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  • Aug 05, 2020

CHA’s COVID-19 Community Management Model

Janice John, MHS, MHCDS, highlights CHA’s early response to COVID-19. Pictured is Yamini Saravanan, MD, and Joanne Rivera, MA. Photo courtesy of Anna Rabkina.

Mr. Jackson (not his real name) was very sick, having trouble breathing and getting treated for possible COVID-19 at the CHA Respiratory Clinic in Somerville, Massachusetts. It was early April and he was afraid about what a possible hospitalization might mean for him and his family. His mind was racing.

“One of our providers took the time to meet him in that terrifying moment and ask him questions getting to the heart of the issue,” said Janice John, MHS, MHCDS, medical director of the Respiratory Clinic. “The care team spent about 45 minutes with this patient and by the end was to share their own concerns for Mr. Jackson’s health.” These crucial conversations improve care at CHA every day.

Mr. Jackson eventually spent three days at CHA Cambridge Hospital in April 2020. That initial conversation at the Respiratory Clinic led him to feel comfortable enough to receive care in the midst of the pandemic. “Soon after, when he came to us for hospital follow-up, Mr. Jackson was thrilled and appreciated the time we took with him before deciding to go to the hospital,” said Janice.

Janice joined CHA in 2012 and spent much of her career as Chief Primary Care Physician Assistant and as a primary care PA at the Union Square Family Health Center, seeing patients and helping integrate primary care teams. In September 2020, Janice transitioned to the CHA Assembly Square Care Center as the associate medical director. CHA is home to 16 primary care centers in Cambridge, Somerville, Everett, Revere and Malden.

In early March, everything changed for Janice and her team at Assembly Square. “I remember seeing one of our first suspected COVID-19 patients in the clinic and worried about how to keep our teams and patients safe from COVID-19. We needed to ramp up and prepare for a surge.”

Lora Council, MD, MPH, senior medical director of primary care at CHA, put out a call to staff asking who wanted to volunteer to build a new Respiratory Clinic from the ground up. “In a little under five days we transitioned a dozen staff and opened up the clinic in Somerville,” said Janice. 

COVID-19 Community Management Model
Launched during the height of the pandemic in Massachusetts, the clinic evaluates patients who require in-person examination with suspected COVID-19 symptoms. Clinic staff careful history and physical exam to differentiate COVID19 from other worrisome issues, and help people connect with vital community resources. For example, they help people find housing support, relieve food insecurity, receive domestic violence counseling and more. Forty-three percent of CHA's primary care population receives care in a variety of languages and face many barriers in order to receive care and social support. 

The new Respiratory Clinic (now the Acute Care Center) that Janice helped create is part of CHA’s innovative COVID-19 Community Management Model focused on keeping patients healthy through in-person care, telephone visits, a triage system and other programs. Janice, along with CHA providers Drs. Leah Zallman and Jessamyn Blau shared an overview of CHA’s COVID-19 response strategy in an opinion piece for STAT. NEJM Catalyst also published a case study by Janice, along with Drs. Zallman, Blau and Council, which further explores CHA’s community management strategy to reduce hospitalizations and improve outcomes.

Health Disparities Further Exposed
“CHA is positioned in some of the communities, like Chelsea, Everett, Revere and Malden, MA, which were hit hardest by COVID-19 during the surge in March and April,” said Janice. As of July 22, Revere and Chelsea had nearly 5,000 COVID-19 positive cases since March out of a population of 93,000 people according to data from the Massachusetts Department of Public Health.

 Sixty-five percent of people living in Chelsea identify as Latino and its neighborhoods are some of the most densely populated in the country. People work mainly in the service industry and hospitality and were unable to work from home during the height of the pandemic. The median household income ($53,280) is well below the Massachusetts average ($77,378). Revere faces similar challenges, in June 2020, the city’s unemployment rate hit nearly 26%, the second-highest in the state. 

COVID-19 has laid bare many health inequities present in our social systems. “As an organization, CHA is deeply focused on serving the most vulnerable and being creative in our care delivery models,” said Janice. “It’s been a rewarding time to be able to partner with our communities, local boards of health, and our community outreach teams to provide care and try to address some of these systemic issues.”

It’s Safe to Get Care at CHA
As CHA began to reopen its services in early June 2020, extra measures are being taken to keep patients, staff and visitors safe. “At every one of our locations, people get their temperature taken before arriving, we are cleaning each day, cohorting patients and requiring masks upon entry,” said Janice. “We are generally seeing COVID-19 cases dip in Massachusetts which means it’s a great time for people to get preventive care.”

Many appointments at CHA are now by video or phone (telehealth). This includes video visits using Google Meet. CHA is the first health system in the country to connect Google Meet with MyChart - making it easy to have a video visit (even three-way visits with an interpreter) while keeping information safe.

If you have a new or ongoing health concern, don’t wait. Just call or send CHA a MyChart message. We can help decide if a video, phone or in-person visit is right for you. We continue to gradually reopen for face-to-face visits, starting with the most pressing needs. If you are coming in person, please know we are working hard to keep you safe.


Disclaimer
This articles provide general information for educational purposes only. The information provided in this article, or through linkages to other sites, is not a substitute for medical or professional care, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider.

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