Category Archives: Health Care in 2013
Time to Understand and Eliminate the Destructive Racial Disparities that Plague Our Health Care System
Historically, it seems that we are a country that takes a step forward only to take two steps back. Consider that May will mark 59 years since our schools were desegregated, yet it required the efforts of the National Guard to allow the “Little Rock Nine” entry into Central High School three years after this declaration. In July we will mark 49 years since President Johnson signed the Civil Rights Act of 1964, one-month after which the bodies of three civil rights workers were found in shallow grave. And, of course, the 20th of this month will mark four years since we inaugurated our first African-American President of the United States, though our health care system is still woefully deficient in providing care to minority groups.
The Affordable Care Act, in many ways, addresses the grave disparities that exist in health care due to race and ethnicity. Extending coverage to the nearly 46 million uninsured Americans—more than half of whom are minorities—will address a serious need, but this act alone will not begin to resolve the larger issue at hand.
Robin Newhouse, PhD, RN, is a grantee of the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative. She is professor and chair, Organizations Systems and Adult Health at the University of Maryland School of Nursing. She is also vice-chair of the Methodology Committee for the Patient-Centered Outcomes Research Institute. This post is part of the "Health Care in 2013" series.
My resolution for the U.S. is to begin the transformation of health care systems to enhance high quality patient-centered care. Despite some improvements, the National Healthcare Quality Report 2011 reveals that health care quality in the U.S. often falls short of expectations—demonstrating geographic and population (minority and low-income) variations. In 2011, the U.S. Department of Health and Human Services (HHS) released the National Quality Strategy (NQS), designed to improve the quality of health care in the U.S. My highest priority for action is the first aim: “Better Care: Improve the overall quality of care, by making health care more patient-centered, reliable, accessible, and safe.” Better care is achievable—with two specific strategies in mind: implementation of evidence-based practices and a focused goal to measure and improve patient-centered outcomes.
Implementation of Evidence-Based Practices. We have not gone far enough, fast enough. It is time to focus on implementation of evidence-based practices in health care systems. Research studies have continued to exponentially produce results intended to inform health care practices. Identifying and implementing evidence-based practices known to work—but that are underutilized—can go a long way to improve health care processes and quality. Performance measures are an example of one approach to drive system changes. The 2012 NQS Annual Progress Report describes the achievements of the first year’s work, including a focus on clinical and patient-reported outcomes (as close as possible to patient-centered) and development of new patient-centered outcomes.
Liana Orsolini-Hain, PhD, RN, ANEF,FAAN, is an alumna of the Robert Wood Johnson Foundation (RWJF) Health Policy Fellows program (20112012), through which she worked at the U.S. Department of Health & Human Services Immediate Office of the Secretary. This post is part of the "Health Care in 2013" series.
My New Year’s resolution for the U.S. health system involves all of us. During my tenure as an RWJF Health Policy Fellow in the Immediate Office of the Secretary of Health, I learned how a small percentage of Americans use up a majority of health care resources. The percentage of individuals who consume a high volume of resources will likely increase as we age, with little regard for our own level of health.
We all need to be a part of the solution to making access to health care and access to health sustainable for current and future generations by caring about and for our own health. Do we exercise regularly? Do we get enough sleep? Do we eat fruits and vegetables every day? Have we stopped smoking? Do we manage our stress levels? Do we practice what we preach?
Jamila Williams, MD, MPH, is an assistant professor and health policy associate at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College, and associate program director of Meharry’s preventive medicine residency program. Sangita Chakrabarty, MD, MSPH, FACOEM, is an associate professor in the Department of Family and Community Medicine, and director of Meharry’s occupational medicine residency program. This post is part of the "Health Care in 2013" series.
Often we are asked: “Is preventive medicine a real subspecialty?” Why yes, Virginia, it is real. Preventive medicine is a medical specialty that incorporates population-based and clinical approaches to health care, and focuses on keeping individuals healthy through a holistic approach to patient care. And to that end, integrative medicine is real and here to stay as well.
According to the Institute of Medicine Workshop Summary, Integrative Medicine and the Health of the Public: A Summary of the February 2009 Summit, integrative medicine can be described as orienting the health care process to create a seamless engagement by patients and caregivers of the full range of physical, psychological, social, preventive, and therapeutic factors known to be effective and necessary for the achievement of optimal health throughout the life span. (Institute of Medicine, 2009 and Bravewell Collaborative Report, June 2010).
The Affordable Care Act, popularly known as “Obamacare,” will authorize funding for activities to enhance integrative medicine and preventive medicine education. Ultimately these enhanced education opportunities will lead to an improved public health workforce. Meharry Medical College’s (MMC) preventive and occupational medicine programs are among the 16 recipients of this funding. It will be used to incorporate evidence-based integrative medicine curricula in its accredited preventive medicine residency program and improve clinical teaching in both preventive and integrative medicine.
Olga Yakusheva, PhD, is a grantee of the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative. She is an associate professor of economics at Marquette University. This post is part of the "Health Care in 2013" series.
History tends to repeat itself in the most peculiar ways. This summer my 5-year-old daughter, Vera, broke her left arm in a playground accident eerily similar to my own some 30 years ago. Pain and tears were the same, and so were a make-shift cast made from a children’s book cover and a rushed trip to the emergency room. My husband and I took Vera to the ER at the Yale-New Haven Children’s hospital. Years ago, my parents took me to the ER at the City Clinical Hospital #1, in my birth town of Almaty, Kazakhstan (former USSR).
In the ER, my daughter’s and my experiences started to diverge. Vera was put on a morphine drip. The procedure was attended to by multiple health care professionals and included a painfully long process of selecting a sticker (Vera settled on one featuring Dora the Explorer). Then she was taken away for a set of X-rays and, upon return, we watched “Toy Story Two” for six straight hours (to prevent possible aspiration from a popsicle she had eaten at the playground). She was seen by numerous other professionals, put under general anesthesia, and given a cast and another set of X-rays in the room. She was taken for a final set of X-rays to “make sure everything was peachy,” before we could go home. My husband and I got a bill for thousands of dollars, including $700 for the second and $800 for the third sets of X-rays, and praised the lord for our very generous insurance plans. My daughter’s arm healed well and she does not remember any pain.
Carole Pratt, DDS, is an alumna of the Robert Wood Johnson Foundation (RWJF) Health Policy Fellows program, where she worked in the office of Senator John D. Rockefeller (D-WV). Pratt was a practicing dentist in rural southwest Virginia for 32 years. This post is part of the "Health Care in 2013" series.
The Times Square ball has dropped, crisp new calendars have been affixed to office walls, and clean new agenda pages gape at us from computer screens, signaling prudent resolution makers that it is time to get serious about 2013. February 10 will mark another New Year, the beginning of the Chinese New Year festival ushering in the Year of the Snake. Parades will be held, people around the world will celebrate, and for a time at least, inherent fear of reptiles will be set aside.
In a century-long history that is somewhat convoluted, the American medical profession has come to be represented by the winged staff and serpent symbol, the Caduceus. So during 2013, the Year of the Snake, it may be no coincidence that things are looking up for the health care profession and the health of the nation in general. In its 2013 annual ranking, U.S. News & World Report announced the top ten most attractive jobs based on factors such as opportunity for employment, salary, work-life balance, and job security. Six of the top ten spots were claimed by jobs in health care.
Arthur Kellermann, MD, MPH, FACEP, holds the Paul O’Neill-Alcoa Chair in Policy Analysis at the nonprofit, nonpartisan RAND Corporation. He is an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program and the RWJF Health Policy Fellows program. This post is part of the "Health Care in 2013" series.
For the first month of my medicine internship at the University of Washington, I was assigned to Seattle’s VA Hospital. I was stunned to learn that my attending physician would be Paul Beeson, widely regarded at the time as one of the giants of American medicine. [i] At an age when most doctors are enjoying their retirement, Dr. Beeson was still doing what he loved best—caring for patients and teaching.
I have forgotten most of the clinical pearls Dr. Beeson taught that month. But one that still stands out is the way he questioned the need for every lab test, x-ray and treatment my team ordered. “Why do you want that?” he’d ask. “What will you do with the result?” Throughout the month, he urged us to forego interventions that offered little benefit to our patients, but exposed them to potential side effects or complications. His message was clear. Do only what’s needed, not more.
Today, we need Dr. Beeson’s message more than ever before. In the three decades since I trained under him, America’s health care system has grown so large, it claims a bigger share of the gross domestic product than American manufacturing or wholesale and retail trade. [ii] As a result, the federal government spends more on health care than national defense and international security assistance. In several states, health care is crowding out spending for education. In the past decade, health care cost growth has wiped out the hard-won earnings of middle-class families. [iii]
New Year’s resolutions are about fresh starts and new beginnings, and for many Americans that includes the decision to finally give up heavy drug and alcohol use. Unfortunately, when it comes to encouraging individuals to enter treatment, providing counseling, and supporting long-term recovery, our health care system is showing up late to the party.
There are 21 million adults and adolescents with a diagnosable substance abuse problem in the United States, but fewer than one in five receive treatment in a given year. The reasons why people do not get treated are complicated. Many are not ready to give up using substances or don’t recognize they have a problem, but many others are discouraged from seeking treatment because of the cost or the perceived lack of treatment options. Opportunities to raise awareness about treatment are often missed, as primary care doctors infrequently screen for substance abuse during routine visits, and are often unaware of where to refer patients for specialized addiction treatment.
A member of the Navajo Nation, Lisa Palucci, MSN, RN, is a nurse consultant at the Centers for Medicare and Medicaid Services and a fellow with the Robert Wood Johnson Foundation Nursing and Health Policy Collaborative at the University of New Mexico. This post is part of the "Health Care in 2013" series.
As the nation trudges forward in its quest to improve health care access for all Americans, I think it is essential that we continue to make progress in decreasing the health disparities and social determinant of health gaps that continue to be ignored in mainstream health policy initiatives. Throughout the course of my PhD program at the University of New Mexico (UNM), we have had numerous opportunities to experience nursing and health policy in action by attending national conferences, meetings, and orientation programs. To my disappointment, discussion about improving health disparities and social determinants of health are seldom a topic on the agenda. This poses the question: Aren’t the health disparities and social determinants of health what got us to the point of an inequitable health care system in the first place?
Around this time of year I think a lot about my friend Hank. He is one of only two people to whom I reliably send a Christmas card each year, and just as reliably I receive a holiday package from him containing thoughtfully chosen gifts.
When I first met Hank he was homeless, living out of a van he parked near Golden Gate Park in San Francisco. Hank had multiple serious chronic medical conditions, and the homelessness certainly did not help any. He was very sick and, sadly, though he was barely 50 years old I thought he had maybe five years left, tops. Well, 10 years have passed and Hank is still ringing in the New Year… in his own apartment. This is no Christmas miracle, but rather a predictable result of supportive housing.