Angela M. Donaldson, M.D., an otolaryngologist at Mayo Clinic in Florida discusses the next steps for the COVID-19 pandemic with a panel of experts. The panel members explain benefits and barriers to telemedicine, contact tracing and partnerships for community health. Each member discusses what they have learned from their institutions to help everyone cope with COVID-19. This presentation provides an overview of how communities can respond to the pandemic moving forward.
Click here to claim credit and view faculty disclosures. Select Register to begin the credit claim process. Welcome to Mayo Clinic Cove in 19 expert insights and strategies. The following activity is supported in part by an independent medical education grant from Pfizer Inc and is in accordance with a C CMI guidelines. Hello and thank you for joining us for this panel, which is part of the cove it 19 expert lecture. Siri's I'm your host, Dr Angela Donaldson. And I'm joined by my distinguished Panelists Dr Ross Jones, Dr Ivan Porter, Dr Pauline, Raul and Monica Alberti. Today we're gonna talk about Covert 19. Where do we go from here? As we all know, the cases of covert 19 have specifically and significantly been disproportionately associated with minority groups, both in the percentage of cases, percentage of hospitalizations and percentages of death. We're also aware that many of the co morbidity ease that are associated with hospitalizations have been found in those who had asthma, hypertension, obesity, diabetes and chronic kidney disease. And unfortunately, many of these conditions are often found in higher rates and those of minority groups and those with limited access to health care. Today, our goal is to give you some actionable steps that you can take to improve access to care as well as community engagement. With our hope at the end of this lecture, Siri's, you'll be able to take some of the tips that we have given to help us bridge the health care gap. So let's get started. We have no financial disclosures. Today's objectives are to discuss the benefits and barriers of using telemedicine from both the historic and future perspective. We will discuss the benefits, barriers and recommendations for contact tracing both in the urban and rural communities. And we'll talk about the role and benefits of community partnership as we address Cove it 19. Our first guest is Dr Ross Jones. He's the medical director of community health at U F Health Jacksonville. He's also the director of Urban Health Alliance of Jacksonville. And he's a clinical assistant professor of US Health College of Medicine. Thank you, Dr Jones, for joining us. I'm Dr Ross Jones. I'm gonna be talking about telemedicine, past utilization. So this talk, I hope to give ah brief definition of telemedicine. Ah, historical perspective about telemedicine use prior to cove it and how our organization that you have health use telemedicine to increase access for the underserved. Currently, there is no standard definitions for telemedicine or telehealth. Telehealth commonly refer, uh, telehealth, or telemedicine commonly refers to the use of telecommunications to provide health care to patients and providers who are separate. Separated geographically, telemedicine is commonly used to refer to when the provision of clinical services, while telehealth, refers to a wider range of services. In addition to clinical services, there are three main types of tele medicine services. One is real time video or synchronous conversation, which is like face time, where we talked with the video and voice communications. There's also stormed forward or a sequence communications and this type of telemedicine. There's actually, uh the patient would provide information in their video or written to a provider. The provider would then look at that and then send a message back. This will probably happen not most likely in real time as a comparison to the first video, and the last type is remote patient monitoring. This is where smart devices such as blood pressure cuffs send information back about the patient's vital signs or other health information back to the providers. So the provider confide feedback to the patient. When we look at the benefits of telemedicine that were proposed. Historically, there were three main buckets. The first one was increased access to care, the second was decreased costs and the third was increased. Patient satisfaction, um, do toe with health care and increasing their quality of life. When we look more closely at the data from increase access to care, we could see that telemedicine had been used to increase access to both primary and specialty care. While uptake of telemedicine was decreased by compared to general population's, access to care has been shown to be increasing these populations. One study actually found access to stroke care among African Americans in Texas had increased access to buy 1.5 million due to the use of telemedicine across the state. When we look a reduced costs, cost savings for the patients have been estate in between anywhere between 20 to $120 per visit. Most of those cost savings came from reduced hospital emissions, reduced reduction in lost productivity and better control of chronic conditions such as diabetes or hypertension. There's also been many studies that have shown to reduce travel time and other child related barriers by the use of telemedicine when we look at the bears. Telemedicine. That kind of four main flavors the reimbursement patient privacy regulations, licensing and infrastructure reimbursement was one of the biggest challenges as there was a lacking system and payment payers, both private and federal, were free to determine decide which services were covered. So commercial payers where I will decide if they're going to cover the synchronous or asynchronous or invoked fish and monitoring. As you can tell this led. Many organizations cannot properly plan for how they create a telemedicine system. The Affordable Care Act. Encourage development telemedicine by providing state grants to states to hope to help develop programs. But that's only one so far. Initially, Medicare would only reverse for synchronous communications. However, they had many regulations about its use. It was really department where the patient was presenting from what type of organist was using it. Usually most cases it was in rural communities, and then Medicaid reimbursement was really decided on a state by state basis, and there was no federal mandate for payment parody in the Medicaid system. The next bucket will be patient of patient protection of patient data. Data. Security was one of the primary concerns. Uh, there has been. As you can imagine, there has been a lot of concern about the data being secure, or hackers taking advantage of the data and locking the patient out or other third parties who are not invested in primate patient care. Being able to gain access to these records, the health organizations must still comply with HIPPA as well, which is another barrier. How do you make sure that these platforms are compliant and protect patients data? And additionally, some states even had their own regulations and laws to protect patient data, which were more stringent than hippo. When we look at licensing is, there's another barrier. Providers must be licensed in the state that they're providing telemedicine services, for example, where we're located in Jacksonville, Florida We're right on the border between North Florida and southern Georgia, so provided to buy telemedicine services to a patient locate in Georgia. They must also those have Florida license and the Georgia license. As you can imagine, this caused a lot of confusion for our providers if they weren't aware of this in several states, also required their own special telemedicine license. Bury someone. Telemedicine also include infrastructure needs. There was a high start up costs, unnecessary technologies that you have to imagine. They have to have all the necessary cameras. Headsets had to be involved. Also, the infrastructure for the health care systems had to be beefed up in terms of servers. And then you also have to make sure that the patients themselves have been necessary. Technology it required the need for establishing new clinical work flows to and involved these new platforms and then trainer providing had to be provided for it health care providers and staff. So here you have helped Jacksonville. We really want to invest in telehealth in 2015 little bit more about our health hospital system. It is an academic medical center and is the largest safety net provider in our region. Our first set of programs really revolved around us, using telemedicine in the neurology space to provide stroke care to those in rural communities. After we had success in that area, our hospital system divided decided to invest more heavily and telemedicine so that we could brought care and support our various missions throughout the organizations, clinics in the Department of Community Health and Family Medicine were early adapters are. Department currently has 30 clinics across northeast Florida and southern Georgia. We look at our roadmap roadmap to tell them that a success it was really could be broken down at the six steps understanding our why building are right. Teams and understanding are what's and how's prime ing the pump, the rollout and refining our process. So the first step was understanding are Y As a safety net provider, we had to provide access to those who are the most vulnerable our situation. Many of them had various various to care, including transportation Thai. They had jobs where they cannot get time off easily, and then they also had various visits that could require multiple trips on the bus or co pays. So we understood that by providing telemedicine, we really could provide better access and care to our patients and and from that it went to. Now that we know that we needed to do this, who needs to be on the team to make sure that we successfully do this? As you can see from the previous slide, telemedicine had tons of barriers from the reimbursement side to the creating the infrastructure to the legal size of revolving around regulations. All of those had to be on our team, so our first step was really making sure that we have all the pieces in place. So we had a clinical team leader who was very passionate about telemedicine. We've also involved are legal can compliance departments. And then we also had our reimbursement and finance departments really timing on this to make sure how can we build a successful program that provides care? Um, it is also sustainable. And then we really went into understanding. How do we roll out telling us and, um, and understand what's and how's of how would we roll this out? So for that process, we actually engaged our clinical staff and so that we can really examine our current work for a process without telemedicine and seeing how could we implement it? So this involved in our front line staff, the providers, and are back office all talking about how do we provide telemedicine? Eso How do we schedule visits? How do we create new visit types? How long will the visit types to be? How do we get on and even went down to our access center How do we even make sure that the the access centers understands? How do you schedule telemedicine visit? And how does that impact their workflow? So all those pieces were integrated were crucial for us to have a success in this program. And then once we really nail down how the process would be go for our patients, we really want to make sure we prime the pump. And by that I want we mean that. How do we make sure that our patients were really receptive to telemedicine and that they understood that this process would help improve their care? This really involved us going out and using our goodwill that we had establishing the community, asked one of the largest safety net providers in the region to make sure that this process was not replacing their traditional care but was supplementing what that was already going on. So we made sure that the patients understood what was telling medicine, what kind of equipment they would need to do. Telemedicine, how their visits will be the same, how they still would receive high quality care. And then what we additionally did was we actually had staff members in the clinic, So who could explain the telemedicine visits? So before they had their first telemedicine visit, they can meet with the staff member they already knew and clinic that staff member could make sure they had the necessary technology. Show them an example of what a visit would look like on their phone on their own device and then help them schedule an appointment before they left the office. This really helped our uptake of telemedicine as the patients, what more comfortable And they understood the process. And then So there wasn't this black box when they went home was trying to figure out on their own. And then finally, once we did this, we rolled out the process. So we really pushed this throughout our various mediums. So when the patient called on the to the access center, they were told about telemedicine, visits all of our television with patient information, had more information about telemedicine on it, and then the providers themselves, the clinic what would select patients who they thought would be a good fit for telemedicine and teach them more about the process as well. This is really show that we had a steady increase in this throughout our over the last five years. The last three years have really shown a dramatic increase in this. Even prior to Covic are most successful. Clinic, which is about 90% Medicaid actually had was able to complete over 2000 telemedicine visits over a six month period prior to Cove it using the strategy. And then finally, we were fined the process. So during the course of our roll out, we've even with prime the pump and making sure that there's everybody understood the Western House. We still found some small areas that could be improved, For example, some the way that the schedules worked with telemedicine visits. We found that it was better to actually block your telemedicine visits together versus scattering among your schedule with well in person visits. Um, because if things going over, it's a lot easier to tell that patient who is physically in the room to that will be running late versus someone who's on the computer. But we actually worked that out that process out by letting patients know having a M a call and let the patients no prior to if the provider is running late. We also had some barriers with the platform at some patients, so they understand. Even with the extra help they had on, they didn't understand how to use the technology. So what we did is we also explored other plat forms that were a bit more user friendly so that they can engage in that so they would take make it simpler for them too completely visit. And then we also have regular meetings where providers and patients can bring any problems they have with telemedicine and figure out how can we make it? So that's the most optimal experience possible for the patients, providers and staff. In the future. We hope to create more patient education about the use of telemedicine. So actually Hope toe provide videos that the patient could look at home prior to a visit so they can understand. How do they connect with telemedicine? Uh, we want to continue our Navigator program for telemedicine. We continue to work, refine our work for processes, and then we really want to continue. Thio continue to expand the services offered by telemedicine. We hope to offer some remote patient monitoring for our patients, especially who have uncontrolled chronic conditions such as diabetes or hypertension. Yeah. Thank you. Thank you, Dr Ross, For that wonderful information, I'm now gonna introduce our next Panelist, Dr Ivan Porter. He is a noces stint, professor in the College of Medicine here in Jacksonville, campus of Mayo Clinic. And he also is a consultant nephrologist. And he's going to talk to us about telemedicine. Future utilization. Thank you, Dr Porter. Thank you very much for having me. I very interested in the discussion on telemedicine. It hits close to home literally. And I'll try to explain what I mean by that, Um, you know, Dr Jones has done an excellent job of going through some of the differences between what we call telemedicine and telehealth. Andi, this kind of really cloudy, murky definition where the two things air truly talked about as though they're the same thing. Um, we know both from past experiences and what companies are doing now to try to implore the use of telemedicine mawr globally, that there are plenty of opportunities for us to make improvements on bats both on the provider side, but also on the patient side. Uh, we saw a very fast what we had to do in order to be able to care for a population in a completely unknown space. And I'm referring to this global pandemic and what we were able to do at Mayo Clinic, for example, where almost 70% of all of our visits at the peak of the pandemic in Jacksonville, Florida so mid April were being done virtually. And as the the closures, the government closures slowed down. People did return to the clinic, but at much lower rates as they were still worried about high levels of community spread. And we still had weeks to months where our virtual visit volumes were still in the 20% range. So going from very, very low to that 20% is a large amount. And the infrastructure, like Doctor Doctor Jones spoke of earlier, um Thio have to do that on the fly is very difficult without those processes to kind of re prime the pump, as was stated earlier, and then to re envision what the true process should be. But we saw this with e consultations and the inpatient setting being able to care for patients that were under isolation, families being able to visit with patients that were admitted, uh, without having A without being allowed in the hospital. That is, with stringent visitor policies being able to be present and end of life discussions and other family meetings. All these were things that were done kind of acutely in the inpatient setting. But what we can do in the outpatient setting what we can do to underserved populations. Really. Uh, that's where the focus of the future needs to go. What other home and hospital based technologies can we use via video conference? How effectively are we using these? Store and forward a synchronous techniques that can replace urgent telephone calls and urgent visits to the clinic? How are we using the remote patient monitoring? Uh, both in the in the acute setting and also for chronic disease management? Um, are we using the videos for pre visit triage or pre visit plannings before patients come on site? And you know, the seeing patients in other locations so truly thinking about delivering care across the state lines and all of the license your components that come with that that we have to worry about from an administrative standpoint as well, um, the technology is there. We need the leverage, the technology and the number of people that we can affect is huge. Let me use Florida as an example. Um, as I talk about what we can do to this underserved population, this here is the, um, agency for healthcare administrations. Medicaid map for Florida and me. Personally, I'm from Okaloosa County, Fort Walton Beach, Florida So that's up there in the top in region won the third county over. And what Medicare data can tell us is how saturated is a market, what specialties air available in a market. So in this 2015 data, we could see that, for example, my specialty nephrologist in Okaloosa County there aren't that many, uh, endocrinologist, same way. These patients that require frequent visits with chronic monitoring in order to stay healthy and to prevent progression of disease processes, they don't have access to care. And we have just a few other areas in Florida that maybe have a what you could. We could consider a saturated market if we could leverage the technology that's available to allow those providers to provide care for some of these others that don't have access. We hit ah lot of locations that otherwise would not be receiving any care at all. These are the things that, um as health care officials, we should concentrate our efforts and then also focus on our legislature to make sure that they are producing laws and producing policies that actually incentivize this process. Because it takes care of more people, it makes more people healthier. And in the long run, it is a cost effective approach. Video appointments is usually what we think about. We think about that as the, you know, simplest way, whether facetime or whether you're using some other approved tools. Um, HIPPA compliant tool. Um, but there are considerations like I need to see this patient or I can't I can't do this without a physical exam, but we know that there are certainly times where we can utilize this technology where that may not be necessary and a direct examination may not be necessary. There are other times where the examination may have been performed a synchronously So was that done a week ago. And this can easily be just a treatment follow up question or we change the medication and let me see what the effect is. Uh, what was the response to the treatment that I prescribed? Um, think about a second opinion just in general. This is the management that I've had at this time, and I just wanted to know. If you agree, that's another use. We could use the post hospital follow up. If someone doesn't necessarily need to be evaluated with a physical exam of the time, there may be ways for us to utilize this technology. Also, think about just educational visits. Okay, so reiterating advice that you've already given. If practices have worked to digitize information and be able to send that Elektronik Lee, then there is certainly no reason that we can't have such a meeting. Justus, you and I are now where we can reiterate information that is already available to the patients in order to reiterate those practices that we need them to do to stay healthy. Phone visits are another type that are available but a little bit more difficult to keep with the nuances of the billing that is, ah, face to face visit may need to accompany or may not be able to have a company that phone visit within a certain amount of time or you may be committing fraud by billing. So again, those those considerations may make one less likely to do a telephone visit, whereas this may be easy for the patient. But, uh, when we also you think about the lower reimbursement that you'll get from the time that spent on a telephone call versus the changes that happened with this public health emergency basically made it to where these video visits were treated the same as the face to face visit. So that man means for reimbursement purposes, at least during the public health emergency, would be equal to the time that you would have spent if they were in your office. Now that's great. But the question is, will that continue? And that's where we have to rely on our Legislature to do the right thing. And there are proposed changes to what the fee schedule the physician fee schedule will be in calendar year 2021 and basically kind of simplifying a lot of those level 23 and four. But the questions remain of how virtual visits will be impacted and what the new revenue at this point will be. Um, these are important to any practice that is trying to plan ahead, but also important from the patient's perspective. Because again, any unnecessary cost or another, uh, you know, unplanned for cost is certainly going to be problematic for many of the patients that we're trying to target with this. So while it's easy for a practice to gain market share, it's easy to improve access to care, to improve quality of care, to improve the efficiency of what we're providing. Andi and honestly, we're able to define populations as well. We're able to define those disease groups that, uh, can definitely be enrolled in such a program and continue to be managed with chronic disease or think about an accountable care organization or an employer based group. These are all people that we can put in a group and manage effectively if we are empowered by those that make the decisions on how we're reimbursed and on those that decide if we can affect those patient barriers, some that Dr Jones alluded to. We think about Internet access, but we also have to think about the hardware that a patient would use. We have to think about the health literacy at baseline, so if someone always has somebody that comes with them to the clinic. Um, in order to kind of elaborate on their care or kind of to understand and then re explain, that may be a difficult thing to do in the setting of a video visitor. That person may not be available at the time of an asynchronous video asynchronous visit. And that's something that we also have toe have to keep in mind. Um, the reality. Excuse me? The reliability of the Internet access is also going to be a problem. And on the provider side, you think about bandwidth issues. So, you know, I want to make sure that I'm able Thio, uh, provide that care without any hang ups on my end or changes in the video quality or things like that. And again, that license your piece is very is big, especially if you're talking about caring for people that are crossing the state line. If you're near state line, um, some practices we're going to have to decide if license sure in multiple states is important for them and if it makes sense financially for them to do so. But again, if the goal is to improve access of care. I think that it is clear that one way to do that is by leveraging the options that we have with telehealth and telemedicine. And I hope that this is the direction that all of us in the U. S. Health care system will be able to employ in the very near future. Thank you very much. Thank you, Dr Porter. That was an amazing discussion. I now have the pleasure of introducing our next Panelist Doctor Polling Raul. She's an MD PhD in a c. PH. And she's also the interim health officer and medical executive director for the Florida Department of Health. And she's going to talk to us today about the public health role in Cove in 19 as well as contract chasing. Thank you, Dr All. Thank you, Dr Donaldson is my pleasure to be here this evening. Thio present. So the Department of Health. So one of our roles during this covert responses toe actus lead agency. Um, And tonight I'm going to cover Some are primary responsibilities and one of the main ones Contact tracing. So march 1st 2020. The governor designated Department health as the lead agency and So what that meant was we were responsible coordinating the cove in 19 emergency response in the state of Florida from the state level down to the local level that included public health advisories operating statewide call centers. We also operated a local call center. We were responsible also receiving all lab results from across the state, whether it be positive or negative. In addition, a primary function of the health department is to perform contact tracing. In fact, it is mandated mandated in statute amongst our other roles include infection control and testing. We provided infection control prevention measures to our long term care facilities and our jails, helping to them to ensure that they had excellent infection control processes in place. Another thing that we did was monitor persons under investigation is a part of our contact racing's quarantine and isolate people. That is what most people are familiar with. Doing this covert 19 response again. Quarantining and isolating is in the purview of the Florida Department health, and it is outlining Statue is one of our responsibilities. We also managed department health testing sites, assess and tested long term care facilities. We oversee school health programs and we monitored hospital bed capacity to ensure that we were ready in the event that we had a surge in cases in. In addition to that, we operate special needs shelters, and so far we have not had to open these shelters in response to hurricane. But it is our duty to operate special needs shelters and ensure that there is a specific shelter for covert positive patients. In our role is the Department of Health. We provided testing directly, including antibody testing and PCR testing. And so we did that in conjunction with the city at Regency Square Mall and at Lot J when it was open. But we also had independent testing sites at the floor, Department of Health on Sixth Street, as well as through mobile units that were throughout the community. Mobile units were strategically placed. Based on the data that we received. We tried to assess the needs in the community in terms of where testing was lacking and send our mobile units into into those areas. We also provide a walk up testing at our central plaza on Sixth Street and walk up testing was available daily to people in the community, one of the things that we did, uh, to provide education to the community was to open up a call center. Since March 13th, our call center has answered over 50,000 calls. We've provided education to the community, answer any questions they had, as well as assisted them in getting their test results. Infection control was a big part of what we do. We partnered with the state to have infection control prevention nurses on site in the city to be a provide education to our long term care facilities. And other agencies that required such services are infection control teams visited schools, restaurants, bars. Many people will remember the outbreak. Um, initially at the bars on the beach are infection control Team went out provided personalized service to those bars to ensure that they had good infection control practices in place to prevent another outbreak. In addition, our infection control team assisted in contact investigations and employees. Exclusions, mhm long term care facilities was a big part of what we did. We had to contact every facility and group home that had a positive resident, and we did investigations in those facilities. We walked side by side with those folks In some instances, we actually provided staffing to those facilities who became overwhelmed by the number of cases they were dealing with. We assisted in testing every employee every two weeks, and we tracked positives. We isolated, separated positives and exposed residents and helped long term care facilities set up systems that were sustainable. To be able to ensure that the disease did not spread within their facilities. One of the other things we did was we recognize the issue of food insecurity in our community, Um, and a zit related to Cove it and a lot of folks didn't think about that during this time. They were busy trying to get tested, trying to stay safe. Onda prevent cove it from entering their homes. However, there were a number of people in our community who experienced food insecurity during this time. And so with that, we partnered with Safe Future Foundation, provide weekly food distribution on site um, and some weeks they would come two days a week. In other days and weeks, they would come one day a week and provided food to the community as well as Pampers and personal care products for women to ensure that folks had what they needed to be able to survive this pandemic, one of things were most proud of. Besides all the other one for work we've done, including contact tracing his mass distribution, the state of Florida, uh, distributed mass throughout the state. Here in Duval, we pass out over 400,000 cloth mask in the community and we continue toe provide those cough mass to non profits and even to the hospitals in in our area. Thes cough masks were available to anyone for free. We partner with a lot of different community groups to get these mask out into the community, and so that's been a very successful venture. The jail was one of our largest projects. We worked very closely with the jail staff to ensure that they mitigated the spread of disease in the jail. As you know, being in close contact is very difficult for insect, and it is very easy for infectious diseases to spread. So I'm working with the jail. We provided support and guidance to ensure that they did not continue tohave disease spread within their system, and so they were great partners, and we continue to work very closely with them. We worked with them on their policies and procedures to ensure that their employees and the inmates that they care for our safe. Now one of our largest partners, Um, it is the school system Duval County Public schools. And so, with dual county public schools in non covert times, we provide school health nurses that help provide, uh, uh provide services on site to schoolchildren to ensure that they don't continue to stay in school when they're ill to take care, any bumps and bruises. But during this time of the pandemic, we've had to ramp up our services within school. And so with that, we've partnered with all county public schools, toe identify any positives. Um, in some cases, they identified positives from parents and employees calling in to state that they themselves or their child or positive, um, and other instances we have identified the positives. And so with that, once a positive identified in the school system to contact investigation ensues. In some cases, disease intervention specialists may come on site and other instances. We work directly with school health nurses that are on the scene. Thio decide who needs to be isolated or quarantined and who does not and also decide who is impacted. Um, individuals who need to be excluded are identified, and their and their parents were notified. And they, if they're an adult, they're notified. And so this has been a great partnership. We worked very well to decrease the number of cases that are generated in the school majority. The cases have come from with from outside of the walls of the school, into the school, and thus far we have not been. We've We've done a great job of mitigating any spread of disease within the school walls. Like I stated before, One of the biggest things we do is contact tracing. Um, and what happens with this? Essentially, if someone tests positive, um, they're asked to self isolated home. We will monitor them periodically, check on them. And one of the things we do also is connect people with services if they have to self isolate and they have issues with their health or with food insecurity or things of that nature, we try to connect them with services to ensure that they have what they need to safely stay in place. So once folks are asked to self isolate because they themselves are positive. Um, we start Thio, find out a little bit more about them and who they may have been in contact with. And so, with that, we reach out to their contacts. And so what we try to get people to understand is this is a very confidential process. And so if a person identifies contacts, we will. When we reach out to those contacts, we are sure not Thio indicate who? The index case Waas Um, we use the same process with S T d H I V. So contact tracing is one of those things that's well established in the public health community. It's not something new. Um, it's just gotten a lot of press with Kobe 19. But it is one of those mainstays of public health that we have done for decades, and it has proven to be six, uh, be very helpful in terms of identifying the spread of disease and mitigating the spread of disease. And so once we identify people and we get their contacts, um, then we advise their contacts as to next steps and as to how long they should quarantine. And so, with that is the object is to keep the community safe and prevent the spread of disease. And so there are times when we have to institute legal means because people are not cooperative. But I can say here and do all the majority of people have been cooperative, and we've been very successful in terms off those contact tracings. You know, of course, there are always challenges with contact tracing. You have people who think where you're calling it's a hoax, or they may have given us a wrong number or wrong address. And so there are times when it is difficult to track down people. But we have other means. Elektronik means of figuring out where people are at any given time and so certainly, um, contact tracing is a mainstay of public health, and it has helped us to mitigate the spread of disease in the community and again not just for covert 19 but also things like HIV and STD. And so we continue to do that. We partner with the Centers for Disease Control, um, toe on board contact tracers to assist us in this work, and the state has been very helpful in terms of providing staffing for this work. If we reach out to folks and we can't get them, we continue to try. And in some instances we will send someone out to the home to check on them to make sure they are aware that they are positive or that they are contact. And they are isolating or quarantining as appropriate. And so we're very proud of the work that we do here in Duval. Um, it's exciting work. Certainly, Cove in 19 has made it that much more so. But again, contact tracing is one of the biggest things that we dio. So as we look toward the future, um, what are we looking to dio? Well, where we want to make sure everyone knows that they can do their part to prevent the spread of covert 19 or other respiratory viruses. We still emphasized the need to wear masks to social distance, um, to ensure that you are protecting yourself and others. Um, And as we go into the flu season, we encourage people to get the flu vaccine again to mitigate the number of people who will need thio access, health, the health care system, Um, and so certainly We also want to identify additional areas for collaboration and partnership. This is not work done in isolation. For sure. We worked with a number of partners, including the University of Florida and Mayo, um, to accomplish the goals in the community of decreasing the spread of disease, insuring people have access to testing and and ensuring that people are educated appropriately. And so with that, we continue to develop those partnerships and identify other areas to collaborate in. And so it's always a pleasure toe work with our community partners to ensure that we get the word out to the community and we do right by the community if you're interested in learning more information. Certainly there's a lot of information out there. But the Florida Department of Health website is always a good, um, place to go and the Centers for Disease Control and of course, the World Health Organization, both the CDC and the and who have provided a wealth of information that have helped to drive our response to the pandemic. And so again, thes air some helpful websites for you. You have any questions? We're your partners in health and so I can be reached at the email address listed, as well as the phone number always available to speak to the issues and assist in collaborations in the community to help make us the healthiest state. Thank you. Thank you, Dr. Well, that was amazing information and now like to introduce our next speaker. Our next speaker is is Monica Alberti. She is an assistant professor of health care Administration. She's an operations manager for the Center of Health Equity and Community Engagement Research. And she's going to talk to us about the role of community partnership in addressing Covert 19. Thank you Good evening. As Dr Role said, um, addressing Cove. It 19 cannot be done by individual institutions alone. And community partnerships are key to addressing the pandemic, especially for racial and ethnic minorities and those living in under resourced communities. So when we talk about, um, partnering for a common goal. So at the onset of the pandemic, health care institutions immediately focused their efforts on keeping their patients, staff and the surrounding community safe. And early on we saw that there was evidence that some communities did not have access to P p e testing or even accurate, easy to understand information about covert 19. As time went on, we found that Colvin, 19 disproportionately impacted racial and ethnic minority communities and especially those that live in under resourced communities. And when we think about under resourced communities were thinking about those communities that lack built infrastructure. They could lack access to health care facilities. They could be in rural areas, areas that are isolated, Um, that make it hard for testing to take place or for information to be disseminated in those communities. There was a clear need that, um, the impact of Kobe 19 in these communities needed to be addressed. So the importance of building institutional and community partnerships in order to address Cove it 19 is key. So when we think about community partnerships, they could be faith based institutions, civic and volunteer organizations, local nonprofits, businesses, advocacy organizations in governmental organizations as well. There are some basic steps that you should think about when you are wanting to build institutional and community partnerships. So the first step is really thinking about connecting with those organizational and community leaders. And when we think about community leaders, they are always going to be the head of organizations, or maybe the CEO or, um, executive director. Sometimes they are the most knowledgeable person that lives in a particular neighborhood, or they could be a long time advocate for health and wellness or community health worker. So first it's kind, identifying and connecting with, um, or those leaders. Second, you really want to think about as you connect and you all have come together really defining and prioritizing partnership goal. So as it relates to Cove it 19 in the partnerships that I will talk through, um, in the next slide, we really worked with community organizations. Mayo Clinic worked with community organizations to really talk about what is going to be the goal of this partnership. What do we want to do in the communities to really help lessen the impact of Kobe 19? The third step is agreeing upon roles and responsibilities. So when institutions, academic, medical institutions, healthcare institutions want to partner with local community organizations, it's important that roles and responsibilities are thought about and discussed upfront. And then finally, you want to define what success looks like. Oftentimes, success to an academic, medical institution or healthcare institution is different than to a local neighborhood or to a local community organization. So there are some benefits in general to community partnerships. So there's this idea of collective impact. And so, really, what collective impact, um is is when groups get together and they're able to make a bigger impact on the community on the health of the community, um, bigger than they would if they just I did this alone. Bi directional communication. So oftentimes, in, um, large institutions, it may be difficult for us to understand what the community needs. What are the issues that the community, um, is facing on DSO? Having community partnerships really creates is bi directional communication toe where we can learn from the community and communities can learn from us. There's also shared power. So there isn't just one, um, entity in this partnership that, um makes the rules or that decides what's going to happen. That's a shared power and also sustainability again when an institution alone tries to address community needs, or particularly in a not only in a pandemic but just in general. Oftentimes it's tough because it's not sustainable, but when there are partnerships, it allows for a sustainability because every single partner has its role. So I'm going to talk a little bit about a partnership, the roadmap, and how we address Cove in 19 here in Jacksonville. So a two beginning of the pandemic, um, community members, through phone calls and emails and texts, really express the need for, um, initially more PPE and information. So community members were really having trouble finding how to get free masks and enough mask for their family. And also, um, they needed accurate information. So we knew Mayo Clinic knew that we couldn't do this alone. So we worked with local organizations, including the Health Department, local faith based organizations, universities to really pull together thes leaders and better understand the need. So together we developed a plan for how we were going to disseminate PPE and information, particularly in communities that lacked resource is or that were hard to reach. Our community partners, through a Siris of, um, phone calls and zoom calls, um, work together. So identify different venues or different locations throughout Jacksonville where PPE could be disseminated, where community members would easily be able to access, um, the in for the PPE, and also where we could also give out accurate information to individuals. We worked with community leaders to deliver PPE and covert 19 information. There were weekly calls that were held with community leaders, where community leaders asked Mayo Clinic experts questions about the disease, about about the virus, about safety measures about masking and quarantining. And so we, they ask the questions. We in turn created kind of a answer sheet and then worked with communities to ensure that it was written in a way that was easy to understand and that the average person would be able to understand and share with their family. Soon after that, we realized that there was a need for rapid testing. S O. Many community members came to us and they needed testing. And while there was testing going on in the community, there was sometimes a need for more rapid testing. So there were community members who needed to go back toe work or who needed to travel. And they needed proof of a, um of a test of a negative test. Um, some community members had, um, they were taking care of elderly relatives, and they themselves needed to make sure that they were, um, feeling well or that they were negative Cove it negative in order to take care of those relatives. So they really said We need a rapid test So we work. Mayo Clinic worked with a local federally qualified health center as well as a few other nonprofit organizations to develop a rapid test screening. A rapid testing plan. We work with our community partners are faith based organizational partners, opened up their facilities for eight weeks straight and allowed for free rapid testing to take place, um, at their locations theme. The testing was offered to anyone who, um wanted or needed a test. The results were given back within 24 to 48 hours on bond. The community really expressed their appreciation for being able to have access to the test, and not only were we able to give access, but through this partnership we were also able to give wrap around care, particularly for those that tested positive. So are we partnered with are the federally qualified Health Center and these other local organizations to really make sure that those that tested positive had information about quarantine, had information about where to test where to retest, but also had information about where to go in case they became symptomatic. So the results of these partnerships, um, we had again information sessions, not Onley passing out flyers and leaving them in places. But there was really a push to do a lot of virtual information to keep people safe. So we had 1700 attendees total and multiple virtual covert 19 information sessions that were in English and Spanish. We also had about 100 direct contact hours with community members, and this led Teoh a reach of about 5000 plus people that received direct tip sheets and information that was generated by Mayo Clinic experts. We also were was able Thio organize a donation of about 3500 different individual pieces of PPE that were donated at, um in hard to reach neighborhoods and locations. And also we were able to test over 2500 individuals. Um, they receive free rapid Kobe 19 tests, and particularly in African American and Hispanic communities. So in summary, what we have found, what we know is a community partnerships are ideal for quickly identifying and addressing community needs is help as health care institutions. Um, it's important that we you know care for the needs of our patients and for the needs of our staff. But it's also important that we understand and address the needs of the communities. The surrounding communities that we serve and community partnerships are ideal for helping toe, understand, identify, understand and address those needs. Partnerships should always be mutually beneficial, and they should involve bi directional communication. It's important that there are clearly defined roles and responsibilities for all partners that are involved, and also, and finally, institutional and community partnerships are important to make a collective impact in communities. Thank you. Thank you, Monica. Wow. We've had a really informative hour of time, and I just like to end by saying thank you to all my Panelists and two reminding everyone who took the time to click. Um, to start this video that there are so many things that you can do even small things to try and impact the health care disparities that we see in our country, both on a local level or even on a regional and national level. We asked you to remember to use telemedicine with kind of fortitude and ingenuity. We think of all the places that we don't necessarily reach as the rural areas in the urban areas where people can't get out to see us. And we think of how we can use telemedicine to reach those patients so that we can improve access to care. We think about community contact tracing and we encourage our family and our patients. Thio, answer the phone. If they have a phone call that is concerning that they may have had exposure, we have them use. The resource is in their community to try and improve the safety of their friends, their family and their neighbors. And ultimately, if you are a part of the ivory tower, as people call it, those hospital systems where we have people come in. But we don't always go out, we ask you to reconsider that value. We asked you to go to the people who need the care the most, and we try and engage with them. And we're trying to improve their access to care in their quality of life. I thank you for your time. I thank you to our Panelists for their wonderful information. We hope you got something out of it. Please be the change you wish to see in the world