Approach could become a model for addressing health disparities
UH Innovations in Pediatrics - Fall 2018
Social determinants of health are increasingly viewed as playing an outsized role in health disparities in the United States. The Centers for Disease Control and Prevention, for example, has adopted the framework in its Healthy People 2020 goals, naming factors such as poverty, access to health care, access to primary care and access to foods that support healthy eating patterns as key indicators of whether individuals in a given community will enjoy good health.
In 2015, a multidisciplinary University Hospitals team conducted a community health needs assessment and identified specific areas of need, including lack of access to primary and dental care as well as several social, economic, and environmental health factors.
A direct response to community health needs, the UH Rainbow Center for Women & Children is a new $26 million, 40,000-square-foot health center. It is designed to provide community-centered care that integratively addresses medical, social, and environmental factors influencing health, and to take a collaborative approach with patients and community stakeholders to address health disparities.
The Center’s Medical Directors are Aparna Bole, MD, FAAP, Division Chief of General Academic Pediatrics & Adolescent Medicine at UH Rainbow Babies & Children’s Hospital, and Ann Konkoly, CNM, a nurse-midwife at UH MacDonald Women’s Hospital. Jordan M. Javier is its Director.
“We were able to include the community and our patients and families in a meaningful way, both in planning the Center’s programs and services but also the design of the building,” Dr. Bole says. “It’s integrated in the community and seen as a shared community asset. The Center is also helping to catalyze vibrant and inclusive development in the neighborhood. The emphasis on equity, inclusion, outreach and partnership with patients and community stakeholders underpins the Center’s innovation.”
A Thorough, Collaborative Process Yields Multidisciplinary Services Under One Roof
To help determine the resources and programs to offer at the Center, beyond traditional healthcare, and to incorporate community-centered design features in the building, UH launched a Community Advisory Board that includes more than 70 members representing 35 different organizations, as well as community residents, patients, and families. The result is a Center with multiple services supporting families’ well-being, all under one roof, accessible in the community via multiple modes of transportation. Included are:
- Pediatric primary care and adolescent medicine services
- OB-GYN services, including high-risk OB and imaging
- Integrated mental and behavioral health services
- Dietitians and nutrition education
- Breastfeeding support
- Full-service vision clinic
- Dental screening and cleaning
- WIC office
- Lab services
- Medical/legal partnership
- Social needs navigation & social work services
Pediatrics and obstetrics/gynecology residents and other trainees are an integral part of the care team.
“The ability to provide wrap-around services and create a multidisciplinary medical home for our patients in an academic setting, in a fashion that is truly integrated within the community, while educating the next generation of care providers in this kind of environment – this represents an innovative concept,” Dr. Bole says.
Expanding the Centering Model of Care
One of the Center’s goals is to decrease the infant mortality and pre-term birth rates in Cleveland and Cuyahoga County, both of which are among the highest in the nation. The Centering® model of group healthcare is a proven effective strategy, and UH’s CenteringPregnancy program has achieved positive results. In 2017, the program’s pre-term birth rate was just 3.8 percent, compared with Cleveland’s overall rate of 14.9 percent, according to the March of Dimes.
The new UH Rainbow Center for Women & Children has received grant funding from the Centering Healthcare Institute to expand the Centering group care model to obesity care, nutrition education, postpartum and breastfeeding support and hypertension management. The Center will also provide pediatric well care in a group setting.
“We have heard our community’s feedback that peer-to-peer support is really important, in areas beyond the already-successful group prenatal care model,” Dr. Bole says.
A Focus on Research
A key aspect of the new center is rigorously collecting data to determine whether its multidisciplinary, community-centered approach is having an effect. The goal is to share outcomes and emerging best practices, ultimately becoming a model for addressing health disparities by treating the whole patient with individually tailored care and support.
The Center for Child Health and Policy at UH Rainbow is taking the lead in this research and evaluation, looking at the effectiveness of individual UH Rainbow Center for Women & Children programs, and also assessing patients’ self-reported health status and whether their health needs are being met.
“We’re also very interested in evaluating our staff and our providers’ well-being and experience,” Dr. Bole says. “In addition, we’re exploring a qualitative evaluation of the efficacy of our Community Advisory Board and how our relationship-building in the community has built social capital between organizations and in the community.”
“We have many opportunities for research,” she adds. “We have a number of active research studies even now, including a longitudinal study of patients’ and families’ medical and nonmedical health needs, as well as a study of pediatric residents’ educational experience in the primary care setting. The Center is a very active, fertile ground for innovation and research related to clinical services, quality and patient experience, and education.”
A Good Neighbor
In designing and constructing the new center, Dr. Bole says, every decision was considered for how it could contribute to the well-being of the local community – not only just in health outcomes, but also in environmental and financial impact.
“The building was designed with a sense of environmental sustainability and environmental performance that I think is really important,” she says. “It’s one of the greenest, healthiest healthcare buildings in the country, with optimal indoor air quality, excellent energy performance and on-site renewable energy, and accessibility via multiple modes of transportation. In addition, when we invested in the neighborhood, we were committed to hiring local and increasing job opportunities for local people, and purchasing from minority-owned and women-owned businesses in the community in the construction of the building. We wanted to leverage our investment to attract additional investment to the neighborhood.”
“This is all part of our total health mission,” she says. “It’s the way that we operate, the programs that we offer, the way we invest in the community and the kind of building in which we want to care for our patients and our staff.”
For more information about the new UH Rainbow Center for Women & Children, please email Peds.Innovations@UHhospitals.org.