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PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 22265220.
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FORM 990 SCHEDULE H PART VI SUPPLEMENTAL INFORMATION
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THE PURPOSE OF THIS FORM 990 SCHEDULE H NARRATIVE DISCLOSURE IS TO HELP THE READER UNDERSTAND IN MORE DETAIL HOW THE MEDICAL CENTER CARES FOR ITS COMMUNITY BY PROVIDING CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS, AS WELL AS COMMUNITY BUILDING ACTIVITIES. AS DEMONSTRATED IN THIS SCHEDULE H, ALMOST 30% OF THE MEDICAL CENTER'S TOTAL EXPENSES ARE INCURRED IN PROVIDING CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. THE MEDICAL CENTER PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT WHICH IS SUBMITTED TO THE MASSACHUSETTS ATTORNEY GENERAL EACH YEAR. THAT FILING IS AVAILABLE FOR PUBLIC INSPECTION AT THE ATTORNEY GENERAL'S OFFICE AND ON THEIR WEBSITE AND AT THE MEDICAL CENTER UPON REQUEST. A COPY IS ATTACHED ANNUALLY TO THE MEDICAL CENTER'S FORM 990 FILING. THERE ARE SOME DIFFERENCES BETWEEN THE MASSACHUSETTS ATTORNEY GENERAL DEFINITION OF CHARITY CARE AND COMMUNITY BENEFITS AND THE INTERNAL REVENUE SERVICE DEFINITION OF COMMUNITY CARE AND COMMUNITY BENEFITS. AS SUCH, THERE ARE VARIANCES BETWEEN THIS SCHEDULE H DISCLOSURE AND THE REPORT THE MEDICAL CENTER FILED WITH THE ATTORNEY GENERAL'S OFFICE. CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS - CHARITY CARE AND MEANS TESTED GOVERNMENT PROGRAMSCHARITY CAREAS REPORTED IN THE MEDICAL CENTER'S CONSOLIDATED FINANCIAL STATEMENT AND IN THIS FORM 990 SCHEDULE H, THE MEDICAL CENTER'S NET COST OF CHARITY CARE, INCLUDING CARE FOR EMERGENT SERVICES PROVIDED TO NON-PAYING PATIENTS AND INCLUDING PAYMENTS TO AND RECEIPTS FROM THE HEALTH SAFETY NET TRUST, WAS $16,641,317 IN FISCAL YEAR ENDED SEPTEMBER 30, 2011 AND HAS BEEN REPORTED ON THIS SCHEDULE H. AS NOTED THROUGHOUT THIS FORM 990, HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER (HMFP) IS AN ENTITY EXEMPT FROM INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, AND IS THE DEDICATED PHYSICIAN PRACTICE OF THE MEDICAL CENTER. THE OPERATIONS OF HMFP AND THE ENTITIES FOR WHICH HMFP SERVES AS MEMBER, ARE INTEGRALLY RELATED TO THE MEDICAL CENTER'S ACCOMPLISHMENTS OF ITS PURPOSES. AS PART OF THIS RELATIONSHIP, HMFP PATIENTS WHO MEET THE FREE CARE CRITERIA OF BIDMC ARE PROVIDED FREE CARE AT HMFP, AND ITS AFFILIATED ENTITIES. DURING THE FISCAL PERIOD COVERED BY THIS FILING, HMFP AND ITS AFFILIATED ENTITIES PROVIDED ADDITIONAL ESTIMATED FREE CARE TO PATIENTS OF $3,800,000 ADJUSTED BY THE MEDICAL CENTER'S COST TO CHARGE RATIO. SEE ADDITIONAL INFORMATION BELOW IN THIS SCHEDULE H NARRATIVE.OTHER UNCOMPENSATED CHARITY CARE - MEDICAID AND MEDICAREIN ADDITION TO THE CHARITY CARE REPORTED ABOVE, THE MEDICAL CENTER ALSO PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN OTHER PROGRAMS DESIGNED TO SUPPORT LOW INCOME FAMILIES, INCLUDING THE MEDICAID PROGRAM, WHICH IS JOINTLY FUNDED BY FEDERAL AND STATE GOVERNMENTS. THE MASSACHUSETTS HEALTH REFORM LAW PROVIDED AN INITIATIVE FOR EXPANSION OF MEDICAID COVERAGE TO GREATER POPULATIONS AND FOR ENROLLMENT OF UNINSURED PATIENTS IN OTHER INSURANCE PROGRAMS. PAYMENTS FROM MEDICAID AND OTHER PROGRAMS WHICH INSURE LOW INCOME POPULATIONS DO NOT COVER THE COST OF SERVICES PROVIDED. DURING THE FISCAL PERIOD COVERED BY THIS FILING, 16.8% OR 142,592 OF THE MEDICAL CENTER'S PATIENT ENCOUNTERS WERE WITH MEDICAID PATIENTS. THIS TRANSLATED TO $103,681,840 IN MEDICAID REVENUE WHICH WAS LESS THAN THE COST OF CARE PROVIDED BY THE MEDICAL CENTER FOR SUCH SERVICES BY $24,793,964, AS REPORTED ON THIS SCHEDULE H. MEDICARE IS THE FEDERALLY SPONSORED HEALTH INSURANCE PROGRAM FOR ELDERLY OR DISABLED PATIENTS AND THE MEDICAL CENTER PROVIDES CARE TO PATIENTS WHO PARTICIPATE IN THE MEDICARE PROGRAM. DURING THE FISCAL PERIOD COVERED BY THIS FILING, 30.1% OR 257,218 OF THE MEDICAL CENTER'S PATIENT ENCOUNTERS WERE WITH MEDICARE PATIENTS. THIS TRANSLATED TO $309,754,459. HOWEVER, BECAUSE PAYMENTS TO HOSPITALS THROUGH THIS GOVERNMENT SPONSORED PROGRAM HAVE NOT KEPT PACE WITH INFLATION, REVENUE COLLECTED WAS LESS THAN THE COST OF SERVICES BY $6,073,029. OF THAT AMOUNT, $3,964,469 RELATES TO THE PROVISION OF INPATIENT PSYCHIATRIC CARE AND IS INCLUDED ON THIS SCHEDULE H AS PART OF SUBSIDIZED HEALTH SERVICES. ALTHOUGH THE MEDICAL CENTER CONSIDERS THE PROVISION OF CLINICAL CARE TO MEDICARE PATIENTS AS PART OF ITS COMMUNITY BENEFIT, THE ADDITIONAL MEDICARE SHORTFALL OF $2,108,560 IS NOT QUANTIFIED ON PAGE 1 OF THE SCHEDULE H, PER THE IRS INSTRUCTIONS. RATHER IT HAS BEEN SEPARATELY REPORTED IN SCHEDULE H PART III AS REQUIRED.BAD DEBTSAS REPORTED IN THE BETH ISRAEL DEACONESS MEDICAL CENTER AND AFFILIATES AUDITED FINANCIAL STATEMENT FOR THE PERIOD COVERED BY THIS FILING, IN ADDITION TO CHARITY CARE AND SHORTFALLS IN PROVIDING SERVICES TO PATIENTS INSURED UNDER STATE AND FEDERAL PROGRAMS, THE MEDICAL CENTER ALSO INCURS LOSSES RELATED TO SELF-PAY PATIENTS WHO FAIL TO MAKE PAYMENTS FOR SERVICES OR INSURED PATIENTS WHO FAIL TO PAY COINSURANCE OR DEDUCTIBLES FOR WHICH THEY ARE RESPONSIBLE UNDER INSURANCE CONTRACTS. BAD DEBT EXPENSE IS INCLUDED IN UNCOMPENSATED CARE EXPENSE IN THE CONSOLIDATED FINANCIAL STATEMENTS, AND INCLUDES THE PROVISION FOR ACCOUNTS ANTICIPATED TO BE UNCOLLECTIBLE. CHARGES FOR THOSE SERVICES WERE $22,265,220 DURING THE FISCAL PERIOD COVERED BY THIS FILING AND ARE REPORTED AS BAD DEBTS ON FORM 990 PART IX, FUNCTIONAL EXPENSES. THE ESTIMATED COST OF PROVIDING SUCH SERVICES WAS APPROXIMATELY $5,220,889 IN 2011. AS REQUIRED BY THE INSTRUCTIONS TO THIS FORM 990 SCHEDULE H, THIS AMOUNT HAS NOT BEEN INCLUDED IN THE CALCULATION OF CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS IN SCHEDULE H PART I LINE 7. RATHER IT HAS BEEN SEPARATELY REPORTED IN SCHEDULE H PART III AS REQUIRED.THE PERCENTAGES CALCULATED IN PART I LINE 7 COLUMN F WERE BASED ON EACH ITEM OF COMMUNITY BENEFIT AS REQUIRED AS A PERCENTAGE OF TOTAL EXPENSES REPORTED IN PART IX OF THIS FORM 990 DECREASED BY THE BAD DEBT EXPENSE BASED ON CHARGES ALSO REPORTED IN THE PART IX OF THIS FORM 990.
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BIDMC - COMMUNITY BUILDING ACTIVITIESBETH ISRAEL DEACONESS MEDICAL CENTER IS A SUPPORTER AND SPONSOR OF THE CITY OF BOSTON'S BICYCLE SHARE PROGRAM, WHICH THE MAYOR OF BOSTON ANNOUNCED ON EARTH DAY, APRIL 21, 2011 AND LAUNCHED JUY 28, 2011. THIS "HUBWAY" SYSTEM WAS INITIATED UNDER THE MAYOR'S NATIONALLY RECOGNIZED PROGRAM, WHICH AIMS TO BUILD BOSTON INTO ONE OF THE WORLD'S PREMIERE CYCLING CITIES. THE CITY OF BOSTON IS WORKING WITH STATE AND FEDERAL AUTHORITIES ON THIS PROGRAM WHICH PROMOTES A HEALTHIER TRANSPORTATION OPTION AND AIMS TO DECREASE LOCAL POLLUTION BY DECREASING FOSSIL FUEL CAR USE. THE MEDICAL CENTER IS COMMITTED TO CREATING A SKILLED, DIVERSE WORKFORCE AT ALL LEVELS THROUGH VARIOUS EMPLOYEE AND HIGH SCHOOL STUDENT PROGRAMS. THE MEDICAL CENTER MAKES EMPLOYMENT OPPORTUNITIES AVAILABLE TO QUALIFIED COMMUNITY RESIDENTS THROUGH TRAINING INTERNSHIPS CONDUCTED IN PARTNERSHIP WITH COMMUNITY AGENCIES. WORKING WITH OTHER GROUPS, INCLUDING THE WORK PLACE, FENWAY COMMUNITY DEVELOPMENT CORPORATION, AND JAMAICA PLAIN NEIGHBORHOOD DEVELOPMENT CORPORATION, THE MEDICAL CENTER SEEKS OUT AND INTERVIEWS QUALIFIED COMMUNITY RESIDENTS WHO REFLECT THE CULTURAL DIVERSITY OF THE COMMUNITY SERVED BY THE MEDICAL CENTER AND WHO HAVE APPLIED FOR JOBS. KNOWING THE IMPORTANCE OF PROVIDER/PATIENT CULTURAL CONCORDANCE IN PROVIDING QUALITY CARE, THE MEDICAL CENTER INAUGURATED THE OFFICE OF MULTICULTURAL AFFAIRS (OMA) DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2010. THE OMA WAS CREATED TO REAFFIRM THE INSTITUTION'S ONGOING COMMITMENT TO DIVERSITY AND SPECIFICALLY CHARGED THE OMA WITH RECRUITMENT OF DIVERSE RESIDENTS AND FELLOWS, RETENTION OF JUNIOR FACULTY OF COLOR, AND EDUCATION OF HOUSE STAFF AND FACULTY. EVIDENCE OF THIS SUCCESSFUL ORGANIZATIONAL CHANGE AND STRATEGY WAS SEEN IN THE RESIDENCY RECRUITMENT EFFORTS FOR THE FISCAL YEAR COVERED BY THIS TAX FILING WHERE THE MEDICAL CENTER EXPERIENCED A 25% INCREASE IN THE NUMBER OF UNDERREPRESENTED (URM) APPLICATIONS INTERVIEWED AND A 47% INCREASE IN THE NUMBER OF URM APPLICANTS RANKED TO MATCH AT THE MEDICAL CENTER.THE MEDICAL CENTER IS ALSO COMMITTED TO THE BOSTON AREA'S STUDENT POPULATION, AND PROVIDES SUMMER JOBS AND MID-YEAR INTERNSHIPS TO INTRODUCE HIGH SCHOOL STUDENTS AND OUT-OF-SCHOOL YOUTH TO CAREERS IN THE MEDICAL FIELD. IN ADDITION, THE MEDICAL CENTER PARTNERS WITH THE BOSTON PRIVATE INDUSTRY COUNCIL, AND HOSTS BOSTON PUBLIC HIGH SCHOOL STUDENTS IN AN ANNUAL JOB SHADOW DAY WITH ADDITIONAL STUDENT GROUPS TOURING OUR SKILLS LAB. COLLABORATING WITH THE RED SOX FOUNDATION, THE MEDICAL CENTER CREATED THE RED SOX MENTORS PROGRAM TO SUPPORT 25 6TH-GRADERS ANNUALLY TO SUCCEED IN SCHOOL. UPON GRADUATION, STUDENTS RECEIVE A $10,000 COLLEGE SCHOLARSHIP AS WELL AS THE LIFE-LONG FRIENDSHIP AND SUPPORT OF THE RED SOX MENTOR, ALL DESIGNED TO ENCOURAGE THESE STUDENTS TO REMAIN IN SCHOOL.BIDMC - EMERGENCY CARE ACCESSTHE MEDICAL CENTER IS THE FRONTLINE CAREGIVER PROVIDING MEDICALLY NECESSARY CARE FOR ALL PEOPLE REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL OFFERS THIS CARE FOR ALL PATIENTS THAT COME TO OUR FACILITY 24 HOURS A DAY, SEVEN DAYS A WEEK, AND 365 DAYS A YEAR. BIDMC - CREDIT AND COLLECTION POLICY GUIDING PRINCIPLESTHE MEDICAL CENTER ASSISTS PATIENTS IN OBTAINING FINANCIAL ASSISTANCE FROM PUBLIC PROGRAMS AND OTHER SOURCES WHENEVER APPROPRIATE. TO REMAIN VIABLE AS IT FULFILLS ITS MISSION, THE MEDICAL CENTER MUST MEET ITS FIDUCIARY RESPONSIBILITY TO APPROPRIATELY BILL AND COLLECT FOR MEDICAL SERVICES PROVIDED TO PATIENTS. THE MEDICAL CENTER'S CREDIT AND COLLECTION POLICY, WHICH APPLIES TO THE MEDICAL CENTER AND ANY OTHER ENTITY WHICH IS PART OF THE MEDICAL CENTER'S LICENSE OR TAX IDENTIFICATION NUMBER, IS DESIGNED TO COMPLY WITH BOTH THE MASSACHUSETTS HEALTH SAFETY NET REGULATIONS ON CREDIT AND COLLECTION POLICIES, THE CENTERS FOR MEDICARE AND MEDICAID SERVICES MEDICARE BAD DEBT REQUIREMENTS, THE MEDICARE PROVIDER REIMBURSEMENT MANUAL AND THE FEDERAL HEALTHCARE REFORM LAW'S "FINANCIAL ASSISTANCE POLICY" FOR WHICH THE IRS HAD PROVIDED PRELIMINARY GUIDANCE AT THE TIME THE MEDICAL CENTER FINALIZED THIS POLICY. THE MEDICAL CENTER CONTINUES TO MONITOR GUIDANCE FROM THE IRS AS IT IS ISSUED. BIDMC DOES NOT DISCRIMINATE ON THE BASIS OF RACE, COLOR, NATIONAL ORIGIN, CITIZENSHIP, ALIENAGE, RELIGION, CREED, SEX, SEXUAL ORIENTATION, DISABILITY, OR AGE IN ITS POLICIES OR IN ITS APPLICATION OF POLICIES CONCERNING THE ACQUISITION AND VERIFICATION OF FINANCIAL INFORMATION, PRE-ADMISSION OR PRE-TREATMENT DEPOSITS, PAYMENT PLANS, DEFERRED OR REJECTED ADMISSIONS, LOW INCOME PATIENT STATUS AS DETERMINED BY THE MASSACHUSETTS OFFICE OF MEDICAID, DETERMINATION THAT A PATIENT IS LOW-INCOME, OR IN ITS BILLING AND COLLECTION PRACTICES. BIDMC - CREDIT AND COLLECTION POLICY - NOTICE OF AVAILABILITY OF FINANCIAL ASSISTANCE AND OTHER COVERAGE OPTIONSFINANCIAL ASSISTANCE IS INTENDED TO ASSIST LOW-INCOME PATIENTS WHO DO NOT OTHERWISE HAVE THE ABILITY TO PAY FOR THEIR HEALTH CARE SERVICES. SUCH ASSISTANCE TAKES INTO ACCOUNT EACH INDIVIDUAL'S ABILITY TO CONTRIBUTE TO THE COST OF HIS OR HER CARE. FOR PATIENTS THAT ARE UNINSURED OR UNDERINSURED, THE MEDICAL CENTER WILL ASSIST THEM IN APPLYING FOR AVAILABLE FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER ALL OR SOME OF THEIR UNPAID HOSPITAL BILLS.THE MEDICAL CENTER PROVIDES THIS ASSISTANCE FOR BOTH RESIDENTS AND NON-RESIDENTS OF MASSACHUSETTS; HOWEVER, THERE MAY NOT BE COVERAGE FOR A MASSACHUSETTS HOSPITAL'S SERVICES THROUGH AN OUT-OF STATE PROGRAM. IN ORDER FOR THE MEDICAL CENTER TO ASSIST UNINSURED AND UNDERINSURED PATIENTS FIND THE MOST APPROPRIATE COVERAGE OPTIONS, PATIENTS MUST ACTIVELY WORK WITH THE HOSPITAL'S FINANCIAL COUNSELORS TO VERIFY THEIR FINANCIAL AND OTHER INFORMATION THAT COULD BE USED IN DETERMINING ELIGIBILITY. THE MEDICAL CENTER ADVISES PATIENTS OF THEIR RIGHT TO (I) APPLY FOR MASSHEALTH AND LOW INCOME PATIENT DETERMINATION AND (II) A PAYMENT PLAN. THE MEDICAL CENTER'S FINANCIAL CLEARANCE UNIT (FCU) WILL ASSIST PATIENTS IN FULFILLING THEIR RIGHT TO APPLY FOR COVERAGE WITHIN A FINANCIAL ASSISTANCE PROGRAM INCLUDING MASSHEALTH, COMMONWEALTH CARE, CHILDREN'S MEDICAL SECURITY PLAN, HEALTHY START, MEDICAL HARDSHIP THROUGH THE HEALTH SAFETY NET, HEALTH SAFETY NET AND/OR OTHER FINANCIAL PROGRAMS AS AVAILABLE AND APPROPRIATE.THE MEDICAL CENTER ALSO WILL ASSIST UNINSURED OR UNDERINSURED PATIENTS, WHEN REQUESTED OR AS IDENTIFIED THROUGH INTERNAL SCREENING PROCEDURES, IN APPLYING FOR AVAILABLE FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER SOME OR ALL OF THEIR UNPAID MEDICAL CENTER BILLS. IN ORDER TO HELP UNINSURED AND UNDERINSURED PATIENTS FIND AVAILABLE AND APPROPRIATE FINANCIAL ASSISTANCE PROGRAMS, THE MEDICAL CENTER WILL PROVIDE ALL PATIENTS WITH A GENERAL NOTICE OF THE AVAILABILITY OF PROGRAMS IN BOTH THE INITIAL BILL THAT IS SENT TO PATIENTS WHO HAVE A FINANCIAL LIABILITY AS WELL AS IN GENERAL NOTICES THAT ARE POSTED THROUGHOUT THE MEDICAL CENTER.THE MEDICAL CENTER WILL TRY TO IDENTIFY AVAILABLE COVERAGE OPTIONS FOR PATIENTS WHO MAY BE UNINSURED OR UNDERINSURED WITH THEIR CURRENT INSURANCE PROGRAM WHEN THE PATIENT IS SCHEDULING SERVICES, WHILE THE PATIENT IS AT THE MEDICAL CENTER, UPON DISCHARGE, AND/OR FOR A REASONABLE TIME FOLLOWING DISCHARGE FROM THE HOSPITAL. THE HOSPITAL WILL DIRECT ALL PATIENTS SEEKING INFORMATION ON AVAILABLE COVERAGE OPTIONS, OR THOSE THAT THE HOSPITAL DETERMINES MAY BE ELIGIBLE, TO THE HOSPITAL'S FCU WHERE PATIENT FINANCIAL COUNSELORS CAN SCREEN PATIENTS FOR ELIGIBILITY IN AN APPROPRIATE COVERAGE OPTION. THE HOSPITAL WILL THEN ASSIST THE PATIENT IN APPLYING FOR APPROPRIATE COVERAGE OPTIONS THAT ARE AVAILABLE TO THEM.WHEN REQUESTED, THE HOSPITAL WILL ALSO PROVIDE INFORMATION ON HOW TO CONTACT THE APPROPRIATE STAFF WITHIN THE HOSPITAL'S FINANCE OFFICE TO VERIFY THE ACCURACY OF THE HOSPITAL BILL OR TO DISPUTE CERTAIN CHARGES. CONTACT INFORMATION IS PRINTED ON ALL PATIENT STATEMENTS.FOR CASES WHERE THE HOSPITAL IS USING THE VIRTUAL GATEWAY APPLICATION, THE HOSPITAL WILL ASSIST THE PATIENT IN COMPLETING THE APPLICATION FOR MASSHEALTH, COMMONWEALTH CARE, CHILDREN'S MEDICAL SECURITY PLAN, HEALTHY START, HEALTH SAFETY NET, OR OTHER FORMS OF FINANCIAL ASSISTANCE PROGRAMS AS THEY BECOME PART OF THE VIRTUAL GATEWAY PROGRAM, WHICH IS AN INTERNET PORTAL DESIGNED BY THE MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES IN ORDER TO PROVIDE THE GENERAL PUBLIC, MEDICAL PROVIDERS, AND COMMUNITY-BASED ORGANIZATIONS WITH AN ONLINE APPLICATION FOR THE PROGRAMS OFFERED BY THE COMMONWEALTH.
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BIDMC - CREDIT AND COLLECTION POLICY - ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMSBIDMC PROVIDES PATIENTS WITH INFORMATION ABOUT FINANCIAL ASSISTANCE PROGRAMS THAT ARE AVAILABLE THROUGH THE COMMONWEALTH OF MASSACHUSETTS OR OTHER AVAILABLE PROGRAMS FOR WHICH THE PATIENT MAY BE ELIGIBLE, WHICH MAY COVER ALL OR SOME OF THEIR UNPAID HOSPITAL BILL. FOR PATIENTS THAT REQUEST SUCH ASSISTANCE, THE HOSPITAL ASSISTS THEM BY SCREENING FOR ELIGIBILITY IN AN AVAILABLE PUBLIC PROGRAM AND ASSISTING THEM IN APPLYING FOR THE PROGRAM. THESE PROGRAMS INCLUDE, BUT ARE NOT LIMITED TO: MASSHEALTH, COMMONWEALTH CARE, CHILDREN'S MEDICAL SECURITY PLAN, HEALTHY START, HEALTH SAFETY NET, AND OTHERS. WHEN APPLICABLE THE HOSPITAL MAY ALSO ASSIST PATIENTS IN APPLYING FOR COVERAGE OF SERVICES AS A MEDICAL HARDSHIP BASED ON THE PATIENT'S DOCUMENTED FAMILY INCOME, CURRENT AND PRIOR INSURANCE COVERAGE AND ALLOWABLE MEDICAL EXPENSES. IT IS THE PATIENT'S OBLIGATION TO PROVIDE THE FINANCIAL COUNSELORS WITH ACCURATE AND TIMELY INFORMATION REGARDING THEIR FULL NAME, ADDRESS, TELEPHONE NUMBER, DATE OF BIRTH, SOCIAL SECURITY NUMBER (IF AVAILABLE), CURRENT HEALTH INSURANCE COVERAGE OPTIONS, INCLUDING OTHER INSURANCE OR COVERAGE OPTIONS (SUCH AS MOTOR VEHICLE POLICY OR WORKER'S COMPENSATION POLICY) THAT CAN COVER THE COST OF THE CARE RECEIVED AND ANY OTHER APPLICABLE FINANCIAL RESOURCES, AND CITIZENSHIP AND RESIDENCY INFORMATION - ALL TO DETERMINE IF THE PATIENT IS ELIGIBLE TO APPLY FOR CERTAIN HEALTH INSURANCE PROGRAMS. IF THERE IS NO SPECIFIC COVERAGE FOR THE SERVICES PROVIDED, THE HOSPITAL WILL USE THE INFORMATION TO DETERMINE IF THE SERVICES MAY BE COVERED BY AN APPLICABLE PROGRAM THAT WILL COVER CERTAIN SERVICES DEEMED BAD DEBT. IN ADDITION, THE HOSPITAL WILL USE THIS INFORMATION TO DISCUSS ELIGIBILITY FOR CERTAIN HEALTH INSURANCE PROGRAMS. THE SCREENING AND APPLICATION PROCESS FOR A PUBLIC HEALTH INSURANCE PROGRAM IS DONE THROUGH THE VIRTUAL GATEWAY, WHICH IS AN INTERNET PORTAL DESIGNED BY THE MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES IN ORDER TO PROVIDE THE GENERAL PUBLIC, MEDICAL PROVIDERS, AND COMMUNITY-BASED ORGANIZATIONS WITH AN ONLINE APPLICATION FOR THE PROGRAMS OFFERED BY THE STATE OR THROUGH A STANDARD PAPER APPLICATION THAT IS COMPLETED BY THE PATIENT AND ALSO SUBMITTED DIRECTLY TO THE MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES FOR PROCESSING AS THIS OFFICE SOLELY MANAGES THE APPLICATION PROCESS LISTED ABOVE, WHICH IS AVAILABLE FOR CHILDREN, ADULTS, SENIORS, VETERANS, HOMELESS, AND DISABLED INDIVIDUALS. THE HOSPITAL SPECIFICALLY ASSISTS THE PATIENT IN COMPLETING THE APPLICATION AND SECURING THE NECESSARY DOCUMENTATION REQUIRED BY THE APPLICABLE FINANCIAL ASSISTANCE PROGRAM. NECESSARY DOCUMENTATION INCLUDES PROOF OF: (1) ANNUAL HOUSEHOLD INCOME (PAYROLL STUBS, RECORD OF SOCIAL SECURITY PAYMENTS, AND A LETTER FROM THE EMPLOYER, TAX RETURNS, OR BANK STATEMENTS), (2) CITIZENSHIP AND IDENTITY, AND (3) IMMIGRATION STATUS FOR NON-CITIZENS (IF APPLICABLE), AND (4) ASSETS OF THOSE INDIVIDUALS WHO ARE ALSO ENROLLED IN THE MEDICARE PROGRAM. THE HOSPITAL WILL THEN SUBMIT THIS DOCUMENTATION TO THE COMMONWEALTH OFFICE OF MEDICAID AND ASSIST THE PATIENT IN SECURING ANY ADDITIONAL DOCUMENTATION IF SUCH IS REQUESTED BY THE COMMONWEALTH AFTER COMPLETING THE APPLICATION. THE COMMONWEALTH PLACES A THREE DAY TIME LIMITATION ON SUBMITTING ALL NECESSARY DOCUMENTATION FOLLOWING THE SUBMISSION OF THE APPLICATION FOR A PROGRAM. FOLLOWING THIS THREE DAY PERIOD, THE PATIENT MUST WORK WITH THE MASSHEALTH ENROLLMENT CENTERS TO SECURE THE ADDITIONAL DOCUMENTATION NEEDED FOR ENROLLMENT IN THE APPLICABLE FINANCIAL ASSISTANCE PROGRAM.IN SPECIAL CIRCUMSTANCES, THE HOSPITAL MAY APPLY FOR THE PATIENT FOR ELIGIBILITY IN THE HEALTH SAFETY NET PROGRAM USING A SPECIFIC FORM DESIGNED BY THE MASSACHUSETTS DIVISION OF HEALTH CARE FINANCE AND POLICY. SPECIAL CIRCUMSTANCES INCLUDE INDIVIDUALS SEEKING FINANCIAL ASSISTANCE COVERAGE DUE TO BEING INCARCERATED, VICTIMS OF SPOUSAL ABUSE, OR APPLYING DUE TO A MEDICAL HARDSHIP.ALL VIRTUAL GATEWAY APPLICATIONS ARE REVIEWED AND PROCESSED BY THE COMMONWEALTH OF MASSACHUSETTS, OFFICE OF MEDICAID, WHICH USES THE FEDERAL POVERTY GUIDELINES, ASSET INFORMATION AS WELL AS NECESSARY DOCUMENTATION LISTED ABOVE AS THE BASIS FOR DETERMINING ELIGIBILITY FOR STATE SPONSORED PUBLIC ASSISTANCE PROGRAMS. BIDMC HAS NO ROLE IN THE DETERMINATION OF PROGRAM ELIGIBILITY MADE BY THE COMMONWEALTH, BUT AT THE PATIENT'S REQUEST MAY TAKE A DIRECT ROLE IN APPEALING OR SEEKING INFORMATION RELATED TO THE COVERAGE DECISIONS. IT IS STILL THE PATIENT'S RESPONSIBILITY TO INFORM THE HOSPITAL OF ALL COVERAGE DECISIONS MADE BY THE COMMONWEALTH TO ENSURE ACCURATE AND TIMELY ADJUDICATION OF ALL HOSPITAL BILLS.BIDMC - CREDIT AND COLLECTION POLICY - BIDMC STANDARD COLLECTION PRACTICESAS PREVIOUSLY NOTED IN THE NARRATIVE TO THIS FORM 990 SCHEDULE H, THE MEDICAL CENTER ASSISTS PATIENTS IN OBTAINING FINANCIAL ASSISTANCE FROM PUBLIC PROGRAMS AND OTHER SOURCES WHENEVER APPROPRIATE. ADDITIONALLY, TO REMAIN VIABLE AS IT FULFILLS ITS MISSION, THE HOSPITAL MUST MEET ITS FIDUCIARY RESPONSIBILITY TO APPROPRIATELY BILL AND COLLECT FOR MEDICAL SERVICES PROVIDED TO PATIENTS. AS SUCH, THE HOSPITAL HAS A FIDUCIARY DUTY TO SEEK REIMBURSEMENT FOR SERVICES IT HAS PROVIDED FROM INDIVIDUALS WHO ARE ABLE TO PAY, FROM THIRD PARTY INSURERS WHO COVER THE COST OF CARE, AND FROM OTHER PROGRAMS OF ASSISTANCE FOR WHICH THE PATIENT IS ELIGIBLE. TO DETERMINE WHETHER A PATIENT IS ABLE TO PAY FOR THE SERVICES PROVIDED AS WELL AS TO ASSIST THE PATIENT IN FINDING ALTERNATIVE COVERAGE OPTIONS IF THEY ARE UNINSURED OR UNDERINSURED, BIDMC HAS ESTABLISHED CRITERIA RELATED TO BILLING AND COLLECTING FROM PATIENTS. BIDMC MAKES THE SAME REASONABLE EFFORT AND FOLLOWS THE SAME REASONABLE PROCESS FOR COLLECTING ON BILLS OWED BY AN UNINSURED PATIENT AS IT DOES FOR ALL OTHER PATIENTS. THE HOSPITAL WILL FIRST SHOW THAT IT HAS A CURRENT UNPAID BALANCE THAT IS RELATED TO SERVICES PROVIDED TO THE PATIENT AND NOT COVERED BY A PRIVATE INSURER OR A FINANCIAL ASSISTANCE PROGRAM. BIDMC ALSO HAS ESTABLISHED CRITERIA RELATED TO BILLING AND COLLECTING FROM PATIENTS. BIDMC AND/OR ITS AGENTS DO NOT CHARGE INTEREST ON AN OVERDUE BALANCE FOR A LOW INCOME PATIENT OR ANY OTHER PATIENT.
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BIDMC - CREDIT AND COLLECTION POLICY - OUTSIDE COLLECTION AGENCIESBIDMC CONTRACTS WITH OUTSIDE COLLECTION AGENCIES TO ASSIST IN THE COLLECTION OF CERTAIN ACCOUNTS, INCLUDING PATIENT RESPONSIBLE AMOUNTS NOT RESOLVED AFTER ISSUANCE OF HOSPITAL BILLS OR FINAL NOTICES. HOWEVER, AS DETERMINED THROUGH THE MEDICAL CENTER'S CREDIT AND COLLECTION POLICY, THE HOSPITAL MAY ASSIGN SUCH DEBT AS BAD DEBT OR CHARITY CARE (OTHERWISE DEEMED AS UNCOLLECTIBLE) PRIOR TO 120 DAYS IF IT IS ABLE TO DETERMINE THAT THE PATIENT WAS UNABLE TO PAY FOLLOWING THE HOSPITALS' OWN INTERNAL FINANCIAL ASSISTANCE PROGRAM.BIDMC HAS A SPECIFIC AUTHORIZATION OR CONTRACT WITH ITS OUTSIDE COLLECTION AGENCIES AND REQUIRES SUCH AGENCIES TO ABIDE BY THE HOSPITAL'S CREDIT AND COLLECTION POLICIES FOR DEBTS THAT THE AGENCY IS PURSUING, INCLUDING THE OBLIGATION TO REFRAIN FROM "EXTRAORDINARY COLLECTION ACTIVITIES" UNTIL SUCH TIME AS THE HOSPITAL HAS MADE A REASONABLE EFFORT AND FOLLOWED A REASONABLE PROCESS FOR DETERMINING THAT A PATIENT IS ENTITLED TO ASSISTANCE OR EXEMPTION FROM ANY COLLECTION OR BILLING PROCEDURES UNDER THIS CREDIT AND COLLECTION POLICY. ALL OUTSIDE COLLECTION AGENCIES HIRED BY THE HOSPITAL WILL PROVIDE THE PATIENT WITH AN OPPORTUNITY TO FILE A GRIEVANCE AND WILL FORWARD TO THE HOSPITAL THE RESULTS OF SUCH PATIENT GRIEVANCES. THE HOSPITAL REQUIRES THAT ANY OUTSIDE COLLECTION AGENCY THAT IT USES IS LICENSED BY THE COMMONWEALTH OF MASSACHUSETTS AND THAT THE OUTSIDE COLLECTION AGENCY ALSO IS IN COMPLIANCE WITH THE MASSACHUSETTS ATTORNEY GENERAL'S DEBT COLLECTION REGULATIONS.BIDMC - CREDIT AND COLLECTION POLICY - EXEMPTION FROM BIDMC COLLECTION PRACTICESBIDMC EXEMPTS PATIENTS ENROLLED IN A PUBLIC HEALTH INSURANCE PROGRAM, INCLUDING BUT NOT LIMITED TO, MASSHEALTH, EMERGENCY AID TO THE ELDERLY, DISABLED AND CHILDREN, HEALTHY START, CHILDREN'S MEDICAL SECURITY PLAN AND "LOW INCOME PATIENTS" AS DETERMINED BY THE OFFICE OF MEDICAID, SUBJECT TO SOME EXCEPTIONS, FROM ANY COLLECTION OR BILLING PROCEDURES BEYOND THE INITIAL BILL PURSUANT TO STATE REGULATIONS.BIDMC - CREDIT AND COLLECTION POLICY - HOSPITAL FINANCIAL ASSISTANCE PROGRAMSTHE HOSPITAL, WHEN REQUESTED BY THE PATIENT AND BASED ON INTERNAL REVIEW OF EACH PATIENT'S FINANCIAL STATUS, MAY OFFER AN ADDITIONAL DISCOUNT ON AN UNPAID BILL. ANY SUCH REVIEW SHALL BE PART OF A SEPARATE HOSPITAL FINANCIAL ASSISTANCE PROGRAM THAT IS APPLIED ON A UNIFORM BASIS TO PATIENTS. ANY DISCOUNT THAT IS PROVIDED BY THE HOSPITAL IS CONSISTENT WITH FEDERAL AND STATE REQUIREMENTS, AND DOES NOT INFLUENCE A PATIENT'S ABILITY TO RECEIVE SERVICES FROM THE HOSPITAL. SUCH PROGRAMS INCLUDE: PROMPT PAY DISCOUNTS FOR UNINSURED PATIENTS, ONE TIME OR SPECIAL CIRCUMSTANCE SITUATIONS AND PAYMENT PLANS.BIDMC - CREDIT AND COLLECTION POLICY - DISCOUNT FOR UNINSURED PATIENTSIN ADDITION TO THE FINANCIAL ASSISTANCE INFORMATION PROVIDED ABOVE, THE MEDICAL CENTER GIVES A SELF-PAY DISCOUNT TO PATIENTS WHO ARE UNINSURED.CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS - COMMUNITY HEALTH IMPROVEMENT SERVICES AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPSCOMMUNITY BENEFITS MISSION STATEMENTTHE MEDICAL CENTER IS COMMITTED TO OUR COMMUNITY. WE HAVE A COVENANT TO CARE FOR THE UNDERSERVED AND TO WORK TO CHANGE DISPARITIES IN ACCESS TO CARE AND TO THAT END THE BOARD OF DIRECTORS HAS CHARGED ITS PERMANENT COMMUNITY BENEFITS COMMITTEE WITH AUTHORITY AND OVERSIGHT OF ACTIVITIES TO FULFILL THE MISSION OF COMMUNITY BENEFITS. WE KNOW THAT TO BE SUCCESSFUL WE NEED TO LEARN FROM THOSE WE SERVE. THIS COMMUNITY BENEFIT MISSION IS FULFILLED BY:- IMPLEMENTING PROGRAMS AND SERVICES IN GREATER BOSTON AND OUTER CAPE COD TO IMPROVE THE CURRENT AND FUTURE HEALTH STATUS OF MEDICALLY UNDERSERVED COMMUNITIES WHICH ARE CHALLENGED BY BARRIERS IN ACCESSING AND INTERACTING EFFECTIVELY WITH THE HEALTHCARE SYSTEM, AND IMPACTED BY OTHER SOCIAL DETERMINANTS OF HEALTH.- ENSURING THAT THE MEDICAL CENTER IS WELCOMING AND INCLUSIVE, AND THAT ALL PATIENTS RECEIVE EQUITABLE CARE THAT IS RESPECTFUL AND CULTURALLY RESPONSIVE; AND- ENCOURAGING COLLABORATIVE RELATIONSHIPS WITH OTHER PROVIDERS AND GOVERNMENT ENTITIES TO SUPPORT AND ENHANCE RATIONAL AND EFFECTIVE HEALTH POLICIES AND PROGRAMS. DURING THE FISCAL YEAR COVERED BY THIS FILING, BIDMC PROVIDED COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS OF $7,996,110 AS REPORTED ON THIS SCHEDULE H LINES 7E AND 7I.
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COMMUNITY BENEFITS PROCESSTHE BOARD OF DIRECTORS HAS CHARGED ITS PERMANENT COMMUNITY BENEFITS COMMITTEE WITH AUTHORITY AND OVERSIGHT OF ACTIVITIES TO FULFILL THE MISSION OF COMMUNITY BENEFITS. SPECIFICALLY, THE RESPONSIBILITIES OF THE COMMITTEE ARE TO:"(I) RECOMMEND BROAD GUIDELINES BY WHICH THE CORPORATION'S PROGRAMS AND POLICIES SERVE ITS COMMUNITIES; (II) MAKE RECOMMENDATIONS OF POLICIES AND PRIORITIES WITH REGARD TO PROGRAMS THAT MEET THE HEALTH CARE NEEDS OF ITS COMMUNITIES; (III) STRENGTHEN THE INTEGRATION OF THE CORPORATION'S COMMUNITY SERVICE ACTIVITIES, PUBLIC HEALTH PROGRAMS AND ITS OVERALL STRATEGIC PLANNING EFFORTS; (IV) REVIEW, AT LEAST ANNUALLY, THE EXTENT AND NATURE OF THE COMMITMENT OF RESOURCES TO PROGRAMS TARGETED AT IMPROVING THE CURRENT AND FUTURE HEALTH STATUS OF SURROUNDING COMMUNITIES; (V) ENCOURAGE COLLABORATIVE RELATIONSHIPS WITH OTHER PROVIDERS AND GOVERNMENT ENTITIES TO SUPPORT AND ENHANCE RATIONAL AND EFFECTIVE PUBLIC HEALTH POLICIES AND PROGRAMS; (VI) DISCUSS PUBLIC POLICY ISSUES AND RELEVANT LEGAL AND REGULATORY MATTERS RELATED TO PUBLIC HEALTH AND COMMUNITY BENEFITS AND ADVISE THE BOARD OF TRUSTEES OF THE IMPLICATIONS FOR THE CORPORATION; AND (VII) EDUCATE TRUSTEES, STAFF AND THE COMMUNITY ABOUT HOW THE CORPORATION ADDRESSES ITS MISSION TO FOCUS ON THE HEALTH NEEDS OF ITS COMMUNITIES."THE MEMBERSHIP OF BIDMC'S COMMUNITY BENEFITS COMMITTEE ASPIRES TO BE REPRESENTATIVE OF THE CONSTITUENCIES AND TARGET POPULATIONS OF OUR PROGRAMMATIC ENDEAVORS INCLUDING THOSE FROM DIVERSE RACIAL AND ETHNIC BACKGROUNDS, AGE, GENDER, SEXUAL ORIENTATION AND GENDER IDENTITY, AS WELL AS THOSE FROM CORPORATE AND NON-PROFIT COMMUNITY ORGANIZATIONS. SENIOR MANAGEMENT IS ACTIVELY ENGAGED IN THE DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY BENEFITS PLAN, ENSURING THAT HOSPITAL POLICIES AND RESOURCES ARE ALLOCATED TO SUPPORT PLANNED ACTIVITIES.IT IS NOT ONLY THE BOARD AND SENIOR LEADERSHIP THAT ARE HELD ACCOUNTABLE IN FULFILLING BIDMC'S COMMUNITY BENEFITS MISSION. CONSISTENT WITH THE MEDICAL CENTER'S CORE VALUES IS THE RECOGNITION THAT THE MOST SUCCESSFUL COMMUNITY BENEFITS PROGRAMS ARE THOSE THAT ARE IMPLEMENTED ORGANIZATION-WIDE AND INTEGRATED INTO THE VERY FABRIC OF THE MEDICAL CENTER'S CULTURE, POLICIES AND PROCEDURES. IT IS NOT A STAND-ALONE EFFORT THAT IS THE RESPONSIBILITY OF ONE STAFF OR DEPARTMENT BUT RATHER AN ORIENTATION AND VALUE MANIFESTED THROUGHOUT OUR STRUCTURE, REFLECTED IN HOW WE PROVIDE CARE HERE AT THE MEDICAL CENTER AND IN AFFILIATED PRACTICES IN URBAN NEIGHBORHOODS AND CERTAIN RURAL AREAS.PROVIDING DIRECTION FOR OUR COLLECTIVE COMMITMENT AND EFFORT ARE THE GUIDING PRINCIPLES AS DESCRIBED HERE. ADOPTED BY A BROAD-BASED CONSTITUENCY OF BOARD, SENIOR LEADERSHIP AND STAFF, THESE PRINCIPLES PROVIDE THE FRAMEWORK FOR THE EXECUTION OF THE PLAN, SPEARHEADED BY THE DIRECTOR OF COMMUNITY BENEFITS. THE DIRECTOR OF COMMUNITY BENEFITS IS ACCOUNTABLE TO THE SENIOR VICE PRESIDENT OF CORPORATE AND COMMUNITY AFFAIRS WITH DIRECT ACCESS TO THE PRESIDENT/CEO. IT IS THE RESPONSIBILITY OF THESE THREE SENIOR MANAGERS TO ENSURE THAT COMMUNITY BENEFITS IS AN EFFORT THAT IS ADDRESSED BY THE ENTIRE ORGANIZATION AND THAT THE NEEDS OF UNDERSERVED POPULATIONS ARE CONSIDERED EVERY DAY IN DISCUSSIONS ON RESOURCE ALLOCATION, POLICIES, AND PROGRAM DEVELOPMENT. THIS IS THE STRUCTURE AND METHODOLOGY EMPLOYED TO ENSURE THAT COMMUNITY BENEFITS IS NOT THE PURVIEW OF ONE OFFICE ALONE AND TO MAXIMIZE THE EXTENT TO WHICH EFFORTS ACROSS THE ORGANIZATION ARE FULFILLING THE GOALS OF COMMUNITY BENEFITS.BIDMC ACCOMPLISHES THESE GOALS BY PARTNERING WITH OUR COMMUNITY AS FOLLOWS:- WE PARTNER WITH COMMUNITY LEADERS AND COMMUNITY-BASED ORGANIZATIONS; THEY SERVE AS LINKS TO THE COMMUNITY AND TEACHERS OF HOW WE CAN BETTER SERVE THE POPULATIONS THEY REPRESENT. IN ADDITION, WE COLLABORATE WITH A WIDE VARIETY OF ORGANIZATIONS BECAUSE HEALTHCARE SERVICES BY THEMSELVES ARE NOT ADEQUATE TO MAXIMIZE IMPROVEMENT OF HEALTH STATUS.- IMPROVING THE COMMUNITY'S HEALTH REQUIRES MORE THAN CLINICAL SERVICES. WE LOOK TO PUBLIC HEALTH, PREVENTION, AND OTHER HEALTH-RELATED APPROACHES NOT TRADITIONALLY PROVIDED BY MANY ACUTE CARE HOSPITALS.- OUR COMMITMENT TO THE COMMUNITY BENEFITS MISSION IS AS FUNDAMENTAL AS OUR COMMITMENT TO OUR PATIENT CARE AND ACADEMIC MISSIONS. THAT IS, RATHER THAN ABANDON ANY OF THESE FUNDAMENTAL MISSIONS WHEN BUDGET RESTRAINTS TEMPT US, WE WILL CONSTANTLY SEEK WAYS TO FULFILL ALL OF THEM IN AS EFFECTIVE AND EFFICIENT A MANNER AS POSSIBLE.- COMMUNITY BENEFITS PROGRAMS ARE MOST SUCCESSFUL WHEN IMPLEMENTED ORGANIZATION-WIDE. COMMUNITY BENEFITS CANNOT SUCCEED AS A STAND-ALONE ACTIVITY. THE IMPORTANCE OF THESE PRINCIPLES AND THE EFFORTS THAT RESULT MUST BE EMBRACED BY TRUSTEES, SENIOR MANAGEMENT AND PROVIDERS ALIKE, AS WELL AS BY THE COMMUNITIES SERVED.
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COMMUNITY PARTNERSTHE COMMUNITY BENEFITS PLAN IS DEVELOPED IN CONCERT WITH COMMUNITY PARTNERS, BASED ON COMMUNITY SELF-DEFINITION OF PARTICULAR HEALTH CONCERNS AND ISSUES, AND INTEGRATED WITH AVAILABLE DATA ON PUBLIC HEALTH INDICATORS. IN MOST CIRCUMSTANCES, OUR COMMUNITY COLLABORATORS ARE OUR SEVEN AFFILIATED HEALTH CENTERS THAT COLLECTIVELY SERVE APPROXIMATELY 98,000 PATIENTS IN 14 SITES. THESE CENTERS ARE:BOWDOIN STREET HEALTH CENTERTHE DIMOCK CENTERFENWAY HEALTHJOSEPH M. SMITH COMMUNITY HEALTH CENTEROUTER CAPE HEALTH SERVICESSIDNEY BORUM JR. HEALTH SERVICESSOUTH COVE COMMUNITY HEALTH CENTERTHROUGH THESE COLLABORATIVE PARTNERSHIPS, BIDMC PROVIDES ANNUAL FUNDING THAT SUPPORTS ACCESS TO COMMUNITY-BASED PRIMARY CARE AND SPECIALTY CARE AS WELL AS TARGETED PUBLIC HEALTH INTERVENTIONS. THESE FUNDS SUBSIDIZE SERVICES AND ACTIVITIES OFTEN PROVIDED BY NON-BILLABLE PERSONNEL SUCH AS CASE MANAGERS, INTERPRETERS OR PATIENT FINANCIAL ASSISTANCE REPRESENTATIVES - ALL KEY STAFF TO SUPPORT UNDERSERVED, LINGUISTICALLY AND CULTURALLY DIVERSE PATIENTS WHO ARE TRADITIONALLY DISENFRANCHISED AND ISOLATED FROM THE HEALTH CARE SYSTEM. BIDMC PROVIDED COMBINED DIRECT GRANT SUPPORT OF $2,777,123 TO THESE COMMUNITY HEALTH CENTERS (CHC)S. IN TURN, EACH OF THESE COMMUNITY HEALTH CENTERS IS PART OF A LARGER NETWORK OF COMMUNITY-BASED HEALTH, SOCIAL SERVICE, AND RESIDENT ORGANIZATIONS, FACILITATING BIDMC'S COLLABORATION WITH THESE GROUPS. THE DIABETES PROGRAM AT BOWDOIN STREET HEALTH CENTER IS AN EXCELLENT EXAMPLE OF HOW THIS PROCESS IS SUCCESSFULLY IMPLEMENTED. ORIGINALLY BEGUN AS THE COMMUNITY HEALTHY HEART PARTNERSHIP TO ADDRESS CARDIOVASCULAR DISEASE, BOWDOIN'S PROVIDERS BECAME INCREASINGLY CONCERNED ABOUT THE CO-MORBID CONDITION OF DIABETES. BY RECONFIGURING ITS CHRONIC DISEASE MANAGEMENT PROGRAM TO INCLUDE A FOCUS ON DIABETES, BOWDOIN ESTABLISHED A RELATIONSHIP WITH THE WORLD RENOWNED JOSLIN DIABETES CENTER LOCATED ADJACENT TO THE BIDMC WEST CAMPUS AND WAS SUBSEQUENTLY CHOSEN AS ONE OF FOUR HEALTH CENTERS TO RECEIVE $1.2 MILLION TO DEVELOP "BEST-PRACTICE" MODELS OF CARE FOR UNDERSERVED PATIENTS WITH DIABETES. THE COLLABORATION NOW INCLUDES INPUT FROM COMMUNITY AND SPECIALTY CARE PROVIDERS (PRIMARY CARE PROVIDERS FROM THE FOUR HEALTH CENTERS AND JOSLIN) AS WELL AS PATIENTS, COMMUNITY RESIDENTS, AND A FUNDING FOUNDATION THAT IS COMMITTED TO BRINGING NATIONAL RESOURCES TO IMPROVING CARE FOR DIABETES. ADDITIONAL STAKEHOLDERS' VOICES AND RESOURCES HAVE SUBSEQUENTLY SHAPED BOWDOIN'S DEVELOPMENT OF A HEALTHY FOOD EQUITY STRATEGIC PLAN TO SUSTAIN THE FARMER'S MARKET AND IMPLEMENT A CORNER STORE INITIATIVE.OTHER COMMUNITY CONSTITUENCIES ARE INVOLVED IN THE PLANNING AND EXECUTION OF BIDMC'S COMMUNITY BENEFITS PROGRAMMING. BIDMC IS AN ACTIVE PARTICIPANT IN THE BOSTON ALLIANCE FOR COMMUNITY HEALTH'S STRATEGIC PLANNING PROCESS. JOINING WITH GRASS-ROOTS COMMUNITY GROUPS AND RESIDENTS, THE BOSTON PUBLIC HEALTH COMMISSION, MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, AND ACADEMIC PARTNERS, WE CREATED A VISION FOR BOTH CITY-WIDE AND NEIGHBORHOOD-BASED HEALTH IMPROVEMENT PLANNING AND ACTION. ANOTHER IMPORTANT PARTNERSHIP IS BIDMC'S INVOLVEMENT WITH THE FAITH-BASED CANCER DISPARITIES NETWORK. A COALITION OF NINE CHURCHES, THE BLACK MINISTERIAL ALLIANCE, THE AMERICAN CANCER SOCIETY, AND DANA FARBER/HARVARD CANCER CENTER (OF WHICH BIDMC IS A FOUNDING MEMBER), WE ARE COLLECTIVELY ADDRESSING THE UNEQUAL BURDEN OF CANCER WITHIN COMMUNITIES OF COLOR.COMMUNITY PARTICIPATION IS AN IMPORTANT OPERATIONAL COMPONENT IN MANY OTHER MEDICAL CENTER VENUES. THE MULTICULTURAL CANCER TASK FORCE HELPS SHAPE THE WAY IN WHICH CANCER CARE IS DELIVERED IN THE HOSPITAL AS WELL AS OUTREACH PROGRAMING. COMMUNITY VOICES RESONATE IN THE HOSPITAL-WIDE PATIENT AND FAMILY ADVISORY COUNCIL (PFAC) AS WELL AS PFACS IN THE NEONATAL INTENSIVE CARE UNIT (NICU), THE INTENSIVE CARE UNIT (ICU), THE UNIVERSAL ACCESS COUNCIL AND OUR NEW HEALTH EDUCATION COUNCIL. IN ALL THESE GROUPS, THERE IS AN INTENTIONAL, DELIBERATE STRATEGY TO ENSURE OUR MANY DIVERSE COMMUNITIES - ETHNIC, RACIAL, LINGUISTIC, PHYSICAL ABILITY, GENDER, AGE, SEXUAL ORIENTATION/GENDER IDENTITY - ARE REPRESENTED AND INCLUDED. OTHER COMMUNITY PARTNERS WITH WHICH BIDMC STAFF JOIN IN DEVELOPING AND IMPLEMENTING COMMUNITY BENEFITS HEALTH IMPROVEMENT EFFORTS INCLUDE:
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- ABCD PARKER HILL/FENWAY NEIGHBORHOOD SERVICE CENTER- ABCD HEALTH SERVICES- AIDS ACTION COMMITTEE- ALBERT SCHWEITZER FELLOWSHIP PROGRAM- AMERICAN CANCER SOCIETY- AMERICAN HEART ASSOCIATION- AMERICAN PARKINSON DISEASE ASSOCIATION, MA CHAPTER- AMERICAN RED CROSS- AMERICAN STROKE ASSOCIATION- ATRIUS/HARVARD VANGUARD- BAY COVE HUMAN SERVICES- BIRD STREET COMMUNITY CENTER- BLUECROSS BLUESHIELD OF MA FOUNDATION- BODY BY BRANDY- BOSTON ALLIANCE FOR COMMUNITY HEALTH- BOSTON AREA RAPE CRISIS CENTER- BOSTON CENTER FOR YOUTH AND FAMILIES-STREET WORKERS PROGRAM- BOSTON COLLABORATIVE FOR FOOD AND FITNESS- BOSTON EMERGENCY MEDICAL SERVICE- BOSTON GREEN RIBBON COMMISSION/HEALTHCARE SECTOR- BOSTON HEALTHCARE CAREERS CONSORTIUM- BOSTON INSPECTIONAL SERVICES- BOSTON NATURAL AREAS NETWORK/YOUTH CONSERVATION CORPS- BOSTON POLICE DEPARTMENT- BOSTON PRIVATE INDUSTRY COUNCIL- BOSTON PUBLIC HEALTH COMMISSION- BOSTON PUBLIC SCHOOLS- BOSTON RED SOX FOUNDATION- BOSTON REGIONAL DOMESTIC VIOLENCE PROVIDERS- BOSTON R.O.C.K.S OUT CITY PROGRAM- BOSTON SENIOR HOME CARE- BOSTON URBAN ASTHMA COALITION- BOSTON VISITING NURSES ASSOCIATION- BOWDOIN GENEVA PLANNING GROUP- BOWDOIN STREET GENEVA AVENUE MAIN STREETS PROGRAM- BOWDOIN STREET HEALTH CENTER- BROOKLINE HEALTH DEPARTMENT- BROOKLINE PUBLIC SCHOOLS- BROOKLINE SENIOR CENTER- BUCKLE UP BOSTON- BUNKER HILL COMMUNITY COLLEGE- CAMBRIDGE COLLEGE- CAPE VERDEAN ADULT DAY HEALTH PROGRAM- CENTER FOR COMMUNITY HEALTH EDUCATION AND RESEARCH (CCHER)- CHILD WITNESS TO VIOLENCE PROJECT- CHILDREN'S HOSPITAL BOSTON- COLLEGE BOUND- COMBINED JEWISH PHILANTHROPIES- COMMONWEALTH CORPORATION- COMMUNITY CARE ALLIANCE- COMPASS SCHOOL- CRADLES TO CRAYONS- CVC UNIDO - CONFERENCE OF BOSTON TEACHING HOSPITALS- DANA-FARBER CANCER INSTITUTE- DANA FARBER/HARVARD CANCER CENTER- DEAF, INC.- DORCHESTER BAY ECONOMIC DEVELOPMENT CORPORATION- DORCHESTER CARES- DORCHESTER ENVIRONMENTAL HEALTH COALITION- DORCHESTER HOUSING ACTION TEAM- DORCHESTER LEAD-SAFE YARD PROJECT- DORCHESTER YOUTH COLLABORATIVE- DREAM BIG!- ECUMENICAL SOCIAL ACTION COMMITTEE- EPA NEW ENGLAND- EVERCARE- ETHOS- FAMILY NURTURING PROGRAM- FENWAY HEALTH- FENWAY COMMUNITY DEVELOPMENT CORPORATION- FENWAY HIGH SCHOOL- FEDERATED DORCHESTER NEIGHBORHOOD HOUSE- FITNESS IN THE CITY- FRIENDS OF GENEVA CLIFFS- FRIENDSHIP WORKS- GAY MEN'S DOMESTIC VIOLENCE PROGRAM- GENEVA AVENUE HEAD START- GOTCHA (GET OFF THE CORNER HANGING AROUND) YOUTH SUMMER PROGRAM- GLBT DOMESTIC VIOLENCE COALITION- GREATER BOSTON ENVIRONMENTAL JUSTICE NETWORK- GREATER BOWDOIN/GENEVA NEIGHBORHOOD ASSOCIATION- GREATER FOUR CORNERS ACTION COLLABORATIVE- HARVARD CATALYST- HARVARD COOPERATIVE PROGRAM ON AGING- HARVARD MEDICAL SCHOOL- HARVARD SCHOOL OF PUBLIC HEALTH- HEALTH CARE FOR ALL- HEALTHCARE WITHOUT HARM- HEALTH RESOURCES IN ACTION- HEALTHY HOMES PARTNERSHIP- HEALTHY WEIGHT INITIATIVE- HEBREW SENIOR LIFE- HOSPITALITY HOMES- HYDE SQUARE TASK FORCE- JANE DOE, INC.- JEWISH CHILDREN'S AND FAMILY SERVICES- JEWISH COMMUNITY HOUSING FOR THE ELDERLY- JEWISH COMMUNITY RELATIONS COUNCIL- JEWISH DOMESTIC VIOLENCE COALITION- JEWISH VOCATIONAL SERVICES- JOHN D. O'BRYANT SCHOOL OF MATH AND SCIENCE- JOSEPH M. SMITH COMMUNITY HEALTH CENTER- JOSLIN DIABETES CENTER- KIT CLARK SENIOR SERVICES- LEAD ACTION COLLABORATIVE- LEVENTHAL SIDMAN JEWISH COMMUNITY CENTER- LOUIS D. BROWN PEACE INSTITUTE- MASSACHUSETTS ATTORNEY GENERAL OFFICE- MASSACHUSETTS BAY COMMUNITY COLLEGE- MASSACHUSETTS COMPREHENSIVE CANCER CONTROL COALITION- MASSACHUSETTS COMMISSION FOR THE DEAF AND HARD OF HEARING- MASSACHUSETTS DEPARTMENT OF CHILDREN AND FAMILIES- MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH- MASSACHUSETTS DEPARTMENT OF TRANSITIONAL ASSISTANCE- MASSACHUSETTS DIVISION OF MEDICAL ASSISTANCE- MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES- MASSACHUSETTS HOSPITAL ASSOCIATION- MASSACHUSETTS IMMIGRATION AND REFUGEE ADVOCACY COALITION- MASSACHUSETTS LEAGUE OF COMMUNITY HEALTH CENTERS- MASSACHUSETTS PROSTATE CANCER COALITION- MASSACHUSETTS WORKFORCE INVESTMENT BOARD- MASSCONECT- MATCH-UP INTERFAITH VOLUNTEERS- MATTAPAN COLLABORATIVE FOR FOOD AND FITNESS- MAYHIM HAYYIM- MEDICAL ACADEMIC AND SCIENTIFIC COMMUNITY ORGANIZATION, INC. (MASCO)- MISSION HILL MAIN STREETS ELDER FRIENDLY BUSINESS INITIATIVE- MISSION HILL YOUTH COLLABORATIVE- MULTICULTURAL COALITION ON AGING- NATIONAL PARKINSON FOUNDATION- NEIGHBORHOOD DIABETES PROGRAM- NEIGHBORHOOD HEALTH PLAN- NEWTON SENIOR CENTER- NEW ENGLAND BAPTIST HOSPITAL- NORTHEASTERN UNIVERSITY- OPERATION ABLE- OUTER CAPE HEALTH SERVICES- PETERBOROUGH SENIOR CENTER- PROJECT H.O.P.E.- REACH OUT AND READ- ROCK, ROLL & RIDE/BCYF RECREATION COMMISSION- ROXBURY COMMUNITY ALLIANCE FOR HEALTH- SAFE NEIGHBORHOODS INITIATIVE, OFFICE OF THE ATTORNEY GENERAL- SAGE-BOSTON (STOP ABUSE GAIN EMPOWERMENT)- SECOND STEP- SEXUAL ASSAULT NURSE EXAMINER PROGRAM- SIDNEY BORUM JR. HEALTH CENTER- SILENT SPRING INSTITUTE- SOCIEDAD LATINA, INC. - SOUTH COVE COMMUNITY HEALTH CENTER- ST. PETER'S CHURCH- ST. PETER'S TEEN CENTER/CATHOLIC CHARITIES- SPORTSMAN'S TENNIS CLUB- SQUASHBUSTERS- ST. MARY'S CENTER FOR WOMEN AND CHILDREN- STEPS TO SUCCESS- STREET SAFE BOSTON- SUFFOLK LAW SCHOOL BATTERED WOMEN'S ADVOCACY CLINIC- SUFFOLK COUNTY DISTRICT ATTORNEY'S OFFICE- TEEN EMPOWERMENT- THE BOSTON FOUNDATION- THE CITY SCHOOL - THE DIMOCK CENTER- THE FOOD PROJECT- THE NETWORK/LA RED- THE PARTNERSHIP, INC.- THE WORK PLACE- UMASS BOSTON- UPHAMS CORNER WIC- VICTIMS RIGHTS LAW CENTER- VIETNAMESE AMERICAN CIVIC ASSOCIATION- YMCA BLACK ACHIEVER'S PROGRAM- YMCA TRAINING, INC.
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TARGET POPULATIONS AS LISTED IN THE BIDMC COMMUNITY BENEFITS REPORT TARGET POPULATIONS: LOW INCOME, MEDICALLY UNDERSERVED IN GREATER BOSTON AND OUTER CAPE COD REGIONS; MEDICALLY UNDERSERVED DUE TO ACCESS BARRIERS RELATED TO SEXUAL ORIENTATION, GENDER IDENTITY, RACE, ETHNICITY, GEOGRAPHIC DISTANCEBASIS FOR SELECTION: COMMUNITY HEALTH NEEDS ASSESSMENT; PUBLIC HEALTH DATA AVAILABLE FROM GOVERNMENT (MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, BOSTON PUBLIC HEALTH COMMISSION; FEDERAL AGENCIES) AND PRIVATE RESOURCES (FOUNDATIONS, ADVOCACY GROUPS); BIDMC'S AREAS OF EXPERTISEKEY ACCOMPLISHMENTS OF REPORTING YEAR- SUPPORTED INCREASED CAPACITY OF PRIMARY CARE AND OB/GYN PRACTICES AT THE SEVEN AFFILIATED COMMUNITY HEALTH CENTERS (CHC)- INCREASED COMMUNITY-BASED SPECIALTY CARE SERVICES AT CHCS- STRENGTHENED EFFORTS TO PROVIDE CARE FOR DIVERSE PATIENTS THROUGH CANCER NAVIGATORS, INTERPRETER SERVICES, MULTILINGUAL PATIENT EDUCATION AND CULTURAL COMPETENCE INITIATIVES - NOTE: ALTHOUGH THE MEDICAL CENTER IS A REGIONAL AND NATIONAL LEADER IN PROVIDING INTERPRETER SERVICES TO PATIENTS IN ORDER TO FACILITATE PATIENT ACCESS TO CARE, SUCH EXPENSES HAVE NOT BEEN INCLUDED IN THE CALCULATIONS ON SCHEDULE H PER THE INSTRUCTIONS TO THIS FORM. IN ADDITION TO THE COMMUNITY BENEFITS ENUMERATED IN THIS SCHEDULE H, BIDMC INCURRED $3,268,960 OF COSTS RELATED TO THE PROVISION OF INTERPRETER SERVICES TO PATIENTS.- SUPPORTED TWO STATEWIDE ENVIRONMENTAL AND OCCUPATIONAL HEALTH AND SAFETY SERVICES PATIENT-CENTERED MEDICAL HOME PILOT PROJECTS, INCLUDING PARTICIPATION OF THREE BIDMC-AFFILIATED CHC SITES.- PARTICIPATED IN FAITH-BASED CANCER DISPARITIES NETWORK, INCLUDING NEW WALKING FOR WELLNESS: THE FAITH-BASED WAY PROGRAM- LAUNCHED NEW OFFICE OF MULTICULTURAL AFFAIRS TO IMPROVE RECRUITMENT/RETENTION OF HOUSE STAFF AND FACULTY AND PROMOTE CULTURAL COMPETENCE PROGRAMS- IMPLEMENTED BOWDOIN'S HEALTHY FOOD EQUITY PROJECT, INCLUDING NEW HEALTHY CHAMPIONS PROJECT- SOLIDIFIED PARKINSON SUPPORT NETWORK OF CAPE COD, OFFERING NEW EXERCISE AND SUPPORT GROUPS, SOCIAL EVENTS AND EDUCATIONAL PROGRAMS- IMPLEMENTED ENVIRONMENTAL SUSTAINABILITY PLAN AND HIRED NEW COORDINATOR- INCREASED NUMBER OF UNDERREPRESENTED MINORITY APPLICANTS TO BIDMC RESIDENCY PROGRAMS AS WELL AS NUMBER OF APPLICANTS RANKED TO MATCH- EXPANDED BOWDOIN STREET HEALTH CENTER'S HEALTHY FOOD EQUITY PROJECT WITH NEW CSA PROGRAM- LAUNCHED NEW VIOLENCE PREVENTION AND INTERVENTION PROGRAMS IN BOWDOIN/GENEVA NEIGHBORHOOD THAT DRAMATICALLY DECREASED INCIDENTS OF VIOLENCE IN AREA- IMPLEMENTED NEW CASE MANAGEMENT SERVICES WITHIN CHCS, ALIGNED WITH PAYMENT REFORM EFFORTS, AND FOCUSED ON DECREASING HOSPITAL RE-ADMISSION RATE. COMMUNITY HEALTH NEEDS ASSESSMENTAS NOTED ABOVE, BETH ISRAEL DEACONESS MEDICAL CENTER'S COMMUNITY BENEFITS PROGRAM IS PREDICATED ON THE NOTION OF PARTNERSHIP AND DIALOGUE WITH ITS MANY COMMUNITIES. OUR UNDERSTANDING OF THESE COMMUNITIES' NEEDS IS DERIVED FROM DISCUSSIONS WITH, AND OBSERVATIONS BY, HEALTHCARE AND HEALTH-RELATED WORKERS IN THE NEIGHBORHOODS AS WELL AS MORE FORMAL ASSESSMENTS THROUGH AVAILABLE PUBLIC HEALTH DATA, FOCUS GROUPS, SURVEYS, ETC. THESE DATA ARE THEN AUGMENTED BY DEMOGRAPHIC AND HEALTH STATUS INFORMATION GLEANED FROM A VARIETY OF SOURCES INCLUDING THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, THE BOSTON PUBLIC HEALTH COMMISSION, FEDERAL RESOURCES SUCH AS THE INSTITUTE OF MEDICINE AND CENTERS FOR DISEASE CONTROL AND PREVENTION, AND REVIEW OF LITERATURE RELEVANT TO A PARTICULAR COMMUNITY'S NEEDS.THE ARTICULATION OF EACH SPECIFIC COMMUNITY'S NEEDS (DONE IN PARTNERSHIP BETWEEN BETH ISRAEL DEACONESS MEDICAL CENTER AND COMMUNITY PARTNERS) IS USED TO INFORM OUR DECISION-MAKING ABOUT PRIORITIES FOR COMMUNITY BENEFITS EFFORTS. FOLLOWING OUR CORE THE GUIDING PRINCIPLES DESCRIBED ABOVE, FOR EACH PRIORITY AREA, WE WORK IN CONCERT WITH COMMUNITY RESIDENTS AND LEADERS TO DESIGN SPECIFIC ACTIONS TO BE UNDERTAKEN EACH YEAR. EACH COMPONENT OF THE PLAN IS THUS DEVELOPED AND EVENTUALLY WOVEN INTO THE ANNUAL GOALS AND AGENDA FOR THE MEDICAL CENTER'S COMMUNITY BENEFITS PLAN THAT IS ADOPTED BY THE BOARD OF DIRECTOR'S COMMUNITY BENEFITS COMMITTEE.
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NEEDS ASSESSMENT - SUMMARY OF FINDINGSAS NOTED ABOVE, THE COMMUNITY PARTNERS WITH WHICH BETH ISRAEL DEACONESS MEDICAL CENTER WORKS MOST CLOSELY ARE OUR SEVEN AFFILIATED CHCS. THE 2009 NEEDS ASSESSMENT CONDUCTED WITH THESE COLLABORATORS PROVIDES THE FOUNDATION FOR OUR WORK PLAN THAT IS REVIEWED AND UPDATED ANNUALLY WITH THE CHC ADMINISTRATIVE AND CLINICAL LEADERSHIP. THE MAJOR FINDINGS ARTICULATED SYSTEMS-LEVEL NEEDS AND STRATEGIES TO OPTIMIZE THE HEALTH OF UNDERSERVED COMMUNITIES BY STRENGTHENING OUR VERTICALLY-INTEGRATED SYSTEM OF CARE. TO DELIVER QUALITY CARE ACROSS THE CONTINUUM OF SETTINGS, THE NEEDS ASSESSMENT SUPPORTED:- BUILDING THE CAPACITY OF THE CHCS THROUGH RECRUITMENT, RETENTION AND EDUCATION OF A SKILLED, LINGUISTICALLY AND CULTURALLY COMPETENT WORKFORCE (PROVIDERS AND STAFF); CAPITAL INFRASTRUCTURE NEEDS; AND QUALITY IMPROVEMENT INITIATIVES;- ENSURING ACCESS TO SPECIALTY AND EMERGENCY DEPARTMENT CARE AT BIDMC;- ENHANCING HEALTH INFORMATION EXCHANGE PROCESSES AND TECHNOLOGIES;- EXPANDING COMMUNITY-BASED RESIDENCY TRAINING AND RESEARCH OPPORTUNITIES;- CONJOINTLY DEVELOPING POPULATION-BASED PUBLIC HEALTH IMPROVEMENT STRATEGIES AND PROGRAMS;- SUPPORTING EFFORTS TO POSITION BIDMC/CHC FOR NEW MODELS OF HEALTH CARE DELIVERY AND PAYMENT REFORM ASSOCIATED WITH STATE AND FEDERAL HEALTH CARE REFORM.THIS SYSTEMS-LEVEL ANALYSIS FACILITATES CLINICAL QUALITY IMPROVEMENT EFFORTS THAT HELP PATIENTS NAVIGATE CARE FROM THE COMMUNITY TO THE HOSPITAL AND BACK, AND ENHANCES COMMUNICATION BETWEEN PROVIDERS, RESULTING IN SAFER AND BETTER HEALTH OUTCOMES. WITH THE IMPLEMENTATION OF THE COMMONWEALTH'S HISTORIC HEALTH CARE REFORM LEGISLATION, THE CHCS UNDERSCORED THE URGENCY FOR CHCS AND BIDMC TO PARTICIPATE IN ALL INSURANCE PRODUCTS SO CONTINUITY OF CARE IS NOT DISRUPTED. THE RECOMMENDATIONS INFORMED BY THE NEEDS ASSESSMENT SPEAK TO CLINICAL, ADMINISTRATIVE AND FISCAL EFFICIENCIES AND ECONOMIES OF SCALE AS WELL AS THE SAFER AND MORE EFFECTIVE HEALTH OUTCOMES THAT DERIVE FROM THE VERTICAL INTEGRATION OF THE HEALTH CARE DELIVERY SYSTEM JOINTLY CRAFTED OVER THREE DECADES OF WORKING TOGETHER. WHILE THIS CHC NEEDS ASSESSMENT DETAILED SYSTEMS-LEVEL NEEDS, BIDMC HAS ALSO CONDUCTED TARGETED ASSESSMENTS THAT ADDRESS SPECIFIC POPULATION NEEDS THAT CONTRIBUTE TO THE COMMUNITY BENEFITS PLAN. EXAMPLES OF THESE ASSESSMENTS INCLUDE: - HEALTHY FOOD ACCESS PROJECT: THE UNPRECEDENTED RATES OF OBESITY (58%), HYPERTENSION (22%), AND DIABETES (8%) OF ADULTS LIVING IN THE NORTH DORCHESTER AREA PROMPTED BOWDOIN STREET HEALTH CENTER (BSHC) TO DEVELOP A HEALTHY FOOD EQUITY STRATEGIC PLAN BASED ON A COMPREHENSIVE NEEDS ASSESSMENT. IN THE BOWDOIN-GENEVA NEIGHBORHOOD WHERE MORE THAN ONE-THIRD OF HOUSEHOLDS ARE CAR-FREE, THERE ARE NO FULL-SERVICE GROCERY STORES AND LIMITED PLACES FOR RESIDENTS TO PURCHASE FRESH PRODUCE. LIKE OTHER SMALL CORNER MARKET ENTERPRISES, THE 11 FOOD/CONVENIENCE STORES ARE NOT EQUIPPED TO STORE AND SELL FRESH, HEALTHY FOODS BUT RATHER CARRY LOWER-PRICED PRE-PACKAGED FOODS. RECOMMENDATIONS CURRENTLY BEING IMPLEMENTED INCLUDE: SUSTAINING BSHC'S FARMER'S MARKET, LAUNCHING A CORNER STORE INITIATIVE, AND ENHANCING COMMUNITY EDUCATION ABOUT HEALTHY EATING.- THE LATINO HEALTH NEEDS ASSESSMENT: A COLLABORATIVE UNDERTAKING OF BIDMC, THE LATINO HEALTH INSTITUTE, HARVARD PILGRIM HEALTH CARE, AND SEVEN LATINO COMMUNITY-BASED ORGANIZATIONS THAT INCLUDED FOCUS GROUPS AND HEALTH DATA ANALYSIS, CULMINATING IN A MAJOR SYMPOSIUM TO DEVELOP AN ACTION AGENDA. SEVERAL PROGRAM INITIATIVES DERIVE FROM THIS ASSESSMENT AND PLANNING PROCESS INCLUDING BIDMC'S LATINO MENTAL HEALTH TEAM AND SOBREMESA, THE CITY'S ONLY NETWORKING GROUP FOR SPANISH SPEAKING MENTAL HEALTH CLINICIANS THAT MEETS QUARTERLY AT BIDMC.- THE PARKINSON SUPPORT NETWORK (PSN) OF CAPE COD: BIDMC FORGED AN ALLIANCE OF THREE MAJOR HEALTHCARE PROVIDERS, LOCAL COMMUNITY-BASED ORGANIZATIONS (SENIOR-SERVING ORGANIZATIONS, HOSPICE) AND INDIVIDUALS/FAMILIES LIVING WITH PARKINSON DISEASE (PD) TO COMPLETE A NEEDS AND RESOURCE ASSESSMENT OF PD PROGRAMS ON CAPE COD. AN AREA WITH A DOCUMENTED BURDEN OF DISEASE, THE CAPE REGION IS WOEFULLY UNDERSERVED, PARTICULARLY IN EDUCATION, PSYCHOSOCIAL SUPPORT AND WELLNESS/EXERCISE PROGRAMMING. THE PSN NOW OFFERS QUARTERLY AND ANNUAL EDUCATIONAL SYMPOSIA; STARTED A NEW SUPPORT GROUP IN BARNSTABLE (SO THERE ARE NOW SUPPORT GROUPS IN EACH OF THE FOUR AREAS OF THE CAPE); AND PROVIDES WELLNESS ACTIVITIES INCLUDING DANCE, CHORAL SINGING AND DRUMMING.- THE COMMUNITY BENEFITS STRATEGIC PLANNING PROCESS: IN 2009, BIDMC COMPLETED THE FIRST PHASE OF A MULTI-PRONGED STRATEGIC PLANNING PROCESS. PHASE I INCLUDED KEY INFORMANT INTERVIEWS WITH BIDMC BOARD MEMBERS, CHIEFS OF SERVICE AND SENIOR LEADERS AS WELL AS COMMUNITY HEALTH CENTER EXECUTIVE DIRECTORS AND COMMUNITY LEADERS. RECOMMENDATIONS OF THIS STUDY ARE INTEGRATED INTO THE COMMUNITY BENEFITS PLAN, INCLUDING: ENHANCE INTEGRATION OF SERVICES BETWEEN THE MEDICAL CENTERS AND COMMUNITY SO WE CAN TRULY OFFER A SEAMLESS CONTINUUM OF CARE FOR PATIENTS THAT IS SAFE, EQUITABLE, EFFICIENT, EFFECTIVE AND OF THE HIGHEST QUALITY; RECOGNIZE THE CRISIS IN PRIMARY CARE BY ENCOURAGING MEDICAL STUDENTS/RESIDENTS TO PURSUE CAREERS IN PRIMARY CARE; EXPOSE RESIDENTS TO A COMMUNITY HEALTH EXPERIENCE DURING THEIR TRAINING; FRAME THE DELIVERY OF HEALTH CARE AS NOT ONLY CARING FOR INDIVIDUALS BUT ALSO HEALTHY COMMUNITIES BY ADDRESSING SOCIAL DETERMINANTS OF HEALTH AND INCORPORATING MORE OF A PREVENTION/WELLNESS ORIENTATION.TARGETED ASSESSMENTS SUCH AS THESE, IN CONCERT WITH ONGOING DIALOGUE WITH COMMUNITY-BASED ORGANIZATIONS AND THE VARIOUS QUANTITATIVE DEMOGRAPHIC AND HEALTH DATA PUBLICLY AVAILABLE DRIVE THE DIRECTION OF OUR PUBLIC HEALTH PROGRAM PRIORITIES. OF SPECIAL NOTE THIS YEAR IS THE WORK WITH THE HEALTH EQUITY TASK FORCE AND THE BOSTON PUBLIC HEALTH COMMISSION WORK GROUPS TO COLLECTIVELY EXECUTE PUBLIC HEALTH INITIATIVES SUCH AS THE CITY-WIDE H1N1 VACCINATION PROGRAM UNDERTAKEN IN FY 2010 IN RESPONSE TO AND IN AN ATTEMPT TO PREVENT A FEARED POTENTIAL PANDEMIC. SIMILARLY, BIDMC IS A STRONG COLLABORATOR WITH THE COMMONWEALTH'S EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES AND THE MASSACHUSETTS LEAGUE OF COMMUNITY HEALTH CENTERS INTO PATIENT-CENTERED MEDICAL HOMES (PCMH) PROJECTS, AIMED AT TRANSFORMING THE WAY HEALTH CARE IS DELIVERED AND REIMBURSED. SEVERAL OF BIDMC'S AFFILIATED HEALTH CENTERS ARE IMPLEMENTING THE PCMH MODEL AS IS BIDMC'S AMBULATORY HEALTH CARE ASSOCIATES DEPARTMENT. MASSACHUSETTS LANDMARK HEALTH CARE REFORM LEGISLATION ALSO INFORMS OUR UNDERSTANDING OF THE COMMUNITIES' HEALTH NEEDS AND DIRECTS OUR COMMUNITY BENEFITS PLAN. OF THE ESTIMATED 450,000 UNINSURED RESIDENTS, A SIGNIFICANT NUMBER WERE THOSE CARED FOR IN OUR AFFILIATED HEALTH CENTERS, OUR HOSPITAL-BASED PRIMARY CARE CLINIC, AND BIDMC'S EMERGENCY DEPARTMENT. THE NEW HEALTH INSURANCE PRODUCTS HAVE PROVIDED ACCESS TO COMPREHENSIVE CARE FOR THOUSANDS AND BIDMC HAS BEEN ACTIVELY ENGAGED IN THE IMPLEMENTATION PROCESS AT BOTH THE COMMUNITY LEVEL AND WITHIN THE MEDICAL CENTER. BIDMC'S COMMUNITY BENEFITS PLAN INCORPORATES THE RESEARCH AND RECOMMENDATIONS OF PUBLIC POLICY AND HEALTH DEPARTMENTS, ADVOCACY GROUPS (E.G. HEALTH CARE FOR ALL), INDUSTRY LEADERS (E.G. MASSACHUSETTS LEAGUE OF COMMUNITY HEALTH CENTERS) AND OUR HEALTH CENTER PARTNERS IN HELPING EXISTING PATIENTS TRANSITION FROM THE UNCOMPENSATED CARE POOL INTO THESE NEW MEDICAID AND COMMONWEALTH CARE MANAGED CARE PROGRAMS, AND ENROLLING NEW PATIENTS IN HEALTH CARE PLANS.
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CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS - RESEARCHAS PREVIOUSLY NOTED IN THIS FORM 990 PART III, PART OF BETH ISRAEL DEACONESS MEDICAL CENTER'S MISSION IS TO BE A WORLD-CLASS RESEARCH INSTITUTION WHERE OUTSTANDING SCIENTISTS WORK TO DEVELOP NEW KNOWLEDGE FOR THE BETTERMENT OF THE HEALTH OF OUR LOCAL AND EXTENDED COMMUNITIES. THE RESEARCH PROGRAM STRIVES TO BE RENOWNED FOR ITS BENCH-TO-BEDSIDE MODEL OF TRANSLATIONAL RESEARCH AND FOR ITS COLLABORATION WITH INDUSTRY AS A PATHWAY FOR TRANSFERRING THE FRUITS OF RESEARCH INTO PRODUCTS THAT IMPROVE THE QUALITY OF LIFE.BIDMC'S NOTABLE RESEARCH ACCOMPLISHMENTS INCLUDE CONSISTENTLY BEING RANKED IN THE TOP FOUR IN NATIONAL INSTITUTES OF HEALTH (NIH) FUNDING AMONG INDEPENDENT HOSPITALS. BIDMC SCIENTISTS CONTINUE TO SEARCH FOR IMPROVED UNDERSTANDING OF DISEASES AND BETTER TREATMENTS FOR PATIENTS, WHICH IN TURN DIRECTLY IMPACT THE LIVES OF OUR PATIENTS AND IMPROVE BIDMC'S PATIENT CARE. BIDMC INVESTIGATORS LEAD MORE THAN 850 ACTIVE FEDERAL AND INDUSTRY SPONSORED PROJECTS AND MORE THAN 300 CLINICAL TRIALS DURING THE FISCAL PERIOD COVERED BY THIS FILING. THIS RESEARCH IS LED BY OVER 700 PRINCIPAL INVESTIGATORS WHO ARE HARVARD MEDICAL SCHOOL FACULTY. THE KEY AREAS OF RESEARCH INCLUDE VASCULAR BIOLOGY, MOLECULAR IMAGING, TRANSPLANTATION, SIGNAL TRANSDUCTION, CANCER BIOLOGY, METABOLIC DISEASE, NEUROBIOLOGY, AIDS, AND CARDIOLOGY/CARDIAC SURGERY.AS NOTED IN THIS FILING, BIDMC IS A TEACHING HOSPITAL OF HARVARD MEDICAL SCHOOL COMMITTED TO MAINTAINING A COLLABORATIVE CULTURE AND MODERN, HIGH-QUALITY FACILITIES, AND TO TAKING FULL ADVANTAGE OF THE UNIQUE RELATIONSHIPS THAT EXIST AMONG THE HARVARD MEDICAL SCHOOL AND THE HARVARD TEACHING HOSPITALS. BIDMC DESIGNS AND IMPLEMENTS MANY INTERDEPARTMENTAL AND INTERDISCIPLINARY RESEARCH PROGRAMS WITHIN OUR INSTITUTION. BIDMC ALSO REACHES OUT AND COLLABORATES WITH OTHER NATIONALLY RECOGNIZED AND WORLD RENOWNED EXPERTS IN VARIOUS FIELDS ALL ORIENTED TOWARD TRANSLATING NEW KNOWLEDGE INTO NOVEL MEDICAL TREATMENTS AND PATIENT CARE. BIDMC PARTICIPATES IN HARVARD CATALYST, THE HARVARD CLINICAL AND TRANSLATIONAL SCIENCE CENTER, WHICH BRINGS TOGETHER THE INTELLECTUAL FORCE, TECHNOLOGIES, AND CLINICAL EXPERTISE AT HARVARD UNIVERSITY AND ITS ACADEMIC, HEALTH CARE, AND COMMUNITY PARTNERS TO CREATE CONNECTIONS, ENABLE RESEARCH AT THE CUTTING EDGE OF DISCOVERY, AND NURTURE CLINICAL AND TRANSLATIONAL RESEARCHERS WITH THE GOAL OF IMPROVING HUMAN HEALTH.STUDIES BY BIDMC RESEARCHERS ARE ROUTINELY PUBLISHED IN THE WORLD'S LEADING SCIENTIFIC JOURNALS, INCLUDING NATURE, SCIENCE AND THE NEW ENGLAND JOURNAL OF MEDICINE WHICH HELPS TO BRING THE RESEARCH FINDINGS TO PATIENTS BEYOND BIDMC. BIDMC ENGAGES IN RESEARCH IN ALL OF THE FOLLOWING DISCIPLINES:- ANESTHESIA, CRITICAL CARE, AND PAIN MEDICINE - EMERGENCY MEDICINE - MEDICINE - ALLERGY AND INFLAMMATION - CARDIOVASCULAR MEDICINE - CENTER FOR VASCULAR BIOLOGY RESEARCH - CLINICAL INFORMATICS - CLINICAL NUTRITION - ENDOCRINOLOGY - EXPERIMENTAL MEDICINE - GASTROENTEROLOGY - GENERAL MEDICINE AND PRIMARY CARE - GENETICS - GERONTOLOGY - HEMATOLOGY AND ONCOLOGY - HEMOSTASIS AND THROMBOSIS - IMMUNOLOGY - INFECTIOUS DISEASE - INTERDISCIPLINARY MEDICINE AND BIOTECHNOLOGY - MATRIX BIOLOGY - MOLECULAR AND VASCULAR MEDICINE - NEPHROLOGY - PULMONOLOGY - RHEUMATOLOGY - SIGNAL TRANSDUCTION - TRANSLATIONAL RESEARCH - TRANSPLANT IMMUNOLOGY- VIRAL PATHOGENESIS- NEONATOLOGY - NEUROLOGY - OBSTETRICS AND GYNECOLOGY - ORTHOPAEDIC SURGERY - PATHOLOGY - PSYCHIATRY - RADIOLOGY - SURGERY - CARDIAC SURGERY - CENTER FOR MINIMALLY INVASIVE SURGERY - NEUROSURGERY - PLASTIC AND RECONSTRUCTIVE SURGERY - VASCULAR SURGERY- TRANSPLANT INSTITUTEDURING THE FISCAL YEAR COVERED BY THIS FILING, BIDMC HAD NET EXPENDITURES OF $255,719,283 REPORTED ON THIS SCHEDULE H RELATED TO RESEARCH TO FURTHER SCIENCE AND PATIENT CARE, WHICH REPRESENTED 19.60% OF BIDMC'S TOTAL EXPENSES, ADJUSTED FOR BAD DEBT EXPENSE AS NOTED ABOVE.
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EXAMPLES OF THE RESEARCH ENGAGED IN AT BIDMCBELOW IS INFORMATION RELATED TO JUST A HANDFUL OF THE CUTTING-EDGE RESEARCH STUDIES AND PRINCIPAL INVESTIGATORS AT BIDMC. THESE STUDIES ARE CHANGING PATIENT CARE TODAY AND TOMORROW. WOMEN'S CANCERSLEWIS CANTLEY, PHD, DIRECTOR OF THE CANCER CENTER AND CHIEF OF THE DIVISION OF SIGNAL TRANSDUCTION AT BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) AND A RESEARCH PIONEER WHOSE DISCOVERY OF A MOLECULAR PATHWAY KNOWN AS PI3K HAS LED TO ONE OF THE MOST PROMISING AVENUES FOR THE DEVELOPMENT OF PERSONALIZED CANCER THERAPIES, IS LEADING ONE OF FIVE SCIENTIFIC "DREAM TEAMS" THAT HAVE BEEN AWARDED GRANTS FROM A NATIONAL COALITION CALLED STAND UP TO CANCER (SU2C).A CHARITABLE INITIATIVE CREATED BY THE ENTERTAINMENT INDUSTRY FOUNDATION AND ADMINISTERED THROUGH THE AMERICAN ASSOCIATION FOR CANCER RESEARCH (AACR), SU2C WAS CREATED WITH THE GOAL OF GETTING NEW CANCER TREATMENTS TO PATIENTS IN AN ACCELERATED TIMEFRAME. FOLLOWING A RIGOROUS SELECTION PROCESS, FIVE SCIENTIFIC GROUPS -- COMPRISED OF MORE THAN 300 INDIVIDUALS FROM 20 INSTITUTIONS AND HEADED UP BY SEVEN LEADERS, FOUR CO-LEADERS AND 27 PRINCIPAL RESEARCHERS, AS WELL AS PATIENT ADVOCACY REPRESENTATIVES -- WERE AWARDED THE THREE-YEAR GRANTS. CANTLEY'S TEAM WAS AWARDED A $15 MILLION GRANT.IN AN EXAMPLE OF HOW BIDMC COLLABORATES WITH OTHER NATIONALLY AND INTERNATIONALLY RECOGNIZED AND WORLD RENOWNED EXPERTS IN VARIOUS FIELDS ALL ORIENTED TOWARD TRANSLATING NEW KNOWLEDGE INTO NOVEL MEDICAL TREATMENTS AND PATIENT CARE, CANTLEY, TOGETHER WITH CO-LEADERS FROM MEMORIAL SLOAN-KETTERING CANCER CENTER AND THE UNIVERSITY OF TEXAS M.D. ANDERSON CANCER CENTER, WILL WORK WITH A GROUP OF MORE THAN 20 ESTEEMED SCIENTISTS FROM THE COUNTRY'S LEADING CANCER RESEARCH INSTITUTIONS, INCLUDING OTHER RESEARCHERS AT BIDMC, TO INVESTIGATE THE ROLE THAT PI3K MUTATIONS PLAY IN WOMEN'S CANCERS, SPECIFICALLY BREAST CANCER, OVARIAN CANCER AND ENDOMETRIAL CANCER. A KEY COMPONENT OF THEIR WORK WILL FOCUS ON DEVELOPING NEW APPROACHES TO MORE ACCURATELY PREDICT WHICH PATIENTS WILL RESPOND POSITIVELY TO PI3K PATHWAY INHIBITORS, A GROUP OF TARGETED CANCER THERAPIES CURRENTLY BEING TESTED IN CLINICAL TRIALS AROUND THE COUNTRY."I'M HONORED AND PRIVILEGED TO LEAD THIS OUTSTANDING GROUP OF INVESTIGATORS," SAID CANTLEY AND WILLIAM BOSWORTH, CASTLE PROFESSOR OF MEDICINE AND A CO-FOUNDER OF THE SYSTEMS BIOLOGY DEPARTMENT AT HARVARD MEDICAL SCHOOL. "BY TAKING THE UNIQUE APPROACH OF COLLABORATING NOT ONLY ACROSS MULTIPLE INSTITUTIONS BUT ALSO ACROSS MULTIPLE DISEASES, WE AIM TO ENCOURAGE THE EXCHANGE OF MATERIALS AND IDEAS BETWEEN SCIENTISTS AND CLINICIANS WITH THE ULTIMATE GOAL OF ACCELERATING DRUG APPROVALS AND PROVIDING NEW AND EFFICIENT TECHNIQUES FOR PERSONALIZED CANCER TREATMENTS."NOBEL LAUREATE PHILLIP A. SHARP, PHD, OF THE MASSACHUSETTS INSTITUTE OF TECHNOLOGY, WHO CHAIRED THE SU2C SCIENTIFIC ADVISORY COMMITTEE OVERSEEING THE SELECTION OF THE FIVE SCIENTIFIC DREAM TEAMS ADDED, "RECENT ADVANCEMENTS IN BASIC SCIENCE AND TECHNOLOGIES HAVE PLACED US ON THE CUSP OF IMPORTANT DISCOVERIES THAT CAN REVOLUTIONIZE THE FIGHT AGAINST CANCER. SU2C AIMS TO CAPITALIZE ON THAT PROGRESS AND IS PUSHING IT FORWARD AT WHAT WILL BE AN EXTRAORDINARILY QUICK PACE. THE DREAM TEAMS BRING TOGETHER LEADING LABORATORY SCIENTISTS AND PHYSICIANS, COLLABORATING IN WAYS THAT ARE UNPRECEDENTED WITH A LASER-LIKE FOCUS ON RESEARCH THAT HAS ENORMOUS POTENTIAL TO HELP PATIENTS AND SAVE LIVES."COLLECTIVELY, BREAST CANCER, OVARIAN CANCER AND ENDOMETRIAL CANCER AFFECT MORE THAN 3 MILLION WOMEN THROUGHOUT THE U.S. WITH MORE THAN 200,000 NEW CASES REPORTED EACH YEAR. KNOWING THAT GENETIC ABERRATIONS IN THE PI3K PATHWAY ARE THE MOST FREQUENT EVENTS UNDERLYING WOMENS CANCERS, CANTLEY AND HIS GRANT CO-LEADERS ASSEMBLED THIS PIONEERING GROUP OF BASIC, TRANSLATIONAL AND CLINICAL SCIENTISTS WORKING ON THIS MOLECULAR PATHWAY."OUR GOAL FOR THIS PROJECT IS TO IDENTIFY THE SPECIFIC BIOMARKER MOLECULES THAT WILL PREDICT WHICH PATIENTS WILL BE MOST LIKELY TO BENEFIT FROM PI3K INHIBITOR DRUGS, EITHER AS SINGLE AGENTS OR IN COMBINATIONS WITH OTHER DRUGS," HE ADDS. "AND BECAUSE OF THE EXTRAORDINARY LEVEL OF COLLABORATION CREATED THROUGH THE FORMATION OF THIS "DREAM TEAM," THIS GOAL SEEMS IMMINENTLY POSSIBLE."GENETICS AND BIOLOGY OF CANCER THE INTERESTS OF PIER PAOLO PANDOLFI, MD, PHD AND THE PANDOLFI LAB FOCUS ON THE GENETICS AND BIOLOGY OF CANCER. THE LAB HAS MADE A NUMBER OF SEMINAL CONTRIBUTIONS TO THE CHARACTERIZATION OF THE FUSION ONCOPROTEINS AND GENES INVOLVED IN THE CHROMOSOMAL TRANSLOCATIONS OF ACUTE PROMYELOCYTIC LEUKEMIA (APL), AS WELL AS THAT OF MAJOR TUMOR SUPPRESSORS SUCH PTEN AND P53 AND NOVEL PROTO-ONCOGENES SUCH POKEMON.USING A VARIETY OF ENGINEERED MOUSE LINES TO STUDY THE EFFECTS AND INTERACTIONS OF THESE GENES IN VIVO, THE LAB STRIVES TO DEVELOP MODELS THAT FAITHFULLY REPLICATE HUMAN CANCERS. THESE IN TURN CAN BE UTILIZED FOR THE DEVELOPMENT AND TESTING OF NOVEL TREATMENTS AND THERAPEUTICS.IN PARTICULAR THE PANDOLFI LAB RESEARCH INTERESTS FOCUS ON THE UTILIZATION OF LEUKEMIA AND PROSTATE CANCER MODELS TO DISSECT THE GENETICS OF THESE DISEASES. BY CHARACTERIZING THE NORMAL FUNCTION OF THE STEM CELLS IN THESE TISSUES, WE HOPE TO BETTER UNDERSTAND HOW "STEM CELL-LIKE" CANCER INITIATING CELLS (CIC) DRIVE TUMORIGENESIS, AND HOW THESE CICS AN BE TARGETED FOR ERADICATION OF THE DISEASE.DR. PANDOLFI, IS THE RECIPIENT OF THE 2011 PEZCOLLER FOUNDATION-AACR (AMERICAN ASSOCIATION OF CANCER RESEARCH) INTERNATIONAL AWARD FOR CANCER RESEARCH. THIS AWARD WAS ESTABLISHED IN 1997 TO RECOGNIZE A SCIENTIST OF INTERNATIONAL RENOWN WHO HAS MADE A MAJOR SCIENTIFIC DISCOVERY IN EITHER BASIC OR TRANSLATIONAL CANCER RESEARCH AND WHOSE ONGOING WORK HOLDS PROMISE FOR PROGRESS IN THE FIELD OF CANCER. THIS IS THE SECOND TIME IN THE AWARD'S 14-YEAR HISTORY THAT A BIDMC INVESTIGATOR HAS RECEIVED THIS PRESTIGIOUS HONOR. DR. LEWIS CANTLEY, WHOSE WORK IS NOTED ABOVE, PREVIOUSLY RECEIVED THIS AWARD IN 2005. THIS IS THE FIRST TIME IN THE AWARD'S HISTORY THAT TWO INVESTIGATORS FROM THE SAME INSTITUTION HAVE BEEN RECOGNIZED WHICH SPEAKS TO BIDMC'S POSITION AS A WORLD-CLASS LEADER IN CANCER RESEARCH AND TO THE OUTSTANDING CONTRIBUTIONS BEING MADE BY THE BIDMC CANCER CENTER IN TRANSLATING MOLECULAR DISCOVERIES INTO PATIENT TREATMENTS.DR. PANDOLFI WAS RECOGNIZED BY THE PEZCOLLER FOUNDATION AND THE AACR FOR BOTH HIS OUTSTANDING WORK IN THE FIELD OF CANCER GENETICS, AND FOR HIS GROUNDBREAKING DEVELOPMENT OF CANCER MOUSE MODELS AND UNDERSTANDING HOW MUTATIONS IN ONCOGENES AND TUMOR SUPPRESSOR GENES RESULT IN LEUKEMIAS, LYMPHOMAS AND SOLID TUMORS. "[DR. PANDOLFI'S] PIONEERING WORK IN DEVELOPING TRANSGENIC MOUSE MODELS OF CANCER HELPED LEAD TO NOVEL THERAPEUTIC STRATEGIES FOR ACUTE PROMYELOCYTIC LEUKEMIA [APL], AND, TODAY, THIS UNIQUE EXPERTISE IN MOUSE-MODEL ENGINEERING IS HELPING TO SPEED THE CLINICAL TESTING OF NEW PERSONALIZED CANCER THERAPIES.""I'M EXTREMELY HONORED TO RECEIVE THE PEZCOLLER AWARD," SAYS PANDOLFI. "THIS IS A TREMENDOUSLY EXCITING TIME - I WOULD EVEN SAY REVOLUTIONARY - FOR CANCER RESEARCH AND I'M THRILLED TO BE A PART OF IT. AS WE NOW CLEARLY RECOGNIZE, 'CANCER' IS NOT A SINGLE DISEASE, BUT IS MADE UP OF MANY, MANY DIFFERENT MUTATIONS. WHILE THIS PROVIDES US WITH UNPRECEDENTED OPPORTUNITIES FOR DEVELOPING PERSONALIZED TREATMENTS, OUR ULTIMATE GOAL IS TO UNDERSTAND AND CURE CANCER, AND THIS AWARD GIVES US FURTHER MOTIVATION TO ACHIEVE THIS GOAL AS WE CONTINUE TO FIGHT RELENTLESSLY FOR THE SAKE OF OUR PATIENTS."
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ORTHOPEDIC SURGERY: RESEARCH THE MISSION OF THE ORTHOPEDIC BIOMECHANICS LABORATORY (OBL) IS TO PERFORM PROFESSIONAL INVESTIGATIONS IN THE BASIC AND APPLIED RESEARCH OF MUSCULOSKELETAL BIOMECHANICS, WHILE MAINTAINING THE BETH ISRAEL DEACONESS MEDICAL CENTER PHILOSOPHY OF RESPECT AND COMPASSION FOR ALL HUMAN AND ANIMAL LIFE. AS A PART OF THIS OVERALL MISSION, THE LABORATORY PROVIDES TRAINING TO STUDENTS AND FELLOWS, WHO WILL BECOME THE PROFESSIONAL RESEARCHERS AND HEALTH CARE PROFESSIONALS OF THE FUTURE.BONE MECHANICS AND MODELINGTHE BONE MECHANICS AND MODELING PROGRAM AREA INCLUDES EXPERIMENTAL AND COMPUTATIONAL MODELING OF THE BEHAVIOR OF BONE (INCLUDING FAILURE IN FEMURS, VERTEBRAE AND TRABECULAR BONE STRUCTURES). THIS GROUP IS ACTIVELY WORKING TO VALIDATE MODELING TECHNIQUES TO MAKE PREDICTIONS OF FAILURE LOADS OF THESE BONES BY LABORATORY TESTING OF BONE SPECIMENS UNDER VARIED CONDITIONS, HIGH RESOLUTION IMAGING OF BONE ARCHITECTURE, AND EXPERIMENTAL TECHNIQUES USING IMAGE-GUIDED ASSESMENT OF BONE FAILURE. THESE MODELING TECHNIQUES ARE USED TO FURTHER UNDERSTAND THE FACTORS THAT INFLUENCE FRACTURE SUCH AS DENSITY DISTRIBUTION, BONE GEOMETRY, AND BONE ARCHITECTURE. THE PROGRAM AREA ALSO INCLUDES MODELING OF SEVERAL BONE/IMPLANT SYSTEMS AS WELL AS MODELING THE MECHANICAL CONSEQUENCES OF SPACE FLIGHT. THIS PROGRAM AREA EMPLOYS BIOMECHANICAL TESTING, STATE-OF-THE-ART MICRO-IMAGING AND VISUALIZATION TECHNIQUES OF CONNECTIVE TISSUE AND BIOMATERIALS. AS AN EXAMPLE OF THE ON-GOING RESEARCH PROJECTS, A MATHEMATICAL MODEL WHICH ALLOWS ANALYSIS OF BONE REMODELING IN THE CONTEXT OF FUNCTIONAL ADAPTATION WAS RECENTLY DEVELOPED. THE APPROACH INCORPORATES MICRO-TOMOGRAPHIC IMAGING AND LARGE-SCALE FEA MODELING TECHNIQUES. THESE TECHNIQUES HAVE EXCITING POTENTIAL FOR REVEALING ALTERATIONS IN TRABECULAR BONE STRUCTURAL MORPHOLOGY IN RESPONSE TO DIFFERENT LOADING AND EXERCISE REGIMES, DIETARY SUPPLEMENTS, PHARMACOLOGICAL INTERVENTIONS, OR DEGENERATIVE CHANGES IN SUBCHONDRAL BONE ASSOCIATED WITH POST- TRAUMATIC OSTEOARTHRITIS.JOINT KINEMATICS, INJURY AND RECONSTRUCTIONSPORTS RELATED AND EVERYDAY INJURIES TO THE KNEE AND UPPER EXTREMITY ARE VERY PREVALENT IN TODAY'S ACTIVE POPULATION. THIS PROGRAM AREA EVALUATES JOINT KINEMATICS, KINETICS, MUSCLE AND LIGAMENT FORCES AND CARTILAGE CONTACT STRESSES WHEN A JOINT IS SUBJECTED TO VARIOUS PHYSIOLOGICAL LOADING CONDITIONS. THIS PROGRAM AREA ALSO STUDIES HOW SPORTS AND TRAUMATIC INJURIES AFFECT THE MECHANICS OF JOINTS AND DETERMINES HOW WELL RECONSTRUCTION TECHNIQUES RESTORE JOINT MECHANICS TO NORMAL. THE OBJECTIVE IS TO PROVIDE GUIDELINES FOR OPTIMIZED JOINT LIGAMENTOUS RECONSTRUCTION AND ARTHROPLASTY AND POST-OPERATIVE REHABILITATION. CUTTING EDGE ROBOTIC TECHNOLOGY AND COMPUTATIONAL MODELING TECHNIQUES ARE USED TO SIMULATE JOINT MOTION AND APPLY EXTERNAL LOADS. RECENT AND CURRENT PROJECTS INCLUDE STUDIES OF THE EFFECTS OF SURGICAL INTERVENTION ON THE DISTRIBUTION OF CONTACT PRESSURE IN THE TIBIO-FEMORAL AND PATELLFEMORAL JOINTS; EFFECT OF TKA ON KNEE JOINT KINEMATICS AND LIGAMENTOUS TENSION; INVESTIGATION OF THE STABILITY OF THE ACROMIOCLAVICULAR JOINT AFTER RECONSTRUCTION USING DIFFERENT TECHNIQUES; AND EVALUATION OF INITIAL STRENGTH, FATIGUE STRENGTH, AND GRAFT-BONE TRANSLATION IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTIONS USING A DOUBLED GRACILIS SEMITENDINOSUS GRAFT TECHNIQUE. WE ARE ALSO CONDUCTING RESEARCH TO QUANTIFY AND MODEL THE CARTILAGE OF CHILDREN WITH HIP DYSPLASIA, 3D FINITE ELEMENT MODELING OF CARTILAGE CONTACT MECHANICS, AND INVESTIGATIONS OF IN-VIVO MUSCLE CONTRACTION FORCES USING 3D INVERSE DYNAMIC OPTIMIZATION. THE EFFECT OF CARTILAGE DEFECTS ON STRESS CONCENTRATION IS ALSO BEING STUDIED BY THIS GROUP. ETIOLOGY AND PREVENTION OF AGE-RELATED FRACTURESAGE-RELATED FRACTURES ARE AN IMPENDING PUBLIC HEALTH CRISIS, AS PERSONS OVER 80 REPRESENT THE FASTEST GROWING SEGMENT OF THE POPULATION. TO PREVENT THESE FRACTURES, IT IS NECESSARY TO HAVE A SOUND UNDERSTANDING OF THEIR ETIOLOGY. WHILE MUCH CLINICAL AND LABORATORY RESEARCH HAS FOCUSED ON THE LOSS OF BONE WITH AGE, OUR LABORATORY HAS ADOPTED THE VIEW THAT FRACTURES REPRESENT A STRUCTURAL FAILURE OF THE BONE, WHEREIN THE FORCES THAT ARE APPLIED TO THE BONE EXCEED ITS INHERENT STRENGTH. THEREFORE, WE HAVE AND ARE CONTINUING TO PERFORM A SERIES OF INVESTIGATIONS RELATED TO: 1) DEVELOPING WAYS OF PREDICTING BONE STRENGTH NON-INVASIVELY; 2) IDENTIFYING ACTIVITIES THAT LEAD TO FRACTURES; AND 3) DETERMINING THE LOADS APPLIED TO THE SKELETON DURING THOSE HIGH-RISK ACTIVITIES. THESE INVESTIGATIONS INCLUDE CASE-CONTROL AND OBSERVATIONAL STUDIES OF RISK FACTORS FOR FRACTURE; LABORATORY-BASED STUDIES OF THE STRENGTH AND STRUCTURAL CAPACITY OF HUMAN CADAVERIC WRISTS, FEMURS, AND VERTEBRAE; AND THEORETICAL AND EXPERIMENTAL STUDIES OF FALLS. IN ADDITION, WE ARE EVALUATING THE ABILITY OF QUANTITATIVE ULTRASOUND TO ASSESS BONE ARCHITECTURE AND MICRO-DAMAGE. ETIOLOGY AND PREVENTION OF FRACTURES ASSOCIATED WITH METASTATIC DEFECTS AND BENIGN BONE DEFECTSPATHOLOGICAL FRACTURES THROUGH OSTEOLYTIC DEFECTS IN THE APPENDICULAR AND AXIAL SKELETON OCCUR IN PATIENTS OF ALL AGES AND ARE OFTEN ASSOCIATED WITH PAIN, LOSS OF FUNCTION AND OTHER MORBIDITIES DEPENDING ON PATIENT AGE, SKELETAL SITE AND UNDERLYING PATHOLOGY. BONE IS THE MOST COMMON SITE OF METASTASIS FROM CANCER OF THE BREAST, PROSTATE AND LUNG. MOREOVER, 20-70% OF CHILDREN WITH BENIGN BONE TUMORS ARE AT RISK FOR FRACTURE. IN MANAGING THESE PATIENTS, THE ORTHOPEDIST MUST DECIDE IF THE LESION IS BENIGN OR MALIGNANT AND IF THE TUMOR HAS WEAKENED THE BONE SUFFICIENTLY TO CAUSE FRACTURE. CURRENTLY NO ACCURATE METHOD EXISTS TO PREDICT FRACTURE OF BONES WEAKENED BY METASTATIC OR BENIGN TUMORS. ONE FOCUS OF OUR LABORATORY IS TO APPLY STRUCTURAL ANALYSES OF BONES WITH LYTIC DEFECTS USING COMPOSITE BEAM THEORY OR FINITE ELEMENT MODELS TO BETTER PREDICT THE RISK OF PATHOLOGIC FRACTURE. NON-INVASIVE IMAGING METHODS, SUCH AS MRI, QCT AND DXA, ARE USED TO QUANTIFY THE GEOMETRIC AND MATERIAL PROPERTIES OF BONES WITH REAL AND SIMULATED DEFECTS. FROM THESE IMAGES, THREE-DIMENSIONAL STRUCTURAL ANALYSES CAN PREDICT THE REDUCED LOAD CARRYING CAPACITY OF THE BONE AND IN GENERAL THE BIOMECHANICS OF THE METASTATIC BONE DEFECT OR TUMOR. EXPERIMENTAL INVESTIGATION IS BEING CONDUCTED IN PARALLEL WITH CLINICAL ANALYSIS TO DETERMINE THE ACCURACY OF THE NON-INVASIVELY DERIVED STRUCTURAL PARAMETERS USED TO PREDICT PATHOLOGIC FRACTURE RISK. IN ADDITION, OUR CT BASED STRUCTURAL ANALYSIS FOR PREDICTING FRACTURE THROUGH A SKELETAL METASTASIS IS BASED ON THE HYPOTHESIS THAT ALL BONE (NORMAL OR PATHOLOGIC) FOLLOWS THE SAME CONSTITUTIVE RELATIONSHIPS ESTABLISHED FOR RIGID POROUS FOAMS, I.E. THE STRENGTH (SY) AND MODULUS OF ELASTICITY (E) OF BONE DEPEND ON BOTH THE BONE TISSUE DENSITY (RHO-TISSUE) AND THE BONE VOLUME FRACTION (VVB) SQUARED. THE RHO-TISSUE ACCOUNTS FOR CHANGES IN TISSUE MINERALIZATION, AND THE VVB ACCOUNTS FOR CHANGES IN TRABECULAR MORPHOLOGY. TO THE BEST OF OUR KNOWLEDGE, THIS HYPOTHESIS HAS NEVER BEEN VALIDATED FOR METASTATIC CANCER BONE TISSUE. THEREFORE, IT WAS OUR OBJECTIVE TO ESTABLISH THAT THE MECHANICAL PROPERTIES OF METASTATIC CANCER BONE TISSUE WERE GOVERNED BY THE POWER LAW FUNCTIONS.
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BIOMECHANICS OF FRACTURE HEALING AND TREATMENTMECHANISMS OF BONE FRACTURE AND OPTIMIZATION OF FRACTURE TREATMENT ARE IMPORTANT AREAS OF ORTHOPAEDIC RESEARCH. ALTHOUGH WITH PROPER TREATMENT MOST FRACTURES HEAL WITHOUT SIGNIFICANT COMPLICATIONS, SOME FRACTURES DO NOT HEAL. MOREOVER, AMONG VARIOUS TREATMENT OPTIONS, THE OPTIMAL METHOD OF TREATMENT REMAINS CONTROVERSIAL. ONE AREA OF ACTIVE RESEARCH AT OUR LABORATORY IS THE EVALUATION OF VARIOUS METHODS OF FRACTURE FIXATION. WE USE AN OPTICAL METHOD TO CAPTURE FRACTURE GAP MOTION PRODUCED BY THE APPLICATION OF LOADS SIMULATING ACTIVITIES OF DAILY LIVING OR PHASES OF GAIT AFTER FRACTURE FIXATION WITH VARIOUS DEVICES. FROM THE MOTION DATA, WE PERFORM RIGID BODY KINEMATIC ANALYSIS TO QUANTIFY THE DIRECTION AND MAGNITUDE OF THE MOTION AND EVALUATE THE EFFICACY OF THE FIXATION METHODS. WE HAVE ALSO PROVIDED AN OBJECTIVE MEASURE OF FRACTURE INSTABILITY BY DEFINING THIS AS THE STRUCTURAL COMPLIANCE (I.E., THE AMOUNT OF FRACTURE DISPLACEMENT AS A FUNCTION OF APPLIED LOAD). BY APPLYING LOADS TO THE FLEXOR AND EXTENSOR TENDONS CROSSING THE WRIST JOINT AND MONITORING FRACTURE FRAGMENT DISPLACEMENT WITH SERIAL CT SCANS, WE DEMONSTRATED THAT FRACTURE CLASSIFICATION SYSTEMS BASED ON FRACTURE PATTERN IN COLLES' FRACTURES WERE UNRELATED TO FRACTURE INSTABILITY. HOWEVER, USING THESE SAME TECHNIQUES WE HAVE DEMONSTRATED THAT USING MORE RIGID FIXATION IS NOT NECESSARILY BETTER FIXATION FOR MINIMIZING FRACTURE MOTION WHEN TREATING COLLES' FRACTURES. WE ARE ALSO INVOLVED IN THE BIOMECHANICAL EVALUATION OF BIORESORBABLE PLATES FOR METACARPAL FRACTURE FIXATION, AND INTERNAL FIXATION METHODS FOR FEMORAL SHAFT FRACTURES IN CHILDREN. PRECLINICAL EVALUATION OF OSTEODYNAMIC AGENTS THIS GROUP PERFORMS IMAGING, DENSITOMETRIC AND MECHANICAL EVALUATION OF BONE SPECIMENS FROM ANIMAL STUDIES CONDUCTED BY OUTSIDE COLLABORATORS TO EVALUATE THE SAFETY AND EFFICACY OF NEW OSTEODYNAMIC AGENTS. STUDIES ARE CARRIED OUT WITH ADHERENCE TO STRICT GOOD LABORATORY PRACTICES (GLP) REGULATIONS SET OUT BY THE FOOD AND DRUG ADMINISTRATION (FDA). THE GROUP MEMBERS ARE TRAINED IN DENSITOMETRIC, IMAGING AND MECHANICAL TESTING TECHNIQUES REQUIRED BY GLP STUDY REGULATIONS. ANIMAL MODELS THAT HAVE BEEN EVALUATED INCLUDE TRANSGENIC MICE, RATS, DOGS, RABBITS AND NON-HUMAN PRIMATES. DATA HAVE BEEN GENERATED FOR BONE MINERAL CONTENT, APPARENT BONE DENSITY, CROSS-SECTIONAL GEOMETRIC PROPERTIES AND MICROSTRUCTURAL MORPHOLOGY; AND VARIOUSLY RELATED TO MATERIAL AND STRUCTURAL MECHANICAL PROPERTIES INCLUDING COMPRESSIVE STRENGTH OF TRABECULAR CORE SPECIMENS AND WHOLE VERTEBRAL BODIES, BENDING AND TORSIONAL STRENGTH OF CORTICAL BONE BEAM SPECIMENS AND WHOLE BONES INCLUDING THE PROXIMAL FEMUR, HIP AND LONG BONES OF THE APPENDICULAR SKELETON. THE GROUP IS CONSTANTLY IMPROVING IMAGING PROTOCOLS, ANALYSIS METHODS, MECHANICAL TESTING TECHNIQUES AND THE EFFICIENCY OF DATA ACQUISITION.BIOMECHANICS OF THE SPINETHIS PROGRAM AREA EMPLOYS MECHANICAL TESTING, ANIMAL MODELS AND SEVERAL IMAGING MODALITIES TO INVESTIGATE VARIOUS ASPECTS OF THE BIOMECHANICS OF SPINAL FUSION, SPINAL INSTRUMENTATION AND TRAUMA AND THE USE OF NOVEL BIOMATERIALS IN SPINAL SURGERY.THE MECHANISMS UNDERLYING THE INITIATION AND PROGRESSION OF SPINAL FUSION PROCESSES, THE USE OF NOVEL METHODS AND MATERIALS, AND THE OPTIMIZATION OF INTERNAL SPINAL FIXATION DEVICES EMPLOYED TO PROMOTE THESE PROCESSES, ARE IMPORTANT AREAS IN SPINAL ORTHOPEDICS. THIS GROUP, EMPLOYING A LATERAL FUSION RABBIT ANIMAL MODEL, IS ACTIVELY INVOLVED IN INVESTIGATING THE EFFECTS OF ELECTRICAL STIMULATION IN CONJUNCTION WITH SEVERAL ARTIFICIAL BONE SUBSTITUTES AND THE USE OF GENETIC ENGINEERING DERIVED PRODUCTS, IN PROMOTING THE PROCESS OF SPINAL FUSION. THE SUCCESS OF FUSION IS BEING ASSESSED USING MECHANICAL (THREE- AND FOUR-POINT BENDING), HISTOLOGICAL, AND IMAGING METHODS (DXA, MICRO-CT). A MULTI-AXIAL SPINE TESTING DEVICE HAS BEEN DEVELOPED IN OUR LAB WHICH, WHEN COMBINED WITH NON-CONTACTING OPTICAL 3D MOTION MEASUREMENT SYSTEM, ALLOWS FOR THE INVESTIGATION AND QUANTIFICATION OF THE PERFORMANCE OF SEVERAL INTERNAL SPINAL FIXATION SYSTEMS UNDER COMPLEX DYNAMIC LOADS. IN PARTICULAR, QUANTIFYING THE ABILITY OF SUCH SYSTEMS TO RESTRICT MOTIONS ACROSS THE INJURED SEGMENTS TO A MINIMUM, THOUGHT TO BE CRITICAL FOR THE INITIATION AND PROGRESSION OF THE FUSION PROCESS, IS GREATLY FACILITATED BY THE USE OF THIS DEVICE.A SECOND MAJOR AREA IS THE USE OF NOVEL BIOMATERIALS FOR SPINAL SURGERY. IN AN ONGOING COLLABORATION WITH SEVERAL COMPANIES, WE HAVE DEMONSTRATED THE EFFICACY OF A NOVEL FAMILY OF ELASTIC-BIOPOLYMERS IN GREATLY REDUCING EPIDURAL ADHESIONS (THE ADHESION AND CONSEQUENT TETHERING OF THE DURA MATER AND NERVE ROOTS BY FIBROTIC TISSUE, A COMMON COMPLICATION OF DECOMPRESSIVE LAMINECTOMY OR DISCECTOMY SURGICAL PROCEDURES). THIS FAMILY OF MATERIALS IS ALSO UNDER INVESTIGATION FOR THE RECONSTITUTION (I.E. RESTORATION OF MECHANICAL FUNCTION) OF EARLY DEGENERATION OF THE INTERVERTEBRAL DISC. SUCH MATERIALS HOLD GREAT PROMISE DUE TO OUR ABILITY TO TAILOR-MAKE THESE MATERIALS BOTH WITH RESPECT TO THEIR MECHANICAL AND MATERIAL PROPERTIES, AND AS CARRIERS FOR BIOLOGICAL AGENTS.A THIRD AREA OF RESEARCH IS AIMED AT ELUCIDATING THE UNDERLYING CAUSES FOR VERTEBRAL COMPRESSION FRACTURES THAT ARE VERY PREVALENT IN THE ELDERLY POPULATION. ALTHOUGH THEY CAUSE SUBSTANTIAL PAIN, DEFORMITY, AND DISABILITY, THERE IS NO WIDELY ACCEPTED TREATMENT. THE EFFECTS OF HIGH LOAD RATE IN A SIMULATED FALL CONFIGURATION AND THE VERTEBRAL MATERIAL PROPERTIES ON THE ULTIMATE FRACTURE LOAD AND CONSEQUENT LOSS IN THE STABILITY OF THE SPINAL SEGMENT, ARE BEING INVESTIGATED. FURTHERMORE, AS PART OF THE USE OF NOVEL BIOMATERIALS, THE USE OF SEVERAL BIOCOMPATIBLE CEMENTS AND HYDROXYAPATITE COMPOSITES FOR AUGMENTATION OF THE FAILED VERTEBRAL BODY, A SURGICAL PROCEDURE KNOWN AS PERCUTANEOUS VETERBROPLASTY, IS ACTIVELY BEING ASSESSED. FOR THIS PURPOSE, A SPECIALLY DESIGNED HIGH RATE VERTEBRAL FRACTURE JIG, USED TO CREATE A SIMULATED COMPRESSION-FLEXION FRACTURE, AND A 5DOF STABILITY TEST JIG, USED TO ASSESS THE 3D STABILITY OF THE FRACTURED AND AUGMENTED SPINAL SEGMENT, ARE EMPLOYED.
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LUNG CANCER RESEARCH THE THORACIC ONCOLOGY PROGRAM IS INVOLVED IN CLINICAL, BASIC AND TRANSLATIONAL RESEARCH ACTIVITIES. DRS. DANIEL G. TENEN, SUSUMU KOBAYASHI AND DANIEL B. COSTA HAVE MADE SEMINAL OBSERVATIONS ON THE BASIS OF RESISTANCE TO GEFITINIB AND ERLOTINIB (ORAL EGFR INHIBITORS) IN LUNG CANCER PATIENTS WITH SOMATIC EPIDERMAL GROWTH FACTOR RECEPTOR (EGFR) MUTATIONS. THE PROGRAM IS INVOLVED IN ONGOING CLINICAL TRIALS WITHIN THE DANA-FARBER/HARVARD CANCER CENTER (DF/HCC), INCLUDING THOSE RELATED TO NOVEL EGFR INHIBITORS AND OTHER TARGETED AGENTS. DRS. COSTA AND MARK S. HUBERMAN ARE PRINCIPAL INVESTIGATORS FOR ACTIVE CLINICAL TRIALS AT BIDMC.THE THORACIC ONCOLOGY PROGRAM IS A KEY MEMBER OF THE DF/HCC LUNG SPORE'S EFFORTS TO IDENTIFY TRANSCRIPTION FACTORS INVOLVED IN THE PATHOGENESIS OF LUNG CANCER. DRS. COSTA AND TENEN ARE CO-LEADERS OF THE LUNG SPORE PROGRAM AT D/FHCC. MAIN INTERESTS IN BASIC RESEARCH INCLUDE: TRANSCRIPTION FACTORS INVOLVED IN LUNG DEVELOPMENT AND CANCER, ONCOGENES INVOLVED NON-SMALL CELL LUNG CANCER, MECHANISMS OF ACTION OF EGFR TYROSINE KINASE INHIBITORS, APOPTOSIS, AND EGFR MUTATED ADENOCARCINOMAS OF THE LUNG.DRS. TENEN AND COSTA ARE STUDYING THE STUDYING THE ROLE OF TRANSCRIPTION FACTORS, INCLUDING C/EBP ALPHA AND FOXA2, IN NORMAL LUNG DIFFERENTIATION, AS WELL AS IN LUNG CANCER. DR. COSTA IS ALSO INVOLVED IN CLINICAL TRIALS AND TRANSLATIONAL RESEARCH TOWARDS HOW ONCOGENE MUTATIONS (SPECIFICALLY IN EGFR) AND TRANSLOCATIONS AFFECT THE RESPONSE TO TYROSINE KINASE INHIBITORS IN NON-SMALL CELL LUNG CANCER.DR. KOBAYASHI IS INTERESTED IN STUDYING THE MECHANISMS OF RESISTANCE CAUSED BY EGFR TYROSINE KINASE INHIBITORS; THE BCL-2 FAMILY PROTEINS, WHICH ARE RESPONSIBLE FOR TYROSINE KINASE INHIBITOR-INDUCED APOPTOSIS; AND PHARMACOGENOMIC STUDIES OF COMPOUNDS CAPABLE OF INDUCING CELL DIFFERENTIATION OF LUNG CANCER CELLS. THESE STUDIES WILL LEAD TO NEW INSIGHTS INTO MUTANT EGFR-DRIVEN TUMOROGENESIS, AS WELL AS THE IDENTIFICATION OF NOVEL TARGET PATHWAYS FOR THERAPEUTIC INTERVENTION IN LUNG CANCER.
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BONE MARROW TRANSPLANTATION RESEARCH THE PROGRAM IN BONE MARROW TRANSPLANTATION (DRS. DAVID E. AVIGAN, JON ARNASON, VASSILIKI BOUSSIOTIS, ROBIN M. JOYCE, JAMES D. LEVINE, JACALYN ROSENBLATT, DIMITRIOS TZACHANIS, AND JEFFREY I. ZWICKER) IS LARGELY INVOLVED WITH CLINICAL AND TRANSLATIONAL RESEARCH ACTIVITIES.A FUNDAMENTAL MISSION OF THE HEMATOLOGICAL MALIGNANCIES AND BONE MARROW TRANSPLANTATION PROGRAM IS TO ENHANCE OUR UNDERSTANDING OF THE BASIC BIOLOGY OF BLOOD CANCERS AND TO TRANSLATE THIS KNOWLEDGE TOWARDS THE DEVELOPMENT OF EFFECTIVE THERAPIES. THE PROGRAM CONDUCTS A BROAD ARRAY OF RESEARCH STUDIES DIRECTED TOWARDS ENHANCING AND REFINING EXISTING THERAPIES, AS WELL AS EXAMINING THE EFFICACY OF NEW TREATMENT APPROACHES. THESE INCLUDE THE DEVELOPMENT OF CLINICAL PROTOCOLS THAT ARE CONDUCTED THROUGH THE DANA-FARBER/HARVARD CANCER CENTER (DF/HCC), THE EASTERN COOPERATIVE ONCOLOGY GROUP (ECOG), AND THE CLINICAL TRIALS NETWORK. THESE EFFORTS ARE SUPPORTED BY A LARGE INFRASTRUCTURE OF RESEARCH STAFF REQUIRED FOR PATIENT MONITORING, DATA COLLECTION, AND RESEARCH ANALYSIS OF STUDIES.A CENTRAL AREA OF TRANSLATIONAL SCIENTIFIC INVESTIGATION HAS BEEN THE DEVELOPMENT OF NOVEL IMMUNE BASED THERAPIES FOR THE TREATMENT OF BLOOD CANCERS. BONE MARROW TRANSPLANTATION IS UNIQUELY CURATIVE FOR MANY PATIENTS WITH HEMATOLOGICAL MALIGNANCIES DUE TO THE TARGETING OF TUMOR CELLS BY THE TRANSPLANTED DONOR IMMUNE SYSTEM. HOWEVER, THE RISKS ASSOCIATED WITH THIS APPROACH ARE CONSIDERABLE DUE TO TREATMENT RELATED TOXICITY, TRANSPLANT RELATED INFECTIONS, AND THE LACK OF SPECIFICITY OF THE ANTI-TUMOR RESPONSE RESULTING IN DAMAGE OF THE NORMAL TISSUES BY THE INFUSED DONOR CELLS.INVESTIGATIONS INTO THESE RISKS HAVE LED TO THE DEVELOPMENT OF NOVEL STRATEGIES TO MINIMIZE TRANSPLANT-ASSOCIATED TOXICITY WHILE PRESERVING ITS UNIQUE EFFICACY. WE HAVE DEVELOPED SEVERAL APPROACHES FOR ALLOGENEIC TRANSPLANTATION WITH REDUCED INTENSITY CHEMOTHERAPY REGIMENS IN WHICH ANTI-TUMOR EFFECTS ARE PRIMARILY MEDIATED BY DONOR IMMUNE CELLS. THIS APPROACH ALLOWS FOR THE ADOPTION OF THIS POTENTIALLY CURATIVE THERAPY IN OLDER AND INFIRM PATIENTS WHO WOULD NOT BE ABLE TO TOLERATE A TRADITIONAL TRANSPLANT. WE ARE ALSO STUDYING NEWER REGIMENS THAT WILL ENHANCE THE REDUCTION OF THE LEUKEMIA CELL BURDEN PRIOR TO THE TRANSPLANT BURDEN, AND HAVE FOCUSED OUR EFFORTS ON EXAMINING HOW THE PATTERN OF IMMUNE RECOVERY POST-TRANSPLANT EFFECTS PATIENT OUTCOMES.THERE HAS BEEN STRONG INTEREST IN HARNESSING THE PATIENT'S OWN IMMUNE SYSTEM TO TARGET AND ELIMINATE CANCER CELLS. HOWEVER, TUMOR CELLS ACTIVELY PREVENT THEIR RECOGNITION BY THE IMMUNE SYSTEM BY CREATING AN IMMUNOSUPPRESSIVE MILIEU THAT INHIBITS CELLULAR IMMUNE FUNCTION. RESEARCH EFFORTS LED BY DR. DAVID AVIGAN, THE PROGRAM DIRECTOR, AND DR. JACALYN ROSENBLATT HAVE FOCUSED ON THE DEVELOPMENT OF TUMOR VACCINES THAT WOULD EFFECTIVELY REVERSE THE CANCER CELL'S ABILITY TO SUPPRESS THE IMMUNE SYSTEM, STIMULATE ANTI-TUMOR IMMUNE RESPONSES, ERADICATE EXISTING DISEASE AND PROVIDE LONG-TERM PROTECTION AGAINST RECURRENCE THROUGH THE DEVELOPMENT OF IMMUNOLOGIC MEMORY AGAINST THE TUMOR. TO ACCOMPLISH THIS EFFECT, WE ARE USING POTENT IMMUNE STIMULATING CELLS KNOWN AS DENDRITIC CELLS (DCS), WHICH ARE THE NATIVE "TEACHERS OF THE IMMUNE SYSTEM". DCS PRESENT ANTIGENS IN THE CONTEXT OF POTENT COSTIMULATORY SIGNALS THAT ARE NECESSARY FOR THE INDUCTION OF PRIMARY IMMUNE RESPONSES. AS THE CENTRAL MEDIATORS OF IMMUNE STIMULATION, DCS DEMONSTRATE THE CAPACITY TO OVERCOME TUMOR ASSOCIATED IMMUNE TOLERANCE.THROUGH OUR PRECLINICAL WORK, WE DEVELOPED A VACCINATION SYSTEM USING DCS FUSED TO WHOLE TUMOR CELLS TO PRODUCE A FUSION CELL THAT CARRIES A BROAD ARRAY OF TUMOR TARGETS, INCLUDING TARGETS THAT ARE SPECIFIC TO A PARTICULAR PATIENT. APPLIED INITIALLY IN A MOUSE MODEL, WE DEMONSTRATED THAT MICE VACCINATED WITH FUSION CELLS DEVELOPED STRONG ANTI-TUMOR RESPONSES, WERE PROTECTED FROM A LETHAL CHALLENGE OF TUMOR CELLS, AND, MOST IMPORTANTLY, DEMONSTRATED COMPLETE REGRESSION OF ESTABLISHED METASTATIC DISEASE. WE THEN DEMONSTRATED THAT FUSIONS CREATED WITH PATIENT DERIVED TUMOR CELLS AND DENDRITIC CELLS INDUCED POWERFUL IMMUNE RESPONSES, IN VITRO, AGAINST A VARIETY OF HUMAN TUMORS INCLUDING BREAST CANCER, OVARIAN CANCER, AND MULTIPLE MYELOMA.WE HAVE SUBSEQUENTLY RECEIVED APPROVAL FROM THE FDA TO STUDY THE SAFETY AND EFFECTIVENESS OF THE FUSION VACCINE IN PATIENTS WITH CANCER. WE ESTABLISHED AN IMMUNOTHERAPY PROGRAM AT BIDMC IN WHICH PATIENT SPECIFIC FUSION VACCINES ARE GENERATED IN OUR CLINICAL IMMUNOTHERAPY AND CELL MANIPULATION FACILITY. THIS PROGRAM IS MULTIDISCIPLINARY, DRAWING UPON THE EXPERTISE OF MEMBERS OF THE DEPARTMENTS OF MEDICINE (SPECIFICALLY, THE BONE MARROW TRANSPLANT AND ONCOLOGY PROGRAMS), SURGERY AND PATHOLOGY AS WELL AS OTHER INVESTIGATORS AT THE HARVARD CANCER CENTER. WE HAVE SUCCESSFULLY COMPLETED PHASE I/II STUDIES IN BREAST AND RENAL CANCER AND HAVE DEMONSTRATED IMMUNOLOGIC AND CLINICAL RESPONSES IN A SUBSET OF PATIENTS. WE ARE CURRENTLY FOCUSING OUR EFFORTS ON IMPROVING THE EFFICACY OF THE VACCINES AND HAVE RECEIVED GRANT SUPPORT FROM THE NATIONAL CANCER INSTITUTE, DEPARTMENT OF DEFENSE AND THE LEUKEMIA SOCIETY TO STUDY OUR CANCER VACCINE IN PATIENTS WITH BLOOD CANCERS AS WELL AS BREAST, MELANOMA, RENAL AND OVARIAN CARCINOMA. WE ARE CONDUCTING TWO STUDIES FOR PATIENTS WITH MULTIPLE MYELOMA INCLUDING A PROTOCOL IN WHICH PATIENTS UNDERGO VACCINATION FOLLOWING AUTOLOGOUS TRANSPLANTATION IN AN EFFORT TO ELIMINATE POST-TRANSPLANT RESIDUAL DISEASE. OUR PRE-CLINICAL WORK IS CURRENTLY FOCUSING ON EFFORTS TO REVERSE TUMOR-MEDIATED SUPPRESSION OF THE IMMUNE SYSTEM. WE ARE DEVELOPING STRATEGIES TO EXPAND TUMOR REACTIVE T CELLS EX VIVO IN AN EFFORT TO GENERATE T CELL THERAPIES FOR PATIENTS WITH ACUTE LEUKEMIA. WE ARE ALSO DEVELOPING OTHER APPROACHES FOR PRODUCING CANCER VACCINES INCLUDING THE USE OF VIRUSES THAT HAVE BEEN MANIPULATED TO CONTAIN TUMOR SPECIFIC GENES.ANOTHER AREA OF INVESTIGATION CONCERNS THE IDENTIFICATION OF CANCER STEM CELLS IN PATIENTS WITH BLOOD CANCERS. ONE OF THE FUNDAMENTAL CHALLENGES OF ERADICATING MALIGNANCY IS THAT TUMOR CELLS ARE DERIVED FROM A SMALL NUMBER OF STEM CELLS THAT ARE DISTINCT FROM THE MAJORITY OF TUMOR CELLS AND APPEAR TO BE MORE RESISTANT TO EXISTING THERAPIES. THIS MAY ACCOUNT FOR THE OBSERVATION THAT PATIENTS WITH BLOOD CANCERS MAY RESPOND TO CHEMOTHERAPY BUT SUBSEQUENTLY SUCCUMB TO DISEASE RECURRENCE. BONE MARROW TRANSPLANTATION IS POTENTIALLY EFFECTIVE IN ELIMINATING BLOOD CANCER STEM CELLS THROUGH THEIR REPLACEMENT BY NORMAL DONOR HEMATOPOIESIS. HOWEVER, THE CHEMOTHERAPY TREATMENT AND THE SUBSEQUENT DISRUPTION OF THE PATIENT'S IMMUNE SYSTEM RESULTS IN SIGNIFICANT TREATMENT ASSOCIATED MORBIDITY AND MORTALITY. DRS ROSENBLATT AND AVIGAN ARE EXAMINING APPROACHES TO SELECTIVELY IDENTIFY AND ISOLATE TUMOR STEM CELLS SO THAT WE COULD DEVELOP NOVEL THERAPEUTIC STRATEGIES TO TARGET THESE CELLS.UNDER THE DIRECTION OF DR. ROBIN JOYCE, THE PROGRAM HAS ALSO LED EFFORTS TO DEVELOP ANTIBODY-MEDIATED THERAPIES FOR NON-HODGKIN'S LYMPHOMA. WE HAVE COMPLETED A STUDY, WHICH DEMONSTRATED DISEASE FREE SURVIVAL IN A MAJORITY OF PATIENTS TREATED WITH RITUXAMAB IN CONJUNCTION WITH AUTOLOGOUS STEM CELL TRANSPLANTATION. DR. JOYCE HAS ALSO BEEN ON THE FOREFRONT IN STUDIES EXAMINING THE EFFECT OF ANTI-LYMPHOMA ANTIBODIES BOUND TO A RADIOACTIVE MATERIAL IN THE TREATMENT OF PATIENTS WITH LOW GRADE AND AGGRESSIVE LYMPHOMA.DR. BOUSSIOTIS AND HER LABORATORY ARE INTERESTED IN: THE MOLECULAR MECHANISMS OF T CELL TOLERANCE, THE ROLE OF P27KIP1 IN T HELPER AND CYTOLYTIC RESPONSES, THE REGULATION OF T CELL IMMUNE RESPONSES BY RAP1, PI3K AND ITS DOWNSTREAM PATHWAYS AS THERAPEUTIC TARGETS FOR T-ALL, AND THE RECONSTITUTION OF T CELL IMMUNITY AFTER UNRELATED CORD BLOOD TRANSPLANTATION IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES.
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CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS - GRADUATE MEDICAL EDUCATION BIDMC'S DEVOTION TO TEACHING, RESPECT FOR STUDENTS/TRAINEES, AND WILLINGNESS TO EMBRACE TECHNOLOGICAL AND CLINICAL PRACTICE INNOVATION MAKE BIDMC A TOP CHOICE AMONG MEDICAL STUDENTS AND HEALTH CARE PROFESSIONALS. WE TRAIN HUNDREDS OF MEDICAL STUDENTS, INTERNS AND RESIDENTS, AS WELL AS PROFESSIONALS IN NURSING, SOCIAL WORK AND THE ALLIED HEALTH SCIENCES. THE MEDICAL CENTER HAS 39 APPROVED RESIDENCY PROGRAMS WITH OVER 400 RESIDENTS AND 31 CLINICAL FELLOW PROGRAMS WITH OVER 150 FELLOWS.STAFF PHYSICIANS AT BIDMC WHO HOLD FACULTY APPOINTMENTS AT HARVARD MEDICAL SCHOOL INSTRUCT THE DOCTORS OF TOMORROW THROUGH SUPERVISION OF THEIR DAILY PATIENT CARE AND A RANGE OF INTERACTIVE LEARNING EXPERIENCES. CORE CLINICAL TRAINING PROGRAMSBIDMC SPONSORS CORE CLINICAL TRAINING PROGRAMS IN THE FOLLOWING FIELDS:- ANESTHESIOLOGY- EMERGENCY MEDICINE- INTERNAL MEDICINE- NEUROLOGY- OBSTETRICS AND GYNECOLOGY- PATHOLOGY- RADIOLOGY- SURGERYDURING THE FISCAL YEAR COVERED BY THIS FILING, BIDMC HAD NET EXPENDITURES OF $66,042,911 REPORTED ON THIS SCHEDULE H RELATED TO BIDMC'S TEACHING FUNCTION WHICH REPRESENTED 5.06% OF BIDMC'S TOTAL EXPENSES, ADJUSTED FOR BAD DEBT EXPENSE AS NOTED ABOVE.RESIDENCY PROGRAMSBIDMC SPONSORS ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) APPROVED RESIDENCY PROGRAMS IN EACH OF THE CORE CLINICAL TRAINING PROGRAMS LISTED ABOVE, AS WELL AS PSYCHIATRY. FELLOWSHIP PROGRAMSIN ADDITION TO THE RESIDENT TRAINING PROGRAMS LISTED ABOVE, BIDMC SPONSORS A WIDE VARIETY OF FELLOWSHIP TRAINING PROGRAMS FOR ELIGIBLE DOCTORS WHO HAVE COMPLETED THEIR RESIDENCY AND WANT TO ENGAGE IN MORE SPECIALIZED STUDY. THE MAJORITY OF THESE PROGRAMS (38 OF 44) ARE ACGME APPROVED OR APPROVED BY A COMPARABLE BODY RELATED TO THE PARTICULAR SUBSPECIALTY. BIDMC SPONSORS THE FOLLOWING FELLOWSHIP PROGRAMS:ANESTHESIACARDIOTHORACIC ANESTHESIA- CRITICAL CARE MEDICINE ANESTHESIA- PAIN MANAGEMENTDERMATOLOGY- DERMATOLOGYMEDICINE- CARDIOVASCULAR DISEASE- CLINICAL CARDIAC ELECTROPHYSIOLOGY- INTERVENTIONAL CARDIOLOGY- CLINICAL INVESTIGATOR TRAINING PROGRAM- ENDOCRINOLOGY, DIABETES, AND METABOLISM- GASTROENTEROLOGY- TRANSPLANT HEPATOLOGY- GENERAL MEDICINE -GERIATRIC MEDICINE-GERONTOLOGY- HEMATOLOGY / ONCOLOGY- INFECTIOUS DISEASE- NEPHROLOGY- INTERVENTIONAL PULMONARY- PULMONARY, CRITICAL CARE - RHEUMATOLOGY- SLEEP MEDICINENEONATOLOGY- NEONATAL-PERINATAL FELLOWSHIPNEUROLOGY- NEUROLOGY- NEUROMUSCULAR MEDICINE- VASCULAR NEUROLOGY- CLINICAL NEUROPHYSIOLOGY,- EEG AND AUTONOMIC DISORDERS FELLOWSHIP OBSTETRICS AND GYNECOLOGY- REPRODUCTIVE ENDOCRINOLOGY- MATERNAL FETAL MEDICINEPATHOLOGY- CYTOPATHOLOGY- DERMATOPATHOLOGY- HEMATOPATHOLOGY- SELECTIVE PATHOLOGY- MEDICAL MICROBIOLOGYRADIATION ONCOLOGY- RADIATION ONCOLOGYRADIOLOGY- RADIOLOGYSURGERY- CARDIOTHORACIC SURGERY- CRITICAL CARE SURGERY- MINIMALLY INVASIVE SURGERY- ORTHOPAEDIC SPINE- PODIATRY- SOLID ORGAN SURGERY-TRANSPLANT- PLASTIC/HAND SURGERY- ORTHOPAEDIC HAND SURGERY- VASCULAR SURGERYUROLOGY- UROLOGY
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ADDITIONAL INFORMATION ON CLINICAL RESIDENCY AND FELLOWSHIPS - EXAMPLESBELOW IS MORE DETAIL ON JUST A FEW OF THE SPECIFIC GRADUATE MEDICAL EDUCATION PROGRAMS OFFERED AT BIDMC:HARVARD AFFILIATED EMERGENCY MEDICINE RESIDENCY (HAEMR) AT BIDMC THE BETH ISRAEL DEACONESS MEDICAL CENTER HARVARD AFFILIATED EMERGENCY MEDICINE RESIDENCY IS A THREE-YEAR PROGRAM (PGY-1 TO PGY-3) AFFILIATED WITH HARVARD MEDICAL SCHOOL AND BASED AT BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC). THE BIDMC EMERGENCY DEPARTMENT (ED) IS A 53,000 VISIT PER YEAR LEVEL I TRAUMA CENTER. THE EDUCATIONAL GOALS OF THE RESIDENCY ARE TO PROMOTE EXCELLENCE IN THE CLINICAL, ACADEMIC, AND ADMINISTRATIVE ASPECTS OF EMERGENCY MEDICINE. RESIDENTS ARE TAUGHT HOW TO BE OUTSTANDING CLINICIANS. THIS IS ACCOMPLISHED THROUGH CLINICAL EXPERIENCE IN SEVERAL BUSY EMERGENCY DEPARTMENTS (RESIDENTS PARTICIPATING IN THIS PROGRAM HAVE THE OPPORTUNITY TO ROTATE AT CHILDREN'S HOSPITAL BOSTON, SOUTH SHORE HOSPITAL, NEW ENGLAND MEDICAL CENTER, ST. VINCENT'S HOSPITAL, ST. LUKE'S HOSPITAL, MOUNT AUBURN HOSPITAL AND BETH ISRAEL DEACONESS HOSPITAL-NEEDHAM) AS WELL AS THROUGH A HIGH QUALITY DIDACTIC PROGRAM. DURING THE CLINICAL EXPERIENCE, THE RESIDENTS ARE CLOSELY SUPERVISED AND GIVEN GRADED RESPONSIBILITY FOR PATIENT CARE AND ULTIMATELY FOR PATIENT FLOW IN THE ED. ADDITIONALLY, RESIDENTS ARE TAUGHT HOW TO SUPERVISE MEDICAL STUDENTS AND OTHER RESIDENTS AND HOW TO TEACH THE PRACTICE OF EMERGENCY MEDICINE. RESIDENTS TEACH MEDICAL STUDENTS AND PREHOSPITAL PERSONNEL AND CONTRIBUTE TO THE DIDACTIC PROGRAM. SENIOR RESIDENTS TAKE ON THE RESPONSIBILITY OF SUPERVISING JUNIOR RESIDENTS IN THE CLINICAL ARENA. THE FOCUS OF THE RESIDENCY PROGRAM IS ON TEACHING THE LEADERSHIP SKILLS NECESSARY TO DIRECT A BUSY EMERGENCY DEPARTMENT IN ANY SETTING.THE OTHER MAJOR EDUCATIONAL GOAL OF THE RESIDENCY IS TO DEVELOP THE RESEARCH AND ACADEMIC SKILLS REQUIRED FOR A CAREER IN ACADEMIC EMERGENCY MEDICINE. PARTICIPATION IN RESEARCH IS PROMOTED THROUGH A SYSTEM OF MENTORSHIP, JOURNAL CLUB PARTICIPATION, AND A DIDACTIC PROGRAM THAT TEACHES RESEARCH DESIGN AND STATISTICAL METHODS. RESIDENTS ARE REQUIRED TO COMPLETE A RESEARCH OR ACADEMIC PROJECT THAT RESULTS IN A PAPER SUITABLE FOR PUBLICATION. FUNDING IS AVAILABLE WITHIN THE DIVISION OF EMERGENCY MEDICINE AT HARVARD MEDICAL SCHOOL AND THE DEPARTMENT OF EMERGENCY MEDICINE AT BIDMC. PROMOTING THE ADMINISTRATIVE ASPECTS OF EMERGENCY MEDICINE IS ANOTHER GOAL OF THE BIDMC HARVARD AFFILIATED EMERGENCY MEDICINE RESIDENCY. THROUGH AN EMS/ADMINISTRATIVE ROTATION AND A LONGITUDINAL EXPERIENCE IN PREHOSPITAL ADMINISTRATION, RESIDENTS GAIN EXPERIENCE IN RUNNING A LOCAL PREHOSPITAL SYSTEM.THIS PROGRAM TAKES ADVANTAGE OF THE UNIQUE ACADEMIC OPPORTUNITIES AT HARVARD MEDICAL SCHOOL, THE HARVARD TEACHING HOSPITALS, AND THE HARVARD SCHOOL OF PUBLIC HEALTH. THESE OPPORTUNITIES INCLUDE THE OUTSTANDING EXPERIENCE AVAILABLE THROUGH BOSTON CHILDREN'S HOSPITAL AND THE DEPARTMENTS OF MEDICINE, SURGERY, OBSTETRICS AND GYNECOLOGY, AND ANESTHESIA AT BETH ISRAEL DEACONESS MEDICAL CENTER. SURGERY: EDUCATION THE ROBERTA AND STEPHEN R. WEINER DEPARTMENT OF SURGERY OFFERS EDUCATION OPPORTUNITIES FOR RESIDENTS, FELLOWS AND MEDICAL STUDENTS IN CARDIAC SURGERY, GENERAL SURGERY, PLASTIC AND RECONSTRUCTIVE SURGERY, PODIATRY, TRAUMA SURGERY, MINIMALLY INVASIVE SURGERY, AND VASCULAR SURGERY. STUDENTS LEARN THE MOST ADVANCED TECHNIQUES IN A STATE-OF-THE-FACILITY. STUDENTS ALSO HAVE THE OPPORTUNITY TO LEARN MINIMALLY INVASIVE TECHNIQUES AT THE CARL J. SHAPIRO SIMULATION AND SKILLS CENTER, THE FIRST OF ITS KIND TO BE ACCREDITED IN THE COUNTRY AND LOCATED WITHIN THE MEDICAL CENTER.GENERAL SURGERY RESIDENCY: EDUCATION THE DEPARTMENT OF SURGERY AT BETH ISRAEL DEACONESS MEDICAL CENTER IS ONE OF THREE MAJOR TEACHING AND RESEARCH UNITS OF HARVARD MEDICAL SCHOOL'S DEPARTMENT OF SURGERY. THE PROGRAM IS NON-PYRAMIDAL. THE SURGICAL HOUSESTAFF IS COMPOSED OF 25 FIRST YEAR RESIDENTS, CONSISTING OF 9 CATEGORICAL (FULL FIVE-YEAR), AND 16 PRELIMINARY RESIDENTS (ONE- OR TWO-YEAR DEPENDING ON THE REQUIREMENTS OF THEIR CHOSEN SUBSPECIALTY). GENERALLY THERE ARE 9 CATEGORICAL, 4 NON DESIGNATED PRELIMINARY RESIDENTS AND 1 ROTATING PLASTIC SURGERY RESIDENT AT THE PGY-2 LEVEL. IN THE PGY-3, PGY-4 AND PGY-5 CHIEF RESIDENT LEVELS, THERE ARE GENERALLY 9 CATEGORICAL RESIDENTS. ALL MEMBERS OF THE HOUSE-STAFF HOLD ACADEMIC APPOINTMENTS AS CLINICAL FELLOWS IN SURGERY AT HARVARD MEDICAL SCHOOL.THE SURGICAL TRAINING PROGRAM PRODUCES THE COUNTRY'S FUTURE SURGICAL LEADERS. CLINICAL EXCELLENCE IS THE FOUNDATION UPON WHICH THAT LEADERSHIP IS BUILT, AND OUR TRAINING PROGRAMS ENDEAVOR TO HELP YOUNG SURGEONS DEVELOP BOTH TECHNICAL AND COGNITIVE EXPERTISE. AT ALL LEVELS, THE HOUSESTAFF ENJOY THE TRAINING AND PRACTICAL EXPERIENCE IN THE PREOPERATIVE, OPERATIVE, AND POST-OPERATIVE CARE OF PATIENTS. THE BETH ISRAEL DEACONESS PROGRAM EMPHASIZES RESIDENT-FACULTY INTERACTION FOR EDUCATIONAL PURPOSES. TEACHING CONFERENCES AND SEMINARS FOR THE HOUSESTAFF CAPITALIZE ON WORKING RELATIONSHIPS DEVELOPED WITH THE ATTENDING STAFF.UPON COMPLETION OF FIVE YEARS OF SURGICAL TRAINING, RESIDENTS ARE ELIGIBLE FOR THE AMERICAN BOARD OF SURGERY EXAMINATION. OUTSTANDING SPECIALTY FELLOWSHIPS IN PLASTIC, CARDIOTHORACIC, PEDIATRIC, TRANSPLANT, COLORECTAL, AND VASCULAR SURGERY ARE OBTAINED ROUTINELY BY OUR GRADUATES. GRADUATES TYPICALLY ENJOY SUPERB OPPORTUNITIES IN EITHER PRIVATE OR ACADEMIC PRACTICE.
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DIDACTIC TEACHINGTHE PROGRAM HAS DEDICATED EDUCATION TIME, INCLUDING A STRONG DIDACTIC CONFERENCE SCHEDULE, TO PROVIDE A BASIC FOUNDATION OF SURGICAL KNOWLEDGE AND SKILLS. REQUIRED WEEKLY CONFERENCES INCLUDE:- RESIDENT CURRICULUM CONFERENCE / MIS SKILLS LAB - SURGICAL SERVICE MORBIDITY/MORTALITY & SURGICAL GRAND ROUNDS - COMBINED GI CONFERENCETHROUGHOUT TRAINING, A PRIMARY RESPONSIBILITY OF SENIOR RESIDENTS IS TEACHING MORE JUNIOR RESIDENTS AND THE STUDENTS ON THEIR SERVICE. THEY ARE ALSO RESPONSIBLE FOR THE ASSIGNMENT OF CASES, CLINICAL SUPERVISION OF MEDICAL STUDENTS AND RESIDENTS, AND PREPARING MATERIAL FOR SERVICE AND TEACHING CONFERENCES.CARL J. SHAPIRO SIMULATION AND SKILLS CENTERTHE CARL J. SHAPIRO SIMULATION AND SKILLS CENTER (SASC) AT BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC) OFFERS THE LATEST ADVANCES IN MEDICAL SIMULATION TECHNOLOGY TO BIDMC, NEIGHBORING INSTITUTIONS AND THE GLOBAL HEALTHCARE FIELD IN A NEW, STATE-OF-THE-ART FACILITY. THE CENTER PROVIDES REALISTIC TRAINING OPPORTUNITIES FOR LEARNERS AT ALL LEVELS, FROM ALL DISCIPLINES, AND USES PROGRESSIVE TEACHING METHODS TO REPLICATE REAL-LIFE PATIENT CARE SITUATIONS, FROM ROUTINE PROCEDURES TO ACUTE MANAGEMENT CRISES. THE SASC RAISES THE BAR FOR MAJOR ACADEMIC MEDICAL CENTERS BY PROVIDING HEALTH CARE STUDENTS AND PROFESSIONALS WITH CURRICULA AND SKILLS TRAINING ON THE LATEST MEDICAL AND SURGICAL TECHNIQUES IN A STATE-OF-THE-ART, TECHNOLOGICALLY ADVANCED FACILITY. ALTHOUGH MOST HEALTH CENTERS OFFER SOME DEGREE OF MEDICAL SIMULATION TRAINING, THE SCALE AND SCOPE OF BIDMC'S SASC MAKE IT ONE OF THE MOST COMPREHENSIVE SIMULATION TRAINING CENTERS IN THE COUNTRY. THE CENTER INCLUDES A LARGE TELECONFERENCE ROOM FOR UP TO 65 LEARNERS AND CONTAINS LIVE MEDIA FEEDS TO FOUR DIFFERENT OPERATING ROOM ENDOSUITES, ALLOWING FOR TELEPROCTORING, INTER-INSTITUTIONAL COURSES, AND INTERCONTINENTAL BROADCASTING OF GRAND ROUNDS. THE HIGH FIDELITY MOCK OPERATING AND INTENSIVE CARE UNIT ROOMS USED FOR FULL-BODY SIMULATION FEATURE WORKING WATER AND GAS LINES, VIDEO CAMERAS AND OBSERVATION WINDOWS WITH STATE-OF-THE-ART TELECONFERENCING ABILITY. TWO SKILLS LAB AREAS ARE DEDICATED TO PROVIDING LEARNERS WITH HANDS-ON TRAINING FOR BASIC CLINICAL PROCEDURES, OPEN SURGICAL SKILLS, ENDOSCOPIC, ULTRA-SONOGRAPHY, AND LAPAROSCOPIC SKILLS WITH OVER 30 PARTIAL TASK TRAINERS AND HIGH-FIDELITY PROCEDURAL SIMULATORS.BIDMC'S CARL J. SHAPIRO SIMULATION AND SKILLS CENTER HAS BEEN FORMALLY ACCREDITED AS A LEVEL 1 FACILITY BY THE AMERICAN COLLEGE OF SURGEONS (ACS), THE FIRST IN BOSTON AND NEW ENGLAND - AND ONE OF ONLY SEVEN INAUGURAL CERTIFIED CENTERS IN THE UNITED STATES - TO PROVIDE SIMULATION-BASED SKILLS TRAINING TO HEALTH CARE STUDENTS AND PROFESSIONALS FROM ALL MEDICAL AND SURGICAL DISCIPLINES. AS AN ACS ACCREDITED EDUCATION INSTITUTE, THE SASC IS PART OF THE ACS' DEVELOPING NETWORK OF REGIONAL EDUCATION FACILITIES DESIGNED TO "SPECIFICALLY ADDRESS THE TEACHING, LEARNING AND ASSESSMENT OF TECHNICAL SKILLS USING STATE-OF-THE-ART EDUCATIONAL METHODS AND CUTTING-EDGE TECHNOLOGY." THIS LATEST ACCREDITATION FOLLOWS THE CENTER'S RECENT CERTIFICATION AS ONE OF 11 NATIONAL TEST SITES FOR FUNDAMENTALS OF LAPAROSCOPIC SURGERY (FLS) CANDIDATES. SASC FACULTY PROCTOR THE TWO-PART COGNITIVE AND MANUAL SKILLS EXAM FOR RESIDENTS, FELLOWS AND SURGEONS PERFORMING LAPAROSCOPIC SURGERY.GENERAL SURGERY PGY-1 YEARTHE INTERNSHIP YEAR FOCUSES ON THE ACQUISITION OF BASIC PRINCIPLES AND CLINICAL SKILLS IN GENERAL AND VASCULAR SURGERY; ADDITIONAL ROTATIONS IN THE EMERGENCY DEPARTMENT AND SUBSPECIALTY SERVICES ROUND OUT THE FIRST YEAR EXPERIENCE. THE MAJORITY OF THESE ROTATIONS ARE AT BETH ISRAEL DEACONESS MEDICAL CENTER, SUPPLEMENTED BY COMMUNITY-BASED EXPERIENCE AT MOUNT AUBURN HOSPITAL AND ST. VINCENT HOSPITAL, AND PEDIATRIC EXPERIENCE AT CHILDREN'S HOSPITAL. PRE- AND POST-OPERATIVE PATIENT CARE IS EMPHASIZED UNDER THE GUIDANCE OF THE ATTENDING SURGEONS AND RESIDENT STAFF. INTERNS PARTICIPATE IN THOSE PROCEDURES APPROPRIATE FOR THEIR STAGE OF TRAINING AND CAN EXPECT TO PERFORM APPROXIMATELY 100 MAJOR AND MINOR CASES.GENERAL SURGERY PGY-2 THROUGH PGY-4THE SECOND AND THIRD YEARS OF RESIDENCY INCLUDE LONGER ROTATIONS TO PROVIDE MORE IN-DEPTH TRAINING IN GENERAL SURGERY, THORACIC AND TRAUMA SURGERY, AS WELL AS IN CRITICAL CARE AND ENDOSCOPY. IN THE FOURTH YEAR, SENIOR LEVEL EXPERIENCE IS OBTAINED IN GENERAL SURGERY, VASCULAR, TRANSPLANT AND PEDIATRIC SURGERY. CHIEF RESIDENCYDURING THE FIFTH YEAR OF TRAINING, CHIEF RESIDENTS HONE THEIR CLINICAL SKILLS, PERFORMING AN AVERAGE OF OVER 225 CASES AS SURGEON IN THEIR FINAL YEAR. ALSO IN THEIR CHIEF YEAR, RESIDENTS ARE ENCOURAGED TO DEVELOP THEIR ADMINISTRATIVE AND TEACHING SKILLS BY LEADING DIDACTIC SESSIONS, HEADING INPATIENT TEAMS AND TEACHING JUNIOR RESIDENTS. ONE CHIEF RESIDENT IS SELECTED ANNUALLY TO SERVE AS ADMINISTRATIVE CHIEF, AND ALSO SERVES AS RESIDENT REPRESENTATIVE TO THE HOUSE STAFF EDUCATION COMMITTEE. WHILE MOST OF THE RESIDENCY YEARS ARE SPENT AT THE BETH ISRAEL DEACONESS MEDICAL CENTER, THAT EXPERIENCE IS ROUNDED OUT WITH AN EXCELLENT COMMUNITY BASED EXPERIENCE AT OUTSIDE ROTATIONS AT NEARBY HOSPITALS:CARDIAC AND THORACIC SURGERY: EDUCATION - RESIDENCY IN CARDIOTHORACIC SURGERYA TWO-YEAR, ACCREDITED RESIDENCY IN CARDIOTHORACIC SURGERY IS OFFERED TO APPLICANTS WHO HAVE COMPLETED TRAINING IN GENERAL SURGERY. BASED AT BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC), THE PROGRAM INCLUDES A ROTATION AT THE CHILDREN'S HOSPITAL AND PROVIDES IN-DEPTH EXPOSURE TO CARDIAC, ESOPHAGEAL, PULMONARY AND COMPLEX AIRWAY SURGERY.
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ABOUT CARDIOTHORACIC SURGERYWITH FOUR FULL-TIME ADULT CARDIAC SURGEONS AND TWO DEDICATED GENERAL THORACIC SURGEONS, ABOUT 800 CARDIAC CASES AND ABOUT 600 MAJOR THORACIC CASES WERE PERFORMED AT BIDMC OVER THE PAST YEAR. THE VARIETIES OF OPERATIONS INCLUDE:- VATS LOBECTOMY AND MINIMALLY INVASIVE ESOPHAGECTOMY (MIE)- TRACHEAL RESECTION AND TRACHEOBRONCHOPLASTY- MINIMALLY INVASIVE AND "OFF-BYPASS" CORONARY REVASCULARIZATIONS- AORTIC HOMOGRAFTS- AORTIC ROOT OPERATIONSOTHER MAJOR AORTIC PROCEDURESTEACHING BY OUTSTANDING HARVARD MEDICAL SCHOOL FACULTY ENABLES THE RESIDENT TO BECOME PROFICIENT IN THE OPERATIVE AND PERIOPERATIVE CARE OF PATIENTS. PROGRESS TOWARD TECHNICAL PROFICIENCY IS EVALUATED AT MULTIPLE POINTS DURING THE RESIDENCY. MULTIPLE EDUCATIONAL SESSIONS OCCUR THROUGHOUT THE WEEK ON EACH SERVICE, INCLUDING PREOPERATIVE CASE CONFERENCE, CORE CURRICULUM CONFERENCE, PROFESSOR ROUNDS, CLINICAL CASE CONFERENCE AND CARDIAC CATHETERIZATION CONFERENCE. IN ADDITION, MONTHLY JOURNAL CLUBS AND MULTIDISCIPLINARY AIRWAY CONFERENCES ARE HELD. PARTICIPATION IN THE HARVARD COMBINED CARDIOTHORACIC CONFERENCE IS MANDATORY. TWO-YEAR PROGRAMOUR TWO-YEAR PROGRAM CONSISTS OF:- SIX MONTHS OF GENERAL THORACIC SURGERY AT BIDMC- NINE MONTHS OF ADULT CARDIAC SURGERY AT BIDMC- THREE MONTHS OF PEDIATRIC CARDIAC SURGERY AT BOSTON CHILDREN'S HOSPITAL- SIX MONTHS OF ADULT CARDIOTHORACIC SURGERY AT BIDMC - A CHIEF RESIDENT EXPERIENCE ON THE ADULT CARDIAC SURGERY OR GENERAL THORACIC SURGERY SERVICE, A FLEXIBLE DESIGNATION DEPENDING ON THE TRAINEE'S CAREER GOALSGENERAL THORACIC SURGERYTHE FIRST SIX-MONTH BLOCK OF THE FIRST YEAR IS COMPOSED OF GENERAL THORACIC SURGERY. EDUCATION CONSISTS OF: - PARTICIPATION IN THE PREOPERATIVE, OPERATIVE AND POSTOPERATIVE CARE OF ALL PATIENTS, WITH THE TRAINEE SERVING AS CHIEF RESIDENT OF THE SERVICE- GRADUALLY INCREASED OPERATIVE AUTONOMY, INCLUDING COMPLEX MINIMALLY INVASIVE PULMONARY AND ESOPHAGEAL OPERATIONS, COMPLEX AIRWAY SURGERY AND SURGICAL TREATMENT OF AIRWAY DISEASE - PARTICIPATION IN THE WEEKLY MULTIDISCIPLINARY THORACIC CLINIC, FOLLOWED BY A CONFERENCE AT WHICH THORACIC SURGEONS, MEDICAL ONCOLOGISTS, RADIATION ONCOLOGISTS, PULOMONOLOGISTS AND THORACIC RADIOLOGISTS DISCUSS THE PATIENTS SEEN EARLIER IN THE DAY - CLOSE COLLABORATION WITH INTERVENTIONAL PULMONOLOGY, INCLUDING A TWO-WEEK ROTATION LEARNING ENDOBRONCHIAL ULTRASOUND (EBUS), RIGID BRONCHOSCOPY WITH ADVANCED ENDOSCOPIC INTERVENTION, PLEURAL ULTRASOUND AND MINIMALLY INVASIVE PLEURAL INTERVENTIONS ADULT CARDIAC SURGERYTHE SECOND SIX-MONTH BLOCK OF THE FIRST YEAR IS COMPOSED OF ADULT CARDIAC SURGERY. EDUCATION CONSISTS OF EXPOSURE TO: - CORONARY REVASCULARIZATION- VALVE REPAIR AND REPLACEMENT- AORTIC SURGERY AND REPAIR OF CONGENITAL DEFECTS SEEN IN ADULT PATIENTS- REPAIR OF ATRIAL SEPTIC DEFECTS- PARTICIPATION IN PREOPERATIVE, OPERATIVE AND POSTOPERATIVE CARE- RESIDENTS ARE INVOLVED IN THE OPERATIVE CARE AT AN EARLY STAGE, BUT ONLY AT A TIME WHEN THE ATTENDING SURGEON FEELS COMFORTABLE IN ALLOWING THE RESIDENT TO PERFORM AN ACTIVE ROLE.- TRAINING IN TRANSESOPHAGEAL ECHOCARDIOGRAPHY BOSTON CHILDREN'S HOSPITALDURING THE SECOND YEAR, IN A THREE-MONTH BLOCK, THE RESIDENT IS AT THE BOSTON CHILDREN'S HOSPITAL, A FELLOW HARVARD TEACHING HOSPITAL, WHERE THE RESIDENT IS EXPOSED TO CONGENITAL CARDIAC SURGERY IN INFANTS, ADOLESCENTS AND YOUNG ADULT SURGERY. PEDIATRIC CARDIAC SURGERY IS AN INTEGRAL COMPONENT OF THE SPECIALTY. ADULT CARDIAC SURGERYDURING THE SECOND QUARTER OF YEAR TWO, IN A THREE-MONTH BLOCK, THE RESIDENT IS AGAIN EXPOSED TO CARDIAC SURGERY. EDUCATION CONSISTS OF THE FOLLOWING:- THE RESIDENT WILL FUNCTION AS THE CHIEF RESIDENT AND WILL HAVE PRIMARY OVERSIGHT OF ALL PATIENTS ON THE ADULT CARDIAC SURGICAL SERVICE WHETHER OR NOT THE RESIDENT PARTICIPATES IN THE OPERATION - RESIDENTS EVALUATE POSTOPERATIVELY ALL PATIENTS ON WHICH HE/SHE PARTICIPATES IN THE OPERATIVE CARE, AND AT THIS POINT, IS THE OPERATING SURGEON ON THE VAST MAJORITY OF CASES- CONSULT MUST BE SEEN BY THE RESIDENT AND THE RESIDENT IS EXPECTED TO BE INVOLVED IN THE DECISION-MAKING PROCESS REGARDING INDICATIONS AND TIMING OF OPERATIONS
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ADULT CARDIOTHORACIC SURGERYDURING THE SECOND HALF OF YEAR TWO, IN A SIX-MONTH BLOCK, THE RESIDENT SPENDS TIME ON THE ADULT CARDIAC SURGERY OR GENERAL THORACIC SURGERY SERVICE. THIS WILL BE DEPENDENT ON THE INDIVIDUAL RESIDENT'S EVENTUAL CAREER FOCUS AND EXPOSURE TO THAT POINT. THE RESIDENT FUNCTIONS AS THE CHIEF RESIDENT ON EITHER SERVICE.NEUROSURGERY THE PROGRAM WILL PROVIDE AN INTRODUCTORY EXPOSURE TO NEUROSURGERY. IN THIS ROTATION, TRAINEES EXPAND UPON THEIR UNDERSTANDING OF THE BASIC PHYSIOLOGY OF THE NERVOUS SYSTEM AND EXPLORE CRITICAL CONCEPTS IN THE PATHOPHYSIOLOGY OF NEUROSURGICAL DISORDERS. DIDACTIC SESSIONS HAVE BEEN DEVELOPED TO FAMILIARIZE YOU WITH CURRENT RESEARCH ON ASPECTS OF NEUROSURGICAL TREATMENT. PARTICIPATION IN PATIENT CARE PROVIDES A FRUITFUL GROUND FOR INTEGRATING KNOWLEDGE OF THE BASIC NEUROSCIENCES, DISEASE PATHOPHYSIOLOGY, AND CLINICAL PRACTICES. TRAINEES ARE EXPOSED TO BOTH IN-PATIENT AND OUT-PATIENT NEUROSURGICAL PRACTICES. FINALLY, EXPERIENCES IN THE OPERATING ROOM ARE DESIGNED TO FACILITATE AN UNDERSTANDING OF THE BASIC NEUROSURGICAL TECHNIQUES AND ETIQUETTE.ADDITIONALLY, THE PROGRAM IS DESIGNED TO OFFER A SAMPLING OF THE NEUROSURGERY PROGRAMS AVAILABLE THROUGH THE HARVARD MEDICAL SCHOOL. TRAINEES ROTATE THROUGH THE OTHER INSTITUTIONS OF THE HARVARD MEDICAL SCHOOL INCLUDING MASSACHUSETTS GENERAL HOSPITAL AS WELL AS THE BRIGHAM AND WOMAN'S HOSPITAL NEUROSURGERY PROGRAMS.PODIATRY: EDUCATION - RESIDENCY PROGRAMTHE DIVISION OF PODIATRIC SURGERY SPONSORS A THREE YEAR RESIDENCY PROGRAM IN PODIATRIC SURGERY.FIRST YEARTHE FIRST YEAR CONSISTS OF A ROTATING SURGICAL INTERNSHIP DESIGNED TO PREPARE THE NEW PODIATRIC GRADUATE WITH KNOWLEDGE AND SKILLS TO CARE FOR THE GENERAL SURGICAL AND HOSPITALIZED PATIENT. ROTATIONS INCLUDE INTERNAL MEDICINE, EMERGENCY MEDICINE, ANESTHESIOLOGY, GENERAL SURGERY, VASCULAR SURGERY, INFECTIOUS DISEASE, RADIOLOGY AND RHEUMATOLOGY.SECOND AND THIRD YEARTHE SECOND AND THIRD YEARS ARE DEVOTED TO THE DEVELOPMENT OF SURGICAL KNOWLEDGE AND SKILLS. THIS INCLUDES SURGICAL TRAINING IN DIABETIC FOOT SURGERY, TRAUMA AND RECONSTRUCTIVE SURGERY OF THE FOOT AND ANKLE.ACUTE CARE SURGERY / SURGICAL CRITICAL CARE : EDUCATION OUR ONE YEAR ACGME ACCREDITED SURGICAL CRITICAL CARE FELLOWSHIP AT HARVARD / BIDMC PROVIDES ROBUST CLINICAL AND ACADEMIC TRAINING TO SURGEONS SEEKING TO BECOME LEADERS IN ACUTE CARE SURGERY AND SURGICAL CRITICAL CARE. THE PROGRAM IS FOCUSED ON A BROAD-BASED CURRICULUM IN TRAUMA AND SURGICAL CRITICAL CARE WITH A MULTIDISCIPLINARY EXPOSURE IN TWO HIGH-ACUITY INTENSIVE CARE UNITS, A TRAUMA SURGICAL ICU AND A SURGICAL ICU. OVER 2500 COMBINED ADMISSIONS PER YEAR ARE REPRESENTED BY A WIDE VARIETY OF GENERAL SURGERY SUBSPECIALTIES, AS WELL AS ACUTE CARE SURGERY, CARDIOTHORACIC, NEUROSURGERY, ORTHOPEDICS, OTORHINOLARYNGOLOGY, PLASTIC SURGERY, TRANSPLANT, UROLOGY, AND VASCULAR SURGERY. GRADUATING FELLOWS WILL BE WELL-TRAINED AND CONFIDENT IN CUTTING EDGE BEDSIDE ECHOCARDIOGRAPHY, A UNIQUE ASSET AMONG CRITICAL CARE TRAINING PROGRAMS. ADDITIONAL CRITICAL CARE EXPERIENCE WILL BE AVAILABLE IN THE CARDIOVASCULAR ICU, AS WELL AS LOCAL ROTATIONS IN BURN AND PEDIATRIC INTENSIVE CARE UNITS. A DEDICATED RESEARCH ELECTIVE ALLOWS FOR INNOVATION AND SCIENTIFIC DISCOVERY. ELECTIVES ARE AVAILABLE IN ACUTE CARE SURGERY, TRAUMA RADIOLOGY, EMERGENCY MEDICAL SERVICES, GLOBAL HEALTH, OR CAN BE FASHIONED TO INDIVIDUAL INTERESTS. OVERALL, THE FELLOWS RECEIVE A COMPREHENSIVE EDUCATIONAL EXPERIENCE IN THE MANAGEMENT OF COMPLEX PATIENTS, USING MODERN TECHNOLOGIES AND INNOVATIVE TECHNIQUES IN ADVANCED AIRWAY MANAGEMENT, CONVENTIONAL AND NON-CONVENTIONAL MODES OF VENTILATION, INVASIVE AND NON-INVASIVE HEMODYNAMIC MONITORING, PERMISSIVE HYPOTENSION, HYPOTHERMIC RESUSCITATION, AND CONTINUOUS RENAL REPLACEMENT THERAPY. THEY ARE EXPECTED TO GRADUATE AS MASTER BEDSIDE CLINICIANS. CENTER FOR MINIMALLY INVASIVE SURGERY: EDUCATION A ONE YEAR CLINICAL TRAINING PROGRAM IN MINIMALLY INVASIVE SURGERY IS OFFERED TO APPLICANTS WHO HAVE COMPLETED TRAINING IN GENERAL SURGERY. THE PROGRAM PROVIDES A FULL EXPERIENCE IN ALL AREAS OF ADVANCED MINIMALLY INVASIVE SURGERY. THE EMPHASIS IS ON LAPAROSCOPIC GASTRIC BYPASS AND LAPAROSCOPIC ADJUSTABLE BAND AND TREATMENT OF THE MORBIDLY OBESE PATIENT. BASED AT THE BETH ISRAEL DEACONESS MEDICAL CENTER, THE PROGRAM INCLUDES ROTATIONS TO BRIGHAM AND WOMEN'S AND MASSACHUSETTS GENERAL HOSPITALS.
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PLASTIC AND RECONSTRUCTIVE SURGERY: EDUCATION THE DIVISION OF PLASTIC SURGERY PARTICIPATES IN THE COMBINED HARVARD PLASTIC SURGERY RESIDENCY PROGRAM. THE BIDMC IS ONE OF THE AFFILIATE INSTITUTIONS IN THIS PROGRAM, WHICH ALSO INCLUDES THE BRIGHAM & WOMEN'S HOSPITAL, CHILDREN'S HOSPITAL, MASSACHUSETTS GENERAL HOSPITAL AND THE SHRINERS BURNS HOSPITAL. IN ADDITION TO THE PLASTIC SURGERY RESIDENCY PROGRAM, THE DIVISION OF PLASTIC SURGERY ALSO SPONSORS THREE POST-RESIDENCY FELLOWSHIP PROGRAMS. ALL OF THESE FELLOWSHIPS ARE FOR ONE YEAR AND INCLUDE THE FOLLOWING PROGRAMS:- AESTHETIC PLASTIC SURGERY FELLOWSHIP- HAND / MICROSURGERY FELLOWSHIP - PETER JAY SHARP AESTHETIC & RECONSTRUCTIVE BREAST SURGERY FELLOWSHIPVASCULAR AND ENDOVASCULAR SURGERY: EDUCATION - RESIDENCY PROGRAMTHE OVERALL GOAL OF THE VASCULAR SURGERY RESIDENCY PROGRAM IS TO PREPARE RESIDENTS TO FUNCTION AS QUALIFIED PRACTIONERS OF VASCULAR SURGERY AT THE HIGH LEVEL OF PERFORMANCE EXPECTED OF A BOARD-CERTIFIED SPECIALIST BY PROVIDING:- COMPREHENSIVE CLINICAL TRAINING IN VASCULAR SURGERY- BASIC SCIENCE OR CLINICAL RESEARCH EXPERIENCE FOR THE RESIDENT- EXCELLENT SURGICAL AND MEDICAL CAREBY ACCOMPLISHING THESE GOALS, THE MEDICAL CENTER AIMS TO PRODUCE TRAINEES WHO WILL BE ABLE TO SUCCESSFULLY PURSUE A CAREER IN ACADEMIC SURGERY OR ENTER PRIVATE PRACTICE IN VASCULAR SURGERY. OVERALL, THE PROGRAM IS DESIGNED WITH GRADUATED RESPONSIBILITY AND SUPERVISION AT EACH LEVEL OF TRAINING.
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Attach to Form 990 or Form 990-EZ. 
Attach to Form 990 or 990-EZ.