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TEMPLE UNIVERSITY HOSPITAL

COMMUNITY BENEFIT REPORT


A Letter to the Community Temple University Hospital was founded in 1892 as Samaritan Hospital, with just 20 beds and a mission of providing care to low-income residents of its surrounding North Philadelphia neighborhood. Our mission has guided us through 127 years of health care innovation and service. Today’s Temple University Hospital is a 732-bed acute-care, non-profit academic medical center that trains the next generation of physicians and provides a comprehensive range of medical and psychiatric services to patients throughout our community, Southeastern Pennsylvania and beyond.

Michael A. Young, MHA, FACHE President & CEO, Temple University Hospital

You might be surprised by today’s Temple University Hospital: for example, we performed 144 lung transplants in 2018—the most of any hospital in the nation, and for the second consecutive year—with patients coming not only from our immediate community, but across Pennsylvania and the nation for our cutting edge services, including Florida, South Carolina and Washington DC . They could have gone anywhere, but they came here where all of our patients get that same world-class care—right here in our North Philadelphia neighborhood. Among our recent distinctions is also the achievement of Magnet status from the American Nurses Credentialing Center, a prestigious recognition of quality nursing care, community commitment and staff dedication bestowed upon only 8% of U.S. health care organizations. We are also an indispensable health care provider in America’s largest city without a public hospital. Among Pennsylvania’s full-service safety-net providers, we treat the highest volume and percentage of patients covered by Medicaid. We amplify our impact through local partnerships and programs that actively engage community stakeholders to ensure our services effectively meet residents’ greatest needs. This report summarizes these programs and highlights some of our many success stories. We embrace and are humbled by our extraordinary responsibility as the leading healthcare provider in one of the nation’s most underserved regions. As we continue to serve our community, we are especially thankful for all of those whose talented efforts and sustained support make our important work possible.

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Michael Young, MHA, FACHE President & CEO, Temple University Hospital


NOTABLE FACTS & FIGURES: TEMPLE UNIVERSITY HOSPITAL

COMMUNITY BENEFIT BREAKDOWN Total

$167,000,000

CHARITY CARE & UNDER-REIMBURSED MEDICAID $63 million

Last year we handled:

COMMUNITY HEALTH IMPROVEMENT

$1.5 million

HEALTH PROFESSIONS EDUCATION SUPPORT

$82 million

130,530

SUBSIDIZED HEALTH SERVICES

$11 million

COMMUNITY BENEFIT CASH & IN-KIND

$7.7 million

COMMUNITY-BUILDING PROGRAMS

$2 million

FY 2018 IRS 990 Schedule H

Emergency Department visits

2,360

Trauma activations

11,547

Psychiatric Crisis Response visits

$500 Million

400+

Community benefit programs engaged in last year

Salaries, wages and benefits

Surgical procedures

4,500

Organ transplants

Employees

160,000

Community members served through free programs

14,677

260

Volunteers

347 300

Burn Center patients

2,488

Babies delivered

$63 Million Charity care and under-reimbursed Medicaid

$1.7 BILLION TOTAL ECONOMIC IMPACT Community benefit describes programs, services, education and research subsidized by Temple University Hospital that do not generate inpatient or outpatient revenue and are carried out for the express purpose of improving community health. Community benefits meet a specific community need, reduce health disparities, are broadly available to the public and provide government relief by improving access to health services for underserved individuals. Sources: page 5

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OUR PATIENTS & COMMUNITY PATIENT PROFILE

COMMUNITY SNAPSHOT

Temple University Hospital cares for many medically complex patients who rely on government programs for healthcare coverage.

Our services are especially important to residents of our diverse, economically challenged North Philadelphia neighborhood.

HEALTH INSURANCE

86%

covered by government health programs

CHRONIC DISEASE

70% suffer from one

or more chronic conditions

BEHAVIORAL HEALTH

41%

have a behavioral health diagnosis

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POPULATION

462,455

40%

46%

Medicare

Medicaid

AGE

POVERTY LEVEL

53%

45%

live below 100% federal poverty level

50 or older

LANGUAGES

14% do not speak English as primary language

POVERTY LINE

FAMILY Hola

Nǐ Hǎo

78% of children live in

a single-parent household


HEALTH DISPARITIES Residents of our North Philadelphia service area experience many health disparities due to the social and economic inequality they face.

LIFE EXPECTANCY *In years

EDUCATION

67.5 76.6

DISEASE RATES *Per 100,000 population

64%

CANCER MORTALITY

North Philadelphia

250.3

achieved a high school education or less

176.4

UNEMPLOYMENT

National Average

OBESITY

40%

of adults

HEART DISEASE MORTALITY

24%

of children

88.6

23%

DIABETES

62.5

are unemployed

19%

NEW HIV DIAGNOSIS

of adults, almost 2x national average of 10%

40.6 16.6

RACE BLACK

75.9 81.8

46%

HISPANIC

30%

WHITE

18%

North Philadelphia

HYPERTENSION National Average

Sources (pg 3-5): 2017 Community Health Assessment of the Philadelphia Department of Health, North District Siegel, R., Ma, J., Zou, Z. and Jemal, A. (2014), Cancer Statistics, 2014, CA A Cancer

ASIAN/PACIFIC

4%

Journal for Clinicians, 64: 9-29. doi:10.3322/caac.21208

OTHER

2%

TUH Internal Data Sources

42%

of adults compared to 31% national average

National Vital Statistics Reports, Vol. 66, No. 4, Year 2013. *Percents rounded to nearest whole percent

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OUR PROGRAMS Temple University Hospital’s community benefit programs address the social determinants of health affecting health outcomes in our North Philadelphia neighborhood. Whether improving access to healthy food, connecting homeless patients with housing assistance, providing residents job training, or offering substance abuse treatment for those battling addiction, we are responding to the social and economic challenges causing health disparities in our community. This section describes a small sample of the over 400 programs we engaged in last year and highlights how we have improved the lives of those we serve.

400+

Community benefit programs engaged in last year

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MOTHERS & NEWBORNS In partnership with government agencies and external foundations, Temple University Hospital nurses are leading several programs that provide a comprehensive and coordinated approach to pre and postnatal care and education.

 ll new mothers receive a free Baby Box that A provides babies a safe place to sleep.

SAFE-T Program Making a Difference  emple delivered over T 2,400 babies last year.

Prenatal Education: All our expectant mothers receive counseling on pre-natal nutrition and other topics to promote healthy pregnancy. We provide free childbirth classes covering labor and delivery techniques, breastfeeding basics, postnatal recovery and newborn needs. Our free yoga classes help expectant mothers with stress reduction, fitness, breathing and overall wellness. Breastfeeding Education: As a Baby-Friendly USA designated “Baby Friendly” birth facility, our obstetrical team members are trained to provide evidence-based lactation education proven to improve infant health. We encourage new mothers to initiate breastfeeding within one hour of birth and educate on breastfeeding maintenance and benefits of breastfeeding on-demand.

North Philadelphia has one of the highest infant mortality rates in the nation. Many babies are born to young mothers living in poverty who lack resources to care for a newborn. To address these issues, the Sleep Awareness Family Education at Temple (SAFE-T) program educates new moms and families about safe infant sleep during a baby’s first year. Families also receive free “Baby Boxes” – functioning bassinets that come complete with a sheet, mattress and essential baby supplies. These provide babies a safe place to sleep and reduce the dangerous practice of co-sleeping, in which parents and babies share the same bed.

SAFE-T reduced bed sharing by 25%

Temple’s Pediatric research team found participation in SAFE-T reduced bed sharing by 25% during babies’ first eight days of life. For exclusively breastfed infants, this was reduced by 50%.


Infant Mortality

A Career Dedicated to Mothers and Babies

Our service area’s 11.9* infant mortality rate is nearly 2x the 6.0 national average

For three decades, Clinical Nurse Specialist Cheryl Selden-Klein has cared for new mothers and babies at Temple University Hospital. It’s a mission born of her own experience when she became a new mother herself.

*Per 1,000 live births

Source: 2017 Community Health Assessment of the Philadelphia Department of Health, Average North and Lower North Districts

“I enjoyed my childbirth education class and could see myself doing that,” says Selden-Klein, an Assistant Nurse Manager in the hospital’s Labor and Delivery Unit. “I also contrasted the care provided to me by two of my nurses—one who was great and one who wasn’t so great. I wanted to be like the first nurse for my patients.” Over the decades, Selden-Klein has educated and cared for tens of thousands of new mothers and babies. A particular passion of hers is breastfeeding education.

4,900+ mothers & babies

served by SAFE-T last year

1,800+ mothers

received in-depth breastfeeding education last year

“It’s the single most important thing you can do to impact the future health of your baby,” she says. “I don’t just talk to new moms about it, I also tell aunts and grandmothers to encourage it because they have great influence.” After 30 years, Selden-Klein’s time at Temple can be measured in generations. It’s not uncommon for her to care for new mothers whom she helped bring into this world. And when it’s eventually time to call it a career? “Even when I’m not officially working anymore, I’ll be involved in some way with mothers and babies,” she says. “It’s what I do.”

 heryl Selden-Klein has been C educating new moms about the importance of breastfeeding for over 30 years.

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OBESITY & FOOD INSECURITY Due to limited access to fresh food, members of Temple University Hospital’s community suffer from many serious diet-related health conditions. We collaborate with local community organizations and governmental agencies to create programs that decrease food insecurity and improve access to nutritional food. Food Insecurity Screening: Following hospital discharge, our Community Health Workers screen patients for food insecurity. Those identified as food insecure are referred to the Supplemental Nutrition Assistance Program (SNAP), food banks and other resources that provide access to affordable, nutritious food. Farm to Families: This program brings fresh, low-cost produce to our hospital for families in North Philadelphia. Community members may use SNAP benefits and a “prescription” from a Temple doctor to purchase local fruits and vegetables on a weekly basis. We also provide instruction on food preparation and invite families to cooking demonstrations.

27% of patients

are food insecure

PATIENT SUPPORT SERVICES We offer a wide range of patient support services that augment our ability to provide high-quality, culturally competent care. Linguistic and Cultural Services: Our 373 77,000+ language proficient bilingual staff, who we interpretations train and credential, perform thousands conducted last year of interpretations annually. This unique program, known for its excellence, is one of many resources we provide to non-Englishspeaking patients and families. We also assist other area hospitals that call on us to adapt our linguistic services module to their patient populations. Financial Services: Working within and beyond hospital walls, our team of 34 financial counselors is dedicated to helping uninsured patients get coverage. For patients ineligible for insurance, we offer a sliding-scale self-pay schedule or our Charity Care Program. Social Support Services: We connect thousands of patients with community-based supports each year, including free transportation, legal assistance, housing, and clothing. We also assist with free pharmaceuticals, waived co-pays and medical supplies that provide vulnerable patients the resources they need to heal after discharge.

Every week, area residents pick up boxes of fresh produce at Temple University Hospital 8 | COMMUNITY BENEFIT REPORT


DISEASE & CARE MANAGEMENT

Community Health Workers:

A Lifeline for Those in Need

Patient care is not confined to our hospital walls. Through partnerships with government agencies and numerous community organizations, Temple University Hospital provides many programs which enhance care coordination and reduce readmissions by helping patients and caregivers manage medical conditions at home.

Elizabeth Negron says she doesn’t know what she would do without Temple Community Health Worker Ivette Pratts. Elizabeth’s son, Luis, is lucky to be alive. After being shot 10 times, he spent months in the hospital and then rehab. His medical care remains overwhelming, especially for a single mother whose first language is Spanish.

Temple Care Transitions: Our Community Health Workers and Nurse Navigators identify patients with complex social and medical health issues through intakes conducted in the hospital, community and by telephone. They also assist with scheduling appointments, coordinating transportation, obtaining home support, and educating patients on how they can manage health issues and avoid future hospitalization.

During a hospital readmission for Luis, Elizabeth was introduced to Ivette. In her role as a Community Health Worker, Ivette helps patients and families navigate today’s complex healthcare system to reduce preventable ER visits and hospital readmissions.

Real World Diabetes Education: Our Certified Diabetes Educators provide personalized counseling in Spanish and English, on causes of diabetes, monitoring blood sugar levels, insulin pump use, reading food labels, meal planning, cooking and healthy restaurant dining. We offer this at four convenient community based locations in North and Lower-Northeast Philadelphia.

Elizabeth says that Ivette, who speaks fluent Spanish, has been a godsend, helping her navigate everything from medical insurance issues to doctors’ appointments. “Ivette is the first person I call when I have a question about my son’s care,” she says.

Diabetes Prevention Program: This 12 month program serves adults diagnosed with pre-diabetes and gestational diabetes and those at risk for type 2 diabetes. Diabetes Educators focus on weight loss and increasing physical activity to prevent disease onset. Topics include healthy eating, weight and stress management, understanding food labels and more.

Diabetes Prevention Program participants lost an average of 6% of their body weight

 ommunity Health Worker Ivette C Pratts helps families navigate the complex healthcare system with personal interaction and home visits.

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BEHAVIORAL HEALTH Behavioral health is a major concern in Temple University Hospital’s service area. More than 25% of adults in our surrounding community and 41% of inpatients have a mental health diagnosis. Many of our patients also suffer from comorbid substance abuse and mental health conditions.

Mental Health Training: Our staff members provide hundreds of hours of free training annually to community-based providers and non-profit organizations on topics such as patient safety and mass casualty response.

Our Episcopal Campus is home to Temple’s behavioral health services, including a Crisis Response Center that handles over 11,000 psychiatric emergency visits each year. As state mental health facilities have closed in recent decades, Episcopal is a key provider of long-term psychiatric care for patients whose length of stay can be measured in years.

Community Education: Our physicians and staff provide communitybased education on seeking help for depression, suicidal behavior and other mental health issues. We are proud to partner with Michael’s Giving H.A.N.D. (Handling Anxiety Navigating Depression), which engages teenagers at area high schools.

As demand for comprehensive behavioral health and substance abuse services grows, we are increasing access and coordinating care across our community. Support Groups: Our Episcopal campus is home to free support groups for patients and family members affected by mental health issues, as well as those fighting addiction. Adopt-a-Patient: Each December, staff members “adopt” patients in our long-term psychiatric unit. During an annual holiday party, employees provide patients gifts to boost their emotional and social health.

 emple psychiatry residents T regularly speak about risk factors during suicide-prevention presentations for teachers, students and families at area schools.

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41%

of inpatients cases include a behavioral health diagnosis


COMBATTING THE OPIOID EPIDEMIC Temple University Hospital is on the front lines of the opioid crisis, serving neighborhoods with among the highest opioid mortality rates in the Commonwealth of Pennsylvania. Through multidisciplinary patient care, innovative education programs, and cutting-edge addiction and pain management research, Temple is a leader in addressing opioid abuse and addiction. Recovery Overdose Survivor Project: In partnership with the City of Philadelphia, this project’s Certified Peer Recovery Specialists link overdose patients and their families with needed services and provide follow-up 48 hours after treatment in our Emergency Department or Crisis Response Center. Comprehensive Opioid Respite Center: We are working with Philadelphia’s Office of Homeless Services to establish a 40-bed respite center to address homelessness among opioid users.

Breaking the Cycle of Addiction

Opioid-Related Mortality *Rate per 100,000 people

Temple’s service area has the highest number of opioid-related deaths in Philadelphia 37.9 53.7 31.7 26.7

22.5 18

34.5

75

44.1 15.4

61.5

25.9 23.4

105.1

19.1 56.7

Source: 2017 Community Health Assessment of the Philadelphia Department of Health, Lower North, North and Riverward Districts

Pennsylvania Coordinated Medication-Assisted 15.1 Treatment Program (PAC-MAT): With support from the Commonwealth, we are expanding medicationassisted treatment programs to several community based sites throughout Philadelphia using multidisciplinary care teams and social supports. With Temple’s Department of Family Medicine’s TRUST Clinic (Temple Recovery Using Scientific Treatment) central to this “hub-and-spoke” model, we are coordinating services among our emergency departments, local health centers, physician offices and outreach organizations.

After 48 years of battling addiction, Jonathan Coleman Jr. found the help he needed from a Temple physician. Coleman was only 14 when he was introduced to heroin on the playground. He was instantly hooked.

Jonathan Coleman Jr. is drug free with the help of a Temple physician.

In 2016, at the age of 62, Coleman began seeing Dr. David O’Gurek at Temple University Hospital. Dr. O’Gurek runs a program that uses medications to help people break the grip of opioids. As the primary healthcare provider in North Philadelphia, Temple treats more patients battling addiction than most other institutions.

Today, Coleman has reclaimed a life that was nearly destroyed by drugs. For Dr. O’Gurek, his calling to addiction medicine is one he sums up simply. “You’ve got to become part of the solution and not continue to be part of the problem.”

Temple Center for Excellence Opioid Treatment Program: In partnership with the Commonwealth, we are providing pregnant women battling opioid addiction prenatal consultation and substance abuse treatment and counseling. Through this Center for Excellence, we are integrating behavioral health, primary care, and evidence-based medication-assisted treatment. COMMUNITY BENEFIT REPORT | 11


VIOLENCE PREVENTION Violence is a major problem in Temple University Hospital’s North Philadelphia community, which has one of the highest homicide rates in the nation. Our trauma center also treats over 400 penetrating wound victims each year. We have taken a 360-degree approach to addressing gun violence through a variety of prevention and intervention programs. Cradle to Grave: This award-winning program guides teenagers through the life and death of a 16-yearold gunshot victim, including meeting our clinical trauma team and visiting the morgue. Turning Point: To reduce the chance of retaliation and reinjury, this program connects gunshot victims with personal counseling, employment placement, and housing assistance within 48 hours of hospitalization. Fighting Chance: Temple physicians and nurses train community members on how to provide basic first aid to victims of firearm and other traumatic injuries.

Reducing Violence among Youth Homicide Mortality *Rate per 100,000 people

Temple’s service area has one of the highest homicide rates in the nation North Philadelphia National Average

0

46.6 4.9 20

50

Source: 2017 Community Health Assessment of the Philadelphia Department of Health, North District

980 teenagers reached by

Cradle to Grave last year

400+ gunshot & stab

victims treated last year

Ed Turner was a brash 16-year old when he participated in Temple University Hospital’s awardwinning Cradle to Grave program. Nine years later, what he saw and learned that day still sticks with him.

 d Turner’s participation in E Cradle to Grave positively influenced his life trajectory.

“It’s very different talking about violence and actually seeing the effects of it – it was a turning point in my head,” he says. “The program made me think twice about arguing with someone and making bad choices. It’s better to just walk away.” Today, Turner is director of transportation for a childcare center and recently launched his own side business. Together with friends, he also started a basketball league as a way of engaging kids and keeping them off the street. Through the program, he hopes to pass on some of the same messages he learned at Temple years ago.

Trauma Outreach Coordinator Scott Charles and Chief of Surgery Dr. Amy Goldberg walk students through the life and death of a 16-year-old gunshot victim.

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WORKFORCE DEVELOPMENT & ECONOMIC IMPACT With an annual budget of $1 billion and about 4,500 employees, Temple University Hospital is a major employer in Philadelphia and key driver of the region’s economy. Each year, we pay out about $1 billion in employee salaries, supply purchases and other expenses. This produces an estimated total $1.7 billion economic impact and yields a total of about 8,000 jobs in the region. In addition to serving as one of the city’s largest employers, we have partnered with many local organizations to offer workforce development programs for our community members. Community Health Workforce Program: In partnership with District 1199C Training and Upgrade Fund, we connect union members, Medicaid beneficiaries, unemployed workers, welfare recipients and many other community members to skills training in nursing, behavioral healthcare, childcare, health IT and other healthcare workforce career pathways. This program reinforces skills with confidence for continued participation in an ever-changing healthcare workforce. Training Tomorrow’s Healthcare Professionals: Temple University Hospital is the primary teaching site for the Lewis Katz School of Medicine at Temple University, where hundreds of physician residents and fellows come for specialized, postgraduate training. Upon completing training, many set up practice in our region and across Pennsylvania.

Community Health Workers:

Training Those with a Passion for Helping Others After years of working at a “boring bank job,” Jannette Cruz finally found a career where she feels at home. Through Temple’s Community Health Worker Training Program, Cruz was trained as a Community Health Worker (CHW), a position where she now serves as a liaison between patients and their doctors, helping to improve patient health self-management to reduce ER visits and hospital readmissions. “I grew up in a tough neighborhood, so I know the needs of the community,” Cruz says. “I wanted a job where I could help people and this is it.” As a CHW, she spends most of her day visiting patients in their homes, removing barriers they may face, and making sure they have the support needed to stay healthy. “When you see people at home, you get a whole different picture than our doctors and nurses get in the hospital,” says Cruz, who is one of three Spanish-speaking CHWs at Temple. “Patients face challenges with finances, transportation, childcare, housing and food.”

Over $82M invested in Health Professions Education last year

“It’s so fulfilling to help someone. Being a Community Health Worker is the best job I’ve ever had.”

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AT YOUR SERVICE VOLUNTEER INTERN PROGRAM “At Your Service” is an innovative and award-winning program that provides undergraduate students with invaluable learning and professional experience in a healthcare setting, while simultaneously helping Temple University Hospital patients. Piloted in 2014 with 15 interns, the program has grown to encompass more than 100 students each semester. Interns, who come from multiple states and countries and speak dozens of languages, participate in rounding across inpatient and outpatient units to assist with non-clinical patient needs. When an issue comes to their attention, interns coordinate with the care team to address the patient’s concern in real time. In this way, they strengthen staff responsiveness and improve patient satisfaction. Through this symbiotic program, our patients benefit from the company of caring volunteers who help with their healing during their hospital stay.

15,430 hours of

service provided last year

74,950 patients

served last year

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Interns come from 7 states, 25 countries, 29 fields of study and speak 24 languages

186 interns

last year

Helping Hands, Listening Ears Two weeks into her long stay at Temple University Hospital, Kendra Jones missed her children and was ready to sign herself out against medical advice. That’s when an intern from the hospital’s At Your Service program stopped by her room with a newspaper. “She remembered I liked to read a newspaper each day…I couldn’t believe it,” Jones says. “I feel like I made a connection with her and the other students who stopped by every day. I’ve talked to them about school and life in general. They really care.” One of those interns is Alexander Serraton-Cazeau, a junior biochemistry major at Temple University who volunteers in the program twice a week. Serraton-Cazeau helped Jones set up her Wi-Fi on her phone and also answers call bells, brings people water or reading materials and, often, just spends time talking to patients. “The interns have a passion in their heart for us,” Jones says.

Interns like Alexander Serraton-Cazeau get real-world experience in the hospital while interacting with patients daily.


Our Partners

STAFF COMMUNITY ENGAGEMENT Temple University Hospital employees spend thousands of hours each year serving individuals and community organizations. Activities range from providing free health screenings and collecting clothing and food to volunteering at homeless shelters and educating 18,500+ students at schools. Through events employee hours sponsored by organizations such as the provided to American Heart Association, United community last year Way, and Gift of Life Donor Program, staff members  raise much needed funds for charity every year.

Temple University Hospital values its many Temple University and federal, state and local government partners that make our community benefit programs and services possible: ■■ ■■

 e provide over 120 full meals W to families during our annual Thanksgiving food drive.

■■

■■ ■■

■■

■■

■■

 n “ugly sweater” party garnered A donations of 125 breastfeeding pillows for new moms.

Temple’s Adopt-a-Family program demonstrates our employees’ generosity at the holidays.

■■

■■

 ur Surgical Team prepared dinner for organ transplant  O patients and families at the Gift of Life Family House.

 emple employees participate in T numerous fundraising events each year.

Temple University Health System Temple Center for Population Health Lewis Katz School of Medicine at Temple University Temple Physicians, Inc. Temple University Physicians Faculty Practice Plan Temple University Institute for Survey Research District Council 1199C Training & Upgrade Fund U.S. Department of Health & Human Services and other federal agencies Commonwealth of Pennsylvania’s Departments of Health, Human Services, Aging and other agencies. City of Philadelphia’s Departments of Health, Behavioral Health & Intellectual Disability Services, Housing and other agencies.

We also thank the many communitybased organizations whose passion and commitment to our vulnerable communities cannot be understated. COMMUNITY BENEFIT REPORT | 15


Serving the community since 1892

Temple Health refers to the health, education and research activities carried out by the affiliates of Temple University Health System (TUHS) and by the Lewis Katz School of Medicine at Temple University. TUHS neither provides nor controls the provision of health care. All health care is provided by its member organizations or independent health care providers affiliated with TUHS member organizations. COMMUNITY BENEFIT Each TUHS member organization is owned and operated pursuant to its governing documents.

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Profile for Temple Health

2019 Community Benefit Report - Temple University Hospital  

Temple University Hospital's community benefit programs address the social determinants of health affecting health outcomes in our North Phi...

2019 Community Benefit Report - Temple University Hospital  

Temple University Hospital's community benefit programs address the social determinants of health affecting health outcomes in our North Phi...