Archive for: April 2014

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 Watch an archived version of the Hangout, above.)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.

 

A Healthier Denver

Apr 29, 2014, 8:55 AM, Posted by Shale Wong

Bldg a Healthier Denver Members of the Collective - GlaxoSmithKline

I live in Denver. I work in Denver. And as a pediatrician, I’ve dedicated my life to the health of Denver’s kids. It is remarkable to me how connected our health is to our community. In Denver, we have some of the finest health care in the state, yet more and more of our kids are struggling to maintain a healthy weight. It takes much more than having great hospitals in our community for our kids to live a healthy life.

If we want all our kids to grow up healthy in Denver and throughout the United States, we must recognize all of the elements that affect their well-being. That means ensuring our communities are safe, with strong education and ample access to healthy foods and recreational spaces. And it means addressing poverty whether it is tucked into pockets or widespread in our communities.

This connection between our health and our community was affirmed by the release of the latest County Health Rankings and Roadmaps—an initiative of the University of Wisconsin Population Health Institute and sponsored by the Robert Wood Johnson Foundation. The latest installment showed that those of us who live in the least healthy communities in America are twice as likely to live shorter lives as those who live in healthy communities. And these least healthy communities have twice as many kids living in poverty.

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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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Reflections on TED2014: Ideas Worth Spreading … FASTER!

Apr 18, 2014, 2:11 PM, Posted by Lori Melichar

Pattie Maes on stage at TED2014 (Photo: Bret Hartman) Pattie Maes, MIT Media Laboratory, speaking at TED2014

When people find out I work for the Robert Wood Johnson Foundation, they often want to tell me their idea for solving the problems that keep Americans from being as healthy as they can be. It's one of the pleasures of my job. Some of these ideas are indeed pioneering,  with the potential for breakthrough change.  All of them are helpful in shaping my vision of a path to achieving a Culture of Health.

I heard a lot of ideas last month while representing RWJF at TED2014. If you aren’t familiar, TED is an organization dedicated to spreading ideas through inspiring talks and conversations. Their annual conference is a great place to meet leaders from a variety of disciplines, from science and technology to business and the arts, and it was a privilege to attend.

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The Doctor Will Share With You Now

Apr 17, 2014, 4:43 PM, Posted by Risa Lavizzo-Mourey

Elaine Benes Seinfeld Screen Grab for Risa OpenNotes LinkedIn blog post

What does an episode of the Seinfeld show have in common with an RWJF national initiative?

In the first case, Seinfeld character Elaine Benes gets to see the notes written about her by her doctor. In the second, OpenNotes promotes exactly the same thing—patient access to the visit notes written by their doctors.

In Elaine’s case, that access was accidental. She took a quick look at her chart, only to see herself described as “difficult.” And merriment ensued.

Under the OpenNotes initiative, which started in 2010, Elaine would have been able to check out her doctor visit notes via a web-based portal. She wouldn’t have needed to sneak a peek. It’s unlikely she would have been described as “difficult.”

Numerous studies show that patients do want to see their records, and the evidence suggests that when they do, it leads to better health.

In a new post on the professional social networking site LinkedIn, RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA, notes that the concept is catching on, and OpenNotes is leading the charge. “OpenNotes will lead not only to a more efficient health care system,” she writes, “but better health for all of us.”

Read Lavizzo-Mourey’s LinkedIn post

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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We Do Better When We Do for Others

Apr 14, 2014, 3:15 AM, Posted by Jody L. Struve

Jody Struve's son Jody’s son mashing it up at MakerFaire NYC

This morning, I figured out how to save the planet. That’s the power of Twitter, friends. (Or that’s the power of Twitter when you’re bleary-eyed at 5:10 a.m., and meant to hit the Weather app to find out if your kids’ school might close, but instead you see a tweet that the United Nations has concluded global warming is indeed our fault, next to a tweet about food trucks, next to one about ...)

Twitter allows you to take in lots of disparate information at odd hours, and that can result in ... odd ideas.

In a flash, I saw an opportunity to solve two problems with one solution—a mash-up, if you will. By 5:15 a.m., still half asleep, looking at my smartphone, it became clear to me that the way to save the planet was to create “energy parks” that generate power through peoples’ physical activity, addressing obesity and climate change in one fell swoop.

Stay with me here.

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"It's Good to Know the Red Cross is There"

Apr 11, 2014, 5:06 PM, Posted by Jeff Meade

American Red Cross visit to RWJF No. 5 Northern New Jersey American Red Cross volunteers Hart Coven and Bob Hassmiller (photo by Jeff Meade)

The emergency response vehicle (ERV) fielded by the American Red Cross of Northern New Jersey is all gleaming white with shining chrome, flashing lights, diesel engine chugging away, the distinctive Red Cross logo emblazoned on its sides, larger than life.

The truck itself is about the size of a small delivery van, but even with a pair of comfortable padded seats, the inside looks roomy. But don't be fooled. Each of the red plastic insulated crates stacked like Lego bricks up toward the front of the truck can contain 50 hot meals. That’s a lot of mac and cheese. Up to 350 meals in all on a really busy night. There's enough coffee and juice to revive and hydrate exhausted firefighters for hours. Volunteers can give out a good many compact little "comfort kits," containing toiletries and other day-to-day necessities.

And of course, there are blankets—the big, warm white ones, also bearing the Red Cross symbol. The kind you see on local TV news, draped around the shoulders of folks driven from their  apartment complex by an overnight multi-alarm blaze.

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Why Empathy is Essential to a Culture of Health

Apr 11, 2014, 11:34 AM, Posted by Tara Oakman

Peace activist Zak Ebrahim speaks at TED 2014

Everyone knows it is hard to get 2-year-olds to do anything on a schedule. They want to do everything their way, on their own time. As you can imagine, trying to get my twins out the door each morning—let alone take a bath or eat a meal, can be quite a challenge. After trying a number of different parenting methods, I have discovered that the one way I can usually motivate them is to talk about feelings, and get them to recognize how their actions affect their sibling. Just yesterday, the only way I could get my son out of the bath was by telling him that his sister was sad and lonely waiting for him. And then, and only then, did he move.

Building empathy has been a critical strategy in my household of late—not only because it helps motivate them, but also because it is an important part of their social development. Lately I have been thinking about empathy on a larger scale, beyond my household, and how critical it is to building a Culture of Health.

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Five Simple Things to Do Today to be Prepared for an Emergency

Apr 7, 2014, 9:00 AM, Posted by Sean D. Andersen

New Jersey American Red Cross Fire Photo

What if your doorbell rings tonight, and a policeman tells you your neighbor’s home is on fire and you and your family must get out of the house immediately?

What if a family member starts choking at the dinner table?

What if a tornado warning is issued at this very moment?

Although scary to imagine, all of the above are realistic scenarios families face here in New Jersey, and throughout the United States. Would you know what to do? Are you prepared?

Disasters can strike quickly and often without warning. Being prepared and knowing what to do in an emergency can make all the difference—it can even save lives.

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