Ann Kao, MD, MPH

Ann Kao, MD, MPH

2006-2007

Co-Director, Pediatric Hospitalist Program, Massachusetts General Hospital, Boston, MA

Dr. Kao is currently the Co-Director of the Pediatric Hospitalist Division at Massachusetts General Hospital for Children, and attends on both the Internal Medicine and Pediatric services at Massachusetts General Hospital. She combines this with frequent international projects, most recently in Ecuador as part of an effort to increase services to developmentally disabled children; she also recently led a team in a health care project for children in Panama supporting a local NGO, Pro Ninez. Previously, Dr. Kao was a Durant Fellow in Refugee Medicine, and Clinical and Research Fellow at MGH who was trained in both internal medicine and pediatrics. In 2005, she worked on behalf of the Tsunami Relief effort as part of “Project Hope,” and as a result co-authored an article for the New England Journal of Medicine. She has also traveled to Rwanda, where she started up a health center and hospital in a refugee camp, as well as to Romania, Vietnam, and is a pediatric clinical advisor to the Cambodian Health committee. Domestically, she has worked at a Navajo Reservation in Chinle, AZ and an urgent care clinic in Chelsea, MA, serving a population largely consisting of immigrants from Latin America. She received the University of Washington School of Medicine Alumni Humanitarian award in 2007.

Dr. Kao received her medical degree from the University of Washington, Seattle, WA in 2000, and completed her combined residency in internal medicine and pediatrics at Massachusetts General Hospital, Massachusetts General Hospital for Children and Children’s Hospital Boston in 2004. She received an M.P.H. from the Harvard School of Public Health in 2007 as a CFHU Fellow.

2006

Impact of a Comprehensive Refugee Intake Program on Subsequent Health Care Utilization and Quality of Care Received

Objective:

To determine the health utilization patterns of refugees who obtain their initial federally funded refugee health assessments from Jan 2004-March 2005, for the subsequent 24 months.

Background:

Since 1975 the United States has resettled 2.4 million refugees, and continues to admit on average nearly 100,000 refugees annually.  These populations are generally from conflict ridden areas and have experienced extreme hardships because of their vulnerability based on ethnicity or class in their homelands.  The Refugee Act of 1980 passed by U.S. congress standardizes the resettlement services for all refugees admitted to the U.S.  States are granted funds to give medical assessments and aid to the refugees resettled within their jurisdiction.  Massachusetts has one of the most comprehensive Refugee Health Assessment programs, providing 2 standardized intensive medical visits, along with social services and support groups.  The Chelsea-MGH health care center serves a community where many refugees from various areas of the world (largely Bosnia, Somalia and Afghanistan) are resettled.  Their providers, social workers and interpreters have developed comprehensive health and social programs to aid those who have been resettled in Chelsea.  There is very little known as to how these intensive first 2 visits affect later health seeking behavior as well as the quality of health care received by the refugee program.  This project evaluated refugees who received their initial evaluation between January 2004 and March 2005 and evaluated their access / utilization of care and quality of care over the subsequent 24 months.

Methods:

IRB approval was obtained through Massachusetts General Hospital. The database of refugees/asylees who received their first visits at the Chelsea-MGH health center was obtained through the Chelsea – MGH Health Center refugee patient registry.  Electronic patient records were evaluated to determine the number of scheduled visits, number of “no-shows” and number of ER/Urgent care visits in the 24 months subsequent to their initial intake visits.  Electronic records were available from all Partners institutions including Massachusetts General Hospital, Brigham and Women’s Hospital, Newton-Wellesley Hospital, and Spaulding Rehab hospital.  Records were also evaluated to determine whether general primary health data was collected/given such as blood pressure, immunizations, as well as Mental Health services and other specialty services.

Results:

Missed visit rate for pediatric patients was 8% and for adult 18%.  For adult patients 10% of visits occurred in an Urgent Care or Emergency Setting., for pediatric patients 5% of visits were in an Urgent Care or Emergency Setting.  100% of adults had recorded Blood Pressure measurements and 100% of pediatric patients had immunizations recorded in the electronic medical record.   92% of pediatric refugee patients and 88% of adult refugee patients were enrolled into an insurance system, whether public or private, 24 months after the initial intake.

Conclusions:

Refugees are a difficult group to care for given their unique medical needs, history of trauma and cultural differences.  Standardized care in two simple visits along with culturally sensitive support staff can effectively empower these patients to obtain high-quality care, and enable them to access the health care system in an appropriate way. This model may be of use in initial intake visits of immigrants seeking care for the first time as a way of empowering these patients in successful access of primary care services.

Preceptor:

Leslie Aldrich, MPH, Director of Research & Evaluation, Community Benefit Office, MGH