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This Is a Critical Moment: Delaware Must Not Go Backward in Health Equity
The proposed Delaware House Bill 350 is well-intended but would have terrible consequences for Delaware’s most vulnerable populations. There is a better way. By LeRoi S. Hicks, M.D., MPH, FACP As a Black physician who has dedicated his 25-year career to understanding and addressing health equity, I am deeply concerned about Delaware’s proposed House Bill 350, which aims to address rising health care costs by establishing a body of political appointees that would oversee the budgets of Delaware’s nonprofit hospitals. While the goal of bending the cost curve in health care may be well-intentioned, this bill will have horrific consequences for Delaware’s most vulnerable populations, including Black people, Hispanic people and other groups that have been traditionally underserved in health care. We can and must work together to solve this problem and provide the right care, in the right place, at the right time. A tale of two cities To borrow a phrase from Charles Dickens, Delaware, like much of America, is a tale of two cities. The experience of life—including a healthy, safe environment and access to good-quality health care—is vastly different depending on where you live and your demographic background. In the city of Wilmington, for example, ZIP codes that are just a few miles apart represent more than 20 years difference in life expectancy. This is not OK—it’s a sign that we have serious structural problems in our communities that are causing harm to people and making their lives shorter. Importantly, chopping $360 million out of Delaware’s hospital budgets, as House Bill 350 would do in year one, is not going to help this problem—it’s going to make it worse. And in doing so, it would ultimately make health care in Delaware more expensive—not less expensive. The key to lowering health care costs is to improve quality, access and equity Data show that about 5% of patients in the United States account for more than 50% of all health care costs. These are primarily patients who have complex and poorly managed chronic conditions that cause them to end up in the most expensive care settings—hospitals, operating rooms, emergency departments. The key to driving down health care costs is to improve quality and equity so that everyone is supported in achieving their best health, and these high users of the most expensive kinds of care are better supported in managing their health conditions such as diabetes or heart failure in the appropriate way. In doing so, they prevent the need for costly emergency or “rescue” care. Let’s do more—not less—of what we already know works Health care is not a one-size-fits-all industry. The delivery of care for patients across a diverse population requires multiple interventions at the same time. These interventions are designed not only to improve the quality of care but also to close the gap in terms of health care disparities. That’s important, because when we improve care and outcomes for the most vulnerable populations, we tend to get things right for everyone. One type of intervention is about doing exactly the right things for a patient based on the evidence of what will help—and doing nothing extra that will cause harm or generate additional costs without providing additional benefit. An example of this might be ensuring that every patient who has a heart attack gets a certain drug called a beta blocker right after their heart attack, and they receive clear guidance and support on the actions they must take to reduce their risk of a second heart attack, such as regular exercise and good nutrition. The second type of intervention is for the highest-risk populations. These are patients who live in poor communities where there are no gyms and no grocery stores, and people commonly have challenges with transportation and lack of access to resources that makes it difficult—sometimes impossible—to follow their plan for follow-up care. They lack access to high-nutrient food that reduces their risk of a second heart attack. They also live in areas where there are fewer health care providers compared to more affluent areas. These interventions tend to be very intensive and do not generate income for health systems; in fact, they require significant non-reimbursed investment, but they are necessary to keep our most vulnerable patients healthy. The medical community has developed interventions for these populations that are proven to work. A local example is the Delaware Food Pharmacy program, which connects at-risk patients with healthy food and supports their ability to prepare it. The program helps patients improve their overall health and effectively manage their chronic conditions so they can prevent an adverse event that would put them back in the hospital or emergency department. When we work together, we succeed We’ve seen incredible examples of how this work can be successful right here in Delaware. Delaware was the first state in the country to eliminate a racial disparity in colorectal cancer, and we did this by expanding cancer services, including making it easy for vulnerable people to get preventive cancer care and screenings. This is an incredible success story that continues to this day, and it was the result of thoughtful, detail-oriented partnerships among the state and the health care community. The work continues as we collaborate to reduce the impact and mortality of breast cancer in our state. Unfortunately, these kinds of interventions are the first thing to go when health care budgets get slashed, because they don’t generate revenue and are not self-sustaining. These kinds of activities need to be funded—either through grants or an external funder, or by the hospitals and health care systems. By narrowly focusing on cost, we risk losing the progress we have made Delaware House Bill 350, as it’s proposed, would cause harm in two ways: First, it would compromise our ability to invest in these kinds of interventions that work. Second, it increases the risk that higher-cost health services and programs that are disproportionately needed by people in vulnerable communities could become no longer available in Delaware. In states where the government has intervened in the name of cutting costs, like Vermont and Massachusetts, we see the consequences–less quality and reduced equitable access to much-needed services. House Bill 350 will widen the gap between those who have means and those who are more vulnerable. These changes will lead to increased disease burden on these populations. They will end up in the emergency room more and hospitalized more, which is by far the most expensive kind of care. That’s not what anyone wants—and it’s the opposite of what this bill was intended to accomplish. At this moment, in Delaware, we have an opportunity to put our state on a sustainable path to better health for all Delawareans. House Bill 350 is not that path. However, the discussion that House Bill 350 has started is something that we can build on by bringing together the stakeholders we need to collaborate with to solve these complicated problems. That includes Delaware’s government and legislators, the hospitals and health centers, the insurance, pharmacy and medical device industries, and most importantly, patients and the doctors who care for them. LeRoi Hicks, M.D., is the campus executive director for ChristianaCare, Wilmington Campus.
Healthy Environment, Healthy People: The Intersection Between Climate and Health
How is climate change influencing our health? Why does climate change have a greater impact on vulnerable populations and low-income people? How does the U.S. health care system affect the climate? How can health care systems improve their impact on the climate and the environment? ChristianaCare’s inaugural Climate and Health Conference addressed these topics and raised possible solutions at the John H. Ammon Medical Education Center on the Newark, Delaware, campus on April 12. At the conference, the common denominator was this: An unhealthy environment can lead to illnesses and deaths from air pollution, high heat, contaminated water and extreme weather events. Health systems, government entities, community organizations and individuals all have a role to play in decreasing these effects. “Climate, the environment and health care systems are intertwined,” said Greg O’Neill, MSN, APRN, AGCNS-BC. “We need to pay close attention to this relationship so we can improve health for everyone.” O’Neill is director of Patient & Family Health Education and co-chair of the Environmental Sustainability Caregiver Committee at ChristianaCare. Climate change and intensifying health conditions Negative health effects are so closely tied to the environments where people live, work and play that The Lancet called climate change “the greatest global health threat facing the world in the 21st century [and] the greatest opportunity to redefine the social and environmental determinants of health.” At the conference, speakers addressed specific areas of concern. Asthma. Air pollutants, while largely invisible, are associated with asthma. What’s more, people who live in urban areas with little green space are more likely to have uncontrolled asthma, said speaker Robert Ries, M.D., an emergency medicine resident at ChristianaCare. And there’s the rub, he said: When people with asthma spend time in green spaces, it may improve their health. “In Canada,” he said, “some doctors prescribe nature – two hours a week for better overall health outcomes. Could we do that here?” Heat-related illness. Temperatures worldwide have been rising, increasing the likelihood of heat-related health incidents. Heat waves may be harmful to children and older adults, particularly those who don’t have access to air conditioning, swimming pools or transportation to the beach, said speaker Alan Greenglass, M.D., a retired primary care physician. Children visit the emergency room 20% more frequently during heat waves. Weather-related illness. Climate change is causing more floods, which may result in respiratory problems due to mold growth; and droughts, which may threaten water safety and contribute to global food insecurity, said speaker Anat Feingold, M.D., MPH, an infectious disease specialist at Cooper Health. Stress and anxiety. Climate change can affect mental health, even leading to “solastalgia,” which is distress about environmental change and its effect on one’s home, said speaker Zachary Radcliff, Ph.D., an adolescent psychologist at Nemours. He encouraged clinicians in the audience to keep this mental health concern in mind when seeing patients as it may become more prevalent. Cardiovascular disease risk. Frequent consumption of red meat increases the risk of cardiovascular disease, the top cause of death in the U.S. It’s also unhealthy for the environment, said speaker Shirley Kalwaney, M.D., an internal medicine specialist at Inova. Livestock uses 80% of available farmland to produce only 17% of calories consumed, creating a high level of greenhouse gas emissions. By comparison, plant-based whole foods decrease the risk of cardiovascular disease and diabetes. They use only 16% of available farmland, producing 82% of calories consumed. This makes reducing red meat in our diets one of the most powerful ways to lower the impact on our environment. Health equity and the environment People in low-income communities are more likely to live in urban areas that experience the greatest impacts of climate change, including exposure to air pollutants and little access to green space, said speaker Abby Nerlinger, M.D., a pediatrician for Nemours. A Harvard study in 2020 demonstrated that air pollution was linked with higher death rates from COVID-19 — likely one of the many reasons the pandemic has disproportionally harmed Black and Latino communities. Similarly, access to safe, affordable housing is essential to a healthy environment, said Sarah Stowens, Ed.D., manager of State Policy and Advocacy for ChristianaCare, who advocated for legislation including the Climate Solutions Act, another bill that increased oversight regarding testing and reporting of lead poisoning and a policy to reduce waste from topical medications. Opportunities for change in health care Reduce emissions from pharmaceuticals and chemicals. These emissions are responsible for 18% of a health system’s greenhouse gas emissions. One way to reduce this number is for clinicians to prescribe a dry-powder inhaler (DPI) instead of a metered-dose inhaler (MDI) when applicable and safe for the patient and to give patients any inhalers that were used in the hospital at discharge if they are going home on the same prescription. Hospitals have opportunities to reduce greenhouse gases while caring for patients, said Deanna Benner, MSN, APRN, WHNP, women’s health nurse practitioner and co-chair of ChristianaCare’s Environmental Sustainability Caregiver Committee. The health care sector is responsible for 8.5% of U.S. greenhouse gas emissions, the highest per person in the world. U.S. greenhouse gas emissions account for 27% of the global health care footprint. One way to significantly reduce the carbon footprint is to use fewer anesthetic gases associated with greater greenhouse gas emissions, Benner said. Limit single-use medical devices. Did you know that one surgical procedure may produce more waste than a family of four produces in a week? Elizabeth Cerceo, M.D., director of climate health at Cooper Health, posed this question during her talk. Sterilizing and reusing medical devices, instead of using single-use medical devices, she said, may meaningfully reduce hospital waste. ChristianaCare’s commitment to healthy environments and healthy people As one of the nation’s leading health systems, ChristianaCare is taking a bold, comprehensive approach to environmental stewardship. ChristianaCare reduced its carbon footprint by 37% in 2023 by purchasing emission-free electricity. ChristianaCare joined the White House Climate Pledge to use 100% renewable energy by 2025, reduce greenhouse gas emissions by 50% by 2030 and achieve zero net emissions by 2050. ChristianaCare has created an Environmental, Social and Governance structure to help advance a five-year strategic plan that delivers health equity and environmental stewardship. Nearly 150 staff members have become Eco-Champions, an opportunity to be environmental change-leaders in the workplace. In 2023, ChristianaCare’s successful environmental stewardship included: Reducing our carbon footprint by 37% by purchasing emission-free electricity. Recycling 96,663 pounds of paper, which preserved 11,485 trees. Reducing air pollution by releasing an estimated 33,000 fewer pounds of nitrogen oxides and sulfur oxides through the use of a cogeneration energy plant on the Newark campus. Donating 34,095 pounds of unused food to the Sunday Breakfast Mission in Wilmington, Delaware. Donating 1,575 pounds of unused medical equipment to Project C.U.R.E., ChristianaCare’s Virtual Education and Simulation Training Center and Delaware Technical Community College. “In quality improvement, they say you improve the things that you measure,” O’Neill said in expressing goals for continued success. In looking ahead, said Benner, “I really hope that this conference is the catalyst for positive change with more people understanding how climate is connected to health, so that we can protect health from environmental harms and promote a healthy environment for all people to thrive.”
Ask the Expert: What is the impact of the Francis Scott Key Bridge on the supply chain?
Early in the morning on March 26, 2024 a super freighter lost complete power and struck a support column on the Interstate 695 (I-695) resulting in catastrophic collapse of the bridge. This will limit shipping until salvage and cleanup operations are completed. The shutting down of the port will have a direct impact on the economy of Baltimore at a rate of over $200 million of cargo passing through the port every day. Dr. David Rollins, a supply chain expert and an assistant professor in the Rader School of Business at Milwaukee School of Engineering, provides insight into the industrial, consumer and fiscal impact of the Key Bridge collapse. "The port’s major exports are coal, automobiles, and light trucks, while it imports goods like sugar, cars, light trucks, heavy farm and construction machinery, minerals, and fertilizer. The shipping methods employed by the port of Baltimore include containerized units, break bulking, and roll-on roll-off for automobiles, trucks, and machinery. "The impact on the global supply chains will be negligible from the standpoint that the ports of Philadelphia and Norfolk are poised to accept international shipping vessels and have the capacity for the extra traffic. The supply chain for coal and automobiles will be disrupted in the short term as the traffic of both international cargo ships and railcars will be rerouted to the other ports. Materials loaded on ships scheduled to depart after March 26th will likely be held until the salvage and cleanup are completed. However, if a customer needs expediting services, materials may be shipped through air cargo or rerouted to another port for shipment. "A supply chain requires three elements to be successful: The logistics and transportation of physical goods, which is a short-term issue for Baltimore. An information channel, if executed properly supply chain and logistics managers shipping through the Port of Baltimore have rerouted goods to either Norfolk, VA or Philadelphia, PA, the two closest ports. The transfer of funds for both goods and services, which has a limited impact on the supply chain compared to the potential impact on the city of Baltimore’s economy. "Prior to COVID-19, the information exchange part of supply chains was mostly overlooked. Improved communication will help render the bridge collapse a minor issue in the global supply chain. "One domestic issue will be the time and distance between the seaports and the supplier’s location or the destination of the products. From the Midwest, the largest source of automobile suppliers, rail shipping requires extra lead time but will keep transportation costs low. If producers ship via truck, the increase in mileage to the closest port, Philadelphia, is 56 miles resulting in an increase in fuel cost per shipment of approximately $34.461. "The Key Bridge incident will result in the rerouting of traffic via Interstate 95 (I-95) through Baltimore. I-95, which travels through the Fort McHenry tunnel to downtown Baltimore will be highly congested during commuting times resulting in slower deliveries. Interstate 895 (I-895), traveling through the Harbor tunnel, also provides another. Both routes will only add a couple of miles for goods movement. Hazardous material trucking will not be allowed through the tunnels and will be required to take I-695 around the west and north side of the city. This route is 14 miles longer than the Francis Scott bridge route. "Typically, semis get around 6.5 miles per gallon of diesel fuel2. Increasing the costs for the logistics and trucking companies. Based on the load capacity of a semi-trailer at 48,000 pounds, the increase in fuel expenditures will have a negligible effect on the cost to consumers. "The resilience of the supply chain has improved in the past couple of years due to lessons learned during the COVID-19 pandemic. The extent to which supply chain managers have grown and adopted changes will determine the ultimate effect the Francis Scott Key Bridge had on the supply chain." Dr. Rollis is available to speak with media about the impact the Key Bridge collapse will have on the supply chain. Simply click on his icon below to arrange an interview. ### 1Estimated fuel costs based on mileage from Chicago to the port with an estimated truck mileage of 6.5 per gallon at a price of $4.00 per gallon. 2Motorask.com, supported by the U.S. Bureau of Transportation Statistics. The BTS did not have data after 2021, but the website Motorask.com used the higher mileage which is used in the calculation.
Opening up supply chain blockages in the wake of the Baltimore bridge collapse
The impact of the Baltimore bridge collapse on supply chains is as massive as it is obvious. Finding the solutions to repairing the damage is not so simple, according to Bintong Chen, professor of operations management at the University of Delaware. Pain points include the loss of a major access point to a busy port and international car and truck shipping; a significant dent in commercial trucking (especially hazardous material transportation); and a strain on civilian commuting. Chen offers two solutions: Clear the water way first and quickly so that shipping will resume normally. This is the first priority and should not take long. Develop a plan to re-route traffic, as it will take four to five years to build a bridge to replace the Francis Scott Key Bridge. He proposes the following traffic changes: Divert all commercial trucking flow to William Preston Lane Jr. Memorial Bay Bridge. Reduce or remove the toll for night trucking in order to spread the truck flow and reduce the congestion. Reduce or remove the toll for the Baltimore tunnel at night for civilian commuting for the same purpose. To schedule an interview with Chen, visit his profile and click on the contact button or reach out to the UD Media Relations team.
With the Port of Baltimore all but closed, how will the supply chain be impacted?
Following the incident of the container ship crashing into the Francis Scott Key Bridge at the Port of Baltimore and the bridge collapsing, there are now some supply chain concerns. While they may not be felt right away by consumers, there are a number of businesses that will be affected by it. Rick Franza, PhD, professor in Augusta University's James M. Hull College of Business and an expert on operations and supply chain management, said one immediate impact is where container ships will be diverted to for offloading. The Port of Baltimore is a major shipping hub and ranks first among U.S. ports for autos and light trucks. Now those ships will have to find other ports to unload their goods, which becomes a logistical problem as much as anything. “Most ports on the East Coast are at 70% to 80% capacity, which is where you want to be. You don’t want to have much more than that, but they’re going to have to,” said Franza. “It could affect a good bit of the eastern half of the United States.” Ports in Savannah, Charleston and New York, among others, will have to become the destination for those currently sitting outside Baltimore and those en route from around the world. The good news, Franza said, is that most foreign car manufacturers have plants in the United States so it will likely only affect those consumers looking for a certain brand or even a specific model. Baltimore is also one of the furthest inland ports and has the best rail service coming from it. The outbound goods coming off the ships will now face more of a transportation hurdle when they are diverted to another port. “It’s not just the capacity of the port, that’s one thing, but it’s also their capacity of the outbound items,” he said. “It may be more trucks are needed, and new routes are needed to move inventory. It now becomes a whole different set of providers for the trucks because it’s no longer the people in Baltimore.” Franza added companies will also have to decide which distribution centers they may want to use, whether it’s closer to the area they serve or closer to the port. All those factors affect where the items from overseas end up. While it’s not a good scenario, at the end of the day, he feels the consumer likely won’t see much of an impact. “First of all it’s going to take a while before we see any effect on certain things,” Franza said. “The bad news for inflation is that it’s going to raise the cost of transportation for the goods coming off the ships. Will businesses absorb the cost or pass them along to consumers?” Looking to know more? Then let us help. Richard Franza, PhD, is available to speak with media about trending issues like inflation, small business and the economy – simply click on his icon now to arrange an interview today.
Municipalities around the world have invested significant resources to develop connected smart cities that use the Internet of Things (IoT) to improve sustainability, safety and efficiency. With this increased demand for IoT experience, the VCU College of Engineering formed the OpenCyberCity testbed in 2022. The 1:12 scale model city provides a realistic, small-scale cityscape where students and researchers can experiment with new and existing smart city technology. Sherif Abdelwahed, Ph.D., electrical and computer engineering professor, is director of OpenCyberCity. He recently answered some questions about new developments within the testbed. The OpenCyberCity is a smart city testbed, but are there any real-life cities that one could call a smart city? Several real-life locales are considered smart cities due to their extensive use of technology and data-driven initiatives to optimize infrastructure and services. Dubai is one of the most notable. They have implemented smart transportation systems, buildings and artificial intelligence to transform the city’s operations and make them more efficient. Other reputable smart cities include Singapore and Seoul, which utilize smart energy management, smart transportation and comprehensive data analytics for improved urban planning and services. Seoul, in particular, has an initiative with smart grids and connected street lights, which VCU Engineering’s own OpenCyberCity test bed is working to implement. How does the OpenCyberCity address privacy? With so much technology related to monitoring, how are individual citizens protected from these technologies? Privacy is a major concern for smart cities and it is one of the main research directions for VCU Engineering’s OpenCyberCity. We are developing several techniques to prevent unwanted surveillance of personal information. Sensitive data is protected by solid protocols and access restrictions that only allow authorized users to view the data. Our aim is to find a reasonable middle ground between technological progress and privacy rights, staying within legal and ethical bounds. Some techniques to address privacy concerns include: Data Anonymization: This makes it difficult to trace back information to individual identities. Within the testbed, we will evaluate how to protect individual privacy while maintaining data utility and assess the impact on data quality. Secure Data Storage and Transmission: Encrypt data to protect it from unauthorized access. In the smart city testbed, these access control mechanisms will be implemented within the testbed’s infrastructure. We will also test different data handling processes and access control models to determine their ability to safeguard sensitive data. Privacy Impact Assessments: Regularly evaluate potential privacy risks of new smart city projects in order to mitigate them and ensure the ethical handling of data by those with access. Policy and Regulation Development: Data and insights generated from OpenCyberCity experiments can inform the development of cybersecurity policies and regulations for smart cities. How is the College of Engineering’s OpenCyberCity test bed different from similar programs at other institutions? While other universities have similar smart-city-style programs, each has their own specialty. The VCU College of Engineering’s OpenCyberCity test bed focuses on real-world contexts, creating a physical space where new technologies, infrastructure, energy-efficient transportation and other smart city services can be tested in a controlled environment. Our lab monitors real-time data and develops smart buildings, smart hospitals and smart manufacturing buildings to enhance the city’s technologies. Recent additions to the OpenCyberCity allow for expanded research opportunities like: Advanced Manufacturing: Students can apply advanced manufacturing techniques in a controlled environment. They can also test new materials, processes and automation technologies to improve efficiency and product quality. Energy Efficiency Testing: Environmental engineers and sustainability experts can evaluate energy consumption patterns within the smart manufacturing unit to implement energy-saving measures and assess their impact on sustainability. Production Optimization: Manufacturers can use real-time data from the smart manufacturing unit to optimize production schedules, minimize downtime and reduce waste. Predictive maintenance algorithms also help prevent equipment breakdowns. Education and Training: Hands-on experience with state-of-the-art manufacturing technologies helps train the workforce of the future. Integration with Smart City Services: Data generated by the manufacturing unit can be integrated with smart city services. For example, production data can inform supply chain management and energy consumption data can contribute to overall city energy efficiency initiatives. How has the OpenCyberCity changed in the last year? Is the main focus still data security? What started with research examining, analyzing and evaluating the security of next-generation (NextG) applications, smart city operations and medical devices has expanded. Data security is now only one aspect of OpenCyberCity. Its scope has grown to encompass more expansive facets of cybersecurity like automation and data analytics in the domain of smart manufacturing systems. The implementation of a smart manufacturing system in 2023 is something students really enjoy. Thanks to the vendor we used, undergraduate students had the option to develop functionality for various features of the manufacturing plant. Graduate students were also able to research communications protocols and cybersecurity within the smart manufacturing system. What does the smart manufacturing system entail and what kind of work is occurring within that system? An automated system is there for students to work with. Robot arms, microcontrollers, conveyor belts, ramps, cameras and blocks to represent cargo form an environment that emulates a real manufacturing setting. We’re currently brainstorming an expansion of the smart manufacturing system in collaboration with the Commonwealth Cyber Initiative (CCI). We plan to set up two building models, one for manufacturing and one for distribution, linked by a sky bridge conveyor system that moves items between the locations. Students work to leverage convolutional neural networks that use images to facilitate machine learning. When paired with the advanced cameras, it forms a computer vision system that can accurately place blocks in a variety of lighting conditions, which can be a challenge for other systems. By having to optimize the communication protocols that command the smart manufacturing system’s robotic arms, students also get a sense for real-world constraints . The Raspberry Pi that functions as the controller for the system is limited in power, so finding efficiencies that also enable stability and precision with the arms is key. Is there an aspect of cybersecurity for these automated systems? Yes. Devices, sensors and communication networks integral to the IoT found in smart manufacturing systems and smart cities generate and share vast amounts of data. This makes them vulnerable to cybersecurity threats. Some of the issues we look to address include: Data Privacy: Smart systems collect and process vast amounts of data, including personal and sensitive information. Protecting this data from unauthorized access and breaches is a top priority. Device Vulnerabilities: Many IoT devices used in smart systems have limited computational resources and may not receive regular security updates, making them vulnerable to exploitation. Interconnectedness: The interconnected nature of smart city components increases the attack surface. A breach in one system can potentially compromise the entire network. Malware and Ransomware: Smart systems are susceptible to malware and ransomware attacks, which can disrupt services and extort organizations for financial gain. Insider Threats: Employees with malicious intent or negligence can pose significant risks to cybersecurity. Potential solutions to these problems include data encryption, frequent software updates, network segmentation with strict access controls, real-time intrusion detection (with automated responses to detected threats), strong user authentication methods, security training for users and the development of well-designed incident response plans.
Improving Care for Black Patients With Heart Failure and Hypertension
ChristianaCare’s Center for Heart & Vascular Health has dramatically improved the clinical outcomes of Black patients living with heart failure and hypertension by using a digital hybrid platform that provides patients with a dedicated health coach to ensure their care plan is followed and treatment goals are achieved. Through this innovative approach, ChristianaCare achieved a significant improvement in the number of Black patients adhering to prescribed doses of guideline-directed medical therapy (GDMT) for heart failure. “At ChristianaCare, we are deeply committed to eliminating disparities and achieving health equity in the communities we serve,” said Kirk Garratt, M.D., medical director of the Center for Heart & Vascular Health. “We are proud that we have been able to significantly improve the health outcomes of our patients, especially addressing health disparities in the Black population for patients with heart failure and hypertension.” Approximately 32% of ChristianaCare’s heart failure patient population identify as Black, which is a higher percentage compared to the Black population nationally (12.4%). Historically, Black Americans have experienced racial disparities in heart failure treatment and experience worse patterns of adherence to guideline-directed medical therapy (GDMT) . Additionally, Black Americans have a 30% greater risk of death from heart disease than white Americans. Combining technology and human-powered guidance This novel approach to care is powered by Story Health, a leading health technology services company. Its digital platform and health coaches have been able to deliver superior outcomes for ChristianaCare’s patients regardless of race. Black patients in particular have made remarkable gains: 6 times improvement on target doses of beta blockers (76%). 7 times improvement on target doses ACE/ARB/ARNIs (54%). 2 times improvement on target doses of MRAs (57%). ChristianaCare was also able to achieve improvement in Black patients taking SGLT2 inhibitors, rising from a 32% baseline to 74%. Despite their vital role in treating heart failure, SGLT2 inhibitors are historically underprescribed and see lower adherence – largely due to affordability challenges, as costs can be $500 per month or more. Helping patients overcome cost barriers is critical, which is why the health coaches directly engage with patients to identify those who may need assistance and will work on their behalf to qualify for prescription assistance programs. “Along with their digital platform, the health coaches from Story Health understand the unique needs of our patients and have helped us create deeper, more accessible relationships with our patients to help improve their health and outcomes,” said Sourin Banerji, M.D., medical director of Advanced Heart Failure and Mechanical Circulatory at ChristianaCare. The health coaches serve as an extension of the clinician to identify and resolve challenges such as medication adherence, lab work coordination, transportation arrangement and even prescription assistance that cause disruptions in a patient’s care journey and lead to negative outcomes. Improved control of hypertension In addition to heart failure patients, ChristianaCare’s collaboration with Story Health supported patients with hypertension, delivering significant reductions in blood pressure for those enrolled regardless of race. Among Black patients specifically, there were significant decreases in average absolute systolic and diastolic blood pressure levels (17 mm Hg and 8 mm Hg, respectively) after 120 days, compared to 8 mm Hg and 5 mm Hg decreases for uncontrolled hypertensives in another digital program after 12 months. As a result of this initial success, ChristianaCare’s Center for Virtual Health is expanding the use of this care model beyond cardiology to support all patients in the population. Many of these patients struggle to manage high blood pressure, and the use of a continuous care program will be an important tool to help with medication management and addressing social barriers. “Health equity is an incredibly important initiative, and we see our mission as critical to helping specialty and primary care providers drive more equitable care,” said Story Health Co-founder and President Nita Sommers. “As an industry leader, ChristianaCare understands that every individual deserves compassionate care that is accessible, so we are honored to be working with its cardiology team and now the Center for Virtual Health to improve the health of patients.” ChristianaCare has been recognized numerous times for high-quality heart care. Among the many achievements are the American College of Cardiology HeartCARE National Distinction of Excellence Award for three consecutive years (2020-2023) and being named among Healthgrades top 100 hospitals for heart care in the U.S. for the past two years (2022-2023).
ChristianaCare Opens Three New School-Based Health Centers in Delaware Elementary Schools
To address health concerns when they are at their earliest, most preventable stages, ChristianaCare has opened three new school-based health centers in Delaware elementary schools: Brookside Elementary School in Newark – part of the Christina School District. Silver Lake Elementary School in Middletown – part of the Appoquinimink School District. Richardson Park Elementary School in Wilmington – part of the Red Clay School District. “At ChristianaCare, we recognize that early intervention is vital in order to address the comprehensive health needs of adolescents in our community,” said Erin Booker, chief bio-psycho-social officer at ChristianaCare. “Childhood trauma hurts the ability of children to learn and increases their risk of chronic disease and mental health issues. Through the opening of these three new school-based health centers, these children now have convenient access to medical services, behavioral health services and wraparound social care. These centers can improve their health and education and set them on a lifelong path of wellness.” These new elementary school Wellness Centers are a partnership between ChristianaCare, the Delaware School-Based Health Alliance, the schools and school districts, supported by New Castle County government with funds from the American Rescue Plan Act. With the latest additions, ChristianaCare now operates school-based health centers in seven elementary schools and 19 high schools and middle schools. Each ChristianaCare school-based health center includes a health care team of medical, mental health, community health and nutrition experts. The health centers also provide a host of services by appointment during the school day. A parent or guardian must provide a signed permission form prior to a student’s first visit to a health center. Priscilla Michelle Mpasi, M.D., FAAP speaks at the ribbon-cutting at Richardson Park Elementary School. “At ChristianaCare, we serve together, guided by our values of love and excellence, and that mission of service is why we are committed to improving the health and wellbeing of the community,” said Priscilla Michelle Mpasi, M.D., FAAP, assistant medical director for the Clinically Integrated Network and Delaware Medicaid Partners. “School-based health centers are the connection of whole-child health and education. As we all know, early intervention is the key to wellness. Children can learn better when they are happy and healthy and know they have a safe place to go when they need care.” At no cost to the students, and located within each elementary school, the three school-based health centers also alleviate the need for parents and students to find transportation to address their health care needs. “Ensuring that our students are prepared to learn is crucial, but it can be challenging when they are dealing with various obstacles,” said Dan Shelton, Ed.D., superintendent of Christina School District. “That’s why our collaboration with ChristianaCare and New Castle County presents an incredible opportunity to bring essential services directly to our school. By establishing an in-school wellness center at Brookside Elementary School, we are thrilled to provide our students with the support they need to be fully prepared and eager to learn.” “Empowering our future starts with nurturing the health and well-being of our youngest minds,” said Dorrell Green, Ed.D., superintendent of the Red Clay Consolidated School District, which oversees the new school-based health center at Richardson Park. “Elementary school-based health centers play a pivotal role in fostering a thriving community by providing accessible, comprehensive healthcare, ensuring every child has the opportunity to learn, grow, and succeed.” “We are so grateful to open the first school-based health center at an elementary school in Appoquinimink School District,” said Matt Burrows, superintendent of the Appoquinimink School District. “This wouldn’t be possible without the partnership of New Castle County Government and the Delaware School-Based Health Alliance. The services provided by school-based health centers span a large array of care – including physicals, vaccinations, mental health, and more. As fast as our community is growing here in the MOT area, we know access to health care can be a challenge for many of our families. Having these services inside one of our elementary schools will be incredibly helpful for our families. The services that are being provided by ChristianaCare are invaluable for our students and their families.”
Countdown To the Big Game: Dr. Tyrha’s Top Five Super Bowl Commercials for the Past Five Years
Advertising executive and multicultural media expert Tyrha M. Lindsey-Warren, Ph.D., clinical assistant professor of marketing at Baylor University's Hankamer School of Business, , is a sought-after media commentator on the brands who win big during the game's commercial breaks. Commercials always are the most anticipated and talked-about aspect of the Super Bowl, but the expanding digital landscape requires advertisers to use more authentic and nuanced strategies to reach consumers. Advertising executive and multicultural media expert Tyrha M. Lindsey-Warren, Ph.D., clinical assistant professor of marketing at Baylor University’s Hankamer School of Business, is a sought-after media commentator on the brands who win big during the game’s commercial breaks. How do companies break through the noise and make a lasting impression on viewers? Lindsey-Warren – or Dr. Tyrha, as she is known – says the key is empowered storytelling. As a consumer behavior scholar, Dr. Lindsey-Warren’s research is rooted in narrative transportation theory – in other words, storytelling – that exudes the emotion of empowerment and its impact on consumer attitudes, behaviors, purchase intention and message recall. “There is a growing space for cleverly crafted and positive storytelling that can break through the clutter and competition and get the attention of Millennials, Gen Z and Alpha generations in an authentic and meaningful manner,” Lindsey-Warren said. At the top of every year, Dr. Tyrha always enjoys exposing the juniors and seniors in her advertising class to the joys of storytelling in advertising by way of the Super Bowl commercials. By leveraging the Super Bowl as an “edutaining” entry point for student learning, Dr. Lindsey-Warren finds it to be a fun and wonderful way to bring many advertising lessons to life for her students, including branding, consumer targeting and segmentation, social media campaign analysis, and more. To that end, here are Dr. Tyrha Lindsey-Warren’s top picks for the best Super Bowl commercials over the past five years. COUNTDOWN TO THE SUPER BOWL: DR. TYRHA’S TOP 5 SUPER BOWL COMMERCIALS FOR THE PAST 5 YEARS #5: Company/Brand: AMAZON Title of the commercial: “#BeforeAlexa” (With Ellen Degeneres and Portia de Rossi) Year it ran in the Super Bowl: 2020 Link to the commercial: https://www.youtube.com/watch?v=PLUwmnPJIGk Ad Agency that produced the commercial: Droga5 Dr. Tyrha’s rationale as to why this ad is so good: In my opinion, this was a wonderfully creative and clever introduction of the Alexa product by Amazon. The nostalgic storytelling in the spot humorously does make you wonder and realize how “did” we all live “before Alexa?” The commercial is multigenerational, incorporates women extremely well, and is so funny! #4. Company/Brand: NFL Title of the commercial: “Bring Down the House!” Year it ran in the Super Bowl: 2022 Link to the commercial: https://www.youtube.com/watch?v=8PhfMtZce1k Ad Agency that produced the commercial: Co-directed by Peter Berg of Film 47 and Arthur Mintz of Swaybox Studios Dr. Tyrha’s rationale as to why this ad is so good: In 2022, the NFL creatively leveraged the power of animation to get our attention with this wonderfully told story with children as the lead Talent and set in a situation that all families can relate to! The spot is so much fun and keeps you guessing as well as laughing with Grandma saving the day in the end. The commercial is multigenerational, multicultural, and incorporates women and girls extremely well. #3. Company/Brand: MOUNTAIN DEW & DORITOS (OWNED BY PEPSICO) Title of the commercial: “Doritos Blaze vs. Mountain Dew Ice” (with Morgan Freeman and Peter Dinklage) Year it ran in the Super Bowl: 2018 Link to the commercial: https://www.youtube.com/watch?v=C2tyVjEuqcY Ad Agency that produced the commercial: Goodby, Silverstein & Partners Dr. Tyrha’s rationale as to why this ad is so good: The “in your face” storytelling of this commercial – performed exquisitely by acclaimed actors, Peter Dinklage and Morgan Freeman, and accompanied by the perfect voiceover narrators in Rappers Missy Elliot and Busta Rhymes – is so much fun and truly unforgettable! The commercial also cleverly makes you pay attention to the presentation of the products being promoted as well as compels you to wonder as to “when did you last have a Mountain Dew and some Doritos?” This commercial is multicultural, multigenerational, multibodied, and incorporates women well and UBER memorable! #2. Company/Brand: NFL Title of the commercial: “The 100-Year Game” Year it ran in the Super Bowl: 2020 Link to the commercial: https://www.youtube.com/watch?v=tJjiIuH1VnY Ad Agency that produced the commercial: 72 and Sunny Dr. Tyrha’s rationale as to why this ad is so good: If you love the game of football, you have to love this ad that celebrates the fun and contagious spirit of the game. Truly, this commercial has something for everyone who loves the game of football! The unassuming opening of the ad’s storytelling set at an awards banquet and led by NFL Commissioner Roger Goodell quickly evolves into a fun and rambunctious game of football with NFL players of all ages in their tuxedos destroying the ballroom with their play. The musical hip-hop soundtrack alone for the spot is amazing, current, and supports the action of the storytelling extremely well. This spot is multigenerational, incredibly diverse in age ethnicity and more, as well as weaves women and girls into the spot ever so cleverly. A truly memorable ad and so much fun! #1. Company/Brand: Mr. Clean (OWNED BY P&G) Title of the commercial: “Cleaner Of Your Dreams” Year it ran in the Super Bowl: 2018 Link to the commercial: https://www.youtube.com/watch?v=ozuWoZITX3Y Ad Agency that produced the commercial: Leo Burnett Dr. Tyrha’s rationale as to why this ad is so good: Every year I show this commercial to my Advertising students at Baylor University and they absolutely LOVE this ad! The storytelling of this commercial leverages the animated Mr. Clean in such a clever manner, while showing the product benefits at the same time, and not being “in your face” with the product’s selling proposition. The music and the dancing accompaniment to the storytelling all help to bring an emotional connection to the viewer, especially the female audience. Plus, the spot is just super funny and so much fun! Every time I see this ad, I want to run and buy Mr. Clean. And, I tell my female students every year that when they get older, they are going to LOVE a man who can clean a house!!!! Additionally, this was an incredibly smart move by P&G to put this ad in the Super Bowl. This is due to the fact that the “current and future market power of women – as a whole and by segments – is undeniable and truly cannot be ignored by marketers, especially the NFL.” Today, women influence more than 80% of all consumer spending; 89% of the financial decisions are made by women; and globally, women control more than $20 trillion in worldwide spending. In addition, nearly 24.3 million African American women are brand loyalists and cultural trendsetters who have influence over the $1.2 trillion in Black spending power. And, Forbes reported in 2018 that “women constituted about 49 % of the 108 million-plus people who watched” that year’s Super Bowl – and they paid closer attention to the ads!
Winnipeg, MB, September 5, 2023 – As Manitoba students head back to class this week, parents say speeding and traffic congestion are their biggest worry when it comes to road safety near schools. A recent study by CAA Manitoba, conducted by DIG insights*, shows that 94 per cent of parents have at least one concern about safety in school zones. “We want to remind motorists that they need to be extra vigilant as students return to school this week,” says Ewald Friesen, manager of government and community relations, CAA Manitoba. “Kids will be excited to see their friends and teachers and may fail to check their surroundings before stepping out onto the street.” The top three concerns are drivers speeding (32 per cent), traffic congestion in and around school (30 per cent), and a lack of street/school parking (26 per cent). Other concerns include illegal parking or stopping, jaywalkers, distracted pedestrians and drivers, and drivers not obeying traffic signs. As a result of those concerns, many parents drive their children to school, further exacerbating traffic congestion, Friesen notes. “While there are always parents who must drive their children to school, we do encourage parents and students to try other modes of transportation to get to class,” says Friesen. “Things like walking, biking and skateboarding are great exercise and lots of fun, and fewer cars will help alleviate parents’ concerns.” The study also showed that parents would like to see additional solutions. About 26 per cent of parents want better road infrastructure in school zones and 21 per cent want to see more police enforcement. More crossing guards and road safety education for parents and students was also suggested. “Helping to keep school zones safe for everyone is the primary goal of CAA’s School Safety Patrol program,” says Friesen. “Watch for our trained patrols in bright yellow-lime vests helping people safely cross the street.” According to Stats Canada, there were about 183,000 students enrolled in about 700 K-12 schools across Manitoba in 2022. Back to School Safety Tips for Drivers: Drivers can also use the following CAA Manitoba tips to ensure they are staying safe in school zones. Slow down: Know the speed limit in your neighbourhood’s school zones and respect them. Give yourself plenty of time to drop off your kids at school to avoid rushing. Follow the rules of the road near school buses: Always stop for a stopped school bus with its upper flashing lights and stop arm activated, then wait for children to get safely on or off. Stay alert and watch for children or parents/guardians crossing the road when the bus moves on. Choose a safe spot to drop off and pick up your children from school: Follow your school’s rules and avoid double parking or stopping on crosswalks, dropping off or picking up your kids on the opposite side of the street, and stopping in moving traffic as kids rush out. Instead, use the designated drop off areas or consider a spot a bit farther away from school that is easily accessible and safe. Make eye contact with pedestrians: With the excitement of going back to school, anticipate that children may not easily see or hear your moving vehicle, so be sure to make eye contact with pedestrians crossing the road. Watch for CAA School Safety Patrollers: When travelling to and from school, watch for CAA School Safety Patrollers in their safety vests, as they play an important role in ensuring the roadway is safe before kids cross on their own. Avoid fines: Passing another vehicle in a school zone is not permitted. Passing a bus with its lights flashing and stop sign activated will result in a $673 fine and five demerits. Speeding in school zone is a minimum $200 fine and two demerits. * The study, commissioned by CCG and conducted by Dig Insights in May 2023, surveyed 613 Manitoba parents/guardians between the ages of 18 and 74 with children attending school from kindergarten to grade 8. The margin of error for a sample of this size is plus or minus 4% at the 95% confidence level.
