healthcare delivery and access
In 2021, the Board of Directors of the Greater Black Point Community Foundation voted to focus the foundation’s unrestricted grant making on issues of health and wellness, particularly in response to the gaps illuminated by the Covid-19 pandemic. Below is a summary of the current initiatives under review by our grants committee. If you believe your organization can help us make a difference in these areas, please contact us.
Greater Black Point Community Foundation
Leadership Initiatives Under Consideration
June 2022
Healthcare Education
Focus: Interprofessional Education
Interprofessional education is emerging as one of the most cutting edge issues in medical education, in America and globally. The goal of interprofessional education (IPE) is to improve patient outcomes by changing the medical education system to produce teams, not individuals in silos, working together to give patients the best possible diagnosis and treatment. Collaboration and teamwork among health professionals are critical to the delivery of high-quality patient care. IPE is increasingly identified in the medical education literature as critical to the delivery of high-quality patient care.
The basic definition of IPE is
"Occasions when (students) from two or more professions learn with, from and about each other to improve collaboration and the quality of care." (Freeth et al. Effective Interprofessional Education: Development, Delivery & Evaluation. Blackwell Publishing, Oxford, UK, 2005)
"Interprofessional education occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes. Interprofessional education is a necessary step in preparing a 'collaborative practice-ready' health workforce that is better prepared to respond to local health needs.” (World Health Organization (2010): Framework for Action on Interprofessional Education & Collaborative Practice)
In an IPE model, students from all disciplines (medical students, nursing students, allied health students) are together in the classroom, in small group venues, and in clinical experiences with patients.
Examples of Grantees
Three universities appear to be leading the way in building and deploying a curriculum designed revolutionize medical education in this country, breaking down the silos of today’s medical education systems.
Thomas Jefferson University/Jefferson Medical College
University of Kansas Medical Center
Medical University of South Carolina
University of California, Irvine
Examples of Possible Grants
A. Building online modules to introduce learners to the concept of interprofessional education. Clinical students have been trained in silos and they often have no concept of what value other professions bring to the table. The students need an introduction to the roles of each profession and how they can communicate and work more effectively in medical teams. Online modules accomplish this effectively and efficiently.
B. Training educators on how to build interprofessional learning experiences with students or clinical teams. Most medical educators have no background in IPE. Faculty development is essential to the success of the program.
C. Pilot a patient-centered interprofessional collaborative practice model with acute care pediatric patients. At-risk children rarely receive the benefit of clinical trials or medical education pilots. A pilot like this would engage IPE students and the hospital to assist at-risk children, particularly with their transition back into their home environments. The goal of such a pilot would be to build a model that could be replicated in other units in the hospital and then used to train others in the field.
D. Invest in medical simulation mannequins, such as SimMan or Harvey, which are essential to an effective IPE medical education program. Virtual patients allow medical professionals to practice working together in realistic settings, testing the IPE concepts they are learning in class.
E. Installing telemonitoring devices to allow an IPE medical team to be able to work with families once they are home. Technology is often a gap in IPE medical education programs.
F. Bolster the intersection of technology and interprofessional medical care by supporting a project called Estrellita at the University of California, Irvine. Early health decisions for high-risk babies can make a big difference in how well they do down the road. The Estrellita team has created a mobile application to collect information from high-risk infants and their caregivers. The app allows the caregivers to more easily interface with clinicians to improve care and communication. Caregivers use the Estrellita app to record observations of daily living (ODLs) like the baby’s temperament, diapering, and weight as well as caregiver ODLs like stress levels and risk for post-partum depression. Estrellita also helps caregivers manage communication with clinicians by tracking clinical appointments and encouraging them to review the ODL data and ask questions during appointments. Estrellita is part of the Robert Wood Johnson’s healthcare technology program called Project HealthDesign.
Healthcare Consumption
Focus: Consumer Lifestyle Education
Healthcare consumption in America is a major problem. The United States spends significantly more on healthcare than any other nation. In 2006, healthcare expenditures totaled more than $7,000 per person, more than twice the average of 29 other developed countries. Still, the average life expectancy in the United States is far below many other nations that spend less on health care. More than 75% of health care spending is on people with chronic conditions.
Furthermore, according to statistics from the Centers for Disease Control and Prevention, the percentage of overweight children and adolescents in the United States has nearly tripled since the early 1970s. More than one in five children between the ages of 6 and 17 are now considered overweight. Childhood obesity has been linked to diabetes, high blood pressure, depression, anxiety, and poor academic performance.
None of this is a surprise; the issue of healthcare consumption is widely discussed. So is the issue of childhood obesity and its link to the chronic conditions that feed healthcare consumption over time. Hundreds of programs at nonprofits, hospitals and educational institutions claim to be addressing the problem. What programs, though, are actually working?
Studies point to programs that directly target the consumer, providing education about nutrition, diet and exercise. The challenge is getting the consumers to listen. Celebrity power helps, too. For example, Rachael Ray launched a nonprofit organization called Yum-O! The mission of Yum-O! is to “empower kids and their families to develop healthy relationships with food and cooking.” The Yum-O effort is often praised, even by professionals at academic medical institutions. Positive reinforcement appears to be more effective than negative reinforcement. For instance, New York City Mayor Michael Bloomberg’s recent proposal to limit the size of soft drinks received mixed reviews. The analysis of the ban’s projected effectiveness was even challenged by the scientists on whose research the analysis was based.
Examples of Grantees
1. PE4life
2. Share Our Strength
3. The Food Trust
4. DonorsChoose
5. Boys & Girls Clubs of America
Examples of Possible Grants
A. Fund efforts to bring supermarkets back to underserved communities. Interestingly, hunger and obesity are linked; lack of access to healthy food compounds the problem in underserved populations.
B. Fund school-based programs in our region to improve nutrition, physical activity and staff wellness by training teachers to better address the needs of at-risk children.
C. Fund specific teacher needs to support teachers in their unique opportunity to instill lifelong health and fitness habits in students through nutritional education, gym activities, yoga and even purposeful play at recess. Many schools lack the basic equipment needed to bring these initiatives to life. Sometimes simple things like balls, books and juggling kits, and even heart rate monitors, are things that would greatly assist teachers in helping their students learn about staying fit and healthy.
D. Fund a community facilitator. The most successful physical education programs incorporate community involvement. The first step in enlisting community involvement is getting key decision makers and leaders in the same room and sometimes that simply requires a little bit of funding to pay for a professional to facilitate and convene the key players (community leaders, school leaders, parent leaders, funders) to bring a school-based program to an entire community.
E. Fund outdoor playgrounds, especially providing access to children for whom playgrounds typically are not built. Playgrounds are usually designed for young, healthy kids. Only rarely are parks and playgrounds designed to serve the entire community, in every neighborhood, for children of all ages, demographics and abilities.
F. Support rural and disadvantaged communities’ access to digital healthcare tools by reaching families through the children. Web sites with personal databases, smartphone and Twitter apps for logging diet and exercise routines, pedometers, accelerometers and heart-rate monitors are often not available in rural settings because of the lack of access to technology. Rural and low income usage of the Internet is lower compared to urban and higher income usage. The digital divide is impacting healthcare. Teaching children to use the technology at an early age will pay dividends in the future.
Healthcare Delivery
Focus: Patients Left Behind
Healthcare delivery is a challenge, no matter what the patient’s condition. But healthcare delivery is particularly challenging for patients who suffer from diseases or disorders that receive very little funding to discover and improve treatment. Focusing on underfunded medical conditions is not often a priority for healthcare funders. A focus like this would make a statement, and it would make a tremendous difference in the lives of patients.
The healthcare delivery problem extends to underserved populations, specifically pediatric patients. The disparity in the availability of correctly formulated drugs for treating children as compared with adults creates a significant challenge in the delivery of healthcare to children. Due to the small size of the pediatric market, there has historically been a significant disparity in medical products available for treating children as compared with adults.
The Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act have increased the number of drugs that have been studied in children, this has had little effect on the number of drugs prepared and available commercially in a dosage and delivery form optimized for children. Most drugs are available as pills made in adult dosage and most children under the age of 6, who are unable to swallow pills. Pediatric hospitals are forced to reformulate hundreds of drugs needed for treating children, but children sent home for continuing treatment generally need to obtain prescription refills from community pharmacies that lack the ability to reformulate the drugs. This means that parents and caregivers are given instructions to crush pills and re-suspend the solids in apple sauce or some other carrier. These preparations lack accuracy of dosage, have unknown drug stability in carrier, often taste bad or have unpalatable mouth feel/texture and have unknown bioavailability. For children with chronic illnesses that require daily well-calibrated dosing of drug over a period of years, these factors are believed to result in poor adherence and variable dosing, posing the risk of poor outcomes. For example, in children with chronic pediatric hypertension, failure to treat consistently and correctly can lead to serious kidney and heart conditions in adolescence and adulthood.
Examples of Grantees
1. Institute for Pediatric Innovation
2. Myelin Repair Foundation
3. RARE Project
4. Beyond Batten Foundation/National Center for Genome Resources
Examples of Possible Grants
A. Fund the evaluation of the comparative effectiveness of home treatment of chronic hypertension in children aged 1 to 6 using a commercially prepared liquid formulation of an ACE inhibitor versus treatment using the generic form of the compound available only as pills. To connect this work to Boston, Tufts Medical School and Floating Hospital is seeking funding to participate in this pediatric drug and device development consortium.
B. Fund a hospital to hire and train community outreach workers for chronic, yet underfunded, diseases, such as asthma and diabetes. This can significantly improve healthcare delivery to these patients. Disorders like this require patients to take multiple medications and make frequent visits to the doctor’s office. Often a health crisis intervention is required because a patient disregards his or her condition, due to lack of adequate healthcare delivery mechanisms, and the condition becomes acute, requiring emergency treatment. The stories about what these workers do, the relationships they build and patient health they maintain is inspiring and truly community-building in nature, far beyond general health.
C. Fund a pharmaceutical researcher to facilitate a demonstration project to prove that collaboration is in fact effective in developing pediatric medicines, encouraging broader and deeper participation in the overall effort. Collaboration partners currently include Bristol-Myers Squibb, Eli Lilly and Company, Johnson and Johnson, Pfizer, Inc., and Shire Pharmaceuticals. Pediatric clinical stakeholders include the American Academy of Pediatrics and the Pediatric Pharmacy Advocacy Group. Regulatory institutions include the FDA, EMA and NICHD.
D. Support incentives for academic scientists, commercial biopharma and government regulators to work together to shorten the time to market for new medicines for patients who can't afford to wait, supporting the launch of several Phase I Clinical Trials.
E. Leverage technological advances in genome mapping to develop a test to screen for 600 rare diseases, supporting the work of Dr. Stephen Kingsmore and the National Center for Genome Resources (NCGR), in Santa Fe, New Mexico, one of the world’s top genetic screening laboratories, to create a low-cost, comprehensive screening test for hundreds of genetic diseases, like Batten disease and others.