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If Patients Are Flipped Out by Today's Physician Encounters, Why Not "Flip" The Clinic?

Mar 3, 2014, 5:34 PM, Posted by Susan Dentzer

“I am stressed.”

“I am feeling pressured.”

“I have been through all this before.”

“Why is it taking so long?”

If you’ve ever had any of these feelings while biding your time in a doctor’s office, you’re not alone.  There are a myriad ways in which the classic physician visit can often be sub-optimal: Spending a long time in a waiting room before a too-short doctor’s visit; barely understanding or absorbing what the physician says before he or she rushes off to see the next patient.

The experience could try the patience of the most self-confident of patients—and positively overwhelm the more nervous among us.  Small wonder that some patients experience “white coat syndrome,” or elevated blood pressure during a clinical encounter.  It’s believed to be brought on by some combination of apprehension about a potential disease or diagnosis, or even intimidation at the sight of the doctor in a white coat.

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Progress, Hope, and Commitment

Feb 28, 2014, 10:55 AM, Posted by Risa Lavizzo-Mourey

RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA

Nearly seven years ago, this Foundation made a major commitment to reversing the nation’s childhood obesity epidemic. We had many reasons, but chief among them was the decades of data showing more and more young people in America facing greater challenges to growing up healthy. We, and many others, knew it was an unsustainable path. So we pledged $500 million to reverse the trend, and joined forces with a wide range of partners to address the many different facets that an effort of this magnitude would require. Big challenges require big commitments.

This week has been one of the most exciting in the last seven years. Research published Tuesday shows a major decline in the obesity rate among children ages 2 to 5 over the last eight years. This is a very real sign of progress, because we know that preventing obesity at an early age is likely to help children maintain a healthy weight into adulthood. The significant decline measured by researchers with the Centers for Disease Control and Prevention follows progress we’ve started to see over the last 18 months.

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ACOG Issues New Guidelines to Curb Overuse of C-Sections

Feb 27, 2014, 5:27 PM, Posted by Tara Oakman

Tara Oakman Tara Oakman

While I knew that having children would turn my world upside down, I assumed that this transition would be more metaphorical than literal. Ha! Moments before I was discharged from a Maryland hospital a few days after my twins were delivered by c-section, the ground shook violently. My husband had just left the hospital room to get the car, so I was alone with two newborns and a painful surgical wound. All I could think was ... “This is an earthquake! I have two babies. And I can’t move!

One of the scariest parts of the experience was that I couldn’t respond to my maternal instinct to quickly pick up and protect my babies because I had just had major abdominal surgery. Granted, managing in an earthquake is not a common part of recovery from a C-section, but there can be many other dangerous complications that occur more frequently, such as infection, emergency hysterectomy or heavy blood loss. It can also lead to greater difficulty with breastfeeding. C-sections are also very costly, even if there are no major complications. They are much more expensive than vaginal delivery.

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A New Way of Looking at Health

Feb 18, 2014, 3:58 PM, Posted by Andrea Ducas, Thomas Goetz

Putting outbreaks of disease into context “Putting outbreaks of disease into context” via VizHealth.org. The VizHealth site and the associated content are available under GNU Lesser General Public License version 3.0 (LGPL-3.0) and Creative Commons Attribution 3.0 United States licenses.

It’s not always easy to think in statistics.

While that statement might seem obvious, applying that knowledge when it comes to health and health care is anything but.

Think, for example, about your last visit to the doctor. (Doctors, put on your patient hats and bear with us.) In the first couple of minutes, you (we hope) had your blood pressure, weight, and other vital signs checked. You might have also talked about changes you could make—like exercising more or quitting smoking—and how they might decrease your risk of developing a chronic disease or help you live longer.

As a patient, all of this information is valuable, but it is not often meaningful or actionable: what does a systolic blood pressure of 175 actually mean? Exercising regularly might bring my risk for diabetes down, but by how much? And what does that difference translate to for me?

There are lots of ways to answer these questions, but up until recently there hasn’t been much clarity at all when it comes to how to communicate those answers effectively. That’s why we’re so excited to announce the launch of our newest project, Visualizing Health.

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Getting Ready for the Oscars: Three Things that the Movie “Gravity” Has in Common with Health Insurance Exchanges

Feb 18, 2014, 10:32 AM, Posted by Susan Dentzer

Sandra Bullock in "Gravity"

The Academy Awards are just a few short weeks away, much as is the end of this year’s open enrollment period for the health insurance exchanges. We health policy geeks who also love movies can now give out our own award—for the film that most closely resembles the rollout of the marketplaces under the Affordable Care Act.

As far as I’m concerned, there’s only one real candidate: “Gravity,” the science-fiction space drama directed by Mexican-born Alfonso Cuaron and starring the actors Sandra Bullock and George Clooney.

The film wins because its big themes are the same ones reflected in the experience of the exchanges: the omnipresence of Murphy’s Law and human perseverance overcoming calamity. What’s more, gravity—the real star of “Gravity”—is a universal force that can’t be overcome (and is one of the few scientific aspects of the movie that the critics agree the filmmakers got right). Is it too much to see a parallel to the Affordable Care Act’s coverage expansion, which is inching forward despite the formidable odds stacked against it?

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Aligning Measures to Improve Quality

Feb 11, 2014, 4:51 PM, Posted by Gerry Shea

Doctors go over a patient's charts in the emergency room.

The quest over the last decade and a half to define and quantify “quality” in health care in the United States has resulted in widespread use of quality measures. Unfortunately, the alignment of these measures among entities in both the private and public sectors has been secondary to the efforts to identify and use good measures. This failure has resulted in a tremendous lack of comparability between quality improvement efforts.

While not surprising, the near total lack of alignment has become a major obstacle in the effort to improve care for patients. It leads to significant burdens for those looking to improve, wastes valuable (and finite) resources and is a drag on overall quality improvement efforts. Additionally, it creates a considerable barrier to efforts encouraging value-based decision making by consumers and others.

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We Are All in This Together

Feb 11, 2014, 4:41 PM, Posted by Risa Lavizzo-Mourey

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Building a culture of health means recognizing that while Americans’ economic, geographic, or social circumstances may differ, we all aspire to lead the best lives that we can.

For the Foundation, it also means working hand-in-hand with all Americans to inform the dialogue and build demand for health by pursuing new partnerships, create new networks to build momentum, and stand on the shoulders of others striving to make America a healthier nation.

Learn more in our President’s Message
Risa Lavizzo-Mourey, MD, MBA, is president and CEO of the Robert Wood Johnson Foundation

 

 

Investing in Children to Improve the Nation's Health

Jan 27, 2014, 6:28 PM, Posted by Susan Dentzer

RWJF recently convened a panel of distinguished guests for a Google+ Hangout to examine targeted interventions that could help America’s youngest children live healthier, happier, and safer lives. Here's an archived version of the Hangout.

"It is easier to build strong children than to repair broken men," wrote Frederick Douglass, the 19th century African-American social reformer, writer and orator. A century and a half later, to improve the health of Americans, it's essential to start with kids.

That’s a preeminent conclusion of the new report of the RWJF Commission to Build a Healthier America called Time to Act: Investing in the Health of Our Children and Communities. The report focuses on ways to influence the upstream determinants of Americans' generally poor health, including low levels of education and incomes, unsafe environments, and non-nutritious food. Of the panel's three top recommendations, the first is distinctly child-centric: "Invest in the foundations of lifelong physical and mental well-being of our youngest children." Were he alive today, Douglass would surely agree.

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Simple, Small Changes Can Lead to Healthier Food Choices

Jan 21, 2014, 11:20 AM, Posted by Deborah Bae

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At this time of year, many of us find ourselves trying hard to stick to that New Year’s resolution to eat healthier. Here is some good news: simple changes in our environment can have meaningful, sustained effects on our ability to make healthy food choices.

Committing to a healthier diet and trying to lose weight is hard, and many people believe they can do it as long as they have the right motivation and attitude. We’ll say things like, “I’m going to eat better” or “I’m going to eat fewer unhealthy foods.” But that commitment can be tough when people face a variety of unhealthy choices and just a few healthy ones. Or when it’s hard to tell which is which.

Researcher and physician Anne Thorndike and her colleagues at Massachusetts General Hospital tested a novel idea: if all healthy food and drinks sold in the hospital cafeteria were labeled green, and all unhealthy items had red labels, would people make healthier choices?

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Reforms in Oregon’s Medicaid Program and Emergency Department Use

Jan 16, 2014, 5:23 PM, Posted by Susan Dentzer

 Inter Professional Nursing

“Past performance is no guarantee of future results,” goes the boilerplate warning on financial investments. The caution is worth keeping in mind in the wake of a recently published study that found that expanding Oregon’s Medicaid program in 2008 led to a 41 percent increase in emergency department (ED) use by many of those newly covered by the program.

The study, by an esteemed group of researchers (some of whom are affiliated with the National Bureau of Economic Research) is the latest to emerge from the Oregon Health Insurance Experiment. This series has focused on the effects of 2008-2009 policy changes that led thousands of previously uninsured Oregonians to enroll in Medicaid. The latest study found that costly visits to the ED rose across the board over a two-year period, including for relatively simple conditions, such as headaches, that could easily have been treated in primary care settings.

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