Now Viewing: Patient-Centered Care

Health Data Outside the Doctor’s Office

Dec 2, 2014, 9:46 AM, Posted by Jon White, AHRQ , Karen DeSalvo, HHS/ONC, Michael Painter

A man rides a bike, with a child on a bike kid trailer behind him. "... if a city wants to plan bike infrastructure, they could invest millions in conducting studies into where bike lanes should go, or they instead could quickly access information generated by bikers, such as Map My Ride or Strava, to see where people are actually riding."

Health primarily happens outside the doctor’s office—playing out in the arenas where we live, learn, work and play. In fact, a minority of our overall health is the result of the health care we receive. If we’re to have an accurate picture of health, we need more than what is currently captured in the electronic health record.

That’s why the U.S. Department of Health and Human Services (HHS) asked the distinguished JASON group to bring its considerable analytical power to bear on this problem: how to create a health information system that focuses on the health of individuals, not just the care they receive. JASON is an independent group of scientists and academics that has been advising the Federal government on matters of science and technology for over 50 years.

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Big (Box) Medicine?

Nov 6, 2014, 4:55 PM, Posted by Michael Painter

Lucy in the chocolate factory

Let’s see a show of hands. Who among us, doctor, nurse, patient, family member, wants to give or get health care inspired by a factory—Cheesecake or any other?

Anyone?

I didn’t think so.

True confession: I have never actually eaten at a Cheesecake Factory (hereinafter referred to as the Factory). My wife, Mary, and I did enter one once. We were returning from a summer driving vacation. Dinnertime arrived, and we found ourselves at a mall walking into a busy Factory.

It seemed popular. The wait was long—really long. We got our light-up-wait-for-your-table device. We perused the menu. There was a lot there. Portions seemed gigantic. We looked at each other and, almost without speaking, walked back to the hostess, returned our waiting device and left.

You got me—I cannot say 100 percent that I wouldn’t love Factory food. We were so close that one time!

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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.

 

From Trauma to TED: Boston Marathon Survivor Adrianne Haslet-Davis on Recovery, Care, and Collaboration

Apr 21, 2014, 12:30 AM, Posted by Shaheen Mamawala

Boston Marathon survivor Adrianne Haslet-Davis performs at TED2014 Adrianne Haslet-Davis (photo by James Duncan Davidson)

Last month, I attended my first TED conference in Vancouver, Canada. Though inspiring, it was also overwhelming—in a sea of over 1200 guests, it can often be challenging to make meaningful personal connections. However, when I saw Adrianne Haslet-Davis step onto the stage and dance a beautiful rumba while wearing her prosthetic leg, I knew she was someone I wanted to meet.

While Adrianne and I had just a quick exchange of hellos in person at TED, I was further inspired by the message she wrote when she stopped by our RWJF Culture of Health Café. There she offered her own vision of a Culture of Health, framed within her personal experiences as a victim of the 2013 Boston Marathon bombing. Adrianne graciously offered to expand on her personal Culture of Health vision in a brief interview with me.

Shaheen: You recently returned from TED2014 in Vancouver, where you gave a powerful dance performance. Tell us about that experience.

Adrianne: It was no question at all where I wanted to dance [publicly] again for the first time.  It was important for me to do it at TED because I so strongly believe in TED’s message of getting people to think outside the box about issues that maybe we don’t know we’re interested in. I think it’s really eye-opening in that way.

I went into the project with Hugh Herr, director of the Biomechatronics Group at the MIT Media Lab, who came to me and said “Adrianne, I think we can make this [performance] happen but I’m not going to guarantee it. Are you in?” I said yes because it really helped me have a goal.

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The World’s Biggest Expert In Me

Mar 24, 2014, 2:03 PM, Posted by Anne Weiss

Flip the Clinic Graphic for Advances

I've worked at the Robert Wood Johnson Foundation for almost 15 years, and it’s still thrilling (and a little intimidating), working with some of the world's leading experts, thinkers, and innovators, not to mention colleagues who are brilliant, passionate, and kind. While I’ve never admitted this before, as a long-time fan of television medical dramas the people from clinical backgrounds, the “white coats,” especially fascinate me. The doctors, nurses and other health professionals I work with seem part of some mysterious club, survivors of years of arduous training who have the ability to improve peoples' lives in a way I simply can't.

But it turns out that I am an expert, something I learned from a new Robert Wood Johnson Foundation initiative called Flip the Clinic. Flip the Clinic aims, quite simply, to help patients and their doctors (or other providers) get more out of the medical encounter: that all-too-short office visit that leaves both parties wishing for more time, more information, more of a relationship. You can learn more about the history of Flip the Clinic, including its intriguing name, here.

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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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Flipping the Clinic: The Beginning of the Beginning

Sep 25, 2013, 5:13 PM, Posted by Thomas Goetz

memorial day micro

How do you turn an idea into something bigger? It's necessary, but not sufficient, to start with a good idea, of course. But it also takes a community of supporters—people willing to step out of their busy day-to-day, and contribute time and brainpower to turning that idea into something closer to reality.

That was the goal of the first Flip the Clinic workshop, held in mid-September at the Foundation’s headquarters in Princeton, N.J. We invited 15 amazing thinkers and doers from various perspectives—doctors, nurses, patients, policymakers, entrepreneurs—and asked them to spend a full day (and then some) helping us turn the Flip the Clinic idea into something substantial, or at least substantiated.

The idea was to get some honest feedback on whether the idea has legs, and some expert input on where it might go. The result, by all measures, exceeded our expectations. Not only does the Flip the Clinic idea seem to meet a clear and broad need for new thinking about health care delivery, but it may just offer a necessary inspiration for doing some hard but necessary work in changing it.

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This Year’s Health Care Transformation Oscar Goes To…

Jun 17, 2013, 3:55 PM, Posted by Michael Painter

A doctor reviews information with a patient.

For an actor—let’s call her Jennifer for discussion purposes—who suddenly has a big award-winning breakthrough—there is nothing sudden about her success.  Jennifer’s accolades come to her not by accident but rather after years of below-the-radar hard work, striving and struggle.  That same principle applies to seeming sudden success in other fields—say, health care.  In fact, today let’s go crazy and salute some breakthrough health care actors.  Health care is transforming before our very eyes. 

Hang onto your hats, because it’s changing from one predominantly focused on churning out more services and procedures to one relentlessly driving the right care at the right time at the best price. 

That’s not happening all by itself. That slowly accelerating transformation could seem sudden—or spontaneous.  It might seem like it’s happening effortlessly—almost by magic.  Nothing, of course, could be further from the truth.  Trust me— there is a bunch of struggling, starving transformation artists who have been working years for this moment—like the great people at the Consumer-Purchaser Disclosure Project.

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