Closing the Gap in Diabetes Care
Last summer, UF Health received a $3.3-million, three-year grant from the Helmsley Charitable Trust to expand its efforts to help diabetics in medically underserved areas.
Background: In 2002, Sanjeev Arora, a doctor at the University of New Mexico, developed a model of medical education and care management to try to improve the health of hepatitis C patients in poor and isolated communities. Called Project ECHO (Extension for Community Healthcare Outcomes), Arora’s model encourages specialists at university medical centers to use tele- or video-conferencing to share their expertise with community-based practitioners.
Problem: Experts saw potential with Type 1 diabetic patients, who should see an endocrinologist at least every three or four months to avoid complications. But in many low-income areas, endocrinologists are in short supply, non-existent or inaccessible because the patients lack health insurance.
Virtual Training: Last year, UF launched Project ECHO Diabetes at public health clinics across Florida to teach community primary care providers how to better treat Type 1 diabetes. Twice a month at lunchtime, specialists at UF Health hold hour-long training sessions with the clinics’ medical practitioners via Zoom, a video-conferencing service. The practitioners also can consult with UF’s specialists on medically complex cases.
Patient Liaisons: The program pairs patients with diabetes-care liaisons — people who have a personal connection to the disease and strong interpersonal skills — to provide emotional and practical support.
Expansion: UF will use the $3.3-million grant to expand Project ECHO from 10 communities to 20 statewide, with services for both Type 1 diabetics and Type 2 diabetics who need insulin.
Success: UF will gauge success by a decline in the number of patients who go to the ER and are hospitalized and by an overall improvement in glycemic control as measured by A1c levels. — By Amy Martinez
Leon Bain grew up as one of three sons of a single mother in Miami’s Liberty City neighborhood. His mother worked “all the time” and rarely took him to the doctor, he says. “She did the best she could.”
It wasn’t until Bain turned 28 that he learned he had diabetes. Then a branch manager at Bank of America, he went for a regular checkup with a primary care doctor and, based on a hemoglobin A1c test, was diagnosed as a Type 2 diabetic.
A decade later, he saw an endocrinologist and underwent more tests, which led to a new diagnosis of Type 1 diabetes, a chronic autoimmune disease that requires daily insulin injections.
Bain, 48, says his diabetes is under control and he’s in good health, but he now wants to help other diabetics get the kind of care he wishes he and his oldest brother, Larry, could have had earlier in life. Two years ago, Larry died of complications from uncontrolled Type 1 diabetes.
“The loss was painful. I saw all of the nasty effects that uncontrolled diabetes plays on someone,” Bain says.
Last year, Bain, who has an associate’s degree in psychology from Miami-Dade College, joined UF Health as a patient liaison for Project ECHO. He works one-on-one with diabetics in Liberty City and Miami Beach to help them control their blood sugar levels. He shows them how to use insulin pumps and continuous blood-glucose monitors, accompanies them to doctor appointments and addresses their insurance issues. — By Amy Martinez
A Blood Test for Brain Injuries
When Dr. Linda Papa started working with University of Florida scientists two decades ago on finding a biomarker to develop a blood test for brain injuries, many dismissed the effort as too difficult, if not downright impossible. But they didn’t give up.
“We hunkered down and started looking at the serum of patients with severe traumatic brain injuries, and from there we realized there were some significant protein elevations after severe brain injuries,” recalls Papa, an ER physician at Orlando Health and unpaid consultant to UF spinoff Banyan Biomarkers.
The next big revelation was that they could use those biomarkers, known as UCH-L1 and GFAP, to accurately predict whether a patient had a significant lesion on a computed tomography (CT) scan. The discovery sparked interest from the Department of Defense and the National Institutes of Health, and soon funding was pouring in for large-scale trials.
Last year, the researchers hit another milestone: The Food and Drug Administration authorized Banyan Biomarkers to start marketing its biomarker blood test — known as the Banyan Brain Trauma Indicator — to companies that can fine-tune it into something all physicians can use.
Right now, it takes about four hours to run the biomarker test on special equipment in a lab, Papa says, so it’s not quite ready to roll out to the masses. But she says they’re getting close to having a more practical test unit that could provide results within minutes in an ER, an ambulance, a sports field or on a battlefield. “I think within the next year, we’re going to have that,” she says.
Papa predicts the blood test will one day reduce the number of CT scans — which are expensive and deliver radiation to the patient — ordered by doctors.
She also believes the test holds promise for a subset of patients with mild concussions that don’t show up on CT scans and go undiagnosed. “It can be significant for 30% of people, and it can disrupt their lives where they can’t work properly anymore, they can’t function with their family anymore,” she says. — By Amy Keller
Tampa General Hospital has installed an OnMed tele-health station, where the hospital’s employees can get quick video access to physicians and other health care providers and receive automated pharmaceutical services. OnMed is based in Clearwater. — By Art Levy
HealthHub: At the recently opened BayCare HealthHub in Valrico, patients can see a physician, take a fi tness class, work out, shop for food and buy a Fitbit. “Our goal was to create a state-of-the-art health and wellness destination, incorporating innovative technology and convenience to not just treat symptoms but also keep families healthier,” says Jim Cote, BayCare’s senior vice president for ambulatory services. The HealthHub includes a 20,000-sq.-ft. fitness center, a walking trail and access to local vendors selling produce and other products. — By Art Levy
In October, UM’s Miller School of Medicine opened a 10-bed medical psychiatric unit at UM Hospital, which treats patients who cannot be admitted to a general psychiatric unit because of medical conditions. It is the only medical psychiatry unit in Miami-Dade, Broward and Palm Beach counties. The hospital also dedicated 14 new inpatient rooms as its Mood Disorders Unit in October. This unit is for high-functioning adults dealing with depression, anxiety, bipolar disorder and other mood disorders. They receive medication management, therapy and a variety of other interventions and approaches for complex mood disorders.
Community Health of South Florida, a non-profit that specializes in affordable primary and behavioral health care, is gearing up to build a children’s crisis unit, the Dr. Jacquelyn T. Hartley Children’s Crisis Center, on its main campus in the southern part of the county. The organization receives about 600 children each year who have been Baker-acted (involuntarily hospitalized for psychiatric care) by the police, and currently transfers them all to other facilities.
The Jerome Golden Center for Behavioral Health, a 44-bed psychiatric hospital in West Palm Beach, closed in October. The nonprofit hospital served low-income and uninsured patients.
New CEO: Broward Health, the taxpayer-subsidized hospital system, appointed nurse and Broward Health Medical Center COO Heather Havericak CEO of the medical center, the system’s largest facility. She had been interim CEO. — By Mike Vogel
Lee Health’s Gulf Coast Medical Center in Fort Myers is nearing completion of a $315-million addition/renovation that will make it one of the biggest hospitals in Southwest Florida. By next January, the hospital will have a new emergency department, and 216 new acutecare beds are expected to open by spring 2020. A new intensive care unit with 52 new beds is scheduled to open in 2021.
About the project:
- After the work is completed, the total number of beds at Gulf Coast Medical Center will be 624 — 536 acute and 88 intensive care — giving the hospital the most beds of any hospital between Sarasota and Miami. The hospital currently has 356 beds.
- The number of emergency room beds will increase from 42 to 74.
- The hospital employs 2,108. Over the next two years, employment will increase by 400.
- The hospital is adding 367,500 square feet of new space and 48,500 square feet of renovated space. — By Art Levy
Growth Plans: Pensacola-based Baptist Health Care is planning to build a $550-million hospital. The existing hospital near downtown Pensacola will continue to operate as a full-service hospital. The new hospital will have 250 beds, with the potential to grow and add floors. — By Carlton Proctor
Medicare cut payments to 159 Florida hospitals out of 2,583 nationally as part of an Affordable Care Act effort to rein in the number of patients who have to be readmitted within a month.
Kaiser Health reports five Florida hospitals were among the 56 nationally that got the maximum penalty of a 3% cut. They are Palms of Pasadena, St. Petersburg; Lakeland Regional, Lakeland; Raulerson Hospital, Okeechobee; St. Lucie Medical Center, Port St. Lucie; and St. Vincent’s Southside, Jacksonville. The average penalty nationally was 0.71%.
Nationally, 83% of hospitals evaluated were penalized. The penalty is deducted from each payment for Medicare patients during this fiscal year. Industry observers say the eight-year program incentivizes hospitals to focus on patient recovery and helping patients obtain medications and make it to follow-up appointments. Others worry the program hasn’t led to any major reduction in readmissions and might lead hospitals to avoid readmitting patients who need it. The review covers patients treated for heart failure and heart attack, pneumonia, chronic lung disease, bypass graft surgery and hip and knee replacements.
Five Florida hospitals were evaluated and not penalized: Naples Community, Naples; Venice Regional Bayfront, Venice; Sarasota Memorial, Sarasota; Mease Countryside, Safety Harbor; and Douglas Gardens, Miami.
Hospitals penalized at 0.09% or less: Holy Cross, Fort Lauderdale; Homestead Hospital Baptist Health, Homestead; Health First Cape Canaveral Hospital, Cocoa Beach; Memorial Hospital, Miramar; West Kendall Baptist, Kendall; and Tallahassee Memorial, Tallahassee. — By Mike Vogel
Miami’s Hospital Scene
Miami-Dade is experiencing a hospital building boom. Planned or under construction are:
Plans for a 200-bed Palmetto Bay hospital on 71 acres are tied up in a court battle between the village and developer Luxcom Builders over whether the land is zoned for a hospital.
Jackson West Medical Center in Doral wants to open an acute-care hospital, José Milton Memorial Hospital, a 100-bed facility on 27 acres.
Jackson South Medical Center is adding 100 beds, bringing its total to 354.
Christine E. Lynn Rehabilitation Center for The Miami Project to Cure Paralysis at UHealth/Jackson Memorial Medical Center is adding 100 beds. The facility will house inpatient and outpatient rehabilitation facilities for adult and pediatric patients with spinal cord and traumatic brain injuries
In the Keys, Baptist Health South Florida is rebuilding Fishermen’s Community Hospital. The hospital was almost destroyed by Hurricane Irma.
License to Treat
- 63% of bed licenses are held by non-profits
- Top Six Owners of Hospital Bed Licenses in Miami-Dade
- Jackson Health System (non-profit): 2,137
- Baptist Health South Florida (non-profit): 1,720
- Tenet (for-profit): 1,328
- HCA (for-profit): 789
- University of Miami Health System (UHealth) (non-profit): 700
- Mount Sinai Medical Center (non-profit): 672
Top Owners of Hospital Bed Licenses in Monroe County
- Baptist Health South Florida (non-profit): 29 beds
- dePoo Hospital (for-profit): 49 beds
- Lower Keys Medical Center (for-profit): 118 beds
Source: Florida Agency for Health Care Administration
Read more in Florida Trend's December issue.
Select from the following options:
* offer valid for new subscribers only