2004 Case Examples

Alabama
Arkansas    
California
Colorado
Florida
Georgia
Hawaii
Illinois
Louisiana
Maine
Maryland
Massachusetts
Michigan
Missouri
New Jersey
New York
North Carolina
Ohio
Pennsylvania
South Carolina
Tennessee
Texas
Virginia
Washington


Alabama

PRINCETON BAPTIST MEDICAL CENTER
BIRMINGHAM, AL

Executive Summary:  Princeton Baptist Medical Center is located in a community that is becoming increasingly diverse. The medical center and its employees have partnered with the community to decrease crime and improve the neighborhoods near the medical center. Princeton believes that a strong relationship with the community is important, and it established a program to work with local salons to promote health information. The Salons Saving Sisters program provides nail and hair salon owners with health information on a variety of issues, ranging from breast cancer and prostate cancer awareness to heart disease and diabetes. In addition, the medical center provides speakers to the salon owners who discuss the importance of promoting the health information and the impact it can have on the salon owner’s customers. The program provides the medical center with an avenue to reach the area’s African American community.

In addition, the medical center recently implemented cultural diversity training in its new employee orientation and established an online educational program for existing employees. The computer-based training is required for all employees, and emphasizes cultural diversity issues in both the workplace and surrounding patient care.

Organization Size:  330 beds

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Arkansas

DELTA AHEC
HELENA, AR

Executive Summary:  The Delta Area Health Education Center (Delta AHEC) is a seven-county health education outreach program of the University of Arkansas for Medical Sciences.  Established in 1990, the organization provides a variety of professional education options, community health education and intervention programs.  The seven counties served consist of a highly diverse population and struggling economies, and Delta AHEC reaches out to individuals through its integrated approach with local community organizations.  Rather than waiting for individuals to seek care, the organizations’ “Your Body, Your Health” program reaches out to minority and disadvantaged populations by providing free health screenings and culturally appropriate educational materials at local organizations such as barber shops, beauty shops, churches and schools.

Delta AHEC also provides continuing education opportunities for professionals in the area and promotes health care professions to minority students in an effort to establish a health care workforce that is representative of the area’s diverse population.  The organization regularly meets with community members in each of the areas, allowing its three offices to establish programs and outreach efforts that target the specific needs of each community.

Organization Size:  Delta AHEC consists of 55 employees

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ST. EDWARD MEDICAL CENTER
FORT SMITH, AR

Executive Summary:  St. Edward Medical Center provides a clinic in the area’s most economically disadvantaged neighborhood.   Large portions of the clinic’s visitors are uninsured and underinsured Hispanic patients, and the clinic staff observed a higher proportion of Hispanic patients with diabetes compared to the general population.  As a result, the organization applied for and received a grant to offer a new program at the clinic targeting the health care needs of the area’s Hispanic population.  Using the grant, St. Edward Medical Center has hired a bilingual clinical staff member to assist the clinic’s mid-level provider, established a diabetic education and screening program in Spanish, and is working with local organizations to promote the new program.  The clinic will not turn away anyone in need of health care services, offering care on a free or sliding scale basis.  In addition to implementing this new program, St. Edward Medical Center strives to offer culturally competent care by providing each clinical department with cultural information, subscribing to the AT&T translation service, and translating documentation into the common languages spoken in the community.

Organization Size:  343 beds

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California

LITTLE COMPANY OF MARY
LOS ANGELES, CA

Executive Summary:  Little Company of Mary operates two hospitals located in the South Bay area of Los Angeles. Although the Samoan population in the area is small, it requires primary health care services and health education. In response to this need, Little Company of Mary created a diabetes outreach program targeting the Samoan population. Little Company of Mary began by sending a Samoan doctor to local churches to give presentations about diabetes. Each church service was followed with free blood sugar screenings. Approximately 30 percent of the tested individuals either had impaired glucose tolerance or were diabetic. In addition, approximately 60 percent of the known diabetics tested had blood sugar levels that were out of control.

The program refers these at-risk and diabetic patients to a physician, including four free visits over a six-month period as well as a referral to a diabetic education program. The eight-week program, taught in Samoan, addresses issues surrounding management and prevention of diabetes. The continued success of this Samoan outreach program has recently allowed Little Company of Mary to receive funding from its parent company, Providence Health System, to implement a similar program in the Latino community.

Organization Size:  Little Company of Mary San Pedro Hospital: 259 beds; Little Company of Mary Hospital in Torrance: 317 beds

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Colorado

KIT CARSON COUNTY MEMORIAL HOSPITAL
BURLINGTON, CO

Executive Summary:  Kit Carson County Memorial Hospital serves a community that is approximately 20 percent Spanish-speaking. In order to ensure the best care to all its patients, the hospital strives to eliminate potential language barriers by posting all signs in English and Spanish, providing language translators upon a patient’s request or identified need, and translating its documents into Spanish. The hospital also hires bilingual employees when possible, and the majority of the staff is bilingual at its local medical clinic.

Organization Size:  25 beds

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Florida

NORTH BROWARD HOSPITAL DISTRICT
FT. LAUDERDALE, FL

Executive Summary:  Since 1993 the North Broward Hospital District has operated primary care clinics for patients, regardless of their ability to pay.  As the need for primary health care services has continued to grow, the number of clinics has expanded to 20.  The North Broward Hospital District operates 15 of these 20 community primary care clinics, which are located in easy-access areas to ensure that diverse patient populations can easily access a clinic near them.  In addition to operating the clinics, in 1999 the hospital district established a disease management program.

The disease management program is available for uninsured and Medicaid patients who visit the clinics. The goal of the program is to help patients with chronic conditions learn to manage their disease, increase their health status, and decrease the number of unnecessary emergency room visits and hospital admissions.  The program is specifically for patients with maternal/child health needs or for patients suffering from HIV/AIDS, asthma, diabetes, hypertension or congestive heart failure.  Patients meet regularly with a nurse at their local clinic to help them recognize the signs of declining health and understand when and where to seek care appropriately to prevent greater declines in their health status.  The program is funded by grants from the state, county and local businesses, and is a partnership between the hospital district, another local hospital system, and many local community organizations.  A recent study showed that the county has less racial and ethnic health disparities compared to national averages.  Local hospitals have also enjoyed $980,000 in cost avoidances due to individuals proactively managing their health and utilizing the emergency room at appropriate times.

Organization Size:  Four hospitals and 35 facilities including an outpatient surgical center, physician practices and 15 primary and specialty care sites.

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Georgia

GWINNETT HOSPITAL SYSTEM, INC.
LAWRENCEVILLE, GA

Executive Summary:  Gwinnett Hospital System, Inc. is located in one of the fastest growing counties in the United States, in a community 30 miles northeast of Atlanta. In addition to its rapid population growth, the composition of the population has changed from 5 percent minority (non-Caucasian) in 1982 to 33 percent minority and 67 percent Caucasian in 2004. This trend is expected to continue into the foreseeable future. As the guardians of the community’s good health, the system recognized
the increasing diversity of the population and their unique needs. The system hired Roosevelt Thomas Consulting & Training, Inc. to assist with the creation and implementation of a diversity action plan. The consulting company began by conducting an organization-wide assessment to determine employee perceptions as well as the organization’s strengths and weaknesses; a holistic approach was then created and implemented. The approach is comprehensive, including targeting recruitment and retention of minorities in the community, employee training, and an expansion of the culturally diverse care and services available for patients. The organization is committed to building on its longstanding relationship with the community, and will continually strive to improve the quality of care offered to all cultures in the community.

Organization Size:  479 beds

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PHOEBE PUTNEY MEMORIAL HOSPITAL
ALBANY, GA

Executive Summary:  Phoebe Putney Memorial Hospital serves a population that has a high proportion of low-income individuals, many of whom are African American men.  The hospital regularly conducts focus groups in the community to understand issues affecting its patients, and has created several programs in response to health disparities prevalent in the area.   The Men’s Health Program was created in response to significantly higher morbidity and mortality rates among African American males in the community than in the state.  Phoebe Putney Memorial Hospital’s Men’s Health Program reaches out to churches to educate men about health awareness and works to help them understand issues impacting their ability to access care.  The hospital then recruits men interested in serving their community by working to educate other men in the community about health issues.  Titled “Men on the Move,” the group of laymen has been educated by hospital physicians and medical providers and now hosts health events and screenings throughout the community, attracting between 500 and 1,000 men to each community event.

Organization Size:  446 beds

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Hawaii

KAHI MOHALA BEHAVIORAL HEALTH
EWA BEACH, HI

Executive Summary:  In 2004 Kahi Mohala Behavioral Health established an adolescent enhancement program for children receiving treatment at the facility for an extended period of time. The “Kohua Ho’okele”, or the “Foundation for Navigation” program is a values-based program founded on the Hawaiian values of “Aloha,” or self-worth and self-love, respect, self-care and self-awareness, adapting and coping skills, and responsibility. The children and their families are assigned two “Alakai,” or coaches to assist in the healing process of treatment, helping them to enhance their personal and family functioning in all aspects of living and encouraging the children to have cultural acceptance and cultural humility. In addition to the Alakai, the program consists of clinical assessments, group therapy, and cultural activities. The children participate in weekly “Ohana Nights,” or family nights, a bi-monthly luau, and an annual Aloha Day that includes a variety of cultural activities and performances by the children. Each child in the program moves through a series of levels, beginning as a novice and becoming a navigator before leaving the facility. To achieve navigator level the children must have cultural acceptance and cultural humility, understanding that no one culture is better than the other.

Organization Size:  88 beds

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Illinois

NORTHWESTERN MEMORIAL HOSPITAL
CHICAGO, IL

Executive Summary:  The Diversity Program at Northwestern Memorial Hospital emphasizes the promotion of diversity interests in every aspect of hospital operations.  It maintains that in order to effectively address racial and ethnic disparities and promote diversity within a hospital, efforts should be focused in three areas: representation, inclusiveness, and cultural competency.  Representation addresses the hospital’s desire to reflect the races and cultures represented in a diverse Chicago community.  Northwestern has found that diversity within the staff leads to an increase in the ability to adequately and appropriately address patient needs.  Inclusiveness is achieved through creating and encouraging an environment where all patients, staff, and students feel welcome.  Finally, cultural competency programs acknowledge the differences that exist among patients in their cultural backgrounds and beliefs, and equip medical staff with the ability to provide treatment that is sensitive to those differences.

The program’s successes include an increase in the number of minority medical staff, a more diverse panel of physicians for patient selection, and a higher level of minority physician retention and satisfaction.

Organization Size:  1,350 medical staff physicians; 6,000 employees; 750 beds

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Lousiana

LAKEVIEW REGIONAL MEDICAL CENTER
COVINGTON, LA

Executive Summary:  Lakeview Regional Medical Center is striving to achieve an increasingly diverse workforce as well as a diverse advisory board. The medical center’s current  dvisory board exists of 11 members, with one minority member. The organization has identified and is recruiting specific minority community members who can be an asset to the board for their minority perspective as well as their well-rounded skills and knowledge. In addition, Lakeview Regional Medical Center has placed a stronger emphasis on achieving greater diversity in its management positions, hiring two highly qualified minority managers in the past four months.

Organization Size:  141 beds

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Maine

ST. MARY’S REGIONAL MEDICAL CENTER
LEWISTON, ME

Executive Summary:  St. Mary’s Regional Medical Center is located in a region that was 99 percent Caucasian until 2001, when it experienced an influx of African refugees and immigrants. The hospital wanted to continue its philosophy of reaching out to the poor and disadvantaged populations, so it created an advisory group composed primarily of individuals from the two new African cultures, the Togalese and the Somalis. The group established four objectives: (1) to guarantee health care access; (2) to ensure that employees and the community understand the perspectives and cultures of the new groups; (3) to create a hospital workforce that mirrors the community’s racial and ethnic diversity; and (4) to  ollaborate with other community organizations to promote cultural diversity in the community. The hospital is now achieving all four of these goals, and has established itself as a strong supportive body for the community and its new citizens.

Organization Size:  230 acute care beds, 280 long-term care beds

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Maryland

NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE
AND KIDNEY DISEASES, NATIONAL INSTITUTES OF HEALTH
BETHESDA, MD

Executive Summary:  Recognizing a need to address the increasing problem of kidney disease, the National Institute of Diabetes and Digestive and Kidney Diseases formed the National Kidney Disease Education Program (NKDEP).  The goal of the NKDEP is to prevent or slow the progression of kidney failure. The NKDEP is particularly concerned with kidney disease among African Americans as they have four times the risk for kidney failure as the overall U.S. population. Focusing their attention on the African American community and the physicians who treat them, the NKDEP launched a program to raise awareness about the seriousness of kidney disease, the importance of testing those at high risk, and the availability of treatment to prevent or slow kidney failure in four metropolitan areas.  The results of the program in these four cities will be assessed and will form the foundation for a nationwide education campaign set to begin in June 2004.

Organization Size:  N/A

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Massachusetts

Dana-Farber Cancer Institute
Boston, MA

Executive Summary:  National cancer statistics demonstrate that women of specific racial and ethnic minority populations experience lower rates of cancer screening and/or higher rates of breast and cervical cancer morbidity and mortality than their white counterparts. In Boston, as in the country as a whole, breast cancer incidence is actually lower in African-American women as compared to white women, yet mortality rates from the disease remain higher. Nationally, African-American, Latina and Asian women exhibit higher incidences of cervical cancer than white women, and in Boston, mortality from cervical cancer among African-American women has been documented as twice that of white women.  Asian women and recent immigrants tend to have lower cancer screening rates, due in part to limited access to primary care and distinct cultural beliefs and practices, which leads to later stage detection of the diseases and thus poorer outcomes. Many factors contribute to these disparities, only one of which is lower cancer screening rates; other factors include lack of access to health services, patient distrust, and possible provider bias.

In recent years Dana-Farber has enhanced its commitment to addressing disparities via a multi-pronged effort, including hiring a full-time Director of Health Disparities, convening an Executive Committee on Health Disparities, sitting on the Mayor's Task Force to Eliminate Health Disparities/ Hospital Working Group, and developing a business plan for the Institute dedicated to addressing disparities via both research and service initiatives.  Two such initiatives aimed specifically at addressing breast and cervical cancer disparities do so by increasing access and reducing barriers to breast and cervical cancer screening for all women in the Greater Boston area:  Boston’s Mammography Van and the Breast and Cervical Screening Collaborative.

Established in 1998, the Breast and Cervical Screening Collaborative (BCSC) is a collaboration of the Dana-Farber Cancer Institute, Partners HealthCare System and 14 community health centers who collectively provide breast and cervical cancer screening and diagnostic follow-up services to approximately 1,400 uninsured and underinsured women over the age of 40 each year.  In 2002, Dana-Farber partnered with the City of Boston to operate Boston’s Mammography Van, providing mammograms to residents of Boston right in their neighborhood, regardless of ability to pay.  The van provides mammograms to approximately 25 women per van day, and about 3,000 women per year.

Organization Size:  N/A

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FAIRVIEW HOSPITAL
GREAT BARRINGTON, MA

Executive Summary:  Fairview Hospital’s community was primarily white-Caucasian and English speaking until recently. As the proportion of Hispanic and other cultures has increased, the hospital realized the importance of providing culturally competent care to all its patients. It began by educating its management about the importance of providing culturally competent care, and then expanded the education program to various departments in the organization. Each education program included a pre-test and a self-learning packet, followed by a post-test to track learning progress. Each unit is also provided with reference materials about various cultures, as well as copies of all documents in both English and Spanish. The organization has a program in place to translate new documents into Spanish and existing documents into other languages as necessary, as well as verbal translation services available to non-English-speaking patients.

Organization Size:  25 beds

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Michigan

CHIPPEWA COUNTY WAR MEMORIAL HOSPITAL
SAULT STE MARIE, MI

Executive Summary:  Sault Ste Marie has a large Native American population.  Although the tribe has a comprehensive, state-of-the art medical center, it has not made business sense to keep the medical center open after business hours.  As a result, the Chippewa County War Memorial Hospital was experiencing an overwhelming number of patients in its emergency room, many of which were non-emergency cases.  Because the majority of these non-emergency cases were Native Americans, the hospital approached the tribe and proposed a business agreement.

The agreement resulted in opening a Community Care Clinic next to the hospital’s emergency room.  The clinic’s physical location and administrative staff are funded by the hospital, while the caregivers are provided by the tribe.  It is open during high-volume hours (10 a.m.-11 p.m.), with a focus on providing care to the community’s indigent population.  Although the partnership has not yet earned back the initial cost of opening the clinic, the community’s greater access to primary care services combined with the hospital’s decline in non-emergency cases are indicators of the program’s success.

Organization Size:  83 acute beds, 52 long-term care beds

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HENRY FORD HEALTH SYSTEM
DETROIT, MI

Executive Summary:  Henry Ford Health System (HFHS) has a long tradition of commitment to excellence in patient care, education, research, and community-based service.  Henry Ford strives to deliver health care services that meet the needs of the community.  The system works conscientiously to develop effective and culturally appropriate approaches to medical care. The Institute on Multicultural Health (IOMH) has been extraordinarily successful in this arena.  The goal of the IOMH is to build the Henry Ford Health Systems’ expertise in academic and community-based research while implementing and evaluating new strategies to reduce racial and ethnic health care disparities and improving the health and quality of life for underrepresented racial and ethic populations.

Organization Size:  Four hospitals, a medical group, and a managed care plan including Henry Ford Hospital (903 beds), Henry Ford Wyandotte Hospital (302 beds), Bi-County Community Hospital (203 beds), Kingswood Hospital (100 beds), Henry Ford Medical Group, and the Health Alliance Plan.

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WILLIAM BEAUMONT HOSPITAL
ROYAL OAK, MI

Executive Summary:  An increase in immigration of Eastern European and Arab people in the Royal Oak area led to treatment difficulties resulting from language barriers between patients and health care workers.  In response, the Communicating with Non-Communicative Patients program was implemented to create a way in which health care workers could effectively communicate with patients who are not fluent in English.  The program focused on the development of functional “communication tools.” The tools contain pictures and sentences translated into several languages including Chaldean, Russian, Albanian, Romanian, and Greek. Through the use of the tools, patients, their families, and health care workers who share no common language are able to engage in dialogue regarding treatment. The tools allow hospital staff to administer the best treatment possible and help patients and their families feel more comfortable with their experience at Beaumont Hospital.

Organization Size:  1,000 beds

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Missouri

SSM HEALTH CARE
ST. LOUIS, MO

Executive Summary:  SSM Health Care has been committed to diversity inclusion for many years.  However, while creating its formal strategic plan in 1998, SSM Health Care analyzed the demographics of the communities it served and realized that the organization’s workforce was not adequately representative of the diversity of its patient population.  Diversity inclusion is an integral part of the organization’s mission, so a plan was created that included specific strategic initiatives focusing on increasing the number of diverse professionals and managers, creating a climate welcoming to all ethnicities and cultures, partnering with other organizations dedicated to diversity inclusion, and establishing a Supplier Diversity program.  The Supplier Diversity program identifies vendors that are small business or f or minority-owned, and encourages SSM Health Care’s purchasers to conduct business with these vendors whenever possible.  The program’s goal was ten percent of the organization’s discretionary spending dedicated to these vendors, and has grown significantly.

SSM Health Care also created a mentoring program for diverse individuals.  Mentees are people of color who are paired with a senior-level executive to help them enhance their professional and leadership skills and prepare them for potential leadership positions within the organization.  The organization also established a Diversity Forum for minority managers and executives to meet and discuss their perception about barriers to success and how the organization could remove those barriers.  These programs, combined with other initiatives, have helped SSM Health Care exceed its goal of ten percent of its professionals and managers representing diverse individuals.  It was through the use of the Baldrige model that SSM accomplished its diversity success, and was one of the contributing factors in making SSM the first health care organization to receive the Malcolm Baldrige National Quality Award in 2002.

Organization Size:  20 Acute Care Hospitals

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New Jersey

SHORE MEMORIAL HOSPITAL
SOMERS POINT, NJ

Executive Summary:  Shore Memorial Hospital recently began a series of initiatives addressing diversity in its workforce as well as health care disparities that exist in the community’s Latino population.  The hospital established a fellowship program in collaboration with another local health system for Latino individuals interested in earning a registered nurse or radiologic technology degree.  Ten fellowship positions will be available each year, funding tuition and fees for the Latino students in exchange for a work commitment at the organization.  In addition to this educational opportunity, the Shore Memorial Hospital also has an internal Diversity Champion addressing workforce development and health care disparity issues.

The hospital also collaborated with local Latino organizations, community members, and another local health system to develop a multi-disciplinary task force identifying the health needs of the Latino Community.  A key issue emerging from the task force was the need to address diabetes prevalent in the area’s Latino population.  At the same time, Shore Memorial also formed internal focus groups to identify effective methods for communicating and providing information the Latino Community.  Based on the results of the two groups, Shore Memorial Hospital will soon launch a campaign featuring both informational spots on the local Spanish television network during prime time and copies of bilingual documents with health information and community resources available.  These copies will be distributed at local bodegas, or grocery stores.  The campaign’s emphasis will be focused on diabetes management and prevention, and will include a “call to action” that will help the organization track its success.

Organization Size:  195 beds

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ST. JOSEPH’S WAYNE HOSPITAL
WAYNE, NJ

Executive Summary:  St. Joseph’s Wayne Hospital strives to embrace and accommodate individuals of all racial, ethnic and faith backgrounds.  The hospital asks patients during admission whether there are any cultural, ethnic or spiritual needs that are important for them to know about to include in patients’ plans of care.  Nurses and other care providers then utilize the information provided to ensure each patient receives culturally appropriate care, including the food they are served and visits from the pastoral care staff.  The hospital’s pastoral care staff meets regularly with local religious leaders to understand each faith’s beliefs and perspectives surrounding patient care, pain management and end of life issues.  The pastoral care staff regularly communicates patient care issues to hospital employees, and staff is provided with a reference manual that describes various cultural/religious beliefs and practices, providing special instructions and guidance to staff for how to provide care to each group.  The hospital celebrates every religious holiday, and publishes a monthly Interfaith Calendar.  St. Joseph’s Wayne Hospital also conducts community outreach to specific minority and faith-based groups.  The hospital recently hosted a health fair for a nearby Middle Eastern community, including health screenings, a nutritionist with knowledge of Middle Eastern food preferences and translation services.  Women’s health and information about breast self-exams were located in a secluded area without men present.

Organization Size:  211 Beds

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ST. MARY’S HOSPITAL
PASSAIC, NJ

Executive Summary:  St. Mary’s Hospital serves a largely immigrant population. To better serve their health care needs, the hospital asked community residents “what more can St. Mary’s do for you?”  The chief response was that the immigrant community needed help learning English, becoming citizens, and becoming healthier.  Based on this assessment, the hospital developed the “Caritas Connection” (Caritas is Latin for charity).

The hospital provides free outreach to the community in several languages and, with the help of grants, has been able to participate in the building of three new parish nursing sites in the downtown area, which has a high immigrant population.  The hospital provides tutors to teach English in formal and non-formal settings, and anyone interested in obtaining citizenship is encouraged to attend a training class that helps review for the exam.

The hospital has been successful in gaining the trust of the immigrant population to ensure their willingness to attend trainings and outreach programs.  In 2001, the hospital was recognized for having registered the most children and families in New Jersey Family Care, a health care program for the uninsured, and, in 2002, the hospital was showcased as a best practice hospital for insuring families in New Jersey Family Care.

Organization Size:  200 beds

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New York

St. Elizabeth Medical Center
Utica, NY

Executive Summary:  Approximately half of Utica's minority population is African American, and the area is also the fourth largest refugee settlement center per capita in the United States, with over 11,000 refugees living in Utica representing a variety of countries.  St. Elizabeth Family Medicine Center is located two blocks from the area's Mohawk Valley Resource Center for Refugees, and is constantly challenged to provide culturally-appropriate care, train new employees and new residents and ensure adequate interpreter services are available at all times.  In order to effectively address the area's diverse needs, the medical center began a formalized approach to understanding and addressing the needs of its patient base in 1999, when it was approached by a professor at Colgate University, Hamilton, NY, to offer a class project for the university's Community Service Learning course.  St. Elizabeth's Residency Program and Family Medicine Center became the focus of the student project, with the goal of identifying the positions, morals and beliefs of Utica's primary ethnic groups, particularly Bosnians, Vietnamese, Russians, African Americans and Latinos.

Organization Size:  201 bed acute care hospital, 18 physician offices

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ST. JOHN’S RIVERSIDE HOSPITAL
YONKERS, NY

Executive Summary:  St. John’s Riverside Hospital, partnering with the Community Planning Council of Yonkers and 35 community organizations, formed the Yonkers Community health Coalition. Using grant funding from the New York State Department of Health, Office of Minority Health, the Coalition is dedicated to decreasing minority health disparities, with an emphasis on cardiovascular disease. The Coalition uses a grassroots approach to provide educational information about cardiovascular disease and the relationship between obesity and cardiovascular health. Specific programs have included a “Good Health, Better Living” poster campaign, eight-week educational sessions at the YMCA targeting nutrition and exercise lifestyle changes, and one-time community events providing education and materials about cardiovascular disease. The program’s initial three-year grant was awarded in 2000, and was recently extended another three years to 2006.

Organization Size:  407 acute beds, 120 skilled nursing beds (8 ventilator beds)

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ST. JOHN’S RIVERSIDE HOSPITAL
YONKERS, NY

Executive Summary:

St. John’s Riverside Hospital was experiencing a high rate of children presenting in the emergency room for asthma episodes. A large percentage of the children were from minorities. This led the hospital to consider developing a community asthma intervention and education program. However, when a young boy died from a severe asthma attack while playing basketball in an after-school program, the hospital dedicated itself instead to creating a comprehensive approach to caring for asthmatic children. The hospital partnered with the school district to establish a school-based asthma program that allowed nurses to administer treatment to children suffering from asthma attacks at school. The hospital donated compressors, nebulizers, medication, and other supplies necessary for treatment and educated the school nurses about how to use the supplies, as well as about asthma in general.

Each of the school nurses maintained a log of the children with asthma-related  lisits, revealing that in the first year the nurses administered 937 nebulizer treatments, resulting in 95 percent of the students returning to class and reducing student asthmarelated emergency room visits by 80 percent. Since the program’s inception, the schoolbased asthma program has grown from the 55 original schools to 277 schools in the region, with support and grants from the state of New York.

Organization Size:  407 acute beds, 120 skilled nursing beds (8 ventilator beds)

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North Carolina

ANSON COMMUNITY HOSPITAL
WADESBORO, NC

Executive Summary:  Anson Community Hospital is located in Anson County, North Carolina, a small rural community with a population mix of approximately 50 percent African American and 50 percent Caucasian American.  The hospital and the local health department recognized the health disparities in the African American population and decided to participate in the state’s Healthy Carolinians initiative, a state version of the national Healthy People 2000 and 2010 initiatives.  In 1996, Anson Community Hospital established the Healthy Ansonians Task Force with specific goals targeting substance abuse, sexually transmitted diseases, maternal and child health, and injury control.  In subsequent years, the task force added several additional initiatives such as the Mobile Health Screening Clinic and the Parish Nurse Program.

The Mobile Health Screening Clinic was purchased in 1998 when the Healthy Ansonians Task Force recognized that the lack of public transportation in the community was creating a barrier to patients in receiving the care that they needed.  The Mobile Health Screening Clinic was established through an initial grant from The Duke Endowment. Today, the Mobile Health Screening Clinic has ten permanent sites in Anson County and screens about 6,000 community members annually.  The program has been so successful that, even though the grant has expired, Anson Community Hospital has included the operating cost of the clinic into its budget in support of the hospital’s mission to improve the health status of the people of Anson County.

In addition to the Mobile Health Screening Clinic, the Healthy Ansonians Task Force also established a Parish Nurse Program in 1998.  The Task Force recognized that one of the best ways to reach the African American population in the community was through their churches.  The program received an initial start-up grant from The Duke Endowment and currently serves 32 churches in the community.  One full-time parish nurse and over 40 volunteer nurses in the various congregations staff the program.   The Parish Nurse Program provides a variety of services depending on the needs of each individual church, from basic health screenings to CPR training and American Red Cross babysitter certification courses.  The Parish Nurse Program has been well received in the community and recently received a grant from the Duke School of Divinity to expand the program.

Organization Size:  30 acute, 95 long-term care beds

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DUKE UNIVERSITY MEDICAL CENTER AND HEALTH SYSTEM
DURHAM, NC

Executive Summary:  Rather than seeking health care from a primary care physician, many of Durham County’s economically disadvantaged, elderly, and minorities obtained treatment through the Emergency  Department.  In order to improve the quality and consistency of the delivery of primary care, the Duke University Medical Center and Health System initiated Promising Practices.  Promising Practices’ initial objective was to establish a proactive solution in the form of a “new type of house call.”  Promising Practices delivers primary care in the patient’s home or nursing care facility.  The objectives have since expanded to include providing health education in the areas of diabetes, hypertension and asthma, and screening for disease and indicators of future disease.

Since its inception, hospitals in the Duke University Health System have reported a significant decrease in the number of patients with non-emergency illnesses seen in the Emergency Department, an increase in compliance with medical prescriptives, and financial savings.  Patients have benefited from an increase in preventative treatment for disease and are pleased with the continuity of care they are now able to receive.

Organization Size:  1,500 beds

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Ohio

CATHOLIC HEALTHCARE PARTNERS
CINCINNATI, OH

Executive Summary:  Catholic Healthcare Partners, a large health care system based in the Midwest, is developing a comprehensive diversity and inclusion program to implement in all of the organization’s regions. The organization began by defining diversity with a “diversity wheel,” made up of 26 components in different layers, from personality in the center, to physical appearances such as age, race, and gender, to non-visual components such as education, religion, marital status, and income. The outermost layer of the wheel includes organizational factors such as work location and functional level.

Once the organization defined diversity, it implemented a three-phase cultural assessment process. The phases included performing personal individual profiles for randomly selected employees in each region, conduc ting focus groups, and doing a cultural audit survey. Catholic Healthcare Partners is currently completing the second and third phases of this process. Once completed, the organization will use the results to implement an organizationwide strategic plan addressing diversity and inclusion as an essential part of the system’s business strategy to support its mission of compassionate care for all patients and an inclusive workplace for all employees.

Organization Size:  Over 100 corporations, including 30 hospitals

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CLEVELAND CLINIC FOUNDATION
CLEVELAND, OH

Executive Summary:  In an effort to increase employment opportunities for the local Hispanic population, expand the number of bilingual health care workers, and increase the percentage of people with health care benefits, the Cleveland Clinic Foundation teamed up with the local Hispanic community organization El Barrio to establish “Creating Possibilities” or “Creando Posibilidades.” The initiative includes three different programs: (1) an adult nursing care assistant training program; (2) a nursing academy; and (3) community outreach. Each of the three areas will focus on bringing bilingual workers into the health care field, educating the community, and eliminating economic and cultural barriers that currently restrict the quality of care available to a largely uninsured, unemployed, and uneducated population.

Organization Size:  1,000 beds

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FOSTORIA COMMUNITY HOSPITAL
FOSTORIA, OH

Executive Summary:  While the rate of diabetes is an alarming 8 percent in the Fostoria area among the Caucasian population, the rate is a staggering 12 percent in the minority populations. Approximately 6 percent of the county population is African American, 8 percent is Hispanic, and 1 percent is comprised of other minorities.

It is well known that for diabetic persons to live a full, healthy life, they must self-manage their disease through regular monitoring and healthy habits. Most diabetic persons learn the skills of self-management through classes taught by health care professionals.

In spite of an easily accessible education program for diabetics, Fostoria  Community Hospital was not reaching its higher at-risk minority population. A collaboration of hospital departments and community agencies devised a process to identify persons who have untreated diabetes by taking screening opportunities to community places, particularly churches. When at risk persons are identified, the trusted health care professionals direct them to appropriate medical follow-up.

Partnering with parish nurses within the local church congregations provided direct
access for the screenings to identify persons at risk. Quick results testing equipment was purchased to enable on-site counseling by the parish nurses at the same time. Parish nurses counsel identified at-risk persons and refer them to medical follow-up. They also provide advice in seeking financial assistance and monitor the person’s health care progress, as needed.

The program is only a few months old, but already the screenings are prompting desired results.

Organization Size:  Critical Access Hospital – 25 beds

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MOUNT CARMEL HEALTH SYSTEM
COLUMBUS, OH

Executive Summary:  The city of Columbus, Ohio, has seen an upsurge of immigrants. Columbus is currently home to the second largest Somalia refugee population in the United States and one of the fastest growing populations of Hispanics.  Since 1886, Mount Carmel Hospital has been improving the health of Central Ohioans through innovative programs designed specifically to help the poor and underserved.  One of these programs started in 1984 by the Sisters of the Holy Cross is the Community Outreach Program.  The mission of this program is to provide free health care to those who are traditionally underserved.  The program receives funding from the hospital and foundation supported grants, as well as, private donations.  Recent immigrants have had difficulty traveling to the hospital, so the Community Outreach Program learned of the many apartment complexes housing the refugees and immigrants by providing their summer “door to door” immunization project throughout Columbus.  Learning of the many cultural barriers, including language and transportation, the Outreach program included several of these sites for their Mobile Medical Coach program.  The mobile care locations include shelters, rest homes, community centers, and neighborhoods where specific ethic groups are prevalent.  Various services are provided on the mobile coach, including medical care by physicians, nurses, and other medical staff, patient advocacy, and assistance from health caseworkers to help them access medical and social services available to each of them.

Organization Size:  1,000 beds

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PROMEDICA HEALTH SYSTEM
TOLEDO, OH

Executive Summary:  As the number of teenage women giving birth at Toledo Hospital each year continued to rise, the Promedica Health System focused on finding a way to counteract the trend and eliminate its associated problems. Levels of child abuse and child neglect among this age group was high and many of the children born to teenage mothers were not receiving proper immunization and checkups for a variety of reasons. In 1994, Promedica founded Toledo Healthy Tomorrows. Participation in the program is available to any woman under the age of 19 who has given birth at Toledo Hospital, lives in the area, and meets certain financial requirements. The program offers support and education to the young women with the goals of increasing the level of health care the new babies receive and decreasing the chances that the young women experience additional teen pregnancies. To date, Toledo Healthy Tomorrows has helped 300 teen mothers, resulting in 300 healthy children.

Organization Size:  700 beds

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Pennsylvania

CENTER FOR MINORITY HEALTH,
GRADUATE SCHOOL OF PUBLIC HEALTH
UNIVERSITY OF PITTSBURGH
PITTSBURGH, PA

Executive Summary:  Acknowledging a lack of health education and access to medical care among local minority populations, specifically the African American community, the Center for Minority Health (CMH) set out to establish a multi-year campaign to disseminate important health information regarding diabetes and hypertension, two preventable diseases with common risk factors that impact a disproportionate number of African Americans.

In addition, CMH researchers also identified a lack of trust in the African American community toward physicians and medical care institutions.  The program aims to mobilize trusted opinion leaders in the African-American community as agents for health promotion and disease prevention.  Recognizing the historic role that barbershops and beauty salons play as a cultural institution, the CMH launched “Take a Health Care Professional to the People Day” as a strategy to bring public health and medical professionals into trusted settings in the African-American community.  Local physicians, pharmacists, dentists, health educators, and nurses volunteered to spend time at nine participating barbershops and beauty salons.  This annual event is designed provide health education and health screenings for diabetes and hypertension.  For each of the past two years, CMH identified people who needed to be rushed to the hospital for treatment of hypertension that had previously gone undiagnosed and untreated.  

Building upon the success of the program and seeing a necessity to reach people more than once each year, CMH has established the Lay Health Advisor training program designed for barbers and beauticians to become ”first responders,” trained in the use of CPR and the AED.  In addition, their shops are turned into “portals” for dissemination of health information that is scientifically sound and culturally acceptable.

Organization Size:  N/A

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MAIN LINE HEALTH SYSTEM
BRYN MAWR, PA

Executive Summary:  Discouraged by their inability to adequately address local health and social needs, local Haddington clergy decided to seek out assistance from Main Line Health System. Their goal was to initiate a broad-based program through which the Haddington community’s significant health and social needs would be better met.

Main Line offered its financial support, and the Haddington Community Health Project was established. What began as a four-member organization has grown to over 80 members, including doctors, clergy, schools, and local business owners. All participants contribute with the goal of improving the quality of life and health of Haddington’s residents. Current project programs include providing lead paint testing, tutoring programs, health screening, and health education.

The number of programs has grown each year, and community members are enjoying healthier lives.

Organization Size:  200 beds

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THOMAS JEFFERSON UNIVERSITY
PHILADELPHIA, PA

Executive Services:  The arrival of greater numbers of Chinese immigrants in the Philadelphia metropolitan area has resulted in some unique challenges for health care workers and their Chinese patients.  Cultural and language differences as well as a lack of understanding of the American health care system have kept the immigrants from receiving much needed health care and health education.  In an attempt to overcome this problem, Thomas Jefferson University created the Chinese Health Information Center.  The center does not provide direct health care services.  Rather, it serves as a liaison between the Chinese community and Philadelphia health care providers.  Offering translation services, educational programs, a health information hotline, screening, and assistance with social services, the center has bridged the gap and has assisted thousands of members of the Chinese community in obtaining health care and health information.

Organization Size:  720 beds

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South Carolina

GREENVILLE HOSPITAL SYSTEM
GREENVILLE, SC

Executive Summary:  Greenville Hospital System (GHS) collaborated with three other area hospitals and received a grant from the Robert Wood Johnson Foundation to improve patient/provider communication for the Latino population. A not-for-profit organization called MedVerse was created to hire and train interpreters and then test their competencies to provide a well-trained group of professionals.

This organization offers its services at a much lower rate than hospitals and physicians paid previously for interpretation and translation.

If MedVerse develops a financial surplus, it plans to partner with other organizations such as the March of Dimes to provide prenatal care for low income, non-English speaking Latina women.  The projects that improve the quality of life of the targeted populations will be given priority by MedVerse for community reinvestment.

Organization Size:  1,200 beds

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Tennessee

WEST TENNESSEE HEALTH CARE
JACKSON, TN

Executive Summary:  West Tennessee Health Care has partnered with the Tennessee Hospital Association to provide a summer internship program for minority students studying health care administration. The Agenda 21 program provides minority students with a designated preceptor and the opportunity to participate in organizational projects, attend department director and board meetings, and rotate through a variety of departments in West Tennessee Health Care’s six acute care hospitals. Participating in the Tennessee Hospital Association program is aligned with the system’s mission of providing educational opportunities for health care students. In addition to gaining first-hand knowledge and experience of the health care administration profession, interns are provided with on-campus housing, free meals in the cafeteria, and a $10,000 stipend. West Tennessee Health Care has participated in the program for over 10 years, and every intern has continued their education or career in the health care field.

Organization Size:  Six Acute Care Hospitals

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Texas

BAYLOR UNIVERSITY MEDICAL CENTER
DALLAS, TX

Executive Summary:  Baylor University Medical Center has implemented a comprehensive program to address the needs of the elderly population in the community, with programs specifically targeting the economically disadvantaged areas where the population is primarily African American and Hispanic senior citizens with limited access to health care services.  The medical center began by opening full-service geriatric clinics throughout the community.  The geriatric clinics are staffed by internists as well as weekly rotations of specialists, and refer many of the patients to medical sub-specialties located at the medical center.  Baylor University Medical Center has also established a geriatric chaplaincy program and a house call program that sends geriatricians, social workers, and chaplains to a patient’s residence, rather than requiring the patient to come to a local center.

In addition to these geriatric care services, Baylor University Medical Center has formed the Memory Alliance with the Alzheimer’s Association.  The Memory Alliance strives to ensure that senior citizens in the community receive a correct and accurate diagnosis for the disease, and that those who suffer from Alzheimer’s receive the care they need, from nutrition to spiritual support to health care services.  The medical center has also recently initiated a volunteer and scholarship program targeted toward the minority youth in the economically disadvantaged areas of the city.  The high school students will volunteer at the new geriatric clinic in the area to learn about the various health care professions, and can then apply for scholarships to pay for their education while they attend the local junior college working toward a health care career.

Organization Size:  1,029 beds

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EAST TEXAS MEDICAL CENTER - QUITMAN
QUITMAN, TX

Executive Summary:  East Texas Medical Center, Quitman, TX, utilizes a block grant from the Texas Department of Human Services to fund its Primary Health Care (PHC) program for uninsured patients.  The program covers primary health care services for patients who earn too much income to qualify for other public assistance programs but cannot afford health insurance on their own.   Individuals that qualify for the program can seek care at three rural primary care clinics in the area, including primary care services, basic x-ray services, and some specialty radiological exams and ultrasounds.  A few non-maintenance prescriptions, such as antibiotics, are also covered under the program.

The number of Hispanic patients in the program is significant, despite a small proportion of Hispanic individuals in the community.  As a result, the medical center ensures that all documents are available in English and Spanish and strives to staff the clinics with bilingual employees.  The PHC program has been in place for five years, and has had a positive impact on the hospital’s bad debt and emergency room utilization.

Organization Size:  30 beds

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PRESBYTERIAN HOSPITAL OF PLANO
PLANO, TX

Executive Summary:  Presbyterian Hospital of Plano (PHP) received data from the U.S. Census Bureau, which identified that, in 2002, 27 percent of the community population represented a minority culture or ethnicity. According to population projections for future years, this number is expected to increase considerably. As a not-forprofit, faith-based, community hospital, PHP places a great importance on the hospital being reflective of the community, as an employer as well as a health care provider. For this reason, PHP has implemented a variety of diversity initiatives, including hosting an annual celebration for Multicultural Day, requiring diversity training for all new employees, developing a patient-centered menu and food service, and recognition of employees, physicians, and volunteers who contribute to the organization and community’s diversity initiatives.

In addition to these initiatives, employees of PHP created a Diversity Action Team (DAT) in May 2003. The multidisciplinary team meets monthly to establish clear goals and programs that will help the hospital create a culture where diversity is celebrated and people feel comfortable regardless of their ethnicity, cultural background, religion, etc. Although the Diversity Action Team (DAT) is still in an early stage of development, the combination of its initial efforts and the organization’s existing diversity initiatives have helped the organization to achieve its goal of a 24.7 percent of diverse individuals employed within management and the hospital’s professional staff.

Organization Size:  231 beds

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ROLLING PLAINS MEMORIAL HOSPITAL
SWEETWATER, TX

Executive Summary:  Rolling Plains Memorial Hospital serves a community that is approximately 20 percent Hispanic. However, significantly more than 20 percent of the hospital’s patients are Hispanic due to higher incidences of chronic disease in the Hispanic population. The hospital strives to provide each of its Spanish-speaking patients with the same communication and health care experience that an English-speaking patient would receive. This is done not only through written and verbal translation services, but also by providing a bilingual pharmacy technician, offering videos in Spanish to complement a Hispanic-oriented television station, and airing Spanish promotional advertisements on the local Spanish radio station.

In addition to strengthening patient-provider communication, Rolling Plains Memorial Hospital offers a free diabetes clinic staffed by a full-time bilingual nurse. The nurse provides diabetes education, counseling, and support groups five days a week in both English and Spanish. The hospital also works closely with the public health department’s prenatal care clinic.

Organization Size:  54 Beds

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Virginia

UNIVERSITY OF VIRGINIA HEALTH SYSTEM
CHARLOTTESVILLE, VA

Executive Summary:  Over the past few years, health care workers in Charlottesville watched as the number of people immigrating to or seeking refuge in their community greatly increased.  In order to better address the barriers this population faces in obtaining health care, such as cultural and language differences, the Department of Family Medicine at the University of Virginia Health System established the International Family Medicine Clinic (IFMC) in 2002.  Since its inception, IFMC has worked to ensure that Charlottesville’s immigrants and refugees receive the best possible care.  Staff at IFMC are trained to understand cultural differences as well as differences in the health problems of people coming from outside of the United States.

IFMC has reported an increase in the level of patient satisfaction, support from the community, and alleviation of strain on the main departments of the system that previously treated this population.

Organization Size:  N/A

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Washington

HARBORVIEW MEDICAL CENTER
SEATTLE, WA

Executive Summary:  Harborview Medical Center and University of Washington (UW) Health Sciences Libraries, in cooperation with several other organizations, have developed a Web site dedicated to providing medical and cultural information to immigrant and refugee groups. The Web site, Ethnomed.org, attempts to bridge cultural and language barriers during medical visits by giving health care providers and other groups, immediate access to information on cultural, language, health, illness and community resources for a number of ethnic groups. While EthnoMed was developed and has been reviewed by members of local ethnic-related organizations, avenues also exist for health care providers and other interested parties to update the organization on current treatments, cultural perspectives and resources.

Organization Size:  353 Beds

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UNIVERSITY OF WASHINGTON MEDICAL CENTER
SEATTLE, WA

Executive Summary:  The University of Washington Medical Center (UWMC) created “Culture Clues,” a program designed to increase the awareness of the culture and preferences of diverse patients served by the medical center. The University of Washington Medical Center considers each patient unique and seeks to meet individual concerns and needs.  Culture Clues are published by the medical center as a guide to provide high-quality patient care while respecting cultural backgrounds of the patients and their families.  Culture Clues are distributed to staff in hard copy format, through the Internet (http://depts.washington.edu/pfes/cultureclues.html) and through computerized medical records. Medical center staff is introduced to Culture Clues during staff training and in-services.

Organization Size:  398 beds

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