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Population Health

Collaborations and Partnerships

Improving health outcomes is key to our mission, but health isn’t just in the doctor’s office—it is a stable home, healthy food, social support, education, and more. In pursuit of a healthier Philadelphia, the Temple Center for Population Health is a leader in creating partnerships and collaborations that address the social determinants of health, improve access to healthcare, and support transitions of care, driving better outcomes and quality of life in our region.

Our partners are community organizations, philanthropies, other large health systems, state and city health departments, and care providers at all levels and specialties. Together, we keep people healthier physically, emotionally, and socially, helping them avoid the need for hospital and emergency care, and ensure consistent quality across all healthcare contexts.

Our Partnerships

Housing Smart, an Award-Winning Innovation

In the first program of its kind, Temple Health is collaborating with Health Partners Plans, Keystone First, and Resources for Human Development, Inc., to coordinate provider, payer, and housing services to reduce recurrent hospitalizations and emergency room visits among people who are unhoused. The Housing Smart program provides peer outreach, supportive services, and free or subsidized housing to vulnerable patients in need, and is already showing dramatic results. Since its launch in 2020, the program’s initial patient cohort has experienced:

  • 75% decrease in emergency department visits
  • 79% decrease in readmissions

The Housing Smart team was awarded 1st Place Innovator in the Housing and Community Development Category of the 2022 Philadelphia Innovations Awards.

PHA Cares: A Peer-Powered Success

In partnership with Temple’s Center for Urban Bioethics and the Philadelphia Housing Authority, the Center for Population Health trains and employs people who live in either PHA or Section 8 housing for positions as community health workers. Started in response to COVID-19, the PHA Cares program has been highly successful, prompting expansion for broader impact beyond COVID-19 prevention. Community Health Workers educate their neighbors about COVID-19 vaccination and other important health issues, screen for social determinants of health, and connect them with resources to address health challenges.

TRUST: Treating Opioid Use Disorder, Helping Providers on the Frontlines

Our support for patients with substance use disorders includes the Temple Recovery Using Scientific Treatments (TRUST) Clinic, a care delivery hub for patients with opioid use disorder and a support network for local primary care physicians who treat them. The clinic also houses our work with the PA Coordinated Medication-Assisted Treatment (PacMAT) Program.

Temple Substance Use Disorder and Recovery Programming >

Frazier Family Coalition for Stroke Education and Prevention

A Temple Health and Jefferson Health initiative, the Frazier Family Coalition provides American Heart Association-approved stroke prevention and education to high-risk people with hypertension living in areas of North Philadelphia. The Frazier Family Coalition develops culturally sensitive programs to address the clinical and social needs of the community that may lead to stroke such as diabetes, lack of nutritious foods, and stress.

Learn more about Clinical Programs >

North Philadelphia Collective

Temple Health and Temple University Lewis Katz School of Medicine are active participants of the North Philadelphia Collective (NPC). The NPC represents individuals, community and faith-based organizations with a shared vision to respond to the health and educational needs of people connected to North Philadelphia, in particular, Nicetown, Tioga and Hunting Park.  

Farms to Families

Our Farms to Families program brings fresh, low-cost produce to North Philadelphia families through home delivery and neighborhood distribution. In partnership with the Temple University Center for Urban Bioethics, and supported by the St. Christopher’s Foundation and others, our program addresses the lack of adequate access to affordable, fresh produce. Inadequate nutrition increases the risk for chronic conditions such as hypertension, diabetes, and heart disease. 

Emergency Food Pantry

Temple Health maintains a food pantry for patients who are food insecure. Our pantry supplies individuals and families with food to meet their urgent needs while the community health workers simultaneously assist patients with additional resources.

Temple Health Community Connect: A Database of Support

Temple Health maintains a Community Connect database of more than 300,000 community care programs and resources for food and nutrition support, clothing, housing, utility assistance, and other social determinants of health. The database is user-friendly and features resources at your fingertips. It is searchable by zip code.

Temple Health Community Connect >

Healthy Together Mobile Health Vehicle

The Temple Center for Population Health partners with community organizations in selected neighborhoods to provide health screenings, education, and connections to community resources through its mobile health vehicle. Along with providing screenings and education on the basics of blood pressure and stroke prevention, our team of community health workers introduce selected health topics every month, such as chronic disease prevention and management, gun violence prevention, and support for addressing social determinants of health.

Learn More >

Fox Chase Community Outreach

Fox Chase Cancer Center’s Office of Community Outreach offers cancer-related patient education on-site and on the go. The Lippincott Resource and Education Center provides patients and families with a wealth of information about cancer, cancer care, and survivorship, available in multiple media, with health educators to help patients find what they need. A Speakers Bureau offers free educational sessions on cancer topics, in English and Spanish, to groups located across multiple local counties. And the Fox Chase Cancer Mobile Screening Unit partners with community organizations to offer neighborhood cancer screenings throughout Southeastern Pennsylvania and parts of New Jersey.

Fox Chase Office of Community Outreach >

For many of our patients, improving their overall health first requires addressing the social determinants of health, and housing is the second most impactful social determinant of health after food security. With this novel program, we’re bringing meaningful and lasting health improvement to their lives. 

— Steven R. Carson, MHA, BSN, RN, Senior Vice President of Population Health, Temple University Health System

Care Management and Quality Improvement Programs

Skilled Nursing Facility Collaborative

Temple Health works with 15 skilled nursing facilities that care for Temple Health patients to improve transitions, advance quality, and reduce readmissions from the post-acute setting. The program is establishing a clinical communication strategy, metric standardization, and a care management competency inventory with the goal of stronger hospital-SNF partnerships.

Home Health Collaborative

The Home Health Collaborative, developed along with six partner home health agencies, is working to reduce readmissions through improved discharge problem solving and shared resources. Initiatives include developing tools like surgical wound discharge dressing kits; and educational resources like information on medication reconciliation and documentation, and patient-directed instructions for use of after-hours call systems.

Long Term Care RISE: Building Resiliency Against Outbreaks

The LTC-RISE (Long Term Care Resiliency, Infrastructure Support and Empowerment) collaboration between Penn Medicine and Temple began as a grant from the PA Department of Health to provide COVID-19 outbreak response in skilled nursing facilities and care homes in Southeast Pennsylvania. The program has expanded through federal and state funding to include workforce development, assessment of and assistance with operational recovery and quality improvement, and creation of sustainable response systems for resiliency in the face of future outbreaks. The program convenes health systems, departments, healthcare coalitions and emergency management groups to create a regional outbreak response system that will last long into the future. Member facilities receive tools and training to build an organizational culture of safety and preparedness, along with help coordinating services and support from the state, such as staffing/recruitment and PPE. Our partners include Temple’s Skilled Nursing Home, Home Health, and Post-Acute Care Collaborative with whom we work to facilitate discharge planning.

Learn more about LTC-RISE >

Learn more about Temple skilled nursing, home health and post-acute care management >

Many residents are scared to receive the vaccine. I help them to understand its many benefits so they can make an informed decision. When we work together they see themselves in me. This helps build trust and a relationship so that I can connect them with the resources they need to get healthy.

— Angela Sutton, Community Health Worker