Ed Wagner, MD, MPH, is director emeritus of the MacColl Center for Health Care Innovation. A general internist and epidemiologist, Wagner was founding director of Group Health Research Institute.
Better care. Healthier patients. Happier staff. A new online resource provides practical, hands-on tools to build better primary care teams that can put those outcomes within reach.
Nationwide, primary care practices are finding that creating more effective practice teams is the key to becoming a patient-centered medical home, improving patients’ health, and increasing productivity. The Improving Primary Care Team Guide (Team Guide) is a free online resource for primary care practices working to do just that. It:
- Provides hands-on tools and resources that are actionable and measureable
- Is appropriate for practices at any stage of development
- Includes modules that enable practices to easily pinpoint relevant topics and areas of interest
The new Team Guide presents practical advice, case studies, and tools from 31 exemplary primary care practices across the country that have markedly improved care, efficiency, and job satisfaction by transforming to a team-based approach. For the last three years, with funding from the Robert Wood Johnson Foundation (RWJF), the LEAP team has identified, studied, and engaged these practices to develop the lessons contained in the Team Guide.
Katherine Diaz Vickery, MD, MSc, is an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program, an assistant professor of medicine at the University of Minnesota Medical School, and a clinician-investigator in the Division of General Internal Medicine at Hennepin County Medical Center. On December 5, she will be a panelist when RWJF holds its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.
People who know me–even just a little–know of my pride for my home state of Minnesota. While there are beautiful lakes, biking trails, farmer’s markets, and a ridiculous state fair (that takes special pride in its offerings of various types of food-on-a-stick), there’s something more... Minnesota has been making strategic efforts to improve the health of its communities for many years.
If I could bring you to Minnesota today (bundle up!), I’d show you what I mean by taking you to Hennepin County Medical Center (HCMC) and specifically to a meeting of the patient advisory board of the Hennepin Health Accountable Care Organization (ACO).
I would introduce you to Jorge, a Mexican-American whose road to recovery from severe depression was paved by his multi-disciplinary care team from Hennepin Health. Jorge might tell you about Susan, the social worker who helped him find transitional housing. Or Lucky, a community health worker who gave him a voucher to get a haircut, a toiletry bag, and helped him find a primary care medical home. And if he really opened up, he might tell you of his career aspirations to take courses to supplement his graduate degree from Mexico and become a family therapist or community health worker.
Susan B. Hassmiller, PhD, RN, FAAN, directs the Future of Nursing: Campaign for Action, which is implementing recommendations from that report. Hassmiller also is senior adviser for nursing for the Robert Wood Johnson Foundation.
In 2013, the Institute of Medicine released a report, U.S. Health in International Perspective: Shorter Lives, Poorer Health, that compared the United States with 16 other affluent nations. The United States ranked last or near last on nine key indicators: infant mortality and low birth weight; injuries and homicides; teenage pregnancies and sexually transmitted infections; prevalence of HIV and AIDS; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability. This is despite the fact that we spend significantly more on health care than any other nation.
I believe there are five ways nurses can contribute to improving these conditions in 2015.
Nurses Can Help Us Build a Culture of Health
In a Culture of Health, the goal is to keep everyone as healthy as possible. That means promoting health is as important as treating illness. Unless everyone in the country joins this effort, we will remain at the bottom of the list of healthiest nations. “Everyone” means all health care workers, business owners, urban planners, teachers, farmers and others, including consumers themselves. Nurses especially understand wellness and prevention, and have a special role to play in building a Culture of Health.
Stress and Family Support – Two Important Social Determinants of Health for Hispanic/Latino Communities
Rosa M. Gonzalez-Guarda, PhD, RN, CPH, FAAN, is an assistant professor at the University of Miami, School of Nursing & Health Studies and an alumna of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program. On Friday, December 5, she will be a panelist at the RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.
My research has focused on understanding and addressing behavioral and mental health disparities experienced by Hispanic/Latino communities. Although I initiated my research looking at substance abuse, violence, HIV and mental health as separate conditions that often co-occurred in marginalized communities, I soon realized that these conditions were just symptoms of an underlying phenomena— something my colleagues and I refer to as the Syndemic factor.
We have been studying the social determinants of the Syndemic factor in hopes of developing culturally tailored interventions that can potentially address multiple behavioral and mental health outcomes for the Hispanic/Latino community. From this research we have learned that interventions that address stress and family support offer promise for this community.
Harry J. Heiman, MD, MPH, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health Policy Fellows program. He practiced clinical family medicine for more than 20 years and is currently director of health policy at the Satcher Health Leadership Institute, Morehouse School of Medicine. On December 5, Heiman will be a panelist when RWJF holds its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.
The importance of place and geography and its impact on health is not a new concept in public health, but one that has been largely overlooked until recently. John Snow’s map of the London cholera outbreak in 1854, a precursor of today’s more sophisticated geo-spatial mapping, reminds us of the powerful impact public health has always had through assessment and intervention at the neighborhood level. Health care not only drains a disproportionate share of our resources, it also gets a disproportionate share of our attention. Access to affordable, quality health care is necessary, but not sufficient. While important and often life-saving to individuals, it is a relatively weak determinant of population health.
A large body of research has demonstrated the importance of health behaviors, with almost half of all deaths attributable to tobacco, diet and sedentary lifestyle, alcohol and substance use, firearms, and sexual behavior. What has not been adequately understood or discussed is the influence of the social and economic environment on health behaviors. People in lower social classes are more likely to have unhealthy behaviors—something that is strongly associated with the lack of available healthy choices and the impact of increased psychosocial stress. The impact of stress is life-long, occurring not only in childhood, but prenatally, leading to what some experts refer to as inherited disadvantage.
Maya M. Rockeymoore, PhD, is president of the Center for Global Policy Solutions, a nonprofit dedicated to making policy work for people and their environments, and director of Leadership for Healthy Communities, a national program of the Robert Wood Johnson Foundation (RWJF). On December 5, RWJF will hold its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.
When I think of the resilience of disadvantaged communities disproportionately affected by health disparities, I think of the Arabbers of Baltimore, Md. They are not Arabic speaking people from the Middle East or North Africa, but scrappy African American entrepreneurs who started selling fresh foods in Baltimore’s underserved communities in the aftermath of the Civil War.
Their relevance continued into the modern era as supermarkets divested from low-income neighborhoods, leaving struggling residents with few options aside from unhealthy fast food and carry-out restaurants. Driving horses with carts laden with colorful fresh fruits and vegetables, Arabbers sold their produce to residents literally starving for nutritious food.
What’s Your “Street Race-Gender”? Why We Need Separate Questions on Hispanic Origin and Race for the 2020 Census
Nancy López, PhD, is an associate professor of sociology at the University of New Mexico (UNM). She co-founded and directs the Institute for the Study of “Race” and Social Justice at the Robert Wood Johnson Foundation (RWJF) Center for Health Policy at the UNM. On December 5, RWJF will hold its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more.
How should we measure race and ethnicity for the 2020 Census? How can health disparities researchers engage in productive dialogues with federal, state and local agencies regarding the importance of multiple measures of race and ethnicity for advancing health equity for all?
If we depart from the premise that the purpose of race, ethnicity, gender and other policy-relevant data collection is not simply about complying with bureaucratic mandates, but rather it is about establishing communities of practice that work in concert toward the creation of pathways (from harmonized and contextualized data collection, analysis and reporting) to effective policy solutions and interventions that address the pressing needs of diverse communities across the country, then we have planted the seeds of a culture of health equity and social justice.
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of the Foundation’s nursing programs, and the latest news, research and trends relating to academic progression, leadership and other essential nursing issues. Following are some of the stories in the November issue.
RWJF Grantees Help Veterans Become Nurses
With unemployment a problem for many veterans, nurse educators are launching innovative programs to turn veterans into nurses—a “win-win” solution for the military, the health care system and patients, proponents say. The programs address both the looming nurse shortage and the fact that veterans cannot get academic credit for health care experiences that took place in the battlefield.
‘Ebola Care is Nursing Care’
The Ebola outbreak is shining a spotlight on the critical—but often unseen—work of nursing in the United States and abroad, nurse leaders say. Nurses are mounting the main caregiving response to the deadly virus, according to Sheila Davis, DNP, ANP-BC, FAAN, an RWJF Executive Nurse Fellow who recently returned from Liberia and Sierra Leone. Nurses also are educating the public about how the disease is transmitted and dispelling sometimes-unfounded fears.
Sarah L. Szanton, PhD, ANP, FAAN, is an associate professor at the Johns Hopkins University School of Nursing and an alumna of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program. On December 5, RWJF will explore this topic further at its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more about it.
Resilience is not just an individual character trait. There are resilient families, communities, and societies.
Within the individual, there are resilient organs, cells, and genetic expressions. Although many people who experience health disparities are resilient on the individual level—they are optimistic, committed, loving, bright—the groups of people who suffer from health disparities (such as non-English speakers, racial and ethnic minorities, and those living in poverty) draw on their personal resilience daily, but suffer from reduced contact with the resilient potential of communities and society overall.
To me, building a Culture of Health means developing multiple layers of resilient possibilities so that each person’s cells, organs, families, communities, and society are able to respond to stressors, challenges, and opportunities with resilient potential.
Daniel E. Dawes, JD, is a health care attorney and executive director of government relations, health policy and external affairs at Morehouse School of Medicine in Atlanta, Georgia; a lecturer of health law and policy at the Satcher Health Leadership Institute; and senior advisor for the Transdisciplinary Collaborative Center for Health Disparities Research. On December 5, the Robert Wood Johnson Foundation (RWJF) will explore this topic further at its first Scholars Forum: Disparities, Resilience, and Building a Culture of Health. Learn more about it.
With growing diversity relative to ethnicity and culture in our country, and with the failure to reduce or eliminate risk factors that can influence health and health outcomes, it is imperative that we identify, develop, promulgate, and implement health laws, policies, and programs that will advance health equity among vulnerable populations, including racial and ethnic minorities.
Every year, the Agency for Healthcare Research and Quality publishes its National Healthcare Quality and Disparities Report, which tracks inequities in health services in the United States. Since the report was first published in 2003, the findings have consistently shown that while we have made improvements in quality, we have not been as successful in reducing disparities in health care. This dichotomy has persisted, despite the fact that health care spending continues to rise. In fact, health care costs have been escalating at an unsustainable rate, reaching an estimated 17.3 percent of our gross domestic product in 2009, according to the Centers for Medicare and Medicaid Services. Despite these high costs, the delivery system remains fragmented and inequities in the quality of health care persist. The impact of disparities in health status and access for racial and ethnic minorities is quite alarming.