MUSC Initiatives and Responses to Community Needs
MUSC sets out to provide initiatives, programs, projects, resources, and priorities that are strategically tailored to the community’s needs. MUSC continually strives to provide excellence in patient care in an environment that is respectful of others, adaptive to change, accountable for outcomes, delivered by coordinated interprofessional teams, and attentive to the needs of underserved populations.
SE VIEW Projects
The Southeastern Virtual Institute for Health Equity and Wellness (SE VIEW) is a cooperative agreement between the United States Department of Defense and MUSC to develop educational and outreach programs and conduct community-based research on health disparities.
1. Stroke and Stroke Risk Reduction Initiative (SSRI)
Bruce Ovbiagele, professor and chair of MUSC’s Division of Neurology, rose awareness when he explained in a recent Catalyst article that stroke care costs are expected to rise 130 percent from 2010 to 2030, while the occurrence of stroke is expected to rise 20 percent. The SSRI program, led by Robert Adams, MD and Daniel Lackland, DrPH, enhances the REACH (Remote Evaluation of Acute Ischemic Stroke) telemedicine system to attain earlier identification and management of young and rural patients with hypertension and is designed to extend access to expert stroke care to SE VIEW regions, which have very high stroke incidence, morbidity and mortality rates. The stroke treatment center at MUSC has assembled a remarkable team that works together to diagnose each patient's problem, plan and deliver the best treatment available to maximize the outcome for each patient.
2. SC TeleSupport: Diabetes Management Initiative
This program, led by Leonard Egede, MD, MS, Professor of Internal Medicine, is designed to develop a practical and sustainable system of diabetes management in indigent patients in Charleston and neighboring counties. Emphasis is on home/self care with a focus on four key areas: medication adherence, self-glucose monitoring, diet, and physical activity. The patient monitors glucose with a device (the FORA System) that uploads to a central server. A nurse case manager reviews the information and provides necessary therapy and medication for the patient (with the approval of a physician). The device also monitors blood pressure. The purpose is to improve patient adherence with prescribed therapy.
3. Tele-Critical Care Program to Reduce Rural Health Disparities (CREST)
This is a research project led by Dee Ford, MD, Assistant Professor of Pulmonary and Critical Care Medicine, that combines telemedicine technology with provider education and selectively targets two specific conditions: sepsis and trauma. The specific research piece focuses on the Interstate-95 corridor and involves the process (feasibility), clinical expertise, and economic implications.
4. Telemedicine in the Evaluation of Alzheimer’s Disease in a Rural, African American Population
The specific aims of this program led by Jacobo Mintzer, MD, Professor of Neurosciences, are to validate the use of telemedicine to evaluate African American patients suffering from Alzheimer ’s disease in SC using a previously identified cohort of subjects that are now being followed in remote sites across SC and to add two new sites to recruit subject using telemedicine. The intent is to broaden diagnosis and treatment services within the clinical practice and provide in home diagnosis and treatment services through mobile communication technology.
5. Heart Health: Preventive Cardiology Research Center
This initiative led by Melissa Henshaw, MD, Assistant Professor of Pediatric Cardiology and Medical Director of Heart Health is the preventative cardiology and weight management program of the Children’s Heart Program of SC. CHP-SC serves the complex health care needs of predominantly obese children and adolescents with cardiovascular risk factors such hypertension, pre-diabetes, and dyslipidemia. Families are taught how to improve lifestyle behaviors through a series of medical evaluations, one-on-one nutrition and behavioral counseling sessions, group education classes, and individual fitness sessions. This program is has developed a cookbook, “The Art of Healthy Cooking” for families to use. Staff also uses text messaging to communicate with the children.
6. Lean Team Initiative
The Lean Team was created as a partnership between MUSC Division of Adolescent Medicine, and the Charleston County School District. This initiative, also known as MUSC’s Boeing Center for Children’s Wellness, is designed to prevent and treat childhood obesity through family-centered clinical programs paired with policy and environmental changes in schools and communities. It includes individual assessment and counseling, social networking, classroom education, school wellness councils, web-based resources, and community activities. Exercise videos are available on the web-based resources that fulfill the physical activity requirements of the SC Student Health and Fitness Act.
7. Health Careers Academy
The South Carolina AHEC Health Careers Academy focuses on increasing diversity in the healthcare workforce through one-on-one mentoring, parental involvement, ongoing academic advisement, and career tracking. This initiative offers a one-week residential summer program for undergraduate students to prepare for competitive admission to medical, dental, or nursing school.
8. Community Engaged Scholars Initiative (CES)
This program is an education and training initiative of the Center for Community Health Partnerships at MUSC. This program provides training, pilot funds, and mentorship for five teams consisting of an MUSC researcher and community partner(s) who have collaborative interests in community-based participatory research (CBPR) to eliminate health disparities.
9. The Health Empowerment Zone
This community coalition, led by Deborah Williamson, DHA, CNM, Associate Dean for Practice; Assistant Professor, College of Nursing, addresses healthy eating, active living and positive lifestyles through a partnership with the City of North Charleston and several organizations to develop programs that target health and wellness, poverty, and crime. The City of North Charleston has allocated land for recreational facilities, created fitness programs for city employees, and developed policies that address social violence, poverty and educational success. This coalition recruits the assistance of local leaders and policy makers to help implement programs.
10. Mobile Outreach Van, Educational, and Navigational Health Services for Underserved Populations (MOVENUP Initiative)
This MUSC Hollings Cancer Center community initiative addresses the major public health problem of cancer in SC. It is designed to provide mobile health unit and patient navigation services, provide cancer education, nutrition and physical activity education to the I-95 Corridor counties. It also provides needed screening services and follow-up care and training via outreach and service delivery.
11. MUSC Public Information and Community Outreach (PICO) Initiative
The purpose of this program is to heighten public awareness of health issues, provide prevention and health screening opportunities, and promote awareness of/access to affordable and culturally competent care. PICO delivers programs that address the health and wellness of communities nationwide, drawing strength and diversity from the unique relationship between human health, environmental quality, environmental justice and economic development in assuring community development and quality of life; and from the value of diverse partnerships, including those human and programmatic resources available to a state-supported, health sciences institution, to identify, and resolve complex issues.
12. Community Institutes for Traditional and Nontraditional Leaders (CLI)
This program is designed to help communities and constituencies build capacity to identify, access and develop leadership resources through the linkage of scientific, political and local communities, and incorporation/cultivation of nontraditional (artists, musicians, athletes) and traditional leaders (elected officials, preachers, lawyers, etc.).
13. Healthy People in Healthy Communities
This program, with the motto, “Promoting Good Health in Williamsburg County Across the Lifespan,” supports awareness of risk factors for chronic disease, behaviors to achieve healthy lifestyles, and access to effective healthcare and necessary medications as keys to lifelong health promotion and disease prevention. The program engages in community dialogues about ongoing needs and resources; provides health education and small grants for local programs; supports health screening/referral for care; assesses and overcomes barriers to obtaining healthcare and medications; strengthens local healthcare delivery network; builds local capacity for sustainability; promotes and assists adoption of electronic medical record (EMR) systems and health information technology (HIT).
14. Junior Doctors of Health
This initiative uses a comprehensive strategy targeting children, adolescents, teachers and parents in order to prevent childhood obesity in underserved populations. Within a dynamic curriculum, MUSC students serve as instructors and mentors, teaching children how to track eating and exercise habits. Teachers serve as healthy role models as well, participating with the children in exercise programs and pedometer competitions. Parents actively participate in workshops and family health activities. This program also strives to teach adolescents about health-related careers and offers service-learning experiences. This initiative addresses issues of childhood obesity, nutrition, physical inactivity, and education/health literacy.
15. STEER Away from Alcohol and Drugs
This project will use a multifaceted approach (Screening, Training, Educating, Evaluating, and Referral) to address health disparities in access, education and treatment of the use/misuse of alcohol and drugs in minority, rural, underserved and at risk populations. A cadre of experts based in MUSC’s Center for Drug and Alcohol Programs will forge partnerships with schools, churches and community centers in four targeted counties and will also utilize the Palmetto State Providers Network to reach individuals in isolated rural areas. Evidence-based strategies will be implemented in screening individuals for alcohol/drugs; training multidisciplinary workers, teachers and community workers; educating the population of the target counties; evaluating individuals for alcohol/drugs; and referring individuals for treatment. This project directly addresses the issues of education/health literacy, substance abuse, and access to healthcare.
16. Providing a Medical Home for Underserved Children in Williamsburg County via Telemedicine
This project will use telemedicine technology to extend and enhance the local healthcare infrastructure in rural, underserved Williamsburg County in the I-95 Corridor. The rural geography and limited number of providers in the county restrict the availability of in-person visits for many children, leading to increased morbidity and elevated health care costs. A medical home-focused initiative will allow local providers, in collaboration with MUSC personnel, to see their patients in a school setting. The Telemedicine Medical Home is intended to reach children who do not have an existing provider, and will be constructed with goals of equal access to local providers to minimize redundancy of care and maximize efficiency of existing resources. The model will have fixed site telemedicine units and mobile units for smaller schools. In addition to practicality, this set-up has the advantage of allowing a comparison of two approaches to facilitate deployment to other areas.
17. Evaluating a Media Strategy - Closing the Gap, Inc. (CGHI)
This program is designed to assess and refine the design, implementation and quality of a health communication strategy utilizing radio broadcasts to provide health messages to medically underserved populations with low health literacy. This program directly addresses the issue of education/health literacy.
18. CBPR to Improve Oral Health
Through the collaborative efforts of MUSC’s College of Dental Medicine, Our Lady of Mercy Community Outreach Clinic and the Community Advisory Board, this program seeks to improve the oral health of a rural, racially and ethnically diverse community by overcoming existing barriers to oral healthcare and building necessary community oral health infrastructure. The overarching goals of this program are to promote sustainable oral care self-management practices, improve availability of preferred oral healthcare options, and incorporate advanced technology in dental restorative procedures. This initiative will use a community-based participatory research (CBPR) approach to design and test a multi-level intervention including church-level strategies, group-based education and community-based oral health promoters. Findings will inform the design of a larger, adequately powered community-based trial suitable for NIH grant support. This program directly addressed the issue of community oral health.
19. Patient Risk Assessment and Health Education with Computer Kiosks in Community Health Centers
This project will develop, implement and evaluate an intervention to increase exposure to health information technology (HIT) and provide patients with their perceived/actual risk of disease prior to meeting with their healthcare provider. This initiative proposes an innovative use of health computer kiosks to promote patient self-assessment of risk factors in a community clinic setting. The desired outcomes include improved accuracy of patient perception of disease risk factors, more effective patient/provider interactions, increased patient self-efficacy and health knowledge, and ultimately healthier lifestyle behaviors.
Additional MUSC Center for Global Health Projects
1. Hispanic Health Initiative
The Office of Hispanic Health Initiatives in the MUSC College of Nursing, led by Dr. Williamson, has received grant funding from The Duke Endowment, Health Resources and Services Administration, Communities In Schools and The National Libraries of Medicine and other private funding sources. Bilingual health services and educational programs are now being provided to individuals and families from birth to adulthood. The objectives of HHI are to provide seamless, culturally appropriate primary health services for Spanish-speaking women and their families utilizing an inter-professional team; provide culturally competent and linguistically appropriate family-centered care emphasizing education, support and healthy lifestyles; build cultural and linguistic awareness about the diverse Latino cultures and existing health needs through curriculum innovations; and increase recruitment of under-represented populations in nursing.
2. MUSC Healthy South Carolina Initiative
In 1997, MUSC Family Services Research Center (FSRC) was asked by the state of South Carolina to conduct the Neighborhood Project, to address community violence and youth crime. Union Heights, an inner-city, high-crime neighborhood in North Charleston, South Carolina was selected and people collaborated to reach solutions to problems concerning children in their neighborhood. The leaders, parents, youth, and other citizens of the neighborhood determined the major areas of concern and with the MUSC FSRC staff, they pulled together to put in place community-based interventions (multisystemic therapy) for youth and developed neighborhood-based activities. At the end of the project, there was an 85% reduction in police calls for service, reduced recidivism and substance abuse among referred youth, decreases in community violence among children, decreases in expulsion and suspension and increases in days in school and increases in youth and community participation in pro-social activities. To sustain the activities, the neighborhood and FSRC together developed a nonprofit, 501(c)3 called Gethsemani Circle of Friends, run solely by volunteers to continue addressing issues children in the neighborhood face. The strong sustainability plan through Gethsemani Circle of Friends has enabled the Union Heights Neighborhood Project to grow and flourish more than a decade beyond the point the original governmental funding ended. The program continues to thrive and the energy generated by the initial project has taken on a self-sustaining life of its own, redefining and broadening the initial outreach mission and propelling it from a local neighborhood-based initiative to a trans-Atlantic program of global scale. This initiative directly addresses the issues of community violence and substance abuse.
3. Cost-Effectiveness of HIV-Related Mental Health Interventions
This NIH Challenge Grant funded by National Institute of Mental Health will conduct comparative cost-effectiveness analysis of three pairs of critical HIV mental health interventions: (1) abstinence-based interventions versus comprehensive sex education, (2) condom social marketing versus free condom distribution programs, and (3) HIV voluntary counseling and testing versus provider initiated testing and counseling. For each we will collect data from representative field intervention programs in developing countries on the cost per client to deliver each intervention. MUSC Dr. Michael Sweat is the Principal Investigator. The team shall cull results from systematic reviews and meta-analyses they have recently completed on the efficacy of each intervention. For provider initiated testing and counseling they shall conduct a systematic review and meta-analysis to allow for a full complement of comparative effectiveness analyses. Costing and cost-effectiveness analysis will be in accordance with methods recommended by the Panel on Cost-Effectiveness in Health and Medicine. Outcomes to be examined include the cost per: (a) quality adjusted life year (QALY) saved from each intervention, (b) disability adjusted life year (DALY) saved from each intervention, (c) HIV infection averted. Sweat and his colleagues shall use a Bernoulli Process formula together with descriptive and behavioral data based on pooled effect size estimates from meta-analysis to model HIV incidence with and without the intervention. This initiative directly addresses the issues of mental health, sexual health, and education/health literacy.
Additional Community Programs and Initiatives
1. MUHA Drug Pricing Program and Specific Medication Programs
As a Disproportionate Share Hospital (DSH) that is formally granted governmental powers by the state of South Carolina, the hospital and provider-based clinics are eligible for participation in the 340B drug discount program. This program allows The Medical University Hospital Authority (MUHA) of the Medical University of South Carolina to purchase outpatient drugs for qualified patients at significant savings.
The discounts available to MUHA as a qualified 340B hospital are used by MUHA as intended by the 340B Program to enable MUHA to expand services to patients and to provide charity care and community based programs. A detail of those programs and the financial benefit to the community is provided below:
Patient Assistance / Medication Assistance Program: The program accesses pharmaceutical company patient assistance programs to provide available medications to patients who meet program financial criteria. Five (5) MUHA funded staff members are dedicated to helping patients find funding through various resources including churches, community organizations and drug companies for their medications. This includes three (3) staff members dedicated to take home meds and two (2) staff members dedicated to clinic medications and infusions.
Discount Medication Program: There is a $4.00 discount drug list available to all patients who fill prescriptions at MUHA pharmacies. The complete list of drugs included in the program is made available to all patients and is strongly encouraged. Additionally, information on the discount medication program is located on the MUHA Pharmacy Website.
Specially Priced Over-The-Counter (OTC) Items: Discounts are offered on over-the-counter medications to all patrons of MUHA pharmacies.
Social Worker Pricing: If the Case Management group pays for medications to facilitate a discharge, then the prices charged to the group are based on acquisition cost + $15.00 dispensing fee, unless the drug is included in the Discount Medication Program or the OTC price list.
Sample Medications: MUHA Pharmacies stock sample medications on behalf of the clinics to maintain record keeping. Sample medications are used to help those who cannot afford medications or are waiting for prior authorizations as a means to not disrupt treatment.
Institute of Psychiatry (IOP) 7 Day: Medications are provided to patients in IOP to facilitate discharge and the cost of the 7 day supply is charged and paid by the IOP Case Management Group.
Charge Accounts: MUHA has allowed patients to establish charge accounts whereby statements are sent at the end of each month.
Price Matching: MUHA pharmacies consistently work with patients that have limited funds in an attempt to obtain medications at the most affordable price.
Smoking Project: MUHA Pharmacies currently waive copays/charges on smoking cessation medications when employees present with a voucher. Employees are able to obtain the voucher by registering on a MUHA website. The cost of the medication is charged to a MUHA fund and reimbursed to the pharmacy.
Home delivery: MUHA Pharmacies provide delivery service of medications to a patient’s home or work at no additional charge.
Medicaid Copay Waive: Patients with Medicaid prescription drug coverage that cannot afford their copay are recognized by pharmacy staff whereby the MUHA waives the patient copay and the Medicaid beneficiary is not charged, meaning the balance is considered paid in full.
Other Patient Support Programs: 340B drug pricing makes it possible to provide a variety of clinical pharmacy programs that enhance both the quality and scope of patient care at MUHA (e.g. pharmacists that provide a variety of clinical services in specialty areas, such as nutritional support, hemophilia, oncology and anticoagulation clinics) that would not otherwise be possible.
2. MUSC CARES Clinic
The CARES Clinic, which stands for Community Aid, Relief, Education and Support, is a medical student-initiated and managed non-profit organization providing free medical care to the underserved, uninsured population in the local Charleston area. The CARES Clinic opened its doors in 2005, providing free primary care to individuals without insurance. This program directly addresses the issue of community access to primary care.
3. Independent Transportation Network
The Independent Transportation Network (ITN), supported by MUSC Center on Aging, is the first and only national non-profit transportation system for America’s aging population. Trained drivers volunteer to provide rides in private automobiles for people 60 years and older, and adults with visual impairments. ITNCharlestonTrident directly addresses issues of community transportation and access, providing services 24/7 for any type of ride within a 15-mile radius of Charleston, SC.
4. MUSC Urban Farm
The MUSC Urban Farm, spearheaded by the Office of Health Promotion, provides a place where the Charleston Community can come and learn about the connection between land, food, and health. The 0.5-acre Farm, located on the corner of Bee & President Street, hosts workshops, seminars, volunteer workdays, and tours for local schools. Leftover crops head to charity groups such as the Lowcountry Food Bank and the Charleston Area Children’s Garden Project. Also, farm staff has worked with MUSC dietitians to put together dinners prepared from the harvest for families of sick children staying at the Ronald McDonald House and for cancer patients staying at Hope Lodge. These combined efforts strive to increase community access to healthy foods.
5. MUSC Wellness Center Programs
The MUSC Wellness Center is a facility dedicated to the promotion of good health. The center fosters the development of healthy lifestyles through the promotion of wellness attitudes and practices. More than a health club, the MUSC Wellness Center focuses on the development of total wellbeing, with the belief that wellness is a balance of social, emotional, spiritual and physical health. The Wellness Center hosts various events for the community, such as the Adventure Out program and the Healthy Charleston Challenge. The Adventure Out program is a partnership among MUSC, Charleston County Parks and Recreation Commission, and the Parklands Foundation of Charleston County featuring a month-long outdoor fitness campaign to encourage community residents to visit county parks for exercise. The Healthy Charleston Challenge is a 10-week fitness and weight loss program designed for those who are 30+ pounds overweight and in need of permanently changing lifestyle habits for decreased risk of chronic disease. The goal is to increase physical activity and provide skills, professional guidance, and accountability for developing healthy lifestyle habits.