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Author Archives: Susan Dentzer

Why Nursing is Key to a Culture of Health

Oct 9, 2015, 1:38 PM, Posted by Susan Dentzer

Nurses taking blood pressure

If a Culture of Health means recognizing health’s central importance in our lives, then nurses can be among that culture’s leading ambassadors. More often than not nurses are fully immersed in their patients’ lives, and there are case studies throughout the nation of nurses using that involvement to guide patients in innovative ways to better health.

Consider Stephen and Sandra Sheller 11th Street Family Health Services, a nurse-led Philadelphia clinic serving residents of four low-income public housing projects. Their health center was created in direct response to residents’ requests, and includes not just primary care, but also mental and behavioral health, dental health, and couples and family therapists. There’s a small urban farm producing fruits and vegetables, and a “teaching kitchen” where residents can learn healthy cooking techniques.

At the 11th Street Clinic, nurse-led teams carefully consider each patient’s unique needs. “We don’t ask, ‘What’s wrong with this person?’,“ the clinic’s founder, public health nurse Patricia Gerrity, said at a recent Robert Wood Johnson Foundation Google+Hangout. “We ask, ‘What’s happened to this person?“ that could affect his or her health.

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Reaping the Rewards of the Culture of Health Prize

Aug 10, 2015, 3:25 PM, Posted by Susan Dentzer

It's been a year since Brownsville, Texas, won the Culture of Health Prize for its engagement of leaders across sectors to improve local health outcomes. Here's what the community has been up to since.

Brownsville, TX 2014 Culture of Health Prize Winner

Brownsville, Texas, had plenty to celebrate when it became one of six communities to win the Robert Wood Johnson Foundation’s Culture of Health Prize in June 2014. This predominantly Hispanic city along the U.S.-Mexico border is one of the poorest in the country. Seven in 10 residents are uninsured, 8 in 10 are overweight or obese, and 1 in 3 has diabetes. Yet the community’s efforts to improve health—including new bike trails, community gardens, and a successful bilingual public health education campaign—have earned it wide respect and national recognition, along with $25,000 that goes with the RWJF Culture of Health Prize.

City officials are still discussing how to use the prize money. One option is commissioning a piece of artwork that could be moved around to highlight various initiatives, such as the periodic CycloBia events that make some of the city’s streets car-free for a day so that residents can bike, run, or engage in other physical activity.

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Getting to the Essence of Value in Health Care

Aug 3, 2015, 1:57 PM, Posted by Susan Dentzer

In this era of value-based payment, we need to consider how different players within health care approach the value equation.

2013 April Cost Test

How would you judge the value of your health care? A longstanding definition of treatment holds that value is the health outcomes achieved for the dollars spent. Yet behind that seemingly simple formula lies much complexity.

Think about it: Calculating outcomes and costs for treating a short-term acute condition, such as a child’s strep throat, may be easy. But it’s far harder to pinpoint value in a long-term serious illness such as advanced cancer, in which both both the outcomes and costs of treating a given individual—let alone a population with a particular cancer—may be unknown for years. And then there’s the complicating issue of our individual preferences, since one person’s definition of a good outcome—say, another few years of life—may differ from another’s, who may be seeking a total cure.

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Building Healthier Places In Birmingham and Beyond

Jun 1, 2015, 11:46 AM, Posted by Susan Dentzer

How a section of Birmingham, Alabama is redeveloping and offering greater opportunities for people at multiple income levels. The secret? Engaging the community throughout the process.

With its elegant homes, pleasant park and bustling stores, the Woodlawn section of Birmingham, Alabama was described in a 1950 news article as “a really great section of Birmingham...typical of the fine things in life." Then came the racial unrest of the 1960s, disruption from urban renewal gone awry and white flight to Birmingham’s suburbs. Joblessness and poverty took root; the housing stock decayed. Today, median income in Woodlawn is just $21,000, less than half the level for Birmingham as a whole.

But now Woodlawn is in the midst of a turnaround, aiming to become not just a neighborhood that prospers economically, but also one where people live healthier lives.

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Opening the Care Conversation through OpenNotes

May 4, 2015, 10:01 AM, Posted by Susan Dentzer

More than 30 health systems have adopted the practice of sharing clinicians' notes with patients, making OpenNotes more than just a revolutionary idea but a movement in health care.

Open Notes_20120530_01007

It’s a memory aid. It’s truth serum. Using it can transform relationships forever. These may sound like come-ons for the type of product typically hawked on late-night television. But in fact, they’re some of the things people are saying about OpenNotes.

OpenNotes isn’t a product, but an idea: That the notes doctors and other clinicians write about visits with patients should be available to the patients themselves. Although federal law gives patients that right, longstanding medical practice has been to reserve those visit notes for clinicians’ eyes only.

But Tom Delbanco and Jan Walker, a physician and nurse at Beth Israel Deaconess Medical Center in Boston, have long seen things differently. Their personal experiences with patients, and inability to access care records for their own family members, persuaded them that the traditional practice of “closed” visit notes had to change. So, with primary support from the Robert Wood Johnson Foundation, they launched what has now become a movement.

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Three Key Lessons from the Health Care Transparency Summit

Apr 16, 2015, 1:36 PM, Posted by Anne Weiss, Susan Dentzer

A magnifying glass lies on top of money. (Image via taxrebate.org.uk)

“There is no single more powerful concept” in transforming health care than transparency—that is, accurate information for everybody about the costs, quality, and other aspects of health care—according to former US Senate Majority Leader and Robert Wood Johnson Foundation Board Member Bill Frist at the Second National Summit on Transparency in Health Care Costs, Prices, and Quality. Not only is shining the spotlight on costs and quality the key to making health care markets work, Frist said, but it’s also central to delivering the vaunted Triple Aim of better health, better health care, and lower costs. Here are our key takeaways reflecting how much transparency discussions have advanced since the first RWJF sponsored summit in 2013:

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What Will it Take to Help All Kids Grow Up at a Healthy Weight?

Mar 4, 2015, 11:16 AM, Posted by Susan Dentzer

We can all play a role in helping children grow up at a healthy weight, including the U.S. Soccer Foundation. Their work is helping make strides in reducing childhood obesity rates. Here's how.

A group of teens playing soccer.

Washington, D.C.’s Shaw neighborhood is named after Colonel Robert Gould Shaw, who commanded the famed 54th Massachusetts Volunteer Infantry, the all-black regiment that fought for the Union during the Civil War. Today, the multi-ethnic neighborhood is home to the U Street Corridor, a revived commercial district known in the early 1900s as “Black Broadway"; Ben’s Chili Bowl, a celebrated city landmark; and Seaton Elementary, a public school whose students are mainly Hispanic, African-American, and Asian.  

It’s also home to the young goalie of Seaton’s soccer team, sixth grader Kevin Alvarez.

Like many kids in his neighborhood, Kevin, age 13, never played sports until recently, and was seriously overweight. Then his school was fortunate to become home to Soccer for Success®, a program managed locally by DC SCORES, a Washington, D.C., nonprofit.

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A Portrait of Women with Health Insurance

Feb 19, 2015, 2:21 PM, Posted by Susan Dentzer

2015 Health Care Coverage Billboard Image

For the second year running, more women than men have signed up for coverage in health insurance marketplaces during open enrollment under the Affordable Care Act. According to the Department of Health and Human Services, enrollment ran 56 percent female, 44 percent male, during last year’s open enrollment season; preliminary data from this year shows enrollment at 55 percent female, 45 percent male—a 10 percentage point difference.

What gives? An HHS spokeswoman says the department can’t explain most of the differential. Females make up about 51 percent of the U.S. population, but there is no real evidence that, prior to ACA implementation, they were disproportionately more likely to be uninsured than men—and in fact, some evidence indicates that they were less likely to be uninsured than males.

What is clear that many women were highly motivated to obtain coverage under the health reform law—most likely because they want it, and need it.

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Roadmaps Out of Fantasyland: RWJF’s Outbreaks Report and the National Health Preparedness Security Index

Jan 30, 2015, 5:47 PM, Posted by Susan Dentzer

Outbreaks 2014

“When you hear hoofbeats, think of horses, not zebras,” the late Theodore Woodward, a professor at the University of Maryland School of Medicine, cautioned his students in the 1940s. Woodward’s warning is still invoked to discourage doctors from making rare medical diagnoses for sick patients, when more common ones are usually the cause.

And while many Americans have worried about contracting Ebola—in viral terms, a kind of “zebra”—more commonplace microbial “horses,” such as influenza and measles viruses, continue to pose far greater threats. For instance, a large multistate measles outbreak has been traced to Disneyland theme parks in California—while this year’s strain of seasonal flu has turned out to be severe and widespread.

One obvious conclusion is that many microbes remain a harmful health menace, expected to kill hundreds of thousands of Americans this year. Another—speaking of Disneyland—is that much of America appears to live in a kind of fantasyland, thinking that it is protected against infectious disease.

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Open Health Data: How To Go for the Gold?

Jan 16, 2015, 1:25 PM, Posted by Susan Dentzer

Dr. Eric Topol Eric J. Topol, M.D.

In his new book, The Patient Will See You Now, Eric Topol, MD, invokes the famed Arabian folk tale One Thousand and One Nights, in which the poor woodcutter Ali Baba utters "Open Sesame" to unseal the cave where thieves have a treasure of gold coins. Topol asks "whether we, like Ali Baba, can breech the gate that keeps us from [health and health care] data, to a new world of openness and transparency."

It's worth remembering that, in the folk tale, Ali Baba does get rich — but after fighting over the gold, almost everybody else ends up dead.

So how do we ensure that the story of increasingly open health data has a more universally happy ending?

It won’t be easy, and Topol acknowledges the quandaries of dealing with the "gold" — the enormous flow of health data already under way.

Among the issues:

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