PHILADELPHIA—Penn Medicine has established a new center to directly connect vulnerable patients to surgical care, a pathway that is often out of reach for this population. Known as the Center for Surgical Health (CSH), this first-of-its-kind, multidisciplinary center, housed in the department of Surgery, provides a new access point into sustainable, high-value surgical care for patients who typically rely on the emergency room for treatment.
"Many uninsured patients from marginalized groups—particularly immigrant communities in Philadelphia—use the ER for their surgical needs, regardless of the condition, which can lead to costly care and worse outcomes," said CSH director Jon B. Morris, MD, the Ernest F. Rosato-William Maul Measey Professor in Surgical Education in the department of Surgery at the Perelman School of Medicine at the University of Pennsylvania. "We believe in caring for all of our neighbors. This starts with an infrastructure through which patients can access high-quality, elective surgeries, from gallbladder surgery to hernia repair, that eliminates the ER as a preoperative clinic."
CSH expects to support and provide surgical services to approximately 175 patients in 2021, many referred through Puentes de Salud and the University City Hospitality Coalition, with that number expected to grow in 2022 and beyond as the CSH expands. With Penn Medicine now managing the inpatient clinical services at the newly formed PHMC Public Health Campus on Cedar, patients from West and Southwest Philadelphia will have an additional access point at Hospital of the University of Pennsylvania (HUP) – Cedar Avenue to receive care through CSH. So far, CSH has treated 154 patients.
The CSH team is comprised of Penn surgeons, residents, nurses, medical students, social policy and practice, and law students, who help navigate each patient through the surgical continuum, connect them to world-class surgical care, and deliver social support through a comprehensive patient navigation program. Elective operations are associated with decreased length of hospital stay, less time to return to work, decreased morbidity and mortality, improved patient perceived health, and more financial stability.
Matthew Goldshore, MD, PhD, MPH, a resident in the department of Surgery at Penn, serves as deputy director of the CSH, and Carrie Z. Morales, MD, a resident in the department of Surgery at Penn, serves as the associate deputy director.
"2020 shined a brighter light on systemic bias and health care inequities in our country, further underscoring the importance of establishing a new care model here in Philadelphia to help address surgical gaps," Goldshore said. "Now is the time for a smarter, more cost-conscious approach that fits the needs of the patients in our own backyard."
The center is also comprised of research, policy, and medical education arms to support expansion beyond the Philadelphia region.
One of the first research questions will focus on dissemination of CSH's model. An analysis of health policies is currently underway to better understand the health insurance landscape nationwide. In the education space, courses centered on surgical equity, including an introduction to the social determinants of surgical health, are being implemented into the Perelman School of Medicine's curriculum.
"Our goal is to create a culture of care through which Penn Medicine leads the academic medical community in surgical service delivery to marginalized populations around the country," Morris said. "That starts here by building a new clinical model, as well as an interdisciplinary cadre of clinical and public health scientists to solve problems through research, education, and advocacy surrounding access to and quality of surgical care."
