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October 19, 2015

Table of Contents

Keep Yourself Healthy During Flu Season

Coughing. Sneezing. Sore throats and runny noses. The sounds of flu season are suddenly all around us, but you can help protect yourself by getting a flu shot. This year, flu shots will be available for staff members from October 5 to 31.

"Flu shots not only help to keep our staff safe, but they also help to keep our patients safe," says Ravin Davidoff MD, Chief Medical Officer. "Thousands of individuals in the US die from the flu each year and we see many people at the hospital who are particularly vulnerable to the flu and its complications. We all have a commitment to our patients and to each other to prevent the spread of infectious diseases such as flu. Getting the flu shot is a very important way to achieve this."

Annual flu shots are required for everyone who works or volunteers at BMC, including employees, residents, students, physicians, interns, vendors, or other contracted personnel. To this end, free vaccinations will be available at BMC Occupational Health throughout the month of October. There will also be events on both campuses and mobile OEM flu shot carts across campus, including evening, night and weekend hours, to ensure that everyone is able to get their shots at a convenient time. Employees can also get a flu shot at a non-BMC location, but must bring proof of the immunization to Occupational Health.

All employees must receive their flu shots by October 31. If an employee does not receive a flu shot by that date, they will have to wear a surgical mask while on BMC property for the duration of the flu season, starting on December 1. If there is a medical reason why an employee cannot receive a flu shot, Occupational Health can grant an exception, but those employees will still be required to wear masks. This year, there will be an alternative immunization available for staff with severe egg allergies.


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Diabetes Self-Management in the Virtual World

When you think of virtual reality or online role-playing games, you might picture teenagers sitting on the couch all day. But these virtual worlds can also have serious uses, as a study being undertaken at BMC is showing. The study will look at teaching diabetes self-management through group medical visits on Second Life, a popular, free online virtual world, and has recently been awarded a $783,906 grant from the National Institute of Diabetes and Digestive and Kidney Diseases.

The current study is based on a pilot study done by BMC researchers in 2010 that looked at whether virtual group medical visits are feasible for people with diabetes. The study found that these visits are not only possible, but that patients like to have group visits this way. It also found that virtual group visits had a significant positive impact on physical activity for participants versus a control group who had in-person group visits.

"This result supports the hypothesis that a virtual world is a simulation experiment," says Suzanne Mitchell, MD, a physician in Family Medicine and the lead investigator on the study. "People identify with their avatars; for example, they have strong opinions on what those avatars should look like. Therefore, they can use those avatars to identify and overcome barriers to behaviors such as physical activity. The virtual world provides a low stakes way to simulate behaviors you don't currently do, and there's evidence both in this study and others that those behaviors translate to real life experiences."

Mitchell's study is specifically looking at the efficacy of using virtual world technology for medical group visits for minority women with diabetes. The group visits, both face-to-face and in the virtual world, will be led by a physician and a peer educator and will run for eight weeks. Each weekly visit will include a report on vital signs (virtual world participants will be given blood pressure and glucose monitors to use at home), a physician check-in with each participant, and education on a specific topic related to diabetes self-management, such as nutrition or mindfulness. Second Life participants can also interact in and explore the virtual world outside of the eight sessions.

Each group will consist of 8-10 participants, with 220 participants total in the study. The Second Life groups will meet once in person to receive a laptop and computer training, including help setting up an avatar and navigating the virtual world. Two-thirds of the participants will be African-American, one-third will be Spanish-speaking Latina, and most will be patients at BMC or a community health center.

"Engagement is an essential part of health education and self-management," says Mitchell. "There's evidence that a virtual world is not only important for visualization of certain behaviors, but also for the peer support that gives people further confidence they can do those behaviors. Peer support and bonds with clinicians are just as powerful in virtual worlds as they are in face-to-face situations and help people gain agency in the same way."

Currently, Mitchell, Paula Gardiner, MD, Oscar Cornelio-Flores, MD, and Gabriela Weigel, all of whom work in Family Medicine, are adapting the Centers for Disease Control's Diabetes: Power to Prevent curriculum for use in a virtual world by developing new experiences and activities that correlate with the curriculum's objectives. The study will start recruiting in June 2016 and the grant lasts for five years.

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BMC Showcases Provider Expertise in First Annual HUBWeek

From October 3-10, universities, restaurants, hospitals, artists, and a variety of organizations and institutions throughout Greater Boston took part in the first annual HUBWeek, a weeklong series of events and experiences designed to bring together and celebrate art, science, and technology and the unique innovations and solutions they produce in Boston. Representatives of Boston Medical Center participated in HUBWeek events that showcased the expertise and innovative thinking the hospital has to offer.

On Monday, Kate Walsh, President and CEO, Alexander Walley, MD, MSc, director of the Addiction Medicine Fellowship, and Colleen LaBelle, BSN, RN-BC, CARN, Director of the O-BAT program and the Program Director of Training and Technical Support for Massachusetts' medication assisted treatment programs, took part in a discussion on designing an effective response to addiction. At the event, called "From Opioids to Alcohol," physicians, researchers, and other health care providers from across Boston and the nation discussed the opioid epidemic and how to get effective treatment from theory and research to practice.

Walsh, along with Peter Slavin, MD, President of Massachusetts General Hospital, opened the event by outlining the scope of the problem and the purpose of the event. They challenged the attendees to figure out a way to solve the problem of substance abuse and addiction using new approaches, such as the latest brain science, rather than falling back on the typical standard solutions, such as more money or more beds, that everyone agrees we need.

"Boston and Massachusetts are leading the way in tackling this epidemic, but there's a lot more to do," said Walsh. "BMC has long been a leader in for addiction treatment and research. Addiction is a very prevalent illness in BMC's population, but it knows no bounds. It will take all of us to confront our own biases and come together as a community to form a comprehensive approach."

Thomas McLellan, PhD, the founder and board chair of the Treatment Research Institute, and Wilson Compton, MD, MPE, Deputy Director of the National Institute on Drug Abuse, both presented keynote speeches. McLellan discussed the reasons substance use disorders should, and soon will be, part of mainstream healthcare, including $40 billion in excessive healthcare costs per year they cause, medication overdose being the biggest cause of accidental death in the United States, and that treating these disorders will make medicine as a whole more efficient and cost-effective. Compton highlighted that healthcare providers need to leverage personal, social, and environmental resources, such as sober houses, in order to fight substance use disorders.

The keynote speeches were followed by LaBelle and Walley commenting on a case presented by Sarah Wakeman, MD, of Massachusetts General Hospital. The case concerned a 31 year old patient who was addicted to opioids and was hospitalized multiple times for a severe infection.

According to Walley "the culture of medicine is not set up to roll out the red carpet for patients with substance use problems." In many cases, there is no plan for addiction treatment while other illness are being treated, because many hospitals simply do not have the expertise to do so. However, said Walley, interventions for addiction should be on par with other medical interventions – otherwise, you won't be treating the root cause of illness. Walley also noted that BMC now has an addiction consult service to improve the treatment of inpatients with substance use disorders and develop a plan for discharge that will prevent future problems.

LaBelle echoed these sentiments, highlighting the legal and logistical barriers that make it difficult for patients to receive medications to treat their addictions after they are discharged from a hospital where they are treated with those medications. But, said LaBelle, medication assisted treatment is spreading. In Massachusetts community health centers, 8,000 patients have been treated in programs based on BMC's OBAT model.

BMC also participated in another HUBWeek event, entitled "Beyond Technology: The Future of Value-driven Health Care." This event brought together Boston's community of healthcare providers, payers, policy makers, and academics to exchange and explore ideas about innovative new models of care delivery to improve quality and reduce costs. Walsh moderated a panel on patients as consumers and Thea James, MD, Vice President of Mission and Director of the Violence Intervention Advocacy Program (VIAP) was part of a panel discussion on preventive care delivery. As part of the event, a video about BMC's Comprehensive Care program was shown as a model program. Walsh also took part in a "CEO Crossfire," where she debated innovation in healthcare and its cost, care, and regulation implications.

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Making Sense of Health Care Buzzwords

Is a patient covered by Medicare or Medicaid? Is an EHR the same as an EMR, and what are they anyway? Even for those who work at a hospital, health care terminology can be confusing and frustrating. The BMC Brief is here to help, with a glossary of terms you might have encountered recently around the hospital or in the news.

  • Patient-centered medical home: A patient-centered medical home is a way of organizing primary care so that it is comprehensive, team-based, accessible, focused on quality and safety, and emphasizes treating patients with respect, dignity, and compassion. A patient-centered medical home prioritizes partnerships between patients and providers and between all providers treating a patient to ensure that patients are well-informed and care decisions respect a patient's wishes. Primary care programs can be accredited as patient-centered medical homes if they meet certain criteria. At BMC, Family Medicine, General Internal Medicine, and Pediatrics are all accredited as patient-centered medical homes.
  • Pay-for-performance: A payment model in which health care providers are given a financial incentive for better health outcomes. Instead of getting paid for each test or each procedure (fee-for-service), providers are rewarded for meeting certain quality and efficiency outcomes and penalized if they do not meet them. For example, hospitals are penalized when patients are readmitted less than thirty days after discharge and receive bonuses if they meet a certain number of safety standards. The goal of pay-for-performance is to improve outcomes while lowering costs and reducing unnecessary tests and procedures.
  • Throughput: Patient throughput refers to a patient moving from the Emergency Department to an inpatient bed or discharge, depending on their needs. Efficient throughput entails getting patients to a bed or discharge as quickly as possible while still providing best care. This will help ensure that patients will get the more specialized care they might need, and create space in the ED for new patients. BMC's 2015 QUEST goal was to move admitted patients from ED arrival to ED departure in under 350 minutes.
  • Electronic health record (EHR): Also known as an electronic medical record (EMR), this is a digital version of a patient's paper chart. It includes all the information you might see on a paper chart, but in a software program that can instantly provide information to authorized users. BMC's EHR is called eMERGE, which comes from our vendor Epic. As of May 2015, all inpatient and ambulatory units are using eMERGE.
  • Naloxone: A medication (brand name Narcan) that can reserve the effects of an opioid overdose. Naloxone can be given in a nasal spray, intravenously, or intramuscularly. BMC patients and staff members can get naloxone without a prescription at BMC pharmacies.
  • Medicare/Medicaid/MassHealth: Medicare and Medicaid are both health insurance programs run by the federal government. Medicare provides insurance for Americans aged 65 or older who have worked and paid into the Medicare system, as well as people with disabilities, end stage renal disease, and ALS. Medicaid provides health insurance for families and individuals with low income (up to 133 percent of the poverty line). MassHealth is a state program that provides Medicaid insurance to eligible Massachusetts residents.
  • P-tube: Short for pneumatic tube, this is the tube system used to transport laboratory specimens, medications, and other items throughout the hospital. BMC recently started working with a new vendor to operate the p-tube.

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New Record Set for Treatment of Stroke Patients

"It all happened in an instant," said BMC patient Christopher Perry. August 20 was just another day on the job for the 43-year-old construction worker, but what began as a normal day quickly changed into something entirely different when he lost ability to speak and lost feeling in his right arm and leg. After that, everything went dark and the next thing Mr. Perry recalled was waking up at BMC.

Perry had experienced a stroke and was rushed to Tobey Hospital in Wareham, then taken via MedFlight to Boston Medical Center. Upon his arrival, Perry was placed in the care of Thanh Nguyen,MD, Director of Interventional Neuroradiology and Neurology and Hugo Aparicio, MD, Vascular Neurology Attending at BMC. They determined that Perry had an extensive clot in the carotid and middle cerebral artery of his brain. Perry immediately underwent an intervention procedure during which Nguyen unblocked his blood vessels and removed the clots.

Door to groin or "DTG" is the time from which a patient presents in the Emergency Department to the start of an intervention procedure. It is often used as a benchmark to examine team times in the management of acute stroke. Mr. Perry's DTG time was just 26 minutes—a new record for the Neurology Department, Radiology Department, and the hospital. The record previously stood at 60 minutes. Nguyen points to several factors, including early transfer and early pre-hospital notification to the stroke and neuroIR services, for making this particular case unique.

"To call it great teamwork is an understatement. Mr. Perry's care was a full-scale team effort starting from the Tobey Hospital ER notification to the decision making and execution of our EMS/ER, acute stroke, interventional radiology and nursing teams. All involved worked rapidly in parallel to get Mr. Perry's artery opened as quickly and safely as possible," Nguyen said.

Perry is a father of three and has coached football in Wareham for several years. When word traveled online that the well-known coach had a stroke, well wishes began pouring in. The stroke could have sidelined him for good, but luckily that wasn't the case. Perry has had an excellent recovery with no speech impairments and has regained complete strength in his arms and legs. He's taken some time off from coaching this season, but hopes to return to the field next year.

"We are constantly working on improving the way we deliver care to reflect a coordinated and effective progression from the time a patient begins to experience symptoms to the time they come through the doors at BMC," Nguyen said. "Mr. Perry's dramatic neurological recovery is directly attributed to the exceptional care our team delivered."

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Development Campaign Raises Money for the New BMC

Boston Medical Center recently closed out its fiscal year, and with it, another successful year of fundraising has come to an end.

Over fiscal year 2015, BMC fundraised a total of $50 million in gifts and pledges. This surpassed the Development Office's fundraising goal for the year and marked the second year in a row that $50 million has been raised to support the hospital. Contributions to the hospital came from a variety of donors, from $26 raised by three Boston children hosting a cookie sale to a $10 million challenge grant.

In October 2014, the Development Office launched a comprehensive campaign with a goal of raising $250 million— of which $100 million will be devoted to BMC's Building the New BMC campaign, which will fund the hospital's clinical campus redesign plan. At the close of fiscal year 2015, $128 million was raised for the comprehensive campaign with $67.291 million being directed to Building the New BMC. The redesign will ultimately decrease costs and improve the delivery of health care at BMC. According to the Development Office, the hospital is set to reach the $100 million capital campaign goal by 2018.

"BMC is deeply gratified that so many of our leadership and friends stepped forward to support the vitally important work our caregivers undertake each day to improve the health of our community," says Norman Stein, Vice President of Development. "Raising $50 million for the second year in a row in such a competitive environment is both a noteworthy achievement and a major stepping stone on the pathway to realizing the vision of a completely modernized campus."

In addition to its ongoing fundraising efforts, the Development Office has also been looking ahead to fundraising in the future. Over the last year, the office has been working with BMC's marketing agency, Small Army, to develop a philanthropic brand awareness campaign, honoring unsung heroes in the BMC community. The result is a campaign that complements Marketing's Stronger Together campaign to strengthen BMC's presence as a philanthropic organization in Greater Boston. The campaign will consist of print and digital advertisements in publications such as Boston Magazine and, as well as radio ads.

The campaign features real stories from four patients, Cassie, Wayne, Jackie, and Gail. Each have shared how BMC is critical to their health and wellbeing, from Cassie's involvement with Project RESPECT to Gail receiving support from her primary care physician when she had to raise her grandchildren after her daughter was killed in a tragic accident.

"BMC is fortunate to have an ever growing community of donors and leaders—many of Boston's most notable residents—supporting our mission as we continue to build our philanthropic efforts," concludes Stein. "The breadth of support for BMC's mission is an extraordinary testament to the depth of commitment so many have for the life changing work BMC clinicians and staff undertake every day to make the Boston area a better place for our whole community."

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What do you do, Erica Neufeld?

Name: Erica Neufeld
Titles: Director of Marketing
Time at BMC: 1 year, 4 months

What brought you to BMC?
I came to BMC for the opportunity to build a strategic Marketing Department. I've always worked in health care marketing and communications, and I was challenged by the opportunity to take an existing function and better align it with BMC's business operations.

What do you do here?
Marketing has three main functions: to grow patient volume, to run the external website, and to work on patient communications. We spend the majority of our time on the volume growth side, although it overlaps with the other two functions. We look at how patients access care at BMC and how they find out about our services, and then develop strategies and tactics to increase that. For example, primary care physicians often refer patients to specialists, so one of the things we're very concentrated on is referral development – how we can encourage primary care physicians, both at BMC and in the community, to send their patients to BMC specialists when they need further care. To this end, we do a lot of work getting our specialists known to the referring primary care community.

Another thing we do is create materials for BMC, such as patient brochures, newsletters, flyers, or anything else that will be seen by patients and the outside community. We work hard to make sure everything is appropriately branded and looks like it comes from BMC. People should call us if they need any printed materials created!

For me personally, a typical day involves a lot of meetings. For example, I might meet with a department to talk about where we are in their current marketing activities and what projects are coming up next. I might also work on new website content or update existing content, review data analytics from the marketing campaign to understand how it can be more effective, set up physician specialist meetings with primary care providers at the community health centers, and tour the new construction to see how we can make our facilities the best for patients and families. My days really vary based on what's going on or coming up around campus and involve a lot of different kinds of work.

The new Stronger Together campaign for BMC launched in March. Can you tell us what the campaign entails and give us an update on where it is now?
The campaign is focused on attracting new primary care patients to BMC, because we know that if we bring in new primary care patients in their 30s-50s, it generally means they'll use BMC for all of their care as their lives progress, and they'll bring in family members. It's a heavy digital campaign, but we also have a presence on the transit system, print ads, and radio and TV, in a very geotargeted way. This means that the ads will be predominantly placed in areas and neighborhoods that our patients are mostly likely to come from.

We're currently looking at the analytics, but so far the campaign is on track and shows a marked increase in new patients making primary care appointments.

There's also a brand awareness piece of the campaign. Prior to launching the campaign, we did a survey to test the awareness and reputation of BMC in our market. We're currently running a follow-up survey to see if the campaign has moved market share or changed the perception of BMC.

What's one thing about working in Marketing that people might not guess?
A lot of people tend to think that marketing is about putting logos on shirts and designing banners and posters, and while we do that, the majority of our work is very data-driven. We spend a lot of time understanding how consumers think and react when it comes to placing ads and what those ads should say and look like. When we think about how to bring a clinical department out into the community and increase referrals to that specialty, we're looking at where their volume comes from, what's happening in the marketplace that would or would not drive volume, where there are pockets of disease, where there are areas without providers in that specialty, and other factors like that. There's a lot of analytics that goes into how we make a decision to do a marketing campaign, bring a department out, or create a website that has a certain navigation to it.

What do you like most about working at BMC?
What makes BMC really unique and special to me is that, on the days that I feel like I'm spending my time looking at dollars or the numbers of patients we've brought in, I know that it's not about the money. It's about bringing in enough patients to help create a financial scenario in which BMC can continue to provide all the amazing resources that is does for our patients. These resources are so important to the community that we serve and it's an honor to be part of helping us continue to do that work.

What do you do for fun outside of work?
I have a three year old, so that keeps me very busy. I also love to cook and I love to travel. My most recent big vacation was to Paris.

Do you know a staff member who should be profiled? Send your suggestions to [email protected] .

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News of Note

Brendan Magauran, MD, Named Medical Director of Care Management and Associate Chief Medical Officer
Brendan Magauran, MD, has been named Medical Director of Care Management and Associate Chief Medical Officer. Magauran is currently BMC's first Physician Advisor for Utilization Management, where he ensures that BMC is compliant with the conditions of participation in Medicare and Medicaid and CMS regulatory requirements. He is also an attending physician in the Emergency Department, where he has served as Associate Medical Director, Medical Director for the East Newton and Menino Pavilions, Clinical Director of Operations, and Vice Chair for Administration during the nearly 25 years he has been at BMC. Magauran received his medical degree from Brown University and an MBA in Healthcare Management from Boston University. He currently serves at the Vice President and President-Elect of the Medical Dental staff.

National Prescription Drug Take-Back Day
On September 26, BMC was a host site for National Prescription Drug Take-Back Day, which is organized by the Drug Enforcement Administration (DEA) and was held in partnership with the Boston Police Department. During the day, which allowed people to safely and anonymously dispose of prescription medication, BMC collected 55 lbs. of medication.

Falls Prevention Awareness Week
On September 25, BMC held its first annual BMC Fall Prevention Awareness event during National Fall Prevention Awareness Week. The goal of the event was to raise hospital-wide awareness about the changes we have made to the policy and procedure on fall prevention and educate staff on ways to better engage patients and families in the effort to prevent falls. The event included trivia about fall prevention and posters highlighting BMC's efforts on reducing falls. The event was put on by the BMC's Fall Prevention Committee, a multidisciplinary team that works to reduce falls, which are the leading cause of injury deaths, unintentional injuries, and hospital admissions for trauma among older adults, at BMC. Over the last year, fall rates at BMC have decreased significantly, with a fall rate under the national benchmark for three of the last four quarters.

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Awards and Accolades

Boston Medical Center Receives $1 Million Grant to Support Male Survivors of Violence
Boston Medical Center's Violence Intervention Advocacy Program (VIAP), directed by Thea James, MD, Vice President of Mission and Associate Chief Medical Officer, has been awarded a $997,966 grant from the Office of Victims of Crime, administered by the U.S. Department of Justice. The grant will be used to develop and support programs at BMC designed specifically for male survivors of violence.

VIAP, which serves as a national model for other hospitals across the country, is a hospital-based violence intervention program serving more than 450 clients each year, 68 percent of whom are black males. The grant will be used to support a demonstration project that, through its partnerships with community-based programs, will allow VIAP to identify gaps and barriers to care and support, and develop an action plan to meet the needs of male survivors, their families and significant others. Gaps already identified include lack of resources to help male victims find employment and housing, and a lack of trauma-informed care, which is commonly used in behavioral health settings but is not often found in community-based settings. Trauma-informed care is a treatment model that involves understanding, recognizing, and responding to the effects of all types of trauma.

Justin Pasquariello Named Outstanding Young Leader
Justin Pasquariello, Executive Director of Children's HealthWatch was named one of ten outstanding young leaders by the Greater Boston Chamber of Commerce. This award, which has been presented since 1956, honors Greater Boston's future and current leaders for their professional, personal and civic commitment to improving quality of life in the community.

Pasquariello was also the founding Executive Director of Silver Lining Mentoring and currently serves on its board, as well as the advisory board of the Taubman Center for State and Local Government at the Harvard Kennedy School. He is currently working on his memoir.

BMC Honored as LGBT Healthcare Equality Leader
The Human Rights Campaign has named BMC a Leader in LGBT Healthcare Equality in its 2015 Healthcare Equality Index (HEI) report. The HEI provides participating health care facilities with resources and training to provide equitable, knowledgeable, sensitive, and welcoming care for LGBT individuals. Health care facilities named as Leaders in LGBT Healthcare Equality meet all four of the HEI criteria for LGBT patient-centered care, including an LGBT-inclusive patient non-discrimination policy, and LGBT-inclusive visitation policy, and LGBT- inclusive employment non-discrimination policy, and staff training in LGBT patient-centered care.