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Planned Parenthood: LGBTQ Healthcare in Southern New England
Christina Bastida; Rachel Clare; Erin McConocha; Rachel Perler; Matthew Wilcox; Lauren Rosato , (Preceptor); Brian Forsyth , (Faculty Advisor); Debbie Humphries , (Faculty Advisor); and Elina Kurkurina , (TA)
The LGBTQ community experiences health disparities related to access to care, utilization of care, experiences of discrimination, perceptions of injustice, healthcare neglect, and inappropriate care. In addition, statistics often cite higher rates of some health outcomes, such as higher rates of mental illness and substance use in the LGBTQ community at large and HIV/AIDS for transgender women and gay and queer men (Alvy et al., 2011; Cochran et al., 2003; Coulter et al., 2015). These disparities in health and healthcare stand as an emergency beacon to both community members and organizations aimed to serve them. Organizations throughout Connecticut and Rhode Island, such as AIDS Project New Haven, True Colors in Hartford, Triangle Community Center in Norwalk, and SAGE in Providence advocate and work toward the better health of these organizations. But the question of what healthcare needs and desires among LGBTQ community members are not being met by local organizations remains uncertain. This report highlights health disparities and needs among the LGBTQ community using both previous research and the voices of community members. Through highlighting the health care experiences of community members, we illuminate some key factors that influence the health outcomes and thoughts around healthcare within the LGBTQ community.
Several of the recommendations and thoughts regarding the expansion and changes to PPSNE are simple, yet poignant fixes to strengthen the comfort and confidence levels of PPSNE staff and providers into the highly comfortable strata found in the survey. This cyclical relationship between providers and patients offers a new and expansive market and community access to Planned Parenthood, with another, often expansive healthcare organization to provide care to community members. Other Planned Parenthood locations throughout the United States offer services and amplify access through specific marketing campaigns to LGBTQ community members. Utilizing these models and heeding the suggestions of community members can offer potential success to both parties, as well as potentially working toward intangible goals, like reducing stigma, increasing awareness, and spreading positive health outcomes throughout the LGBTQ community and the general community. We encourage Planned Parenthood of Southern New England to consider these these steps, and believe that doing so will improve the health status of many LGBTQ community members by dramatically increasing both accessibility and demand for high quality clinical services at PPSNE.
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Naloxone Training and Distribution Evaluation: AIDS CT
Xiang Cai; Alice Conant; Sheridan Finnie; Emmanuel Gaeta; Sara Kim; Katherine Rich; Julia Telfer , (Preceptor); Shawn Lang , (Preceptor); Lauretta Grau , (Faculty Advisor); Debbie Humphries , (Faculty Advisor); and Monica Guo , (TA)
This project set out to evaluate AIDS Connecticut’s current naloxone training and distribution program. The project was executed through a partnership between the AIDS CT organization, and the Yale School of Public Health. The evaluation focused on the training effectiveness, and reach of the naloxone distribution services. Both quantitative and qualitative methods were used to best serve the needs of the AIDS CT organization. Quantitative data was divided into four different categories: opioid-related accidental deaths in CT, reversal report data, syringe service program (SSP) van client’s needs and satisfaction survey, and geographic information system (GIS). For the qualitative portion of the evaluation semi-structured qualitative interviews were conducted with AIDS CT staff. These interviews were completed to evaluate whether the goals of the training and distribution program were being met. Qualitative interviews were also conducted with clients of the AIDS CT needle-exchange van. These interviews were semistructured, and they aimed to evaluate the current Naloxone training program.
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Common Ground: A Place to Grow
Adriana Collings; Camille Fonseca; Grace Sun; Cecilia Wang; Sarah Elizabeth Weingarten; Joel Tolman , (Preceptor); Alycia Santilli , (Preceptor); Kathleen O’Connor Duffany , (Preceptor); Debbie Humphries , (Faculty Advisor); and Nicole Collins , (TA)
Common Ground (CG) High School is a public charter school in New Haven, CT with approximately 200 students. CG’s mission is to cultivate habits of healthy living and sustainable environmental practices within its community. The school maintains an urban farm that provides food for students, staff, and approximately 2,500 residents of low-income neighborhoods in the area. The current literature suggests that CG’s programming should have positive health outcomes for its students and their families. CG has data on these outcomes via an online survey distributed to students, but does not yet have the internal capacity to analyze this data. This project aims to develop a protocol that enables CG faculty to autonomously analyze data and determine key impacts and outcomes. A current YSPH student-led team analyzed data from the student surveys in order to provide feedback on CG’s health-related programs and understand students’ health behaviors. Results from analysis were then used to conduct Community Data Discussion Groups to garner feedback from students and parents about how Common Ground has impacted their health and leadership behaviors. Detailed analysis protocols were created to enable CG faculty to independently analyze data. CG faculty was trained to implement protocol, which will allow for future independent data analysis. Overall, the results suggest that Common Ground’s programming and curriculum has had a positive impact on students’ health behaviors. We recommend that Common Ground expand its health-related and farm-based programming as much as possible, paying special attention to improving school lunch and allowing for physical activity. We encourage Common Ground to continue using a mixed methods approach to evaluate its programs, use the provided data analysis protocol, and work in conjunction with CARE and YSPH as they transition into independent research.
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Building Capacity for Volunteerism and Social Support at Leeway, Inc., a Skilled Nursing Facility
Jacqueline Goldbach; Yuki Hayashi; Sukriti Mohan; Carolina Valle; Nicole Collins; Heather Aaron , (Preceptor); and Lorrie Wesoly , (Preceptor)
Leeway Inc., a skilled nursing center in New Haven that cares for individuals with HIV/AIDS, was founded in 1995. Its continuum of care includes skilled nursing care, residential care, independent housing, and community case management. It provides a wide variety of care, which includes medical, behavioral, and nursing services, as well as mental health services and addiction treatment. One of Leeway’s priorities is to address the psychiatric disorders that many HIV/AIDS patients have, such as depression, anxiety, addiction, and substance-related disorders (Leeway, 2012). Among patients admitted to Leeway between October 1995 and December 1999, 25% had severe, long-term comorbid psychiatric disorders. Each year, the prevalence of psychiatric comorbid disorders has increased. Between 1996 and 1998, the prevalence of psychiatric comorbid disorders increased from 38% to 53%. This trend could be due to low discharge rates and longer lengths of stay among these individuals (Goulet, 2000). Leeway places a significant emphasis on creating a plan of care that addresses and manages these disorders (Leeway, 2012).
Some of the obstacles faced by the residents include social stigma, lack of engagement in their community, and lack of companionship. Moreover, the resident population is unique for several reasons, one of which is age. Leeway residents are younger than those at the typical nursing home facility, which introduces a variety of challenges to keep them engaged in activities. A current volunteer program has attempted to address many of these obstacles, but demonstrates the need for improvement. Residents reported differing levels of interest in both the frequency and structure of volunteer engagement. Staff also expressed the needs to balance the benefits and drawbacks of an individualized program, a “buddy” or more group activities facilitated by volunteers which would help increase companionship and engagement among residents. Residents also frequently expressed satisfaction with activities outside of the facility, which is one way in which the program could be expanded in the future.
Recommendations and Products: 1. Advertise the volunteer positions as “Community Programming Volunteers” to boost enrollment and encourage a sense of agency and investment, 2. Hire a volunteer coordinator to serve as a point of contact, summarize feedback for staff, lead new initiatives, and perform basic administrative tasks, 3. Divide the year into three terms, and hold one orientation session at the beginning of each term, 4. Replace the ad hoc system of volunteer applications, training, and feedback with concise online platforms that automatically feed into a central system of records, 5. Create a separate but converging program structure that allows for two screening and orientation processes for regular and sporadic volunteers, 6. Create a two-part schedule for volunteer sessions: a. Matching interested residents with regular volunteers based on interests. Residents and volunteer buddies will meet for a 10-20 minute check-in with the option of joining the group activities and b. Regular and sporadic volunteers engage in a group activity or game, 7. Implement a hybrid individualized-group volunteer program structure, 8. Provide volunteers with nametags, and 9. Connect with schools and colleges throughout New Haven to access new volunteer pools.
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From the Community to the Clinic: Building Community Health Worker-Inclusive Healthcare Teams
Medha Vyavahare; Nicole Hood; Lanxin Jiang; Daniel Chiu; Meredith Ferraro , (Preceptor); Debbie Humphries , (Faculty Advisor); and Nicole Collins , (TA)
Multidisciplinary clinical teams with strong community linkages can engage with patient needs and address the social determinants of health. Community Health Workers (CHWs) have emerged as one such embodiment of this cultural shift in improving delivery and coordination of care to reach patient communities. However, misunderstandings of CHWs’ contributions have limited their uptake into clinical teams.
In partnership with the Southwestern Area Health Education Center, this project investigated the context and perspectives of CHW engagement in Connecticut, focusing barriers and facilitators of CHW integration into clinical teams. Through experimentation, innovation, and mutual learning, integrated, CHW-inclusive healthcare teams can begin taking the necessary steps to bridge the divide between the community and the clinic. Commitment to service should be meaningfully considered in the CHW hiring process. Being altruistic, compassionate, nonjudgmental, and service-oriented are important attributes facilitating camaraderie and trust within healthcare teams, while also enhancing CHWs’ long-term commitments to organizations. Purposively seeking out these traits during the onboarding process can foster a team dynamic anchored by CHWs mutual commitment to serving and connecting with patients. Organizations should foster mutual understanding and respect for the varied roles CHWs play. Clearly defining roles and responsibilities and demonstrating the value that CHWs bring outside of the context of clinical care can improve collaboration, encourage skills-sharing, and promote an organizational climate of respect. Organizational decision-makers should increase the visibility of CHWs and include CHWs in conversations and meetings with other clinical team members where added value can be consistently demonstrated and where mutual learning and collaboration can meaningfully occur. Healthcare organizations should critically consider how to holistically support the CHW workforce. Organizational levers that promote retention, mutual learning, networking, and management of job stress amongst CHWs can improve their ability to function effectively and contribute to a diverse team culture. The fact that CHWs not only navigate the disparate worlds of the community and the clinic but also endure the stress of managing complex intra- and extra-organizational relationships should be recognized, valued, and appreciated by organizational leadership.
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Assessing an Asthma Care Intervention at Optimus Health Care
Mari Armstrong-Hough, Louis Gregory, Yang Zhang, Alix Pose, Janneane Gent, Debbie Humphries, and Colette Matysiak
In the summer of 2015, the East Main Street branch of Optimus Health Care planned, developed, and initiated a quality improvement interven-tion for pediatric asthma care. The intervention consisted of a provider-designed EMR template to enhance asthma clinic visits, a new on-site spi-rometer, and new tools for patient and staff education. The objective was to support Optimus providers in their efforts to provide high quality, guideline-compliant care to their patients and thereby improve patient outcomes. A chart audit of 27 patient records conducted six months after the beginning of the project found high rates of compliance with two im-portant measures of quality asthma care: spirometer use (85% of charts) and documentation of an asthma action plan (96% of charts.)
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Farmington Valley Health District Community Health Assessment
Megan Carroll, Heather Ferguson, Monica Guo, Colette Matysiak, Debbie Humphries, and Jennifer Kertanis
Project used quantitative and qualitative data to describe the public health within the Farmington Valley Health District and identify community needs.
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Homelessness, Rent Stress, and Available Housing in New Haven, CT
Chasmine Flax, Michael Perrin, Colette Matysiak, Debbie Humphries, Bonita Grubbs, and Merryl Easton
Project was to assess the availability of affordable housing in New Haven and understand the health effects of rent stress and homelessness.
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Screening for Elder Abuse: Exploring the Acceptability of the Elder Abuse Suspicion Index to Law Enforcement Officers for Field Use
Elina Kurkurina, Sonam D. Lama, Brittany C. L. Lange, Erin Burk-Leaver, Joan Monin, and Debbie Humphries
National surveys conducted on community-dwelling older adults have reported the overall prevalence of elder abuse to be approximately 10% in the US.1 For every elder abuse case known to programs and agencies, an estimated 24 cases go unreported.2 Since the criminalization of elder abuse in the 1990's, law enforcement officers (LEOs) are in a unique position to detect and respond to elder abuse cases. Despite increased interaction between LEOs and elderly persons in the community, LEOs report significant knowledge gaps in responding to elder abuse cases.3,4 Currently, there are no known instruments used by LEOs to assess for risk of elder abuse. The Elder Abuse Suspicion Index (EASI),5 a screening tool previously validated for use by physicians in clinical settings, shows potential for use by officers. This report presents findings from a survey and interviews with LEOs and community advocates in the state of Connecticut exploring acceptability of the EASI as a law enforcement screening tool.
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Identifying the Community Health Needs in the Yale New Haven Health System: Key Priorities, Barriers to Health, and Recommendations
Julia Anderson, Kathy Doan, Alexandra Hua, Maria Ma, Ema Tiburcio, Augusta Mueller, Carolyn Salsgiver, Kathy Carley-Spanier, Sarah Ali, Danya Keene, and Debbie Humphries
Bridgeport Hospital, Greenwich Hospital, and Yale-New Haven Hospital are nonprofit hospitals that are part of the Yale New Haven Health System (YNHHS). Table 1 outlines the towns covered by each hospital’s service delivery network.
In order for nonprofit hospitals to remain tax-exempt, they must comply with federal requirements to provide “community benefits,” as outlined in Section 9007 of the Affordable Care Act (ACA). One provision outlined in the ACA requires nonprofit hospitals to “give increased attention to working with others to determine community health needs and take action to meet those needs”. This requirement is fulfilled in part by the triennial completion of a Community Health Needs Assessment (CHNA) with community partners.
This report presents findings from the first stage of the second round of the community health improvement coalitions, which include all three YNHHS hospitals, CHNA: the key informant interviews. These interviews incorporate input from persons representing the broad community served by the hospitals, focusing on a range of public health issues relevant to the community at large. Input was gathered through an online survey of key informant perceptions surrounding community health.
Key informants comprised two groups: (1) Health and Human Service representatives and (2) Government and Community Leader representatives. This report outlines the top health issues and barriers to good health in the communities served as identified and prioritized by key informants, as well as suggestions they have to address these concerns.
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Perceptions, Attitudes, and Behaviors of Active Transportation Among Key Stakeholders in Norwalk, CT
Courtney Choy, Luis E. Maldonado, Wilhelmenia Ross, Rui Ye, Alycia Santilli, Jennifer Grasso, Timothy Callahan, Theresa Argondezzi, Kaitlin Latham, and Debbie Humphries
To characterize the perceptions, attitudes, and behaviors surrounding active transportation among key stakeholders in Norwalk. Specifically, the project aimed to identify: 1. Social, physical, and financial barriers to walking and biking 2. Perceived importance and utility of bike lanes and sidewalks 3. Priority improvements to make the city more conducive to active transportation 4. The most important areas on which to educate the general public about active transportation
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Recommendations for Substance Abuse Safety and Engagement at New London Homeless Hospitality Center
Gabrielle Daniels, Fkadu Gelaw, Brittany C. L. Lange, Colette Matysiak, Anji Yi, Catherine Zall, Jennifer Grasso, David Fiellin, and Debbie Humphries
Examines substance abuse at the New London Homeless Hospitality Center (NLHHC) and makes recommendations for safety and engagement for the Center regarding substance abuse.
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Evaluating the Impact of Common Ground High School, Urban Farm, and Environmental Education Center on Student Health Behaviors and Outcomes
Cara Donovan, Joanne Fernandez, Shaylen Foley, Melody Kingsley, Morgan Pratte, Mengxin Christie Zhu, Joel Tolman, Sarah Ali, Debbie Humphries, and Jeannette Ickovics
Discusses how the curriculum and other factors of Common Ground High School affect the health behaviors of students attending the high school.
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Optimus Health Care: Weight Gain Patterns and Nutritional Services Among Underserved Pregnant Women
Senate Amusu, Stephanie Boegeman, Yosuke Kita, and Ugochi Ukegbu
Abstract
Background
Optimus, a Joint Commission accredited and a federally qualified healthcare center (FQHC), serves over 1200 pregnant women a year. Excessive Gestational Weight Gain (GWG) can lead to maternal health complications, including gestational diabetes, preeclampsia and increased risk for C-section. This study seeks to assess the prevalence and magnitude of GWG among Optimus clients, evaluate nutrition services available for pregnant women at Optimus, and identify approaches to enhancing pregnancy outcomes through optimum GWG that can be made available to Optimus clients.
Methods
Data on weight gain patterns, socio- demographic information, and health history for all pregnant women with clinic visits between 01/01/2013 and 12/31/2013 were extracted from the Optimus’ electronic medical records system. Trends in weight gain during each trimester were compared and analyzed by age, education, race/ethnicity, country of origin and language. Gaps in available nutrition services for pregnant women were determined through staff interviews and surveys.
Results
Overall, the weight trends of the clients who used Optimus’ prenatal services in 2013 increased across the trimesters. There were no significant differences in weight gain between trimesters by all variables evaluated (age, education, race/ethnicity, country of origin and language). Teenage mothers had the lowest weights during each trimester of pregnancy while mothers with advanced maternal age had the highest average weights per trimester. On average, Black women had the highest weight from the first trimester and continued to do so throughout pregnancy. Women with only elementary or middle school education gained on average of 9.19lbs over the course of the three trimesters. This value is lower than the minimum that is recommended by the Institute of Medicine for any women in spite of their 3 BMI (11lbs). Results from the survey showed that Optimus’ staff consider cost, time and emotional barriers to be potential barriers to caring for pregnant women at Optimus.
Conclusions
Special educational nutrition services should be offered to women who represent the highest risk groups at Optimus (teenage mothers, mothers of advance maternal age, mothers with only middle school education or lower and also African American women). Optimus’ staff should account for cost, time and emotional barriers when designing nutritional and other support services for Optimus’ clients.
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Examining the Effectiveness of Medicaid Family Planning Expansion in Connecticut
Meghan Angley, Moiuri Siddique, and Kimberly Vasquez
Abstract
Introduction
Medicaid family planning expansion programs have been shown to improve reproductive health outcomes and reduce unintended pregnancies. Connecticut implemented Medicaid Family Planning Expansion in March of 2012 with the intention of expanding access to family planning services and improving reproductive health outcomes. The aims of this study are to evaluate the effectiveness of the Medicaid Family Planning Expansion in reducing unintended pregnancies, estimate the funds saved to the state of Connecticut due to the expansion and to demonstrate that women will choose highly effective methods of contraception when cost is not a barrier.
Methods
Mathematical models developed by the Guttmacher Institute were adapted to estimate the number of pregnancies averted in the state based on patterns of contraceptive use in participants after enrolling in the program and contraceptive failure rates. The number of pregnancies averted was used to determine the state funds saved by reducing pregnancies that would have resulted in births covered by Medicaid. Multivariate logistic regression was used to examine predictors of using a highly effective method of contraception.
Results
Complete data were available for 1,153 women enrolled in the Medicaid Family Planning Expansion program. Our calculations indicated that an estimated 84 unintended pregnancies were averted in this group between 2011 and 2013, with an estimated 31.2 unintended births averted and $324,379 saved to the state of Connecticut. Women enrolled in the expansion program were more likely to choose a highly effective method of contraception than women not enrolled (OR: 7.16, 95% CI: 5.76, 8.90).
Discussion
Our results support the conclusion that when the barrier of cost is removed, women are more likely to choose highly effective methods of contraception, helping them to avoid unintended pregnancies. Our results suggest the need for continued funding of Medicaid Family Planning Expansion in Connecticut, and further research on barriers to enrollment in the program.
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Assessing the Impact of a Community-Based Nutrition Education Program in the Haven Free Clinic
Chin-Hee Chung, Aliyar Fouladkhah, Geliang Gan, Tracy George, Renu Nadkarni, and Mary D'Alimonte
Abstract
Background
The Haven clinic is a volunteer and student-run clinic serving low-income residents of the Fair Haven community in New Haven, CT. The Advancing Nutrition and Dietary Outcomes (ANDO) program is a one-on-one counseling program for patients at risk for chronic disease. This project aimed to evaluate the ANDO program for efficacy and patient satisfaction.
Methods
Two main data collection methods were used to assess the efficacy and patient satisfaction with ANDO, resulting in a mixed methods analysis. A baseline survey instrument measured patient skills, knowledge and attitudes about healthy eating and physical activity. Key informant interviews gauged these same topics as well as satisfaction with the program.
Results
Survey results revealed a strongly positive attitude towards improving diet and increasing physical activity as ways of overcoming chronic disease. Surveys also illustrated the lack of knowledge and skills of patients to make those lifestyle changes on their own. Interviews with patients who have gone through at least one module of ANDO revealed strong satisfaction with the program, though some suggestions for improvement were made.
Conclusions
The ANDO program is a strong patient-focused program that reaches a portion of the target population in the Fair Haven community. Patients who enroll are satisfied with the program and offer suggestions for continued strength of the program including group sessions and consistent counselors. Evaluation team recommendations include producing a thorough program manual for more program consistency, administering pre- and post-program surveys with future patients, and conducting an evaluability assessment prior to future evaluation endeavors.
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Recommended Sustainable Payment Methods for Community Health Workers that Align with PPACA SIM-CT
Jennifer Grasso, Rumana Rabbani, Rongrong Wang, and Ahsan Malik
Abstract
The role of community health workers (CHWs) is a growing profession throughout the United States. These individuals have been a valuable supplement to healthcare systems because their work has reduced disparities in health access and contain costs, especially in hard-to-reach areas and underserved populations. However, issues of legitimacy, centralization, and sustainability challenge the effectiveness of such programs. In Connecticut especially, the CHW program lacks clarity and perhaps most importantly a sustainable means of financially supporting CHWs. This lack of steady funding leads to high attrition rates and missed opportunities for full-time employment of passionate individuals who can make a positive difference in communities where they live. Investigation into the potential payment methods for CHWs is critical if Connecticut is to have a long-term sustainable community-based program. Through a partnership with Southwestern Area Health Education Center (SW AHEC), Inc., our team of graduate and professional students from the Yale School of Public Health collected data from public and private payers regarding identification of sustainable payment methods for CHWs in the state. Interviews were conducted with key informants from various entities including Medicaid, State Innovation Model Connecticut (SIM-CT), private state payers, and private national payers. Our team hypothesized that payers would express interest in incorporating CHWs into their payment plans and would provide information regarding action steps toward making this change. The project deliverable was an analysis based on data collected from secondary sources and feedback from payer interviewees regarding how CHWs can become fully involved into delivering healthcare to underserved populations within healthcare reform programs. This analysis took into consideration new programs being recommended by the Patient Protection and Affordable Care Act (PPACA) and SIM-CT that will be presented to healthcare stakeholders, including SW AHEC, in order to advance the legitimacy and sustainability of the CHW program in Connecticut. Our findings show that several payers are interested in providing sustainable funding for CHWs through their plans but there still exist several barriers to make this advancement a reality. Future investigation is necessary to determine specific steps that ought to be taken to include CHWs in healthcare teams under the guidelines of PPACA. In addition, feedback from providers, who work directly with CHWs and other auxiliary health promoters should be gathered and analyzed.
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Building a Case for Community Respite: A New London Homeless Hospitality Center Project
Anandi van Diepen-Hedayat, Doug Keene, Tara Baysol, and Vamshidher Gankindi
Abstract
Background
Homelessness is a widespread problem, particularly of urban environments, and has been growing over the last two decades nationally. It is estimated that between 2.5 to 3.5 million people, including 1.35 million children, are homeless in the United States in a given year and the likelihood of becoming homeless is 7.5% over an individual's lifetime. Much of the homeless population reports physical health, mental health, alcohol and substance abuse, and social problems. New London Homeless Hospitality Center (NLHHC) has recently opened a respite care facility to help coordinate care and provide basic medical attention. This report will examine the premise and progress of this effort.
Methods
A literature review was developed to provide the national and local facts and trends on homelessness and respite care. Several key informant interviews were conducted to provide qualitative data on program specific respite services in the New London community. Additionally, a model for cost-effectiveness was proposed, based upon the unit-costing approach for health care.
Results
The median length of stay at the respite was found to be 10 days. The unit-costing is based on inputs from the interviews and existing respite records. When data were missing, assumptions were made to estimate the unit costs for each distinct output recognized. Such assumptions are disclosed herein. Semi-structured key informant interviews with guests revealed that the respite program is their only and last opportunity for shelter and recuperation in times of injury and illness. Moreover, we found that the respite feature of NLHHC's services is in general satisfactory to them in fulfilling their human service needs, although the shelter's facilitation of interaction between guests and social service agencies could be improved to assure the continuum of care following respite stay. Interviews with Lawrence and Memorial (L&M) Hospital and NLHHC staff demonstrated accord that the respite program is effective and serves a vital need in the community, although communication and coordination between NLHHC and L&M could be improved, especially apropos of enhancing homelessness detection (and thus respite guest referral) via the hospital's intake process.
Conclusions
The NLHHC respite center is new, but has already demonstrated positive impact. Respite guests and staff give anecdotal evidence that this is a needed community resource. The humanitarian and social benefit is substantial. Quantitative evaluation has not yet been applied, but in other locales respite care has been successful at reducing costs. We recommend continued research and monitoring of this innovative program for fiscal effectiveness and excellence in guest services.
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Improving Patient Satisfaction: Assessment and evaluation of VNA Healthcare’s HHCAHPS performance (Visiting Nurse Association Healthcare Inc.)
Courtney Armstrong; Lauren Warren; Katherine Gendreau; David Muccino; Christine Anderson , (Preceptor); Ingrid Nembhard , (Faculty Advisor); Debbie Humphries , (Faculty Advisor); and Neel Iyer , (TA)
Background: Federal law mandates that Medicare-certified home healthcare agencies measure patient satisfaction using the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey. Results are publicly reported to allow prospective patients to make meaningful comparisons between home healthcare agencies and to provide incentives for home healthcare agencies to improve their services. Medicare payments are also tied to HHCAHPS survey results. VNA Health Care, Inc.(VNAHC) currently falls below their own preferred standards for two key measures of patient satisfaction from the HHCAHPS survey: 1.)"Overall Rating of Care"; 2.)"Likelihood of Recommending "the agency to family or friends.
Objectives: The objective of this project was to identify variables which may influence these two key measures of patient satisfaction, and in doing so, to identify areas of opportunity for VNAHC to improve patient satisfaction and their HHCAHPS survey scores.
Methods: Three analyses were under taken during this project including an initial data review, logistic regression analysis and qualitative analysis. For the initial data review, 19 HHCAHPS survey questions across five categories were analyzed. VNAHC's average scores in each category were compared to Connecticut and national averages in both 2011 and 2012. For the logistic regression analysis, HHCAHPS survey data from 200 randomly selected VNAHC patients were analyzed using a bivariate logistic regression model. A chi-square test was used to assess associations between specific HHCAHPS variables and VNAHC’s "Overall Rating of Care". For the qualitative analysis, areas for improvement identified through the initial data review were used to construct a VNAHC employee questionnaire. Telephone interviews were conducted with 20 VNAHC employees to identify barriers to delivering quality patient care.
Results: The initial data review revealed that VNAHC's average scores in five categories increased between 2011 and 2012. In 2012, each of the five categories exceeded either the Connecticut or national average. The initial data review also identified several questions on which VNAHC has consistently scored lower over the last two years as well as several questions on which VNAHC has consistently scored higher. The regression analysis revealed that a variety of characteristics regarding the patient-provider relationship significantly affect the odds of patients rating VNAHC’s “Overall Rating of Care” at least 9 (out of 10). Finally, the qualitative analysis revealed opportunities for improving patient care in the following areas:1.) transfer of patient information from hospitals to VNAHC staff; 2.) transfer of patient information among VNAHC staff; 3.) communication with patients about medications and side effects.
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Providing Culturally Competent Care in the Face of Health Disparities: Assessment and Training Recommendations
Rosalyn Chan; Adam Eldahan; Mary D'Alimonte; Athena Samara; Sisi Wang; Alix Pose-Sussman , (Preceptor); Judith Lichtman , (Faculty Advisor); Debbie Humphries , (Faculty Advisor); and Margaret Lippit , (TA)
Background: Community health centers are a critical source of care for populations who disproportionally experience health disparities, including the uninsured and underinsured, racial and ethnic minorities, and patients with a preferred language other than English. Optimus Health Care (Optimus) is the second largest health center in Connecticut, with clinics located in Bridgeport and Stamford. Cultural competency, or a set of behaviors, attitudes, and policies that enable professionals to work effectively in cross-cultural situations holds immense potential for improving patient-physician communication and for providing effective service delivery. Objectives: This study sought to (1) better understand the barriers to care faced among patients at Optimus (2) assess staff knowledge, attitudes, and skills regarding cultural competency to make recommendations regarding future cultural competency staff trainings.
Methods: Electronic medical records (EMR) of patients seen at Optimus between January 2012 and March 2013 who had a diagnosis of hyperlipidemia, hypertension, and/or diabetes were analyzed to describe characteristics related to insurance status, race/ethnicity, primary language, age, gender, and clinic location. A web-based survey was developed based on the Cultural Competence Self-Assessment Questionnaire (CCSAQ) and distributed electronically to Optimus staff. Survey results were analyzed to compare responses according to staff position type and themes were examined among respondent assessments of the current cultural competency trainings provided by Optimus.
Results: The majority of patients included in the EMR analysis receive Medicare or Medicaid (75.8%) and the majority of chronic conditions among the sample were among racial and ethnic minorities. Interestingly, the majority of Optimus patients with a diagnosis of diabetes, hypertension and/or hyperlipidemia were between the ages of 30-54. Cultural Competency survey respondents noted difficulties in providing care due to language barriers, limited knowledge of intra-cultural group differences, and limited knowledge of how the causes of mental health are viewed by different cultural groups (Survey response rate: 22.4%). When asked to critique Optimus’ current cultural competency training, staff members reported efficiency as a strength and lack of applicability to a practical setting as a weakness, emphasizing the need for an interactive training.
Conclusions and Recommendations: In concordance with the national trend, the results of our study indicate that Optimus patients of racial and ethnic minorities are disproportionally affected by chronic illness. Several areas were identified that can be targeted for improving the cultural competency knowledge, practice and delivery, and training needs of Optimus staff. Future studies should assess patient perceptions of cultural competency to allow for further insight into this emerging area of research.
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Funding Community Health Workers: Best Practices and the Way Forward (Southwestern Area Health Education Center)
Charles Felix; Crystal Gibson; Jennifer Alvisurez; Jasmin Harpe; Ben Clopper; Meredith Ferraro , (Preceptor); Elaine O'Keefe , (Faculty Advisor); Rafael Perez-Escamilla , (Faculty Advisor); Debbie Humphries , (Faculty Advisor); and Amelia Reese Masterson , (TA)
Community health workers (CHWs), in their delivery of culturally competent care, play an integral role in promoting the health of communities. Many states have successfully utilized CHWs to reduce health disparities and promote health among low-income communities. Connecticut, in contrast, has a fragmented CHW workforce that is poorly understood and likely underutilized. Southwestern Area Health Education Center (SWAHEC), Inc. partnered with a student team at the Yale School of Public Health to identify initiatives and progress made by various states around the US related to funding mechanisms for CHW positions. Key informant interviews were conducted with representatives from Massachusetts, Vermont, Rhode Island, New York, California, and Texas to identify best practices and challenges faced when organizations and other agencies seek funds to pay CHWs. CHWs and those who work with CHWs are still facing poor recognition and lack of understanding, which contributes to difficulty in paying CHWs; as they are not a recognized professional workforce, it is challenging to identify funding sources for CHW positions. When funding for CHW positions is available, it is often in the form of short-term, soft money from sources such as grants. This theme appeared in the majority of interviews, suggesting that this remains a challenge in many, if not the majority, of states in the US. An important consequence for this type of funding is that positions for CHWs are often temporary and unstable, which affects their ability to work continuously within their communities. This is detrimental for both the CHWs and the communities they work in. Those working towards organizing CHWs in CT should ensure CHWs are the primary driving force behind CHW initiatives. In addition to educating health care professionals about the capacity of CHWs, establishment of formal training/certification programs may help facilitate the recognition and acceptance of CHWs as not only cost saving but integral to promoting the health of communities.
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Improving Efficiency of Care at Planned Parenthood Through Understanding Patient Demographics and Service Provision Patterns (Planned Parenthood of Southern New England)
Tammie Kwong; Erik Heinonen; Uzma Alam; Aditya Mahalingam-Dhingra; Monica Jordan; Susan Lane , (Preceptor); Trace Kershaw , (Faculty Advisor); and Debbie Humphries , (Faculty Advisor)
Background: Planned Parenthood is a national-level nonprofit that seeks to provide affordable, high-quality reproductive health care and sexual education for both men and women in America. Planned Parenthood of Southern New England (PPSNE) is interested in understanding how the Affordable Care Act (ACA), which heralds changes to the delivery and finance of care for lower-income and other underserved groups, will affect its service provision. PPSNE was interested in defining their typical user to gain a customer projection for 2014. This can help guide their marketing campaign and service expansion.
Methods: We conducted in-depth descriptive statistics of PPSNE's patient base and built multivariate models to gain further insights into patients' usage patterns at the aggregate and health center level.
Results: Across all health centers, diagnoses of abortion or STD were associated with notably reduced likelihood of repeat visits (OR 0.54 and 0.54, respectively). On the procedure side, receiving contraception or injected medication was associated with a notable increase (OR 1.89 and 1.59, respectively). All other age groups had much higher odds of repeat visits than 15-19-year-olds, reflecting a preponderance of one-off visits by that age group. Commercial or Medicaid insurance was also predictive, relative to self-pay, with Medicaid especially predicative of repeat visits.
Discussion: With the steep drop-off in repeat visits by 15- to 19-year olds, there could be large returns-on investment in efforts to build provider loyalty among patients younger than 15. Efforts to liaise with patients, be more responsive to young patients, and expand a range of primary care services could be part of an effective strategy to increase access to clients. Medicaid is the strongest predictor of repeat visits, suggesting that those with commercial insurance view PPSNE as an alternate to their regular provider. Furthermore, we identified a few examples of striking variation in care among different health centers in the region. We recommend that PPSNE follow up on these findings with their individual health centers to better understand this variability.
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Using Technology to Fight Elder Abuse: Exploring the Potential of Interactive Tools to Increase Health Care Provider Recognition and Reporting (Jewish Home for the Elderly)
Sophia Yuan Zhao; Hannah Mitchell; Lela Posey; Laura Snow , (Preceptor); Julia Portale , (Preceptor); Joan Monin , (Faculty Advisor); Debbie Humphries , (Faculty Advisor); and Neel Iyer , (TA)
Objectives: To understand the barriers to recognition and reporting of elder abuse and identify existing opportunities to implement technology to address these obstacles among stakeholders.
Background: The phenomenon of elder abuse, including mistreatment, neglect, and exploitation, is an underreported and growing problem. An estimated 11% of U.S. elders experience some form of abuse or neglect, yet only one out of every 14 cases of elder abuse is reported. With a Robert Wood Johnson Foundation grant and the support of other major funders, The Jewish Home (TJH) of Fairfield, Connecticut started the Center for Elder Abuse Prevention in 2008 to protect and advocate for vulnerable elders; however, since elders are often isolated, there is a need for scalable, cost-effective tools to increase awareness and enable rapid recognition and reporting of incidents of abuse.
Methods: We conducted individual key-informant interviews with experts on elder abuse and technology and social media to assess barriers to recognizing and reporting elder abuse, and determine the components of the best possible interactive tool to combat these barriers. We held focus groups with current medical, physician associate, and nursing students to assess clinical knowledge and identify opportunities for intervention during medical education.
Results & Conclusions: Based on our interviews and focus groups, we identified several social and institutional barriers to reporting and recognition of elder abuse. These included a lack of proper practitioner education, the limited time of all types of healthcare providers, blurred lines between symptoms of abuse versus symptoms of disease in a population with a tendency to have multiple chronic diseases, a fear of doing harm by reporting a case of abuse, and the possibility of not knowing what happens to a patient once the act of reporting occurs. However, our focus groups yielded information on the possible content and timing of affective intervention via the use of interactive tools. Future initiatives to use such means to help increase recognition and reporting of elder abuse should carefully consider these specific recommendations to ensure successful delivery and adoption.
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The Dietary Intake, Food Security, and Quality of Life of HIV-Positive Individuals Receiving Home Delivered Meals
Xindi Fang, Stephanie Shao, Mariam Girguis, Isy Tavarez, Chris Cole, and Debbie Humphries
Background: Nutritional status has become an increasingly important aspect of quality of life for people living with HIV/AIDS (PLWA). Ensuring the best possible treatment of HIV/AIDS additionally requires a nutritionally balanced diet to maintain a healthy body. AIDS Project New Haven (APNH) is an organization that provides access to a variety of comprehensive support services to those affected by HIV/AIDS. In order to address the nutritional shortcomings of homebound PLWAs, APNH provides home delivered meals through a program called Caring Cuisine.
Objective: To inform APNH of client characteristics of both Caring Cuisine and case management. Additionally, a comparison of dietary intake, food security, quality of life, mental health, and HIV risk behaviors between Caring Cuisine and case management clients is important. With these descriptive measures, we aimed to assess the influence of home delivered meals through Caring Cuisine on nutritional status, clinical indicators, and various quality of life measures.
Design: There were two parts to this evaluation that included a medical chart review (n=164) of all active APNH clients and client surveys (n=21) that were used to assess demographic information, dietary intake and diversity, food security, and quality of life/ mental health. Of those that completed the questionnaire,11 individuals were Caring Cuisine clients while 10 were case management clients. Scores were developed for survey measurements that were analyzed by student t-test and chi-squared test.
Results: Overall, Caring Cuisine clients were older, less able to work and live in smaller households. There was no significant difference in quality of life indicators, except for social functioning. Less social functioning was seen for Caring Cuisine clients (43.6±35.6) than for case management clients (78.0±22.0). Additionally, household size was significantly smaller in Caring Cuisine households (p-value = 0.0006). On average, Caring Cuisine clients had lower physical health(34.1±8.8) and mental health summary scores (43.5±9.8) compared with case management clients (41.5±8.7 and 49.2±9.3, respectively). Furthermore,Caring Cuisine clients reported higher food security (1.7±2.2) than case management clients (6.0±7.1) and consumed 3 more vegetables, fruits dairy, meat and grains. However, Caring Cuisine clients also consumed more saturated fats, cholesterol, and sodium.
Conclusion: As a preliminary analysis assessing subject characteristics of APNH clients enrolled in Caring Cuisine compared with general clients, we saw differences in absolute values of dietary, behavioral, and clinical outcomes. However, at this time, there is not a large enough client base to suggest that clients of APNH are significantly different from one another by Caring Cuisine enrollment status.Trends indicate that Caring Cuisine clients have on average less healthy eating habits, higher foods security, more risk behavior activities, and decreased quality of life indicators as compared with case management clients. Larger studies are needed to confirm and validate these findings.
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Surmounting Obstacles to Smoking Prevention: Barriers to Smoking Cessation Counseling at a Community-based Health Center in Connecticut
Tiffanie Jones, Frank Lin, Avantika Sara, and Alix Pose-Sussman
Background: Cigarette smoking is currently a leading cause of morbidity and mortality in the United States and throughout the world. Smoking cessation has emerged as an important preventative avenue for reducing the population-level attributable risk of cardiovascular, pulmonary, and oncologic disease due to cigarette smoking. Despite the health benefits of abstinence, durable smoking cessation is achieved by only a fraction of current smokers. As potential agents of change, healthcare providers possess the ability to promote smoking cessation through both counseling and pharmacotherapy. Consequently, the purpose of this investigation was to assess the challenges and limitations encountered by the Smoking Cessation Counseling Service at Optimus Health Care, the largest community-based health center in a low income area of Connecticut.
Methods: Following a literature review of current best practices for smoking cessation in the clinical setting, this study utilized an interview and survey tool to identify the primary barriers to smoking cessation counseling in partnership with the healthcare providers at Optimus Health Care.
Results: Preliminary demographic data indicated that approximately 88% of the smoking patients at Optimus Health Care have received smoking cessation counseling in the last 12 months. The main barriers assessed in this study included time with patients, patient motivation, access to cessation interventions, and patient comorbidities. Through a series of 14 healthcare provider interviews and 13 survey questionnaires throughout the locations of Optimus Health Care, this study illuminated the lack of time in clinician schedule, patient’s preparedness to quit, and competing patient comorbidities as the primary barriers to providing smoking cessation counseling.
Conclusions: Understanding the barriers to smoking cessation counseling faced by healthcare providers in the community setting remains an important objective for disease prevention and public health. This study identified the main barriers cited by clinicians in the community setting towards providing smoking cessation and generates recommendations for community-based healthcare providers regarding surmounting barriers to smoking cessation counseling.
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