Taking Health Care to the Streets / Illinois Medicine magazine

volume 20

A publication of the University of Illinois College of Medicine

number 1

summer 2017

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Inspired Education. Innovative Research. Impassioned Patient Care.

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Constellations of

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Clinical and educational transformation starts with a single spark

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Rockford and Peoria campuses impact rural care, pediatric cardiology and beyond

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Partnering to bring health, housing to homeless

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Julius Richmond feted as 2016 COM Pioneer in Medicine M4s open up next step in medical training on Match Day

clinical urban impact story by Susan Reich photos by Lloyd DeGrane

TAKING HEALTH CARE TO THE STREETS

Through innovative outreach and education ef for ts,

UI Health and the College

of Medicine are tackling some of Chicago’s most urgent urban health challenges

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ore than 1,200 Chicagoans will be unsheltered tonight,

according to a survey report from the Nathalie P. Voorhees Center for Neighborhood and Community Improvement at the University of Illinois at Chicago.

Chicago Coalition for the Homeless statistics show that 44 percent to 60 percent of the city’s homeless suffer from mental illness and 25 percent to 38 percent grapple with substance-use disorders. Many have undiagnosed traumatic brain injuries or cognitive impairments.

Homelessness is also the single greatest risk factor for a significantly reduced lifespan. The average life expectancy of a chronically unsheltered individual is 53 years, according to the report, “Healthcare and Homelessness,” published by the University of Illinois Hospital & Health Sciences System.

Given these statistics, it’s easy to see why homelessness is a health hazard—or a social determinant of health. While homelessness is a much bigger problem than any single hospital or health system can solve, the College of Medicine and UI Health are playing leadership roles in the citywide effort to meet the immediate health care needs of this vulnerable population.

Meeting the Homeless on Their Terms and on Their Turf IN MARCH 2016, COM student Joshua Smith happened across a newspaper article about Jim Withers, MD, who has treated the homeless on the streets of Pittsburgh for 25 years. Inspired by the article, Smith reached out to The Night Ministry, an organization that provides medical care and supportive services for Chicago’s homeless. In May, he began to accompany The Night Ministry’s Health Outreach Team to a South Loop field, where more than 70 city residents were living in a state of chronic, unsheltered homelessness.

The human cost of homelessness was immediately apparent to the first-year medical student as he walked through the field, introducing himself to the inhabitants of the makeshift tent city, listening to their stories and administering to minor medical needs. But it was not long before Smith—a dual degree candidate in medicine and public health—also recognized the staggering societal cost of providing health care for the city’s homeless.

“Some of these people had been living on the streets for 10 to 20 years, and they had become so marginalized by society that they no longer felt welcome in our world,” he says today. “This fear of institutions made them less likely to seek out primary or preventive care.

Whenever a health care need arose, they chose the most accessible and most expensive option: the emergency departments of the city’s safetynet hospitals.”

Smith began to wonder if a Chicago street medicine program staffed by medical students could deliver more consistent care for less

COM students Joshua Smith (above, left, attending to a homeless man) and Brandon Collofello (pictured with flashlight on opposite page) were inspired to connect with The Night Ministry to address health the issues of Chicago’s homeless population.

money, while building relationships with the unsheltered homeless and restoring their trust in the health care system.

When he broached the topic during a steering committee meeting at UIC’s Student Run Free Clinic, his thoughts about street medicine captured the imagination of fellow COM student Brandon Collofello.

“Josh and I bonded over a common passion for serving the underserved and helping this vulnerable population,” says Collofello. “We saw that there was an enormous, unmet need—and we wanted to do something about it.”

Soon, Smith and Collofello were teaming up for street rounds with The Night Ministry and brainstorming ideas for a student-run street medicine program that would bring compassionate, cost-effective primary and preventive care to Chicago’s homeless “on their terms and on their turf,” as Smith has called it.

As their dream began to take shape, Smith—who was enrolled in the Patient-centered Medicine (PCM) Scholars Program at the College of Medicine—turned to PCM program director and associate head of family medicine Memoona Hasnain, MD, MHPE, PhD, for advice, assistance and oversight.

The idea resonated with Hasnain, who agreed to serve as a faculty mentor for the students as they roughed out the program and applied for grant funding.

“I am happy to help Josh and Brandon shape the street medicine program, and we will be working closely to operationalize it and design and gather impact data after the program’s launch,” she reports.

“We have also discussed the possibility of integrating the program into our PCM Scholars curriculum.”

From Hasnain’s perspective, the street medicine program is a natural fit for a PCM Scholar.

“The PCM Scholars Program has been training students in the

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Enrolled in the COM’s Patientcentered Medicine Program, Smith and Collofello recently received grant funding from the Arnold P. Gold Foundation and the department of family medicine to cover startup costs for student-led street rounds.

unique area of care for the homeless and other vulnerable populations since 2007,” she notes. “Our goal is to foster the development of leaders and change agents who understand the value of compassionate and humanistic care, taking into account the social determinants of health.

We try to teach our students to balance the art and science of medicine with public health priorities, so that they can address the needs of Chicago’s diverse and evolving patient populations and develop multidisciplinary approaches to complex health care problems.”

This spring, Smith, Collofello and Hasnain celebrated their first Chicago Street Medicine milestone: an Arnold P. Gold Foundation grant with matching funds from the department of family medicine to cover startup costs.

With funding in hand and more than 20 medical students lined up to help them address some of the health care needs of Chicago’s unsheltered homeless, Smith and Collofello will be moving forward with their first student-led street rounds this summer.

From the Hospital to a Home WHILE SMITH AND COLLOFELLO are taking health care to the streets, UI Health, through the department of emergency medicine’s Better Health Through Housing (BHH) program, is helping chronically homeless Chicagoans achieve stability—and better health—by getting them off the streets and into homes of their own.

Here’s how the program works: UI Health, which committed $250,000 to help launch the pilot in 2015, pays Chicago’s Center for Housing and Health $1,000 per month to house and provide supporting services for each chronically homeless patient. The Center for Housing and Health, in turn, partners with social service agencies to help the patients furnish their apartments, manage their money, set up medical appointments, access mental health services or addiction treatment, and obtain other services that enhance their health and well-being.

A housing initiative for the homeless may seem a little off-mission

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for a department of emergency medicine—until you consider the backstory. That story begins with Chicago’s emergency room “super-utilizers”— patients who each account for more than seven emergency room visits annually. According to a 2017 report on Healthcare and Homelessness issued by UI Health, 45 percent of the top 100 emergency department super-utilizers are homeless, and 80 percent of their trips to the ER could have been avoided if their health care needs had been managed in an outpatient setting.

While many of these homeless patients are in legitimate need of care, others land in the ER out of sheer desperation. At an average cost of $1,000 per ER visit, that’s a steep price to pay for a warm bed and a hot meal. Contrast that with the daily cost of $57 per patient to provide permanent supportive housing, and that’s money well-invested. With little or no follow-up care between ER visits, health care for the homeless is not only expensive, but fragmented and often inefficient.

“As providers of emergency care, we are at the interface between the health care system and the community,” says Terry Vanden Hoek, MD, chair of the department of emergency medicine. “This gives us a unique perspective—and a unique opportunity to use what we see in the ER to help us think about how to improve the health care system and address unmet needs in the community. Housing is one of those unmet needs.

Through our Better Health Through Housing pilot, we have provided housing and supportive services for approximately two dozen chronically homeless patients. The bottom line is that their health is better, and the cost of their care is substantially lower. We are now working with other hospitals in the Chicago area to help them set up similar programs.”

So far, outcomes have been promising: The cost of care for the first 15 patients enrolled in the pilot decreased by 42 percent while the number of hospital visits dropped by 34 percent. Stephen Brown, MSW, LCSW, project director for BHH, who leads the department’s Preventive Emergency Medicine initiative, notes that the homeless are some of the most expensive patients in health care. “We’ve found 575 patients who are homeless, and 32 percent are in the highest cost decile, with annual costs that are 15 to 40 times our average annual patient costs,” he says.

The Better Health Through Housing program, led by Terry Vanden Hoek, chair of emergency medicine (white coat, at left), and Stephen Brown, project director and head of the Preventive Emergency Medicine Initiative, has greatly improved the health prospects of formerly homeless individuals like Glenn Baker (above), who now has a place to call home thanks to the project.

Many are very sick, too, with uncontrolled chronic diseases such as hypertension, asthma, diabetes, COPD and heart failure. “We’ve been surprised to find high rates of traumatic brain injury, and head and neck cancers,” says Brown, “and their average life expectancy is 25 years less than the average American.”

“Traditionally the health care industry has focused on ‘curing’ people during episodes of sickness,” says Avijit Ghosh, PhD, CEO of UI Health. “As a result, homeless patients tend to make repeated visits

to the emergency room or the hospital. Better Health Through Housing is trying to break that cycle by providing some of these patients with a stable living environment.”

For more information about Better Health Through Housing, visit go.uic.edu/Better-Health-Through-Housing.

Select photography by Lloyd DeGrane was supported by a grant from the Social Justice News Nexus at the Medill School of Journalism, Media, Integrated Marketing Communications.

CARDIAC CRUSADERS

Illinois Heart Rescue is taking cardiac resuscitation to the streets It can happen in a heartbeat. Someone next to you collapses and stops breathing—at home, in the workplace or on the street.

Caused by an electrical malfunction in the heart that disrupts the flow of blood to the brain and other vital organs, sudden cardiac arrest can kill within minutes—and lost time can mean lost lives.

According to the American Heart Association, nearly 90 percent of those who suffer from an out-ofhospital cardiac arrest don’t survive—and only 46 percent get the immediate help they need to have any chance. In many Chicago neighborhoods, the odds of getting immediate help can be below 10 percent.

Since 2012, Illinois Heart Rescue has been working to improve these outcomes by strengthening three critical links in the chain of survival: bystander CPR, pre-hospital resuscitation by emergency medical personnel, and post-arrest hospital care. Led by UI Health and funded by a $2.5 million grant from the Medtronic Foundation, Illinois Heart Rescue is achieving these goals by offering free instruction in bystander CPR, providing simulation training for EMS providers and 911 dispatchers, working with hospitals to improve post-cardiac-arrest care, and addressing at the policy level disparities in survival rates.

With a goal of doubling sudden-cardiac-arrest survival rates throughout the state, Illinois Heart Rescue is offering free CPR training at events large and small at locations throughout Chicago, including homeless shelters, domestic abuse shelters and other organizations that serve the public.

“Immediate CPR, performed by a bystander, is the best chance a person has of surviving a sudden cardiac event,” says Terry Vanden Hoek, MD, chair of the department of emergency medicine at UI Health and the project leader for Illinois Heart Rescue. “We’re reaching out to every Illinois resident because everyone deserves the best care, no matter where they have their cardiac arrest.”

— Susan Reich

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