Role for Graduate Medical Education in the Response to COVID-19 Pandemic in Southeast Michigan Community Health Care System

On March 10, 2020, the State of Michigan reported its first case of severe acute respiratory syndrome due to coronavirus disease 2019, which was admitted to Ascension Providence Hospital (APH). Michigan was the third most affected state in March 2020. To address the pandemic, Department of Graduate Medical Education joined the incident command team which consisted of APH leaders (Accreditation Council for Graduate Medical Education Designated Institutional Official, the Chief Medical Officer as commander, Chief Operating Officer, Chief of Logistics, Chief Nursing Officer, representatives from the medical and surgical sections, laboratory, finance, infection control, and occupational health). The team initiated the “crisis capacity surge plan” that was focused on patient care and led mainly by our trainee. In this correspondence we share our successful experience and provide our recommendation on how GME can navigate pandemic crisis.

Food access initiatives: An integral piece of the Revere, Massachusetts, COVID-19 response

Cambridge Health Alliance (CHA) is a community health care system that serves the region north of Boston, including the city of Revere, Massachu­setts. In an effort to confront the root causes of poor health, CHA has engaged in an initiative to address the social determinants of health, including food insecurity, homelessness, and unemployment. In 2017, we learned that 51% of our patients in Revere screened positive for food insecurity. In response, we committed to increasing our patients’ access to healthy foods.

LÍMITES AL DERECHO DE ASISTENCIA SANITARIA TRANSFRONTERIZA Y PRINCIPIO DE PROPORCIONALIDAD TRAS LA SENTENCIA DEL TJUE DE 23 DE SEPTIEMBRE DE 2020.

Health protection is one of the fundamental pillars of the European Union and of the process of social-democratic constitutionalism. The achievement of a Community health care system is now more than ever one of the great challenges for the European community. In spite of these objectives, the European Union has adopted a logic that relies more on an interventionist model than on simple coordination, rather than on a harmonised system for all Member States. Unfortunately, this particular cooperative pluralism has made each of the Community countries competent and responsible for the coordination rules laid down by the Union. In this sense, Directive 2011/24/EU is set as the reference standard to guarantee the right of all European citizens to receive safe and quality healthcare, both in the public sphere and in the private sphere of another Member State. The aim is to guarantee the freedom of movement and movement of persons without damaging health. Today, the right to health care is a fundamental social right of a primary nature, which is linked to the right to life and dignity.

Implementation and outcomes of lung cancer screening in a community health care system.

e13035 Background: Lung cancer screening using low dose computed tomography (LDCT) in patients meeting criteria is a covered preventative service under the Affordable Care Act and policies of CMS. The purpose of this study is to describe implementation and results of a lung cancer screening program in a community health care system. Methods: We prospectively collected data on all patients obtaining a baseline LDCT scan who enrolled beginning February 2015. Referring provider, smoking history, demographics, comorbidity, findings, and, in those found to have an abnormality, diagnosis were collected. The study was reviewed by the St Joseph Mercy Health System Institutional Review Board and was considered exempt. Results: Over the course of 18 months, 955 patients were referred for a baseline LDCT. 57% were current smokers, 53% were male, and 38% had no comorbid conditions. The mean number of pack-years was 50 (range 6 to 160). 76% of patients were referred by primary care providers. The number of new patients referred per month increased from 8 to 89, largely due to outreach and education directed at primary care physicians and office staff. Of the 955 patients screened, we identified cancer in 2% overall (small cell cancer in 0.2% patients and non-small cell lung cancer (NSCLC) in 1.6%). Among those with NSCLC, 60% had Stage I disease, 20% had Stage II, 13% had Stage III, and 7% had Stage IV disease. Compared to the stage distribution of lung cancer patients identified before the implementation of the screening program, there was significant down-staging in those with NSCLC. Barriers to implementation have included lack of clear smoking history documentation and billing code release delays which led to reimbursement difficulties. Conclusions: Successful implementation of a LDCT lung cancer screening program in a community setting. Improving patient/provider education and documentation of tobacco use in electronic medical records will streamline the referral process and increase screening among eligible patients. Outreach to practices that serve minority and other medically-underserved populations will require specific efforts to achieve health equity in the area of lung cancer screening.