Researchers at the University of Iowa College of Public Health have been awarded a $1.54 million grant from the National Institute on Minority Health and Health Disparities to study the role federally qualified health centers (FQHCs) might play in reducing disparities in potentially preventable hospital-based care among dual-eligibles.
Approximately 10 million Americans are eligible for both Medicare and Medicaid. According to Brad Wright, assistant professor of health management and policy at the UI and principle investigator on the grant, these dual-eligibles are a disproportionately high-cost population with substantial and often unmet healthcare needs.
“Despite having two sources of insurance coverage, dual-eligibles are one of the most vulnerable populations in the country,” he says. “They often experience high rates of potentially preventable hospitalizations and emergency department visits resulting from disparities in access to primary care.”
Little is known about the relationship between primary care access and the broader continuum of potentially preventable hospital care, which includes not only emergency department visits and hospitalizations, but also observation stays, 30-day return ED visits, and 30-day all-cause readmissions.
“This grant allows us to further our understanding of how we might use FHQCs to improve access to primary care, reduce disparities along ethnic and racial lines, and reduce those costly and potentially preventable emergency department visits and hospitalizations,” Wright says.
This year, Iowa becomes one of just a handful of states to conduct a health assessment of its lesbian, gay, bisexual, transgender, and queer (LGBTQ) residents. The University of Iowa College of Public Health, the Iowa Cancer Consortium, and One Iowa (a state-wide LGBTQ advocacy organization) have partnered to conduct a comprehensive survey to describe the health status and identify the health needs of LGBTQ Iowans.
“There’s a saying in public health that no data equals no problem,” says Paul Gilbert, CPH assistant professor of community and behavioral health and principal investigator. “We’re doing this survey to find out what LGBTQ Iowans need in order to be the healthiest they can be.”
The group began with an in-person survey earlier this summer at LGBTQ Pride events in Des Moines, Iowa City, Council Bluffs, and Cedar Rapids, and have just launched an online survey to ensure participation across the state. The group also plans to augment findings through several focus groups to be held later this year.
Lauren Pass, an MPH student in community and behavioral health, has helped develop and launch the LGBTQ health assessment. “Designing the survey, we wanted to account for the diversity within the community so we can represent all LGBTQ Iowans as best and accurately as possible,” she says.
Invest Health: Developing Strategies for a Healthier Iowa City
Monday, April 3
12:30 -1:30 p.m.
Natalie Debernardi, MPH Candidate
Amanda Kahl, MPH Candidate
Vickie Miene, Deputy Director of IIPRHP
Tracy Hightshoe, City of Iowa City
Invest Health is a new initiative, funded by the RWJF and Reinvestment Fund, developed in 2016 that brings together diverse leaders from mid-sized cities across the nation to develop strategies that will leverage private and public investments designed to improve neighborhoods that are facing the biggest barriers to health equity.
The Iowa City team is focusing efforts on developing a comprehensive plan to address asthma and mental health challenges in low-income neighborhoods. The Iowa City project includes forming a broad stakeholder group with members from the health, housing, public health, banking, education, mental health, and private sectors. The project is tasked with developing a comprehensive plan including a pipeline of projects and potential funders to improve housing and health in three specific Iowa City neighborhoods. This seminar will report progress made to date on this project and next steps.
Hansen Distinguished Lecture
“Lessons from Baltimore: The Intersection between Public Health and Physician Activism”
Wednesday, April 19
Callaghan Auditorium (Room N110)
Iowa’s small towns may not appear to have much in common with a large city like Baltimore, but rural and urban areas are facing some similar health challenges.
“There is an opioid emergency across our country,” says Leana Wen, MD, Commissioner of Health for the City of Baltimore, citing one example, “and it’s vividly and dramatically affecting Baltimore.”
Iowa, too, has seen significant increases in opioid use. Opioid overdoses killed 61 Iowans in 2015, more than double the number from 2005, according to the Iowa Department of Public Health.
Wen will discuss this and other public health issues when she delivers the Hansen Distinguished Lecture, “Lessons from Baltimore: The Intersection between Public Health and Physician Activism,” on Wednesday, April 19, at 12:30 p.m. in Callaghan Auditorium (Room N110), College of Public Health Building. The event is free and open to the public.
The front lines of public health delivery
Wen describes her talk as “lessons from the front lines of public health delivery in Baltimore – both successes and failures,” she says. “I’ll also share my views on what it is students can do to be involved right now, and how they can be most effective in their communities.”
The University of Iowa College of Public Health named Wen the recipient of its 2016 Richard and Barbara Hansen Leadership Award and Distinguished Lectureship in recognition of her leadership in improving well-being and reducing health disparities.
To combat opioid overdose in Baltimore, Wen issued a blanket prescription for the opioid antidote, naloxone, to all 620,000 city residents. Since 2015, this program has saved over 530 lives.
“There are differences in the implementation of programs, but the challenges are the same,” Wen says about addressing the opioid epidemic, adding that there is a common need to “reduce stigma surrounding addiction and mental health.”
Under Wen’s direction, the Baltimore City Health Department has implemented a number of innovative health programs, including B’More for Healthy Babies, which has resulted in a 38 percent reduction of infant mortality in just seven years; Vision for Baltimore, an initiative to provide glasses to every child who needs them; Safe Streets, a program to engage citizens and hospitals in treating gun violence as a contagious disease; and Healthy Baltimore 2020, a blueprint for health and well-being that enlists all sectors to achieve the ambitious goal of cutting disparities in half in ten years.
Urban and rural health disparities
Wen points out that health disparities affect both urban and rural populations.
“The challenges might seem different, but it comes down to social determinants of health,” Wen says.
Examples of social determinants include access to health care services, exposure to crime and violence, availability of safe housing and local food markets, quality of education and jobs training, and transportation options. In other words, where you live has a big impact on your health.
Before her appointment as health commissioner in January 2015, Wen was an attending physician and director of patient-centered care in the Department of Emergency Medicine at George Washington University (GWU).
“I learned about public health not through academic training, but through practical experience,” Wen says. “I saw in the ER how little impact I had on the long-term health of my patients. That’s what clued me in on the importance of public health. Housing, food, the environment all affect how we live.”
As a professor of emergency medicine at the School of Medicine and of health policy at the School of Public Health, she co-directed GWU’s Residency Fellowship in Health Policy and co-led a new national collaboration on health policy and social mission with Kaiser Permanente.
Wen is also the author of the critically acclaimed book When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, and has recorded several popular TED and TEDMED talks on patient-centered care, public health leadership, and health care reform.
The Hansen Leadership Award is presented annually by the UI College of Public Health to honor individuals who have made sustained contributions in the public health field. The award recognizes exemplary leadership, high ethical standards, and an enduring commitment to improving health on a national and international level. The award is made possible by a gift from Richard and Barbara Hansen of Iowa City.
The Future Directions of LGBT Public Health Symposium will be held Saturday, April 15, from 9 a.m. to 3:30 p.m. in the College of Health Building. The event is open to all University of Iowa community members and affiliates, and is made possible by a Diversity Catalyst Award Seed Grant.
Register now (there is no cost to attend)
Attendees will learn about contemporary topics impacting diverse LGBT communities.
Light breakfast and lunch will be provided. This event is open to all. Registration is not mandatory to attend, but is required for lunch.
For any questions, please contact CPH-LGBTAdvocates@uiowa.edu.
Individuals with disabilities are encouraged to attend all University of Iowa-sponsored events. If you are a person with a disability who requires a reasonable accommodation in order to participate in this program, please contact the College of Public Health in advance at 39-384-1500.