ACHE – Equity of Care
Steven R. Carson, RN, BSN, MHA
Vice President, Clinical Integration
Chief of Operations
May 6, 2015
2
Temple University Health System
Organizations:
Key Facts:
• Serves one of the nation’s
most economically challenged
urban areas
• Highest volume of patients
covered by Medicaid in
Pennsylvania among fullservice hospitals
• Major delivery sites are
located in
• Urban Renewal Area
• Federally designated
Primary Care Professional
Shortage Area
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Temple University Hospital
Jeanes Hospital
Fox Chase Cancer Center
Episcopal Hospital
Temple Physicians Inc.
Temple University Physicians
Our Community
• Our primary population service
area includes more than 750,000
residents
• 62 % have < a high school
education compared to 44%
nationally
• 64 % have a household income of
under $ 30,000
• 49 % of the community is African
American
• 20 % are Hispanic
• Emerging ethnicity Asian cultures
– Vietnamese
– Korean
– Cambodian
Potentially Preventable Admission
Low income to High Income
Potentially Preventable Admission
Ethnicity
Health Burden
Most Prevalent
Chronic Conditions
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Heart Disease / Hypertension
Asthma / COPD
Diabetes
Renal Disease
Obesity
Mental Health
• depression
• psychotic disorders
• Substance Abuse
Perinatal Issues
– Late or no Prenatal care
– Pre-pregnancy Obesity
Major Cause of Death
– Trauma and Trauma Related
Conditions
– Cardiovascular Disease
– Renal Disease
– Chronic Dialysis
Social Issues
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Medical literacy
Overall literacy
Substance Abuse
Violence
Population
Health Model
Determinants of Health
• Health Outcomes
• Health Factors – if
improved have a significant
impact on making
communities healthier
Robert Wood Johnson 2015
County Health Rankings
8
Utilizing Community Health Workers to Improve Patient Engagement
TUH - Demographics
• 714 bed non-profit safety net hospital
• Greatest volume & highest percentage of Medicaid
patients among PA full service hospitals
• Located in economically challenged area of Philadelphia
• 37% of area families with children live below
federal poverty level
• Population is culturally diverse
• 83% of population is minority
• 85% of population insured by government programs
• 31% Medicare
• 53% Medicaid
• Of adults ages 18-64, 24.7% do not have health insurance
• Patients have multiple chronic medical conditions
• Frequent and unnecessary hospital admissions and
readmissions.1
TUH - Approach
• Multidisciplinary team, led by Nurse Manager
• Focus: CHF discharge populations
• Medical Record Case Review
• Reasons for readmission determine level of
intervention required from team.
• Introduce skills of non-medical Community Health Worker
• Assessment completed by CHW at bedside
• CHW telephonically contacts patient and in some
cases meets patient in their home after discharge
• CHW follows patient to assist with non-medical
social barriers to include housing, utilities,
transportation, insurance, medications, and home
based services.
• CHW schedules, attends, and is patient advocate at
Primary Care and Specialty Care appointments.
• Collaboration with Nurse Navigator prior to discharge
• Assess patient health literacy and their capacity for
managing disease.
Community Health Worker
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Specially trained professionals
Members of the community
Have similar life experiences to patient population
Focus on non-medical patient needs in coordination
with all members of the health care team.
• Average case load is 25 patients
Readmission Rates
• All patients receive a follow up call from CHW after
discharge from hospital
• Patients that received call back had lower than average 7
and 30-day readmission rates
• Improved scheduling of follow up appointments prior to
discharge
Edit for
Title Visits
Improvement
in Office
• Compliance with physician office visits improved
• Hospital admission & readmission rates have improved
• Patients more engaged in their care
Evaluation
• Under nursing supervision the program showed there was an
improvement in transitions of care.
• CHWs facilitate communication amongst multiple care
providers.
• Future plans include evaluating CHW use in emergency room
and high-risk pregnancy.
• Opportunity to apply across multiple care settings: SNF, Home
Care, Primary Care, Medical Home.
References
1. Temple University Health System Community Health
Needs Assessment, April 2013. Public Health
Management Corporation.
• https://www.dropbox.com/s/u3e0y61qy1btiy
9/templechw-v4-nostill-v3.wmv?dl=0
Programs Addressing Community Need
• Established a Linguistic and Cultural services
department.
– Cultural Sensitivity
– Cultural Competency
• Violence reduction
– Cradle to Grave ( At Risk Youth)
– Cease Fire
• Healthy Philadelphia
– CDC Diabetes Education
– Improvement of access to healthy food
HLNDV Panel Discussion
Rosa M. Colon-Kolacko, Ph.D., MBA, CDM
Senior VP Christiana Care Learning Institute and
Chief Diversity Officer
Panel Discussion
• Make the connection with learning, diversity and
inclusion with health disparities.
• Provide examples on ways that the Learning Institute
Center for Diversity, Inclusion, Cultural Competency
Equity have implemented Language Services, education
and build partnerships to build understanding of
healthcare disparities and provide equitable care.
• Share strategies to leverage bilingual CCHS Staff as
medical interpreters to improves quality, availability and
safety of care for LEP (limited English proficiency)
patients.
Learning Institute
Center for
Transforming
Leadership
Center for
Educator
Development
Research
Center for
Innovation,
Instructional
Design and
Technology
Center for
Diversity,
Cultural
Center
for
Competency
and
Diversity, Inclusion,
Communications
Cultural
Competency
& Equity
Center for
Employee
and Career
Development
Center for
Simulation
Education
Center for
Patient
Education
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To implement strategies to address
the cultural and language needs of
our colleagues and patients.
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To implement programs and services
to reduce the healthcare disparities in
our community.
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To grow DE diverse talent to grow the
availability of healthcare professionals
and leaders

To implement education programs
and tools to equip our employees and
partners with skills to promote a
culture of inclusion, and have the
capability to provide culturally
competent care to the diverse patient
population that we serve.
Our Strategy..
Connecting with Christiana Care Way
Reducing Health Disparities and Improving
Population Health Management through the
Implementation of Cultural Competency
Cultural competency is the ongoing capacity of healthcare systems,
organizations and professionals to provide for diverse patient
populations high quality care that is safe, patient and family
centered, evidence based and equitable.