Category Archives: AcademyHealth
A major theme at this year’s AcademyHealth Annual Research Meeting was the need to become more aggressive on translating and disseminating health research. Just last month, the Mailman School of Public Health at Columbia University announced that is was becoming the first school at the university and one of the first of U.S. schools of public health to adopt an open access resolution. The resolution calls for faculty and other researchers at the school to post their papers in openly available online repositories such as Columbia’s Academic Commons, where content is available free to the public, or in another open access repository, such as the National Institutes of Health’s PubMed Central.
“A wider dissemination of research and information has been a number one priority of our faculty, who are motivated by the belief that scientific knowledge belongs to everyone,” said Linda P. Fried, MD, MP, the dean at Mailman. “It is in the interest of all of us to take every measure possible to improve and simplify the process of gaining access to our research findings,” Fried said.
NewPublicHealth spoke with Bhaven N. Sampat, PhD, Assistant Professor of health policy and management at Mailman and a lead faculty member on the open access endeavor.
NewPublicHealth: Why haven’t many journals been open access before and what is making researchers, particularly in the field of public health, interested in more widely disseminating their research?
Under the Affordable Care Act, tax-exempt hospitals are now required to conduct a community health needs assessment at least every three years and develop an implementation strategy to tackle the needs identified by the assessment.
At this week’s AcademyHealth meeting in Baltimore, experts moved from the “guess what you have to do” approach to community benefit heard at some public health meetings to some practical strategies hospitals can follow not only to fulfill the letter of the law, but to actually improve community health.
Peter Sartorius, community benefit director of the Muskegon (Michigan) Community Health Project, which brings together several Mercy hospitals in the region, told the audience that costs of the requirement can range from about $12,000 for a staff person to conduct the needs assessment to about $65,000 if a consultancy, such as a public health institute, does the work. Mercy requires that the County Health Rankings, developed through a collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, be used by the hospitals in its network as the baseline measures of community health.
Sartorius urged hospitals to choose “collaborative partners” such as community health clinics, United Way agencies and universities, who can help develop the assessment and report and also share in the cost. Others have said that community benefit also offers a ripe opportunity for collaboration between hospitals and public health departments, which already house a lot of data and have similar community needs assessment requirements for voluntary accreditation.
An anniversary session at the AcademyHealth Annual Resarch Meeting yesterday looked back at the organization’s thirty years of translating research into policy. It’s an important topic. A number of recent meetings focusing on public health, including last week’s public meeting of the Commission to Build a Healthier American, stressed the need for evidence in order to consider planning and community improvement decisions. The Affordable Care Act has a number of new initiatives that call on clinical and public health practitioners to seek and rely on an evidence base, including the Patient-Centered Outcomes Research Institute (PCORI), which is authorized by Congress to evaluate the best available evidence to help patients and their health care providers make more informed decisions.
Decades of research is beginning to pay off, according to the panelists. For example, according to Sherry Glied, PhD, professor of health policy and management at the Columbia University Mailman School of Public Health, the experts involved in crafting the Affordable Care Act drew on a body of research to inform the expected cost of implementing the law.
Gail Wilensky, senior fellow at Project HOPE, an international health foundation, who directed the Medicare and Medicaid programs from 1990 to 1992, pointed out that sometimes evidence has limitations. “Getting legislation passed also has to do with, among other things, the political mood of the country,” said Wilensky, who added that sometimes policy passes and sometimes it doesn’t, which is important for younger researchers to realize. “Important legislation has passed with minimal analysis including Medicaid and Medicare,” Wilensky pointed out.
NewPublicHealth is on the road this week at the AcademyHealth Annual Research Meeting in Baltimore, Maryland and the International Making Cities Livable Conference meeting in Portland, Oregon.
AcademyHealth is a key organization in the United States for the study of health services research—a discipline that looks at how people get access to health care, how much care costs and what happens to patients as a result of this care. The main goals of health services research are to identify the most effective ways to organize, manage, finance and deliver high-quality care; reduce medical errors; and improve patient safety.
An important focus of this week’s Annual Research Meeting is the translation and dissemination of research into health practice. The Public Health Systems Interest Group, AcademyHealth’s largest interest group with close to 3,000 members, is meeting this week as well and has a particular focus on translating and disseminating public health systems and services research to the public health practitioners who could benefit from practical findings.
NewPublicHealth recently spoke with Paul Erwin, MD, MPH, and head of the department of public health at the University of Tennessee School of Public Health, about the importance of having strong evidence available for public health practitioners.
NewPublicHealth: Why is the translation and dissemination of Public Health Services and Systems Research (PHSSR) so important?
Paul Erwin: Ultimately PHSSR is meant to go out into the practice community so that research can actually make a difference. I think historically that is part of what has set PHSSR apart from closely related research disciplines. PHSSR really is intended to help produce the kinds of evidence-based practices that are more effective with limited resources, and likely to move the needle on population health.
A highlight of last week's Public Health Systems Research Interest Group meeting, which followed the AcademyHealth Annual Research Meeting, was a “Critical Opportunities” reception during which several presenters pitched their ideas for a law that could be used to improve or solve critical public health issues. The presenters were timed, given only five minutes to share the background of the issue to be addressed, their idea for the law, evidence that it could work and the feasibility of implementing the change. Attendees were encouraged to vote on their favorite to see which Critical Opportunity ranked highest--see below for the results!
This was the second such event since this year’s debut of Critical Opportunities for Public Health Law, an initiative of the Public Health Law Research Program (PHLR), a Robert Wood Johnson Foundation program at Temple University. The goal is to make the case for laws that can improve current critical public health needs by:
- Identifying important ways to use law to improve the public’s health
- Enhancing public and professional recognition of law as a vital force for better public health
- Guiding public health law research
NewPublicHealth caught up with two of the invited presenters, who also accrued the most votes on their topics--Tamar Klaiman, assistant professor at the Jefferson School of Population Health in Philadelphia, and Georgia Heise, DrPh, director of the Three Rivers District Health Department in Kentucky, and recently elected vice president of the National Association of County and City Health Officials.
NewPublicHealth: What did you both present on?
Tamar Klaiman: The policy that I addressed is about requiring physicians to offer new parents TDAP (pertussis) vaccines because infants who are [less than] six months of age are at the highest risk of mortality from pertussis, and so parents can protect their children by being vaccinated. Around 80 percent of pertussis cases in infants, when they can track where the pertussis came from, come from parents. The policy that I talked about is having providers offer pertussis vaccine to new parents prior to leaving the hospital or birth center with the newborn.
NPH: Why would that be valuable?
Tamar Klaiman: Newborns are not fully protected against pertussis until after their 6-month booster so vaccinating parents offers the best protection. So it’s a very low risk, high reward policy.
NPH: Are there states that are already implementing this law?
Tamar Klaiman: None as far as I know.
NPH: Georgia, what’s your critical opportunity?
Georgia Heise: I talked about voluntary public health department accreditation for local health departments. Accreditation encompasses a myriad of standards that cover the mission of public health and what health departments should be doing. This would standardize public health across the nation and force into place a lot of preventive measures and assessments and best practices that the health department would be doing things that would actually make a difference in population health.
NPH: Why is this a critical opportunity?
Georgia Heise: I think that across the United States we operate on a medical model, which means we don’t really put enough funding into anything that would teach people how to be healthy or keep them healthy. We put a lot of money into taking care of somebody once they’re sick or dying. We need to push in the opposite direction and focus on keeping people healthy, and these accreditation standards are a framework for health departments to start that. There’s now an opportunity for health departments to become accredited at the national level. It’s in place and ready to go, however, not all the health departments have opted in yet.
Results of the Critical Opportunities Vote at AcademyHealth
About 100 people texted their votes for the presentations at the Interest Group meeting. The results were as follows:
- Requiring physicans to vaccinate parents of newborns against pertussis (whooping cough) to better protect young babies: 50 percent of votes
- A law requiring that states health departments be accredited and that funding be provided to go through the accreditation process: 24 percent of votes
- Establishing comprehensive laws to deal with designer drugs such as synthetic marijuana that would be broad enough to encompass new drugs as they are introduced: 18 percent of votes
- Creating standards for public health department contracts with private entities: 9 percent of votes
>>Watch YouTube videos of Critical Opportunities presentations at the Public Health Law Research Program meeting earlier this year.
Social media has been hyped for everything from communicating during emergencies to tracking the spread of the flu. So how are state health departments using such tools as blogs, Facebook, and Twitter? That was the subject of a presentation at the recent Public Health Systems Research Interest Group meeting that followed the AcademyHealth Annual Research Meeting last week.
In an unfunded study, Jenine Harris and Doneisha Snider of Washington University in St. Louis looked at how widely Facebook and Twitter are used by state health departments. Harris pointed out that social media can augment the resources health departments have to communicate with the public and “have the potential to diffuse information quickly.” Harris added that health departments can use social media to communicate with each other about new information, best practices and lessons learned in addition to communicating with the public.
Researchers shared stats on state health department social media presence so far:
- 28 have a Facebook page
- 41 have a Twitter feed
- 37 state health departments were following each other on Twitter
- 24 state health departments had friended each other on Facebook
- On average, state health department Facebook pages have 993 friends
- The average number of Twitter followers for a state health department is 1,340
- State health departments are actively using their Facebook and Twitter accounts; thirty-six health departments had tweeted within the last week and 24 had posted on Facebook
Harris says content for the tweets and Facebook posts primarily includes prevention (such as immunization, nutrition and smoking cessation information) and operations (hours of operations, job openings). Tweets were mostly aimed at the general public.
Harris offered some recommendations on how state health departments could potentially use Facebook and Twitter to communicate with each other to share best practices. However, she says there is much left to learn about the potential of social media for public health practice and how to use this new tool most effectively.
For more detailed analyses, look for Harris’s article, “The network of Web 2.0 connections among state health departments: New pathways for dissemination,” which is forthcoming in the Journal of Public Health Management and Practice. Harris and her colleagues also plan to examine social media use in local health departments.
>>Catch up on what you may have missed at the AcademyHealth Annual Research Meeting.
A new study, published in the journal Diabetes Care, examined number of steps walked on average and diabetes risk, and found that people who walked the most were 29 percent less likely to develop diabetes than those who walked the least. This study builds on research linking even limited physical activity to lower diabetes risk, and helps to quantify the effect with number of steps taken on average. The association held when accounting for age, smoking status and other diabetes risk factors, but not BMI. Read more on diabetes.
Preventive mammography rates in women in their 40s have dropped nearly 6 percent nationwide since the U.S. Preventive Services Task Force recommended against routine mammograms for women in this age group, according a Mayo Clinic analysis. The study was presented at the AcademyHealth Annual Research Meeting this week. Read more NewPublicHealth coverage from the AcademyHealth meeting.
Forty million Americans ages 12 and older have an addiction involving nicotine, alcohol or other drugs, according to a five-year national study released this week by The National Center on Addiction and Substance Abuse at Columbia University. The study authors say only about 1 in 10 people who need treatment for addiction involving alcohol or other drugs receive it. Read more on substance abuse.
Three entities in Minnesota shared their experience with workplace wellness programs at this week’s AcademyHealth Annual Research Meeting. Employers can play critical roles in improving the health and lifestyles for their employees and their community, but many are still on the learning curve of why it’s important, according to presenters at the session.
Marc Manley, MD, MPH, chief prevention officer of Blue Cross Blue Shield (BCBS) of Minnesota says “workplace wellness needs a business plan, not just a culture.” Manley says to be successful, workplace wellness plans need goals and a decision on who will pay for it. It also needs a long-term commitment—at least three years, says Manley, since most firms can’t afford to introduce every wellness incentive—such as healthier foods, incentives for healthier lifestyles, and company-based programs such as smoking cessation and weight loss—all at once.
Manley adds: "You also need infrastructure, communication with employees, feedback, incentives, goals, a measurement strategy; and a lot of employers just don’t have this in place for wellness."
Examples of things to focus on include the types of food offered throughout the workplace, and what you will do to make the healthy choice the easy choice, such as pricing healthier foods differently than less healthy ones.
Manley, who is also the chief medical officer for Invitation Health & Wellness, a consulting arm of BCBS Minnesota aimed at widely sharing evidence-based practices, says small firms often want to know what they can introduce that’s fully free of financial costs that will help improve the health of their employees. Manley says he does have one suggestion: have CEOs model healthy behaviors, and serve as role models.
Wellness initiatives at BCBS Minnesota, which has 3,500 employees and 2.5 million members, include online and telephone behavior coaching, unlimited office visits to physicians and dieticians, discounts to lifestyle programs such as weight loss classes, provider incentives, paid media campaigns, lobby for strong health policies such as active transportation and funding of local community efforts to promote physical activity and healthy eating. Also needed, said Manley, are data to establish priorities, evidence-based strategies that support goals, measureable goals, and measurement and reporting of progress.
“Firms that have a business plan for a healthier workplaces connected to a culture of health, are more likely to succeed in helping employees get and stay healthy,” says Manley.
Manley cited a 2012 study in the American Journal of Health Promotion that found that workplace wellness programs can produce, on average, reductions in sick leave, health plan costs, and workers’ compensation and disability insurance costs by around 25 percent.
Target’s corporate headquarters are based in Minneapolis, and recently the company started a “wellbeing” initiative as its inaugural project for workplace wellness. While they’ve started some wellness projects, such as reducing the cost of fruit in the cafeteria, well being is what the company is after, to start—including camaraderie and teambuilding efforts. "When they go home we want them feeling good about where they work," says Kara McNulty, senior group manager of medical affairs at Target, who added that the biggest influence from well being on health is on stress-related disease such as coronary artery disease and depression.
McNulty says team members with a higher rate of well being are more likely to stay with the company, volunteer in the community and participate in health surveys. Target’s next steps will be to grow participation in the well being program, study the role of well being “captains” and establish more actionable measurement systems.
At a panel convened by the Alliance for a Healthier Minnesota, a collaborative private and public stakeholders, Target was one of the firms discussing an accreditation program for wellbeing. The program sets standards for workplace wellness programs in three areas: organizational engagement and alignment; population health management and well-being; and outcomes reporting.
Tom Mason, head of the Alliance for a Healthier Minnesota and the final speaker on the session on workplace wellness, said that although business is not often seen as a change agent, real health care reform requires both business and public health. “There has to be coalition building, we have to stick with it for the long haul, and we have to do have forward looking companies."
The Alliance has completed focus groups with small companies on their thinking with regard to workplace wellness, with results to be released in the fall. “The big challenge is small business,” says Mason; "in Minnesota 65 percent of those employed, work for small companies."
Dr. Manley added a twist to his presentation that showed the relative ease of introduction of small changes, especially for a willing audience. He bemoaned the need for conference attendees to spend so much of the meeting sitting, and challenged the sessions attendees to get out of their chairs and stand, and even move their arms and legs a bit, after each speaker—and just about everyone did as he asked, after a careful look around to be sure they wouldn’t be the only ones. “Changing a norm is not so easy,” said Manley. “But it’s possible if you start thinking about what you need to do.”
>>Weigh in: What’s a small change your community has made that has increased, even slightly, physical activity among a group?
>>Bonus Interview: Read a NewPublicHealth Q&A with Tom Mason of the Alliance for a Healthier Minnesota
We’ll never know if it was the spirited discussions or Tropical Storm Debby, which is pummeling northern and central Florida, that kept most of the 2,000-plus attendees at this year’s AcademyHealth Annual Research Meeting—this year in Orlando—indoors and packed into the sessions and the exhibit hall at just about every minute of the meeting this year. Public Health was a featured topic, according to AcademyHealth president and CEO Lisa Simpson, and a session on the IOM report on the integration of public health and primary care, led by the committee chair, Paul Wallace, MD, was a featured, and well-attended, session as well.
Not surprisingly, many public health officials made their way into a ballroom very early Tuesday morning to hear three health law scholars, Sara Rosenbaum of the George Washington University, Timothy Jost of Washington and Lee and Mark Hall of Wake Forest, talk about the issues likely contemplated by the Supreme Court Justices as they considered the cases brought against the Affordable Care Act. Critical for public health were the discussion points aired just before the session ended, concerned with continued state and federal budget cuts including cuts to the Centers for Disease Control and Prevention and other divisions of the Department of Health and Human Services, which could impact public health service delivery now underway, as well as implementation of the Affordable Care Act, if it is upheld.
Health disparities were also a focus of several sessions, as well as the topic that won the student poster award of the conference. Stephen Vance, a fourth-year medical student at the University of North Carolina at Chapel Hill School of Medicine, won the best student poster award for his work with Aida Lugo-Somolinos, MD, of the medical school, on clinical trial enrollment barriers faced by the Hispanic population in North Carolina. Vance’s research found that the barriers identified by the Hispanic participants in the study differ from those expected by clinical investigators.
The study provided a questionnaire for physicians on their perceptions of why more members of the Hispanic community don’t enroll in clinical trials, and also collected patient questionnaires on trial participation from close to 400 members of the Hispanic community.
The physician responses showed that they viewed language and transportation as the key barriers. But the patient responses showed other concerns including worries about what participating might cost them, concern about missed work time and a lack of understanding about the potential benefits of trial participation, including access to health care. The researchers say the following should be considered as a means to enroll more members of Hispanic communities in trials:
- Provide information about studies to health care providers in areas with large Hispanic populations
- In large cities, create partnerships with Hispanic advocacy groups
- Communicate that trial participation is not necessarily costly and may take no more time than a regular doctor’s appointment
- Include a person fluent in Spanish on the research team
“Before this study, I would have thought that transportation and language were the key barriers,” says Vance. “It’s really a lack of understanding of what a clinical research project entails.”
“Perhaps as clinicians, we’re asking the wrong questions,” says Vance, who is on track to get an MBA as well as his MD degree, and plans to go into health management. “This study focuses on the Hispanic community, but should push us to look at the reasons why other groups are underrepresented in trials.”
Primary care and public health share a common goal but historically have functioned independently of each other. However, health experts say that better integration of the two disciplines could result in critical improvements in the health of individuals and communities. The Centers for Disease Control and Prevention and the Health Resources and Services Administration asked the Institute of Medicine (IOM) to look at issues related to the integration of primary care and public health, and the resulting report was released earlier this year.
The recent report on integrating was so groundbreaking, that it has launched a number of discussions and publications on the issue, including a keynote panel at the recent 2012 Keeneland Conference, a first ever joint issue of the American Journal of Preventive Medicine and the American Journal of Public Health and a session on the report at next week’s AcademyHealth Annual Research Meeting by the IOM report’s committee chair, Paul Wallace, MD. NewPublicHealth spoke with Dr. Wallace, Director of the Center for Comparative Effectiveness Research at the Lewin Group, about the committee’s critical finding and recommendations.
The IOM identifies a set of core principles common to successful integration efforts, such as involving the community in defining and addressing its needs. The principles provided in this report can serve as a roadmap to move the nation toward a more efficient health system.
NewPublicHealth: What were the key findings were in the report?
Dr. Wallace: There are many instances in which communities have figured out aspects of integration but, as we learn over and over again in health care, solutions often need to be locally adaptive, and that holds true in thinking about how integration takes place as well.
I think what was very helpful for us was recognizing that integration is really a continuum, sort of extending from either being disintegrated or, if you will, parallel play on one end up through quite formal partnerships or mergers on the other end. There are opportunities for creating better care and efficiencies along that continuum. For public health to be aware of what primary care is doing and for primary care to be deeply aware of what public health is doing would be a substantial element of progress.
NPH: Why is integration coming about now?
Dr. Wallace: It isn’t quite yet. Until about a hundred years ago health care was the province, almost exclusively, of the clinician-patient relationship. Previously, though, if you go back 150 years, in medical schools, there was really a sort of blending of what we now would think of as public health and what we think of as health care. But the Flexner Report back in the early 20th century re-configured how medical education took place, which changed the structure of medical schools, and public health wasn’t really part of that.
The other thing that happened was that public health was figuring out what it needed as an academic base, and that was about the time that the Rockefeller Foundation stepped up and started funding separate schools of public health. So really what happened is that the education and the academic foundation sort of diverged and they followed separate paths for most of the last century.
NPH: With stronger collaboration between public health and health care, what could be achieved?
Dr. Wallace: I think if you look at it from a patient-centered perspective, there would be rational and consistent availability and access to a whole range of services like healthy food and the ability to exercise, and it would be reinforced by our public policy. There would be a shared awareness of who are the people at greatest risk, perhaps related to data and information systems. There would be an alignment between messaging from public health agencies and what you would hear in your clinician’s office. And in the clinician’s office there would be recognition that it isn’t just about doing physical exams and prescribing pills, it’s also thinking about aspects of healthy living such as active living and healthy eating.
But I think that there really would just be a blending of the whole continuum, and I think that the other really important thing is that a lot of the emphasis would shift from fixing things through health care to more of a proactive context of prevention, and really primary prevention. It’s about not waiting until people have high cholesterol and heart attacks and then trying to treat them with lipid-lowering drugs, but thinking how you get ahead of this in public schools, in the workplace and in our communities.
NPH: Would money be saved with the appropriate integration?
Dr. Wallace: Another way to think about it would be—can we get more health for the dollars we’re spending? We certainly could make the system more efficient. There are a lot of issues of maldistribution, for instance, where we tend to over-treat certain people in certain ways, and as a consequence there are other folks who are poorly treated. The disparities discussion I think is a very rich one that’s right in the middle of this.
Over time, we might start to see spending migrate from very high-risk dollars on things that are very unlikely to work with expensive interventions, to more fundamental upstream interventions that will have dividends over many years.
NPH: Is it sufficient to just have primary care and public health at the table together to solve the massive problems that have been created?
Dr. Wallace: If you really want to create health on a community basis, you need public health and you need the health care delivery system, primary care, but almost all of the successful programs also have some third party. And that third party may be government, it may be schools, it may be a faith-based organizations. It gives you sort of a place to convene. Rather than having public health and primary in a tug of war over who is bigger and brighter and smarter, you realign that effort to think about how we can collectively engage to support this third party. That sort of triangulation I think is a really critical thing about trying to bring these mindsets and forces back together.
NPH: What are the next steps to the report’s findings?
Dr. Wallace: What was different about this report we feel is that it involved people who have a direct interest in this, who are motivated to actually do some things to try and support this. CDC and HRSA, who together commissioned the report, between them have a footprint that really extends into every community. They’re actively thinking together about a lot of things that we’ve suggested, but a lot of our suggestions reflected openness from them to where they want to go. CDC and HRSA are increasingly aware of what each other are doing, they actively cooperated in funding the study and they’re collaborating now in thinking about some funding models.
There are also workforce issues. There probably is a set of workers who are critical to this and they aren’t necessarily traditional health care roles, but they’re more like the community health worker who can help people with education. They’re in the community, they understand the culture, they understand the nuance and may be more effective at translating some of these messages.
NPH: What made it feasible to have a receptive audience for this report now?
Dr. Wallace: There is a growing understanding of what population health is, and in a sense that population health is bigger than either primary care or public health and it’s only going to get addressed if they do it collaboratively. The other really critical factor that makes things different now is the availability of data. That is just fundamentally changing people’s thinking. An example of that would be creating community-wide registries that can be used to recognize where there’s opportunity such as pockets of a city that have a very high incidence of asthma, and then being able to think about what are the community or public health-based interventions.
Data democratization is also creating new levels of transparency and accountability. There’s this growing recognition that you can now know what is going on, where before people always wondered or hypothesized.