Mitchell Wolfson Sr. Department of Community Service (DOCS) ANNUAL REPORT
Academic Year 2017/2018
A DOCS Family Thank You DOCS would not be what it is today if it weren’t for the support of our donors, patients, students, and physician volunteers. We would like to extend a huge thank you to the Mitchell Wolfson Sr. Foundation, without which DOCS would be unable to carry out our multiple weekly clinics, annual health fairs, and our continuous innovative endeavors. Year after year, the generosity of the Mitchell Wolfson Sr. Foundation allows medical students, physicians-in-training, and faculty members to serve patients around South Florida through DOCS. In addition to the Wolfsons, we would like to express our gratitude to the numerous other donors this academic year who have chosen to support our mission and have helped us continue to do what we love for our community and our patients. Every year we are humbled by how many communities in South Florida have entrusted us with the medical screenings of their populations. We are particularly grateful to community partners and vendors who play an integral role in making each fair a reality. DOCS would not be what it is today without the continuous commitment of our medical students, faculty, and staff. We would especially like to thank our DOCS staff members for investing so much of their energy, time, and ideas into continually improving the way in which we provide community service. Thank you to the physicians-in-training and faculty members for not only patiently teaching clinical skills to our students but also for modeling what it means to be compassionate physicians. Thank you to the leaders of the Medical Parents Association for always coming out to our health fairs to support us and to make sure each and everyone one of us is well fed. Thank you to our faculty advisors, Dr. Amar R Deshpande and Dr. Julia L Belkowitz, for always being supportive of our ideas for growth and improvement within DOCS. And finally, thank you to Raysa Christodoulou, known throughout the medical student cohort as much more than just our ‘DOCS mom’, who never fails to keep us organized and always reminds us to advocate for our patients. Thanks to all our supporters, DOCS has been able to see many of last year’s goals fulfilled this year, including POC lipid testing, in-house HIV testing, blood-based colorectal cancer screening, and the opening of a wound care clinic at the IDEA Needle Exchange. We are looking forward to an even more rewarding year of fairs, clinics, and new endeavors in 2018-2019. Sincerely,
Stephanie Ioannou and Nikesh Doshi
Executive Directors 2017-2018
Table of Contents Our Organization
4
Clinics
8
Regional Medical Campus Projects
14
Health Fairs
16
Behind the Scenes
24
Research and Quality Improvement
30
Disseminating the Model
32
Professional Collaboration
34
Emergency Preparedness
36
Future Goals
38
Contact Information
39
Our Mission DOCS, enlisting the participation of students and physicians at the University of Miami Miller School of Medicine (UMMSM), is dedicated to providing preventive, primary, and subspecialty 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 enabling students to hone essential clinical skills
Education
realizing the importance of not only educating ourselves but also our patients and the communities in which we live
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Our Story 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, umbrella organization 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 2017-2018 year, DOCS brought health screening and educational services to over 2,500 patients through the volunteer efforts of several hundred medical students and physicians. DOCS holds annual fairs in medically underserved communities throughout South Florida. We also have a Palm Beach chapter at our regional medical campus (RMC DOCS). We operate 4 student-run free clinics that provide both primary and specialty care. We screen for the most prevalent diseases in our community, including hypertension, diabetes, dyslipidemia, vision loss, mental health issues, osteoporosis, and obesity, as well as colon, breast, cervical, prostate, and skin cancers. Using a referral system consisting 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.
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This year in numbers
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1000+
clinic patients seen
1500+
health fair patients seen
2500+
physician hours dedicated to the community
In our 4 clinics, San Juan Bosco, Lotus House, IDEA Wound Care Clinic, and Caridad Clinic, students and volunteer physicians have provided numerous specialty and primary care services to patients in Miami-Dade County and Palm Beach County.
Through our 9 health fairs and several other service events we have reached numerous underserved communities throughout South Florida.
Our committed physician volunteers have spent a significant amount of time across our health fairs and clinics supporting the medical education experience of our students while caring for the underserved populations of South Florida. Our students have also spent countless hours applying their clinical skills to serve the community.
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Clinics
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Lotus Wellness Center
A resource facility serving women and children experiencing homelessness in the heart of Overtown
The Sundari Foundation, Inc., best known for the Lotus House Women’s Shelter, provides a safe haven with wrap around supportive services for high special needs women and children experiencing homelessness, whether due to violence, medical or mental illness, disability, or economÂic insecurity. Over 400 women and children are sheltered each night at Lotus House. Distinguished by its holistic approach, wrap around services give voice to those who have survived by being invisible. DOCS works with Lotus Wellness Center, LLC, a subsidiary of Sundari Foundation, to operate a free, Good Samaritan health clinic to assist those who are uninsured with free, access to quality health care and health education. This has been an exciting year for Lotus House and the Lotus Wellness Center as they have moved into their new home in Lotus Village. In addition to expanding the capacity of the shelter to serve women, youth and children in need, Lotus Village includes an array of new program spaces for child and family therapies as well as new clinical operations. DOCS has been working closely with Lotus House to support them through this transition and ensure we can continue to provide high-quality care at our existing weekly Monday night clinic to the women and children of Lotus House as well as the surrounding Overtown community.
abetes, in a comfortable and personalized setting. We initiated a new domestic violence screening protocol in our clinic, including providing referrals to support services for women who have a history of experiencing intimate partner violence. We have supplemented our regular weekly primary care clinic with additional specialty nights, including psychiatry nights and a quarterly transgender clinic.
In an effort to continually respond to the needs of our patients, we initiated a project to assess and address the most pressing medical concerns that patients have. We also created a patient education and empowerment program in which we discuss prevalent chronic diseases with small groups of Lotus House guests. This program enables patients to better understand the causes, pathophysiology, symptoms, treatment and prevention of common medical problems, such as di-
our clinic has received.
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Our clinic was featured on the national stage in an article written in the January 2018 Society of Student Run Free Clinics newsletter. 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 DOCS would like to extend a special thanks to Constance Collins, Rai Johnson, and Anna Frusciante for their kindness, hard work, and constant support.
San Juan Bosco Clinic
A community clinic that cares for patients at 200% or below the federal poverty level
Our services include laboratory and diagnostic testing provided at no cost to San Juan Bosco (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 academic year, continuing to focus on serving our patients across a broad spectrum of medical specialties. We initiated a new Patient Education Program through which student volunteers provide a variety of educational and empowerment tools to patients, including written materials and in-person counseling sessions tailored to the specific medical and social needs of our patients. Our clinic completed a quality improvement study examining ways to reduce patient wait times and presented the results at the Society of Student Run Free Clinics Conference held in February 2018 in Omaha, Nebraska. Our staff members Vanessa Nascimento and Isabel Penabad presented our clinic and led a workshop on catering to the health care needs of Miami’s Latino population at the 2017 Latino Medical Student Association Policy Summit in Washington, D.C. We are so grateful to work with the staff and patients at SJB and look forward to another wonderful year of new initiatives. DOCS would like to extend a special thanks to Berta Cabrera, Marta Villalta, and Luz Gallardo for their constant support to enable us to collectively provide the best patient care possible.
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IDEA Clinic Infectious Disease Elimination Act (IDEA) Wound Care Clinic
IDEA is our newest student-run clinic that was opened this year to provide essential care to persons who inject drugs, a historically underserved population in Miami. Our clinic works in conjunction with the IDEA Needle Exchange Program, the first legal syringe exchange program in Florida that currently serves more than 500 people. The goals of our clinic include addressing patient health care needs in a timely and comprehensive manner, working with patients to increase their trust in the health care system, and providing important educational opportunities for medical students regarding harm reduction. In addition to offering general primary care services, student volunteers at our clinic work with surgeons, dermatologists, and emergency medicine physicians to treat skin infections and abscesses that often occur secondary to chronic use of injectable drugs. IDEA clinic had a wonderful inaugural year. Working in the Overtown community, we were able to reach a variety of patients with primary care and wound care needs. Our physician volunteers educated both students and patients in not only the principles of harm reduction and ways to encourage historically marginalized patient populations to access health care, but also in the execution of necessary procedures such as abscess care and prevention. We also provided free real-time HIV and Hepatitis C screenings to our patients. We presented our clinic’s work at the 2018 Society of Student Run Free Clinics Conference in Omaha, Nebraska. In addition, one of our student leaders was honored with an award from the East Harlem Health Outreach Partnership from the Icahn
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School of Medicine at the Society of Student Run Free Clinics Conference, and also received the Arnold P. Gold Foundation Service Fellowship Award for his work with the clinic. In the coming year, we are hoping to expand our services by implementing a mobile wound care unit and expanding our interdisciplinary work environment by engaging nursing students from the University of Miami School of Nursing and Health Studies. We would like to thank Dr. Hansel Tookes, Emy Martinez, Carlos Padron, David Forrest, Annie Liu and all of the staff members at the IDEA Exchange for their support and guidance.
The 2017-2018 clinic team
The program’s main site is centrally located in the Overtown community, with outreach expanded with a mobile unit
In addition to wound care provided by DOCS, the clinic offers important harm reduction services via bloodborne disease testing and more
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Regional Medical Campus Projects Healthcare Access Project
The Regional Medical Campus (RMC) Healthcare Access Project aims to educate students regarding the health insurance options available in Palm Beach County and to train students as Certified Application Counselors (CACs) in partnership with Health Council of Southeast Florida (HCSEF). Our students volunteer at enrollment events organized by HCSEF and enroll consumers in insurance plans through the Affordable Care Act. This year six students were trained as CACs and participated in several HCSEF health insurance enrollment events, where they assisted 12 consumers of whom three were fully enrolled in a health insurance plan and three created an insurance marketplace account in preparation for future enrollment. Other educational events included hosting a speaker from HCSEF who spoke to the MS3 MD/MPH class about qualification criteria for the Affordable Care Act and resources available to patients seeking free or low-cost care. We also provided all RMC students with cards for our patients outlining health clinics, resources for the homeless and victims of domestic violence, mental health resources, and information on smoking cessation. HCSEF has offered to train RMC students to enroll patients for Medicare; the pilot program has already begun training future RMC leaders.
Caridad Center Health Clinic
Caridad Center is the largest free clinic in South Florida. It serves a very unique, predominantly foreign-born population with little to no access to traditional healthcare resources. DOCS partners with Caridad Center in order for UM faculty and students to provide free primary care appointments to Caridad Center patients on Saturdays. This year DOCS hosted six clinic dates at Caridad. In addition, we were invited to participate at Caridad’s Family Festival and Health Fair on November 18th 2017. Fifteen UM students and one faculty member collaborated with FAU medical students and faculty to provide screening for close to 100 patients throughout the day. Patients were screened for hypertension, diabetes, and obesity, and those with positive results were counseled and referred for further care at Caridad Center. Overall, more than 30 UM student volunteered at Caridad to serve over 100 patients this year.
The Caridad team presented a poster titled “A Collaborative Model to Establish a Student Run Free Clinic Using Limited Resources via a Partnership with an Existing Clinic” at the 2018 Society for Student Run Free Clinics Conference.
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Stonybrook
Stonybrook is a Section 8 housing project in Riviera Beach with whom RMC DOCS has partnered for several years. In the past, through a Community-Based Participatory Research process, we have identified asthma as one of the community’s highest priority health concerns. This year, we were involved in a number of great initiatives. We kicked off the year by volunteering at the Stonybrook Community Back to School Bash. During this event we provided education on asthma triggers and surveyed community members on the prevalence of asthma and asthma and its triggers in the housing complex. In addition, we partnered with UMMSM’s Academic Societies to collect school supply donations for the community. Later in the Fall, the Stonybrook community was affected by Hurricane Irma and then a fire, so we collected towels, canned food, and monetary donations from the UM community to support Stonybrook during this difficult time. We also continued our involvement in the Urban Youth Impact Christmas Store. This year we provided nutrition and exercise counseling, health insurance information and asthma trigger avoidance education. In addition, we partnered with the UMMSM Pediatrics Interest Group to organize an arts and crafts table for the children attending the event. Finally, we presented and discussed the Back to School Survey findings with community members. This survey identified asthma as an important issue for the residents, common triggers correlated with asthma in the community, and the local hospital to which community members reported they most commonly go during asthma exacerbations. We have reached out to this hospital to initiate collaborative efforts to reduce asthma exacerbations in the Stonybrook Community. In addition, we will continue to provide education and resources to help community members avoid exposure to asthma triggers.
Guatemalan Mayan Community
The Guatemalan-Maya 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. In previous years, through a Community-Based Participatory Research process, we have identified diabetes, nutrition, exercise, and access to healthcare as some of the community’s highest priority health concerns. We addressed these concerns via a weekend health promotion workshop series for parents over four weekend sessions. Next year we plan to add a pediatric component to the health promotions workshop. So far we have performed an extensive literature review of previous health promotion interventions for children and have begun designing the pediatric curriculum.
Light of the World Health Fair This year we continued our partnership with the Light of the World Clinic in preparation for hosting a health fair with them in the Spring of 2019.
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Health Fairs
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SOUTH DADE HEALTH FAIR October 7th, 2017 Branches Community Center The South Dade Health Fair (SDHF) was formerly known as the Florida City Health Fair and once part of the Florida Keys Health Fairs. Currently, SDHF is an annual event that aims to provide medical care to uninsured, low-income, and migrant worker families in the Florida City and Homestead areas.
LITTLE HAITI HEALTH FAIR October 28th, 2017 Center for Haitian Studies The Little Haiti Health Fair (LHHF) is hosted at the Center for Haitian Studies, a non-profit organization working with local members of the large Haitian community living in Miami. LHHF kicks off National Primary Care Week and is a great opportunity to help the underserved.
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HIALEAH/OPA-LOCKA HEALTH FAIR November 19th, 2017 Dr. Robert B Ingram Elementary School Traditionally, Hialeah Health Fair served the citizens of West Miami-Dade County, a population comprised of many Hispanic immigrants. In order to reach patients from both the Hialeah and Opa Locka communities, we started the Hialeah-Opa Locka Health Fair (HOLHF) at our new site Dr. Robert B Ingram Elementary School. The health fair strives to empower patients through community partnerships with local organizations and churches.
LIBERTY CITY HEALTH FAIR December 9th, 2017 Holmes Elementary School Liberty City has been a vibrant and growing community in our own backyard. Despite its proximity to a large hospital system, the community faced challenges in healthcare access. With the services we provide through the Liberty City Health Fair (LCHF), our goal is to address health needs of our patients while also linking them to invaluable community resources.
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JACK AND JILL HEALTH FAIR January 20th, 2018 Jack & Jill Children’s Center The Jack and Hill Health Fair (JJHF) was held in Broward County at the Jack & Jill Children’s Center, a community resource providing childcare and parenting classes to the underserved in Ft. Lauderdale. In working with the administration of this center and community partners, we seek to provide care to both the parents of children attending the center and the surrounding community in need.
MARATHON HEALTH FAIR February 3rd, 2018 Stanley Switlik Elementary School Marathon Health Fair (MHF) is held in one of the three Keys where we operate the Florida Keys Health Fairs (FKHF). This past year the community’s main hospital was decimated by Hurricane Irma, leaving residents in dire need of medical care and support. Despite losing our previous site to hurricane damage, we served our patients from a new site at Stanley Switlik Elementary School. We aim to continue our service next year to meet the needs of this healing community.
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BIG PINE KEY HEALTH FAIR February 3rd, 2018 Big Pine United Methodist Church & First Baptist Church of Big Pine Key The Big Pine Health Fair (BPHF) has been the initial site of UM’s presence in the Keys since 1971. For over 40 years, our program has provided screening services and medical care to the Keys’ various populations. Last year, some of the original patients on Big Pine attended our yearly fair. In light of the extensive regional damage from Hurricane Irma, we aim to work with our community partners to continue to serve our patients in Big Pine Key.
KEY WEST HEALTH FAIR February 3rd, 2018 Key West High School Our largest site in the Florida Keys, the Key West Health Fair (KWHF) provided various medical and screening services to the diverse population on Key West. Although the school did suffer damage from Hurricane Irma, we worked with our partners to provide care to our patients in the Lower Keys. Next year, our fair hopes to expand on the services provided to our patients in Key West.
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WEST KENDALL HEALTH FAIR April 14th, 2018 Mother of Christ Catholic Church West Kendall Health Fair (WKHF) provides health screening services to a community that primarily consists of Hispanic immigrants. This site was identified as an area of medical need through the efforts of our Research and Quality Improvement team. As this was our 2nd annual fair at this location, our future teams will continue to lay the groundwork and build community partnerships in the area.
CROCKETT FOUNDATION BACK TO SCHOOL EVENT August 5th, 2017 Blanche Ely High School This was our first year participating in the Crockett Foundation Back to School Extravaganza in Pompano Beach. We offered services including vitals, POC glucose and lipids, and pediatric education resources as well. The UM Gordon Center also participated in the event, providing life-saving skills training to attendees. We look forward to returning to this event and serving this community in the future.
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COMMISSIONER EDMONSON BACK TO SCHOOL EVENT August 12th, 2017 Olinda Park/Overtown This was our first year participating in the Commissioner Audrey Edmonson-District 3 Annual Back to School Fun Day/Health and Information Fair in Overtown. We offered services including ophthalmology, vitals, POC glucose and lipids, and pediatric education resources. We hope to return to this event so that we may continue to serve this community.
A sampling of our health fair services This academic year, some of the services we offered include: •
1000+ Lipid tests
•
1000+ Ophthalmologic exams
•
722 Hepatitis C tests
•
707 Dermatologic exams
•
563 Dental screenings
•
495 HIV tests
•
457 Bone density screenings
•
298 Pap smears
•
288 Mental health screenings
•
262 Men’s Health examinations
•
219 Colorectal cancer screenings (16 FIT and 212 Septin-9)
•
168 Memory screenings Page 23
Behind the scenes Public Relations
The overall approach for public relations (PR) this year has been to continue emphasizing community engagement. We encourage our teams to become immersed in the community, pushing them to identify community leaders and reach out to advisory boards, schools, churches, day care centers, restaurants, nonprofit organizations, and other groups. These influential community centers help publicize our fairs and identify community needs. We maintained methods known to be successful in each respective community in the past, including flyering, print/radio/video ads, and social media ads targeting specific locations. We have analyzed results of patient surveys from 2016-2017 and 2017-2018 on the DOCS Electronic Medical Record (REDCap) to determine the most effective methods of advertising. We will continue analyzing data from 2017-2018 to optimise these processes. DOCS has become a community service program that involves nearly 100% of medical students at UMMSM and serves over 2,500 patients from communities throughout South Florida. While we believe we have a formula that works, our PR team continues to learn from our colleagues across the nation. We
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communicate with other medical schools nationally through two related branches of DOCS. The first is the DOCS Consortium, an evolving national forum where student leaders can share resources and engage in conversations about programs implemented at other institutions. The second is the Community Health Leadership Conference, an event that brings students from across the nation to the UMMSM campus and DOCS events to present on their initiatives, with the goal of fostering future discussions and collaborative efforts.
Improving our services
Lab testing and Logistics
In 2017-2018, DOCS continued to expand and diversify the array of screening tests we offer patients. A highlight from last year was the implementation of point-of-care lipid testing, which has been well received by patients who now can get same day cholesterol results. This has provided an opportunity to calculate the risk of cardiovascular disease for patients on site. Additionally, DOCS now offers blood-based testing for colorectal cancer screening. This was implemented due to a low return rate in traditional stool-based testing. The Septin-9 test uses state-of-the-art genome sequencing technologies to detect slight variations in DNA segments associated with colorectal cancer. Patients are notified of their results
usually within a month, and positive results are followed by referral for colonoscopy. In addition to Septin-9, DOCS now offers point-of-care HIV testing, which has been added to our Hepatitis C station. Patients identified with positive results for either HIV or Hepatitis C are counselled by an onsite physician in a private and confidential setting and are provided a referral for further care. Patients at this station are also screened for high-risk behaviors including IV drug use and are referred to local clinics or DOCS-run clinics, including the DOCS IDEA Clinic.
viewed by a physician and then mailed to patients within a month with instructions on appropriate next steps. As we look to the upcoming year, we are exploring other screening tests that could benefit our patient population. Given the difficulty in continuity of care inherent to an annual health fair, we are primarily focused on point-of-care testing where patients can be informed of their results and appropriately referred on-site. At this time, all services are point-of-care with the exception of colorectal and cervical cancer screening.
We continue to perform high numbers of cervical cancer screenings. Pap smears are read by UM pathologists, results are re-
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Physician Recruitment It has been an extraordinarily successful year in physician recruitment across all of our health fair and clinic projects. A dedicated group of students who served as Professional Liaisons recruited physicians and other health care professionals who volunteered over 2,500 hours across our health fairs and clinics. We are indebted to our UM clinical departments who supported us in our endeavors.
Health Fairs
Our physician volunteer workforce consisted mainly of attendings and housestaff from many clinical departments at the University of Miami Miller School of Medicine. The Liaisons carried out recruitment efforts that included sending monthly email reminders and attending morning conference for many of the specialties where announcements regarding our health fairs were made. One of the strategies the team implemented this year was the assignment of individualized physician arrival times to improve efficiency. In addition to physician volunteers, our relationship with local dentists has continued to grow, allowing us to staff our health fairs and provide dental screening services to our patients. One of our most valued partners is Community Smiles, a nonprofit organization on a mission to bring lasting and healthy smiles to the community. Through this partnership we have been able to connect with the Colgate Mobile Dental Van to be present at our fairs.
Clinics
Tapping into the same pool of physician volunteers, our clinic Professional Liaisons were able to effectively staff clinics throughout the academic year to serve a variety of underserved populations. This year we recruited a wide range of physicians, as we expanded our services to include transgender medicine, opioid overdose rescue treatments, and more medical specialties.
Vendors and other Volunteers Local Dentists
Thanks to the help of Ms. Ana Kalias at Community Smiles, Dr. Marvin Feldman, and Dr. Phillip Estes, we were able to provide dental screening to patients at our health fairs once again this year. This is a very important initiative given that dental care is often neglected due to high costs. Our dental station proved to be one of the most requested amongst patients at our fairs.
Translators
In order to provide proper care to the diverse population of South Florida, two of our student leaders acted as Translator Coordinators to recruit undergraduate and high school students to serve as translators. They led efforts such as contacting pre-health offices at local colleges and reaching out to previous volunteers to build a robust roster of skilled individuals fluent in Spanish, Haitian Creole, and Portuguese. These volunteers worked alongside professional students and physician volunteers to ensure that our patients were receiving the best care possible.
Vendors
Throughout the year, we recruited vendors from across the community that offered our patients the opportunity to explore and learn about a variety of resources at each of our health fairs, including pharmacy discounts, mental health, rehabilitation, health insurance, and STD testing. We also partnered with Walgreens to provide flu shots during the influenza season. These vendors provided a great way for patients to connect with many local institutions while waiting to be seen at the other stations.
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Patient Registration, Callbacks, and Referrals Patient Education Booklet
This valuable resource is provided to every patient at registration and includes both essential medical information and space for results gathered at each station. This year we revised the entire booklet to include all the new changes implemented at health fairs.
Callback system
Historically, it has been difficult for us to provide laboratory results to patients who have had address changes after attending our fairs. In response to this challenge, we created a new system this year to reach patients who have moved. Through this new system, patients are called by an automated service in their native language to alert them of a missing or incorrect address. The patient then calls the Longitudinal Access Voicemail to leave their correct address, at which point a team member can then mail out their results to the correct address. This system replaced our previous workflow that required coordinating project managers who had specific language skills. Through this new initiative, we have decreased the time to send out updated labs as well as increased the efficiency and decreased the manpower required to deal with returned labs.
Referrals
As part of our effort to make our referrals process run more effectively and efficiently, we implemented a digital database using ArcGIS mapping technology. This database allows checkout volunteers to immediately locate preferred referral clinics across South Florida depending on the patients’ home addresses and referral needs. Additionally, our checkout station now includes referrals coordinators who are trained to counsel patients on individualized local resources. It is our goal that this system will increase patient follow-up and improve healthcare access in the community.
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Our Health Fair Stations INITIAL HEALTH ASSESSMENT At the Initial Health Assessment station, we have continued building on the entirely electronic registration process in order to better target patients to services they may need. Additionally, we have expanded pre-registration services to more fairs, allowing patients to enter our fairs quickly and efficiently.
AUDIOLOGY The Audiology station screens patients for hearing loss.
DERMATOLOGY The Dermatology station screens for various skin conditions including skin cancer.
GLUCOSE & LIPIDS (POC) The Point of Care (POC) station is able to screen people for diabetes and dyslipidemias with instant results and referral to care.
BONE DENSITY
HIV AND HEP C
The Bone Density station screens patients for osteoporosis.
The HIV and Hepatitis C station screens patients for these diseases with on-site physician counseling.
COLORECTAL CANCER The Colorectal Cancer station screens patients using blood and stool-based testing.
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MEMORY SCREENING The Memory Screening station screens stations for memory disorders including Alzheimer’s disease and dementia.
MEN’S HEALTH The Men’s Health station provides prostate cancer screening and genitourinary examinations, as well as a safe space for discussing other concerns such as domestic violence screening.
VITAL SIGNS The Vitals station provides blood pressure, heart rate and body mass index (BMI) evaluation to screen for diseases including hypertension and obesity.
MENTAL HEALTH The Mental Health station provides screening for psychiatric disorders including depression and suicide.
OPHTHALMOLOGY The Ophthalmology station provides comprehensive ocular screening and evaluation.
PEDIATRIC EDUCATION
WOMEN’S HEALTH The Women’s Health station provides services including cervical and breast cancer screening, domestic violence screening, and information and resources about safe sex practices including condom dispensation.
FINAL DOCTOR EVALUATION The Final Doctor Evaluation station serves as a physician-supervised summative evaluation in which results from all stations are reviewed with the patient.
The Pediatric Education station provides parents age-specific information on important pediatric health/safety concerns. Oral health, gun safety, and vision screenings are also provided.
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Research and Quality Improvement (RQI) DOCS Medical Education Training Video Series Last year, the RQI team completed an internal quality improvement assessment which identified that DOCS, as an organization, was meeting its mission statement and objectives. However, this internal report illustrated a need to improve the training aspect of our program for students before health fairs, thus paving the way for the DOCS Medical Training Video Series Project. This project aims to develop station-specific, supplementary online training modules for medical students to prepare for health fairs. Comprehensive training modules were designed, developed and implemented for five stations which require the most training prior to health fairs: (1) Initial Health Assessment (previously Registration), (2) Point of Care, (3) Women’s Health (previously Female Exam), (4) Men’s Health (previously Male Exam), and (5) Final Doctor Evaluation (previously Checkout). The training modules consist of an introductory video, which educates students on the purpose of conducting screenings, current USPSTF guidelines, and possible signs or symptoms one might encounter with patients at a given station. Additional videos instruct students on obtaining a history or conducting a physical exam for a given station. There is also a video that shows students how to navigate and input data on the DOCS EMR page for the station. Upon completing the training module, students then take a five-question examination to evaluate comprehension of the material. Internal surveys have preliminarily highlighted increased satisfaction with training from students and station managers with respect to improvement in efficiency and comprehension of material. This project will continue next year for the remaining stations.
Data from this project has also supported ongoing work at our Lotus House and San Juan Bosco clinics. Improved training programs are being developed for students who volunteer at these clinics. The San Juan Bosco clinic developed a video training module to orient volunteers prior to arriving to clinic. This has decreased the overall wait time of patients being seen at the clinic and has allowed additional time to be dedicated to teaching volunteers about medical topics related to the specialty clinic of the night. Last year at Lotus House, we partnered with STAND (Students Against Domestic Violence) and developed a protocol and training session to assist volunteers in screening for intimate partner violence. This protocol was implemented and is currently being designed into its own video training module that will be incorporated at both clinics and at the Women’s and Men’s Health stations at the health fairs.
Guardrails Nutrition Counseling In an effort to improve both the quality and efficiency of patient care, we teamed up with the University of Miami’s Masters of Nutrition counseling program and invited them to some of our health fairs to help counsel our patients on nutrition and healthy lifestyle skills. Algorithms were developed and incorporated into the DOCS EMR to filter patients who would benefit from this counseling. At-risk patients who visited the station received individualized counseling on nutrition, diet, and exercise and were provided with a comprehensive report for their session. We received positive feedback regarding this station and hope to continue to work with the Guardrails team next year.
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Flow Improvement Flow Improvement Project
Project
Last year, we conducted an internal analysis to assess the pathway of patients through health fairs in order to relieve bottleneck effects at certain stations and maximize efficiency of patient flow through our stations. Because we identified multiple issues with flow, we decided to partner with the UM Department of Industrial Engineering (IEN) to help improve flow at our health fairs. We worked with a group of engineering students who analyzed our health fairs throughout the fall semester. The IEN analysis revealed bottlenecks at the Women’s Health and Ophthalmology stations and identified that most patients did not make it to the Final Doctor Evaluation station (previously checkout). They provided us with recommendations to improve these issues which have already been implemented with noticeable positive results. For instance, improvement in the visual aesthetics of fair maps and better use of signage have aided patients in successfully navigating through the stations they want to visit at fairs. The IEN students also created a preliminary version of a program which allows station managers to log number of patients at a station and current wait times. This program could be used when registering patients to plan their fair day to alleviate the bottleneck effect. We hope to work with DOCS MedIT next year to create a version of this that can be included on the health fair server to update in real-time. We also hope to work with the IEN students again to improve other areas of our organization.
GIS Mapping Through analyzing why patients were lost to follow-up in our Patient Navigation Program, we realized patients are often unaware of many health resources in their communities. Our Health Fair GIS Mapping project was developed last year 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. We developed an informative guide on the demographic and socioeconomic analyses of the communities each health fair serves to better educate students on the population they are serving. For the patients, we have developed an interactive map of resources and an algorithm to help patients identify resources closest to their area. This map is available on the DOCS website and has been incorporated at the weekly clinics as well as at the health fairs. Since the demographic profile of many areas we serve has changed over time, we used GIS mapping with census data to see if our fair locations were still targeting appropriate communities with need. The data gathered from this project revealed a shift in the socioeconomic status and demographics in Hialeah and prompted us to relocate this health fair to the area of Opa-Locka which had greater need. As we continue to develop this program, we hope to collaborate with the UM Department of Electrical and Computer Engineering to assist us in incorporating GPS technology.
Scholarly Work This year we created a standardized procedure for the proposal, conduct, and publication of scholarly work within DOCS. Through this platform, we have had many students work with RQI to conduct scholarly work aimed at improving the DOCS organization or the care delivered to our patients. This year we had a total of 10 presentations at various conferences throughout the country.
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Disseminating the Model Our efforts to assist and enable medical students around the United States in serving their own communities Annual AAMC Trip
Our PR team traveled to the AAMC Learn, Serve, Lead national conference in November 2017 in Boston, Massachusetts, to share our model on a national stage. The team continued to build a network of students and faculty at other institutions interested in future partnerships.
DOCS National Health Leadership Consortium
The DOCS Consortium aims to be a national forum for discussion and collaboration among medical students seeking to serve their communities. This year, we established a more formalized structure for this initiative on our DOCS website. DOCS Community Health Leadership Conference participants from 2017 were invited to register for the forum and navigate the website to encourage them to share our resources within community service organizations at their home institutions. The initiative continues to evolve with the goal of involving more students, organizations and institutions nationally. Our information-sharing model has already had several successes, including: After visiting the San Juan Bosco Clinic at CHLC in March of 2017, a student from Michigan State University reached out to DOCS as she implemented a medical student-run clinic in tandem with faculty at her institution. After visiting CHLC in March of 2017, a student from University of Texas Medical School at Houston reached out for guidance in determining who, what, and how to screen at health fairs as well as documents used for patient education. After visiting a fair in 2017, a student from the University of California-Los Angeles reached out to elicit guidance in hopes of developing an electronic medical record for their student-run clinic. After visiting one of our health fairs, students from the University of Florida reached out to DOCS in hopes of streamlining flow for Ophthalmology nights at their student-run clinic.
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Community Health Leadership Conference (CHLC)
The 2nd annual DOCS Community Health Leadership Conference occurred on December 8th and 9th, 2017. Combining attendance from our March and December conferences, the DOCS PR team hosted 103 students from 30 medical schools throughout the country. The goal of the conference was to share and encourage collaboration between similarly-minded students and community service organizations. The morning of December 8th, we had various members of the UM faculty speak to the students, including Dr. Amar R. Deshpande on new developments in DOCS, Dr. Hansel Tookes on Miami’s pilot needle exchange program, and Dr. Erin Kobetz on the execution of community-based participatory research. We had three oral and one poster session for students throughout the country to present their work. Thereafter, students were invited to two workshop sessions on pre-determined topics based on surveys of the participants. Students enjoyed a conference banquet and awards session meant to recognize the wonderful initiatives presented to the group. Conference participants had the opportunity to participate in our Liberty City Health Fair, giving them an opportunity to volunteer alongside our students and physicians.
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Professional Collabor Our efforts to integrate multiple medical and non-medical specialties to provide a truly diverse healthcare access portal for patients
Physical Therapy
For the second year in a row, the Physical Therapy station has successfully provided fall risk assessments to patients. This collaborative effort continues to give MD students the opportunity to rotate with DPT students, allowing both sides to learn about each other’s profession. Additionally, their implementation of the STEADI (Stopping Elderly Accidents, Death and Injury) protocol to reach at-risk members of local communities was showcased in a poster presentation entitled: “Interprofessional Education Experiences and Service Learning through the Department of Community Service at the University of Miami Miller School of Medicine.”
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Public Health
We continued to recruit MPH students to work alongside MD students at different health fair stations. MPH students consistently provide important knowledge on preventive strategies to address public health issues affecting our local communities such as hypertension, diabetes, and healthy lifestyle choices. This interdisciplinary approach allows for a better combination of screening and education at each of our stations.
Nursing
Through one of our largest interprofessional partnerships, BSN and Nurse Practitioner student volunteers play an integral role in helping staff many of our health fair stations thanks to the recruitment efforts of our liaisons, Dr. Regine Reaves, Dr. Yui Matsuda, and Dr. Juan Gonzalez. Collaborating with nursing students provides the MD students with the opportunity to learn to work in a team that reflects the modern workforce and provides patients with a more interdisciplinary approach to care.
ration Bascom Palmer Eye Institute
This year, Bascom Palmer not only provided physician volunteers to staff our Ophthalmology station, but it also introduced us to students pursuing their Masters in Vision Science and Investigative Ophthalmology (MVSID). Not only do these volunteers provide manpower to help run one of the busiest and most complex stations at our fairs, but they also bring their expertise in ophthalmological medicine to complement and educate MD students.
FIU College of Law
At our very last health fair of this academic year in West Kendall, we successfully pioneered a new Legal station with the assistance of law professionals from the College of Law at Florida International University. They provided our health fair participants with important information regarding community law resources on immigration and medical advanced directives.
Florida Keys AHEC Collaboration In the Fall, DOCS hosted an event for the Florida Keys Area Health Education Center (AHEC). Current medical students and residents spoke to high school students interested in pursuing careers in the health sciences in order to give them a better understanding of the requirements, the training, and the expected experience of being a health care professional. Featured speakers included Dr. Mousa Botros (Psychiatry) and Dr. Sibi Krishnamurthy (Internal Medicine). Medical student speakers were project managers for our Florida Keys Health Fair teams.
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Emergency Preparedness
Hurricane Irma Relief
CPR and Emergency Training
Gun Safety
In the wake of Hurricane Irma, the DOCS Emergency Preparedness team organized several UMMSM student volunteer efforts. The team partnered with The Department of Children and Families (DCF) and The Florida Department of Health to supply a Disaster Food Stamp Program (DSNAP) event with student volunteers over four days in October 2017 at 5 locations in Miami-Dade County. The team also organized student volunteers to help pack supplies destined for Puerto Rico at packing sites in North Miami and Kendall. They also made special efforts this year to provide hurricane preparedness education to patients at health fairs.
Now in its third year, the Emergency Preparedness team’s CPR training program at Lotus House enjoyed another year of success. The team also continued to teach basic, hands-only CPR and AED usage to patients at DOCS health fairs with the help of certified first aid instructors and local firefighters. Other lifesaving skills, including the abdominal thrust (Heimlich) maneuver for adults and fire safety for children were reviewed. These efforts make the Emergency Preparedness station a useful stations to patients year after year.
With gun safety becoming an increasingly important topic in society, the Emergency Preparedness team worked closely with the Gun Violence Research Advocacy Program (GVRAP) on several initiatives. Students were trained to provide counseling to gun owners with young children in the home. Additionally, over 100 gun locks were distributed at health fairs throughout the year.
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Future Goals
Portable Mammography Screening
It has been an ongoing effort within DOCS to provide portable mammography screening to our patients at our health fairs. We offer a confidential space to discuss women’s health concerns, provide intimate partner violence screening and counseling, and private rooms for cervical cancer screenings. Logistically it has been difficult to provide on-site mammography screening at our fairs, however we continue to provide referrals for free and low-cost mammograms in the community. We are currently working with the Sylvester Cancer Center at the University of Miami in order to create a partnership through which we can arrange to have breast cancer screening on-site. While this is just one piece of the puzzle, we are hopeful that with continued networking and spreading awareness of our DOCS mission we can provide a suitable solution to the women in our communities who are either uninsured or cannot access health care for other reasons.
Robust Patient Referrals
Currently we have in place a referrals system whereby patients who screen positive for any of our screening tests at our fairs are referred to pre-approved free and low-cost clinics in the community that can provide them with follow up care. We are currently working internally to train individual referrals specialists who will be readily available at our fairs to counsel patients on their next steps in receiving appropriate care after they’ve had their Final Doctor Evaluation with our physicians. We are also building an innovative GIS referrals map that can be accessed both on-site and electronically so that patients can find convenient locations for both specialty-specific medical care and community resources such as parks, health food stores, and more.
ENT/Head and Neck Cancer Screening
As of this last year, we have implemented two new stations at each of our fairs that fall under the umbrella of Ear, Nose, and Throat (ENT). These include an audiology screening station run by audiologists from the University of Miami and a dental screening station run by community dentists and oral maxillofacial surgery residents and faculty. Additionally, we partnered with the University of Miami Head and Neck Screening Fair, which fell during the week of our West Kendall Fair, in order to have additional head and neck cancer screenings at our last fair of the year. Our goal is to provide these screening services yearround at all our fairs in order to screen for the various cancers of the head and neck that are commonly associated with tobacco use, alcohol use, and high-risk sexual activities, as well as addressing patients’ concerns such as obstructive sleep apnea.
Improvement of Colorectal Cancer Screening Patient Follow Up
One of our greatest achievements this year has been the ability to provide our patients with a novel blood-based colorectal cancer screening test at our health fairs. The samples are collected and sent to an outside lab for processing, and patients are contacted 2-4 weeks after the fair with their results. We are actively working to improve our follow up capabilities so that patients with positive results are navigated into the healthcare system in a timely fashion in order to receive low-cost colonoscopies. We are working toward gathering a CRC-screening specific group within our patient navigators who are solely responsible for counseling these patients and helping them receive adequate follow up.
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2017-2018 DOCS Executive Board
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