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Entering the Final Stretch

Feb 3, 2015, 6:15 PM, Posted by David Adler

2015 Affordable Care Act ACA Enrollment Website Screen

As we head into the final weeks of this year’s open enrollment season, we can all be proud of the progress that’s been made. New numbers released last week show 9.5 million Americans signed up for health coverage through marketplaces across the country. Behind each number is someone who now has quality, affordable health coverage with access to health care when they need it and protection from financial ruin if they get sick.

But there are still millions more who are eligible for coverage this open enrollment period. RWJF and our partners are doing all we can to get as many people enrolled as possible before the February 15 deadline. These collective efforts focus on breaking down the biggest enrollment barriers for people to get covered. Our research shows that consumers are more motivated to enroll when they understand the benefits of coverage, believe they can afford the cost, and know they can find enrollment support to complete the process.

Enroll America, an RWJF grantee, is addressing the need for in-person help head on—operating grassroots efforts in 11 states and connecting consumers to enrollment tools and help nationwide. Their connector tool, allows consumers to schedule appointments for in-person help right away. Drawing from lessons learned from the first open enrollment period we know this one-on-one support will be critical for many consumers during these final weeks.

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Journey Towards Becoming a Mindful Leader

Feb 2, 2015, 11:35 AM, Posted by Teri Pipe, PhD, RN

Mindfulness zen garden

In our fast-paced, overcommitted world, our typical automatic first response—to be better multitaskers and problem solvers—often leads to increased stress and reduced satisfaction. As leaders—especially in the high-stakes, quickly changing health care sector, we focus our attention outwardly on the well-being of others. We’re faced with a number of competing priorities, interruptions, and distractions that too often get the best of us. It seems that, for many, the noisy world has taken up residence within us.

As a nurse focusing on gerontology and oncology, I learned to help others find what was most important during times of bittersweet transition, prioritizing where and how their energy was spent. Through my clinical research experiences, I learned that the perception of stress, rather than a specific circumstance, could just as easily lead to physiologic consequences. I also observed how some people used their challenges to become more resilient, while others weakened.

Because of these experiences, the ideas of resiliency, mindfulness, and caring began shaping my research questions and investigations. My research and my work with my nursing colleagues showed me that teaching self-awareness, compassion and attention-focusing practices can reduce stress, build resilience and extend the positive impact of nurses and other leaders, including their ability to care for patients, strengthen communication, mentor others and lead successful organizations.

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Roadmaps Out of Fantasyland: RWJF’s Outbreaks Report and the National Health Preparedness Security Index

Jan 30, 2015, 5:47 PM, Posted by Susan Dentzer

Outbreaks 2014

“When you hear hoofbeats, think of horses, not zebras,” the late Theodore Woodward, a professor at the University of Maryland School of Medicine, cautioned his students in the 1940s. Woodward’s warning is still invoked to discourage doctors from making rare medical diagnoses for sick patients, when more common ones are usually the cause.

And while many Americans have worried about contracting Ebola—in viral terms, a kind of “zebra”—more commonplace microbial “horses,” such as influenza and measles viruses, continue to pose far greater threats. For instance, a large multistate measles outbreak has been traced to Disneyland theme parks in California—while this year’s strain of seasonal flu has turned out to be severe and widespread.

One obvious conclusion is that many microbes remain a harmful health menace, expected to kill hundreds of thousands of Americans this year. Another—speaking of Disneyland—is that much of America appears to live in a kind of fantasyland, thinking that it is protected against infectious disease.

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Some Unconventional Approaches to Stress: Pioneering Ideas Podcast Episode 7

Jan 29, 2015, 7:00 PM, Posted by Lori Melichar

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A man asking for money on the subway this week told me how Hurricane Sandy led to a series of events that left him stressed out by the challenges of putting food on the table for his children.

Recessions, hurricanes, violence—how many ways can we count that add stress to our lives? Whether dealing with economic stress, the stress of caring for an aging parent, or even the stress of keeping up with email, research shows that all of it affects our health. As Alexandra Drane, a guest in the latest episode of RWJF’s Pioneering Ideas podcast, puts it: “When life goes wrong, health goes wrong.”

This episode of the Pioneering Ideas podcast explores unconventional approaches to tackling stress­—and other health problems—with energizing possibilities that could also transform health and health care. From monitoring electricity use as a way of helping the elderly stay in their homes, to measuring the indirect health effects of social services (what if heating assistance led to greater medication adherence?), these conversations offer cutting-edge ideas for building a Culture of Health.

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Field Notes: What Cuba Can Teach Us about Building a Culture of Health

Jan 29, 2015, 9:54 AM, Posted by Maryjoan Ladden, Susan Mende

MaryJoan Ladden and Susan Mende Trip to Cuba

Ever since President Obama announced the restoration of diplomatic ties between the United States and Cuba, there’s been growing excitement over the potential for new opportunities for tourism, as well as technology and business exchanges. Most people assume that the flow will be one-sided, with the United States providing expertise and investment to help Cuba’s struggling economy and decaying infrastructure.

That assumption would be wrong. America can—and already has—learned a lot from Cuba. At RWJF, we support MEDICC, an organization that strives to use lessons gleaned from Cuba’s health care system to improve outcomes in four medically underserved communities in the United States—South Los Angeles; Oakland, Calif.; Albuquerque, N.M.; and the Bronx, N.Y. Even with very limited resources, Cuba has universal medical and dental care and provides preventive strategies and primary care at the neighborhood level, resulting in enviable health outcomes. Cuba has a low infant mortality rate and the lowest HIV rate in the Americas, for example—with a fraction of the budget spent in the United States.

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Identifying the Causes of a Persistent Health Disparity: High Blood Pressure Among African-Americans

Jan 29, 2015, 7:31 AM, Posted by Jacquelyn Taylor

Jacquelyn Taylor, PhD, PNP-BC, RN, FAAN, is an associate professor of nursing at Yale University and an alumna of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program (2008-2012). She recently received a $3.4 million grant from the National Institute of Nursing Research, a department of the National Institutes of Health, to conduct a large-scale study on the influence of genetic and psychological factors on high blood pressure in African-American women and children.

Jackie Taylor Jacquelyn Taylor

Human Capital Blog: Congratulations on your new grant from the National Institutes of Health to study blood pressure in African-Americans. What will be your focus?

Jacquelyn Taylor: African-Americans have the highest incidence of hypertension of any racial or ethnic group in our country. Studies show that some medications don’t work very well in reducing blood pressure in this population, and we are convinced that some other underlying mechanisms are at play. My co-principal investigator, Cindy Crusto, PhD, an associate professor in the department of psychology at Yale School of Medicine, and our research team and I will be studying two of those—genetic markers and psychological factors, such as perceived feelings of racism, mental health, and parenting behaviors—in our study. We want to know what effects these variables have on increases in blood pressure among African-American women and children over time.

HCB: Does this study build on your earlier work?

Taylor: In a previous study in Detroit, I looked at gene-environment interactions for high blood pressure in three generations of African-American women and identified hypertension risk alleles in grandmothers and in their daughters and granddaughters. Then I replicated the study in West Africa, where people live the same way as they did in the 1400s—in clay huts, with no running water, no sanitation, and no fast food as in the developed areas such as Detroit. The West African Dogon sample were mostly underweight, participated in large amount of physical activity, and had a limited but healthy diet. But they still had the same genetic markers for hypertension that I had identified in the sample in Detroit.

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What Will It Take to Diversify Medicine?

Jan 28, 2015, 3:00 PM, Posted by Sheree Crute

Every few weeks, Dana Todd, MD, does something rare for an American physician:  She makes a house call. The visits are her way of making life easier for a bedridden stroke survivor and her caregiver daughter.

“One afternoon, I looked out into the clinic waiting room and there they were,” Todd recalls. “My patient was laying on a stretcher. Her daughter was by her side. Her family was adamantly against putting her in a nursing home because she is only in her 50s, so coming in was the only way she could get care. I just hated seeing her that way so I said, ‘Next time, I’ll come to you.’”

Todd is one of four primary care physicians who, along with a small group of nurse practitioners, provide care for residents of Greensboro, Ala., population 2,440, in rural Hale County. The little town, though, is a lot more to Todd than a place to work. 

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‘Good Morning, My Name is Aara’: Building Trust in Health Care

Jan 28, 2015, 8:00 AM, Posted by Aara Amidi-Nouri

Aara Amidi-Nouri, PhD, RN, is associate professor of nursing and director of diversity at Samuel Merritt University in Oakland, Calif. She is a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow (2014-2017) and has served as a project director for the RWJF New Careers in Nursing scholarship program at Samuel Merritt University since 2009.

Aara Amidi-Nouri

Trust. Our health depends on it, and so do our lives.

Our very first stage of personality development as infants starts with trust, according to renowned developmental psychologist Erik Erikson. A newborn’s basic needs—food, shelter, and clothing—are entirely entrusted to a caregiver, one who hopefully recognizes that he or she does not yet have an ability to shiver, sweat, or shed tears.

When caregivers are attuned to babies’ environments and hunger cues, they are able to meet their needs and build their trust in other human beings. When caregivers hold newborns close, they meet their need for love and affection, building trust with every heartbeat and with every breath. We are social beings, dependent on one another. We must trust one another in order to survive. It’s no coincidence that our pennies—our most basic form of currency—are engraved with that very word.

What happens when, instead of building trust, we createmistrust? What happens when we can’t trust our health care system or our health care providers—our own caregivers, the very people who hold our fate and our lives in their hands? 

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How Not to Flip Out: Flip the Clinic

Jan 27, 2015, 4:38 PM, Posted by Beth Toner

Flip the Clinic San Francisco January 2015 Hard at work at the first regional Flip the Clinic meeting in San Francisco

“If you’ve been waiting more than 15 minutes, please see the receptionist.”

That’s the sign that was posted on a bulletin board in the radiology clinic where I was waiting for an MRI earlier this month. The funny thing? It was so lost amid the other postings around it screaming for attention that I only saw it on my way out, as I waited for a copy of the disk with my MRI on it. It struck me as odd, and a little concerning; did that mean I should be worried the clinic staff might have forgotten about me if I’d been waiting more than 15 minutes?

Don’t get me wrong: I understand that unpreventable delays happen. For me, the most frustrating aspect of signs like this is that they take the power away from the patient. 

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How Data Will Help Me Keep My Resolution

Jan 27, 2015, 10:54 AM, Posted by Emmy Ganos

Pioneering the Use of Personal Health Data - Banner

It's a brand new year and like many Americans, I'm thinking about New Year’s resolutions—specifically, fitness and exercise resolutions. People who know me well know how I feel about working out (Hint: I don't like it. Or do it). But I have lots of good reasons for wanting to start. I turned 30 this year, so I’m starting to age out of that Young Invincible demographic (#GetCovered), and realizing that I am, in fact, “vincible.” As I get older, and watch my parents age, it's starting to hit home that getting to a particular shape or size really isn't the point. The point is getting my heart and body in the best shape I possibly can.

So this year, New Year’s resolution time feels a little different. And as I start thinking about making some changes, I’m reflecting back over the last two Data for Health listening sessions I attended in Charleston and San Francisco. As a result, I’ve decided that it’s time to think about setting my New Year’s resolutions in an entirely different way--by using data.

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