Dr. Ruth Perry with Gregory Paulson, deputy director of the Trenton Health Team. (Photo by Matt Rainey for B Taylor PA.)
Dr. Ruth Perry (right) at the Rescue Mission of Trenton with Mary Gay Abbott Young. (Photo by Matt Rainey for B Taylor PA.)
Health professionals from area hospitals team up to treat Trenton residents
Trenton Health Team executive director Dr. Ruth Perry tells the story of a homeless woman who was living at the Trenton train station and, despite being a frequent user of hospital emergency room services — 465 times in the prior year — was still falling through the social cracks.
Then a tip from a station transit officer to an engaged health professional set things in motion. Using the resources being shared by the Trenton Health Team professional health agency partners, team members reviewed the woman’s records, and a social worker began helping her with the basics, such as obtaining a valid I.D. card and straightening out problems preventing her from receiving Social Security. Then she received coaching on how she could start taking care of herself better.
Today the woman has housing that she pays for herself and gets the regular medical attention that supports her. The once lost woman’s case history points to one of the team’s successes in city with a number of challenges.
“If you’re socially disadvantaged and traumatized since youth, it’s very difficult to navigate the system,” Perry says.
The Trenton Health Team (THT) is a nonprofit collaborative between St. Francis Medical Center, Capital Health Systems, the Henry J. Austin Health Center (the largest health clinic in Trenton) and the City of Trenton Health Department.
The issue of treating repeat emergency room visitors came into focus in 2005 when Mayor Doug Palmer was entering his final term and Capital Health Systems was proposing to close one of its two city-located hospitals as it planned to open a new one in Hopewell Township.
Palmer started a conversation regarding the impact of reduced hospital services on the Trenton residents who most depended on them. A major challenge was the needs of the homeless, especially those who had personal medical issues that were difficult to manage and who were most likely to go to emergency rooms for treatment.
The city’s two largest hospitals decided to set aside their competitive interests and address a larger issue, namely how the combined efforts of the city’s major health care players could benefit all by reducing the costs from treating people who relied on hospital emergency rooms like they were their own private doctor’s offices. One thing that became apparent right away was that frequent users of emergency rooms very often used more than one emergency room.
The coordinated effort of using previously unavailable data to track patients also had a greater benefit of reducing state and national medical costs.
According to the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality, the cost of treating repeat visitors to hospital emergency rooms — a fact of life in New Jersey cities — is about 21 percent of the nearly $1.3 trillion spent each year on health care in the United States, more than $270 billion per year.
To maximize existing medical services in the capital city, THT launched a 2011 strategic initiative to improve patient experience, improve the health of the Trenton’s population, and lower costs. To do so, the team developed five goals:
One, lay the groundwork to become a Medicaid Accountable Care Organization (ACO), defined by the Center for Medicare and Medicaid Services groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve, and provide better population health and containment of health care costs.
Two, expand access to primary care by reducing wait times at the city’s health centers and providing new patient-centered, personalized approaches to care.
Three, coordinate community-wide clinical care for those seeking primary care in the emergency room by targeting high users of hospital services.
Four, share information among health care providers across settings to improve care coordination, avoid duplication of services, and reduce medical errors;
Five, engage residents in a concerted effort to understand and overcome obstacles to quality health care.
In an editorial in February 2012, Perry noted many of the challenges that the city faces: “One quarter of Trenton’s underprivileged have no health-care coverage and suffer from higher-than-average rates of diabetes, hypertension, and obesity. Residents have little access to primary care, and until recently it could take weeks to get a clinic appointment. Instead, patients often visit emergency rooms for problems that are not emergencies. Using the ER this way is more expensive than using primary care services, and without follow-up care, the patient will probably end up in the ER again soon.”
Add other circumstances — high violent crime and poverty rates — and one finds “a city where poverty combines with a broken system to create significant barriers to health and overwhelming health-care costs. The city’s most destitute also frequently face homelessness, substance abuse and mental health issues.
“An improved Triple Aim for the city of Trenton will not occur until collaborative work is undertaken by all community stakeholders to alleviate lack of economic opportunity, education, and housing, because all of these factors are intimately tied to improved health and quality of life,” says Perry in a March, 2013, report.
The same report lists the following preliminary results: a reduction of 30-day hospital readmissions in Mercer County by 6.8 percent between 2011 and mid-2012; reduced patient wait times across the board, most notably at Henry J. Austin, from 37 days to 2; improved patient provider continuity at St. Francis Medical Center from 0 percent to more than 95 percent, building trust and reinforcing use of primary care services for non-emergent care; and a Capital Health pilot program to bring sickle cell patients from the emergency room into a dedicated primary care practice, reducing emergency room visits by 33 percent in an initial group of five patients.
While the efforts are felt in Trenton, they are being noticed elsewhere. In August, 2013, the National Quality Forum recognized Perry’s expertise regarding healthcare quality and appointed her to its national healthcare workgroup and two subcommittees.
“Dr. Perry brings a broad spectrum of healthcare experience and vision, having served in a leadership role in corporate environmental health and safety and as an emergency room physician prior to leading the Trenton Health Team. Her rich background will enable her to contribute significantly to this national effort to ensure quality healthcare outcomes,” says David Knowlton, former deputy commissioner of the New Jersey Department of Health and CEO of the Pennington-based New Jersey Health Care Quality Institute, who recommended Dr. Perry for the Workgroup position.
Perry, who received her M.D. at Temple University in Philadelphia, says that her awareness of emergency room returnees began 25 years ago as an emergency room physician at the Albert Einstein Medical Center in Philadelphia. After several years she began another career and focused on product safety and best practice implementations at Rohm and Haas. When the company merged with another and transferred its offices to Michigan, she then became involved with the Trenton Health Team, where she uses both her business and medical expertise.
Perry, a classical pianist who also sings in the choir of the Trinity Episcopal Cathedral in Trenton and lives with her two grown daughters outside Philadelphia, says “one busy night I remember standing in the emergency room and realizing that most of the people were there for Medicaid ramifications of social problems. It’s very interesting to fast-forward 25 years and we see that case management is not new.”
However, the Trenton Health Team efforts are related to the changes in federal and state health care laws and the availability of health care in the capital city. Its positive efforts are being aided by support from the Nicholson and Robert Wood Johnson foundations and engagement in pilot programs such as the Horizon Foundation for New Jersey funded program to enable healthcare professionals to digitally communicate complex data in more simple terms and enhance communication.
As Perry states in her editorial, the overall effort is related to a simple premise. “Trenton residents deserve better health care. Through the efforts of all of us on the Trenton Health Team and our partners, they are beginning to receive it. With their active engagement, we fully intend to reach our goal of making Trenton the healthiest city in the state.”
The Trenton Health Team office is located at the Trenton City Health Department, 218 North Broad Street, Trenton. For more information call (609) 989-3262 or visit trentonhealthteam.org.
–Ron Shapella and Dan Aubrey