Community Benefit Report

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2010 Commu n ity Benefit Rep or t

H

ow does a healthy community ensure a healthy future?

At The Children’s Hospital of Philadelphia (CHOP), it happens through a dedication to the highest level of care, research and expertise we can achieve to improve the lives of the children we serve. For more than 155 years, CHOP’s continued commitment and expansion has driven us one step further, taking us beyond our walls and redefining the CHOP community.

We’re proud to present the 2010 Community Benefit Report, Healthy Communities, Healthy Futures. It shares our core message: We believe healthy communities must be safe communities. To achieve this, we’ve taken aggressive leaps forward, transforming the culture of the Hospital and developing an environment that will provide the safest experience for our patients. CHOP is striving to become the safest children’s hospital in the nation by 2015, with changes under way to eliminate preventable harm. Our goal is to ensure that every child receives the flawless care they need and deserve.

In this report, you will read about the Hospital’s growth and expansion into more programs and resources that fulfill our mission while providing more benefits to our community. You will find information about the numerous outreach efforts that contribute toward the goal of making our community a healthier one.

From our primary care centers in Philadelphia to our international rural health clinics, there is one certainty that unites them all: CHOP’s commitment to the highest quality of care for all children. This year’s Community Benefit Report is dedicated to our healthy communities, because healthy communities cultivate the healthy futures that every child deserves.

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Total number of beds in servic e: 514 Number of patient visits: 1 million-plus Our language services invest ment was $3 million to inte rpret 44,500 encounters in 72 langu ages $96,000 to support partnerships wit h nonprofit organizations

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the CEO m o r f e t A no

Inside 4 Community Benefit 6 Primary Care 8 Education and Advocacy 10 Global Outreach 12 Ambulatory Network 14 Community Programs 16 Community Benefit (continued) 18 Training and Education 20 Research 22 Economic Impact

I am pleased to share with you the 2010 Healthy right of every child to have access to affordable care Communities, Healthy Futures Community Benefit despite preexisting conditions. We also recognize Report. This year’s theme reflects the Hospital’s the growing importance of primary care and the vision and mission to ensure that communities need for more pediatric providers to meet the needs everywhere are healthy places for kids to grow up. of a growing influx of families and children into the CHOP has made notable healthcare system.

CHOP has grown into a steps forward to improve and expand our care in children’s hospital without borders. When the the community. We’ve embarked on unprecedented earthquake in Haiti devastated the infrastructure initiatives—locally, nationally and globally.

The importance of the country and dismantled their healthcare of accessible primary care to a community is vital for system, CHOP physicians and nurses responded the health and development of its children. This year’s immediately. Committed to the children of the report showcases our commitment to this with the island of Hispaniola, the Global Health department Nicholas and Athena Karabots Pediatric & Adolescent at CHOP continues to send care teams to pediatric Care Center at 48th and Market Streets. As CHOP’s clinics in neighboring Dominican Republic.

The economic struggles largest facility for primary care, it will provide new of the past few years have had an unforgiving effect and expanded space for the Hospital’s two practices in widening the healthcare gap that exists for currently located at University City and Market children everywhere. At CHOP, we are continuously Street. This collaborative effort between community developing ways to close this gap and to aggressively members, experts in urban planning, and CHOP fight against threats to children. physicians, nurses and social workers has created I invite you inside our 2010 Community Benefit a framework that not only will provide the highest Report to learn more about the invaluable programs quality of healthcare to children who are at greatest and initiatives of our community. risk for chronic disease, but a building that will simultaneously serve the community as an epicenter for health promotion and community engagement.

Perhaps one of the Steven M. Altschuler, M.D. most influential pieces of legislation affecting our Chief Executive Officer CHOP community was the passage of healthcare The Children’s Hospital of Phil adelphia reform in 2010. At CHOP, we advocated for the

Moving Forward:

Global Reach:

Collaborative Expansion:

Closing the Gap:

Legislative Reform:

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deserves to er y child at CHOP ev at th ve lie be e W rve the vacation. They dese er m m su ake a e nc rie ex pe w activ ities and m fr iendships, tr y ne ild bu eds to ne l ity ia un ec rt oppo n with sp a lifetime. Childre st la ll wi t, at Bu th . es ies memor perienc ese long-lasting ex th m fro d de l clu ia ex ec are often at cater to their sp summer camps th thanks to specia l the fun. le to safely join in needs, they are ab ds with is a place where ki For 24 y just being kids. siblings—can enjo eir th d cancer an th — wi er n nc ca n childre ald Camp has give on cD M ld na .

Ro ar s, year eks of their ye one of the best we and their siblings o are currently ren, ages 7 to 17, wh ild ch r fo is p m ca The ted for cancer. who have been trea or t en tm ea tr ng from being undergoi dship, and freedom ien fr d an n fu of ire new sk ills It’s a week activ ities and acqu w ne e nc rie pe ex ta lk different. Kids ent. And they can rtur ing environm s. in a suppor tive, nu derstand er and ever yone un mp as openly about canc envisioned the ca , .D M ey Evans, ve ha , gh CHOP doctor Audr unity to lau n have the opport re ild ch e have er rs wh ee e a plac and volunt ds. Dedicated staff ki g in be one y jo to in en d og ram fun an al summer camp pr on iti ad tr a e ap sh worked to . eds of the campers onald that meets the ne n the Rona ld McD ee tw be p hi rs ne rt pa a is p ed 24 hours The cam llness center is staff we e Th .

OP CH d diatric Foundation an l/socia l staff of pe l and psychologica ica ed l. m a ita by sp y Ho da e a s from th and socia l worker es rs nu s, st gi lo co on

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Matters of the Heart—Camp Dragonfly

gives kids a place of love, understanding and friendship. This special summer camp, for children who have received a heart and/or lung transplant, or who have been diagnosed with pulmonary hypertension, is the first in the country that is specifically designed to accommodate children with these complex cardiopulmonary conditions.

For the last four years, patients from CHOP have descended to the eastern shore of Maryland for a free weeklong adventure. Dragonfly Heart Camp is a place where kids can build their confidence, learn about team building and meet other kids just like them.

As the camp’s medical director, Brian Hanna, M.D., M.D.C.M., Ph.D, coordinates volunteers from CHOP who attend to the campers, ranging in age from 7 to 18. In 2010, two doctors, two psychologists, four nurse practitioners, seven cardiac nurses and two child life therapists from the Hospital provided expert medical care to campers.

Sickle Cell Camp

, risks and complications don’t stand At in the way of a safe, fun time.

Children with sickle cell disease require a broad range of specialty services. Pediatric general surgeons, ophthalmologists and pulmonologists with expertise in the care of these patients work closely with the sickle cell team.

A getaway is a tall order, but CHOP’s annual overnight camp, held each August, enables sickle cell patients ages 7 to 14 to experience the fun of summer camp. They are safe in a caring environment with specially trained staff who are aware of their needs. The camp is staffed by physicians, nurses, social workers, psychologists and community volunteers.

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Transportation, food, medical equipment and other expenses are funded solely through contributions. The families of the campers pay nothing.

“I can do it!” sums up the experience at the

Paul Newman Hole in the Wall and Hole in the Woods camps. Last summer, several CHOP

patients attended these free camps, in northeastern Connecticut, which serve children between the ages of 7 and 15 who have been diagnosed with cancer or serious blood disorders.

Every child has the chance to successfully do regular activities, from swimming, boating and fishing to horseback riding, theater and sports. Activities continue during weekend programs from fall through spring. And through a hospital outreach program, physicians and nurses help take the camp experience to seriously ill hospitalized children. More than 15,000 children benefit from these camps each year.

OP donated In 2010, CH ard w to 0 00 0, $7 sts and co g in at oper ra ms to og pr intern al ilies who suppor t fa m a Ph ila delphi st ay at the ald House. on cD M ld Rona

fast fact More than

175 CHOP cancer patients attended

last summer’s Ronald McDonald Camp. CHOP donated

$10,000 toward the cost of creating these memories.

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Turning Evidence into Action

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olicyLab at CHOP has one goal: to achieve optimal child health and well-being by informing program and policy changes through interdisciplinary research.

PolicyLab disseminates its findings beyond research and academic communities as part of its commitment to transform “evidence into action.”

By partnering with numerous stakeholders in traditional healthcare and community locations, PolicyLab is identifying the programs, practices and policies that support the best results for children and their families. This work drives research topics that identify major gaps in evidence and practice know-how.

PolicyLab’s core areas for research are: • Behavioral health • Child welfare • Family and parenting supports • Health services • Sexually transmitted infection (STI) and pregnancy education and prevention • Complex chronic conditions Research Making a communit y impact

CSAW: Therapeutic Parenting Intervention: In partnership

with the city of Philadelphia’s Department of Human Services and the Department of Behavioral Health, this project pilots the co-location of two behavioral health interventions. The goal is to provide behavioral health services for children in foster care to improve mental health outcomes.

PolicyLab is leading Pennsylvania’s evaluation of an evidence-based visitation program, the Nurse Family Partnership (NFP), at its sites across the state. NFP pairs nurses with first-time moms to provide prenatal, infant and toddler visitation.

The Nurse Family Partnership (NFP):

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Translating Evidence-Based Developmental Screening (TEDS): Standardized developmental screening instruments to monitor

a child’s development at 9, 18 and 30 months of age can help identify developmental delays. The TEDS project followed 2,100 children and their families for two years to assess the adaptability, feasibility and effectiveness of developmental screening in pediatric primary care.

Communit y outreach and action

Mental Health:

PolicyLab’s fall 2010 Evidence to Action brief examines key issues surrounding children’s mental health and makes recommendations that focus on prevention, intervention, integrated services and evaluation.

PolicyLab released a report on the impact of the recession on child health, food security, housing stability and child maltreatment with First Focus and the Foundation for Child Development. This report was the center of a congressional briefing in November 2010 with Senator Bob Casey.

In fall 2010, PolicyLab convened leadership from state Medicaid and child welfare agencies to identify strategies for coordinating and delivering healthcare to children in foster care as part of the National Association of Public Child Welfare Administrators’ Policy Summit in Washington, D.C.

Children in the Recession:

Foster Care:

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fast fact Madel ine Be ll, President an d Ch ief Operatin g Of ficer

PolicyLab involves children and families in improving health services.

• 2,092 primary care center patients were studied to

Building a Path to Better Care

improve developmental screenings and access to early intervention services

• 405 children in the Philadelphia welfare system were followed to identify opportunities to strengthen services

• 86 children were enrolled in a project providing co-located behavioral health services in two local foster care agencies

CHOP has an ambitious goal: To become the safest children’s hospital in the nation by 2015. “We’ve taken aggressive leaps forward to transform the culture of the Hospital and develop an environment that will provide the safest experience for our patients,” says Madeline Bell, president and chief operating officer.

Expanding Services and Efficiencies

In the last year, Ms. Bell notes, CHOP has trained 12,000 employees in safety behaviors for prevention. The Hospital has decreased the incidence of harmful events and has focused more on the quality of care. At the same time, we have expanded our primary care services.

We are working toward our vision of the future by being more efficient, using nurses in better ways and providing more education to parents. These changes, already under way, will help eliminate preventable harm and ensure that every child receives the best healthcare experience possible.

A Physician’s Perspective: Debuting the Medical Home

“The design of our primary care offices will be improved by reformatting the way in which we approach a patient appointment,” says Lisa Biggs, M.D. A primary care pediatrician, she is working on a five-year initiative that aims to expand the scope of primary care services by using nurse practitioners, physicians and support staff in a more efficient way.

The team is approaching care through the patient-centered medical home model, which emphasizes the partnership between patients and their personal healthcare team. A medical home isn’t a place, but an idea, based around creating a solid foundation of healthcare where patients are in charge of their treatment and have a team of support at their fingertips.

The goal is to provide the best patient care experience through this medical home model, within which most issues can be treated. The goal at CHOP is to treat what we can and refer patients only when necessary.

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Giving Children a Healthy, Happy Star

Helping the Homeless

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he CHOP Homeless Health Initiative (HHI) has continued to provide a coordinated, multidisciplinary approach toward improving medical care of children in shelters by offering high-quality, culturally competent acute care services and health education to children, their families and the shelter staff for 22 years.

In 2010, there was a 12 percent increase in children ages 4 and under living in shelters and a 16 percent increase in youth ages 18 to 24. Hundreds of dedicated volunteers made 28 visits to three main shelter partners, providing 238 children with free healthcare services and 195 children with free dental services.

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Our New Efforts to Meet the Needs of Shelter Partners • Piloted “Operation Choices,” promoting healthy nutrition and physical activity in shelters • Partnered with the Travelers Aid Family Services shelter to provide wellness and education workshops • Worked with city agencies to compile a report card on the health status of children experiencing homelessness in Philadelphia

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The Early Head St ar t prog ram at CH OP is a unique child family-centered pr - and og ram. This prog ra m encourages eligi preg nant women ble and families to id entif y their ow n ne interests, and then ed s and develop sk ills that wi ll help them prom their children’s gr ote ow th and developm ent during the first years of life. three Staff help foster he althy and self-suffi cient families thro week ly home visit ugh s and parent-chi ld pl ay groups that focus on health promot ion and child deve lopment activ ities prog ram’s location at the in the Kirkbr ide Ce nter and at sites wi community. This pr thin the og ram also prov id es enrichment activ children with disa ities for bi lities, as well as menta l health educ suppor t, among ot ation and her serv ices.

Members of the pr og ram’s Polic y Co uncil, which repres community and en ent the rolled families, he lp hi re staff and recr ui families, finalize t new policies and proced ures, develop curr approve the budg icu lums and et.

In 2010,

$440,000 worth of in-kind services

and supplies were donated to fam ilies and children

by Early Head Start. 229 chil dren were ser ved.

1,200-plus hou rs were volu nte ered. Visit

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fast fact More than

600 children were screened for

heart problems in 2010, and some were diagnosed with previously unknown cardiac abnormalities.

Keeping the Beat Going Strong Youth Heart Watch at CHOP, an affiliate of Project ADAM®, features two programs: • The Heart Health Screening Study (HHSS) focuses on primary prevention, with the goal to identify young people with potentially serious heart problems. The HHSS held three Heart Health Screenings in 2010, giving children an ECG and a cardiac exam if warranted.

• The Youth Heart Watch School AED Program focuses on secondary prevention. Last year, the program presented automated external defibrillators (AEDs) to 26 Philadelphia middle schools and met with each to ensure that they have the resources necessary to sustain a public access defibrillation program. In 2010, program members met with 51 schools throughout Pennsylvania, New Jersey and Delaware to help launch and sustain their own public access defibrillation program.

As a result, this program fielded more than 200 calls regarding AEDs and sudden cardiac arrest.

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Help for Families in Financial Need The mission of the Family Health Coverage Programs (FHCP) is simple: to assist CHOP patients and families who are having financial difficulties and need help paying their medical bills.

The FHCP office renders guidance and assists with applications to state public welfare agencies for medical assistance and departments of insurance for SCHIP programs. In 2010, staff members also assessed more than 1,350 families for state-assisted coverage and charity care, with more than 200 families receiving charity care.

FHCP participates in community outreach health fairs and partners with community organizations such as the Philadelphia Coalition for Children and Youth to make Philadelphia families aware of the resources available at CHOP.

Photos (left to right): During CHOP’s second annual Healthy Kids Day in May 2010, Youth Heart Watch members provided manikins and an AED trainer for youth to practice CPR skills and automated external defibrillator use.

The Youth Heart Watch Program at CHOP presented an automated external defibrillator to 26 middle schools in Philadelphia. Pictured are Rachel Moyer, a Monroe County, Pa., parent of a teenager who died from sudden cardiac arrest; Bettyann Creighton, director of Health, Safety and Physical Education, Office of Teaching and Learning, School District of Philadelphia; Victoria Vetter, M.D., medical director of Youth Heart Watch and pediatric cardiologist at CHOP; and Gerald Branch, principal, Grover Washington Junior Middle School in Philadelphia.

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iti — A Blog it Notes from Hfliaghts, the 12-member medical team madeare layed e 10 -d ay tr ip After snow de nd ition s for th ince. Livi ng co Pr u-a rt Partners In Po by to sa fely ca mp operated nt te a in g in . st ay mun ity center simple. We are cour t of a com ll ba et sk ba te ncre Health on a co

of mpus is a pi le the center of ca in g in ly al l ild bu hool d, forcin g near The nu rsin g sc ctural ly un soun ru st e ar ita l sp gs in ho bu ild roug hout the stone. Severa l d Cross tents th Re d an e iv ry ce ta re m ili ren line up to patient care to men and ch ild wo , en m of reds grou nd s. Hu nd ASH un it. sim ilar to a M ng tti se a in care

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iversity work in g at Un med ica l teams al ion at rn diatric te in pe ra l uages. The There are seve y di fferent la ng an m ng ki ea h of sp uc H), 25 ch ild ren. M Hospita l (H UE th about 20 to wi ch ea e s, th nt te eventable in ward is in four is completely pr ts ea tr d ired an qu es Re p se hydration. what the grou fection s and de in d un wo d d an an rs ood in g ventilato U.S., such as bl e are no work er Th : ce eme tr ar sc ex ai ns had to ta ke equipment rem ph ysician s have s, se ca y an m s. ol . In med ica l to lim ited ox ygen of lig htin g and g res with a lack su ea m g to tent, look in in nt av lifes moved from te we , ift sh ren ar st W n,” recounts “D ur in g ou r fir

cr yi ng, ch ild re es im et ment. m rt so pa d an emergency de in on sleepin g, rse in CHOP’s nu ed er me, st gi ab re gr r, a r ch ild would Fran kenberge e floor beside he th on t g ec in rf ep pe sle e her ch ild. A “Often, a mom or Creole, to se ch en on Fr r p m he eit and a head la plead to me in ou nd his neck .” stethoscope ar a th wi er very ow n ch ild ng r stra for care of he to s ok lo e sh ne becomes someo

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Global Health Team Heads to Haiti On January 12, 2010, a magnitude 7.0 earthquake struck 16 miles west of Port-au-Prince, Haiti’s capital city. As one of the poorest countries in the Western Hemisphere, where 80 percent of the population lives in poverty, the loss of life and property was monumental. The devastation displaced 1.3 million Haitians, while 230,000 lives were lost and an additional 300,000 were injured and in desperate need of medical attention. In Port-au-Prince, all hospitals were leveled or rendered unusable from the earthquake. volunteers bring specialized care

As a nation almost completely reliant upon foreign aid, Haiti’s internal relief resources were scarce. CHOP, along with many other international organizations, came to this epicenter of disaster

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to provide resources and healthcare personnel to assist with the dire medical situation unfolding on the ground. A mere four days after the quake, a child was flown out of Haiti to the Hospital for treatment. CHOP then began relief efforts, assembling a team of experts to assist with the situation on the ground in Haiti. The Hospital’s 12-member Global Health Haiti Disaster Response team, comprised of five pediatric emergency physicians and seven pediatric nurses from the Emergency Department, intensive care unit and transport teams departed from Philadelphia on January 31 and arrived in Haiti on February 1, 2010.

The volunteers served for 10 days at Hopital de l’Universite d’etat d’Haiti (HUEH), Haiti’s largest hospital located in Port-auPrince. Team members blogged about their experience. The blogs can be read in full at www.chop.edu/globalhealth.

Other Global Health Programs

In addition to the disaster relief provided to the people of Haiti, the Global Health department at CHOP leads efforts to reverse preventable childhood mortality through building and enhancing targeted, sustainable, collaborative partnerships and interventions with developing partner countries.

In the Dominican Republic, the Niños Primeros en Salud (Kids First in Health) program offers access to pediatric medical care, nutrition interventions for children, breast-feeding education and health promotion workshops for community health workers in the town of Consuelo. In Botswana, CHOP staff collaborates with the University of Botswana School of Medicine to provide support, guidance and resources to their Department of Pediatrics.

To learn more about CHOP Global Health, visit www.chop.edu/ globalhealth.

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conser vi ng gluc ose strips for those who “rea there is now on lly” need it, an e ventilator op d eratin g in the

hospita l compo As much of th und. e disaster-rela ted inju ries ar care yield s to e addressed, postoperative and on goin g m ed ica l care.

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“T he pediatric ward remai ns fu ll of severe inju ries—I have or thoped ic seen as man y femur fractu re in two years— s as I usua lly with amputees see and complex ha amon g the patie nd inju ries m ixed nts,” notes Ra kesh M istry, M

.D. A great stru gg le for the team is witnessin g th that could be pr e end of life evented in bette r circu mst ance that with their s, and ba la ncin ability to relie g ve su fferi ng.

Last Day The Ha itian pe ople have taug ht us more than have taug ht th we could ever em. The ex perie nces we br in g be diverse yet back to CHOP tied together w wi ll ith

a com mon th re pa in and su ffe ad. The ri ng is cr ushi ng ... the streng th natu re of thes and resi lient e people inspir in g.

fast fact The Hospital’s Haiti Disaster Response efforts included approximately $96,000 for the relief effort in the way of supplies, equipment and expertise. Additional medical expenses were accrued from care given to several Haitian children at CHOP.

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Growing with Yo

g ’s pledge to keepin rnerstone of CHOP co a is s ice rv m se re y ca gift fro Ex panding pr imar boost thanks to a t received a major or eff is illion toward Th m . .5 hy $7 alt ve children he ts, who ga bo ra Ka na he At d cholas an us a projected philanthropists Ni lphia. Their gift, pl de ila Ph t es W in Athena re facility the Nicholas and a new pediatric ca CHOP, wi ll create m fro n d Market io an ill m th 5 48 the corner of investment of $2 at er nt Ce re Ca care & Adolescent ’s largest pr imar y Karabots Pediatric , this wi ll be CHOP 12 20 r be m ce De in Streets. Opening am rooms. ket uare feet and 56 ex sq 00 ,0 rsity City and Mar 58 th wi , center practices at Unive re Ca nt , ce st es co ol wAd lo & prov ides The two Pediatric Care Center, which nt ce m es fro ol re Ad e he Th te bined. ll reloca Street wi ll be com rv ices to teens, wi se ng ni an pl d ve ily m er unders ntia l fa tiona l practices in subsidized, confide maintain two addi ll wi OP CH .

St t 3550 Marke iladelphia. eek and South Ph areas in Cobbs Cr ram. ica l education prog n for CHOP ’s med tio ca lo ining. re tra co te a ua be eir grad The site wi ll also the site as part of th h ug ro th a te a ta vi ro s ll wi ain Campu Sevent y residents cally to CHOP’s M ni ro ct ele d nic te ro ec ct nn co CHOP ’s ele The building will be stem and wi ll use sy gy lo no ch te ion rmat sophisticated info to stem. sy ating resources in rd co medica l re w center, consolid ne e th to ily te m ca fa lo d ll re child- an Early Head Star t wi e severa l ancil lary us ho so al ll wi er . The cent this CHOP facility and serv ices. s m focused prog ra

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eas: birth throug lly underser ved ar Primar y care from located in medica es tic ac pr re Ca nt ce Pediatric & Adoles • University City

et re St t ke • Mar • Cobbs Creek lphia • South Philade 2010, including immunizations in 9 22 2, 12 ed er ist OP Care Network es admin avai lable at 23 CH These four practic is re ca r he rt Fu . w Jersey. unizations nnsylvania and Ne 16,924 H1N1 imm Pe in th wi es tic ac ysician cent Care pr munity. CHOP ph Pediatric & Adoles valuable to the com in e ar s Merck ice m rv fro se t e an ded a gr These preventiv rsity City, was awar ive Un at ma care ., th .D as M , ul ns her successf Tyra Br yant Stephe in recognition of N) CA (M k or tw a Ne Childhood Asthm

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coordination model, wh ich uses an asthma care navigator (community health worke r) to provide care coordi nation for children with This includes visits to the asthma. children’s home.

Me et ing So ut h Ph illy’s Gr ow ing

Ne eds Across tow n, the South Philadelphia practice, wh ich provided care for 27, patients last year, of wh 000 om many are receiv ing Me dicaid benefits, has fou ways to improve the pat nd two ient experience.

Along with two other Ca re Network practices, So uth Philadelphia particip in a pilot to offer MyCh ated art to patients. Through MyChart, parents can acc chi ld’s medical informati ess the ir on online from a secure site, request appointment lab results, and commu s and nicate with their physicia n and the practice. Hund patient families at the sit reds of e sig ned up and received access codes.

Through another pilot pro ject with Keystone Mercy Health Plan, the South Philadelphia site is worki ng to reduce emergency room visits for non-urge issues. The team is focusi nt ng on educating parents, and providing home vis and outreach to patients its who miss critical well-c hild visits or who have chr illnesses. Two primary onic care nurses, Susan Brenn an and Brook Bazz Park, nationa l recog nition for wo n their research on why pat ients use the emergency at times when primary roo m care would better meet their needs.

fast fact There were 117,69 4 primary care visits to the practices in medicall y underserved area s in 2010, includ ing the Adole scent Care Center.

Th is volume represents a 7 percent increas e from 2009, in part from a grow ing Me population that shou dicaid ld increase under he althcare reform an current economic sit d the uation. The four Pe diatric & Adolescent practices had a $5 Care ,480,420 net loss.

care on call

24/7/365

It’s 9 p.m. on a Saturday night and an 8-month-old baby has a fever and is crying. Who can the caregivers call?

The parents of children whose pediatrician is part of the CHOP Care Network can call the After Hours Program.

The After Hours Program provides specially trained nurses to call when the pediatrician’s office is closed.

This program is subsidized by a fund from CHOP.

Staffed by 32 full- and part-time nurses, the After Hours Program triaged 114,609 calls last year.

Working evenings, nights, weekends and holidays, the After Hours nurses guide parents when their children are sick or injured. This may mean a trip to the Emergency Department, an office visit or home care advice. A qualified nurse using critical thinking skills can make a difference between a 911 call and safely managing an ill child at home.

The program is the first at CHOP to have the majority of its staff working in home offices. During the H1N1 flu outbreak in 2009, the call center took an unprecedented 12,348 calls in October 2009 and met this high demand because of the increased flexibility of the staff. During the snowstorms that winter, nurses safe in their home offices could provide telephone support for the pediatrician offices until their staffs could get in.

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Riding to Safety Keeping kids safe is what it’s all about. The Kohl’s Injury Prevention Program at CHOP educates families about safety and provides protective equipment to help avoid injury for children.

This program offers education and safety devices to increase safety practices in the community through the Kohl’s Safety Center at CHOP, the Kohl’s Mobile Safety Center and community events. At its eight community child safety seat inspection stations, families can bring their child’s safety seat and learn how to install it correctly. Families who cannot afford a child safety seat can receive one at no charge through the Kohl’s Safety Center. Many safety devices, such as bicycle helmets, are donated through Kohl’s Mobile Safety Center and through CHOP’s Care Network.

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Creating a Safety Net The Poison Control Center (PCC) at CHOP is more than a 24-hour-a-day emergency hotline. It serves as a free public health safety net, fielding more than 80,000 calls from families and healthcare providers last year. Nearly 55 percent of these calls involved patients who were 5 years of age or younger.

The PCC helps save valuable healthcare dollars and resources by enabling callers to manage concerns

about poisons at home. The program is highly successful: 78 percent of the calls involving exposures to poisons were treated at home, with 60 percent of those calls involving kids age 5 or younger.

Funding for poison control centers in the U.S. is decreasing, but through generous support from CHOP, this PCC has been open since 1986. It is supported by a dedicated team of nurses, pharmacists and doctors every day of the year.

in CHOP offers poison assistance d Delaware.

23 Pennsylvania counties an

fast fact Injury Prevention

highlights

Value of in-kind donations:

$81,590

• Distributed more than 5,669 bike helmets, valued at $35,000 • Checked the quality of 1,235 child safety seats during 132 events at child safety seat inspection stations, which equaled 823 staff hours • Distributed a total of 1,093 new child safety seats to low-income families — valued at $45,455 • Distributed 84 home safety devices, valued at $1,135

14

rs

safe cleane

All-Purpose Cleaner 2 cups white distilled vinegar 2 cups warm water 20-30 drops essential oil such as lavender or rosemary (optional)

Furniture Polish 1/4 cup olive oil 1/4 cup white distilled vinegar 20-30 drops of lemon essential oil

Mix ingredients and shake well before using.

com mu n ity prog ra ms

Being prepared for a poison emergency is the best defense against the harmful effects to our families.

Families can learn about poisons in their home and how to protect children from them by visiting the PCC website, www.poisoncontrol.chop.edu. You can also find us on Facebook by typing “Philadelphia poison control” in the search box.

Printed materials are another resource. In 2010, one of the most popular children’s education activity booklets, Poison Control Patrol, debuted in Spanish, widening poison prevention’s outreach.

CHOP uses electronic health records designed to pinpoint specific patient information. In late 2010, an alert system was added to track information such as immunizations, asthma care/action plans and developmental milestones.

A new program, “Making Your Home a Greener and Safer Place,” was also launched in 2010. It teaches families how to poison-proof their homes and make them more environmentally sound. Household cleaners are among the top five poisons encountered by children and adults each year in the home. Using “green alternatives” to cleaners provides a significant reduction of risk.

Sharing the Joy of Reading

“S

eeing the spark in a toddler’s eye” is what compels Brenda Waber, R.D., C.S.P., C.N.S.D., L.D.N., a neonatal dietitian at CHOP, to volunteer for Reach Out and Read®.

In this national school readiness program, children ages 6 months through 5 years receive a brand-new (and free) book from their primary care doctor or nurse practitioner during every checkup.

“I look forward to Wednesday afternoons when I volunteer for Reach Out and Read,” Waber says. She reads aloud to children of all ages in the waiting room at the CHOP Care Network, Pediatric & Adolescent Care, Cobbs Creek practice. “When a toddler turns the pages in a board book or I help an older child discover historical fiction, it reminds me of how I enjoyed reading to my own children so many years ago. It’s a joyful weekly ritual that I feel privileged to be a part of.”

Research shows that Reach Out and Read improves the home literacy environment.

it c o m mu n

i t r epor y b e ne f

t • w w w.chop.edu

Reach Out and Read’s accompl ishments and highlig hts at CH OP duri ng the past year: • Approx imat ely

70 Reach Out and Read and nu rse prac titioners and 142 resident ph ysician s distrib uted 26,000 br new, developm andenta lly and cu ltu ra lly approp book s to ch ild ria te ren ages 6 mon ths th roug h 5 du ri ng well vi years sits. They enco uraged the pa rents and caregivers to read aloud to th eir yo un g ch ild ren wh ile offeri ng age-ap propriate tips.

• Reach Out an d Read served 20,079 ch ild re n ages 6 months th ro ug h 5 years at six of CHOP’s Network, Pedi Care atric & Adolesc ent Care practic Ph iladelphia an es in d New Jersey (Cobbs Creek, Care Center, M Fa m ily arket Street, Sa lem Road, Sout Ph iladelphia an h d Un iversity Ci ty ).

• Si x practices distributed 45 ,000 gently us ed book s to ch ild ren of al l ages du ri ng well and sick vi • Reach Out an sits. d Read received a va n donation the Auto Dealer fr om s CA Ri ng for Ki ds Foundation.

Th is va n has be come the first CHOP Reach Ou Read vehicle us t and ed for pick ups from book dr iv es. pediatricia ns

Photos above, from left to right: Trude Haecker, M.D., presents a book to an infant and his parents. Jacqueline Aveta, M.D., watches Salvatore’s father read to him. CHOP’s Reach Out and Read van was donated by the Auto Dealers CARing for Kids Foundation.

15

making

healthy fun y— a D s id K y h lt a e 2010 H ss! e c c u S g in h s a m AS

od tertainment and go ness session to en fit d an . p es -u ili m rm fa wa t for area mor ning t fu ll of excitemen From an incredible en ev y rg ne -e gh Day was a hi food, Healthy Kids e Mann Center ugh the gates of th ro th ed ur po n re hy Kids parents and child anticipated Healt More than 8,000 10, for the much20 , 22 ay prov ides M y on Da ts g Ar althy Kids for the Performin h and wellness, He alt he e ot in a om n pr io to or t educat Day 2010. In an eff h information and alt he th r wi ea ar . te es e tr i-sta the famili A majo attendees from th ided at no cost to ov pr t in is t en en m ev st e ve tir The en rt of its in fun, engaging way. event’s costs as pa e th e rit rw de un helped to sponsor, Walmar t, mmunity. co a the Philadelphi

At te nda nc e

Do ub le S

e! d high school t Se t an d M ov urag ing middle an co Ge t Re ady, Ge en t, en ev e . The th buted as part of of fun and fitness

ng The Youth Wal k de me out for a mor ni ving delphia area to co ila Ph e Fairmount Park, gi th h m ug ro fro th ts s se ur studen co er et m lo ng a ed 1-mile and 5-ki ance of maintaini Youth Wal k featur d learn the import an e tiv -up ac rm be to wa e rtunity ding th students the oppo ing the wa lk and lea en Op e. nc . ce ies es ill ol ring ad gles and Ph healthy lifestyle du the Philadelphia Ea m fro es ed et as hl -b at l essiona her CHOP exercises were prof phasized during ot em s wa e nc Injury ’s ce es hl hy adol ram, Ko The goal of a healt althy Weight Prog He e th on cs ng pi ni to ai , CPR tr ns including olescent medicine ad information sessio a, m th as , ne ici m nts to ake m, spor ts med powering participa em on Prevention Prog ra s cu fo s m ra nter. These prog and the Cardiac Ce tomor row. day for a healthier healthy choices to

16

it c o m mu n

com mu n ity benefit

i t r epor y b e ne f

t • w w w.chop.edu

Free Healthy Fun Anyone?

Medical residents, attending physicians, nurses, social workers and other CHOP staff members offered their time and resources to provide invaluable education to parents and children, all with the hope of creating a healthier community.

Families could talk with these professionals, ask questions and learn how to make their homes healthier ones.

Being active was the order of the day. A variety of activities for children and their families ranged from the opportunity to shoot some hoops with the Temple University basketball team, play soccer with the Philadelphia KiXX, run the bases with the Camden Riversharks, serve up some aces with Arthur Ashe Youth Tennis, practice karate and dance with Zumba instructors. These activities showed kids that there are many different ways to incorporate physical activity into daily living—and that being healthy should be fun!

Hip Hop Harry from The Hub network joined previous year’s hit Laurie Berkner from Nick Jr. to close out the event with a free concert.

Reaching

into the

future

The benefits of Healthy Kids Day 2010 reached into the homes of more than

8,000 children

and their

families. This premier health promotion event for CHOP’s community provided invaluable resources, education and fun for the whole family.

Recipe y a D s lthy Kid The Hea 60,000 dollars of CHOP commitment to the community 1,935 hours of volunteer service 1,000 books donated from the Reach Out and Read Program 300 bicycle helmets donated for bike safety 379 volunteers 20 programs from CHOP providing information and resources to families

1 H ip H op Har ry 1 L au r ie Berk n er B a T he se nd cret in g red ie nt: H

ea lth y K id s! g size: More t ha n 8,0 hea lth y k id s 00 hap a nd t h py, eir fa m il ies

Ser v in

17

g developin

l ealthy ski

h

ls

Asthma Management in Schools

r

Resident Projects Community Pediatrics and Advocacy Program The Community Pediatrics and Advocacy Program (CPAP) aims to teach residents to become pediatricians who are as comfortable and competent in their role as child advocates as they are in medical practice. The longitudinal training program works to build core advocacy skills in partnership with private and public community-based agencies to promote the well-being of children.

18

This project promotes enhanced communication between primary care doctors and school nurses to improve asthma care in schools through increased use of medication administration prescriptions.

Ballroom Dance for LIFE: Partnering with Dancing Classrooms Philly

In conjunction with Dancing Classrooms’s weekly ballroom dance lessons for fifth graders, residents created five brief, interactive lessons to illustrate the health benefits of dance.

Creating a Healthier South Philadelphia Community (Recipient of AAP CATCH grant)

The goal is to improve awareness in South Philadelphia about the importance of nutrition at an early age, and enable families to access healthy fresh fruits and vegetables within their neighborhood.

Curriculum Development for the South Philadelphia High School ELECT Program

Residents created a forum for teen parents at South Philadelphia High School to receive healthcare information and ask questions about their children’s healthcare needs in an informal setting. Participants are students enrolled in the Education Leading to Employment and Career Training (ELECT) program, which helps them complete high school.

CHOP Refugee Health Initiative

Opening in March 2011, this pilot project evolved from the work of residents interested in the resettlement of refugee families and access to pediatric care.

Communit y Advocates

REACH for College: A Group Mentoring Program

Pediatric residents at CHOP pursue a community advocacy project, often initiated during their intern year and completed during their third year of training. The following are a few of the many projects Hospital residents took on during the past year.

for Teens With Chronic Illness

This group mentoring program provides resources to teens and parents to prepare for the academic, financial, social and medical adjustments that attending college with chronic illness necessitates.

trai n ing an d education

it c o m mu n

Community Nursing Advocacy Fellowship

T

he Community Nursing Advocacy Fellowship (CNAF) is a nine-month educational program for senior-level nurses at CHOP who are interested in community outreach and building strong advocacy skills on behalf of children and families.

CNAF supports 10 nurse fellows each year, through a grant from the Carol Ware Gates Foundation. The program combines lectures, conference attendance and research projects with community-outreach opportunities. The core curriculum includes: • Advocacy and community outreach • Early-intervention services • Education • Chronic/terminal illness and children with special healthcare needs • Housing and homelessness • Sexuality, sexually transmitted diseases, adolescent pregnancy and reproductive health • Child maltreatment • Juvenile justice • Violence and injury • Environmental health During their commitment, CNAF nurse fellows continue their clinical work, which gives them the chance to directly integrate advocacy into their clinical practice.

Past Grand Rounds Sustainable CNAF Projects

• Therapeutic yoga group for children along the autism spectrum • Bicycle safety and nutrition education in partnership with Neighborhood Bike Works

• Health and fitness through dance: Hip Hop Dance Club at St. Francis De Sales School • Unintentional injury prevention in a North Philadelphia secondgrade classroom • ELECT Program at University City High School: Educating Expectant Teen Parents • Ask a Nurse! Nursing Education at Homeless Health evening clinic visits • Teen workshop at Jane Addams Place (A shelter for teens and families in West Philadelphia) • Home safety program with CHOP’s Early Head Start Program The 2010 CNAF Sustainable Projects

• Recruiting Future Allied Health Professionals: A Focus on Men and Minorities • Taking Charge of Your Health: Education for Homeless Youth • University City High School: First Annual Health Fair • Healthy Exercise Program at St. Barnabas Mission • Junior Phillies Health Club: Incorporating Healthy Eating and Lifestyle into 2nd Grade Curriculum • Urban Nutrition Initiative: Creating Curriculum for High School Students Around Healthy Nutrition Choices • “The Biggest Winner,” a multidisciplinary approach to healthy eating through a mind/body connection

i t r epor y b e ne f

t • w w w.chop.edu

19

unlockin

g

inies

t ealthy des

h

re tu u F r ie h lt a e H a g in Research

G

s can help determine . Unlocking their secret are we o wh ine erm det enes help cs (CAG), part nter for Applied Genomi Ce the m fro ers rch sea our future. Re rch Institute, have led the tal of Philadelphia Resea as a of The Children’s Hospi many conditions—and that for m the basis for way in identifying genes to cures. result, may hold the key

be te s th We ig ht to Dia involved in the Ty ing Lo we r Bir from CAG, found a gene , .D. uan Grant, Ph

to having a lower Investigators led by Str o predisposes children als t tha es bet dia 2 e development of typ ongoing genomebir th weight.

Caucasian chi ldren in an 00 5,7 m fro A DN of 20 gene locations Draw ing on a cohort d his team investigated an t an Gr .

Dr ty, esi ob of urrence wide association study es. They compared the occ ated with type 2 diabet oci ass be that to nd wn fou y sho y previousl s analysis, the h bir th weight. From thi wit es gen se ight, the we in th ts bir with lower of the var ian had a strong association , L1 KA CD led cal e gen a var iant, in a betes later in life. se the risk of type 2 dia ean study with similar which is know n to increa nforces a smaller Europ rei es, bet Dia in d she bli tal events may set This finding, pu influence on how prena c eti gen ble ssi po a on ant’s team findings. It sheds light ood or adu lthood. Dr. Gr diabetes in later chi ldh g pin elo dev o additiona l tw for er ge cov sta the s worldwide to un up gro le ltip mu h wit ces subsequently joined for s in Nature Genetics. t and published the result igh we th bir in ed olv genes inv ho od Dis eas es ne tic s of Ch ild t diseases from Ex pl or ing th e Ge ly manage or even preven

g ways to effective s driven the work of An investment in findin etic predisposition—ha gen ’s son per a on ed bas hnology, investigators occurr ing—all ts of this genoty ping tec tpu ou ing ield h-y hig genetic basis for many CAG. Through the r understanding of the ate gre a ve ha ers vid and helps physicians and hea lthcare pro ts for chi ldhood diseases tes ic ost gn dia w ne s conditions. This guide te therapies. g research under find the most appropria m CAG’s groundbrea kin fro ts gh hli hig the of e The fol low ing are som 10 alone. ng D., Ph.D, in fiscal year 20 mber var iations—missi Ha kon Ha konarson, M. ions where rare copy nu ism aut h Identified 27 genetic reg wit in the genes of chi ldren seg ments—were found or extra copies of DNA Ds). spectr um disorders (AS

Autism:

20

it c o m mu n

research

Neuroblastoma: Collaborated with John Maris, M.D., chief of

the Division of Oncology at CHOP, on a genome-wide association study that discovered common variants in the gene BARD1 that increases a child’s susceptibility to a high-risk form of neuroblastoma, the most common solid cancer of early childhood.

Identified a novel gene, called DENND1B, that affects cells and signaling molecules thought to be instrumental in the immune system overreaction that occurs in asthma.

Evaluated the DNA of more than 15,000 children and played a primary role in the discovery of five

Asthma:

Inflammatory Bowel Disease:

new genes that raise the risk of early-onset inflammatory bowel disease (IBD), a painful, chronic inflammation of the gastrointestinal tract.

Analyzed the genomes of patients with schizophrenia and discovered numerous copy number variations that increase the risk of developing this condition.

Identified the first major gene location responsible for a severe, often painful, type of food allergy called eosinophilic esophagitis (EE). This disease can cause weight loss, vomiting, heartburn and swallowing difficulties and can leave the patient unable to eat a wide variety of foods.

Schizophrenia:

Food Allergies:

2010 Research Financials All Sources of Funding External Endowment

$161,639,180 $6,361,173

Hospital

$41,743,170

Other

$16,658,134 $226,401,657

All Sources of External Funding (Grants and Contracts) Federal

$115,101,703

Federal-Stimulus

$10,938,785

Industrial

$10,544,101

State/Local

$4,327,339

Foundation

$11,830,300

Other

$8,896,952 $161,639,180

Total Research Operating Expenditures New Awards (Grants and Contracts) Number of Awards Dollar Value ($) Millions

i t r epor y b e ne f

$253,058,865 Non Stimulus

Stimulus

Total

320

80

400

$67.3

24.1

91.40

t • w w w.chop.edu

21

h

Saint Peter’s University Hospit al (Cardiac Center)

Grand View Ho

spital

Indian Valley

Doylestown Ho spital Central Bucks Bucks County

MONTGOM

ERY

ds e e N l ia c e p S y b Driven

T

22

d Behavioral nsive Emotiona l an te In n’s re ild Ch he Care Center in CHOP ’s Specia lty at ) BP IE (C m ra Prog ughout the children from thro es rv se ty un Co ic d 12, with At lant een the ages of 5 an tw be , on gi re ey rs South Je d socia l needs. oral, emotiona l an sig nificant behavi hours daily ever y e prog ram for six is to Children attend th n of the prog ram onths. The missio m ur fo be of e d ag an er can stay week for an av ning so that a child tio nc fu ily m fa d improve child an and community. her home, school or s hi in unity as a e tiv uc prod tation in the comm pu re a d ire qu ac s vative and This prog ram ha care. By using inno l ca ni cli nt lle ce g ex ted model for prov idin s successf ul ly trea s, the prog ram ha ice rv se t en en be t tm no ea s ers ha proven tr t with other prov id en tm ea tr om wh r children fo clude: unique serv ices in year with the successf ul. Other veral times each se ts en ev l ia ec d to join children Hosting sp Families are invite n. re ild ch d te ren and promote families of trea lents of these child ta e th ht lig ot sp e that in activ ities that ts are the first tim . Often, these even ns io ct ra child. As a te eir in th ive of posit plishments m co ac e th in e id e pr at comes from parents ex perienc t in self-esteem th os bo a e nc rie pe n ex m their families. resu lt, the childre t of their effor ts fro en gm led ow kn ac receiv ing at families g skills groups th g Evening parentin charge, includin to attend, free of in is m ra are encouraged og ique pr child care. This un ten complimentary s and caregivers of nt re pa fact that the e th of ed on rg iti ha sc gn di co re children are suppor t after the continue to need . from the prog ram ich enhances d playground, wh le al st , in ly nt ce A re n. The playground ed to the childre id ov pr es ti vi ti daily ac spor tation for the us to prov ide tran possible due as well as a minib og ram, were made pr e th m fro d an children to donations. tion to community to a grant, in addi

Princeton

MERCER

High Point King of Prussia

Phoenixville Ho

spital

Chestnut Hill

CHESTER Exton

Chester Co. Hospital

West Chester North Hills Kennett Square West Grove

Flourtown Chestnut Hill Ho

Newtown spital Abington Hospit al Holy Redeemer

Roxborough

Paoli

Coatesville

BUCKS

Broomall Haverford

Springfield Chadds Ford Springfield

MIDDLESEX

University Medical Center at Princeton

PHILA.

Hospital Salem Road

Pennsylvania Ho spital University City Market Street

Cobbs Creek Drexel HUP Media Hill South DELAWARE Philadelphia

MONMOUTH

Virtua Mt. Lau rel Mt. Laurel

OCEAN

Virtua Voorhee

s

Voorhees

GLOUCESTER CAMDEN NEW CASTLE

BURLINGTON

SALEM

ATLANTIC Harborview/Smit

hville

Atlantic Count y

CUMBERLAN

D

Harborview/Som Shore Memorial

CHOP Newborn

Care

CAPE MAY

CHOP Pediatr

ic Care

CHOP Newborn Primary Care Specialty Care Specialty Care Specialty Care

ers Point

Hospital

& Pediatric Car e Harborview/Cape

Center

May Co.

& Surgery Cen

ter

Center & Home

Care

CHOP includes nearly

50 sites.

02-11

ng supporti

ooks

l ealthy out

In 2010, the 10 New Jersey sites treated more than

173,000 children.

econom ic im pact

it c o m mu n

i t r epor y b e ne f

t • w w w.chop.edu

2010 Financial Comm itment to the Commu nity Charity Care

(free or discounted healthcare provided to families who cannot afford to pay)

$7,323,000

Unpaid Cost of Medicaid Programs

$75,596,000

Unpaid Cost of Medical Education Programs

$13,597,000

Losses at Pediatric & Adolescent Care Practices in South and West Philadelphia Subsidies for Research

(investment and support to research programs that would otherwise go unfunded)

Research In-kind Donations* Bad Debt

(healthcare receivables that could not be collected)

$5,480,000 $49,392,000 $447,162 $36,065,000

Note: The costs of many other community benefit services are not calculated in this report. All financial data is for fiscal year 2010. *Research in-kind donations comes from research finance

23

Of fic e of Gove rnm ent Affair s, Comm unity Relations For more inform & Advo cacy ation, ple ase co ntact: 267-426 -6 90 4 • ww w.chop.edu/g ov t_affairs 34th Street and Civic Ce nte r Bo uleva rd Philadelphia, PA 1910 4- 4399 1-8 00 TRY CHOP • ww w.chop.ed u

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