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 Amanda Jepson | Categories: | Comments Off on Increasing Birth Equity in Washington, D.C.
Black families in Washington, D.C., account for 50 percent of all births in the city and 90 percent of all pregnancy-related deaths. More than 65 percent of all pregnancy-related deaths occur in D.C.’s Black-majority wards 7 and 8, where infant mortality rates are twice the city’s average. Data from MedStar Washington Hospital Center’s Women’s and Infants’ Services (WIS) patients and needs assessments indicated that multiple social determinants of health (SDOH), including access to medical care, housing, food, and transportation, also disproportionately affect wards 7 and 8.
WIS aims to increase early interventions for adverse SDOH, decrease the number of patients experiencing birthing complications, and mitigate risk factors associated with higher mortality rates. This includes upstream efforts, such as preconception health assessments, and prenatal SDOH screenings. WIS provides trauma-informed clinical services and connects prenatal patients to resources, including support for substance use disorder; food banks; legal aid; assistance obtaining Supplemental Nutrition Assistance Program and Special Supplemental Nutrition Program for Women, Infants, and Children benefits; and more.
A key partner in the D.C. Safe Babies Safe Moms initiative, WIS collaborates with fellow partner Mamatoto Village, a nonprofit that provides lactation consulting and other perinatal support services to primarily Black patients in wards 7 and 8.WIS also partners with Community of Hope to increase service accessibility and improve continuity of care on-site at Community of Hope’s Ward 8 location, allowing patients to see a high-risk obstetrician in the same location where they schedule their maternal and fetal medicine appointments.Additionally, MedStar Washington Hospital Center partnered with the Georgetown University Health Justice Alliance to launch the Perinatal Legal Assistance & Well-being project in 2021, which provides no-cost legal assistance to pregnant and postpartum individuals to address health-harming unmet legal needs, including employment, housing insecurity, and public benefits.
WIS has seen a clear increase in patients accessing interdisciplinary services focused on treating hypertensive disorders, anemia, depression, anxiety, and diabetes. For example, the number of patients receiving diabetes support has nearly tripled since the program launched in 2020, and now, 92 percent of high-risk patients receive services for diabetes control—a nearly 30 percent increase. The rate of babies born with very low birth weights (less than 1,500 grams) decreased by more than 15 percent and rate of babies with low birth weights (less than 2,500 grams) decreased by more than 7 percent.
By Amanda Jepson | Categories: | Comments Off on Sustainability Program
Boston Medical Center (BMC) began its sustainability journey in 2012 after recognizing that the communities it serves are disproportionately affected by climate change. Implementing sustainability efforts is part of the health care the hospital provides, with a focus on improving energy efficiency, reducing carbon emissions, decreasing operating costs, and increasing access to care. BMC first reassessed its real estate portfolio to maximize the impact of every square foot, which led to the sale of several real estate assets. The proceeds then were used to upgrade other buildings for increased energy efficiency. BMC reduced 300,000 square feet while increasing its capacity to care for patients: patient volumes increased by almost 30 percent.
BMC’s climate mitigation work covers a variety of entities that all aim to serve the local community. BMC is the largest safety net hospital in New England; 73 percent of the hospital’s patients are covered by public insurance, and many reside in communities facing environmental inequalities. In 2022, BMC opened the Brockton Behavioral Health Center, the first net-zero behavioral health facility in the United States. The center is powered by solar energy and heated by geothermal wells. Since spring 2017, Boston Medical Center has generated much of its own electricity and heat through a natural gas–fired, two-megawatt combined heat and power plant, also known as cogeneration. The plant operates at 70 percent efficiency compared with a typical gas-fired power plant’s 35 percent efficiency. It also has “black start” capability, meaning that if the electric grid goes down, the hospital can use the cogeneration plant in combination with a recently-installed Tesla battery system to heat and power its inpatient units on an “island” for months at a time, as long as it has a natural gas supply.
In 2016, BMC took a major step toward a carbon-neutral campus with an innovative solar purchase and partnership with the Massachusetts Institute of Technology and the Post Office Square Redevelopment Corporation. Through this partnership, BMC invested 255,000 solar panels across 650 acres in North Carolina. BMC purchases 26 percent of the power the solar facility produces, which is equivalent to 100 percent of BMC’s electricity consumption.
BMC’s reduced physical footprint and efforts to improve energy efficiency reduced utility costs significantly which generated savings that were reinvested back into patient care. Between 2011 and 2022, BMC reduced carbon emissions by 91 percent and electric consumption by 29 percent. These savings have enabled the reinvestment of funds in patient care and other sustainability projects, such as the opening of the Brockton Behavioral Health Center.
To learn more about BMC’s sustainability efforts, please visit their website through this link.
By Amanda Jepson | Categories: | Comments Off on Mobile Medicine Program
Atrium Health launched two Mobile Medicine programs to improve access to care for their patient populations. Three Care Everywhere primary care units, along with Drive to Thrive, a mobile OB-GYN unit, aim to increase access to care by tackling transportation challenges, language barriers, and lack of insurance. Specifically, Care Everywhere brings clinical care to areas where traditional clinics may not be convenient or accessible, provides resources that help meet acute social needs, and connects patients to a primary care medical home. Drive to Thrive works to decrease unintended pregnancies via increased access to education and contraception and to connect patients in underserved communities to prenatal care earlier in their pregnancies to improve overall health outcomes.
The Mobile Medicine units park at different locations each weekday based on patient need. Atrium Health strategically chose locations using a data-informed approach that paired internal patient data with publicly available U.S. census data to target communities with the greatest health needs and social risk factors. Care Everywhere unit services include short-term and long-lasting health concerns, and Drive to Thrive primarily focuses on obstetrics and education. Neither program requires appointments, enabling patients to visit at their convenience. Both programs offer additional wellness services, such as referrals to other Atrium Health facilities and connections to resources for non–health care needs.
The Care Everywhere units were primarily funded by The Tepper Foundation and Truist Foundation, among other community funders. The Drive to Thrive unit received funding from a retired OB-GYN and other community donors. Both units required collaboration with nonprofits, faith-based organizations, and other community organizations to understand patient needs fully.
As a vertically integrated health care system, Atrium Health maintains an extensive inpatient and outpatient database of electronic health records that enables in-depth analysis of health care utilization and health outcomes across the system’s footprint. The Care Everywhere units launched in fall 2022, and the Drive to Thrive unit launched in January 2023. The Mobile Medicine program is expected to serve more than 480 patients by the end of 2023. Key program outcomes include increasing the establishment of ongoing support through placement with a primary medical home and connecting patients to care and social needs support through screening, diagnosis, and referrals to specialty care.
By aoguagha | Categories: | Comments Off on ZSFG Health Advocates Program
The health care professionals of Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG), in San Francisco, understand health care alone does not necessarily mean good health. Social factors, such as access to food, safe housing, and education impact overall health, as well. ZSFG launched its Health Advocates program in 2013 to improve community health by connecting families with community resources that address their social needs. These needs might otherwise not have been met outside their typical hospital visits. The ZSFG Health Advocates program aims to change how people think about health.
The Health Advocate program is a student and community volunteer–based service group that conducts standardized social and legal needs screenings for patients at the ZSFG health centers for children, women, and families.
The Health Advocates program extends the care of patients and connects them directly to resources that help overcome systemic societal barriers and legal obstacles that impact health and well-being. Through the Health Advocates program, ZSFG improves the quality of life and health outcomes for families.
The ZSFG Health Advocates program connects families with existing benefits programs and external community organizations based on their level of need. The program collaborates with Bay Area Legal Aid as part of the San Francisco Medical-Legal Partnership (MLP) to provide legal advice and support to families. Families screened for more complex issues by the health advocates — family mental health issues or complicated legal challenges, for example — are connected with clinical social workers and/or lawyers from the MLP network who can provide professional support and case management.
By Madeline White | Categories: | Comments Off on Social Needs Screening and Interventions
The Promotora and African American Health Conductor programs were initially birthed at our Bay Point Family Health Center in 2002 and 2005. The initial goal of these programs was to create more effective cultural bridges between Contra Costa Health Services, a county-run health system, and the Latino and African American communities through the utilization of indigenous community representatives in order to assist the populations in better utilizing and navigating the Contra Costa Health Services system of care. The core functions of these two programs included: assisting patients with health navigation, community health education, assisting with group medical visits and conducting community outreach. In July 2016 through a collaboration with Health Leads (a nationally recognized resource linkage organization) some of these staff were trained on the Health Leads REACH tool – a very sophisticated resource linkage software tool which allowed these staff to screen patients for social needs, input patient demographic data, link patients to appropriate resources and agencies, track actions and follow up on each patient assisted, and measure impact.
Contra Costa Health Services partners with a community non -profit, the Center for Human Development to employ and oversee these staff. However, the staff receive direct supervision from two Health Services staff. The contract with the non-profit is primarily funded through the Health Services budget with supplementation from Medicaid revenue generated by the staff, as well as occasional grants. The two programs are housed in five of the 11 Contra Costa Health Services health centers. They work closely with health center administrative leadership, with medical providers, with our Health Leads advocate partners and with many community based organizations.
From July 11, 2016 – April 14, 2017, The West County Health Center Health Leads pilot program has served over 750 patients with a 86-91% linkage connection success rate – according to Health leads one of the highest in the country. The Promotoras and Health Conductors have assisted over 2,000 households with health navigation, and conducted over 7,791 community outreach encounters.
By Madeline White | Categories: | Comments Off on Healthy Youth Transitions
Memorial Healthcare System in Hollywood Florida started the Healthy Youth Transitions (HYT) Program 7 years ago as a result of an investigation of the child welfare system which identified gaps in services when youth unsuccessfully transitioned to adulthood with little support, skills or preparation. HYT helps youth and young adults age 15 to 22 who are aging out of foster care make the transition to independent living.
The program structure is provided by Memorial Life Coaches, who develop rapport and engage youth in an open, honest professional relationship in order to assist them with successful transition to an acceptable, responsible, productive adulthood. Typically, the youth distrust the very systems they have relied on as they have been disappointed frequently by foster care agency staff turnover, lack of services, frequent group home relocations (several youth served have been in over 20 homes in the 10-12 years they have been in foster care) and being separated with the siblings. By building a safe and nurturing relationship, HYT youth being to realize that the Memorial staff are here to help them grow, mature and develop into the adults they desire to become but did not have the role models or consistent caring adults in their lives. The Life Coach aims to help each participant gain skills and self-sufficiency to navigate the logistics of daily living, health management, social relationships, education, employment and money management, and other aspects of young adulthood.
All of Memorial Healthcare System’s Community programs and initiatives are rooted in collaborative partnerships that work to strengthen families and communities. HYT involves internal collaboration, with partnership from the primary care, specialty services, and behavioral health departments. External community partners include local universities, food banks, legal service providers, and the sheriff’s office.
Current outcome measures of the program found that 96% of the females have had no new pregnancies, 98% of all youth have had no new law violations, 98% demonstrated proficiency in employability and/or job retention skills, 86% made progress in school, were promoted, graduated, or obtained a GED, and 89% have obtained stable housing.
