Category Archives: Community-based care
James Perrin, MD, FAAP, began a one-year term as president of the American Academy of Pediatrics (AAP) in January. A professor in the department of pediatrics at MassGeneral Hospital for Children and Harvard Medical School, Perrin received a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research in 1997.
Human Capital Blog: Congratulations on your new role as president of the American Academy of Pediatrics! What is your vision for the organization?
James Perrin: We are focused on addressing three main areas, which have really driven a lot of our thinking and, more importantly, our activity and change in the last several years.
First, we are working to help pediatric practices take on more community-based interventions to help young families raise their kids more effectively. There is a tremendous growth in the number of chronic diseases among children in four major areas: asthma, obesity, mental health, and neurodevelopmental disorders. We recognize these are not classic health conditions; they arise from and within communities, and both their prevention and their treatment are really community-based endeavors, as opposed to office-based activities.
Our second, and highly related priority, is an increased focus on early childhood development. We have understood the tremendous importance of early childhood for years, but there is now so much more science behind it. We know a lot more about how negative experiences and toxic stress can affect child development and how it can affect brain growth and neuroendocrine function. On the positive side, we also have more knowledge about the importance of reading to children, increasing language in the home, and other early-childhood interventions.
Thirdly, we have a better understanding of the tremendous impact of poverty on child health. Almost a quarter of American children live in households below the federal poverty line, and almost 45 percent live in households with incomes less than twice the federal poverty line. So a large number of American children are poor or near poor, and we know that poverty affects essentially everything related to child health. It makes those four categories of chronic conditions—asthma, obesity, mental health, and neurodevelopmental disorders—more prevalent and more serious, and it affects children’s responses to treatment. Lower-income kids with leukemia or cystic fibrosis, for example, have higher death rates than kids with the same diseases who are middle class. It’s impossible not to see on a daily basis how poverty affects child health.
This is part of the July 2014 issue of Sharing Nursing’s Knowledge.
Short Rest Between Nurses’ Shifts Linked with Fatigue
New research from Norway suggests that nurses with less than 11 hours between shifts could develop sleep problems and suffer fatigue on the job, with long-term implications for nurses’ health.
Psychologist Elisabeth Flo, PhD, of the University of Bergen in Norway, led a team of researchers that analyzed survey data from more than 1,200 Norwegian nurses, focusing on questions about how much time nurses had between shifts, their level of fatigue at work and elsewhere, and whether they experienced anxiety or depression.
Analyzing the data, they found that nurses, on average, had 33 instances of “quick returns” in the previous year—that is, shifts that began 11 hours or less after another shift ended. Nurses with more quick returns were more likely to have pathological fatigue or suffer from difficulty sleeping and excessive sleepiness while awake—both common problems for night workers.
The nation’s community health centers are poised for expansion thanks to the availability of new funds authorized under the Affordable Care Act.
In June, the U.S. Department of Health and Human Services announced the availability of up to $300 million to expand community health center services throughout the nation. The funds are intended to help centers expand service hours, hire more medical providers, and add services in areas including oral and behavioral health, pharmacy, and vision.
Community health centers “deliver comprehensive, high-quality preventive and primary care to patients regardless of their ability to pay,” according to the Health Resources and Services Administration (HRSA). Currently, nearly 1,300 such centers provide care to more than 21 million patients across the country.
"These funds will allow health centers to expand health services to better serve newly insured patients,” said HRSA Administrator Mary Wakefield, RN, PhD, FAAN.
Existing grantees of HRSA’s health center program are eligible to apply for funding. Applications demonstrating how funds will be used to expand services are due by July 1.
Learn more about the application process here.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Jamila Michener, PhD, an assistant professor of government at Cornell University, responds to the question, “What does the country need to do to address disparities and build a culture of health that includes all people?” Michener is an alumna of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research program at the University of Michigan, Ann Arbor.
In my undergraduate class on the politics of poverty, there is an uncomfortable yet persistent question that looms whenever the conversation turns to racial and ethnic disparities: why? The students generally (and rightly) believe that biological distinctions are not the answer and in the search for other solutions, culture frequently emerges as a likely suspect. In response, I challenge these young people to think more conscientiously about cultural explanations of poverty. I push them to problematize the notion that racial and ethnic groups are homogenous bearers of a common and undifferentiated culture. I prompt them to consider how social, economic, and political institutions constitute and are constituted by various elements of culture.
Linnea Windel, MSN, RN, president and CEO of VNA Health Care in Aurora, Ill., received the Illinois Primary Health Care Association’s Danny K. Davis Award last fall for her leadership of and service to the community health center movement. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2008-2011).
Human Capital Blog: Congratulations on your award! What does this mean for you and for your organization’s work?
Linnea Windel: The community health center movement (and the work that we do) reaches thousands of uninsured and underinsured people who, in most cases, wouldn’t have access to primary health care services otherwise. The award highlights the purpose of our work and the work of many.
HCB: The award is named for Danny K. Davis, a member of the U.S. House of Representatives and a champion of the community health center movement. How is VNA Health Care carrying out his mission?
Windel: When we became a federally qualified health center (FQHC) 12 years ago, we were serving 6,000 patients; this year we are on track to serve 60,000 patients. In the space of 12 years, we’ve expanded our service area and now have nine health centers in suburban Chicago. We live out the purpose of the community health center movement and the purpose of the award through the provision of care in communities with significant need.
For nearly 25 years, Robert Wood Johnson Foundation Community Health Leader Carmen Velásquez, MA, has helped members of Chicago’s immigrant community access the health care they need. She founded the Alivio Medical Center in 1988, which has now grown to six locations that serve 25,000 patients annually. Two more clinics are slated to open later this year.
In recognition of her work, Illinois Governor Pat Quinn proclaimed October 2, 2013 “Carmen Velásquez Day.” At an event celebrating Latino Heritage Month at the National Museum of Mexican Art in Chicago, Quinn called Velásquez “a true pioneer in public health policy and health care affordability.”
“As the immigrant population in the Pilsen neighborhood grew in the 1980s, Carmen Velásquez was among the first to see the crying need for a health clinic, so she went out and built Alivio Medical Center,” he said. “Hundreds of thousands of Illinoisans are alive today thanks to her, proving that one person truly can make a difference.”
Zane Gates, MD, is a Robert Wood Johnson Foundation (RWJF) Community Health Leader and medical director of Altoona Regional Partnering for Health Services in Altoona, Pennsylvania. Gates and Patrick Reilly, president of Impact Health Solutions, founded the Empower3 Center for Health program, which is the model for a new health care law in Pennsylvania.
The Commonwealth of Pennsylvania has recently adopted a law to fund community-based clinics that can demonstrate real impact to the community with regard to increased access, reduced costs, lower emergency room (ER) visits, and improved behavioral health outcomes for the low-income working uninsured. It is modeled on community-based clinics featuring a unique structure that I created along with Patrick Reilly, an insurance consultant from western New York:— Empower3 Center for Health program.
The model we created features an “insurance-less” office concept that allows patients to come in as frequently as needed without worrying about being billed or having any balances to pay. The program has no co-pays, deductibles or balance billing when the patients use the participating community hospital that partners with the program. Since there is no billing at the point of service, there is more face time with the medical professionals to spend creating a true relationship that focuses on care and provides dignity to the patients seeking quality medical care. The office is open five days a week to provide access to patients as needed.
Richard Rieselbach, MD, is an alumnus of the Robert Wood Johnson Foundation Health Policy Fellows program and a professor emeritus and health policy consultant for the University of Wisconsin Medical Foundation.
In the last decade, the nation’s community health centers (CHCs) have doubled their capacity. They now provide care for more than 22 million underserved children and adults in every state. But they’re going to need to do it again. By 2019, some 40 million patients will be in need of care.
The United States does not have enough primary care providers to serve these new patients, and our public investment in health professions education—graduate medical education (GME)—is failing to produce the pipeline we need. Medical students are choosing specialties over primary care at an alarming rate, and a policy vacuum keeps the GME program from being held accountable.
An initiative was launched in 2011 that I think holds great promise: the Teaching Health Center Graduate Medical Education initiative. This five-year, $230 million program was funded by the Affordable Care Act and created to increase the number of primary care graduates trained in community settings.
My colleagues and I have proposed a modified and expanded version of this initiative, called “CHAMP” Teaching Health Centers (CHAMP THCs). Our teaching model would pair CHCs with academic medical centers to develop a THC track that would encourage students to graduate in primary care and practice in urban and rural underserved areas.
Anneleen Severynen, RN, MN, PHN, is a public health nurse working on the South King County Mobile Medical Unit for Public Health Seattle and King County in Washington State.
I work as a public health nurse on King County’s mobile medical unit, traveling south of Seattle in a van, providing for the health care needs of homeless individuals. I perform many “nursing” tasks in my job – taking blood pressures, getting health histories, dressing wounds. But my most important nursing skill is my ability to listen.
This morning I met Charlie. Charlie is a 60-year-old Native American man who reported that he began drinking at age 12, while being passed around to various foster families.
At 17, he went to Vietnam to get away from abuse and neglect, only to be traumatized further by the war.
He called himself a “lost cause” and said he would probably never stop drinking, and knows that he “will die soon.” As I sat silently, I listened to him grieve the loss of his culture and detail the many kinds of discrimination he has suffered. Though he spoke with the slurred speech of a chronic alcoholic, his eloquence moved me. I noticed tears in his eyes as he described a few happy childhood memories with his father—memories not quite lost to him.
This is part of the May 2013 issue of Sharing Nursing's Knowledge.
“National Nurses Week gives us a chance to recognize the contribution of the health care providers at the heart of our health care system. Every day, nurses provide leadership, innovation and advocacy to meet the health care needs of Americans... The health care law’s emphasis on keeping people healthy, preventing illness, and managing chronic conditions, opens new opportunities for nurses to shape and lead the future delivery of healthcare and capitalizes on the expertise of the nursing profession... Please join me in thanking our nation’s nurses for the critical work they do in bringing better care and better health to all Americans.”
-- Health & Human Services Secretary Kathleen Sebelius, HHS Secretary Kathleen Sebelius on National Nurses Week, HHS.gov, May 6, 2013
“There are just over 180,000 APRNs [Advanced Practice Registered Nurses] in the United States, most of them in primary and long-term care ... extensive research finds they are able to handle 80 percent to 90 percent of primary care cases — and achieve outstanding results. APRNs can handle the vast majority of primary and preventive care needs and leave the more complex cases to physicians. This is a win-win situation, that frees nurses and physicians to spend more time with the patients who need them most. Utilizing APRNs provides the fastest and most cost-effective strategy for meeting the health and health care needs of millions more Americans ... Millions of Americans need help maintaining healthy lives or managing chronic conditions. Millions of older people need care in their homes. And millions of soon-to-be-insured patients need a health care provider with the time and training to listen, diagnose and educate. Unleashing the skills of nurse practitioners will improve health care. It is the right thing to do and it is the right time to act.”
-- Sheila Burke, Malcolm Wiener Center for Social Policy, Harvard University, and Future of Nursing: Campaign for Action strategic advisory committee (SAC); and Bill Novelli, McDonough School of Business, Georgetown University, and Future of Nursing: Campaign for Action SAC, Advanced Nurses Lower Costs, Improve Care, Politico, May 6, 2013