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Students envision solutions to opioid epidemic

Opioid abuse is one of the nation’s most severe public health crises. The problem strikes close to home, with nearly 900 Coloradans dying of intentional or unintentional drug overdoses in 2014. Many of those deaths came from misusing prescription medications such as Vicodin, Percocet and OxyContin, three of the most prescribed opioid painkillers. Addiction to those drugs also is leading to a surge in heroin use.

2016 public health case competition winners
The winners of the 2016 competition, along with Colorado School of Public Health dean David Goff.

Public health experts, health care practitioners and lawmakers are among those working hard to find solutions to the epidemic, and recently teams of University of Colorado Denver | Anschutz Medical Campus students joined the cause. About 55 students competed in this year’s Rocky Mountain Region Public Health Case Competition, competing to find innovative solutions that could alleviate the crisis. The annual event was hosted by the Colorado School of Public Health (ColoradoSPH) and run by its students.

Inventive ideas were not in short supply—including one proposal that would create specially equipped buses and design smartphone apps that could give addiction sufferers an accessible and discreet way to receive help recovering.

The proposal, named “Heals on Wheels” by the team, would use the vehicle to take back drugs, screen patients and give them referrals for treatment, educate and train people about drugs that stop overdoses and exchange needles.

Christy Colalancia, a student getting a master’s degree in public health, was a member of the winning team. She said a model for the idea was mobile mammography clinics, and the team considered the challenge of creating effective outreach strategies.

“We were thinking about what has worked and what didn’t work in the past. Our idea was as original as we could make it, but by taking into consideration evidence-based approaches,” Colalancia said.

Inventive ideas

Competition was stiff, with the panel of judges impressed by each of the proposals.

“We had a real belief that if any one of them were implemented, it would improve the public health of Colorado,” said ColoradoSPH Dean David Goff, MD, PhD, one of the judges.

Finishing second was a team with an idea to improve the rehab system in southeast Colorado by adding case managers who would work to educate and support patients. The case workers also would become liaisons between patients and doctors.

The third-place team proposed developing a drug takeback program that would allow people to return unused medication any day of the year by dropping the medications in secured bins at pharmacies around the state. Currently, some communities, government agencies and others including the Skaggs School of Pharmacy and Pharmaceutical Sciences will collect drugs for disposal, but most programs are one-day events. Additionally, many rural areas, where the opioid abuse problem is most severe, do not have those programs.

A growing problem

Colorado is one of the states hit hardest by the opioid epidemic, according to the Centers for Disease Control and Colorado Health Institute. In 2014, Colorado had 899 deaths related to drug overdoses. That works out to 16.3 deaths per 100,000 residents, which is up 68 percent since 2002. Colorado’s fatality rate is above the national average of 14.7 drug-related deaths per 100,000.

Twelve counties, including Denver and Adams counties, had rates of more than 20 deaths per 100,000 residents, making them among the highest in the nation.

Research also shows that prescription pain killers are a gateway drug, with 75 percent of heroin users saying they abused painkillers before switching drugs, according to nationwide stats from the CDC.

Real-world challenges

The goal of the annual competition is to give students across varied disciplines the experience of working as members of interdisciplinary teams, Goff said. It also gives them the chance to design innovative solutions to real-world health problems. Up to six students had to research the problem, develop a proposal, craft a presentation and answer questions from judges. They also needed to ensure their ideas could be implemented for less than $3 million and address challenges to implementation.

“I think one of the greatest parts of the program is getting a real-world scenario to try to solve in a limited amount of time, using limited funds and resources, and having an integrated approach,” Colalancia said.

The teams also had to beat the clock—students had 24 hours before their presentations were due. It led to some bleary eyes at the awards ceremony.

The competition was open to students from the ColoradoSPH, the School of Medicine, College of Nursing, Graduate School and the pharmacy school, among others. Students from CU Boulder, Colorado State University and the University of Northern Colorado also participated.

Representing CU Anschutz on the judges’ panel for the final round were Goff and Robert Valuck, PhD, a professor in the pharmacy school and director of the Colorado Consortium for Prescription Drug Abuse Prevention. Colorado Department of Public Health and Environment Executive Director and Chief Medical Officer Dr. Larry Wolk, state Sen. Jim Smallwood and state Senator-elect Dominick Moreno also were judges.

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High school girls seek health care careers

In early June, over 50 high school girls from around Aurora and Denver had the extraordinary opportunity to get an inside look at several centers operating on the University of Colorado Anschutz Medical Campus. The one-day program, “Exploring Careers in Health Care,” is hosted by the Center for Women’s Health Research and UCHealth. Its goal is to expose a diverse group of young women to careers in health care that they may not know about and to connect them with mentors who can share insight into their own career paths.

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Participants test out medical instruments for surgery.

The participants toured the Gates Biomanufacturing Facility, learning about stem cell therapy and personalized medicine. The Gates researchers explained how following a path of biology, chemistry or engineering could lead to unique careers in health care to treat and cure various cancers, skin and muscle diseases, and type 2 diabetes. One participant was particularly interested, noting, “This is a field that you don’t hear about on a regular basis, but has the potential to change the world of medicine and the future.”

At the Skaggs School of Pharmacy and Pharmaceutical Sciences, the girls heard from students about their varied paths into pharmacy and the rewarding careers for which they are training. The Skaggs students guided the girls through activities to make their own lip balm and to experiment with drink flavoring. They also had an interactive discussion with Laura Borgelt, PharmD, FCCP, BCPS, associate dean for administration and operations at Skaggs School of Pharmacy and Pharmaceutical Sciences, about the complications, challenges and opportunities in medical marijuana research.

A visit to the University of Colorado Eye Center allowed the girls to learn about eye health, diseases of the eye, and the state-of-the-art treatment and surgery happening at CU Anschutz. Using blindfolds and special glasses to simulate visual impairments, the girls helped each other through common tasks such as pouring water into a cup and typing on a keyboard. They could momentarily experience how a patient interacts with the world, and how a caregiver helps guide them through treatment.

The highlight of the day was the visit to the Center for Surgical Innovation where the girls got to try their hand at suturing and experimenting with medical instruments for surgery. One participant said, “I loved it. I came home excited and ready to learn more. It opened up my mind to medical professions I had never heard of.”

Surgical training at CWHR Girls Career Day, 2016

Surgical training at CWHR Girls Career Day, 2016

As they interacted with doctors, pharmacists, research assistants and ophthalmologists, the girls had smiles on their faces and asked thoughtful questions. “We were delighted to welcome these young women to campus. We know the importance of helping young people learn about careers in science and also connecting them with leaders and mentors in the field to help them navigate various career paths in healthcare and research,” said Judy Regensteiner, PhD, director of the Center for Women’s Health Research, professor of medicine, and holder of the Judith and Joseph Wagner Chair in Women’s Health Research.

The program is in its second year and was a tremendous success. With such high demand, the Center for Women’s Health Research and UCHealth plan to make this an annual activity.

Guest Contributor: Sarah Westmoreland, MPH, Public and Community Education Liaison, Center for Women’s Health Research

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Surgery workshop will offer skills to doctors in low resource areas

Despite the dangers, more and more physicians are drawn to working in impoverished or strife-torn areas where medical care is rudimentary yet the needs are overwhelming. But few possess the skills to operate under such harsh conditions.

On June 4 and 5, a dozen doctors from around the country take part in the Colorado Humanitarian Surgical Skills Workshop at the Center for Surgical Innovation on the University of Colorado Anschutz Medical Campus.

The Center for Surgical Innovation is a multi-disciplinary training center dedicated to promoting education courses for surgeons around the world. From 2015-2016, it trained over 4,000 surgeons.

Dr. David Kuwayama, a vascular surgeon, has worked with Doctors Without Borders and other humanitarian groups worldwide.

This unique program will teach senior surgical and obstetrics residents how to perform surgery in low-resource environments without high-tech surgical tools. They will learn how to do a craniotomy with a handsaw, hernia repair without mesh and skin grafts using hand blades rather than electrical ones.

“This is the only humanitarian training course for surgical residents in the country,” said David Kuwayama, MD, MPA, a vascular surgeon at CU Anschutz and director of global health in the department of surgery. He has also worked with Doctors Without Borders and other humanitarian groups in developing countries, disaster zones and areas of conflict.

The work is often dangerous. Last October, 30 people were killed at a Doctors Without Borders/ Médecins Sans Frontières hospital in Kunduz, Afghanistan when an American AC-130 gunship opened fire at what they thought were Taliban fighters. Other hospitals supported by the group have been attacked in Idlib, Aleppo, and Hama governorates in Syria, forcing at least three to close down.

But it’s done nothing to quell enthusiasm for humanitarian medical work.

“There is a wellspring of interest now in global health despite the often difficult situations,” Kuwayama said. “More and more people want to make it part of their careers but there are few training opportunities.”

Kuwayama held a pilot program last year with just four senior surgical residents to gauge outside interest. This year, they have increased that to 12 residents. The workshop will be taught by attending physicians from CU Anschutz and will cover general surgery, vascular surgery, orthopedic surgery, neurosurgery and OBGYN.

“While working abroad, I found that American doctors often lack the skills to work in these often tough environments,” Kuwayama said. “Our goal is to provide those skills so they are prepared for whatever the situation calls for.”

What:  The Colorado Humanitarian Surgical Skills Workshop

Where: The Center for Surgical Innovation, University of Colorado Anschutz Medical Campus, Aurora, Colo.

When:  June 4 & 5 from 7:30 a.m. – 5 p.m.

More information: Interested media are invited to attend the lectures. For more information please contact David Kelly, 303-503-7990, david.kelly@ucdenver.edu

 

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ColoradoSPH graduate learns to adapt, persist and excel

Mohammed Tahir has lived through a remarkable range of experiences – from the war-torn chaos of his native Afghanistan to the peaceful and modern environs of Colorado and the CU Anschutz Medical Campus.

About three years ago, at a pivotal juncture of his journey from one end of the spectrum to the other, he drove through a war zone in Afghanistan to reach a GRE-testing site.

Now, as he wraps up his master’s in public health (MPH) from the Colorado School of Public Health (ColoradoSPH), he plans to give back to his homeland, which continues its struggle to rebuild.

“I will contribute to the health sector of Afghanistan what I’ve learned here,” he says. “I’ve seen the big gap between these two health systems – what’s available in a developing country and the model here in the United States – so I can understand how these gaps can be filled.”

Bridging gaps and striving for connections have defined Tahir’s life. Having earned his MD in Afghanistan, Tahir found his career options limited in the early 2000s when war broke out and “all the sectors were destroyed, including the health sector,” he says. He started working for the World Health Organization to educate the public about the benefits of polio immunizations.

He then became a grant officer for the U.S. Agency for International Development (USAID), an agency that provides humanitarian assistance to developing countries. Tahir managed grants for non-governmental organizations (NGOs) that implemented health systems in rural Afghanistan. Public health became a “natural pathway” for Tahir, as he discovered ways to improve the health of entire populations.

Winning a Fulbright

Wanting to learn more about public health, he applied for one of the prized Fulbright Scholarships available to Afghans. Out of 14,000 applicants, he was among the 75 awardees.

Mohammed Tahir of Colorado School of Public Health

Mohammed Tahir’s educational journey is a story of persistence, adaptation and excellence.

He applied to the ColoradoSPH and immediately impressed admissions reviewers with his unique background and international public health experience. “His letters of reference were glowing as to the potential that he had, and he brought that same enthusiasm to his study here,” says Elaine Morrato, DrPH, associate dean for public health practice and associate professor in Health Systems, Management and Policy.

Morrato says Tahir is an excellent example of the diverse and experienced talent that is drawn to the ColoradoSPH. His interest in the MPH program in Health Systems, Management and Policy illustrates the program’s flexibility in delivering leadership opportunities at local, national and international levels. “Tahir was strategic and used his practicum and capstone to help him pivot to what should be a meaningful next step in his career journey,” Morrato says.

For his practicum last summer, Tahir served as a support to the Regional Desk Officer at the United Nations Fund for Population Activities (UNFPA) in New York. He remains on the UNFPA payroll as a National Program Officer in Afghanistan, getting two years of special leave to complete his MPH. In the short term, he may seek a promotion within the UNFPA, and in the long term, he plans to be a leader in reforming Afghanistan’s public health system. “With a master’s degree from the Colorado School of Public Health more doors are going to open for me,” he says.

Nations across the globe are lining up financial support to help reconstruct Afghanistan, Tahir says. He wants to help maximize that momentum.

“I can help figure out how the money should be directed for priorities in the public health sector, and in the health education sector, rather than for the demands of the politicians running the country,” he says.

Afghanistan’s health system is currently almost entirely dependent on donations. Tahir says the country needs to prioritize the launch of accredited and revenue-generating systems, such as those used in the United States, to ensure that both the health and education sectors become high-quality and self-reliant.

‘Always felt accepted’

Prayer Room at CU Anschutz

Muhammed Tahir and students of a variety of religions and cultures at CU Anschutz are appreciative of this prayer and meditative room in the Ed2 South Building.

Self-reliance is one of Tahir’s key characteristics, but he acknowledged that adjusting to the United States – especially the very different academic structure – was initially difficult. “For every international student, the first semester is stressful,” he says. “I was greatly helped by Elaine (his academic advisor) and by the people from the Colorado School of Public Health’s international student group. I also found American Muslim students here on campus and got networked with them.”

Tahir has enjoyed the international group’s friendship and support – the club offers regular potlucks, cultural celebrations and day trips – and he’s a founder and leader of the Muslim Medical Society (MMS) at CU Anschutz.

“The Muslim Medical Society linked me with all these diverse disciplines on the campus, and this is a really good thing,” he says. “I’m so glad that the campus has assigned a room for meditation (in Ed2 South), which is not only for Muslims but a place where people of all faiths can relax.”

He says the society, which currently has 75 members, wants to play an active role in helping the campus meet its diversity and community outreach objectives. The MMS also encourages its members to to be active professionals and contributors to the state’s medical sector and the ColoradoSPH.

Mohammed Tahir and other students at CU Anschutz

Mohammed Tahir has enjoyed the academic, cultural and recreational opportunities offered at the friendly and welcoming CU Anschutz Medical Campus.

Tahir says he’s been around the United States – to 17 states so far – and Colorado is by far his favorite. “I’ve always felt accepted here – no matter other people’s color, religion or ethnic group. I never felt sidelined,” he says. “My opinions were always respected and, in the Colorado School of Public Health, I’ve met friends from different corners of the world and I’ve been exposed to many different cultures.”

Besides gratitude, Tahir has a message of encouragement for his health care peers at CU Anschutz. He recommends the Fulbright Scholarship program as a way for his American counterparts to get exposed to other nations.

Much of the rest of the world, he says, is interested in learning from American values and systems. “Students here can serve all over the world – in developing countries, for NGOs – so they shouldn’t only concentrate on (the United States),” Tahir says. “There are people who are in need and our CU Anschutz graduates can help fill those needs.”

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School of Medicine students get lesson in crisis response

A dangerous virus wasn’t the only thing quickly spreading when an outbreak of avian flu swamped the hospitals and clinics of Mountain City and High Plains City.

Tension sometimes flared as public health officials responded to the crisis. Stress often centered around dissemination of accurate information, so as not to touch off undue panic about the pandemic.

It was all part of this week’s preparedness drill on the CU Anschutz Medical Campus – an annual tabletop exercise in the Integrated Clinicians Course for University of Colorado School of Medicine (SOM) students. Two fictional cities in Colorado were dealing with the “outbreak,” and the responders were about 150 fourth-year students representing all disciplines within the SOM. Leading each student team were actual professionals representing health agencies, cities, hospitals, clinics and the media.

‘Critical decisions’

CU School of Medicine students act as media team

Students on the Metro News team discuss a story to pursue during the emergency preparedness drill. Tyler Anderson, center, a fourth-year psychiatry student, acted as the team’s editor.

Students went into the exercise knowing only they’d face a health crisis of some kind. “This tabletop is going to cram a pandemic of six to eight weeks … into about 90 minutes,” said Charlie Little, DO, associate professor of Emergency Medicine in the SOM. “There are really no right or wrong answers,” Little told the group before students broke into 16 teams representing health agencies, city and state offices, hospitals and clinics, media and an ethics group. “It’s designed to help you work cooperatively in a group. The key thing is you’re going to have to make critical decisions with limited information, and that’s what happens in emergency management.”

A key part of the exercise was seeing how public health emergency response unfolds and how various agencies coordinate to best manage a crisis, Little said. “The goal is to have the students work through the issues under time pressure like they would in a real-life event,” he said. “That usually gets them a little stressed.”

Metro News, the media outlet in the drill, became a source of irritation for a few agencies and government offices scrambling to contain the pandemic as well as release timely and accurate information.

‘Difficult balance’

Tyler Anderson, a fourth-year psychiatry student, volunteered to be editor of Metro News. He enjoyed the exercise, but found it quite challenging. “It’s kind of a difficult balance” to be both quick and accurate in news reports, he said. “I understood better the reporters’ need for information – like why they push so hard and why it can be annoying to people. But it really helps get information to the public.”

At one point, as Metro News reporters fanned out to press for information, a hospital representative stepped into the “newsroom” and threatened to sue the outlet for an alleged libelous tweet (see video below). Metro News stood by its story.

Anderson said the drill brought to light some comforting insights as well, such as learning about actual strategic medication supplies. “We as medical students aren’t the only ones being trained in what emergency response looks like,” he said. “It’s something that’s being thought about at many levels – city and national government, as well as public health agencies. It’s good to know that it’s being considered and thought about, so something won’t hit us completely off guard.”

Shilo Smith, a fourth-year neurology student, said she has received incident-command training and knows just how quickly things can come unglued in an emergency. “I can tell you it is a challenge to make sure that people have the supplies they need,” she said.

CU School of Medicine students discuss response to health crisis

A public health team discusses how to respond to an avian flu pandemic during the emergency preparedness exercise.

Jeffrey Druck, MD, associate professor of Emergency Medicine and director of the Integrated Clinicians Course, spoke to the full group at the exercise debriefing. Students said the fast-paced drill was at times stressful, but also informative as to the enormous coordination required to manage a public health emergency.

“We hope this brings home to you how important it is to get involved in disaster planning early as opposed to later,” Druck said. “As you can see from this exercise, if you are behind the 8-ball it can be much worse than if you are in front of the 8-ball.”

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Wilderness Medicine Series draws huge interest

A packed house. People interested in the outdoors – as well as staying safe when they venture into the wild – showed up in force for the launch of a Wilderness Medicine Series at the Liniger Building at CU South Denver.

Wilderness Medicine launch at CU South Denver

A large crowd turned out for the Wilderness Medicine Series launch event at CU South Denver.

In front of a crowd of 200, Jay Lemery, MD, associate professor of emergency medicine in the CU School of Medicine, and wilderness medicine instructor Todd Miner, Ed.D., recently gave a snapshot of the innovative series that starts this spring. The program includes three courses at CU South Denver, as well as evening film events and educational travel experiences.

‘Energy and enthusiasm’

Wilderness Medicine program at CU South Denver

Participants in the Wilderness Medicine Series will learn important skills on how to stay safe when venturing into remote areas.

“There was a lot of energy and enthusiasm,” said Lemery, who is also section chief of of the Wilderness and Environmental Medicine Section (WEM) in the SOM’s Department of Emergency Medicine. “It was clear we hit the right demographic group. Now it’s a matter of building a successful program.”

Natural fit for wilderness programming

The Liniger Building at CU South Denver houses a unique wildlife museum, and the architectural design and materials used in the building enhance and support a sense of the great outdoors.

The location is perfect for wilderness medicine programming. “You walk in that building and outdoors stewardship and education is all over the place,” said Jay Lemery, MD, CU School of Medicine. “The stuff we do is very accessible to the public, and it fits with the Liniger Building’s theme (of outdoor education), so it was a natural fit. We’re there to run a great series of courses and to think what else could work there.”

The community events portion of the Wilderness Medicine Series features two film screenings, each with featured speakers. The films are “Tales from a High Altitude Doctor” on March 15, and “Climate Change & Human Health” on May 4. For more information, click here. For information about the adventure/educational trips being offered, click here.

“The launch of the Wilderness Medicine Series,” said Joann Brennan, associate vice chancellor for academic affairs at CU South Denver, “points to the possibility that CU South Denver could be a location that propels educational innovation and collaboration – contributing in a unique way to the excellence of CU.”

Already, there is a class for almost everyone – both healthcare professionals looking to better apply their skills in the backcountry, or people wanting to learn winter survival basics and first aid, or seeking a primer on safe practices in remote places and developing nations.

Miner, education director for WEM, said programs like this bring the medical world to the outdoors in an evidence-based way. “Whether it’s a family going camping in the Rockies or somebody doing an expedition in the Himalayas, we’re excited about making the bridge between medicine and wilderness,” Miner said.

The non-degree Wilderness Medicine Series:

In each class, students will receive a SOM certificate and, in the case of Advanced Wilderness Life Support, they will also earn continuing medical education (CME) credit hours accredited by the Accreditation Council for Continuing Medical Education. All classes take place over three days and are taught by expert medical faculty from the CU Anschutz Medical Campus.

“We picked courses we thought were good for all learners,” Lemery said. “They’re a way to learn how to mitigate risk in the outdoors, and they’re fun.”

Also, a Polar & Mountain Medicine course is going to be run at 11,000 feet on Chicago Ridge, outside of Leadville.

‘Practice pure medicine’

Lemery and Miner have always gravitated to the outdoors – a place they get to combine two of their biggest passions. “I call it the art and science of taking care of people in remote and austere places,” Lemery said. “I’ve always thought it’s a very exciting way to be true to medicine.”

While health care in the United States has become technology dependent, Lemery said, most places across the globe don’t have access to similar levels of technology. “Wilderness medicine gives us a way to practice pure medicine – the way it’s done in the majority of the world. Also, it’s an outstanding vehicle for education. It has its hands in wilderness, global health and disaster response. It’s very creative. You have to teach people to think beyond the algorithm, outside the box.”

Creative collaboration

WEM at CU Anschutz offers destination trips

The Wilderness & Environmental Section in the Department of Emergency Medicine offers adventure trips to some of the planet’s most spectacular destinations.

Joann Brennan, associate vice chancellor for academic affairs at CU South Denver, said the student-centered program emerged from a creative collaboration between Lemery and Miner’s team and CU South Denver. “The program was designed for learners of all ages and skill sets, with multiple entry points – courses, community events, and travel study experiences,” she said. “In addition, we wanted to leverage the unique assets of the Liniger Building – outdoor spaces, classrooms and movie theatre – into program offerings.”

Lemery said the Wilderness Medicine Series will help measure demand in South Denver for new programming as well as cross-promote wilderness medicine and educational travel opportunities already offered by WEM. WEM currently offers CME trips for all comers looking to combine medical education with travel to some of the planet’s most spectacular destinations – including Costa Rica, Patagonia, the Colorado Rockies and Greenland. The latter, the site of an Introduction to Polar Medicine course this August, is one of its newest offerings, the result of WEM being awarded a prestigious subcontract grant from the U.S. National Science Foundation to provide field health care services in Greenland.

The collaboration will continue as Lemery and Miner’s team works with the CU South Denver team to develop a K-12 wilderness and environmental medicine curriculum that could integrate into the outdoor and K-12 educational programs currently offered at the Liniger Building. This kind of programming is a perfect fit for CU South Denver, as the Liniger Building is a four-campus location that provides educational opportunities for the entire learning lifecycle.

“It just goes to show how outdoor-oriented Coloradans are,” Miner said of the excitement generated by the Wilderness Medicine Series. “They recognize these are important skills. If you’re going to play outside, you want to have the ability to take care of yourself and family so you can come back in one piece and go out and do it again.”

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Hot Spotters offers unique undergraduate internship

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Scott Cao

During summer 2015, a patient walked into the Emergency Department at University of Colorado Hospital only to hear very bad news. This patient needed a 30-day supply of a medication immediately —not in two weeks or seven days—but immediately. The drug was very expensive and the patient, who didn’t have insurance, could not afford it.

Within 48 hours, the patient had the medication in hand, thanks to the intervention and quick action of CU Denver junior Scott Cao, a biology major in the College of Liberal Arts and Sciences. The situation, which might have seemed hopeless at first glance, was business as usual for Cao in his summer internship working as a “Hot Spotter” at the hospital on the CU Anschutz Medical Campus.

“It was a fantastic experience,” Cao said. “It changed my perception of people who have chronic illnesses. I now look at them and realize many different factors could be affecting their health.”

The Hot Spotters

Hot Spotters is a summer experiential learning program developed by Roberta Capp, MD, MPH, assistant professor of Emergency Medicine. It teaches students from a variety of disciplines about the needs of underserved populations with the goals of improving access and quality of care for these patients and reducing their reliance on the Emergency Department for care. During summer 2015, the Hot Spotter program helped more than 3,500 patients address their health needs.

Cao found the internship through Charles Fergsuson, PhD, director of CU Denver’s Health Professions Programs. One of 19 Hot Spotters, Cao joined small Hot Spotter teams staffing the Emergency Department 24 hours a day, seven days a week. He was working side-by-side with students in medicine, nursing, pharmacy, public health and sociology. All were trained to identify resources available to high-risk patients who had come to the Emergency Department multiple times in a short period.

“Many patients come in with something manageable, like type 2 diabetes, but after they get discharged they don’t get the correct follow-up care,” said Cao, sounding more like a medical student than an undergrad. “They don’t have insurance, or they don’t have a pharmacy, or they do have Medicaid but they don’t have a primary care physician, or they don’t have transportation. Some are homeless.”

After these patients were treated, a physician or nurse would call in a Hot Spotter to help the patient navigate the health care system and receive follow-up care from a primary care physician. The students also assessed the patients’ barriers to accessing health care and provided resources to overcome those barriers, including health insurance enrollment, housing, transportation to appointments, medication and food pantry services.

“Our mission was to make sure we provided patients with enough resources and information that they did not have to come back to the Emergency Department unless they had life-threatening injuries,” Cao said. “We cut through red tape, sometimes making calls while the patient was still in bed.”

After Hot Spotters

In the months after his summer internship, Cao compiled and analyzed data he had collected from patients who had completed a medical screening survey. He turned his internship into a research project looking at the demographics of patients, their access to a car, whether they were homeless, had chronic illnesses, knew a primary care physician, could access prescription medication. He is hoping that the research could lead to the creation of more patient navigator programs like Hot Spotters.

He credits Capp with doing a “tremendous job” training the Hot Spotters to engage with patients. “She taught us to look at the big picture,” he said.

In the case of the patient who needed help paying for medication, Cao picked up the phone and reached an insurance enrollment specialist. Two days later, the patient was enrolled in an insurance plan that would cover the medication immediately—a singular example of how Hot Spotters, even when they are juniors in college, can change lives.

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