Category Archives: Hospitals
The Community Health Initiative (CHI), a program of the Cincinnati Children’s Hospital Medical Center in Ohio, includes work with nontraditional community partners to support community organizing and address critical children’s health issues in the community. For example, using geocoding technology to identify areas of greatest need—“hotspots”—by mapping clusters of readmitted asthma patients to substandard housing units owned by the same landlord. CHI partnered with the Legal Aid Society of Greater Cincinnati, which helped tenants form an association and compel the property owner to make repairs. CHI also makes referrals to Legal Aid for patients who need help with Medicaid benefits or require other legal assistance. CHI has developed specific health metrics with which it evaluates the effectiveness of its programs and shares these data with local community organizations and CHI’s community partners.
The CHI work was featured in a new community benefit issue brief from The Hilltop Institute at UMBC, “Community Building and the Root Causes of Poor Health.”
NewPublicHealth recently spoke with Robert Kahn, MD, MPH, who is the Director of Research in the Division of General and Community Pediatrics at Cincinnati Children’s Hospital.
NewPublicHealth: What are the goals of the Community Health Initiative?
Robert Kahn: The Cincinnati Children's Hospital board established in its strategic plan for 2015 four goals that relate to the health of all 190,000 children in our county. The goals relate to: infant mortality, unintentional injuries, asthma, and obesity rates as they relate to hospital readmissions. Our plan is to build a strategy and an infrastructure to cover the ground between a more traditional clinical approach and a truly public and social wellbeing approach to these conditions.
NPH: Why are partners so critical?
Jose T. Montero, MD, director of the Division of Public Health Services at the New Hampshire Department of Health and Human Services, was elected president of the Association of State and Territorial Health Officials (ASTHO) during the association’s recent annual meeting in Austin, Texas.
Dr. Montero began his medical career in Putumayo, Colombia, where he served as a local, county and state health official. He then went to teach family and preventive medicine and later became Colombia’s public health director. Dr. Montero began his service in New Hampshire in 1999 as chief of the New Hampshire Communicable Disease Section in the Division of Public Health. Before becoming director of the New Hampshire Division of Public Health Services, Dr. Montero was the state epidemiologist. He is an adjunct professor of family medicine and a member of the preventive medicine residency advisory committee at Dartmouth Geisel School of Medicine.
NewPublicHealth spoke with Dr. Montero about the new ASTHO President's Challenge, which will focus this year on the integration of public health and health care.
NewPublicHealth: Why is so critical now to work toward the improved integration of public health and health care?
Dr. Montero: We keep talking about the health system but there is not much that is health-focused—it’s currently mostly about providing care after people becomes ill. From a public health perspective we’re trying to improve outcomes and quality, without spending the amount of money on health that we’re currently spending because we can’t sustain that. The system needs to continue changing and evolving, but we don’t yet know what exactly how it will look or how it should look. We need to create a new system. Based on the experiences of some states, such as Massachusetts and Oregon, we know gaining access to health insurance has expanded use, but we don’t know if they’ve achieved improved health outcomes yet. We’re working toward that. But we need to work on the right indicators that allow us to consistently measure total population health.
When you look across the country, you see that public health entities provide the continuum of care throughout the life cycle. We are already integrating health care and the public health system at several different places and levels, but it’s not consistent. To prepare ourselves for the future, we need to be able to look at public health and health delivery systems and integrate them philosophically. We need to capture examples, decode them, and see what works and what doesn’t and how to use which in different parts of the country. We have different cultures, different investment levels, and different expectations. We can’t just copy and paste.
NPH: What are the critical issues you’re looking at?
Health promoting hospitals—it sounds like an obvious concept, but a reimbursement-driven focus on treatment rather than prevention actually makes this a somewhat novel idea. Now, the World Health Organization health promoting hospitals initiative incorporates health promotion concepts, values and standards into the organizational culture and daily routines of hospitals around the world. The concept also allows all hospital employees and their families, patients and their families, and community residents to participate in health promotion together.
Taiwan has the largest network of health promoting hospitals in the world, Shu-Ti Chiou, MD, director-general of Taiwan’s Bureau of Health, told state health officers attending the ASTHO meeting. In Taiwan, one-quarter of all hospitals have received status as a health promoting hospital and many more have signed on to cancer screening initiatives that give reminders to patients about certain cancer screenings no matter the primary reason for their hospital or clinic visit.
Examples in Taiwan include a tobacco awareness campaign by the Pingtung Christian Hospital for community residents. Participants who smoked were provided with referrals for counseling services, and the outpatient smoking reminder system kicked into gear every three months to create contact with the smoker and discuss their smoking status or quit plans.
At the Cardinal Tien Hospital in Yung Ho, through the health promoting program of hospital, the rate of women hospital employees aged 30 and above who have had a Pap smear has increased from 30 percent to 80 percent, while those aged 50 and above who received mammography screening has reached 82 percent, thanks to a reminder system in place at the hospital.
In an interview with NewPublicHealth, Dr. Chiou says she has seen individual examples of health promotion at a number of hospitals in the United States, and two health promoting hospital networks are now in place—with three hospitals each—in Connecticut and Pennsylvania, both at early stages of their work.
“No matter the reason for a hospital visit, health promotion is an opportunity during an outpatient or inpatient stay,” says Dr. Chiou.
While so far only 25 percent of beds are in health promoting hospitals in Taiwan, the national cancer screening initiative is in place in 232 hospitals that have installed automatic reminder systems for cancer screening in outpatient services. The hospitals provide screening reminders for four types of cancer: oral, cervical, breast and colorectal. When an oral cancer screening reminder is prompted, health professionals also ask about smoking status “and the next step is to invite smokers to join cessation services,” says Dr. Chiou.
“We have found that many hospitals see the concept as a win/win and are applying for [health promoting hospital] status, and we look forward to meeting more hospital leaders in the U.S. to share the concept,” says Dr. Chiou.
GUEST POST by Lisa Junker, CAE, director of communications for the Association of State and Territorial Health Officials (ASTHO)
At the opening session of the ASTHO Annual Meeting in Austin, Paul Wallace, vice president of The Lewin Group, pointed toward the need for collaboration and partnership between the health care and public health sectors to overcome key challenges and trends facing the United States at the federal, state and local level.
>>Read our earlier interview with Paul Wallace on public health and primary care integration.
“What are the opportunities to create a shared conversation around prevention?” asked Wallace, who chaired the Institute of Medicine (IOM) Committee on the Integration of Primary Care and Public Health.
He gave attendees an overview of the process his IOM committee underwent to develop the recently-released report “Primary Care and Public Health: Exploring Integration to Improve Population Health.” The committee was charged with identifying the best examples of effective integration and the factors that promote and sustain those efforts, examining the ways federal agencies can use the provisions of the Affordable Care Act to promote integration, and discussing how Health Resources and Services Agency (HRSA) supported primary care systems and state and local public health can promote those efforts moving forward.
On July 1, John Wiesman, Director of Clark County Public Health Department in Washington State became president of the National Association of County and City Health Officials (NACCHO), which is having its annual meeting in Los Angeles this week. NewPublicHealth spoke to Wiesman about his work in Clark County and his goals as president of NACCHO.
>>Follow NewPublicHealth coverage of the NACCHO conference throughout the week.
NewPublicHealth: What are some health-related accomplishments in Clark County that might serve as models for other communities?
John Wiesman: I think we’ve done a number of important things in our county. We strategically transitioned out of clinical services and partnered with community organizations that could provide those services.
NPH: What were some of the advantages of that change?
Richard J. Umbdenstock, American Hospital Association: Opportunities for Collaboration Between Health and Health Care
The intersection of health and health care was an important theme at this year’s Keeneland Conference—during sessions on recent IOM reports, in hallway conversations, in discussions of Public Health Services and Systems Research that explores the most efficient ways to deliver public health services, and, notably, during the keynote address by Richard Umbdenstock, president and CEO of the American Hospital Association.
In his presentation, Umbdenstock talked about hospitals and public health, "collaborating for communities," and said that as health care providers, hospitals had tended to focus on treating the individual, rather than on prevention for the population. Now, he said, the money is gone and the public cares more about health, meaning it makes less and less sense for either hospitals or public health to be concerned with protecting their turf. “We need to incent health and deglamourize consumption.” Quoting a colleague, Umbdenstock said “what we need to do is create an epidemic of health.”
Umbdenstock spoke frankly when he told the attendees, “hospitals want to improve the lives of their patients, and not just their health care. Rather than wait for an [hospital] admission that won’t be paid, they’d rather get upstream on primary care.”
“Public health departments must be funded and supported so that wellness and prevention touches all and there are enough resources to do that,” said Umbdenstock. “And this is where research can play a big part—collaborative health research. We need to know the most effective collaborative models and the most effective ways to advocate for greater personal and community responsibility.”
NewPublicHealth caught up with Richard Umbdenstock following his talk.
NewPublicHealth: What are you hearing from hospitals about the new IRS community benefit requirement?
Richard Umbdenstock: Some hospitals have had similar responsibilities at the state level and many have had to put out accountability reports to their communities, so for many it’s not a new concept. In addition, hospitals have long been under a microscope and they also understand that community benefit is a wonderful community education tool. If they can tell it in a clear and consistent fashion, there’s a real opportunity for the public to better understand what hospitals and public health departments do.
NPH: Do hospitals and public health understand the critical community roles each one plays?
Richard Umbdenstock: I don’t think there’s any question what public health departments do after you’ve see them spring into action after a disaster, just as a lot of people don’t value what hospitals do until after they’ve been a patient. On a day-to-day basis we can all get so deep in our work that we just don’t see what the other person is doing. What we’re learning is that we all serve the same person.
Non-profit hospitals are required to provide a “community benefit” to qualify for tax-exempt status with the Internal Revenue Service. The Patient Protection and Affordable Care Act includes provisions for expanded community benefit opportunities with a focus on improving community and population health.
Massachusetts has had a similar community benefit provision at the state level for decades. NewPublicHealth recently spoke with Massachusetts State Health Commissioner John Auerbach, DPH, about what other states can learn from Massachusetts’ experience, particularly regarding the benefits – and challenges – of critical collaboration between public health departments and hospitals and other health care institutions.
NewPublicHealth:Massachusetts may have a leg up on some states when it comes to community benefit. Can you give us some background on that?
John Auerbach: The state Attorney General has long had community benefit guidelines that direct hospitals to address the non-hospital-based health and social needs of their patients. Consequently every hospital has been accustomed to implementing community benefit projects that follow the Attorney General’s criteria aimed at improving population or community health.
To help public health officials and policy-makers better understand the opportunity around the community benefit requirements for nonprofit hospitals, the Robert Wood Johnson Foundation funded the The Hilltop Institute at UMBC – a research center that focuses on the needs of vulnerable populations – to publish a series of issue briefs on best practices, new laws and regulations, and study findings related to community benefit activities and reporting. The most recent Hilltop Institute brief on community benefit and partnerships between hospitals, public health agencies and the communities they serve includes a discussion of an innovative asthma management program created by Children’s Hospital Boston. Last week, new data was published in the journal Pediatrics showing that this program reduced hospitalizations and emergency room visits, improved patient outcomes and saved $1.46 for every dollar spent.
NewPublicHealth spoke with Laurie Cammisa, Vice President for Child Advocacy at the hospital, about the project and the hospital’s approach to community benefit.
>>Read more on community benefit and the Hilltop issue brief series in a Q&A with Abbey Cofsky, program officer at the Robert Wood Johnson Foundation.
NewPublicHealth: The new IRS regulations on community benefit begin in March, but you are far ahead of the game with some of your community benefit initiatives. How did that come about?
Laurie Cammisa: The State Attorney General called for voluntary community benefit guidelines beginning in the 1990s, so we have been thinking about our initiatives since then. Our community benefit initiatives have included programs on mental health, child development, fitness and asthma. We have programs in each area, in partnership with communities.
NPH: Why is asthma one of the focus programs?
NewPublicHealth spoke with Eduardo Sanchez, MD, the chief medical officer for Blue Cross Blue Shield of Texas and Chair of the Partnership for Prevention, at the AcademyHealth annual National Health Policy Conference in Washington, D.C. Dr. Sanchez shared his perspective on the intersection and potential opportunities for collaboration between public health and health care.
NewPublicHealth: How do you think public health is being redefined now?
Dr. Sanchez: I think the health system needs to be thought of as being made up of two interdependent components—public health and medical care—that traditionally have been thought of as two different systems. The reason is that a high quality, cost-effective health system that is going to achieve optimal health for all Americans, depends on appreciating that “public health” is important for a truly successful effort to optimize health.
NPH: Where does the responsibility lie for making the critical changes needed for public health?
The holiday message from NewPublicHealth is: stay safe.
A recent report from the University of California at San Francisco finds that emergencies spike during the holidays for a number of reason, including overindulgence and delayed care.
Heart-related deaths increase by 5 percent during the holiday season. Fatal heart attacks peak on Christmas, the day after Christmas, and New Year’s Day, according to a 2004 study in the journal Circulation.
“The holidays are a time when we really increase the amount of salt and fat we eat. Most people don't notice the difference. However, there are certain people -- for example, those with heart failure -- for whom the slight increase in salt intake could result in big problems,” said Ameya Kulkarni, MD, a cardiology fellow with the UCSF Division of Cardiology.
UCSF physicians say another excess that fills the emergency room during the winter holidays involves binge drinking. On New Year’s Eve 2010, the UCSF emergency department saw a 50 percent jump in the number of ER visits from the year before. Of that, 70 percent were for alcohol admissions.
UCSF's Emergency Room Medical Director, Steven Polevoi, MD, says that typically binge drinking patients are so intoxicated that they aren’t able to walk or talk. They can lapse into unconsciousness, have trouble breathing and sometimes even die.
And drunken patients can impede the care of others because no medicine can reverse intoxication. “We must wait until their blood alcohol level decreases and that’s a slow process,” Polevoi said. “Basically we are left with lots of patients in semi-conscious states. They often spend six or eight hours with us until they’re sufficiently sober to go home.”
Bonus to Help Prevent Emergencies: The American College of Emergency Physicians has a good primer on emergency care on its website and gives additional advice on safety for older people, travel and home.
Have a safe, happy and above all healthy holiday.
Extra Bonus from NPH: Here’s a sneak peek at a new portal from the Department of Health and Human Services to help make us all healthier in 2012.