Returning to the New Orleans just days after Katrina’s waters began to recede, Eboni Price-Haywood, MD, MPH, joined her colleagues from Tulane University Medical Center in a desperate effort to provide medical services to the city’s devastated residents. “We were unable to use the medical center so first, we had to find a place where we could work,” explains Price-Haywood, a young physician who had just completed a fellowship at Johns Hopkins in Baltimore and moved to New Orleans in 2005, shortly before the hurricane.
“On some level, in those days, it was the survival of the fittest, so we started setting up clinics in any way that we could. In some cases, ‘clinic’ meant putting up a card table, with an ice chest and some vaccines,” Price-Haywood recalls. “So the director of Covenant House (a support program for homeless youth) offered us some space in her building—she loved the idea of having a clinic on the premises and it was a great help to us.”
Adding Insult to Injury
While Katrina created an unprecedented health care crisis in New Orleans, “the city was already at the bottom of the list when it came to health care indicators,” explains Price-Haywood, a 2008-2012 Robert Wood Johnson Foundation (RWJF) Harold Amos Medical Faculty Development Program Scholar. “Nearly 40 percent of New Orleans residents were uninsured at the time and the city had a very large vulnerable population of poor and homeless even before the hurricane.”
In an effort to address the city’s growing need for health care, officials were already in the midst of an effort to restructure the system of primary care. They never would have guessed that the circumstances created by Katrina would lead Price-Haywood, a team of health care providers from Tulane, community-based organizations and many of the city’s neediest citizens to come together and solve that health care services problem on their own. But that’s exactly what occurred.
The Power of Partnership
Community activists and many people who represented the population most in need of accessible care worked with Tulane’s health experts to create what is now the Ruth U. Fertel/Tulane Community Health Center (named for the founder of Ruth’s Chris Steakhouse who donated the building). The Fertel/Tulane Center was so successful that it eventually became part of a coalition of 18 community-based organizations that share ideas and provide care through a network of independent, community health centers around the city.
“We have experts in technology, academic health centers, faith-based organizations, even a musician’s group that share ideas on what the community really needs,” says Price-Haywood, who is now medical director at the Fertel/Tulane Center. “We could not have accomplished what we did without these groups.”
The coalition’s expertise contributed to the development of a comprehensive, urgent care clinic that began in the space loaned by Covenant House and has now grown into a network of three clinics that have served 90,000 residents since Katrina. In 2011, the National Committee for Quality Assurance awarded the Fertel/Tulane Center its highest level of recognition as a high quality, patient-centered medical home.Their road to success revealed practices worthy of modeling nationwide:
- Let the community lead. “People from the neighborhoods that will become the patients of any center must be actively engaged in the process of building that health center to be sure the programs will be culturally and socially appropriate,” Price-Haywood says. “We formed a patient advisory council and had them guide us every step of the way.”
The recommendations of the patient council really amounted to the community asking Price-Haywood and her colleagues to address their social determinants of health. “They let us know that in addition to just providing care, we had to have a legal clinic on site to help people address housing issues, for example. We have social workers and case workers who help people find resources to support their health, such as vouchers for the farmers’ market or maps showing where to buy fresh, healthy food.”
- Go high tech. “We have very advanced electronic medical records because we saw—firsthand—what could happen to paper records in a crisis,” says Price-Haywood, noting that years of paper patient records were lost during Katrina. “The records must also link all parts of the facility—physicians, specialists and all care staff.”
- Consider the mind/body connection. The Fertel/Tulane Center began by addressing physical health problems, but now includes a mental health care component. Patients are able to receive psychotherapy at the clinic.
- Build a community care legacy. “We also have an educational mission. We teach future health professionals how to work in this type of comprehensive, community health care setting,” Price-Haywood says. “The clinic hosts 21 primary care internal medicine residents and four medicine-psychiatry residents, as part of their training in outpatient medicine. We also host nursing students, clinical pharmacy students, and public health students as part of the care team. The model places trainees in multidisciplinary care teams in order to learn how to work effectively in patient-centered medical homes.”
In addition to her work at the Fertel/Tulane Center, Price-Haywood has used her time as a RWJF Harold Amos Medical Faculty Development Program Scholar to conduct research on shared decision making in cancer screening for people with low levels of health information literacy.
“My goal is to teach physicians how to counsel this population and to be more culturally sensitive in cancer treatment and screenings. We followed a group for up to two years, including people who had mammograms, Pap smears, colorectal exams and other tests. We hope to publish our results later in 2012,” Price-Haywood says.
But she is most proud of the improvements in community health that can be attributed to the Fertel/Tulane Center. “We have dramatically increased the continuity of care for many patients here—some poor, some homeless—and therefore been able to greatly increase treatment received for conditions such as diabetes, hypertension and depression.”