2019 Year In Review

Year In Review 2019

...to enhance the well-being of the community through education and the promotion of public health.

FROM THE ACADEMY/DPHA LEADERSHIP Welcome to the 2019 editor of our Year In Review. The Centers for Disease Control and Prevention identified nine health threats that made headlines in this past year (2019): 1) Lung Injuries linked to E-Cigarette use and Vaping 2) Opioids 3) Antibiotic and Antimicrobial Resistance 4) Foodborne Outbreaks (E. coli and Salmonella) 5) Pregnancy-Related Deaths 6) A stall in HIV prevention progress 7) Measles outbreaks 8) Mounting challenges in Immunization and Vaccination across demographics 9) Domestic Preparedness and Global Health Security – Ebola Retrieved from: https://www.cdc.gov/media/releases/2019/p1218-nine-health-threats-2019-review.html

It is with this national and global backdrop that we worked locally, and we are pleased to provide the following report on our activities and initiatives in the past year. As always, we remain poised for the unanticipated and the unexpected, through a strong foundation of remaining focused on our mission of improving health for all Delawareans.

Founded in 1930, next year will be our 90th year of operation – and we look forward to special activities and events to honor our past and set the course for our future. As always, our strength is in our membership and our partnerships, and to everyone we say “Thank you for all that you do” as we work in our mission to “Enhance the well-being of our community through education and the promotion of public health.”

Omar A. Khan, M.D., M.H.S., FAAFP President of the Board

Timothy E. Gibbs, M.P.H. Executive Director

On the cover: Left: Omar A. Khan, M.D., M.H.S. and Kara Odom Walker, M.D., M.P.H. present Sherman Townsend (at right) with the 2019 President’s Award for his leadership of the DIMER Program; Center: attendees to the 89th Annual Meeting; Right: Tim Gibbs, M.P.H. and Omar A. Khan, M.D., M.H.S., present Arlene Bincsik, M.S., R.N., C.C.R.C., A.C.R.N., and Susan Szabo, M.D. with the 2019 Public Health Recognition to the William J. Holloway, MD Community Clinic (originally called the Christiana Care HIV Program).

P U B L I C H E A LT H P R O G R A M S & ENGAGEMENT

2019 review

Delaware Medical Orders for Scope of Treatment www.delawaremost.org The DMOST form is the end-product of communication between a patient and/or their authorized representative, and their medical practitioner. This communication ensures informed medical decision-making and the honoring of a patient’s preferences regarding life-sustaining medical procedures such as cardiopulmonary resuscitation (CPR).

The Academy/DPHA implemented the DMOST program in April of 2016, and coordinated the training of users and institutional trainers in its use for the next four years. The Academy/DPHA transitioned the DMOST program, website, and implementation to the Delaware Quality of Life Coalition in 2019; this transition was completed on March 31, 2019.

During Academy/DPHA purview, 578 individuals were trained online, and 739 trained in person (for a total of 1,317) to utilize the DMOST form to ensure a patient’s decisions (see Table 1, Figure 1).

Table 1. Self-Reported User Credentials, DMOST Online Training, April 2016 – March 2019

Figure 1. DMOST Training, April 2016 – March 2019

P U B L I C H E A LT H P R O G R A M S & E N G A G E M E N T The Immunization Coalition of Delaware www.immunizedelaware.org The mission of the ICD is to bring together local, state, and community organizations and individuals to promote education about vaccine preventable diseases and new vaccines, with the goal of improving access and vaccination rates throughout the lifespan. The ICD works in partnership with its members and their organizations to advocate for policy issues related to childhood, adolescent, and adult immunizations; reduce disparities in adult access to immunizations; and to shape the healthcare process and outcomes for Delaware residents in relation to vaccine preventable disease.

In 2019, the ICD attended health fairs, held four quarterly meetings, presented throughout the state, and published 52 editions of the Week in Review. The ICD’s website is http://www.immunizedelaware.org/, and has sections for both healthcare professionals and the public, with links to immunization stories in the news, events planned by the coalition, and other immunization topics.

The public can use the ICD website to inform themselves about the importance of immunization across the lifespan, how vaccines are made, links to flu clinics and information about the Vaccines for Children program. Providers gain access to many materials published by the Centers for Disease Control and Prevention (CDC) including vaccine information statements (VIS) and fact sheets, links to the Pink Book and the Delaware Department of Public Health, and continuing education opportunities. There is also information on Delaware specific immunization data, an information page about so-called vaccine conspiracies to help providers speak to their patients’ concerns, best practices for administering and reporting vaccines, and links to videos discussing how to speak with patients and parents regarding immunization.

The coalition had an information table at various health fairs throughout the state, including:

• January - Health and Wellness Expo (Wilmington),

• March - Garfield Park Rec Center Health Fair (New Castle),

• April - Delaware State University Student Wellness Expo (Dover),

• September - Wilmington Wellness Day (Wilmington), and

• October - Christiana Care’s Hit Me With Your Best Shot (Newark)

The table had brochures containing immunization recommendations throughout the lifespan, information on the different vaccines available, and an informed staffer to answer any questions that were asked. Providers had the option of becoming a member of the coalition and signing up for the ICD’s weekly newsletter at the table.

The ICD also made several presentations throughout the year, including Vaccines and Public Health (University of Delaware), HPV (Smyrna Christian School), Vaccines for Immigrants (Delaware Nurses Association), HPV Vaccine (Delaware Pharmacists Annual Meeting), and Medical Grand Rounds – Influenza (ChristianaCare).

In February, May, August, and November the ICD held a quarterly meeting, so that all the membership could discuss issues pertaining to immunization in Delaware and the nation as a whole, outreach to the population of Delaware, infectious disease throughout the world, and any regulatory issues or new recommendations in the news.

At the end of the year, the ICD was asked to comment on the potential removal of any non-medical vaccine exemptions from the State. The ICD worked with State representatives and the Division of Public Health (DPH) to discuss what was best for Delaware as a whole.

On December 9, the ICD was pleased to collaborate with the Medical Society of Delaware (MSD) and the Delaware Division of Public Health (DPH) on the annual Communicable Disease Summit. This summit included presentations on hospital acquired infections, vaccine hesitancy, one health (the intersection of human, animal, and environmental health), re-emerging threats, threats due to the opioid epidemic, and an update on Delaware health.

2019 review Delaware State Health Improvement Plan www.delawareship.org The State Health Improvement Plan (SHIP) is a long-term, systematic plan to address issues identified in the State Health Assessment (SHA), and is used by the community, stakeholders, and partners to set priorities, direct resources, and develop and implement projects, programs, and policies to better the community. The Delaware SHIP is on a three-year cycle – the steering committee for this phase includes colleagues from the University of Delaware, the Delaware Division of Public Health (DPH), and the Academy/DPHA. This year, the main goal of the Steering Committee was to monitor the high impact groups identified by the SHIP and monitor their progress in the SHIP impact areas of Chronic Disease, Maternal and Child Health, Behavioral Health, and Addiction.

The Academy/DPHA is responsible for reports and communications of the SHIP Steering Committee, and the creation of the SHIP website. In February 2019, the website (delawareship.org) went live, and the Delaware Journal of Public Health (Data to Decision Making) issue highlighted the SHIP program, documents, and impact groups.

The first annual meeting was held on October 23; the Academy/DPHA assisted in the planning process, and created the visual design for the corresponding annual report and executive summary.

Delaware Chronic Disease Collaborative

D CDC

The Delaware Chronic Disease Collaborative is a program of the Academy/DPHA in partnership with the American Lung Association of the Mid-Atlantic that began in December of 2016 with an informational summit about chronic disease in Delaware. The program was reinvigorated after the State Health Improvement Plan was released and the Collaborative was identified as one of the high impact groups focused on chronic disease.

Part of the reinvigoration efforts included a re-imagining of the collaborative, outreach to other chronic disease groups in the state, and a discussion on updating the goals and deliverables of the collaborative.

Delaware Stroke Resources In 2019, the Academy/DPHA took over some of the activities of the Delaware Stroke Initiative (DSI), most significantly the Stroke Support Group, which meets once a month, at Christiana Hospital.

The Academy/DPHA also created the Delaware Stroke Resources website (http://delawarestrokeresources.org/); a resource for stroke survivors and caregivers in Delaware. It has information on support groups; resources such as adaptive clothing, counseling and mental health services, and elder law; and links to organizations in and around Delaware that can assist in stroke treatment and rehabilitation.

DSI and the Academy/DPHA worked together to plan the yearly John Scholz Stroke Education Conference on October 3, which included presentations on anticoagulation therapy; physical therapy, technology, and stroke recovery; nurses’ role in acute stroke therapy; a post-acute stroke care panel; driverless cars; and speech therapy.

P U B L I C H E A LT H P R O G R A M S & E N G A G E M E N T Delaware Health Sciences Alliance The Academy/DPHA was contracted by the DHSA to provide back office assistance and program coordination while the search for a full-time coordinator was completed. During this period, the Academy/DPHA assisted in the planning and implementation of the 2019 DHSA Research Shark Tank: Population Health (May), and the 2019 Physician Recruitment Day (July). They were both successful, and will likely become annual events.

Additionally, DHSA is contracted to the State of Delaware to provide assistance to the Delaware Institute for Medical Education and Research (DIMER). In February, the DHSA attended an interactive panel discussion at Delaware State University about applying to medical school. This event was repeated in September. A similar panel discussion was held in September at Wilmington Friends School in New Castle County.

Student Internship www.delamed.org/programs/student-internship/ In 2019, the Academy/DPHA assisted seven students with internships in public health. There were four college undergrads (Delaware State University, University of Delaware, University of Maryland Baltimore County), one grad student (Boston University), and two high school students. These interns researched topics including: - Chronic Disease - Cyclical Vomiting Syndrome - Immunization and HPV - Meals on Wheels as a Vehicle for a Health Check - The State Health Improvement Project and Maternal/Child Health - Telehealth Tori Mignott was an undergrad at Delaware State University. She worked with Dr. Smith to update the Delaware Chronic Disease Coalition website and program goals.

Margot West was an undergrad at the University of Delaware. She researched whether Meals on Wheels volunteers could be a first-line health check for their clients.

Jolian Stephens was a grad student at Boston University.

Her research project increased awareness of Cyclical Vomiting Syndrome.

Inaya Wahid was an undergrad at the University of Maryland – Baltimore County. She assisted the State Health Improvement Plan Steering Committee in their work to identify programs in Delaware utilizing SHIP recommendations

COMMUNIT Y EDUCATION

2019 review

Delaware Mini-Medical School www.delawareminimed.org If you have a passion for health care or just want to get a taste of what doctors learn in medical school, Mini Medical School is a program of interest.

This popular six-week course of free lectures, led by partners Delaware Academy of Medicine/Delaware Public Health Association and Christiana Care, attracted 200 students this year. Sessions, taught by Christiana Care caregivers, included a look at Nursing Today, the Gene Editing Revolution, and Clinical Trials 101.

“Mini Medical School is an amazing way to engage our community and those we serve,” said Omar Khan, M.D., M.H.S., Christiana Care physician leader for Research Administration & Scientific Affairs and president and CEO of the Delaware Health Sciences Alliance.

“Caregivers throughout Christiana Care love being partners in education, and this is a wonderful opportunity to serve,” said Dr. Khan. “The talks are topical and interactive, and our diverse audience, representing the breadth of Delaware, looks forward to this program each year. They’re a true team effort.”

For more than a decade, this peek inside medical school has attracted both teens and adults with a love for science and medical knowledge. The classes are designed to share in-depth medical information with no pressure, no tests and no grades. Participants who attended all six sessions received a certificate of achievement.

Timothy E. Gibbs, M.P.H., executive director, Delaware Academy of Medicine, said the annual program has dual, equally important purposes. “Mini-Medical School is an educational and health literacy program for adults, and a way that we engage middle, high school and undergrad students, encouraging them to consider a career in the health sciences,” he said.

Week 1 – What is Nursing Today?

Richard G. Cuming, Ed.D., M.S.N., R.N., NEA-BC, FAAN

Week 2 – Clinical Research Trials -The Basics Marta Hayden, M.S.N.

Week 3 – Aging and Memory, Memory Impairment and Memory Care James M. Ellison, M.D., M.P.H., DLFAPA

Week 4 – What Does Innovation Have to Do with Health Care?

Catherine Burch, M.S.M., C.X.A.

Week 5 – The Gene Editing Revolution Eric Kmiec, Ph.D.

Week 6 – New Developments in Vascular Surgery Kathryn Bowser, M.D.

COMMUNIT Y EDUCATION Osher Lifelong Learning Institute, University of Delaware https://delamed.org/education/education-for-the-public/

As in previous years, we are honored to present the Dental, Medical, and Public Health Lecture Series at the Wilmington Campus of University of Delaware’s Osher Lifelong Learning Institute. This calendar year topics included: Obstructive Sleep Apnea: Contemporary Surgical Management – Dan Meara, M.D., D.M.D. Exercise and Aging – Taylor Alger, P.T. Trauma – Case Presentations and a Focus on Falls – Sandra Medinilla, M.D., M.P.H. Early Language Acquisition and Cognitive Development – Giovanna Morini, Ph.D. Addiction is a Disease of the Brain – Vishesh Agarwal, M.D. Nanomedicine and Gene Regulation – Emily Day, Ph.D. Kidney 101 – S. John Swanson, M.D. Polypharmacy and its Management – Amanda Schartel, PharmD and Sean Thomas, PharmD Scope of Practice for Physician Assistants, and a focus on Atrial Fibrillation and its Treatment – Ed Woodford, P.A. View from the Cabinet Secretary’s Office – Healthcare in Delaware – Kara Odom-Walker, M.D., M.P.H., M.S.H.S. In Vitro Blood Brain Barrier for cutting edge research and treatment of neurodegenerative diseases (Alzheimer’s) – John Ruano-Salguero, B.S. Delaware Healthcare Commission Roles and Responsibilities – Elisabeth Scheneman, M.A. The PreDiabetic Discussion – Ed Sobol, D.O. BioSafety – Gregory Hovan, B.S., M.B.A. Cardiology – Audrey Sernyak, M.D. Bone Health – Timothy Manzone, M.D., J.D. Trends in Healthcare – Chris Manning, M.P.A. Oral Maxillofacial – Daniel Meara, M.D., D.M.D. Measles Update – Ashley Panichelli, M.D. Socioeconomic Variation and Cancer – Jobayer Hossain, M.D. Spleen 101 – Kate Smith, M.D., M.P.H. Hypertension / Kidney – Prayus Tailor, M.D. Respiratory Therapy – Tom Blackstone, R.T. Neuro Movement Disorder Case Studies – Justin Martello, M.D.

S U P P O RT I N G TO M O R ROW ’ S PROFESSIONALS

2019 review

Student Financial Aid https://delamed.org/education/educational-series/financial-aid/ The Academy’s Student Financial Aid program was established in 1961 to help encourage Delaware students to study medicine and dentistry. To date, over 300 students have received close to $2 million in loans. While the Academy has funds to support both medical and dental students, we have only received applications from medical students for the past several years.

The program is self-sustaining in that the loans are given based on the amount of money collected annually from the students after they graduate. The maximum loan amount was increased to $11,000 in 2018 to help with the rising costs of tuition, which increased an average of 3% from the previous year. According to the American Medical Association, most medical students come out of school an average of $190,000 in student loans. To relieve some of the debt burden, repayment doesn’t begin until one year after they graduate and interest rates are kept lower than most government and private loans.

The Delaware Academy of Medicine approved $66,000 in loans for 6 Delaware students studying medicine in 2019.

Of the 6 students, 4 are enrolled at Sidney Kimmel Medical College, 1 at the University of Pittsburgh, and 1 at the University of Miami.

Any student interested in applying for a loan can submit an application to the Academy by May 15th of each year. To be eligible, students must be Delaware residents enrolled in medicine or dentistry at an accredited graduate school.

Funds are made available through endowments established by doctors, dentists, and other benefactors. The Delaware Academy of Medicine has six separate funds specifically for the purpose of issuing student loans. Operations manager, Elizabeth Lenz, oversees the SFA loan program as well as the rest of the Academy/DPHA finances.

S U P P O RT I N G TO M O R ROW ’ S P RO F E S S I O N A L S

The Delaware Institute of Medical Education and Research (DIMER) contracted the Delaware Health Sciences Alliance (DHSA) to inventory the DIMER physicians who had matriculated through medical school in the program’s fifty-year history. Once that project was completed, the Delaware Academy of Medicine / Delaware Public Health Association requested a continuation of that project, to include the many healthcare professions in the State of Delaware.

The goals of the project were to answer questions like the following: - What are the different types of healthcare practitioners currently serving Delaware? o How many of each type are there? o How many are actively practicing? o What specialties are they practicing?

- Where are these providers practicing? o Geographic – on the County level, by ZIP code? o Private vs. public? o Sole proprietor or within a healthcare system?

- Where did they attend medical school/graduate school? o Where did they complete their residency/post-graduate work? o Does this influence their vocation - How does this affect Delaware? o How many Delaware trainees stay in Delaware after graduation? o How many leave? o How many non-Delaware trainees come to Delaware after graduation?

Delaware Journal of

Public Health

2019 review

A publication of the Delaware Academy of Medicine / Delaware Public Health Association

https://djph.org The Delaware Journal of Public Health is the official journal of the Delaware Academy of Medicine/Delaware Public Health Association. We have been in continuous publication since 2015 and on a bimonthly basis, publish 5 issues a year. Notable themes over the last year have been: Volume 5 | Issue 5. Road to Value – Health Policy (December) Volume 5 | Issue 4. Disaster Preparedness (October) Volume 5 | Issue 3. LGBTQ+ Health (June) Volume 5 | Issue 2. Communicable Disease (May) Volume 5 | Issue 1. Data to Decision Making (February) We follow a model which facilitates the best of Delaware-based, regional, national and international material to be included in the Journal. Each issue is led by the core leadership (see below), with a Guest Editor who selects content most appropriate to that particular theme issue. In the last 12 months, Guest Editors have included: Professor Rita M. Landgraf Neal D. Goldstein, Ph.D., M.B.I. and Deborah Kahal, M.D., M.P.H., F.A.C.P. Timothy Rodden, M.Div., M.A., F.A.C.H.E. and Anna Filip, M.D. Timothy R. Cooper, M.A., C.E.M. and Rick Hong, M.D. DHSS Cabinet Secretary Kara Odom-Walker, M.D., M.P.H., M.S.H.S. All issues of the Journal feature a particular theme, and also other general content which has been submitted.

We are proud of our partnership with Delaware’s health systems, who provided us material of general interest to the public, which we are pleased to disseminate. We leverage our national partnerships with the National Academy of Medicine and the NIH’s Fogarty International Center, and host (with permission) content from their publications. In 2019, we started our affiliation with the Trust For America’s Health and started to carry selected content from them as well. To our knowledge, we are the only journal to have this unique feature for the benefit of our readership.

The Journal is led by: Editor in Chief: Omar Khan, M.D., M.H.S., FAAFP Publisher: Tim Gibbs, M.P.H.

Managing Editor: Elizabeth Healy, M.P.H. Copy Editor: Kate Smith, M.D., M.P.H.

DJPH by the Numbers: The DJPH is direct distributed to email addresses in our database representing healthcare, public health, state, philanthropy, and the general public. A link to the Journal is also posted on the following locations: 1) Our website: www.delamed.org 2) Our facebook page: www.facebook.com/delamed1 3) The State of Delaware library listserv 4) Various intranets Of our readers, 70% view the Journal on their desktop computer, 5% on their tablet, and 25% on their mobile device.

Each issue has an average of 1,250 reads, and since inception, over 440 “link-outs” have occurred from within the publication to other references, resources, or agencies.

All issues are provided on an open-access basis with no publication or subscription charges.

PROVIDING

February 2019 The stylized eye on the cover was chosen to represent this issue of the Journal because as how we look for, and analyze data is fundamental to the data to decision making model. Also, known as datadriven decision management (DDDM), the success of the data-driven approach is reliant upon the quality of the data gathered and the effectiveness of its analysis and interpretation.

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Volume 5 | Issue 1. Data to Decision Making 3 | In this Issue Omar A. Khan, M.D., M.H.S. and Timothy E. Gibbs, M.P.H. 4 | Guest Editors’ Welcome Rita M. Landgraf 6 | Social Determinants of Health 101 for Health Care: Five Plus Five Sanne Magnan, M.D., Ph.D. 16 | Holding Course for Health Impact: All Aboard Delaware’s State Health Improvement Plan (SHIP) Cassandra Codes-Johnson, M.P.A., Noël Duckworth, D.V.S., Timothy Gibbs, M.P.H., N.P.Mc., Lucy Luta, M.D., M.P.H., Karen E. McGloughlin, Katherine Smith, M.D., M.P.H. 20 | UD Partnership for Healthy Communities: Expanding Campus-Community Channels for Delaware’s SHIP Rita Landgraf, Erin K. Knight, Ph.D., M.P.H., Noël Duckworth, D.V.S. 24 | Statewide Alignment: Coordinated Efforts for Delaware’s Behavioral Health Needs Bethany A. Hall-Long, Ph.D., R.N., Lieutenant Governor Chair, Behavioral Health Consortium 26 | Mapping the Burden of Chronic Diseases in Delaware for Public Health Decision Making Russell K. McIntire, Ph.D., M.P.H., Madeline Brooks, M.P.H., Scott D. Siegel, Ph.D., M.H.C.D.S., Mia Papas, Ph.D., M.S. 30 | Geographic Patterns of Asthma Rates and Air Quality in Delaware Rachel Vecchione, M.P.H., Caleb Dafilou, M.P.H., Violetta Gerzen-Feshchenko, M.P.Hc., Nicole LaRatta, M.P.H., Madeline Brooks, M.P.H. 40 | Smoking and Tobacco Retail Density Among Neighborhoods in Delaware Margaret Pearce, Robert Zucker, Crystal Lee, M.P.H., Opinderjit Kaur, M.P.H., Russell K. McIntire, Ph.D., M.P.H. 50 | Geographic Relationships Between Smoking and Chronic Lower Respiratory Disease in Delaware Arielle Horowitz, M.P.H., Danny Cheong, M.P.H., Robert Martin, M.P.H., Russell K. McIntire, Ph.D., M.P.H. 58 | Food Access in Delaware: Examining the Relationship of SNAP Retailers, Food Deserts, Obesity, and Food Insecurity Alex Fossi, M.P.H., Desmond McCaffery, Courtney Riseborough, Niharika Vedherey, M.P.H., Lisa Armstrong, Madeline Brooks, M.P.H. 66 | Using Geographic Information Systems (GIS) to Display Spatial Patterns of Diabetes in Delaware Saheedat Sulaimon, M.P.H., Rashida Smith, B.S., Ariel Paz, M.P.H., Madeline Brooks, M.P.H. 76 | Global Health Matter Fogarty International Center 88 | Chronic Disease in Delaware Helen Arthur, M.H.A. 96 | The Division of Public Health Adopts New Population Health Approach Lisa M.G. Henry, M.S., Cassandra Codes-Johnson, M.P.A. 102 | The Data of Disease: How Data Collection Leads to Healthy Populations Katherine Smith, M.D., M.P.H. 105 | Social Determinants of Health: Life Expectancy and the Relationship with Race, Education and Poverty in Delaware Kalyn McDonough, Ph.D. 110 | Trust for America’s Health Wellness and Prevention Digest 116 | Data To Decision Making Lexicon of Terms 117 | Data To Decision Making Resources 117 | In Memoriam: LTG William H. Duncan M.D. Joseph Kestner M.D. 119 | Index of Advertisers 120 | From the History and Archives Collection

2019 review

May 2019 “Communicable disease” means an illness caused by an infectious agent or its toxins that occurs through the direct or indirect transmission of the infectious agent or its products from an infected individual or via an animal, vector or the inanimate environment to a susceptible animal or human host. New York, N.Y., 24RCNY Health Code § 11.01 (2010).

Volume 5 | Issue 2. Communicable Disease 3 | In this Issue Omar A. Khan, M.D., M.H.S. and Timothy E. Gibbs, M.P.H. 4 | Comments on the Communicable Disease Issue Neal D. Goldstein, Ph.D., M.B.I. and Deborah Kahal, M.D., M.P.H., F.A.C.P. 6 | Delaware Faces Immunization Challenges Head-on Jim Talbott, M.P.A. and Paul Hess 12 | Pertussis Outbreak in an Amish Community: Kent County, Delaware, 2018 Paula Eggers, R.N., Tabatha N. Offutt-Powell, Dr.P.H., M.P.H., Lisa Henry, M.S.H.A., Rick Hong, M.D. 18 | Vaccination is the Most Effective Strategy for HPV Prevention Margot Savoy, M.D., M.P.H., F.A.A.F.P., F.A.B.C., C.P.E., C.M.Q., F.A.A.P.L. 20 | Management of Hepatitis C in Delaware Prisons: Approaching Microenvironmental Eradication William P. Mazur, M.D. 30 | Global Health Matter Fogarty International Center 42 | Hepatitis C in Pregnant Women and Their Children Stephen C. Eppes, M.D. 46 | Delaware and HepatitisC: Is it Time for Universal Screening?

Navin Vij, M.D., M.S.H.P. 50 | Statewide Antibiotic Stewardship: An eBrightHealth Choosing Wisely Initiative Marci Drees, M.D., M.S., Kimberly Fischer, B.S.N., R.N., Loretta Consiglio-Ward, M.S.N., R.N., Janelle Caruano, PharmD, B.C.I.D.P., Shannon Chan, PharmD, William Chasanov, D.O., M.B.A., Jami Jones, R.N., B.S.N., Alexander Kashmanian, PharmD, B.C.P.S., B.C.I.D.P., Jillian D. Laude, PharmD, B.C.P.S., Nicole Harrington, PharmD, B.C.P.S. AQ-ID, Elizabeth A. Richardson, M.S.N., M.P.H., R.N., Arezoo Zomorrodi, M.D., Robert Dressler, M.D., M.B.A. 60 | Low Incidence and High Profile: Tuberculosis Control in Delaware Joanna S. Suder, J.D. 64 | Four Decades of Epidemiologic Science on HIV Infection and Disease, and Its Impact on Public Health Practice and Policy for Sexual and Gender Minority Persons Nguyen K Tran, M.P.H., and Seth L Welles, Ph.D., Sc.D. 74 | Access to HIV Medication in the Community Versus a Nursing Home for the Medicare Eligible HIV Population Brianne L. Olivieri-Mui, M.P.H. 80 | Communicable Disease Lexicon of Terms 81 | Communicable Disease Resource Guide 82 | Index of Advertisers

PROVIDING

June 2019 Health and wellness should be universal, but are not. Like the “Progress Pride Flag” shown on this issue’s cover, additional differentiation in the LGBTQ community recognizing the uniqueness of its constituent parts allows us to focus on the health opportunities and challenges of those groups. Designed by Daniel Quasar, the traditional 6 stripe flag is augmented by the trans flag stripes and marginalized community stripes shifted to the hoist of the flag and given a new arrow shape. The arrow points to the right to show forward movement, while being along the left edge shows that progress still needs to be made.

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Volume 5 | Issue 3. LGBTQ+ Health 3 | In this Issue Omar A. Khan, M.D., M.H.S. and Timothy E. Gibbs, M.P.H. 4 | Guest Editor’s Welcome Timothy Rodden, M.Div., M.A., B.C.C., F.A.C.H.E., Anna Flipp, M.D. 6 | The Value of Identity: Providing Culturally-Responsive Care for LGBTQ+ Patients Through Inclusive Language and Practices Christopher Moore, B.A., LSSGB, Catherine Dukes, Ph.D., M.S.W. 10 | Delaware Hospitals and the Healthcare Equality Index since 2011: How do they rate?

Timothy Rodden, M.Div., M.A., B.C.C., F.A.C.H.E., Tari Hanneman, M.P.A. 12 | Caring for Our Community: Telehealth Interventions as a Promising Practice for Addressing Population Health Disparities of LGBTQ+ Communities in Health Care Settings Alex Waad 18 | Keep Trans Youth Alive: Considerations for Suicide Prevention of Gender Expansive Youth Elise Mora, L.C.S.W., I.C.G.C.-I 24 | Improved Data Collection for Our LGBTQ Population is Needed to Improve Health Care and Reduce Health Disparities Karyl T. Rattay, M.D., M.S. 28 | A Mother’s Story Sally McBride 32 | Global Health Matters Fogarty International Center 46 | Building Resilience, Reducing Risk: Four Pillars to Creating Safer, More Supportive Schools for LGBTQ+ Youth Rev Karla Fleshman, L.C.S.W., M.Div. 56 | Part of the Solution to Address Sexual and Gender Minority Health and Health Care Disparities: Inclusive Professional Education Karla Bell, Ph.D. 64 | Why Count and Measure?

Justin Glasgow M.D. 68 | The Religious Landscape for LGBTQ+ Persons The Rev. Dr. Douglas D. Gerdts 74 | LGBTQ+ Lexicon of Terms 76 | LGBTQ+ Resource Guide 80 | Index of Advertisers

2019 review

October 2019 From preventive flu vaccination to evacuation routes and emergency preparedness drills, the work of preparing for the worst is never done. Our national and state preparedness is the shared responsibility of all levels of government, the private and nonprofit sectors, and individual citizens.

Volume 5 | Issue 4. Disaster Preparedness 3 | In this Issue Omar A. Khan, M.D., M.H.S., and Timothy E. Gibbs, M.P.H. 4 | Guest Editors Timothy R. Cooper, M.A., C.E.M., Rick Hong, M.D. 6 | DPH Photos 8 | Creating a Culture of Preparedness Timothy R. Cooper, M.A., C.E.M. 10 | The Storm of March 1962 Photos from the Delaware Public Archives 12 | Emergency Management in the First State Edward (Tony) Lee 14 | Mini Tip Follow Instructions from Emergency Officials 16 | The American Red Cross’ Disaster Protocol—The Delaware Chapter Israa Hassan 18 | Volunteers: The Core of the American Red Cross Response, Preparedness Autumn Thompson 19 | Mini Tip Volunteers Needed 20 | Delaware Medical Reserve Corps (DMRC) Lisandra Clarke, B.S. 24 | Debunking 10 Disaster and Preparedness Myths Mollee Dworkin 28 | The Importance of Communication Before and During a Public Health Emergency Andrea Wojcik 30 | Mini Tip Organize household documents to rebound faster after emergencies 32 | Global Health Matter Fogarty International Center 44 | The Disaster Research Center at the University of Delaware: The World’s First Center for the Social Scientific Study of Disaster Zachary Cox, James Kendra, Tricia Wachtendorf & Valerie Marlowe 50 | When it Comes to Disaster Preparedness, Local Innovation Equals Global Resilience Joshua L. Kelly, C.E.M. 52 | Super Storm Sandy: What We Learned Timothy R. Cooper, M.A., C.E.M. & Rick Hong, M.D. 53 | Mini Tip How to Stay Safe during a Power Outage 54 | Get a Plan; Make a Kit Nicholas Colazzo, M.D. & Douglas Ader, D.O. P.A.C. 56 | Emergency Plans should be in place for seniors and people with access and functional needs April A. Cleveland & Beth MacDonald 57 | Mini Tip Designate a Preparedness Buddy to provide help during emergencies 57 | Mini Tip TTY services 58 | Nurses Were Built for the Front Lines Malikah Taylor, M.P.H., M.S.N., R.N. 61 | Mini Tip Caring for yourself and others in time of crisis. You are the help, until help arrives.

62 | Being pet prepared saves human and animal lives Karen A. Clark 64 | Review of Emerging Infectious Disease Preparedness Measures for the State of Delaware Nikki Kupferman, M.S. & Emily Hanlin 67 | Mini Tip Weather advisories, watches, and warnings 68 | Chemical Disaster Preparedness for Hospitals and Emergency Departments Gregory K. Wanner, D.O. & Sukhi Atti, M.D. 80 | Helpful Preparedness Resources 81 | Continuity Planning for the Health Care Delivery System: Building Resilience within Delaware Reed Jones, M.P.S., C.E.M. 90 | Index of Advertisers

PROVIDING

December 2019 The “road to value” is a bit like a bus traveling along with a variety of passengers - each seeking a slightly (or greatly) different goal - yet everyone is inexorably traveling in the same general direction, and no one seems to have a good map upon which all can agree.

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Volume 5 | Issue 5. Road to Value – Health Policy 3 | In this Issue Omar A. Khan, M.D., M.H.S., and Timothy E. Gibbs, M.P.H. 4 | Guest Editor Kara Odom Walker, M.D. 6 | Delaware Needs to Act to Save Primary Care Rep. David Bentz 8 | Investing in Primary Care: A Work in Progress Nancy Fan, M.D. 16 | The relationship between food deserts, farmers’ markets, nutrition benefits, and health in Delaware census tracts; 2017 Macred Gbenro Jr., B.S., M.P.H., Andrea M. Brace, Ph.D., C.H.E.S., Todd L. Matthews, Ph.D. 26 | The Unintended Consequences of Medicare Observation Status Jennifer N. Goldstein, M.D. M.Sc. 30 | Moving Delaware Medicaid to Value: Leveraging Contracts as Policy Tools Stephen Groff, Steven Costantino, Elizabeth J. Brown, M.D., M.S.H.P. 34 | Understanding the Success behind Maryland’s Mode Madeline Jackson-Fowl, Willem Daniel 40 | Primary Care Spending in Delaware: Qualitative Features for Innovation Charles G. Jose, M.D., M.P.H., Yalda Jabbarpour, M.D. 42 | Measuring and Increasing Investment in Primary Care: Delaware Marches On Christopher F. Koller 46 | Align and Invest for Impact with Our Communities Karyl T. Rattay, M.D., M.S., Rita Landgraf, Stuart Comstock-Gay 48 | Does Being “First” Matter? Thoughts on Ranking, Health and Public Policy Robert J. Laskowski, M.D., M.B.A. 52 | A Stroke Reduction Health Plan for Older Adults in Rural Sussex County, Delaware Stacey Novello, B.S.N., R.N., C.C.R.N., Mary Elizabeth Bowen, Ph.D., Mari Griffioen, Ph.D., R.N. 56 | High Hospital Prices and Margins in Delaware Call for Action Aditi P. Sen and Ge Bai 58 | Reflection - The APHA Annual Meeting Timothy E. Gibbs, M.P.H. 60 | An APHA Experience Matt McNeill 61 | From John Snow to Vaccine Hesitancy Katherine Smith, M.D., M.P.H. 62 | Delaware Hospitals Make Significant Investments in Value Wayne A. Smith 68 | Nutrition Coaching by Registered Dietitians as an Effective Strategy to Reduce Adolescent Obesity Mary Stephens 74 | Health Care Needs of Homeless Older Adults: Examining the Needs of a Senior Center Cohort Victor M. Ye, M.S., Richard J. Caplan, Ph.D., Loretta Consiglio-Ward, M.S.N., James M. Ellison, M.D., M.P.H. 84 | Health Policy - Lexicon of Terms 85 | Index of Advertisers

P R E S E RV I N G A N D E X H I B I T I N G OUR PAST

2019 review

Delaware Academy of Medicine Archives 2019 Report Sharon Folkenroth Hess, M.A., collections manager https://delamed.org/programs/archives-and-history/ January 2019 - December 2019 In preparation for the 2018-2019 renovations on Suite L-10, eight new display cases were delivered to the Ammon Center. Four are in the first-floor lobby for rotating exhibitions. The other four were added to the existing five cases in Suite L-10 for the storage and display of the artifact collection.

In January 2019, artifacts were unpacked and arranged in the cases by medical specialty. Once the objects had been rehoused, the process of survey and review of the collections began. The speed of evaluating the artifacts has been hindered due to the previous method of labeling that used paper tags that were laid on top of artifacts or loosely tied to the artifact with a string tag. Many of these tags have become separated from the artifacts over the years. Without this identifying number, the connection between the artifact and corresponding records is lost.

Nearly half of the artifacts in the collection needed to be researched and identified to re-establish the connection.

Likewise, the locations and descriptions of the artifacts (labeled and unlabeled) have not been maintained to any sufficient degree. The re-housing of objects has rendered all location data null. To remedy this issue, the collections manager has been identifying each artifact individually, adding a semi-permanent ID number (per American Alliance of Museums standards and the new labeling policy instituted in September 2018), and cataloging it in the collections management database (PastPerfect 5.0).

This large-scale project of identifying, cataloging, and preservational cleaning is ongoing. To speed up processing time, objects are researched in groups by specialty. Completed groups are then showcased in exhibitions in the Ammon Center display cases.

During the summer of 2019, the collections manager focused her attention on the manuscript and library collections. Books were cataloged, labeled, and arranged according to the revised 2019 National Library of Medicine Classification. This project included creating protective covers and other preventive care measures for objects in the Rare Book Collection. The second phase of this project will be to add or revise records of the books in our collections management database that will enable keyword searching.

Concurrent to the library project, our intern from the University of Delaware worked on two primary projects: 1) researching, cleaning, and cataloging objects from our physical collection and adding records to our collections management database; and 2) preparing an exhibition for the Ammon Center lobby. During her internship, Abby Manganiello received training in best practices in care and handling, collections management procedures, and PastPerfect 5.0. Her exhibition on forensics was installed in September 2019.

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ACADEMY BOARD OF DIRECTORS

Officers Omar A. Khan, M.D., M.H.S., President S. John Swanson, M.D., Vice President Lynn Jones, F.A.C.H.E., Acting Secretary David M. Bercaw, M.D., Treasurer Daniel J. Meara, M.D., D.M.D., Immediate Past President Timothy E. Gibbs, M.P.H., Executive Director, Ex-officio

Directors Stephen C. Eppes, M.D., At-Large Member Eric T. Johnson, M.D., At-Large Member Joseph F. Kestner, Jr., M.D., Bylaws Committee Professor Rita Landgraf, At-Large Member Brian W. Little, M.D., Ph.D., Chair, History and Archives Committee Arun V. Malthora, M.D., At-Large Member John P. Piper, M.D., At-Large Member

C O U N C I L S

EMERITUS MEMBERS OF THE BOARD Robert B. Flinn, M.D. Barry S. Kayne, D.D.S. INVESTMENT ADVISORY COUNCIL 2019 Scott Gates Richard L. Laird, Jr., M.C., B.A. Martin G. Mand, M.B.A. H. Rodney Scott ASSET MANAGEMENT Brown Advisory DPHA ADVISORY COUNCIL Louis E. Bartoshesky, M.D., M.P.H. Gerard Gallucci, M.D., M.S.H. Richard E. Killingsworth, M.P.H. Erin K. Knight, Ph.D., M.P.H. Melissa K. Melby, Ph.D. Mia A. Papas, Ph.D. Karyl T. Rattay, M.D., M.S. William J. Swiatek, M.A., A.I.C.P.

Suite L10 4765 Ogletown Stanton Road Newark, DE 19713 302-733-3900 www.delamed.org www.delawarepha.org