2017 Year In Review

Year In Review

2017

...to enhance the well-being of the community through education and the promotion of public health.

From the Academy/DPHA leadership....

Reframing the Optics The Delaware Academy of Medicine / Delaware Public Health Association as a Service Organization The mission statement of the Delaware Academy of Medicine reads, “to enhance the well-being of the community through education and the promotion of public health.” That revised mission statement, became active in 2008 after approval by the full membership at its annual meeting. Considerable thought went into its adoption, and after ten years, it still aptly defines who we are and what we do.

In 2013, after another multi-year exploratory process, the Delaware Academy of Medicine took a major step in realizing the second part of our mission statement by becoming the state affiliate to the American Public Health Association. This gave us our new, longer name – the Delaware Academy of Medicine / Delaware Public Health Association. At each board and advisory council meeting, during countless conversations in between, and in our daily operations, we challenge ourselves to make a difference, and engage a diverse set of health sciences partners who share their strength, knowledge, and commitment.

We focus a significant portion of our effort and resources to benefit our community, as there are other healthcare membership organizations who prioritize the needs of their own membership. We honor those organizations’ significant contributions in the larger ecosystem of healthcare, public health, and population health in our state.

At this time, we reaffirm the service nature of our organization, and our mission to attract individuals and affiliates who share our passion and investment in the well-being of our community. Gone are the days when individuals and companies were members of the Academy of Medicine for library services and a place to meet. Today we are 500 strong and growing – authors, instructors, mentors, teachers, influencers, and visionaries. Our members are engaged with us, not just for what they can get from membership, but for what they can give through coordinated effort to change and improve the health and well-being of all Delawareans.

We invite you to reach out to your friends and colleagues, and ask them to join us. We welcome all those committed to a healthy Delaware!

Daniel J. Meara, MD, DMD President of the Board

Omar A. Khan, MD, MHS President of the Advisory Council

Timothy E. Gibbs, MPH, NPMc Executive Director

On the cover....

Kathleen McNicholas, MD, JD and Victor Battaglia, Esq, presenting the Lewis B. Flinn President’s Award to the Honorable Susan Del Pesco, Esq.; attendees at a Plan 4 Health planning meeting; student intern - Kadeija Griffin; Albert Rizzo, MD, presenting the Public Health Recognition Award to the American Lung Association of the MidAtlantic and CEO Deborah Brown, BS, MS; CKD project members; University of Delaware students with Victor Dzau, MD (President of the National Academy of Medicine) and Richard Killingsworth, MPH (Professor at the University of Delaware, and DPHA Advisory Council Member); Margot Savoy, MD and friends; S. John Swanson, MD; Victor Dzau, MD, Prayus Taylor, MD, and Timothy Gibbs, MPH; attendees of an Academy conference; board members (including past presidents Joseph F. Kestner, Jr, MD, William H. Duncan, MD, Arun V. Malhotra, MD, Joseph “Skip” Kuhn, MD, and Barry Kayne, DDS).

DELAWARE JOURNAL OF PUBLIC HEALTH

In the fall of 2015, we welcomed colleagues, professionals, students, and members of the public health community to the first edition of the newly developed publication of the Delaware Academy of Medicine/Delaware Public Health Association. The Delaware Journal of Public Health is an electronic publication released on a bi-monthly basis.

In 2017, there were 5,999 reads of the Journal, and over 114,836 impressions (each time the publication was displayed on social media or in an email). The Issu.com web platform allows us to track these metrics, as well as the number of times readers are following embedded links within articles to other resources, which has also increased. This tracking ability is a strategic advantage of an online publication over the traditional hardcopy format; despite this, we are considering a financial model that would support printing a limited number of hardcopy issues for distribution to libraries and other key partner locations.

The Journal is always freely available at djph.delamed.org. The Issuu.com publishing platform also supports download and print capability, and the ability to request a copy be printed and mailed to you for an additional cost.

In the five issues published during the 2017 calendar year, 118 authors contributed their expertise and perspectives.

Below, and on the following two pages, are the covers of these Journals and their Tables of Contents.

Delaware Journal of

Volume 3 | Issue 1

Public Health March 2017

A publication of the Delaware Academy of Medicine / Delaware Public Health Association

Diagnosis,Treatment, Prevention

of Chronic Diseases - Part 1 www.delamed.org | www.delawarepha.org 1

March 2017 Chronic diseases are responsible for the largest number of deaths in the United States each year, and many of these conditions are often preventable. Public health plays an important role in reducing the burden of chronic disease through the promotion of healthy lifestyles and the identification of environment factors resulting in these diseases. Increased efforts in chronic disease prevention will ensure healthier future generations and reduce growing costs associated with these diseases.

3 | In This Issue Omar A. Khan, MD, MHS; Timothy E. Gibbs, MPH; and Deb Brown, BS, MS 6 | Childhood Asthma in Delaware Zhongcui Gao, MS; Marlon Satchell, MPH; Danielle Haley, MPH; and Kristina Olson, MHS 10 | Asthma, a Comprehensive Clinical View Andrew Weinstein, MD 24 | Partners in Research: Developing a Patient-Centered Research Agenda for Chronic Kidney Disease Claudine Jurkovitz, MD, MPH; Sarahfaye Dolman, MPH, MTA; and Holly Archinal 32 | Cardiovascular Disease in Delaware Edward Goldenberg, MD; Elisabeth Bradley, APN; Denise Taylor RD; and Janice Anderson, MSN 36 | Arthritis and its Public Health Burden Guy S. Eakin, PhD; Kayla L. Amodeo, PhD; and Randeep S. Kahlon, MD 46 | Vaccines and Chronic Disease Katherine Smith, MD, MPH 54 | Cookfresh: Feasibility and Acceptability of Teaching Cooking Skills to Adolescents with Obesity Michell Fullmer, RD, LDN, CSP, CNSC; Mary M. Stephens, MD, MPH; P. Babu Balagopal, PhD; Karen Anthony, MS; and Sandra Hassink, MD, MSc, FAAP 62 | Diabetes in Delaware: What’s Social Support Got to Do with It? Madeline Brooks 66 | Teen Perceptions of Sexual Activity: Influences, Consequences, Realities, and Thoughts on Safe Sexual Health Practices Judith W. Herrman, PhD, RN, ANEF, FAAN 78 | A Primary Care Nursing Perspective on Chronic Disease Prevention and Management Cynthia D. Griffin, MS, RN, CPHQ, CCM 86 | The Role of Primary Care Physicians in Managing Chronic Disease Margot Savoy, MD, MPH, FAAFP, FABC, CPE, CMQ, FAAPL; Colleen HazlettO’Brien, DO; and Jamie Rapacciuolo, DO 94 | From the History & Archives Collection Brian W. Little, MD, PhD

P R O V I D I N G A V O I C E A N D P L AT F O R M

The peer-review publication dedicated to public health in Delaware.

P R O V I D I N G A V O I C E A N D P L AT F O R M

Delaware Journal of

Volume 3 | Issue 2

Public Health April 2017

A publication of the Delaware Academy of Medicine / Delaware Public Health Association

Diagnosis,Treatment, Prevention

of Chronic Diseases, Part 2 www.delamed.org | www.delawarepha.org 1 Delaware Journal of Public Health MARCH 2017

April 2017 Part 2 - Chronic diseases are responsible for the largest number of deaths in the United States each year, and many of these conditions are often preventable. Public health plays an important role in reducing the burden of chronic disease through the promotion of healthy lifestyles and the identification of environment factors resulting in these diseases. Increased efforts in chronic disease prevention will ensure healthier future generations and reduce growing costs associated with these diseases.

Delaware Journal of

Volume 3 | Issue 3

Public Health June 2017

A publication of the Delaware Academy of Medicine / Delaware Public Health Association

Special Section on Community Health Workers in Delaware

www.delamed.org | www.delawarepha.org

June 2017 The world’s oldest recorded case of cancer is from Egypt in 1500 BC, describing breast cancer. It states there is no cure, only palliative treatment. As today, Egyptian healers removed surface tumors. 3517 years later we have progressed significantly in the diagnosis, treatment, and understanding of cancer – but there is still much work to be done.

3 | In This Issue Omar A. Khan, MD, MHS, Timothy E. Gibbs, MPH, and Deborah P. Brown, BS, MS 4 | Center of Biomedical Research Excellence in Cardiovascular Health Megan M. Wenner PhD; Freda Patterson, PhD; Regina Wright PhD; Shannon Lennon, PhD; Melissa Witman, PhD, and David Edwards, PhD 12 | Community Perspective: A Comprehensive Approach to Building Healthy Communities Reverend Dr. T. S. Keeling 22 | Care Link in Action: Information Technology Enhanced Care Management Improves Clinical Outcomes and Lowers Costs in Chronic Disease and Episodes of Care Tabassum Salam, MD, FACP 28 | Understanding Type 2 Diabetes - Truth or Myth Leann Marcinek, MPH and Tricia Jefferson, RD, LDN 36 | A Public Health Response to Diabetes in Delaware through Partnership, Referral, and the Diabetes Self- Management Program Donald Post; Andrea Rodi, MBA; and Stephanie H. Belinske, MPH 42 | Strategies to Engage Community Partners in Research used by The Delaware Clinical and Translational Research, Accelerating Clinical and Translational Research Jennifer Passarella, BS; Heather Bittner Fagan, MD, MPH, FAAFP; Michael Rosenthal, MD; Omar Khan, MD, MHS, FAAFP; Carolyn Jenkins, PhD, RD, APRN, F.A.A.N.; Iman Sharif, MD, MPH, MS; Barret Michalec, PhD; Christopher C. Moore, BA, L.S.S.G.B.; and Peggy Geisler, BA 52 | Preventing Chronic Disease: The Vision of Public Health Karyl T. Rattay, MD, MS; Lisa M.G. Henry, MS; and Richard E. Killingsworth, MPH 58|Your Guide to Prevent, Test, and Treat and Chronic Disease Provided by the Delaware Health and Social Services, Division of Public Health 86|Chronic Disease Lexicon Terminology 95 |Local Resources Delaware Resources for Chronic Illnesses

3 | In This Issue Omar A. Khan, MD, MHS and Timothy E. Gibbs, MPH 4 | Cancer Care in Delaware: A National Model Nicholas J. Petrelli, MD, FACS 8 | Delaware Cancer Consortium Nicholas J. Petrelli, MD, FACS, and Heather Brown 10 | Improving Access to Cancer Genetic Counseling through Telegenetics – A Bayhealth – University of Pennsylvania Initiative Cara Cacioppo, Neeraja Reddy, Elisabeth M. Wood, Jan Jaeger, Demetrios Ofidis, Rishi Sawhney, Priya Singh, Kimberly Vidrine, Harriet Pinkston, John Shevock, and Angela Bradbury 14 | Commission on Cancer (CoC) CP3R Measures for Colon Cancer Evaluation of Delaware Cancer Registry Data Betsy Cromartie, MA, CTR; Bob Hall-McBride, CTR; and Zeinab Baba, DrPH, MS 20 | Nanoparticle-mediated Gene Regulation as a Novel Strategy for Cancer Therapy Nicole L. Kreuzberger, Jilian R. Melamed, and Emily S. Day. 26 | Development and Deployment of Community Health Workers in Delaware June 2017 74 | An Interview with Vicky Cooke Timothy E. Gibbs, MPH 80 | Timeliness of Breast Cancer Treatment in Delaware Stephanie H. Belinske, MPH; James Spellman, MD; Lisa Henry, MS; and Marjorie Shannon, M.S 88| The Nation’s Health Links - A publication of the American Public Health Association.

Provided as a courtesy to our readers in partnership with the APHA Nation’s Health Editorial Board June - July 2017 90 | Screening for Prostate Cancer David M. Bercaw, MD 96 | Community View Psychosocial Care for People with Cancer: The Cancer Support Community Model Sean M. Hebbel, LCSW, OSW-C 100 | Delaware Cancer Treatment Program (DCTP) Omar A. Khan, MD, MHS, and Timothy E. Gibbs, MPH 101 | The Delaware Cancer Consortium Retreat: The Role of Sport and Physical Activity in Cancer Prevention Kate Smith, MD, MPH 102 | Delaware Cancer Registry Regulations Brian W. Little, MD, PhD 103 | Cancer Lexicon of Terms 114 | Cancer Types 122 | From the History & Archives Collection 123 | Index of Advertisers

Delaware Journal of

Public Health

August 2017

A publication of the Delaware Academy of Medicine / Delaware Public Health Association

www.delamed.org | www.delawarepha.org

August 2017 Addiction and misuse of opioids (prescription and non-prescription painkillers, synthetic opioids, and heroin) has increased rapidly in the United States in recent years. Public health officials have cited this as one of the worst drug epidemics in history. Although new treatments have been created such as naloxone for overdoses, and suboxone, to ease withdrawal symptoms, there is no sign of the the end of the opioid epidemic.

Delaware Journal of 3 | In This Issue Omar A. Khan, MD, MHS and Timothy E. Gibbs, MPH 4 | Guest Editors’ Welcome Kerri Yandrich, MS and Jennifer de Mooy, MA 5 | From the Office of the Lieutenant Governor Bethany Hall-Long, PhD, RNC, FAAN 6 | Ozone pollution in Delaware: How does climate change influence ozone-related health?

Joseph F. Brodie, PhD; Cristina L. Archer, PhD; and Sara A. Rauscher, PhD 12 | The DHP Bulletin: Special Flu Edition 14 | Safeguarding Worker Health and Safety from a Changing Climate: Delaware’s Climate-Ready Workforce Pilot Project Yoon Kim, Kerri Yandrich, Jennifer DeMooy, and Kendall Starkman 24 | Woodshole Research Center: Climate Change and Health Phillip B. Duffy, PhD 32 | Health data for Delaware: the path towards creating Delaware’s Environmental Public Health Tracking Network Tabatha N. Offutt-Powell, Marcy Parykaza, Canio Caputo, and Richard Perkins 44 | Climate and Health in Maryland: The Maryland Climate Change Health Adaptation Program Allison Gost, Rachel Hess-Mutinda, Clifford Mitchell, and Amir Sapkota 52 | Climate Change: Vector-Borne Diseases and Their Control William H. Meredith, PhD and Stephen C. Eppes, MD 60 | Climate Change and Population Health Alan Greenglass, MD 70 | Climate and Health Resources 72 | Climate and Health Lexicon OF TERMS 74 | Index of Advertisers 75 | From the history and archives collection Kate Lenart, MA

Volume 3 | Issue 4

Volume 3 | Issue 6

Public Health

October 2017

A publication of the Delaware Academy of Medicine / Delaware Public Health Association

www.delamed.org | www.delawarepha.org

October 2017 The impact of climate change on health outcomes can be complex. Changes in climate can create new health problems (as well as exacerbate existing health problems) and are reliant on multiple factors. For example, inadequate housing in an environment with extreme temperatures, or living in an area with inadequate disaster management plans, can lead to negative health outcomes. Every American is at risk of being affected by changes in climate.

P R O V I D I N G A V O I C E A N D P L AT F O R M

4 | In This Issue Omar A. Khan, MD, MHS and Timothy E. Gibbs, MPH 5 | Guest Editor Terry Horton, MD 6 | The APHA PHACT Campaign in action in Delaware Katherine Smith, MD, MPH and Timothy E. Gibbs, MPH 12 | Reflections on the Opioid Abuse. Problem from a Delaware Perspective John Goodill, MD 16 | A Vision for the SUD Treatment System in Delaware Kara Odom Walker, MD, MPH, MSHS and Karyl Rattay, MD, MS 18 | The Department of Justice Focuses on Prevention and Treatment of Substance Abuse Matt Denn, Attorney General 20 | Informing Practice: A Review of Overdose Fatality & Drug Monitoring Initiatives in Delaware Rebecca Walker, PhD, JD, MSN 26 | The Delaware Opioid Epidemic Paul R. Silverman, DrPH; Jamie Mack; Frann S. Anderson, LCSW, CADC; and Karyl T. Rattay, MD, MS 36 | Heroin and Pain Irina Phillips, MD 42 | Medication Treatment for Opioid Use Disorders: A Brief Overview with Comments on Extended Release Naltrexone George Woody, MD 46 | Medication Assisted Treatment for Opioid Use Disorder Catherine Devaney McKay, MC, AADC 52 | Mitigating Post-Operative Dental Pain: as easy as 1, 2, 4, 24 Jason H. Goodchild, DMD; Mark Donaldson, BSP, ACPR, PharmD, FASHP, FACHE; and Nicholas R. Conte Jr., DMD, MBA 59 | Building a System to Prevent, Recognize, and Treat Substance Exposure in Infants Jennifer Donahue, Esq. and Emily Knearl, MPA 68 | Press Event of SB48 70 | Interview: Person in Recovery Rachel Rex 72 | Opioid Lexicon of Terms 81 | Prescription Drug Abuse 85 | Opioid/Addiction Resource Guide Delaware 91 | From the history and archives collection Kathyn Lenart, MA

DELAWARE MINI-MEDICAL SCHOOL In its tenth year, Delaware Mini-Medical School continues our mission of educating the public by sharing the expertise of local professionals in medicine and health. Designed for individuals who want to gain a deeper understanding of the world of medicine, Mini-Medical School is a six-week series of lectures for students and adults of all ages co-sponsored with the Christiana Care Health System. Attendees learn about important trends in diagnosing and treating illness and general health topics. Faculty provide in-depth lectures and allow time for questions to enhance the experience. There are no tests or grades. No previous medical training is required.

Participants who attend all six sessions receive a Certificate of Achievement. There is no cost to attend this series.

In 2017, each lecture attracted between 75 to 125 participants, some seeking guidance in career choices, others looking to make positive changes to improve their own health, and still others just wanting to learn more about advances in modern medicine. In addition to improving the public’s understanding of medicine, the series is aimed at encouraging middle and high school students to learn about medicine and health as possible career options. We also seek to address health literacy: the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

The 2017 series covered the following topics: • Christopher Mitchel, MD on Minimally Invasive Robotic Surgical Techniques in the Field of Urology • James Ellison, MD on Memory Care, Dementia or Cognitive Disorders that Affect Thinking and Memory • Neil Wimmer, MD on New Advances in Structural Heart Procedures (TAVR) • David Paul, MD on Infant Mortality in Delaware: Why has it been such a vexing problem? ( pictured below) • Omar Khan, MD on Global Health & Tropical Medicine • Jennifer Sims Mourtada, MD on Breast Cancer Translational Research

OSHER LIFELONG LEARNING INSTITUTE

In the Spring and Fall of each year, we are honored to provide the “Medical Lecture Series” at the Wilmington Campus of the University. Topics covered this calendar year included: Spring 2017 Fall 2017 Ophthamalic Trauma Holistic Dentistry Hearing Aids Medication Safety Blepharoplasty Medical Malpractice Complementary Medicine Carpal Tunnel Hearing Difficulties Oncologic Gynecology Retinal Disease Gene Editing

Ralph Milner, MD Lewis Yu, DMD Barbara Prestano, AuD Linsey Brandt, MD David Larned, MD Alan Fink, MD Robert Abel, MD Anthony Cucuzzella, MD Michael Teixido, MD Mark Cadungog, M.D Jason Kaplan, MD Eric Kmiec, PhD

Back Pain and PT Bone Health Dementia Kidney Transplant Migraines Cardiology Pelvic Conditions Human Subject Protection Neuro Intervention Future of Healthcare Becoming a Physician Adult Vaccines

Gregory Burton, APTA Brad Sandella, DO David Simpson, MD Velma Scantlebury, MD Michael Teixido, MD Kathleen McNicholas, MD, JD Babak Vakili, MD Brian Little, MD, PhD Barbara Albani, MD Janice Nevin, MD Jason Weinberger, DO Margot Savoy, MD, MPH

Each year, with the support of a fund established by the Hoopes Family (pictured), held at the Delaware Community Foundation, and in partnership with the Delaware State Dental Society, we are pleased to present the Frank M. and Robert R. Hoopes Medical/Dental Lecture. Frank Hoopes was ahead of his time in recognizing this need for medical-dental collaboration, a subject in which he was especially interested.

This year, Jeffery N. Rodney, DMD, FACP, a maxillofacial prosthodontist at Christiana Care Health System was the 2017 keynote speaker. Dr. Rodney cares for patients with defects or disabilities to the head and neck that were present when born or developed due to disease or trauma. The title of this year’s keynote was “The World of Maxillofacial Prosthetics.”

STROKE EDUCATION CONFERENCE Now in its 16th year, this annual conference honors the life and dedication of John Scholz, PT, PhD. Dr. Scholz was a highly regarded movement scientist renowned for his ability to take complex theoretical concepts of motor control and apply them to the understanding and treatment of neurologic problems.

Dr. Scholz was a professor of Physical Therapy at the University of Delaware, and, for many years, a member of the Board of Directors of the Delaware Stroke Initiative (DSI). This conference is jointly presented by the DSI and the Academy/DPHA. The 2017 conference covered the topics of Hemorrhagic Stroke, Stroke Caregiver Support, Opioid Use and Stroke, Migraines and Stroke, Stroke in Neonates, Standardizing the Stroke Recognition and Evalution Protocols, Transcranial Magnetic and Direct Current Stimulation Therapies, TIA Prevention & Treatement, How to Properly Use the NIH Stroke Scale, Rehabiliation for Vascular Dementia due to Stroke, and the Relationship Between Hypertension and Stroke.

MILITARY AND VETERANS MENTAL HEALTH SUMMIT In partnership with the Mental Health Association of Delaware and the Delaware Military & Veterans Suicide Prevention Coalition, we were honored to present the 2017 conference. Our participation in this conference is an outgrowth of our previous Military Medicine Symposia, which directly addressed some of the most pressing needs of our deployed armed forces and our veterans. This year’s topics included: Enlisted and Veteran Women’s Mental Health, Moral Injury and the clergy, CALM training, and The Journey of the Military Caregiver; the Battle that Begins After War. Pictured below, Call to Colors (left), Francis Graves award presentation to Daniel Young by Rocky Graves (right)

P R O F E S S I O N A L D E N TA L A N D M E D I C A L E D U C AT I O N

HOOPES MEDICAL/DENTAL LECTURESHIP

P U B L I C H E A LT H P R O G R A M S & E N G A G E M E N T

The mission of the ICD is to bring together local, state, and community organizations and individuals to promote education about vaccine preventable diseases and new vaccines, with the goal of improving access and vaccination rates throughout the lifespan.

The ICD works in partnership with its members and their organizations to advocate for policy issues related to childhood, adolescent, and adult immunizations; reduce disparities in adult access to immunizations; and to shape the healthcare process and outcomes for Delaware residents in relation to vaccine preventable disease.

In 2017, significant progress was made to expand the coalition’s reach throughout the state. Through health fairs, quarterly meetings, and electronic publications, news of the ICD is slowly reaching interested parties. There are currently 182 active members of the ICD representing local government; education; the industries of health care, pharmacy, pharmaceuticals, and insurance; and the general public who help expand the knowledge and need for vaccines in the State of Delaware (table 1).

The website of the ICD can be found at immunizedelaware.org, and it caters to healthcare professionals and the public alike. It offers links to immunization stories in the news, events planned by the coalition, and other immunization topics.

The public can use the ICD website to inform themselves about the importance of immunization across the lifespan, how vaccines are made, links to flu clinics and information about the Vaccines for Children program.

Providers gain access to many materials published by the Centers for Disease Control and Prevention (CDC) including vaccine information statements (VIS) and fact sheets, links to the Pink Book and the Delaware Department of Public Health, and continuing education opportunities. There is also information on Delaware specific immunization data, an information page about so-called vaccine conspiracies to help providers speak to their patients’ concerns, and best practices for administering and reporting vaccines.

Website metrics have been tracked since September, and there appears to be good traffic to the site (Figure 1).

In total 23,206 visits, 46,077 views, and 75,135 hits were recorded between September and December. A visit is recorded every time an IP address visits the website. Page view records how many times that particular page is viewed. A hit is recorded every time a request is sent to the server for a file (i.e. web pages, images, documents).

The coalition used an ICD table at the many health fairs throughout the state as one of its primary methods of outreach to both the public and health care providers. The table had brochures containing immunization recommendations throughout the lifespan, information on the different vaccines available, and an informed staffer to answer any questions that were asked. Providers had the option of becoming a member of the coalition and signing up for the ICD’s weekly newsletter at the table.

The ICD also made several presentations throughout the year, discussing its plans for education and outreach, and educating the public and health care professionals on several aspects of immunization current events.

In February, May, August, and November the ICD held a quarterly meeting, so that all the membership could discuss issues pertaining to immunization in Delaware and the nation as a whole, outreach to the population of Delaware, infectious disease throughout the world, and any regulatory issues or new recommendations in the news.

On December 8, the ICD was pleased to collaborate with the Medical Society of Delaware (MSD) and the Delaware Division of Public Health (DPH) on the second annual Communicable Disease Summit. This summit included information on the overall health of Delaware, and included topics like staphylococcus aureus infection, tuberculosis, understanding waterborne pathogens, antimicrobial stewardship, mumps and meningitis disease prevention, and the opioid epidemic. This year was the first year the ICD was a part of the planning committee and was able to assist in the logistics of the summit.

The State of Delaware Education

Health Care

Pharma, Pharmacy, and Insurance

Other

Institutions Department of Education Division of Public Health Delaware Technical and Community College Medical Society of Delaware School Districts (K-12) St. Edmonds Academy University of Delaware American Academy of Pediatrics Bayhealth Medical Center Christiana Care Health System Delaware Family Medicine Henrietta Johnson Medical Center Nemours/Alfred I. duPont Institute for Children Passport Health USA Westside Health Wilmington Veterans Affairs Medical Center AstraZeneca Highmark Blue Cross/Blue Shield of Delaware GlaxoSmithKline MedImmune Marck Pfiser Rite Aid Sanofi Pasteur Walgreens Cozen O’Connor Delaware Valley Outcomes Research Food Bank of Delaware Rose Hill Community Center WVMI (QID)

Figure 1. Website Metrics for Immunizedelaware.org

E L I M I N AT I N G VA C C I N E P R E V E N TA B L E I L L N E S S E S

Table 1. Immunization Coalition of Delaware Partners

P U B L I C H E A LT H P R O G R A M S & E N G A G E M E N T

PARTNERS IN RESEARCH: DELAWARE CKD ENGAGEMENT PROJECT The Academy/DPHA was once again honored to work in partnership with our colleagues at the Value Institute at Christiana Care Health System on Delaware’s only Patient-Centered Outcomes Research Institute (PCORI) Engagement Award.

The project aims to understand which outcomes and research questions patients, physicians, and payers are most interested in; what additional data would be important for Patient-Centered Outcomes Research (PCOR); and to solicit feedback on research designs, privacy issues, and data sharing in the context of PCOR. The Academy/DPHA provided dissemination expertise, conference planning, and support for this unique initiative.

The group held community meetings in January, March, April, and May to discuss PCOR, how registry data can be used for research, End Stage Renal Disease (ESRD) and end-of-life care, confidentiality, and safety of data.

It also disseminated three newsletters in February, May, and December discussing the importance of the project, the need for more research in this area, and information for patients with these diseases.

On World Kidney Day (March 9), the Partners in Research group, together with Henrietta Johnson Medical Center, hosted a day of free health screenings and a panel discussion featuring care providers and patients who answered questions and shared their experiences with kidney disease.

The main event of this research project was a full-day conference on September 15 at the Ammon Center at Christiana Hospital. Over 200 attendees heard presentations and discussions about patient and caregiver experiences, transitions of care for teenagers with CKD, treatment choices, shared decision-making, and exercise for patients with CKD or ESRD. Clockwise from top left: discussion group; S. John Swanson, MD at the podium; Q&A from the attendees; and Tracy Burton-Zigman and Tim Gibbs, MPH.

The Delaware Chronic Disease Collaborative is a program of the Academy/DPHA in partnership with the American Lung Association of the Mid-Atlantic that began in December of 2016 with an informational summit about chronic disease in Delaware. The Collaborative aims to provide patients with information about chronic diseases on a national and state-wide level.

The Centers for Disease Control and Prevention (CDC) reports that as of 2012, half of all adults (117 million people) had one or more chronic health conditions. One in four adults had two or more. Seven of the top 10 causes of death in 2014 were chronic diseases, and heart disease and cancer together accounted for nearly 46% of all deaths. During 2011 – 2014, more than one-third of adults and one in six youths were obese.

Studies have reported that more than 65% of Delaware adults had at least one of the 12 chronic conditions (angina, arthritis, asthma, cancer, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, high blood pressure, high cholesterol, myocardial infarction, obesity, or stroke) .

The website (dechronicdiseasecoalition.org) is updated to provide patients information on the different types of chronic disease, local and national statistics, definitions, and local resources as they become available.

The Collaborative also followed Dr. Kara Odom Walker, Secretary of the Delaware Division of Health and Social Services, as she mapped out and presented her 2017 Healthcare Benchmarking Agenda. The Inaugural Summit to Establish the Benchmark was held on September 7. Additional summits throughout the fall covered information about data analytics, governance and authority, legal and regulatory issues, and provider leadership. The final summit was held on November 7, wherein Dr. Walker presented all the information learned from the previous summits, and presented on the Healthcare Benchmark.

Delaware Statistics Number of Chronic Conditions Total Male Female White Black Hispanic < 65 â&#x2030;Ľ65 Kent New Castle Sussex

P U B L I C H E A LT H P R O G R A M S & E N G A G E M E N T

DELAWARE CHRONIC DISEASE COLLABORATIVE

PA R T N E R S H I P S I N P L A N N I N G

Delaware The Delaware Chapter of the American Planning Association (APA) and the Delaware Academy of Medicine/ Delaware Public Health Association have completed the final report in the Plan4Health Program. Funding for this project was provided through an award from the Centers for Disease Control and Prevention (CDC) at the state level.

The Plan4Health program strives to combat two determinants of chronic disease: lack of physical activity and lack of access to nutritious foods. By working with local coalitions and communities, the Plan4Health program promotes the inclusion of health and public health planning in non-traditional sectors.

According to County Health Rankings, Kent County has the highest rate of obesity in the State of Delaware, despite being the least populated. The county also contains multiple food deserts, has the fewest miles of off-road trails in the State, and its residents engage in regular physical activity less frequently than residents of New Castle or Sussex Counties. The timing of the comprehensive plan updates for Kent County and Dover were leveraged to integrate land use, design, and policy guidelines incorporating health and health equity, and improved opportunities for healthy living.

Dover and Kent County communities were consulted during the planning process via a survey identifying needs relating to increasing healthy food availability and accessibility, and physical activity opportunities (walkable neighborhoods, park access, etc.). The Plan4Health team then conducted a health and equity analysis to identify priority areas relating to health food access, walkability, bike-ability, and parks/open space. Finally, two 3-day planning charrettes were conducted in priority areas (a rural area of the county, and an urban part of Dover) for targeted interventions.

Results from these planning sessions, surveys, and analyses allowed planners to recommend policy and programming changes to: -

Increase the affordability and availability of healthy foods,

-

Enhance transit options,

-

Increase parks and open space, and

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Create and enhance walkable and bike-able infrastructure.

Planners also utilized the Comprehensive Plan Score Card previously developed by Nemours Health and Prevention Services and their partners. The Score Card allowed the Plan4Health Team to recognize areas within Kent Countyâ&#x20AC;&#x2122;s and Doverâ&#x20AC;&#x2122;s comprehensive plans that are amenable to improving health when linked with planning decisions.

The final report for Kent County, Guidance for Incorporating Health into Kent Countyâ&#x20AC;&#x2122;s Comprehensive Plan, was completed in October 2017 and can be found at: http://deplan4health.org. The report documented suggestions for incorporating health equity and health data into comprehensive plans for the county; recognized the health value of utilizing alternate forms of transportation (walking, biking, etc.) and the park system; recommended adding healthy food systems planning to normal operations; and promoted the economic value of healthy communities.

In 2012, the Delaware Academy of Medicine initiated a pilot program to provide a highly customized internship program for a variety of age and educational stage learners. In 2017 and early 2018, we hosted two interns to learn with us.

Kadeija Griffin, a native of Rochester, NY, prospective graduate (BA in Biological Sciences) of the University of Delaware and an aspiring physician; chose Neonatal Abstinence Syndrome (NAS) as her study focus. She started with learning about the Kellogg Foundation Logic Model (used to aid in program design) then worked on a literature review and annotated bibliography on NAS. Through this, she complied a series of pertinent studies, interviewed key figures involved in this topic (including Christiana Care physicians), and observed newborns suffering from this syndrome. Kadeija hopes to utilize the data collected to complete this project and have it peer-reviewed for publication in the upcoming months.

Matt McNeill, a native of Wilmington, DE, is completing his Bachelor of Science in Health Behavior Science, with a minor in Public Health from the University of Delaware. He recently finished an internship with the Delaware Academy of Medicine/ Delaware Public Health Association in March 2018, working primarily on evaluating policy statements submitted to the APHA for revision. He also helped organize a Texting and Driving Simulator event at the University of Delaware during National Public Health Week. Matt has been working with the Success Won’t Wait organization for over a decade, a non-profit organization that holds book drives, cleans the donated books, and redistributes them to schools, libraries, prisons, and our overseas military.

Global Health The Christiana Care Health System’s Global Health Curriculum, with the support of the Delaware Academy of Medicine, the Delaware Public Health Association, and the Delaware Academy of Family Physicians, is an interdepartmental collaboration between the Departments of Medicine and Family Medicine, and the Med-Peds Residency Program, to encourage education and interest in the Global Health Field. The 2017 curriculum included the following lectures: • • • • • • •

A Case Study of the Rwanda Health and Healing Program Migrant & Seasonal Agricultural Workers Program - Health for the Hands that Feed Us Cardiovascular Medical and Surgical Care in Vietnam Introduction to Global Health Refugee Healthcare in Our Community Obstetrics and Gynecology - Practicing in a Resource-Poor Environment and Tools for Success Climate Changes Health - Global Impact

C U LT I VAT I N G T O M O R R O W ’ S P R O F E S S I O N A L S

INTERNSHIP PROGRAM

ALIGNING CHOICE AND CARE PROVISION

The DMOST form is the end-product of communication between a patient and/or their authorized representative, and their medical practitioner. This communication ensures informed medical decisionmaking and the honoring of a patient’s preferences regarding life-sustaining medical procedures such as cardiopulmonary resuscitation (CPR). The DMOST form is a single, standardized document that functions as an actionable medical order and is portable through all health care settings. The DMOST form and program are based on recommendations from the National Physician Orders for Life Sustaining Treatment (POLST) program: the form and online training module can be found at delawaremost.org.

In 2017, significant progress was made towards the goal of educating and informing both the professionals and the public in the state of Delaware. Over 2,800 pink DMOST envelopes were requested in 2017 for use in private offices and acute care settings. Additionally, the Delaware Health Information Network (DHIN) entered into a contract with VYNCA to implement an electronic DMOST registry and electronic version of the DMOST form.

There were 130 learners utilizing the online training module in 2017, and 301 learners attended live training sessions. When added to the 489 people trained on the DMOST form in 2016 (342 online and 147 live), a total of 920 people have been trained on the DMOST form since its inception. Thirty-eight people took additional training to allow them to train others on the DMOST form and procedures.

Each facility is responsible for developing a DMOST policy that works best with their current standard of practice. These policies refer to EHRs, DMOST education and accountability, and the updating and integrating of DMOST forms.

The DHIN began implementing an electronic registry with the help of VYNCA, a corporation that has successfully implemented similar online Advance Directive and POLST registries in other states. In order to more accurately match patients, the DMOST form was updated to include more demographic information.

At the same time, Section E was reworded to clearly allow patients to allow or dis-allow their authorized representative to change their DMOST form if the patient loses capacity (Figure 2). The DMOST program manager will continue to work with both DHIN and VYNCA to train users throughout the state on the e-Registry and e-Form as they become available. Once the registry and e-Forms are available to healthcare providers, previously completed paper forms will be scanned and uploaded.

The DMOST form helps individual professionals trained in its use to honor a patient’s end-of-life decisions, but more training and education is needed to get all healthcare facilities in Delaware to take up the effort.

Education on the form will also continue for the public – both patients and caretakers alike – to allow for quality end-of-life discussions and clear instructions for a patient’s goals of care.

All of the many stakeholders of this program have expressed their approval of the DMOST program as a tool for increasing provider/patient communication, standardizing end-of-life treatment options, and giving patients more control over their final wishes. There are barriers to the use of the DMOST form throughout the state, especially concerning the education about and training on the use of the DMOST form. With ongoing training in both the professional and public sectors, and the upload of the DMOST form to the DHIN, these barriers may no longer be an issue, and many more citizens of Delaware may be able to use the DMOST form to guide and standardize their end-of-life treatment decisions.

L E A D E R S H I P A N D A DV I S O RY C O U N C I L S ACADEMY BOARD OF DIRECTORS Officers Daniel J. Meara, MD, DMD President Omar A. Khan, MD, MHS President-Elect Victor L. Gregory, DMD Vice President S. John Swanson, MD Treasurer Arun V. Malhotra, MD Immediate Past President Timothy E. Gibbs, MPH, NPMc Executive Director, Ex-officio and Acting Secretary Directors David M. Bercaw, MD, At-Large Member Stephen C. Eppes, MD, At-Large Member Cynthia A. Gabrielli, DO Chair, Student Financial Aid Committee Eric T. Johnson, MD, At-Large Member Joseph F. Kestner, Jr., MD, Bylaws Committee Brian W. Little, MD, PhD, Chair, History and Archives Committee Kathleen W. McNicholas, MD, JD, Personnel Committee Joseph A. Napoli, MD, DDS, At-Large Member John P. Piper, MD, At-Large Member Ehtasham Qureshi, MD, At-Large Member Albert A. Rizzo, MD, Chair, Program Committee

EMERITUS MEMBERS OF THE BOARD Robert B. Flinn, MD Barry S. Kayne, DDS Leslie W. Whitney, MD

INVESTMENT ADVISORY COUNCIL Scott Gates Martin G. Mand, MBA Richard L. Laird, Jr., MC, BA H. Rodney Scott ASSET MANAGEMENT Brown Advisory

DPHA ADVISORY COUNCIL Omar A. Khan, MD, MHS President Timothy E. Gibbs, MPH, NPMc Executive Director, Ex-officio Louis E. Bartoshesky, MD, MPH Gerard Gallucci, MD, MSH Richard E. Killingsworth, MPH Erin K. Knight, PhD Melissa K. Melby, PhD Mia A. Papas, PhD Karyl T. Rattay, MD, MS Margot L. Savoy, MD, MPH William J. Swiatek, MA, AICP

STUDENT FINANCIAL AID The Academyâ&#x20AC;&#x2122;s Student Financial Aid program was established in 1961 to help encourage Delaware students to study medicine and dentistry. To date, over 300 students have received close to $2 million in loans. While the Academy has funds to support both medical and dental students, we have only received applications from medical students for the past several years.

The program is self-sustaining in that the loans are given based on the amount of money collected annually from the students after they graduate. The maximum loan amount was increased to $10,000 in 2016 to help with the rising costs of tuition. According to the American Medical Association, most medical/dental students come out of school an average of $170,000 in student loans. To relieve some of the debt burden, repayment doesnâ&#x20AC;&#x2122;t begin until one year after they graduate and interest rates are kept lower than most government and private loans.

The Delaware Academy of Medicine approved $60,000 in loans for 6 Delaware students studying medicine in 2017. Of the 6 students, 5 are enrolled at Sidney Kimmel Medical College and 1 at the Philadelphia College of Osteopathic Medicine.

Our 2017 graduates enrolled in residencies at Thomas Jefferson University Hospital in Philadelphia, PA, Barnes Jewish Hospital in Melvin Blanchard, MD, Montefiore Medical Center in New York, NY, and New York Presbyterian/Columbia Medical Center in New York, NY. About 25% of our loan recipients return to practice medicine and dentistry in Delaware after residency.

Any student interested in applying for a loan can submit an application to the Academy by May 15th of each year. To be eligible, students must be Delaware residents enrolled in medicine or dentistry at an accredited graduate school.

Funds are made available through endowments established by doctors, dentists, and other benefactors. The Delaware Academy of Medicine has six separate funds specifically for the purpose of issuing student loans. Operations manager, Liz Lenz, oversees the SFA loan program as well as the rest of the Academy/DPHA finances.

D E L AWA R E ACADEMY of MEDICINE

Suite L10, 4765 Ogletown Stanton Road Newark, DE 19713 302-733-3900 www.delamed.org www.delawarepha.org