Blog Archives
By Hannah Lambalot | Categories: | Comments Off on Clinical Waste Audit
This program began with the goal to perform a Clinical Waste Audit to understand St. Luke’s “waste” categorizations, weights, and types. This data then can be used to inform waste reduction, reprocessing, and recycling projects. In the long term, this information can work in tandem with an implemented software program to capture all utility data into a database and set a baseline on water, waste, and energy consumption; this data can help reduce costs and allocate utilities more efficiently.
Stephanie Wicks was hired as the environmental sustainability manager to begin working on these types of projects.
This type of work is best done by hospital staff with guidance from subject matter experts or tools to assist in the process. This program involved a wide range of hospital staff: infection prevention, nursing management, physicians, environmental services, building services, hospital administration, information technology, employee safety, pharmacy management, and governance. In addition to internal hospital staff, the program team is working with a Sustainability Leader Coalition within the City of Boise and maintaining a relationship with the City of Boise leadership.
St. Luke’s Health System has developed a Clinical Waste Audit Playbook to be disseminated across the association to assist other hospitals on “How to Perform a Clinical Waste Audit.” This deliverable is an immediate cost-save for any hospital looking to engage in this arena, as it prevents the need to hire an outside consultant and therefore saves tens of thousands of dollars (when investing in this space, St. Luke’s received a quote of $85,000 for the consultant on this project). This program also generated hospital-wide engagement and has created opportunities for the departments generating waste to work on identifying the difficult processes/waste generating flow areas.
By Hannah Lambalot | Categories: | Comments Off on Reducing Scope 1 & Scope 2 Emissions from Inhaled Anesthetics & OR Energy Consumption
UCSF made a pledge to be carbon neutral by 2025, and this commitment to sustainability drives this health system to innovate and reduce its carbon footprint across different scopes of work. This program specifically focused on two aspects: scope 1 inhaled anesthetics emission reduction via a Clinical Decision Support (CDS) tool and scope 2 emissions from operation room (OR) energy consumption reduction via HVAC setback and an equipment shutdown checklist. These two projects work in tandem to make the clinical operations at UCSF Medical Centers more efficient and sustainable, while generating tools that can be widely disseminated to other hospitals for decarbonization.
Sustainability has been a focus at UCSF Health and the broader UC system, where we have an ambitious carbon neutrality goal. We couldn’t achieve what we accomplished today without the support and funds from leadership. Dr. Gandhi started working on sustainability as an anesthesiologist on their own time as a passion and was appointed to be the inaugural medical director of sustainability to have dedicated time for these clinical mitigation efforts. UCSF Health also has a robust Office of Sustainability where two sustainability analysts help facilitate a variety of mitigation efforts.
The Sustainability Committee (UASC), led by the chief operating officer, instills a sustainability focus into the four biggest areas of operation. The four pillars, including Purchasing, Perioperative, Energy, and Waste, also collaborate on different projects where there is overlap, which enables us to have a good working relationship with the facility management team. In addition, UC established a system-wide sustainability workgroup and anesthesia workgroup where we can exchange ideas, experiences, and best practices. This program also engages the OR leadership, surgeons, trainees, and facility management in the process and education surrounding this work.
For the Scope 1 emissions work, UCSF has developed a self-guided toolkit that educates providers on the impact of inhaled anesthetics and advises them on more sustainable anesthesia practices and how to implement a similar CDS tool to reduce inhaled anesthetics emissions. Any hospital that utilizes EPIC as its electronic health record system will be able to implement this CDS tool based on the blueprint. Regarding Scope 2 Operation Room (OR) energy reduction, the team has completed the initial data collection on both upstream (electrical and mechanical) energy consumption, as well as the individual equipment energy monitoring, and is currently in the process of OR HVAC setback validation.
By Hannah Lambalot | Categories: | Comments Off on Food Rx: A Cross-Sector Approach to Improving Health and Health Equity
High Harris County, Texas, has America’s highest number of uninsured residents, and one in five patients at Harris Health System screen positive for food insecurity. The health system partnered with Houston Food Bank (HFB), the University of Texas School of Public Health, and grocery store H-E-B for a Food Rx program based at two family practice clinics.
“Our food ‘farmacies’ are unique in that we go beyond a food insecurity model. Our patients are able to select the healthy foods they want as they walk and learn with a dietitian,” said Chief Integration Officer Karen Tseng. “We also provide them with the skills and confidence to translate those raw ingredients into healthy, cost-effective, culturally appropriate meals through our culinary medicine programming.”
Patients enroll with a community health worker, work with a dietitian to select healthy food; connect with an HFB navigator to enroll in the Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families program, and are linked to community food resources.
Patients with uncontrolled diabetes are invited to join a nine-month program, in which they participate in biweekly “walk and learn” sessions with a diabetes educator while redeeming 30 pounds of fresh food from the food farmacy. During the COVID-19 pandemic, Harris Health System adapted the walk-and-learn education model with curbside delivery, biweekly tele-education, and virtual culinary education initiatives.
Food Rx served more than 650 patients in its first year. Participants improved their nutrition knowledge scores, increased daily fruit and vegetable consumption, and reported increased confidence in basic cooking techniques. Program graduates decreased HbA1c levels by an average of 0.72 percentage points.
By Hannah Lambalot | Categories: | Comments Off on Mothers Overcoming Maternal Stress (MOMS)
Postpartum Support Helps Improve Mental Health, Family Connection
High levels of parenting stress can cause poor birth outcomes, slow child development, lack of child-parent bond, and child maltreatment. Memorial Healthcare System started Mothers Overcoming Maternal Stress (MOMS) in 2008 to help mothers improve mental health and keep children healthy.
MOMS serves women who exhibit symptoms of depression or anxiety affecting daily functioning for more than two weeks, as well as mothers with additional risk factors, including low-income status, single-parent households, early or unplanned pregnancy, medical complications, and traumatic life events. Customized participant plans include in-home cognitive behavioral therapy, parenting classes, community resources, and case management services.
MOMS offers flexible hours for counseling and case management, transportation to appointments and program activities, and help applying for government assistance programs. Other benefits include:
- connections to the local food pantry and housing authority to mitigate food and housing insecurity;
- cooking classes;
- dollar store and supermarket tours to teach label reading and healthy shopping skills;
- warm handoffs to Memorial Primary Care to develop a medical home;
- financial assistance;
- employment opportunities; and
- quarterly family retreats to provide bonding opportunities within and among program families.
Amid the COVID-19 pandemic, MOMS provided participants smartphones with six months of prepaid service to use for telehealth services and delivered masks, diapers, gloves, cleaning supplies, and food to participants’ homes. MOMS has served 1,532 participants since 2008. Among participants, 97 percent report improved overall family functioning and parenting skills, 96 percent report feeling more connected to the community, 94 percent report fewer depression or anxiety symptoms, 93 percent demonstrate an acceptable level or improvement of attachment and bonding with their child, and 86 percent have children that score within range of developmental milestones.
By Hannah Lambalot | Categories: | Comments Off on Maternal Medical Home
New York City is grappling with high rates of maternal mortality and morbidity with stark racial disparities. As of 2018, non-Hispanic Black women are 8 times more likely to die from a childbirth-related complication and three times more likely to experience a life-threatening event in pregnancy than non-Hispanic white women. The highest rates of severe maternal morbidity are in some of New York City’s most under-resourced communities, areas like East Flatbush, Brooklyn, and Jamaica/St. Albans, Queens. The Maternal Medical Home improves high-risk obstetric outcomes by providing referrals to necessary specialty care, mental health services, and enhanced wraparound services to address socioeconomic challenges, as well as parenting support and education. The Maternal Medical Home is one component of the Maternal Mortality Morbidity Reduction Program of NYC Health + Hospitals (NYCH+H).
NYC Health + Hospitals established the Maternal Medical Home to provide enhanced services, attention, and care to pregnant patients who needed it. This program received funding from the City of New York, as well as internal support. Two frameworks shape the program, the Socio-ecological model encourages 1) health education and literacy for patients to stay informed, 2) building trust between the team, patient, and partners 3) standardizing the screening and assessment tools for patients across the system. The Socio-cultural environmental model inspired 1) connecting patients with needed resources and services, and 2) encouraging patient autonomy in prenatal care and patient services.
Any member of the healthcare team may refer patients to the Maternal Medical Home. Patients with additional medical diagnoses, which may place a pregnancy at higher risk for an adverse outcome, such as (but not exclusive of) hypertension and diabetes, are followed by the Maternal Medical Home team. Patients with behavioral health diagnoses or patients who have needs related to social determinants of health (such as patients with food or housing insecurity, or in need of legal services) may be referred to the Maternal Medical Home for additional coordinated care and/or support services. The Maternal Medical Home team uses additional screening and assessment tools, such as the Prenatal ACES to stratify patients most at risk during pregnancy. The Maternal Medical Home team serves as a locus to help patients navigate a complex medical system and access needed resources.
The Maternal Medical Home program staffs seven Maternal Care Coordinators who have an interest and expertise in public health and nine Supervisors who have a master’s degree specifically in Social Work. Care coordinators and Supervisors are tasked to communicate with the clinical team, behavioral health specialists, and create tight linkages with community health workers and home health care. The clinical team includes physicians, advanced practice nurses, and nurses across the system.
Based on the screening assessment and associated risks score, the multi-disciplinary teams provide patients with referrals to specialty care, behavioral health and emotional support, pharmaceutical needs, socioeconomic needs, and parenting support/education. The screening and assessment build documentation templates for patient screenings, patient birth plans, and post-partum assessment plans. The program aims to create a stable, safe, and healthy environment for the patients to successfully take care of themselves and their newborns.
The Maternal Medical home program was piloted at NYCHH Kings County Site in October of 2019 and ran for two months. Since then, NYCHH has rolled out implementation to 11 facilities as of June 2021. Since the program’s launch, more than 3,000 pregnant patients have been referred to additional care or support services, such as nutrition, dental, and housing. Additionally, 405 pregnant patients were referred to the program and 1226 unique patients were supported.
By Hannah Lambalot | Categories: | Comments Off on CommunityConnect
Contra Costa Regional Medical Center’s (CCRMC) top 5% of users represent 49% of total costs, and the top 15% of users represent 79% of costs. Through a review of high need patients, it was revealed that a large portion of these high costs were associated with patients accessing medical services due to underlying social needs.
CommunityConnect was designed to target interventions for high-need patients with the aim to provide upstream care and services. The program utilizes predictive model analytics, that incorporates data points from across county, to proactively identify patients that are likely to use the emergency room or be admitted to the hospital for an avoidable reason in the future, such as to meet their urgent social needs. Patients who are enrolled into the program are provided one year of case management to coordinate medical services and provide community and government resources that can improve patient well-being and health. CommunityConnect receives funding of $40 million annually through the California Medicaid 1115 waiver Whole Person Care.
Patients are identified and enrolled int the program based upon data gathered through a comprehensive set of sources: from Medicaid managed care plans, behavioral health, the coordinated entry housing program, EMS and the county detention facility. These data points are combined to create patient-level risk factors. As the program identifies enrollment based on a predictive model, a number of patients are identified for enrollment not based on their prior health utilization (based on Medicaid claims data, apart from CCRMC). Leveraging data through a holistic patient record allows for identification of county residents that may not have otherwise ever been referred into services through traditional means.
Upon patient enrollment, case managers conduct a comprehensive social needs assessment with the patients to identify areas in which the program can help. This covers areas such as: medical, behavioral health, safety, housing, food security, transportation, finances, legal, and support system. Depending on patient acuity, case management services are either provided in-person or telephonically by multi-disciplinary staff that includes public health nurses, social workers, substance use counselors, homeless services specialists, mental health clinicians, and community health workers.
Once the CommunityConnect case managers assess a patient’s unmet social needs, they help enrollees create a patient- centered care plan, access resources, and work in partnership with the patient and other care team members to implement the plan, with the shared goal of improving the patient’s health. In addition to a providing linkages to community resources through a comprehensive social needs online resource directory, the program provides direct benefits to patients aimed at addressing unmet social needs. CommunityConnect patients have access to a transitional housing fund that can assist with security deposit or moving costs; a free cell phone in order to engage in services and link with resources; non-medical transportation in order to obtain identification documents; Free legal assistance from two full-time lawyers at the local legal aid; and social service workers to help apply and renew public benefits including Medicaid, SNAP, and TANF.
Since June 2017, the program has connected more than 17,000 people to critical health and social services. The first year (2017) resulted in a 3% reduction in ED visits and an 12% reduction in inpatient admissions compared to 2019 results that improved to show a 20% reduction in ED visits and 18% reduction in inpatient admissions. Other measures are in process of being analyzed, including primary care visits, behavioral health visits, access to public benefits, and other biometric health indicators. Success measures show that 37% of patients that lapse Medicaid are able to be restored within 90 days due to case management services, and 34% of patients have had a successful outcome with a social-related goal.
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 Hannah Lambalot | Categories: | Comments Off on Food Pharmacy
The Food Pharmacy originally began as a food pantry, but like most essential hospitals this meant the demand may outstrip the NGH Foundation’s funding resources to maintain the program. Hence, Nashville General Hospital focuses on patients with food insecurity who also have a diagnosis of chronic illness or cancer. The goal is to provide prescribed food supplementation to the patient’s diet which offers education for long term food choices for chronic illness self-management or completion of infusion services.
Patients are identified through the emergency department, outpatient clinic, inpatient dismissal or oncology infusion services. The NGH Foundation is currently funding all of the food, staffing needs, and recruiting community volunteers through grants. The hospital is providing in-kind, the Food Pharmacy square footage, care management team members for some education, dietary staff oversight, and the infrastructure of the referral departments to recommend patients.
The program relies on patient flow from the emergency department, outpatient, inpatient, and oncology. Additionally, patient outcomes for diabetes, hypertension, and oncology compliance with the Food Pharmacy are tracked through clinics and oncology. External community partners provide food, volunteers and funds.
Early results for oncology patients using the Food Pharmacy for the past three years reveal 100% of patients on the program maintaining or gaining weight – preventing pause in chemo services due to toxicity. Outcomes for chronically ill patients is still too new to offer reliable data until January 2020.
By Hannah Lambalot | Categories: | Comments Off on Lyft Partnership and Vouchers
Denver Health formed a partnership with Lyft to provide no-cost rides to recently discharged patients or those in need of transportation to and from outpatient clinic appointments. The program began in the ED and expanded after three months to include the hospital and outpatient clinics. Hospital and clinic staff request and track Lyft rides for patients, and the Denver Health Foundation funds the service at an average cost of $8.50 per ride, with a 25-mile limit. Now in its third year, the program has provided more than 5,000 rides. Denver Health also offers no-cost bus tickets, cab vouchers, and a car service using a vehicle donated by Oprah Winfrey to those patients with limited resources. The “Oprah” car is staffed by local retired community residents on a volunteer basis.
