The COVID-19 pandemic of 2020 significantly changed how we connected with our communities. Due to fear and misconceptions related to COVID-19, informing and educating the populace on the virus and avoiding contagion was paramount, yet the “stay at home” edict by the Governor meant people could not gather in public places for informational health programs as usual. It became vital that we connect with our citizens and communicate information in order to mitigate the spread of the virus. The following information details how the Community Health team pivoted to care for our communities, and especially care for the most at-risk members of our region. The pandemic magnified health disparities and inequities for minority populations, and we acknowledged the need to address and alleviate the issues that were causing even more distress for them.
Connect – the following initiatives helped us stay in contact with our residents as the health crisis evolved:
- We started the Community Check-In Program in March 2020 at the beginning of the “stay at home” recommendation. The goal of this outreach was to contact approximately 1,500 of our most vulnerable patients over the age of 60 who had participated in some of our health programs and simply check in with them by phone. The Community Health team spoke directly to 657 clients located across 82 zip codes and 9 counties. The team assured the clients that they were not alone, asked if they had questions or concerns about COVID-19, checked for social isolation and made referrals for services such as food distribution and mental health needs. We made follow-up calls to sustain contact over a period of 2 months.
- Our Ambulatory Care department developed and initiated the COVID-19 Community Monitoring Program, which had two key functions. First, caregivers called primary care patients who met criteria for COVID-19 exposure or symptoms to assess their chronic condition symptoms and advise them about how to stay safe at home. Second, caregivers maintained contact with patients for 14 days after discharge from hospitalization for COVID-19. Registered nurses consistently called and advised patients on appropriate measures to enhance convalescence, ascertain adherence to medications and, at times, intervene quickly to call an ambulance or contact a physician for serious symptoms. Between the two arms of the monitoring program, our caregivers contacted and supported 36,885 patients in 2020.
- Through the Minority Men’s COVID-19 Project, we called more than 760 men who had attended our Minority Men’s Health Fairs in recent years. The purpose of the calls was to evaluate individuals for social needs during the pandemic and to connect them to resources for food, prescriptions, health screenings and social isolation as needed.
Communicate – Accurate, up-to-date, bidirectional information exchange with both residents and community leaders was crucial during 2020 as COVID-19 cases surged and ebbed throughout the year. Some of our outreach initiatives are detailed below.
- Our regional hospital presidents held monthly (and sometimes weekly) virtual meetings with local mayors and public health officials to provide intelligence and guidance on incidence, as well as novel technology developed to fight and treat the virus.
- The Community Health team shifted from in-person health education offerings to virtual webinars and programs. We held COVID-19 forums in collaboration with community partners, such as the Cuyahoga County Public Library, local health departments and schools. We leveraged our diverse workforce and subject matter experts to provide educational materials on COVID-19 in English, Spanish and Chinese.
- Community outreach teams from the major health systems in Cleveland joined together to develop and disseminate a Community Resource Guide. During the height of the outbreak, the guide provided citizens with fast access to phone numbers and websites for various types of aid, including free meals, food distribution sites, unemployment assistance and mental health support.
- We engaged with local faith-based organizations through a series of virtual Faith-Based Leaders Forums. The forums provided a platform for us to have meaningful conversations with neighboring pastors, rabbis and imams regarding COVID-19, and enabled us to provide support to faith-based leaders dealing with the significant impacts of COVID-19 on their congregations.
- Recognizing the impact of the digital divide in low-income communities, Community Health managers and medical students provided education on signing up for My Chart and Express Care Online, as well as conducting virtual provider visits. We also created a plan to increase broadband access for our underserved residents to increase healthcare access and enable students to connect to their remote classrooms.
Mitigate – as a leading multispecialty academic medical center, we are committed to sharing resources and expertise to help prevent the spread of COVID-19 in accordance with evolving science:
- Our COVID-19 response efforts included providing over 593,000 COVID tests for our communities. Our laboratory served as the reference lab to 15 hospitals and 100 extended care facilities, federally qualified healthcare centers (FQHC), colleges and universities. We also partnered with the National Guard to conduct testing in some of the most affected areas in Cleveland.
- Cleveland Clinic provided extensive donations of Personal Protective Equipment (PPE) to our community partners. This included face masks, shields and antiseptic cleaners to churches, schools, FQHCs and community-based organizations, as well as cots, blankets and pillows to the overwhelmed homeless shelters in the area.
- In the summer and fall of 2020, we offered numerous virtual programs once the State of Ohio started to re-open facilities and amenities. We counseled educators and faculty with programs such as “Back to School Safely”, we guided employers with “Back to Work” webinars and information and assisted pastors through “Back to Worship” sessions that were specific to types and forms of worship. We also supported organizations such as the Boys and Girls Clubs with in-person evaluations of their spaces so that children could return to those environments safely.
Toward the end of 2020 when COVID-19 vaccines were pending Emergency Use Authorization, we began shifting our dialogue to plan and prepare our partners and community members for the roll-out of the vaccine. Our overarching message in the vaccine conversations was that the vaccine offered the best hope for returning to pre-pandemic activities and routines.
Women's Health/Men's Health
Mammography Clinic at the Langston Hughes Community Health & Education Center
The Mammography Clinic provides breast exams, women’s health education and more. Breast Exams and mammogram screenings are usually covered under most insurance plans. Cleveland Clinic offers financial aid for the uninsured and underinsured. Interested individuals can complete a financial assistance application to determine financial responsibility. The Mammography Clinic is offered through a collaboration between Community Relations and Taussig Cancer Institute.
Interested individuals can schedule an appointment by calling 216.444.2626 and specifying they would like to schedule a mammogram at Langston Hughes Community Health & Education Center.
Maternal and Infant Mortality
Despite the unprecedented events of 2020, Cleveland Clinic continued to respond to the high infant mortality rates in the priority areas of Cuyahoga, Lorain and Summit Counties. Driven by the Infant Mortality Task Force, we continued working on improving birth outcomes and remained more committed than ever to the collective impact goals set for each community in partnership with First Year Cleveland, Lorain Full Term First Birthday and Full Term First Birthday Akron.
In 2020, the COVID-19 pandemic further underscored the critical impact of social determinants of health. In response, we tailored interventions to individuals, connecting them to needed resources for support. We also expanded the evidence-based Centering Pregnancy program to additional communities and reached more pregnant women with Progesterone Therapy, a proven treatment for reducing premature birth.
We moved many of our health initiatives to virtual platforms to continue educational programming about healthy pregnancy and minimizing complications for minority populations and others most at risk. Additionally, Cleveland Clinic is committed to ending longstanding structural racism that causes health disparities by educating more providers and caregivers about health equity and unconscious bias.
Through our Community Health Strategy, we will remain engaged in these and other efforts that show positive measurable birth outcomes and contribute to infant vitality in the communities we serve.
- Established a Centering Pregnancy program at Akron General Hospital to serve the needs of expectant mothers living in greater Akron who are due near the same time through group prenatal care. We also launched a Centering program at the Lorain Family Health Center. These new locations expanded the list of Cleveland Clinic sites where Centering programs are already underway – Lakewood Medical Building, South Pointe Hospital, Stephanie Tubbs Jones Health Center and the Westlake Medical Campus.
- Trained 41 caregivers associated with Centering Pregnancy using the Unconscious Bias Cook Ross seminar to address racism and biases in the healthcare workplace, and specifically reduce the number of African American infant deaths.
- Established a pilot OB Maternal Navigator Program with funding received from the Ohio Department of Health, focusing on infant mortality hot spots in Cuyahoga and Lorain counties.
- Supported HB 11, along with our partners at First Year Cleveland and Full Term First Birthday Greater Akron, and in alignment with the Lorain County Community Health Improvement Plan (CHIP). This legislation advocates for grant-funded, group-based prenatal health care services for pregnant Medicaid patients living in communities with the highest preterm birth rates. Our Government Relations team continued to follow other bills that improve access to care for the medically underserved, improve birth equity, reduce disparities and ensure positive health outcomes.
- Collaborated with other partners of First Year Cleveland to produce social videos to help support pregnant women during the pandemic with tips, resources and updates on hospital safety precautions at the time.
- Rolled out the film TOXIC: A Black Woman’s Story, chronicling the unconscious bias a Cleveland woman encountered during her pregnancy, and held panel discussions for more than 400 women’s health providers at Hillcrest, Fairview and Akron General Hospitals.
- Trained 2,272 Cleveland Clinic caregivers on the ABCs of Safe Sleep, ensuring that baby sleeps alone, on its back and in a crib.
- Collaborated with Lerner School of Medicine and Case Western Reserve University to form an Addressing Infant Mortality group in partnership with Cleveland Clinic’s Infant Mortality Task Force. The group hosted a forum for students about the impact of high cortisol levels on birth outcomes.
- Educated and treated 72.8% of patients who are at risk of recurrent, spontaneous preterm birth with Progesterone Therapy, which is proven to significantly improve birth outcomes.
- Educated expectant mothers and dads, and provided resources through Community Baby Showers and Boot Camps for Dads.
Opioid Awareness Education
We continued our efforts to reduce Opioid Use Disorder (OUD) in 2020 through advocacy, policy work and regional collaboration. Additionally, through our Opioid Education and Prevention Committee, passionate caregivers from across the Enterprise participate in community outreach programs designed to help prevent and reduce opioid and substance abuse. Some of our current efforts to address the opioid crisis include:
- Reducing opioid prescribing by: determining procedural standards via opioid dashboards designed for data collection and sharing, standardizing opioid prescriptions for procedures and implementing numerous tools to ensure appropriate opioid prescribing and dosage.
- Providing educational talks, distributing drug deactivation bags for safe prescription drug disposal at home and collecting unused opioid medications for safe disposal.
- Establishing an Opioid Awareness Center to support caregivers and their families who may be suffering from OUD.
- Participating in the Northeast Ohio Hospital Opioid Consortium, whose members work to: provide education to hospital employees, expand the use of treatments, share and implement evidence-based alternative pain management practices, promote policy changes and increase opioid prevention efforts.