Category Archives: Health care delivery system
Last week, efforts to add a ten year old with cystic fibrosis to the list of adult patients waiting to get donated lungs, increasing her chances of a transplant, made big news. NewPublicHealth had planned to write about the urgent need for citizens to step up and sign on to become organ donors and help whittle down the long lists of patients desperately waiting for hearts, lungs, kidneys and other organs. But our colleagues at the The Public’s Health, a well-worth-reading public health blog hosted by the Philadelphia Inquirer, beat us to it. We urge you to read the post by Michael Yudell, one of the blog’s writers as well as an associate professor at the Drexel University School of Public Health.
"…The demand for organs in the United States far outpaces the supply. There are currently 75,650 active candidates (meaning they are medically suitable for a transplant) waiting for organs in the United States. But 18 people die every day, on average, waiting for an organ transplant."
This week, the Robert Wood Johnson Foundation (RWJF) will host a national discussion via webinar with prominent health care leaders to discuss solutions for bridging the gap between medical care and social needs in health care delivery. The webinar—“Health Care’s Blind Side: Exploring Solutions to Address Social Needs,” taking place April 5, 2012, from 1:30 to 2:30 p.m. EST—will explore possibilities for health care professionals to connect patients to needed resources in the community that can improve their health. Speakers will also discuss the business case for physicians, clinics and hospitals to bridge the gap in treating medical and social needs.
The event builds off of the December poll findings RWJF released showing that three out of four primary care physicians surveyed felt that patients’ unmet social needs—like secure housing, nutritious food and reliable transportation—were as important to address as their medical conditions. The poll also revealed that physicians overwhelmingly felt they lacked the capacity to connect patients to needed resources beyond the clinic walls, and many indicated they wanted the health care system to cover the cost of making such resource connections.
>>Read a related Idea Gallery guest post from Dr. Douglas Jutte about the significance of these findings, and the impact of social factors on his patients’ health.
While the survey helped to document the perceived gap between social needs and care delivery, the Webinar organizers hope to move the conversation forward toward real solutions, and identify answers to questions such as:
- What changes need to happen within the health care system to more meaningfully address the social barriers that keep people from taking the steps they need to be healthy?
- What promising models exist?
On Thursday’s webinar, Jane Isaacs Lowe, Senior Program officer at RWJF and team director of the Vulnerable Populations portfolio, will moderate the discussion, featuring the following panelists:
- Rebecca Onie, Co-Founder and CEO of Health Leads
- Dr. Kavita Patel, Managing Director for Clinical Transformation and Delivery, Engelberg Center for Health Care Reform at the Brookings Institution, and RWJF Clinical Scholar alumna
- Dr. David Labby, Director of Clinical Learning and Support, CareOregon
After the webinar, the conversation will continue on the “Health Care’s Blind Side” discussion forum through April 13. This online discussion will feature additional questions and commentary from health care leaders. Join the conversation on Twitter using the hashtag #RXsocial.
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. Today, Douglas Jutte, MD, MPH, offers a physician's perspective on how unmet social needs—like access to nutritious food, transportation assistance and housing assistance—are affecting the health of Americans.
During medical school and pediatric residency I spent over a year living in the Dominican Republic and Guatemala, so when I finished my training I wanted to continue my work with Spanish-speaking families. My first job was in the neighborhood clinic of East Palo Alto, California, a low-income community inhabited primarily by first- and second-generation Mexican immigrants.
One of my earliest patients in East Palo Alto was a little boy with Down syndrome and a serious congenital heart defect, a common feature of that condition. When I met him, he had recently undergone open-heart surgery and had a gastric tube placed so that he could be fed without requiring him to eat. His mother was enormously attentive but had very limited resources and spoke only Spanish. Together we monitored his health as he stabilized, grew and began to eat on his own. With a full medical recovery, his continued healthy development now relied primarily on obtaining the proper setting for his schooling.
With no caseworker or nurse in my clinic to help me out, I made calls and wrote letters to enroll him in a fantastic school near the Stanford campus. Months later, before a pending well-child visit, I called the school to get an update on his development. I was shocked to learn that it had been weeks since he had last attended. When he and his mother came in for their appointment, I learned her car had broken down. She was saving money for a fix, but had no one to rely on for her son’s transportation and hadn’t known where to turn for help. Desperate, I called the school and discovered that not only did they have a shuttle service but also it was free for needy children.
This was a crystallizing moment for me. The long-term health and well being of a developmentally delayed child whom I had helped coax through recovery from prolonged hospitalizations and multiple complicated surgeries hinged not on the quality of my medical care but on a taxi voucher and a broken carburetor.
This month the Robert Wood Johnson Foundation, in partnership with Harris Interactive, released a poll indicating that the majority of physicians are not only conscious of the relationship between the social risk factors of their patients and poor health outcomes, but they perceive these factors to be as important as their patients’ medical conditions. In regard to that latter point—the recognition that social needs are as important as medical conditions—I was, admittedly, a bit surprised. And when I told a colleague of mine, her response was, “Are you kidding me?”
Our experience has been that, in many ways, the medical field rejects or downplays the notion that social factors are as important to consider as biological factors. It’s not the way we, as doctors, are trained. Two years ago, I completed an article comparing the importance of social and biological risk factors in predicting poor health and educational outcomes for children, but was forced to publish in an epidemiology journal. Several medical journals rejected it, their reason: not “clinically relevant.”
Perhaps the tide is turning. But what can be done to compel more health care providers to recognize this relationship? And what must be done to ensure they have the support to address these important social needs effectively?