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COVID 19 Team-Based Approaches to Patient Populations

As presented as part of The Path Forward on Jan 28, 2021:
Stable housing and health outcomes are inextricably linked. When a patient loses housing – or is in jeopardy of losing housing– health outcomes suffer. COVID has led us to a moment of crisis. Thirty million to 40 million people in the United States face eviction. People of color are disproportionately impacted. Addressing housing as a social determinant of health is critical to achieving health equity. This webinar brings together experts from housing, healthcare and the intersection of both to share innovative short- and long-term solutions you can implement in your community.

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COVID 19 Team-Based Approaches to Patient Populations

  1. 1. Team-Based Approaches to Meeting Patient Population Needs February 3, 2021
  2. 2. Introducing Joint Accreditation Community Health Center, Inc. (CHC) and its Weitzman Institute have received Joint Accreditation for Interprofessional Continuing Education. This designation confers simultaneous continuing education accreditation across nine national accrediting bodies. This Weitzman ECHO program is now able to award continuing education credit to a wide array of health professionals, including physicians, nurses practitioners, physician assistants, pharmacists, nurses, psychologists, dentists, social workers, and dietitians. If you have not been filling out previous CE evaluation forms because you were not able to use credits through AAFP, we highly encourage you to begin filling them out moving forward so you can receive credits!
  3. 3. This week’s COVID-19 ECHO session is a collaboration with
  4. 4. Disclosure • With respect to the following presentation, there has been no relevant (direct or indirect) financial relationship between the party listed above (or spouse/partner) and any for-profit company in the past 12 months which would be considered a conflict of interest. • The views expressed in this presentation are those of the presenter and may not reflect official policy of Community Health Center, Inc. and its Weitzman Institute. • We are obligated to disclose any products which are off- label, unlabeled, experimental, and/or under investigation (not FDA approved) and any limitations on the information hat I present, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion.
  5. 5. Team-Based Approaches to Meeting Patient Population Needs Stephen Scholand, MD; Infectious Disease Specialist, Midstate Medical Center February 3, 2021 www.
  6. 6. 26,377,125 cases on 2/2/21 with 445,030 deaths COVID-19 in the United States
  7. 7. Cases dropping
  8. 8. How Many ‘Jet Liners’? A320 seats 182 passengers
  9. 9. Pressure on Hospital Systems
  10. 10. At least 32 states U.K. strain • 315 total (B.1.1.7 strain): FL (147), CA (113), NY (42), MI (22), CT (8)… Other strains have arrived: • B.1.351 (S. African strain) • P.1 (Brazilian strain) Strains Threatening the United States
  11. 11. COVID-19 Vaccinations Across the Nation • As of 2/2, ~32 million people had received at least one dose of Covid-19 vaccine • About 6 million received 2 doses • Averaging ~1.3 million doses/day • Alaska, W Virginia and Connecticut lead
  12. 12. Resources • Nuvance Health 2000+ Articles Reviewed: • CDC: • WHO: • Johns Hopkins: • Others
  13. 13. Approaching the Social Determinants of COVID Care Neighborhood Health Courtney Riggle-van Schagen, MSW, LCSW Director of Behavioral Health, Neighborhood Health February 3, 2021
  14. 14. “I had a fever of 105 degrees and pain all over my body and I was like that for a week…”—Maria Zelaya Korff, Jay. (2020, May 13). 'Things are getting worse': 28% of Virginia COVID cases are in Latinx/Hispanic communities. ABC7. 'Things are getting worse': 28% of Virginia COVID cases are in Latinx/Hispanic communities | WJLA
  15. 15. NH at a Glance • 40,000+ patients • 13 sites across Alexandria, Fairfax and Arlington in suburban Northern Va. • Primary care, behavioral health, dental services, HIV, prenatal • 71% Hispanic/Latinx • 19% Black/African American • 56% uninsured • 29% Medicaid/Famis
  16. 16. COVID Response May 2020 • State-wide 10% positive • NoVa-25% positive • NH patients-54% positive Response • Testing • Primary care treatment • Contact tracing • BH support for primary care teams • Social Determinants of Health actions to support prevention and treatment
  17. 17. SDOH Response-The Successes • Individual needs assessment of each COVID+ pt to identify those unable to isolate due to lack of masks, food, secure housing • Partnerships with community stakeholders established • Contact-free delivery of food, masks, sanitizer, pulse oximeters, thermometers, diapers to support quarantine • Referral relationships between local government partners to secure safe spaces providing quarantine options for those unable to isolate
  18. 18. Isolation as an SDOH of COVID • How do you target isolation? • Who does it impact (anecdotally/based on clinical observation)? – Elderly – Minority populations – Youth (teens) – What do you see in your areas of work? • Build connections and help patients tell their stories • Community partnerships and stakeholders
  19. 19. Food for Thought • How can we build on community relationships to address concerns about vaccine efficacy? • Are we asking the right questions to be sure that we are addressing the most important social determinants for our particular populations?
  20. 20. Thank You! “Whatever affects one indirectly, affects all indirectly. I can never be what I ought to be until you are what you ought to be. This is the interrelated structure of reality.” ~Martin Luther King, Jr.
  21. 21. Vija Sehgal MD, MPH, PhD, Chief Quality Officer Weitzman ECHO Series on COVID-19 Wednesday, February 3, 2021 Responding to Community Needs During the COVID-19 Pandemic
  22. 22. • Established 1972 as a community-driven response to the lack of health care providers available on the Waianae Coast. • The largest and oldest of Hawaii’s 15 community health centers, with a main site; 5 satellite clinics; 3 SBHC sites; and a 24 hour Emergency Department • In 2019, served 38,699 patients through 219,339 encounters, the majority Native Hawaiian (47%), with 67% of patients at or below 100% of the federal poverty level and 56% covered by Medicaid • Largest employer on the Waianae coast with over 650 employees – 54% of whom are residents of the community. Waianae Coast Comprehensive Health Center
  23. 23. •Highest number of households in the state receiving SNAP or other forms of public assistance •Highest percent of individuals on Oahu living below the Federal Poverty Level, with an average annual per capita income of $17,800 •Highest number of obese adults, adults with diabetes, and adult smokers. 2016 State of Hawaii Primary Care Needs Assessment Data Book (Hawaii State Department of Health, May 2016) Waianae Coast Primary Service Area
  24. 24. COVID-19 Timeline Hawaii • March 6, 2020 – First presumptive positive case of COVID-19 confirmed in a cruise ship passenger returning to Hawaii​ • March 11 - WCCHC decision made to scale back operations and postpone non-essential visits​ • March 16 – WCCHC reduced operations begin; • COVID-19 hotline and drive-thru testing open​ • March 16 – School spring break begins​ • March 23 – Governor David Ige issues emergency ‘stay at home’ proclamation​ • March 27 – Mandatory 14 day quarantine for out of state travelers • April 1 – Mandatory 14 day quarantine for inter-island travelers
  25. 25. • Fewest COVID-19 cases in U.S. (per 100,000) • Second lowest case fatality rate in the country. • 2.6% Case positivity (4th Lowest in the country) • Highest daily case count: 353 (August 12, 2020) • Highest positivity rate
  26. 26. April 2020: Hawaii Unemployment Soars •Over a quarter of a million unemployment claims filed (Feb 1 to May 9) •Greater than 1500% increase from same period last year •Nearly 1 in 4 workers in Hawaii were unemployed
  28. 28. HAWAII UNEMPLOYMENT 2019-2020
  29. 29. PRAPARE Survey Modified in Response to COVID-19
  30. 30. Pre-Pandemic Statistics (2019) Waianae Coast 47,774 residents – #1 Obesity (40.9%) – #1 Diabetes (15.1%) – #1 Cancer – #1 Diabetes – 38% Food insecure – 33.3% Households receive EBT/SNAP – 100% Keiki (Children) receive free school breakfast & lunch
  31. 31. WCCHC’s Approach (2019) • Farmers markets • EBT Double Bucks program • Keiki produce prescription pilot • Summer mobile meals • Keiki pantry • ʻOhana Nights
  32. 32. WCCHC’s COVID Response to Food Insecurity (2020) 258,718 meals distributed 2.4 million lbs. of food distributed 26,019 households served Projects: • Keiki and Kupuna Grab & Go Pantries • Community Food Distributions • Front Line Worker Food Distributions • Keiki Produce Prescription Program • Waianae ʻOhana Produce Prescription Program
  33. 33. Daily Keiki Food Distributions
  34. 34. Large Scale Community Food Distributions
  35. 35. Collaborating with Community Partners
  36. 36. WCCHC’s Community Impact 2019 2020 Food Distributed (lbs.) 250,000 2,400,000 Meals Distributed 13,384 258,718 Families Served 10,326 26,019 WCCHC’s Community Impact (2019 vs. 2020)
  37. 37. WCCHC’s Economic Impact WCCHC’s Local Food Purchases 2019 2020 Local Food Purchases $13,000 $1,71,297 Food Producers Supported 6 45+ Jobs Saved/Created 10 temporary part-time 25 full-time+
  38. 38. “Never underestimate the power of a small group of committed people to change the world. In fact, it is the only thing that ever has.” ~ Margaret Mead.
  39. 39. Mahalo Vija Sehgal MD, MPH, PhD
  40. 40. Thank You! To learn more about The Path Forward series To view previous COVID-19 sessions: