St. Luke’s Miners Hospital, USA Expanding Flinders to a US Rural Health Population-a Preliminary Report and Plans for Progress September 25, 2015 By Mark Kender, M.D., CMO, St. Luke’s Miners Hospital, USA

Initial Steps… In 2011, I began my clinical career and St. Luke’s University Health Network I continued to perform Flinders on my patients in my clinical Internal Medicine Practice in Allentown, Pennsylvania I started a Hospital Medicine program at the St. Luke’s Miners Hospital Campus in 2011 and became the Chief Medical Officer and Academic Officer thereafter- SLM is located in the mountainous Pennsylvania Anthracite Coal Regions 35 miles north of my office; this is a Rural Health area

Early Development… I developed an outline with Bill Moyer (President, St. Luke’s Miners Campus), JP Orlando (Vice President for Academic Affairs, SLUHN), Micah Gursky (Chief Administrator, St. Luke’s Miners Rural Health Clinics) and Dr. Gregory Dobosh (Medical Director, St. Luke’s Miners Rural Health Clinics) to implement Flinders at our 3 SLMRHC’s as well as to conduct clinical research in order to measure progress and spread Flinders to other clinical entities

2014 July: Clinical Implementation, Funding, Measurements, Training and Research plans were discussed August 6: kick-off meeting by Skype between Bill Moyer, Dr. Battersby and me August 21: Flinders Miners kick-off meeting among our project leaders September and October: I became Recertified as Master Trainer with the help of Vee Pols; a study design and IRB approval followed. General clinical implementation was also defined. October/November: training for ALL Rural Health Workers, Administrators and SLM Officers involved in the Flinders Miners Program

2014-2015 November 2014: Care Plan submission period and clinical initiation at Rural Health Clinics January 1-December 31, 2015- Controlled Trial for Flinders Miners Rural Health Initiative April 23 and 24, 2015: Dr. Battersby’s visited LVHN and SLUHN, which included his visit and round table discussion with the Miners Rural Health Staff at SLM Hospital June 2015: training for new Rural Health staff as well as for the SLUHN Warren Campus FP Residency Faculty Leaders and Residents and the Bethlehem Campus IM Residency Faculty Leaders and Residents occurred at the Temple- St. Luke’s Medical School in Bethlehem, Pennsylvania

Flinders Study Goals: Target population Improve HgA1C levels Improve patient quality of life and provider/staff satisfaction Reduce ED utilization / Increase RHC visits Target population 93 patients 17 currently had a Flinders interview 3-year study: 2014 - 2016 Inclusionary/exclusionary criteria Named a Rural Health Center Provider as PCP Patient for over 2 years Excludes minors (<18 years old) A1cs greater than 9

Preliminary Findings Comparing Flinders Patients from Year-to-Year   Jan 1 – Dec 31, 2014 (12 mon) Jan 1 – Aug 30, 2015 (8 mon)  Measures Population Mean (# patients) A1cs 9.7 (17) 9.4 (17) Population Mean (# tests) BMI 42 (122) 41 (83) WGT 248 (124) 243 (84) Diastolic 81 (124) 78 (85) Respiration 18 (110) 18 (72) Systolic 131 (124) 132 (85)

Note: Similar Utilization to 2014 (Jan-Dec) Preliminary Findings Flinders Patient Visits by Utilization (January 1, 2015 – August 30, 2015) Note: Similar Utilization to 2014 (Jan-Dec)

Current and Future Activity 1.Follow up on Care Plans with all participants is ongoing 2.Data retrieval and analysis of study results has begun 3.Data mining for overall usage of Flinders is set up and data retrieval is pending 4.Feasibility for integration of FlinCare into EMR is an ongoing discussion 5. I received a recent invitation to incorporate Flinders into SLUHN Innovation Committee as part of a behavioral health initiative for primary care practices in our network of 6 hospital systems 6. Publication of the study and the presentation of our program by Micah Gursky at National Rural Health forums are goals for 2016 7. Collaboration with other US based Flinders sites is an area of increasing interest. 8. My personal goal is to visit Dr. Battersby and Flinders University!

Thank you! My contact information: Mark Kender, M.D., F.A.C.P. 3050 Hamilton Blvd, Suite 110 Allentown, PA 18103 Phone: (484)223-3300 Email: mark.kender@sluhn.org