Category Archives: Health Care in 2012

Jan 6 2012
Comments

New Year's Resolution: Fully Informed Choices

As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing and Co-Director, Center for Health, Media & Policy, Hunter College, City University of New York; Strategic Adviser, Future of Nursing: Campaign for Action; co-editor, “The Nursing Profession: Development, Challenges, Opportunities,” RWJF Health Policy Book Series.

file

While I was editor-in-chief of the American Journal of Nursing, I and some of the editorial staff noticed that most of the manuscripts we received for our narrative column, Reflections, were about death and dying. We begged people to submit columns on other topics, lest Reflections become As I Lay Dying. But I shouldn't have been surprised.

As a nurse and daughter of a man who died at 58 from metastatic cancer, I have cared for many dying people and have been privileged to be with some at the moment of their deaths. I've had patients who told me that they were going to die that night—and they did. I've seen an 85-year-old woman kept alive on a respirator with an open abdominal wound for four weeks before she became septic and died, despite her stated wishes to not have such extraordinary measures. Caring for my father during the last month of his life was the most precious gift I was able to give to him—and to myself. Yet, I had to fight with the health care system to ensure that he was adequately medicated when hospitalized or to be able to remain with him during an emergency room procedure. I fought to take him home so he could die there, as he wished, with love and comfort care.

file

These experiences imprint themselves indelibly on our memories and our souls. They can be rich and profoundly move us to confronting the realities of our own life and inevitable death. Or they can make us witnesses to torture and inhumane treatment of the dying, and shake our core beliefs about how a rational, caring society behaves.

Read More

Jan 6 2012
Comments

Abject Poverty Affects Health

file

As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Suzanne Gagnon, CFNP, RWJF Nursing and Health Policy Fellow, RWJF Nursing and Health Policy Collaborative at the University of New Mexico.

I live, work and study in a state that has one of the highest poverty rates in the nation. It is difficult for me as a nurse practitioner to focus my New Year’s resolution on the health care system. Yes there are health care system problems and complicated ones, but I cannot remove my gaze from the impact of abject poverty and its effects on health. Until New Mexico addresses its poverty, health care will continue to be a trailer indicator, not a primary factor for the state’s overall impact on quality of life.

file

I work at a School-Based Health Center in a low-income area high school in Albuquerque. I have many patients who have no other means of receiving health care due to immigration status or income-related constraints. I had a student last year who had just moved to New Mexico from another state and wondered why the amount of food stamp assistance he and his mother received was so little in comparison to his previous state. He says: “I’m so hungry all the time, I can never get enough to eat, we don’t have enough to last all month. Why is it like that here?”

We are failing our children and families in fundamental ways. I cannot supply that child with enough food by making changes in the health care system, but eventually the effects of his hunger and poverty will affect the health care system. Currently his poverty and hunger are making a huge impact on his ability to succeed as a student. Elizabeth Bradley and Lauren Taylor nailed this topic in their December 8, 2011 New York Times article, ‘To Fix Health, Help the Poor.’ They pointed out the differences between our country’s investment in health care versus social support. While we spend one dollar on health care and 90 cents on social services, other countries spend the same for health care but double that for social services. Investing in social services can do more to improve health than additional health care reforms.

A December 29, 2011 op-ed in the Albuquerque Journal by Angela Merkert and Wendy Wintermute, respectively the executive director and advocacy program director of Cuidando Los Ninos and A Home for Every Child, lists the staggering statistics that impact our state’s homeless population:

Read More

Jan 5 2012
Comments

A Holistic and Comprehensive Approach

file

As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Laura Brennaman, MSN, RN, CEN, a fellow at the RWJF Nursing and Health Policy Collaborative at the University of New Mexico.

As we enter 2012, my resolution and wish for the U.S. health care system is a fundamental and transformative shift from a focus on disease management to one of health promotion. As Americans and health professionals, we must recognize that even the most advanced and best interventions to remedy diseases do not improve the overall health status of our country. Only preventing epidemics of chronic problems like metabolic syndromes, heart disease, and lung disease that plague our population can have significant wellness and economic benefits.

file

The Affordable Care Act offers a mechanism to foster such a change in emphasis with the establishment of the National Council for Prevention, Health Promotion, and Public Health that intertwines the governance of 17 executive agencies. Leadership from diverse arenas such as transportation, trade, agriculture and labor concentrating on health promotion strategies from within and across domains provides opportunities to affect many of the determinants of poor health and transform them into positive scenarios to improve health status of all Americans.

Actualizing new health promotion strategies through shifting spending from direct care provision to prevention mechanisms of social programs like job training, housing supports, public transportation systems, and childcare services has greater potential to improve health outcomes for Americans than new technology or pharmaceuticals for disease management.

In this coming election year, the candidates for office will propose a bevy of ideas concerning health care. However, we must pay heed to all programs they propose to enhance or curtail through a lens of health outcomes. Proposals dealing with environment, energy and economic issues will affect our health as surely as any health care reform plan.

Hence, my resolution for our health care system is holistic and comprehensive consideration of the health impact of every policy. Through such integrated deliberation, we will achieve improvement in health outcomes and reductions in health disparities for all Americans.

Jan 5 2012
Comments

Housing, Neighborhoods and Health Disparities

As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Corina Graif, PhD, RWJF Health & Society Scholar at the University of Michigan, Ann Arbor.

file

In the New Year I hope that our thinking about housing policy will more systematically incorporate the expanding evidence and relevance of housing conditions for population health and health care policy. Many aspects of internal housing conditions are known to affect health. For instance, heating, ventilation, mold and lead are linked to cardiovascular health, excess mortality, asthma, disability, intellectual functioning, ADHD [Attention Deficit Hyperactivity Disorder] and delinquent behavior.

file

We are also learning more and more about the health relevance of various characteristics of the physical environment surrounding one’s residence. For example noise, spatial proximity to vegetation, to grocery shops and to highways, and other sources of air pollution are linked to cardiovascular, mental health, obesity, asthma and allergic effects. Limited but important evidence also exists on the health implications of the socio-spatial context of housing. For instance, fear of crime, crowding, neighborhood disadvantage, social exclusion, and residents’ social exchange are linked to cardiovascular and mental health, obesity, diabetes and low birth weight.

In my dissertation work and related projects, I ask questions about the spatial context of neighborhood effects to investigate how the urban geography of inequality and cumulative spatial disadvantage shape the health and well-being of the inner-city poor. I analyze residential mobility data from the Moving to Opportunity Experiment in Los Angeles, New York, Boston, Baltimore, and Chicago together with data from PHDCN [Project on Human Development in Chicago Neighborhoods], and a large collection of data based on Census and other administrative records over several years.

Read More

Jan 4 2012
Comments

In 2012, Let's Trim Our Waistline, Embrace Change and Play to Our Strengths

file

As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Jodi Joyce, BSN, RN, MBA, CENP, NEA-BC, RWJF Executive Nurse Fellow and vice president, quality and patient safety at Legacy Health in Portland, Oregon.

1. TRIM OUR WAISTLINE. Health care needs to become more efficient and more effective—health care expenditures as a percentage of GDP are increasing at an unsustainable pace and now exceed 18 percent. I not only encounter waste every day, but I contribute to it—by tolerating redundancies and processes that don’t add value for our customers, accepting unnecessary variations in practice, failing to improve systems that pose risks for our workforce and our patients.

file

2. EMBRACE CHANGE. We have the benefit of so much science about new approaches that are delivering improvements, as well as ample input from customers about how we could better meet their needs. There is a huge opportunity for us to embrace these ideas and innovations, instead of allowing the habits and the gravitational forces of our organizations and our industry to keep us tied to the past.

3. PLAY TO OUR STRENGTHS. As health care professionals, we have been trained to assess, diagnose, advise, console, treat, nurture, restore. We have the skills and the opportunity to serve as healers—not only for the individuals in need of our care, but for our entire United States health care system—at a point in time where healing has never been more needed.

Jan 4 2012
Comments

Let's Toast the Beginning of Health Care Equity

file

As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Nalo M. Hamilton, PhD, MSN, WHNP/ANP-BC, Assistant Professor at the University of California Los Angeles School of Nursing and an RWJF Nurse Faculty Scholar.

As 2012 approaches, I hope that the United States remains resolute in providing access to equitable health care for all, especially women.

We live in a time where women have made significant contributions in academic, social and political areas but their contributions to women’s health care are eroded with every passing year. Currently, as the working poor, a record number of women are living in poverty and are unable to access affordable health care.

file

Thus, their diaspora of medical conditions go without primary care management resulting in acute conditions that are stabilized in the emergency department. However, once the condition is stabilized, a woman is sent home without the ability to follow-up with her primary care provider, thus continuing the cycle of acute onset, ER admission and discharge.

In my current practice I primarily manage: hypertension, tobacco dependence, obesity, anxiety, depression, dyslipidemia, breast disorders, diabetes, hypothyroidism, infections, dysfunctional uterine bleeding and family planning. For me this list represents the many organs that exist between a woman’s eyeballs and toes. Additionally, these conditions highlight how critical it is for women to have access to health care, not only for chronic conditions but for preventative screening as well.

The Affordable Care Act is a critical first step but much remains to be done at local and national levels.

A new year brings with it new opportunities and hope, so raise your glass with me in a toast to 2012—the beginning of health care equity.

Jan 4 2012
Comments

A Diverse, Well-Educated Nursing Workforce

As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Dennis Sherrod, EdD, RN, RWJF Executive Nurse Fellow, Cohort 2003 and Professor and Director of Graduate Programs, Forsyth Medical Center Endowed Chair of Recruitment & Retention, Winston-Salem State University, Winston-Salem, North Carolina.

file

Increasing access and quality of health care services and promoting individual health continue to be national priorities. As Affordable Care Act provisions increase access to care and prevention services, demand for primary care providers, registered nurses, and other health professionals are expected to increase. A high priority for health care systems will be to develop innovative health care delivery models that fully utilize health promotion, chronic care management, and health care delivery skills of advanced practice nurses and registered nurses. Health systems will need to collaborate effectively with university systems to measure outcomes of these models and rapidly integrate findings into nursing curricula and educational programs, therefore informing the preparation of future nurse professionals.

file

The nursing profession will need to attract and retain a diverse nurse workforce educated to focus on health promotion and primary prevention. And health systems will need to encourage advanced practice nurses and registered nurses to practice within the full range of their educational preparation.

My New Year’s resolution for United States health care systems is to establish, activate, and/or reactivate health system and health professions educational program advisory groups to clearly communicate rapidly changing and evolving competencies and skills required to promote health and address evolving health care needs of our citizens. Advisory groups can assist stakeholders from service and education to collaboratively prepare and introduce nurse professionals better equipped and prepared to address health and health care needs in rapidly changing health care systems.

Jan 3 2012
Comments

Physical Activity is Essential

file

As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by by Rashawn Ray, PhD, RWJF Scholar in Health Policy Research, University of California, Berkeley.

My New Year's resolution for the United States health care system is to more systematically include physical activity to get people moving to a healthier lifestyle. The health care system is more than markets and insurance. It includes prevention, maintenance and community resources to get people healthy and keep them that way. Physical activity is one key way to accomplish these goals.

file

Physical activity increases life expectancy, reduces the likelihood of obesity, some cancers, and chronic diseases (e.g., type-2 diabetes, hypertension, cardiovascular disease), improves self-rated health, mental health and quality of life, enhances productivity at work, helps maintain full functioning and independence among the elderly, and decreases the costs of late life care.

Despite these benefits, 60 percent of adults do not engage in the recommended amount of physical activity, which is at least 30 minutes per day, five times per week. Like other outcomes, there is a racial difference in who attains the recommended amount of physical activity. Roughly 50 percent of blacks are physically inactive, compared to one-third of whites. These percentages correspond to the percentage of individuals who are obese.

Read More

Jan 3 2012
Comments

The Imperative to Reduce Cost Without Sacrificing Health

file

As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Alexander Tsai, MD, PHD, RWJF Health & Society Scholar, Harvard University.

In the absence of addressing long-term drivers of population health in the U.S., changes in the health care delivery system may be within reach in the near term.

Management of care for chronic conditions remains notoriously poor, even among insured persons for whom out-of-pocket costs are not the primary barrier. Only one in two Americans with chronic conditions such as depression, diabetes and hypertension receives guideline-concordant care.

file

Poor chronic care management is often associated with systems-level failures such as lack of electronic data sharing among practitioners, or lack of care coordination for patients for multiple chronic conditions who struggle to adhere to complex medication regimens.

Further opportunities for cost containment are lost with regards to secondary prevention (e.g., readmissions for congestive heart failure), where better management could result in lower lifetime costs.

Reducing the costs for medical care in the United States without sacrificing health is among the highest priorities for the U.S. As our country continues to go through the demographic transition of becoming an aging society, we must consider ways to contain medical care costs and simultaneously increase healthy life expectancy.

Jan 2 2012
Comments

If Not You, Then Who?

As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Nancy E. Donaldson, RN, DNSc, FAAN, is a clinical professor and director, University of California San Francisco Center for Evidence-Based Quality Improvement, a JBI Affiliate Centre, and an investigator for RWJF's Interdisciplinary Nursing Quality Research Initiative.

As health care professionals, nurses are privileged and empowered by a unique proximity to patients and families. We share the first breath of newborns and the last breaths of all those beloved people at the end of life; we see patients and families in clinics, homes, extended care, correctional, community, and acute care settings. In the midst of unprecedented technological innovation, we still honor and practice the fundamentals of care by bringing comfort, cleanliness, safety, nutrition, dignity and caring to persons and families whose values, preferences and health traditions vary widely.

file

It is difficult and rewarding work, perhaps a calling. As we embark on a new year, more than ever before we are truly called to lead and fully engage in transforming the American health care system. If not now, then when? If not us, then who?

We—you and me, our families and the community of all Americans— deserves the best health care to maximize health and healing and to optimize the lived experience and contributions to benefit society.

We don't have that level of health care yet, or only a few of us do because we have the funds, mobility and sophistication to seek it out and demand it. We all have stories of friends, loved ones, or strangers whose lives are cut short or changed forever by lack of access to evidence-based, affordable, quality health care.

Read More