Population Health

Matters Spring 2018 | Vol. 31, No. 1

EDITORIAL Quarterly Publication

Raising All Boats: Part II Raising All Boats: Part II...... 1 From Classroom to Curriculum: Population The Jefferson College of Population Health quality and safety in the U.S. and Canada: Health Onboarding in the Real Word...... 2 (JCPH) continues in its leadership role as four of them started just a few months prior a key national thought leader with regard to that date. In response to the significant Jefferson Health Begins Its Comprehensive Primary Care Plus Journey...... 4 to the emerging fields of graduate study in growth in academic programs in HQS, healthcare quality and safety, population and the rise of professional development Hospital Community Benefit: What is it, health, and health economics and outcomes programs in this space, program directors why is it important, and how could it be research. Nearly a year ago, the editorial representing these academic institutions more effective?...... 5 “Raising all Boats”1 described an important met in Philadelphia in the early Fall of 2017 Student Perspectives on Hotspotting: meeting in New Orleans, nestled inside the to discuss developing an accreditation What it takes to improve care for annual meeting of AcademyHealth, where framework for stand-alone graduate “high utilizer” patients...... 7 the Deans of emerging schools and colleges programs in HQS. Defining Population Health Use Policies of Population Health were working together for a Regional Health Information to standardize the curricular framework for The Commission on Accreditation of Exchange...... 8 this new discipline. JCPH was the sponsor of Healthcare Management Education Disease Specific Chronic Care Management that special session, and this piece describes (CAHME) was identified to serve as for the Underserved Population...... 11 a subsequent panel on related topics at the the accreditation partner given the Optimizing Older Adult Sexual Society for General Internal Medicine (SGIM) complimentary nature of HQS with Expression...... 16 annual meeting in Denver, CO. healthcare management, and the existing Reducing Cancer Disparities by relationships that most partnering Engaging Stakeholders (RCaDES) SGIM is arguably the nation’s most prominent institutions already had with CAHME to Initiative - 2nd Annual Conference...... 17 national organization for general internists accredit their academic degree programs who practice mostly in academic medical in healthcare management. Following When Online Faculty Meet in Person: centers. Having joined when it was still the same development process that The CATS program...... 22 called, SREPCIM (Society for Research and CAHME undertook nearly 50 years ago Investiture of Dr. Trina Thompson as Education in Primary Care Internal Medicine) for healthcare management education, the first Victor Heiser, MD Professor of at the recent SGIM meeting in Denver, one of the group agreed upon a “certification to Population Health...... 23 us (Dr. Nash) proudly sported a badge noting accreditation approach.” that this was his 35th anniversary meeting! Announcements & Upcoming Events Simply put, nearly a year ago, under JPCH’s Massachusetts Housing and Shelter While academic longevity is interesting, leadership, one of us (Dr. Oglesby) brought Alliance Receives Hearst Health Prize...... 11 it certainly is not the core reason for this together all of the stand-alone graduate In The News...... 12 editorial! Rather, we write to share our programs in HQS in the United States and excitement that our competitive application Canada. They have subsequently committed JCPH Publications...... 14 to present a special session within the SGIM to a deep self-evaluation with the goal of JCPH at the International Society for annual meeting, was accepted by their becoming certified in healthcare quality and Pharmaeconomics and Outcomes leadership. In the narrative that follows, we safety under the auspices of a major national Research (ISPOR)...... 14 will set the context for the SGIM Annual accrediting body. Population Health Forum: Community- Meeting, and why we felt it was so important Based Population Health Research: A to bring together leaders in the JCPH journey With this accomplishment in mind, our team Report from the Field...... 20 to certify and accredit graduate programs in submitted the aforementioned proposal to JCPH Presentations...... 21 healthcare quality and safety (HQS). SGIM, which was accepted at their annual The Second Annual Greater meeting. We noted in the application Philadelphia Trauma Training As of September 2017, there were 12 stand- Conference July 23-26, 2018...... 19 alone graduate programs in healthcare Continued on page 2 Continued from page 1 Also participating in the panel were the focusing on the need to improve education directors of two current graduate programs, in quality and safety. process to SGIM that general internists, including Annette Valenta, DrPH (University among others, are being called upon to of Illinois) and Sue Feldman, RN, MEd, PhD Looking toward the future, we believe that, assume leadership responsibilities related (University of Alabama) who presented Jefferson’s leadership role in population to healthcare quality and safety as the updates on each of their programs. Given health (and HQS as a core component), delivery system moves from one based that the SGIM meeting had an additional will serve the delivery system well and will on the volume of services delivered to the focus on the role of information technology, continue to contribute to improving the value generated by those services. The goal Drs. Valenta and Feldman emphasized health of our citizens. was that our panel, nested within the SGIM this aspect of their unique curriculum, annual meeting, could stimulate the national and how general internists might become conversation regarding career trajectory in strong advocates for the merger of health quality and safety, with a special emphasis information technology, and improvements David B. Nash, MD, MBA on self-evaluation, measurement, and the in healthcare quality and safety. Dean road toward accreditation. The leadership Jefferson College of Population Health of SGIM agreed, and our panel had solid Certainly, general internists are not the [email protected] attendance during the meeting in Denver. only leaders in the HQS movement, but having the privilege of presenting at a Billy Oglesby, PhD, MBA, MSPH, FACHE Dr. Nash was joined in Denver by Anthony major national scientific meeting with a Associate Dean for Academic & Stanowski, DHA, FACHE, the President and competitive submission process is further Student Affairs CEO of CAHME, who gave a brief overview evidence of the growth of academic Associate Professor of its history and current operations. Dr. credibility for the 12 stand-alone graduate Jefferson College of Population Health Stanowski did an excellent job outlining the programs in HQS. This also represented [email protected] evolution of CAHME, most especially in the another leadership opportunity for JCPH last decade, and why their board of directors to “raise all boats”, not just for colleges of felt that accrediting programs in quality and population health, but for the curricular safety was so central to their future mission. champions at 12 other graduate schools

REFERENCES 1. Nash DB. Raising all boats. Popul Health Matters. 2017; 30(3).

From Classroom to Curriculum: Population Health Onboarding in the Real Word Newly hired clinicians transitioning into roles Health includes course work in Teaching concrete problems; Third Order, which that independent practicing primary care and Learning principles and execution, is the creative form of problem solving providers must absorb a great deal of new which laid the groundwork for developing where new perspectives and questions information while assuming responsibility the Population Health Overview Program are assimilated; and Fourth Order, which for their patient panels. Acclimating to the described here. Congruent with JCPH’s is ‘world’ knowledge at a social evolution variety of payer programs, organizational encouragement of students to incorporate level. Curriculum in the Population Health accountabilities, and patient care activities real-world experiences into learning Overview Program builds upon each can be a considerable challenge for newly opportunities, the need for a pragmatic level and culminates with problem-based minted providers and requires network population health onboarding program learning exercises (Table 1). For instance, support. The onboarding of new physicians was identified through this connection. learners in the program complete a patient into an ambulatory care network is a critical The program was developed utilizing the case vignette assignment from a reflexive time for imprinting the organization’s cultural resources and support provided by JCPH knowledge perspective in Module 2 and norms and priorities as well as nurturing faculty in collaboration with the local build upon this this during Module 3 from a their confidence. In an effort to facilitate this clinical leadership team. more experiential perspective. This holistic transition and foster a learning environment, application of knowledge and skills aims to the Jefferson Community Physicians (JCP) The Population Health Overview Program guide more interconnectedness between division of Jefferson Health developed a employs adult learning principles and providers’ workflows and patients’ outcomes hybrid population health overview course techniques to convert theoretical concepts while enabling them to take ownership of with problem-based learning as part of the and knowledge into actionable steps for population health care delivery with each onboarding process. busy practitioners. Lindvang & Beck (2015) subsequent case vignette. summarize four categories of learning: First Jefferson College of Population Health’s Order, which is factual knowledge; Second The Population Health Overview Program (JCPH) doctoral program in Population Order, which is reflexive knowledge to solve kicks off with a learner self-assessment

2 | POPULATION HEALTH MATTERS Table 1.

Learning Principle Defined Application in program (activity) Learner Feedback First Order Factual knowledge Each module’s lecture and reading materials “Week 1’s lecture was a great overview target acquiring the foundational knowledge of of the material. I had attended a each topic meeting earlier about CPC +, but this presentation was much more effective Example: Week 1 contained readings about the and easier to understand.” National Quality Strategy (NQS) and the Week 1 lecture described all of the payer programs we currently are participating in. Second Order Reflexive knowledge to Each of the modules had assignments and “I think it would be helpful to have a solve concrete problems activities that required the synthesis of facts in concise list of the care gaps we at JCP order to complete the activity. are being asked to close. This would be useful for providers and staff and Example: Patient case vignettes were introduced promote closure of those gaps.“ in the second module and using during the third module. During the in-person session, Population Health Jeopardy also aided in cementing key learning objectives. Third Order The creative form of Each of the online modules contained a “I learned the most during week 2’s quiz problem solving where discussion board whereby attendees were and practical application; consider adding new perspectives and asked to respond to reflective questions about more of these vignettes and less of the questions are assimilated their practice in relation to these population long readings which I found difficult to health topics. incorporate in to practice. Example: In module 1, providers were asked 100% of learners rated their proficiency to consider how, individually, they could in describing to a colleague the variety advance the national population health of payer programs in place at JCP as agenda in their community. Very Good or Outstanding on the final course evaluation. in order to gauge their level of familiarity assessments and interventions using explored including using an abbreviated and confidence in the material about to vendor-established, certified workflows in version as a continuing education module be presented. The Program itself is divided the electronic medical record (EMR). This for seasoned providers, in an effort to help into three separate modules and aims live, in-person session builds on the patient keep them abreast of fluctuations in payer to accomplish three learning objectives. vignettes to mirror clinical scenarios learners program requirements and EMR changes. Module 1 familiarizes learners with the will face in their respective practices, while Holding true to the initial focus of this current national health care climate the course leaders demonstrate how to program, subsequent iterations will continue and describes key components of the accurately document that patient encounter. to be learner-centric and utilize problem- various payer programs in which JCP is based learning techniques. participating. Module 2 answers the question To date, the Population Health Overview ‘how are we evaluated’ by reviewing quality Program has been piloted with the Jefferson *Special acknowledgement to Juan Leon, metrics for which all network primary care Community Physicians at the Abington PhD, Director Online Learning, Jefferson providers are held accountable. Fourteen campus with the intention of rolling this College of Population Health for his electronic clinical quality measures (eCQMs) curriculum out next at the Aria campus. guidance and mentorship in learner-centric are reviewed in depth, along with metrics Learners in the pilot group have completed curriculum development. to track the successful achievement of course evaluations, and have provided payer and enterprise goals. Both of these feedback on content, structure, and modules are facilitated through narrated activities, which will be used to help shape PowerPoint presentations and by directing future iterations of this program (Table 1). Lori Merkel MSPH, RN, CPHQ learners to readings that underscore Recognizing that this program could benefit Population Health Business Analyst the key theoretical underpinnings. This the entire primary care interprofessional Jefferson Community Physicians content review aims to illustrate the team, the pilot group recommended [email protected] scope and diversity of population-based expanding the target audience and modules health care delivery to prepare clinicians to encompass other disciplines such as Ms. Merkel is a PhD candidate in for what they will experience at JCP. Medical Assistants, Office Managers, and Population Health at Jefferson College Module 3 is a demonstration of how to Care Managers. Additional opportunities of Population Health properly document the population health for growth of this program are also being

REFERENCES Lindvang C, Beck, B. Problem Based Learning as a Shared Musical Journey--Group Dynamics, Communication and Creativity. J Problem Based Learning in Higher Ed. 2015; 3(1):,1-19. https://eric.ed.gov/?id=EJ1108356. Accessed April 8, 2018.

Spring 2018 | 3 Jefferson Health Begins Its Comprehensive Primary Care Plus Journey

The Jefferson Health System is a large Table 1. Program domains health enterprise in the Philadelphia Metropolitan area, composed of 14 Requires that practices engage in activities such as 24-hour patient Access and hospitals, that employs hundreds of primary access and assigning care teams to patients. Practices must also offer Continuity care physicians in more than 100 primary electronic visits and expanded office hours beyond traditional times. care practices. In 2017, Jefferson Health embarked on an exciting new journey to transform its outpatient practices. As part Requires stratification of the entire population into different risk of the Affordable Care Act, the Center for Care categories based on their clinical condition. High-risk patients, who are Medicare and Medicaid Services (CMS) Management more likely to have poor health outcomes, are required to take part in a comprehensive care management program. created The Innovation Center. The Center was set up to test innovative payment and delivery system models that may show Comprehensive Includes formulating discharge follow-up planning and using promise for maintaining or improving the Coordination behavioral health services to improve health outcomes. quality of care in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), while slowing the rate of growth in Requires the formation of a patient family advisory council (PFAC) program costs. The original Comprehensive Patient and to involve the patient in feedback about the transformation process Primary Care (CPC) program was initiated Caregiver occurring in the practice. This domain also supports creation of self- in 2012 with a grant from the Innovation Engagement management tools for patients with high-risk conditions. Center. The purpose was to explore whether outpatient quality outcomes could be achieved through improvements Ensures the practice is analyzing payer reports including the CPC+ Planned Care in infrastructure in outpatient practices. feedback reports that are provided quarterly by CMS. The practice is Population After some promising early outcomes, obligated to schedule a weekly care team meeting with a focus on Health CMS decided to move forward with the quality health improvement. second phase of the project, entitled Comprehensive Primary Care plus (CPC+). Nationwide approximately 3,000 primary Timing of the CPC+ program was chronic diseases are adversely affected care practices and 13,000 clinicians were advantageous for Jefferson Health as by their underlying psychosocial ailments. chosen to take part in CPC+ in the fall of it continues to integrate the expansion The Care Management Committee is 2016. Sixty-one owned Jefferson Health of different campuses into its growing working diligently to ensure that there primary care practices and 3 affiliated sites health system. It was paramount for the is a standardized plan to address the were chosen as part of this group to take system to coordinate its efforts across all high-and rising-risk patients, who are part in the CPC+ program and benefit from of its campuses to further the integration not only the most vulnerable but are this 5-year program. journey, so a centralized structure was also the most costly in the system. The formulated to act as the control center. Quality Committee is working to ensure Each office practice at Jefferson Health The central structure included key the successful reporting of the electronic chose one of two tracks, with an almost administrative and clinical leaders from clinical quality metrics (eCQMs) that are equal distribution of the two types across the respective campuses to facilitate required to be reported to CMS as part the enterprise. Track 1 was chosen by a central strategy with local control of the CPC+ requirements. Finally, the practices that were able to meet minimum of implementation. A CPC+ project Primary Care Innovation Committee is requirements, while Track 2 was chosen director was hired to oversee the entire ensuring that a portion of the granted by practices that were farther along in project and ensure standardization and funds are spent at the local practices on their transformational journey. While communication amongst the campuses. innovative ideas that will not only improve the program is sponsored by CMS, the care but also improve the satisfaction structural reforms provided have to improve A Jefferson population health retreat and efficiency of the clinicians providing the care provided for all patients in a early in the process led to the formation the care. The Innovation Committee practice -- including those with commercial of several subcommittees to meet the has proposed additional positions that insurance. Regardless of the track, the CPC+ requirements. The integrated will help the system reach quality goals: program is designed to change how behavioral health committee, whose documentation scribes and advanced patients are managed in order to improve role is to create a centralized approach medical assistants who will allow clinicians the clinical quality, health care costs, and to behavioral health, will equip current to spend less time documenting the visit patient experience. There are five specific and newly hired practice-embedded and more time providing expert clinical domains that need to be addressed to behavioral health specialists with the tools decision making based on the patient’s remain in the program (Table 1). to improve the health of patients whose medical problems. Additionally, Ambulatory

4 | POPULATION HEALTH MATTERS Pharmacists will assist in improving the process that have moved the integration of quality of medical management of patients Jefferson Health’s primary care practices in with complex and low-value medication a positive direction. Strategic planning for Steven Spencer, MD, MPH regimens, as well as to enhance the use of the future has focused on meeting specific Director of Population Health high-value medications. financial and quality goals. As the program Jefferson Community Physicians (JCP) progresses, the mandate is that it will [email protected] As outlined above, the first year of the move beyond process and get to a place CPC+ program has seen some incredible of improved health care value as well as success in formulating structure and improved patient and provider satisfaction.

REFERENCES 1. Patient Protection and Affordable Care Act of 2010, PL 111-148, sec. 3021. 2. N Engl J Med. 374;24. June 16, 2016.

Hospital Community Benefit: What is it, why is it important, and how could it be more effective?

Nonprofit hospitals achieve and maintain greatest potential to address upstream regional health needs and related their official nonprofit status through determinants of health.4 However, this initiatives outlined in the implementation undertakings aimed at promoting the category has historically accounted strategies as reported by each of health of their communities, referred to for a small portion of overall hospital the Philadelphia nonprofit hospitals. as community benefit activities. Among community benefit expenditures, with Access to primary care and services the categories of community benefit estimates ranging from 4-8% of overall for substance abuse were identified as designated by the Internal Revenue community benefit spending.2,3,5 This is community health needs by all of the Service (IRS), over 85% of overall hospital notably lower than expenditures in direct Community Health Needs Assessments expenditures fall under direct patient care, patient care categories.3 in Philadelphia County, but only half of including financial assistance programs, the hospitals reported a plan to address shortfall from Medicaid and other In recent work, our team explored these community needs. In addition, while means-tested government programs, allocations of community benefit dental health, mental health, insurance and subsidized local health service. The expenditures and compared this to local coverage, and pharmacy and drug costs remaining 15% of hospital community health needs from 23 nonprofit hospitals were among the most frequently reported benefit funds are applied in domains and health systems across the five-county community needs, these domains including medical research, health greater Philadelphia region. We performed were very rarely included in hospital professions education, and community this work with the concept that there implementation strategies. health improvement services.1 In 2011, may be opportunity to better maximize hospitals reported over $62 billion in community benefit through coordination Coordination of Nonprofit annual community benefit investments,2 of investments across hospitals, especially Hospital Community Benefit and annual per capita community benefit in a dense, urban region. Two manuscripts Investments investments have been shown to exceed have been generated by this work.6,7 In the In this work (currently in press), we combined annual state and local health following, we summarize our findings, and explored local community benefit department spending.3 Non-profit provide recommendations for next steps spending patterns, specifically hospital community benefit investments to increase community characterizing spending allotments in have the potential to positively impact the benefit impact. CHIS. We analyzed hospital-published health of communities across the country, Community Health Needs Assessments yet a number of factors, including lack Understanding What (CHNA) as well as Internal Revenue Service of clear mechanisms for accountability Communities Need and tax filings from 23 nonprofit hospitals and or inter-hospital cooperation, may limit How Hospitals Allocate health systems across the five-county the effectiveness of these expenditures at Their Expenditures greater Philadelphia region. The urban core improving the health of local populations. The Affordable Care Act (ACA) mandates of Philadelphia County had higher rates that, every three years, nonprofit of poverty, more non-White residents, The community health improvement hospitals perform a community health lower average educational attainment and services (CHIS) category, which is needs assessment and establish an higher overall community need than the explicitly defined as activities or programs implementation strategy to address surrounding suburban counties. However, carried out “for the express purpose of identified needs. We performed a improving community health,” has the qualitative content analysis to understand Continued on page 6

Spring 2018 | 5 Continued from page 5 programs on local community health. Kristin L. Rising, MD, MS While current policies demand Associate Professor & Director of while hospitals in Philadelphia County reporting of monetary inputs for Acute Care Transitions reported far higher overall community community benefit investments, there is Department of Emergency Medicine benefit expenditure, they reported no expectation for reporting outcome Sidney Kimmel Medical College significantly less spending on CHIS as measures. Measures might vary by Thomas Jefferson University compared to surrounding suburban region, and hospitals should be able to [email protected] counties, both as a proportion of their total select outcome measures most relevant community benefit spending and as an to the documented needs of their Brendan G. Carr, MD, MS absolute dollar amount. community. Examples might include Professor, Department of measures of rates of immunizations Emergency Medicine Recommendations to Maximize supported by community benefit Associate Dean, Healthcare the Impact of Community funding, or number of individuals Delivery Innovation Benefit Spending provided access to job training Sidney Kimmel Medical College While the hospital community benefit has programs, or number of pregnant Thomas Jefferson University tremendous potential for impacting and women connected to insurance [email protected] improving regional health, our work has coverage through community demonstrated substantial gaps between benefit supports. David N. Karp, MUSA community need and community benefit Department of Biostatistics, Epidemiology expenditure. In order to maximize the 4. Increase transparency within CHNA & Informatics impact of the hospital community benefit, implementation strategies, including Perelman School of Medicine we propose the following priorities: information on how hospitals prioritize University of Pennsylvania which needs will be targeted, what [email protected] 1. Improve regional coordination hospitals have identified as specific between hospitals that serve goals and objectives regarding their Amanda M.B. Doty, MS overlapping communities CHNA, hospital dollars invested per Department of Emergency Medicine program, people served per program, Sidney Kimmel Medical College 2. Establish a mechanism for hospital and any other relevant outcomes Thomas Jefferson University accountability to ensure that identified [email protected] community health needs are being addressed in a community-centered Rhea E. Powell, MD, MPH manner, and that evidence-based Avi Baehr, MD Associate Professor, Department approaches are being employed to Resident In Emergency Medicine of Medicine address those needs. Denver Health Emergency Medicine Sidney Kimmel Medical College [email protected] Thomas Jefferson University 3. Expand hospital reporting requirements [email protected] to include measures assessing the effect of community benefit-funded

REFERENCES 1. Rubin DB, Singh SR, Young GJ. Tax-exempt hospitals and community benefit: new directions in policy and practice.Annu Rev Public Health. 2015;36:545-557. 2. Rosenbaum S, Kindig DA, Bao J, Byrnes MK, O’Laughlin C. The Value Of The Nonprofit Hospital Tax Exemption Was $24.6 Billion In 2011.Health Aff (Millwood). 2015;34(7):1225-1233. 3. Singh SR, Bakken E, Kindig DA, Young GJ. Hospital Community Benefit in the Context of the Larger Public Health System: A State-Level Analysis of Hospital and Governmental Public Health Spending Across the United States. J Public Health Manag Pract. 2016; (22)2;164-74. 4. Rosenbaum S. Hospitals as community hubs: integrating community benefit spending, community health needs assessment, and community health improvement. Economic Studies at Brookings. 2016;5. 5. Young GJ, Chou CH, Alexander J, Lee SY, Raver E. Provision of community benefits by tax-exempt U.S. hospitals.N Engl J Med. 2013;368(16):1519-1527. 6. Powell RE, Doty AMB, Rising KL, Karp DN, Baehr A, Carr BG. A Content Analysis of Nonprofit Hospital Community Health Needs Assessments and Community Benefit Implementation Strategies in Philadelphia. J Public Health Manag Pract. 2017. 7. Baehr A, Doty A, Karp D, Rising K, Carr B, Powell R. Developing Data to Support Effective Coordination of Nonprofit Hospital Community Benefit Investments. Journal of Healthcare Management. In Press

6 | POPULATION HEALTH MATTERS Student Perspectives on Hotspotting: What it takes to improve care for “high utilizer” patients Introduction of healthcare, being picked up by an visits, we have a few small wins – a change “Hotspotting” is an emerging method ambulance every few months had become in our client’s treatment plan and a regular aimed at improving care and reducing costs routine, and we wanted to know why. Earlier follow-up with a trusted social worker – that by identifying “high utilizers” or patients that month, team members had visited feel like huge victories. At the beginning, I with complex chronic conditions who the elderly woman, living alone with some never imagined I’d be thrilled by such tiny, over use emergency departments and assistance, and described her as having a flat incremental steps. Now I see how these inpatient hospital care. The Interprofessional affect with signs of cognitive decline. But slight shifts can correct course over time Student Hotspotting Learning Collaborative the person I saw in the hospital that night and make a difference not just in health promotes collaboration and interprofessional was alert, sociable, and engaged, although outcomes but in saving system resources team-based learning among the various anxious to get back home after a stimulating and costs as well. This is a memorable health and social service professions for day in the ER. Since the doctors couldn’t lesson as I begin my own nursing practice these complex patients. The program guarantee her safety home alone, she had and it reminds me to celebrate progress addresses social determinants of health been admitted for an overnight stay until wherever I find it. through patient interactions, home visits, a caregiver could pick her up. She didn’t accompaniment to providers’ offices/ understand this. Waiting until the nurse left Meghan’s experience hospital visits, and navigation of community the room, she turned to me. “Can’t you It was very easy to make the decision to resources. just call the ambulance to take me back participate in Student Hotspotting because home?” she asked. That’s when I understood I wanted to be able to help identify “super- Last year, the Jefferson Center for what an important role social isolation was utilizers” and see what I could do as a Interprofessional Practice and Education playing in our client’s health. Home alone student pharmacist to ensure the number of (JCIPE) was selected as one of four and anxious about her symptoms, she knew hospital admissions decreased by increasing national Student Hotspotting hubs by the that the ambulance was only a reassuring the health of my patients. While it was Camden Coalition of Healthcare Providers, phone call away. easy to say yes to participating, it was also Association of American Medical Colleges, stressful stepping into an advanced role Primary Care Progress, Council on Social By joining our patients as they navigate beyond just being a student pharmacist. I Work Education, National Academies of the health system, students can observe knew I was going to be visiting the homes Practice, and American Association of smaller moments like these that provide of different patients and performing Colleges of Nursing. As a hub, Jefferson clues about high utilization otherwise medication reconciliations and would has scaled up its hotspotting program to missed somewhere between a doctor’s potentially be faced with situations I did include eight interprofessional teams in appointment and a trip to the ER. Our not know how to necessarily handle. I addition to hosting twelve teams from interprofessional team from medicine, remember being beyond nervous to call my regional institutions, playing an integral nursing, occupational therapy, pharmacy, first patient and set up a time to meet at her role in propelling this national movement and public health can then compare apartment because I was honestly afraid of for caring for complex patients forward. insights from different points of view. After rejection, but she turned out to be the nicest Interested students throughout Thomas following up with another home visit, we woman and was more than happy to have Jefferson University apply to the program discussed how our patient’s unmet social my team come to her home and meet her. and participate in small teams of four to six needs were leading to serious medical interprofessional students. problems, as well as avoidable visits to the Our first roadblock with our patient came ER triggered by anxiety, confusion, or even when I called her to confirm our visit a The following summary describes the loneliness. We shared this information with few days after originally reaching out, and Hotspotting observations and experiences our advisors and our patient’s physician, she did not remember agreeing to the of two 2017-18 student participants, suggesting a few changes. visit. For a moment I didn’t know what Jessica Shipley (Nursing) and Meghan to say because I did not want to alarm Bresnan (Pharmacy). As for what it’s like to “do Hotspotting”, all I her, so I asked her again if it was okay for can say with certainty is that it’s complicated. us to come over and she kindly agreed. Jessica’s experience The program’s organizers prepare us for Luckily, when we went to our first visit, One night while working as a nurse extern ambiguity in a complex patient’s situation she remembered I called her the previous at Jefferson, I saw a text from our student and urge us to resist the impulse to fix it, day; therefore, what I thought was a Hotspotting team: “Our patient has been suggesting we simply get to know the major roadblock turned out to be a case admitted from the ER, can someone come person instead, using a trauma-informed of forgetfulness. Throughout our original talk with her?” I volunteered to go after my approach. These patients have been let visit with our patient we became more and shift, and that was when I met “Mary” for down by the system and sometimes all we more comfortable asking her questions the first time. can provide in our short time together is a about her previous hospitalizations, but first step back towards a healthier routine. our biggest source of information was For most people, landing in the emergency our patient’s nurse aide. She was able to room is a frightening, singular event. For I’m proud to say that after months of our client, as with other high utilizers meetings, case conferences, and home Continued on page 8

Spring 2018 | 7 Continued from page 7 more background information, to get the Click here to watch Jefferson students full picture of how we could approach describe their Hotspotting experiences. detail every reason for our patient’s recent such a complex situation. Overall, Student hospitalizations, which was helpful because Hotspotting has showed me how taking we soon discovered our patient was care of a patient is way beyond prescribing diagnosed with mild dementia which was medications and checking on a patient’s Jessica Shipley affecting her ability to recall recent events. physical well-being. There are so many FACT 2 Nursing ‘18 social and mental factors that contribute to Jefferson College of Nursing Throughout this entire experience so far, a patient’s overall health that are sometimes [email protected] not only did I have my team to work with forgotten in the usual day to day practice to help our patient, but I was also working of medicine which need to seriously be Meghan Bresnan with our patient’s primary care physician. I considered if a clinician wants to treat their Jefferson College of Pharmacy ‘18 was able to speak to the physician to obtain patients to the best of their ability. [email protected]

Defining Population Health Use Policies for a Regional Health Information Exchange

Regional health information exchanges Table 1. Examples of scenarios used to develop population health use (HIEs) primarily aim to improve healthcare by policies for a regional health information exchange. facilitating clinicians’ access to information about their patients from electronic health Healthcare uses A consortium of providers participating in a neighborhood records maintained by other providers1 health improvement project seeks to characterize patients or from claims records maintained by who use ED services excessively in order to formulate insurers. This might include information interventions. on diagnoses, medications, test results, or An individual provider is interested in assessing and care encounters.1­ In addition, information improving cancer screening rates among her patients. in HIEs can be used for multiple population A primary care practice is interested in better understanding 2,3,4 health applications. For providers and birth outcomes within its patient population, including infant insurers, this might include improving the birthweights and maternal post-partum visits. completeness of data for performance monitoring and quality improvement or As part of its periodic community health needs assessment, for assuring the delivery of recommended which is required for maintenance of not-for-profit status, services.2,3 For public health agencies, this a hospital seeks to assess the prevalence of hypertension might include improving disease monitoring among Asian people residing in its service area (a population systems or supporting linkages between that is insufficiently represented in a local community health clinical and public health services.2,4 survey). Incorporating population-level uses into Public health uses A metropolitan health department endeavors to assess HIE operations requires consideration of the prevalence of obesity by selected demographic governance and policy questions that are characteristics across the city, based on body mass index distinct from those that underlie direct calculations derived from height and weight measurements clinical applications. During 2016-2017, recorded in medical records, in comparison to other HealthShare Exchange (HSX), a regional methods for obtaining such measures. 5 HIE centered in Philadelphia, PA, initiated A healthcare provider wishes to submit mandated reports such efforts by convening a workgroup to a health department on certain infectious diseases and that included representatives from immunization services. member organizations (hospitals, insurers, As part of an outbreak investigation, a local public health accountable care organizations, clinicians, department seeks to assess the extent of the problem in community health centers) and the public order to inform its response. health field (a list of participants is available at https://www.healthshareexchange.org/ hsx-population-health-workgroup). In HSX is an increasingly mature HIE serving health providers, and post-acute-care this article, we summarize the key issues the greater Philadelphia metropolitan area entities.5 HSX policies and procedures have that arose in these deliberations and the and the Delaware Valley region, including been defined through “use cases” that strategies the workgroup identified to southern New Jersey.5 Participants include describe the purpose, scope, and terms address them, with the aim of providing a large hospital and healthcare systems, of specific data uses, such as automated resource to other HIEs interested in adding insurers, primary and specialty care providers, retrieval of information when patients are or expanding population health activities. accountable care organizations, behavioral seen in hospital emergency departments and

8 | POPULATION HEALTH MATTERS Table 2. Examples of scenarios used to develop population health use users’ responsibilities and not to develop policies for a regional health information exchange. more generalizable knowledge, the latter objective being a defining attribute of Topic Question(s) research in Federal regulations that protect 7,8 Definition of population What distinguishes population health versus patient care research participants, the workgroup health uses of an HIE? concluded that population health uses were not research and thus not subject to institutional review board approval and Applicability of federal Are population health uses of an HIE research? oversight. This conclusion, which was regulations that protect Is institutional review board (IRB) review and approval affirmed by HSX legal counsel, was also research participants required? based in part on the analogy between Data access and data- Should users have access to individual-level patient/client proposed population heath uses of HSX and use agreements data with or without identifying information versus data on investigations in public health practice that 9 numbers of patients in different classification strata (i.e., are classified as “nonresearch.” aggregate data)? Questions regarding the level of data Should users have access to information regarding the granularity that should be provided to identity of providers who had seen population members? analysts and procedures for granting analysts Should data extracts be released to analysts for use outside access to HSX data (Table 2) consumed HSX, or should analysts be required to work onsite at HSX or considerable attention. The group resolved to access HSX data via a secure channel? that data should be provided at a level of detail necessary to address a proposed Would the user be restricted from accessing data for query, but not beyond, under terms patients with HIV or mental health diagnoses? specified in data-use agreements that Could HSX members obtain data only for those with whom protect confidentiality and data security. they have an ongoing provider or insurer relationship? Depending on the nature of specific requests, as exemplified in Table 1, data Potential conflicts What is the boundary between performance assessment would be provided in ways that are also between the interests of for informing service improvement versus informing commensurate with a user’s established payers and providers reimbursement incentives or rates? relationships to patient or client populations, Project approval and How would proposed population health uses be approved? adherent to the Health Insurance Portability transparency What requirements would analysts have to share findings? and Accountability Act of 1996 (HIPAA) privacy rule,10 and compliant with other state and federal regulations that govern notifications to primary care providers when For example, characterization of persons uses of personal health information. For patients are discharged from hospitals or diagnosed with hypertension would be a example, in the scenario involving a primary emergency departments.6 The growth of HSX population health use, which might inform care practice interested in assessing birth has been enabled by a shared recognition improved prevention services or outreach outcomes within its patient population, among members of its utility for improving to those whose blood pressure was not well the practice has established relationships patient care, attention to data security and controlled. Envisioned population health uses with patients who might have delivered data-use policies, and trust engendered reflected insurers’ interests in improving care at multiple hospitals. Thus, the HIE would among users by their participation in coordination and quality for their members, provide patient data from those hospitals. In governance and policy committees. providers’ interests in improving their care addition, a proposed analysis might require quality and outcomes, and public health individual-level data to explore risks for In examining potential population health entities’ interests in monitoring and protecting adverse outcomes, and needs for patient uses of HSX and its data from healthcare the health of populations within their purview. follow-up might be recognized that would and public health perspectives (Table HSX can enhance capacities to address these require access to patient identifiers. In the 1), the workgroup identified multiple needs because its data repository includes scenario where a hospital is conducting questions (Table 2) that set the agenda for information about patients or clients that a community health needs assessment its deliberations. The resolution of these is maintained in record systems outside using data for people residing in its defined questions is summarized in the remainder members’ individual systems and because it community service area, the population of this article. allows geographically-based queries. Such of interest would likely include a mix of population health uses are distinct from people who are or are not its patients. In The workgroup defined population health clinical uses where queries seek information that situation, hospital analysts would be uses as queries that seek to characterize a about an individual patient or client. provided data that does not include personal group of patients (e.g., those under the care identifiers, and, as in any instance where de- of a particular provider, enrolled in a particular Population health data users would include identified individual-level data are provided, health plan, with a particular diagnosis HSX members or authorized governmental the data-use terms would prohibit analysts or health risk, or residing in a particular public health agencies. Because the scope from making any effort to re-identify persons geographic area), regardless of whether those of population health uses is to inform queries prompt follow-up with individuals. services or functions directly connected to Continued on page 10

Spring 2018 | 9 Continued from page 9 also prohibit any member from using HSX data for market analyses. The workgroup represented in the data. If that same hospital recognized that, in some instances, the James W. Buehler, MD were interested in assessing the prevalence distinction between data that could be used Clinical Professor of HIV within its service area, HSX would for performance management (an accepted Dornsife School of Public Health provide aggregate counts of persons living population health use) and prohibited uses Drexel University with HIV but would not provide analysts might be ambiguous. It concluded, though, [email protected] with individual-level data because of special that HSX member organizations were protections surrounding personal-level HIV unlikely to engage in prohibited data uses, Debbie S. Bernstein data under Pennsylvania state law.11 In the given the spirit of collaboration among them Vice President, Client Implementation scenario where a local health department that had created and sustained the exchange and Relations seeks to assess the prevalence of obesity and their commitment to transparency HGE Health communitywide, aggregate counts of the regarding planned population health uses. [email protected] number and percentage of people who are obese, would likely be provided; although, Ultimately, the workgroup recognized Pamela E. Clarke, MSW HSX staff effort would be needed to conduct that population health data uses by HSX Senior Director the analyses and prepare the tabulations. For members and public health authorities HealthShare Exchange people who elect to opt-out of having their were sufficiently distinct to require [email protected] personal health data exchanged through the development of separate use case HSX, only de-identified data would be documents for each. These documents, Karla Geisse, MS, MPH provided for any project. which address the workgroup’s resolution Karla is a recent graduate of the JCPH MPH of the critical questions in detail, were program and a Management Fellow with The workgroup also determined that all approved by the HSX board in July HealthShare Exchange population health projects would be subject 2017 and are available online (www. [email protected] to approval and oversight under existing healthshareexchange.org) along with policies and governance procedures of the other HSX policies.6,12,13 Going forward, an HIE.6 For example, HSX member-contract informal user group will be established terms prohibit payers from using data to share insights and experiences and to derived from the system to leverage contract foster best practices for population health negotiations with providers. The terms uses of HSX data.

REFERENCES 1. Office of the tionalNa Coordinator for Health Information Technology. Health Information Exchange (HIE), What is HIE? https://www.healthit.gov providers-professionals/health-information-exchange/what-hie. Accessed November 27, 2017. 2. Meyer M. How HIEs Use Data to Improve Population Health. J Am Health Information Management Assoc, Blog posted April 19, 2017. http://journal. ahima.org/2017/04/19/how-hies-use-data-to-improve-population-health/. Accessed November 27, 2017. 3. Lento J. The Relationship Between HIE and Population Health Management. Phillips Wellcentive, Blog posted January 2, 2013. https://www. wellcentive.com/blog/the-relationship-between-hie-and-population-health-management/. Accessed November 27, 2017. 4. Shapiro JS, Mostashari F, Hripcsak G, Soulakis N, Kuperman G. Using Health Information Exchange to Improve Public Health. Am J Public Health. 2011;101(4):616-623. 5. HealthShare Exchange. https://www.healthshareexchange.org. Accessed November 27, 2017. 6. HealthShare Exchange. HealthShare Exchange Approved Policies (Governance, Use Cases). https://www.healthshareexchange.org/HealthShare Exchange-approved-policies. Accessed November 27, 2017. 7. U.S. Department of Health and Human Services. Protection of Human Subjects. Code of Federal Regulations, Title 45, Part 46 (45 CFR 46), 2009. Part 46.102(d), https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html. Accessed November 27, 2017. 8. U.S. Department of Health and Human Services. Federal Policy for the Protection of Human Subjects, Final Rule (2017 Revision). Federal Register 2017;82(12), Part 46.102(l), January 19, 1017, p 7260. https://www.federalregister.gov/documents/2017/01/19/2017-01058/federal-policy-for-the- protection-of-human-subjects. Accessed November 27, 2017. 9. Centers for Disease Control and Prevention. Distinguishing Public Health Research and Public Health Nonresearch, July 29, 2010. https://www.cdc. gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf. Accessed November 27, 2017. 10. U.S. Department of Health & Human Services. The HIPAA Privacy Rule. https://www.hhs.gov/hipaa/for-professionals/privacy/index.html. Accessed November 30, 2017. 11. Pennsylvania General Assembly. Confidentiality of HIV-Related Information Act, 35 P.S. § 7601et seq. http://www.aidslawpa.org/wp-content/ uploads/2011/04/Act-148-as-amended-2.pdf. Accessed November 30, 2017. 12. HealthShare Exchange. Participants Population Health Use Case, July 18, 2017. https://www.healthshareexchange.org/sites/default/files/pdf/ participants_population_health_use_case_7-18-2017.pdf. Accessed November 27, 2017. 13. HealthShare Exchange. Public Health Authority Population Health Use Case. July 18, 2017. https://www.healthshareexchange.org/sites/default/files/ pdf/public_health_authority_population_health_use_case_7-18-2017.pdf. Accessed November 27, 2017.

10 | POPULATION HEALTH MATTERS Massachusetts Housing and Shelter Alliance Receives 2018 Hearst Health Prize The winner of the $100.000 Hearst They are listed below in Health Prize for Excellence in Population alphabetical order: Health was announced at the Population Health Colloquium on March 20, 2018. Cincinnati Children’s Massachusetts Housing and Shelter Alliance Hospital Medical Center (MHSA) was recognized for its successful (CCHMC) for their All Home and Healthy for Good program, a Children Thrive (ACT) permanent supportive housing program Learning Network, an addressing chronic homelessness, and initiative which is focused overutilization of acute care and emergency on population-based care, by removing barriers to housing. improvements aimed at Individuals are provided with their own reducing infant mortality, home where they can maintain sobriety, reducing days that children find employment and achieve other health spend in the hospital, and and life goals. The program was able ensuring that children thrive to show reductions in the utilization of by being school-ready at age Robert Kahn, MD, MPH, Cincinatti Children’s Hospital Medical emergency services and an increase in the five and reading proficiently Center (finalist); Joe Finn, Massachusetts Housing and Shelter placement of adults experiencing chronic by the third grade. Watch Alliance (winner); David Olds, PhD, Nurse Family Partnership homelessness into permanent housing. the video. Watch MHSA Executive Director, Joe Finn each expectant mom with a personal nurse describe the program. Nurse-Family Partnership (NFP), a national to help her have a healthy pregnancy, maternal and child health program that improve her child’s health and development The two other finalists for the 2018 Hearst changes outcomes for the most vulnerable and set goals to become economically self- Health Prize were each awarded $25,000. moms and babies in poverty. NFP provides sufficient.Watch the video.

2019 $100K Hearst Health Prize Call for Submissions Open! The Hearst Health Prize, in partnership with the Jefferson College of Population Health, is now accepting applications for the 2019 award. The winner will receive a $100,000 prize, with $25,000 awarded to up to two finalists, in recognition of outstanding achievement in managing or improving population health. The goal is to discover, support and showcase population health programs that have made a measurable difference. For more information, visit Jefferson.edu/HearstHealthPrize. Submission deadline is Thursday, August 9, 2018, 3:00 PM EDT/ 12:00 PM PDT. For questions, please email [email protected].

Disease Specific Chronic Care Management for the Underserved Population

More than 30 million Americans are resources to successfully self-manage management for those with complex currently living with diabetes.1 Each their disease. As a result, hospitals across health and social needs. year, an additional 1.5 million are newly the nation have seen an influx of diabetic diagnosed.2 Diabetes has a major impact cases flow through their emergency Beginning in 2011, Jefferson Health New on people who live with the disease, their departments. The costs associated Jersey embarked on the Delivery System family members, and society as a whole. with diabetic hospitalizations can easily Reform Incentive Payment Program Not all people living with diabetes have be reduced and/or avoided with the equal access to care or the necessary implementation of comprehensive case Continued on page 15

Spring 2018 | 11 IN THE NEWS

Alumni Cordelia Elaiho presented at the Association for Prevention MPH student and Jefferson employee Madalene Zale with her poster at Teaching and Research (APTR) Annual Meeting . the APTR Annual Meeting .

Nine MPH students were honored at the Leadership LIVE ceremony. Leadership LIVE is a student leadership development program which HEOR Fellow Lauren Bartolome, PharmD was recognized for her poster consists of a series of workshops, special events, and community with a silver ribbon award at the Academy of Managed Care and Specialty service opportunities. Photo left to right: Saheedat Suliamon; Pharmacy Annual Meeting. Rashida Smith; and Nicole La Ratta.

Charles Baron at the Spring MPH Student Capstone Symposium . Jane Jacob at the Spring MPH Student Capstone Symposium .

12 | POPULATION HEALTH MATTERS IN THE NEWS

The MPH Student Capstone Symposium with (left to right): Preethi MPH Student Spring Capstone Symposium . Selvan, Ndidi Enwerji, and Samantha Soprano.

Former Secretary of U.S. Department of Veteran Affairs, David Darryl Strawberry shared his moving story about his journey through Shulkin, MD gave a key note presentation at the 18th Population addiction at the 18th Population Health Colloquium . Health Colloquium.

Niki Buchanan, Population Health General Left to right: Jennifer Voelker, PharmD; Vittorio Maio, PharmD, MS, MSPH; Lauren Bartolome, PharmD, Manager of Philips presented on value-based and Alberto Batista, PharmD. care at the Population Health Colloquium.

Spring 2018 | 13 JCPH PUBLICATIONS

Baker JL, Stevenson HC, Talley LM, Jemmott Harris RE, Richardson J, Frasso R, Anderson Newcomb RD, Frasso R, Crux P, Breeher LS, Jemmott John B. Development of a ED. Experiences with skin and soft tissue LE, Molella RG, Green-McKenzie J. barbershop based violence intervention infections among people who inject drugs Medical surveillance for hazardous drugs: a for young black emerging adult men. J in Philadelphia: a qualitative study. Drug & qualitative assessment of current practices. Commun Psych. 2018; April 2018. Alcohol Dep. 2018; 187:8-12. J Occup Environ Med. 2017 Dec. 1. Epub ahead of print. Birmingham LE, Oglesby WH. Readmission Harris RE. Richardson J, Frasso R. Perceptions rates in not-for-profit vs. proprietary hospitals about supervised injection facilities among Segal AG. Frasso R, Sisti DA. County jail or before and after the hospital readmission people who inject drugs in Philadelphia. Int J psychiatric hospital? Ethical challenges in reduction program implementation. BMC Drug Policy. 2018; 52: 56-61. correctional mental health. Qual Health Health Services Research. 2018;18:31. Research. 2018; 28(6). Kaufman MR, Delgado D, Costa S, George Cunningham AT, Delgado DJ, Jackson JD, B, Mitchell EP. Racial disparities in the Shahidullah JD, Kettlewell PW, DeHart KA, Crawford AG, Jabbour S, Lieberthal RD, presentation of hepatocellular carcinoma Rooney K, Ladd IG, Bogaczyk TL, Signore A, Diaz V, LaNoue M. Evaluation of an ongoing in the population of 65+ years in the Larson SL. An empirical approach to assessing diabetes group medical visit in a family United States. J Clin Onc. 2018; 36 (4 pediatric residents’ attitudes, knowledge, and medicine practice. J Am Board Fam Med. suppl):249-249. skills in primary care behavioral health. Int J 2018; 31(2):279-281. Health Sciences Ed. 2017;4(2):1-14. LaNoue MD, Gerolamo AM, Powell R, Nord Djatche L, Lee S, Singer D, Hegarty SE, G, Doty AM, Rising KL. Development and Skoufalos A, Clarke JL, Ellis DR, Shepard VL, Lombardi M, Maio V. How confident are preliminary validation of a scale to measure Rula EY. Rural Aging in America: Proceedings physicians in deprescribing for the elderly patient uncertainty: the “Uncertainty Scale.” of the 2017 Connectivity Summit. Popul and what barriers prevent deprescribing? J J Health Psychol. 2018 Jan. 1. Epub ahead Health Manag. 2017; 20;(suppl.2) Clin Pharm Ther. 2018;1-6. of print. Voelker J, Maio V, Mammen P. Changing the Djatche LM, Varga S. Lieberthal RD. Cost- Louis DZ, Callahan CA, Robeson M, Liu narrative: refocusing efforts of emergency effectiveness of aspiring adherence for M, McRae J, Gonnella JS, Lombardi M, departments in the opioid epidemic. Am J secondary prevention of cardiovascular Maio V. Predicting risk of hospitalization: a Med Qual. 2018, April 1. Epub ahead of print. events. Pharmacoecon Open. 2018; April 21. retrospective population-based analysis in Wong Y-L, Kong D, Tu L, Frasso R. Epub ahead of print. a pediatric population in Emilia-Romagna, “My bitterness is deeper than the Italy. BMJ Open. 2108; 8:e019454 Harris D. How to keep people’s health data ocean:”understanding internalized stigma private-without hurting research. WSJ. May McIntire RK, Keith SW, Boamah M. Leader from the perspectives of persons with 4, 2018. AE, Glanz K. Klassen AC, Zeigler-Johnson schizophrenia and their family caregivers. Int CM. A prostate cancer composite score to J Ment Health Syst. 2018; April 3; 12:14. Harris D. Gun violence isn’t just about identify high burden neighborhoods. Prevent guns; it’s about our children and our Med. 2018; 112:47-53 neighborhoods. Phila Inquirer. April 12, 2018.

JCPH at the International Society for Pharmaeconomics and Outcomes Research (ISPOR) Annual Meeting 2018 Jennifer Voelker received the Best New Lee S, Savant K, Hsiao C. National May 19 - May 23 Investigator Podium Research Presentation. Health and Nutrition Examination Survey Baltimore, MD (NHANES) Analysis of the USA’s obese Poster Presentations population and related comorbidities. Podium Presentations Bartolome L, Choi M. The impact of online Batista A, Bartolome L, Nelson F, Maio patient communities on patient outcomes: Decker-Palmer M, Thompson T, George V, Mammen P. Cost-effectiveness A systematic review. M, Frasso R. Identifying community analysis of universal vs. targeted Human reported health priorities using free listing Immunodeficiency Virus (HIV) screening Bartolome L, Payton C, Maio V, Altshuler M. interviews in a mixed methods approach. approaches to identify new HIV diagnosis Prevalence of pneumococcal vaccination in in the emergency department (ED). a recently resettled refugee population. Decker-Palmer M, Delgado D, Maloney TD. Emphasizing quality of life in treatment Voelker J, Crawford A, Sabonjian M, Lee S, Romney M, Goldfarb N. Return on recommendations for node-positive stage Maio V, Mammen P. Annual change in Investment (ROI) of Value-Based Insurance II non-small cell lung cancer. controlled substance opioid prescribing and Design (VBID) for diabetic patients. concomitant medications from an urban academic emergency department from 2011 – 2016.

14 | POPULATION HEALTH MATTERS Continued from page 11 Evidence-based health coaching Unlike other population health case approaches were designed and are management initiatives, DSRIP provides (DSRIP) with the New Jersey Department utilized to support effectiveness in a comprehensive, collaborative, patient of Health and Centers for Medicare & patient engagement and care. This is an centered approach that educates and Medicaid Services. Our DSRIP program innovative approach that our DSRIP team empowers patient to enact the changes focuses on the care and treatment of has embraced to engage patients. It puts they need to improve their overall health. patients 18 years and older, who are the focus solely on the patient, which This initiative provides a strong return on residents of New Jersey, living with is different from the traditional medical investment that can be reinvested into diabetes and/or hypertension, insured model in which health care professionals health promotion and improving quality by Medicaid, Managed Medicaid and who “know best” define the agenda, outcomes across the Jefferson Health NJ Charity Care. terms, and the goals of care. Through community. Chronic care management this practice, the team has developed and programs will become essential revenue The goals of Jefferson Health refined their Motivational Intervention sources to hospital systems as financial New Jersey DSRIP program are: to (MI) techniques that help patients work incentives for better quality outcomes increase patient access to primary through ambivalence with change-talk become standard with the adoption of and specialty care; improve care and goal setting. MACRA. Our DSRIP model has shown coordination between hospital and great success in managing care for those outpatient settings; improve patient In addition to linking patients to underserved patients with diabetes and self-care management; reduce hospital appropriate social services, our master’s hypertension. We believe our model will admissions relating to complications level social workers employ cognitive easily translate to additional disease states of diabetes and hypertension; reduce behavioral therapy as a technique and can be used for future Jefferson unnecessary Emergency Department to address issues with treatment Health chronic Case Management (ED) visits; increase preventive diabetes adherence and psychosocial barriers applications such as COPD, Congestive and hypertension health screenings; to overall health. Heart Failure, and Asthma. promote overall wellness; and leverage technology to facilitate patient tracking Our nurse navigators work with patients and communication of clinical data. The to provide clinical education in order to overarching goal of our project is to better understand their chronic medical Christina Micoli address the critical gap between clinical conditions, symptoms, medications and Administrative Assistant care and community services in the actions they can take to support Jefferson Health New Jersey current health care delivery system. their health. [email protected]

Currently, the project has enrolled As a result of the team’s continuous Amanda Kimmel, MSW more than 4,000 patients, who are efforts in patient engagement, care Assistant Vice President, Population Health provided medical services from over 800 coordination/navigation, and education, Jefferson Health New Jersey physicians. Jefferson Health New Jersey the team has had many successes within [email protected] has implemented relationship-building as the last year. the primary method to engage patients in their health care, with such techniques as The DSRIP team has seen a 17% motivational interviewing and therapeutic overall reduction in ED utilization and communication, as well as addressing hospitalization of patients and a 15% health-related social needs through reduction in hospital admissions for enhanced clinical-community linkages. uncontrolled diabetes. In addition there has been an 11% reduction in hospital Many of our patients have complicated admissions for short-term complications social needs that must be addressed in due to diabetes and a 23% reduction conjunction with their medical needs. in hospital admissions for uncontrolled Unmet health-related social needs, hypertension. Jefferson Health New such as food insecurity and inadequate Jersey’s DSRIP project has resulted in or unstable housing, may reduce an a significant reduction in health care individual’s ability to manage their medical spending, through reduced hospital costs conditions, increase health care costs, and and reduced governmental payments, lead to avoidable health care utilization. aggregating approximately $3.3M.

REFERENCES 1. About Diabetes. CDC - Diabetes Basics. https://www.cdc.gov/diabetes/basics/diabetes.html. Published June 1, 2017. Accessed February 21, 2018. 2. Overall Numbers, Diabetes and Prediabetes. Statistics About Diabetes . http://www.diabetes.org/diabetes-basics/statistics/. Published July 19, 2017. Accessed February 21, 2018.

Spring 2018 | 15 Optimizing Older Adult Sexual Expression

Sex is Alive and Well back such pleasant memories.” A 70+ experiences. Being “sexually active” Most people are uncomfortable when year old transwoman talked about her involves more than just intercourse. confronted with issues relating to older gender transition process that started in adult sexuality. In my experience as a her mid 50’s and how much happier she is. • Understand your beliefs and attitudes trainer and sexuality educator for close Grandparents asked questions about their toward sexuality in later life, and to 25 years, I have talked about sex with grandchildren’s “gay identity” and if the examine any barriers there might be to people of all ages: young girls and their word “queer” was okay to use. Older LGBT working supportively with older adults. parents (mostly their moms) about what adults voiced concerns and fear about The Aging Sexual Knowledge and to expect in puberty, high school and “coming out” when seeking aging services. Attitudes Scale (ASKAS) is a tool designed college students navigating their way to measure two realms of sexuality as through mating and dating, adults who So many people, even those who work in they relate to older adults: knowledge were incarcerated and/or in recovery, and the field of public health, may not think about changes in sexual response and older adults and their service providers. of seniors experiencing intimacy and general attitudes about sexual activity.1 Human sexuality is a compelling topic, sexuality concerns. The above anecdotes and the curiosity and enthusiasm it reflect some of the needs seniors have • Get to know the important sexuality arouses is perfectly normal regardless of in relation to their sexuality and sexual and intimacy issues that are specific to the age group. activities; concerns about relationships, those served—older adults living with feelings, memories, morality, and the lack HIV, residents in long-term care setting, However, for many, fascination with the of knowledge. lesbian, gay, bisexual and/or transgender subject of human sexuality is also charged older adults, clients with dementia. with negative emotions and concerns. Sex and Sexuality: Is there Increasing understanding will help Sometimes curiosity is tinged with feelings a difference? providers become more aware of and of guilt, shame, fear, and foreboding; and There are many facets of senior sex and identify intimacy needs and opportunities often for good reason. Sexuality issues sexuality, but too often, the words sex and for discussion, as well as offer tools to include topics that are very difficult to sexuality are used interchangeably, and begin addressing intimacy needs. discuss and this can be especially true that may lead to diminishing the value of when we talk about older adults. sexuality as we age. • Advocate that sexuality and intimacy be integrated into the services provided. For Sex and sexuality are human needs that One can think of sex in terms of intimate example, education for staff, addressing evolve and change over the lifecycle behaviors people engage in, or what box sexual consent policies, activities and the need for intimacy is ageless. It is to check when identifying one’s gender. that allow seniors to build intimacy/ simply not true that people lose interest in Sexuality is a central aspect of being relationships (dances, date nights, social sex as they age, regardless of their sexual human and encompasses sex, gender functions), incorporate physical intimacy orientation and gender identity or the identity and roles, sexual orientation, goals into physical therapy, or provide health challenges they may face. pleasure, intimacy and sexual health; a confidential space for older adults to and it is influenced by social, economic, discuss sexual health issues. The following anecdotes exemplify some political, cultural and religious factors. of the ways sexuality evolves and changes We express our sexuality in our thoughts, • Learn about the PLISSIT model. PLISSIT as we age, but is still very much a part of fantasies, desires, attitudes, values, and is an acronym for Permission, Limited who we are. behaviors, and these change throughout Information, Specific Suggestions, and our lives. Intensive Therapy, a model developed Consider the following question asked by by psychologist Jack Annon to address a member during a recent workshop on Implications for Practice sexuality issues with patients.1 The “SEXcessful Aging” that I conducted at a Sexual expression and intimacy among PLISSIT model provides a framework for local senior center: “Will I have a chance older adults is a reality that providers conversations about sexuality, including to talk about Eddy today?” My response: who work with them must be prepared sexual health. The model includes “Sure, tell me more about Eddy.” Older to face. How can we help them to meet several suggestions for initiating and adult: “Eddy is my vibrator.” this challenge and support healthy older maintaining the discussion of sexuality. adults’ sexual expression across the A man in his 80s talked about how decades of aging? Here are some tips: To summarize, sexuality is an important making love to his wife (now deceased) contributing factor to quality of life was “the best sex he ever had, and I still • Remember that sexuality is physical, and wellbeing. Sexuality, intimacy, and think about those years.” Another person mental, emotional, and spiritual and sex are central pleasures to the human asked whether or not oral sex was still spans an individual’s entire life. The experience and all adults have the right “sex” and if it was “safe”. A woman shared, need to enjoy and express one’s to express their sexuality, regardless of “It’s been so good to talk about sex and sexuality does not diminish with age. their age, sexual orientation, gender relationships. I haven’t talked about it to Older adulthood can be a time of identity or HIV status. We all need to anyone in years, these conversations bring new discoveries and powerful sexual join in conversations with older adults

16 | POPULATION HEALTH MATTERS to empower them with comprehensive serves on the American Society on information about sex and sexuality, Aging’s Leadership Council of their LGBT thereby increasing knowledge and Terri Clark, MPH Aging Issues Network (LAIN) constituent developing positive attitudes and Prevention Services Coordinator group and is currently the Coordinator of behaviors towards sexuality, intimacy and Action Wellness Prevention Services at Action Wellness in relationships, which are key to successful [email protected] Philadelphia, PA. To learn more about Terri aging and quality of life. and Action Wellness visit: https://www. Terri is a certified trainer with the SAGE actionwellness.org/ (Services and Advocacy for GLBT Elders)

REFERENCES 1. White CB. A scale for the assessment of attitudes and knowledge regarding sexuality in the aged. Archives of Sexual Behavior. 1982 December; 11(6):491-502. 2. Annon, JS. Behavioral Treatment of Sexual Problems: Brief Therapy. Oxford, England: Harper & Row; 1976.

Reducing Cancer Disparities by Engaging Stakeholders (RCaDES) Initiative - 2nd Annual Conference

Beginning in 2015, the Sidney Kimmel Program for the Pennsylvania Department Cancer Center (SKCC), a National of Health described progress made by Table 1: RCaDES Coordinating Cancer Institute (NCI)-funded cancer the Commonwealth of Pennsylvania to Team Presenters center, initiated a 2-year collaborative address cancer screening disparities. Marty Romney, RN, MS, JD, MPH project with Jefferson Health (JH) and She applauded the work of the RCaDES RCaDES Coordinating Team Assistant Lehigh Valley Health Network (LVHN) to Initiative and reinforced the importance Professor form a learning community dedicated of collaborative efforts to engage Jefferson College of Population Health to reducing colorectal (CRC) and stakeholders in the public and private lung cancer (LCa) progress screening sectors to increase cancer screening rates Beth Careyva, MD disparities in primary care practice patient and reduce screening disparities. RCaDES Steering Committee populations. This project, known as the Associate Director Reducing Cancer Disparities by Engaging Following these introductory remarks, Lehigh Valley Practice-Based Stakeholders (RCaDES) Initiative, was members of the RCaDES Initiative Research Network supported by the Patient Centered CT (Table 1) presented a summary of Lehigh Valley Health Network Outcomes Research Institute (EAIN accomplishments from each year of Jenné Johns, MPH 2471) and Thomas Jefferson University. the 2-year project. These included: 1) RCaDES Steering Committee The RCaDES Initiative sponsored its Establishing a communication strategy Director of Health Disparities first annual conference in December, to foster a collaboration and develop Corporate Medical Management 2016 .The 2nd Annual Conference, trust, 2) Developing shared statements of AmeriHealth Caritas which is described below, took place on purpose and common agendas for each December 1, 2017 at Thomas Jefferson learning community component (CT, SC Melissa DiCarlo, MPH, MS University campus. and PASACs), 3) Measuring CRC screening RCaDES Project Manager rates among whites, African Americans, Clinical Research Coordinator Ronald E. Myers, DSW, PhD, Professor of Hispanic Americans, and Asian Americans Division of Population Science Medical Oncology and Director of the served by JH and LVHN primary care Thomas Jefferson University Center for Health Decisions at Jefferson, practices, 4) Conducting a literature opened the 2nd Annual Conference. review to identify effective evidence- Randa Sifri, MD He described the learning community based intervention(s) to increase CRC RCaDES Coordinating Team infrastructure (a coordinating team [CT]; cancer screening adherence and reduce Director of Research a steering committee [SC] and a patient related disparities, and, 5) Completing Department of Family and and stakeholder advisory committee an environmental scan of CRC and LCa Community Medicine [PASAC] in each health system), and screening programs in the health systems. Thomas Jefferson University provided an overview of the meeting agenda. Next, Sharon Sowers, Director These efforts yielded the following of the Comprehensive Cancer Control observations: 1) CRC and LCa screening Continued on page 18

Spring 2018 | 17 Continued from page 17 important setting for the project, due Practice, and Director of the University of to a high LCa risk in the population, and Illinois Cancer Center. rates are low in the general and minority socioeconomic and cultural barriers that patient populations; 2) decision support deter those who are at risk from screening All panel speakers spoke to the strengths and navigation intervention(s) can and from seeking smoking cessation of the RCaDES Initiative: the use of increase CRC screening rates and services (Table 2). diverse partners, assessing organizational reduce CRC screening disparities; 3) readiness as one of the first steps of the the implementation of LCa screening project, and the creation of a learning programs lags behind CRC screening Table 2: Bristol-Myers Squibb community structure that could be used programs; and 4) there is little Foundation Announcement with other cancers. Dr. Studts noted coordination between payers and health the use of a systematic approach to systems in efforts to encourage patients The Bristol-Myers Squibb identifying and adapting an evidence- to have CRC and LCa screenings. Foundation’s $2.8 million grant to based intervention strategy; and the launch a multi-year initiative to use of a model-based approach to A panel on LCa screening, “Adapting increase LCa screening in vulnerable engage diverse populations in cancer Evidence-Based Strategies for populations in the Philadelphia region screening. In terms of weaknesses, all Implementation,” was moderated by Linda was made possible through the efforts keynote speakers agreed that greater Fleisher, PhD, MPH, Senior Researcher, of the Jefferson Office of Institutional outreach by the health systems was Digital Health, Health Communications Advancement and: needed to engage those most in need and Disparities, Children’s Hospital of of preventive health care. For example, • Gregory Kane, MD, Jane and Philadelphia, in which PASAC patients Leonard Korman Professor of and providers shared what they learned Pulmonary Medicine and Chair about the process of adapting a feasible of the Department of Medicine Table 3: The RCaDES Initiative LCa screening program for the respective 2nd Annual Conference patient populations and health systems. • Ronald E. Myers, PhD, Professor Roundtable Discussion Panel members reported the following: and Director of Population Questions and Answers 1) Literacy-appropriate and culturally- Science at Sidney Kimmel Cancer sensitive patient education materials Center 1) What do learning communities are needed, 2) Clinician support for LCa need to achieve their goals? • Rickie Brawer, PhD, MPH, Assistant screening is necessary to encourage Professor and Co-Director of the • Motivated/engaged patients and patient uptake, 3) Community members Center for Urban Health other stakeholders are not sufficiently aware of LCa screening opportunities and screening eligibility • Nate Evans, MD, Associate • Commitment of health criteria, and 4) Efforts to encourage Professor and Chief of system leadership patient uptake of LCa screening must Thoracic Surgery • Consensus on shared statement address patient knowledge, attitudes, of purpose and common agenda Their collaboration leverages the beliefs, and need for social support. • Continuous communication among full breadth of Jefferson enterprise’s learning community members The morning concluded with an expertise in pulmonary and lung announcement by Bruce Meyer, MD, cancer care, public health and 2) How can the success of a learning MBA, Senior Executive Vice-President community and engagement, and community be measured? of Thomas Jefferson University and the population science and shared Chief Physician Executive for Jefferson decision making research. • Community member participation Health. Dr. Meyer announced that • Adoption by health systems Jefferson was to receive a $2.8 million • Identification, adaptation, grant from the Bristol-Myers Squibb Following lunch, a panel conversation implementation of Foundation that would build on the titled, “Learning Community Formation intervention strategies RCaDES Initiative learning community as a Strategy for Reducing Disparities: model, and launch a multi-year initiative Strengths, Weaknesses, Opportunities • Intervention strategy reach, fidelity, to increase LCa screening in vulnerable & Threats” took place between Electra and effectiveness populations in Philadelphia. Patricia M Paskett, PhD, Marion N. Rowley Professor 3) Who should provide resources Doykos, PhD, Director of the Bristol-Myers of Cancer Research, Director, Division needed to support and sustain a Squibb Foundation, followed Dr. Meyer, of Cancer Prevention, of Ohio State learning community? and expressed her excitement about University; Jamie L. Studts, PhD, Professor working with Jefferson to increase LCa at University of Kentucky Louisville • Public health grants screening and improve related outcomes College School of Medicine, and Director • Private foundations in vulnerable populations, and about of Behavioral Oncology Program at the the potential for developing a model James Graham Brown Cancer Center • Health systems approach to engaging health systems and Community-Based Research SRF; • Private payers in LCa screening. Both Drs. Meyer and and Robert A. Winn, MD, Associate • Communities Doykos highlighted Philadelphia as an Vice Chancellor for Community-Based

18 | POPULATION HEALTH MATTERS Dr. Winn suggested that in the future, to embrace the PASACs as a resource to for members of the learning community RCaDES Initiative staff could arrange guide the adaptation and implementation to share both with each other and all to have meetings in the community, in of screening activities, and the problem conference attendees the opportunities addition to those that take place in health of catalyzing cooperative efforts involving and challenges that lie ahead to increasing system locations. Dr. Studts noted that health systems and payers. both CRC and LCa screening in health in terms of LCa screening, it would be systems and how working together can important to focus more attention on The afternoon session of the conference move this needle forward more efficiently. understanding the at-risk populations’ consisted of roundtable discussions on views of screening, including stigma, supporting and sustaining a health-based If you are interested in learning more perceived bias against smokers and learning community. Attendees were about the RCaDES Initiative, and if you former smokers, and fatalism. They assigned to 4 groups (including a virtual would like to become a member of speakers agreed the RCaDES Initiative group of NCI-designated cancer centers) to the learning community, please email opportunities are substantial. As explained discuss three questions (see sidebar) designed [email protected]. by Dr. Studts, “Persons at risk for lung to facilitate discussion and collaborative cancer represent a unique community of thinking about learning communities, their individuals that has not been targeted for goals, the ways to measure their success and LCa education and screening in the past. the resources needed to support and sustain Emily Lambert, MPH This initiative is a unique effort that can be them. Each group reported out key points Clinical Research Coordinator transformative.” Potential threats to the from their discussions at the close of the Division of Population Sciences success of the RCaDES Initiative included session (Table 3). Department of Medical Oncology the need to obtain continued support for Thomas Jefferson University the learning community, the challenge The RCaDES Initiative 2nd Annual [email protected] of encourage health system leadership Conference provided a unique opportunity

The 2nd Annual Philadelphia Trauma Training Conference Preventing Childhood Trauma and Its Impact Across the Lifespan: An Interprofessional Agenda for Providers, Advocates, Policy Makers and Community Members July 23-25, 2018

Nearly one in eight children (12 percent) Program of Jefferson (Philadelphia The program is for professionals and have had three or more negative life University + Thomas Jefferson University) paraprofessionals working in the following experiences associated with levels of has organized and will host the Second fields: medical, healthcare, mental health, stress that can harm their health and Annual Greater Philadelphia Trauma justice, child welfare, early childhood and development, according to Child Trends, Training Conference, to be held on K-12 education, and philanthropy, as well a national research organization based Jefferson’s East Falls Campus on July 23- as lay people invested in the health of in Washington, DC. Unfortunately, many 25, 2018, with special post-conference their communities. Continuing eduction health and human service providers do workshops available on July 26. credits will be available in a variety not have adequate skills and training of disciplines. to identify, mitigate, and address the The program will offer intensive, complex health and psychological needs discipline-specific trauma training; For more information or to register, visit: of trauma-affected clients and patients. exposure to innovative practice models; EastFalls.Jefferson.edu/PTC. and opportunities for cross-sector, To address this significant unmet need, interprofessional case conceptualization the Community and Trauma Counseling and planning.

Spring 2018 | 19 POPULATION HEALTH FORUMS Community-Based Population Health Research: A Report from the Field Sharon L. Larson, PhD Executive Director Norma Padron, PhD, MPH Associate Director Main Line Health System Center for Population Health Research Lankenau Institute for Medical Research Trina Thompson, DrPH, MPH, BSN Executive Director Marquita Decker-Palmer, MD, PhD Associate Director 1889 Jefferson Center for Population Health

April 11, 2018

This Forum highlighted the work of the 1889 Jefferson Center for Population Health and Center for Population Health Research (CPHR) at Lankenau Institute for Medical Research (LIMR).

Leaders from both research centers provided an overview of the history and purpose of the centers and described accomplishments and current initiatives. These centers exemplify health partnerships between academia (College of Population Left to right: Norma Padron, PhD, MPH; Sharon Larson, PhD; David Nash, MD, MBA, Marquita Health), research, and community. Decker-Palmer, MD, PhD; and Trina Thompson, DrPH, MPH, BSN

Sharon Larson, PhD, Executive Director of of the Center is to improve health and health related infrastructure by bringing in CPHR, kicked off the session by offering a wellness by building resilient communities initiatives that will help the community. foundation for the work of both centers. through collaboration, research, and She described the Learning Health education. Located in Johnston, PA, the Marquita Decker-Palmer, MD, PhD, Approach, which is focused on knowing Center is primarily focused on improving Associate Director of the 1889 Jefferson – characterizing the groups of people health in Cambria and Somerset counties Center for Population Health, described served; learning – identifying the needs in southwestern PA. Based on an analysis of the details of various tools and research of the populations and best practices for local data and community interviews, it was methods used to assess community addressing health, wellness, and prevention; decided that priority health areas would be: -reported health priorities that will doing – developing relevant strategies diabetes, obesity and inactivity; tobacco, inform the Center’s strategic plan. She and interventions to improve the quality drugs, and alcohol, and mental health. found the “free list” qualitative research of care and outcomes for populations in technique to be very helpful. This method partnerships with consumers, communities, Thompson explained that the Center is not is based on the assumption that the first providers, healthcare organizations, payers, an “implementer” but rather a “facilitator.” item a respondent places on a list may and others. She went onto point out the There are many organizations in the carry the most importance. In interviews importance of learning some more – region working to improve health, but participants were asked to: list the things assessing what is working and what they are working independently from one that improve your health; list the health isn’t working. another, often with the same goals. The problems that affect you; and list the Center hopes to bring those organizations things that make it hard for you to stay Trina Thompson, DrPH, MPH, BSN, and communities together to work healthy. Dr. Decker-Palmer explained that Executive Director of the 1889 Jefferson collaboratively and increase their impact. one of the surprising findings was that Center for Population Health gave an The Center is also seeking to partner with both populations of adults 65+ and 18-64 overview of the young Center, which was organizations that have had demonstrated identified work and occupational concerns the result of a philanthropic donation from success in implementing evidence-based as being very important. Younger adults the 1889 Foundation, Inc to Jefferson programs to serve as a consultant or stated that motivation was a barrier to College of Population Health. The mission mentor. The Center also aims to build a health while older adults identified aging

20 | POPULATION HEALTH MATTERS as a barrier. She emphasized that this type been tackling include: human trafficking, panel, “what would you like to see happen of assessment is important in focusing emergency department utilization, in two years, what will you tell us about future health interventions and developing women’s heart health, and cancer and your work?” Dr. Larson responded with the community buy-in. care coordination. Challenges they have idea of helping the health system figure out faced include: identifying silos and potential where the vulnerabilities are by providing Dr. Larson described the environment of partners; data access and development; them with the data. “We are the detectives CPHR as being very different from the staffing, and funding. that help figure out where’s the data, how 1889 Jefferson Center. Because CPHR do we tell the story, and does it reflect what is embedded in a clinical system, it is Norma Padron, PhD, MPH, Associate we thought it would reflect.” She described very important to forge partnerships that Director of CPHR, talked specifically about the idea of a farm that would grow fresh engage clinicians in telling important ED utilization and what is referred to as fruit and vegetables, but the challenge is population health stories. Lankenau serves “unscheduled” care. Padron created a knowing how it would produce change. two very different populations – one that population health dashboard prototype is urban with striking health disparities, and to convey what the center could do. Dr. Thompson described the challenges of the other that is suburban with mostly high She started by aggregating and pulling collecting data in rural areas and believes socioeconomic status – which creates information from various sources, looking that the Center could be the collector of some distinct differences and needs. For at designs and tools used in other settings. new rural health data in the region. She example, it is no surprise that the lower Padron then used the data to outline also described the need for a cultural shift socioeconomic area had greater challenges geographic variations in ED utilization in the and education moving toward health. accessing affordable medications than their five southeastern Pennsylvania counties. She Thompson would like to see new ways of higher socioeconomic counterparts. pointed out that for this type of research transporting people in her region, with more center in this setting, it is not only important opportunities to access areas for walking CPHR is involved with many initiatives; one to outline the problem, but to use evidence and activity. that has generated a great deal of discussion based strategies to connect the dots. Padron has been a CPHR’s scientific review of safe concluded by explaining that the model of To view slides and listen to Population injection facilities conducted in conjunction the CPHR could be very valuable to other Health Forum audio recordings visit: with the Philadelphia Department of Health health systems with huge opportunities for http://jdc.jefferson.edu/hpforum/ and the Mayor’s Opioid Task Force. The multi-sectoral collaborations. report was published in December 2017 and showed that these facilities can in The Forum was followed by the Grandon To learn more about the fact save lives but that tailored, evidence- Society Workshop, which afforded members Grandon Society visit: based strategies must be considered when the opportunity to engage with the speakers Jefferson.edu/GrandonSociety implementing harm reduction program. in more detail with an interactive discussion. Other research topics that CPHR has Dr. Nash initiated the session by asking the

JCPH PRESENTATIONS

Bartolome L. Utilization of non-opioid Frasso R, Buckshire K, Garg P, Ivins R, Frasso R. Social determinants of health: pain therapies prior to initiating an opioid Thompson M, Hexem K. Oral health: addressing the needs of every patient. among chronic opioid users across understanding the LGBTQ experience. Presented at: 45th Annual LSMA Northeast multiple employer plans. Poster presented Presented at APHA Annual Meeting, Nov. Regional conference, February 17, 2018. at: Academy of Managed Care Pharmacy, 4-9, 2017. Haltzman B, Leader A, McIntire RK. A April 23-26, 2018, Boston, MA. Poster Frasso R, Godissart C, Martinez A, Siddiqui qualitative investigation of the relationship received a silver ribbon recognition. H. Public health: an overview and new view. of social capital and health amongst older Decker-Palmer M. Bayesian network Presented at: Penn State, April 4, 2018. adults in the Kensington neighborhood of meta-analysis of breast cancer utilities – an Philadelphia, PA. Presented at: APHA Annual Frasso R. Public health: the lens, the innovative approach to evidence synthesis. Meeting, November 4-9, Atlanta, GA. mission, the tools. Presented at: Rutgers Presented at: Society for Medical Decision University, March 20, 2018, Camden, NJ. Harris D. Best in class collaboration models Making 39th Annual Meeting, October 24, with Pharma for improving population health 2017, Pittsburgh PA. Frasso R. Public health professionals: in chronic conditions. Panel presentation at: what do we know? Presented at Rider Ekije N, Frasso R, Andy U, Flick L, Markland 18th Population Health Colloquium, March University, April 6, 2018, Lawrenceville, NJ. A, Arya L. Diet modifications in older women 20, 2018, Philadelphia PA. with fecal incontinence: a qualitative study. Frasso R. Public health: the lens, Harris D. Keynote address at PopHealth Presented at APHA, Nov. 4-9, 2017. the mission the tools. Presented at 18 Summit, University Hospital, March 26, Philadelphia College of Osteopathic 2018, Newark NJ. Medicine, March 19, 2018. Continued on page 22

Spring 2018 | 21 Continued from page 21 Rutkowski-Urban T, LaNoue M, McIntire Stockbower G, D’Alonzo B, Solomon RK. Associations between social capital and S, Dupuis R, Lawman H, Mendelson Harris D. Keynote address at Healthcare health in Kensington, Philadelphia. Presented A, Cannuscio CC, Frasso R. Urban Business Academy Fellowship Program, at: Association for Prevention Teaching and gardening: keeping it safe, healthy and March 23, 2018, Rochester, NY. Research, April 2018, Philadelphia, PA. fun through the development of an urban Juon H, McIntire RK, Lake M, Barta J. Racial gardeners’ handbook in Philadelphia, Saeks C, Karamanian V, Curry A, Frasso R. differences of Lung-RADS among patients PA. Presented at: APHA Annual Meeting, A qualitative study of food pantry patron enrolled in a lung cancer screening program. November 4-9, Atlanta, GA. experiences in Philadelphia. Presented at: Presented at: American Society for Preventive APHA Annual Meeting, Nov. 4-9, 2017. Thompson T. Meeting the needs of Oncology, March 2018, Chicago, IL. rural and urban communities at the 18th Scalzo L, McIntire RK, Juon, H. Borders and Padron N. Collaborative design of tools Population Health Colloquium, March 20, blood pressure: understanding the role of to assess and prevent algorithm bias: 2018, Philadelphia, PA. acculturation in a hypertension diagnosis the context of health care. Presented at: among Hispanic Americans: 2014 California Walsh K. ACMQ’s Population Health 2018 Health Datapalooza, April 26-27, Health Interview Survey. Presented at: APHA Intelligence: What does big data tell us Washington, DC. Annual Meeting, Nov. 4-9, Atlanta, GA about quality and safety. Presented at: Paniagua-Avila MA, Frasso R, Calderon ACMQ webinar, March 27, 2018. Segal A, Frasso R, Sisti D. Is it jail or a hospital? TA, Bream K, Barg F. Social, emotional, Ethical conflicts in correctional mental health Weigelt D, Frasso R, Facund R, True J. economic and physical factors that care. Presented at: APHA Annual Meeting, Reintegration: using photovoice to explore influence type 2 diabetes mellitus self- November 4-9, 2017, Atlanta, GA. veterans experiences after war. Presented at: management in a Guatemalan indigenous APHA Annual Meeting, Nov 4-9, Atlanta, GA. Tz’ utujil community. Presented at: APHA Skoufalos A. Developing your team to Annual Meeting, November 4-9, 2017. meet local needs. Presented at: Population Health Webinar Series, UCB Pharma, May 4, 2018.

When Online Faculty Meet in Person: The CATS program

The Jefferson College of Population Health develops online faculty through a systematic program of course authoring and teaching support known as ‘CATS’. Comprised of both online and face to face meetings with College administrators and faculty, CATS program activities culminate each fall and spring term with a working dinner held on campus—the CATS dinner. At these events program-level meetings held with Program Directors in the late afternoon lead in to a meeting of the whole conducted over dinner to address a selected general theme. Photo by Lisa Chosed In recent years, the dinner’s themes have Dean for Academic and Student Affairs, and off into separate groups to discuss included the role of virtual office hours in Dr. David Nash, the Dean of the College individual approaches to providing online environments, options for enhancing of Population Health. After updates from feedback to students and implementing online lectures, and the use of grading Dean Nash on strategic planning and workable methods for any challenges rubrics online. Importantly, these CATS opportunities afforded by the merger with they come across in their classes. dinners also provide an opportunity for Philadelphia University, Dr. Leon highlighted Dr. Oglesby concluded the evening online instructors to share experiences and successes program graduates have had with explaining plans for redevelopment of learn what is working for other instructors their Capstone Projects, and he explored certain courses to accommodate students while coming together in person with with the group the various ways online wishing to move more quickly through administrators to discuss College news. instructors can provide the ‘rich feedback’ the online curriculum. to students that supports that success. At the latest February gathering, the faculty All in all, these sessions end up being were joined by Dr. Juan Leon, Director of The faculty in the room, as well as those professionally enriching for the faculty and Online Learning, Dr. Billy Oglesby, Associate participating via web conference, broke administration due to the exchange of ideas,

22 | POPULATION HEALTH MATTERS and the opportunity to have some social effectively utilize online educational Juan Leon, PhD engagement with each other outside of the technology across the College. Director, Online Learning semester-to-semester responsibilities. Jefferson College of Population Health [email protected] In addition, the future of CATS will be Lisa Chosed, MA an attempt to bring together all on- Assistant Director, Online Learning site faculty with the instructors who Jefferson College of Population Health teach primarily online. The goal will be [email protected] to encourage all instructors to more

Investiture of Dr. Trina Thompson as the first Victor Heiser, MD Professor of Population Health Excerpt from Executive Vice President and Chief Development Officer, Elizabeth Dale’s speech.

We are truly honored to welcome a great American, a narrator, and historian Mr. David Mc Cullough. Mr. McCullough has been called America’s greatest storyteller, which is really just a way of saying he’s a national treasure. I’m a huge fan! My favorite quote – a timeless bit of McCullough wisdom – “history is a guide to navigation in perilous times.”

Left to right. Stephen Klasko, MD, MBA; David Nash, MD, MBA, Mark Tykosinski, MD, Trina Thompson, DrMPH, BSN; Susan Mann; and Elizabeth Dale

Mr. David Mc Cullough class of 1897. Dr. Heiser went on to circle behalf of Jefferson, I extend our deepest the earth 17 times between 1903 and appreciation to the 1889 Foundation for their The Johnstown Flood, which was 1934 on public-health missions to combat gift of $7.5M to improve lives in Johnstown. Mr. McCullough’s first book, is among malaria in the Philipines, hookwork in my favorites. What’s fascinating is, the India, and disease in Egypt and China. That gift, like every gift to Jefferson, was disaster of the Johnstown Flood of 1889 born out of a bold vision to improve lives. that was recounted in his great book is Dr. Heiser’s name is now associated with That vision owes a great deal to Dr. David now bound, in perpetuity to Jefferson. Dr. Trina Thompson who is now invested Nash who founded the first College of as the first Heiser Professor, a professorship Population Health here at Jefferson 10 Perhaps the most famous survivor of the endowed by the 1889 Foundation. years ago. flood was Dr. Victor Heiser, Jefferson Congratulations to Dr. Thompson and

Spring 2018 | 23 Population Health Matters Jefferson College of Population Health Thomas Jefferson University 901 Walnut Street, 10th Floor Philadelphia, PA 19107

EDITORIAL BOARD Editor Rosemary Frasso, PhD, MSc, CPH Colleen Payton, MPH, CHES Alexis Skoufalos, EdD Program Director, Public Health Clinical Research Coordinator II Associate Dean for David B. Nash, MD, MBA Associate Professor Department of Family and Strategic Development Dean Jefferson College of Population Health Community Medicine Executive Director Jefferson College of Population Health Thomas Jefferson University Center for Population Health Innovation Max Koppel, MD, MBA, MPH Jefferson College of Population Health Managing Editor Clinical Associate Professor of Urology Etienne Phipps, PhD Department of Urology Director Rachel Sorokin, MD Emily J. Frelick, MS Thomas Jefferson University Einstein Center for Urban Health Chief Patient Safety and Quality Officer Senior Project Director Policy and Research Thomas Jefferson University Hospital Jefferson College of Population Health Juan Leon, PhD Einstein Healthcare Network Director of Online Learning Steven Spencer, MD, MPH, FACP Editorial Board Jefferson College of Population Health Shoshana Sicks, EdM Director of Population Health Administrative Director Abington Health Physicians Lauren Collins, MD Mary Lou Manning, PhD, CRNP, Jefferson Center for InterProfessional Jefferson Health Associate Director, Jefferson Center CIC, FAAN Education for InterProfessional Education Associate Professor Richard G. Stefanacci, DO, MGH, Director, Jefferson Health Mentors Program Jefferson College of Nursing Randa Sifri, MD MBA, AGSF, CMD Professor Lecturer, Jefferson College of Assistant Professor Ronald E. Myers, PhD, DSW Division of Geriatric Medicine Director of Research Population Health Professor Department of Family and Director, Research Fellowship Chief Medical Officer, The Access Group Director of the Division of Population Science Community Medicine Co-Director, Postdoctoral Fellowship Department of Medical Oncology Sidney Kimmel Medical College Family and Community Medicine Sidney Kimmel Medical College Thomas Jefferson University Michael Dryer, DrPH, PA-C Billy Oglesby, PhD, MSPH, FACHE Executive Dean for College of Science, Associate Dean for Academic and Health and the Liberal Arts Student Affairs Thomas Jefferson University, Jefferson College of Population Health East Falls Campus 901 Walnut Street, 10th Flr. Tel: 215-955-6969 Fax: 215-923-7583 Philadelphia, PA 19107 Jefferson.edu/PopulationHealth Population Health Matters is a quarterly publication of the Jefferson College of Population Health.