Blog Archives
By Amanda Jepson | Categories: | Comments Off on Health Equity Accelerator
The Health Equity Accelerator at Boston Medical Center (BMC) originated from research and development after COVID-19 highlighted multiple health inequities that would not have been uncovered in normal conditions. These discoveries, paired with BMC’s historical interest in closing the health equity gap, fuel the Health Equity Accelerator. The program’s goal is to drive racial health equity in the areas of pregnancy, infectious diseases, behavioral health, chronic conditions, and oncology and end-stage renal disease, with a vision to transform health care to deliver health justice and well-being.
The Health Equity Accelerator incorporates three foundations of health care: research, clinical care, and community, including social determinants of health (SDOH). The Accelerator team consists of executive leadership, project managers and analysts, community navigators, and research experts. This team breaks problems down into core elements and, through research and evaluation, identifies and implements innovations to combat the problem. The team will partner with community leaders to seek insight on how well those solutions and interventions affect the target issues. The program aims to serve patients and their communities, specifically those of color, that face immense health inequities.
The Health Equity Accelerator’s strategy aims to promote four pillars to collaborate and complement each other in the mission. These groups include clinical operations, community and SDOH, research and evaluation, and policy and advocacy. The Accelerator team also identifies external partners interested in participating in interventions to help communities BMC and other health institutions share.
The Accelerator’s Equity in Pregnancy program focuses on improving the rate of severe maternal morbidity for mothers of color and the rate of babies of color born small for gestational age. Through research, the program identified gaps and developed recommendations that will help close those gaps. Another project focused on empowering people of color, who were at a higher risk for disease transmission, to make informed decisions regarding COVID-19 vaccinations.
By Hannah Lambalot | Categories: | Comments Off on The Sky Farm
Wellness and prevention have long been key components of the Eskenazi Health model of care. Through a large primary care network, numerous community-based health fairs, the Eskenazi Health Farmers’ Market and other initiatives, Eskenazi Health has been committed to community health and wellness. Dr. Lisa Harris, CEO of Eskenazi Health, believes the best opportunity to improve the lives of patients and, by extension, the health and vitality of our community lies in helping individuals stay well. Several years ago, employees at then Wishard Health Services (now Eskenazi Health), developed a garden area in a courtyard where employees could plant and grow flowers as well as fruits and vegetables. When plans moved forward to build a new hospital campus, leaders looked at ways to enhance its commitment to wellness for employees, patients, and visitors.
The construction of The Sky Farm occurred as part of the overall construction of the Sidney & Lois Eskenazi Hospital and Eskenazi Health campus, which opened in December 2013. Marion County voters approved construction of new facilities to replace the Wishard Memorial Hospital campus in the Nov. 3, 2009 election, with 85 percent support for the measure. Sidney and Lois Eskenazi of Indianapolis contributed $40 million to the project’s capital campaign in June 2011, and Health & Hospital Corporation of Marion County recognized their gift in naming the new hospital the Sidney & Lois Eskenazi Hospital, as well as the campus and system Eskenazi Health.
A number of individuals and organizations were involved, including RATIO Architects, Inc., of Indianapolis. The original design of The Sky Farm at Eskenazi Health was developed by Erik Reid Fulford of NINebark, Inc. Fulford was an Indianapolis-landscape architect who passed away in 2012. David Rubin of Land Collective, a world-renowned landscape architect, who also designed the outside main entrance landscape at the Sidney & Lois Eskenazi Hospital, helped to carry out Fulford’s work.
The rooftop farm is utilized to grow fresh produce for patient education, which is distributed to the community at Eskenazi Health’s community health centers and given to employees during “Fresh Veggie Fridays” (FVF). In addition to the produce, the farm is home to approximately 500 bees to increase crop production through pollination. The Sky Farm, open 24 hours a day, 7 days a week, has 24 crop beds, some of which are wheelchair height for easy accessibility, and produced and harvested more than 3,700 pounds of produce in 2018. Additionally, The Sky Farm, in partnership with the Eskenazi Health Food & Nutrition Services, provides classes, “Fresh Veggie Fridays” to sample healthy recipes, learn healthy cooking techniques, receive at-home gardening tips, and obtain fresh vegetables grown from The Sky Farm. “Fresh Veggie Fridays” hosts more than 1,000 visitors each season. It also welcomes field trips and tours throughout the year.
Produce grown on The Sky Farm is used to engage Eskenazi Health patients and employees. The Sky Farm Produce Classes are held at Eskenazi Health Center sites, with another 100 people participating in CSA-style 4-week classes. Each class includes a full nutrition lesson, cooking demo, recipe book, and take-home produce. Fresh Veggie Friday is a drop in nutrition, recipe sampling, and produce distribution free to employees, patients, and visitors during the summer growing season. Around 125 people attend each session, there are 10 sessions each summer.
The Sky Farm opened as part of the opening of the Sidney & Lois Eskenazi Hospital and Eskenazi Health campus in December 2013 and we are finishing up our sixth growing season. Overall, through our various programs, we distribute about 3,000 pounds of produce with cooking and nutrition education directly into our community at no cost to the participants.
By Hannah Lambalot | Categories: | Comments Off on StreetCred
StreetCred was founded in 2015 after recognizing the need for doctors to address poverty as a disease, not simply just a social problem. For many families, income tax preparation is a challenge as they try to navigate a complicated system. As a result, they often do not receive the tax benefits they are entitled. StreetCred is an innovative program established at Boston Medical Center (BMC) which offers free tax services to families receiving pediatric care at BMC, who are eligible to receive the Earned Income Tax Credit (EITC) and Child Tax Credit. This service functions as a solution to the financial burden a significant portion of BMC patients face from living with annual incomes below the federal poverty level.
BMC disproportionally serves individuals who are low-income or under-or un-insured. Fifty-four percent of BMC families with children live below the federal poverty level. StreetCred aims to transform families’ wealth and health in a setting they frequent and trust, their pediatrician’s office. During visits, doctors prescribe StreetCred, offering free tax preparation to ensure families receive the Earned Income Tax Credit, the largest, but underutilized, U.S. anti-poverty program. The hospital provides the space, and partners with community tax partners, under the umbrella of the IRS, that provide expertise in tax preparation.
BMC engages with a number of partners, including Yale New Haven Hospital, South End Community Health Center, CAHS, Foundation Communities, Boston Tax Help Coalition, Boston Medical Center, Boston Healthcare for the Homeless Program, Boston Children’s Hospital, People’s Community Clinic, New York Health and Hospital (Gotham Health), Grow Brooklyn, American Academy of Pediatrics, Blue Hills Banks, DCU, Chris Gordon, Santander, BlackRock, The Paul Phyllis Fireman Charitable Foundation, The Claneil Foundation. These partners work with BMC to provide volunteers, financial programming, grants, technical support, marketing, and client engagement.
StreetCred scaled rapidly and effectively with $5.3 million returned to 2,700 families. In addition, families and staff report 96% acceptability rates.
By Katherine Susman | 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 Katherine Susman | 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 Katherine Susman | Categories: | Comments Off on PROgram for Non-emergency TranspOrtation (PRONTO)
PRONTO, a partnership with local health-access startup Kaizen Health, utilizes ride-hailing service Lyft to provide free rides to patients being transitioned home from medical surgical and critical care units. Inadequate transportation can be a significant barrier to accessing healthcare — and can contribute to slow bed turnover and lower patient satisfaction.
With PRONTO — which stands for PROgram for Non-emergency TranspOrtation — UI Health social workers can assess a patient’s transportation needs and, if necessary, arrange for transportation home in a Lyft car. The service is available for all adult patients living in Chicago who are ambulatory and expected to depart by 5 pm, Monday through Friday. The hospital pays for the cost of the program, which averages $20/ride.
PRONTO utilizes the Kaizen Health platform to schedule Lyft rides for patients. The interdisciplinary team that launched the program included representation from Nursing, Social Work, Patient Care Services, Materials Management–Logistics, Information Services, Emergency Department, Population Health Sciences, and Health Policy & Strategy.
Following a successful 4 month launch, PRONTO became a permanent service in May 2017. The program continues to have high patient and staff satisfaction and has been an important part of improving hospital throughput.
By Katherine Susman | 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 Katherine Susman | 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 Katherine Susman | 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 Katherine Susman | Categories: | Comments Off on Fresh Foodies
A significant proportion of Harris Health System’s primary care patient population is obese (BMI > 30); and nearly one third of patients with a diabetes diagnosis are considered to have poor control of their blood glucose levels (A1c >9). This data highlighted the need for more comprehensive, patient-centered education and support and led to the development of the Fresh Foodies program. The goal of the program is to help patients with diabetes and obesity manage their health with nutrition through grocery store tours and food vouchers. These tours reinforce the lessons from group nutrition classes and individual appointments that participants have with a registered dietitian.
Patients have to attend two appointments with a registered dietitian or one appointment with the dietitian (RD), and one nutrition class. Once completed, the RD sends the patient list to the health educator who then invites the patient to participate in the tour. The health educator works with grocery store management to schedule the tour and order the $30 gift cards. Health educators and community health workers provide reminder calls, grocery store tours, and follow-up phone calls. The tour guide focuses on the perimeter of store and selected inner aisles (i.e. bread, beans, and frozen food aisles). Upon completion of the grocery store tour, the patient is provided with a $30 grocery store gift card to practice planning and purchasing healthy foods for family meals on a budget.
Funding for the program was provided by the Harris County Hospital District Foundation. Harris Health Nutrition Services and Harris Health Community Outreach Services work collaboratively to provide nutrition education to patients in individual and group settings and lead patients on the tour. The grocery store tour takes place at an a H-E-B Grocery Store located near the participating community health centers.
In five months, 67 patients were provided with semi-personal (one staff per two patients) guided grocery store tours and 40 of the 67 participated in the two-week follow-up phone call. Patients have reported learning how to purchase more food for less money, select fresh produce, read labels, shop for fresh and not processed food. Patients also report learning that fresh vegetables and fruits are better than canned food. All patients believe the grocery store tour enhanced what was taught during the nutrition class and during their appointment with the dietitian, and all patients report that they would recommend the tour to friends and family.
