Community Pandemic, What's Ahead

This just in from our friends at the DFW Hospital Council:  

The Dallas-Fort Worth Hospital Council wants to remind you of public health considerations as we approach the fall and have three viruses ( COVID-19, West Nile and Influenza ) in North Texas. 

Please pass this information to your friends, family and business associates, especially on social media. These three diseases display many of the same symptoms, so prevention is key in reducing the spread.

 Wear a mask

Wash your hands

Watch Your distance

Get your flu shot early

Remove standing water on your property

Wear long sleeve shirts

Utilize insect repellent

 

We need to be prepared for the triple threat and we can help tap down the community spread of these viruses if we all work together to protect each other.

 

Thanks for your cooperation and support.

 

W. Stephen Love

President/CEO

Dallas-Fort Worth Hospital Council

300 Decker Drive, Suite 300

Fairway Centre Building

Irving, Texas 75062

Telephone ( 972 ) 719 4900

www.dfwhc.org

Tell me your ZIP, I'll tell you about your health

Just in from the Colorado Health Foundation.  Move evidence of the interrelated complexity of poverty.  This poverty is destroying our neighborhoods. 

Health by ZIP Code

Where You Live Determines Your Health – for Good or Ill

By Sandy Graham

Opportunities for good health bypass far too many people, in Colorado and nationwide.

If you live in a poor neighborhood, chances are that you are not as healthy as someone who resides in a more affluent neighborhood. Your address reflects your health – and more.

"There's a lot of information in an address," says Anthony B. Iton, MD, JD, MPH, senior vice president of healthy communities for The California Endowment. "It tells me about your income, your education, the health amenities you have access to and employment opportunities you can access. I can pretty much predict your life expectancy by where you live."

Iton has data to back his point. Mapping life expectancy in major metro areas by census track or ZIP code finds wide ranges even a few miles apart. In Philadelphia, for example, those in the city's center live 6.4 years less on average than neighbors 21 miles away in Chester County. Life expectancy in Oakland, Calif., is less than 74.3 years compared with more than 80 years in much of the rest of the county.

Assuring the highest level of health for all Americans is a goal that many experts believe makes both humanitarian and economic sense. But achieving what some call "health equity" requires tackling social determinants of health such as income, education, nutritious food, safe housing, affordable and reliable public transit, culturally sensitive health care professionals, health insurance, and clean water and air.

A Complex Problem
"That's why health equity is so elusive," says Len Nichols, PhD, director of the Center for Health Policy Research and Ethics at George Mason University. "You can't push one button. You have to think about the totality of the social fabric of the community."

Read more here.

The essay that follows is a mind-twister for certain!  What you read may surprise you, unless you have a degree in public health.  Much food for thought on how to intervene for life and health in the really tough parts of a city like mine.  Reactions, as always, welcomed!

Why We Need to Treat America's Poorest Neighborhoods Like Developing Countries

The average life expectancy in Japan right now, home to one of the healthiest, longest-living populations in the world, is about 83 years. That's four years longer than in the United States, a decade longer than in much of North Africa, and as many as 30 years longer than some war-torn parts of the world like Sierra Leone.  

These global patterns are well-known, but we seldom look at our own communities in the same way.

"Most people appreciate at a country level that there are huge disparities in health between the U.S. and, for example, countries in Africa," says David Fleming, the public health director and health officer for Seattle and King County. "I think what is not as obvious to most people is that you don’t need to go any further than your front door, and most of us are living in communities where those same profound differences occur across much smaller geographic areas."

In fact, that area may span the distance of a stop or two on the subway, or another exit off the highway. In New Orleans, for instance, a couple of miles down Interstate 10 can mean the difference in 25 years in life expectancy. . . .click here to read more.

CitySquare clinic scores big!

What follows is a direct, cut and paste email message that I received recently from Frances Martinez, Operations Manager for CitySquare's Community Health Services. 

Our clinic, located in South Dallas-Fair Park just off the intersection of Malcolm X and Grand Avenue, scored big in the latest Health Texas Provider Network (the Baylor Health Care System's physicians group) audit of our Adult Preventative Services. 

The translation is very simple, and most encouraging:  our clinic ranked second among all the HTPN clinics in the system!  This includes the clinic that I call my medical home out in the North Dallas suburbs! 

Great work, CitySquare health care team!  Great work! 

Our patients receive the best care possible, and evidently the best care available! 

 

____________________________________

 

Everyone,

Please see below, we are #2 in HTPN for the July-September Adult Preventative Services (APS) audit!!  Congratulations everyone!  It is definitely a team effort from scheduling WWEs, to requesting the tests, to putting in the orders, to scheduling the tests.  Please take a moment and give each other a high five!

 

Rank Practice Name

POA

1 Signature Medicine

N 278

95.41%
 

2 City Square Community Health Services

N 643

92.87%

Frances Martinez

Operations Manager

CitySquare-Community Health Services

2835 Grand Ave.

Dallas, TX 75215

214-421-1783

francema@baylorhealth.edu

Project Access lost. . .

CitySquare was one of the original partners in the formation of Project Access Dallas. We wrote the initial grant to fund the concept.  We provided a team of "health navigators" to serve the special needs of our patients.  After more than a decade leaders at the Dallas County Medical Society have decided to shut the project down.

Ironically, the change may result in even more services for the very poor in Dallas.  I hope so.  We will be working with our medical and hospital partners to continue to serve the poor and marginalized, hopefully on an even greater scale.  That's what we're looking to the hospitals to accomplish in our community, and especially on behalf of the poor and uninsured. 

Here's the story by Dallas Morning News reporter Sherry Jacobson that appeared in Wednesday morning's edition: 

Dallas County Medical Society to end program providing low-cost care for uninsured
by Sherry Jacobson

sjacobson@dallasnews.com

05 December 2012 11:25 PM

The Dallas County Medical Society will pull the plug early
next year on its Project Access Dallas, a popular program that
matches uninsured county residents with doctors willing to
provide them low-cost medical care.

The 10-year-old effort, which employed 30 people, will end
as early as March, after more than 3,000 current patients have
found a “new medical home,” said Dr. Rick Snyder,
president of the medical society.

More than 2,200 local doctors, many of them specialists, had
voluntarily provided low-cost care to uninsured patients,
including surgery, chemotherapy and chronic-disease
management.

To continue reading click here.

Progress continues

Work progresses on CitySquare's new "Opportunity Center" located at the corner of Malcolm X and I-30! Completion will be in late spring 2013.

Costumbres Peligrosas

Kathy Bennett, our social work director at Community Health Services here at CtiySquare sent me the following information about a novella (soap opera) that our team produced with the help of our AmeriCorps team and an ExxonMobil intern.  I think you'll find this creative piece most encouraging.  We'll let you know when the finished product is set to air--complete with sub-titles!

We are using our ExxonMobil intern to direct this educational film in Spanish in the form of a Spanish novella (Soap opera.) We think this format is more interesting and appealing to the people we serve.


The completed video will have subtitles in English. I am happy with the response of our clinic family in all the help the patients and staff have given for this to be a success.  Almost everyone in the video is a patient and everyone associated with it except for the interns are volunteers. We have a long list for the credits of people to thank. I would love to hear what you think of the trailer. Of course we are all hoping the video is as good as the trailer.

CitySquare Community Health Services receives highest rating as "medical home"!

Great news for CitySquare's Community Health Services!  The National Committee for Quality Assurance, a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality recently released the results of the following practices as receiving the organization's highest quality ranking:

Baylor Family Medicine at Legacy
Family Medical Center at Terrell
Baylor Occupational and Family Health Center at TI
City Square
City Square- Pediatrics

Since 1997, our Community Health Services department has partnered with the Baylor Health Care System and Health Texas Provider Network to bring extremely high quality medical services to inner city Dallas.  The following letter tells the wonderful story:

Congratulations!

We have not only completed the application process for NCQA Patient Centered Medical Home recognition for all of our adult, geriatric, residency and pediatric practices, but have now received the results. All practices received the highest possible level of recognition. Level 3 is the highest level for Electronic Health Record (EHR) practices and the highest for paper practices is Level 2. Out of a possible 100 points, our EHR clinics scored in the mid-90s on average. This means that we now have 60 practices, 271 physicians, and 59 non-physician providers (APRNs and PAs) in recognized medical homes. This is the second highest total of any system in the nation.

During this implementation and application process we have seen engagement in new discussions around topics like pre-visit planning, ambulatory care coordination, patient/family activation and patient access. More practices have extended hours than ever before. Heart failure readmissions have dropped significantly. Diabetes scores have improved. Guidelines have been standardized across our practices including many specialty practices. Insurers are coming to us asking for PCMH contracts that allow for new funded resources and opportunities for shared savings.

The journey started many years ago with the Quality committee's work on quality standards and measurement of preventive services and diabetes metrics. It continued with the work of the Service Excellence committee, the Ambulatory EHR committee, Patient Safety committee, Disease Management and EHR Content Committee, and then the PCMH Task Force. The medical home applications included work from all of these committees.

Join me in thanking the chairwomen/chairmen and members of these committees for their hard work as well Sarah Gahm and David Winter for their leadership. Of course we should especially thank Pat Link, the PCMH Director, and her team of consultants, writers and contributors: Endia Kendrick, Michell Martin, Niki Shah, Patrice McConnell, Ashley Wood, Vivian Plumlee, Joe Brumbelow, Nancy Trinh, Kelly Risinger, Beulah Casey, Cynthia Granade and Tim Houtchens. We also need to thank our physician auditor team who gave personal time to audit over 2,300 patient records, Drs. Hickl, Astbury, Aponte, Molen, Massey, Stroud, Thompson, Bassel, Berry, Caudill, Garcia, De Leon, Holbrook, McMillin and Sharp.

The journey of course never ends. We are already implementing the new PCMH criteria into our practices. Many of these are meaningful use criteria. We are also preparing to apply for NCQA recognition for our new practices under these new guidelines as well as preparing to support BQA non-HTPN practices.

We are blessed to have a group of physicians, nurse practitioners, physician assistants, administrators and staff who strive to provide safe, effective, efficient, equitable, timely and patient centered care. It makes our work more enjoyable and meaningful.

Thank You All,

Cliff Fullerton, M.D., M.Sc.
VP Chronic Disease Baylor Health Care System
Chief Quality Officer HTPN

What a privilege to be working in tandem with our partners at Baylor and Health Texas!  CitySquare continues to help provide the highest quality care possible to low income neighbors in the inner city of East and South Dallas. 

Way to go, CitySquare team!



Private Screening of "Killer at Large"


At CitySquare, we believe in health for all. Over 600,000 residents of Dallas County lack health insurance, which means they are forced to use emergency rooms as their sole source of medical care. Often, these crises could have been prevented with proper preventative health care. A simple cavity becomes an abcess with infection. Uncontrolled diabetes becomes a life-threatening blood sugar crisis. A heart condition becomes fatal without proper medication and maintenance.

Not only does lack of healthcare affect the health of individuals in our community, but it impacts their ability to work and to be the type of parent, spouse or community member they could otherwise become.

Join us for a free screening of the provocative documentary about the correlation between obesity and poor health, “Killer at Large: Why Obesity is America’s Greatest Threat.”

WHEN 7:00 p.m. Thursday, June 23, 2011

WHERE Angelika Film Center & Cafe

(5321 East Mockingbird Lane, Suite 230, Dallas, TX 75206)

Click here to register!

Obesity rates in the United States have reached epidemic proportions in recent years. The Centers for Disease Control estimate that at least 110,000 people die per year due to obesity and 1/3 of all cancer deaths are directly related to it. From our human evolution and our changing environment to the way our government's public policies are actually causing obesity, Killer at Large shows how little is being done and more importantly, what can be done to reverse it.

Killer at Large also explores the human element of the problem with portions of the film that follow a 12-year old girl who has a controversial liposuction procedure to fix her weight gain and a number of others suffering from obesity, including filmmaker Neil Labute.

[Brought to you as a service of the Public Policy Department at CitySquare.]

Community medicine. . .really!

Here at CitySquare we've been working off of a "community care," community-based model in our Community Health Services department for a long time.

Listen to the following NPR report describing new approaches to medical education and community health improvement.  When in doubt, go to the community!

New Medical School Model: Adopt A Family to Treat

Diabetes and depression--hand-in-hand?

Type-2 diabetes continues to ravage low-income, inner city communities.  Many factors contribute to the escalating health challenge, including diet, obesity and the lack of safe places for exercise.  Now comes a study indicating that diabetes and depression may be feeding each other. 

As I read the report below from the "Health Day" section of Bloomberg News, I recalled a conversation I had with an elderly woman from South Dallas years ago. 

"Brother Larry," she said, "around here we carry our grief in buckets."  Her way of describing the many sources and forces behind her own depression.  The work we do creating hope and friendship as a vital part of our daily response to diabetes is right on target. 

Diabetes, Depression Can Be Two-Way Street


By Ellin Holohan
HealthDay Reporter

MONDAY, Nov. 22 (HealthDay News) -- Diabetes and depression are conditions that can fuel each other, a new study shows.

The research, conducted at Harvard University, found that study subjects who were depressed had a much higher risk of developing diabetes, and those with diabetes had a significantly higher risk of depression, compared to healthy study participants.

"This study indicates that these two conditions can influence each other and thus become a vicious cycle," said study co-author Dr. Frank Hu, a professor of nutrition and epidemiology at the Harvard School of Public Health in Boston. "Thus, primary prevention of diabetes is important for prevention of depression, and vice versa."

To read the entire report click here.

"Let's Move" time to join the effort!

Central Dallas Ministries plays a part in the "Let's Move" initiative here in Dallas by providing healthy after school and summer lunches to thousands of children.

This summer our Nurture, Knowledge and Nutrition program will deliver meals to over 200 sites where children take advantage of organized summer activities.

In addition, thanks to a partnership involving our AmeriCorps team, PepsiCo and the Texas Department of Agriculture, an additional 500,000 meals will be delivered to thousdands of children who are not enrolled in organized programs, but who need the food. All together we expect to deliver and serve well over 1 million meals.  Our efforts focus on reaching as many children as possible with healthier food than ever before.

The video provides some national context for our local efforts. Enjoy!

Urban Farm at Paul Quinn College

Michael Sorrell, President of Paul Quinn College, possesses a clear vision for the renaissance of the historically black college. A new factor in Dr. Sorrell's dream involves engagement, big time engagement, in the urban farming movement that is gaining strength in Dallas.

Recently, I visited the Paul Quinn campus and captured the video posted below. The school recently plowed up its football field as a part of its conversion into an "urban farm."

The idea is to involve students and neighbors in the farming/gardening. The crop will be distributed to the growers, the community and hopefully a market.

Students at the school will benefit from the experiences of the farm in numerous ways. Much about the plan is still being worked out, but I believe Dr. Sorrell is really onto something important and special.

The revival of this important community institution may be one of the results of this innovative approach to community health and development.

Stay tuned.

"Medical ghetto"?

Even though I expect this post will set off a firestorm of comments, many or most of which will be very negative, I cannot find the words to properly express just how offensive I find the words of Senator Lamar Alexander (R-TN) during a speech he delivered in the current Senate health care debate.

Give him your attention.



In the first place, Medicaid represents the only health care option available to a portion, and only a portion, of the very poor in America. The major negative associated with Medicaid relates directly to the fact that so few physicians will accept patients covered by the otherwise very good plan.

As a result, my poorest neighbors must wait for care, and not only in long lines or in crowded clinic and ER waiting rooms, but for weeks at a time for scheduled treatment. This would be remedied if we had the benefit of a comprehensive, national health care plan.

But second, and even more offensive, if the good Senator feels that Medicaid is a "health care ghetto." doesn't he have a moral responsibility to improve it? Doesn't he have a fiscal responsibility to the nation to reform it, extend it and promote it? Hasn't he signed on as a national leader with the responsibilities that accompany such a decision? 

Never mind the obvious race baiting here. Let's talk quality, equity and health care justice, not to mention improving the nation's wellness and health outcomes across a broad array of health measures.

Senator, please!

Cover everyone or worry about donations???

Here's a really great essay by E. J. Dionne, Jr., "Uncharitable Charities" from today's edition of The Washington Post.

Thoughts?

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Indra Nooyi

We've come to know and appreciate PepsiCo and its CEO, Indra Nooyi. Her vision, her values and the team she leads inspire us.

Her vision for sustainable business models that can benefit and "lift" low-income residents of inner city communities is unique. I'm convinced business must play a new role in any sustainable approach to overcoming poverty.

We're working together on some exciting ideas.

More to come.

Enjoy this window into her vision and business philosophy. May her tribe increase!

Our latest E-magazine

Check out Central Dallas Ministries' latest e-magazine here.

Reactions welcome!

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Health Care Crisis

The health care "debate" rages on, fueled at times by hysterical fears and plenty of outright falsehood.

What seems lost to many is the growing need among millions of Americans for basic health care.

Take a look at the video. It first aired on "60 Minutes" in 2008 before the Presidential election.



Sustainability and scale are the key challenges facing "free clinics" like the ones featured in the report. We need to find a way to care for one another, and that means everyone.

Reactions?
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Waiting for a doctor's care. . .nothing new here

Forgive me for not being too sympathetic. But, I find the barrage of TV ads concerning the evil health threat posed by the Obama health care reform plan laughable.

For the past 15 years I've been surrounded by countless friends who have had to wait and wait to receive the health care they needed to stay alive. Due to delayed treatment and diagnosis, many of my friends died.

Why?

Simply because they were poor, uninsured and unable to pay for the care their conditions demanded. Too young for Medicaid, too poor for private insurance and too sick to be effectively treated by the MASH approach of the Emergency Departments of local hospitals, my friends had to wait.

They waited on charity--on folks like me to beg for free treatment.

They waited on disease severity to reach a point where the ER might lead to hospitalization.

They waited for admission to Parkland where everything is over crowded beyond belief.

So, you'll understand if I'm not moved by the concerns of the well off, like myself, who get the best of care because we can pay to buy private health insurance. I'm certainly not concerned with the pain of the insurance lobbyists.

I say provide coverage for everyone. Let all of us pay something based on ability. Let everyone receive the care needed.

Frankly, if I have to wait on my brother or sister to go first, I'm ready to do so.

In every other developed nation on the planet this willingness to share and to wait, just a bit, results in far better national, public health outcomes than are realized in the USA at a fraction of the per capita cost.

We need to read the Golden Rule as we consider what is needed in health care reform. And, even more, we need to remember one another.

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