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 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 Jamie Cetrone | Categories: | Comments Off on Trauma to Triumph
Trauma to Triumph (T2T) began at Santa Clara Valley Medical Center in 2012 through a partnership with the City of San Jose Mayor’s Gang Prevention Task Force (MGPTF). The hospital had previously collaborated with the Task Force on the Clean Slate Program, a tattoo removal service. Interpersonal violence has increasingly become a public health issue, and the program’s priority is to embrace teachable moments in order to engage patients and help them on their journey to resilience and recovery. The T2T program provides outreach, mentorship, and community services to victims of interpersonal violence, specifically youth and their families. These resources are designed to help patients cope with present circumstances, foster hope, and promote wellness, with an ultimate goal of reducing re-injury and recidivism of violence in the community.
Eligible participants for the Trauma to Triumph Program include trauma patients ages 13 to 30 within Santa Clara County who have sustained a gunshot wound, physical assault, stab wound, or assault with a weapon. A peer intervention specialist visits the patients at their bedside within the first 48 hours of admission to the hospital. Based on needs identified by the patient, the hospital social worker and intervention specialist create a discharge plan and coordinate resources for patients and families. Resources range from victim services, housing assistance, mental health/substance abuse services, job placement assistance, education support, basic subsistence needs, and court or probation advocacy. The T2T team builds a close, trusting relationship with clients over a six to twelve month period by providing one-on-one coaching and support so that clients can overcome trauma, set-backs, and challenges to while adopting a healthier lifestyle.
The T2T Program is a partnership between the City MGPTF and Santa Clara Valley Medical Center. As a result, the T2T Program has referral access to a continuum of other City operated/funded interventions and community service providers. These service resources are not only available to the primary client but also other family, siblings, and friends that may be negatively impacted by violent incidents. As part of the hospital’s commitment to being informed and engaged in violence prevention and best practices, they maintain a membership with the National Network of Hospital Violence Intervention Programs.
The T2T Program is the only formal evidenced-based hospital-based intervention program in the highly populated Santa Clara County. Prior to the T2T program, marginalized victims were released to unstable housing, transitional living situations or homelessness. They were also often in a traumatized state, with limited coping skills, no or limited support to prevent re-victimization, and without help to establish a healthier life style. Since full program funding was received in 2015, the T2T Program has served over 210 clients with 5,844 hours of service, representing 7,305 service sessions. Program evaluation client interviews have indicated; 96% “felt program was very helpful” and 92% felt “more hopeful about their future”. Since 2015, the program has had two patients who voluntarily participated in a service plan be re-admitted to the hospital.
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 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 UMass Memorial Medical/Legal Partnership
The partnership of the UMass Memorial Legal Department and Community Legal Aid, Inc. (CLA) assists low income, Medicaid-eligible families in addressing socially complex living conditions that adversely affect health. Recently, CLA was a key partner in the pediatric asthma prevention pilot program, a model that has expanded into a comprehensive, multi-sectoral, citywide intervention. The relationship targets patients and leverages pro bono services with several law firms and volunteer lawyers to address the multiple social factors that impact patient health. Recognizing that the most vulnerable populations require a much broader intervention that goes beyond medical care, the program screens patients at three community-based clinics about social determinants of health: access to fresh food, home environment, employment and educational attainment. Through CLA training and support, the dedication of clinical staff and a shared vision, UMass is working to change lives.
Through this collaboration with Community Legal Aid, Inc. (CLA) the activities of the Medical-Legal Partnership will be integrated into several UMass Memorial primary care clinical sites serving low-income, Medicaid-eligible populations in central Massachusetts.
Since its launch in 2016, the program has served approximately 70 people annually.
By Jamie Cetrone | Categories: | Comments Off on Hurley Medical Center Food FARMacy
After reviewing other hospital programs which address social determinants of health (via America’s Essentials Hospitals and Advisory Board), Administrator of Population Health, Alisa Craig, developed a strategy that was approved by Hurley Senior Leadership. This resulted in hospital-wide screening (2-questions) for food insecurity and referral to the Food FARMacy (opened 8/1/17) if screening was positive. Hurley Medical Center’s (HMC) vision is to expand beyond the walls of the hospital to provide the best possible care to our community. By truly treating “hunger as a health issue”, Hurley is taking an important step in addressing social determinants of health within very vulnerable populations. With the rate of food insecurity being higher in Genesee County than the national average, addressing this issue proactively will have a tremendous impact on a patient’s ability to manage a chronic disease or fight illness. This is extremely important in children and older adult populations who have high rates of food insecurity. Hurley Medical Center’s Food FARMacy addresses the issue of food insecurity in their patient population by increasing access to healthy foods and providing them with additional resources to assist them long-term.
In August 2017, Hurley began screening for food insecurity (within their electronic medical record – EPIC) and providing referrals to the newly opened Food FARMacy. Upon discharge from inpatient units or outpatient primary care clinics, a patient who gets this referral can get nutritious food for themselves and their household members, twice per month, for three months. The food provided is tailored based on their health needs, chronic conditions, and allergies. The patients have the opportunity to meet with a Registered Dietitian while at the FARMacy, and are given community resources for longterm support. Assistance is provided to make sure the patients are appropriately enrolled in benefits such as SNAP, WIC, and Double Up Food Bucks.
By addressing their food insecurity, patients will be able to better manage their chronic conditions, not have to make as many financial “trade-offs” (like having to choose to pay for medicine vs. food), and may have improvements in health status. Hurley provides the physical space for the Food FARMacy, which is co-located within the Adult Diabetes Center. Funding for a part-time dietitian and food comes from a Community Foundation grant. Program staff work closely with the IT department (EPIC) to establish the screening/referral/reporting process.
Collaboration is key, both internally and externally. The EPIC (EMR) team is crucial in this project, and staff has engaged all levels of nursing, nursing management, nursing education, residents, and the GME dept. Externally, staff work very closely with the Food Bank of Eastern Michigan to get most of the food. They also supplement via local gardens (MSU-E Edible Flint) and growers. Volunteers come from the hospital’s foundation volunteer services, students from the MSU School of Human Medicine’s Leadership in Medicine for the Underserved, and AmeriCorps team members via Pediatric Public Health Initiative. Funding is provided from the hospital, hospital foundation, and the Community Foundation of Greater Flint.
Funding through the Community Foundation of Greater Flint;
To date, close to 800 people have received food from the Food FARMacy, with new patients being referred daily. The need is great, and they have already seen a 35-53% Food Insecurity rate in primary clinic settings. In addition, the program has helped several patients get appropriately enrolled in nutrition assistance programs. Program staff hope to have more specific data, related to health outcomes, to share by July 2018.
By Jamie Cetrone | Categories: | Comments Off on Screening for Social Determinants in Primary Care
This program originally started at a retreat held by the Ambulatory Care Department at Lincoln Hospital. The hospital formed a workgroup with the goal of developing a social determinants screening tool and accompanying referrals to helpful resources. The ultimate goal of the program is to improve the health status of the patient population, by improving social and economic influences on health.
The screening tool was designed with input from multiple hospital stakeholders, as well as partner organizations. The hospital is now ready to implement the tool at nurse led visits for diabetes, hypertension, and depression management. Pending positive outcomes, Lincoln Hospital plans to implement the tool more widely. Based on answers to screening questions, nurses will refer patients to known entities within the hospital including social work, a legal health program, healthcare financial counselors, and a table staffed by a partner non-profit where patients can enroll in a food stamp program. The
The screening tool covers multiple domains, including housing, food insecurity, housing conditions such as pests and mold, health insurance and health care cost barriers, immigration, domestic abuse, and others. There has been no additional funding for the program. With respect to staffing, in addition to nursing and departments already mentioned, the project is supported by the population health team in Ambulatory Care. The screen is used in paper form, and data will be manually entered into an Access Database.
The working group behind the program has been multidisciplinary, consisting of population health staff, physicians, nurses, clerical and finance staff, social workers, lawyers from the Legal Health program onsite, and staff from partner NGOs specializing in housing, food stamps, and health insurance advocacy. There has been some liaising with care managers and the ED, to explore the use of the screening tool in high risk populations.
Moving forward, outcome measures will be: A1C scores, BP scores, show rates to nursing visits, and show rates to PCP visits. The thinking behind these metrics is that when patients are connected to resources to address their economic and social problems, they are better able to manage their health care appointments, have the resources necessary to improve their health status (such as buying better quality food), and with the reduced stress of dealing with economic and social problems, have more mental wherewithal to address their chronic diseases. Moving forward, the program will compare patient populations who are administered the tool to those that are not, to measure the effect of systematically screening for social determinants. Program staff plan to test the screening tool to gage if it’s easy to understand and self-administer, and whether the referral pathways work.
Internal partners include: ambulatory care, social work, healthcare financial counselors, and care management. Community partners include : New York Legal Assistance Group (NYLAG) Legal Health Program, Community Service Society of New York, Bronx Works, Public Health Solutions
