based within communities those hospitals serve, each are staffed with a medical provider, registered nurse, social worker, addiction counselor, peer counselor, community health worker, and registration clerk. The program provides primary care, wound care, mental health support, harm reduction services, and basic material necessities to unsheltered residents in New York City, while connecting patients with the health system’s larger continuum of care via PCSN clinics, specialty care, and other services.
The health system works with multiple partners in this effort, including the New York City Department of Homeless Services, as well as numerous community-based organizations and service providers. These partnerships drive the program’s ability to link patients to services and shelter, as SHOW and NYC Health + Hospitals work to support and strengthen the ecosystem of care for people experiencing unsheltered homelessness.
Since the program’s April 2021 launch, SHOW teams have had more than 233,000 engagements with community members and provided 21,000 medical consultations, 9,000 vaccinations, and 60,000 social work engagements. , as the program evolved its model, more than 1,000 unique patients established care with the SHOW teams, and the program connected nearly 200 individuals with PCSN clinics for ongoing care. All this work feeds into systemwide goals of improving chronic condition outcomes for patients experiencing homelessness, and ultimately, connecting patients into housing.
By Amanda Jepson | Categories: | Comments Off on Rooftop Farm
Boston Medical Center’s (BMC’s) Rooftop Farms opened in 2017 as part of the Nourishing Communities program, which includes the Preventative Food Pantry and Teaching Kitchen. A second farm will open in the spring of 2024, bringing the total growing space to approximately square feet. With two farms, the program will yield 10,000 pounds of fresh, organically grown produce annually to distribute throughout the food pantry, a low-cost farmer’s market, and our kitchens. The farm partners with internal departments and organizations in the Boston area to host team–building, volunteer, and educational opportunities focused on growing food, nutrition, and green infrastructure.
The hospital employs two part-time farm staff who focus on food production, education, and community outreach. The program also sponsors two to four interns per year who assist the farm staff and earn experience in rooftop farming and community engagement. The program’s educational component reaches a wide swath of the community, from public school students to immigrant groups, to patients, employees, and clinical staff. For example, the farm reported more than 1,300 visits in 2023. in 2023, 50 percent goes to patients facing food insecurity who visit the food pantry, 41 percent goes to the general community through the low-cost farmers market, and 10 percent goes to the kitchens.
Since opening seven years ago, the rooftop farm has grown approximately 30,000–35,000 pounds of food for community members, with approximately 75 percent directly reaching those who are low–income or experiencing food insecurity. The original farm also has engaged individuals in tours, volunteer days, and educational events more than 9,000 times, providing community members with a forum to connect with each other, learn about green innovation, and experience a hospital space that builds healthy communities in multiple ways. With a second farm opening, BMC expects to double its impact and continue to grow its community partnerships, aiming to support fair Boston food system that provides workforce development, climate resilience, and nourishing food for all people.
To learn more about the Rooftop Farm, please visit this link.
By Amanda Jepson | Categories: | Comments Off on Sustainability Program
Boston Medical Center (BMC) began its sustainability journey in 2012 after recognizing that the communities it serves are disproportionately affected by climate change. Implementing sustainability efforts is part of the health care the hospital provides, with a focus on improving energy efficiency, reducing carbon emissions, decreasing operating costs, and increasing access to care. BMC first reassessed its real estate portfolio to maximize the impact of every square foot, which led to the sale of several real estate assets. The proceeds then were used to upgrade other buildings for increased energy efficiency. BMC reduced 300,000 square feet while increasing its capacity to care for patients: patient volumes increased by almost 30 percent.
BMC’s climate mitigation work covers a variety of entities that all aim to serve the local community. BMC is the largest safety net hospital in New England; 73 percent of the hospital’s patients are covered by public insurance, and many reside in communities facing environmental inequalities. In 2022, BMC opened the Brockton Behavioral Health Center, the first net-zero behavioral health facility in the United States. The center is powered by solar energy and heated by geothermal wells. Since spring 2017, Boston Medical Center has generated much of its own electricity and heat through a natural gas–fired, two-megawatt combined heat and power plant, also known as cogeneration. The plant operates at 70 percent efficiency compared with a typical gas-fired power plant’s 35 percent efficiency. It also has “black start” capability, meaning that if the electric grid goes down, the hospital can use the cogeneration plant in combination with a recently-installed Tesla battery system to heat and power its inpatient units on an “island” for months at a time, as long as it has a natural gas supply.
In 2016, BMC took a major step toward a carbon-neutral campus with an innovative solar purchase and partnership with the Massachusetts Institute of Technology and the Post Office Square Redevelopment Corporation. Through this partnership, BMC invested 255,000 solar panels across 650 acres in North Carolina. BMC purchases 26 percent of the power the solar facility produces, which is equivalent to 100 percent of BMC’s electricity consumption.
BMC’s reduced physical footprint and efforts to improve energy efficiency reduced utility costs significantly which generated savings that were reinvested back into patient care. Between 2011 and 2022, BMC reduced carbon emissions by 91 percent and electric consumption by 29 percent. These savings have enabled the reinvestment of funds in patient care and other sustainability projects, such as the opening of the Brockton Behavioral Health Center.
To learn more about BMC’s sustainability efforts, please visit their website through this link.
By Amanda Jepson | Categories: | Comments Off on Feed1st Program
In 2010, a group of University of Chicago Pritzker School of Medicine medical students, University of Chicago faculty, and Comer Children’s Hospital staff started the Feed1st program after one of the hospital Chaplains discovered many parents were going hungry at their child’s bedside during a hospital stay. The goal of the Feed1st program is to address hunger in the healthcare setting and minimize the stigma surrounding food insecurity.
The Feed1st program operates 11 food pantry sites throughout UChicago Medicine’s facilities, including the adult, pediatric, inpatient, and outpatient areas of academic health system’s South Side medical campus. The pantry sites are strategically located in emergency departments, patient waiting areas, family lounges, and a hospital retail cafeteria. The program primarily serves community members from the South Side of Chicago, which has some of the highest food insecurity rates in the city; however, the pantry sites are available to everyone in the UChicago Medicine community, including staff.
It takes a village to operate a hospital pantry program at this scale. The hospital and individual departments provide Feed1st with funding support and space for pantry shelves and storages; Clinical staff champions, medical students, undergraduates, and other volunteers keep the pantry sites and storages stocked regularly and well maintained.
The food in the pantry sites is provided by the Greater Chicago Food Depository. The UChicago Medicine Garden Committee also provides fresh produce during harvest seasons throughout the year. The Feed1st Community Advisory Committee, comprised of parents, patients, concerned community members, hospital administrators, faculty, students, and others, plays a consistent role in ensuring the program meets the needs of the people we serve. Feed1st engages clinical staff in individual departments to help monitor and restock pantry shelves and communicate with patients about the program.
the Feed1st program had distributed more than 94 tons of food to more than 88,000 people since opening in 2010. The UChicago Medicine Garden Committee has provided more than 6,000 pounds of fresh produce to the Feed1st pantry sites since May 2022. The Feed1st program also released a toolkit on how to launch a no questions asked food pantry system. To read the newest version of the Feed1st toolkit, click here.
