Category Archives: Patient-Centered Care
Chris Love, MMin, MSLE, is the program director for the Arkansas Community Foundation, which served as the lead foundation for the Partners Investing in Nursing’s Future (PIN) project, Planning for Workforce Development in Geriatric and Long-Term Care.
As PIN holds its final national meeting this week, the Human Capital Blog is featuring posts from PIN partners about the program’s legacy of encouraging innovative collaborative responses to challenges facing the nursing workforce in local communities. PIN is an initiative of the Northwest Health Foundation and the Robert Wood Johnson Foundation (RWJF).
The PIN journey with Arkansas Community Foundation and University of Arkansas for Medical Sciences (UAMS), among other partners, has been one of both providence and progress. It was in the fall of 2008 that we were approached by leaders from UAMS with the idea for us to become partners with them in this endeavor.
At first, the idea seemed daunting. Then, after some consideration by our senior leadership, it became an open door for opportunity—an opportunity to leverage the structure and resources of our foundation to complement the expertise of our colleagues and friends at UAMS to address a major issue of mutual concern: the aging population in our state and the significant shortage of adequately prepared nurses to care for that population. Not long into the partnership, our organizations realized this would be a match made in heaven.
Joy P. Deupree, PhD, MSN, APRN-BC, is an assistant professor at the University of Alabama (UAB) School of Nursing and a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow. She is engaged in community participatory research studies on health literacy. For 12 years, Deupree has taught a campus-wide elective on health literacy and has been a guest lecturer on the topic at the UAB schools of medicine, dentistry and public health. She founded the Alliance of International Nurses for Improved Health Literacy and established a nursing special interest group for the Health Literacy Annual Research Conference.
Health literacy is extremely important to building a culture of health. Basic understanding of health care information is essential if people are to live healthy lives, but an alarming number of American adults report poor understanding of health care instructions.
This year marks the 10-year anniversary of the Institute of Medicine (IOM) report, Health Literacy: A Prescription to End Confusion.While progress has been made, the work has really just begun. We can no longer blame the patient for poor health literacy, and we should keep in mind that limited health literacy affects us as all and contributes to increased health care costs.
The IOM report defines health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” These skills involve not only reading ability but also numeracy. Failure to develop the necessary skills to manage health care can cost millions of dollars as well as add to human suffering and even cause death.
Mitesh S. Patel, MD, MBA, MS, is an assistant professor of medicine and health care management at the Perelman School of Medicine and the Wharton School at the University of Pennsylvania. He is a staff physician and core investigator at the Center for Health Equity Research and Promotion at the Philadelphia Veterans Administration (VA) Medical Center. Patel is an alumnus of the VA/Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program at the University of Pennsylvania (2012-2014).
Cardiovascular disease is the number one cause of hospitalizations, morbidity and mortality among the veteran population. Building a Culture of Health could address this issue by focusing on individual health behaviors that contribute to risk factors associated with cardiovascular disease such as physical inactivity, diet, obesity, smoking, hyperlipidemia and hypertension.
The current health system is reactive and visit-based. However, veterans spend most of their lives outside of the doctor’s office. They make everyday choices that affect their health such as how often to exercise, what types of food to eat, and whether or not to take their medications.
Connected health is a model for using technology to coordinate care and monitor outcomes remotely. By leveraging connected health approaches, care providers have the opportunity to improve the health of veterans at broader scale and within the setting in which veterans spend most of their time (outside of the health care system). The Veteran’s Health Administration (VHA) is a leader in launching connected health technologies. VHA efforts began in 2003 and included technologies such as My HealtheVet (serving approximately 2 million veterans) and telemedicine (serving about 600,000 veterans).
Ilse Wiechers, MD, MPP, MHS is associate director at the Northeast Program Evaluation Center in the Office of Mental Health Operations of the U.S. Department of Veterans Affairs and faculty with the Yale Geriatric Psychiatry Fellowship. She is an alumna of the Yale Robert Wood Johnson Foundation (RWJF)/VA Clinical Scholars Program (2012-2014).
Health and disease are on a continuum. We are at a point in time where we are trying to understand the constituents of health, whereas historically our focus has been on understanding disease. It is important to recognize that veterans have unique determinants of health not shared with the rest of the population, such as exposure to combat and prolonged time spent away from social support networks during deployment.
These exposures can put veterans at increased risk for mental health problems, such as posttraumatic stress disorder, depression, and substance use problems. The U.S. Department of Veterans Affairs (VA) has a health care system uniquely positioned to help improve the overall health of veterans because of its expertise in addressing these unique mental health needs.
I have the privilege to serve our nation’s veterans through my work as a geriatric psychiatrist conducting program evaluation for the Office of Mental Health Operations (OMHO) at the VA. My work provides me an opportunity to directly participate in several of the key components of the comprehensive mental health services the VA provides for veterans.
Erin Krebs, MD, MPH, is the women’s health medical director at the Minneapolis VA Health Care System and associate professor of medicine at the University of Minnesota Medical School. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Physician Faculty Scholars program and the RWJF Clinical Scholars program.
How can we create a Culture of Health that effectively serves veterans? We can put veterans in charge of their pain care.
Chronic pain is an enormous public health problem and a leading cause of disability in the United States. Although 2000-2010 was the “decade of pain control and research” in the United States, plenty of evidence suggests that our usual approaches to managing chronic pain aren’t working. Veterans and other people with chronic pain see many health care providers, yet often describe feeling unheard, poorly understood, and disempowered by their interactions with the health care system.
Evidence supports the effectiveness of a variety of “low tech-high touch” non-pharmacological approaches to pain management, but these approaches are not well aligned with the structure of the U.S. health care system and are often too difficult for people with pain to access. Studies demonstrate that patients with chronic pain are subjected to too many unnecessary diagnostic tests, too many ineffective procedures, and too many high-risk medications.
This is part of the November 2014 issue of Sharing Nursing’s Knowledge.
“As a nurse, I understand the risk that I take every day to go to work, and he’s no different than any other patient that I’ve provided care for. So I wasn’t going to say, ‘No, I’m not going to provide care for him. I didn’t allow fear to paralyze me. I got myself together. I’d done what I needed to get myself prepared mentally, emotionally, physically, and went in there.”
--Sidia Rose, a nurse at Texas Health Presbyterian Hospital, Treating Ebola: Inside the First U.S. Diagnosis, 60 Minutes, CBS News, Oct. 26, 2014
“...I grabbed a tissue and I wiped his eyes and I said, ‘You’re going to be okay. You just get the rest that you need. Let us do the rest for you.’ And it wasn’t 15 minutes later I couldn’t find a pulse. And I lost him. And it was the worst day of my life. This man that we cared for, that fought just as hard with us, lost his fight. And his family couldn’t be there. And we were the last three people to see him alive. And I was the last to leave the room. And I held him in my arms. He was alone.”
--John Mulligan, a nurse at Texas Health Presbyterian Hospital, Treating Ebola: Inside the First U.S. Diagnosis, 60 Minutes, CBS News, Oct. 26, 2014
“Someone asked a nurse, what do you make? I make sure your seriously ill father is cared for. I make sure that when you’re incontinent you’re cared for. It’s this everyday, profound yet intimate work that people do. People don’t understand it. It requires incredible cognitive and emotional intellect to do it. You are with someone at the most difficult and challenging and joyous moments of their lives.”
--Diana Mason, PhD, RN, FAAN, professor, Hunter-Bellevue School of Nursing and president, American Academy of Nursing, Nurses Want to Know How Safe is Safe Enough With Ebola, NPR.org, Oct. 14, 2014
Michael Hochman, MD, MPH, is medical director for innovation at AltaMed Health Services, the largest independent federally qualified health center in the United States. AltaMed has enrolled more than 30,000 Southern Californians in Medi-Cal and Covered California, the state health care exchange. Hochman is an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program at the University of California, Los Angeles, and the U.S. Department of Veterans Affairs. Martin Serota, MD, is AltaMed’s chief medical officer.
Although the dust is still settling, most indicators suggest that the first wave of national health care reform was a success, particularly in California. More than 8 million Americans enrolled in commercial health plans under the Affordable Care Act, surpassing targets set by the Obama administration. Many more will qualify for plans under Medicaid expansion. As leaders at a community health center that serves a large population of low-income patients—many of whom currently lack coverage—we could not be happier about the new opportunities for our patients.
But we also know that the work is far from complete. Health care reform will only be a success if coverage expansion results in improvements in quality and efficiency, and better health for the population. As we know from the Massachusetts experience, it took time and a lot of effort for these benefits to ensue. Only now, several years after health care reform began in Massachusetts, are residents of the state starting to reap the benefits.
Physician assistants (PAs) received high marks from patients in a recent survey conducted by Harris Poll for the American Academy of Physician Assistants (AAPA). Among 680 Americans (out of more than 1,500 surveyed) who have interacted with a PA in the past year, 93 percent see PAs as part of the solution to the nation’s shortage of health care providers; 93 percent regard PAs as trusted health care providers; and 91 percent agree that PAs improve health outcomes for patients.
“The survey results prove what we have known to be true for years: PAs are an essential element in the health care equation and America needs PAs now more than ever,” AAPA President John McGinnity, MS, PA-C, DFAAPA, said in a news release. “When PAs are on the health care team, patients know they can count on receiving high-quality care, which is particularly important as the system moves toward a fee-for-value structure.”
The AAPA points out that more than 100,000 PAs practice medicine in the United States and on U.S. military bases worldwide. A typical PA will treat 3,500 patients in a year, the association says, conducting physical exams, diagnosing and treating illnesses, ordering and interpreting tests, prescribing medication, and assisting in surgery.
How Can Health Systems Effectively Serve Minority Communities? Improve Medical Literacy, Take a Holistic Approach.
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, Cheryl C. Onwu, BS, a public health graduate student at Meharry Medical College, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Onwu is a Health Policy Scholar at the RWJF Center for Health Policy at Meharry Medical College.
A doctor informed an African American male that he has diabetes mellitus, and medication was prescribed. However, the doctor did not mention the extent of the dangers involved in having diabetes, or “the sugars.” Additionally, the doctor did not explain the detrimental effects if the patient failed to follow the prescription regimens and other recommendations.
Some of the challenges faced by minorities include lack of medical literacy, which can affect their overall health. Clear communication between a health care provider and his or her patients is important, so patients are cognizant of their health status, the importance of maintaining a healthy lifestyle, potential threats to well-being, and how to control health problems.
As the patient-centered medical home (PCMH) has emerged as a model for providing effective team-based care that can help offset the impending primary care provider shortage, so, too, is there a growing need for educational strategies that promote interprofessional collaboration. A short report published online by the Journal of Interprofessional Care describes the strategies in place at the VA Connecticut Healthcare System Center of Excellence in Primary Care Education (CoEPCE) and indicates promising results in just one year: doubled productivity in patient care delivered by faculty providers, and a marked increase in same-day clinic access for patients receiving care from an interprofessional team.
The Connecticut CoEPCE, like four other program sites funded through the U.S. Department of Veterans Affairs Office of Academic Affiliations, builds on the VA’s system-wide PCMH model, known as Patient Aligned Care Teams (PACT). It seeks to develop exportable models of interprofessional education and patient care, according to the report, “Moving From Silos to Teamwork: Integration of Interprofessional Trainees Into a Medical Home Model.” The CoEPCE sites share four core curricular domains—shared decision-making, sustained relationships, interprofessional collaboration, and performance improvement—and the Connecticut center groups together physician, nurse practitioner (NP), pharmacy, and health psychology trainees.
The trainees divide their time evenly between interactive educational sessions and caring for patients, guided by faculty who provide supervision, mentorship, and collaborative shared care. Additionally, the Connecticut center incorporates a one-year post-master’s adult NP interprofessional clinical fellowship, to further enhance clinical proficiency and teamwork experience for NPs.