How Chicago hospitals, health systems are tackling their top public health concerns

Before healthcare leaders in Chicago experienced the effects of the COVID-19 pandemic, they were focused on health disparities related to where residents live and social determinants of health such as housing. And many indicated a team approach to effect change citywide. Nearly two years later, their focus also includes tackling issues such as the mental toll of the pandemic on youth and racism as a public health crisis.

Becker's Hospital Review reached out to healthcare organizations in Chicago in November to gain current insights into their most pressing concerns related to the social and economic factors that affect people's overall health. They were again asked to identify the most pressing public health concern facing their organizations and share how they're addressing it.

Within the Chicago area, organizations are addressing public health issues by supporting youth through psychiatry and behavioral health clinics; identifying the most medically and socially complex patients; and opening new outpatient facilities to improve care access, among other initiatives.

Here is an overarching look at public health — in leaders' own words.

Matthew Davis, MD, MAPP, head of pediatrics and executive vice president and chief, community health transformation at Ann & Robert H. Lurie Children's Hospital

The top challenge 

Children and adolescents in Chicago are continuing to experience high levels of mental and emotional distress as the pandemic continues. This isn't the direct result of COVID-19 illnesses. Instead, many youth are experiencing mental/behavioral health challenges because their routines and their relationships with peers and their families have been deeply disrupted by the pandemic and how our communities have been trying to prevent coronavirus transmission. In addition, we know that likely several thousand Chicagoland youth have experienced the death of a parent, grandparent or other family member due to COVID-19. This bereavement that so many children are experiencing is a trauma for them that can contribute to their behavioral health needs. We know that children of color are disproportionately likely to have experienced the death of a family member attributable to the pandemic and to inequities in health and healthcare that existed before and during the pandemic.

An equally important challenge we are facing at Lurie Children's is the need to vaccinate children, adolescents and their family members against COVID-19, in order to help city and suburban neighborhoods control the pandemic. This effort has gotten a big boost with the recent approval of vaccination for children 5-11 years old. Obviously, vaccinating young people and their families against COVID-19 prevents the illness, but the benefits are broader than that. Vaccination and other preventive approaches offer our best chance to return to ways of living and learning that Chicagoans of all generations were experiencing prior to March 2020.

How your organization is responding 

Lurie Children's is tackling the behavioral health crisis head on, within our medical center and in the neighborhoods of Chicago and the suburbs. Like other hospitals, we are treating unprecedented numbers of children and adolescents with mental/behavioral health needs in our emergency department and in our hospital. In addition, we have supported many thousands of young people through our psychiatry and behavioral health clinics just since the pandemic began, and we will continue to do so. It is gratifying to see how clinics; hospitals and the City of Chicago are working together to do their best to meet the mental and emotional needs of youth today.

But at the same time, we know that treating behavioral health after it is already at a crisis level is overwhelming our systems. That's why we are also training primary care providers about how they can treat children with mild to moderate behavioral health needs in clinics and medical offices, through our Mood, Anxiety and ADHD Collaborative Care Program. It's also why we are working with schoolteachers and school administrators throughout Chicago and in many other communities to nurture resiliency of children in their daily learning environments, through our Center for Childhood Resilience

To help vaccinate as many children and adolescents as possible against COVID-19, Lurie Children's is hosting free vaccination clinics for youth. We are also teaming up with the Chicago Department of Public Health and community-based organizations to host free vaccination clinics in under-resourced neighborhoods of the city. For parents or other family members who have questions about the newly recommended COVID-19 vaccination for children, we have prepared easy-to-read information on our website.

Debra Wesley, president of Sinai Community Institute

The top challenge

Besides COVID and its impact on the lives of the communities we serve, public safety rises to the top. When a community does not feel safe, its ability to thrive is significantly challenged. Addressing the root causes of public safety, which is also embedded in underlying issues that have impacted our community's mortality, morbidity and emotional stability rates. Sinai Chicago is also addressing health equity through inclusion, innovation and investment.  

How your organization is responding

Sinai Chicago has been an active member in our community and a committed participant in city-led efforts to address public safety. We are also addressing health equity through inclusion, innovation and investment. Specifically, we are a member of the Community Safety Coordinating Center Launch Committee facilitated by the mayor's office. Additionally, we are part of the North Lawndale Community Coordinating Council, which is embarking on a strategic planning process to revisit its quality-of-life plan, including an analysis and strategy for each of its 13 committees to address public safety issues. We are also members of the mayor's Racial Equity Rapid Response Steering Committee, formed to address COVID and its impact along with root cause health equity issues. This work has allowed Sinai Chicago to contribute to solutions as it relates to COVID education, vaccine education, vaccine access and distribution. 

Our work is about ensuring vitality, employment, safety and good health in a part of Chicago plagued with disparities. It's about access and inclusion for communities that have been on the outside looking in for far too long. It's a fundamental piece of Sinai Chicago's mission — all Chicagoans deserve good health, no matter where they live.  

Helen Margellos-Anast, president of Sinai Urban Health Institute

The top challenge

Sinai Chicago serves patients from some of the city's most over-burdened and under-resourced communities. The communities we serve were particularly impacted by the pandemic, both with higher infection and mortality rates early on, as well as longer term effects, including the exacerbation of existing social and economic inequities that were already present. The higher rates of underlying chronic conditions such as diabetes, hypertension and asthma that were present prior to the pandemic remain and likely have increased due to reduced access to preventive care, reduced access to healthy food, and other growing social and economic challenges. 

How your organization is responding 

Sinai Chicago developed the Community Health Worker Complex Care Support Program in 2019 to specifically focus on identifying our most medically and socially complex patients. Our CHWs screen for housing insecurity, food insecurity, domestic violence, employment factors, utility challenges and transportation challenges, among other things, and link people to services to support them in addressing those issues.

Since July 2020, our CHWs have screened over 700 patients deemed as at high risk for readmission by our social work department, and have identified food insecurity (26 percent), behavioral health (20 percent), lacking a primary care provider (15 percent), housing insecurity (15 percent), lacking health insurance (15 percent), transportation challenges (12 percent) and utility difficulties (12 percent) as the most pressing needs. Seventy-nine percent of those served have been successfully connected to the resources they need to support their wellness. Through the program, we have reduced 30-day readmissions within this highest risk group from nearly 40 percent to 26 percent. 

Israel Rocha Jr., CEO of Cook County Health

The Top Challenge

The main public health challenge Cook County Health continues to address is ensuring that all residents, regardless of their ability to pay or immigration status, have access to care. The COVID-19 pandemic has accentuated the many structural barriers to equitable health services. Over the past year and half, we have seen Black and Brown communities disproportionately impacted by the virus, resulting in higher rates of morbidity and mortality. While there are many social risk factors that contribute to this disparity, the privatized nature of our country’s healthcare system and the lack of adequate healthcare infrastructure in some of our most in-need areas left these communities at risk during a global pandemic. The availability and accessibility of medical care is essential to ensuring our communities’ long-term health and wellbeing.

How your organization is responding

Cook County Health has been prioritizing projects that will allow us to provide primary and specialty care to our patients where and when they need it. In the last year, we have opened three new outpatient facilities in areas that are more convenient for our patients. These sites are more centrally located in the neighborhoods we serve, easy to access via public transportation and offer ample parking. With more space and modern amenities, we can offer more specialty services and accommodate more patients per day than in our older facilities. This year we also opened a new freestanding dialysis center at Provident Hospital on Chicago's South Side, where rates of kidney failure are twice as high as the national average. In 2022, we plan to re-open Provident Hospital’s Intensive Care Unit, as well as expand med/surg beds and emergency department capacity. We will also be moving forward with our plans to build a replacement Provident, selecting a design/build team next year.

In addition to our brick-and-mortar facilities, Cook County Health leveraged telehealth at the start of the COVID-19 pandemic, and it has shown to be a successful tool for engaging our patients in care. The pandemic accelerated our plans to implement this technology and Cook County Health provided more than 85,000 telehealth visits in the first six months of the pandemic. 

While we still have much work before us, we are confident that by letting our patients’ needs guide our strategies we will continue to make strides in achieving equity in access to care.

Cristal Gary, chief advocacy officer at Amita Health

The top challenge  

In 2020, Amita Health joined many in the healthcare community in declaring racism a public health crisis and pledging to address racial health disparities. One of our biggest challenges today is unraveling the complex, multi-faceted nature of the health disparities impacting our patients. Through the community health needs assessment and our own internal analyses, we know that the communities we serve have barriers to accessing primary care and specialty services, and experience higher incidences of behavioral health, maternal morbidity and chronic disease. Yet, as a system with a large geographic footprint across the Chicagoland area, we recognize these inequities show up differently across the various communities we serve and cannot be addressed with a one-size-fits-all approach.

How your organization is responding 

Amita Health is pursuing multiple initiatives to meet these needs. We launched a community health worker program designed to address unmet social determinants of health needs for patients with diabetes and patients with substance use disorders. We are also collaborating with partners to improve access to specialty services on the west side of Chicago and address disparities in maternal outcomes in our south region.  

Lastly, we recently completed a health equity assessment to identify other opportunities to improve equity across our system. The results of this assessment will inform future health equity initiatives and the development of a comprehensive health equity plan.

Cynthia Barnard, PhD, vice president of quality at Northwestern Memorial HealthCare

The top challenge  

As a large healthcare system affiliated with a top medical school, we face the sobering fact that living a long and healthy life in metropolitan Chicago is determined far less by the quality of your healthcare than by geography and social factors. Life expectancy varies by 30 years across Chicago and northern Illinois ZIP codes. Dramatic differences in chronic and acute disease, premature mortality and maternal and infant morbidity are driven by social determinants of health, which interfere with our communities' ability to access high-quality healthcare and to optimize their health. Our Community Health Needs Assessments identify priority public health gaps including poverty, hunger, safe and affordable housing, childhood education, transportation, mental health resources and exposure to violence, trauma and racism.  

How your organization is responding 

Northwestern Medicine has engaged in three major strategies to address the critical public health problems associated with social determinants of health in our communities.  

  • First, we invest in our communities in partnership with local leaders. We are one of the leading nonprofit providers of Medicaid in Illinois. Northwestern Medicine provides $70 million in charity care annually and invest nearly $5 million annually in donations to community partners across northern Illinois, from federally qualified health centers to faith-based agencies and local schools. We have hundreds of young people engaged in our pipeline programs to help them pursue advanced training, good jobs and careers in healthcare. And we invest in our communities through practical strategies such as targeted supply chain spend.  
  • Second, we are now implementing social determinants of health screening and referral across all eleven Northwestern Medicine hospitals and 200 primary care clinics, to provide effective interventions for the most common and significant barriers to health and healthcare faced by our patients. Ultimately, 1 million patients per year may be touched by these efforts. Our quality and outcomes program provides comprehensive support to investigate healthcare disparities, and to design improvements and interventions to eliminate them.
  • And third, we work to improve the infrastructure of our communities and public health system with nationally recognized research and interventions through the Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine, and advocacy at the city, state and federal level. 

Terry Vanden Hoek, MD, head of emergency medicine and CMO at UI Health

The top challenge  

The University of Illinois Chicago's health system, UI Health, serves many of the Chicago communities hardest hit by the COVID-19 pandemic communities that historically have had inadequate access to healthcare, mistrust of institutions and increased vulnerability due to chronic health conditions. Our top challenge is health disparities and for the communities we serve, the pandemic has only exacerbated these disparities. And they are being combined with added risk due to postponed treatment, diagnostic and preventive care during the pandemic and emerging health issues such as long COVID. Unfortunately, issues around access and trust mean that patients turn to emergency departments to treat myriad health issues, including those that need to be managed long term. 

These issues add up to increased risks for patients while also adding stress on healthcare systems as they attempt to provide care with resources already stretched thin.   

How your organization is responding 

UI Health was an early champion of vaccination efforts that cut across traditional barriers to care. We developed pop-up vaccination clinics across the city as well as opened a mass vaccination site on the UIC campus and implemented successful community outreach programs to encourage citizens to get vaccinated. The UIC faculty and staff led a massive volunteer effort to deliver more than 150,000 shots to more than 70,000 people.  

We support our own employees, many of whom are members of vulnerable communities, who become sick with COVID-19 with a home monitoring program to keep track of their vital signs and offer support if there are indicators of a worsening illness.  

We opened a post-COVID clinic to treat those patients who experience long-term complications from COVID-19 and our researchers are working on plans to study the causes and effects of long COVID. 

UI Health also has several initiatives underway that seek to improve health equity. We are expanding efforts to improve diversity among healthcare providers, including future healthcare providers, and to make process improvements in data collection, analytics and information that can help us better understand health opportunities — stratified by race or ethnicity, gender identity and sexual orientation — among communities that experience health disparities.  

We are also investing in our physical care delivery infrastructure. In 2020, UI Health broke ground for a new Outpatient Surgery Center & Specialty Clinics building adjacent to the main hospital. In September of this year, we purchased a health facility in Chicago's Gage Park and West Elsdon community where soon we will be able to provide enhanced access to specialty care, state-of-the-art advanced diagnostics, much-needed behavioral health, and mental health resources, and a women's wellness center in this underserved community. Our UI Health Mile Square Health Center Primary and Immediate Care Center in Auburn Gresham is slated to open in 2022 and will serve more than 8,000 individuals annually with primary, dental and behavioral healthcare. This FQHC will anchor a lifestyle hub that will incorporate a pharmacy, a test kitchen and training center, and social services aimed at improving financial health and employment preparedness for low-income residents. 

 

 

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