NEJM Catalyst

📢 Out now: The August 2024 issue of NEJM Catalyst Innovations in Care Delivery showcases successful collaborations between public health and care delivery organizations. Sponsored by Common Health Coalition and guest edited by Nicholas Stine MD, this special issue includes articles, case studies, and research reports on coordination across public health and care delivery, Covid-19 response, tuberculosis screening, the 2022 mpox outbreak, pediatric asthma intervention, abortion and reproductive health care, and public health data. 📖 View the issue: https://nej.md/4f4TDGi 🎧 Read or listen to the letter from our guest editor: How to Bridge Public Health and Care Delivery https://nej.md/3Sb7otv 🏥 Insights Report: Public Health and Care Delivery: Similar Missions, Separate Paths https://nej.md/469vn1D ⚕️🌏 Sponsored article, from Common Health Coalition: Public Health and Care Delivery — a Common Destiny https://nej.md/3Wp4BiD 😷 In Depth: The San Francisco Health Systems Collaborative: Public Health and Health Care Delivery Systems’ Response to the Covid-19 Pandemic https://nej.md/3SbFAoz 🩺 Case Study: "Think. Test. Treat TB" in Action: An Innovative Primary Care and Public Health Partnership to Improve Tuberculosis Prevention and Care https://nej.md/4cJgeXl 💉 Case Study: Knocking Down Public Health and Health Care Silos: An Innovative Covid-19 Health Equity Response https://nej.md/4cXPu5T 🧒 Case Study: Pediatric Asthma Surveillance System (PASS): Community-Facing Disease Monitoring for Health Equity https://nej.md/4fguBV0 🤰 Article: Strengthening the Provision of Abortion and Sexual and Reproductive Health Care Post-Dobbs: An Initiative of the Philadelphia Department of Public Health https://nej.md/3RXrib4 🚑 Article: New York City’s Rapid Response to the 2022 Mpox Outbreak https://nej.md/469k35L 📈 Commentary: Plugging Public Health Data into the Health IT Ecosystem to Protect National Health https://nej.md/3Wokrdi

Tuberculosis (TB) elimination in the United States hinges on large-scale TB screening, testing, and preventive treatment of individuals at risk for TB disease. However, the path from TB screening to TB preventive therapy (TPT) completion is not straightforward and relies on collaboration between public health departments and primary care providers to deliver quality TB services. North East Medical Services (NEMS) is a federally qualified community health center in the San Francisco Bay Area that provides primary care services to a large low-income Asian immigrant population at increased risk for TB infection and disease. To address a gap in primary care guidance on how to manage a patient who is asymptomatic and TB screening test–positive with abnormal chest imaging, NEMS and the San Francisco Department of Public Health TB Clinic, with support from the California Department of Public Health and University of California, San Francisco as partners, collaborated to utilize both provider education and radiology, laboratory, and electronic health record (EHR) systems modifications as decision aids for TB risk stratification of patients for home collection TB sputum evaluation and/or TB clinic referral before TPT is offered. A multidisciplinary group made up of local provider stakeholders from TB public health, infectious disease, pulmonary care, and primary care was convened in August 2022 to develop novel primary care workflows surrounding asymptomatic patients’ abnormal chest imaging following a positive TB screening test, rolled out from August to December 2022. The TB risk stratification algorithm and associated EHR modifications and trainings supported provider decision-making and led to a significant improvement in the quality of TB diagnostic evaluation. Through this multipronged approach, this community health center simplified TB prevention workflows for primary care providers and streamlined the provider decision-making process to refer patients at higher risk for developing TB disease to the TB clinic: https://nej.md/4cJgeXl

The Covid-19 pandemic challenged health care delivery systems worldwide. Hospitals serving low-income communities, communities of color, and those in other historically marginalized or vulnerable groups reported the greatest operational impacts of surges. However, cross-institutional collaborations within jurisdictions offer unique opportunities to prevent or mitigate health disparities in resource utilization and access to care. In January 2020, the San Francisco Department of Public Health (SFDPH) and local hospital and health systems partners (Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Department of Medicine) convened to align and coordinate medical surge planning and response. Adopting a governance structure of mutual accountability and transparency, the San Francisco Health Systems Collaborative guided local medical and public health response in the areas of medical surge, vaccination administration, testing, and therapeutics. Four principles guided the collaborative response: (1) shared priorities, (2) clear governance and accountability, (3) data transparency, and (4) operational coordination. High-level priorities established included protecting vulnerable people, protecting health care workers, and maintaining health system capacity. The governance structure consisted of three layers. Data visibility and transparency were key principles facilitating operational decision-making and executive-level coordination of resources. Applying these four principles helped the public health and individual hospital systems make contributions to the overall response that were aligned with their unique strengths and resources. Publication here represents the first official public use of the name San Francisco Health Systems Collaborative and the first time codifying this structure. Through this coordination, San Francisco achieved one of the lowest Covid-19 death rates and had one of the highest vaccination and booster rates, compared with rates across California or the United States: https://nej.md/3SbFAoz

We are proud of our leadership in demonstrating the need for and value of collaboration between public health and healthcare. NWHRN is honored to be in a special NEJM Catalyst article on the vital nature of such partnerships to prepare and respond effectively to health emergencies and disasters. https://lnkd.in/g3KSpZ2W With trusted expertise in our sector, our work continues to expand, and we are passionate about lending our voice to vital conversations. Onora Lien, our executive director, is participating in a Washington, D.C. event hosted by the Common Health Coalition. Today, July 18, she will speak about our work through the lens of partnership and coalition building, particularly regarding respiratory disease readiness, response, and data sharing.

Insightful findings: A survey of the NEJM Catalyst Insights Council finds strong interest and engagement with a range of patient-centered data, including patient-reported outcomes measures. NEJM Group NEJM Catalyst James Merlino, MD

Mary Piscitello Mercer, MD, MPH, Chief of Medical Staff at Zuckerberg San Francisco General Hospital, is the lead author of the article published in NEJM Catalyst. "The threat to public health created by the COVID-19 pandemic prompted those organizations that are traditional competitors in the marketplace to work together to meet the system-wide health needs of the public," Dr. Mercer says of the collaboration between medical and public health experts from all major San Francisco health systems, including the San Francisco Department of Public Health, University of California, San Francisco, Kaiser Permanente, Chinese Hospital, and Sutter Health. "We shared information and pooled resources which provided broad community access in ways not seen before.” Read:

Chief among the United States’ health care paradoxes is the divide between public health and care delivery. While these two sectors should be natural partners, patchwork policies and operational siloes have instead produced a health system that falls short of its capabilities to create better health. This gap can have devastating consequences for patients. While tragedies like Covid-19 can prompt reflection on common bonds, converting memory into movements requires commitment and action around common goals. It is in this spirit that the Common Health Coalition was born, founded by five of the country’s leading health organizations around the shared goal of strengthening partnership between public health and care delivery. Its four priorities are defined by advancing the acronym “CARE”: (1) Coordination between health care and public health, (2) Always-on emergency preparedness, (3) Real-time disease detection, and (4) Exchanging data to advance health equity: https://nej.md/3Wp4BiD Kushal Kadakia Chelsea Cipriano Dave A. Chokshi, MD

📢 Out now: The August 2024 issue of NEJM Catalyst Innovations in Care Delivery showcases successful collaborations between public health and care delivery organizations. Sponsored by Common Health Coalition and guest edited by Nicholas Stine MD, this special issue includes articles, case studies, and research reports on coordination across public health and care delivery, Covid-19 response, tuberculosis screening, the 2022 mpox outbreak, pediatric asthma intervention, abortion and reproductive health care, and public health data. 📖 View the issue: https://nej.md/4f4TDGi 🎧 Read or listen to the letter from our guest editor: How to Bridge Public Health & Care Delivery https://nej.md/3Sb7otv 🏥 Insights Report: Public Health and Care Delivery: Similar Missions, Separate Paths https://nej.md/469vn1D ⚕️🌏 Sponsored article, from Common Health Coalition: Public Health and Care Delivery — a Common Destiny https://nej.md/3Wp4BiD 😷 In Depth: The San Francisco Health Systems Collaborative: Public Health and Health Care Delivery Systems’ Response to the Covid-19 Pandemic https://nej.md/3SbFAoz 🩺 Case Study: "Think. Test. Treat TB" in Action: An Innovative Primary Care and Public Health Partnership to Improve Tuberculosis Prevention and Care https://nej.md/4cJgeXl 💉 Case Study: Knocking Down Public Health and Health Care Silos: An Innovative Covid-19 Health Equity Response https://nej.md/4cXPu5T 🧒 Case Study: Pediatric Asthma Surveillance System (PASS): Community-Facing Disease Monitoring for Health Equity https://nej.md/4fguBV0 🤰 Article: Strengthening the Provision of Abortion and Sexual and Reproductive Health Care Post-Dobbs: An Initiative of the Philadelphia Department of Public Health https://nej.md/3RXrib4 🚑 Article: New York City’s Rapid Response to the 2022 Mpox Outbreak https://nej.md/469k35L 📈 Commentary: Plugging Public Health Data into the Health IT Ecosystem to Protect National Health https://nej.md/3Wokrdi Dave A. Chokshi, MD Namita Seth Mohta Chelsea Cipriano

Effective coordination between public health and care delivery organizations continues to be one of the more elusive care goals in health care. While nearly everyone sees value in greater collaboration, elevating its priority sufficiently to overcome widespread inaction and address the many financial and structural barriers that stand in its way is still a work in progress. In a survey of NEJM Catalyst Insights Council members, 70% of the 790 total respondents say they think public health and care delivery organizations should have full coordination at all times, and another 21% recommend at least partial coordination. Only 7% prefer incident-specific coordination (e.g., for pandemics). Nicholas Stine MD, MD, is an Executive-in-Residence at Haas School of Business at the University of California, Berkeley, and Senior Scholar at the Stanford CERC. He previously served as System Vice President for Population Health at CommonSpirit Health, where he led population health strategy and operations. He says that while most health care professionals believe in the need for greater public health and care delivery coordination, achieving it in practice is an ongoing challenge. While the Covid-19 pandemic improved coordination across the public health and care delivery sectors, formal integration has not progressed since then. Learn more in our Insights Report: https://nej.md/469vn1D

What an insightful perspective (US-based) on “CARE”: (1) Coordination between health care and public health, (2) Always-on emergency preparedness, (3) Real-time disease detection, and (4) Exchanging data to advance health equity. By Kushal Kadakia Chelsea Cipriano Dave A. Chokshi, MD NEJM Group NEJM Catalyst