... the health of residents and neighborhoods.
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Five years into its funding cycle, the MetroHealth Closing the Gap initiative, funded by a $10 million, 10-year grant from the Saint Luke's Foundation, is helping to revitalize the Buckeye neighborhood by focusing on the social determinants that affect the health and well-being of its residents.
What are Social Determinants of Health?
"The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution
of money, power and resources at global,
national and local levels, which are themselves
influenced by policy choices. The social determinants of health are mostly responsible for health inequities — the unfair and avoidable differences in health status seen within and between countries.”
World Health Organization, 2009
The good news about Closing the Gap: results are showing. Momentum is building. Lessons are being learned. The reach of medical care is being extended.
The challenge ahead is sustainability. And getting people healthier.
Focusing on health disparities.
Since its first year of funding, the Closing the Gap initiative has
been steadily working to reduce health disparities in the Buckeye neighborhood. Managed
out of the MetroHealth
Buckeye Health Center, near the site of the former
Saint Luke’s Medical Center, work under the initiative’s umbrella addresses
chronic diseases that disproportionately affect people living in urban neighborhoods.
Among these are asthma, diabetes, high blood pressure and obesity.
But what accounts for the health differences between people in poorer communities and their neighbors in other areas?
“Everybody is interested in living a long and healthy life; that’s no different
in the Buckeye community than it is in any community,” says Dr. Alfred F.
Connors Jr., chief medical officer of The MetroHealth System. “But there may
be differences in understanding diseases and how they impact certain groups
of people. Part of that is differences in access to education about disease
prevention and access to high quality, affordable health care.”
Because
of the Saint Luke’s Foundation’s commitment to the Buckeye/Larchmere
neighborhood, choosing that same neighborhood for the Closing the Gap
initiative made natural sense. But from the onset, both the Foundation
and its partners at MetroHealth recognized an opportunity to not
only provide health care in the short term, but also to help change behaviors
over the long term.
According to Connors, multiple factors impact a person’s health.
For example, “(In some neighborhoods) there may be limited access to grocery
store options. As a result, we often see fattier diets, which can
increase the risk of heart disease, or saltier diets, which tend to make hypertension
worse, or diets high in carbohydrates, which may increase the risk
of diabetes,” Dr. Connors explains. He added that care is often complicated
by the fact that, according to statistics, many urban residents wait until
diseases are more developed before they go to a physician – “which is exactly
what you DON’T want them to do.”
Closing the disparity gap.
Dr. E. Harry Walker is working to make health disparities disappear.
As the director of the MetroHealth Center for Community Health, Walker oversees nine community health centers, including the Buckeye location. As an internal medicine doctor whose focus is diabetes, he also sees patients twice a week at Buckeye.
One result of Closing the Gap that Walker cites is that people are better
able to manage their diabetes. Patients come into the program with
high levels of glucose intolerance and leave with their glucose at a manageable
level. Just as important, they’re maintaining those levels afterwards.
Dr. Walker credits Closing the Gap for this positive change.
“The challenge for any primary care physician is that you have a limited amount of time during each visit to spend with the patient,” Walker explains. “You try to answer all their questions and do the best you can but many times the patients just don’t know what they don’t know. And then they think of it later and it’s very hard to make progress that way...
“…To be able (through Closing the Gap) to say to a patient, ‘I want to refer you to this class, I want to refer you to one of our dieticians… our nurse is going to be calling you every day to find out what your blood sugar is’ … It’s a level of concern and management that patients are very happy with. I’ve seen it make the difference.”
Although the changes have been dramatic, Dr. Walker stops short of calling it miraculous.
“It’s not that I have any magic medicine; it’s this ability to get them the help that they need,” he says.
Dr. Connors concurs, citing similar results in a related area: weight management.
“People in the weight management program generally have achieved weight loss, but more importantly have made real changes in their exercise and eating habits,” he explains. “You don’t need to lose a lot of weight to improve your health. You can get a lot of benefit from a relatively small weight loss. Just starting the process makes a difference.”
It’s making a tremendous difference among Buckeye-Larchmere residents. Not only are more people losing weight and managing their diabetes better, many are quitting smoking. Others are learning how to balance their asthma medications to avoid emergency room visits.
“The weight management program… the asthma program… the smoking cessation program… (each) makes a difference,” says Connors, who feels good about being part of such a vital effort.
Patients are feeling good too.
And as individuals become revitalized, so does the community.
Patients are taking charge.
Another result of Closing the Gap is that patients are feeling more
empowered to do something about their health.
For example, diabetes patients came to Dr. Walker and said they wanted to get together as a group to talk about diabetes-related issues amongst themselves.
“One of the improvements we’ve made is to have a sort of ‘reunion group’ that comes together… graduates of the program. Some of them have actually come to talk to people coming into the program about their experiences,” says Walker.
The neighborhood’s children are doing their part too. Through community outreach into the schools, health officials have the chance to get in front of kids, teach them about good health, and then have them act as health ambassadors.
Dr. Connors says getting kids involved and thinking about health can have a big impact on their parents and families.
“I’m a pulmonary physician, and people will come in and tell me they’re stopping smoking because their grandchild asked them to,” Connors relates. “Those kinds of things are very powerful.”
These kids are also learning about behaviors that will affect them for a lifetime. Connors says if the program’s outreach can get children to understand how to live a healthier life, it can help them prevent problems as adults. “Maybe they won’t need a weight management program 15 or 20 years from now,” he says.
These children and other patients are also learning something doctors have long known: It’s much easier to stay healthy than to have to deal with a disease.
And it’s not just better for individuals, it’s better for society as a whole.
“Our mission isn’t simply to treat disease, it’s to promote wellness and promote the health of the community,” says Connors. “The best way to keep health care costs down is to keep people healthy.”
Taking it to a larger audience.
One challenge that program leaders are working hard to address is
how to get a greater number of people to take advantage of Closing the Gap
programs available at the Buckeye Health Center.
Dr. Connors says, to date “we’ve affected a few hundred people. How do you impact thousands of people so they change their behaviors or recognize they need care and get it quickly?”
Connors says it’s heartbreaking to see a 35-year-old man in the intensive care unit with renal failure due to hypertension, when proper treatment and help with medications could have kept him healthy.
“This is exactly what our programs are there to prevent,” he observes.
To get the message out, Closing the Gap leaders are reaching into the community. In addition to working with the schools, they’re connecting with churches and civic groups.
“The Buckeye neighborhood has this wonderful interaction of block leaders
and advocates within the community… churches and community groups at the neighborhood
level,” Connors explains. “They’re become increasingly more engaged with this
initiative and over time will have a big influence” in the Buckeye neighborhood.
To MetroHealth, “engaging” residents means asking them for their
input. “They’re the best source of information” on how to reach people, says
Connors. “So we’re trying to make this a very interactive process. We know
a lot about giving good health care; residents know a lot about their neighborhoods.
If we work together we can come up with something that will make a lot of
sense and everybody wins.”
Sustaining progress.
The Saint Luke’s Foundation is committed to funding Closing the Gap
through 2014, so program officials are using the next five years to figure
out how to sustain the program in the future.
Long term, Connors noted, “one of our solutions is to do a better job of funding preventive care, so in the long run these kinds of programs pay for themselves. If you do a better job of keeping people healthy, we’ll spend less money on treatment." That’s a win-win for all involved – patients, MetroHealth, the community at large, funders – and that makes the initiative well worth the investment.
| Posted by Sandy Chappelle on Dec 3, 2009, 12:49 pm |
| Recently, MetroHealth’s Chief Medical Officer, Alfred F. Connors, Jr., M.D., and Director of the Center for Community Health, E. Harry Walker, M.D., presented a progress report that impressed the Saint Luke’s Foundation.
The progress report included these highlights:
The Adult Asthma and Allergy Program offers access to pulmonary specialists and pulmonary function testing not normally available in a community setting. By screening patients for problems and teaching better self-management of chronic asthma, the program reduced the number of hospitalizations and trips to the emergency room. Also, patients in the program were significantly more likely to quit smoking. The Pediatric Asthma Compliance and Technique (PACT) Clinic dramatically reduced emergency room visits and hospitalizations by teaching children and families the proper use of inhalers.
The Diabetes Self-Management and Education Program provides intensive and individualized diabetes education to improve patients’ self-management skills, reduce the risk of medical complications of diabetes, and improve health outcomes. The program features cooking demonstrations to teach patients how to prepare tasty foods lower in sugar and fat; trips to the grocery store to learn how to make wiser food choices by understanding food labels; weekly group exercise classes; and more. Patients enrolled experienced a drop in hemoglobin A1C levels indicating improved blood sugar control, reducing the risk of blindness, amputation, heart attack, stroke, and kidney failure. Cholesterol levels and blood pressures also were reduced.
Adult Weight Management and Health Lifestyles programs proved successful in helping obese patients lose weight and improve overall health. Over a two year period, nearly 6,000 patients were found to be significantly overweight, and many were discovered to have previously undetected diabetes and high blood pressure. Lifestyle counseling and follow-up were successful in stopping weight gain. A 12-week lifestyle change course resulted in an average weight loss of nearly 9 pounds and improved weight loss management. Patients who purchased fresh produce through the City Fresh program offered at Buckeye reduced their intake of fast food.
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