Blog Archives
By Jamie Cetrone | Categories: | Comments Off on Food as Medicine
Cuyahoga County, home to The MetroHealth System, ranks highest in Ohio for the greatest number of food insecure adults and children. To impact health outcomes for patients identified as food-insecure and who have chronic health conditions, MetroHealth opened a new food clinic, with a pantry, “Food as Medicine,” on their main campus. The Food as Medicine Clinic is a targeted food-based intervention designed to address food insecurity as a social determinant of health, and improve health outcomes for patients with certain chronic health conditions that are common in MetroHealth’s patient population and are impacted by diet.
The Food as Medicine clinic works on a referral basis, where MetroHealth case managers and social workers refer patients based on a food insecurity screen and medical criteria. Patients enrolled in the pilot program must screen positive for food insecurity at the time of hospital discharge, have a primary care physician at MetroHealth, and have uncontrolled diabetes, uncontrolled hypertension or acute exacerbation of heart failure. Once prescribed, patients can select a two-to-three-day supply of healthy foods for themselves and family twice a month, stocked by the Greater Cleveland Food Bank, which include whole grains, dairy, fresh and frozen produce, canned fruits and vegetables, and meat products. Additionally, a diet technician will provide nutritional education and assistance in the clinic, along with information about healthy cooking. For patients in need of transportation assistance, a bus or parking pass can be provided to and from the clinic. The pilot phase of this program aims to serve 100 patients.
Citizen’s Bank, through their Citizens Helping Citizens Fight Hunger program, provided the initial investment to help develop the Food as Medicine pilot program and food clinic. Additional funds have been received from Mt. Sinai Health Care Foundation and The Reinberger Foundation who have recently approved two-year grants to support and sustain the program. The Greater Cleveland Food Bank continuously stocks the clinic’s pantry. Students pursuing nutrition-related degrees from area colleges provide volunteer support for the program.
MetroHealth is starting with a 100-person pilot to measure the effects of the Food as Medicine intervention on eating habits, particularly fruit and vegetable consumption, healthcare utilization (hospitalization and ED visits), and clinical measures such as hemoglobin A1c, blood pressure, and BMI. This is a relatively new program and still in the enrollment phase; MetroHealth is just beginning to collect 3-month follow-up surveys to assess preliminary outcomes.
By Jamie Cetrone | Categories: | Comments Off on Flavor Harvest@HOME
Studies indicate that as many as 1 in 3 patients 65 or older are at risk for malnutrition upon admission. Without proper treatment, approximately 2/3 of malnourished individuals will experience further decline in their health status due to increased risk of infection, pneumonia, etc, which is then posing financial risk to the health system.
In late 2013 Lee Health System assessed their treatment of malnourished patients, and identified that only 1.3% were diagnosed as malnourished. Knowing that 45% of patients were 65 or older, they recognized a need to change the way they address this medical need. Initially the program was piloted at one hospital, and once outcomes were validated it was expanded to all acute and post acute facilities. The primary goal of the program is to assist patients in their recovery by facilitating their transition from Acute Care to Self Care through the provision of appropriate nutrition, which when properly administered has proven to improve recovery, limit costs, and reduce readmission rates.
Flavor Harvest@Home is an in home medical nutrition therapy program designed to provide nutritional support for the home bound patients who are either diagnosed and/or at risk for becoming malnourished. Flavor Harvest@Home provides therapeutically appropriate meals to home bound patients recently discharged from the hospital delivered to their doorstep for 4 weeks free of charge. A full array of therapeutic meals covering all meal periods, snacks and beverages are available to patients either through direct intervention by their caregiver or a nutrition call center.
Flavor Harvest@Home is part of a 4 component nutritional intervention plan designed to improve patient recovery times. Incorporating many of the Alliance for Advanced Nutrition’s multidisciplinary Nutrition intervention framework, the program includes: (1) nutrient dense food and/or nutrition home meal delivery, (2) nutrition education for clinical providers for better identification of malnourishment risk, improved screening tools and increased nutrition assessment, (3) nutritional counseling with patients and families, and (4) coordination of nutritional care during and after hospital discharge. The Flavor Harvest@Home project is designed to measure the effectiveness of an enhanced interdisciplinary nutrition intervention program on targeted hospital patients with a state of malnutrition or at risk for malnutrition.
This model is a multidisciplinary effort that requires coordination with clinical professionals, registered dietitians, providers, food service staff and third-party contractors.
Readmission rates in the program participants continue to show improvement. Between 2015 and March 2017, 1,259 patients qualified for the program. To date, over 1500 patients have completed the full 4 weeks of meals.
By Jamie Cetrone | Categories: | Comments Off on Housing is Health
Central City Concern (CCC) responded to Portland’s crisis in housing and homelessness with the Housing is Health campaign, initiated by CCC’s executive director and health system CEOs. With a lead gift of $21.5 million by a pioneering collaboration of six local hospitals and health organizations—Adventist Health Portland, CareOregon, Kaiser Permanente Northwest, Legacy Health, Oregon Health & Science University and Providence Health & Services–Oregon—the Housing is Health initiative will bring homes, health, and healing into the Portland community where they are needed most.
The Housing is Health initiative is an unprecedented push to build 379 new homes designed specifically for individuals and families who are homeless or at risk of becoming homeless. These buildings are spread across three separate locations, one of which is anchored by a critically needed health care clinic. All locations will offer residents a variety of support services, including substance use disorder recovery support, mentoring, life skills training, and help re-entering the workforce.
Housing is Health enables health care systems to work together to address social determinants of health such as housing and employment. Central City Concern’s Recuperative Care Program (in the Blackburn Building) gives homeless people who are exiting hospital stays more time to get better in a safe environment. Employment specialists in the Housing is Heath collaborative help residents to enter/reenter the workforce.
All three Housing is Health buildings are under construction. Charlotte B. Rutherford Place (51 family-housing apartments) in North Portland and Hazel Heights (153 work-force apartments) in Southeast Portland will open summer 2018. The Blackburn Building (51 units of respite care housing, 124 units of transitional housing, as well as a primary care clinic and pharmacy) will open in 2019.
By Jamie Cetrone | Categories: | Comments Off on 500 in 5 campaign (housing development)
This program originated from Truman Medical Center’s behavioral health program (TMCBH). TMCBH’s homeless outreach services needed access to housing units to stabilize behavioral health clients with multiple health care needs that were routinely rotating through the emergency department (ED). They renegotiated a state contract that had unused funds and secured a partnership with a supportive housing developer. A local university did a brief market analysis to help determine the number of units that could have a significant impact in the community. This led to a 5-year campaign to develop 500 units of housing in the metro area while measuring impact on healthcare and treatment.
The hospital does not allocate any direct resources. Medicaid pays for support services for most tenants served, and HUD pays for non-Medicaid reimbursed support services for those pending Medicaid and the chronically homeless. HUD dollars or Missouri Department of Mental Health monies are used to pay rental assistance, and private foundation dollars are sometimes used to fill gaps. In year one, the program has been targeting chronically homeless individuals that frequent the ED and transition-aged youth at risk of homelessness.
TMCBH partners with organizations on a project by project basis, including the Vecino Group, the Corporation for Supportive Housing, local non-profits, and multiple community landlords. When targeting transition-aged youth with mental illness, the program partnered with a local private university that had vacant dorm space to create four units of supportive housing while also enrolling the youth in college (with private foundation monies). For chronically homeless individuals, program staff secured a local landlord and master-leased 20 units with HUD and state dollars. TMCBH agreed to provide on-site staffing for 40 hours per week and keep the units filled so there are no vacancies longer than 30 days. Collaborations are specific to the population being housed.
TMCBH launched the campaign in October 2017 and have secured 25 units with an additional 45 under development. An initial report demonstrated a 68% reduction in ED visits for 22 clients in the first 6 months of housing. Research will be collected every 6 months to evaluate impact.
By Jamie Cetrone | Categories: | Comments Off on Vita Health and Wellness District
In 2000, Stamford Hospital (SH) partnered with Charter Oak Communities (COC) to expand and redevelop their respective real estate holdings on Stamford’s West Side. The 2013 Community Health Needs Assessment (CHNA) identified the neighborhood as a priority due to its disproportionate share of chronic diseases. The CHNA results, along with the Affordable Care Act’s emphasis on addressing the upstream causes of disease, prompted Stamford Hospital to undertake a series of strategic investments in the surrounding community. Stamford Hospital and COC crafted a unique exchange of owned properties that enabled both to complete a series of complex redevelopment projects, including a new hospital and hundreds of housing units. This relationship led to the Vita Community Collaborative in 2012, which aims to promote health and wellness in the West Side neighborhood. Vita developed an interactive tool, entitled Vita Impact designed to show the linkages between targeted social initiatives and other characteristics that can broadly impact a community.
The Vita Health and Wellness district has become a health-themed neighborhood where numerous distressed public housing projects have been replaced with lower-density, mixed-income communities with dedicated resident support services, public green spaces, an independent pharmacy, and a revitalized hospital and campus. Each aspect of Vita addresses the social determinants of health, including healthy housing, economic stability, education and attainment, public health and access to medical care, physical activity and improved social cohesion. The core of Vita includes hundreds of new mixed-income, townhouse-style communities (with more under construction). Vita’s unique volunteer-powered urban farm (www.FairgateFarm.com) hosts numerous community-building programs such as nutrition education, cooking classes, food waste composting, and food security. Residents of the Vita community are afforded access to non-emergent medical care with two federally qualified health centers (FQHCs) serving patients on Medicaid and Medicare along with the underinsured, and the Americares Free Clinic, which provides primary care for uninsured patients who do not qualify for any government funded programs. Stamford Hospital supports the entire Vita initiative by contributing to its operating budget and providing dedicated in-kind staff support.
Stamford Hospital and Charter Oak Communities provide the essential backbone support to the Vita initiative, which includes program management, administrative services, communications and public relations, program evaluation, fund raising and strategic leadership. Vita Collaborative members represent nearly every discipline among community organizations including healthcare, public health, mental health, human services, education, food security, affordable housing and local government representation. Stamford Hospital also provides nutritionists, data analysts, and clinical staff to participate in planning and program implementation. Stamford Hospital completed construction on its new hospital and redeveloped campus, investing $450 million, and Charter Oak Communities has completed nearly 400 units of mixed-income housing through its strategic application of public and private resources – totaling an investment of over $200 million.
Each year, Fairgate Farm engages hundreds of participants and volunteers including students of all ages, corporate and civic volunteers, gardening enthusiasts and ‘foodies’, and numerous local residents. In 2017, the Farm grew over 4,000 pounds of organic fruits and vegetables, donating much of it to local hunger relief organizations. The Parents-as-Co-Educators program, designed to improve Kindergarten readiness for children of immigrant families, had a 100% success rate in its 2015-2018 cohort. This program has been rigorously measured through its partnerships with the Harvard Business School Community Partners and the University of Connecticut. A second cohort is planned to begin in the fall of 2018.
By Jamie Cetrone | Categories: | Comments Off on Violence Interrupters
In November 2016, the Northern Ohio Trauma System (NOTS) launched the “Violence Interrupters” program at MetroHealth Medical Center with a goal of curbing violence. This collaboration with the Cleveland Peacemakers Alliance and United Way places a person, the “violence interrupter,” in the hospital emergency department to work with patients who are victims of violence. The initial goal is to defuse reactions to conflicts and prevent retaliation. Victims, their friends, and their families are then advised about community resources providing alternatives to continued violence.
Violence interrupters are former gang members or reformed criminals trained to be mediators in their community. Mediators work from 7 p.m. to 3 a.m., Monday through Thursday, when admissions are highest for violent injuries. They guide and counsel victims (ages 15 to 25) and their families. Cleveland Peacemakers Alliance and United Way provided pilot funding.
Social workers within the hospital are key to the program, and externally, the Victims of Crime staff help coordinate additional support in the community for patients and families.
In January 2018, a research project will be launched to evaluate who is being reached, the level of engagement, and if attitudes and behaviors are changing.
As of the end of 2017, MetroHealth has worked with 90 patients, their families, and friends. The view is that immediate intervention is the reason none of these patients has been seen at MetroHealth Medical Center as a repeat gunshot wound victim.
By Jamie Cetrone | Categories: | Comments Off on Spartanburg’s Way to Wellville
In 2015, Spartanburg was one of five communities in the nation chosen to participate in the Way to Wellville; a challenge to develop new and innovative solutions that amplify and accelerate community health. Sponsored nationally by HICCup, Spartanburg’s Way to Wellville is working to improve health outcomes through five focus areas in the City of Spartanburg: obesity prevention; kindergarten readiness; access to care for the uninsured; health for the insured; and community pride.
A Core Team of cross-sector leaders serves as the key navigator for Spartanburg’s Way to Wellville. This leadership group monitors progress, supports committees in meeting their goals, and explores and evaluates other potential partnerships and related opportunities. Way to Wellville committees create goals and develop specific projects and programs for each of the five focus areas. The hospital and participating organizations leverage resources and equally share the expenses of the Coalition. Although the Way to Wellville focuses on all residents in the City of Spartanburg, particular emphasis is placed on the vulnerable and the very young.
Hospital leadership sit on the core team and look for multiple ways to include the health system in the work. Programs working to find access for the uninsured, a small business wellness cooperative, home visitation programs for new moms…..all involve the health system in some way.
The Way to Wellville explores innovative and creative ways to address critical health issues in the City of Spartanburg. Examples include:
- A major initiative to introduce nine programs that would be available to all new mothers and the 650 babies born in the city each year is underway. From home visitation to parenting classes to quality early learning, they are working on a pay-for-success model of financing and look forward to rolling out in 2019.
- A prototype of a small business wellness cooperative is currently being built and a pilot will launch mid- 2018. This will allow small business owners to provide similar resources to their employees that large employers do.
By Jamie Cetrone | Categories: | Comments Off on Cure Violence
Cure Violence was launched in Chicago and has since expanded to numerous sites across the United States. Cure Violence uses strategies and methods similar to disease control and prevention to prevent violence. The program aims to shift the thinking, policy, and practice of violence prevention so that violence is recognized and treated as a health issue. Cure Violence was founded by Dr. Gary Slutkin, former head of the World Health Organization’s Interventions Development Unit, and professor of Epidemiology and International Health from the University of Illinois-Chicago.
Cure Violence uses methods and strategies associated with disease control to stop the spread of violence. This model is centered on three essential elements, detecting and interrupting potentially violent conflicts, identifying and working with those at highest risk for involvement, and mobilizing communities to change existing norms. This work is conducted by trained health workers who engage those at highest risk in the community, schools, and hospitals. The community-based interventions are supported through partnerships with local organizations and city agencies, which provide financial and operational support. The hospital-based interventions, while connected to the community-based projects, are implemented in partnership with the trauma team, and social work and chaplaincy staff.
Beyond being integrated into the trauma team and providing direct assistance to patients, program staff collaborate with all departments engaged in treatment plan development and follow-up to reduce likelihood of reinjury. In collaboration with the community-level intervention, the model partners with all sectors, including community organizations, city agencies, faith and community leaders, and schools, to provide comprehensive prevention programming and support for those at highest risk of involvement in violence. Services provided may include counseling, crime victim compensation, employment, housing, education assistance, and case management.
The Cure Violence model has been replicated in 60 communities across the United States and has been independently evaluated numerous times. These evaluations have demonstrated large statistically significant reductions in shootings and killings of up to 73%. In addition to reductions in violence, the model has been shown changes in behavior and norms, such as reduced support for the use of violence within the target areas.
By Jamie Cetrone | Categories: | Comments Off on Henry’s Groceries for Health
Gleaners and Henry Ford Health System recognized an opportunity to improve the health of patients who are already high-risk clinically (multiple chronic conditions) and are screened positive for food insecurity. Case managers in three high-risk clinics screen patients for food insecurity and eligibility, and patients who accept enrollment in the program are offered a package of food (including fresh produce and frozen meats) every two weeks for six months. The pilot will enroll 300 patients total, with expansion based on success. Measures include ED visits, admissions, and readmissions experienced by the enrolled population.
The program scope includes the patients currently being seen in three Henry Ford Medical Group clinics across Southeast Michigan, including two in the City of Detroit. Case managers already support these clinics, so no new staff resources were required. Gleaners receives lists of patients to receive food deliveries (for patients at two of the clinics) or food pick-up (for patients in the third clinic). Funding is handled through existing Patient Needs Fund, covering the cost of the food and delivery for the patients.
HFHS Public Health Sciences assisted with the software to send patient information in a de-identified way to Gleaners. HFHS legal team assisted with ensuring a Business Associate Agreement. The Gleaners senior team meets with the HFHS program team weekly to track progress in the pilot.
The program launched in the three clinics on 11/15/17. As of 1/8/18, 575 patients have been assessed, of which 118 (20.5%) have been identified as food insecure. Some of these patients proved ineligible for the program due to extensive dietary restrictions, in-home cooking limitations, or family size, bringing the total eligible to 100 (17.5%). Of these, 100% have accepted the program, and only three have subsequently dis-enrolled for various reasons.
By Jamie Cetrone | Categories: | Comments Off on Worcester ACTs
The HOPE Coalition (Healthy Options for Prevention and Education), funded by UMass Memorial Medical Center, is launching a new initiative, Worcester Addresses Childhood Trauma (Worcester ACTs) for children who have witnessed violence. This program is a response to research conducted by the coalition’s director Laurie Ross, PhD in partnership with the Worcester Youth Violence Prevention Initiative (WYVPI).
For over a decade, the Worcester Police Department (WPD) has actively worked to reduce gang-related violence, and progress has been made in lowering the occurrence of violent incidents involving city youth. But young men of color — particularly Latinos — are still highly involved in serious incidents. In 2012, as the research partner with the Safe and Successful Youth Initiative (SSYI), a state program, Dr. Ross read case histories of young men who are a proven risk for gun or knife violence. Thirty percent had their first violent experience (as a victim or witness) before age 12, and 30 percent were parents, creating the potential for an ongoing cycle of violence. Analysis of WPD data encompassing 24,000 men (younger than 27) and 98,000 incidents showed that if they had been a victim or witness to violence before age 12, they were 49 percent more likely to have a violent incident later and participate in three more recorded incidents than those not involved with police at an early age.
Even more surprising was that if they had been a witness only, they were more likely to experience violence later in life than those who were victims only. While most social services support victims, Worcester ACTs will introduce timely trauma-informed family support for children under 10 and their families who have witnessed an incident. Within 72 hours of a call to the police, a culturally competent Community Health Worker (CHW) will help the family with emergent and longer term needs.
Worcester ACTs includes the below partners, who work together to address an identified gap in the connection of young children who have witnessed violence to needed social and mental health services:
- Center for Health Impact
- Central Massachusetts Area Health Education Center, Inc.
- Clark University
- Community Healthlink
- Fairlawn Foundation Fund at Greater
- Worcester Community Foundation
- Straight Ahead Ministries
- UMASS Medical School Child Trauma Training Center
- Worcester Division of Public Health
- Worcester Police Department
- YWCA of Central Massachusetts
All 400 WPD officers have already received training on how trauma affects a child’s brain development and hiring of CHWs is underway. The program launches in January, 2018.
