Author Archives: Susan Dentzer

The 21st Century Medical School and the “Flipped” Classroom

Sep 30, 2014, 9:30 AM, Posted by Susan Dentzer

Flip the classroom video still

Pity the poor medical student...or at least many students now slogging away in medical schools across the nation.  

Most spend the first two years of medical school cramming their heads with facts about the functions of cells, organ systems, and other aspects of the human body. Having contact with real patients—the reason most students went to medical school in the first place—is quite limited until the third year, when clinical clerkships begin.

Meanwhile, medical knowledge is exploding, doubling every five years, and taxing the human brain’s capacity for processing and recall. Today’s medical students know that one day, they’ll be most likely to practice medicine with the aid of “cognitive computing” systems like IBM’s Watson, which has already “learned” as much as a second-year med student, and is helping clinicians at the Mayo Clinic, Memorial Sloan-Kettering Cancer Center, and other institutions process reams of medical information to make clinical decisions. 

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Living Out Their Salad Days: Shaping Healthier Environments for Kids in the Nation’s Schools

Sep 2, 2014, 10:59 AM, Posted by Susan Dentzer

A school lunchroom full of hundreds of young children, happily slurping up ... salad.

If you’re someone who’s ever struggled to get kids to eat their vegetables, it sounds like an impossible dream.

But this is reality at Anne Frank Elementary School, the largest in Philadelphia, with 1,200 students from kindergarten through fifth grade. Serving salads was the brainchild of Anne Frank principal Mickey Komins, who had the salads brought in from a local high school cafeteria.

Along with the after-school Zumba and kickboxing classes that the school now sponsors for kids, parents, and staff, healthier food offerings are among the innovations that earned Anne Frank an award from the Alliance for a Healthier Generation. The Alliance, a Robert Wood Johnson Foundation grantee, is a nonprofit founded by the American Heart Association and the Clinton Foundation to help stem the tide of childhood obesity. It’s at the vanguard of a growing national movement to turn schools into healthier environments, and offer kids fundamental lifelong lessons about maintaining their health.

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Building the Information-Rich Culture of Health

Aug 20, 2014, 10:36 AM, Posted by Mike Painter, Susan Dentzer

Reform by the Numbers Visual

What if your mother wanted to take some ibuprofen for her arthritis, but didn’t know if it would interact adversely with her other medications?

No problem, right?

She could whip out her smartphone and launch an app that connected to her local health information exchange. Within fractions of a second, the exchange would verify her identity, locate the computer storing her electronic health record (EHR), and shoot an answer back to her.

This scenario is just one example of the many ways that having timely access to health information could contribute to health. It could, that is, if the nation had an agreed-upon way to organize data about health and health care in ways that made it easily accessible and usable while still secure and protected.

But for now, we don’t.

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Advanced Practice Nursing: Providing Care and Promoting Health

Jul 29, 2014, 10:50 AM, Posted by Susan Dentzer

Check out an August 1 Google+ Hangout with the Campaign for Action and RWJF.

The U.S. population is growing, getting older and suffering from more chronic disease. Thanks to the Affordable Care Act (ACA), more people are gaining health coverage and the means to obtain care. And there’s a widespread view that the country faces a drastic shortage of doctors—and primary care providers in particular.

So why are so many states seemingly determined not to let advanced practice registered nurses deliver the primary care they specifically trained to provide—and help millions of patients in the process?

Across the country, 31 states impose varying limits on the ability of nurse practitioners (one of the four types of advanced practice registered nurses) to evaluate patients; diagnose, order and interpret diagnostic tests; and to initiate and manage many treatments, including prescribing medications.

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Putting a Female Face on the Need for a Culture of Health

Jul 25, 2014, 11:29 AM, Posted by Susan Dentzer

A doctor examines a patient.  An image appears on a computer monitor.

Statistics are “human beings with the tears washed away,” an old saying goes. Sadly, the tears behind one set of statistics, showing that women’s life expectancy has been falling in just under half of U.S. counties, have rarely garnered much notice.

How to put a face on this story, to help mobilize corrective action?

Progress toward that end was made last week, when the Robert Wood Johnson Foundation teamed up with Women’s Policy, Inc, a nonprofit, nonpartisan organization that seeks to inform policy-making on women’s issues, to sponsor a briefing on that subject on Capitol Hill. About 75 people, including several female members of Congress, gathered in the Rayburn House Office Building to learn what is driving the widespread trend of poorer female health. (Watch the webcast by clicking here).

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Promoting A “Green” Culture of Health: Instead of Wasting Food, Getting it to Those Who Need It

Jun 25, 2014, 3:54 PM, Posted by Susan Dentzer

Mercer Street Friends Food Bank Warehouse Trenton

“A mind is a terrible thing to waste,” goes an old slogan of the United Negro College Fund. Another terrible thing to waste is healthy food.

That’s especially true in a nation where 1 in 7 U.S. households are “food insecure”—that is, they lack consistent, dependable access, typically for financial reasons, to “enough food for active, healthy living,” as a U.S. Department of Agriculture report puts it. About 1 in 10 U.S. households have food-insecure children—an equally appalling reality in a country that wastes an estimated 30 to 40 percent of its food supply, or a whopping 133 billion pounds of food in 2010 alone.

In California’s Orange County, however, a solution is at hand—and there’s no reason it couldn’t take hold and spread nationwide. Since 2012, the Waste Not Orange County Coalition, a public-private partnership, has worked to boost donations to local food pantries of surplus healthy food from local restaurants, grocery stores and other facilities. The organization was formed out of the realization that enough food was tossed out every day to feed the nearly 380,000 local residents—almost half of them children—who are deemed food insecure.

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Closing the Gap on Child Obesity

May 22, 2014, 9:56 AM, Posted by Susan Dentzer

An elementary school student takes plastic cutlery for the meal he is holding.

Imagine a splashy, big bucks television commercial selling kids on the tantalizing deliciousness of eating ... carrots.          

Or a new course sandwiched into already packed middle-school and high school curricula: “Food Shopping and Cooking for a Healthy Life.”

Sound implausible? Maybe—but then again, such innovations could be a part of what is needed to make more progress in the war on child obesity.

These were some of the suggestions that emerged from a recent conference in Newark, where the Clinton Health Matters Initiative, the Robert Wood Johnson Foundation, and Grantmakers in Health sponsored a day-long summit entitled Closing the Gap: Childhood Obesity (and in which I was a participant). You can watch a video of the meeting here.

As RWJF CEO, Risa Lavizzo-Mourey reminded the audience, the Foundation has set a goal of reversing the U.S. child obesity epidemic by 2015—and as that date approaches, she confessed, “I’m getting a little nervous.” (View Risa's remarks.)

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Choosing Wisely: Intensifying the Spotlight On Health Care of Dubious Value

Apr 30, 2014, 8:52 AM, Posted by Susan Dentzer

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“If you study the kinds of decisions that people make, and the outcomes of those decisions, you’ll find that humanity doesn’t have a particularly impressive track record,” write the brothers Chip and Dan Heath in their masterful book Decisive. Invoking research from psychology and behavioral economics, the Heath brothers demonstrate how people often make decisions by looking at what’s in the “spotlight”—the information immediately before them, sparse as it may be.

But what’s in that spotlight “will rarely be everything we need to make a good decision,” the Heaths counsel. To choose wisely, we need to broaden our focus, or “shift the light.”

That’s especially true in health care, where the consequences of any decision, poorly made or not, may be life or death.

Enter Choosing Wisely, a program that shifts the spotlight onto many of the tests and treatments that both providers and patients should question, if not abandon completely.

(Editor's note: On May 2, 2014, RWJF held a First Friday GoogleHangout to explore how Choosing Wiselysprang from critical examination of the overuse of medical care in the United States—and how it’s changing how care is delivered in communities. Watch an archived version of the Hangout, above.)

This two-year old campaign, launched in 2012 by the American Board of Internal Medicine Foundation, has identified more than 250 tests and procedures that warrant scrutiny because they are ineffective, unnecessary, unsupported by evidence, or possibly harmful. Even so, physicians and other clinicians perform them regularly, and patients sometimes request them.

Fifty-four of the nation’s premier medical specialty societies have joined the Choosing Wisely effort, and most of these have contributed to their own lists of questionable care. This week, three non-physician groups will also sign on to the campaign. Among the categories of dubious care identified on various societies’ “top five” lists are these:

  • Excessive imaging: CT or MRI scans for low back pain shouldn’t be ordered within the first six weeks of treating a patient, unless there are severe neurological symptoms, while patients with minor head injuries shouldn’t routinely get a head CT unless they have a skull fracture or are bleeding. Excessive scans expose patients to radiation that increases their lifetime risk of cancer.
  • Unnecessary medications: Antibiotics are not effective against viruses and should not be prescribed for viral illnesses such as sinus infections or bronchitis, particularly in children. But doctors say they frequently feel pressured to write these prescriptions by anxious parents.
  • Superfluous screening or diagnostic tests: Patients with no symptoms of heart disease and are at low risk of developing it are still frequently subjected to electrocardiograms when they get routine physical exams, despite evidence that this routine screening doesn’t improve patient outcomes. By the same token, hospitalized patients may have their blood drawn countless times for costly diagnostic testing that often yield little useful information, and can contribute to anemia.

The Robert Wood Johnson Foundation is supporting Choosing Wisely with a $2.5 million grant to extend the influence of these lists beyond medical specialty societies and into communities. State medical societies in Texas, Oregon, Minnesota, Tennessee, Washington, and Massachusetts have undertaken steps to promote the lists, including developing continuing medical education courses for doctors. So have ten regional health collaboratives, such as Maine Quality Counts and the Washington Health Alliance outside Seattle (both are among RWJF’s Aligning Forces For Quality communities as well).

Consumer Reports and AARP are among organizations that have taken the lead in publicizing the lists for consumers. All told, these efforts have reached an estimated 170,000 or more physicians and 16 million-plus consumers. There’s even a Wikipedia page for the campaign, with the lists of tests and procedures curated by a “Wikipedian” in residence.

Caveats: Although more than 200 articles have been written about aspects of the campaign in medical journals, there is as yet little hard evidence that is has reduced superfluous care. A recent perspective in the New England Journal of Medicine noted that the specialty societies’ lists “vary widely in terms of their potential impact on care and spending”—and suggests that some societies omitted lucrative elective procedures, such as knee replacement surgery, that also aren’t appropriate for many patients.

The bottom line: As a nation, we need to shine a spotlight on an even broader range of questionable health care in the future. But for now, the Choosing Wisely campaign is illuminating plenty of “care” that we can clearly pass up with impunity as we pursue our real objective:  better health.

 

Understanding The Value In Medicare's Physician Payment Data Dump

Apr 14, 2014, 9:24 AM, Posted by Susan Dentzer

New Jersey Patient Care

A 35-year battle is over and the taxpayers have won: We have the right to know how much physicians receive in Medicare dollars in exchange for providing our care. But now that the Centers for Medicare and Medicare government has released data on $77 billion in Medicare Part B payments to providers during 2012, what do we really know—or have—that we didn’t have previously? Information alone isn’t knowledge or, for that matter, insight.

For consumers, the slew of raw data ultimately may be useful if it can be packaged into applications that help them compare the way physicians practice—as the Office of the National Coordinator for Health Information Technology now proposes in a newly announced challenge. Private payers, such as insurers, may also find the Medicare data useful, as they can the information to better understand the practice patterns of providers they include in their networks.

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County Health Rankings: Five Key Elements of The Picture of Health

Mar 28, 2014, 10:16 AM, Posted by Susan Dentzer

Behind the County Health Rankings: What makes a county healthy or unhealthy?
Skip Rope

Paint a portrait of a healthy county, and you’d show the features that contribute to good health: high incomes and levels of education; access to health care; plentiful healthy food, and ample places to exercise.   

Paint a portrait of an unhealthy county, and the palette becomes darker: higher rates of joblessness; more children in poverty; high rates of smoking, obesity and physical inactivity; and more people living in sub-par housing that they may struggle to afford. 

Those, in fact, are the real portraits emerging from the 2014 County Health Rankings, newly released by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

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