Mount Sinai Institute for Advanced Medicine Annual report 2022 by Mount Sinai Health System

Mount Sinai Institute for Advanced Medicine

Annual Report 2022

Mission The Institute for Advanced Medicine’s mission is to lead the field in providing compassionate, inclusive, integrated, and holistic primary care, prevention, and education to advance the health of individuals and communities.

Vision Quality Care. Every Patient. Every Time.

About Us IAM achieves its mission through an extensive network of caring clinicians and supportive programs to meet the unique needs of its patients. We unite the Mount Sinai Health System’s outstanding physicians and staff from multiple disciplines into one integrated program for comprehensive services. Our unique programs, highlighted throughout this report, are designed to benefit and provide compassionate care to the diverse people we serve throughout New York City.

Quality Care Every Patient Every Time

Dear Friends and Colleagues, The Mount Sinai Health System Institute for Advanced Medicine’s (IAM) annual report showcases the developments, transformations, and progress that occurred during 2022. During 2022, the COVID epidemic began to wane, however, mpox (previously known as monkeypox) began. Our providers quickly became experts in mpox, providing information and vaccines to our patients and the community. We are so proud of our staff for their continued compassion and resilience, both professionally and personally, and for the large role they play in providing critical care for our own patients at IAM, as well as patients across the Health System. Services and programs continue to grow at IAM’s five clinics, at which we continue to provide safe and welcoming spaces for our communities. During 2023, IAM’s Morningside and Jack Martin Fund clinics will combine and move to a new space on West 124th Street where IAM will continue to provide a full range of comprehensive care, including dental and pharmacy services. In addition to our mental health services, additional mental health services will be available in the building. We continue to remain at the forefront of state-of-the-art medical prevention, treatment and clinical education services, as well as community outreach services, and access to clinical trials and research. On behalf of the Institute for Advanced Medicine, we thank our patients, staff, and supporters for taking this journey with us in 2022, and for continuing to be part of the resiliency across New York City.

Michael Mullen, MD

Matt Baney, MS

Jean DiNapoli, DNP, RN

Executive Director

Senior Director of Business

Senior Director of Clinical

and Strategic Development

Services and Administration

2022 Accomplishments 15,611 Patients Received

80,374 Clinical Encounters

12,152 Patients Received Primary Care Services 2,672 Patients Received Mental Health Services 4,269 Patients Received Social Work Services 2,074 People Received 5,395 Rapid HIV Tests 911 People Received Hepatitis C Testing

6,003 People Received Medications at IAM Pharmacies

78% of Whom Were IAM Patients

10,386 People Received Sexually Transmitted Infection (STI) Screenings 1,272 People Received Pre-Exposure Prophylaxis (PrEP) and 1,411 People Received Post-Exposure Prophylaxis (PEP)

9,075 People with HIV (PWH) Attended 58,377 Clinical Encounters

8,339 Received Primary Care Services 847 Received Oral Health Care Services 631 Received Care Coordination Services 253 Received Food and Nutrition Services

2,212 People Who Identify as Transgender and Gender Diverse (TGD) Attended

11,850 Clinical Encounters

1,310 Received Primary Care Services 848 Are on a Surgical Path 2,736 Received Hormonal Therapy 1,094 Received Mental Health Services 885 Received Case Management or Psychosocial Services

6,551 NYS Providers Attended 123 Clinical Education Training Events on HIV, Hepatitis C, and Drug User Health 4

Patient Demographics

0-12 years, 1%

65 and over, 15%

Age

Gender

13-24 years, 6%

Non-Binary 5%

Transfeminine 7% Transmasculine 3%

45-64 years, 39%

Female, 22%

25-44 years, 39%

Male, 63%

Race & Ethnicity 5,000

4,501

4,390

4,069

4,000 3,000

1,740

2,000 1,000

603 31

255

te d

or nr ep

e on

U n/

th U

no w

or e

Al or an di In

as ka n

fic ci Pa n/

ra c

at iv e N

nd Is

As ia aw ai N

at iv e

Am an Af ric Bl

n ia

o/ a at in c/ L ni pa

is H

hi te

(n ot H

Overview of Services Clinical Services

Community Based Services

Primary Care Medical Care

IAM Services

Dental Services

HIV, HCV, STI Testing

Pre-Exposure Prophylaxis (PrEP)

Street Outreach

Post-Exposure Prophylaxis (PEP)

24-Hour PEP Hotline

TelePrEP

Risk Reduction

HIV Prevention, Testing, Care, and Treatment

Health Education

Mental Health Services

Workshops

Hepatitis C Screening and Treatment

PEP/PrEP

Integrative Medicine Pain Management LGBTQIA Health Services

Supplemental Services via Community Partnerships Housing

Center for Transgender Medicine and Surgery (CTMS)

Legal Services

Sexually Transmitted Infection (STI) Screening and Treatment

Vocational Training

Food Pantries, Meals, and Vouchers Support Groups

Specialty Services

Drug Treatment

Cardiology

Mental Health Services

Dermatology

Additional Health Services

Endocrinology Gastroenterology (GI) Geriatric Medicine Gynecology High Resolution Anoscopy (HRA) Neurology Pharmacy Services

Support Services Social Work/Case Management Care Coordination Adherence Support Substance Use and Harm Reduction Services Nutrition Services Health Education and Risk Reduction Re-Entry Services Crime Victims Treatment Center 6

IAM Accomplishments IAM’s five clinics provide comprehensive prevention, care, and treatment services to a diverse group of people and populations. Our patients include people seeking primary care, PWH and people taking HIV prevention medication, people returning to the community from jails and prisons, people who identify as transgender and gender diverse (TGD), and many others. We have streamlined clinic flow and operations, and have improved our outreach, linkage, and retention procedures to support our communities with improved health care and quality of life. We provided primary care and supportive services to 15,611 individuals during 2022. During May 2022, the monkeypox outbreak (now renamed mpox, as per the World Health Organization (WHO)) began in the United States. Mount Sinai’s Institute for Advanced Medicine responded rapidly to contain the mpox outbreak that was spreading locally in NYC and globally. As cases started appearing in New York City, Mount Sinai quickly convened an incident command team to coordinate our preparedness and response efforts across the Health System. • We established mpox testing capabilities in our clinical laboratories to facilitate prompt diagnosis. • Our infectious disease experts provided up-to-date guidance on testing, infection control, and treatment to frontline staff through presentations and FAQ documents. • We also launched an mpox referral system throughout the Mount Sinai Health System to provide consultative support on suspected cases.

• We provided treatment to hundreds of patients with the antiviral tecovirimat, through a research protocol led by Mount Sinai’s Infectious Disease Infection Prevention Team. • Recognizing vaccine access as a key tool for outbreak control, we advocated for more vaccine supply from local and federal health authorities. Once the vaccine became available, we quickly mobilized to set up large-scale vaccination access across the IAM clinics and prioritized doses for high-risk patients. Throughout the evolving outbreak, IAM remained committed to providing our community with the highest quality clinical care while advancing research and public health understanding of this emerging infection. Our coordinated and evidence-based response exemplified Mount Sinai’s leadership in managing communicable disease threats.

IAM provides a “one-stop shop” for comprehensive health services. IAM provides multiple services under one roof, addressing health care needs and the social determinants of health. Each clinic provides services to address the needs of their community. Certified Specialty Pharmacies, on-site at the Samuels Clinic and the Comprehensive Health Program, serve all five IAM clinics and are open the same hours. • pharmacy staff are available 24/7 • provide free delivery to all five boroughs, Long Island, and upstate NY Care Coordination Program at all five clinics provides navigation, medical and social services coordination, virtual directly observed therapy (DOT), health education, and adherence support for PWH. Project Safety, Harm Reduction, And Recovery for Everyone (Project SHARE) provides support to reduce the negative impact of drugs and/or alcohol use on PWH: individual and group counseling, crisis intervention, overdose prevention and education, and art/recreational therapy.

Institute for Advanced Medicine

Dental Services side Clinic Mount Sinai St. Luke’s - Morning 6th Floor 440 West 114th Street, Clark Building, 0 Appointments: (212) 523-650 4:20 PM Monday – Friday 8:40 AM — Clinic Mount Sinai West – Samuels 1000 10th Avenue, Suite 2T 0 Appointments: (212) 523-650 4:20 PM Monday – Friday 8:40 AM — Krueger Clinic Mount Sinai Beth Israel – Peter 317 East 17th Street, 1st Floor 0 Appointments: (212) 420-262 PM 4:00 — AM 9:00 ys Thursda

Institute for Advanced Medicine Pharmacy Program

Institute for Advanced Medicine

HIV PEP

Post-Exposure Prophylaxis

Food and Nutrition Services (FNS) program at Samuels and Morningside clinics provides nutrition assessments and plans, individual and group nutrition counseling, workshops, food voucher support for those in need, and trips to NYC neighborhoods to sample diverse healthy cuisines. Comprehensive Dental Services at the Morningside and Samuels clinics include diagnosis and treatment of dental and oral diseases, routine dental hygiene, cleanings, and X-rays. Integrative Medicine located at the Morningside Clinic includes massage, yoga, acupuncture, meditation, and other stress reduction therapies to help address a variety of issues, including pain, insomnia, anxiety, and chronic disease management. Pain Management Services are now available at the Peter Krueger Clinic, Jack Martin Fund Clinic, and Comprehensive Health Program for those living with chronic pain.

Institute for Advanced Medicine

Social Work Services

Mental Health Services e Clinic Mount Sinai St. Luke’s - Morningsid 6th Floor 440 West 114th Street, Clark Building, New York, NY 10025 Appointment Phone: (212) 523-6500

The West Village Pharmacy

275 7th Avenue, 12th Floor, New York, NY 10001 (Between 25th & 26th St.) | Tel: (212) 604-1780 Monday through Friday, 9 AM to 5 PM

Mount Sinai Health Syste m

Institute for Advanced

Medicine

COMING HOME PROGRAM

els Clinic Mount Sinai St . West - Samu 1000 10th Avenue, Suite 2T New York, NY 10019 Appointment Phone: (212) 523-6500

Samuels Clinic Pharmacy

1000 10th Avenue, 2nd Floor, New York, NY 10019 (Between 58th & 59th St.) | Tel: (212) 636-3600 Monday through Friday, 9 AM to 5 PM

We Got You. HIV Post-Exposure Prophylaxis (PEP) is an emergency medicine that can prevent HIV if taken within 1 or 2 days after a possible exposure. • We run a 24/7 NYC PEP Hotline, 844-3-PEPNYC, which links callers with an immediate medical appointment or PEP starter doses any time • It’s free of charge, regardless of insurance or immigration status. • You can speak to an HIV doctor quickly, skip long waits and large bills at Emergency Rooms, and get meds at a convenient pharmacy. • We’ll link you to free or low cost care on the next business day. If you or someone you know has a suspected HIV exposure in NYC, don’t delay— call 844-3-PEPNYC.

- Peter Krueger Clinic Mount Sinai Beth Israel Hospital 317 East 17th Street, 1st Floor New York, NY 10003 Appointment Phone: (212) 420-2620 Mount Sinai St. Luke’s - Morningside Clinic 440 West 114th Street, Clark Building, 6th Floor New York, NY 10025 Appointment Phone: (212) 523-6500

Mount Sinai St. West - Samuels Clinic 1000 10th Avenue, Suite 2T New York, NY 10019 Appointment Phone: (212) 523-6500

Mount Sinai Beth Israel Hospital - Peter Krueger Clinic 317 East 17th Street, 1st Floor New York, NY 10003 Appointment Phone: (212) 420-2620 Mount Sinai Hospital - Comprehensive Health Program 275 7th Avenue, 12th Floor New York, NY 10001 Appointment Phone: (212) 604-1701

Mount Sinai Hospital- Jack Martin Clinic 17 East 102nd Street, 3rd Floor New York, NY 10029 Appointment Phone: (212) 241-7968

Institute for Advanced Medicine

rehensive Health Program M o u nt S i n a i H o s p i t a l - C o m p 275 7th Avenue, 12th Floor New York, NY 10001 Appointment Phone: (212) 604-1701 Clinic Mount Sinai Hospital- Jack Martin 17 East 102nd Street, 3rd Floor New York, NY 10029 Appointment Phone: (212) 241-7968

Morningside Clinic

440 West 114th Street, Clark 6 (6th Floor) New York, NY 10025 To make an appointment,

call

(212) 523-6500

We fulfill the health needs of diverse communities and populations in NYC. Formerly Incarcerated Population: IAM’s Coming Home Program, located at IAM’s Morningside Clinic, addresses the physical, mental, and social well-being of formerly incarcerated people after they return to the community from prison or jail. In 2022, the program provided trauma-informed treatment to 119 formerly incarcerated people, 79 percent attended a social work visit, and all attended a primary care provider visit. Women, Infants, Children, and Youth (WICY): Located at the Morningside, Samuels, and Jack Martin Fund clinics, our WICY program provides primary and specialty medical care and support services, including treatment adherence support, OB/GYN care, specialty care, mental health, substance use, oral health, nutrition, and case management for PWH. In 2022, WICY served 2,450 women, infants, children, and youth with HIV. Young Adults: IAM’s Young Adult Sexual Services (YASS!) program serves young men of color who have sex with men (YMCSM). Since COVID restrictions have become less restrictive, the team was able to go back into the community to provide point-of-care HIV/ STI testing, conduct presentations, and establish more partnerships with schools, sex venues, and CBOs. In 2022, YASS! staff provided 268 encounters to 87 YMCSM clients, both in-person and telephonically. On social media, YASS! garnered more than 1,500 interactions, reached more than 5,400 accounts, and secured 119 new followers (total of 801). Drug User Health: IAM’s services to people who use drugs (PWUD) are low threshold, peer driven, and trauma informed. We strive for them to be non-judgmental and stigma free. The Peter Krueger Clinic’s harm reduction program Project SHARE and the Morningside Clinic Coming Home Program both employ a Certified Alcoholism and Substance Abuse Counselor (CASAC). Project SHARE served 53 PWH in 2022. Older People with HIV (OPWH): IAM’s Peter Krueger Clinic (PKC) has a program specifically for older people with HIV, developed through the Mount Sinai Department

of Geriatrics and Palliative Care. The care model includes a fully developed team that includes a geriatrician (a physician who specializes in the care of older adults), a nurse, a social worker, pharmacist, and community health worker. During the first year of operation, the team completed 183 visits for 112 patients. In line with the goal of creating replicative optimal programs, the Department of Geriatrics and Palliative Care is creating a training program that includes a master educator in the field of geriatrics to guide the training program, developing a fellowship-like program where learners from multiple disciplines can be taught the core skills of comprehensive care for older adults with HIV. LGBTQIA Health Services: IAM provides health care and supportive services to Lesbian, Gay, Bisexual, Transgender, Non-Binary, Gender Non-Conforming, Queer and/or Questioning, Intersex, Asexual, and others who choose to self-identify in countless affirmative ways. We provide a full range of services including primary care, specialty care, mental health services, geriatric services, PrEP and PEP, HIV, STI and HCV testing, social work, and care coordination. IAM has numerous programs that serve LGBTQIA individuals, including the PlaySure Network (PSN) 2.0 program, which offers a comprehensive package of HIV prevention, care, mental health, substance use, and supportive services using an equity-focused one-stop-shop and holistic approach, Voices in Partnership (VIP), Center for Transgender Medicine and Surgery (CTMS), and the Keith Haring Foundation Pediatric and Youth Gender Center. People with HIV Not Connected to Care: Our Enhanced Data-to-Care (eD2C) Program, funded by the NYCDOHMH/Public Health Solutions, focuses on identifying PWH not in care and engaging them in care by integrating multiple data sources, including NYCDOH, the Regional Health Information Organization, and MSHS. Program staff then reach out to the person to link them back to care, and provide support for improved retention. Outreach, linkage, and retention in care are also integrated throughout our services and programs. 9

New Programs in 2022 During 2022, IAM received funding for three new programs: Beyond Diversity: Cultivating a Culture of Inclusivity in NYC Healthcare strives to address the needs of lesbian, gay, bisexual, and transgender (LGBT) individuals by providing mental health services in a primary care setting, and job training to increase the numbers of LGBT individuals providing health related services. This program was created through a collaboration between Mount Sinai’s Office of Diversity and Inclusion (ODI) and the Institute for Advanced Medicine. We strive to promote well-being and positive health outcomes by increasing the availability of culturally competent health care providers, improving the availability of mental health services, and providing an employment pipeline (LGBT Young Queer Urban Teens for Health in MEDicine (LGBT YQUTH MED)) program that includes high school and college-age individuals. The mental health services are provided virtually through the Mount Sinai Morningside Clinic. ODI oversees the summer internship program, while IAM will be collaborating with CUNY Hunter to incorporate a mental health counselor intern to increase capacity at the clinics. The PlaySure Network 2.0 (PSN2.0) program offers a comprehensive package of HIV prevention, care, mental health, substance use, and supportive services using an equity-focused, one-stop-shop and holistic approach. Through this program, located at IAM’s Comprehensive Health Program, we provide client-centered services to PrEP, PEP, HIV/STI testing and treatment, iART, vaccines, mental health and client education, as well as outreach and navigation services for individuals, including those who are uninsured and underinsured. PSN2.0 relies on numerous partnerships to meet its goals, including the NYC DOHMH Sexual Health Clinics, GMHC, Alliance for Positive Change, TransLatinx Network, sex venues, and many others. Improving Care for Older Adults with HIV – A Novel Model and a New Curriculum Overview was developed by the Mount Sinai Department of Geriatrics and Palliative Care in collaboration with the IAM, supported by a federal Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) grant. This is one of 10 awards nationally to develop optimal models to serve people over 50 living with HIV and to create a geriatric educational program for medical providers to further enhance a primary care physician’s ability to effectively manage an aging patient panel. The model of care includes an interdisciplinary team with a geriatrician, geriatricstrained social worker, nurse, and pharmacist within the HIV outpatient practice to create a practice-within-a-practice model. This program sits within the Peter Krueger Clinic (PKC) in the Chelsea neighborhood of Manhattan. In its first year, the program saw more than 100 older adults with HIV and provided comprehensive geriatric assessments as well as assisted with management of comorbidity, behavioral health, and patients’ psychosocial needs. Through the support provided by HRSA, we were able to add a community health worker who will improve screening, engagement and retention of older people with HIV in our geriatrics interdisciplinary model of care, thus improving outcomes among this population. We will also be developing training materials to enable replication of this model for other sites throughout the country.

Program Spotlights Long-Acting Injectables (LAIs) In the second and third quarter of 2022, clinic leadership under the direction of Dr. Antonio Urbina and Carlotta Starks, RN, developed and implemented an LAI protocol for both treatment (Cabenuva) in persons living with HIV, and prevention (Apretude) in persons at risk for HIV. As part of this rollout, standardization for eligibility, documentation, and order sets for medication and laboratory tests were developed within our electronic medical record. Coordination and input from multiple disciplines at IAM, which included pharmacy, nursing, finance, and administrative staff, were crucial for the successful launch of these new longacting therapies. In 2022, 47 patients initiated therapy with Cabenuva across the IAM sites. IAM was also awarded the Accelerating Implementation of Multilevel-strategies to Advance Long-Acting Injectables for Underserved Populations (ALAI UP) grant. We are one of 10 demonstration sites nationwide, and part of a national HRSA Special Project of National Significance award coordinated through Columbia University. This three-year grant looks at scaling up implementation of LAIs to vulnerable and underserved populations, based at IAM’s Jack Martin Fund Clinic located at the newly formed Mount Sinai Harlem Health Center. Key elements of this grant are to set up systems to support the development of strategies for community education, awareness, and demand generation that specifically address historical inequities in treatment access and uptake to LAIs.

TelePrEP TelePrEP increases accessibility to oral PrEP by providing an easy and convenient way to connect to a PrEP provider. Mount Sinai’s TelePrEP service allows clients to use a phone, tablet, laptop, or desktop computer to have a video visit with a licensed medical provider. Clients register through IAM’s TelePrEP website, complete a brief health inquiry, and then schedule an appointment with one of our providers for a video visit. Before clients begin PrEP, they have labwork completed in-person, including a blood test to determine that clients are HIV-negative. The provider conducts the video visit, and if PrEP is the right fit, we will mail the medication packaged discreetly within one week, and will automatically refill the prescription at the quarterly TelePrEP follow-up visits. Currently, insurance or Medicaid is necessary in order for the client to participate and receive PrEP without copays. IAM has established a PrEP Warmline (929-400-7739) for assistance with becoming insured.

We reduce HIV transmission in our communities and we improve health outcomes and quality of life for people with HIV. HIV Testing: • IAM’s community-based outreach efforts began to be reinstated in 2022, after a continued reduction in 2021 due to COVID-19. We began providing community-based outreach again, in addition to the innovative social media mechanisms and messages developed during COVID, to continue to successfully help thousands of diverse individuals with access to affordable prevention and sexual health services. • In 2022, we provided 5,395 rapid HIV tests.

Diagnosed with HIV and Living with HIV: • For those newly diagnosed with HIV, we provide immediate linkage to antiretroviral treatment per the state’s test and treat protocols. Programs are available to assist people with receiving care and treatment at low or no cost. • IAM provided medical services to 9,075 PWH in 2022. • IAM patients with HIV maintained an average viral load suppression rate of 90 percent. This helps those who are living with HIV to reduce their illness, maintain a healthy lifestyle, and live longer, while preventing further transmission to others. • New injectable HIV treatment is now FDA approved, and provided at IAM. We are developing policies and procedures to efficiently and optimally integrate this service into our clinic flow.

HIV Prevention for Those Who Are HIV-Negative: • We helped 1,272 individuals at risk for HIV receive pre-exposure prophylaxis (PrEP), which prevents HIV infection if taken daily. We provide assistance to underinsured or uninsured patients with accessing PrEP medications at low or no cost. • Injectable PrEP medication is also FDA approved, and IAM is developing procedures and policies, expecting to institute this service within the first half of 2023.

For Those Who Were Exposed to HIV: • We linked 1,411 people to post-exposure prophylaxis (PEP), which prevents HIV infection when taken after potential HIV exposure. We administer NYC and NYS’s 24/7 PEP Hotline, which links people to immediate or next-day PEP appointments, with access to free PEP starter packets.

Center for Transgender Medicine and Surgery (CTMS) Clinical Services: In 2022, just under 4,000 transgender and genderdiverse (TGD) patients were actively receiving gender-affirming medical care with Mount Sinai Health System providers. In addition, more than 800 gender-affirming surgeries were performed at Mount Sinai Health System hospitals. CTMS was launched in 2016, and is the most comprehensive TGD program in the country, serving patients of all ages. More than 8,000 TGD people have received gender-affirming care with us. CTMS medical services include adult primary care, adolescent medicine, adult endocrinology, pediatric endocrinology, plastic surgery, gynecology, urology, otolaryngology, and mental health services. Spiritual care is available as part of our comprehensive interdisciplinary approach to care for inpatient surgical patients. The CTMS Trauma Healing and Resilience Initiative for Transgender Survivors of Violence (THRIV) program provides trauma-focused, gender-affirming short-term therapy for TGD individuals who have experienced interpersonal violence, including sexual and intimate partner violence, childhood sexual abuse, trafficking, hate crimes, and community violence. During 2022, the CTMS primary care network of champion providers in the Mount Sinai Health System rose to 20 across multiple sites. Approximately 10 new patients start hormone therapy each week, and most patients receive surgery within 7-10 months from when they reached out to the CTMS program. We expect to reduce this time to six months. Education/Research: The CTMS training programs continued with the Mount Sinai LGBTQ fellowship, the dedicated CTMS plastic surgery fellowship, the CTMS psychiatry fellowship, and the CTMS Genitourinary (GU) fellowship. In addition, gender-affirming surgery continued as a core rotation for the Mount Sinai Plastic Surgery Residency, and gender-affirming hormone therapy continued as a core rotation for the Mount Sinai Endocrinology Fellowship program. The Mount Sinai free online course for primary care providers in transgender health care (www.coursera.org/ learn/transgender-medicine) was used by approximately 5,000 students worldwide in 2022. CTMS also had 20 presentations at the annual World Professional Association for Transgender Health (WPATH) conference that was held in Montreal, in addition to disseminating more than a dozen publications.

We provide clinical education to NYS medical providers on HIV primary care, HIV prevention, hepatitis C, and drug user health. During 2022, IAM’s Clinical Education Initiative (CEI) trained 6,442 clinicians (MD/DO, NP, PA, RN, PharmD, and other health care providers) through 123 clinical education activities. Funded by the NYSDOH AIDS Institute, CEI aims to improve statewide health outcomes through CEI’s free programming, including conferences, webinars, ECHO tele-mentoring sessions, trainings for organizations (in-person or remote), comprehensive preceptorship programs, CEI warmline, customized technical assistance, YouTube videos, podcasts, and clinical tools. In 2022, CEI partnered with 39 organizations throughout NYS to ensure far-reaching impact. In 2022, CEI hosted two conferences: The HIV Primary Care and Prevention Annual Conference, “Advancing the HIV Care Continuum: From Routine Testing to Optimizing Patient Outcomes,” with 385 participants in attendance; and the NYS Hepatitis C and Drug User Health Conference, “The Next Stage in Hepatitis C and Drug User Health Care: New Approaches for NYS Providers,” with more than 200 attendees. IAM operates two of CEI’s statewide Centers of Excellence: the HIV Primary Care and Prevention Center of Excellence and the Hepatitis C and Drug User Health Center of Excellence.

CEI Participants, 2022 Case/Care Managers, 1,141 Dentists, 48 Health Program Administrators, 425 Nurses, 1,141 Public Health Professionals, 480 Physicians, 1,081

Pharmacists, 407

Physician Assistants, 253

Nurse Practitioners, 852

Other/unknown, 903 Nurse Midwives, 37

Social Workers, 292

The HIV Primary Care and Prevention Center of Excellence (HIV COE) is a statewide clinical education program addressing HIV screening, PEP and PrEP, and HIV diagnosis and treatment. The HIV COE reaches primary care providers and other disciplines working in clinical settings, such as local health departments, community health, family practice, and emergency medicine. The HIV COE staffs the CEI warmline for clinical consultation for inquiries related to HIV treatment, PEP, PrEP, and maternal-infant exposure to HIV. In addition to providing clinical education on HIV primary care (e.g., screening, diagnosis, treatment, prevention, managing comorbidities, etc.), the HIV COE has created programming to respond to emerging topics, such as COVID-19, health equity, and racial justice. The Hepatitis C and Drug User Health Center of Excellence (HCV/DUH COE) serves as a statewide clinical education program to address both HCV and drug user health. The HCV/DUH COE establishes relationships and collaborates with primary care and other frontline providers, as well as substance use disorder, addiction and mental health clinicians. The COE prioritizes reaching upstate New York providers through collaborations with local departments of health, area health education centers, opioid treatment programs, clinics, and hospitals. The HCV/DUH COE also staffs the CEI warmline for case-based educational consultation on HCV clinical care and drug user health, and is committed to creating clinical education resources and training activities that promote health equity and address the ongoing stigma and discrimination faced by individuals who use drugs. From an HCV/DUH COE Preceptorship Program participant, “I can’t say enough about this program— I would recommend it to all my colleagues! It was a great opportunity to learn about harm reduction and buprenorphine prescribing from a total expert. I really enjoyed the virtual shadowing and learned a lot that I can take home and implement in my practice.”

IAM’s Work to Improve JUST CULTURE

Just Culture is a fair and just system of accountability that supports an organization’s values and reflects what we know about: • System Design > systems aren’t perfect • Free Will > people make choices • Our Inescapable Human Fallibility > people make mistakes It moves our paradigm from one of blame and punishment to one of understanding and accountability. “ The single greatest impediment to error prevention in the medical industry is that we punish people for making mistakes.” —L ucian Leape, MD, Professor, Harvard School of Public Health Source: Testimony before Congress on Health Care Quality Improvement

As leaders, we are accountable for:

Just Culture

• Continuously working to design systems that are safe from error

Support of System Values

Applies to Everyone Employees Managers Executives Senior Leadership

• Responding to employees after a safety event in a fair and just manner

Blame-Free Culture

Punitive Culture

As frontline providers, we are accountable for:

• The quality of our choices

• The reporting of errors (including our own) and potential system vulnerabilities that could lead to harm

Patient Experience IAM receives input and feedback from our clients in both formal and informal ways. These include patient satisfaction surveys, patient feedback surveys, feedback boxes at each of IAM’s clinics, and patient groups including those focused on specific populations (i.e., senior group). IAM’s Consumer Advisory Boards meet monthly or quarterly remotely for each of the five clinics and CTMS. This ensures continued valuable input and provides optimal patient and family involvement in assessing patient needs; designing, delivering, and evaluating services; and sustaining program improvements. Members consist of a cross representation of IAM’s patients, which include women, men, adolescents, and LGBTQIA patients of all ethnicities.

Patient Testimonials Patients provide positive feedback through post-appointment survey and letters of gratitude:

Patient at the Jack Martin Fund Clinic states, “I like the doctor. She listens to me and helps me find solutions to my medical issues. I really appreciate that because it is hard to find doctors who listen to you and help you in these current times.”

Patient from the Comprehensive Health Program at 275 7th Avenue states, “ Everything about Mount Sinai was more than I expected. I am very happy I have chosen you guys to be my medical professionals.”

Peter Krueger Clinic patient states, “Always is a pleasure to go to see the doctor and her team—for healthy, friendly environment and care. Thank you.”

Morningside Clinic patient states, “I love this hospital, and most of all I really love my doctor. She takes very good care of me; she shows me a lot of love and care. I recommend a lot of people to this hospital.”

Patient at the Samuels Clinic states, “My doctor does care about my health issues. He is a good listener, and understanding about my worries in health issues.”

Community Partnerships IAM has a successful history in collaborating and coordinating services for our targeted population via partnerships with community providers. Our active referral linkages with more than 60 agencies help connect patients with supplementary services that include housing, vocational training, food pantries, meals and vouchers, drug treatment and mental health services, legal services, support groups, and additional health services. IAM staff participate in numerous community-oriented groups that focus on planning and targeting HIV prevention, testing and treatment

services throughout NYC and NYS, and addressing the needs of priority populations. These include the New York State LGBT Health & Human Services Network (The Network), HIV Health and Human Services Planning Council of New York, NYC HIV Planning Group, NYS HIV Advisory Body, Public Health Solution Community Advisory Group, NY Knows, and NY Links. IAM continues to be heavily involved with the NYS HIV Medicaid Coalition to identify opportunities, educate and advocate, and generate best practices and lessons learned.

Continuous Quality Improvement IAM’s Continuous Quality Improvement (CQI) Program was established nine years ago to ensure that IAM achieves our vision to provide the highest quality of care to every patient, at every visit. CQI Program staff work closely with each clinic’s multidisciplinary teams to plan, assess, measure, and implement improvements in the coordination and delivery of quality care and services for all patients, across all clinics and programs. At the heart of our quality work is improving both patient experience and patient outcomes. IAM’s Quality Infrastructure (QI) is governed by a CQI plan, updated annually, that speaks to the goals and clinical focuses for each year, and the role that each team member plays, individually and collectively, to advance our quality initiatives. With a return to more normal operations post-COVID, the IAM team was able to continue, and expand upon, our high-quality service provision and commitment to quality improvement. IAMwide clinic and program QI projects in 2022 focused on raising performance in key clinical areas, including tobacco cessation, cervical cancer screening, colorectal cancer screening, hypertension reduction, care coordination efforts, STI screening, and, of course, viral load suppression (VLS). Our current IAM-wide VLS rate remains at 90 percent; outperforming the NYS Ending The Epidemic (ETE) goal of 85 percent. Each clinic’s team has made marked progress towards their QI goals, no doubt impacting the lives, health, and longevity of the patients we serve. We also recognize the importance of our patients and their involvement in our CQI efforts. During 2022 and beyond, we continue to expand our partnerships with each clinic’s Consumer Advisory Boards to further engage them in our CQI efforts, and to ensure that our clinical focuses align with the priorities of our patients.

Awards, Presentations, and Publications In 2022, IAM staff disseminated more than 20 publications, and provided more than 20 presentations at conferences, webinars, trainings, and media events throughout the world. In addition, our staff is involved in addressing HIV long-acting therapies, including long-acting injectables, functional cures, anal precancer in women, anal cancer and dysplasia, opioid prescribing, chronic pain, autonomic neuropathy, HIV-associated cognitive impairment, mpox, and PWH who have COVID-19. Conferences included: • New York State Hepatitis C and Drug User Health Annual Conference • New York State HIV Primary Care and Prevention Annual Conference • United States Professional Association for Transgender Health (USPATH)/World Professional Association for Transgender Health (WPATH) Annual Conference • University of Toledo • Queens College Safer Sex Pajama Party • 2022 Conference on Retroviruses and Opportunistic Infections (CROI) • International AIDS Society Conference 2022 • NYS DOH 2022 Ending the Epidemic Summit • Mount Sinai Health Systems Medical Students Presentation • NY Knows • NY Links Quality Improvement Conference, Schenectady, NY

Grant Portfolio $13.9 million in grants to support new and existing programs and approximately 68 percent of IAM staff.

In 2022, IAM received more than

Prevention Programs

Care and Treatment Programs

• PrEP

• HIV Primary Care

• TelePrEP

• Mental Health Services

• 24/7 PEP Hotline for NYC and NYS

• Linkage to Primary and Specialty Care

• PlaySure Network 2.0 – Status Neutral Testing and Navigation

• Food and Nutrition

• PrEP Navigation Specialist for Emergency Room Testing

• Harm Reduction/Project SHARE

$2.2 million

• Treatment Adherence • Hepatitis C Care and Treatment

• Beyond Diversity: LGBT Health and Human Services

• Dental Services • Coming Home Program

• HIV Prevention, Young Adult Sexual Services (YASS!)

• Geriatric Care for Older People with HIV • Psychosocial Support Services to TGNBNC

$6 million Care Coordination

• Enhanced Data to Care Services

Center for Transgender Medicine and Surgery

$4.2 million

• CTMS Pediatric and Adolescent Services • CTMS Trauma Health and Resilience Initiative (THRIV)

Clinical Education Initiatives

$1 million

• HIV Primary Care and Prevention Center of Excellence

$413,766

• Hepatitis C and Drug User Health Center of Excellence

We wish to thank the following funders for their contribution to our programs. Our work would not be possible without their support. • District Attorney of New York/CUNY Institute for State and Local Governance • Keith Haring Foundation • New York City Department of Health and Mental Hygiene/Public Health Solutions • New York State Department of Health AIDS Institute •

Substance Abuse and Mental Health Services Administration (SAMHSA)

• U.S. Department of Health and Human Services – Health Resources and Services Administration (HRSA) 19

Our Locations

Morningside Clinic Mount Sinai Morningside 440 West 114th Street Clark Building, 6th Floor New York, NY 10025 212-523-6500 Medical Director: Alexandra Abrams-Downey, MD

Jack Martin Fund Clinic The Mount Sinai Hospital 17 E. 102nd Street, 3rd Floor New York, NY 10029 212-241-7968

Medical Director: Rachel Chasan, MD

Samuels Clinic Mount Sinai West 1000 10th Avenue, Suite 2T New York, NY 10019 212-523-6500

Medical Director: Amarlis Lugo, MD

Comprehensive Health Program The Mount Sinai Hospital 275 7th Avenue, 12th Floor New York, NY 10001 212-604-1701 Medical Director: Antonio Urbina, MD

Center for Transgender Medicine and Surgery 275 7th Avenue, 12th Floor New York, NY 10001 212-604-1730 Medical Director: Joshua Safer, MD

Peter Krueger Clinic Mount Sinai Beth Israel 275 Eighth Avenue New York, NY 10011 212-420-2620 Medical Director: Tessa Gomez, MD

M a n h att a n 5 6 4

Connect with IAM To learn more about IAM, please visit our website and social media platforms at: Th e Bro n x

www.mountsinai.org/patient-care/iam www.facebook.com/InstAdvancedMed/ www.instagram.com/instadvancedmed/ twitter.com/instadvancedmed

Queens