As our nation’s capital, Washington, D.C., is a tourist attraction, complete with trendy hotels and restaurants, upscale neighborhoods and historical museums and monuments. Juxtaposed to neighborhoods with luxury condos and high-end restaurants are Wards 7 and 8. Although only miles away, these neighborhoods are worlds apart.
Wards 7 and 8 are the lowest socioeconomic areas of Washington, D.C. Unemployment and poor health are among the daily struggles for its residents. Consider that Wards 7 and 8 have three grocery stores servicing 148,000 residents, while the more affluent Ward 3 has nine grocery stores servicing 80,000 residents.
Elisabeth Tamasi, patient and family services manager for the Johns Hopkins National Capital Region at Sibley Memorial Hospital, is part of the Johns Hopkins team ensuring better healthcare for those who live in Wards 7 and 8.
Until 2015, United Medical Center was the only hospital serving all the residents of Wards 7 and 8. Since then, Sibley Memorial Hospital has treated 104 patients for lung cancer, breast cancer, colon and other GI cancers, and a variety of other cancers.
Most of the patients treated are African American, 60 or older, and qualify for Medicaid. Many of the patients have advanced cancers at the time of diagnosis and also suffer from other untreated health conditions, such as diabetes.
With this framework established, Tamasi and team set out to define all of the barriers interfering with the ability of those living in Wards 7 and 8 to receive the care that could lead to earlier cancer diagnosis and better cancer care.
Tamasi began using the National Comprehensive Cancer Network-developed distress thermometer to understand the issues getting in the way of care. The tool allows patients to score their level of distress on a scale of 0 to 10, 0 being no distress and 10 being extreme distress. The tool also includes a checklist of 39 practical, family, emotional, physical, and spiritual/religious problems concerns that patients can mark and also provides space to list problems and concerns not represented.
Using the tool, patients from Wards 7 and 8 were given a voice to begin communicating a variety of stressors. Housing concerns, childcare, insurance, sadness, family health issues, lack of food and fatigue were listed among the many barriers to care these patients faced. Transportation, followed by fear and worry, were the most common stressors marked.
“We can’t care for patients if they can’t get to us,” says Tamasi. The first thing she did was fix the transportation problem. “This year alone, we’ve provided 300 round trips for 19 patients through cab and, when necessary, medical transport,” she says. About 65 percent of the patients are Medicaid recipients.
Surprisingly, the ability to pay was the easiest barrier for Tamasi and group to overcome. “We help patients apply for services they may be eligible for and get them help with the cost of medications.” New contracts between Sibley and insurance companies were negotiated to make sure Medicaid and other coverage available to people living in Wards 7 and 8 were accepted at Sibley.
Sibley has a special needs fund that is used to provide charitable care not covered by other services. They also use the fund to purchase grocery cards, prescription and over-the-counter medications, durable medical equipment and other essential items for patients from Wards 7 and 8 too.
Tamasi’s Patient and Family Services team engage with patients from the onset. She assigns a patient navigator, social worker, and palliative care nurse practitioner (care aimed at addressing issues that cause discomfort for patients), for every patient. The patient navigators and social workers make sure patients understand their diagnoses and treatment plans and work with them throughout their care to help manage barriers to getting the treatment they need. They also engaged other experts at Sibley to manage non-cancer medical problems, such as diabetes.
“Improving access to care and reducing disparities requires identifying, understanding and addressing those barriers. This kind of support is key to the care,” says Tamasi. “These patients have already been through so much and competing obligations often takes precedence over their own health.”
The success of this collaboration led to a new partnership, anticipated to begin in Winter 2019, with Ward 7-based Unity Healthcare, the largest network of community health centers in the district. This partnership is primarily aimed at improving care for gynecologic and prostate cancers.