Oral presentation at the 6th Annual North American Refugee Health Conference, Niagara Falls, New York.
Goal: 
To improve the success of refugee resettlement and health outcomes in Philadelphia by establishing a multi-agency registry with social services and clinical measures

Agoos, MD, Zoe

Altshuler, MD, Marc

Divito, MPH, BSN, RN, Brittany

Payton, MPH, CHES, Colleen

Scott, MD, Kevin

Shanfeld, MPH, Gretchen

Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsDepartment of Family & Community MedicineLectures, Presentations, Workshops Department of Family & Community Medicine6-17-2016Comprehensive Refugee Health Surveillance inPhiladelphia: A Combined Resettlement andClinical Patient RegistryColleen Payton, MPH, CHESThomas Jefferson University, Colleen.Payton@jefferson.eduBrittany Divito, MPH, BSN, RNJefferson College of Population Health, Thomas Jefferson University, brittany.divito@jefferson.eduGretchen Shanfeld, MPHThomas Jefferson University, gretchen.shanfeld@jefferson.eduZoe Agoos, MDThomas Jefferson University, zoe.agoos@jefferson.eduKevin Scott, MDJefferson Family Medical Associates, Kevin.Scott@jefferson.eduSee next page for additional authorsLet us know how access to this document benefits youFollow this and additional works at: http://jdc.jefferson.edu/fmlecturesPart of the Family Medicine CommonsThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inDepartment of Family & Community Medicine Lectures, Presentations, Workshops by an authorized administrator of the Jefferson Digital Commons.For more information, please contact: JeffersonDigitalCommons@jefferson.edu.Recommended CitationPayton, MPH, CHES, Colleen; Divito, MPH, BSN, RN, Brittany; Shanfeld, MPH, Gretchen; Agoos,MD, Zoe; Scott, MD, Kevin; and Altshuler, MD, Marc, "Comprehensive Refugee Health Surveillancein Philadelphia: A Combined Resettlement and Clinical Patient Registry" (2016). Department ofFamily & Community Medicine Lectures, Presentations, Workshops. Paper 128.http://jdc.jefferson.edu/fmlectures/128AuthorsColleen Payton, MPH, CHES; Brittany Divito, MPH, BSN, RN; Gretchen Shanfeld, MPH; Zoe Agoos, MD;Kevin Scott, MD; and Marc Altshuler, MDThis presentation is available at Jefferson Digital Commons: http://jdc.jefferson.edu/fmlectures/128Comprehensive Refugee Health Surveillance in Philadelphia: A Combined Resettlement and Clinical Patient Registry Colleen Payton MPH, Brittany DiVito MPH, BSN, RN, Gretchen Shanfeld MPH, Zoe Agoos MD, Kevin Scott MD, Marc Altshuler MD  June 14, 2016 Background  • Philadelphia receives ~800 newly arrived refugees annually • Philadelphia Refugee Health Collaborative:  • 3 resettlement agencies and 10 health clinics • Coordination of healthcare and social services is important for refugee resettlement success1  • Systematic data collection enables outcomes measurement  2 Goal To improve the success of refugee resettlement and health outcomes in Philadelphia by establishing a multi-agency registry with social services and clinical measures     3 2007 •Thomas Jefferson University 2010 •Nemours Pediatrics October 2012 •Nationalities Service Center October 2013 •Lutheran Children and Family Service October 2014 •REDCap Methods – Data Timeline and Collection Secure web application for building and managing online databases  • Merges resettlement and clinical data • Separate modules with privacy settings  4 Resettlement and Clinical Data 5 Resettlement Data • Demographics • Screening appointment  • Health orientation • Health insurance enrollment • School enrollment  • WIC enrollment • Specialists appointments • Follow-up tests  • Dental care • Eye care • Significant medical needs • Pregnancy  • Employment Clinical Data • Demographics • IOM form • Immunizations and titers • Chronic disease: HTN and diabetes • BMI • Smoking • Infectious disease • Lead screening • Pregnancy  • Cancer screening  • Specialists • Geriatric • Dental health • Mental health     Philadelphia Refugee Health Collaborative Longitudinal Patient Registry 6 Registry Fast Facts  • 2007 – Present • N = 2,709 • Both clinical and resettlement = 598 Results 7 Patient Characteristics Frequency (%) Country of Origin 2,709 (100)       Iraq 703 (26)       Bhutan/ Nepal 673 (25)       Myanmar/ Burma 392 (14)       Democratic Republic of Congo 204 (8)       Afghanistan 155 (6)       Eritrea/Ethiopia 107 (4)       Syria 37 (1)       Other* 438 (16) Resettlement Outcomes:  Time to Health Insurance, Medical Screening, School, Employment 8 *p <0.05; **p <0.01  Clinical Outcomes: LTBI Treatment Completion 9 0%10%20%30%40%50%60%70%2007 2008 2009 2010 2011 2012 2013 20140.0% 33.3% 69.2% 65.5% 59.3% 61.4% 67.3% 50.0%* Percent Completed After Treatment Initiation Year *Data from January 1, 2014 – September 30, 2014 Healthy People 2020  • Target = 79.0% • Baseline = 68.1%   Clinical Outcomes: Hypertension Management Hypertension (n = 149) • 55% diagnosed abroad • 45% diagnosed at clinic  10 Clinical Outcomes: Hypertension Management 11 Combined Resettlement and Clinical Outcomes 12 Number of Days Until Mean (SD) [n] Adults Diagnosed With Chronic Conditions Adults Without Chronic Conditions Association Between Chronic Conditions and Number of Days              (r) Association Between  Number of Chronic Conditions and Number of Days                                           (r) Employment (Adults in Employment Program) 70.00 (39.98)                 [n = 49] 67.10 (30.13)                 [n = 107] 0.04 0.04 Number of Specialists Escorts 0.84 (1.52)             [n = 45] 0.28 (0.57)           [n = 99] 0.26 0.38 Chronic Conditions Included in Analysis:  Hypertension, Diabetes, Asthma, COPD, Arthritis, Mental Health (Anxiety, Depression, PTSD), HIV, Chronic Hepatitis, Chronic Renal Disease, Chronic Kidney Disease, Stroke, Cancer, High Cholesterol, Cardiovascular Disease Improved Data to Improved Outcomes • Success Stories: • Improved medication completion for latent TB • Improved access to hearing loss services • Health education around labor and delivery   13 Conclusions  Collaborative Data Surveillance Led To: • A regularly updated registry of over 2,700 patients  • Changes in coordinated activities between healthcare providers and resettlement agencies • Increased knowledge in healthcare providers and community partners  14 Future Directions • Data collection and community work should expand: • Other resettlement agencies and clinical sites • Key community stakeholders: public health departments, community organizations, pharmacies, other health and public welfare services • Strive towards a community centered health home model • More research is needed to explore the process and outcomes related to implementing formal data sharing efforts among organizations working with refugees  15 Acknowledgement • This presentation was supported in part by Cooperative Agreement Numbers, 5 U50 CK000306 and 5 U50 CK000306-S1, funded by the Centers for Disease Control and Prevention and the National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention, the National Center for Immunization and Respiratory Diseases, or the Department of Health and Human Services.  16 References 1. DiVito, B., Payton, C., Shanfeld, G., Altshuler, M., & Scott, K. (2016). A Collaborative Approach to Promoting Continuing Care for Refugees: Philadelphia’s Strategies and Lessons Learned. Harvard Public Health Review, 7.  2. Healthy People 2020. https://www.healthypeople.gov/node/4555/data_details  17 Questions? Contact Information:  Colleen Payton, MPH, CHES Research Coordinator, Thomas Jefferson University  Colleen.Payton@jefferson.edu  Brittany DiVito, MPH, BSN, RN Health Coordinator, Nationalities Service Center bdivito@nscphila.org   18 

Comprehensive Refugee Health Surveillance in Philadelphia: A Combined Resettlement and Clinical Patient Registry

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Comprehensive Refugee Health Surveillance in Philadelphia: A Combined Resettlement and Clinical Patient Registry

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