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Misfortune at Birth

Nov 14, 2014, 8:00 AM, Posted by Eileen Lake

Eileen Lake, PhD, RN, FAAN, and Jeannette Rogowski, PhD, are co-principal investigators of a study, supported by the Robert Wood Johnson Foundation (RWJF) Interdisciplinary Nursing Quality Research Initiative, that generated evidence linking nurse staffing and work environments to infant outcomes in a national sample of neonatal intensive care units.* A new documentary, “Surviving Year One,” examines infant mortality in Rochester, N.Y. and nationwide. It is being shown on PBS and World Channel stations (check local listings). Read more about it on the RWJF Culture of Health Blog here and here.

Eileen Lake (Smaller photo) Eileen Lake

Are some premature babies simply born in the wrong place? Premature babies are fragile at birth and most infant deaths in this country are due to prematurity.  It is well established that blacks have poorer health than whites in our country, but the origin of these disparities is still a mystery.  It’s possible that the hospital in which a child is born may tell us why certain population groups have poorer health.

A new study by University of Pennsylvania and Rutgers investigators that I led shows that seven out of ten black infants with very low birth weights (less than 3.2 lbs.) in the United States have the simple misfortune of being born in inferior hospitals. What makes these hospitals inferior?  A big component is lower nurse staffing ratios and work environments that are less supportive of excellent nursing practice than other hospitals.  Our study, which was funded by the RWJF Interdisciplinary Nursing Quality Research Initiative, indicates that the hospitals in which infants are born can affect their health all their lives. 

Jeannette Rogowski Jeannette Rogowski

A Brighter Future

What can be done to make these hospitals better?  A first step would be to include nurses in decisions at all levels of the hospital, as recommended by the Institute of Medicine to position nursing to lead change and advance health. Laws in seven states require hospitals to have staff nurses participate in developing plans for safe staffing levels on all units.

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Let’s Put Veterans in Charge of Their Pain Care

Nov 11, 2014, 9:00 AM, Posted by Erin Krebs

Erin Krebs, MD, MPH, is the women’s health medical director at the Minneapolis VA Health Care System and associate professor of medicine at the University of Minnesota Medical School. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Physician Faculty Scholars program and the RWJF Clinical Scholars program.

Erin Krebs (Veterans Day)

How can we create a Culture of Health that effectively serves veterans? We can put veterans in charge of their pain care.

Chronic pain is an enormous public health problem and a leading cause of disability in the United States. Although 2000-2010 was the “decade of pain control and research” in the United States, plenty of evidence suggests that our usual approaches to managing chronic pain aren’t working. Veterans and other people with chronic pain see many health care providers, yet often describe feeling unheard, poorly understood, and disempowered by their interactions with the health care system.

Evidence supports the effectiveness of a variety of “low tech-high touch” non-pharmacological approaches to pain management, but these approaches are not well aligned with the structure of the U.S. health care system and are often too difficult for people with pain to access. Studies demonstrate that patients with chronic pain are subjected to too many unnecessary diagnostic tests, too many ineffective procedures, and too many high-risk medications.

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Transparency in Health Care? Sadly, That's Not How We Roll.

Nov 7, 2014, 3:13 PM, Posted by Andrea Ducas

Patrick Toussaint Andrea’s husband, Patrick Toussaint, using his super strength to tighten a lug nut.

What do changing a flat tire and scheduling a surgical procedure have in common? Nothing. And that’s the problem.

Last month, on our way home to New Jersey from Boston, my husband and I got a flat tire. And while this is a dreaded possibility on any road trip, it happened to us at 9 p.m. on a Sunday. No shops were open, and with an early morning flight just a few hours away we didn’t have time to wait for AAA.

At this point it’s important to emphasize that neither my husband nor I know a thing about cars. We didn’t even know we had a jack or spare in the trunk until we called my uncle, who teased us (“You have a new car! Everything you need is in the back!”) and gave us the pep talk we needed. So we pulled out our owner’s manual.

I’m not sure who that manual is written for, but it clearly isn’t for us. After five minutes of thinking I’d need to call the airline and book a later flight, I realized: There is a better way. I pulled out my iPhone, Googled “how to change a flat tire,” and called up a YouTube video and a step-by-step, picture-guided Wikihow article. Within 20 minutes, the tire was changed, our spare was filled with air to 60 psi, and we were on our way.

So what does any of this have to do with health care? Unfortunately, not very much.

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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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Patients Pleased With Care from Physician Assistants

Oct 29, 2014, 9:00 AM

Physician assistants (PAs) received high marks from patients in a recent survey conducted by Harris Poll for the American Academy of Physician Assistants (AAPA). Among 680 Americans (out of more than 1,500 surveyed) who have interacted with a PA in the past year, 93 percent see PAs as part of the solution to the nation’s shortage of health care providers; 93 percent regard PAs as trusted health care providers; and 91 percent agree that PAs improve health outcomes for patients.

“The survey results prove what we have known to be true for years: PAs are an essential element in the health care equation and America needs PAs now more than ever,” AAPA President John McGinnity, MS, PA-C, DFAAPA, said in a news release. “When PAs are on the health care team, patients know they can count on receiving high-quality care, which is particularly important as the system moves toward a fee-for-value structure.”

The AAPA points out that more than 100,000 PAs practice medicine in the United States and on U.S. military bases worldwide. A typical PA will treat 3,500 patients in a year, the association says, conducting physical exams, diagnosing and treating illnesses, ordering and interpreting tests, prescribing medication, and assisting in surgery.

Read more about the AAPA survey.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

Getting Medical Residents Ready for Real Life

Oct 21, 2014, 11:00 AM

New guidelines from the American Association of Medical Colleges (AAMC) are intended to close the gap between expectations and the reality of what medical students are prepared to do at the start of their residencies.

Known as the Core Entrustable Professional Activities for Entering Residency, the guidelines include 13 activities—such as performing physical exams, forming clinical questions, and handing off patients to other physicians when residents go off duty—that all medical students should be able to perform, regardless of specialty, in order to be better prepared for their roles as clinicians. In August, AAMC launched a five-year implementation pilot with 10 institutions.

Ensuring that the nation’s medical school graduates “have the confidence to perform these activities is critical for clinical quality and safety,” AAMC President and CEO Darrell G. Kirch, MD, said in a news release earlier this year. “These guidelines take medical education from the theoretical to the practical as students think about some of the real-life professional activities they will be performing as physicians.”

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Helping Physicians Do What They Got Into Medicine to Do

Sep 25, 2014, 10:02 AM, Posted by Anne Weiss

Two women are at a desk, one is counting money

“Health care was never intended to be the behemoth it's become. It was intended to be the place where people could get help for medical problems so they can return to living a healthy life.”

For me, this statement—from an internist I met last month—is a refreshing take on the value of the health care system in a Culture of Health. It’s an inspiring vision for those of us focused on the usual litany of problems: Our health care system costs too much, and delivers outcomes that lag behind other countries to such a degree that it threatens our economic health and social fabric.

Last year, the Robert Wood Johnson Foundation (RWJF) invested in five markets—Maine, Minnesota, Oregon, Colorado, and the St. Louis region—where there is the will and ability to measure health care costs and quality, and use that information to drive change. In each of these markets, we’re working with multi-stakeholder organizations who are members of the Network for Regional Health Improvement (NHRI). Each organization will produce reports that compare the cost of treating patients in each primary care practice in their market. (You can learn more about this project here.)

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Patient Privacy: The Elephant in the Room

Aug 25, 2014, 12:30 PM, Posted by Al Shar

Albert Shar / RWJF

Albert Shar, managing principle at QERT and former Robert Wood Johnson Foundation vice president and senior program officer reflects on lessons learned from the RWJF-funded project, “Testing a system of establishing voluntary patient identification across multiple health care records to improve outcomes and reduce costs” (Shar is a guest blogger. His opinions are not necessarily those of the Robert Wood Johnson Foundation).

When it comes to improving patient safety, patient privacy is the elephant in the room.

Virtually every developed country except the United States has a method for identifying patients.  Misidentification of patients is not only costly and inefficient—it’s also dangerous.  According to data from the Institute of Medicine and the Joint Commission, in the U.S., nearly 60 percent of the 200,000 deaths per year caused by medical errors are cases of mistaken identity.

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A Call to Action to Help Caregivers

Aug 19, 2014, 1:53 PM

This week, NewPublicHealth will run a series on new and creative public health campaigns that aim to improve the health of communities across the country through the use of public service announcements, infographics and more. Stay tuned to learn more about a new campaign each day.

As the country turns increasingly gray, more and more adults are experiencing the stresses and strains of caring for aging family members. It has long been a silent struggle for many of the nation’s 42 million unpaid caregivers, but the full impact of family caregiving is starting to come out from the shadows thanks to a major ongoing campaign from the AARP and the Ad Council first launched in 2012. Through a series of ads for television, radio, print media and digital venues, the campaign aims to raise awareness of the ripple effects of family caregiving and to steer overwhelmed families toward resources that may ease the pressure.

The public service advertisements (PSAs) depict the sense of isolation, responsibility and frustration family caregivers often feel as they tend to their loved ones—providing reassurance that they are not alone with these challenges. The ads also highlight a community of experts set up by the AARP to help caregivers take better care of themselves while caring for others and to encourage caregivers to access online tools or call a toll-free hotline (877-333-5885). The website includes resources on planning for long-term care (legally, financially and in other ways) and advice on dealing with emotional issues such as grief and loss.

Nearly 30 percent of caregivers report feeling sad or depressed, and 33 percent isolate themselves by avoiding people or social situations, according to a 2013 AARP report, Caregivers: Life Changes and Coping Strategies. Moreover, 38 percent of those caring for a loved one say they sleep less since they became caregivers, and 44 percent admit they try to squelch their feelings. An earlier survey by the AARP and the Ad Council, involving 500 caregivers between the ages of 40 and 60, revealed that 31 percent describe their caregiving tasks as extremely or very difficult; 21 percent say they don’t feel like they have the support they need; and 26 percent don’t feel confident about knowing where to turn to find support and information for unpaid caregivers.

“Only those who care for others know what it’s really like to care for others—that’s why we created a community where caregivers can connect with experts and others facing similar challenges,” said AARP CEO Barry Rand. “We hope this campaign will help the millions of family caregivers in the U.S. feel heard and supported, in turn, helping them better care for themselves and for the ones they love.”

As an offshoot of the Caregiver Assistance PSAs, the AARP and Ad Council also launched the “Thanks Project”, a digital opportunity for family members and friends to publicly acknowledge and appreciate how much they value the contributions from the caregivers in their lives. The idea is that a note of thanks can mean a lot to caregivers.

>>Bonus link: Read a NewPublicHealth interview with Gail Sheehy, author of “Passages in Caregiving: Turning Chaos into Confidence.”

This commentary originally appeared on the RWJF New Public Health blog.

Help or Hype: The True Costs of Robotic Surgery

Jul 14, 2014, 10:29 AM, Posted by Sheree Crute

Robotic Surgery

Joe Meyer is the model of a well-educated, engaged patient. A self-described “typical Midwestern guy” who settled in Chapel Hill, N.C., to raise a family and build a career, Meyer did everything in his power to make the best decisions when his 2013 physical produced unexpected and frightening results.

“I live a pretty healthy lifestyle. I exercise. I eat well,” says the 62-year-old chief operating officer of a large manufacturing company. “I was very surprised when my PSA test came back at 5.1 [3 to 4 is normal]. Further testing showed that I had prostate cancer.”

One of more than 200,000 men who are diagnosed each year, Meyer put his faith in his physician and the health care system when gathering information about treatment.

“After the biopsy, they told me my Gleason score was 7. [The higher the score on a scale of 1 to 10, the more likely a cancer will spread.] I realized I was high risk, so I started reading as much as I could about the choices I was offered—hormone therapy, radiation, or prostate removal.” He chose robotic prostatectomy over open or laparoscopic prostatectomy. Surgery, as opposed to hormone therapy or radiation, was widely considered a good decision for someone with Meyer’s prognosis.

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