Blog Archives
By aoguagha | Categories: | Comments Off on Jail Release Program
The Jail Release Program at Parkland Health uses a comprehensive approach to link patients recently released from the Dallas County jail to community-based care. The program developed a release workflow and referral hub in collaboration with community-based organizations and the correctional health team at the Dallas County Jail, consisting of a nurse navigator, referral coordinator, peer navigators, and social workers. This referral hub assists patients with their transition back to the community by linking patients with services such as transitional housing, health insurance, pharmacy assistance, career planning and placement, and social support networks. Additionally, patients are supported with transportation through Uber and bus passes. The nutritional needs of patients are also served through connections to food pantries.
By aoguagha | Categories: | Comments Off on Building Recovery Integration for Drug Users into Emergency Medicine (BRIDGE)
Tampa General Hospital’s Building Recovery Integration for Drug Users into Emergency Medicine (BRDIGE) program offers a range of services, including a mobile suboxone clinic, an office-based opioid therapy clinic, mental health and substance use counseling, and essential wrap-around services to improve post-discharge outcomes, decrease re-admissions and shorten the length of hospital stays all while providing world-class care to adults struggling with opioid use. The program, which opened Florida’s second legal syringe exchange that treats over 2,000 patients, is making a significant impact in the community.
The BRIDGE program collaborates with the Hillsborough Housing Authority to assist patients with housing instability, collaborates with local food banks to expand their ability to address food insecurity through mobile pantry days, and recently engaged a volunteer attorney to provide free consultations to patients facing legal challenges that can hinder their full engagement in their recovery program.
By Amanda Jepson | Categories: | Comments Off on Center for Comprehensive Addiction Treatment, “No Wrong Door”
Bergen New Bridge Medical Center in Paramus, N.J., established the Center for Comprehensive Addiction Treatment (CCAT) in response to an increase in patients returning to the hospital for addiction treatment post-discharge. The Center aims to expand availability and access to withdrawal management services and overall substance use disorder treatment.
The Medical Center offers numerous levels of care, including involuntary and voluntary crisis units, withdrawal management, and short-term residential care, allowing a “No Wrong Door” approach that supports immediate direct patient access. The multidisciplinary team consists of psychiatrists, physicians, nurse practitioners, nurses, social workers, and substance use disorder staff. CCAT offers peer recovery specialists who model what recovery could look like for patients. The program mitigates social determinants of health by tackling food security, housing, and transportation—barriers to successful treatment for many patients—and focuses on expanding accessibility to services for underserved, marginalized populations.
Partners for the program include Rutgers University, Integrity House, CarePlus NJ, and other substance use disorder treatment programs, strengthening the culture of change and continuous improvement. Bergen New Bridge hosts community partners including Alcoholics Anonymous and Narcotics Anonymous as well as medication-assisted treatment meetings to provide an all-encompassing approach to care for these patients.
Since starting the program, the Medical Center has expanded its licensures for additional outpatient programs, including adolescent services. Additionally, the team has introduced family nights to provide education about substance use disorders, treatment options, and recovery. In 2024, the program served 3,938 individuals with inpatient care and provided 17,613 units of intensive outpatient care to patients throughout New Jersey. On the office-based addiction treatment level of care, providers have supported and maintained 1,560 individuals in treatment for substance use disorder services. Rates of treatment refusal post-discharge have decreased from 21 percent in 2022 to 12 percent in 2024. The rate of leaving against medical advice also dropped, from 13.59 percent in 2022 to 8.6 percent in 2024.
By Amanda Jepson | Categories: | Comments Off on Pioneering Change: Population Health at Essential Hospitals
Staff at Nashville General Hospital (NGH) frequently encounter patients who need assistance navigating the health system, applying for financial assistance, obtaining affordable medications, and learning how to advocate for their health. In response, NGH curated programs under the Population Health Management department, including the Community Care Team (CCT), Food Pharmacy, Congregational Health and Education Network (CHEN), and NGH HopeMeds Program. The multi-pronged approach seeks to ensure that the patient population uses available resources and sees improvement in health outcomes.
The CCT is a care management team consisting of a medical director, navigators, dietitian, Food Pharmacy manager, social workers, and a nurse practitioner who collaborate to assist patients with health and social needs. The Food Pharmacy supports patients experiencing food insecurity through access to healthy foods tailored to patient health needs, as well as nutritional counseling and social services support. CHEN is CCT’s counterpart in the Nashville area’s faith-based communities with four leading pillars—health literacy, education attainment, access to health care, and membership development. These efforts are supported by grants from the National Institutes of Health and Community Health Worker trainings provided by Meharry Medical College. Additionally, the NGH HopeMeds Program allows qualified patients to receive no-cost medications.
The CCT team works closely with the Patient Experience and Marketing departments to collect patient feedback. Additionally, leaders of the Ambulatory Clinics, Case Management, and Population Health Management departments review this feedback to ensure the programs meet patients’ needs. CHEN partners with multiple external organizations, including NGH’s Clinical Research department; the National Institute on Minority Health and Health Disparities; and several faith-based organizations, with an emphasis on those that serve African American communities.
The Food Pharmacy has had approximately 11,800 visits since 2022 and helped cancer patients facing food insecurity obtain nutritious food to keep the weight needed to sustain cancer treatments. In one year, the NGH HopeMeds program, offered through the Nashville-based nonprofit, Dispensary of Hope, has served more than 1,200 unique patients, filled more than 4,700 prescriptions, and provided more than 8,400 months of no-cost medications, saving patients more than $585,000.
By Amanda Jepson | Categories: | Comments Off on Curbside Care
Boston Medical Center (BMC) recognizes how critical the first six weeks of life are for birthing people and babies. Forty percent of publicly insured birthing people never return for a postpartum appointment. To close this gap, BMC launched the Curbside Care program in January 2023 with the goal of mitigating barriers to postpartum care through a mobile unit.
Curbside Care is a mobile health delivery program that provides high-touch, comprehensive wraparound services for birthing people and their infants in the first six weeks of life outside of their homes in Boston—at the curb! Funded by the Boston Celtics Shamrock Foundation, Curbside Care replaces traditional postpartum visits in this hospital and eliminates the need for transportation and childcare for postpartum appointments. Our clinical staff of doctors, nurse practitioners, certified nurse-midwives, and an international board of lactation consultant examiner provide a range of services including feeding assessments, lactation support, jaundice evaluation, postpartum depression and hypertension screenings, and contraceptive services all on the mobile unit. A community wellness advocate recruits pregnant patients and performs a needs assessment for each dyad. Patients receive material needs, such as diapers, strollers, and food, at each visit.
Curbside Care is an interdepartmental initiative run by the pediatrics and OBGYN departments at BMC. Other hospital partnerships include the Breastfeeding Equity Center, the Economic Justice Hub, and the Center for the Urban Child and Healthy Family. Community partners also include Brewster Ambulance Service, the Vital Village Network, and New England Mothers First.
BMC has cared for 519 patients in the last 12 months, with an average of 3.7 visits per patient. Of the patients seen, 63.97 percent identified as Black and 31.17 percent identified as Hispanic/Latino. All patients received lactation support and were screened for material needs and postpartum depression. All patients reside in Boston ZIP codes, primarily in the Dorchester, Mattapan, and Roxbury neighborhoods. Curbside Care patients have a 2.9 percent “no-show” rate, compared with 15.3 percent in BMC’s pediatric clinic and 18.8 percent in the postpartum OBGYN clinic.
By aoguagha | Categories: | Comments Off on Episcopal Food Pantry
Located on Temple Health’s Episcopal Campus, the Episcopal Food Pantry provides free fresh fruits and vegetables, canned goods, and other non-perishable items to nourish the community. In collaboration with the Share Food Program, the leading food bank in the Philadelphia area, the food pantry is open every Thursday. Since the program opened in May 2022, the number of community members served has doubled, and the program hopes to see continued growth.
For more information about the program, click here.
By aoguagha | Categories: | Comments Off on Farm to Families
To decrease chronic disease related to poor diet and physical inactivity, Farm to Families increases access to healthy foods by providing low-cost, fresh produce, dairy, and meat to over 350,000 residents in North Philadelphia. With a FreshRx prescription from a Temple Health doctor, patients who screen positive for food insecurity can receive coupons to purchase fresh food through the program. Community members and families with food stamps can also buy fresh foods throughout the year and receive nutrition education on how to sustain healthy eating habits.
Temple University Hospital and the Lewis Katz School of Medicine collaborate with the St. Christopher’s Foundation and the Lancaster Farm Fresh Cooperative to source, package, and deliver fresh and organic food to the community. Over 48,000 boxes of food have been purchased by more than 6,400 families since 2010.
For more information about the program click here.
By aoguagha | Categories: | Comments Off on Food As Medicine
The Food as Medicine partnership at Grady Health provides members of the Grady community (patients, families, employees, visitors, and neighbors) access to healthy affordable food through the Jesse Hill Market and other collaborations throughout the Atlanta area. Located just outside Grady’s main entrance, the Jesse Hill Market features a food prescription program that offers eligible patients fresh food, nutrition education, and cooking classes. The Market also offers healthy grab-and-go meals and fresh produce for purchase through its public café.
The Food as Medicine program is a multipronged intervention to address both chronic disease and food insecurity among Grady patients. Grady Health partners with the Atlanta Community Food Bank and Open Hand Atlanta to deliver the Food As Medicine program. The Food as Medicine Partnership aims to fuel patients with healthy foods while bringing the community together.
For more information, click here.
By aoguagha | Categories: | Comments Off on Grady Memorial Hospital
By aoguagha | Categories: | Comments Off on Food Rx
To address food insecurity among their patient population, LA Health Services’ Food Rx program works in partnership with the Department of Public Health CalFresh Healthy Living Program to give patients a stronger footing in their healthcare journey. The program also provides links to CalFresh, SNAP, and other long-term food resources to support patients in reaching their health goals.
Since the inception of the program in 2021, the program has conducted over 392 food distributions, served over 290,186 households, and distributed over one million pounds of food.
For more information click here.
