2016-2017 DOCS Annual Report

MITCHELL WOLFSON, SR.

DEPARTMENT OF COMMUNITY SERVICE (DOCS) ANNUAL REPORT 2016-2017 Academic Year

A

THANK YOU

FOR A SUCCESSFUL YEAR

Thank you to our many donors this year and in years past with particular thanks to the Mitchell Wolfson, Sr. Foundation. With your continued support we are able to provide healthcare services to the members of our South Florida community.

We would also like to acknowledge the incredible work of our students. As a completely student-run organization, we depend on medical students of all years to plan and work all of our clinics, fairs, and other projects.

Miller School of Medicine students have such a sense of generosity and willingness to give back to the community we live and work in. We are also lucky to have site partners and vendors in each community we serve, who work tirelessly to ensure our programs are as successful as they can be.

Within our own institution, we are also thankful for the interprofessional partners who collaborate with us fair after fair. Additionally, we would like to extend a special thanks to our DOCS mom, Raysa, who provides outstanding assistance to our projects and keeps a smile on all of our faces!

Finally, thank you to our tremendous physicians and faculty, including our faculty advisor Dr. Amar R. Deshpande, who donate their time to helping the community and educating our students. Your assistance is invaluable and essential to providing care to those without adequate access.

Joshua Kronenfeld

Executive Director, MS4

CONTENTS OUR ORGANIZATION

1

DOCS CLINICS

5

DOCS HEALTH FAIRS

9

HEALTH FAIR AND CLINIC PLANNING/LOGISTICS/FOLLOW UP

17

MEDIA AND OUTREACH

25

INTERPROFESSIONAL EDUCATION (IPE)

27

NEW TO DOCS THIS YEAR

30

OTHER DOCS PROJECTS

32

RESEARCH PROJECTS

34

REGIONAL MEDICAL CAMPUS (RMC) DOCS

36

FUTURE GOALS

39

CONTACT INFORMATION

40

OUR MISSION DOCS, enlisting the participation of students and physicians of the University of Miami Miller School of Medicine (UMMSM), is dedicated to providing preventive and primary health care to the underserved populations in South Florida through:

Leadership

Fostering students’ leadership abilities among peers, patients, and the community.

Training

Providing formal training and practical experience for students to demonstrate proficiency in clinical skills.

Education

Realizing the importance of not only educating ourselves but also our patients and the communities in which we live.

PAGE 1

OUR STORY

... SO FAR

Starting with a single health fair in Big Pine Key in 1971, followed by the creation of several health fairs throughout South Florida over the next 3 decades, DOCS was ultimately established in 2001 as a student run, non-profit organization endorsed by the UMMSM administration under the direction of Dr. Mark T. O’Connell. In 2006, DOCS received a generous donation and was officially renamed the Mitchell Wolfson, Sr. Department of Community Service.

In the 2016-2017 year, DOCS brought health screening and educational services to over 2,500 patients through the volunteer efforts of nearly 550 medical students and over 210 physicians. DOCS holds annual fairs in 10 different underserved communities in Miami-Dade, Monroe, and Broward counties. We also operate 2 student-run free clinics that provide primary care as well as specialized services and treatments. We screen for the most prevalent diseases in our community including hypertension, diabetes, dyslipidemia, vision loss, mental health, osteoporosis, obesity, and depression, as well as colon, breast, cervical, and skin cancers. Using a referral system of free and reduced-cost clinics, we also emphasize continuity of care and follow up services by acting as a portal of entry into the health care system for those patients identified to be at risk. We also have a Palm Beach chapter at our regional medical campus (RMC DOCS).

PAGE 2

OUR YEAR...

IN NUMBERS 1865

1,000+

2312

HEALTH FAIR PATIENTS SEEN

CLINIC PATIENTS SEEN

PHYSICIAN HOURS DEDICATED TO THE COMMUNITY

Over our 10 health fairs, we have reached numerous underserved communities throughout South Florida and in the Florida Keys.

PAGE 3

In our 2 weekly clinics, San Juan Bosco and Lotus House, students and volunteer physicians have provided numerous specialty and primary care services to patients in the local Miami area.

Our committed physician volunteers have spent significant time across our health fairs and clinics in supporting the medical education experience while screening the underserved populations of South Florida.

Our students have also spent countless hours applying their clinical skills in serving the community.

...AND CONTINUING TO GROW Health Fair Patient Counts over the past 5 years 1865 1696

1312

1468

2012

2013

2014

1510

2015

2016

PAGE 4

CLINICS

PAGE 5

PAGE 6

LOTUS WELLNESS CENTER CLINIC (LWCC) Serving homeless women and children

Lotus House is a resource facility serving homeless women and their children afflicted by domestic violence, medical or mental illness, disability, or economic insecurity. Up to 100 women and 50 children reside at Lotus House at a time with the goal of empowerment through a holistic approach. Lotus House provides transitional housing and wrap-around support with a wide range of services from job training and placement to medical and mental health services.

This has been an exciting year for Lotus House and the Lotus Women’s Wellness Clinic. Lotus House has started work rebuilding its campus to allow for increased space to host additional women and their families. In addition, the new Lotus campus will house a day clinic that will provide pediatric, primary, specialty, psychiatric and overall wellness care services to guests of the shelter and members of the community. As a clinic, we have been working closely with Lotus House to support them through this transition and ensure we can continue to provide high-quality care to guests and members of the community during our weekly clinic. As the Zika outbreak emerged in Miami in 2016, we helped provide free access to insect repellant and have provided education about Zika and Zika prevention to our patients and clinic staff.

We have continued to serve the transgender community through our quarterly transgender clinic.

We also continue to work to improve and streamline our referral process to local community clinics so our patients can establish ongoing relationships with primary care providers. We have recruited psychiatrists to our volunteer physician staff in response to a specific request by Lotus House and are starting a program of regular psychiatric specialty nights.

Our staff also had several poster presentations involving different aspects of our clinic operations accepted to the Society of Student Run Free Clinics Conference held in February 2017 in California. We are excited to continue working to improve the experience and health of our patients at Lotus House and are so grateful for the support that our clinic has received.

Another honor Lotus recently received was a nomination for an HIV Testing and Linkage to Care award, awarded by the Florida Department of Health to community agencies, counselors, volunteers and peers for exceptional performance in responding to HIV/AIDS. DOCS would like to extend a special thanks to Constance Collins, Rai Johnson, and Anna Frusciante for all their kindness, hard work, and support!

PAGE 7

SAN JUAN BOSCO CLINIC (SJB)

Serving low income patients with specialty care

San Juan Bosco is our second clinic and cares for patients at 200% or below of the federal poverty level. Our services include laboratory and diagnostic testing services provided at no cost to SJB patients. The clinic operates every Tuesday night and rotates through eight different medical specialties including primary care, cardiology, gastroenterology, pulmonology, urology, neurology, rheumatology, and psychiatry.

SJB has had a great school year. The first year staff members quickly picked up their new roles, and it was great to have fresh minds looking for ways to improve SJB. We have several projects currently ongoing. The first is a quality improvement project led by Michael Freedman, MS4.

The team is currently surveying patients to gauge their satisfaction with clinic nights and will eventually use this information to improve their experience. The second project is connecting patients with community resources, led by Sarah Simko, MS2 and Heather Farthing, MS2. They have developed a tool on REDCap (a data collection research tool) that connects patients with resources in their community based on needs reflected in survey responses.

With funds from our donors, we were able to purchase a copy machine for clinic nights, which we use to copy documentation from the Department of Health. We also purchased analgesic injections for patients seen on Rheumatology clinic nights. The donations also are used to purchase food to support medical students and physicians working a clinic night that typically runs from 5pm until 10:30pm. Finally, we also purchased additional blood pressure cuffs for use in both the SJB and Lotus House Clinics. DOCS would also like to extend a special thanks to Berta Cabrera, Marta Villalta, and Luz Gallardo for helping our students and ensuring our patients receive the best care!

PAGE 8

HEALTH FAIRS

PAGE 9

PAGE 10

LITTLE HAITI LITTLE HAITI HEALTH FAIR

DOCS

Mitchell Wolfson Sr. Department of Community Service

Students collaborate with the Center for Haitian Studies to offer health screening to the underserved population living in Little Haiti. It was held on October 1, 2016.

At the LHHF, we piloted our new Electronic Health Record and fecal immunochemical test (FIT) for colon cancer screening. We continued Hepatitis C testing after our pilot last year and saw 350 patients, performed 35 Pap smears, handed out 41 FIT kits, and drew 175 lipid panels.

We saw 107 patients, performed 18 Pap smears, handed out 20 FIT kits, and drew 62 lipid panels.

Students collaborate with the West Hialeah Baptist Church to offer health screening to an underserved and mostly Hispanic population. It was held on October 22, 2016.

HIALEAH HIALEAH

HEALTH FAIR

DOCS

PAGE 11

Mitchell Wolfson Sr. Department of Community Service

UPPER KEYS

UPPER KEYS HEALTH FAIR

DOCS

Mitchell Wolfson Sr. Department of Community Service

Located at a school in the Upper Keys, this fair provides health screening to Key Largo, Tavernier and Plantation Key residents. It was held on November 12, 2016.

We saw 75 patients, performed 5 Pap smears, handed out 40 FIT kits, and drew 53 lipid panels.

We saw 115 patients, performed 26 Pap smears, handed out 18 FIT kits, and drew 72 lipid panels.

This fair serves Homestead, Florida City, and surrounding rural communities and takes place at the Branches Community Center. Our target patient population includes migrant and low-income workers and their families. It was held on December 3, 2016.

SOUTH DADE

SOUTH DADE HEALTH FAIR

DOCS

Mitchell Wolfson Sr. Department of Community Service

PAGE 12

MARATHON

FLORIDA KEYS HEALTH FAIRS

DOCS

Mitchell Wolfson Sr. Department of Community Service

This fair is part of the Florida Keys Health Fairs and takes place at Fisherman’s Hospital on Marathon Key. It was held on January 28, 2017.

We saw 125 patients, performed 12 Pap smears, handed out 66 FIT kits, and drew 84 lipid panels.

We saw 132 patients, performed 11 Pap smears, handed out 73 FIT kits, and drew 89 lipids panels.

This fair is part of the Florida Keys Health Fairs and takes place at the Methodist and Baptist churches on Big Pine Key. It was held on January 28, 2017.

BIG PINE KEY

FLORIDA KEYS HEALTH FAIRS

DOCS PAGE 13

Mitchell Wolfson Sr. Department of Community Service

KEY WEST FLORIDA KEYS HEALTH FAIRS

DOCS

Mitchell Wolfson Sr. Department of Community Service

This fair is part of the Florida Keys Health Fairs and takes place at the Key West High School on Key West. It was held on January 28, 2017.

We saw 131 patients, performed 17 Pap smears, handed out 41 FIT kits, and drew 62 lipid panels.

We saw 192 patients, performed 28 Pap smears, handed out 65 FIT kits, and drew 124 lipid panels.

This fair takes place at the Jack & Jill Children’s Center with much support from The Forum on Women’s Health. It was held on February 11, 2017.

JACK & JILL JACK & JILL HEALTH FAIR

DOCS

Mitchell Wolfson Sr. Department of Community Service

PAGE 14

LIBERTY CITY

LIBERTY CITY HEALTH FAIR

DOCS

Mitchell Wolfson Sr. Department of Community Service

This fair takes place at Holmes Elementary School in the community of Liberty City with much support from Leslie Miller Saiontz. It was held on March 11, 2017.

We saw 207 patients, performed 19 Pap smears, handed out 50 FIT kits, and drew 95 lipid panels.

We saw 289 patients, performed 36 Pap smears, piloted 31 Septin 9 Colon Cancer Screenings, and drew 153 lipid panels.

This was our first year holding the West Kendall Health Fair. Based on a needs assessment conducted throughout South Florida, we found an area lacking adequate access to health services in the community of West Kendall.

The fair was held at the Mother of Christ Catholic Church on April 8, 2017.

WEST KENDALL

PAGE 15

PAGE 16

BEHIND THE SCENES PLANNING, LOGISTICS, AND FOLLOW UP

PUBLIC RELATIONS Our general approach for public relations (PR) this year has been to emphasize community engagement as part of the PR process. Our goal was to move away from anonymous flyering to a more involved, physical presence in the community.

We have stressed to our teams thus far the importance of building relationships with existing community groups and using these relationships to develop a better fair with more patients in attendance. Our teams this year have reached out to churches, veterans’ lodges, daycare centers, night schools, community advisory boards, and other community groups that have helped spread the word about the fairs and requested specific services for some fairs. We encourage our teams to attend meetings of these groups and become immersed in the community. While not initially part of the PR plan for the year, it quickly became evident that print, radio, and video ads would help disseminate fair information. We have focused on obtaining discounted prices and choosing opportunities based on what we think will be most cost effective. In many instances, newspapers or radios were willing to donate ad space.

PAGE 17

PHYSICIAN RECRUITMENT Health Fairs

This year, we have made an effort to connect with physicians in each department at the medical school. Beyond working with the faculty leadership in each clinical department, we have made a concerted effort to reach out to the resident and fellow trainees. We have presented to Internal Medicine (IM) residents at their lunchtime meetings and have worked with IM resident Dr. Fahim Pyarali to generate a better IM turnout. As is the case with any department, having a voice within the program has been of great value. We also presented to the Urology residents at a morning conference in October. Dr. Hana Khidir is the Community Outreach Coordinator for the Med/Peds residents and spent the day touring our fair in South Dade. She is very interested in getting her colleagues more involved with the fairs and has taken a particular interest in helping to further the work that our Pediatrics Station Manager has already done in developing a Pediatric Education Station. Dr. Michelle Fletcher, an OB/ GYN resident and medical school alumna, has served as a great resource to help recruit physicians from her department. We presented to the Committee of Interns and Residents (CIR) at their leadership meeting this year and will continue to present at their community outreach meetings as well. Relationships within CIR should serve to increase physician involvement at our fairs but could also extend beyond simply DOCS. This is probably the relationship that we are most excited about. Beyond our work with the residents, we’ve been making an effort to develop relationships with community dental partners including Community Smiles. They incorporated the Colgate Van into our fair in South Dade and plan to continue to work with us.

On a fair-by-fair basis, we have communicated better with physicians regarding station preferences and with the station managers regarding which physician volunteers will be available throughout the day. We think that staggering the start times for each station has helped to alleviate some of the patient flow issues we saw last year and early this Fall (e.g. having a line at Men’s or Women’s Health until 6pm). We are still working to find a perfect formula but continue to get closer to success. Communicating with Project Managers before beginning recruitment of physicians has helped us to properly staff stations based on expected patient numbers and the limits of the venue.

Clinics

SJB is looking to start an endocrinology specialty night. We are currently in the process of talking to the Endocrinology division to assess interest and feasibility. Hopefully by Fall 2017 we can put it into our schedule along with the eight other specialties. We have also recruited 28 new physicians this year and will continue our recruiting efforts throughout the year.

PAGE 18

LABORATORY AND LOGISTICS Beginning in 2017, we have changed mail-out lipid panels that required full vials of blood to a point-of-care lipid panel testing system that works on drops of blood, saving the patient pain and anxiety in waiting for the result. We now can be certain that the patient has received their result so we can intervene and refer the patient at the fair, instead of waiting weeks for results. This system required an initial investment for the technology but ultimately saves both time and money compared to the cost of our previous mail-out system.

Currently, the only lab results that are not delivered immediately at the fair are Pap smear pathology and screening for colon cancer called fecal immunochemistry test (FIT). We are working with University of Miami pathologists and an outside company that has designed a colon cancer screen blood test to transition to pointof-care Pap smears and easier-to-perform colon cancer screenings.

In addition to changing our current tests to point-of-care, we are offering several completely new tests. Through a partnership with the Sylvester Cancer Center, we have been able to offer on-site Hepatitis C testing, with the results given by a doctor while the patient is still at the fair. Moving forward we hope to transition to doing our own in-house point-of-care HIV testing as well.

By transitioning to completely point-of-care testing, we can decrease patient anxiety in waiting for laboratory results, offer immediate on-site counseling and referrals, and virtually eliminate the possibility of a result not being reported to the patient while also improving our ability to counsel patients.

PAGE 19

PAGE 20

UPDATES BY HEALTH FAIR STATION

BONE DENSITY Bone density continues to screen women over the age of 60 and men over the age of 70, with no changes this year.

DERMATOLOGY The Dermatology station has not had many notable changes this year beyond the new acquisition of dermatoscopes for students and residents. This has greatly enhanced patient care and student learning opportunities.

FEMALE EXAM Through guided questionnaires and templates, the EHR has allowed for students to better understand services being provided to patients along with the assessment and plan of the physicians. Student volunteers continue to have the opportunity to perform Pap smears and breast exams under physician supervision. A new addition has been the incorporation of STAND (a student group screening for domestic violence) into the female and male exam stations. Condom dispersal and the dissemination of information about safe sex practices with help of an STI prevention program have also been put into action.

PAGE 21

GLUCOSE We have continued to screen patients for diabetes by analyzing their blood glucose levels. At this station, we also now screen patients for Hepatitis C via a point-of-care blood test for those patients who qualify.

VENIPUNCTURE Our first run of point-of-care lipids occurred at the Key West Health Fair this year. Our students were trained on the new modality and new devices were purchased to accommodate this effort.

PEDIATRICS This year, the pediatrics station was converted to an educational station to meet the needs of a consistently strong pediatric presence at health fairs and inform young parents of important pediatric health/safety concerns. Notably, the Colgate pediatric dental van was brought to the South Dade Health Fair, providing a fun, fresh educational station on tooth brushing and dental hygiene.

MENTAL HEALTH A memory screening station has been added to our mental health station this year and has proven to be quite successful. With oversight from a faculty member, students screen patients for cognitive impairments, including Alzheimer Disease and dementia, in addition to depression, suicide risk, and other psychiatric disorders.

VITAL SIGNS Our vital signs station has continued to provide blood pressure, heart rate, and body mass index (BMI) screenings. This year, we purchased new scales for weighing patients.

MALE EXAM This year, we have continued to provide prostate and genitourinary examinations to our male patients. The male exam station also provides a safe space for discussing other concerns. This year, we have also started screening men for domestic violence using a program and questionnaire designed by the female exam station.

OPHTHALMOLOGY Ophthalmology has had no significant changes this year but continues to offer visual field screening, tonometry and tachymetry testing, and fundoscopic examinations.

PAGE 22

MAJOR CHANGES TO REGISTRATION AND CHECKOUT REGISTRATION The registration process has become entirely electronic, which marks a substantial improvement in the ability of DOCS to welcome a larger number of potential patients on-site. A pre-registration system was also optimized. Patients who pre-register simply receive a wristband with an already prepared health fair booklet with station order and fair trajectories delineated.

CHECKOUT The transition from paper charts to REDCap as a cloud-based Electronic Health Record (EHR) has significantly enhanced the present and future capabilities of DOCS. The computerization of patient demographics, vitals/lab results, medical histories and referrals certainly ensures greater patient care and follow-up. At the checkout station, we can now easily see a summary of the results from all the stations the patient attends (excerpt below). Physicians and students can also look back at results from previous years to analyze trends and track patient progress.

PAGE 23

HEALTH FAIR VENDORS Vendor attendance at the health fairs has been going very well. We have maintained relationships with vendors who have been coming year after year to the health fairs including Jessie Trice Community Health Center, which has been increasing involvement in multiple health fairs. They have been providing necessary HIV screening and health education.

In addition, we have successfully reached out to new vendors this year who are bringing new information, education, and services to our patients. One of these new additions is Walgreens, which has provided free flu shots at multiple health fairs.

The health fair teams have also been working with the education team to help provide additional vendors familiar to that community. Both the Little Haiti Health Fair and South Dade Health Fair in particular reached out to local vendors who were familiar with their unique populations. By having local vendors attend, the vendors are better able to provide education that pertains to that specific community.

HEALTH FAIR VOLUNTEERS DOCS health fairs have been drawing the attention of students in the Miami area. Students from undergraduate universities who are interested in medicine are reaching out looking for volunteer opportunities. We have been encouraging outside participation while also maintaining opportunities for our medical students. Outside volunteers have been working at registration by helping maintain the efficiency of registration and filtering patients to the medical students who are available to register. In addition, volunteers have been helping patients navigate the health fairs, making sure they are finding all stations they wish to visit. Another large subset of health fair volunteers is the translators, which include high school and college students and others involved in the local communities. The translator coordinator has done a great job at making sure there are enough translators and they are distributed throughout the fair where they can be of the most help. The translators include Spanish and/or Haitian Creole speakers.

PATIENT CALLBACKS The DOCS referrals system helps ensure that patients obtain necessary and adequate followup care after receiving screening services at our health fairs. Some patients are deemed high-risk, which warrants additional care in community clinics. Patients may be considered high-risk due to abnormal lab results (e.g. high cholesterol, hepatitis C positive), abnormal Pap smears, or abnormal screening exams during the health fair. These patients have all been placed on the callback list to ensure they receive necessary follow-up at community clinics. Some patients have made follow-up appointments by themselves. For those who are still looking for an appointment, each health fair team constructs a referrals list, which includes affordable, low-cost clinics in the surrounding neighborhood. Using this resource, the DOCS referrals team and health fair teams are able to help direct patients to follow-up care.

PAGE 24

MEDIA AND OUTREACH DISSEMINATING THE DOCS MODEL Since our first health fair decades ago, community service at the University of Miami Miller School of Medicine has evolved into the current DOCS program with almost 100% student participation and nearly 3000 patients served annually. The Media and Outreach team strives to share our formula for success with colleagues across the nation while simultaneously learning from our peers and refining our model. There are two intimately related arms of this mission. The first is to create a DOCS consortium, a forum where student leaders meet monthly via teleconference to discuss ongoing community service efforts. The second is to host the annual Community Health Leadership Conference, an event that attracts students from across the nation to present their schools’ community service and fosters future collaborations.

UDOCS.MED.MIAMI.EDU

One big initiative this year was to travel to the AAMC Learn, Serve, Lead national conference in Seattle, Washington, to bring national awareness to the DOCS name. Here we presented three posters related to different aspects of DOCS and began to build a network of students and faculty who demonstrated interest in future partnerships. We learned that our DOCS model is truly unique in the nation with respect to the breadth of services provided and the level of student involvement.

Back home, we are ensuring that all UM faculty members are exposed to DOCS projects by publishing achievements in the electronic ‘eUpdate’ newsletter.

PAGE 25

COMMUNITY HEALTH LEADERSHIP CONFERENCE The DOCS Community Health Leadership Conference occurred on March 10th and March 11th.

On March 10th, nearly 70 medical students from 25 medical schools throughout the country gathered to collaborate and share ideas about similar community service organizations. In the morning, we had introductions from several key members of the Miller School of Medicine faculty including Dr. Amar Deshpande, Dr. Alex Mechaber, Dr. Roderick King, and Dean Laurence Gardner. We had six oral presentations judged by a two physician and one medical student panel.

The afternoon consisted of two poster sessions each containing 24 posters, judged by a team of physicians and medical students. Conference participants had the opportunity to participate in a clinic night at San Juan Bosco clinic, working alongside our students and physicians.

On March 11th, conference attendees took part in the Liberty City Health Fair. Their day was split into two components. One group of students participated in small group seminars discussing the DOCS approach to implementing a health fair and clinic model. The other half of our participants volunteered at our health screening stations. They had the opportunity to perform medical tests and work with our students and physicians to provide health services to our patients. The groups switched in the afternoon to allow all students to have both experiences.

Our conference culminated with a debrief session to analyze and critique our efforts in order to facilitate an even better conference next year. Finally, the students enjoyed an endof-conference banquet and awards session that recognized some of the great student initiatives that our attendees had presented to the group.

PAGE 26

PROFESSIONAL COLLABORATION INTERDISCIPLINARY EDUCATION Department of Physical Therapy

Our Physical Therapy station was formed last year and has continued to grow in success as we add more services and assessments including a ‘Timed Up and Go Test’ and ‘Four-Stage Balance Test’.

Medical students are able to rotate with physical therapy students and their students are able to rotate at some of our stations to develop an appreciation and understanding of both.

Department of Public Health Sciences

We have continued our partnership with the Department of Public Health Sciences that was formed last year. Our public health students work alongside our medical students at the fairs to provide information pertinent to the screening exams we are performing. They have provided educational materials about hypertension, diabetes, healthy eating and exercise habits, and women’s health.

School of Nursing

In the past, nursing students have participated at our fairs by helping to take vital signs or performing fingerstick glucose checks. We have been working to increase the participation of the School of Nursing to have Nurse Practitioner students work alongside our students at some specialty stations and Registered Nurse students to help counsel our patients. Students and faculty from both of these programs have participated in several of our health fairs this year, and we hope to include them in all future health fairs.

Local Dentists

After speaking with leaders in several communities we serve, there have been an overwhelming amount of requests for dental services at our fairs. A new partnership with Community Smiles, a free non-profit dental clinic, has offered large-scale dental screening to the underserved community for the first time. Two dentist parents of our medical students, Dr. Estes and Dr. Feldman, have also served as dentists at our fairs, working to teach our medical students about identifying oral lesions.

PAGE 27

NEW TO DOCS THIS YEAR ELECTRONIC HEALTH RECORD This year, we successfully implemented our own electronic health record (EHR) for the patients who attend our health fairs. This move benefits all parties involved – by having an electronic health record, DOCS staff can spend less time pulling, managing, and storing paper charts and will not have to enter the data from each chart into a database after each fair. It also allows for standardized and consistent data collection, which allows our Research and Quality Improvement Team to examine our impact on the populations we serve as well as identify new and better ways to extend our reach.

REDCap, an online research data collection tool developed at Vanderbilt and used at many universities (including ours) for secure data collection, is used as the backbone for the EHR. We spent a considerable amount of time structuring it to allow data to be collected effectively and for health fairs to run smoothly. Thanks to generous donations from a CaneFunder fundraiser, we purchased mobile hotspots and routers to set up internet access at each of our health fair sites as well as tablets to allow students to access the EHR during the fair. The EHR has been a great success at each fair. We also improved the flow of performing Pap smears by printing lab ID labels seamlessly from REDCap. This move has made the health fair flow much more efficient.

PAGE 29

DOCS WEBSITE We completely revamped and redesigned our DOCS website with a newer, more modern theme that can more effectively and artistically display information about DOCS. Through the website, patients can access resources about health fairs, students from other schools can read about DOCS and learn about opportunities such as the annual Community Health Leadership Conference, and our own students can access DOCS resources including sign-ups for our two student-run free clinics. Sign-ups for these clinics were also transformed, allowing for more modern looking sign-ups as well as easier management of student volunteers.

UMDOCS.MEDEDU.MIAMI.EDU

NEW STATIONS Dental Station

In speaking with numerous community partners over the past year, there were many requests for a dental station at our fairs. Community dentists, as well as the parents of two students who are dentists, have provided dental services to our patients this year. Students now are getting exposure to dental examinations as well.

Memory Station

Many members of our aging community are affected by a cognitive decline as they continue to age. The signs of cognitive disorders can be difficult to identify, especially for those who live with or around the individual. By partnering with faculty from the Departments of Psychiatry and Behavioral Sciences and Neurology, we have begun to screen patients for cognitive decline. Students work alongside professionals in the field to administer minimental exams as well as other tests to identify memory-related conditions. Patients and their families are then counseled on the signs of decline and how to slow further decline and cope with the changes to the patient.

PAGE 30

NEW SCREENINGS Fecal Immunochemical Test:

For many years, we have been providing colon cancer screening to our Florida Keys Health Fair patients who attended our pre-registration event. The traditional guaiac-based fecal occult blood testing required three samples to be collected over several days with many dietary and other limitations, and patients would return the tests to be run at the health fairs. With the fecal immunochemical test (FIT), patients can be given the test to be taken home and be mailed back to us after completion, with only one sample needed with virtually no dietary/environmental restrictions. The University of Miami Hospital laboratory runs the tests and DOCS students inform the patients of their results by mail. We have handed out about 450 test kits this year. We are also working to bring a colon cancer blood test screening modality to our fairs.

Hepatitis C Test:

Hepatitis C (HCV) has become increasingly diagnosed and affects many of our patients; it was a screening test we felt essential to add to our repertoire. In addition to intravenous drug users and patients engaging in high-risk sexual activity, many patients may be unknowingly at risk for HCV if they received blood products before transfused blood was screened for the complete panel of diseases we look for today. The United States Preventive Services Task Force recommends screening for HCV infection in persons at high risk for infection as well as offering one-time screening for HCV infection to adults born between 1945 and 1965. We offer counseling and referrals for patients who test positive for HCV. This year, nearly 250 patients were screened for Hepatitis C.

PHOTO CREDIT: CBS NEWS

PAGE 31

OTHER DOCS PROJECTS EMERGENCY PREPAREDNESS Zika Virus Outreach

In 2016, DOCS partnered with the Miami Poison Control Center at the newly established Zika Hotline. Seventy medical students were trained in educating and counseling callers about the Zika virus, offering helpful advice to those inquiring. To date, we have logged over 600 student volunteer hours at the center.

Our students have also partnered with the Jackson Memorial ACC West OB/GYN clinic to help educate women about the Zika virus and distribute ‘Zika Kits’ provided by the Department of Health.

Finally, our students have staffed a Zika Education station at our health fairs. Thanks to donations of mosquito repellent and educational flyers from the Department of Health and Poison Control Center respectively, we have successfully provided repellent and information to several hundred patients.

CPR and Emergency Training

Last year, we piloted a CPR training program at Lotus House with the help of the ‘MA Emergency’ organization.

We have since continued to train the women of Lotus House and have begun teaching basic, hands-only CPR and AED usage to patients at our health fairs. Other lifesaving skills, including the abdominal thrust (Heimlich) maneuver for adults and fire safety for children are also reviewed. Our Emergency Preparedness team created Emergency Information cards that contain important phone numbers, emergency medical information, and a hands-only CPR pictograph; this card also has doubled as public outreach for the health fairs as well as our clinic sites. We have been hearing that the cards have been well received by the communities.

This note was passed on to us regarding a woman who took one of our CPR classes at Lotus House. “One of the women at the CPR training on Saturday was on a bus on Monday and a guy collapsed. She was the only one on the bus who helped him. She called 911 and the man on the phone was able to walk her through everything and when EMT was on the scene they actually said that without the steps she took the man would have died. When she went to Lotus House yesterday, she told Lindsey (UMMSM medical student) all of this and wanted to thank DOCS since the only reason she was able to step up was because of that class we had just held.”

PAGE 32

CERTIFIED APPLICATION COUNSELORS (CAC) The Certified Application Counselor (CAC) program helps individuals understand, apply for, and enroll into insurance plans through the Affordable Care Act (ACA). Since the start in 2014, the CAC program at the Miller School of Medicine was amongst the first of its kind in the nation. During the open enrollment period (November 1 - January 31), we tabled outside of the medical school building, in the University of Miami Hospital lobby, at health fairs, and at other off-campus events. Over the last few years, over 100 students have become certified. These students are committed to connecting individuals with long-term healthcare solutions. With the expected change in the health care delivery landscape with a new presidential administration, we are working to expand this group to become experts in health care policy in general including local, state, and federal programs that can help our adult and youth patients learn more about insurance options.

ENHANCED CALLBACK SYSTEM PILOT Following up with high-risk patients after a health fair is one of the most important roles of this organization. After a pathological finding is identified, it is essential that the patient is contacted and a visit with a primary care or specialty physician is scheduled. By training patient navigators who are seeking the degree of Masters of Public Health, we hope to be able to have those training to be experts in counseling and public health awareness forge bonds with and establish follow-up goals for our patients. This program was piloted at our South Dade and Liberty City Health Fairs where patient navigators were introduced to the high-risk patients with whom they would be following up after the fair. Preliminary results of this pilot show that patients schedule and attend physician visits more often and more quickly. We are hopeful that this system will replace our current method of calling patients back, as we believe our patients will receive enhanced care. This is discussed further in the ‘Research Projects’ section.

ALUMNI ENGAGEMENT EVENT Miller School of Medicine Students are, in our perhaps biased opinion, the greatest medical students in the world! Their commitment to service and dedication to their community is matched by few other institutions. As such, most of our alumni have participated in at least one health fair, clinic, or community outreach project during their time in medical school. The organization, now known as The Mitchell Wolfson, Sr., Department of Community Service (DOCS), has undergone many changes and improvements over the past 40 years. We are eager to share our efforts with our alumni in the hopes that they can help us continue to improve and perfect this great organization.

MS. JERI L. WOLFSON & DR. AMAR R. DESHPANDE

On March 5th, during Medical Alumni Weekend, we had an Alumni Engagement Event where we showcased the DOCS organization and offered time for discussion with student leaders and current students.

PAGE 33

RESEARCH AND QUALITY IMPROVEMENT ANNUAL STUDENT REPORT We completed an annual student support program report, which identified that DOCS, as an organization, was meeting its mission statement and objectives. The conclusions drawn from this report illustrated a need to improve the training aspect of our program for students before health fairs, thus a Student Training Standardization Project is now underway which aims to develop station-specific, supplementary online training modules for medical students to prepare for health fairs. Data from this project has also benefitted ongoing work at our two local clinics hosted at Lotus House and San Juan Bosco. Improved training programs are being developed for students who volunteer at these clinics. Currently we have partnered with STAND (Students Against Domestic Violence) to develop a protocol and training session that helps student volunteers feel confident in effectively screening patients for domestic violence.

FLOW IMPROVEMENT PROJECT We established the Flow Improvement Project to analyze the pathway of patients through each health fair, paying particular attention to overburdened stations in the hope of maximizing efficiency and patient experience. A study of the Hialeah fair was conducted in which RQI volunteers counted the number of patients at each station at set time points throughout the fair. We found a large number of patients were sent to the same stations following registration (ophthalmology and female exam) and that dividing patients to different initial stations may be beneficial. Additionally, one volunteer moved through the system as a mock patient to report on the qualitative experience of a community member attending a fair. This volunteer reported that the availability of Spanish speakers was a rate-limiting step for patients moving through the fair and identified possible station layouts which would be beneficial for creating more efficient flow. We are also in the process of administering a station manager survey to the DOCS executive team to receive feedback on workload and flow from those most involved in each station. Our goal is to compile a report and make recommendations based on this survey and the data compiled from quantitative and qualitative measures at the Hialeah Health Fair and future fairs.

PHOTO CREDIT: FRANCISCO HALILI, MS3

PAGE 34

PATIENT NAVIGATION PROGRAM

It was noted that many high-risk patients were either not being identified properly or were being lost to follow-up. Two projects were developed to address this. Using data from 2014-2015, we have identified potential areas of improvement in determining which patients should be referred. Since the ASCVD risk calculation is used nationwide for risk identification, it was decided this was the best measurement for our patient population. Initial data analysis shows that using current referral guidelines, we are catching only about 1/3 of patients with an elevated ASCVD risk. This problem persists through different ASCVD cutoffs, a measure that shows our current referral guidelines may not be sufficient at capturing the correct number of at-risk patients. We are continuing to analyze the data and will present a modified referrals algorithm that will better estimate risk by year-end. This algorithm will correctly identify the patients who should be immediately referred to a care facility for health management. This work could not be done in isolation as ASCVD risk calculation requires a lipid panel; moving to point-of-care cholesterol screening allows us to do this.

With regard to patients being lost to follow up, we identified the need to develop a better referrals program for the patients who require additional care outside of the health screening fairs. The Patient PHOTO CREDIT: FRANCISCO HALILI, MS3 Navigation Project began this semester with the goals of optimizing and ensuring our high-risk patients receive the additional care needed without getting lost to follow-up. This project is an interdisciplinary effort with students obtaining a Masters in Public Health (MPH). At the South Dade health fair, six MPH students volunteered and worked with the 15 high-risk patients identified and have been assisting them with the follow-up care process.

Within two weeks after the health fair, seven appointments were made and one patient had already attended an appointment. We are still awaiting additional data on the other patients enrolled in this study; however we hope to incorporate this with the ASCVD Risk Calculation project in all future fairs to ensure follow up care is received by all individuals who immediately need it.

GLOBAL INFORMATION SYSTEM (GIS) MAPPING PROJECT Finally, we are looking at the potential reasons patients often are lost to follow-up. We fear that many patients are unaware of the many health resources in their communities. Our Health Fair GIS Mapping project is currently using both GIS mapping and data exercise for the health fairs with goals to better educate and inform both medical student volunteers and health fair patients about resources in the area. On the medical student side, a demographic and socioeconomic analysis of the communities each health fair serves will better educate students and equip them to provide better care. On the patient side, a map of resources and an algorithm for which resources are closest to his/her residence can improve patient follow-up and continuing care. As we continue to develop this program, we hope to use census data to compare with data from past health fairs to see if health fairs are targeting the appropriate communities that are in need.

PAGE 35

REGIONAL MEDICAL CAMPUS PROJECTS RMC CAMPUS CERTIFIED APPLICATION COUNSELORS Similar to our main campus Certified Application Counselors (CAC) program, our Regional Medical Campus (RMC) CAC program aims to educate students regarding health insurance options available in Palm Beach County and train students as Certified Application Counselors in partnership with Health Council of Southeast Florida (HCSEF). Our students volunteer at enrollment events through HCSEF and enroll consumers in insurance plans through the Affordable Care Act. Finally, they engage with various populations (e.g. HIV positive patients, those released from incarceration, single parents, etc.) in the community to learn about their specific needs.

This year, we have provided resource cards outlining health clinics, resources for the homeless and victims of domestic violence, mental health resources, and information on smoking cessation for our patients. We have also hosted two speakers from HCSEF at public health seminars to discuss CAC initiatives and updates to Florida KidCare and opportunities for students. Lastly, we tabled at Stonybrook Apartment Complex’s Back to School Event with information on open enrollment and Florida Kidcare and provided flyers for the Stonybrook Mini Health Fair. We had seven students from the RMC campus complete our CAC training program.

In the second semester, we collaborated with HCSEF on ways to stay involved throughout the year and not just during open enrollment (November-January). Next year, we hope to expand health insurance training to include Health District Options in Palm Beach County, Medicaid, and Florida KidCare. Finally, we are working on ways to incorporate policy training and advocacy training for medical students.

CARIDAD CLINIC The Caridad Clinic serves a very unique, predominantly foreign-born population with little to no access to traditional healthcare resources here in the United States. It also serves as one of the teaching facilities for the University of Miami’s Regional Medical Campus. In the Fall, we held three clinic dates and provided services to about 20 patients. For the Spring semester, we recruited 4 new attendings to increase the number of clinic days we held. We are currently looking to expand our services to include some medical subspecialties as requested by our patients.

GUATEMALAN MAYA COMMUNITY The Guatemalan-Maya Community Center (GMC) is located in Palm Beach County and offers its services to anyone in need. Their various programs serve an incredibly diverse clientele, which includes people of all ages and from all parts of the world who live throughout South Florida. This year, we have led three separate focus groups at the Center working to organize the most common topics discussed into other information sessions. Through this work, we have determined that some of the Lake Worth Guatemalan Mayan community’s highest priority health concerns are diabetes, nutrition and exercise, and access to healthcare; other concerns include violence and drug use. We have been working to establish weekend classes about diabetes, nutrition and exercise, and access to healthcare as requested by the community members. Finally, we presented the results of the focus groups and literature review to community partners and discussed implementation of a specific diabetes education intervention that will take place during the Fall 2017 semester.

Our RMC team has also tabled at GMC to provide information about the Zika virus, similar to our main campus initiative. We have partnered with GMC for their annual clothing drive and volunteered at the annual Fiesta de San Miguel with a group of 15 medical students.

PAGE 36

LIGHT OF THE WORLD (LOW) CLINIC In the summer of 2016, we met with Sandy Lozano, LOW Clinic Director, to learn about the clinic and annual health expo. As one of the newer partnerships, we wanted to work on improving DOCS involvement in the LOW health expo as well as find ways that RMC DOCS could have a more longitudinal role at the clinic. Topics of discussion included the barriers to care that LOW patients still face and Sandy’s desired improvements for this year’s health expo. From Sandy’s perspective, the largest gaps in care for her patient population included psychiatric and psychological services, neurologic assessments, and rheumatologic care.

In the Fall of 2016, the RMC DOCS LOW team received two assistant project managers. At our team meetings, we decided it was important to obtain a better understanding of the needs of LOW patients. We set a deadline for the end of November to complete a literature review on validated needs assessment survey tools. The goal was to use the literature to create our own survey, which will then be distributed to all patients at the beginning of their visit by the front desk receptionist. To date, we have a survey draft and plan to finalize and distribute it at the clinic after the health expo.

The Light of the World Health Expo took place on March 18, 2017. The DOCS stations included registration, cholesterol, mental health, ophthalmology, bone density and check-out. A total of 138 patients were seen at the fair, and 95 participants were screened at cholesterol. Overall, there were two high-risk patients. Medical students from both campuses participated, with a total turnout of 37 medical students. We also had nine attending physicians and three residents (two internal medicine and one psychiatry) volunteer.

PAGE 37

STONYBROOK Stonybrook is a Section 8 housing project in Riviera Beach with whom RMC DOCS has partnered.

This year, we were involved in a number of great initiatives. We kicked off the year by attending their ‘Back to School Bash.’ At the event, we had a table with games and information about nutrition, exercise, and our CAC program. We also had a Calorie equivalence game (guess how many sugar cubes are in healthy and unhealthy snacks) and an exercise game for children.

Our team also attended their Urban Youth Impact (UYI) annual ‘Christmas Store’ event where registered families choose from gifts donated to UYI and have them wrapped to give to their kids on Christmas.

It is a huge event with hundreds of families, so we held a mini-health fair for the parents to receive health screenings (including vital signs, body mass index (BMI) testing, and diabetes screening) while they shopped.

Fifteen University of Miami medical students from both campuses, along with one physician, conducted 44 health screenings.

Another initiative the team has been working on is a mold and asthma project.

Mold and asthma were health issues raised by the community via surveys and focus groups conducted by previous Stonybrook teams. We have been working to develop a long-term project goal of investigating the prevalence of mold and asthma at Stonybrook.

We then hope to implement a plan for resident surveys, mold testing, and data gathering from nearby hospitals to help combat this growing issue.

Lastly, RMC DOCS submitted and presented a poster entitled “Implementing community-driven health interventions at the Stonybrook Housing Project: Collaborations between UMMSM’s Department of Community Service (DOCS) and community residents” for the 2016 AAMC conference.

PAGE 38

FUTURE GOALS PORTABLE MAMMOGRAM MACHINE Our fairs currently offer many services at our Female Exam station. We offer a friendly, safe, and private environment for our patients to ask personal questions or voice health concerns. We also conduct domestic violence screenings and offer counseling and information about local women’s shelters if a woman feels unsafe in her home. Lastly, we offer Pap smears and pelvic exams as well as manual breast examinations.

According to the United States Preventive Services Task Force, biennial screening mammography for women 5074 years is recommended. We have partnered with community groups and mammogram centers to provide ‘free referrals’ to women who qualify for a mammogram, but we have only provided a limited number of these referrals and cannot ensure that our patients are seen by providers when referred. There are several organizations in the community that have portable mammogram vans, but unfortunately we have been unable to have them attend our fairs due to a variety of barriers. It is our goal to obtain a portable mammography machine to bring to each fair. With the help of our students, University of Miami physicians would be able to screen and evaluate women for breast cancer, a treatable condition if caught early.

POINT-OF-CARE PAP SMEARS, LIPIDS AND A1C Currently, we send our Pap smears to an outside laboratory to be read and send the results to our patients by mail.

We are working with our Department of Pathology to explore the option of establishing a pathology station at our fairs where students and physicians can read the samples on-site. We will then be able to appropriately counsel patients about their cervical pathology and potential next steps in preventing/treating cervical cancer before they leave the fair.

For lipids and glucose testing, one barrier we encounter is that patients may not have fasted. For next year, we hope to move to non-fasting lipids and non-fasting A1c testing for diabetes to better screen patients for these disorders.

ENT & HEAD AND NECK CANCER STATION Although we provide many services through our various stations, we are always looking to add screening modalities that will benefit our patients. Head and neck cancer affects many in our patient population with an increased incidence in those who use tobacco and alcohol products and those who engage in high-risk sexual activities. We have been working with members of the ENT department to establish a station that evaluates patients for head and neck cancer as well as obstructive sleep apnea and hearing loss. We hope to have this station up and running in the Fall of 2017.

DOCS HIV TESTING For many years, we have called upon community partners to volunteer their time to provide HIV testing and counseling to our patients. While we graciously thank them for their time and recourses, we are hoping to provide these services ourselves in the years to come. We have started looking into training requirements for administering HIV tests.

IDEA NEEDLE EXCHANGE CLINIC This clinic, started by a JMH Resident, Dr. Hansel Tookes, is the first needle exchange program in Florida. DOCS will be joining this program with its very own clinic night in this upcoming year. Students will be participating in HIV and Hepatitis C point-of-care testing, patient counseling, and needle exchanges. Additionally, we will be implementing wound care alongside attending physicians.

In 2017-2018, we hope to continue building new relationships in underserved communities in our area, including Little Havana, Overtown, and more.

PAGE 39

2016-2017

DOCS EXECUTIVE BOARD

Mitchell Wolfson, Sr., Department of Community Service (DOCS)

DOCS CONTACT INFORMATION

DOCS Staff 2016-2017 DOCS Faculty Position Name Email DOCS Faculty Mentor Amar Deshpande, MD adeshpande@med.miami.edu DOCS RMC Faculty Mentor Julie Belkowitz, MD JBelkowitz2@med.miami.edu DOCS Manager Raysa Christodoulou rchristodoulou@med.miami.edu DOCS Executive Board Position Name Email Executive Director Joshua Kronenfeld jpkronen@med.miami.edu Co-Director Stephanie Ioannou s.ioannou@med.miami.edu Co-Director Nikesh Doshi n.doshi@med.miami.edu Clinics Director Elizabeth Sierocinski esier@med.miami.edu Media and Outreach Director Roy Elias relias2@med.miami.edu Finance Director Dustin Massel dmassel@med.miami.edu Public Relations Director Matthew Cranshaw mwc18@med.miami.edu New Initiatives Director Sara Bressler s.bressler@med.miami.edu External Affairs Director Kelly McCarter kmm118@med.miami.edu Professional Recruitment Director Nicholas Waler njw10@med.miami.edu Training Director Louis Vincent l.vincent@med.miami.edu Logistics Director William Patterson wpatterson@med.miami.edu Research and Quality Improvement Director Jennifer Rodriguez jrodriguez20@med.miami.edu Medical Informatics Director Karam Alawa kalawa@med.miami.edu Longitudinal Access Director Catherine Hoeppner choeppner@med.miami.edu DOCS Regional Medical Campus (RMC) Executive Board Position Name Email RMC Director Jennifer Shiroky j.shiroky@med.miami.edu Clinics Director Michael Freedman m.b.freedman@med.miami.edu Clinics Assistant Director Samuel Kareff sak57@med.miami.edu CAC Director Genevieve Wiehl gfw4@med.miami.edu Guatemalan Mayan Center Director (2) Ilana Mayer-Hirshfeld i.mayerhirshfeld@med.miami.edu Guatemalan Mayan Center Director (2) Daniel O'Shea dmo19@med.miami.edu Stonybrook Director Catherine Cichon c.cichon@med.miami.edu

PAGE 40

MITCHELL WOLFSON, SR.

DEPARTMENT OF COMMUNITY SERVICE (DOCS) ANNUAL REPORT 2016-2017 Academic Year