Announcing New Psychiatry Clinics
 Jacob Venter, MD, MBA, CPE
Chief of Child Psychiatry
We are excited to announce that several new Psychiatry clinics are now available for CHA patients. To refer to any of these clinics, please complete a referral order to the Child/Adolescent Psychiatry Ambulatory Service in EPIC. In the "comments" section, indicate which service you are referring to.
DANAA Clinic - Developmentally and Neurologically Atypical Adults
Location: Central Street, Somerville
Age range: Adults
School Based Substance Abuse Prevention Intervention and Treatment Services
Location: CHA Teen Health Centers at Cambridge Rindge and Latin, Somerville High and Everett High
Age Range: Adolescents
 Description: Substance abuse treatment services are provided by David G. Stewart, Ph.D., ABPP, following the READY treatment model. Students who receive READY services have shown significant reductions in substance use, associated problems and a significant increase in school attendance.
Please note: Due to a high demand for services, we are prioritizing appointments for patients who are enrolled in Primary Care at CHA.
Managing Frailty in Older Adults
 An update on the CMS Waiver Frailty Care Plan Project
Serena Chao, MD
Chief, CHA Division of Geriatrics
As part of CHA's waiver work, the Geriatrics Division spearheaded implementation of the Vulnerable Elder Survey (VES-13), an assessment tool to identify older patients with higher predicted risk for functional decline and mortality. Older adults who score 3 or more on the VES-13 have four times the odds of functional decline or death in the following two years (Min L et al., J Am Geriatr Soc. 2009; 57: 2070-2076).
During the project period (July 2014-June 2017), clinicians in our House Calls program administered the VES-13 to identify patients who might benefit from added supports in the home. They also provided guidance to primary care staff at Cambridge and Somerville Hospital who administered the VES-13 to all patients 75 and older.
For each patient with a positive VES-13 screen, clinical staff at the 3 sites, with assistance from the VNA of Eastern Massachusetts, completed a frailty care plan (FCP) in EPIC. This was placed in the "Patient Care Coordination Note" section of the problem list. CHA's IT department created an EPIC smart text for the FCP, ".frailtycareplan", that included the patient's overall goals of care; current involvement of certified home health agencies (VNAs) or local area agencies on aging (Somerville Cambridge Elder Services or Mystic Valley Elder Services); and barriers to achieving goals. If staff members felt patients would benefit from any home-based services not already in place, they would document the need for new referrals in the "action plan" section of the FCP.
At the end of the final project year, 83% of the target population had completed VES-13 screens and 37% of VES-13-positive patients had completed FCPs. Primary care staff reported increased frequency of patient referral to community-based elder services as compared to the pre-waiver period. They also agreed to recommend use of the VES-13 and FCP tools to other CHA primary care practices.
The Geriatrics Division has future plans to implement the VES-13 more broadly and inform others about the tool's effectiveness in adding value to the care of older adults at risk of functional decline. This includes developing a tutorial (in collaboration with IT) to train clinical staff to administer and score the questionnaire and connecting primary care teams with community resources to support frail elders. Timely referral of older patients to community-based home services would enhance patients' ability to manage their personal and health needs at home.
For more information about the VES-13, or the frailty care plan, please contact Serena Chao, MD.
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Cytology Updates
Rebecca Osgood, MD, Chief of Pathology
Some recent improvements in our cytology service include additional staffing to provide consistent turn-around times for both gyn and nongyn specimens. 90% of our gyn specimens should be reported in 5 days and 90% of nongyn specimens should be completed in 48 hours.
A new walk-away automated processor for gyn and nongyn specimens, the
Hologic Thin Prep 5000, will be installed shortly. This will process up to 20 specimens at one time, with improved consistency, and will allow our laboratory assistants to complete other work in cytology during processing. Barcoding technology improves verification checks and reduces the risk of sample mix up and other processing errors. These improvements will result in faster turn-around times and more accurate results. This instrument will go live by the end of December.
Changes in Ordering Cardio-Pulmonary and Vascular Tests
Previously, orders for the Cardiopulmonary Vascular LAB were placed as a referral order in Epic. This referral (9043.1) will be removed and replaced with discrete orders for Cardiac/Pulmonary/Vascular studies. Please contact Jessica Stout at 617-665-1696 or 617-665-2490 with questions.
Travel Medicine Services
Adults who travel outside the US often need special precautions to protect their health. Our Travel Medicine clinic offers a full range of consultations, vaccines and prescriptions to meet this need. They also offer custom travel plans with important guidance for over 200 international travel destinations (health risks, pre-departure preparations, vaccine recommendations, local safety considerations, etc.). Have your patients call
617-591-4660 or email
travel@challiance.org to learn more. A reminder: Travel Medicine services should be completed 30 days before a trip.
Immigration Physicals at CHA
Patients applying for green card status are required to have USCIS immigration physicals for Homeland Security and the US Citizen and Immigration Services. CHA physicians in Occupational Health are certified as Civil Surgeons and are authorized to do these exams. Please tell your patients about this service and have them call
617-591-4660 for more information.
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Welcome to our Newest Staff
 Katherine Dudley, MD, MPH, is the newest addition to our Division of Pulmonary, Critical Care and Sleep Medicine. She is a graduate of the University of Rochester School of Medicine and Dentistry who completed her IM residency and Sleep Medicine fellowship at Beth Israel Deaconess Medical Center. She then completed a fellowship the Harvard Combined Pulmonary and Critical Care Medicine program followed by an MPH at the Harvard T.H. Chan School of Public Health. She is board certified in Internal Medicine with subspecialty recognition in Critical Care, Pulmonary Disease and Sleep Medicine.
 Jessica Stern, MD, has joined us as a Child Psychiatrist on the Adolescent Assessment Unit. She is a graduate of New York Medical College who completed her Psychiatry Residency at Beth Israel Deaconess Medical Center and her Child and Adolescent psychiatry fellowship here at CHA. She also completed a Fellowship in Psychodynamic Psychotherapy from the Boston Psychoanalytic Society and Institute.
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Newsletter Archives
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Description: Dr. Debra Rosenblum provides services for adults with intellectual disabilities to expand the ability of our psychiatry and medical staff to care for these patients. The clinic provides consultation, education for providers and a limited ongoing clinical case load for psychopharmacological services. The aim is to provide better care integration for adult patients with intellectual disabilities. 
Description: This clinic provides evaluation and treatment for pediatric patients presenting with neurodevelopmental disorders. The clinic is led by Dr. Lee Robinson (Child and Adolescent Psychiatrist) with additional expertise from Dr. Laura Gaugh (Psychologist). 
