Panel members shared strategies based on decades of experience that enable necessary conversations and access to care.

1. The Importance of Inclusion, Equity & Diversity
in Advanced Illness

2. CME Provider Information
Satisfactory Completion
Learners must complete an evaluation form to receive a certificate of completion. You must
participate in the entire activity as partial credit is not available. If you are seeking continuing
education credit for a specialty not listed below, it is your responsibility to contact your
licensing/certification board to determine course eligibility for your licensing/
certification requirement.
Physicians
In support of improving patient care, this activity has been planned and implemented by
Amedco LLC and VITAS®
Healthcare. Amedco LLC is jointly accredited by the Accreditation
Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy
Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide
continuing education for the healthcare team. Credit Designation Statement – Amedco LLC
designates this live activity for a maximum of 1 AMA PRA Category 1 CreditTM
. Physicians
should claim only the credit commensurate with the extent of their participation in the activity.
2

3. CE Provider Information
VITAS Healthcare programs are provided CE credits for their Nurses/Social Workers and Nursing Home Administrators through: VITAS
Healthcare Corporation of Florida, Inc./CE Broker Number: 50-2135. Approved by: Florida Board of Nursing/Florida Board of Nursing
Home Administrators/Florida Board of Clinical Social Workers, Marriage and Family Therapy and Mental Health Counseling.
VITAS Healthcare programs in Illinois are provided CE credit for their Nursing Home Administrators and Respiratory Therapists through:
VITAS Healthcare Corporation of Illinois, Inc./8525 West 183 Street, Tinley Park, IL 60487/NHA CE Provider Number: 139000207/RT CE
Provider Number: 195000028/Approved by the Illinois Division of Profession Regulation for: Licensed Nursing Home Administrators and
Illinois Respiratory Care Practitioners.
VITAS Healthcare, #1222, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB)
Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and
provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing
education credit. VITAS Healthcare maintains responsibility for this course. ACE provider approval period: 06/06/2021-06/06/2024.
Social workers completing this course receive 1.0 continuing education credits.
VITAS Healthcare Corporation of California, 310 Commerce, Suite 200, Irvine, CA 92602. Provider approved by the California Board
of Registered Nursing, Provider Number 10517, expiring 01/31/2025.
Exceptions to the above are as follows: AL: No NHAs, DE: No NHAs, DC: No NHAs, GA: No NHAs, KS: No NHAs, NJ: No NHAs,
OH: No NHAs, PA: No NHAs, TX: No NHAs, VA: No NHAs, WI: No NHAs and Nurses are not required – RT only receive
CE Credit in Illinois.
3

4. Today’s Panelists
Diane Deese, MCLSS-GB,
CDEI-HC, CACPFI, EMT
VP, Community Affairs
VITAS®
Healthcare
Yolangel (Yogi) Hernandez Suarez,
MD, MBA, FACOG
Senior Associate Dean for Student Affairs
FIU Herbert Wertheim College of Medicine
Caroline Ezekwesili, MPH
Medical Student
FIU Herbert Wertheim
College of Medicine
Ileana Leyva, MD
Regional Medical Director
VITAS®
Healthcare
4

5. Diane Deese, MCLSS-GB, CDEI-HC, CACPFI, EMT
VP, Community Affairs
VITAS® Healthcare

6. Goal
In the context of social determinants of health, this symposium will
explore the importance of inclusion, equity, and diversity for persons
with advanced illness. Participants will discover an integrative approach
to inclusion, equity, and diversity through medical training and clinical
practice in this population. Panel members will share strategies based
on decades of experience that enable necessary conversations and
access to care, including hospice and palliative services, earlier in the
disease process.
6

7. • Discuss contributors that
impact timely care in
underserved communities
• Describe one innovative
medical school curriculum
that incorporates DEI
to shape current and
future practice approaches
• Identify opportunities to incorporate
DEI in daily practice through a
case study
Objectives
7

8. *Data taken from the CDC and the NCHS National Vital Statistics Report Volume 70, Number 4 May 17, 2021
Heart Disease,
24.1
Cancer,
19.7
Alzheimer's Disease,
7.9
Stroke,
5
Homicide,
4.5
Diabetes,
4.4
Chronic Lower
Respiratory Disease,
3.3
Kidney Disease,
2.7
Septicemia,
1.7 Hypertension,
1.7 Heart Disease
Cancer
Alzheimer's Disease
Stroke
Homicide
Diabetes
Chronic Lower Respiratory Disease
Kidney Disease
Septicemia
Hypertension
Leading Causes of Death – Males – Non-Hispanic – Black –
United States, 2018
8

9. Leading Causes of Death – Females – Non-Hispanic – Black –
United States 2018
*Data taken from the CDC and the NCHS National Vital Statistics Report Volume 70, Number 4 May 17, 2021
Unintentional Injuries,
3.7
Chronic Lower Respiratory
Disease,
3.6
Kidney Disease,
3
Septicemia,
2.2
Unintentional Injuries
Chronic Lower
Respiratory Diseases
Kidney Disease
Septicemia

10. Leading Causes of Death – Females – Hispanic –
United States 2018
*Data taken from the CDC and the NCHS National Vital Statistics Report Volume 70, Number 4 May 17, 2021
Diabetes,
4.7%
Chronic Lower Respiratory
Disease,
3.1
Influenza and
Pneumonia,
2.3
Kidney Disease,
2.2
Diabetes
Chronic Lower
Respiratory Disease
Influenza and Pneumonia
Kidney Disease

11. Leading Causes of Death – Males – Hispanic –
United States, 2018
*Data taken from the CDC and the NCHS National Vital Statistics Report Volume 70, Number 4 May 17, 2021
Heart Disease,
20.2
Cancer,
19.4
Unintentional Injuries,
11.3
Stroke,
4.7
Diabetes,
4.5
Chronic Liver
Disease and
Cirrhosis,
4.1
Suicide,
3.1
Chronic Lower
Respiratory Disease,
2.6
Alzheimer's Disease,
2.3 Homicide,
2.2 Heart Disease
Cancer
Unintentional Injuries
Stroke
Diabetes
Chronic Liver Disease and Cirrhosis
Suicide
Chronic Lower Respiratory Disease
Alzheimer's Disease
Homicide
11

12. VITAS Key Pillars
DEI Outreach
Healthcare Systems
Employee Advocates
Faith Based Organizations
Community Services

13. Healthcare Systems and Services
13

14. Yolangel (Yogi) Hernandez Suarez,
MD, MBA, FACOG
Senior Associate Dean for Student Affairs
FIU Herbert Wertheim College of Medicine

15. FIU Community Partnership Program: History
• FIU HWCOM - a medical school born in the Affordable Care Act
• Our mission: culturally competent, community engaged physicians
• Community based: 13 major partners
• Contemporary curriculum: Social Determinants of Health,
System-Based Practice
• Advocacy training
• VITAS partnership
15

16. FIU Community Partnership Program: Results
• 1000 alumni
• All have passed through a curriculum
shaped by VITAS/HWCOM partnership
• Placement
• Regionality
• Program directors: “Students are day 1 ready.
They have maturity and situational awareness.”
16

17. FIU Community Partnership Program: Future
• “Where the puck is going”
• Employed physicians
• Risk-based compensation
• Innovative practice models
• New competencies
• Intersectional collaboration
17

18. Caroline Ezekwesili, MPH
FIU Herbert Wertheim College of Medicine
Medical Student

19. FIU Community Partnership Program: Experience & Perspective
Neighborhood Assigned Community Survey
Miami-Dade County Miami Gardens
Population 2,758,636 110,867
Black/African American 16.33% 66.8%
Adults 65+ without
health insurance
2.6% 3.8%
Households below
federal poverty level
17.2% 20.2%
Adults with diabetes 9.8% 15.6%
High blood pressure
prevalence
31.9% 39.3%
19

20. Household Assigned Care Team Care Management
Medical student
Leads household visit
Nursing student
Attending physician
Outreach worker
“Ms. Smith”, 71 y/o F,
program member
since 2016
• Monthly communication
with households
• Quarterly virtual or
in-person visits
• Learning to manage
chronic diseases and
SDOH
FIU Community Partnership Program: Experience and Perspective
Social work
student
20

21. Between July 1, 2021, and June 30, 2022:
• There were ≈567 social needs reported by ≈311 households.
Services were offered for ≈94% of the needs identified and
≈78% of reported needs were met.
• 61% of patients with high blood pressure had their pressure
under control (higher than the NCQA* average of 56%).
• 59% of patients with diabetes had controlled diabetes
(higher than the NCQA* average of 45%).
Graduating HWCOM students report more experience with
clinical interprofessional education and health disparities
compared with their peers from other schools.
FIU Community Partnership Program: Experience and Perspective
*NCQA is the National Committee for Quality Assurance 21

22. Dr. Ileana M. Leyva, MD, FAAHPM
Regional Medical Director
VITAS® Healthcare

23. 67 yr old male, married, recently arrived from Venezuela, uninsured
• Presented to outside ER with the following complaints:
Good Medicine Is Good Medicine
1. Abdominal pain
2. Nausea
3. Early satiety
4. 12 # weight loss
• Admitted to outside hospital with
diagnostics identified pancreatic tail
mass, with solitary liver metastases
• Liver biopsy positive for adenocarcinoma
• Patient referred and admitted to
hospice and transferred to VITAS IPU
23

24. VITUS IPU
• Complaints of fatigue, debility,
abdominal pain, nausea, vomiting,
inability to take PO, additional
8 # weight loss, no BM x 8 days,
clinically dehydrated
• Had been informed that due
to his poor clinical status and
ongoing symptoms, no cancer
therapy was recommended
• Code status changed to DNR
• Treatment till time of admission to VIPU:
1. Hydrocodone 5/325 mg 8 tabs
per day with ongoing pain 10/10
despite max dose /day
• GOC discussion
– Have better pain and
symptom control
– Improvement of tiredness and fatigue
– Hoped he could live longer and
open to cancer therapy if it would
allow for longer lifespan
Good Medicine Is Good Medicine
24

25. • VIPU Interventions
1. IVF resuscitation
2. Pain control with IV opioids
secondary to nausea/emesis
3. Nausea control with prokinetic
agent and antiemetics
4. Bowel regimen with resultant
large multiple BMs
Patient improved markedly, pain
resolved, nausea/emesis resolved,
able to initiate PO intake and advanced
to general diet, which was well tolerated.
Debility and fatigue improved with
hydration. Patient’s performance
status improved, regained functional
status with ability to ambulate and
regain ADLs
Good Medicine Is Good Medicine
25

26. After reassessment and further discussions with patient and adult son
1. Contacted GI oncology and requested consult for second opinion
2. Based on location of pancreatic mass with solitary liver metastases,
patient deemed candidate for clinical trial
3. After detailed discussion with patient and family along with oncology
team and hospice team, decision made to discharge from hospice
to allow for cancer directed therapies, understanding that he did not
have curative disease but with goal to slow disease process, prolong
duration of life while ensuring concurrent symptom management.
4. Also reassured that when disease progressed and/or no longer
responsive to interventions, hospice would be available to him and
his family
Good Medicine is Good Medicine
26

27. Outcome
• Patient went on clinical trial.
• Also referred to concurrent palliative medicine service for symptom management.
• Patient did well on clinical trial for 9 months, then had disease progression.
• After discussion with oncology team and palliative team, patient and family
felt their goals and needs would be best served with hospice level of care.
• Son called VITAS and requested services; patient admitted to hospice.
Hospice
• On service for 2 months, remained at home with family, then died at home
with family at his side
Good Medicine is Good Medicine
27

28. Discussion

29. What one key takeaway regarding DEI in healthcare would you
like our audience to keep top of mind as they care for underserved
patients with advanced illnesses?
Yolangel (Yogi) Hernandez Suarez,
MD, MBA, FACOG
Senior Associate Dean for Student Affairs
FIU Herbert Wertheim College of Medicine
Caroline Ezekwesili, MPH
Medical Student
FIU Herbert Wertheim
College of Medicine
Ileana Leyva, MD
Regional Medical Director
VITAS®
Healthcare
Diane Deese, MCLSS-GB,
CDEI-HC, CACPFI, EMT
VP, Community Affairs
VITAS®
Healthcare
29

30. Q & A
Closing Remarks