Primary Care for the Homeless and Formerly Homeless: A Community Based Quality Improvement Project for Health Professionals

No abstract available

Community Service and Public Health: The Jefferson Health System

No abstract available

A Comparison of Screening, Prevention, and Management for Hepatitis B Patients between the US and Chinese Healthcare Systems

Introduction: Hepatitis B (HBV) is a complex disease entity with potentially serious outcomes, including developing hepatocellular carcinoma (HCC). HBV is estimated to be responsible for about 50-80% of HCC cases worldwide, and 75-95% of HCC cases in HBV endemic regions.1 HBV and HCC are great concerns especially in East Asian countries like China. In China, HCC ranks as the 2nd most common cancer and 2nd in cancer mortality, both behind only lung cancer.1 China is considered an endemic HBV region, with about 100-150 million people infected. In comparison, only an estimated 550,000-2 million people are chronically infected in the US.2 With such high volumes of HBV and HCC cases in China, there are lots to be learned from how the Chinese healthcare system addresses this public health issue. Objective: The purpose of this study was to elucidate if there were any efficiencies or best practices the US healthcare system can adopt from how the Chinese healthcare system screens for and manages HBV. Methods: This qualitative study was done through primary research, including methods such as interviews, clinical shadowing, and photo-journaling. Key informant interviews (KIIs) were conducted with Jefferson hepatologists (N=2), to set a baseline understanding of how HBV patients are managed in the US. Similar KIIs were conducted with Chinese hepatologists (N=2), infectious disease physicians (N=1), and liver surgeons (N=2) at West China Hospital in Chengdu, China. Notes from 2 weeks of clinical shadowing were also included to provide additional understanding. Finally, a qualitative, cross-country comparison was done to uncover similarities and differences between the two countries with regards to how HBV patients are managed. Results: Pharmacologic treatment of HBV patients in China is very similar to that of the US. Antiviral therapies, such as entecavir and tenofovir, continue to be first-line treatments in both countries. Clinical management of HBV patients in China is also very similar to the US. In both countries, HBV patients are followed-up every 3-6 months, with routine labs (i.e. CBC, LFTs, viral load) and imaging (i.e. abdominal US) required. However, the most stark contrast between the two countries is the physician-patient relationship. Due to differences in patient volume and general population size, the Chinese healthcare system is much more focused on quantity of patients served rather than quality of services provided. Conclusion: The biggest difference in management of chronic HBV between US and China is how patients are treated. It’s typical for Chinese hepatologists to see 60-80 HBV cases per day (~5-7 minutes / patient), whereas US hepatologists see 5-15 cases per day. From clinical shadowing, it’s apparent that US hepatologists take much more time on patient education, whereas the Chinese hepatologists do not focus on this due to time constraints. Whether or not the closer doctor-patient relationship in the US translates to better disease outcomes is still an open question that warrants further studies. Because HBV is a bigger issue on a much larger scale in China, physicians, health officials, and the government have been trying to address this issue on a public health scale through national efforts to improve vaccination rates and HBV screenings

Career Support Network

Project Overview: This project is funded under the Robert Wood Johnson Foundation’s Local Funding Partnerships Annual Program in support of innovative, community-based projects that improve the health and health care for underserved and vulnerable populations.Philadelphia currently confronts an unprecedented employment crisis. InSouth Philadelphia, the unemployment rate is 35%. Those who are unemployed present with multiple health problems that are barriers to retaining jobs and achieving economic stability. The Career Support Network was conceived to help underserved, newly-employed adults to overcome these barriers and succeed in long-term careers. It will accomplish this mission by creating an integrated, one-stop center that weaves together occupational counseling, job training, peer support, and mental and physical health services. Project Objectives: The goal of the CSN is to enable vulnerable adults with limited skills, physical and/or behavioral health problems to become independent and productive members of the community through retaining sustainable jobs. Objectives to meet these goals focus on: 1) increasing healthy lifestyle behaviors related to chronic disease prevention and/or management among program participants, 2) improving chronic disease self-management such as diabetes and hypertension, asthma, and arthritis, among program participants, and 3) assisting participants in developing skills and obtaining the supports necessary for independent productive living and job retention. Expected Outcomes: Vulnerable adults who participate in the CSN will: 1) demonstrate improved physical, mental and behavioral health through improved knowledge, skills and self-efficacy in managing chronic health conditions, practicing healthy lifestyle behaviors, and managing life and work-related stresses; 2) be employed in jobs that pay family-sustaining wages for a minimum of one year, and for those participants with a chronic disease, the absenteeism rate, due to personal illness, will be no more than 6 per year, and 3) experience a reduction in criminal recidivism rates among ex-offenders participating in the Network. Learning Objectives: Participants attending this session will be able to: 1. Organize an approach to providing chronic disease management/ prevention and work enhancement programs in a workforce development and jobs program utilizing an interdisciplinary team 2. Apply a methodology of engaging community organizations and funders to address job retention 3 Identify the challenges of incorporating chronic disease management/ prevention and work enhancement programs in a workforce development and jobs program utilizing an interdisciplinary tea

Predictors of Length of Stay at Jefferson Hospice

No abstract available

Endgame for polio eradication? Options for overcoming social and political factors in the progress to eradicating polio.

In 1988, the Global Polio Eradication Initiative (GPEI) was launched with the goal of eradicating polio by the year 2000. After 25 years, several dynamics still challenge this large public health campaign with new cases of polio being reported annually. We examine the roots of this initiative to eradicate polio, its scope, the successes and setbacks during the last 25 years and reflect on the current state of affairs. We examine the social and political factors that are barriers to polio eradication. Options are discussed for solving the current impasse of polio eradication: using force, respecting individual freedoms and gaining support from those vulnerable to fundamentalist \u27propaganda\u27. The travails of the GPEI indicate the need for expanding the Convention on the Rights of the Child to address situations of war and civic strife. Such a cultural and structural reference will provide the basis for global stakeholders to engage belligerent local actors whose local political conflicts are barriers to the eradication of polio. Disregard for these actors will result in stagnation of polio eradication policy, delaying eradication beyond 2018

Southeastern Pennsylvania (SEPA) Regional Enhancements Addressing Disconnects (READS) in Cardiovascular Health Communication

The objective of SEPA- READS is to enhance the capacity of health care systems and professionals to address health literacy needs of adults’ (aged 50+) to improve cardiovascular health outcomes by 1) identifying, implementing and evaluating educational/systems changes designed to improve written materials, navigation and provider communication skills, and 2) enhancing the ability of older adults to communicate effectively with healthcare providers. This is accomplished by: 1) creating a broad-based Cardiovascular Health Literacy Coalition (CHLC) 2) improving the ability of adults to communicate effectively with healthcare providers/staff at multiple points of care. The CHLC consists of a Coalition Steering Committee that provides overall guidance to the project and is composed of project leadership and representatives from two Advisory Working Groups. These Working Groups include: 1) a Professional Advisory Group (PAG) with representation from at least 10 hospitals and/or health systems, local literacy initiatives, and cultural groups dealing with non-English speakers such as the Nationalities Service Center and Southeast Asian Mutual Assistant Association’s Coalition, and 2) a Community Advisory Group (CAG) to ensure cultural and health literacy relevance for older adults. The CHLC utilizes a multi-pronged approach that includes: 1) assessing the quality and content of communication across multiple points of care; 2) integrating literacy improvement techniques and strategies, such as Teach Back, use of Plain Language, Creating a Shame Free Environment, into staff development programs 3) activating patients through training on Ask Me 3. Ultimately the impact of SEPA-READS includes: 1) Institutionalization of effective communication strategies into the culture of patient quality and safety protocols; 2) Creation of a centralized repository for culturally and linguistically forms and educational materials; 3) Improved cardiovascular health outcomes in adults aged 50+; 4) Reduced CVD related readmissions; 5) Reduced CVD medical errors; and 6) Improved CVD patient self-care behaviors. Learning Objectives: Participants attending this session will be able to: 1. Organize an approach to recruiting multiple hospital/health systems into a literacy initiative 2. Apply a methodology of engaging hospitals, community organizations and older adults to address health literacy 3. Identify the challenges in addressing cardiovascular health literacy at multiple level