Thomas Jefferson Health System Medical Legal Partnership

Introduction: Medical-legal partnerships (MLPs) provide civil legal services in concert with healthcare services to mitigate complex social conditions with health-harming effects. Currently, there are 333 MLPs in 46 states. Thomas Jefferson Health System (TJHS) does not have a systemwide MLP. (Magee Rehabilitation Hospital does have an MLP used by qualifying Magee patients). This project sought to identify the core components of an MLP and to demonstrate the value an MLP would provide TJHS. Methods: Assessed existing literature. Interviewed an existing MLP director. Patients from the Jefferson Hospital Ambulatory Practice (JHAP) clinic completed a written survey regarding health-harming social-legal issues. Entered survey data into Excel and analyzed using descriptive statistics. Results: Six common core components of all MLPs were identified. Existing MLPs have demonstrated a reduction in readmission rates, decreased inpatient and emergency department visits, and recovery of payments for unreimbursed clinical services. Patients report improved health when unmet civil legal needs are addressed. Results of the JHAP clinic survey are pending, but preliminarily many patients appear to have social-legal issues. Conclusions: This project demonstrates that a TJHS MLP program could improve patient health and reduce overutilization of the health system. Over time the cost of the program would potentially be offset by the recovery of healthcare dollars. TJHS patients appear to have social-legal issues that negatively impact their health and could be addressed through legal remedies. Based on the analysis, an Opportunity Assessment was generated. Critical next steps are to draft a business plan and identify potential funding

Literature Review on Hospital Costs for Patients Undergoing Colectomy

Objective: This study aims to identify the range of direct hospital costs associated with a minimally invasive or open colectomy procedure across different countries. Poster presented at 2016 ISPOR conference in Washington DC.https://jdc.jefferson.edu/jcphposters/1009/thumbnail.jp

Literature Review on Hospital Costs for Patients Undergoing Hysterectomy

Objective: This study aims to identify the range of direct hospital costs associated with a minimally invasive or abdonimal hysterectomy procedure across different countries. Poster presented at 2016 ISPOR conference in Washington DC.https://jdc.jefferson.edu/jcphposters/1010/thumbnail.jp

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

Seminar (39 PowerPoint slides) 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

Mental Health Interventions for U.S. Women in Prison: A Rapid Review

Objective: The population of women in prison, although small, has been steadily increasing over the last few decades. Women in prison are more likely to suffer mental illness while incarcerated. This leads to poor outcomes during and after incarceration. Mentally ill women in prison often lack access to quality treatment. Mental health interventions targeted towards women is vital to improving outcomes, enhancing quality of life, and decreasing burden on the criminal justice system. The goal of this study is to conduct a rapid systematic review on empirically tested interventions to improve the mental health of women in prison. Methods: A rapid systematic review was conducted to answer the following two questions: (1) What interventions designed to improve mental health of incarcerated women have been empirically tested, and (2) what are the effects of these interventions on women’s mental health in prison? Results: 30 articles were identified and six met inclusion criteria. Five unique mental health interventions for incarcerated women were reviewed from those six articles. The interventions are discussed for their findings and limitations. Conclusion: Interventions for mental health can have a significant impact during incarceration, particularly if an intervention is introduced early in a woman’s sentence. Results support the need for further research on effective mental health interventions for incarcerated women, especially for women with longer sentences. Suggestions for future research are addressed within, including collaboration between correctional health providers and researchers

Healthcare Interpreter Services (HIS) In the Pennsylvania Medicaid Program: A Policy Proposal

Limited English proficient (LEP) Pennsylvania Medicaid enrollees are at risk of being denied access to timely and effective healthcare services due to the inconsistent availability of qualified healthcare interpreter services (HIS) at all points of care within the Medicaid healthcare system. Lack of qualified HIS has been found to increase disparity in access, quality of care, and health outcomes for LEP individuals while increasing resource utilization and hospital readmission rates. In an effort to address the needs of their LEP populations, several state Medicaid programs have developed language access programs that include healthcare provider reimbursement for the cost of using HIS. The Pennsylvania Medicaid program does not provide standardized HIS reimbursement for all healthcare providers. This creates a cost burden for smaller healthcare practices, impacting LEP Medicaid enrollees’ access to services. The objective of this Capstone project was to develop policy provisions that will improve the timeliness, consistency, and quality of Pennsylvania Medicaid HIS. To inform this proposal, an analysis of the 12 states and Washington D.C. Medicaid programs with existing HIS reimbursement policies was conducted. Pennsylvania’s current Medicaid HIS policy was also evaluated. Four domains of the HIS policies were evaluated: administrative vs. covered claims, reimbursement mechanisms, quality assurance, and capacity. State Medicaid websites, managed care organization (MCO) contracts were the primary sources for collecting information. The analysis revealed that the predominant method of providing HIS is through MCO contractual requirements. There is limited data available regarding HIS request and usage rates. Some states have developed methods to increase HIS capacity and improve program quality. Recommendations for the Pennsylvania Medicaid HIS policy proposal include expanding current MCO HIS provisions, establishing MCO reporting mechanisms for HIS request and request fulfillment rates, and creating a stakeholder taskforce to oversee development of HIS standards, workforce recruitment, and healthcare personnel training initiatives