On Friday, April 10, the first patients are to arrive at Boston Hope, a medical center recently constructed inside the Boston Convention and Exhibition Center. The thousand-bed hospital will serve post-acute COVID-19 patients and homeless patients with COVID-19.
- The chest radiographs performed at the clinics revealed disparities in the pandemic and confirmed Chelsea as a hot spot
- Patients were either admitted to the hospital or given care kits to recover at home
- Proactively treating patients in a highly affected area increased access to timely care and likely decreased the severity of the disease while also preserving health care resources
In order to meet the needs of underserved communities at the start of the COVID-19 pandemic, Massachusetts General Hospital opened three respiratory illness clinics (RICs), and the RIC at the MGH Chelsea HealthCare Center served patients in the Massachusetts cities Chelsea, Revere, Charlestown and Everett. Mass General partnered with community leaders in each city to broadcast public service announcements that the clinics were open to all people, regardless of health insurance and immigration status.
But, why does the pandemic pose a higher risk to these communities? Efren Flores, MD, a physician who works in Imaging and provided imaging care at the RICs explains that many people in these areas are essential workers who are not able to physically distance in ways available to others, such as by working from home or ordering groceries and household supplies for delivery.
"The most important message to the community is that you come here to get evaluated because we are here to take care of people," says Dr. Flores. And, in focusing on treatment in a community considered a COVID-19 hot spot, it actually benefits overall community health.
Underlying Challenges and Disparities in Underserved Communities
Dr. Flores explains that the frequency and severity of COVID-19 cases presenting to radiology for initial evaluation at the Chelsea RIC were significantly higher than at the main campus in Boston. This helped confirm Chelsea as a hot spot early on in the pandemic and illuminated the disparity that occurs in communities with a higher proportion of Latino individuals and lower socio-economic status—factors that, in this circumstance, often result in higher risk of comorbidity.
Moreover, there is greater housing density, with large, multi-generational families often living together in small homes, so self-quarantining is difficult and, in some cases, impossible. All of these circumstances led to people being exposed to the virus and postponing their care, therefore, increasing community spread of the disease and leading to many cases of severe illness.
"Many Chelsea residents have jobs that do not include paid sick leave, so they had to choose between putting food on the table for their loved ones or protecting their health," says Dr. Flores. "Also, we learned that many people were worried about how they were going to pay for their hospital visit, a concern that took precedence over focusing on their health."
How the RICs Have Supported These Communities
Patients were understandably cautious about entering the clinics at first, as many were unfamiliar with the health system—especially if they were not already Mass General patients—scared about coronavirus exposure and nervous about their health insurance and immigration statuses.
However, Mass General has fostered longstanding community programs and relationships through the MGH Chelsea HealthCare Center and the Center for Community Health Improvement (CCHI), and implemented a variety of measures to support patients.
- Creating materials in multiple languages: To support those patients with limited English proficiency, Mass General's Spanish Language Care Group and the Disparity Solution Center created material about COVID-19 testing in multiple languages so people would know what to expect
- Extending clinic hours: The clinics were open extended hours so that residents could stop by before or after work
- Setting up a RIC in convenient locations with trusted providers: The location was closer to work and home for many community members and staffed with trusted providers. Testing within the community helped decrease exposure to COVID-19 for many patients by eliminating a trip on public transit, and potentially decreasing spread to other household members and co-workers
Many patients seeking care at the clinics did not know with certainty whether they had COVID-19 and, if positive, what to do next. As in testing at the main campus, standard nasal swab tests were supplemented at the RICs with chest radiographs to help confirm severity of active infections. Portable chest radiographs allocated from the radiology department helped the clinical teams in the frontlines with triaging patients so that the health care providers could quickly decide whether patients should recover at home or whether they needed to be admitted to the hospital.
For example, one patient did not show obvious symptoms of severe disease, but chest radiograph revealed severe lung infection. The patient was admitted to the hospital, where they recovered without needing intensive care. According to Dr. Flores, if this patient had not gone to the clinic on time, they might have gotten sicker and potentially required a ventilator due to increased severity of disease.
However, by catching the illness early enough, doctors conserved hospital resources and supported the patient back to health.
"By proactively treating patients at a hot spot, we increased access to timely care and decreased severity of the disease due to delays of care, therefore, we had more resources available to the greater community," says Dr. Flores.
Many of the clinic's patients faced food insecurity, so CCHI collaborated with the MGH Chelsea HealthCare Center, the town of Chelsea and nonprofit organizations to assist families and provide them with food and care kits. For patients who did not need hospitalization, these kits helped them safely recover while being as isolated as possible. The kits included:
- Hand sanitizer
- Cleaning equipment
- Information about COVID in different languages
"These interventions show how public health is an extension of health care," says Dr. Flores.
By providing patients with essential items, the clinics served as point to assist patients and the community helped people and the limit their exposure to the community and their household members. Dr. Flores reports that the efforts paid off.
"We saw the number of patients coming to radiology decrease and the severity of disease in chest radiographs also decrease," he says.
Lessons for the Future
The RICs were a measure to extend health care deeper into communities at the peak of the pandemic. However, they revealed the need for a system that is proactive and flexible enough to respond to unexpected challenges in the communities, as well as underscored the benefits of health care systems collaborating with community health centers to provide high-quality care for all patients.
Overall, the clinics helped increase access to timely care in a trusted setting and protected vulnerable communities during a historical public health crisis.
"We are willing to do whatever it takes to provide the best care possible for all of our patients," says Dr. Flores.
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