Advancing Health Podcast

00;00;00;26 - 00;00;29;29
Tom Haederle
Even 15 years ago, you often would have searched in vain for a title like Chief Wellness Officer on the payroll of most employers. Today, the job is increasingly common as employers have taken note of the high levels of stress and burnout reported by their employees. This is especially true in health care, where burnout is rampant and costly. Not only is burnout associated with more errors on the job, but a physician who chooses to leave costs on average at least a half a million dollars to replace.

00;00;30;01 - 00;01;08;18
Tom Haederle
This is where a robust wellness program can make a huge difference. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. In this podcast, Elisa Arespacochaga. AHA’s vice president for clinical affairs and workforce, speaks with an expert on developing organizationally wide wellness and well-being programs that are making a difference.

00;01;08;20 - 00;01;24;17
Tom Haederle
As Dr. Kristine Olson, chief wellness officer for Yale-New Haven Hospital, says, "it's not possible to have reliable access to cost effective, safe, high quality, patient centered care without high performing professionals and health care workers." Let's join them.

00;01;24;20 - 00;01;45;10
Elisa Arespacochaga
Thanks, Tom. I’m Elisa Arespacochaga AHA, vice president of Clinical Affairs and Workforce. And I'm joined today by Dr. Kristine Olson, chief wellness officer for Yale New Haven Hospital and director of Work Life, Wellbeing Analytics, a Yale New Haven health system. And today we're really talking about her journey in developing and leading organizational wide wellness programs, what she's learned and what advice she has for others.

00;01;45;13 - 00;01;50;12
Elisa Arespacochaga
So to get started, Kristine tell us a little bit about yourself and your role and how you got to where you are.

00;01;50;14 - 00;02;16;03
Kristine Olson, M.D.
Sure. Thank you for having me. It's great to be here and it's great to see you what the American Hospital Association is doing in making this a priority. My journey is I'm currently the chief wellness officer and I do the data analytics, as you mentioned, that's started. Maybe I'll do it chronologically. I had a grandmother who was very influential, who always helped to make life good for people outside of her family and was civic-minded who encouraged my education.

00;02;16;03 - 00;02;34;20
Kristine Olson, M.D.
I went to the Peace Corps because when you have, you are expected to give back. There I learned a lot about what it means for government and policies to create the environment in which we thrive. And then I came back and I did medical school at University of Minnesota, where I started to look at the health care system.

00;02;34;20 - 00;03;16;20
Kristine Olson, M.D.
I’m...a system-minded person. And I started to be curious and started studying that for the last 25 years. And then when health care reform was becoming evident that that was going to happen, I should say I did internal medicine and pediatrics training at Yale-New Haven Hospital first. And then when health care reform was underway, I went to fellowship at Cornell for Health Services, Research and Epidemiology in 2010 to study the to create models of health care so that we could use professional satisfaction as a compass to tell us the adverse effects from health policies and to find how it was affecting organizational performance as a health care system.

00;03;16;20 - 00;03;51;12
Kristine Olson, M.D.
And so we could identify things that we could correct before they had adverse effects. So that's how I got started in that. And that that took me to 2015 where I got to meet one of my mentors, Mark Linzer, who invited me in to a group that was with the early group of Mayo, Stanford and the AMA, where we were the steering committee for the Joy and Medicine Initiative, and then created the three domain model called the Stanford Model of Culture Climate, a practice efficiency and resiliency and the first recommendations for a research agenda.

00;03;51;15 - 00;04;21;10
Kristine Olson, M.D.
That group went to see the National Academy of Medicine, the American Conference of Physician Health and P-WAC, the Professional Wellness Academic Consortium, of which we were an early adopter. And that takes me into my current role. I should say, maybe, how we socialize that at Yale as well. So in 2016, we did our first burnout assessment to show that we too had burnout similar to the national level.

00;04;21;10 - 00;04;40;25
Kristine Olson, M.D.
So we were seeing that (?) was showing in the triennial surveys. We also coupled that with a path forward that we had to start to work on and the organizational strategies that we put in the first step forward module at the AMA for the joy in medicine. So that showed that it was something that was dynamic in health care.

00;04;40;25 - 00;05;03;20
Kristine Olson, M.D.
It was temporally related to people entering health care, it was dose related to their FTE, whereas otherwise static in the general population. So we knew that it was something that we had to correct as an industry, that it was our responsibility and we adopted that through the School of Medicine and through the Yale-New Haven health system. And then we consolidated them and we're moving forward with that agenda.

00;05;03;23 - 00;05;22;21
Elisa Arespacochaga
So you've spent a while doing this work, and you certainly have come about. I really love the idea that you started with this sense of how do you build thriving more broadly, not just in your community, not just among your fellow physicians, but really how do you build that as a community, as a government, as an organization? How do you put those structures in place?

00;05;22;24 - 00;05;50;19
Elisa Arespacochaga
So you had all of that supporting your knowledge. What helped you refine the strategy, the messaging, the conversations specific to your health system, where obviously you're facing challenges of the focus areas around quality, around patient safety, around the financial pressures that hospitals are under. How did you get that messaging refined to be able to go to your colleagues and your leadership to say this is a problem that we have to address?

00;05;50;19 - 00;05;53;06
Elisa Arespacochaga
It is ours to own.

00;05;53;08 - 00;06;16;02
Kristine Olson, M.D.
One was showing that the numbers were consistent with the national numbers and that we had a problem at the organizational level. It wasn't something that belonged to individuals themselves to fix. We also know that the interventions at an organizational level are more effective than those at an individual level from different systematic reviews. A meta analysis that had been done.

00;06;16;04 - 00;06;47;29
Kristine Olson, M.D.
So that was a galvanizing event and to be able to put together the strategy. But the burning platform of not only the prevalence of the problem, but the fact that health care is dependent on its health care professionals and health care workers, those caregivers. And it's not possible to have reliable access for the population that reliable access to cost effective quality, safe, high quality, patient centered care without high performing professionals and health care workers.

00;06;48;01 - 00;07;26;08
Kristine Olson, M.D.
So we knew that there was plenty of evidence showing that burnout is associated with errors. Burned-out physicians may be present, but their patients know that they're burned out and don't have the same kind of reciprocity in adherence to the recommendations as likely to follow up, show up and follow those recommendations. We knew that it was related to people's perception of quality, the idea of moral injury, if they weren't able to live up to their standards and we knew that it had a very high return on investment. For physicians, for example, just the turnover costs alone is half million to $1.8 million in turnover costs. That was in the literature and we validated that

00;07;26;08 - 00;07;40;17
Kristine Olson, M.D.
that was true at our organization as it was in the literature. So that made it a business case for it as well as you can't carry out the mission and you have to adopt the quadruple aim to include professional well-being and workforce well-being.

00;07;40;19 - 00;08;00;10
Elisa Arespacochaga
Absolutely. Absolutely. We cannot care for others if we're not well ourselves. And I know that's easier said than done. So in addition to the chief wellnes officer, I mentioned that you also do the data and analytics for the well-being program for the system. And I'd like you to talk a little bit about how you approach that work and some of the lessons that you've learned.

00;08;00;12 - 00;08;19;10
Elisa Arespacochaga
Because what I've found over time is that this is a very hard subject to measure. It's not as easy as: you did an intervention, and therefore you've seen this results. The indicators are very lagging. There's a lot of challenge in pinning down what use of help, what is not of help, and really building that evidence in that business case.

00;08;19;13 - 00;08;25;22
Elisa Arespacochaga
So can you talk a little bit about what are the ways that you thought about those analytics and how have you refined that as you've gone forward?

00;08;25;24 - 00;08;44;23
Kristine Olson, M.D.
Yeah, I think first and foremost is always thinking of our mission. We assume good intent of everyone who shows up to deliver health care every day and all of the stakeholders. We assume that all of them are mission driven to make sure that people have access to cost effective, safe, high quality, patient-centered care. So that's the number one thing that we're trying to accomplish.

00;08;44;23 - 00;09;09;28
Kristine Olson, M.D.
So those are always my outcomes that I'm thinking of as most important. But then to make sure that we have people that are engaged and able to carry out some of the outcomes that we're looking at, are looking at burnout. Let me talk about how we think about those outcomes of burnout. So there's the job demand resource theory that we often talk about where the job demands and the resources and latitude of control that you have to meet your demands.

00;09;10;03 - 00;09;35;23
Kristine Olson, M.D.
There may be a mismatch and the conservation of resource theory being that if you have hindering obstacles that prohibits you from being masterful in your mission, that you that makes you feel proud and inspired, that you are going to feel depleted by those obstacles and you're going to withdraw yourself. So burnout is a sense of a lack of accomplishment, and then you're feeling emotionally exhausted and checked out.

00;09;35;26 - 00;10;07;18
Kristine Olson, M.D.
Moral injury would be that you feel like you can't live up to your own values for something you did or didn't do. It was a compromise of your own values or the compassion fatigue that is required to move a patient through a congested system that may have obstacles. So when we think about measuring burnout of professional fulfillment, we're looking to identify those hindering obstacles so we can remove those so that they can engage themselves in the challenges that make them satisfied in which they're absorbed.

00;10;07;18 - 00;10;34;04
Kristine Olson, M.D.
And that is the care for the patient and the challenge of doing that. The diagnose is the treatment, the education and care. So we try to find those obstacles. We look for the outcomes of trying to make sure that people are not burned out, that they're professionally fulfilled, that they don't intend to leave, that they're likely to promote the practice that they promote, the quality of care that we deliver there.

00;10;34;06 - 00;10;58;13
Kristine Olson, M.D.
And then we look for the system, how the system works to try to identify those drivers. So those system elements are how are we as a culture that supports wellness? So if you think about the latitude of control, the professionals and people at work, they all want a sense of agency, they want voice and agency because they are aligned with you in what is to be accomplished, and they just want to be able to accomplish that.

00;10;58;15 - 00;11;32;23
Kristine Olson, M.D.
So if they have voice and agency, they are able to get the job done and feel good about it. And so you want to find a way to communicate with them, to hear from them so that you can identify those things and then take care of those obstacles. So what we do is we look in our culture to find out our leader, our type of wellness informed leadership, often transformational servant style leadership, distributive collaborative that brings out the voices and input from people that we get input. We seek buy-in, especially from our high-stakes complex decision makers.

00;11;32;25 - 00;11;52;14
Kristine Olson, M.D.
So leadership, teamwork, how we work as a team not only in the culture of teamwork, but also in the way we share the care together, in the way we support each other as colleagues, and the sense of belonging that you fit in and you have that voice and agency you're seeing, heard, valued, supported and developed. So that's a culture.

00;11;52;17 - 00;12;22;08
Kristine Olson, M.D.
And then we look at the practice efficiency. Nursing might call it care plans and we might call practice efficiency. But our ability, our workload flow, pace and our latitude of control to live up to our professional standards and do a good job for our patients. And then when you think about personal resiliency, you're often thinking of your ability to maintain work life integration so that you're able to maintain your relationships and your self-care and come back rested and recharged and ready to go.

00;12;22;09 - 00;12;36;11
Kristine Olson, M.D.
So we look at this environment to see how well people are able to do their jobs masterfully and what leads to their professional fulfillment and how those affect the outcomes and the mission that we're trying to accomplish.

00;12;36;13 - 00;12;57;21
Elisa Arespacochaga
I like the idea that you really balance this between the individual responsible to come prepared to address those solutions, create those solutions, identify where there might be solutions and the system responsiveness to really put those into place. I think that that marriage is really essential to this work. So let me ask you, it hasn't all been sunshine and roses.

00;12;57;21 - 00;13;13;14
Elisa Arespacochaga
You've obviously certainly faced some challenges, as we all have when we try to implement a new thing. We all love the idea of change just right up until it lands at our doorstep. So what's one of the biggest hurdles you face in moving forward in your role? And was it something that you said, "Yeah, I know going in.

00;13;13;14 - 00;13;23;25
Elisa Arespacochaga
I know this this department, this challenge, this area is going to be a problem." And how did you prepare for it if you expected it or would you do if it came out of the blue at you?

00;13;23;28 - 00;13;57;24
Kristine Olson, M.D.
Yeah, I think the greatest challenge has been what's happening around the country with the disruption. So much change in leadership. So as I mentioned, how we socialized on both the school medicine side and the health system side and then came together with the consensus that was just the fall of 2019 and then 2020, the pandemic hit and we continued to hold the wellness agenda and advance it and move it forward, especially supporting psychological first aid and peer support and really focusing on that through the pandemic.

00;13;57;26 - 00;14;32;24
Kristine Olson, M.D.
Our earlier preparations created the Care for the Caregiver website and allowed us to be prepared with a safety net because we knew we had to have a safety net first to do the work of removing these obstacles that improved efficiency. So in 2022, today we've had a lot of changes in leadership on both sides of the street. And I think we're seeing that around the country and re-socializing the agenda and being able to create that platform that then moves forward as things are shifting all the time.

00;14;32;27 - 00;14;57;16
Kristine Olson, M.D.
So I think that has been a challenge because you have to do it every day and you have to keep socializing it. The other thing is communications. I wish that I had a dedicated communications officer because there are stakeholders across the organization that are doing things and in keeping our professional fulfillment or health care worker well-being in mind in everything that they do.

00;14;57;18 - 00;15;25;26
Kristine Olson, M.D.
And they may see another initiative that's been implemented, but they don't see how much work goes behind the scenes to make sure that we implement this mandate as easily and as possible without disruption. So I think some of the things that they don't see, that's a challenge too, because you want them to see how much work is going into everything we do on their behalf. I should mention how we use also the assessments to mobilize the whole health care system.

00;15;25;28 - 00;16;05;06
Kristine Olson, M.D.
And that is when we get these assessments, we will get them by every department and section for every hospital and delivery network, for every type of practice model, whether it's private practice, academic or employed. We will get them at every level, whether you're a physician, advanced practice clinician or trainee, for example. We will look at them in every way that we can for every hospital, every delivery network, every practice model, so that we can find where the positive deviants are, so that we can see what we can scale up and we can see the health of our delivery of health care services so we can see if there's a threat somewhere that needs to be

00;16;05;06 - 00;16;28;28
Kristine Olson, M.D.
addressed. And also we order all of those scores so that they go to our stakeholders. So that we use that data driven approach to make policy or governance decisions to find out where service lines or services may be threatened, to find out which stakeholders can take a piece of that puzzle and implement it into their work as a priority.

00;16;29;00 - 00;17;01;12
Kristine Olson, M.D.
And then at the department in section level and then at the individual level. So people feel empowered for themselves. I mentioned that after I mentioned the communications person, because I don't think that each level that we implement vertically and horizontally, I don't think they all know how much the other people are also taking a piece of that puzzle so that they feel like if we all move and we all take a piece of this, that we're going to move our organization faster to make this the professional home, the place to be faster.

00;17;01;12 - 00;17;24;29
Elisa Arespacochaga
You know, it's always a challenge to make sure everyone understands the nuances of what's being done and how it's being done and how people can help. And sometimes it's just those conversations of, Oh, hey, did you know about this? And it it can make such a difference. But sometimes you think this should happen better, more routinely. more standardized. And sometimes it's just impossible to get to that level of communication.

00;17;25;02 - 00;17;41;28
Elisa Arespacochaga
So my last question for you is, you mentioned you've been doing this for quite a while. This is certainly been a passion for a long time. But how do you maintain your enthusiasm for this work? I mean, you're looking at something that has often been a side of the desk activity. It's not always had the focus and attention.

00;17;41;28 - 00;17;51;12
Elisa Arespacochaga
I think it has more now, but how do you keep up engagement to say not only are we aiming for absence of burnout, but we're really aiming for a thriving community.

00;17;51;15 - 00;18;15;26
Kristine Olson, M.D.
I think that's the reason itself. I think being a system thinker and just loving the puzzles of this work, of putting systems together, seeing how they work and wanting to fix them so that they're more efficient and better. I also think that having done a lot of international health and Peace Corps ... in the United States, we take for granted that we have a reliable health care system and I don't want anything to happen to that.

00;18;15;26 - 00;18;34;22
Kristine Olson, M.D.
I really want to make sure that we as a country have the best, most reliable health care in the world and to keep moving toward that. We still have a lot of work to do, but to keep moving toward that because it should be a real point of pride for us. As it has been, as it should be.

00;18;34;24 - 00;18;57;12
Kristine Olson, M.D.
And I want to make sure that my parents in a different state than me have access to reliable, the best health care and my family and my sisters, my loved ones, my friends. I want to make sure wherever they are that there is a reliable health care system in this country. So how do I keep mission-driven? I keep that in mind when I have obstacles.

00;18;57;12 - 00;19;16;10
Kristine Olson, M.D.
I remember that this is just a piece of the puzzle to keep moving in the direction of my calling, my mission. I use gratitude for having a such a problem to deal with these obstacles. I'm very grateful to be in a position now that I think of growth mindset. What can I how can they grow and learn from every situation that I have?

00;19;16;10 - 00;19;26;27
Kristine Olson, M.D.
Every difficulty? Grit to be persistent and grace to give myself grace and to know that I'm doing the best that I can with the resources that I have and I will keep at it.

00;19;26;29 - 00;19;35;06
Elisa Arespacochaga
It sounds like you're very much living the mission of being a well-being officer and really driving wellness in your system. Thank you so much for joining me and for sharing your story.

00;19;35;09 - 00;19;35;26
Kristine Olson, M.D.
Thank you.

00;00;00;26 - 00;00;31;11
Tom Haederle
Having all patient data available on the ESR is essential for clinical and nursing teams to make critical patient care decisions. With this data, care is based on what providers can see and analyze themselves. But what if more could be done with the data? This is where predictive analytics comes in.

00;00;31;14 - 00;01;05;21
Tom Haederle
Welcome to Advancing Health, a podcast brought to you by the American Hospital Association. I'm Tom Haederle, with AHA Communications. With comprehensive, real-time, accurate patient data from predictive analytics, the patient's care team can predict and can see where a patient's condition is heading to make more informed care decisions to achieve positive outcomes. Join us to hear a discussion of how NorthBay Health reduced unplanned patient transfers to the ICU by 30% and observed mortality by 16% by using the Rothman Index in its new predictive analytics model.

00;01;05;23 - 00;01;10;20
Tom Haederle
Today's podcast is brought to you by Spacelabs Health Care.

00;01;10;22 - 00;01;42;14
Marie Cleary-Fishma
I'm Marie Cleary Fishman, the vice president of Clinical Quality with the American Hospital Association. We know in patient safety and in the work that we do the goal of predictive analytics goes way beyond knowing the patient's current condition to providing the best assessment of where the patient's condition is actually headed in the future. The knowledge gleaned from predictive analytics offers more opportunities to mitigate risk of patient deterioration and escalation of care before it happens.

00;01;42;16 - 00;02;08;16
Marie Cleary-Fishma
With the power of technology and data, the care team can bolster their clinical decision making and clinical actions to actually improve outcomes and patient safety. So with me today are Natalie Correll-Yoder, a critical care clinical nurse specialist with North Bay Health, and Nikki Rasmussen, senior clinical account manager with Spacelabs. Thank you both for joining me today. We really appreciate the chance to have this conversation.

00;02;08;18 - 00;02;22;19
Marie Cleary-Fishma
Natalie, let me start with you. So predictive analytics can really be a game changer for clinicians when they're caring for patients and monitoring their conditions. How is North Bay incorporating predictive analytics into patient care?

00;02;22;21 - 00;02;50;06
Natalie Correll-Yoder
So we utilize a artificial intelligence type software that tracks the patient through documentation into the medical record and then feeds that information back to our critical care ICU nurses that are rounding on those patients to identify any changes in status that may happen so they can get to them sooner and then intervene timely to either elevate care or prevent complication.

00;02;50;09 - 00;03;14;24
Marie Cleary-Fishma
That's great. Well, we hear so much about artificial intelligence in AI, in the media and all kinds of things that people are talking about. But when you're really looking at transitioning to a predictive analytics model in the field, it's got to be a significant undertaking. So what steps did North Bay take to ensure awareness adoption and that sustained utilization of the technology while battling through COVID?

00;03;14;24 - 00;03;24;28
Marie Cleary-Fishma
That was an unprecedented time for all of us. And on top of it, you were working on all of this new technology and really looking at this to help improve care.

00;03;25;01 - 00;03;52;05
Natalie Correll-Yoder
So that is all true. And COVID challenged all of us. We had identified the Rothman Index as the tool we wanted to use prior to any kind of significant COVID breakout. And so we made a plan to roll it out throughout our health system. We are a small two hospital health system. And then as COVID came on the forefront, we decided to stage our rollout.

00;03;52;05 - 00;04;25;13
Natalie Correll-Yoder
So we focused on our intensive care nurses who were rounding in the acute care area first. They are the subject matter experts around this work, and they have the more complex, higher functioning competencies and assessment skills. And so we trained them and we did it through webinar, which is always ideal, but it was at the beginning of that before any of our technical platform technologies became a thing and we taught them how to use the Rothman Index and then set it up for them so they could then start tracking patients.

00;04;25;18 - 00;04;52;10
Natalie Correll-Yoder
And then as the warnings would come across from the Rothman, they would go out and see patients. And then that was right before the holidays of 2020, right? And then we then staged it department by department, nursing unit by nursing unit after that. And the rounders then became the true experts in the technology, identifying the patients, working with the physicians, and then the nursing staff, and then they continue training.

00;04;52;12 - 00;05;23;19
Natalie Correll-Yoder
And then for the nursing staff, we did elbow-to-elbow education because we couldn't get them in a room. We weren't allowed to have them in a room together, right? So and webinar wasn't necessarily a reasonable thing to do. So we did elbow-to-elbow education with the nursing staff, and the education team supported me in this transition and we went out to all the units and educated all the staff, spent lots of man hours, but over probably a six month period of time and then got all of our staff trained on the Rothman Index and how to utilize it.

00;05;23;22 - 00;05;46;05
Marie Cleary-Fishma
So Natalie, just talk to us a little bit about transitioning a predictive analytics model and the significance of that undertaking. Nikki, if you could give us the perspective from Spacelabs about the support and what your role is when you're implementing, and then a little bit about what your ongoing role is in supporting this kind of technology going forward.

00;05;46;08 - 00;06;08;06
Nikki Rasmussen
Thank you. That's a great question. You know, during the time of implementation, it's a very close knit process. And we did all of that remote with North Bay during that time. It was in the height of the pandemic. So we weren't at capable of getting out there to travel and do the one on one implementation the way that we would have done pre-pandemic.

00;06;08;06 - 00;06;45;21
Nikki Rasmussen
So everything was done fully remotely. And the way that North Bay had organized and planned really lent itself very well to that process. And then we continue with an ongoing support. So we have a regular cadence of meetings in which we discuss data, we discuss the things that are happening at North Bay. We also have a tremendous data analytics team that pulls together some very custom data and then also some standard data reporting that we share with the executive team at North Bay, as well as with the ICU rounders that Natalie's talked about in that team.

00;06;45;21 - 00;07;07;07
Nikki Rasmussen
So it's a great opportunity for all of us that have the clinical background to get together and share the data and the things that are happening and the opportunities for growth and advancement. And we work together very, very closely. We meet every two weeks. So it's a really great relationship of ongoing support and partnership. It really helps with engagement.

00;07;07;08 - 00;07;20;06
Nikki Rasmussen
It really keeps everybody recognizing the importance of what they do to take care of patients and how that has an impact on the overall outcomes and goals of the organization as well.

00;07;20;09 - 00;07;28;20
Natalie Correll-Yoder
And I think what I would add is that it's the same data that the executive team gets, the medical staff, the nursing leadership and the frontline staff.

00;07;28;22 - 00;07;34;04
Natalie Correll-Yoder
So we're trying to be transparent about what we're doing and how the program is going.

00;07;34;07 - 00;07;53;08
Marie Cleary-Fishma
That's really important to make sure the care team is involved across the board. So thank you for that point. So one thing I'd like to just ask for a minute. For all of our listeners, in case anyone isn't familiar, can you just describe the Rothman Index just a little bit in, you know, some brief terms so that folks can at least go look it up more if they want to see more?

00;07;53;10 - 00;08;36;08
Natalie Correll-Yoder
Certainly. The Rothman Index is an algorithm that runs off of nursing documentation, vital signs, and then some selected labs. Dr. Rothman pioneered and developed the Rothman Index, and it is designed to look at key elements that are common to all patients. And so it doesn't cherry pick certain lab work or certain procedures. It looks at basic things that every single patient gets, and then how the nurse documents around the patient assessment and so those elements are really important in identifying subtle changes in the patient, because a lot of times that may be one assessment item or one particular element will change.

00;08;36;10 - 00;09;03;10
Natalie Correll-Yoder
But you don't see it in the big picture of things. And so the Rothman Index allows us to trend the data and then identify which direction the patient's going. So a higher number is actually good. It's kind of inverse of many of the other algorithms that are out there. So a higher number is that the patient is healthier, a lower number is the patient is sicker, and then the algorithm will then send you a warning if there's sudden changes.

00;09;03;12 - 00;09;13;07
Marie Cleary-Fishma
So, Nikki, we've had some description from Natalie about the Rothman Index. Is there anything from the Spacelabs perspective that you'd like to add to that?

00;09;13;10 - 00;09;36;28
Nikki Rasmussen
Well, I think one of the most unique things about the Rothman Index is that it came out of a very personal story. Dr. Rothman himself lost his mother following a very routine procedure. And he and his brother, who are Ph.D. scientists, had taken a lot of opportunity to study in partnership with the hospital where she had passed from.

00;09;37;00 - 00;10;04;18
Nikki Rasmussen
And look at where did we lose an opportunity, where we might have been able to catch her deterioration? Her deterioration was one of those kind of slow, steady deteriorations. And what they identified was that truly the nursing assessments are those leading indicators of change in patients. And if we think about it clinically, that makes sense. Because a lot of times we see those changes happen in patients well ahead of changes in vitals or in changes in lab values, we start to see patients become more somnolent.

00;10;04;18 - 00;10;36;28
Nikki Rasmussen
They start to need more assistance for transfers. They change their eating habits, and we start to notice those things. And that's documented in the nursing assessments. And so they identified that the key elements in that identification of early deterioration lies within the nursing assessment. And I think that's one of the unique things that sets the Rothman Index apart is I think just a, you know, a really great story out of something that was sad became something that was really impactful and is able to save many, many lives.

00;10;37;00 - 00;10;55;28
Marie Cleary-Fishma
That's a great description. Thank you for that. And based on that, then in what you've seen in your experience with rollout, what really what kind of direct impact are you seeing on the care team's ability to really care for patients using that? What have you seen in experience sort of real world kinds of activity?

00;10;56;00 - 00;11;25;00
Natalie Correll-Yoder
Well, when we first rolled it out, it was actually very amazing. In fact, one of my intensivists told me that the Rothman Index probably saved his patient's life because she had been on the floor, had some kind of slow, subtle GI bleeding that hadn't really been identified. And the Rothman Index had a clear deterioration. The ICU rounder went out and saw the patient, got him involved in the patient, got the treatment they needed very timely and then, you know, exit at our facility in a much healthier state.

00;11;25;02 - 00;11;43;27
Natalie Correll-Yoder
And then we've also used it to identify patients that we should maybe transition to palliative care. And so that's been another nice aspect of it, of identifying patients who are having a gradual trend and are not improving. And maybe it's time to really look at what's the best thing for them in the next stage of their life.

00;11;44;00 - 00;11;55;16
Marie Cleary-Fishma
So tell me a little bit about what the future looks like. What's next for North Bay when it comes to patient care goals and technology and A.I. and all of the kinds of amazing things that you're doing?

00;11;55;18 - 00;12;19;18
Natalie Correll-Yoder
I am doing a lot of work in looking at how to reduce our mortality. So since we've implemented the Rothman Index, we did initially reduce our mortality 30%, which was huge for us. We've been able to sustain right around 27 to 30% pretty consistently each quarter around looking at how we're doing and where we've been. And it's a two year rolling calendar, just to give you an idea of the timeline.

00;12;19;24 - 00;12;48;26
Natalie Correll-Yoder
And so I'm trying to look at with my physician partners, looking at what are those patients that we can still rescue, and then what are those patients that we can identify for that transition? And what is it that we can do to best provide the care these patients need? I think as far as the technology piece is, my goal would be to transition the Rothman Index, not just on to the computer and kiosks, which the staff are using now, but onto their hospital cell phones so that the warnings come to them.

00;12;48;28 - 00;12;55;04
Natalie Correll-Yoder
That software is available. It's not quite in our picture yet, but it's one of those things I'm advocating for That's okay.

00;12;55;04 - 00;12;58;04
Marie Cleary-Fishma
Future vision is important, right? It helps us get there.

00;12;58;04 - 00;12;59;14
Natalie Correll-Yoder
Yeah, absolutely.

00;12;59;16 - 00;13;16;13
Marie Cleary-Fishma
So if you were going to tell your colleagues, other folks, hospitals across the nation, what kind of guidance or lessons learned would you share with them to help them be successful with integrating and incorporating predictive analytics and using that to improve the quality of care they provide?

00;13;16;16 - 00;13;43;04
Natalie Correll-Yoder
I think the Rothman Index speaks for itself. And in consistently sharing the data, I've actually gotten a lot of our physician leadership involved and committed to the Rothman Index as a as a solid tool. We're looking at incorporating it into other domains of really working with the palliative care team to identify that. And then I think I want to get it more into some of our readmissions and care management work.

00;13;43;07 - 00;14;07;06
Natalie Correll-Yoder
I think some of our lessons learned would be you cannot reinforce new technology often enough. And so with any new thing, there is a learning curve for the whole organization. And I think COVID has brought us a lot of staff turnover. Folks have transitioned out of health care for a variety of reasons. COVID was a very difficult time for many of us.

00;14;07;09 - 00;14;18;21
Natalie Correll-Yoder
Lots of staff have suffered burnout and then we have a lot of new staff. And so that ongoing education and training and putting resources into that, you cannot underestimate the importance of that for sustainability.

00;14;18;23 - 00;14;34;21
Marie Cleary-Fishma
So, Nikki, could you give me the perspective from Spacelabs on what guidance or lessons learned that you would share with others who are listening, listening to this now and who might be interested in pursuing some kind of predictive analytic tool in their patient care models?

00;14;34;23 - 00;15;10;04
Nikki Rasmussen
Oh, that's a great question too. I think the important thing to think about is that there's no time like the present. You know, there's always going to be something that's going to come up that you think about, Oh, we can't do this now. Let's do it later, or Let's do it in a year or two. And I think the more that you can just figure out how to plug it into the existing circumstances with our help, certainly that's one of the things that we do as the part of the customer success team is help to identify and break down those barriers and help a client grow and adopt and find a way to make something

00;15;10;04 - 00;15;37;25
Nikki Rasmussen
like this successful in their organization. So I think that and to Natalie's point to talking about education, that you've got to have that sustained education plan. You know, we know in health care there's a lot of turnover. Things move very quickly. So we need to have that sustained plan in place for how we're going to continue to make sure that everyone who comes into the organization has the same education and the same knowledge base moving forward as those who've been part of the organization for a period of time.

00;15;37;28 - 00;16;10;06
Marie Cleary-Fishma
So that makes me think of one more question I'll sneak in really quickly, and that is about workforce. You talked about the turnover and in bringing in younger, newer clinical staff and care providers. Does it help them feel more comfortable and confident to know they have this kind of a tool or resource that will help them if maybe they're not quite seeing everything right away, that they have this backup sort of something that will give them additional data to support the care decisions they're making.

00;16;10;08 - 00;16;12;11
Marie Cleary-Fishma
How does that look?

00;16;12;14 - 00;16;33;19
Natalie Correll-Yoder
Yeah, I think that the the more senior staff value that and utilize it for that purpose. We do a daily safety call with the organization and many of the managers will report on the call that they're monitoring two or three patients on their unit that have either warnings or trends that they need to pay attention to. So I think that's really helpful.

00;16;33;21 - 00;17;01;12
Natalie Correll-Yoder
I think the number of new staff because we're hiring a lot of new grads or people new to acute care from nursing homes, that there's a challenge there and trying to get them up to speed and learn the role that in there. If you look at, you know, business model of competency and development and where people are in that learning, I think the new staff are still learning how to use the tool. But they do rely on the rounder and they go to the rounder for that information.

00;17;01;18 - 00;17;07;11
Natalie Correll-Yoder
So the rounder will get those questions and then they're doing a lot of mentoring with a lot of our newer staff.

00;17;07;12 - 00;17;15;13
Marie Cleary-Fishma
That's great. Yeah. So it's that combination of technology and the personnel knowledge and knowing they have somebody as a resource to go to.

00;17;15;14 - 00;17;16;00
Natalie Correll-Yoder
Absolutely.

00;17;16;00 - 00;17;36;00
Marie Cleary-Fishma
That's great. That's wonderful. You've highlighted a quite a few patient safety best practices today as we've had this conversation. So congratulations for all of that and the data you shared and the trends you're seeing in your reduction of mortality. Really, really well done. So we've heard a little bit from Natalie about the future for North Bay health.

00;17;36;03 - 00;17;41;05
Marie Cleary-Fishma
Nikki, what can you tell us about the future for Spacelabs health care?

00;17;41;07 - 00;18;03;07
Nikki Rasmussen
Oh, that's so exciting. There's so much happening. I feel like things are moving at the speed of sound over here, which I guess it kind of makes sense given our given our name of Spacelabs. But we are really moving forward into how to integrate the Rothman Index tool in with some existing other Spacelabs tools, some other software and patient monitoring

00;18;03;07 - 00;18;20;28
Nikki Rasmussen
that's happening over here. There's a lot of work right now in the data and really what the data can tell us and how we can continue to build tools that have that predictive capability and are able to identify risk in patients before things get too late.

00;18;21;01 - 00;18;37;20
Marie Cleary-Fishma
It's all about the data and the patients and what we can do to help them. So Natalie and Nikki, thank you so much for joining us today and for sharing all of your insights and thoughts and the great work that you've been doing. If you'd like to learn more about Spacelab's health care, please visit www.spacelabshealthcare.com.

00;00;00;26 - 00;00;23;23
Tom Haederle
It's been forecast for years. The retirement of the baby boomers is exacerbating our already urgent shortage of health care workers and creating new challenges that must be faced now. It's estimated we'll need at least 3.5 million health care workers in the next five years to meet demand. Where will they come from, especially when high rates of burnout are causing so many health care professionals to leave?

00;00;23;25 - 00;01;02;06
Tom Haederle
Experts say we may be overlooking an important source of new talent. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle, with AHA communications. Community health workers aren't trained nurses or physicians, but they can provide critically needed skills in the health care space, including social support, care coordination, navigation and advocacy...at a fraction of the cost of clinical labor.

00;01;02;08 - 00;01;28;09
Tom Haederle
In fact, one expert calls community health workers the new American health care workforce. In this podcast, Joy Lewis, senior vice president of Health Equity Strategies and the executive director of AHA Institute for Diversity and Health Equity, speaks with three guests who believe that expanding the number of trained community health workers and integrating them more fully into hospital and health system operations could go a long way towards meeting our future health care needs.

00;01;28;11 - 00;01;44;29
Tom Haederle
Joining Joy today are Dr. Shreya Kangovi, associate Professor of Medicine at Penn Med; Tawandaa Austin, lead community health worker and product specialist at Penn Med; and Dr. Briar Ertz-Berger, Northwest Medical director for Social Health and Quality Management.

00;01;45;01 - 00;02;09;04
Joy Lewis
Thanks, Tom, and welcome, Shreya, Tawandaa and Briar. Thank you very much for taking time today to speak with me about the value of integrating community health workers into the operations of hospitals and health systems. We're going to kick off our conversation with you, Briar. And I want to ask you about some of the macro changes that you see happening in the health care field right now.

00;02;09;04 - 00;02;13;28
Joy Lewis
And what pressures are these changes putting on hospitals and health systems?

00;02;14;01 - 00;02;45;11
Dr. Briar Ertz-Berger
Yeah, I appreciate that. And thank you very much for the invitation to the conversation today. Pertinent to this conversation. I would call out a few specific things. You know, we're seeing big changes in our patient population, the populations that we're serving. We're seeing tremendous pressures put on our clinical workforce and we're seeing some exciting, innovative things happening in the regulatory and accreditation space. In looking at the patient population,

00;02;45;11 - 00;03;11;14
Dr. Briar Ertz-Berger
I think it's important to call out. I mean, there are some trends we've been talking about for years. I mean, the baby boomers are retiring, so we have a growing population of patients and people we're serving over 65. And with that comes a greater burden of disease and chronic illness. I think it's one thing to call out, you know, over 25% of people over the age of 85 have dementia or some sort of cognitive decline.

00;03;11;16 - 00;03;43;22
Dr. Briar Ertz-Berger
And then this older population, this larger older population, and our population in general, has been impacted by the pandemic. You know, there was a time when the pandemic first hit that we were sheltering in place. People were afraid to come in and access health care. You know, clinics were closed. Providers were ill. And so, you know, for months and even for over a year, we saw big delays in care. Patients and people were more socially isolating and not moving their bodies very much.

00;03;43;22 - 00;04;10;12
Dr. Briar Ertz-Berger
So we saw, you know, older folks, especially with loss of physical function and the loss of social interactions led to worsening cognitive decline. And then I think we have to call it the COVID effect. We're learning more and more about long COVID. You know, we've seen higher rates of strokes and heart attacks post-COVID. We've seen impacts again on patients cognition, vascular effects.

00;04;10;14 - 00;04;34;18
Dr. Briar Ertz-Berger
We're just starting to learn this and unpackage this more. And so, you know, you kind of take all this together population who has a larger number of people over 65, greater burden of chronic disease, big impacts from the pandemic on the population in general. We're just seeing people presenting to the hospitals who are sicker than they were pre-pandemic.

00;04;34;21 - 00;04;57;07
Dr. Briar Ertz-Berger
We don't expect that trend to change. And then I would also add a layer of complexity on there. You know, I think that's very important for us to talk about. You know, we are looking at a population with fewer social resources. And what I mean there I'm talking about patients having know, lack of reliable financial resources, food, housing, transportation.

00;04;57;09 - 00;05;23;23
Dr. Briar Ertz-Berger
And there's various reasons for that. You know, we've seen a lot of loss of jobs, business closures, inflation that we're all struggling with. And then you can compound that with the other big macro change that I was mentioning, which is the tremendous pressures we're seeing on the health system workforce. You know, there's been multiple causes of health care, workforce shortage.

00;05;23;23 - 00;05;51;17
Dr. Briar Ertz-Berger
We already knew this was coming. But as we're talking about, you know, the baby boomer generation retiring, that means a lot of physician nurses, clinical staff are retiring. There's also a big increase in health care worker burnout and, of course, exodus of health care workers from during the pandemic. The shortage of clinical staff is not just physicians, but it's physicians, nurses, EMS techs.

00;05;51;17 - 00;06;04;07
Dr. Briar Ertz-Berger
And it affects every sector of the health care system. Right? Primary care, specialty care, the hospital, the post-acute space. So we're looking at this really severe mismatch of resources.

00;06;04;09 - 00;06;40;00
Joy Lewis
Well, you've certainly laid out for us a very complex landscape following the pandemic. And what we're seeing even and even prior to the pandemic, where you talked about just the an older, sicker patient population, an older population, meaning there's probably greater reliance on on government payers, Medicare in this case. And so looking at some of the nonmedical needs, those societal factors that we know impact one's overall health status and well-being.

00;06;40;03 - 00;07;09;12
Joy Lewis
I don't think we even touched on on the renewed call for social justice and racial justice and how that shows up in the health care space around really doubling down our efforts to eliminate health disparities. And all of this with a backdrop of, I know at least for hospitals, we issued our Cost of Caring report earlier this year and the financial picture is pretty gloomy.

00;07;09;14 - 00;07;41;04
Joy Lewis
I think we're we projected that over 60% of our hospitals will end this year in the red. So lots of very complex issues to solve for. So, I want to pivot to Shreya and ask her to then help us to kind of better understand how do community health workers fit into this larger macro environment that Briar just outlined for our listeners?

00;07;41;06 - 00;08;02;03
Dr. Shreya Kangovi
Yeah, I think she said it perfectly. You know, we need to keep an aging poorer America healthy at lower cost and with fewer clinicians. How are we going to do that? We have to push health care out of the glass walls of the ICU into the community. That is where so much of health and well-being are shaped, especially for older adults, or working class Americans.

00;08;02;05 - 00;08;24;20
Dr. Shreya Kangovi
And, you know, the shift to communities is being accelerated by the move from fee for service to value based models that capitate costs and require quality. And we are seeing that the biggest companies not only in our sector but in the entire U.S. economy, are making huge bets on this push of health care into the community. A CVS, Walmart, Amazon.

00;08;24;22 - 00;08;51;26
Dr. Shreya Kangovi
But I'd argue they aren't going to get there because they are constrained by workforce. Most of the American health workforce are clinicians like me. We mean well. But I would argue that we are overrepresented as a sector of the workforce because our main lever is medical care and that only accounts for 15% of health outcomes. And we're less well positioned to address the social, behavioral and economic factors that shape the health of most Americans.

00;08;51;26 - 00;09;18;10
Dr. Shreya Kangovi
And that is where community health workers come in. They are the new American health workforce. These are trustworthy people who come from within the communities they serve. They can provide social support, care, coordination, navigation and advocacy at a fraction of the clinical labor cost. When we want to talk about, you know, there are nurse or physician shortages. That may be true, but there are only 50,000 community health workers in the entire country.

00;09;18;12 - 00;09;35;21
Dr. Shreya Kangovi
So that's a shortage we haven't even begun to wrap our minds around. And I think that's the real focus here, because when we think about who is the workforce that is going to produce health, not necessarily just medical care, but health, we have a severe community health workforce shortage.

00;09;35;23 - 00;10;08;11
Joy Lewis
So I'm hearing you make the case for us to actually expand the definition of the workforce of the health care workforce, to include community health workers and and other similar community based resources. So I want to at this point introduce Tawandaa, really invite her into the conversation because Tawandaa is a community health worker. So can you tell us a little bit more about who you are Tawandaa as a person, and what do you do as a community health worker?

00;10;08;11 - 00;10;29;15
Joy Lewis
I know at times there's some confusion around role differentiation between case managers and some nurses who may serve as case managers or a program manager, a social worker. So can you clearly articulate for our audience today who you are and what you do as a community health worker?

00;10;29;18 - 00;11;00;09
Tawandaa Austin
My name is Tawandaa and I am from Philadelphia, Pennsylvania. I was raised by primarily by my grandmothers. My grandmother, she had diabetes, she had blindness, and I learned that the reason why we would cross the street, we would have to wait several times across the street was because she had some trauma around crossing the street due to being hit by a truck once when she was younger.

00;11;00;11 - 00;11;23;27
Tawandaa Austin
I have the lived experience through, you know, growing up in an environment that I grew up in, which is of course, Philadelphia was Philadelphia. So it was in a Germantown section. So I kind of know the areas. And when when my patients tell me where they're from, I can easily identify that region. So that's what makes it more alive to me.

00;11;23;29 - 00;12;02;02
Tawandaa Austin
But the most unique part about my job is that when I meet patients, I'm meeting them where they are. I primarily work in primary care with those patients who are working on long term chronic health goals with their provider. And my job is to assist them to get to the finish line. They may identify by certain stressors that they have or like violence in a neighborhood in food deserts, issues with paying for their medications and all of these different attributes that makes it harder for them to reach their long term chronic health goals with their provider.

00;12;02;05 - 00;12;24;04
Tawandaa Austin
So one of the things I just do is just to talk to them, get to know them a little bit better, see what's important to them, their goals, their fears, and really just focus on them as a person to help their goals become more manageable. So I might provide resources and just emotional support depending on the patient and where they are in their journey.

00;12;24;06 - 00;12;49;15
Joy Lewis
Wow. Sounds like really impactful work. Really the definition of what we, many of us refer to as patient centered care, where you are meeting folks, where they are and aligning with their health goals, and how might you then help them to achieve and inch their way closer to pursuing their health goals. How long have you been doing this work, Towandaa?

00;12;49;17 - 00;13;07;25
Tawandaa Austin
I was born a community health worker, I definitely have to say that. Actually doing the work and getting paid for? I would say this is my seventh year at Penn Center for Community Health Workers. Okay. Okay. I definitely I have a story to if we have time, I have to make those to make my work come alive.

00;13;07;27 - 00;13;12;02
Joy Lewis
I'd love to hear more about your story. So I'm going to give you the floor.

00;13;12;04 - 00;13;34;25
Tawandaa Austin
So I had a patient by the name of Mrs. T, and Mrs. T was assigned to me for six months to work on a decrease in her agency. What I will call Mrs. T at least once a week. And I would like try to type that and say like Mo and I would get nothing from Mrs. T. And I think it's because of all of the mistrust.

00;13;34;28 - 00;13;59;11
Tawandaa Austin
So one day she finally answered, and I learned that she wanted to have home care services. And I kind of use that to try to build the connection between her and primary care provider, because there was a mistrust between them, too, because the provider was a resident doctor and she was new. So the patient felt like she didn't know her or wasn't here and the request that she was trying to get.

00;13;59;13 - 00;14;34;21
Tawandaa Austin
So one of the things that I did was demonstrated to Mrs. T that I have her back by talking to the doctor and in explaining or advocating on her behalf of why the services were necessary. So when Mrs. T saw that I was able to do that for her, she then allowed me to come to her home. And then when I came to her home, she shared more with her story of, you know, being sexually abused as a young child and then conceiving a child and then her child having a child at the age of 14.

00;14;34;22 - 00;15;05;16
Tawandaa Austin
It was like a cycle that kept on going. And she was embarrassed because she had bedbugs and she she didn't want me to see her environment. But I when I came in, I acted like it was my home. She sat on the floor. I sat on the floor with her and we and we talked. And I got a chance to really get to understand, like, what's causing her or preventing her from reaching her long term goal and how can I better assist her with resources around getting the services that she needed.

00;15;05;19 - 00;15;24;09
Tawandaa Austin
So while I worked on it, I thought to myself, what would make me feel good in this time, in this time of need? Or, you know, when I don't, when my light is dim, like, how can I brighten up Mrs. T's light? So I went out and I got zoo tickets for her one year old granddaughter. They've never been to the zoo, yet they live so close.

00;15;24;09 - 00;15;45;23
Tawandaa Austin
But it's really costly. They didn't have any the money to go there. So I got four zoo tickets and I me kind of made the family like their own custom bag, depending on like what I heard them say when I was interacting with them in the living room. And I got Mrs. T a hair weave and we had a we had a make over and that was she loved it.

00;15;45;23 - 00;16;02;25
Tawandaa Austin
And so I was able to provide her with just the hope, just to make her feel better and let her know that she is appreciated despite how she was feeling and the fact that she didn't feel like she was being heard. So it actually helped the rapport and it really strengthened the rapport with her, her provider as well.

00;16;02;26 - 00;16;07;08
Tawandaa Austin
So she felt comfortable enough to go to her provider when she needed things.

00;16;07;10 - 00;16;16;25
Joy Lewis
I mean, that level of engagement that you're describing simply just cannot happen in a clinical setting, right.

00;16;16;25 - 00;16;17;27
Tawandaa Austin
You know, you're.

00;16;17;27 - 00;16;39;12
Joy Lewis
Sitting on the floor right there with her, right? Yeah. Yep. Your ability to to put yourself in her shoes, I mean, that's just that's remarkable. And then the carry through, the carry over, and how that then positively impacted the relationship with the provider. Right.

00;16;39;15 - 00;16;40;07
Tawandaa Austin
Yes.

00;16;40;09 - 00;17;08;12
Joy Lewis
That's a really compelling story. So I guess I would want to turn to Shreya, because you're a part of the Penn program that she's spent her blood, sweat and tears building out the impact model. And the goal really is to try to spread and scale the kind of magic that you just described for us Tawandaa. And so I'm going to ask you to tell us a little bit more about the work that she's been leading and the evidence behind it.

00;17;08;14 - 00;17;39;17
Dr. Shreya Kangovi
Yeah, thank you. Well, you know, stories like Tawandaa are what gets me out of bed in the morning. And the goal of impact is to make sure that those sorts of stories remain magical, but they're not accidental. So we've tried to answer the question, how do you do magic with consistency? And it turns out that if you want to generate, you know, an enterprise scale community health worker program that is effective and sustainable, you have to get a few things right.

00;17;39;19 - 00;18;05;25
Dr. Shreya Kangovi
Number one, you have to hire the right people. As Tawanda said earlier, she was born a community health worker. This is a calling. It's not just a job that you can solve for by posting a job on Indeed or going through a two week training and certification program. We in the impact model help organizations by recruiting and assessing natural helpers from within local communities.

00;18;06;01 - 00;18;24;27
Dr. Shreya Kangovi
And we use behavioral interviews, for example, to gauge traits like empathy and non-judgment and reliability and listening skills so that at the end of the day, you have people who are just tailor made for this job and who are set up for success. So the first thing is kind of hiring is a core part of the impact model.

00;18;24;27 - 00;18;57;17
Dr. Shreya Kangovi
The second piece is training. And our insight there is that you can't just train community health workers. You have to train both community health workers and supervisors and program leaders. And so we offer really experiential training at all of those levels, as well as ongoing professional development. Being a community health worker is a profession. Sometimes you hear about folks saying, oh, you know, community health workers, you know, maybe they can graduate on to becoming social workers or becoming nurses know being a CHW is a profession.

00;18;57;17 - 00;19;24;27
Dr. Shreya Kangovi
So we support CHWs all across the country in being able to progress in their field and advance and gain additional skills, whether it's direct patient care or advocacy or community mobilization, etc.. So recruitment, hiring, training. Then there's the actual workflows. You know, Towandaa mentioned that she met Mrs. T where she was. She got to know who she was as a person.

00;19;24;27 - 00;19;51;24
Dr. Shreya Kangovi
She asked her, you know, Mrs. T, what do you want and what do you think will improve your health? And she provide tailored, person centered support to that. And that doesn't come accidentally. There are workflows that we've developed and tested with at this point over 70,000 patients in multiple clinical trials and we've really refined these socio behavioral practices through which community health workers can provide effective tailored support.

00;19;51;27 - 00;20;18;17
Dr. Shreya Kangovi
And then the final layer is infrastructure and supervision for CHWs, you know, and that takes into account performance assessments, support coaching, compensation and those are additional managed services that are part of the impact model. So, you know, sometimes a community health worker program sounds so intuitive and there's a risk of, oh, this is so simple. You know, any hospital can create their own community health worker program.

00;20;18;17 - 00;20;40;22
Dr. Shreya Kangovi
Right? But CHWs have been around for 300 years and many of those programs have really struggled in that time. And we really have tried initially at Penn and now with our spinout called Impact Care, to just make this process streamlined, effective and sustainable for organizations who are really trying to grow this workforce.

00;20;40;24 - 00;21;07;19
Joy Lewis
So you're describing a level of intentionality that is required if one is to design and stand up a successful CHW program. You know, your comment around hiring the right people cause me to think of the author Jim Collins in his good his book Good to Great, where he talks about how do you take an organization from being good to great and and he said, you know, too often we talk about our biggest asset being our people.

00;21;07;22 - 00;21;27;27
Joy Lewis
And he said, but it's got to be the right people. You have to get the right people in place, because then you can actually pivot and, you know, you can get folks to to do the actual work you need to do if they're already motivated around the mission and the vision and are in alignment with the broader goals.

00;21;27;27 - 00;21;30;03
Joy Lewis
But you have to get the right people on the bus.

00;21;30;10 - 00;21;51;12
Dr. Shreya Kangovi
Yeah, absolutely. And, you know, there's there's a real risk, I think, to your audience, because in the field, you know, people tend to be reductionist and think about community health workers as just a training function and then think about their workflows as, okay, let's screen for unmet social needs and refer to resources. Both of those approaches are highly reductionist.

00;21;51;12 - 00;22;22;21
Dr. Shreya Kangovi
You asked about our outcomes. Impact has the strongest outcomes for any CHW program in the country, including a $2 and 47% return on investment annually and a 70% patient engagement reduction of total hospital days of 66% compared with matched controls, improved A1 c BMI, systolic blood pressure, improved quality through caps and H-caps. You you can't get those outcomes without the inputs that I described, right?

00;22;22;23 - 00;22;25;24
Dr. Shreya Kangovi
So that's really kind of the key point.

00;22;25;27 - 00;22;50;06
Joy Lewis
So let's talk about that. Brier, You've spent some time as a health system leader, really building a CHW workforce. What what is that experience been like and what are some learnings and pitfalls to avoid some lessons you might share for other health system leaders who might be thinking about standing up one of these programs?

00;22;50;08 - 00;23;21;14
Dr. Briar Ertz-Berger
Thank you for asking. I've had this conversation with and without Shreya training multiple times. The journey has been transformative for me personally and also, I believe for our the health system and the teams that these CHWs are embedded working with and actually got connected to Dr. Kangovi through mutual contact. I struggled, I initially struggled. They came and gave us the pitch and I really struggled with the concept of how CHWs

00;23;21;15 - 00;23;48;19
Dr. Briar Ertz-Berger
were going to be supporting patients with complex physical and mental health diagnoses. So it was a very humbling experience to come in contact with, you know, Shreya's program and to really start thinking about this industry. I had said like kind of blasting over open the glass walls of how I was thinking about health and how we've been traditionally thinking about health in our country as being generated by a physician and nurse working in partnership with a patient.

00;23;48;24 - 00;24;09;25
Dr. Briar Ertz-Berger
You know, that's not entirely true. You know, so strong leadership is is various is essential. You need to get your leadership on board. And they have to deeply understand this model because it's it's going to require change management. And as with all change management, you're in it for the long haul. There are going to be people who are skeptical.

00;24;09;25 - 00;24;20;10
Dr. Briar Ertz-Berger
As I was just saying, because this is introducing a non-clinical role into a clinical setting and folks are going to have to understand how that works and you're going to need clinical champions.

00;24;20;13 - 00;24;22;25
Joy Lewis
It's a paradigm shift almost, right?

00;24;22;27 - 00;24;42;23
Dr. Briar Ertz-Berger
Absolutely. And it's really essential that the supervisors and the folks that are going to help run this program deeply understand the work and they can create a safe working environment for the team. Because, you know, as Tawandaa talked about, you just listening to the story that she had shared, there's a lot of very intimate and personal details and information that are coming from that team.

00;24;42;25 - 00;25;01;18
Dr. Briar Ertz-Berger
You should be working also with a patient population who has dealt with poverty and racial discrimination. And so you've got to create the safe working environment for the people who are doing the work because there's a lot of secondary trauma that they're going to experience. And there's got to be, you know, tremendous amount of support that's provided.

00;25;01;20 - 00;25;07;18
Joy Lewis
But I'm hearing you say. Briar, that there's room for for multiple disciplines at the table.

00;25;07;24 - 00;25;08;17
Dr. Briar Ertz-Berger
Absolutely.

00;25;08;24 - 00;25;16;23
Joy Lewis
You know, you can have your social worker still on the team, as you should. But that doesn't you know, it's not a zero sum game right?

00;25;16;23 - 00;25;32;11
Dr. Briar Ertz-Berger
And this is not a replacement for you know, our in care managers or social workers. Absolutely not. They this is an addition to the team that has been sorely needed for a very long time. You know, it complements these clinical roles and allows them to work at top of scope.

00;25;32;13 - 00;26;20;11
Joy Lewis
You know, you remind me of when I was at Kaiser Permanente and a leader in preventive medicine, Dr. David Sobel. I don't know if you know that name. He coined the phrase "patients are the true primary care providers." And I don't know that that landed very well with his colleagues. But, you know, as I'm listening to Tawandaa's reflection on her time in Mrs. T's home and and the program you stood up, and just it just really makes sense that we ought to rethink who's at the nucleus, who's at the center of all of our work, and how do we then create the care plan around what the patient is identifying as as their health goals.

00;26;20;13 - 00;26;59;09
Joy Lewis
So super helpful. Tawandaa, do you want to weigh in here and talk a little bit more about how your role as the CHW adds a different flavor, a different element, if you will, to the work that we're all after, which is, you know, to make patients lives better. And how in particular does your lens that you apply to the work that you do, how is that different from other approaches like, you know, screening for social needs or referring patients to community based organizations?

00;26;59;11 - 00;27;08;04
Joy Lewis
If you can speak a little bit around how CHWs differ compared to other population health approaches, that would be helpful.

00;27;08;06 - 00;27;33;13
Tawandaa Austin
I would say they're scaled up. Use definitely differ because often physicians are confined to the room with their patients. I get to go to different places in a community with patients. I get to just really dive deeper, be in their homes. That's really intimate. I really get to look at the family portraits and get to know a lot more to you that a physician would learn with the short period of time.

00;27;33;13 - 00;27;54;16
Tawandaa Austin
I really don't have the time frame of working with patients in the day. I can spend as much time is as it's appropriate rather, and I get to use my creativity. I get to be myself. I can identify with the patients. I've been through more than half of the things that they've been through. I am a patient, so I understand them.

00;27;54;16 - 00;28;15;17
Tawandaa Austin
I can use empathy instead of sympathy to really just be in moments with them during the most trying times that they that you can ever imagine. I just get to be there and maybe just like, take a pause and just really just be in a moment with them to try to, you know, ease their mind or try to come up with other ways to make them feel appreciated.

00;28;15;17 - 00;28;19;25
Tawandaa Austin
And really give them there that sun healthy shine again.

00;28;19;27 - 00;28;30;07
Joy Lewis
There's such an authenticity when I listen to you speak I mean it's it's amazing I see how that then translates into trust building, right?

00;28;30;09 - 00;28;31;09
Tawandaa Austin
Absolutely.

00;28;31;12 - 00;28;33;09
Joy Lewis
Sure. You wanted to say something?

00;28;33;12 - 00;28;55;27
Dr. Shreya Kangovi
Yeah. I wanted to add, I think it's really important to contrast and evidence based community health worker model with social needs, screening and referral. It's about power. When someone, you know, either a community health worker or clinician, you know, sits at a computer and says, you know, are you being abused at home? Do you have enough food to eat?

00;28;56;02 - 00;29;26;27
Dr. Shreya Kangovi
Click, click. Here are some food pantries. There is no power changing hands. It is still, you know, the sort of privileged clinical system that is pathologizing the people who may have experienced health inequity or poor health outcomes and just, you know, the approach that Tawandaa is taking is the opposite. She is meeting them literally where they are, and she is asking them what they need and helping them do that.

00;29;26;27 - 00;29;52;10
Dr. Shreya Kangovi
It's about power. And I think perhaps not coincidentally, that's why it works. You know, that the as much as we've seen social need screenings and closed loop referrals just propagate across our health systems. And they they certainly do have a role. But they have not been proven to improve downstream health care costs and they have pretty low rates of patient engagement.

00;29;52;10 - 00;30;11;15
Dr. Shreya Kangovi
You know, patients know where the food pantry is. They passed it on the way to the clinic. Did you? So the real evidence is behind these person centered approaches where people get to say what they need, and a community health worker who shares life experience with them supports them on that journey.

00;30;11;18 - 00;30;49;21
Joy Lewis
Well, if health is our cause, I almost get goosebumps when I read the AHA's vision statement, which we revised just a couple of years ago, the vision is of a "just society of healthy communities, where all individuals reach their highest potential for health." And at the end of the day, if we keep that as our North Star, then it's really hard to create plans outside of the wishes and the desires of the patient in front of us.

00;30;49;23 - 00;31;29;01
Joy Lewis
And so I really want to thank all of you so much for your time spent today, and in particular for elevating for our audience how community health workers are vital are critical. They're a key component to the equation when it comes to advancing health and inching our way again closer to equitable care. And so at the American Hospital Association, we actually have developed a number of resources to advance health equity and support our members in the work that they do day in and day out on behalf of the patients and families and communities that they serve.

00;31;29;01 - 00;31;53;19
Joy Lewis
And so I would invite our listeners to look more into our health equity roadmap. That's a national initiative that we launched last year to drive improvement in health care outcomes, to address the disparities that we know exist and have long existed, to really begin to tackle our work environments, to make sure that they're more diverse and representative and inclusive.

00;31;53;22 - 00;32;33;03
Joy Lewis
There's also our hospital community collaborative, and through that work we provide really proven to Shreya's point earlier, the evidence that's needed the insights, the resources to create sustainable collaborations between hospitals and community organizations with the goal of accelerating health equity and advancing health. And I think we we know on this call that too often, as you just talked about, the power dynamics, that the community voice is left out of the conversations and out of the solutions as we're busy developing them.

00;32;33;03 - 00;33;08;16
Joy Lewis
So one, to call out those two pieces of work and also our Community Investment for Health portfolio, where we're looking at those upstream factors that influence one's health. So again, thanks for listening and for more information, I would invite everyone to visit our web site: IFDHE.aha.org. Thanks everyone.

00;00;01;00 - 00;00;36;09
Tom Haederle
Carrying a child and giving birth is generally depicted as one of the happiest times in a person's life. And for many birthing people, it is. But not all. For one in five Americans who give birth and through no fault of their own, the experience of bringing a baby into the world can significantly impact their mental health. Welcome to Advancing Health, a podcast from the American Hospital Association.

00;00;36;16 - 00;01;10;17
Tom Haederle
I'm Tom Haederle with AHA Communications. Perinatal mental health conditions, including depression, anxiety and OCD, affect 800,000 new parents each year. That's roughly the population of San Francisco. Why are so many people experiencing perinatal depression? And most importantly, what can health care organizations do about it? In this next episode of the Beyond Birth series, the AHA’s Julia Resnick, director of Strategic Initiatives, explores these questions with an expert from UMass Memorial Medical Center in Massachusetts.

00;01;10;20 - 00;01;34;02
Julia Resnick
Maternal health in the United States is at a pivotal moment. Alongside an increasing maternal mortality rate, as many as 60,000 U.S. women are affected by severe maternal morbidity each year. And these unexpected outcomes can have serious, short or long term health impacts. So what will it take to improve maternal health outcomes? Identifying and addressing perinatal mental health is a crucial piece.

00;01;34;05 - 00;02;00;27
Julia Resnick
Maternal mental health conditions such as depression, anxiety, OCD and PTSD are the most common complications of pregnancy, affecting one in five women. That is 800,000 women each year in the United States alone. People at increased risk of maternal health conditions are those who have a personal or family history of mental illness, lack social support or experienced a traumatic birth or previous trauma in their lives.

00;02;01;00 - 00;02;29;10
Julia Resnick
There are also inequities in who is impacted by maternal mental health conditions. Up to 50% of women living in poverty will suffer from a maternal mental health disorder. Compared to white women, black women are twice as likely to experience maternal mental health conditions, but half as likely to receive treatment. And though these statistics focus on birthing people, we also have to recognize that fathers, spouses and partners can also experience mood changes during the perinatal period.

00;02;29;13 - 00;02;59;22
Julia Resnick
Up to 10% of new fathers will experience postpartum depression or anxiety. But there is good news. Most maternal mental health conditions are temporary and treatable with a combination of social support, therapy, medication and self-care. Welcome to Beyond Birth, a podcast series on how health care organizations can support the social and emotional needs of pregnant people and new parents. I'm Julia Resnick, director of Strategic initiatives at the American Hospital Association.

00;02;59;25 - 00;03;30;12
Julia Resnick
Today's episode will explore maternal mental health conditions, both looking at the root causes, as well as how providers can access the tools they need to identify and support their patients experiencing maternal mental health conditions. I recently spoke with Dr. Tiffany Moore Simas. She is the chair of Obstetrics and Gynecology at UMass Memorial Medical Center in Worcester, Massachusetts. UMass Memorial is the largest nonprofit academic medical center in central Massachusetts and is the fourth largest in the state.

00;03;30;14 - 00;03;45;16
Julia Resnick
They have a level three maternity center, a level three NICU and perform approximately 4500 deliveries a year. Dr. Moore Simas is an advocate for perinatal mental health. And as you'll hear, an expert on this crucial issue.

00;03;45;19 - 00;04;11;14
Julia Resnick
Before we talked about UMass Memorial's work, I wanted to tap Dr. Moore Simas’s expertise about perinatal mental health and what providers need to know about it. So before we really dive into UMass's work around maternal mental health. I'd love to just talk more generally about maternal mental health issues and what providers need to know. So can you talk about why pregnant people are particularly at risk for developing mental health conditions?

00;04;11;16 - 00;04;40;25
Tiffany Moore Simas M.D.
Yeah, it's sort of the perfect storm in many ways. If you think about mental health conditions, there are sort of inherent genetic predispositions, family, you know, family history. None of that goes away, of course, in pregnancy. But what happens in pregnancy is these hormonal changes, physiologic changes. And then if you think about many mental health conditions are exacerbated by, you know, by stress, pregnancy can be a particularly stressful time.

00;04;40;25 - 00;05;03;03
Tiffany Moore Simas M.D.
So you sort of combine biologic risk factors, environmental risk factors and psychosocial risk factors. Pregnancy brings all of those things together. One, sleep deprivation and changes in one sense of self as a new parent. What often happens is alterations in one's relationships and support systems that all comes together to increase risk.

00;05;03;05 - 00;05;07;20
Julia Resnick
And how prevalent is perinatal depression, both nationally and in your community?

00;05;07;22 - 00;05;36;13
Tiffany Moore Simas M.D.
So if you look at perinatal mental health conditions, like all mental health conditions, they affect about one in five perinatal individuals, perinatal being pregnancy in the full year postpartum. Perinatal depression as a single mental health condition. We sort of quote rates of about one in seven, but those are averages, right? As I just said, there are a lot of risk factors associated with mental health conditions, and some people have more risk factors than others and many people have many risk factors.

00;05;36;16 - 00;05;52;19
Tiffany Moore Simas M.D.
So there are some people for which the rates of perinatal depression are as high as one in three or, you know, example, women veterans, adolescents who have pregnancy, persons who are disadvantaged by socioeconomic status and racism. So really it's very, very common.

00;05;52;21 - 00;05;56;28
Julia Resnick
How can providers identify and address perinatal depression among their patients?

00;05;57;01 - 00;06;30;08
Tiffany Moore Simas M.D.
The key to that is the first part the identification. We should be screening pregnant and postpartum individuals for mental health conditions and most commonly depression anxiety. Using validated screening tools, you can't tell if somebody is depressed or anxious. You can't tell by looking at them. You really need to be using these validated instruments. Beyond that, what's a screening instrument is indicated as being positive or, you know, concern or high risk for condition need to do assessment, diagnosis, get connected with treatment. And getting connected with treatment

00;06;30;08 - 00;06;35;01
Tiffany Moore Simas M.D.
also isn't enough. We really need treatment to symptom remission.

00;06;35;04 - 00;06;44;13
Julia Resnick
So thinking about, you know, maternal mental health in the future, what are the challenges and opportunities as we're as we're looking at this space?

00;06;44;15 - 00;07;13;25
Tiffany Moore Simas M.D.
Oh, so many. So the vast majority of people with mental health conditions still go undetected and untreated. And so really providing universal screening at designated time points is at least a good first step. And then, as I said, you know, once, once a condition is identified, really helping everyone who has an identified mental health condition to get down that complete pathway through treatment to symptom remission.

00;07;13;27 - 00;07;29;17
Julia Resnick
So now turning to the work that you do, I know that faculty at UMass Chan Medical School and UMass Memorial Health were critical in developing the first in the nation perinatal psychiatry access program. Can you tell us about that program and what it is and what was the impetus for launching it?

00;07;29;19 - 00;07;56;17
Tiffany Moore Simas M.D.
Yeah, so the program is called MCPap for Moms. The MCPAP stands for the Massachusetts Child Psychiatry Access Program for Moms. There was never going to be enough perinatal psychiatrist or psychiatrist that we're comfortable, you know, treating pregnant postpartum individuals that we really needed to increase the capacity of any clinician that was caring for pregnant, postpartum, lactating individuals, persons who were pre-conception and thinking about conceiving.

00;07;56;19 - 00;08;48;13
Tiffany Moore Simas M.D.
So, MCPap for moms is the first perinatal psychiatry access program in the country. And this access program model, which started in Massachusetts, and now there are 22 state based ones in the country and two national ones are this model of helping clinicians that are not psychiatrists help their patients with a mental health condition. And so we help the clinicians by providing training and toolkits, by providing consultation with a perinatal psychiatrist, by providing, you know, linkages and connections to other behavioral health supports like therapists in the state, and by providing technical assistance to like obstetric practices, for example, and helping them, you know, develop workflows in their offices to to identify, detect, treat and get

00;08;48;13 - 00;09;19;21
Tiffany Moore Simas M.D.
patients through to symptom remission. And so this model is I liken it to sort of, you know, give a man a fish versus teach a man to fish. If, you know, the perinatal psychiatrist just treated that one patient, then they're treating that one patient and their capacity would get filled up very, very quickly. Versus if you teach me, the OBGYN, every time I pick up the phone and call the access program to treat a patient, then you've not just helped me treat that patient, you've educated me and then maybe I'm treating the next one and the next one.

00;09;19;21 - 00;09;25;17
Tiffany Moore Simas M.D.
So it's really building the capacity and thus the workforce to be able to address mental health conditions.

00;09;25;19 - 00;09;31;26
Julia Resnick
That's really fantastic. So can you talk about how providers and care team members can access the hotline?

00;09;31;29 - 00;09;53;11
Tiffany Moore Simas M.D.
Yeah, so it is we call it more of a warm line than a hotline. Hotline often means 24 seven emergency. With a warm line, it's really kind of Monday through Friday, 8 to 5 when, you know, OBGYN offices, for example, tend to be open. And it's not just OB-GYNs that can call. It's any clinician caring for a pregnant postpartum lactating want to conceive you know patient.

00;09;53;11 - 00;10;13;23
Tiffany Moore Simas M.D.
So if there's a reproductive concern during this, you know, mental health condition that needs to be treated or addressed, anybody can call. So you just literally pick up the phone and then you would be met with a resource and referral specialist. And that resource and referral specialist would get, you know, information about what you're calling for. You know, what's the general question that you have?

00;10;13;25 - 00;10;36;02
Tiffany Moore Simas M.D.
And then they would, depending on your need, if my need is, I would like to get some information about therapists in a certain area for this particular patient that's with me. Then I may just talk to the resource and referral specialist. If I have a patient that I really feel like I need to talk to the perinatal psychiatrist about their care, then the perinatal psychiatrist gets paged and the goal is for them to call me back within the next 30 minutes.

00;10;36;05 - 00;10;55;07
Tiffany Moore Simas M.D.
If when I talk to that perinatal psychiatrist, I feel like, okay, you know, we've talked about this patient. They're going to guide me in the care that she needs, and I'm good with that. And that's great. If at the end of that conversation, I say, you know, I'm really still pretty uncomfortable. I don't feel comfortable, you know, providing the care that you're recommending

00;10;55;07 - 00;11;20;08
Tiffany Moore Simas M.D.
then at least in our state, there is the option for that patient to be connected with that perinatal psychiatrist for one on one consultation. And the goal at the end of that consultation is that psychiatrist has done a complete evaluation and not just based on what I told the perinatal psychiatrist, but their actual evaluation of that patient. They can provide a concrete consultative treatment plan and then I can carry that through.

00;11;20;16 - 00;11;27;16
Julia Resnick
That's great. And at what point during pregnancy can you can you call this this warm line? Is it any point?

00;11;27;19 - 00;11;48;19
Tiffany Moore Simas M.D.
Any point. And it's not just pregnancy, it's any time in pregnancy, any time in postpartum, which is that year after childbirth. If they're lactating beyond that year childbirth, they're still eligible or if they're planning to conceive, have a mental health condition and, you know, some consultation around like would it be appropriate to continue this medication regimen or what have you.

00;11;48;24 - 00;11;51;06
Tiffany Moore Simas M.D.
And most of the time, it often is.

00;11;51;08 - 00;11;57;05
Julia Resnick
How do you train providers to ask these sort of sensitive questions to patients regarding their mental health?

00;11;57;07 - 00;12;17;28
Tiffany Moore Simas M.D.
That's a great question. I think, you know, there's a lot of stigma that comes with mental health and how you present the questions and engage in the conversation can be very important and and can dictate whether or not the patient chooses to engage with you in that conversation. So firstly, using some of these validated tools can be helpful and they're often self-administered.

00;12;18;00 - 00;12;55;29
Tiffany Moore Simas M.D.
And also our access programs and most in the access programs across across the country offer trainings. And so we can engage with providers on how to have these conversations. And we've created a lot of toolkits. And within those toolkits, not only do we provide, you know, sort of clinical guidance and recommendations, but we also provide actual verbiage on how you might pose a question around suicidal thoughts or thoughts of self-harm, which can be very hard for people to sort of initiate and vocalize. Most of the guidance and verbiage that we have provided

00;12;55;29 - 00;13;12;24
Tiffany Moore Simas M.D.
we have, you know, vetted with focus groups of persons that have lived experience with perinatal mental health conditions. And remember what things people said to them that turned them off or that felt really judgmental or what have you. And so we've incorporated a lot of that language into our suggested approach.

00;13;12;27 - 00;13;23;16
Julia Resnick
That's really wonderful. I'm also curious about how you're promoting this resource to providers that are working with pregnant people so that they know where they have resources that they can access.

00;13;23;19 - 00;13;55;09
Tiffany Moore Simas M.D.
Be very purposeful efforts into knowing every OB-GYN in the state and try to engage them in a very direct way, whether it was literally going to their offices, going to grand rounds, going to conferences and had an enrollment form like we knew everybody we talked to. And our goal was to get to everybody. We partnered with the Massachusetts chapter of ACOG and through, you know, email, communications, newsletters, conferences, any sort of obstetric related professional society we worked through.

00;13;55;12 - 00;14;10;09
Tiffany Moore Simas M.D.
And now, for example, there is a section about perinatal psychiatry access programs in the ACOG clinical practice guidelines that just came out in June regarding detection and treatment of perinatal mental health conditions.

00;14;10;11 - 00;14;24;11
Julia Resnick
So I know earlier you talked about how there are some populations that are at higher risk for experiencing perinatal mental health disorders. So how are you all taking health equity in to consideration when you're developing this program?

00;14;24;13 - 00;14;52;24
Tiffany Moore Simas M.D.
More recently, over these past years, we've really focused on equity inequities or disparities in persons who are socioeconomically disadvantaged or marginalized by racism have higher rates of these conditions, yet lower rates of detection and treatment. And if we look very concretely at our data, we know that in Massachusetts there's about 72,000 deliveries a year. We know that one in six or seven will have depression anxiety.

00;14;52;24 - 00;15;17;07
Tiffany Moore Simas M.D.
So that's about 12,000. And MCPap for Moms serves about 3,000 patients a year. Almost 25% of the population of patients in the state we could serve. And then if you look at the breakdown of that, for example, the payer mix of those for whom we've provided services. It correlates very closely with the payer mix of the perinatal individuals in the state.

00;15;17;09 - 00;15;26;00
Tiffany Moore Simas M.D.
We recently added to some of the demographics we collect very specifically collecting information about race, ethnicity and other social determinents of health.

00;15;26;02 - 00;15;37;01
Julia Resnick
And I'm sure that things are ever evolving. But I'm also just really interested in the impact of this and how, you know, you're making how do you know you're making progress and what data and metrics are you tracking?

00;15;37;04 - 00;16;00;16
Tiffany Moore Simas M.D.
Yeah, also that's a great question. And similarly, this has been an evolution. Our early metrics were basically like, were people willing to sign up for our trainings? Were we able to get them to engage in the program? How many people called us who were actually utilizing the program? We published a couple of papers early on as it related to that kind of the utilization and the acceptability of clinicians in using these services.

00;16;00;23 - 00;16;21;06
Tiffany Moore Simas M.D.
We recently just finished a five year CDC-funded grant, very specifically looking at, you know, does this make a difference? And so we did a systematic review. It was led by my partner, Nancy Byet. I was the lead author on it back in the 2015 timeframe in the Green Journal, which is the obstetrics and gynecology journal for us.

00;16;21;08 - 00;16;47;27
Tiffany Moore Simas M.D.
And we looked at in that in that systematic review, what is the likelihood of treatment, initiation and treatment sustainment? If you look at that, the likelihood of treatment initiation is less than 25%. So when we look at the study that we did and looked at the MCPap for Mom's program, 43 to 52% of people in the program initiated treatment and 20-25% sustained treatment.

00;16;48;04 - 00;17;17;01
Tiffany Moore Simas M.D.
In a systematic review, less than 25% initiated treatment. And with the MCPAP for Mom's model, 43 to 52%. So a doubling initiated treatment and the systematic review 0 to 1% sustained treatment. So we're seeing marked improvements, which is wonderful. And you asked a question earlier about opportunities, but they're still half people who aren't initiating treatment, who are getting treatment, initiation and, you know, 0 to 1% sustainment up to 20, 25%.

00;17;17;01 - 00;17;34;00
Tiffany Moore Simas M.D.
That's a great marked increase. And still right that 75 to 80% that don't have sustained treatment. And we don't know that they're getting to symptom remission. So we have evidence that this model is working and we have evidence that we have more to do.

00;17;34;02 - 00;17;58;24
Julia Resnick
Addressing maternal mental health in America as an ongoing process. Clinicians need the knowledge to detect patients symptoms and connect them with treatment and support. Every case looks different and providers may feel like they're stumbling in the dark. That's why Dr. Moore, Simas and her colleagues at UMass Memorial are dedicated to shining a light on perinatal depression and taking their work beyond the walls of their hospital and community

00;17;58;27 - 00;18;17;29
Julia Resnick
with Lifeline for Moms. She talked to me about how this project grew out of MCPAP for moms and how they are taking this movement nationally. So when you look back over the past ten years, what has been working well and are there any stories about this program that can really bring it to life for our listeners?

00;18;18;01 - 00;18;42;10
Tiffany Moore Simas M.D.
You know, when I started doing this work as an OBGYN and going out to my fellow OB-GYNs, I would hear things like, I'm an OBGYN not a psychiatrist. In the past ten years, that narrative has changed markedly, especially considering that perinatal mental health conditions are the overall leading cause and the overall preventable leading cause of maternal mortality.

00;18;42;10 - 00;19;05;29
Tiffany Moore Simas M.D.
So it is, you know, not acceptable to say, as women's health care providers, as providers of pregnancy and postpartum care, that mental health is not ours to deal with. It's all of ours to deal with. I think the last ten years is also seen a lot of support through professional societies and governmental organizations in agreement on we should be screening. In agreement on

0;19;06;05 - 00;19;33;20
Tiffany Moore Simas M.D.
we need to screen in contexts that take it beyond screening to actual treatment and a lot of new resources around that. And then for these programs, right, ten years ago, we were the first. Now there's 22 states with programs and there's two national programs. So we're seeing more attention to this. We're seeing more ownership of this by prenatal care providers in general, and we're seeing more resources and more of these programs.

00;19;33;23 - 00;19;40;26
Julia Resnick
That is really great. And last but not least, what's next for UMass Memorial in this space? What are your plans for the future?

00;19;40;29 - 00;20;07;25
Tiffany Moore Simas M.D.
That's a great question. I'll go back to you know, there's evidence that this program works and yet there's still more to do, right? There's still plenty of perinatal individuals who are suffering in silence, who have been screened and maybe are not getting the ready access to care that they need and or have not really achieved symptom remission. And there remain disparities and inequities across that spectrum.

00;20;07;25 - 00;20;21;19
Tiffany Moore Simas M.D.
And so until we can say 100% of people been screened, 100% of people have been identified, 100% of people have access to treatment and or have achieved symptom remission, we will have more work to do.

00;20;21;21 - 00;20;49;08
Julia Resnick
While our health care system is certainly making progress at identifying, addressing and de-stigmatizing perinatal mental health conditions, we still have a long way to go to reach the goal of 100% identified and treated. The AHA is grateful to have physicians like Dr. Moore Simons championing the cause. If you're interested in learning more about Lifeline for Moms, you can find their website at umassmed.edu/lifeline4moms, with the number four.

00;20;49;10 - 00;21;18;23
Julia Resnick
That's umassmed.edu/lifeline4formoms. Providers can access the hotline at 508-856-8455. AHA’s growing library of resources on improving maternal mental health can be found at www.aha.org/betterhealthformothersandbabies. Thank you for tuning in to this episode of Beyond Birth Advancing Health Podcast.