Wollelaw Agmas, MD, MAS
Preventive Medicine Fellow
Assignment Location: Denver Public Health
Project: Opioid Treatment Program Evaluation
Wollelaw performed a program evaluation to identify barriers and facilitators of patient retention in care. He interviewed 40 patients in two groups using two separate interview guides. The top five barriers reported by patients include insufficient methadone dose, uncontrolled withdrawal symptoms, difficulty in transportation to the clinic, continued use of opioids and other drugs, and difficulty in getting appointments to see healthcare providers. Yet, patients who successfully completed their first 6 months of treatment reported that support from treating physicians and program staff, full or partial coverage of treatment cost by the program or insurance, flexibility of program rules, and accessibility of the program to public transportation were the main facilitators.
Background: Denver Health’s opioid treatment program (OTP) provides a medication assisted treatment (MAT) using Methadone, Buprenorphine, or Vivitrol, and psychological support to patients with opioid use disorder (OUD). Despite treatment efforts, retaining patients in care remains challenging and the factors that impede or contribute to poor retention are unknown. In 2017, roughly 50% of patients who initiated MAT at the OTP failed to be retained at the end of 6 months of treatment.
Learner Contribution: Wollelaw led the program evaluation by providing technical support as well as developing and implementing an evaluation plan based on CDC’s program evaluation framework. He identified barriers, and facilitators of patient retention at the Office of Behavioral Health Services (OBHS) which were used to revise policies that should increase patient retention of nearly 500 patients who are currently receiving services at OBHS and an estimated number of 1,500 patients receiving care in the Denver Health system. Improved patient retention should help reduce the nearly 100 people who die every year in Denver from opioid overdose. Retention strategies can be shared with other agencies in Colorado as well as across the U.S. Improving patient retention has potential to reduce the nearly 500 people who die every year from opioid overdose in Colorado and more than 47,000 drug overdose deaths in the U.S. each year.
Emily Lankau, DVM, PhD
Preventive Medicine Fellow
Assignment Location: National Wildlife Health Center/Wisconsin Department of Health Services
Project: Select Agents Program Records Management
Emily applied quality improvement principles to developing a structured file plan for the National Wildlife Health Center’s (NWHC) select agent program that systematically streamlined the documentation process. She worked with national agency staff to establish new retention schedules for select agent program records to guide document storage and destruction decisions. Implementation of the new records management system was projected to reduce time spent on select agent program management by 30%, saving agency staff up to 600 hours of work over a three year registration renewal cycle.
Background: The Federal Select Agent Program allows for necessary research on select agents and toxins under appropriate safeguards to prevent risks to the public. Laboratories with expertise working with these agents and toxins provide important capacity in the case of natural outbreaks or bioterrorism events. Facilities that work with select agents or toxins must register with the Federal Select Agent Program, undergo regular inspection of facilities, and document compliance with program requirements. During 2017, 263 laboratory facilities were registered to possess a select agent or toxin. Maintaining facility registration requires considerable resources committed to documentation of staff security clearances, training, occupational health and safety records, and facility maintenance.
Learner Contribution: Emily worked with NWHC to maintain registration with the Federal Select Agents Program. Select agent registration is vital for preventing and controlling serious diseases in wildlife populations. A relatively small investment in process improvement substantially increased program management efficiency, freeing resources for other programmatic needs. Emily’s contribution to the implementation of a quality improvement process helped reduce staff time spent on document management by 30%, saving the National Wildlife Health Center $27,000 worth of staff labor that can be applied to other programmatic needs over the next three year registration cycle.
Almea Matanock, MD
Preventive Medicine Resident
Assignment Location: New Mexico Department of Health and University of New Mexico, Santa Fe, NM
Project: Refugee Intake Clinic
Almea streamlined the intake process at the refugee clinic and established dedicated clinic time for patients, which helped keep referrals from being duplicated and improved the process for appointments and transporting patients from clinic to clinic. She also integrated the use of best practices for more efficiency and effectiveness when assessing and addressing refugees’ health needs.
Background: New Mexico receives refugees from many places who have varying health risks. Routine preventive services for non-communicable diseases have not been a focus in the past, and many refugees have chronic diseases that have never been addressed. The New Mexico Department of Health (NMDOH) provides the initial screening, vaccinations, and TB treatment, if indicated, to all refugees. After initial screening, NMDOH refers all refugees to a primary care provider. The Southeast Heights Family Medicine Clinic (SEHFM) and Young Children’s Health Center (YCHC), based at the University of New Mexico, are two of the main referral centers. SEHFM provides primary care and mental health services to these patients and has an estimated capacity of 250 refugee patients per year.
Learner Contribution: Almea developed a standardized process for direct care coordination inside the clinics. She also provided refugee centers with information about the screening clinics and assisted YCHC as they started screening refugees and establishing their care. She developed relationships with other stakeholders and resettlement organizations by attending health-specific meetings and presenting on the screening clinics and their processes.
Jefferson Jones, MD, MPH
Preventive Medicine Resident
Assignment Location: CDC, National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Atlanta, GA
Project: Establishing funding and support for CDC’s Model Aquatic Health Code
Jefferson worked with state epidemiologists and other health department partners to lead the creation of a position statementpdf iconexternal icon in support of CDC’s Model Aquatic Health Code (MAHC) to reduce risk, illness, and injury associated with aquatic facilities. Jefferson presented the position statement at the Council of State and Territorial Epidemiologists (CSTE) 2017 annual conference to increase awareness of and support for the code. The position statement was approved and adopted by CSTE in June 2017. If every state and jurisdiction in the U.S. were to fully implement the MACH guidance it would result in a drastic reduction in the more than 10,000 pool-associated nonfatal drownings or health events annually.
Background: Illness and injury associated with aquatic facilities in the United States include disease outbreaks of infectious or chemical etiology, nonfatal drowning, and pool chemical–associated health events (e.g., respiratory distress or burns). Each year, nonfatal drownings and pool chemical–associated health events lead to an average of 5,800 and 4,000 U.S. emergency department visits, respectively. In cooperation with public health and aquatic sector experts, CDC developed the Model Aquatic Health Code (MAHC). States and localities can use MAHC to create or update existing pool codes to reduce risk, illness, and injury associated with aquatic facilities. The MAHC guidelines address the design, construction, operation, maintenance, policies, and management of public aquatic facilities. To keep MAHC up to date with the latest surveillance and study data and aquatics sector innovations, the non-profit, Council for MAHC (CMAHC) was established to solicit national input on MAHC improvements.
Learner Contribution: Jefferson led the creation of a cooperative agreement, using funds from two CDC centers to decrease CMAHC’s reliance on private sponsorships and establish sustainable funding. This included creating a logic model that was approved by CDC’s evaluation office, a budget, an application and applicant evaluation plan, and a performance plan that included specific deliverables. He worked with CMAHC to communicate with state environmental health directors to ensure they understood the importance of MAHC.
Misha Robyn, DVM, MPH, DACVPM
Preventive Medicine Fellow
Assignment Location: CDC, National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases Atlanta, GA
Project: Updating a Compendium: Preventing Zoonotic Disease in Public Settings
Misha collaborated with stakeholders and facilitated a process to revise and improve the Compendium for Preventing Zoonotic Disease Transmission from Animals to People in Public Settingsexternal icon, which has the potential to reach 89,000 veterinarians via publication through the Journal of American Veterinary Medical Association. The compendium is now more accessible and tailored to key audiences associated with recent outbreaks. Veterinarians can use the information to educate the public, petting zoo operators, county fair planners, and other animal event organizers so they can take actions to prevent zoonotic disease transmission.
Background: Contact with animals in public settings, such as petting zoos, fairs, and educational farms, provides opportunity for education, entertainment, and the positive benefits of the human-animal bond. However, these opportunities can lead to outbreaks of disease from human behaviors that increase the risk of infection and a lack of understanding of zoonotic pathogens. From 2010 to 2015, approximately 100 outbreaks of human infectious disease from animal contact in public settings were reported to CDC. No federal laws exist to address the risk for pathogen transmission at venues where the public has contact with animals. However, in 2017 the National Association of State Public Health Veterinarians (NASPHV) published the Compendium of Measures to Prevent Disease Associated with Animals in Public Settings. This set of recommendations is revised approximately every two years.
Learner Contribution: Misha acted as the CDC consultant to the NASPHV Animal Contact Compendium Committee and facilitated the seven steps of the compendium update process: 1) assessing the scope and purpose, 2) soliciting feedback from stakeholders, 3) obtaining and summarizing new data, 4) developing and revising content, 5) distributing and promoting, 6) evaluating reach and impact, and 7) preparing for the next revision. She also provided guidance and project-specific supervision to veterinary students who performed a literature review and descriptive epidemiology of animal contact outbreaks.
Brenna VanFrank, MD, MSPH
Preventive Medicine Resident
Assignment Location: Children’s Healthcare of Atlanta and Georgia Department of Public Health, Atlanta, GA
Project: Implementing Food Insecurity Screening in a Pediatric Healthcare System
Brenna worked with national stakeholders to develop and implement a pilot food insecurity screening and referral program that has the potential to provide food resources to every child in Georgia (approximately 100,000 children) when implemented system-wide. This pilot program can serve as a model to other healthcare systems nationwide and reduce healthcare-related costs by decreasing hospitalizations and improving the health and wellbeing of children.
Background: Approximately 42 million people in the U.S. report food insecurity, defined as “limited access to adequate food due to a lack of money or other resources.” Food insecurity is associated with poor health outcomes and one-third of families experiencing food insecurity indicate having to choose between paying for food or paying for medical care. It is estimated that more than one in four children in the state of Georgia are food insecure. Screening and referral programs in healthcare systems are increasing, but can be challenged by complexities in healthcare-community partnerships, medical-legal implications, and system-integration difficulties.
Learner Contribution: Brenna worked with the Strong4Life program at Children’s Healthcare of Atlanta (CHOA), a pediatric healthcare system in Georgia. She developed a policy brief examining the implications of implementing a food insecurity program and presented the brief and recommendations for next steps to CHOA’s leadership. She facilitated the process by building a team, engaging community partners, building relationships with other healthcare systems engaged in similar work, and drafting a program protocol.