The Kraft Practitioner Program
The Kraft Practitioner Program is a two-year program aimed at better enabling community health centers to recruit and retain talented physicians and masters-prepared nurses by providing leadership development, mentorship and structured learning opportunities for top-performing community health center clinicians.
A highlight of the Kraft Practitioner experience is the independent project that each clinician pursues over the program’s two years. Support from the Kraft Center enables Kraft Practitioners to step away from their clinical responsibilities for one day each week to dig into projects that both interest the Kraft Practitioner and address the health needs of the community.
The latest in our series of Kraft Practitioner Spotlights features Marguerite (Maggie) Beiser, NP and her work at the Boston HealthCare for the Homeless Program.
Meet Maggie Beiser
When Maggie Beiser got her first job as a nurse practitioner at the Boston HealthCare for the Homeless Program (BHCHP), she had a hunch she would stick around for awhile. What she didn’t quite realize when she started, however, was the tremendous opportunities that this very unique community health center, which holds as its singular mission ensuring access to high quality health care for those experiencing homelessness in greater Boston, would offer her to keep learning and growing.
“Our patients are complex,” she explained, adding: “Doing primary care is hard wherever you are. It’s the patients that make it exciting.”
Beiser took on a lot, even from the very beginning. She was initially placed at the Barbara McInnis House, a 104-bed facility that provides medical respite care for some of the health center’s sickest patients. She also quickly became involved in a grant that focused on the delivery of HIV services for homeless populations, an area she had begun to explore while completing her nurse practitioner degree in New York City.
And it was those two experiences, coupled with her own inherent curiosity, which led her to leap headlong into the ambitious project she is pursuing now as a Kraft Practitioner – developing a comprehensive program to address the damaging impact of hepatitis C among BHCHP’s patients.
“Maggie is really galvanizing our response to this disease,” confirmed Jessie Gaeta, MD, BHCHP’s Medical Director and one of Beiser’s mentors on the project. “We needed a driver, and Maggie is that driver.”
Treating Hepatitis C in the Homeless
A distinguishing feature of BHCHP’s approach to health care is the fact that its clinicians bring their services to patients wherever they might find them – usually, in shelters, soup kitchens or on the street. The strategy acknowledges the reality that, for most homeless people, figuring out where to sleep or how to eat on any given day are concerns that trump chronic or basic health needs nearly every time.
Yet, in the case of hepatitis C, a liver disease caused by the hepatitis C virus that can lead to cirrhosis of the liver or liver cancer, the complexity of much of the required treatment has meant that patients are frequently referred to a “liver clinic” or other tertiary care facility. For many BHCHP patients with hepatitis C, the competing demands of basic day-to-day survival too often become insurmountable barriers to getting the type of health care they need to keep them alive.
Indeed, Beiser soon noticed that, while homeless people on the whole tend to die sicker and die younger than the average, a disproportionate number of the deaths at Barbara McInnis House seemed to be in some way associated with hepatitis C. She started reading about the disease and asking a lot of questions, and almost immediately, she was struck by the similarities between hepatitis C and HIV. Both are complex infectious diseases, and both are preventable – but, as Beiser pointed out, hepatitis C is ultimately curable, whereas HIV (of course) is still not.
“There is such a huge gap in knowledge among our patients about what they can do about hepatitis C, and it seemed like closing that gap could have such an impact,” she noted.
Developing a Model for Treatment
The project that Beiser has designed as part of the Kraft Practitioner Program takes a three-pronged approach to tackling hepatitis C’s complexities within BHCHP’s uniquely complex population of patients. Her first step, which she is implementing now, is assessing patients’ perceptions, needs and knowledge level about hepatitis C through a survey that she developed based on readings and research, conversations with patients and guidance from her project mentors.
At the same time, she is embarking upon concerted education efforts to improve understandings of the disease and its treatment options among her fellow health center clinicians and staff. But it is the third component – developing and implementing a plan to bring hepatitis C treatment out of tertiary care centers and into BHCHP’s range of services -- that really has her excited.
Such a far-reaching endeavor will likely not be completed within the Kraft Practitioner Program’s two-year time frame, Beiser admitted. Yet, if successful, it will provide a model with critical implications not only for the health outcomes of BHCHP’s patients, but also for other health centers and – not incidentally – for the cost of treating hepatitis C within homeless populations.
“Homeless individuals are some of the highest cost Medicaid recipients in the state,” emphasized Gaeta. Most tend to have higher rates of emergency room use and longer hospital stays, she continued – because by the time their health needs begin to trump their basic survival needs, it is typically too late for anything but the most expensive forms of health care. Taking health care to them, as is BHCHP’s standard, not only helps homeless patients avoid severe illness and disability; it also shifts the focus of the services provided from emergency response to (the far less costly) preventive care.
Making Time for Innovation
So far, Beiser said, her efforts to transform care for patients with hepatitis C have been enthusiastically embraced by BHCHP clinicians and staff members.
“It’s meaningful to people here because we see this all the time, and we are all looking for a way to deal with it,” she explained, noting that more than 20 percent of BHCHP’s 14,500-plus patients are positive for hepatitis C. (By contrast, the prevalence of hepatitis C in the general population hovers around 1-2 percent).
Beiser credits the Kraft Practitioner Program with enabling her to take on such a challenging issue. It is not only the day per week that Kraft frees her up from clinical responsibilities that has made a difference, she said. It is also that the program’s myriad learning opportunities and resources have together given her the building blocks to “get from point A to point B” and made her feel that an undertaking of this scope is (as she describes it) “even possible.”
Beiser’s participation in the Kraft program has changed BHCHP’s perspective on hepatitis C, too, noted Gaeta.
“Maggie just has this spark,” she said. She added: “She is very bright, and she never lets us forget for even one minute how important this work is.”