Archive for: 2009

Making Decisions about Nurse Practitioners' Scope of Practice

Dec 23, 2009, 1:41 AM, Posted by Lori Melichar

Dr. David Eddy, founder of Archimedes, recently visited the Foundation to present ARCHeS, a Web-based delivery platform that enables policy-makers and health leaders to use the Archimedes model to run their own virtual trials. Dr. Eddy demonstrated a prototype version of what users can expect to access via ARCHeS and previewed new functionality that will allow providers and decision makers to use the model to tailor care decisions for individual patients. Pioneer is supporting Archimedes to build ARCHeS. 

What struck me about ARCHeS was the opportunity it presented to make evidence-based policy decisions about nurse practitioners’ scope of practice that could potentially result in significant savings. Currently, those who advocate for nurse practitioners playing an expanded, autonomous role in delivering primary care point to seminal evidence showing comparable outcomes in patients randomly assigned to either nurse practitioners or physicians where nurse practitioners had the same authority, responsibilities, productivity and administrative requirements, and patient population as primary care physicians. Though this research is not without its critics, it has been used successfully to convince many to see nurse practitioners as part of the solution to expanding access to primary care. 

Nevertheless, the debate around whether and how nurse practitioners’ scope of practice should be expanded and standardized nationally requires evidence that digs deeper into aggregate results. Policy makers need access to evidence that elucidates what nurse practitioners can do as well as physicians vs. tasks/responsibilities that should be left to physicians. 

For example, in his presentation, Eddy showed how ARCHeS, using evidence about both the cost and outcomes of nurse practitioners, indicates that having nurse practitioners administer shots to reduce cholesterol has a striking impact on the cost per QALY for a treatment option. Funders, including NIH, could use these criteria to prioritize funding condition/procedure-specific randomized control trials (RCTs) and other studies. 

To learn more about the implication of ARCHeS, I recommend reading a special report from Business Week entitled “Trimming Health-Care Costs Without Reforming the System,” which implies that the Archimedes model, when made accessible to policy makers and other decision makers, could lead to better decisions that could save billions in health care costs.

Archimedes' ARCHeS Platform and its Potential to Decision Makers

Dec 23, 2009, 1:17 AM, Posted by RWJF Blog Team

Dr. David Eddy, founder of Archimedes, recently visited the Foundation to present ARCHeS, a Web-based delivery platform that enables policy-makers and health leaders to use the Archimedes model to run their own virtual trials. Dr. Eddy demonstrated a prototype version of what users can expect to access via ARCHeS and previewed new functionality that will allow providers and decision makers to use the model to tailor care decisions for individual patients. Pioneer is supporting Archimedes to build ARCHeS.

What struck me about ARCHeS was the opportunity it presented to make evidence-based policy decisions about nurse practitioners’ scope of practice that could potentially result in significant savings. Currently, those who advocate for nurse practitioners playing an expanded, autonomous role in delivering primary care point to seminal evidence showing comparable outcomes in patients randomly assigned to either nurse practitioners or physicians where nurse practitioners had the same authority, responsibilities, productivity and administrative requirements, and patient population as primary care physicians. Though this research is not without its critics, it has been used successfully to convince many to see nurse practitioners as part of the solution to expanding access to primary care.

Nevertheless, the debate around whether and how nurse practitioners’ scope of practice should be expanded and standardized nationally requires evidence that digs deeper into aggregate results. Policy makers need access to evidence that elucidates what nurse practitioners can do as well as physicians vs. tasks/responsibilities that should be left to physicians.

In his presentation, Eddy showed how ARCHeS, using evidence about both the cost and outcomes of nurse practitioners, indicates that having nurse practitioners provide medications to reduce cholesterol has a striking impact on the cost per QALY for a treatment option. Funders, including NIH, could use these criteria to prioritize funding condition/procedure-specific randomized control trials (RCTs) and other studies.

Family Coaching Clinics � A Uniquely New Way to Provide Behavioral Health Services

Dec 22, 2009, 3:01 AM, Posted by Pioneer Blog Team

Last week, the UCLA Family Commons, a retail-based model designed to deliver behavioral health prevention and early intervention services to families in an accessible way, opened its doors to provide the community a free week-long preview of its services. Located in Santa Monica, the UCLA Family Commons is a prototype family coaching clinic developed by the UCLA Semel Institute for Neuroscience and Human Behavior and funded by Pioneer.

The concept caught our eye in 2007 when it was chosen as a winner in Ashoka’s Disruptive Innovations in Health and Health Care competition. Modeled after the successful retail health clinic model, we saw it as a promising way to empower consumers. The Family Coaching Clinics model provides families with the support, guidance and structured approach to problem solving that a preventive approach to mental health offers.  Targeted at families with children of all ages, the UCLA Family Commons provides evidence-based products and services to help address problems and stressors that affect so many families – learning to set appropriate limits at different ages, coping with the effects of divorce, developing good eating habits, dealing with bullying in school and so on. The concept is based around the belief that many issues children and families face can be managed if addressed early, and siting the clinics in storefront retail locations reduces the stigma associated with traditional mental or behavioral health counseling, allowing the expert teams at UCLA to reach families who might otherwise never seek out traditional services or might not do so until crises arise.

Through December 23, the community can drop in and try out a variety of the clinic’s services. The UCLA Family Commons will then close its doors until its grand opening in early February. If proven successful, project leaders will aim to recreate the Family Commons model in other markets, creating a network of retail-based family coaching clinics. The approach could transform treatment and delivery systems for common childhood problems and, ultimately, change public perceptions of the role of prevention and early intervention in mental health care.

Open Notes and the Electronic Medical Record Podcast

Dec 18, 2009, 11:55 AM, Posted by RWJF Blog Team

"If you had the chance to look at what your physician wrote in your medical record about your last visit, would you take advantage of it?  Would this make your relationship with your doctor or primary care provider more collaborative? More effective?" These are just a few of the topics that host Madge Kaplan covered in yesterday's dynamic and engaging WIHI podcast on the Open Notes project and electronic medical records.

Guests included Dr. Tom DelBanco of Beth Israel Deaconess Medical Center and the Open Notes Project, as well as, Dr. Mary Merkel, a family practioner at Dartmouth-Hitchcock and Bob Desauiniers, Dr. Merkel's patient.

If you weren't able to catch yesterday's live broadcast, we encourage you to listen to the archived recording. You can also access additional information on the Open Notes project and the resources mentioned during program.

Gearing Up for the 2010 Games for Health Conference

Dec 16, 2009, 9:27 AM, Posted by RWJF Blog Team

The details have been announced for the sixth Games for Health Conference, the premiere annual event focusing on the role of digital interactive games in health and health care.

On May 25-27, 2010 at the Hyatt Harborside in Boston, health game developers, researchers, advocates and enthusiasts from all over will participate in specially developed learning and networking tracks: Active Gaming, Medical Training & Education, Physical Therapy & Rehab and Cognitive Gaming.  Have an idea for a session? Deadlines are fast approaching for the call for content so make sure to get your submissions in now.  

Every year, the Pioneer team shares highlights here on the blog and on our twitter account. While we will surely be sharing information before, during and after the event, we encourage you to experience the conference firsthand. Click here to register  and we hope to see you there!