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ACHE – Equity of Care

Steven R. Carson, RN, BSN, MHAVice President, Clinical Integration

Chief of Operations

May 6, 2015

Temple University Health System Organizations:

• Temple University Hospital• Jeanes Hospital• Fox Chase Cancer Center• Episcopal Hospital• Temple Physicians Inc.• Temple University Physicians

Key Facts:

• Serves one of the nation’s most economically challenged urban areas

• Highest volume of patients covered by Medicaid in Pennsylvania among full-service hospitals

• Major delivery sites are located in

• Urban Renewal Area • Federally designated

Primary Care Professional Shortage Area

Our Community

• Our primary population service area includes more than 750,000 residents

• 62 % have < a high school education compared to 44% nationally

• 64 % have a household income of under $ 30,000

• 49 % of the community is African American

• 20 % are Hispanic• Emerging ethnicity Asian cultures

– Vietnamese– Korean– Cambodian

Potentially Preventable AdmissionLow income to High Income

Potentially Preventable AdmissionEthnicity

Health Burden Most Prevalent Chronic Conditions

– Heart Disease / Hypertension– Asthma / COPD– Diabetes– Renal Disease– Obesity– Mental Health

• depression• psychotic disorders• Substance Abuse

Perinatal Issues– Late or no Prenatal care– Pre-pregnancy Obesity

Major Cause of Death– Trauma and Trauma Related

Conditions– Cardiovascular Disease– Renal Disease– Chronic Dialysis

Social Issues– Medical literacy – Overall literacy– Substance Abuse– Violence

Population Health Model

Determinants of Health

• Health Outcomes • Health Factors – if

improved have a significant impact on making communities healthier

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Robert Wood Johnson 2015County Health Rankings

Utilizing Community Health Workers to Improve Patient Engagement

TUH - Demographics Edit for Title• Compliance with physician office visits improved• Hospital admission & readmission rates have improved• Patients more engaged in their care

• 714 bed non-profit safety net hospital• Greatest volume & highest percentage of Medicaid

patients among PA full service hospitals• Located in economically challenged area of Philadelphia

• 37% of area families with children live below federal poverty level

• Population is culturally diverse• 83% of population is minority

• 85% of population insured by government programs• 31% Medicare• 53% Medicaid

• Of adults ages 18-64, 24.7% do not have health insurance• Patients have multiple chronic medical conditions• Frequent and unnecessary hospital admissions and

readmissions.1

• Specially trained professionals • Members of the community• Have similar life experiences to patient population• Focus on non-medical patient needs in coordination

with all members of the health care team. • Average case load is 25 patients

• Multidisciplinary team, led by Nurse Manager • Focus: CHF discharge populations• Medical Record Case Review

• Reasons for readmission determine level of intervention required from team.

• Introduce skills of non-medical Community Health Worker • Assessment completed by CHW at bedside• CHW telephonically contacts patient and in some

cases meets patient in their home after discharge• CHW follows patient to assist with non-medical

social barriers to include housing, utilities, transportation, insurance, medications, and home based services.

• CHW schedules, attends, and is patient advocate at Primary Care and Specialty Care appointments.

• Collaboration with Nurse Navigator prior to discharge• Assess patient health literacy and their capacity for

managing disease.

Readmission Rates• Under nursing supervision the program showed there was an

improvement in transitions of care.• CHWs facilitate communication amongst multiple care

providers.• Future plans include evaluating CHW use in emergency room

and high-risk pregnancy.• Opportunity to apply across multiple care settings: SNF, Home

Care, Primary Care, Medical Home.

Community Health Worker

TUH - Approach

Improvement in Office Visits

References

Evaluation

1. Temple University Health System Community Health Needs Assessment, April 2013. Public Health Management Corporation.

• All patients receive a follow up call from CHW after discharge from hospital

• Patients that received call back had lower than average 7 and 30-day readmission rates

• Improved scheduling of follow up appointments prior to discharge

• https://www.dropbox.com/s/u3e0y61qy1btiy9/templechw-v4-nostill-v3.wmv?dl=0

Programs Addressing Community Need

• Established a Linguistic and Cultural services department.– Cultural Sensitivity – Cultural Competency

• Violence reduction– Cradle to Grave ( At Risk Youth)– Cease Fire

• Healthy Philadelphia– CDC Diabetes Education – Improvement of access to healthy food

HLNDV Panel Discussion

Rosa M. Colon-Kolacko, Ph.D., MBA, CDMSenior VP Christiana Care Learning Institute and

Chief Diversity Officer

Panel Discussion

• Make the connection with learning, diversity and inclusion with health disparities.

• Provide examples on ways that the Learning Institute Center for Diversity, Inclusion, Cultural Competency Equity have implemented Language Services, education and build partnerships to build understanding of healthcare disparities and provide equitable care.

• Share strategies to leverage bilingual CCHS Staff as medical interpreters to improves quality, availability and safety of care for LEP (limited English proficiency) patients.

Center for Diversity, Cultural Competency and Communications

Center for Educator

Development Research

Center forTransformingLeadership Center for

Innovation, Instructional Design and Technology

Center for Patient

Education

Center for SimulationEducation

Center forEmployee

and Career Development

Center for Diversity, Inclusion,

Cultural Competency

& Equity

To implement strategies to address the cultural and language needs of our colleagues and patients.

To implement programs and services to reduce the healthcare disparities in our community.

To grow DE diverse talent to grow the availability of healthcare professionals and leaders

To implement education programs and tools to equip our employees and partners with skills to promote a culture of inclusion, and have the capability to provide culturally competent care to the diverse patient population that we serve.

Learning Institute

Our Strategy.. Connecting with Christiana Care Way

Reducing Health Disparities and Improving Population Health Management through the

Implementation of Cultural CompetencyCultural competency is the ongoing capacity of healthcare systems,

organizations and professionals to provide for diverse patient populations high quality care that is safe, patient and family

centered, evidence based and equitable.