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FORM 990 SCHEDULE H SUPPLEMENTAL INFORMATION
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SUPPLEMENTAL INFORMATION FOR SCHEDULE H PART V, SECTION BFINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS COMMUNITY HEALTH IMPROVEMENT SERVICES AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS
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COMMUNITY BENEFITS MISSION STATEMENT
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THE MISSION OF BETH ISRAEL DEACONESS MEDICAL CENTER IS TO SERVE PATIENTS COMPASSIONATELY AND EFFECTIVELY, AND TO CREATE A HEALTHY FUTURE FOR THEM AND THEIR FAMILIES. THE MEDICAL CENTER'S MISSION IS SUPPORTED BY A COMMITMENT TO PERSONALIZED, EXCELLENT PATIENT CARE; A WORKFORCE COMMITTED TO INDIVIDUAL ACCOUNTABILITY, MUTUAL RESPECT AND COLLABORATION; AND A COMMITMENT TO MAINTAINING THE INSTITUTION'S FINANCIAL HEALTH. THE MEDICAL CENTER IS COMMITTED TO BEING ACTIVE IN THE COMMUNITY AS WELL. SERVICE TO COMMUNITY IS AT THE CORE AND AN IMPORTANT PART OF OUR MISSION. THE MEDICAL CENTER HAS A COVENANT TO CARE FOR THE UNDERSERVED AND TO WORK TO CHANGE DISPARITIES IN ACCESS TO CARE. 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 ALL PATIENTS RECEIVE EQUITABLE CARE THAT IS RESPECTFUL AND CULTURALLY RESPONSIVE AND THAT THE MEDICAL CENTER IS WELCOMING AND INCLUSIVE.; 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, THE MEDICAL CENTER PROVIDED COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS OF $16,132,415 AS REPORTED ON THIS SCHEDULE H, PART I, LINES 7E AND 7I. COMMUNITY CARE ALLIANCE (CCA) AND COMMUNITY HEALTH CENTERS (CHC)BIDMC HAS PARTICULARLY STRONG RELATIONSHIPS WITH MANY OF THE PRIMARY CARE CLINICS THAT OPERATE IN ITS COMMUNITY BENEFITS SERVICE AREA, MANY OF WHOM ARE AFFILIATED WITH BIDMC'S COMMUNITY CARE ALLIANCE (CCA). SERVING OVER 100,000 PATIENTS ANNUALLY, THE CCA HEALTH CENTERS INCLUDE:- BOWDOIN STREET HEALTH CENTER- THE DIMOCK CENTER- FENWAY HEATH AND SIDNEY BORUM JR. HEALTH SERVICES- CHARLES RIVER COMMUNITY HEALTH (FORMERLY JOSEPH M. SMITH COMMUNITY HEALTH CENTER)- OUTER CAPE HEALTH SERVICES- SOUTH COVE COMMUNITY HEALTH CENTERTHE MEDICAL CENTER PROVIDED COMBINED DIRECT GRANT, FUNDING AND COMMUNITY BENEFIT PROGRAMMING SUPPORT OF THESE CHCS AND THE CCA OF $6,035,254. THESE AMOUNTS ARE INCLUDED IN SCHEDULE H PART I, LINES 7E, 7G AND 7I AND ARE REPORTED IN SCHEDULE I PART II. THE CCA HEALTH CENTERS ARE IDEAL COMMUNITY BENEFITS PARTNERS AS THEY ARE ROOTED IN THEIR COMMUNITIES AND, AS FEDERALLY QUALIFIED HEALTH CENTERS, MANDATED TO SERVE LOW INCOME, UNDERSERVED POPULATIONS. THESE CLINIC PARTNERS HAVE BEEN A VITAL PART OF BIDMC'S COMMUNITY HEALTH IMPROVEMENT STRATEGY SINCE 1968, WHEN BETH ISRAEL HOSPITAL FIRST JOINED FORCES WITH THE DIMOCK CENTER TO ADDRESS MATERNAL AND CHILD HEALTH ISSUES. HISTORICALLY, BIDMC HAS RELIED HEAVILY ON ITS CCA PARTNERS AS WELL AS A NUMBER OF OTHER KEY COMMUNITY HEALTH PARTNERS TO IMPLEMENT ITS COMMUNITY BENEFITS INITIATIVES. IN THIS REGARD, BIDMC HAS LEVERAGED CCA'S EXPERTISE AND THE VITAL CONNECTIONS THAT THESE ORGANIZATIONS HAVE WITH RESIDENTS AND ORGANIZATIONS IN THE COMMUNITIES THEY SERVE.COMMUNITY BENEFITS LEADERSHIP AND PROCESSFOR THE PERIOD COVERED BY THIS FILING, THE BOARD OF DIRECTORS 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) OVERSEE THE DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY BENEFIT PLAN TO ADDRESS IDENTIFIED NEEDS IN THE COMMUNITY; (V) IDENTIFY, SHARE AND REPLICATE INNOVATIVE AND EVIDENCE-BASED MODELS AND BEST PRACTICES TO ADDRESS THESE NEEDS; (VI) 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; (VII) ENCOURAGE COLLABORATIVE RELATIONSHIPS WITH OTHER PROVIDERS AND GOVERNMENT ENTITIES TO SUPPORT AND ENHANCE RATIONAL AND EFFECTIVE PUBLIC HEALTH POLICIES AND PROGRAMS; (VIII) DISCUSS PUBLIC POLICY ISSUES AND RELEVANT LEGAL AND REGULATORY MATTERS RELATED TO PUBLIC HEALTH AND COMMUNITY BENEFITS AND ADVISE THE BOARD OF DIRECTORS OF THE IMPLICATIONS FOR THE CORPORATION; (IX) EDUCATE DIRECTORS, TRUSTEES, OVERSEERS, STAFF AND THE COMMUNITY ABOUT HOW THE CORPORATION ADDRESSES ITS MISSION TO FOCUS ON THE HEALTH NEEDS OF ITS COMMUNITIES; AND (X) WORK TO RECOGNIZE AND CONFRONT HEALTH DISPARITIES AND ENSURE THAT THE CORPORATION IS WELCOMING AND INCLUSIVE FOR ALL INDIVIDUALS OF DIVERSE BACKGROUNDS."THE MEMBERSHIP OF THE MEDICAL CENTER'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 THE MEDICAL CENTER'S POLICIES AND RESOURCES ARE ALLOCATED TO SUPPORT PLANNED ACTIVITIES.IT IS NOT ONLY THE BOARD AND SENIOR LEADERSHIP THAT ARE HELD ACCOUNTABLE IN FULFILLING THE MEDICAL CENTER'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 THE MEDICAL CENTER'S COLLECTIVE COMMITMENT AND EFFORT ARE THE COMMUNITY BENEFIT GUIDING PRINCIPLES THAT FOLLOW. 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. FOR THE PERIOD COVERED BY THIS FILING, THE DIRECTOR OF COMMUNITY BENEFITS WAS ACCOUNTABLE TO THE GENERAL COUNSEL WITH DIRECT ACCESS TO THE PRESIDENT AND CEO AND THESE SENIOR MANAGERS WERE RESPONSIBLE FOR ENSURING THAT THE ENTIRE ORGANIZATION ADDRESSED COMMUNITY BENEFITS AND THAT THE NEEDS OF UNDERSERVED POPULATIONS WERE 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.THE MEDICAL CENTER ACCOMPLISHES THESE GOALS BY PARTNERING WITH THE COMMUNITY AS FOLLOWS:- THE MEDICAL CENTER PARTNERS WITH COMMUNITY LEADERS AND COMMUNITY-BASED ORGANIZATIONS WHO SERVE AS LINKS TO THE COMMUNITY AND TEACHERS OF HOW TO BETTER SERVE THE POPULATIONS THEY REPRESENT. IN ADDITION, THE MEDICAL CENTER COLLABORATES 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. THE MEDICAL CENTER LOOKS TO PUBLIC HEALTH, PREVENTION, AND OTHER HEALTH-RELATED APPROACHES NOT TRADITIONALLY PROVIDED BY MANY ACUTE CARE HOSPITALS.- THE MEDICAL CENTER'S COMMITMENT TO THE COMMUNITY BENEFITS MISSION IS AS FUNDAMENTAL AS ITS COMMITMENT TO ITS PATIENT CARE AND ACADEMIC MISSIONS. THAT IS, RATHER THAN ABANDON ANY OF THESE FUNDAMENTAL MISSIONS WHEN BUDGET RESTRAINTS ARISE, THE MEDICAL CENTER 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, JUST AS QUALITY AND RESPECT. 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 HEALTH NEEDS ASSESSMENT
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COMMUNITY HEALTH NEEDS ASSESSMENT INTERNAL REVENUE CODE SECTION 501(R)INTERNAL REVENUE CODE SECTION 501(R), ENACTED AS PART OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT, REQUIRES EACH HOSPITAL TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND TO FORMALLY ADOPT AN IMPLEMENTATION STRATEGY PURSUANT TO FEDERAL GUIDELINES, IN ORDER MAINTAIN ITS TAX EXEMPT STATUS AS A HOSPITAL UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) OF 1986, AS AMENDED. THE MEDICAL CENTER COMPLETED ITS MOST RECENT NEEDS ASSESSMENT IN SEPTEMBER 2016. THAT CHNA WAS APPROVED BY THE BIDMC BOARD OF DIRECTORS ON SEPTEMBER 20, 2016. THE ACCOMPANYING IMPLEMENTATION STRATEGY FOR THE MOST RECENT CHNA WAS ALSO APPROVED BY THE BOARD ON SEPTEMBER 20, 2016 WHICH IS WITHIN THE TIMELINE REQUIRED BY THE TREASURY REGULATIONS UNDER IRC SECTION 501(R). THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) ALONG WITH THE ASSOCIATED IMPLEMENTATION STRATEGY/COMMUNITY HEALTH IMPLEMENTATION PLAN (CHIP) REPRESENT THE CULMINATION OF A YEAR OF WORK AND WAS BORNE LARGELY OUT OF BIDMC'S COMMITMENT TO BETTER UNDERSTAND AND ADDRESS THE HEALTH-RELATED NEEDS OF THOSE LIVING IN ITS COMMUNITY BENEFITS SERVICE AREA WITH AN EMPHASIS ON THOSE WHO ARE MOST DISADVANTAGED. THE PROJECT ALSO WAS DESIGNED TO FULFILL THE COMMONWEALTH ATTORNEY GENERAL'S OFFICE AND FEDERAL INTERNAL REVENUE SERVICE (IRS) REGULATIONS WHICH REQUIRE THAT BIDMC ASSESS COMMUNITY HEALTH NEEDS, ENGAGE THE COMMUNITY, IDENTIFY PRIORITY HEALTH ISSUES, AND CREATE A COMMUNITY HEALTH STRATEGY THAT DESCRIBES HOW THE MEDICAL CENTER, IN COLLABORATION WITH THE COMMUNITY AND LOCAL HEALTH DEPARTMENT, WILL ADDRESS THE NEEDS AND THE PRIORITIES IDENTIFIED BY THE ASSESSMENT. THE MEDICAL CENTER ACCOMPLISHED THE 2016 CHNA IN CONJUNCTION WITH ITS AFFILIATES BETH ISRAEL DEACONESS HOSPITAL NEEDHAM (BID-NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL MILTON (BID-MILTON) AND BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH (BID-PLYMOUTH). FOR THE PERIOD COVERED BY THIS FILING, THE MEDICAL CENTER SERVED AS SOLE MEMBER OF THESE COMMUNITY HOSPITALS. THE MEDICAL CENTER'S IMPLEMENTATION STRATEGY WHICH RESULTED FROM THIS PROCESS, IS DESIGNED TO GUIDE AND INFORM ITS COMMUNITY BENEFITS PROGRAMMING FOR THE FOR THE FISCAL YEARS ENDED/ENDING SEPTEMBER 30, 2017, SEPTEMBER 30, 2018 AND SEPTEMBER 30, 2019. COMMUNITY HEALTH NEEDS ASSESSMENT COMMUNITY INFORMATIONBIDMC FOCUSES ITS COMMUNITY BENEFITS EFFORTS ON IMPROVING THE HEALTH STATUS OF THE LOW INCOME, UNDERSERVED POPULATIONS LIVING IN ALLSTON/BRIGHTON, CHINATOWN, DORCHESTER, FENWAY/KENMORE AND ROXBURY. BIDMC ALSO HAS HISTORICAL TIES TO UNDERSERVED COMMUNITIES IN QUINCY AND TO SOME OF THE MOST ISOLATED, VULNERABLE AREAS OF CAPE COD, SPECIFICALLY THE OUTER CAPE (HARWICH, WELLFLEET, TRURO, AND PROVINCETOWN). THESE COMMUNITIES MAKE UP BIDMC'S COMMUNITY BENEFITS SERVICE AREA AND INCLUDE THE COMMUNITY CARE ALLIANCE (CCA), THE NETWORK OF ONE LICENSED AND FIVE FEDERALLY QUALIFIED HEALTH CENTERS AFFILIATED WITH BIDMC. (SCHEDULE H PART VI QUESTION 4). COMMUNITY HEALTH NEEDS ASSESSMENT -- APPROACH AND METHODSTHE FY 2016 CHNA WAS CONDUCTED IN THREE PHASES, WHICH ALLOWED BIDMC TO: 1) COMPILE AN EXTENSIVE AMOUNT OF QUANTITATIVE AND QUALITATIVE DATA, 2) ENGAGE AND INVOLVE KEY STAKEHOLDERS, BIDMC CLINICAL AND ADMINISTRATIVE STAFF, AND THE COMMUNITY AT-LARGE, 3) DEVELOP A REPORT AND DETAILED STRATEGIC PLAN, AND 4) COMPLY WITH ALL COMMONWEALTH ATTORNEY GENERAL AND FEDERAL IRS COMMUNITY BENEFITS REQUIREMENTS. DATA SOURCES INCLUDED A BROAD ARRAY OF PUBLICLY AVAILABLE SECONDARY DATA, KEY INFORMANT INTERVIEWS, AND FOUR COMMUNITY FORUMS. BETH ISRAEL DEACONESS MEDICAL CENTER'S COMMUNITY BENEFITS PROGRAM IS PREDICATED ON THE NOTION OF PARTNERSHIP AND DIALOGUE WITH ITS MANY COMMUNITIES. BIDMC'S 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. THE DATA COLLECTED WAS 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 BIDMC'S DECISION-MAKING ABOUT PRIORITIES FOR COMMUNITY BENEFITS EFFORTS. FOLLOWING THE GUIDING PRINCIPLES DESCRIBED ABOVE, FOR EACH PRIORITY AREA, BIDMC WORKS 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.2016 COMMUNITY HEALTH NEEDS ASSESSMENT SUMMARY OF FINDINGSSOCIAL DETERMINANTS AND HEALTH RISK FACTORS- SOCIAL DETERMINANTS OF HEALTH (E.G., ECONOMIC STABILITY, EDUCATION, AND COMMUNITY/SOCIAL CONTEXT) CONTINUE TO HAVE A TREMENDOUS IMPACT ON MANY SEGMENTS OF THE POPULATION: THE DOMINANT THEME FROM THE ASSESSMENT'S KEY INFORMANT INTERVIEWS AND COMMUNITY FORUMS WAS THE CONTINUED IMPACT THAT THE UNDERLYING SOCIAL DETERMINANTS OF HEALTH ARE HAVING ON THE CBSA'S LOW INCOME, UNDERSERVED, DIVERSE POPULATION COHORTS. MORE SPECIFICALLY, DETERMINANTS SUCH AS POVERTY, EMPLOYMENT OPPORTUNITIES, VIOLENCE, TRANSPORTATION, RACIAL SEGREGATION, LITERACY, PROVIDER LINGUISTIC/CULTURAL COMPETENCY, SOCIAL SUPPORT, AND COMMUNITY INTEGRATION LIMIT MANY PEOPLE'S ABILITY TO CARE FOR THEIR OWN AND/OR THEIR FAMILIES' HEALTH. LARGE PROPORTIONS OF INDIVIDUALS RESIDING WITHIN BOSTON AND BIDMC'S COMMUNITY BENEFITS SERVICE AREA LIVE IN POVERTY, HAVE LIMITED FORMAL EDUCATION, ARE UNEMPLOYED, AND STRUGGLE TO AFFORD FOOD AND OTHER ESSENTIAL HOUSEHOLD ITEMS. THESE POPULATIONS ARE DISPROPORTIONATELY FROM RACIALLY/ETHNICALLY DIVERSE GROUPS AND, PARTLY AS A RESULT OF THEIR POVERTY, FACE DISPARITIES IN HEALTH AND ACCESS TO CARE OUTCOMES. IT IS CRITICAL TO NOTE THAT THERE IS A MULTITUDE OF INDIVIDUAL, COMMUNITY AND SOCIETAL FACTORS THAT WORK TOGETHER TO CREATE THESE INEQUITIES. IT IS INSUFFICIENT TO TALK SOLELY ABOUT RACE/ETHNICITY, IMMIGRATION STATUS, OR LANGUAGE; AS THE UNDERLYING AND CORRELATIVE ISSUES RELATED TO HEALTH AND WELL-BEING INVOLVE ECONOMIC OPPORTUNITY, EDUCATION, CRIME, AND COMMUNITY COHESION. - DISPARITIES IN HEALTH OUTCOMES EXIST IN BIDMC CBSA BY RACE/ETHNICITY, FOREIGN BORN STATUS, AND LANGUAGE: AS WAS ESTABLISHED IN THE FY 2013 BIDMC COMMUNITY BENEFITS CHNA REPORT, THERE ARE MAJOR HEALTH DISPARITIES FOR RESIDENTS LIVING IN BIDMC'S CBSA. THIS CONTINUES TO BE PARTICULARLY TRUE FOR RACIALLY/ETHNICALLY DIVERSE, FOREIGN-BORN, AND NON-ENGLISH SPEAKING RESIDENTS LIVING IN THE NEIGHBORHOODS IN BOSTON THAT ARE PART OF BIDMC'S CBSA (I.E., ALLSTON/BRIGHTON, DORCHESTER, FENWAY, ROXBURY, AND SOUTH END/CHINATOWN). THE IMPACT OF RACISM, BARRIERS TO CARE, AND DISPARITIES IN HEALTH OUTCOMES THAT THESE POPULATIONS FACE ARE WIDELY DOCUMENTED IN THE LITERATURE AND ARE CONFIRMED BY NUMEROUS NATIONAL, COMMONWEALTH, AND LOCAL DATA SOURCES, INCLUDING DATA FROM THE BOSTON PUBLIC HEALTH COMMISSION 2014-15 HEALTH OF BOSTON REPORT. - IT IS CRUCIAL THAT THESE DISPARITIES BE ADDRESSED AND, TO THIS END, BIDMC'S FY 17-19 IMPLEMENTATION STRATEGY/COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) CONTINUES TO INCLUDE A MYRIAD OF PROGRAMS, STRATEGIC INTERVENTIONS, AND SERVICES THAT ARE CAREFULLY TARGETED TO ADDRESS THESE DISPARITIES. HOWEVER, IT IS CRITICAL TO NOTE THAT THERE IS A MULTITUDE OF INDIVIDUAL, COMMUNITY AND SOCIETAL FACTORS THAT WORK TOGETHER TO CREATE THESE INEQUITIES. THE UNDERLYING ISSUE IS NOT ONLY RACE/ETHNICITY, FOREIGN BORN STATUS, OR LANGUAGE BUT RATHER A BROAD ARRAY OF INTER-RELATED ISSUES INCLUDING ECONOMIC OPPORTUNITY, EDUCATION, CRIME, AND COMMUNITY COHESION. ARGUABLY, THESE ARE THE LEADING DETERMINANTS OF HEALTH FOR ALL URBAN COMMUNITIES IN THE UNITED STATES, AND THEY ARE DAUNTING CHALLENGES. MANY OF BOSTON'S MAJOR ACADEMIC AND HEALTHCARE INSTITUTIONS, INCLUDING BIDMC, HAVE BEEN AT THE HEART OF THIS NATIONAL DIALOGUE FOR DECADES. BIDMC IS COMMITTED TO DOING WHAT IT CAN TO ADDRESS THESE FACTORS AND EVERY PRIORITY AREA AND GOAL IN BIDMC'S FY 16-19 CHIP IS STRUCTURED TO ADDRESS HEALTH DISPARITIES AND INEQUITIES IN SOME WAY.
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2016 COMMUNITY HEALTH NEEDS ASSESSMENT - SUMMARY OF FINDINGS (CONTINUED)
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- LIMITED ACCESS TO PRIMARY CARE MEDICAL AND SPECIALTY CARE, ORAL HEALTH, AND BEHAVIORAL HEALTH SERVICES FOR LOW INCOME, MEDICAID INSURED, UNINSURED, AND OTHER POPULATION SEGMENTS FACING BARRIERS TO CARE. DESPITE THE FACT THAT MASSACHUSETTS HAS ONE OF HIGHEST RATES OF HEALTH INSURANCE AND THE COMMUNITIES THAT MAKE UP BIDMC'S CBSA HAVE STRONG, ROBUST SAFETY NET SYSTEMS, THERE ARE STILL SUBSTANTIAL NUMBERS OF LOW INCOME, MEDICAID INSURED, UNINSURED, AND OTHERWISE VULNERABLE INDIVIDUALS WHO FACE HEALTH DISPARITIES AND ARE NOT ENGAGED IN ESSENTIAL MEDICAL AND BEHAVIORAL HEALTH SERVICES. EFFORTS NEED TO BE MADE TO EXPAND ACCESS, REDUCE BARRIERS TO CARE, AND IMPROVE THE QUALITY OF PRIMARY CARE AND SPECIALTY MEDICAL, ORAL HEALTH, AND BEHAVIORAL HEALTH SERVICES.- HIGH RATES OF THE LEADING HEALTH RISK FACTORS (E.G., LACK OF NUTRITIONAL FOOD AND PHYSICAL ACTIVITY, ALCOHOL/ILLICIT DRUG USE, AND TOBACCO USE). ONE OF THE LEADING FINDINGS FROM THE ASSESSMENT IS THAT MANY COMMUNITIES AND/OR POPULATION SEGMENTS IN BIDMC'S CBSA HAVE HIGH RATES OF CHRONIC PHYSICAL AND BEHAVIORAL HEALTH CONDITIONS. IN SOME PEOPLE THESE CONDITIONS HAVE UNDERLYING GENETIC ROOTS THAT ARE HARD TO COUNTER. HOWEVER, FOR MOST PEOPLE THESE CONDITIONS ARE WIDELY CONSIDERED TO BE PREVENTABLE OR MANAGEABLE. ADDRESSING THE LEADING RISK FACTORS IS AT THE ROOT OF A SOUND CHRONIC DISEASE PREVENTION AND MANAGEMENT STRATEGY.BEHAVIORAL HEALTH- HIGH RATES OF SUBSTANCE USE (E.G., ALCOHOL, PRESCRIPTION DRUG/OPIOIDS, MARIJUANA) AND MENTAL HEALTH ISSUES (E.G., DEPRESSION, ANXIETY, AND STRESS). IF THE IMPACT OF SOCIAL DETERMINANTS WAS THE LEADING FINDING, A CLOSE SECOND WAS THE PROFOUND IMPACT THAT BEHAVIORAL HEALTH ISSUES (I.E., SUBSTANCE USE AND MENTAL HEALTH) ARE HAVING ON INDIVIDUALS, FAMILIES AND COMMUNITIES IN EVERY GEOGRAPHIC REGION AND EVERY POPULATION SEGMENT IN BIDMC'S CBSA. DEPRESSION/ANXIETY, SUICIDE, OPIOID AND PRESCRIPTION DRUG DEPENDENCY, AND ALCOHOL AND MARIJUANA USE, PARTICULARLY IN YOUTH, ARE MAJOR HEALTH ISSUES AND ARE HAVING A TREMENDOUS IMPACT ON THE POPULATION AS WELL AS A BURDEN ON THE SERVICE SYSTEM. THE FACT THAT PHYSICAL AND BEHAVIORAL HEALTH ARE SO INTERTWINED COMPOUNDS THE IMPACT OF THESE ISSUES. OF PARTICULAR CONCERN ARE THE INCREASING RATES OF OPIOID ABUSE IN THE COMMONWEALTH.- LIMITED ACCESS TO BEHAVIORAL HEALTH SERVICES, PARTICULARLY FOR LOW INCOME, MEDICAID INSURED, UNINSURED, AND THOSE WITH COMPLEX, MULTI-FACETED ISSUES. DESPITE THE BURDEN OF MENTAL HEALTH AND SUBSTANCE USE ON ALL SEGMENTS OF THE POPULATION, THERE IS AN EXTREMELY LIMITED SERVICE SYSTEM AVAILABLE TO MEET THE NEEDS THAT EXIST FOR THOSE WITH ALL MILD TO MODERATE EPISODIC ISSUES OR THOSE WITH MORE SERIOUS AND COMPLEX, CHRONIC CONDITIONS. EFFORTS NEED TO BE MADE TO EXPAND ACCESS, REDUCE BARRIERS TO CARE (INCLUDING STIGMA), AND IMPROVE THE QUALITY OF PRIMARY CARE AND SPECIALIZED BEHAVIORAL HEALTH SERVICES.CHRONIC DISEASE MANAGEMENT- HIGH RATES OF CHRONIC AND ACUTE PHYSICAL HEALTH CONDITIONS (E.G., HEART DISEASE, HYPERTENSION, CANCER, AND ASTHMA). THE ASSESSMENT'S QUANTITATIVE DATA CLEARLY SHOWS THAT MANY COMMUNITIES IN BIDMC'S CBSA HAVE HIGH RATES FOR MANY OF THE LEADING PHYSICAL HEALTH CONDITIONS (E.G., HEART DISEASE, HYPERTENSION, CANCER, AND ASTHMA). IN MANY COMMUNITIES THESE RATES ARE STATISTICALLY HIGHER THAN COMMONWEALTH RATES, INDICATING A PARTICULARLY SIGNIFICANT PROBLEM. HOWEVER, EVEN FOR THOSE COMMUNITIES WHERE THE RATES ARE NOT STATISTICALLY HIGHER, THESE CONDITIONS ARE STILL THE LEADING CAUSES OF PREMATURE DEATH.- LIMITED ACCESS TO CANCER SCREENING FOR RACIAL/ETHNIC DIVERSITY AND OTHER AT-RISK POPULATIONS. MANY OF THE COMMUNITIES THAT ARE PART OF BIDMC'S CBSA HAVE HIGH CANCER MORTALITY RATES. THIS IS PARTICULARLY TRUE FOR CERTAIN CANCERS IN SPECIFIC COMMUNITIES IN SPECIFIC BOSTON NEIGHBORHOODS, SUCH AS ROXBURY, DORCHESTER, AND SOUTH END/CHINATOWN THAT HAVE A HIGH PROPORTION OF RACIAL/ETHNIC DIVERSITY. AT THE ROOT OF ADDRESSING HIGH MORTALITY IS SCREENING, EARLY DETECTION AND ACCESS TO TIMELY TREATMENT.- HIGH RATES OF HIV/AIDS PARTICULARLY ON THE OUTER PORTION OF CAPE COD AND IN A NUMBER OF BOSTON NEIGHBORHOODS THAT ARE PART OF BIDMC'S CBSA. GREAT STRIDES HAVE BEEN MADE IN CONTROLLING AND MANAGING HIV/AIDS, AND FOR MANY IT IS MANAGED AS A CHRONIC CONDITION WITH MEDICATIONS. RATES OF ILLNESS, DEATH, AND HIV TRANSMISSION DECLINED OVERALL IN THE PAST DECADE. HOWEVER, HIV/AIDS STILL HAS A MAJOR IMPACT ON CERTAIN SEGMENTS OF THE POPULATION, INCLUDING MEN WHO HAVE SEX WITH MEN AND INJECTION DRUG USERS. IN BIDMC'S CBSA, RATES OF HIV/AIDS ARE PARTICULARLY HIGH IN THE OUTER PORTION OF CAPE COD AND A NUMBER OF BOSTON'S NEIGHBORHOODS.ACCESS TO CARE- LIMITED ACCESS TO PRIMARY CARE MEDICAL, MEDICAL SPECIALTY, AND ORAL HEALTH CARE SERVICES FOR LOW INCOME, MEDICAID INSURED, UNINSURED, AND OTHER VULNERABLE POPULATIONS FACING HEALTH CARE DISPARITIES AND BARRIERS TO CARE. DESPITE THE FACT THAT 1) MASSACHUSETTS HAS ONE OF HIGHEST RATES OF HEALTH INSURANCE AND 2) THE COMMUNITIES THAT MAKE UP BIDMC'S CBSA HAVE STRONG, ROBUST SAFETY NET SYSTEMS THERE ARE STILL SUBSTANTIAL NUMBERS OF LOW INCOME, MEDICAID INSURED, UNINSURED, AND OTHERWISE VULNERABLE INDIVIDUALS WHO FACE HEALTH DISPARITIES AND ARE NOT ENGAGED IN ESSENTIAL MEDICAL AND ORAL HEALTH SERVICES. EFFORTS NEED TO BE MADE TO EXPAND ACCESS, REDUCE BARRIERS TO CARE, AND IMPROVE THE QUALITY OF PRIMARY CARE MEDICAL, MEDICAL SPECIALTY, AND ORAL HEALTH SERVICES.- BARRIERS TO ACCESS AND DISPARITIES IN HEALTH OUTCOMES CONTINUE TO CHALLENGE THREE SPECIAL POPULATIONS (INFANTS/MOTHERS/FATHERS, FRAIL OLDER ADULTS, AND LESBIAN, GAY, BI-SEXUAL, AND TRANSGENDER (LGBT) POPULATIONS. BASED ON INFORMATION GATHERED PRIMARILY FROM THE INTERVIEWS AND COMMUNITY FORUMS, THE ASSESSMENT IDENTIFIED A NUMBER OF SPECIAL POPULATIONS THAT FACE BARRIERS TO CARE AND DISPARITIES IN ACCESS. MORE SPECIFICALLY, INFANTS/MOTHERS/FATHERS, FRAIL OLDER ADULTS, AND THE LESBIAN, GAY, BI-SEXUAL, AND TRANSGENDER (LGBT) POPULATIONS FACE DISPARITIES IN ACCESS AND OUTCOME AND ARE PARTICULARLY AT-RISK. IF THESE DISPARITIES ARE GOING TO BE ADDRESSED THEN CARE NEEDS TO BE TAKEN TO TAILOR IDENTIFICATION/ SCREENING AND PREVENTIVE SERVICES AS WELL AS ACUTE AND CHRONIC DISEASE MANAGEMENT SERVICES FOR THESE SPECIAL POPULATIONS.
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COMMUNITY HEALTH NEEDS ASSESSMENT ADDRESSING COMMUNITY HEALTH NEEDS
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LARGE PROPORTIONS OF INDIVIDUALS RESIDING WITHIN BOSTON AND BIDMC'S COMMUNITY BENEFITS SERVICE AREA LIVE IN POVERTY, HAVE LIMITED FORMAL EDUCATION, ARE UNEMPLOYED, AND STRUGGLE TO AFFORD FOOD AND OTHER ESSENTIAL HOUSEHOLD ITEMS. THESE POPULATIONS ARE DISPROPORTIONATELY FROM RACIAL/ETHNIC MINORITY GROUPS AND, PARTLY AS A RESULT OF THEIR POVERTY, FACE DISPARITIES IN HEALTH AND ACCESS TO CARE OUTCOMES. IT IS CRITICAL TO NOTE THAT THERE IS A MULTITUDE OF INDIVIDUAL, COMMUNITY AND SOCIETAL FACTORS THAT WORK TOGETHER TO CREATE THESE INEQUITIES. IT IS INSUFFICIENT TO TALK SOLELY ABOUT RACE/ETHNICITY, FOREIGN BORN STATUS, OR LANGUAGE AS THE UNDERLYING AND CORRELATIVE ISSUES RELATED TO HEALTH AND WELL-BEING INVOLVE ECONOMIC OPPORTUNITY, EDUCATION, CRIME, AND COMMUNITY COHESION. BIDMC STRIVES TO ADDRESS THE PRIORITY AREAS IDENTIFIED IN ITS CHNA AND IMPLEMENTATION STRATEGY/COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) WHICH ARE AVAILABLE ON THE MEDICAL CENTER'S WEBSITE. BIDMC'S MOST RECENTLY COMPLETED CHNA IS AVAILABLE ON THE BIDMC WEBSITE AT: HTTPS://WWW.BIDMC.ORG/-/MEDIA/FILES/BETH-ISRAEL-ORG/ABOUT-BIDMC/HELPING-OUR-COMMUNITY/COMMUNITY-INITIATIVES/COMMUNITY-BENEFITS/BIDMC-2016-CHNA-COMMUNITY-HEALTH-NEEDS-ASSESSMENT.PDF?LA=ENBIDMC'S MOST RECENTLY COMPLETED IMPLEMENTATION STRATEGY (CHIP) IS AVAILABLE ON THE BIDMC WEBSITE AT:HTTPS://WWW.BIDMC.ORG/-/MEDIA/FILES/BETH-ISRAEL-ORG/ABOUT-BIDMC/HELPING-OUR-COMMUNITY/COMMUNITY-INITIATIVES/COMMUNITY-BENEFITS/COMMUNITY-HEALTH-IMPLEMENTATION-PLAN.PDF?LA=ENIN ADDITION, THE CHNA AND CHIP WHICH WERE COMPLETED PREVIOUSLY COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2013 AND UNDER WHICH COMMUNITY BENEFITS ACTIVITIES WERE GUIDED FOR THE FISCAL YEARS ENDED SEPTEMBER 30, 2014, SEPTEMBER 30, 2015 AND SEPTEMBER 30, 2016 S ARE AVAILABLE ON THE BIDMC WEBSITE AT: HTTPS://WWW.BIDMC.ORG/-/MEDIA/FILES/BETH-ISRAEL-ORG/ABOUT-BIDMC/HELPING-OUR-COMMUNITY/COMMUNITY-INITIATIVES/COMMUNITY-BENEFITS/FINALCHNAREPORT92313.PDF?LA=EN IN ADDITION, ALL OF THESE DOCUMENTS ARE ALSO AVAILABLE UPON REQUEST. (SCHEDULE H, PART V, SECTION B, LINE 7A)A SUMMARY OF THE MEDICAL CENTER'S COMMUNITY BENEFIT ACTIVITIES WHICH ADDRESS THE NEEDS IDENTIFIED IN THE CHNA COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2018 AND PRIORITIZED IN THE RELATED CHIP ARE PROVIDED HERE ALONG WITH THE ENTITIES WITH WHICH THE MEDICAL CENTER PARTNERS RELATED TO THESE EFFORTS. KEY: BASELINE 2017, YEAR 1 2018, YEAR 2 2019PRIORITY AREA 1: SOCIAL DETERMINANTS AND HEALTH RISK FACTORSSOCIAL DETERMINANTS OF HEALTH (E.G., ECONOMIC STABILITY, EDUCATION, AND COMMUNITY/SOCIAL CONTEXT) CONTINUE TO HAVE A TREMENDOUS IMPACT ON MANY SEGMENTS OF THE POPULATION. THE DOMINANT THEME FROM BIDMC'S KEY INFORMANT INTERVIEWS AND COMMUNITY FORUMS WAS THE CONTINUED IMPACT THAT THE UNDERLYING SOCIAL DETERMINANTS OF HEALTH ARE HAVING ON THE COMMUNITY BENEFITS SERVICE AREA'S LOW INCOME, UNDERSERVED, DIVERSE POPULATION COHORTS. MORE SPECIFICALLY, DETERMINANTS SUCH AS POVERTY, EMPLOYMENT OPPORTUNITIES, VIOLENCE, TRANSPORTATION, RACIAL SEGREGATION, LITERACY, PROVIDER LINGUISTIC/CULTURAL COMPETENCY, SOCIAL SUPPORT, AND COMMUNITY INTEGRATION LIMIT MANY PEOPLE'S ABILITY TO CARE FOR THEIR OWN AND/OR THEIR FAMILIES' HEALTH. LARGE PROPORTIONS OF INDIVIDUALS RESIDING WITHIN BOSTON AND BIDMC'S COMMUNITY BENEFITS SERVICE AREA LIVE IN POVERTY, HAVE LIMITED FORMAL EDUCATION, ARE UNEMPLOYED, AND STRUGGLE TO AFFORD FOOD AND OTHER ESSENTIAL HOUSEHOLD ITEMS. THESE POPULATIONS ARE DISPROPORTIONATELY FROM RACIALLY/ETHNICALLY DIVERSE GROUPS AND, PARTLY AS A RESULT OF THEIR POVERTY, FACE DISPARITIES IN HEALTH AND ACCESS TO CARE OUTCOMES. IT IS CRITICAL TO NOTE THAT THERE IS A MULTITUDE OF INDIVIDUAL, COMMUNITY AND SOCIETAL FACTORS THAT WORK TOGETHER TO CREATE THESE INEQUITIES. IT IS INSUFFICIENT TO TALK SOLELY ABOUT RACE/ETHNICITY, IMMIGRATION STATUS, OR LANGUAGE; AS THE UNDERLYING AND CORRELATIVE ISSUES RELATED TO HEALTH AND WELL-BEING INVOLVE ECONOMIC OPPORTUNITY, EDUCATION, CRIME, AND COMMUNITY COHESION. KEY: BASELINE 2017, YEAR 1 2018, YEAR 2 2019GOAL: INCREASE PHYSICAL ACTIVITY AND HEALTHY EATINGTARGET POPULATION: CHILDREN, YOUTH, ADULTSPROGRAMMATIC OBJECTIVES: 1.1 INCREASE THE NUMBER OF CHILDREN, YOUTH, AND ADULTS WHO ARE PHYSICALLY ACTIVE1.2 IMPLEMENT PROGRAMS AT BOWDOIN STREET WELLNESS CENTER1.3 INCREASE ACCESS TO HEALTHY AND AFFORDABLE FOODS IN COMMUNITY1.4 IMPROVE NUTRITIONAL QUALITY OF THE FOOD SUPPLY1.5 DECREASE THE NUMBER OF INDIVIDUALS AND FAMILIES WHO SUFFER FROM FOOD INSECURITY COMMUNITY ACTIVITIES/STRATEGIES:- SUPPORT AND PROMOTE THE DEVELOPMENT OF WALKING AND OTHER PHYSICAL ACTIVITY GROUPS IN SCHOOLS, COMMUNITY-BASED AND PRIMARY CARE-BASED SETTINGS (E.G., BOWDOIN STREET WELLNESS CENTER)- SUPPORT AND COLLABORATE WITH BPHC AND COMMUNITY-BASED ORGANIZATIONS (E.G., GBFB, CRCH, BSHC, ETC.) TO PROMOTE ACCESSIBLE/AFFORDABLE HEALTHY FOOD INCLUDING HEALTHY INCENTIVES PROGRAM, FARMERS MARKETS, AND COMMUNITY SUPPORTED AGRICULTURE (CSA) PROGRAM- INCREASE ACCESS TO HEALTHY FOOD CHOICES AVAILABLE AT BIDMC FOR PATIENTS AND STAFF- SUPPORT HEALTHY CHAMPIONS, A GROUP OF TEENAGERS IN HEALTHY COOKING AND EDUCATION WORKSHOPS AT BSHCMETRICS AND STATUS UPDATE:- NUMBER OF SCHOOLS, COMMUNITY GROUPS, AND PRIMARY CARE SETTINGS PARTICIPATING IN WALKING PROGRAMS AND OTHER PHYSICAL ACTIVITY GROUPS (FY17: 44 PUBLIC SCHOOLS WITH 7,175 CHILDREN AND 1,000 SCHOOL STAFF; FY18: 46 PUBLIC SCHOOLS AND 17 AFTER SCHOOL PROGRAMS WITH 4,335 CHILDREN AND 1,000 SCHOOL STAFF)- NUMBER OF FAMILIES PARTICIPATING IN CSA (FY17: 30 FAMILIES; FY18: 23)- PERCENTAGE OF BIDMC TOTAL FOOD AND BEVERAGE SPEND ON LOCAL PRODUCTS (FY18: 4.5%)- PERCENTAGE OF BIDMC TOTAL BEVERAGE SPEND ON HEALTHY BEVERAGES (FY18: 43.6%) - NUMBER OF HOSTED HEALTHY CHAMPIONS (FY17: 15 HEALTHY CHAMPIONS; FY 18: 15 HEALTHY CHAMPIONS)- NUMBER OF CHILDREN SEEN AT AFFILIATED HEALTH CENTERS THAT WERE SCREENED FOR BMI (FY17: 7,650 (75%)); FY18: 10,245 CHILDREN (65%))- NUMBER OF CHILDREN ENROLLED IN FITNESS IN THE CITY (FY18: 43 CHILDREN)- NUMBER OF UNDUPLICATED INDIVIDUALS ACCESS MOBILE MARKET AT CRCH (FY18: 445)COMMUNITY PARTNERS: COMMUNITY CARE ALLIANCE, BOSTON PUBLIC HEALTH COMMISSION, BOSTON ALLIANCE FOR COMMUNITY HEALTH, BOWDOIN STREET HEALTH CENTER, BOSTON PUBLIC SCHOOLS, DAILY TABLE, , CHARLES RIVER COMMUNITY HEALTH, MAYOR'S OFFICE OF FOOD INITIATIVESGOAL: PROMOTE VIOLENCE PREVENTION (SAFE NEIGHBORHOODS AND COMMUNITY COHESION)TARGET POPULATION: CHILDREN, YOUTH, ADULTSPROGRAMMATIC OBJECTIVES: 2.1 INCREASE ACCESS TO MENTAL HEALTH SERVICES AT BSHC FOR AFFECTED VICTIMS2.2 MAINTAIN PARTICIPATION IN ADVOCATE EDUCATION AND SUPPORT PROJECT2.3 PROVIDE COUNSELING AND OTHER MEDICAL SERVICES TO SEXUAL ASSAULT VICTIMS2.4 PROVIDE GRIEVING SUPPORT ACTIVITIES2.5 CONDUCT NEIGHBORHOOD CAMPAIGNS TO ENGAGE COMMUNITY AND CREATE GREATER COMMUNITY COHESIONCOMMUNITY ACTIVITIES/STRATEGIES: - SUPPORT PROGRAMS IN BSHC THAT INTEGRATE SERVICES PROVIDED BY BEHAVIORAL HEALTH SPECIALISTS AND MONITOR, ASSESS, AND TREAT THOSE EXPERIENCING TRAUMA FROM VIOLENCE- HOLD HEALING SERVICES WHEN APPROPRIATE FOR COMMUNITY RESIDENTS- PARTICIPATE IN COMMUNITY INTERVENTIONS THAT RAISE AWARENESS ABOUT VIOLENCE, ENGAGE THE COMMUNITY, ADDRESS FACTORS ASSOCIATED WITH VIOLENCE (E.G., "BROKEN WINDOW" THEORY, BLOCK CAPTAINS PROGRAM, ETC.), AND PROMOTE A SENSE OF COMMUNITY- SUPPORT AND PROMOTE THE IMPLEMENTATION OF TRAINING PROGRAMS, SUPPORT GROUPS FOR ADVOCATES AND AFFECTED COMMUNITY MEMBERS- PROVIDE OVERNIGHT STAYS FOR DOMESTIC VIOLENCE AND/OR SEXUAL ASSAULT VICTIMS WITHOUT SAFE SHELTER- CONDUCT PUBLIC POLICY ADVOCACY FOR SAFE SHELTERS AND LONG-TERM HOUSING SUPPORT- EMPOWER YOUTH TO DEVELOP LEADERSHIP SKILLS, PREVENT VIOLENCE AND CREATE CHANGE IN THEIR COMMUNITY THROUGH THE YOUTH LEADERSHIP PROGRAM AT BOWDOIN STREET HEALTH CENTERMETRICS AND STATUS UPDATE: - NUMBER OF SEXUAL ASSAULT VICTIMS RECEIVING SERVICES (FY17: PROVIDE SERVICES, INCLUDING COUNSELING FOR 75 SEXUAL ASSAULT VICTIMS. PROVIDE POST-HIV EXPOSURE PROPHYLAXIS MEDICATIONS TO 49 SEXUAL ASSAULT VICTIMS; FY18: PROVIDE SERVICES, INCLUDING COUNSELING FOR 62 SEXUAL ASSAULT VICTIMS. PROVIDE POST-HIV EXPOSURE PROPHYLAXIS MEDICATIONS TO 35 SEXUAL ASSAULT VICTIMS.)- NUMBER OF SAFE BED OVERNIGHT STAYS (FY17: 59; FY18: 33)- NUMBER HEALING CIRCLES HELD WITH WOMEN, MEN, AND CHILDREN (FY17: 57; FY18: 58)- NUMBER OF BOWDOIN GENEVA YOUTH PARTICIPATING IN THE BSHC YOUTH LEADERSHIP PROGRAM (FY17: 25; FY18: 22)- PERCENTAGE OF YOUTH IN BSHC YOUTH LEADERSHIP PROGRAM WHO HAD A POSITIVE INCREASE ON A KNOWLEDGE AND ATTITUDE TEST BEFORE AND AFTER THE PROGRAM (FY18: DATA NOT YET AVAILABLE)COMMUNITY PARTNERS: BOWDOIN STREET HEALTH CENTER (BSHC), BOSTON PUBLIC HEALTH COMMISSION, OTHER BOWDOIN/ GENEVA NEIGHBORHOOD ORGANIZATIONS
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GOAL: SUPPORT WORKFORCE DEVELOPMENT AND CREATION OF EMPLOYMENT OPPORTUNITIES
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TARGET POPULATION: YOUTH, YOUNG ADULTS, ADULTS, BIDMC EMPLOYEESPROGRAMMATIC OBJECTIVES: 3.1 ORGANIZE AND SUPPORT PIPELINE PROGRAMS TO ENHANCE SKILLS AND CAREER ADVANCEMENT 3.2 PROVIDE OPPORTUNITIES THROUGH EMPLOYEE CAREER INITIATIVE (ECI) FOR COLLEGE-LEVEL COURSES AS WELL AS COUNSELING 3.3 OFFER ESOL CLASSES, GED CLASSES, A BASIC COMPUTER SKILLS COURSE, CITIZENSHIP CLASSES, AND A FINANCIAL LITERACY CLASS 3.4 PROVIDE JOB AND CAREER INTRODUCTORY OPPORTUNITIES FOR COMMUNITY RESIDENTS3.5 PROVIDE JOB AND CAREER INTRODUCTORY OPPORTUNITIES FOR MIDDLE AND HIGH SCHOOL STUDENTS3.6 CONTINUE TRAIN4CHANGE AT BSHC3.7 IMPLEMENT AND EXPAND LEARN AND EARN PROGRAM THROUGH BUNKER HILL COMMUNITY COLLEGECOMMUNITY ACTIVITIES/STRATEGIES: - ORGANIZE AND SUPPORT PIPELINE PROGRAMS TO ENHANCE SKILLS AND CAREER ADVANCEMENT - PROVIDE OPPORTUNITIES THROUGH EMPLOYEE CAREER INITIATIVE (ECI) FOR COLLEGE-LEVEL COURSES AS WELL AS COUNSELING - OFFER ESOL CLASSES, GED CLASSES, A BASIC COMPUTER SKILLS COURSE, CITIZENSHIP CLASSES, AND A FINANCIAL LITERACY CLASS - PROVIDE JOB AND CAREER INTRODUCTORY OPPORTUNITIES FOR COMMUNITY RESIDENTS- PROVIDE JOB AND CAREER INTRODUCTORY OPPORTUNITIES FOR MIDDLE AND HIGH SCHOOL STUDENTS- CONTINUE TRAIN4CHANGE AT BSHC- IMPLEMENT AND EXPAND LEARN AND EARN PROGRAM THROUGH BUNKER HILL COMMUNITY COLLEGEMETRICS AND STATUS UPDATE: - NUMBER OF PIPELINE PROGRAMS OFFERED (FY17: 4; FY18: 6)- NUMBER OF PARTICIPANTS IN PIPELINE PROGRAM (FY17: 31; FY18: 36)- NUMBER OF PARTICIPANTS GRADUATED FROM PIPELINE PROGRAMS (FY17: 21; FY18: 25)- NUMBER OF EMPLOYEES RECEIVING ECI SERVICES (FY17: 707; FY18: 651)- NUMBER OF EMPLOYEES ENROLLED IN ESOL CLASSES (FY17: 19; FY18: 30)- NUMBER OF EMPLOYEES PARTICIPATING IN COMPUTER SKILLS, CITIZENSHIP, AND FINANCIAL LITERACY CLASSES (FY17: 107 EMPLOYEES PARTICIPATED IN A 10-WEEK COMPUTER SKILLS CLASS; 11 ATTENDED CITIZENSHIP CLASSES AND 123 ATTENDED A FINANCIAL LITERACY CLASS; FY18: 98 IN COMPUTER SKILLS CLASSES (NOT 10 WEEKS), 12 IN CITIZENSHIP CLASSES, 20 IN FINANCIAL LITERACY PROGRAM)- NUMBER OF ADULT INTERNS PLACED (FY17: 8; FY18: 8)- NUMBER OF ADULT INTERNS HIRED AFTER INTERNSHIPS (FY17: 3 FY18: 1)- NUMBER OF REFERRALS/RECOMMENDATIONS GIVEN ON BEHALF OF INTERNS SEEKING JOBS AT LOCAL COMMUNITY ORGANIZATIONS (FY17: 81; FY18: 38)- NUMBER OF PARTICIPANTS IN BSHC'S TRAIN4CHANGE (FY17: 4; FY18: 4)- NUMBER OF INTERNS HIRED FROM BUNKER HILL COMMUNITY COLLEGE'S LEARN AND EARN PROGRAM (FY17: 1; FY18: 2)- NUMBER OF SUMMER JOB OPPORTUNITIES PROVIDED (FY17: 41; FY18: 43)- NUMBER OF SCHOOL INTERNS HIRED (FY17: 3; FY18: 3)- NUMBER OF BOSTON PUBLIC SCHOOL STUDENTS HOSTED FOR PIC'S ANNUAL JOB SHADOW DAY (FY17: 31; FY18: 31)- NUMBER OF MEDICAL CHAMPIONS MENTORED (FY17: 10; FY18: 12)- NUMBER OF HIGH SCHOOL STUDENTS HOSTED IN SUMMER HEALTH CORPS PROGRAM (FY17: 41; FY18: 42)COMMUNITY PARTNERS: BIDMC ADMIN. AND CLINICAL STAFF, BOSTON PUBLIC SCHOOLS, BOSTON PRIVATE INDUSTRY COUNCIL (PIC), BOWDOIN STREET HEALTH CENTER, BUNKER HILL COMMUNITY COLLEGE, JEWISH VOCATIONAL SERVICES (JVS), ONE-STOP CAREER CENTER, ST. MARY'S CENTER FOR WOMEN AND CHILDRENGOAL: PROMOTE ENVIRONMENTAL SUSTAINABILITYTARGET POPULATION: CHILDREN, YOUTH, ADULTSPROGRAMMATIC OBJECTIVES: 4.1 REDUCE ENERGY AND WATER CONSUMPTIONCOMMUNITY ACTIVITIES/STRATEGIES: - IMPLEMENT ENVIRONMENTAL STRATEGIC PLAN- PROMOTE RECYCLING, COMPOSTING, AND CONSERVATION OF WATER AND ENERGY THROUGHOUT BIDMC- REDUCE GREENHOUSE GAS EMISSIONS AND INCREASE DIVERSION RATE AT BIDMCMETRICS AND STATUS UPDATE: - GREEN CHEMICAL CLEANING PRODUCT SPEND AT BIDMC (GOAL: 50% SPEND BY 2019)- GREENHOUSE GAS (GOAL: REDUCE EMISSIONS BY 25% BY 2020)- DIVERSION RATE (FY18: 44.6%)COMMUNITY PARTNERS: MASCO, HEALTH CARE WITHOUT HARM, PRACTICE GREEN HEALTH, EPA, BOSTON GREEN RIBBON COMMISSION, BIDMC ENVIRONMENTAL SUSTAINABILITY COMMITTEEGOAL: PROMOTE TRANSPORTATION EQUITY TARGET POPULATION: YOUTH, ADULTS, BIDMC EMPLOYEESPROGRAMMATIC OBJECTIVES:5.1 PROMOTE TRANSPORTATION EQUITY FOR EMPLOYEES AND PATIENTS AT BIDMC COMMUNITY ACTIVITIES/STRATEGIES: GREEN COMMUTING AT BIDMC - PARTICIPATE IN REGIONAL TRANSPORTATION PLANNING AND/OR MAINTAIN MEMBERSHIP IN TRANSPORTATION MANAGEMENT ASSOCIATION - PROVIDE BIKE RACKS, BIKE PATHS, WALKWAYS AND SHOWER FACILITIES FOR ALTERNATIVE COMMUTERS- INSTALL ELECTRIC VEHICLE CHARGING STATIONS- PROVIDE OR OUTSOURCE SHUTTLE/VANPOOL, CARPOOL OR RIDE-SHARING SERVICES- OFFER TELEWORK, COMPRESSED WORK SCHEDULES TO REDUCE EMPLOYEE COMMUTING- PROVIDE VOUCHERS OR SUBSIDIES FOR PUBLIC TRANSIT, RIDE-AND-BIKE-SHARING SERVICES- PROVIDE PREFERRED PARKING FOR CARPOOL PARTICIPANTS AND LOW-EMISSION, FUEL-EFFICIENT VEHICLESREDUCE TRANSPORTATION BARRIER FOR PATIENTS ACCESSING CARE AT BIDMC- KIT CLARK SENIOR SERVICES- MAYOR'S CANCER RIDE PROGRAM METRICS AND STATUS UPDATE: - NUMBER OF EMPLOYEES COMMUTING TO WORK VIA PUBLIC TRANSPORT, CAR, BIKE, WALKING, OTHER (FY18: DATA NOT AVAILABLE)- NUMBER OF TAXI OR CHAIR CAR VOUCHERS PROVIDED TO PATIENTS BY BIDMC (1,671 TAXI RIDES PROVIDED IN FY18)
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PRIORITY AREA 2: CHRONIC DISEASE MANAGEMENT
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HIGH RATES OF CHRONIC AND ACUTE PHYSICAL HEALTH CONDITIONS (E.G., HEART DISEASE, HYPERTENSION, CANCER, AND ASTHMA). THE ASSESSMENT'S QUANTITATIVE DATA CLEARLY SHOWS THAT MANY COMMUNITIES IN BIDMC'S CBSA HAVE HIGH RATES FOR MANY OF THE LEADING PHYSICAL HEALTH CONDITIONS (E.G., HEART DISEASE, HYPERTENSION, CANCER, AND ASTHMA). IN MANY COMMUNITIES THESE RATES ARE STATISTICALLY HIGHER THAN COMMONWEALTH RATES, INDICATING A PARTICULARLY SIGNIFICANT PROBLEM. HOWEVER, EVEN FOR THOSE COMMUNITIES WHERE THE RATES ARE NOT STATISTICALLY HIGHER, THESE CONDITIONS ARE STILL THE LEADING CAUSES OF PREMATURE DEATH. LIMITED ACCESS TO CANCER SCREENING FOR RACIAL/ETHNIC DIVERSITY AND OTHER AT-RISK POPULATIONS. MANY OF THE COMMUNITIES THAT ARE PART OF BIDMC'S CBSA HAVE HIGH CANCER MORTALITY RATES. THIS IS PARTICULARLY TRUE FOR CERTAIN CANCERS IN SPECIFIC COMMUNITIES IN SPECIFIC BOSTON NEIGHBORHOODS, SUCH AS ROXBURY, DORCHESTER, AND SOUTH END/CHINATOWN THAT HAVE A HIGH PROPORTION OF RACIAL/ETHNIC DIVERSITY. AT THE ROOT OF ADDRESSING HIGH MORTALITY IS SCREENING, EARLY DETECTION AND ACCESS TO TIMELY TREATMENT. HIGH RATES OF HIV/AIDS PARTICULARLY ON THE OUTER PORTION OF CAPE COD AND IN A NUMBER OF BOSTON NEIGHBORHOODS THAT ARE PART OF BIDMC'S CBSA. GREAT STRIDES HAVE BEEN MADE IN CONTROLLING AND MANAGING HIV/AIDS, AND FOR MANY IT IS MANAGED AS A CHRONIC CONDITION WITH MEDICATIONS. RATES OF ILLNESS, DEATH, AND HIV TRANSMISSION DECLINED OVERALL IN THE PAST DECADE. HOWEVER, HIV/AIDS STILL HAS A MAJOR IMPACT ON CERTAIN SEGMENTS OF THE POPULATION, INCLUDING MEN WHO HAVE SEX WITH MEN AND INJECTION DRUG USERS. IN BIDMC'S CBSA, RATES OF HIV/AIDS ARE PARTICULARLY HIGH IN THE OUTER PORTION OF CAPE COD AND A NUMBER OF BOSTON'S NEIGHBORHOODS.KEY: BASELINE 2017, YEAR 1 2018, YEAR 2 2019GOAL: IMPROVE CHRONIC DISEASE MANAGEMENT TARGET POPULATION: LOW INCOME ADULTSPROGRAMMATIC OBJECTIVES: 1.1 INCREASE THE NUMBER OF ADULTS WHO RECEIVE EDUCATION AND COUNSELING REGARDING RISK FACTORS, HEALTHY BEHAVIORS TO INCREASE CHRONIC DISEASE HEALTH LITERACY1.2 INCREASE THE NUMBER OF ADULTS SCREENED FOR DIABETES, HYPERTENSION, HIV/AIDS, AND ASTHMA 1.3 INCREASE THE NUMBER OF ADULTS WITH DIABETES, HYPERTENSION, HIV/AIDS, AND PERSISTENT ASTHMA WHO RECEIVE EVIDENCE-BASED COUNSELING/ COACHING AND TREATMENT1.4 INCREASE THE NUMBER OF ADULTS WITH DIABETES, HYPERTENSION, HIV/AIDS, AND PERSISTENT ASTHMA WHOSE CONDITIONS ARE MONITORED AND CONTROLLEDCOMMUNITY ACTIVITIES/STRATEGIES:- SUPPORT PROGRAMS IN CCA HEALTH CENTERS INCLUDING LIVE AND LEARN DIABETES AT CRCH THAT EDUCATE AND SCREEN PATIENTS FOR DIABETES, HYPERTENSION, AND PERSISTENT ASTHMA - SUPPORT PROGRAMS IN CCA CLINICS INCLUDING LIVE AND LEARN DIABETES AT CRCH THAT EDUCATE AND SCREEN PATIENTS FOR DIABETES, HYPERTENSION, AND PERSISTENT ASTHMA- PROVIDE EVIDENCED-BASED COUNSELING/COACHING AND TREATMENT, AS WELL AS APPROPRIATE REFERRALS FOR SPECIALTY CARE SERVICES FOR THOSE WHO SCREEN POSITIVE FOR DIABETES, HYPERTENSION, HIV/AIDS, AND ASTHMA- PROVIDE SCREENING, EDUCATION/COUNSELING, AND TREATMENT SERVICES HIV/AIDS AND HIV/HCV CO-INFECTION- SUPPORT GROUPS FOR MEN AND WOMEN LIVING WITH HIV/AIDS- SUPPORT PRIMARY CARE PROVIDER EDUCATION AT CRCH IN THE AREA OF DIABETES MANAGEMENTMETRICS AND STATUS UPDATE:- NUMBER OF HIV/AIDS PATIENTS EDUCATED/COUNSELED, AND TREATED FOR HIV (FY17: 2,577; FY18: 2,705) PERCENTAGE OF HIV POSITIVE PATIENTS SCREENED FOR HCV (FY17: 99%; FY 18: 98%) NUMBER OF BSHC PATIENTS PARTICIPATING IN DISEASE MANAGEMENT PROGRAMS (FY17: 900; FY18: 1,015) PERCENTAGE OF CCA FQHC PATIENTS WITH DIABETES WITH HBA1C < 9 (FY17: 79%%; FY18: 70%) PERCENTAGE OF CCA FQHC PATIENTS WITH HYPERTENSION WHO HAD A BLOOD PRESSURE < 140/90 (FY17: 62.4%%; FY18: 65.5%)- PERCENTAGE OF CCA FQHC PERSISTENT ASTHMATIC PATIENTS WITH PHARMACOLOGICAL THERAPY (FY17: 86%; FY18: 94.7%)- NUMBER OF GROUPS CONVENED FOR HIV/AIDS SUPPORT GROUPS FY17 AND FY18: CONTINUED EXPERIENCED AND POSITIVE GROUP FOR GAY MEN WHO HAVE ADVANCED AIDS - 22 SESSIONS; 2 HOURS PER SESSION; 9 (FY17) AND 8 (FY18) PARTICIPANTS AND SUPPORT GROUP FOR HIV+ WOMEN - 22 SESSIONS; 2 HOURS PER SESSION; 8 PARTICIPANTS)- IMPROVE CARE MANAGEMENT FOR BSHC PATIENTS WITH CHRONIC DISEASE BSHC PATIENTS THAT HAD AT LEAST ONE HBA1C TEST (FY17: 87.5%; FY18: 83.9%) BSHC PATIENTS THAT HAD AT LEAST ONE LDL TEST (FY17: 56%; FY18: 66%) BSHC PATIENTS THAT HAD AT LEAST ONE EYE EXAM (FY17: 38.9%; FY18: 50.2%) - IMPROVE CARE MANAGEMENT FOR BSHC PATIENTS WITH CHRONIC DISEASE BSHC PATIENTS THAT HAD AT LEAST ONE HBA1C TEST (FY17: 87.5%; FY18: 83.9%) BSHC PATIENTS THAT HAD AT LEAST ONE LDL TEST (FY17: 56%; FY18: 66%) BSHC PATIENTS THAT HAD AT LEAST ONE EYE EXAM (FY17: 38.9%; FY18: 50.2%)COMMUNITY PARTNERS: CCA HEALTH CENTERS, JOSLIN DIABETES CENTER GOAL: IMPROVE CARE TRANSITIONS FOR THOSE WITH CHRONIC HEALTH CONDITIONSTARGET POPULATION: ELDER ADULTS, LOW INCOME ADULTS PROGRAMMATIC OBJECTIVES: 2.1 IMPROVE CARE TRANSITIONS FROM THE INPATIENT HOSPITAL SETTING TO OTHER CARE SETTINGS, TO IMPROVE QUALITY OF CARE AND TO REDUCE READMISSIONS FOR HIGH-RISK PATIENTS COMMUNITY ACTIVITIES/STRATEGIES:- SUPPORT PREVENTABLE ADMISSIONS CARE TEAM (PACT) PROGRAM METRICS AND STATUS UPDATE: - NUMBER OF HEALTH CENTER PATIENTS ENROLLED IN PACT PROGRAM - NUMBER OF MEDICAID PATIENTS ENROLLED IN PACT PROGRAMCOMMUNITY PARTNERS: CCA HEALTH CENTERS GOAL: INCREASE CANCER SCREENING AND SUPPORT CANCER PATIENTS/CAREGIVERSTARGET POPULATION: LOW INCOME AND RACIAL/ETHNIC DIVERSE ADULTS PROGRAMMATIC OBJECTIVES: 3.1 MAINTAIN AND INCREASE THE NUMBER OF LOW INCOME AND RACIAL/ETHNIC DIVERSE ADULTS EDUCATED AND SCREENED FOR CANCER3.2 MAINTAIN AND INCREASE THE NUMBER OF ADULTS WHO SCREEN POSITIVE FOR CANCER WHO ARE REFERRED FOR EDUCATION, COUNSELING AND TREATMENT3.3 MAINTAIN AND INCREASE THE NUMBER OF ADULTS WHO SCREEN POSITIVE FOR CANCER WHO ARE LINKED TO A CANCER NAVIGATORCOMMUNITY ACTIVITIES/STRATEGIES:- SUPPORT ACCESS TO CANCER SCREENING AND TREATMENT FOR LOW INCOME, UNINSURED ADULTS (BREAST, PROSTATE, COLON, AND LUNG, CANCERS), INCLUDING MAMMOGRAMS, COLORECTAL SCREENING, AND LUNG CT SCANS. - SUPPORT AND PROMOTE THE CITY-WIDE CANCER NAVIGATORS PROGRAM- LINK PATIENTS SCREENED POSITIVE FOR CANCER TO CANCER PATIENT NAVIGATORS- SUPPORT SURVIVOR SELF-PORTRAIT AND TESTIMONIES ACTIVITIES TO REDUCE STIGMA IN COMMUNITIES- PROVIDE EMOTIONAL CANCER PEER SUPPORT PROGRAMS SUCH AS THE PATIENT-TO-PATIENT AND HEART-TO-HEART PROGRAM- COLLABORATE WITH THE HARVARD CATALYST TO TRANSLATE RESEARCH INTO PRACTICEMETRICS AND STATUS UPDATE: INCREASE ACCESS TO PATIENT NAVIGATORS- NUMBER OF PATIENTS SERVED BY CHINESE PATIENT NAVIGATOR (FY17: 469; FY18: 495)- NUMBER OF ENCOUNTERS PROVIDED BY CHINESE PATIENT NAVIGATOR (FY17: 2,279; FY18: 2,350)- NUMBER OF PATIENT SERVED BY LATINA PATIENT NAVIGATOR (FY17: 231; FY18 PROGRAM ENDED)- NUMBER OF ENCOUNTERS PROVIDED BY LATINA PATIENT NAVIGATOR (FY17: 395; FY18 PROGRAM ENDED)- NUMBER OF PATIENT NAVIGATORS PARTICIPATING IN QUARTERLY NETWORK MEETINGS (FY17: 21; FY18: 24)- NUMBER OF MAMMOGRAMS PROVIDED FOR LOW-INCOME WOMEN IN FENWAY, OUTER CAPE, AND SOUTH COVE (FY17: 6,368; FY18: 5,322)- NUMBER OF COLON CANCER SCREENINGS PROVIDED FOR LOW-INCOME PATIENTS (FY17: 1,492; FY18: 1,896)- NUMBER OF PATIENTS SCREENED FOR LUNG CANCER (FY17: 100; FY18: 950)- NUMBER OF PATIENTS PARTICIPATING IN CANCER PEER SUPPORT PROGRAMS (FY17: 172; FY18: DATA NOT AVAILABLE)COMMUNITY PARTNERS: CCA HEALTH CENTERS, CANCER NAVIGATOR PROGRAM, DANA FARBER HARVARD CANCER CENTER (DFHCC)
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GOAL: SUPPORT OLDER ADULTS TO AGE IN PLACE
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TARGET POPULATION: OLDER ADULTS PROGRAMMATIC OBJECTIVES: 4.1 REDUCE INAPPROPRIATE READMISSIONS FOR OLDER ADULTS4.2 REDUCE ELDERLY FALLS4.3 REDUCE SOCIAL ISOLATIONCOMMUNITY ACTIVITIES/STRATEGIES:- INCREASE STRENGTH AND REDUCE THE RISK OF FALLS- OFFER HEALTH AND WELLNESS PROGRAMMING - OTHER PROGRAMS WITH HSL (PENDING)METRICS AND STATUS UPDATE: - NUMBER OF ADULTS ENROLLED IN TAI CHI CLASSES AT BSHC (FY17:29; FY18: 104 TAI CHI CLASSES HELD)COMMUNITY PARTNERS: BIDMC STAFF AND CLINICIANS, KIT CLARK SENIOR SERVICES, CCA HEALTH CENTERS, OTHER COMMUNITY PROVIDER, HEBREW SENIOR LIFEPRIORITY AREA 3: ACCESS TO CARELIMITED ACCESS TO PRIMARY CARE MEDICAL, MEDICAL SPECIALTY, AND ORAL HEALTH CARE SERVICES FOR LOW INCOME, MEDICAID INSURED, UNINSURED, AND OTHER VULNERABLE POPULATIONS FACING HEALTH CARE DISPARITIES AND BARRIERS TO CARE. DESPITE THE FACT THAT 1) MASSACHUSETTS HAS ONE OF HIGHEST RATES OF HEALTH INSURANCE AND 2) THE COMMUNITIES THAT MAKE UP BIDMC'S CBSA HAVE STRONG, ROBUST SAFETY NET SYSTEMS THERE ARE STILL SUBSTANTIAL NUMBERS OF LOW INCOME, MEDICAID INSURED, UNINSURED, AND OTHERWISE VULNERABLE INDIVIDUALS WHO FACE HEALTH DISPARITIES AND ARE NOT ENGAGED IN ESSENTIAL MEDICAL AND ORAL HEALTH SERVICES. EFFORTS NEED TO BE MADE TO EXPAND ACCESS, REDUCE BARRIERS TO CARE, AND IMPROVE THE QUALITY OF PRIMARY CARE MEDICAL, MEDICAL SPECIALTY, AND ORAL HEALTH SERVICES.BARRIERS TO ACCESS AND DISPARITIES IN HEALTH OUTCOMES CONTINUE TO CHALLENGE THREE SPECIAL POPULATIONS (INFANTS/MOTHERS/FATHERS, FRAIL OLDER ADULTS, AND LESBIAN, GAY, BI-SEXUAL, AND TRANSGENDER (LGBT) POPULATIONS. BASED ON INFORMATION GATHERED PRIMARILY FROM THE INTERVIEWS AND COMMUNITY FORUMS, THE ASSESSMENT IDENTIFIED A NUMBER OF SPECIAL POPULATIONS THAT FACE BARRIERS TO CARE AND DISPARITIES IN ACCESS. MORE SPECIFICALLY, INFANTS/MOTHERS/FATHERS, FRAIL OLDER ADULTS, AND THE LESBIAN, GAY, BI-SEXUAL, AND TRANSGENDER (LGBT) POPULATIONS FACE DISPARITIES IN ACCESS AND OUTCOME AND ARE PARTICULARLY AT-RISK. IF THESE DISPARITIES ARE GOING TO BE ADDRESSED THEN CARE NEEDS TO BE TAKEN TO TAILOR IDENTIFICATION/ SCREENING AND PREVENTIVE SERVICES AS WELL AS ACUTE AND CHRONIC DISEASE MANAGEMENT SERVICES FOR THESE SPECIAL POPULATIONS. KEY: BASELINE 2017, YEAR 1 2018, YEAR 2 2019, YEAR 3 2020 GOAL: INCREASE ACCESS TO QUALITY MEDICAL SERVICES, INCLUDING PRIMARY CARE, OB/GYN, AND SPECIALTY CARE IN BOSTON'S NEIGHBORHOODS, QUINCY, AND THE OUTER PORTION OF CAPE CODTARGET POPULATION: CHILDREN, YOUTH, ADULTSPROGRAMMATIC OBJECTIVES: 1.1 MAINTAIN AND INCREASE THE NUMBER OF PATIENTS RECEIVING PRIMARY MEDICAL CARE SERVICES, INCLUDING OB/GYN SERVICE AT CCA HEALTH CENTERS1.2 MAINTAIN AND INCREASE THE NUMBER OF PATIENTS RECEIVING SPECIALTY CARE MEDICAL SERVICES1.3 ENSURE ACCESS TO SERVICES FOR THOSE ON THE OUTER CAPE1.4 ENSURE ACCESS TO APPROPRIATE TRAUMA CARE AND EMERGENCY SERVICES1.5 1.1 MAINTAIN OR INCREASE SUPPORT FOR HSN TRUST FUND; AND ADVOCATE FOR LEGISLATION AND POLICIES SUPPORTING PUBLIC HEALTH, MENTAL HEALTH AND SUBSTANCE USE AND ANTI-POVERTY PROGRAMS1.6 1.2 SCREEN AND ENROLL THOSE WHO QUALIFY FOR HEALTH INSURANCE THROUGH ACACOMMUNITY ACTIVITIES/STRATEGIES: - SUPPORT INSTITUTIONAL AND COMMUNITY EMERGENCY PREPAREDNESS - ENSURE CONNECTION TO SPECIALTY CARE THROUGH CARE CONNECTION'S INPATIENT DISCHARGE FOLLOW UP PROGRAM- CARE INTEGRATION THROUGH INFORMATION SHARING VIA PARTICIPATION IN MASS HIWAY AND A HEALTH INFORMATION EXCHANGE- SUPPORT MED-FLIGHT AND COORDINATED EMS IN BOSTON- SUPPORT HSN- CONDUCT "MYSTERY SHOPPING" TO ADDRESS QUALITY IMPROVEMENT- ADMINISTER ASK DEVELOPMENT EVALUATION PROGRAM- SUPPORT RESIDENT ROTATIONS INTO CCA HEALTH CENTERS - EXPLORE SPREADING PACT PROGRAM TO MEDICAID COHORTMETRICS AND STATUS UPDATE: - NUMBER OF PATIENTS SERVED AT FQHC CCA CLINICS (FY17: 106,463; FY18: 110,268)- NUMBER OF VISITS PROVIDED AT FQHC CCA CLINICS (FY17: 543,713; FY18: 551,521)- NUMBER OF PATIENTS WITHOUT INSURANCE SERVICED AT FQHC CCA CLINICS (FY17: 11,704; FY18: 11,610)- NUMBER OF REFERRALS MADE THROUGH CARE CONNECTION CALL CENTER (FY17:986; FY18: 923)- NUMBER OF INDIVIDUALS SCREENED FOR INSURANCE ELIGIBILITY (FY17: 9,776: FY18: 10,265)- NUMBER OF INDIVIDUALS ENROLLED IN ENTITLEMENT PROGRAMS (FY17: 8,716: FY18 9,152)- NUMBER OF PATIENTS SUPPORTED THROUGH HSN (FY17: 2,603: FY18: 3,025)- NUMBER OF MYSTERY SHOPPING SURVEYS COMPLETED (FY17: 72; FY 18: 72)- NUMBER OF PRESCRIPTIONS FILLED FOR INDIGENT PATIENTS (FY18: 5,452)COMMUNITY PARTNERS: CCA HEALTH CENTERS, BIDCOGOAL: INCREASE ACCESS TO QUALITY ORAL HEALTHTARGET POPULATION: CHILDREN, YOUTH, ADULTSPROGRAMMATIC OBJECTIVES:2.1 MAINTAIN AND INCREASE THE NUMBER OF PATIENTS RECEIVING PRIMARY DENTAL CARE SERVICES AT CCA HEALTH CENTERS2.2 CONDUCT PUBLIC POLICY ADVOCACYCOMMUNITY ACTIVITIES/STRATEGIES: - SUPPORT MEDICAL RESIDENTS AT CCA HEALTH CENTERS- SUPPORT HSNMETRICS AND STATUS UPDATE: - NUMBER OF DENTAL PATIENTS AT FQHC CCA CLINICS (FY17: 25,709; FY18: 26,720)- NUMBER OF UNIQUE DENTAL VISITS AT FQHC CCA CLINICS (FY17: (80,622; FY18: 83,450)COMMUNITY PARTNERS: CCA HEALTH CENTERSGOAL: INCREASE QUALITY AND EFFICIENCY OF CLINICAL SERVICES AT CCA HEALTH CENTERSTARGET POPULATION: CHILDREN, YOUTH, ADULTSPROGRAMMATIC OBJECTIVES: 3.1 MAINTAIN AND INCREASE THE NUMBER OF PROVIDERS AT CCA HEALTH CENTERSCOMMUNITY ACTIVITIES/STRATEGIES:- SUPPORT MEDICAL RESIDENTS AT CCA HEALTH CENTERS METRICS AND STATUS UPDATE:- NUMBER OF MEDICAL RESIDENTS PLACED AT CCA HEALTH CENTERS (FY17: 34; FY18: 31) COMMUNITY PARTNERS: CCA HEALTH CENTERSGOAL: PROMOTE EQUITABLE CARE AND SUPPORT FOR THOSE WITH LIMITED ENGLISH PROFICIENCYTARGET POPULATION: CHILDREN, YOUTH, ADULTSPROGRAMMATIC OBJECTIVES:4.1 CONTINUE INTERPRETER SERVICES PROGRAM4.2 EDUCATE STAFF/CLINICIANS IN HEALTH EQUITY PRINCIPLES4.3 PROMOTE HEALTH EQUITY, HEALTH LITERACY, CULTURAL COMPETENCE ACROSS CCA HEALTH CENTERS COMMUNITY ACTIVITIES/STRATEGIES:- UNDERSTAND CULTURAL IMPACTS ON HEALTH CARE DELIVERY, HEALTH STATUS AND HEALTH OUTCOMES- EXPLORE AVAILABLE TOOLS AND RESOURCES TO FACILITATE CROSS-CULTURAL COMMUNICATION- EXPLORE OPPORTUNITIES FOR CCA HEALTH CENTERS IN THEIR EFFORTS TO BECOME HEALTH LITERATE ORGANIZATIONS- IMPROVE ACCESSIBILITY OF INTERPRETER SERVICES FOR LEP PATIENTSMETRICS AND STATUS UPDATE:- NUMBER OF LEP PATIENTS SERVED AT BIDMC (FY 17: 237,255 IN 73 LANGUAGES; FY18: 229,547 IN 81 LANGUAGE) - NUMBER OF PATIENTS BEST SERVED IN LANGUAGE OTHER THAN ENGLISH AT FQHC CCA CLINICS (FY17: 43,900; FY18: 44,988)- NUMBER OF PATIENTS OF DIVERSE RACE/ETHNICITY SERVED AT CCA CLINICS (FY17: 68,682)- NUMBER OF PATIENTS OF DIVERSE RACE/ETHNICITY SERVED AT CCA HEALTH CENTERS (FY17 68,682; FY18: 71,045)COMMUNITY PARTNERS: CCA HEALTH CENTERSGOAL: PROMOTE GREATER HEALTH EQUITY AND REDUCE DISPARITIES IN ACCESS FOR LGBT POPULATIONSTARGET POPULATION: LGBT POPULATIONPROGRAMMATIC OBJECTIVES:5.1 REDUCE DISPARITIES5.2 PROMOTE HEALTH EQUITY COMMUNITY ACTIVITIES/STRATEGIES:- EXPLORE HOW TO BEST IMPLEMENT SEXUAL ORIENTATION/GENDER IDENTITY APPROPRIATE POLICIES AND PROCEDURES- CONTINUE JOINT RESIDENCY PROGRAM WITH FENWAY HEALTH - SUPPORT PRIDE CELEBRATION- SUPPORT EFFORTS TO ACHIEVE HEALTHCARE EQUALITY INDEX (HEI) RECOGNITION (E.G., SIGNAGE AND PATIENT SELF-IDENTIFICATION OF SEXUAL ORIENTATION)METRICS AND STATUS UPDATE:- ESTABLISH SOGI TASKFORCE- NUMBER OF LGBT PATIENTS SEEN AT FQHC CCA CLINICS (PATIENTS THAT IDENTIFY AS OTHER THAN STRAIGHT: FY17: 12,061; FY18: 13,600; PATIENTS THAT IDENTIFY AS TRANSGENDER: (FY17: 1,549; FY18: 1,916)COMMUNITY PARTNERS: CCA HEALTH CENTERS, GLAD LEGAL ADVOCATES & DEFENDERS FOR THE LGBTQ COMMUNITY, HARVARD MEDICAL SCHOOL, HEALTHCARE EQUALITY INDEX, HUMAN RIGHTS CAMPAIGN
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PRIORITY AREA 4: BEHAVIORAL HEALTH
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HIGH RATES OF SUBSTANCE USE (E.G., ALCOHOL, PRESCRIPTION DRUG/OPIOIDS, MARIJUANA) AND MENTAL HEALTH ISSUES (E.G., DEPRESSION, ANXIETY, AND STRESS). IF THE IMPACT OF SOCIAL DETERMINANTS WAS THE LEADING FINDING OF THE CHNA, A CLOSE SECOND WAS THE PROFOUND IMPACT THAT BEHAVIORAL HEALTH ISSUES (I.E., SUBSTANCE USE AND MENTAL HEALTH) ARE HAVING ON INDIVIDUALS, FAMILIES AND COMMUNITIES IN EVERY GEOGRAPHIC REGION AND EVERY POPULATION SEGMENT IN BIDMC'S CBSA. DEPRESSION/ANXIETY, SUICIDE, OPIOID AND PRESCRIPTION DRUG DEPENDENCY, AND ALCOHOL AND MARIJUANA USE, PARTICULARLY IN YOUTH, ARE MAJOR HEALTH ISSUES AND ARE HAVING A TREMENDOUS IMPACT ON THE POPULATION AS WELL AS A BURDEN ON THE SERVICE SYSTEM. THE FACT THAT PHYSICAL AND BEHAVIORAL HEALTH ARE SO INTERTWINED COMPOUNDS THE IMPACT OF THESE ISSUES. OF PARTICULAR CONCERN ARE THE INCREASING RATES OF OPIOID ABUSE IN THE COMMONWEALTH.LIMITED ACCESS TO BEHAVIORAL HEALTH SERVICES, PARTICULARLY FOR LOW INCOME, MEDICAID INSURED, UNINSURED, AND THOSE WITH COMPLEX, MULTI-FACETED ISSUES. DESPITE THE BURDEN OF MENTAL HEALTH AND SUBSTANCE USE ON ALL SEGMENTS OF THE POPULATION, THERE IS AN EXTREMELY LIMITED SERVICE SYSTEM AVAILABLE TO MEET THE NEEDS THAT EXIST FOR THOSE WITH ALL MILD TO MODERATE EPISODIC ISSUES OR THOSE WITH MORE SERIOUS AND COMPLEX, CHRONIC CONDITIONS. EFFORTS NEED TO BE MADE TO EXPAND ACCESS, REDUCE BARRIERS TO CARE (INCLUDING STIGMA), AND IMPROVE THE QUALITY OF PRIMARY CARE AND SPECIALIZED BEHAVIORAL HEALTH SERVICES.KEY: BASELINE 2017, YEAR 1 2018, YEAR 2 2019, YEAR 3 2020 GOAL: PROMOTE BEHAVIORAL HEALTH (BH)/PRIMARY CARE INTEGRATIONTARGET POPULATION: CHILDREN, YOUTH, ADULTSPROGRAMMATIC OBJECTIVES:1.1 MAINTAIN AND INCREASE THE NUMBER OF PATIENTS RECEIVING MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES IN THE PRIMARY CARE SETTING IN CCA HEALTH CENTERS1.2 MAINTAIN AND INCREASE THE NUMBER OF PATIENTS RECEIVING PRIMARY BEHAVIORAL HEALTH CARE SERVICES AT CCA HEALTH CENTERS1.3 CONDUCT PUBLIC POLICY ADVOCACYCOMMUNITY ACTIVITIES/STRATEGIES:- SUPPORT PRIMARY CARE BEHAVIORAL HEALTH INTEGRATION AT CCA HEALTH CENTERS- SUPPORT TELEPHONIC AND ONSITE PSYCHIATRIC CONSULTATION FOR PRIMARY CARE PROVIDERS SERVING THOSE WITH BH CONDITIONS- PROVIDE OB/GYN SERVICES FOR WOMEN WITH CHRONIC SUBSTANCE ABUSE ISSUES- PROVIDE CULTURALLY APPROPRIATE MENTAL HEALTH SERVICES FOR THE LATINO COMMUNITY- SUPPORT EDUCATIONAL OPPORTUNITIES ON CULTURAL PSYCHIATRY FOR SPANISH SPEAKING MENTAL HEALTH PROVIDERS- CONTINUE SBIRT IN BIDMC'S EMERGENCY DEPARTMENTMETRICS AND STATUS UPDATE:- NUMBER OF PATIENTS ACCESSING BH SERVICES IN FQHC CCA HEALTH CENTERS: (FY17: 8,658; FY18: 9,599)- NUMBER OF PCPS PARTICIPATING IN BH CONSULTATION PROGRAM AT CHARLES RIVER COMMUNITY HEALTH (FY17: 11; FY18: 13)COMMUNITY PARTNERS: CCA HEALTH CENTERSGOAL: REDUCE BURDEN OF OPIOID USETARGET POPULATION: ADULTSPROGRAMMATIC OBJECTIVES: 2.1 INCREASE THE NUMBER OF ADULTS WITH SUBSTANCE ISSUES WHO ARE APPROPRIATELY MONITORED, ASSESSED, AND TREATED IN CCA HEALTH CENTERS2.2 INCREASE THE NUMBER OF PATIENTS RECEIVING DETOX SERVICESCOMMUNITY ACTIVITIES/STRATEGIES: - SUPPORT THE DEVELOPMENT OF SUBOXONE CLINICS IN HCA AND A "BRIDGING" CLINIC FOR NON-HCA PATIENTS (2 SESSIONS EACH)- SUPPORT THE RECRUITMENT OF AN ADDICTION PSYCHIATRIST, PSYCHE-NP, LCSW, AND ADMINISTRATIVE SUPPORT PERSON TO DEVELOP A CORE ADDICTIONS COMPETENCY.- SUPPORT THE DEVELOPMENT OF A BIDMC ADDICTIONS ADVISORY GROUP - SUPPORT THE EXPANSION OF THE DIMOCK INPATIENT DETOX FACILITY METRICS AND STATUS UPDATE:- OPEN/BUILD DIMOCK'S INPATIENT DETOX PROGRAM - OPENED ON APRIL 3RD, 2018NUMBER OF ADDICTION SPECIALISTS HIRED- BIDMC'S ADDICTION TREATMENT TEAM, ESTABLISHED IN FY2017, INCLUDES ADDICTION SPECIALIZED PSYCHIATRY, NURSING, AND SOCIAL WORK. THIS TEAM FOCUSES ON THE CARE OF PATIENTS WITH SUBSTANCE USE DISORDERS IN ALL SETTINGS ACROSS THE MEDICAL CENTER. THE GOAL OF THE ADDICTION TREATMENT TEAM IS TO HELP BIDMC PHYSICIANS AND STAFF PROVIDE THE RIGHT CARE AT THE RIGHT TIME TO PATIENTS WITH SUBSTANCE USE DISORDER. THE TEAM IS COMPRISED OF:- AN PHYSICIAN ADDICTION SPECIALIST, PSYCHIATRY,- AN APN, SPECIALIST IN ADDICTIONS,- A LICSW, SPECIALIST IN ADDICTIONS, AND,- A LICSW, INPATIENT/OUTPATIENT PSYCHOTHERAPY.FORM ADDICTIONS ADVISORY GROUP- THE OPIOID CARE COMMITTEE (OCC) LED BY CHAIR BIDMC'S VICE CHAIR FOR EDUCATION, DEPARTMENT OF ANESTHESIA, CRITICAL CARE AND PAIN MEDICINE, IS A SUBCOMMITTEE OF THE MEDICAL EXECUTIVE COMMITTEE. THIS MULTIDISCIPLINARY TEAM WAS ESTABLISHED IN 2016 AS ONE OF BIDMC'S ANNUAL OPERATING PLAN GOALS TO ENSURE A COMPREHENSIVE APPROACH WHEN CONSIDERING SAFE PRESCRIBING OF OPIOIDS, TREATMENT FOR OPIOID USE DISORDERS, AND ALTERNATIVE THERAPIES FOR PAIN MANAGEMENT. THE COMMITTEE ENSURES BIDMC PROVIDERS FOLLOW ESTABLISHED BEST PRACTICES WHEN ASSESSING, PRESCRIBING, TREATING, EDUCATING, AND PROVIDING URGENT AND CONTINUED CARE FOR THE INDIVIDUAL PATIENT WITHIN THE CONTEXT OF OPIOID USE/MISUSE.ESTABLISH SUBOXONE CLINIC- HEALTHCARE ASSOCIATES OPENED OFFICE BASED OPIOID TREATMENT (OBOT) CLINIC FOR BUPRENORPHINE IN SUMMER 2017. THIS CLINIC SERVES HCA PATIENTS ONLY. - BOWDOIN STREET HEALTH CENTER ESTABLISHED OFFICE BASED OPIOID TREATMENT (OBOT) IN SUMMER 2017.- SUPPORT DIMOCK HEALTH CENTER ACUTE TREATMENT SERVICES (ATS) WHICH IS A 35-BED MEDICALLY MONITORED DETOX UNIT FOR ALCOHOL AND OPIOID USE DISORDERS LOCATED ON THE DIMOCK CENTER'S MAIN CAMPUS.ESTABLISH BRIDGING CLINIC- WITH THE OPENING OF THE NEW ADDICTION PSYCHIATRY CLINIC SPACE AND THE ADDITION OF SEVERAL STAFF MEMBERS, BIDMC'S PSYCHIATRIST/PHYSICIAN ADDICTION SPECIALIST AND HIS TEAM ARE ABLE TO OFFER EXPANDED ACCESS TO BRIDGE CLINIC SERVICES FOR PATIENTS BEGINNING TREATMENT FOR OPIOID USE DISORDER WITH MEDICATION ASSISTED THERAPY. AN ADDITIONAL BRIDGE CLINIC IS AVAILABLE WITH PROVIDERS AT HEALTH CARE ASSOCIATES.ESTABLISH DASHBOARD METRICS- THE INPATIENT OPIOID PRESCRIBING DASHBOARD IS NOW LIVE. THE METRICS INCLUDED IN THE DASHBOARD WERE DERIVED BASED ON THE RECOMMENDATIONS OF THE MASSACHUSETTS HEALTH AND HOSPITAL ASSOCIATION AND THE CONSENSUS STATEMENT BY THE SOCIETY OF HOSPITAL MEDICINE ON SAFE OPIOID USE FOR ACUTE PAIN IN HOSPITALIZED PATIENTS. INDIVIDUALS WILL BE ABLE TO COMPARE THEIR PRESCRIBING TO THAT OF PEERS IN THEIR DIVISION OR DEPARTMENT, AS WELL AS SET GOALS FOR ADHERENCE TO RECOMMENDED PRACTICES. COMMUNITY PARTNERS: CCA HEALTH CENTERSGOAL: INCREASE ACCESS TO QUALITY BEHAVIORAL HEALTH CARE SERVICES TARGET POPULATION: CHILDREN, YOUTH, ADULTS PROGRAMMATIC OBJECTIVES: 3.1 INCREASE PARTICIPATION IN LGBT SUPPORT GROUPSCOMMUNITY ACTIVITIES/STRATEGIES: - SUPPORT TRANSGENDER SUPPORT GROUPS AT BIDMC METRICS AND STATUS UPDATE:- NUMBER OF PARTICIPANTS IN TRANSGENDER SUPPORT GROUPS AT BIDMC (FY17: 13, COMPLETED)COMMUNITY PARTNERS: CCA HEALTH CENTERSGOAL: IDENTIFY THOSE AT RISK FOR BH CONDITION AND PROVIDE ENHANCED CARE MANAGEMENT - TARGET POPULATION: ADULTS PROGRAMMATIC OBJECTIVES: 4.1 SUPPORT ENHANCED CARE MANAGEMENT FOR THOSE AT RISK FOR BH CONDITIONS COMMUNITY ACTIVITIES/STRATEGIES: - CONTINUE TO PROVIDE CASE MANAGEMENT SUPPORT SERVICES FOR BSHC PATIENTS WITH COMPLEX PHYSICAL AND BEHAVIORAL HEALTH ISSUES METRICS AND STATUS UPDATE:- NUMBER OF BSHC PATIENTS PARTICIPATING IN BROOKLINE MENTAL HEALTH PARTNERSHIP PROGRAM (FY17:18; FY18: 11, COMPLETED PROGRAM ROLLED INTO MASSHEALTH ACO)COMMUNITY PARTNERS: CCA HEALTH CENTERSAS DESCRIBED IN DETAIL ABOVE IN THIS SUPPORTING NARRATIVE TO THE FORM 990 SCHEDULE H, THE MEDICAL CENTER IS DEEPLY DEDICATED TO ITS COMMUNITY BENEFITS OPERATIONS AND TO IMPROVING THE HEALTH OF ITS COMMUNITY. HOWEVER, AS NOTED IN SCHEDULE H, PART V, SECTION B, QUESTION 11, THERE WERE SOME NEEDS IDENTIFIED IN THE CHNA THAT ARE NOT INCLUDED IN THE CHIP. EXAMPLES OF IDENTIFIED NEEDS THAT WON'T BE ADDRESSED UNDER THIS CHIP ARE AFFORDABLE HOUSING AND SAFE PARKS/PLAYGROUNDS. THE MEDICAL CENTER WAS UNABLE TO ADDRESS THESE NEEDS DUE TO LIMITED FINANCIAL RESOURCES; HOWEVER, THE MEDICAL CENTER DID PARTICIPATE IN CERTAIN WORKFORCE DEVELOPMENT PROGRAMMING AS QUANTIFIED IN THIS FORM 990 SCHEDULE H PART II AND AS DETAILED IN THE NARRATIVE TO THIS SCHEDULE H PART VI. AS NOTED IN DETAIL ABOVE, THE MEDICAL CENTER'S PRIMARY TOOL FOR ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITIES SERVED IS THROUGH THE CHNA AND CHIP (SCHEDULE H PART VI QUESTION 2).
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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 FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AS WELL AS COMMUNITY BUILDING ACTIVITIES. AS DEMONSTRATED IN THIS SCHEDULE H, DURING THE PERIOD COVERED BY THIS FILING, 14.43% OF THE MEDICAL CENTER'S TOTAL EXPENSES WERE INCURRED IN PROVIDING FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. IN ADDITION AS NOTED IN THE NARRATIVE BELOW, THERE ARE ADDITIONAL ACTIVITIES AND EXPENDITURES WHICH THE MEDICAL CENTER CONSIDERS FINANCIAL ASSISTANCE AND COMMUNITY BENEFITS. UNDER THE INSTRUCTIONS TO THIS SCHEDULE H QUESTION 7 THESE ITEMS ARE NOT QUANTIFIED IN SCHEDULE H QUESTION 7, BUT IT IS WORTH NOTING THAT IF THE MEDICAL CENTER HAD INCLUDED THESE IN SCHEDULE H QUESTION 7, THE FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST WOULD BE 29.19%% FOR THE PERIOD COVERED BY THIS FILING.
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FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS - FINANCIAL
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ASSISTANCE AND MEANS TESTED GOVERNMENT PROGRAMSFINANCIAL ASSISTANCEAS 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 PAYMENTS TO AND RECEIPTS FROM THE HEALTH SAFETY NET TRUST, WAS $16,174,069 IN FISCAL YEAR ENDED SEPTEMBER 30, 2018 AND HAS BEEN REPORTED AS PART OF THE FINANCIAL ASSISTANCE AND CHARITY CARE REPORTED IN THIS SCHEDULE H, PART I, LINE 7A. 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 ACCOMPLISHMENT OF ITS PURPOSES. AS PART OF THIS RELATIONSHIP, HMFP PATIENTS WHO MEET THE MEDICAL CENTER'S FREE CARE CRITERIA 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 NET FREE CARE TO PATIENTS IN THE AMOUNT OF $1,566,619. 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, 21.4% OR 254,330 OF THE MEDICAL CENTER'S PATIENT CASES WERE WITH MEDICAID PATIENTS. THIS TRANSLATES TO $179,164,926 IN MEDICAID REVENUE WHICH WAS LESS THAN THE COST OF CARE PROVIDED BY THE MEDICAL CENTER FOR SUCH SERVICES BY $35,778,658, AS REPORTED ON THIS SCHEDULE H, PART I, LINE 7B. 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, 29.3% OR 348,544 OF THE MEDICAL CENTER'S PATIENT ENCOUNTERS WERE WITH MEDICARE PATIENTS. THIS TRANSLATED TO MEDICARE REVENUE OF $401,739,417. 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 $33,492,068. OF THIS AMOUNT, $8,027,045 IS INCLUDED IN FORM 990 SCHEDULE H PART I, LINE 7G AND RELATED TO THE PROVISION OF SUBSIDIZED HEALTH SERVICES FOR INPATIENT PSYCHIATRIC PATIENTS, THE MEDICAL CENTER'S BOWDOIN STREET COMMUNITY HEALTH CENTER, THE MEDICAL CENTER'S PROVISION OF OUTPATIENT AMBULATORY CARE AND CERTAIN PRIMARY CARE VISITS THROUGH BIDMC'S ONSITE PRIMARY CARE OFFICES AND $25,465,023 OF WHICH IS REPORTED IN THIS FORM 990 SCHEDULE H PART III LINE 7. IN RESPONSE TO THE FORM 990, SCHEDULE H, PART III, LINE 8, ALTHOUGH THE MEDICAL CENTER CONSIDERS THE PROVISION OF CLINICAL CARE TO ALL MEDICARE PATIENTS AS PART OF ITS COMMUNITY BENEFIT, THE ADDITIONAL MEDICARE SHORTFALL OF $25,465,023 IS NOT QUANTIFIED ON PAGE 1 OF THE SCHEDULE H. INSTEAD, PER THE IRS INSTRUCTIONS TO SCHEDULE H, THE MEDICAL CENTER HAS SEPARATELY REPORTED THIS AMOUNT IN SCHEDULE H, PART III, LINE 7, 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 $20,510,577 DURING THE FISCAL PERIOD COVERED BY THIS FILING AS REPORTED IN THE FINANCIAL STATEMENTS AND IN THIS FORM 990 SCHEDULE H, PART III, SECTION A, LINE 2 AS REQUIRED.THE PERCENTAGES CALCULATED IN PART I, LINE 7, COLUMN F WERE BASED ON EACH ITEM OF FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT AT COST AS A PERCENTAGE OF TOTAL EXPENSES REPORTED IN PART IX OF THIS FORM 990. AS REQUIRED BY THIS FORM 990, SCHEDULE H, PART III, LINE 4, BELOW ARE THE BAD DEBT AND ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTES FROM THE MEDICAL CENTER'S AUDITED FINANCIAL STATEMENTS. AS PREVIOUSLY NOTED IN THIS FORM 990, THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF THE MEDICAL CENTER AND AFFILIATES FOR FISCAL YEAR ENDED SEPTEMBER 30, 2018 INCLUDE THE ACCOUNTS OF THE MEDICAL CENTER AND ITS AFFILIATES, (MEDICAL CARE OF BOSTON MANAGEMENT CORPORATION, D/B/A BETH ISRAEL DEACONESS HEALTHCARE A/K/A AFFILIATED PHYSICIANS GROUP (APG)), BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, INC. (BID-NEEDHAM), BETH ISRAEL DEACONESS HOSPITAL MILTON, INC. (BID-MILTON), BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC. (BID-PLYMOUTH), AND HARVARD MEDICAL FACULTY PHYSICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER, INC. (HMFP), THE DEDICATED PHYSICIAN PRACTICE OF THE MEDICAL CENTER AND AN ENTITY INTEGRALLY RELATED TO HELPING THE MEDICAL CENTER ACCOMPLISH ITS CHARITABLE PURPOSES, AS WELL AS ALL ENTITIES FOR WHICH THESE ENTITIES SERVE AS MEMBER. THE MEDICAL CENTER'S FORM 990 IS PREPARED FOR THE MEDICAL CENTER ONLY AND AS SUCH, THE METRICS INCLUDED IN THESE FOOTNOTES WILL NOT TIE TO THE FACE OF THE MEDICAL CENTER'S FORM 990, SCHEDULE H.
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FINANCIAL STATEMENT FOOTNOTES:
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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 DEBTS ARE INCLUDED AS A COMPONENT OF NET PATIENT SERVICE REVENUE IN THE CONSOLIDATED FINANCIAL STATEMENTS, AND INCLUDE THE PROVISION FOR ACCOUNTS ANTICIPATED TO BE UNCOLLECTIBLE. THE ESTIMATED COST OF PROVIDING SUCH SERVICES WAS $20,111,000 AND $16,928,000 IN 2018 AND 2017, RESPECTIVELY. PATIENT ACCOUNTS RECEIVABLE AND RELATED ALLOWANCE FOR DOUBTFUL ACCOUNTSPATIENT ACCOUNTS RECEIVABLE ARE REFLECTED NET OF AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES ITS PAST COLLECTION HISTORY, BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN GOVERNMENTAL AND EMPLOYEE HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS FOR EACH OF ITS MAJOR CATEGORIES OF REVENUE BY PAYOR TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR CATEGORIES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THROUGHOUT THE YEAR, THE MEDICAL CENTER, AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED, WILL WRITE OFF PATIENTS' UNMET OR UNCOLLECTED RESPONSIBILITY AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN ADDITION TO THE REVIEW OF THE CATEGORIES OF REVENUE, MANAGEMENT MONITORS THE WRITE OFFS AGAINST ESTABLISHED ALLOWANCES TO DETERMINE THE APPROPRIATENESS OF THE UNDERLYING ASSUMPTIONS USED IN ESTIMATING THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE MEDICAL CENTER'S METHODOLOGY FOR VALUING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE REMAINED SUBSTANTIALLY CONSISTENT IN 2017 AND 2016. THE MEDICAL CENTER'S ALLOWANCE FOR DOUBTFUL ACCOUNTS REPRESENTED APPROXIMATELY 8.8% AND 9.3% OF PATIENT ACCOUNTS RECEIVABLE, NET OF CONTRACTUAL ALLOWANCES IN 2018 AND 2017, RESPECTIVELY.COMMUNITY BENEFITS -- EMERGENCY CARE ACCESSAS NOTED IN THIS SCHEDULE H, PART V, SECTION A AND SECTION B QUESTION 21, THE MEDICAL CENTER IS A TERTIARY CARE LICENSED ACADEMIC MEDICAL CENTER, PROVIDING MEDICAL AND SURGICAL CARE, TEACHING AND RESEARCH AND AS NOTED ELSEWHERE IN THIS RETURN, PROVIDES 24 HOUR EMERGENCY MEDICAL CARE TO ALL PATIENTS WITHOUT REGARD TO ABILITY TO PAY. FINANCIAL ASSISTANCE POLICY INTERNAL REVENUE CODE SECTION 501(R)(4)FINANCIAL ASSISTANCE POLICY PURPOSE BIDMC'S MISSION IS TO DISTINGUISH ITSELF FROM OTHER PROVIDERS THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, RESEARCH AND THROUGH IMPROVED HEALTH IN THE COMMUNITIES SERVED.BIDMC IS DEDICATED TO PROVIDING FINANCIAL ASSISTANCE TO PATIENTS WHO HAVE HEALTH CARE NEEDS AND ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR A GOVERNMENT PROGRAM OR OTHERWISE UNABLE TO PAY FOR MEDICALLY NECESSARY CARE BASED ON THEIR INDIVIDUAL FINANCIAL SITUATION. THE BIDMC FINANCIAL ASSISTANCE POLICY IS INTENDED TO BE IN COMPLIANCE WITH APPLICABLE FEDERAL AND STATE LAWS FOR OUR SERVICE AREA. PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE RECEIVE DISCOUNTED CARE FROM QUALIFYING BIDMC PROVIDERS.BIDMC DOES NOT DISCRIMINATE BASED ON THE PATIENT'S AGE, GENDER, RACE, CREED, RELIGION, DISABILITY, SEXUAL ORIENTATION, GENDER IDENTITY, NATIONAL ORIGIN OR IMMIGRATION STATUS WHEN DETERMINING ELIGIBILITY.FINANCIAL ASSISTANCE POLICY, CREDIT AND COLLECTION POLICY AND EMERGENCY CARE POLICYAS REQUIRED BY IRC SECTION 501(R)(4) AND THE REGULATIONS PROMULGATED THEREUNDER, THE HOSPITAL MAINTAINS A WRITTEN FINANCIAL ASSISTANCE POLICY (FAP) WHICH APPLIES TO ALL EMERGENCY AND OTHER MEDICALLY NECESSARY CARE PROVIDED BY THE HOSPITAL FACILITY. (SCHEDULE H PART I QUESTIONS 1A AND 1B). DETAIL RELATED TO EMERGENCY AND OTHER MEDICALLY NECESSARY CARE COVERED BY THE POLICY IS INCLUDED WITHIN THE POLICY AND THE DEFINITION OF EMERGENCY CARE MEETS THE DEFINITION OF THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA), SECTION 1867 OF THE SOCIAL SECURITY ACT (42 USC 1395DD). (SCHEDULE H PART V SECTION B QUESTION 21). THE FAP INCLUDES A LIST OF PROVIDERS OTHER THAN THE HOSPITAL ITSELF, WHICH ARE COVERED BY THE FAP AND SPECIFIES ELIGIBILITY CRITERIA FOR BOTH FREE AND DISCOUNTED CARE. THE FAP ALSO INCLUDES THE BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS. THE HOSPITAL MAINTAINS A SEPARATE CREDIT AND COLLECTION POLICY AS PERMITTED UNDER THE TREASURY REGULATIONS AND THIS CREDIT AND COLLECTION POLICY IS REFERENCED WITHIN THE FAP AS REQUIRED, ALONG WITH INFORMATION ON HOW TO OBTAIN A FREE COPY OF THE CREDIT AND COLLECTION POLICY.(SCHEDULE H PART III SECTION C QUESTIONS 9A AND 9B AND PART V SECTION B QUESTION 17). THE HOSPITAL'S FAP AND CREDIT & COLLECTION POLICY WERE ADOPTED BY THE HOSPITAL'S BOARD PRIOR TO SEPTEMBER 30, 2017 AND THESE DOCUMENTS WERE ALL EFFECTIVE AS OF OCTOBER 1, 2017, THE FIRST DAY OF THE HOSPITAL'S FISCAL YEAR IN WHICH THE HOSPITAL WAS REQUIRED TO BE IN COMPLIANCE WITH THE REGULATIONS PROMULGATED BY THE TREASURY AND RELATED TO IRC SECTION 501(R). FINANCIAL ASSISTANCE POLICY APPLYING FOR ASSISTANCE THE HOSPITAL'S FAP INCLUDES INFORMATION ON THE METHOD FOR APPLYING FOR FINANCIAL ASSISTANCE UNDER THE FAP. IN ADDITION, THE HOSPITAL'S FINANCIAL ASSISTANCE APPLICATION INCLUDES A LIST OF INFORMATION/DOCUMENTATION REQUIRED AS PART OF A PATIENT'S APPLICATION FOR FINANCIAL ASSISTANCE. (SCHEDULE H PART V SECTION B QUESTION 15)FINANCIAL ASSISTANCE POLICY ELIGIBILITY GUIDELINES THE HOSPITAL'S FAP USES THE FEDERAL POVERTY GUIDELINES IN DETERMINING ELIGIBILITY FOR FREE AND DISCOUNTED CARE. (SCHEDULE H PART I QUESTION 3A AND 3B AND PART V SECTION B QUESTION 13). IN ADDITION, THE HOSPITAL'S FAP PROVIDES FOR FINANCIAL ASSISTANCE BASED ON MEDICAL HARDSHIP AND ASSET LEVEL (SCHEDULE H PART I QUESTIONS 3C AND 4, PART V SECTION B QUESTION 13 AND PART VI QUESTION 3). FINALLY, THE HOSPITAL UNDERSTANDS THAT NOT ALL PATIENTS ARE ABLE TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION OR COMPLY WITH REQUESTS FOR DOCUMENTATION. THERE MAY BE INSTANCES UNDER WHICH A PATIENT/GUARANTOR'S QUALIFICATION FOR FINANCIAL ASSISTANCE IS ESTABLISHED WITHOUT COMPLETING THE APPLICATION FORM. OTHER INFORMATION MAY BE USED BY THE HOSPITAL TO DETERMINE WHETHER A PATIENT/GUARANTOR'S ACCOUNT IS UNCOLLECTIBLE AND THIS INFORMATION WILL BE USED TO DETERMINE PRESUMPTIVE ELIGIBILITY AS OUTLINED IN THE HOSPITAL'S FAP. (SCHEDULE H PART I QUESTIONS 3C).
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FINANCIAL ASSISTANCE PUBLIC ASSISTANCE PROGRAMS (SCHEDULE H PART I
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QUESTION 3C)IN ADDITION TO FINANCIAL ASSISTANCE ELIGIBILITY UNDER THE HOSPITAL'S FAP, FOR THOSE INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED, THE HOSPITAL WILL WORK WITH PATIENTS TO ASSIST THEM IN APPLYING FOR PUBLIC ASSISTANCE AND/OR HOSPITAL FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER SOME OR ALL OF THEIR UNPAID HOSPITAL BILLS. IN ORDER TO HELP UNINSURED AND UNDERINSURED INDIVIDUALS FIND AVAILABLE AND APPROPRIATE OPTIONS, THE HOSPITAL WILL PROVIDE ALL INDIVIDUALS WITH A GENERAL NOTICE OF THE AVAILABILITY OF PUBLIC ASSISTANCE AND FINANCIAL ASSISTANCE PROGRAMS DURING THE PATIENT'S INITIAL IN PERSON REGISTRATION AT A HOSPITAL LOCATION FOR A SERVICE, IN ALL BILLING INVOICES THAT ARE SENT TO A PATIENT OR GUARANTOR, AND WHEN THE PROVIDER IS NOTIFIED OR THROUGH ITS OWN DUE DILIGENCE BECOMES AWARE OF A CHANGE IN THE PATIENT'S ELIGIBILITY STATUS FOR PUBLIC OR PRIVATE INSURANCE COVERAGE.HOSPITAL PATIENTS MAY BE ELIGIBLE FOR FREE OR REDUCED COST OF HEALTH CARE SERVICES THROUGH VARIOUS STATE PUBLIC ASSISTANCE PROGRAMS AS WELL AS THE HOSPITAL FINANCIAL ASSISTANCE PROGRAMS (INCLUDING BUT NOT LIMITED TO MASSHEALTH, THE PREMIUM ASSISTANCE PAYMENT PROGRAM OPERATED BY THE HEALTH CONNECTOR, THE CHILDREN'S MEDICAL SECURITY PROGRAM, THE HEALTH SAFETY NET, AND MEDICAL HARDSHIP). SUCH PROGRAMS ARE INTENDED TO ASSIST LOW-INCOME PATIENTS TAKING INTO ACCOUNT EACH INDIVIDUAL'S ABILITY TO CONTRIBUTE TO THE COST OF HIS OR HER CARE. FOR THOSE INDIVIDUALS THAT ARE UNINSURED OR UNDERINSURED, THE HOSPITAL WILL, WHEN REQUESTED, HELP THEM WITH APPLYING FOR EITHER COVERAGE THROUGH PUBLIC ASSISTANCE PROGRAMS OR HOSPITAL FINANCIAL ASSISTANCE PROGRAMS THAT MAY COVER ALL OR SOME OF THEIR UNPAID HOSPITAL BILLS.THE HOSPITAL IS AVAILABLE TO ASSIST PATIENTS IN ENROLLING INTO STATE HEALTH COVERAGE PROGRAMS. THESE INCLUDE MASSHEALTH, THE PREMIUM ASSISTANCE PAYMENT PROGRAM OPERATED BY THE STATE'S HEALTH CONNECTOR, AND THE CHILDREN'S MEDICAL SECURITY PLAN. FOR THESE PROGRAMS, APPLICANTS CAN SUBMIT AN APPLICATION THROUGH AN ONLINE WEBSITE (WHICH IS CENTRALLY LOCATED ON THE STATE'S HEALTH CONNECTOR WEBSITE), A PAPER APPLICATION, OR OVER THE PHONE WITH A CUSTOMER SERVICE REPRESENTATIVE LOCATED AT EITHER MASSHEALTH OR THE CONNECTOR. INDIVIDUALS MAY ALSO ASK FOR ASSISTANCE FROM HOSPITAL FINANCIAL COUNSELORS (ALSO CALLED CERTIFIED APPLICATION COUNSELORS) WITH SUBMITTING THE APPLICATION EITHER ON THE WEBSITE OR THROUGH A PAPER APPLICATION.FINANCIAL ASSISTANCE POLICY TRANSLATIONS THE HOSPITAL'S FAP, CREDIT AND COLLECTION POLICY AND PLAIN LANGUAGE SUMMARY OF THE FAP (SEE DETAIL BELOW) HAVE ALL BEEN TRANSLATED INTO THE LANGUAGES SPOKEN BY THOSE WHO MAY COMMUNICATE IN A LANGUAGE OTHER THAN ENGLISH. THE HOSPITAL HAS TRANSLATED THESE DOCUMENTS INTO THE FOLLOWING LANGUAGES: SPANISH, SIMPLIFIED CHINESE, TRADITIONAL CHINESE, RUSSIAN, PORTUGUESE AND VIETNAMESE. (SCHEDULE H PART V SECTION B QUESTION 16I)FINANCIAL ASSISTANCE POLICY WIDELY PUBLICIZING AND AVAILABILITYCOPIES OF THE FAP, CREDIT AND COLLECTION POLICY, FAP SUMMARY AND APPLICATION FOR FINANCIAL ASSISTANCE ARE ALL AVAILABLE IN BOTH ENGLISH AND ALL LEP LANGUAGES AT THE HOSPITAL OR BY MAIL FREE OF CHARGE AND ON THE HOSPITAL'S WEBSITE AT (SCHEDULE H PART V SECTION B QUESTIONS 16A, 16B, 16C, 16D, 16E, 16H):HTTPS://WWW.BIDMC.ORG/PATIENT-AND-VISITOR-INFORMATION/PATIENT-INFORMATION/YOUR-HOSPITAL-BILL/FINANCIAL-ASSISTANCE. IN ADDITION, THE FAP, CREDIT AND COLLECTION POLICY, FAP SUMMARY AND APPLICATION FOR FINANCIAL ASSISTANCE ARE ALL AVAILABLE IN THE HOSPITAL'S EMERGENCY DEPARTMENT AND FINANCIAL COUNSELING OFFICE. (SCHEDULE H PART V SECTION B QUESTION 16F AND SCHEDULE H PART VI QUESTION 3).THE HOSPITAL MAINTAINS SIGNAGE AND CONSPICUOUS PUBLIC DISPLAYS ABOUT FINANCIAL ASSISTANCE AND THE FAP DESIGNED TO ATTRACT THE ATTENTION OF PATIENTS AND VISITORS, INCLUDING BOTH THE EMERGENCY DEPARTMENT AND ADMISSIONS. SUCH SIGNAGE IS POSTED BOTH IN ENGLISH AND THE LEP LANGUAGES NOTED ABOVE. IN ADDITION, FINANCIAL COUNSELING PERSONNEL ROUTINELY VISIT LOCATIONS DESIGNATED FOR SIGNAGE TO ENSURE THAT SUCH SIGNAGE REMAINS VISIBLE TO PATIENTS AND VISITORS AS ATTENDED. THE HOSPITAL PROVIDES INFORMATION ABOUT THE FAP TO PATIENTS BEFORE DISCHARGE AND CONSPICUOUSLY WITHIN BILLING STATEMENTS. INFORMATION PROVIDED TO PATIENTS IN THESE COMMUNICATIONS INCLUDE CONTACT INFORMATION FOR THOSE THAT CAN HELP PROVIDE ADDITIONAL INFORMATION ABOUT THE FAP, INFORMATION ON THE APPLICATION PROCESS AND THE WEBSITE WHERE THE FAP CAN BE OBTAINED. ADDITIONALLY, A PLAIN LANGUAGE SUMMARY OF THE FAP IS PROVIDED TO PATIENTS AS PART OF THE INTAKE PROCESS. (SCHEDULE H PART V SECTION B QUESTION 16G). FINANCIAL ASSISTANCE POLICY PLAIN LANGUAGE SUMMARYAS NOTED IN THIS NARRATIVE SUPPORT TO THIS FORM 990 SCHEDULE H, THE HOSPITAL HAS A PLAIN LANGUAGE SUMMARY OF ITS FAP. THIS IS A WRITTEN STATEMENT DESIGNED TO NOTIFY PATIENTS AND VISITORS THAT THE HOSPITAL HAS A WRITTEN FAP AND PROVIDES FINANCIAL ASSISTANCE. THIS PLAIN LANGUAGE SUMMARY INCLUDES INFORMATION ON FREE AND DISCOUNTED CARE, HOW TO OBTAIN A COPY OF THE FAP POLICY AND APPLICATION, THE LOCATION (INCLUDING THE BUILDING AND ROOM NUMBER) AND PHONE NUMBER OF THE FINANCIAL COUNSELING OFFICE. THE PLAIN LANGUAGE SUMMARY ALSO INCLUDES THE LIST OF LANGUAGES INTO WHICH THE FAP AND SUMMARY HAVE BEEN TRANSLATED AS WELL AS HOW TO ACCESS INFORMATION ON PROVIDERS NOT COVERED BY THE FAP AND TO WHICH OTHER RELATED HOSPITALS APPROVAL UNDER THE FAP WILL APPLY. LIMITATION ON CHARGES INTERNAL REVENUE CODE SECTION 501(R)(5)LIMITATION ON CHARGESAS REQUIRED BY IRC SECTION 501(R)(5) AND THE REGULATIONS PROMULGATED THEREUNDER, THE HOSPITAL LIMITS THE AMOUNTS CHARGED FOR ANY EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IT PROVIDES TO A FINANCIAL ASSISTANCE ELIGIBLE PATIENT, TO NOT MORE THAN AMOUNTS GENERALLY BILLED (AGB) AND LIMITS THE AMOUNTS CHARGED TO ANY FINANCIAL ASSISTANCE ELIGIBLE PATIENT FOR ALL OTHER MEDICAL CARE TO LESS THAN GROSS CHARGES. AMOUNTS GENERALLY BILLED - LOOK BACK METHODTHE HOSPITAL CALCULATES ITS AGB, USING THE LOOK BACK METHOD, DIVIDING THE TOTAL PAYMENTS RECEIVED FROM ALL COMMERCIAL PLANS AND MEDICARE BY THE TOTAL CHARGES SENT TO THOSE SAME PAYERS FOR THE PREVIOUS FISCAL YEAR. (SCHEDULE H PART V SECTION B QUESTION 22). PATIENT REFUNDS FOR CHARGES IN EXCESS OF AMOUNTS GENERALLY BILLEDTHE HOSPITAL REGULARLY MONITORS THE FINANCIAL ACCOUNTS OF FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. WHERE A PATIENT SUBMITS A COMPLETED APPLICATION FOR FINANCIAL ASSISTANCE AND IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, THE HOSPITAL REFUNDS ANY AMOUNTS PREVIOUSLY PAID FOR CARE THAN EXCEEDS THE AMOUNT THAT THE PATIENT IS PERSONALLY RESPONSIBLE FOR PAYING WHERE SUCH AMOUNTS ARE EQUAL TO OR EXCEED $5.00. BILLING AND COLLECTIONS -- 501(R)(6)EXTRAORDINARY COLLECTION ACTIVITIESTHE HOSPITAL DOES NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIVITIES (ECAS) FOR FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. SPECIFICALLY, THE HOSPITAL DOES NOT REPORT TO CREDIT AGENCIES, ENGAGE IN LEGAL OR JUDICIAL PROCESSES OR SELL A PATIENT'S OUTSTANDING AMOUNTS OWED FOR PATIENT CARE. N ADDITION, THIS EXTENDS TO ANY THIRD PARTY CONTRACTED WITH THE HOSPITAL RELATED TO BILLING AND COLLECTIONS. (SCHEDULE H PART V SECTION B QUESTIONS 18 AND 19).APPLICATION PERIOD PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE AT ANY TIME UP TO TWO HUNDRED FORTY (240) DAYS AFTER THE FIRST POST-DISCHARGE BILLING STATEMENT IS AVAILABLE.
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IRC 501(R) REPORTING UNDER REVENUE PROCEDURE 2015-21
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DURING A REVIEW OF THE MEDICAL CENTER'S SECTION 501(R) COMPLIANCE IN FY18, IT WAS DETERMINED THAT CERTAIN INFORMATION IN THE MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY (FAP), PLAIN LANGUAGE SUMMARY (PLS) AND CREDIT AND COLLECTIONS POLICY (CCP) REQUIRED CLARIFICATION OR CORRECTION. IN ACCORDANCE WITH THE PROCEDURES SET FORTH IN REVENUE PROCEDURE 2015-21, EACH OF THOSE ITEMS IS LISTED ALONG WITH THE METHOD OF CORRECTION. CORRECTION OCCURRED BY ADOPTION OF A REVISED FAP, PLS AND CCP BY THE MEDICAL CENTER'S AUTHORIZED BODY PRIOR TO FILING THIS RETURN. (1) WHILE THE FAP SPECIFIED THE PERCENTAGE OF DISCOUNTS AVAILABLE, IT DID NOT SPECIFICALLY REFER TO WHAT CHARGES THOSE DISCOUNTS WOULD BE APPLIED. THE FAP HAS BEEN REVISED TO CLARIFY THAT THE DISCOUNTS ARE APPLIED TO PATIENT GROSS CHARGES. (2) THE FAP DID NOT SPECIFY THE AMOUNTS GENERALLY BILLED (AGB) BY THE MEDICAL CENTER OR SPECIFY THE METHODOLOGY FOR CALCULATING THE AGB. THE FAP HAS BEEN REVISED TO INCLUDE THIS INFORMATION. (3) THE LIST OF PROVIDERS OF EMERGENCY AND MEDICALLY NECESSARY CARE AT THE MEDICAL CENTER DID NOT INCLUDE ALL PROVIDERS. THE LIST HAS BEEN UPDATED AND NOW REFLECTS ALL PROVIDERS. (4) THE PLS DID NOT INCLUDE THE DIRECT WEBSITE ADDRESS WHERE THE FAP AND FAP APPLICATION COULD BE OBTAINED. THE PLS HAS BEEN UPDATED ACCORDINGLY. (5) THE MEDICAL CENTER HAD NOT YET MADE EFFORTS TO INFORM MEMBERS OF THE COMMUNITY SERVED BY THE MEDICAL CENTER ABOUT THE FAP IN A MANNER REASONABLY CALCULATED TO REACH THOSE MEMBERS WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. THE MEDICAL CENTER HAS SINCE MADE SUCH EFFORTS, INCLUDING BY DISTRIBUTING COPIES OF ITS FAP AND FAP APPLICATION TO REFERRING STAFF PHYSICIANS AND TO COMMUNITY HEALTH CENTERS SERVING THE MEDICAL CENTER'S COMMUNITY. (6) WHILE THE MEDICAL CENTER HAD TRANSLATED ITS FAP, FAP APPLICATION AND PLS INTO SEVERAL LANGUAGES, IT HAD NOT YET TRANSLATED THOSE DOCUMENTS INTO ALL LANGUAGES SPOKEN BY LIMITED ENGLISH PROFICIENCY POPULATIONS IN THE MEDICAL CENTER'S COMMUNITY. SUCH TRANSLATIONS HAVE NOW BEEN MADE. (7) THE FAP SPECIFIED THAT FAP-ELIGIBLE PATIENTS WOULD RECEIVE REFUNDS FOR ANY AMOUNTS PAID IN EXCESS OF THE AGB. THIS LANGUAGE HAS BEEN REVISED TO CLARIFY THAT SUCH PATIENTS WILL RECEIVE REFUNDS FOR ANY AMOUNTS PAID IN EXCESS OF THEIR FAP DISCOUNTS. (8) THE CCP DID NOT INCLUDE A DESCRIPTION OF THE OFFICE, DEPARTMENT OR COMMITTEE WITH FINAL AUTHORITY FOR DETERMINING THAT THE MEDICAL CENTER HAS MADE REASONABLE EFFORTS TO DETERMINE FAP-ELIGIBILITY PRIOR TO ENGAGING IN ANY EXTRAORDINARY COLLECTION ACTIONS. THE CCP HAS BEEN REVISED TO INCLUDE SUCH A DESCRIPTION. (9) WHILE THE MEDICAL CENTER HAS HAD A LONGSTANDING EMERGENCY MEDICAL CARE POLICY IN PLACE THE POLICY HAD NOT BEEN ADOPTED BY AN AUTHORIZED BODY. THE MEDICAL CENTER HAS NOW INCLUDED LANGUAGE IN ITS FAP, ADOPTED BY AN AUTHORIZED BODY, REQUIRING THE MEDICAL CENTER TO PROVIDE, WITHOUT DISCRIMINATION, CARE FOR EMERGENCY MEDICAL CONDITIONS TO INDIVIDUALS REGARDLESS OF WHETHER THEY ARE FAP-ELIGIBLE. (10) THE MEDICAL CENTER HAD NOT BEEN INCLUDING WITH BILLS TO PATIENTS OFFERED DISCOUNTED BUT NOT FREE CARE AN EXPLANATION OF HOW THE PATIENT'S DISCOUNT HAD BEEN DETERMINED. THAT INFORMATION IS NOW INCLUDED WITH PATIENT BILLS. FINALLY, THE MEDICAL CENTER HAS ADOPTED PROCEDURES THAT REQUIRE THE MEDICAL CENTER TO REVIEW, ON A REGULAR BASIS, THE MEDICAL CENTER'S POLICIES AND PROCEDURE TO ENSURE COMPLIANCE WITH THE REQUIREMENTS OF SECTION 501(R) AND THE REGULATIONS ISSUED THEREUNDER. THOSE PROCEDURES INCLUDE REVIEWING A SECTION 501(R) COMPLIANCE CHECKLIST.FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS COMMUNITY HEALTH IMPROVEMENT SERVICES AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPSCOMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY HEALTH IMPLEMENTATION PLANDETAIL RELATED TO THE MEDICAL CENTER'S COMMUNITY HEALTH NEEDS ASSESSMENT, IMPLEMENTATION STRATEGY AND COMMUNITY BENEFITS ACTIVITIES HAS BEEN PROVIDED IN FORM 990, SCHEDULE H, PART V, SECTION C ABOVE.COMMUNITY BENEFITS ANNUAL COMMUNITY BENEFITS REPORTAS PREVIOUSLY NOTED IN THIS FILING, MEDICAL CENTER'S MOST RECENT CHNA AND CHIP WERE COMPLETED AND APPROVED BY THE COMMUNITY BENEFITS COMMITTEE AND BOARD OF DIRECTORS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2016 AS REQUIRED PURSUANT TO THE REGULATIONS UNDER INTERNAL REVENUE CODE SECTION 501(R). IN ADDITION, AS NOTED IN THIS FORM 990 SCHEDULE H, PART I, LINES 6A AND 6B, THE MEDICAL CENTER PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT WHICH IS SUBMITTED TO THE MASSACHUSETTS ATTORNEY GENERAL (SCHEDULE H, PART VI, LINE 7). THAT FILING IS AVAILABLE FOR PUBLIC INSPECTION AT THE ATTORNEY GENERAL'S OFFICE, ON THE ATTORNEY GENERAL'S WEBSITE, UPON REQUEST AT THE MEDICAL CENTER AND ON THE MEDICAL CENTER'S WEBSITE AT:HTTPS://WWW.BIDMC.ORG/-/MEDIA/FILES/BETH-ISRAEL-ORG/ABOUT-BIDMC/HELPING-OUR-COMMUNITY/COMMUNITY-INITIATIVES/COMMUNITY-BENEFITS/BIDMC-ATTORNEY-GENERAL-REPORTFY2018V32719.PDF?LA=EN THERE ARE SOME DIFFERENCES BETWEEN THE MASSACHUSETTS ATTORNEY GENERAL DEFINITION OF CHARITY CARE AND COMMUNITY BENEFITS AND THE INTERNAL REVENUE SERVICE DEFINITION OF FINANCIAL ASSISTANCE 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. COMMUNITY BENEFITS EMERGENCY ROOM OPERATIONIN ADDITION, AS NOTED IN THIS FORM 990, SCHEDULE H, PART V, SECTION A, THE MEDICAL CENTER IS A TERTIARY CARE LICENSED ACADEMIC MEDICAL CENTER, PROVIDING MEDICAL AND SURGICAL CARE, TEACHING AND RESEARCH AND AS NOTED ELSEWHERE IN THIS RETURN, PROVIDES 24 HOUR EMERGENCY MEDICAL CARE TO ALL PATIENTS WITHOUT REGARD TO ABILITY TO PAY. FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS RESEARCHAS PREVIOUSLY NOTED IN THIS FORM 990, PART III, PART OF THE 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.THE MEDICAL CENTER'S NOTABLE RESEARCH ACCOMPLISHMENTS INCLUDE CONSISTENTLY BEING RANKED IN THE TOP TIER OF INDEPENDENT HOSPITALS IN NATIONAL INSTITUTES OF HEALTH (NIH) FUNDING. THE MEDICAL CENTER 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 THE MEDICAL CENTER'S PATIENT CARE. DURING THE FISCAL PERIOD COVERED BY THIS FILING, MORE THAN 1,220 ACTIVE FEDERAL, INDUSTRY AND FOUNDATION SPONSORED PROJECTS AND MORE THAN 2,500 ACTIVE EXEMPT, EXPEDITED, AND FULL BOARD-REVIEWED CLINICAL RESEARCH STUDIES. BIDMC RESEARCH IS LED BY MORE THAN 280 PRINCIPAL INVESTIGATORS, THE MAJORITY OF WHOM 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, THE MEDICAL CENTER IS A TEACHING HOSPITAL OF HARVARD MEDICAL SCHOOL AND IS COMMITTED TO MAINTAINING A COLLABORATIVE CULTURE; TO MAINTAINING 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. THE MEDICAL CENTER DESIGNS AND IMPLEMENTS MANY INTERDEPARTMENTAL AND INTERDISCIPLINARY RESEARCH PROGRAMS WITHIN THE INSTITUTION. THE MEDICAL CENTER ALSO COLLABORATES WITH OTHER NATIONALLY RECOGNIZED AND WORLD RENOWNED EXPERTS IN VARIOUS FIELDS IN AN EFFORT TO TRANSLATE NEW KNOWLEDGE INTO NOVEL MEDICAL TREATMENTS AND PATIENT CARE. THE MEDICAL CENTER 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 MEDICAL CENTER 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 CLINICIANS AND PATIENTS BEYOND THE MEDICAL CENTER.
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THE MEDICAL CENTER ENGAGES IN RESEARCH IN ALL OF THE FOLLOWING DISCIPLINES:
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THE MEDICAL CENTER 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- CENTER FOR VIROLOGY AND VACCINE 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- MOLECULAR AND VASCULAR MEDICINE- NEPHROLOGY- PULMONOLOGY- RHEUMATOLOGY- SIGNAL TRANSDUCTION- TRANSLATIONAL RESEARCH- TRANSPLANT IMMUNOLOGY 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, THE MEDICAL CENTER REPORTED $77,578,478 OF NET INTERNALLY FUNDED RESEARCH ON THIS SCHEDULE H, PART I, LINE 7H RELATED TO RESEARCH TO FURTHER SCIENCE AND PATIENT CARE, WHICH REPRESENTED 4.42% OF THE MEDICAL CENTER'S TOTAL EXPENSES. ADDITIONALLY, THE MEDICAL CENTER REPORTED $219,244,237 OF RESEARCH EXPENSES FUNDED BY GOVERNMENTS AND OTHER TAX-EXEMPT ENTITIES INCLUDING OTHER HOSPITALS, UNIVERSITIES AND FOUNDATIONS ON SCHEDULE H, PART I LINE 7H COLUMN D, WHICH, IF INCLUDED IN SCHEDULE H, PART I, LINE 7H COLUMN E CALCULATION, WOULD INCREASE THE NET COMMUNITY BENEFIT REPORTED FROM RESEARCH ACTIVITIES ON THIS SCHEDULE H, PART I, LINE 7H TO 16.77%.RESEARCH ENGAGED IN AT THE MEDICAL CENTERTHE REAL CORNERSTONES OF THE MEDICAL CENTER'S SUCCESS CAN BE DESCRIBED IN THREE KEY WORDS: INNOVATION, CULTIVATION, AND TRANSFORMATION. BEGINNING WITH SUPPORT OF BOLD AND INNOVATIVE IDEAS, EXTENDING TO CULTIVATION AND NURTURING OF PROMISING YOUNG SCIENTISTS, AND CULMINATING IN THE TRANSFORMATION OF NOVEL DISCOVERIES INTO THERAPIES AND DIAGNOSTICS, THE MEDICAL CENTER'S RESEARCH PROGRAM HAS EMERGED AS A UNIQUE AND SUCCESSFUL MODEL FOR TODAY'S RAPIDLY CHANGING HEALTH CARE LANDSCAPE.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 THE MEDICAL CENTER. THE DETAIL BELOW IS DESIGNED TO PROVIDE THE READER WITH A TASTE OF THE MANY CONTRIBUTIONS THE MEDICAL CENTER IS MAKING TO PATIENT CARE TODAY AND TOMORROW. EXPENSES FROM THE RESEARCH ACTIVITIES NOTED BELOW ARE INCLUDED IN FORM 990 SCHEDULE H, PART I LINE 7H COLUMN C AND MAY OR MAY NOT BE QUANTIFIED IN FORM 990 SCHEDULE H, PART I, LINE 7H COLUMN E, DEPENDING ON FUNDING SOURCE. PERSONALIZED IMMUNOTHERAPY CANCER VACCINES IMMUNOTHERAPY ENLISTS A PATIENT'S OWN DEFENSE SYSTEM TO IDENTIFY AND SELECTIVELY ATTACK CANCER CELLS WHILE MINIMIZING TOXICITY. THE CANCER CENTER AT BIDMC'S RESEARCHER-CLINICIANS DAVID AVIGAN, MD, AND JACALYN ROSENBLATT, MD, ARE PIONEERING A PERSONALIZED CANCER VACCINE MADE BY FUSING A PATIENT'S OWN TUMOR CELLS WITH THEIR OWN IMMUNE CELLS. AFTER A SERIES OF MANIPULATIONS IN THE LAB, THE NEW HYBRID CELLS ARE REINTRODUCED TO THE PATIENT AS A POWERFUL THERAPY. THE BIDMC CANCER CENTER OPERATES ITS RANDI AND BRIAN SCHWARTZ FAMILY CANCER IMMUNOTHERAPY AND CELL MANIPULATION FACILITY, A STATE-OF-THE-ART LABORATORY THAT SERVES AS THE HOME BASE FOR THE DEVELOPMENT OF THIS UNIQUE PERSONALIZED VACCINE APPROACH. CONDUCTED UNDER THE AUSPICES OF THE NIH-SPONSORED CLINICAL TRIALS NETWORK, A MULTI-CENTER TRIAL NOW IN PROGRESS AT 17 ACADEMIC MEDICAL CENTERS IN THE UNITED STATES AND CANADA SEEKS TO TEST THE EFFECTIVENESS OF THE BIDMC-DEVELOPED VACCINE MODEL AGAINST MULTIPLE MYELOMA A COMMON BLOOD CANCER FOR WHICH THERE ARE CURRENTLY TREATMENTS BUT NO CURE. THIS FIRST-OF-ITS-KIND RESEARCH EFFORT TAKES AN OPEN-SOURCE APPROACH; IN ADDITION TO TRAINING PARTNERS FROM PARTICIPATING SITES, BETH ISRAEL DEACONESS MEDICAL CENTER SCIENTISTS PROVIDE CENTRAL OVERSIGHT, ENSURING ALL PRODUCTS ARE MADE TO A CERTAIN STANDARD. "HERE AT BIDMC, OUR TEAM HAS CONTINUALLY PUSHED THE ENVELOPE WITH GROUNDBREAKING VACCINE WORK, AND WITH THIS NEW FACILITY WE WILL BE ABLE TO PUSH HARDER AND SMARTER FOR OUR PATIENTS AS WE LEVERAGE THE INNOVATIVE WORK THAT TAKES PLACE HERE EVERY DAY," SAID PIER PAOLO PANDOLFI, MD, PHD, DIRECTOR OF THE CANCER CENTER AND CANCER RESEARCH INSTITUTE AT BIDMC. DIGITAL DATA, DEVICES AND MENTAL HEALTHJOHN TOROUS, MD, IS A STAFF PSYCHIATRIST AND DIRECTOR OF THE DIGITAL PSYCHIATRY DIVISION IN THE DEPARTMENT OF PSYCHIATRY AT BETH ISRAEL DEACONESS MEDICAL CENTER. WITH A BACKGROUND IN ELECTRICAL ENGINEERING AND COMPUTER SCIENCES, DR. TOROUS INVESTIGATES THE POTENTIAL OF MOBILE MENTAL HEALTH TECHNOLOGIES FOR PSYCHIATRY AND HAS PUBLISHED OVER 75 PEER REVIEWED ARTICLES AND FIVE BOOK CHAPTERS ON THE TOPIC. HIS RESEARCH EFFORTS INCLUDE CLINICAL STUDIES ACROSS DIVERSE MENTAL ILLNESSES SEEKING TO UNDERSTAND THE LIVED EXPERIENCES OF ILLNESS FROM THE COMBINED VANTAGE POINT OF SELF-REPORT, BEHAVIOR, AND PHYSIOLOGY GATHERED BOTH ACTIVELY AND PASSIVELY FROM SMARTPHONES, SOCIAL MEDIA AND PHYSICAL SENSORS. CONVERSELY, DR. TOROUS IS ALSO INVESTIGATING THE UNINTENDED CONSEQUENCES OF MOBILE DEVICES AND SOCIAL MEDIA ON THE MENTAL HEALTH OF SOCIETY AT LARGE. IN A RECENT PILOT STUDY, DR. TOROUS AND COLLEAGUES INVESTIGATED WHETHER DIGITAL DATA GATHERED PASSIVELY VIA SMARTPHONE COULD PREDICT FUTURE SYMPTOMS IN A COHORT OF PATIENTS WITH SCHIZOPHRENIA. THE TEAM FOUND THAT INFORMATION GLEANED FROM A PHONE'S ACCELEROMETER AND GPS WHICH PROVIDES A GLIMPSE INTO PATIENTS' MOBILITY AND ACTIVITY LEVELS AS WELL AS APP USAGE PATTERNS WERE INDEED INDICATIVE OF FUTURE SYMPTOM-RELATED SURVEY RESPONSES. THESE RESULTS SUGGEST THAT SMARTPHONE-BASED DIGITAL METADATA IS THEREFORE POTENTIALLY CLINICALLY VALUABLE.
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DETERMINING RISK FACTORS FOR OPIOID ABUSE
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CURRENT RESEARCH DEMONSTRATES THAT PATIENTS' EXPOSURE TO OPIOIDS FOLLOWING MEDICAL CARE HAS CONTRIBUTED TO THE ESTIMATED 2.1 MILLION AMERICANS REPORTED TO HAVE AN OPIOID USE DISORDER ASSOCIATED WITH PRESCRIPTION MEDICATIONS. RESEARCHERS AND CLINICIANS AT BETH ISRAEL DEACONESS MEDICAL CENTER HAVE PERFORMED THE FIRST META-ANALYSIS TO POOL THE EFFECTS OF RISK FACTORS THAT PLACE THE ESTIMATED 234 MILLION PATIENTS WHO UNDERGO MAJOR SURGERIES EACH YEAR AT AN INCREASED CHANCE OF PROLONGED OPIOID USE DEFINED AS USE FOR LONGER THAN TWO MONTHS. PUBLISHED IN THE JOURNAL OF BONE AND JOINT SURGERY, THE ANALYSIS REVEALS APPROXIMATELY FOUR PERCENT OF THE GENERAL PATIENT POPULATION WILL CONTINUE USING OPIOIDS FOR AN EXTENDED TIME PERIOD AND THAT PATIENTS IN THE WORKER'S COMPENSATION SETTING EXPERIENCED THE HIGHEST RATES OF PROLONGED OPIOID USE. THE TEAM, LED BY ARA NAZARIAN, PHD, PRINCIPAL INVESTIGATOR IN THE CENTER FOR ADVANCED ORTHOPAEDIC STUDIES AT BIDMC AND ASSOCIATE PROFESSOR OF ORTHOPAEDIC SURGERY AT HARVARD MEDICAL SCHOOL, ALSO FOUND THAT DEPRESSION, BACK PAIN AND PREVIOUS DRUG USE PUT PATIENTS AT HIGHEST RISK AFTER SURGERY OR TRAUMA AND THAT PHYSICIANS' PRESCRIBING PRACTICES CAN INFLUENCE THE INCIDENCE OF PROLONGED OPIOID USE. LONG-TERM OPIOID USE IS SIGNIFICANTLY HIGHER AMONG PATIENTS TREATED BY HIGH-INTENSITY PRESCRIBERS THAN AMONG THOSE TREATED BY LOW-INTENSITY PRESCRIBERS. BASED ON THEIR FINDINGS, THE TEAM SUGGEST THAT PROVIDING PATIENTS WITH ADEQUATE PAIN RELIEF, INVOLVING PATIENTS IN PAIN MANAGEMENT PLANNING WITH REALISTIC GOAL-SETTING AND PROVIDING THEM WITH COMPREHENSIBLE INFORMATION ABOUT THE RISKS OF OPIOID USE, TAPERING OPIOID USE PRIOR TO HOSPITAL DISCHARGE AND USING MORE UNIFORM PRESCRIBING PROTOCOLS COULD REDUCE THE OVERALL BURDEN OF LONG-TERM OPIOID USE FOLLOWING SURGERY OR TRAUMA.USING NON-INVASIVE BRAIN STIMULATION TO ALLEVIATE SYMPTOMS OF SCHIZOPHRENIAIN A FIRST-OF-ITS-KIND STUDY, RESEARCHERS AT BETH ISRAEL DEACONESS MEDICAL CENTER USED IMAGING DATA TO DETERMINE THE UNDERLYING ANATOMICAL CAUSE OF CERTAIN SYMPTOMS OF SCHIZOPHRENIA AND THEN APPLIED NON-INVASIVE BRAIN STIMULATION TO AMELIORATE THEM. AS THE SCIENTISTS REPORTED IN THE AMERICAN JOURNAL OF PSYCHIATRY, THEY FOUND THAT A SUITE OF SYMPTOMS INCLUDING AN INABILITY TO FEEL PLEASURE, A LACK OF MOTIVATION AND DIFFICULTY WITH NON-VERBAL COMMUNICATION CHRONIC AND TREATMENT-RESISTANT SYMPTOMS THAT SERIOUSLY IMPACT PATIENTS' RELATIONSHIPS, EMPLOYMENT, HOUSING AND QUALITY OF LIFE ARISE FROM A BREAKDOWN IN A NETWORK BETWEEN THE BRAIN'S PREFRONTAL CORTEX AND THE CEREBELLUM. MOREOVER, THE TEAM DEMONSTRATED THAT A NOVEL TYPE OF NON-INVASIVE BRAIN STIMULATION RESTORED THIS CRUCIAL NETWORK'S FUNCTION, WHICH IN TURN IMPROVED THIS GROUP OF SYMPTOMS IN PATIENTS WITH THE DISEASE. "THERE'S AN ENORMOUS BODY OF RESEARCH ASKING HOW PEOPLE WITH SCHIZOPHRENIA ARE DIFFERENT FROM PEOPLE WITHOUT IT, BUT THERE IS SCANT LITERATURE USING IMAGING IN PEOPLE WITH SCHIZOPHRENIA TO PIN DOWN THE BIOLOGICAL DIFFERENCES BETWEEN THOSE WHO ARE VERY SYMPTOMATIC AND THOSE WHO ARE LESS SO," SAID LEAD AUTHOR ROSCOE BRADY JR., MD, PHD, ASSISTANT PROFESSOR OF PSYCHIATRY AT BETH ISRAEL DEACONESS MEDICAL CENTER. "IF WE CAN PIN DOWN WHAT'S DIFFERENT, MAYBE WE CAN INTERVENE." "WE WANTED TO FIND OUT IF WE COULD RESTORE THAT BRAIN CIRCUIT THROUGH NON-INVASIVE BRAIN STIMULATION, AND IF WE COULD, WOULD PEOPLE GET BETTER?" SAID CORRESPONDING AUTHOR MARK HALKO, PHD, ASSISTANT PROFESSOR OF NEUROLOGY AT BETH ISRAEL DEACONESS MEDICAL CENTER'S BERENSON-ALLEN CENTER FOR NON-INVASIVE BRAIN STIMULATION. "THE ANSWER IS THEY ABSOLUTELY DO GET BETTER. IT'S A VERY PROVOCATIVE FINDING."NOVEL APPROACHES TO SUPPRESSING THERAPY-INDUCED TUMOR GROWTH IN RECENT GROUNDBREAKING STUDIES, A TEAM OF RESEARCHERS LED BY BETH ISRAEL DEACONESS MEDICAL CENTER'S DIPAK PANIGRAHY, MD, DEMONSTRATED THAT DEAD AND DYING CANCER CELLS KILLED BY CONVENTIONAL CANCER TREATMENTS PARADOXICALLY TRIGGER THE INFLAMMATION THAT PROMOTES TUMOR GROWTH AND METASTASIS. NOW, IN FOLLOW-UP STUDIES PUBLISHED IN PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCE (PNAS), DR. PANIGRAHY AND COLLEAGUES DESCRIBE NOVEL APPROACHES TO SUPPRESSING THE CHEMOTHERAPY-INDUCED TUMOR GROWTH. WORKING WITH MULTIPLE PRECLINICAL CANCER MODELS, THE TEAM DEMONSTRATED THAT ASPIRIN BOTH BLOCKS PRODUCTION OF COMPOUNDS THAT PROMOTE INFLAMMATION AND TRIGGERS THE PRODUCTION OF NATURALLY OCCURRING ANTI-INFLAMMATORY FACTORS PRODUCED BY THE HUMAN BODY CALLED RESOLVINS. IN ONE STUDY, ASPIRIN-TRIGGERED RESOLVINS INHIBITED PRIMARY TUMOR GROWTH BY ENHANCING THE IMMUNE SYSTEM'S ABILITY TO CLEAR THE BODY OF TUMOR CELL DEBRIS. WHEN THE SCIENTISTS TREATED THE TUMOR-BEARING MICE WITH ASPIRIN-TRIGGERED RESOLVINS ALONE IN THE ABSENCE OF ASPIRIN, THEY FOUND IT INHIBITED PRIMARY TUMOR GROWTH IN A VARIETY OF TUMOR TYPES AND AT LOW CONCENTRATIONS.ANOTHER OF THE TEAM'S ANALYSIS REVEALED THAT CHEMOTHERAPY-KILLED OVARIAN CANCER CELLS INDUCE SURROUNDING IMMUNE CELLS CALLED MACROPHAGES TO RELEASE A SURGE OF IMMUNE-RELATED CHEMICAL COMPOUNDS CYTOKINES AND LIPID MEDIATORS THAT CREATE OPTIMAL CONDITIONS IN WHICH TUMORS CAN SURVIVE AND GROW. NEXT, THE TEAM SHOWED THAT A COMMON ANTI-INFLAMMATORY DRUG CALLED A DUAL COX-2 INHIBITOR TO BLOCK THAT SURGE OF TUMOR-FRIENDLY CYTOKINES AND LIPIDS"CONVENTIONAL CANCER THERAPY IS A DOUBLE-EDGED SWORD THE VERY TREATMENT MEANT TO CONTROL CANCER IS ALSO HELPING IT TO SURVIVE AND GROW," SAID DR. PANIGRAHY, ASSISTANT PROFESSOR OF PATHOLOGY IN THE DEPARTMENT OF PATHOLOGY AND A SCIENTIST AT THE CANCER CENTER AT BETH ISRAEL DEACONESS MEDICAL CENTER. "TO PREVENT TUMOR RECURRENCE AFTER THERAPY, IT WILL BE CRITICAL TO NEUTRALIZE THE INHERENT TUMOR-PROMOTING ACTIVITY OF THERAPY-GENERATED DEBRIS."UNINTENDED CONSEQUENCES: STUDY FINDS HOSPITAL READMISSIONS REDUCTION PROGRAM ASSOCIATED WITH INCREASE IN PATIENT MORTALITYA POLICY DESIGNED TO REDUCE HOSPITAL READMISSIONS THROUGH FINANCIAL PENALTIES WAS ASSOCIATED WITH A SIGNIFICANT INCREASE IN POST-DISCHARGE MORTALITY FOR PATIENTS WITH HEART FAILURE AND PNEUMONIA, ACCORDING TO A LARGE-SCALE STUDY BY RESEARCHERS IN BETH ISRAEL DEACONESS MEDICAL CENTER'S SMITH CENTER FOR OUTCOMES RESEARCH IN CARDIOLOGY. THE HOSPITAL READMISSIONS REDUCTION PROGRAM (HRRP) WAS ESTABLISHED IN 2010 AS PART OF THE AFFORDABLE CARE ACT AND REQUIRED THAT, BEGINNING IN 2012, THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) IMPOSE FINANCIAL PENALTIES ON HOSPITALS WITH HIGHER-THAN-EXPECTED 30-DAY READMISSION RATES FOR PATIENTS INITIALLY HOSPITALIZED FOR THREE CONDITIONS: HEART FAILURE, HEART ATTACK AND PNEUMONIA. BUT POLICY MAKERS AND PHYSICIANS RAISED CONCERNS THAT THE HRRP MAY HAVE ALSO HAD UNINTENDED CONSEQUENCES THAT ADVERSELY AFFECTED PATIENT CARE, POTENTIALLY LEADING TO INCREASED MORTALITY."SOME POLICY MAKERS HAVE DECLARED THE HRRP A SUCCESS BECAUSE THEY BELIEVE THAT REDUCTIONS IN READMISSIONS SOLELY REFLECT IMPROVEMENTS IN QUALITY OF CARE," SAID THE STUDY'S FIRST AUTHOR RISHI WADHERA, MD, MPP, MPHIL, AN INVESTIGATOR IN THE SMITH CENTER FOR OUTCOMES RESEARCH IN CARDIOLOGY AT BETH ISRAEL DEACONESS MEDICAL CENTER. "BUT THE FINANCIAL PENALTIES IMPOSED BY HRRP MAY HAVE ALSO INADVERTENTLY PUSHED SOME PHYSICIANS TO AVOID READMITTING PATIENTS WHO NEEDED HOSPITAL CARE, OR POTENTIALLY DIVERTED HOSPITAL RESOURCES AND EFFORTS AWAY FROM OTHER QUALITY IMPROVEMENT INITIATIVES."EXAMINING MORE THAN 8 MILLION MEDICARE FEE-FOR-SERVICE HOSPITALIZATIONS FROM 2005 TO 2015, THE RESEARCHERS FOUND THAT 30-DAY POST-DISCHARGE MORTALITY AMONG PATIENTS HOSPITALIZED FOR HEART FAILURE ALREADY ON THE RISE BEFORE THE HRRP WAS IMPLEMENTED ONLY ACCELERATED AFTERWARD. THE TEAM ALSO FOUND MORTALITY RATES AMONG PATIENTS WITH PNEUMONIA, WHICH HAD BEEN STABLE PRIOR TO HRRP, BEGAN INCREASING AFTER ITS IMPLEMENTATION. FURTHER RESEARCH IS REQUIRED TO DETERMINE WHETHER THE HRRP ALONE IS RESPONSIBLE, BUT IF IT IS, THE DATA SUGGEST THAT THE POLICY MAY HAVE RESULTED IN AN ADDITIONAL 10,000 DEATHS DURING THE FIVE-YEAR PERIOD AFTER HRRP WAS IMPLEMENTED. "THIS IS AN EXAMPLE OF HOW WE CAN'T ALWAYS PREDICT THE CONSEQUENCES OF APPLYING EXTERNAL INCENTIVES TO MEDICAL CARE," SAID CO-CORRESPONDING AUTHOR ROBERT YEH, MD, MSC, DIRECTOR OF THE SMITH CENTER FOR OUTCOMES RESEARCH IN CARDIOLOGY AT BETH ISRAEL DEACONESS MEDICAL CENTER AND ASSOCIATE PROFESSOR OF MEDICINE AT HARVARD MEDICAL SCHOOL.
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MAPPING THE BRAIN'S FUNCTIONS AND DISORDERS
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NEUROSCIENTISTS LED BY MICHAEL D. FOX, MD, PHD, OF BETH ISRAEL DEACONESS MEDICAL CENTER USED DATA FROM THE HUMAN BRAIN CONNECTOME A PUBLICLY AVAILABLE "WIRING DIAGRAM" OF THE HUMAN BRAIN BASED ON DATA FROM THOUSANDS OF HEALTHY HUMAN VOLUNTEERS TO REASSESS THE FINDINGS FROM NEUROIMAGING STUDIES. DR. FOX AND COLLEAGUES HAVE PREVIOUSLY USED THE NETWORK MAPPING TECHNIQUE PIONEERED BY DR. FOX AND OTHERS TO REVEAL WHICH PARTS OF THE BRAIN ARE RESPONSIBLE FOR A NUMBER OF SYMPTOMS, CONDITIONS, BEHAVIOR AND EVEN CONSCIOUSNESS. NOW THE METHOD COULD PAVE THE WAY TO A DEEPER UNDERSTANDING OF ALZHEIMER'S AND OTHER BRAIN DISEASES. DR. FOX AND COLLEAGUES ANALYZED RESULTS FROM 26 NEUROIMAGING STUDIES OF THE BRAINS OF PATIENTS WITH ALZHEIMER'S DISEASE INVESTIGATING ABNORMALITIES IN STRUCTURE, METABOLISM OR CIRCULATION; HOWEVER, THE FINDINGS WERE SEEMINGLY INCONSISTENT. NO SINGLE BRAIN REGION CONSISTENTLY DEMONSTRATED NEUROIMAGING ABNORMALITIES IN PATIENTS WITH A COMMON DISEASE. HOWEVER, WHEN DR. FOX'S TEAM MAPPED THESE VARIOUS NEUROIMAGING ABNORMALITIES TO THE HUMAN CONNECTOME THE WIRING DIAGRAM OF THE HUMAN BRAIN A DIFFERENT PICTURE EMERGED. "IN NEUROIMAGING, A COMMON ASSUMPTION IS THAT STUDIES OF SPECIFIC DISEASES OR SYMPTOMS SHOULD ALL IMPLICATE A SPECIFIC BRAIN REGION," SAID DR. FOX, DIRECTOR OF THE LABORATORY FOR BRAIN NETWORK IMAGING AND MODULATION AT BETH ISRAEL DEACONESS MEDICAL CENTER AND AN ASSOCIATE PROFESSOR OF NEUROLOGY AT HARVARD MEDICAL SCHOOL. "HOWEVER, COGNITIVE FUNCTIONS, NEUROPSYCHIATRIC SYMPTOMS AND DISEASES MAY BETTER MAP TO BRAIN NETWORKS RATHER THAN SINGLE BRAIN REGIONS. WHEN WE APPLIED THIS APPROACH TO OUR 26 STUDIES, WE FOUND THAT 100 PERCENT OF STUDIES REPORTED NEUROIMAGING ABNORMALITIES THAT WERE PART OF THE SAME CONNECTED BRAIN NETWORK. THESE RESULTS MAY HELP RECONCILE INCONSISTENT NEUROIMAGING FINDINGS AS WELL AS IMPROVE OUR ABILITY TO LINK BRAIN SYMPTOMS OR DISEASES TO NEUROANATOMY." MORE THAN THE SUM OF ITS PARTS: NEW DRUG COMBINATIONS IN THE ERA OF ANTIBIOTIC-RESISTANT BACTERIADEVELOPMENT OF NEW CLASSES OF ANTIBIOTICS HAS SLOWED, EVEN AS BACTERIAL RESISTANCE TO EXISTING DRUGS IS ON THE RISE. NOW, BETH ISRAEL DEACONESS MEDICAL CENTER INVESTIGATORS ARE STUDYING THE POTENTIAL OF COMBINATION THERAPY, IN WHICH TWO OR MORE DRUGS ARE USED TOGETHER TO INCREASE OR RESTORE THE EFFICACY OF BOTH DRUGS AGAINST A RESISTANT BACTERIAL PATHOGEN. SENIOR AUTHOR JAMES KIRBY, MD, DIRECTOR OF THE CLINICAL MICROBIOLOGY LABORATORY AT BETH ISRAEL DEACONESS MEDICAL CENTER, AND COLLEAGUES SCREENED 19 DIFFERENT ANTIBIOTICS FOR SYNERGY WITH COLISTIN, NOW CONSIDERED A TREATMENT OF LAST RESORT.THE TEAM DISCOVERED SEVERAL COMBINATIONS WHERE SYNERGY WAS PRESENT AND INFECTIONS WITH RESISTANT PATHOGENS COULD POTENTIALLY BE TREATED WITH THE COMBINATION THERAPY. THE FINDINGS ARE ESPECIALLY PROMISING BECAUSE RECENT EVIDENCE INDICATES THE POTENTIAL FOR RAPID WORLDWIDE SPREAD OF COLISTIN RESISTANCE. "IT WAS REMARKABLE TO SEE TWO DRUGS, EACH OF WHICH IS INACTIVE ON ITS OWN AGAINST THESE BACTERIA, INHIBITING THEM IN COMBINATION," THE SCIENTISTS NOTED. "FACED WITH HIGHLY RESISTANT PATHOGENS, CLINICIANS OFTEN CURRENTLY TREAT WITH MULTIPLE ANTIBIOTICS WITHOUT KNOWING THE BENEFIT THE COMBINATIONS MAY PROVIDE," SAID DR. KIRBY. "THIS STUDY NOW PROVIDES SOME SCIENTIFIC UNDERPINNING FOR THESE CHOICES AND DIRECTION FOR FUTURE INVESTIGATION." HE ADDED THAT COMBINATION THERAPY MAY ALSO ALLOW CLINICIANS TO USE LOWER EFFECTIVE DOSES OF COLISTIN AND OTHER DRUGS, WHICH WOULD HELP AVOID TOXICITIES ASSOCIATED WITH THE MEDICATIONS AS WELL AS SLOW THE DEVELOPMENT OF ANTIBIOTIC RESISTANCE.RESEARCHERS DISCOVER SIMPLE TREATMENT FOR ACUTE KIDNEY INJURY A MULTIDISCIPLINARY RESEARCH TEAM LED BY BETH ISRAEL DEACONESS MEDICAL CENTER NEPHROLOGIST AND PRINCIPAL INVESTIGATOR SAMIR M. PARIKH, MD, HAS NOW DETERMINED THAT A FORM OF VITAMIN B3 HAS THE POTENTIAL TO PREVENT ACUTE KIDNEY INJURY, AN OFTEN FATAL CONDITION WITHOUT A SPECIFIC TREATMENT THAT AFFECTS UP TO 10 PERCENT OF ALL HOSPITALIZED ADULTS IN THE UNITED STATES. DR. PARIKH AND COLLEAGUES STUDIED THE METABOLIC CHANGES ASSOCIATED WITH ACUTE KIDNEY INJURY IN A MOUSE MODEL. A URINE SCREEN REVEALED THAT LEVELS OF NICOTINAMIDE ADENINE DINUCLEOTIDE (NAD+) THE END RESULT OF VITAMIN B3 AFTER IT IS INGESTED DECLINES IN CASES OF ACUTE KIDNEY INJURY. AFTER CONFIRMING THIS METABOLIC PATTERN IN A SUBSEQUENT STUDY OF 329 INTENSIVE CARE UNIT PATIENTS ALSO AT RISK FOR ACUTE KIDNEY INJURY, THE RESEARCHERS THEN GAVE LARGE DOSES OF ORAL VITAMIN B3 TO 41 CARDIAC SURGERY PATIENTS ENROLLED IN A PHASE 1 PILOT STUDY. "WE FOUND THAT ORAL VITAMIN B3 COULD SAFELY ELEVATE NAD+ IN HIGH-RISK PATIENTS," SAID DR. PARIKH, WHO IS ALSO AN ASSOCIATE PROFESSOR OF MEDICINE AT HARVARD MEDICAL SCHOOL. "THESE FINDINGS ARE VERY EARLY, BUT THE RESULTS SUGGEST THAT WE COULD ONE DAY HAVE A NON-INVASIVE TEST FOR NAD+ STATUS AND PERHAPS EVEN TREAT ACUTE KIDNEY INJURY BY BOOSTING NAD+ LEVELS."*MASSACHUSETTS' ICU NURSE STAFFING REGULATIONS HAD NO IMPACT ON PATIENT MORTALITY OF COMPLICATIONS IN 2014, MASSACHUSETTS LAWMAKERS PASSED A LAW REGULATING PATIENT-TO-NURSE STAFFING RATIO IN THE STATE'S INTENSIVE CARE UNITS (ICU). THE REGULATIONS WERE INTENDED TO ENSURE PATIENT SAFETY IN THE STATE'S ICUS, BUT NEW RESEARCH LED BY PHYSICIAN-RESEARCHERS AT BETH ISRAEL DEACONESS MEDICAL CENTER AND PUBLISHED IN CRITICAL CARE MEDICINE FOUND THE STAFFING REGULATIONS WERE NOT ASSOCIATED WITH IMPROVED PATIENT OUTCOMES. LEAD BY ANICA C. LAW, MD, CORE FACULTY AT THE CENTER FOR HEALTHCARE DELIVERY SCIENCE AND STAFF PHYSICIAN IN THE DIVISION OF PULMONARY, CRITICAL CARE, AND SLEEP MEDICINE AT BETH ISRAEL DEACONESS MEDICAL CENTER, RESEARCHERS EXAMINED RECORDS FROM 246 MEDICAL CENTERS NATIONWIDE, COMPARING PATIENT OUTCOMES IN MASSACHUSETTS' SIX ACADEMIC ICUS WITH OUTCOMES IN 114 OUT-OF-STATE ACADEMIC ICUS BEFORE, DURING AND AFTER THE STATE MANDATE WAS IMPLEMENTED. ANALYZING TENS OF THOUSANDS OF ICU ADMISSIONS RECORDS, DR. LAW AND COLLEAGUES FOUND THAT RISK OF MORTALITY AND RISK OF COMPLICATIONS IN MASSACHUSETTS' ICUS REMAINED STABLE AFTER THE LAW'S IMPLEMENTATION, WITH NO SIGNIFICANT DIFFERENCE IN TRENDS COMPARED TO OUT-OF-STATE HOSPITALS. "OUR RESULTS SUGGEST THAT THE MASSACHUSETTS NURSING REGULATIONS WERE NOT ASSOCIATED WITH CHANGES IN STAFFING OR PATIENT OUTCOMES," SAID DR. LAW. "THE MODEST CHANGES IN NURSE STAFFING WE SAW IN MASSACHUSETTS APPROXIMATELY ONE EXTRA NURSE PER 20-BED ICU PER 12-HOUR SHIFT REMAINED UNASSOCIATED WITH CHANGES IN HOSPITAL MORTALITY."FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS GRADUATE MEDICAL EDUCATION THE MEDICAL CENTER'S DEVOTION TO TEACHING, RESPECT FOR STUDENTS/TRAINEES AND WILLINGNESS TO EMBRACE TECHNOLOGICAL AND CLINICAL PRACTICE INNOVATION MAKE THE MEDICAL CENTER A TOP CHOICE AMONG MEDICAL STUDENTS AND HEALTH CARE PROFESSIONALS. THE MEDICAL CENTER TRAINS HUNDREDS OF MEDICAL STUDENTS, INTERNS, RESIDENTS AND FELLOWS, AS WELL AS PROFESSIONALS IN NURSING, SOCIAL WORK AND THE ALLIED HEALTH SCIENCES. THE MEDICAL CENTER HAS 55 ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) APPROVED CLINICAL RESIDENCY AND FELLOWSHIP PROGRAMS WITH 653 RESIDENTS AND CLINICAL FELLOWS. IN ADDITION, THE MEDICAL CENTER HAS 45 NONSTANDARD CLINICAL FELLOWSHIP PROGRAMS WITH 65 TRAINEES PER YEAR. STAFF PHYSICIANS AT THE MEDICAL CENTER 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 PROGRAMSTHE MEDICAL CENTER SPONSORS CORE CLINICAL TRAINING PROGRAMS IN THE FOLLOWING FIELDS:- ANESTHESIOLOGY- EMERGENCY MEDICINE- INTERNAL MEDICINE- NEUROLOGY- NEUROSURGERY- OBSTETRICS AND GYNECOLOGY- PATHOLOGY- PSYCHIATRY- RADIOLOGY- SURGERY- TRANSITIONAL YEARDURING THE FISCAL YEAR COVERED BY THIS FILING, THE MEDICAL CENTER HAD NET EXPENDITURES OF $ 74,862,985 REPORTED ON THIS SCHEDULE H, PART I, LINE 7F RELATED TO THE MEDICAL CENTER'S TEACHING FUNCTION WHICH REPRESENTED 4.26% OF THE MEDICAL CENTER'S TOTAL EXPENSES.RESIDENCY PROGRAMSTHE MEDICAL CENTER SPONSORS ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) APPROVED RESIDENCY PROGRAMS IN EACH OF THE CORE CLINICAL TRAINING PROGRAMS LISTED ABOVE.
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FELLOWSHIP PROGRAMS
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IN ADDITION TO THE RESIDENT TRAINING PROGRAMS LISTED ABOVE, THE MEDICAL CENTER SPONSORS A WIDE VARIETY OF FELLOWSHIP TRAINING PROGRAMS FOR ELIGIBLE DOCTORS WHO HAVE COMPLETED THEIR RESIDENCY AND WANT TO ENGAGE IN MORE SPECIALIZED STUDY. OVER HALF OF THESE PROGRAMS (55 OF 90) ARE ACGME APPROVED OR APPROVED BY A COMPARABLE BODY RELATED TO THE PARTICULAR SUBSPECIALTY. THE MEDICAL CENTER SPONSORS THE FOLLOWING FELLOWSHIP PROGRAMS:- ANESTHESIA: ADULT CARDIOTHORACIC ANESTHESIOLOGY, ADVANCED CLINICAL ANESTHESIA, CRITICAL CARE MEDICINE, NEUROANESTHESIA, OBSTETRIC ANESTHESIOLOGY, PAIN MEDICINE, REGIONAL ANESTHESIA, VASCULAR ANESTHESIA, PATIENT SAFETY AND QUALITY IMPROVEMENT IN ANESTHESIA- EMERGENCY MEDICINE: EMERGENCY MEDICAL SERVICES, EMERGENCY ULTRASOUND, DISASTER MEDICINE, ACADEMIC EMERGENCY MEDICINE- INTERNAL MEDICINE: ADVANCED CARDIAC NON-INVASIVE IMAGING, ADVANCED ENDOSCOPY, CARDIAC MAGNETIC RESONANCE IMAGING CARDIOVASCULAR DISEASE, CELIAC DISEASE, CLINICAL CARDIAC ELECTROPHYSIOLOGY, CLINICAL INFORMATICS, ENDOCRINOLOGY, DIABETES, AND METABOLISM, GASTROENTEROLOGY, GENERAL MEDICINE, GERIATRIC MEDICINE, GERIATRIC AND DIABETES, GI MOTILITY/FUNCTIONAL BOWEL DISORDERS, GLOBAL HEALTH, HEMATOLOGY AND ONCOLOGY, HEPATOLOGY, HOSPICE AND PALLIATIVE CARE, INFECTIOUS DISEASE, INFLAMMATORY BOWEL DISEASE, INTERVENTIONAL CARDIOLOGY, INTERVENTIONAL PULMONOLOGY, NEPHROLOGY, PULMONARY CRITICAL CARE, RHEUMATOLOGY, SLEEP MEDICINE, SLEEP RESPIRATION, STRUCTURAL HEART DISEASE, TRANSPLANT HEPATOLOGY, TRANSPLANT NEPHROLOGY- NEUROLOGY: AUTONOMIC DISORDERS, COGNITIVE BEHAVIORAL NEUROLOGY, CLINICAL NEUROPHYSIOLOGY, EPILEPSY, MOVEMENT DISORDERS, MULTIPLE SCLEROSIS, NEUROLOGY-HIV, NEUROMUSCULAR MEDICINE, NEURO-ONCOLOGY, VASCULAR NEUROLOGY- OBSTETRICS AND GYNECOLOGY: FEMALE PELVIC MEDICINE & RECONSTRUCTIVE SURGERY, MATERNAL FETAL MEDICINE, MINIMALLY INVASIVE GYNECOLOGIC SURGERY, REPRODUCTIVE ENDOCRINOLOGY- PATHOLOGY: BLOOD BANKING/TRANSFUSION MEDICINE, CYTOPATHOLOGY, DERMATOPATHOLOGY, HEMATOLOGY, MEDICAL MICROBIOLOGY, MEDICAL MICROBIOLOGY CPEP, NEUROPATHOLOGY, SELECTIVE PATHOLOGY - RADIOLOGY-DIAGNOSTIC: ABDOMINAL RADIOLOGY, BREAST IMAGING RADIOLOGY, INTERVENTIONAL RADIOLOGY-INDEPENDENT, INTERVENTIONAL RADIOLOGY-INTEGRATED MRI, MUSCULOSKELETAL IMAGING MSK, NEURORADIOLOGY, THORACIC IMAGING RADIOLOGY, VASCULAR AND INTERVENTIONAL RADIOLOGY, RADIATION ONCOLOGY- SURGERY: ABDOMINAL TRANSPLANT SURGERY/KIDNEY, COLORECTAL SURGERY, CORNEA AND REFRACTIVE SURGERY, CEREBROVASCULAR AND ENDOVASCULAR NEUROSURGERY, INTERDISCIPLINARY BREAST SURGERY, MINIMALLY INVASIVE BARIATRIC SURGERY, NEUROSURGERY/ORTHO SPINE, NEUROSURGICAL ONCOLOGY & STERIOTACTIC NEUROSURGERY, ORTHOPAEDIC HAND SURGERY, ORTHOPAEDIC SPINE SURGERY, PLASTIC HAND SURGERY, PLASTIC SURGERY/AESTHETIC RECONSTRUCTION, PODIATRY, SURGICAL CRITICAL CARE, THORACIC SURGERY, UROLOGY, UROLOGY MALE INFERTILITY/SEXUAL DYSFUNCTION, VASCULAR SURGERY, VASCULAR SURGERY-INTEGRATEDADDITIONAL INFORMATION ON CLINICAL RESIDENCY AND FELLOWSHIPS -- EXAMPLESBELOW IS MORE DETAIL ON JUST A FEW OF THE SPECIFIC GRADUATE MEDICAL EDUCATION PROGRAMS OFFERED AT THE MEDICAL CENTER:HARVARD AFFILIATED EMERGENCY MEDICINE RESIDENCY AT BIDMCTHE BETH ISRAEL DEACONESS MEDICAL CENTER HARVARD AFFILIATED EMERGENCY MEDICINE RESIDENCY IS A THREE-YEAR PROGRAM (PGY-1 TO PGY-3) IS AFFILIATED WITH HARVARD MEDICAL SCHOOL AND IS BASED AT BETH ISRAEL DEACONESS MEDICAL CENTER (BIDMC), A 57,000 VISIT PER YEAR LEVEL I TRAUMA CENTER. RESIDENTS ROTATE AT CHILDREN'S HOSPITAL BOSTON, BROCKTON HOSPITAL, CAMBRIDGE HOSPITAL, TUFTS MEDICAL CENTER, ST. VINCENT HOSPITAL, ST. LUKE'S HOSPITAL, MOUNT AUBURN HOSPITAL AND BETH ISRAEL DEACONESS HOSPITAL-NEEDHAM.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 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 EMERGENCY DEPARTMENT. 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. INTERNAL MEDICINE EDUCATION AT BIDMCTHE GOAL OF THIS PROGRAM IS TO DEVELOP EACH RESIDENT'S JUDGMENT AND SKILLS TO PROVIDE THE HIGHEST QUALITY MEDICAL CARE. THE MEDICAL CENTER TRAINS RESIDENTS AS ACADEMIC INTERNISTS AND PROVIDES THE FOUNDATION FOR THE PRACTICE OF INTERNAL MEDICINE OR FOR SUBSEQUENT CLINICAL AND RESEARCH TRAINING IN MEDICAL SUBSPECIALTIES. RESIDENTS ARE EXPOSED TO A WIDE ARRAY OF PATIENTS IN VARIOUS INPATIENT AND OUTPATIENT SETTINGS, INCLUDING DIFFERENT UNITS WITHIN BIDMC, DANA FARBER CANCER INSTITUTE, AND WEST ROXBURY VETERANS AFFAIRS MEDICAL CENTER. CLINICAL TEACHING IS A FOCUS AT BIDMC AND IS COMPRISED OF FORMAL AND INFORMAL DAILY ROUNDS AND NOONTIME CONFERENCES. THIS TEACHING PROVIDES THE BASIS OF AN ORGANIZED CURRICULUM FOR ALL MEDICAL INTERNS AND RESIDENTS AT BIDMC.INTERNSHIPTHE INTERNSHIP YEAR EMPHASIZES THE CARE OF PATIENTS IN GENERAL INPATIENT MEDICINE, INTENSIVE CARE MEDICINE, ONCOLOGY, CARDIOLOGY, EMERGENCY MEDICINE AND AMBULATORY CARE UTILIZING BOTH CAMPUSES AND SELECTED OUTSIDE SITES. WORKING AS PART OF A 2-4 PHYSICIAN TEAM WHICH INCLUDES AN OVERSEEING RESIDENT, ATTENDING STAFF AND OFTEN MEDICAL STUDENTS, INTERNS GAIN EXPERIENCE IN THE MANAGEMENT OF PATIENTS WITH A BROAD RANGE OF MEDICAL DISEASES. INTERNS HAVE PRIMARY RESPONSIBILITY FOR THE CARE OF ALL PATIENTS ADMITTED TO THE MEDICAL WARD SERVICE AND ARE CONSIDERED THEIR PATIENT'S PRIMARY INPATIENT DOCTOR FOR THE DURATION OF THE HOSPITALIZATION. THROUGHOUT INTERN YEAR, INTERNS MAINTAIN A LONGITUDINAL CONTINUITY CLINIC EXPERIENCE WHERE THEY DEVELOP A PANEL OF THEIR OWN PRIMARY CARE PATIENTS. DURING MOST OF THE YEAR, WITH THE EXCEPTION OF INTENSIVE CARE ROTATIONS, AN INTERN WILL HAVE CLINIC ONE HALF-DAY PER WEEK. DISTRIBUTED THROUGHOUT THE YEAR ARE FOUR "AMBULATORY BLOCKS" OF TWO WEEKS DURATION. DURING THIS TIME THE INTERN IS IN THEIR CONTINUITY CLINIC EVERY AFTERNOON AND ATTENDS OUTPATIENT SPECIFIC DIDACTIC LECTURES DURING THE MORNING HOURS. AS MEMBERS OF THE HARVARD FACULTY, INTERNS PLAY AN IMPORTANT ROLE IN TEACHING, BOTH OF THEIR PEERS AND OF ROTATING MEDICAL STUDENTS. WHILE ON THE MEDICAL WARDS, INTERNS PROVIDE DAILY CLINICAL GUIDANCE AND TEACHING TO THIRD AND FOURTH YEAR MEDICAL STUDENTS. AS PART OF THE AMBULATORY CARE CURRICULUM, INTERNS WILL ALSO HAVE THE OPPORTUNITY TO LEAD PRE-CLINIC CONFERENCES. DURING THE YEAR, THERE ARE SPECIAL INTERN-ONLY EDUCATIONAL ACTIVITIES INCLUDING THE TWICE-WEEKLY INTERN REPORT, MONTHLY INTERN FORUM SESSIONS AND BI-ANNUAL 24-HOUR INTERN RETREATS.
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JUNIOR AND SENIOR RESIDENCY
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RESIDENCY SOLIDIFIES CLINICAL AND TEACHING SKILLS AND ALLOWS TRAINEES TO EXPERIENCE LEADERSHIP OF A MEDICAL TEAM. JUNIOR RESIDENCY PROVIDES THE FIRST OPPORTUNITY FOR RESIDENTS TO SUPERVISE HOUSESTAFF TEAMS ON GENERAL MEDICAL SERVICES AND IN THE MEDICAL AND CARDIAC INTENSIVE CARE UNITS. SENIOR RESIDENCY PROMOTES CONSOLIDATION AND REFINEMENT OF THESE SKILLS, WITH ATTENDINGS ALLOWING INCREASING AUTONOMY. THE RESIDENT ON THE SERVICE IS LOOKED ON AS THE TEAM LEADER AND ASSUMES PRIMARY RESPONSIBILITY FOR TEACHING OF THE TEAM. RESIDENCY ALSO PROVIDES OPPORTUNITIES FOR INCREASED ELECTIVE TIME TO SAMPLE SUBSPECIALTY ROTATIONS. THIS PROVIDES ADDITIONAL SPECIALTY TRAINING IN AREAS OF INTEREST. THE ELECTIVE OPPORTUNITIES ARE DIVERSE, RANGING FROM ELECTROPHYSIOLOGY TO MUSCULOSKELETAL MEDICINE TO HEALTH POLICY. RESIDENTS ALSO HAVE THE OPPORTUNITY TO PARTICIPATE IN ONE OF SEVERAL "TRACKS" WITHIN THE RESIDENCY PROGRAM IF INTERESTED IN ADDITIONAL SPECIFIC TRAINING RESOURCES AND EXPERIENCES.TEACHING AS A RESIDENTAS MENTIONED ABOVE, RESIDENTS ARE VIEWED AS SOME OF THE PRIMARY TEACHERS WITHIN THE DEPARTMENT OF MEDICINE. SOME OF THESE TEACHING OPPORTUNITIES WILL ALSO BE OBSERVED BY DEPARTMENT FACULTY TO HELP THE RESIDENT REFINE THE STYLE AND EFFECTIVENESS OF THEIR TEACHING. TEACHING OPPORTUNITIES WILL INCLUDE:LEADING INPATIENT MEDICINE ROUNDS: - RESIDENTS ARE IN CHARGE OF RUNNING WARD ROUNDS. MEDICAL STUDENTS AND INTERNS PRESENT TO THE RESIDENT DURING ROUNDS. THE ATTENDING HOSPITALIST IS CONSIDERED THE RESIDENT'S CONSULTANT, WITH THE RESIDENT RETAINING THE PRIMARY DECISION-MAKING ROLE FOR THE PATIENTS ON THEIR SERVICE.- DURING THE MONTHS ON MEDICAL WARDS, THE CHIEF RESIDENTS AND FIRM CHIEFS ARE ASSIGNED TO DO WALK ROUND ONCE EACH WEEK WITH ONE OF THE RESIDENTS ON THEIR FIRM. THEY WILL OBSERVE THE RESIDENT RUNNING THE WARD ROUNDS AND PROVIDE FEEDBACK ON THE TEACHING SKILLS OBSERVED DURING ROUNDS.LEADING TEACHING ATTENDING ROUNDS: - DURING EVERY ROTATION ON THE MEDICAL WARDS, EACH RESIDENT WILL LEAD ONE TO THREE ATTENDING ROUNDS SESSIONS. THE TWO TEACHING ATTENDINGS HELP PROVIDE FEEDBACK ON THE RESIDENT'S SMALL GROUP DISCUSSION AND TEACHING SKILLS. SMALL GROUP PRESENTATIONS: - DURING AMBULATORY WEEKS, RESIDENTS WILL LEAD A MAJORITY OF THE PRE-CLINIC CONFERENCES, TYPICALLY PRESENTING EITHER A CHALLENGING AMBULATORY CASE OR AMBULATORY-BASED TOPIC.- ONCE DURING RESIDENCY, EACH JUNIOR RESIDENT WILL ALSO PRESENT A JOURNAL ARTICLE OF AMBULATORY CARE SIGNIFICANCE AT AMBULATORY JOURNAL CLUB TO A SMALL GROUP OF THEIR PEERS. INTERNAL MEDICINE GLOBAL HEALTH PROGRAMOUR MISSION IS TO TRAIN LEADERS IN GLOBAL HEALTH TO BE EFFECTIVE PRACTITIONERS IN UNDERSERVED, RESOURCE-LIMITED SETTINGS AND TO DESIGN, MANAGE, IMPROVE AND EVALUATE GLOBAL PUBLIC HEALTH PROGRAMS THAT ADDRESS THE HEALTH PROBLEMS OF THE WORLD'S NEEDIEST POPULATIONS.PROGRAM OBJECTIVES - INTRODUCE GLOBAL HEALTH ISSUES TO BIDMC MEDICAL RESIDENTS - CONTRIBUTE TO THE HEALTH AND WELL-BEING OF UNDERSERVED POPULATIONS IN BOSTON AND AROUND THE WORLD - ENRICH THE MEDICAL KNOWLEDGE AND ENHANCE THE CLINICAL SKILLS OF RESIDENTS BY PRACTICING IN UNIQUE SETTINGS WITH LIMITED RESOURCES - EXPAND RESEARCH OPPORTUNITIES - ADVANCE THE CAREERS OF BIDMC RESIDENTS IN THE FIELDS OF INTERNATIONAL HEALTH, PUBLIC POLICY AND RESEARCH SITE LOCATIONS - BOTSWANA: THE DEPARTMENT HAS A PERMANENT PRESENCE IN BOTSWANA WITH A MEMBER OF OUR DEPARTMENT FULL-TIME AT SCOTTISH LIVINGSTONE HOSPITAL IN MOLEPOLOLE, BOTSWANA. - VIETNAM: THE MEDICAL CENTER HAS A PERMANENT PRESENCE IN VIETNAM. PHYSICIAN AND NURSE TRAINING ON HIV/AIDS CARE IN VIETNAM TAKES PLACE THROUGH FUNDING FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION. - ADDITIONAL LOCATIONS: THE DEPARTMENT OFFERS ROTATIONS AT THE ALBERT SCHWEITZER HOSPITAL IN GABON AND OTHER INTERNATIONAL SITES. RESIDENTS CAN ALSO DO ROTATIONS THROUGH THE INDIAN HEALTH SERVICE OR AT BIDMC-AFFILIATED COMMUNITY HEALTH CENTERS. GLOBAL HEALTH TRACK LEARNING HOW TO WORK EFFECTIVELY IN RESOURCE-LIMITED SETTINGS REQUIRES BOTH TRAINING AND EXPERIENCE. PARTICIPANTS IN THE GLOBAL HEALTH TRACK WILL PARTICIPATE WITH LEARNERS FROM AROUND THE WORLD IN THE GLOBAL HEALTH EFFECTIVENESS PROGRAM AT THE HARVARD SCHOOL OF PUBLIC HEALTH; THEY WILL ENGAGE IN OUR HOSPITAL-WIDE, YEAR-LONG GLOBAL HEALTH CURRICULUM AND JOURNAL CLUB, AND THEY WILL BE GIVEN THE OPPORTUNITY FOR TWO FIELD EXPERIENCES DURING RESIDENCY. HOSPITAL-WIDE GLOBAL HEALTH PROGRAM THE BIDMC GLOBAL HEALTH PROGRAM IS A HOSPITAL-WIDE PROGRAM AVAILABLE TO ALL BIDMC RESIDENTS. WHILE REQUIREMENTS AND TIMELINES MAY DIFFER BETWEEN DEPARTMENTS AND SPECIALTIES, THE OVERARCHING GOAL IS TO PROVIDE RESIDENTS WITH FURTHER TRAINING AND EDUCATION IN THE DISCIPLINE OF GLOBAL HEALTH. NEUROLOGY EDUCATION AT BIDMCTHE HARVARD MEDICAL SCHOOL NEUROLOGY PROGRAM AT BETH ISRAEL DEACONESS MEDICAL CENTER AND CHILDREN'S HOSPITAL IN BOSTON, MASSACHUSETTS WAS FOUNDED IN 1996 AS THE SUCCESSOR TO THE HARVARD-LONGWOOD NEUROLOGY PROGRAM. THE PROGRAM CONCENTRATES ON THE TRAINING AND RESEARCH OPPORTUNITIES AVAILABLE ON THE HARVARD MEDICAL SCHOOL LONGWOOD CAMPUS, BY COMBINING THE RESOURCES OF TWO MAJOR HARVARD TEACHING HOSPITALS, BETH ISRAEL DEACONESS MEDICAL CENTER AND CHILDREN'S HOSPITAL. THESE COMBINED HOSPITALS, WITH OVER 800 INPATIENT BEDS AND EXTENSIVE OUTPATIENT CLINICS, PROVIDE THE SETTING FOR TRAINING PHYSICIANS IN THE ART AND SCIENCE OF CLINICAL NEUROLOGY.THE COMBINED FACULTY CONSISTS OF MORE THAN 80 NEUROLOGISTS AT THE TWO PARTICIPATING HOSPITALS, AND PROVIDES CORE EXPERIENCES IN INPATIENT AND OUTPATIENT NEUROLOGY, AS WELL AS TRAINING IN ELECTROPHYSIOLOGY (INCLUDING EEG, EMG, AND SLEEP POLYSOMNOGRAPHY) AND NEUROPATHOLOGY. THE KEY DISTINGUISHING FEATURE OF THE PROGRAM IS THE CLOSE RELATIONSHIP BETWEEN THE CLINICAL FACULTY, NEARLY ALL OF WHOM ARE FULL-TIME ACADEMIC NEUROLOGISTS ENGAGED IN SUBSTANTIVE RESEARCH AND TEACHING EFFORTS, AND A SELECT GROUP OF RESIDENTS WHO ARE KEENLY INTERESTED IN FORGING ACADEMIC CAREERS IN NEUROLOGY. VIRTUALLY ALL OF THE CLINICAL TRAINING TAKES PLACE WITHIN A 2 BLOCK RADIUS ON THE HARVARD MEDICAL SCHOOL LONGWOOD CAMPUS. A CRITICAL COMPONENT OF THE PROGRAM IS THE OPPORTUNITY FOR RESIDENTS TO HAVE A MENTORED TEACHING EXPERIENCE AS WELL AS THE OPPORTUNITY TO UNDERTAKE A MENTORED PROJECT, WHICH MAY ENTAIL EITHER CLINICAL OR LABORATORY BASED INVESTIGATION OR PREPARATION OF INNOVATIVE TEACHING MATERIALS OR METHODS.
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PATHOLOGY EDUCATION AT BIDMC
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THE DEPARTMENT OF PATHOLOGY AT BETH ISRAEL DEACONESS MEDICAL CENTER IS COMMITTED TO PROVIDING STATE-OF-THE-ART TRAINING TO PREPARE PHYSICIANS FOR LEADERSHIP ROLES IN PATHOLOGY AND ACADEMIC MEDICINE. THE PROGRAM OFFERS THREE RESIDENT TRAINING PATHWAYS: FIRST, A COMBINED ANATOMIC PATHOLOGY/CLINICAL PATHOLOGY (AP/CP) PATHWAY PROVIDES COMPREHENSIVE TRAINING IN ALL AREAS OF TISSUE DIAGNOSTICS AND LABORATORY MEDICINE. SECOND, THE AP ONLY PATHWAY PREPARES RESIDENTS FOR CAREERS AS ACADEMIC SURGICAL PATHOLOGISTS. THIRD, THE CP ONLY PATHWAY PREPARES RESIDENTS FOR CAREERS AS FUTURE LEADERS IN LABORATORY MEDICINE. ALL PATHWAYS INCLUDE EXTENSIVE OPPORTUNITIES TO PARTICIPATE IN RESEARCH PROJECTS WITH WORLD-RENOWNED EXPERTS IN PATHOLOGY OR RELATED DISCIPLINES. KNOWLEDGE COMES THROUGH EXPERIENCE AND EXTENSIVE INTERACTION WITH FACULTY. IN ANATOMIC PATHOLOGY SIGN OUT, RESIDENTS PREPARE THEIR OWN DIAGNOSES AND ARE THEN IN A POSITION TO TAKE FULL ADVANTAGE OF SIGN OUT WITH STAFF MEMBERS. IN CLINICAL PATHOLOGY, RESIDENTS GAIN EXPERIENCE DURING DAILY ROUNDS WITH ATTENDINGS, SOCRATIC TUTORIALS, AND THROUGH POSITIONING OF RESIDENTS AS AN INTERMEDIARY BETWEEN CLINICIAN AND LABORATORY. THERE ARE DAILY TEACHING AND CASE MANAGEMENT CONFERENCES COVERING THE DIFFERENT PATHOLOGY SPECIALTIES. GIVEN THE IMPORTANT ROLE PATHOLOGISTS PLAY IN TEACHING MEDICAL STUDENTS AND COLLEAGUES IN OTHER SPECIALTIES, THE PROGRAM PROVIDES GUIDANCE FOR RESIDENTS AS THEY HONE THEIR TEACHING SKILLS. SUCH "RESIDENT-AS-TEACHER" PROGRAMS ARE COMMON IN OTHER SPECIALTIES BUT NOT AS WELL-DEVELOPED IN PATHOLOGY. THE CURRICULUM INCLUDES SESSIONS DESIGNED TO IMPROVE SKILLS RELATED TO GIVING FEEDBACK AND SMALL GROUP TEACHING. THERE IS A SESSION ON DEVELOPING PRESENTATION SKILLS WITH CLOSE MENTORING OF FIRST YEAR RESIDENTS, BY SPECIFIC FACULTY WHO HAVE ALSO BEEN THROUGH THE CURRICULUM, AS THEY PREPARE FOR THEIR FIRST PRESENTATION. THERE ARE ALSO OPPORTUNITIES FOR RESIDENTS TO TEACH MEDICAL STUDENTS BOTH WITHIN OUR DEPARTMENT AND AT HARVARD MEDICAL SCHOOL, AS WELL AS TO RECEIVE FEEDBACK ON THEIR TEACHING SKILLS. RECOGNIZING THE NEED TO INTEGRATE TECHNOLOGY INTO RESIDENCY TRAINING, ALL FIRST YEAR RESIDENTS ARE PROVIDED WITH IPADS. THESE TABLETS ALLOW RESIDENTS TO MORE EASILY PREVIEW THE SLIDES THAT ARE ROUTINELY SCANNED FOR OUR SURGICAL SLIDE CONFERENCE. GENOMIC TECHNOLOGY WILL AFFECT THE PRACTICE OF ALL MEDICAL PRACTITIONERS. AS THE PHYSICIANS WHO MANAGE THE HOSPITAL LABORATORIES, PATHOLOGISTS MUST UNDERSTAND NEXT-GENERATION SEQUENCING TECHNOLOGY AND ITS APPLICATION TO PATIENT CARE. IN 2009, THE PROGRAM CREATED, TO OUR KNOWLEDGE, THE FIRST GENOMIC PATHOLOGY CURRICULUM IN THE COUNTRY. THE CURRICULUM HAS BEEN PUBLISHED AND HAS SERVED AS THE BASIS FOR A COLLABORATIVE EFFORT TO DEVELOP A NATIONAL GENOMICS CURRICULUM (WWW.ASCP.ORG/TRIG).TRAINING IN EVIDENCE-BASED MEDICINE IS CRITICAL. A FIRST-YEAR RESIDENT JOURNAL CLUB ALLOWS AN INTRODUCTION TO CRITICAL REVIEW OF THE MEDICAL LITERATURE. IN LATER YEARS, RESIDENTS LEAD SMALL-GROUP DISCUSSIONS IN MONTHLY JOURNAL CLUBS. THERE IS ALSO AN EVIDENCE-BASED TRANSFUSION MEDICINE CURRICULUM TO HONE THESE SKILLS DURING CP TRAINING. RADIOLOGY EDUCATION AT BIDMCTHE RADIOLOGY RESIDENCY PROVIDES FOUR YEARS OF TRAINING IN DIAGNOSTIC IMAGING. APPOINTMENTS ARE HELD JOINTLY AS A RESIDENT AT THE MEDICAL CENTER AND AS A CLINICAL FELLOW AT HARVARD MEDICAL SCHOOL. WITH A CENTRAL ROLE IN CLINICAL SERVICE, TEACHING, AND RESEARCH, THE RADIOLOGY DEPARTMENT PERFORMS OVER 400,000 RADIOLOGIC EXAMINATIONS EACH YEAR. THE DEPARTMENT PROVIDES RADIOGRAPHY, CT, ULTRASOUND, MRI, NUCLEAR MEDICINE, MAMMOGRAPHY, ANGIOGRAPHY, AND INTERVENTIONAL RADIOLOGY SERVICES TO BOTH THE MEDICAL CENTER AS WELL AS OUR AFFILIATED HEALTH CARE FACILITIES. A RADIOLOGY RESEARCH AND ANIMAL LABORATORY IS HOUSED ADJACENT TO THE RADIOLOGY DEPARTMENT. ALL RESIDENTS, FELLOWS, AND FACULTY HAVE APPOINTMENTS AT HARVARD MEDICAL SCHOOL. ALL RADIOLOGIC STUDIES ARE INTERPRETED UNDER THE SUPERVISION OF STAFF RADIOLOGISTS. THE NUCLEAR MEDICINE PROGRAM IS A PART OF THE JOINT PROGRAM IN NUCLEAR MEDICINE AT HARVARD MEDICAL SCHOOL. THE DEPARTMENT PLACES STRONG EMPHASIS ON THE QUALITY OF TEACHING-BOTH IN DIDACTIC LECTURES AND IN INDIVIDUAL CASE-BASED TEACHING.WITH THE ADVENT OF RECENT CHANGES IN RESIDENCY TRAINING, THE CURRICULUM HAS RECENTLY BEEN REVISED SO THAT RESIDENTS UNDERTAKE A COURSE OF STUDY WHICH WILL PERMIT THEM TO OBTAIN EXPERTISE NOT JUST IN CLINICAL SUBSPECIALTIES BUT ALSO IN OTHER KEY AREAS SUCH AS RESEARCH, EDUCATION, GLOBAL HEALTH, QUALITY IMPROVEMENT, AND HEALTH POLICY. RADIOLOGIC PHYSICS HAS BEEN INTEGRATED INTO DAILY DIDACTIC SESSIONS. IN ADDITION, MANY DIDACTIC SESSIONS UTILIZE AUDIENCE RESPONSE TECHNOLOGY, VIDEO-RECORDING, AND IPAD2 TECHNOLOGY.THERE ARE NINE FORMAL SECTIONS IN THE DEPARTMENT: ABDOMINAL IMAGING, BREAST IMAGING, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY (CVIR), MRI, MUSCULOSKELETAL IMAGING, NEURORADIOLOGY, NUCLEAR MEDICINE, ULTRASOUND, AND THORACIC IMAGING. MOST NON-ANGIOGRAPHIC INTERVENTIONAL PROCEDURES ARE PERFORMED BY THE RESPECTIVE SERVICES. RESIDENTS ROTATING THROUGH THESE SECTIONS ARE PROVIDED WITH READING SUGGESTIONS AND MATERIAL. ACADEMIC ROTATIONS ARE MADE UP OF THIRTEEN 4-WEEK BLOCKS ANNUALLY. AT THE END OF EACH ROTATION RESIDENTS RECEIVE WRITTEN EVALUATIONS AND HAVE THE OPPORTUNITY TO EVALUATE THE STAFF.FIRST YEAR ROTATIONS EMPHASIZE FUNDAMENTALS AND COMMON RADIOLOGIC EXAMINATIONS IN PREPARATION FOR INPATIENT AND EMERGENCY DEPARTMENT RESPONSIBILITIES. PRIOR TO TAKING CALL, ALL FIRST YEAR RESIDENTS ROTATE THROUGH ABDOMINAL IMAGING, BREAST IMAGING, EMERGENCY RADIOLOGY, FLUOROSCOPY, MUSCULOSKELETAL IMAGING, NEURORADIOLOGY, NUCLEAR MEDICINE, THORACIC IMAGING, AND ULTRASOUND.DURING THE SECOND YEAR, RESIDENTS CONTINUE TO GAIN EXPERIENCE IN THESE SECTIONS, PERFORMING AND INTERPRETING MORE ADVANCED EXAMINATIONS AND INTERVENTIONS AS THEIR LEVELS OF EXPERTISE INCREASE. ADDITIONAL ROTATIONS IN MORE SPECIALIZED TOPICS OCCUR THROUGHOUT THE SECOND THROUGH FOURTH YEARS, INCLUDING INTERVENTIONAL RADIOLOGY, MRI, HEAD AND NECK IMAGING, AND PEDIATRIC RADIOLOGY. IN ADDITION, ALL RESIDENTS PARTICIPATE IN A TWO-WEEK ROTATION IN QUALITY ASSURANCE WHICH PROVIDES THEM WITH ESSENTIAL SKILLS FOR EVENTUAL BOARD RE-CERTIFICATION.ROTATIONS AT OTHER TRAINING LOCATIONS DURING THE SECOND AND THIRD YEARS OF TRAINING INCLUDE:- THREE MONTHS OF TRAINING IN PEDIATRIC RADIOLOGY AT THE BOSTON CHILDREN'S HOSPITAL DURING THE SECOND YEAR.- FOUR WEEK PROGRAM IN RADIOLOGIC-PATHOLOGIC CORRELATION AT THE ARMED FORCES INSTITUTE OF PATHOLOGY (AIRP) SPONSORED BY THE AMERICAN COLLEGE OF RADIOLOGY IN SILVER SPRINGS, MARYLAND DURING THE THIRD YEAR.- ONE MONTH ROTATION AT THE MASSACHUSETTS EYE AND EAR INFIRMARY IN HEAD-AND-NECK RADIOLOGY DURING THE THIRD YEAR.UPON COMPLETION OF THE SECOND YEAR OF RESIDENCY TRAINING, RESIDENTS SELECT AN AREA OF ACADEMIC FOCUS FOR THEIR FOURTH YEAR WHICH WILL GUIDE CHOICES FOR THE 3-MONTH MINI-FELLOWSHIPS AND THE OTHER TWO MONTHS OF ELECTIVE TIME.OUR UNIQUE EDUCATIONAL TRACKSCURRENTLY, SIX TRACKS ARE OFFERED:- CLINICAL- EDUCATION- RESEARCH- GLOBAL HEALTH- QUALITY IMPROVEMENT- HEALTH POLICY/HEALTH ECONOMICSEACH OF THESE TRACKS HAS SPECIFIC CURRICULAR OFFERINGS AND EDUCATIONAL GOALS. MOST OF THE TRACKS ARE LINKED TO SPECIFIC EDUCATIONAL ENDEAVORS. FOR EXAMPLE, A RESIDENT SELECTING THE GLOBAL HEALTH TRACK WILL ENROLL IN THE GLOBAL EFFECTIVENESS CURRICULUM OFFERED BY THE HARVARD SCHOOL OF PUBLIC HEALTH AND WILL SPEND TIME ABROAD PROVIDING CLINICAL RADIOLOGY SERVICES AND UNDERTAKING A GLOBAL HEALTH PROJECT. A RESIDENT SELECTING THE EDUCATION TRACK WILL PURSUE ADVANCED TRAINING IN EDUCATIONAL THEORY AND ADULT LEARNING BY PARTICIPATING IN THE HARVARD MACY PROGRAM FOR PHYSICIAN EDUCATORS AND UNDERTAKE AN EDUCATIONAL PROJECT BASED AT BIDMC OR HARVARD MEDICAL SCHOOL. A RESIDENT CHOOSING THE RESEARCH TRACK WILL PARTICIPATE IN GRANT WRITING WORKSHOPS AND DELVE DEEPLY INTO A RESEARCH PROJECT OF THEIR CHOICE.NO MATTER WHICH TRAINING TRACK, THE EXPECTATION IS THAT EVERY RESIDENT WILL HAVE THE OPPORTUNITY TO UNDERTAKE A SUBSTANTIAL PROJECT DURING RESIDENCY THAT WILL CULMINATE IN PRESENTATION AT A NATIONAL MEETING AND/OR PUBLICATION.
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SURGERY EDUCATION AT BIDMC
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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.THE MEDICAL CENTER'S DEPARTMENT OF SURGERY IS ONE OF THREE MAJOR TEACHING AND RESEARCH UNITS OF HARVARD MEDICAL SCHOOL'S DEPARTMENT OF SURGERY. AT ALL LEVELS, THE HOUSESTAFF GAIN TRAINING AND PRACTICAL EXPERIENCE IN THE PREOPERATIVE, OPERATIVE, AND POST-OPERATIVE CARE OF PATIENTS. THE 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. 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.
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SCHEDULE H PART VI QUESTIONS 5 AND 6
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ADDITIONAL PROMOTION OF COMMUNITY HEALTH AND AFFILIATED HEALTH CARE SYSTEMAS NOTED IN THIS FORM 990 PARTS I AND VI, THE MAJORITY OF THE MEDICAL CENTER'S BOARD MEMBERS ARE INDEPENDENT COMMUNITY MEMBERS. IN ADDITION, AS NOTED THROUGHOUT THIS FORM 990 AND SCHEDULES' NARRATIVE SUPPORT, FOR THE PERIOD COVERED BY THIS FILING, THE MEDICAL CENTER WAS PART OF THE CAREGROUP NETWORK OF AFFILIATES AND CAREGROUP SERVED AS THE MEDICAL CENTER'S SOLE MEMBER. FOR THIS SAME TIME PERIOD, THE MEDICAL CENTER SERVED AS THE SOLE MEMBER TO BETH ISRAEL DEACONESS HOSPITAL NEEDHAM, BETH ISRAEL DEACONESS HOSPITAL MILTON, BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, MEDICAL CARE OF BOSTON MANAGEMENT CORP D/B/A BETH ISRAEL DEACONESS HEALTHCARE A/K/A AFFILIATED PHYSICIANS GROUP AND JORDAN HEALTH SYSTEMS, INC. EACH OF THESE ENTITIES MAY, IN TURN, HAVE SERVED AS THE SOLE MEMBER OF ADDITIONAL AFFILIATES. EFFECTIVE MARCH 1, 2019, CAREGROUP AS PART OF A STATUTORY PLAN OF MERGER, CAREGROUP MERGED INTO THE MEDICAL CENTER AND BETH ISRAEL LAHEY HEALTH, INC. (BILH) BECAME THE SOLE MEMBER OF THE MEDICAL CENTER AND OTHER HOSPITALS LISTED IN THIS PARAGRAPH. THE MEDICAL CENTER AND EACH OF THESE AFFILIATES WAS FOR THE PERIOD COVERED BY THIS FILING AND EACH REMAINS TODAY, COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES THEY SERVE.
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Attach to Form 990 or Form 990-EZ. 
Attach to Form 990 or 990-EZ.