Toby Cosgrove, MD, CEO of the Cleveland Clinic, spoke about bringing a business lens to health during a panel discussion this morning at the Spotlight: Health expansion program of the Aspen Ideas Festival. In an article in this month’s Harvard Business Review, he wrote that “Fixing health care will require a radical transformation, moving from a system organized around individual physicians to a team-based approach focused on patients.”
NewPublicHealth spoke to Cosgrove about this transformation just before the Spotlight: Health conference.
Toby Cosgrove: The first thing we did is that for the last decade we’ve been very transparent around our quality, and we’ve released books on quality outcomes which are available both in paperback form and on our website. The second thing that we’ve done is we’ve consolidated services. For example, we started out having six hospitals in the system that provided obstetrics care, and now we’ve got three and are about to have two. And each time we’ve consolidated we’ve increased the volume of patients and improved the quality. We’ve done consolidations with pediatrics, cardiac surgery, rehabilitation, psychiatry, trauma and obstetrics. We think that it’s called the practice of medicine—the more you practice at it, the better you get at it, and every time we’ve done that we’ve seen that happen.
In Cleveland, for example, we partnered with Metro Health, a large network of health providers. We previously had five trauma centers in Cleveland. Now we have three and as we’ve done that, the mortality rate has improved 20 percent. So there are real activities that have begun to drive the business approach.
NPH: What are other ways that the Cleveland Clinic has been able to respond to consumer needs using a business model?
Cosgrove: We think you’ve got to do three things. You’ve got to have improved access, quality and affordability. The access is not just having insurance—the access is actually getting to see a provider, and last year we provided about one million same-day appointments in addition to our scheduled ones. We also took our emergency room wait times from 43 minutes to 11 by changing the system that we use. And in our call center we’ve reduced the number of dropped calls and improved the speed of answers. All of that is aimed at giving patients access to the caregivers. We also reorganized our internal system so that when you, say, have a neurologic problem, instead of coming to see a neurologist and then a neurosurgeon, you come into the neurologic institute where you can be seen in one location under one leadership of neurology, neurosurgery and psychiatry, so that you are seamlessly seen with all the specialties right there in one location.
“What we mean by ‘building a Culture of Health’ is shifting the values—and the actions—of this country so that health becomes a part of everything we do,” said Risa Lavizzo-Mourey, MD, MBA, president and CEO of theRobert Wood Johnson Foundation (RWJF), during her keynote address at Spotlight: Health. RWJF is a founding underwriter of the two-and-a-half day expansion of the annual Aspen Ideas Festival.
“With health, each one of us can make the most of life’s opportunities,” she said. “That’s why we at the Robert Wood Johnson Foundation have made building a Culture of Health our North Star—the central aim of everything we do.”
Lavizzo-Mourey explained that the Foundation brought the Culture of Health concept to the Festival because of this year’s theme of “Imagining 2024.”
“When it comes to building a Culture of Health, I believe a decade from now we will have a powerful story of how we resolved to no longer accept that our nation spends more than $2.7 trillion dollars on health care, and yet continues to lose $227 billion dollars in productivity each year because of poor health,” she said.
Lavizzo-Mourey told the audience—which included health thought leaders from around the country—that building a true Culture of Health means changing our current understanding of health and creating a society where everyone has the opportunity to lead a healthy life. She gave the example of the Metro system in Washington, D.C., where babies born in the region of the Red Line—which intersects some of the wealthiest counties in the country—can expect to live to be 84 years old. However, babies born just a few stops away will have lives that are up to seven years shorter.
According to Lavizzo-Mourey, there are multiple ideas being practiced around the country that contribute to the emerging Culture of Health, including:
- Helping patients with things such as housing and food assistance at every medical visit.
- Changing the workplace culture to be a healthier one, including using stairs instead of elevators and holding standing or walking meetings.
She also enumerated several key ways that RWJF is working to build a sustainable Culture of Health, including committing $500 million toward reversing the U.S. childhood obesity epidemic; helping to ensure that everyone who is eligible for health care coverage knows about the benefits available to them; encouraging businesses to take the lead in investing in the wellbeing of the communities they serve; and addressing community violence.
HHS’ Million Hearts Initiative Launches Health Eating Resource Center
The Million Hearts initiative from the U.S. Department of Health and Human Services has launched a new online resource center to promote healthier eating by individuals and families. The Healthy Eating and Lifestyle Resource Center features lower-sodium, heart-healthy recipes and family-friendly meal plans, and emphasizes managing sodium intake. The searchable recipes include nutritional facts and use everyday ingredients. “This resource helps people see that it’s not about giving up the food you love, but choosing lower sodium options that taste great," said Tom Frieden, MD, Director of the U.S. Centers for Disease Control and Prevention. “Small changes can make a big difference. We can prevent 11 million cases of high blood pressure each year if everyone reduced their daily sodium intake to 2,300 mg.” The Million Hearts initiative was launched with the goal of preventing 1 million heart attacks and strokes by 2017. Read more on nutrition.
3-D Mammograms Improve Breast Cancer Detection Rate, Reduce Recall Rate
Tomosynthesis—also known as 3-D mammography—can increase the detection rate of breast cancer while also decreasing false positives that can lead to multiple and unnecessary re-tests, according to a new study in the Journal of the American Medical Association. Researchers analyzed the results of 454,850 examinations, finding that when 3-D mammography was combined with traditional digital mammograms the detection rate for breast cancer climbed 40 percent while there was a 15 percent decrease in the recall rate, or the percentage of women who needed additional screening due to inconclusive results. The findings come as more and more hospitals and physicians are turning to 3-D mammography. The researchers cautioned that more study was needed into the relatively new technology. Read more on cancer.
AAP: Reading to Young Kids Starting in Infancy Improves Literacy Later in Life
Read to your kids—aloud and every day—starting as early as their infancy. That’s the latest recommendation from the American Academy of Pediatrics' (AAP) Council on Early Childhood. The policy statement is set to appear in the August print issue of the journal Pediatrics. "This is the first time the AAP has called out literacy promotion as being an essential component of primary care pediatric practice," said statement author Pamela High, MD, director of developmental and behavioral pediatrics at Hasbro Children's Hospital in Providence, R.I., and a professor at Brown University. "Fewer than half of children are being read to every day by their families, and that number hasn't really changed since 2003. It's a public health message to parents of all income groups, that this early shared reading is both fun and rewarding." According to the AAP, reading proficiency in the third grade is the most important predictor of eventual high school graduation, but approximately two-thirds of all U.S. children and 80 percent of kids living in poverty finish third grade lacking in reading proficiency. Reading aloud to a young child can promote literacy while also strengthening family ties. Read more on pediatrics.
During this week’s Spotlight: Health at the annual Aspen Ideas Festival, Cleveland Clinic CEO Toby Cosgrove, MD, will be talking about the future of academic medicine. The topic has received a great deal of attention recently, including a white paper from the Bipartisan Policy Center (BPC) and a pilot program from the American Medical Association (AMA) to give $1 million each to eleven medical schools redesigning their teaching programs—many of which include a focus on prevention, wellness and population health.
Teamwork is a recent and critical emphasis at the Cleveland Clinic Lerner College of Medicine, said Cosgrove in a conversation with NewPublicHealth ahead of the Aspen conference.
“When a lot of us went to medical school we were all taught to be rugged individuals, and so [now] we’re trying to teach teamwork...at the very beginning of health care education,” he said. To that end, instruction at the medical school now emphasizes team-based learning and the students will begin doing some of their work with nursing and dental students in the same physical facility “so we begin to break down the silos that are going on right now and encourage team play.”
The 11 medical schools that received the recent AMA grants were chosen from among 119 schools that submitted proposals. “Their bold, transformative proposals [are] designed to close the gaps between how medical students are trained and how health care is delivered,” said former AMA President Jeremy A. Lazarus, MD, when the AMA awarded the grants last year. Among the winners:
- The Alpert Medical School of Brown University, which has proposed establishing a dual MD-MS degree program in primary care and population health. A clerkship during the third year of medical school will integrate care of the individual patient and population health, and the fourth year will include population health course content and require a Master's thesis. The admissions process will include required interviews with stakeholders and patients.
- The University of California-Davis School of Medicine is partnering with Kaiser Permanente to create the Accelerated Competency-based Education in Primary Care (ACE-PC) program, which will require all students to work in the Kaiser Health system so that they can learn by experiencing the patient-centered medical home model. Changes to curriculum include population management, chronic disease management, quality improvement, patient safety, team-based care and preventive health skills, with a special emphasis on diverse and underserved populations.
The eleven schools won’t be working in silos, either. Susan Skochelak, MD, the AMA’s group vice president for medical education, told NewPublicHealth that the initiative was designed “very specifically to bring the schools together in a consortium, because we wanted to disseminate the best practices rapidly.”
Public Health Campaign of the Month: National Crime Prevention Council, AAP Campaigns Urge Firearm Safety
NewPublicHealth continues a new series to highlight some of the best public health education and outreach campaigns every month. Submit your ideas for Public Health Campaign of the Month to email@example.com.
Two national multimedia campaigns are urging precautions and safe practices when it comes to firearms and children.
The National Crime Prevention Council (NCPC)—in partnership with the Ad Council and funded by the Bureau of Justice Assistance—has launched the Safe Firearms Storage campaign to encourage owners to make safe firearms storage a priority. According to a study by the RAND Corporation, about 1.4 million homes have firearms stored in a way that makes them accessible to children, at–risk youth, potential thieves and people who could harm themselves or others.
“We teach all drivers to buckle up in case of accidents and to lock their cars,” said Ann M. Harkins, President and CEO of the NCPC. “The same logic applies to this campaign; we want owners to lock up their firearms to prevent accidents and keep them out of the wrong hands. Safe storage ensures that owners are doing their part to increase public safety.”
In addition to a website, the NCPC campaign features television, radio, print, outdoor and online PSAs that call on firearms owners to use safety devices such as trigger locks, as well as to store ammunition in a separate locked container. A “Snapguide” illustrates options for properly storing a firearm in a household, and the website also offers resources to help firearm owners talk with their children about firearm safety.
The American Academy of Pediatrics (AAP), in partnership with the Brady Center to Prevent Gun Violence, is also making a beginning-of-summer push as part of its ongoing ASK campaign—“Asking Saves Kids”—to remind parents to ask whether there is an unlocked, loaded gun in a home before a child goes on a play date. A response of “yes” should be followed with questions about where the gun is and whether the children will be supervised. Concerned parents should then not be afraid to suggest the children play somewhere else, such as a playground or another home without a gun.
Follow NewPublicHealth this Week for News from ‘Spotlight: Health’ at the Aspen Ideas Festival and the Winners of the RWJF Culture of Health Prize
The Robert Wood Johnson Foundation (RWJF) is a lead sponsor for this week’s Spotlight: Health meeting, a two-and-a-half day expansion of the Aspen Ideas Festival, convened annually by the Aspen Institute in Colorado.
Spotlight: Health will bring together world leaders, corporate executives, innovators, entrepreneurs, policy experts, media, philanthropists and thought leaders from many sectors to showcase what health and health care can look like a decade from now.
On Wednesday, RWJF CEO Risa Lavizzo-Mourey will deliver a keynote address: “We Will Have A Powerful Story to Tell: Building a Culture of Health in America,” which will be live-streamed at 10 a.m. (EDT). She will also announce the six winners of the RWJF Culture of Health Prize, which honors communities working at the forefront of health improvement.
NewPublicHealth will live tweet and live blog from the event, as well as post interviews with key thought leaders presenting at the conference. They will include investor/entrepreneur Esther Dyson on “The Way to Wellville,” a wellness competition that’s looking for the key metrics to help improve population health; Cleveland Clinic CEO Toby Cosgrove, MD, on bringing business best practices to health care; and Michael Murphy, of the Boston-based MASS Design Group, on better design ideas for hospitals and health systems.
Follow RWJF and NewPublicHealth coverage of Spotlight: Health using the hashtag #AspenIdeas.
HUD Releases Progress Report on Rebuilding After Hurricane Sandy
The U.S. Department of Housing and Urban Development’s (HUD) Sandy Program Management Office has issued its first report tracking progress on the Sandy Rebuilding Strategy. “While this report shows we are following through on [our rebuilding commitment] we also recognize that many families and business are still on the road to recovery and delays in connecting them to the services and support they need are often too long,” said HUD Secretary Shaun Donovan. “Although more work needs to be done, HUD and the federal government will continue coordinating with local officials until the region has recovered and we meet all the goals of the Sandy Rebuilding Strategy.”
The report tracks progress on several goals set by HUD, including:
- Promoting resilient rebuilding
- Restoring and strengthening homes and providing families with safe, affordable housing options
- Supporting small businesses and revitalizing local economies
- Addressing insurance challenges and affordability
- Building state and local capacity to plan for and implement long-term recovery and rebuilding
- Improving data sharing between federal, state and local officials
Read more on Hurricane Sandy.
New Report Finds Tobacco Companies Have Made Cigarettes Even More Addictive and Deadly
Design changes and chemical additives introduced by tobacco companies in recent decades have made cigarettes more addictive, more attractive to kids and even more deadly, according to a new report, Designed for Addiction, released by the Campaign for Tobacco-Free Kids.
The report finds that tobacco companies have:
- Made cigarettes more addictive by controlling and increasing nicotine levels and enhancing the impact of nicotine.
- Made cigarettes more attractive to kids by adding flavorings such as licorice and chocolate that mask the harshness of the smoke, menthol that makes the smoke feel smoother and other chemicals that expand the lungs’ airways and make it easier to inhale.
- Added ingredients that make cigarettes even more deadly, according to a Surgeon General's report on tobacco and health, released in January which found that smokers today have a much higher risk of lung cancer than smokers in 1964, when the first Surgeon General's report disclosed the harms caused by smoking.
Read more on tobacco.
CDC to Launch Fourth ‘Tips From Former Smokers’ Series
The U.S. Centers for Disease Control and Prevention (CDC) will be launching its next “Tips from Former Smokers” series on July 7. The ads will run nationwide for nine weeks on television, radio and billboards, as well as online, in theaters, in magazines and in newspapers. According to the CDC, the Tips national tobacco education campaign has helped hundreds of thousands of smokers quit since it began in 2012.
“These new ads are powerful. They highlight illnesses and suffering caused by smoking that people don’t commonly associate with cigarette use,” said CDC Director Tom Frieden, MD, MPH. “Smokers have told us these ads help them quit by showing what it’s like to live every day with disability and disfigurement from smoking.”
Smoking remains the leading cause of preventable death and disease in the United States, according to the CDC, and kills about 480,000 Americans each year. More than 16 million Americans are living with a smoking-related disease. For every person who dies from a smoking-related disease, about 30 more people suffer at least one serious illness from smoking.
The most recent “Tips” campaign resulted in more than 100,000 additional calls made to 800-QUIT-NOW. On average, weekly quitline calls were up 80 percent while the ads were on the air, compared to the week before they began running. Read more on tobacco.
Study: Today’s Drugged Drivers More Likely to Mix Alcohol and Drugs, Have Taken Multiple Prescription Medicines
The profile of a drugged driver has changed substantially since 1993, according to a new study released today in the journal Public Health Reports, which shows that more drivers are now testing positive for prescription drugs, marijuana and multiple drugs.
“While we’ve seen a decrease over the years in motor vehicle fatalities involving people under the influence, the nature of those crashes is changing,” said study author Fernando Wilson, PhD, an associate professor at the University of Nebraska Medical Center.
The study examines trends in the characteristics of U.S. drivers who were involved in fatal crashes between 1993 and 2010 and tested positive for drugs. The study, funded by the Public Health Law Research program of the Robert Wood Johnson Foundation, was set up to investigate the relationship between state laws and the consumption of alcohol and other drugs in fatal car crashes. It found that the percentage of drugged drivers with three or more drugs in their system nearly doubled from 1993 to 2010, increasing from 11.5 percent to 21.5 percent.
“In 1993, about one in eight drivers were using multiple drugs concurrently. By 2010, it was closer to one in five. That’s a large increase in drug use,” Wilson said. “Beyond that, we’re also seeing more and more people using drugs and alcohol together. About 70 percent of drivers who tested positive for cocaine had also been consuming alcohol, and almost 55 percent of drivers who tested positive for cannabis also had alcohol in their systems.”
- Almost 60 percent of cannabis-only users were younger than 30 years.
- Thirty-nine percent of prescription drug users were 50 years old or older, which seems to be in line with an overall increase in the use of prescription drugs by Americans, and the older population in general.
“These trends are likely to continue into the future given the aging U.S. population, an increasing reliance on prescription medications by medical providers and increasing initiatives to legalize marijuana,” said Wilson. “However, it is unclear whether current state policies are completely up to the challenge of addressing the growing issue of drugged driving.”
NewPublicHealth recently spoke with Wilson about the study. He said he embarked on the research because of the tens of thousands of motor vehicle crashes each year and the need to figure out the most effective policies to curb distracted driving. According to Wilson, eighteen states have zero-tolerance laws for drugged drivers, but recent studies suggest that these laws may not be effective enough in decreasing traffic deaths.
Study: Indoor Cooking Can Lead to Exposure to Dangerous Pollutants
Routine cooking also routinely exposes many Americans to dangerously high levels of pollutants such as carbon monoxide (CO), nitrogen dioxide (NO2) and particulate matter (PM), according to a new study in the journal Environmental Health Perspectives. While the World Health Organization is currently establishing guidelines for indoor air quality, neither the U.S. Environmental Protection Agency (EPA) nor any other U.S. agency regulate indoor air quality in non-industrial buildings. Researchers determined that during the average winter week approximately 1.7 million Californians could be exposed to excessively high CO levels simply because of cooking on gas stoves without range hoods; 12 million could be exposed to excessive NO2 levels. “That’s a lot of people in California, and those results ballpark-apply across the country,” said Brett Singer, study author and a staff scientist at Lawrence Berkeley National Laboratory (LBNL). “The EPA would say we don’t have a carbon monoxide or nitrogen dioxide problem in this country...In reality, we absolutely do have that problem; it’s just happening indoors.” The researchers listed improved ventilation; improved filtration; and improved building codes and standards as ways to combat the public health danger. Read more on air and water quality.
Multiple Errors Behind CDC’s Anthrax Exposure Incident
Multiple protocol breaches at a U.S. Centers for Disease Control and Prevention (CDC) laboratory led to 84 workers being exposed to live anthrax, including the fact that CDC researchers allowed only 24 hours to kill the pathogens—half the recommended time—according to Reuters. So far no one has died or become ill from the unprecedented U.S. exposure incident, but they are being treated with a vaccine and antibiotics. The errors at the biosafety level 3 facility raise new concerns over lax laboratory oversight. "If the protocol was already there, then there is really no excuse for it," said Amesh Adalja, MD, an infectious disease expert at the University of Pittsburgh Medical Center. "The question goes down to personnel and why wasn't protocol followed.” Read more on infectious disease.
Study: Autism Risk Higher in Children Whose Mothers Lived Near Commercial Pesticides
Pregnant women who live within a mile of places where commercial pesticides area used—including farms, golf courses and other public places—are more likely to have children with an autism spectrum disorder, according to a new study in the journal Environmental Health Perspectives. In a study of approximately 1,000 families, researchers determined that depending on the kinds of chemicals used, proximity to the treated area and when during the pregnancy the mother was exposed, their children were 60 to 200 percent more likely to develop autism; exposure during the third trimester brought the highest risk. Approximately one in every 68 children has autism, according to the U.S. Centers for Disease Control and Prevention. Read more on maternal and infant health.
Earlier this week the American Academy of Pediatrics (AAP) hosted a daylong Symposium on Child Health, Resilience & Toxic Stress in Washington, D.C. that brought together federal government officials, national thought leaders and medical professionals to discuss the emerging science of toxic stress.
According to the AAP, science shows that adversity experienced in childhood has long-lasting physical and emotional effects that have come be known as "toxic stress.” Toxic stress can occur when a child experiences chronic adversity without access to stable, supportive relationships with caring adults. These adverse childhood experiences can include physical and emotional abuse; neglect; exposure to violence; food insecurity; and economic hardship. An AAP 2011 policy statement found that toxic stress can affect a child's brain development and lead to the presence of many adult diseases, including heart disease, cancer, chronic lung disease and liver disease.
“[Currently], there are more randomized trials for leukemia than for effects of stress on children,” said James S. Marks, MD, MPH, senior vice president of the Robert Wood Johnson Foundation, at the symposium. “This is about more than our children—it’s about our future as a people and a society, and the earlier you invest in children the better the return to society and to those children and families.”
During the symposium, the AAP announced the formation of the Center on Healthy, Resilient Children to launch in the next year or so, which will be a national effort coordinated by the AAP and many partners to support healthy brain development and prevent toxic stress. In addition to prevention efforts to keep children healthy, the Center will focus on ways to help pediatricians and others identify children who have experienced adversity and toxic stress and ensure they have access to appropriate interventions and supports.
"Pediatricians envision a world in which every child has every opportunity to become a healthy, successful adult," said James M. Perrin, MD, president of the AAP. "Achieving this will require strong, sustained investments in the health of the whole child, brain and body. It will require building upon our existing work and forging new partnerships across sectors and fields of expertise.”
NewPublicHealth spoke with Perrin following the symposium
NewPublicHealth: How familiar are pediatricians with the evidence surrounding the burden and response to toxic stress in children and families?
James Perrin: I think there is increasing awareness of toxic stress in pediatric practice, not only in community practice, but in our specialty practices, too. I think people are recognizing how critically important toxic stress is to the developing child and developing brain. And the increasing science in this area has been incredibly helpful for us to understand the potential permanent effects of toxic stress. But we also want to focus on positive ways to affect brain development. Reading to children, for example, affects brain development and brain growth in positive ways.