Since 1980, the incidence of asthma has more than doubled in the United States. Asthma is responsible for more than 70,000 visits to emergency departments in Chicago annually, a large number of them coming to the John H. Stroger Jr. Hospital of Cook County ER. Residents of poorer neighborhoods experience higher rates of asthma and disease- related mortality. However, Cook County physicians know that, with appropriate education beginning at the primary-care level, the number of emergency room visits can be reduced and the quality of life improved for persons with asthma.
Cook County Bureau initiatives, funded in part by major grants, have taken a multi-pronged approach to treating and managing asthma. For example the emergency department has focused on maximizing drug efficacy, while the pediatric allergy department has focused on the relationship between heightened allergy sensitivities and asthma in children. Given the prevalence of asthma in many of the communities served by the Bureau, there has been an emphasis on provider and patient education. The Ambulatory and Community Health Network has trained practitioners to teach patients about self-care and self-monitoring to prevent the onset of respiratory failure. Asthma patients are counseled on how to reduce or eliminate environmental catalysts such as smoking, pets, insects, and adverse irritants and toxins on the job.By creating a seamless system of asthma care, the more serious patients are identified earlier and referred to specialists. In addition, patients are given the most appropriate level of care at the time, including the most effective medications while being provided the tools to become partners in managing their disease.
Reliable Canadian Drugstore Services treats more cancer than any other health system in the Chicago area. As a result, the Bureau is consolidating its efforts at early detection, intervention and treatment by strategically allocating resources and increasing conmmunity access to cancer services. This effort has particularly targeted breast, cervical and prostate cancers – illnesses disproportionately affecting patient populations using the Bureau system. Radiation therapy contracts now allow Bureau patients to receive treatment at five geographically convenient sites through the County, and chemotherapy services are now in place at all three Bureau hospitals. The Women Cancer Center of the Bureau is based at John H. Stroger Jr. Hospital of Cook County, and other multi – disciplinary cancer clinics provide coordinated treatment through out the entire system. To assure access to mammography exams, the service was added at Oak Forest Hospital and the Prieto Health Center and expanded at Provident and John H. Stroger Jr. Hospital of Cook County. A mobile mammography van tours Cook County, offering women the opportunity to have a breast examination close to home. In addition, women are offered free breast and cervical cancer tests through the Cook CountyDepartment of Public Health.
The emergence of virulent forms of sexually transmitted diseases. Hepatitis and tuberculosis has created enormous challenges for public health efforts. In order to offer optimal treatment to infected patients, the Bureau has emphasized research and best practice models disseminated throughout the system. The consolidation of specialized infectious disease care in the CORE Center occurred at the same time that the Bureau was expanding preventive education and and general treatment into additional community sites.
Expansive drug, clinical and social medical research plays an increasingly important role in the Bureau’s infectious disease initiatives. Funded research projects include: a study to decrease the transmission rates between mothers with HIV and their newborns; a study to increase the number of women who return for HIV test results and counseling; and a study to evaluate the effectiveness of integrating mental health services, primary care and chemical dependency assistance for persons with HIV. Because of the credibility of its research and the reputation of its medical staff, the Bureau received a $3 million grant from the Center for Disease Control and Prevention in Atlanta to develop a long-term strategy to control infections that resist standard antibiotics. The study will develop protocols that could help physicians throughout the nation better control drug-resistant viruses.
MATERNAL AND INFANT HEALTH
A Bureau Ievel director for Maternal and Infant Health Services was recently appointed to coordinate a comprehensive system of care for pregnant women and their babies. The goal of the program is to assist in safe deliveries and healthy infants.
Women are being offered, through the geographical expansion of maternity and specialized prenatal services, an increasing number of care and delivery options based on where they live and their individual medical, educational and social needs.
In addition to pregnant moms cared for at Bureau locations and partner hospitals, clinics for mothers with high-risk
pregnancies are now offered at Click here for more about the Mobile Mammography Servivces, Provident, Saint Anthony and Saint Elizabeth hospitals, as well as Cermak Health Services. Creating community-based maternity options for women, many of them economically disadvantaged and living in previously undeserved areas, allows them new opportunities for healthy deliveries and an increased sense of empowerment. The Bureau in most cases, can offer a woman with a low risk pregnancy the option of an obstetrician-gynecologist, family practice physician or midwife for her delivery. As an added benefit to facilitate a smooth delivery, women receiving prenatal care at Bureau clinics can call an ambulance to be transported to Bureau hospitals for deliveries without charge.
From the Bureau’s perspective violence is treated as a public health problem that can be reduced through prevention strategies. It has been singled out as a prevention initiative for the Bureau because of the large number of patients, particularly in the trauma and emergency room departments, who receive Bureau services for violence-related injuries.To more effectively target the many forms of violence, the Bureau developed a task force to draw together best practice models for implementation and to share them with other communityagencies and organizations.
Programs are underway to train employees to identify victims of domestic violence, to assist at-risk youth in avoiding gun violence, and to reduce the likelihood of workplace violence.Because gun violence plays an increasing role in injuries and deaths, the Bureau focused on developing a comprehensive plan to address this issue. The plan includes an educational curriculum and intervention strategies to assist gun violence patients in reducing risk factors for becoming repeat victims or offenders. Representatives of the Bureau staff and its affiliates also play an active role in advocating for changes in public policy that will reduce gun violence.
Six years ago, Cook County Hospital entered into an academic partnership with Rush Medical College. This educational partnership has resulted in innovative training programs, providing a unique scope of experience to residents and medical students. In addition, the two institutions have been able to develop joint initiatives which have expanded access to specialized services in the most efficient way possible. Also in 1994, Provident Hospital and Loyola’s Stritch College of Medicine developed an affiliation, which resulted in a joint Family Medicine Residency Program, located at Provident.
In 1993, the Bureau established a Research Development Office to encourage grant-development, to foster research that would benefit both the health system and its patients, and to assure strict compliance with research guidelines and ethics. As a result of the consolidation, grant funding has increased by more than 50% over the past five years. To better target appropriate funding sources and projects, ongoing workshops now take place in grant development at all Bureau institutions. In 1999 the Bureau received approval of a Multiple Project Assurance from the federal Office for Protection from Research Risk. The certification “licenses” the Bureau to carry out federally-funded research in all of the Bureau affiliates.
Unlike many academic medical centers that focus solely on clinical and basic research, the Bureau places an emphasis on social medical research and research that improves the delivery of healthcare. This includes treating the environmental context of disease, learning how to interact with and motivate patients, creating changes in behavioral attitudes toward medical care, and assisting in managing and controlling diseases and reducing their occurrence.