2. 2 ACHE – Equity of Care Steven R. Carson, RN, BSN, MHA Vice President, Clinical Integration Chief of Operations May 6, 2015

3. Temple University Health System Organizations: Temple University Hospital Jeanes Hospital Fox Chase Cancer Center Episcopal Hospital Temple Physicians Inc. Temple University Physicians Key Facts: Serves one of the nation’s most economically challenged urban areas Highest volume of patients covered by Medicaid in Pennsylvania among full- service hospitals Major delivery sites are located in Urban Renewal Area Federally designated Primary Care Professional Shortage Area

4. Our Community Our primary population service area includes more than 750,000 residents 62 % have < a high school education compared to 44% nationally 64 % have a household income of under $ 30,000 49 % of the community is African American 20 % are Hispanic Emerging ethnicity Asian cultures – Vietnamese – Korean – Cambodian

5. Potentially Preventable Admission Low income to High Income

6. Potentially Preventable Admission Ethnicity

7. Health Burden Most Prevalent Chronic Conditions – Heart Disease / Hypertension – Asthma / COPD – Diabetes – Renal Disease – Obesity – Mental Health depression psychotic disorders Substance Abuse Perinatal Issues – Late or no Prenatal care – Pre-pregnancy Obesity Major Cause of Death – Trauma and Trauma Related Conditions – Cardiovascular Disease – Renal Disease – Chronic Dialysis Social Issues – Medical literacy – Overall literacy – Substance Abuse – Violence

8. Population Health Model Determinants of Health Health Outcomes Health Factors – if improved have a significant impact on making communities healthier 8 Robert Wood Johnson 2015 County Health Rankings

9. Utilizing Community Health Workers to Improve Patient Engagement TUH - Demographics Edit for Title Compliance with physician office visits improved Hospital admission & readmission rates have improved Patients more engaged in their care 714 bed non-profit safety net hospital Greatest volume & highest percentage of Medicaid patients among PA full service hospitals Located in economically challenged area of Philadelphia 37% of area families with children live below federal poverty level Population is culturally diverse 83% of population is minority 85% of population insured by government programs 31% Medicare 53% Medicaid Of adults ages 18-64, 24.7% do not have health insurance Patients have multiple chronic medical conditions Frequent and unnecessary hospital admissions and readmissions. 1 Specially trained professionals Members of the community Have similar life experiences to patient population Focus on non-medical patient needs in coordination with all members of the health care team. Average case load is 25 patients Multidisciplinary team, led by Nurse Manager Focus: CHF discharge populations Medical Record Case Review Reasons for readmission determine level of intervention required from team. Introduce skills of non-medical Community Health Worker Assessment completed by CHW at bedside CHW telephonically contacts patient and in some cases meets patient in their home after discharge CHW follows patient to assist with non-medical social barriers to include housing, utilities, transportation, insurance, medications, and home based services. CHW schedules, attends, and is patient advocate at Primary Care and Specialty Care appointments. Collaboration with Nurse Navigator prior to discharge Assess patient health literacy and their capacity for managing disease. Readmission Rates Under nursing supervision the program showed there was an improvement in transitions of care. CHWs facilitate communication amongst multiple care providers. Future plans include evaluating CHW use in emergency room and high-risk pregnancy. Opportunity to apply across multiple care settings: SNF, Home Care, Primary Care, Medical Home. Community Health Worker TUH - Approach Improvement in Office Visits References Evaluation 1. Temple University Health System Community Health Needs Assessment, April 2013. Public Health Management Corporation. All patients receive a follow up call from CHW after discharge from hospital Patients that received call back had lower than average 7 and 30-day readmission rates Improved scheduling of follow up appointments prior to discharge

10. https://www.dropbox.com/s/u3e0y61qy1btiy 9/templechw-v4-nostill-v3.wmv?dl=0 https://www.dropbox.com/s/u3e0y61qy1btiy 9/templechw-v4-nostill-v3.wmv?dl=0

12. Programs Addressing Community Need Established a Linguistic and Cultural services department. – Cultural Sensitivity – Cultural Competency Violence reduction – Cradle to Grave ( At Risk Youth) – Cease Fire Healthy Philadelphia – CDC Diabetes Education – Improvement of access to healthy food

14. HLNDV Panel Discussion Rosa M. Colon-Kolacko, Ph.D., MBA, CDM Senior VP Christiana Care Learning Institute and Chief Diversity Officer

15. Panel Discussion Make the connection with learning, diversity and inclusion with health disparities. Provide examples on ways that the Learning Institute Center for Diversity, Inclusion, Cultural Competency Equity have implemented Language Services, education and build partnerships to build understanding of healthcare disparities and provide equitable care. Share strategies to leverage bilingual CCHS Staff as medical interpreters to improves quality, availability and safety of care for LEP (limited English proficiency) patients.

16. Center for Diversity, Cultural Competency and Communications Center for Educator Development Research Center for Transforming Leadership Center for Innovation, Instructional Design and Technology Center for Patient Education Center for Simulation Education Center for Employee and Career Development Center for Diversity, Inclusion, Cultural Competency & Equity  To implement strategies to address the cultural and language needs of our colleagues and patients.  To implement programs and services to reduce the healthcare disparities in our community.  To grow DE diverse talent to grow the availability of healthcare professionals and leaders  To implement education programs and tools to equip our employees and partners with skills to promote a culture of inclusion, and have the capability to provide culturally competent care to the diverse patient population that we serve. Learning Institute

17. Our Strategy.. Connecting with Christiana Care Way

18. Reducing Health Disparities and Improving Population Health Management through the Implementation of Cultural Competency Cultural competency is the ongoing capacity of healthcare systems, organizations and professionals to provide for diverse patient populations high quality care that is safe, patient and family centered, evidence based and equitable.