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Expanding Opportunities for Rural Communities to Get Quality Care

Jun 9, 2015, 4:58 PM, Posted by Susan Hassmiller

Initiatives like the Future of Nursing and Project ECHO are expanding opportunities for more communities to get quality health care and lead healthier lives regardless of ZIP code.

Buncombe Farm Land

I read recently in The New York Times about Murlene Osburn, a cattle rancher and psychiatric nurse, who will finally be able to start seeing patients now that Nebraska has passed legislation enabling advanced practice nurses to practice without a doctor’s oversight.

Osburn earned her graduate degree to become a psychiatric nurse after becoming convinced of the need in her rural community, but she found it impossible to practice. That’s because a state law requiring advanced practice nurses to have a doctor’s approval before they performed tasks—tasks they were certified to do. The closest psychiatrist was seven hours away by car (thus the need for a psychiatric nurse), and he wanted to charge her $500 a month. She got discouraged and set aside her dream of helping her community.

I lived in Nebraska for seven years, and I know firsthand that many rural communities lack adequate health services. As a public health nurse supervisor responsible for the entire state, I regularly traveled to small, isolated communities. Some of these communities did not have a physician or dentist, let alone a psychiatric nurse. People are forced to drive long distances to attain care, and they often delay necessary medical treatment as a result—putting them at risk of becoming even sicker, with more complex medical conditions.

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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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What’s the Airbnb for Health? Pioneering Ideas Podcast Episode 9

May 27, 2015, 4:47 PM, Posted by Lori Melichar

The rise of the sharing economy could surface new innovations in health and health care. The latest episode of the Pioneering Ideas Podcast explores this idea and more.

RWJF Pioneering Ideas Podcast Editorial Art

Could the ideas behind Airbnb — a service that lets people share their homes with strangers — transform health and health care?

Airbnb is just one example of a company that’s emerged as part of the sharing economy (also referred to as the “collaborative” or “peer” economy), an ecosystem of companies all over the world that are fueled by collaborative consumption:

Named by TIME as one of the “10 Ideas That Will Change the World”, collaborative consumption describes the shift in consumer values from ownership to access. Together, entire communities and cities around the world are using network technologies to do more with less by renting, lending, swapping, bartering, gifting and sharing products on a scale never before possible. From Airbnb to Zipcar to Taskrabbit, collaborative consumption is transforming business, consumerism and the way we live for a more fulfilling and sustainable quality of life.” – collaborativeconsumption.com

Rachel Botsman, an expert on the sharing economy whose TED talk on the subject has been viewed nearly a million times, recently visited the Foundation as part of our What’s Next Health series of conversations with pioneering thinkers. In an email to staff after her visit, she observed that, “to date, there has been a lack of dialogue and actionable insights on the potential to apply sharing/collaborative economy principles to different aspects of health.”

This is not to say that there aren’t examples of collaborative consumption addressing aspects of our lives that are related to health. Take the example Rachel shared with me of Landshare, a company in the United Kingdom that matches people who want to grow food with people who have the space for a garden. Imagine transforming vacant lots in some of the poorest areas of our country into places to grow fresh fruits and vegetables; the sustained effect on Americans’ health and wellbeing could be profound.

The founders of another company, Cohealo, observed that so much health care equipment sits idle for over half of its lifetime, accessible only to a finite group of professionals working in a single location. By encouraging sharing within and across facilities, Cohealo has the potential to decrease costs and waste.

Rachel joins us in the latest episode of our Pioneering Ideas podcast to explain the rise of the sharing economy and to brainstorm how new additions to the movement may help solve some of the thorniest challenges in health and health care. Could your company apply the sharing economy to the ongoing challenge of helping others lead healthier lives?  What are you willing to share to help build a culture of health in America?

Listen below or on iTunes – and, in the spirit of the episode, we hope you’ll share it, too, with anyone you know who’s passionate about building a Culture of Health.

More stories in this episode:

  • Reimagining Medical Education: Discover how emerging technologies and approaches are powering collaboration within and between medical schools;
  • Exploring Agile Science: Explore how “agile science” seeks to rapidly discover and test the most effective paths to healthy behavior change;
  • A Personal Essay on Personal Data: Learn why grantee Gary Wolf of Quantified Self believes access to our personal health data is essential to building a true Culture of Health.

After you listen, share your thoughts below, or join the conversation on Twitter at #RWJFPodcast. And if you have cutting-edge ideas to share about building a Culture of Health in this country, I hope you’ll reach out to me at @lorimelichar or consider submitting a proposal.

Be well.

Lori Melichar

Lori Melichar, a labor economist, is a director at the Robert Wood Johnson Foundation where she focuses on discovering, exploring and learning from cutting edge ideas with the potential to help create a Culture of Health. Read her full bio.

One Cure for the World’s Toughest Challenges? Bold Leaders, Connected

May 19, 2015, 9:00 AM, Posted by Herminia Palacio

Change leadership means thinking big about impact, responding to urgent needs, and actively tolerating risk. This is the kind of big, bold way of working—together—that will get us to a Culture of Health.

Members of the Camden Coalition make home visit to patients around Camden, NJ.

Just over a year ago, I started in a new role at the Robert Wood Johnson Foundation. Not long after, my colleagues and I began the exciting, challenging, and collaborative process of co-designing four new programs that will develop, train, and network change leaders who will help build a Culture of Health.

You may be wondering – What is change leadership? How do we know it when we see it? And, why is it essential for achieving RWJF’s vision?

>>Could your organization serve as a National Leadership Program Center? View the call for proposals.

Here's the type of challenge our nation's leaders often face:

“For a half-century, charities, nonprofits and local and federal governments have poured billions of dollars into addressing the problems plaguing [many] Americans. But each issue tends to be treated separately – as if there is no connection between a safe environment and a child’s ability to learn, or high school dropout rates and crime.” –The Wall Street Journal, September 2013

Now here's an example of what change leadership looks like:

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Clearing the Air in Louisville through Data and Design

May 13, 2015, 12:44 PM, Posted by Alonzo L. Plough

Louisville, Kentucky ranks among the poorest in air quality and highest in asthma rates among U.S. cities. A new art installation from Propeller Health shows residents real-time changes in the city's air quality, equipping them with the data to reach their goal of becoming one of the healthiest cities by 2020.

Airbare air quality installation in Louisville, Kentucky

I stand in front of an intriguing art installation on a busy street corner in downtown Louisville, KY, and visualize the invisible. It’s a bright orange steel kiosk outfitted with an interactive touch screen that allows passersby to “see” how air pollution levels change around the city in real time while also learning how these pollutants impact the severity of asthma symptoms. Called AirBare, the installation project was funded by RWJF and represents a unique collaboration between visual artists, big data analysts and local health advocates. By “popping” virtual bubbles on the screen, users find out what causes air pollution and what it will take to reverse it. This is relevant information for residents of Louisville, a city that consistently ranks among the lowest in air quality in the nation and has one of the highest rates of asthma and other respiratory conditions.

My visit to the AirBare installation coincided with a conference held in Louisville in March that brought together economists, health policy folks, food experts and, remarkably, Charles, the Prince of Wales, to examine the issue of air quality and the larger concept of sustainability in this Ohio River Valley city. The Prince, a longtime advocate for environmental issues with connections in Louisville, added star power to the Harmony & Health conference, sponsored by the non-profit Institute of Health Air Water & Soil. But there is plenty else to be excited about in Louisville. Under the leadership of Mayor Greg Fischer, city agencies have collected reams of data on air quality, health outcomes, life expectancy, income inequality, and unemployment, among many other measures. What has emerged is a far better picture of the tough environmental and socioeconomic issues impacting the health and wellbeing of Louisville’s 600,000 residents, and a serious and concerted commitment to build a culture of health.

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Nurses and Physicians Need to Learn Together in Order to Work Together

May 11, 2015, 9:34 AM, Posted by Maja Djukic

Many practitioners understand the value of interprofessional education—the challenge is to make sure all our nation’s educators and providers do.

Nurse and physicians

Imagine your grandmother or someone you love falls and breaks her hip, arriving at the hospital in excruciating pain. She desperately needs pain medication and the nurse or medical resident on duty calls a senior clinician to request it. But the clinician says she’s busy and can’t see your loved one for at least an hour. How would you feel if the nurse or resident passively accepted this response? Alternatively, what if they challenged it?

Nurses and early career doctors regularly encounter thorny scenarios like these. Unfortunately, many hesitate to challenge senior colleagues, even when a fragile patient urgently needs help. Senior clinicians may even berate perceived subordinates for challenging their authority.

At New York University, we are part of a growing movement that aims to change these pernicious patterns. Marc Triola, MD, and I co-led a project to give nursing and medical students the training they need to work better together.

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Retail Clinics Are Expanding Their Role Within the Health Care System

May 6, 2015, 3:38 PM, Posted by Tara Oakman

With convenient weekend and after-hours care, retail clinics have the potential to expand access to basic primary care and help address some non-clinical needs underlying the social determinants of health.

A CVS Retail Clinic at the corner of a street.

My husband had been suffering from a very painful sore throat for a couple of days when he finally decided to call his doctor. Just one problem: It was a Friday morning and the office was booked for the day. The doctor called back later in the afternoon and told my husband it sounded like a virus and he should simply “wait it out.” With the weekend approaching, the next available appointment—if needed—was on Monday. Rather than suffer all weekend with a raw throat, my husband followed the advice of a relative (who also happens to be a physician) and went to a clinic at our local CVS. Less than an hour later he was diagnosed with strep throat and started on antibiotic therapy he picked up at the pharmacy. By Saturday evening he was feeling a lot better.

Access to quick, convenient care on nights and weekends is one of the prime selling points of “retail clinics” based in pharmacies, groceries, and big-box retailers. With longer operating hours and no need for an appointment, these clinics, sometimes called “doc-in-a-box,” give patients more flexibility to avoid time away from work and family. Plus, a trip to a retail clinic costs about one-third less than a visit to a doctor’s office, and is far cheaper than an emergency room. Retail clinics usually accept private insurance, Medicare, and, in many cases, Medicaid; yet people without insurance or a personal physician also are using them for treatment of routine illnesses, basic health screenings, and low-level acute problems like cuts, sprains, and rashes.

New shopping list: Pick up milk, breakfast cereal, and toilet paper; get a flu shot and that weird rash checked out.

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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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No Time to Waste in Battle to Regulate E-cigarettes

Apr 28, 2015, 8:53 AM, Posted by Joe Marx

The CDC just released alarming data on the new rise of electronic cigarette use among U.S. teens. Unless the FDA acts now, it may get worse with each passing day which is a gamble we can't take.

If the health debate coalescing around e-cigarettes feels familiar, there’s good reason. The uncertainty and questions about this relatively new—and unregulated—product harken back to an age when it was chic for Hollywood stars to blow smoke at the screen, and cigarette brands were plastered all over race cars.  

The tobacco industry knew just what to do to entice young people, and this formula hooked millions upon millions of them and locked in a lifetime of smoking—tragically shortening lives in countless cases.

Even today, just over 50 years since the Surgeon General’s first landmark report on Smoking and Health, tobacco addiction causes a host of cancers and other illnesses. Smoking is still the leading preventable cause of death in the U.S., killing 480,000 people annually and costing over $325 billion in medical expenditures and lost productivity.

E-cigarette graphic

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We Went to Oxford and Got Schooled in Primary Care

Apr 23, 2015, 9:00 AM, Posted by Maryjoan Ladden, Susan Mende

As other countries continue to spend far less on health care but perform better on measurable health outcomes, there's opportunity to learn what works abroad and apply those lessons stateside.

Oxford University

It’s a hard notion for many Americans to accept—although we spend more money on health care than any other country in the world, we are far from having the best health outcomes. When you look at measures that include life expectancy, infant mortality rates and preventable illness, other countries that spend far less than the U.S. perform better. But in many of these countries people of all ages and socio-economic status are able to easily access primary care that is comprehensive, patient-centered and rooted in local communities.

One of our goals as program officers at RWJF is to look beyond our borders to identify promising practices that might be incorporated into America’s health care system. Last fall we traveled to Oxford, England, to learn first-hand about promising primary care practices in Chile, England, the Netherlands and Canada—all high and middle income countries that spend less on health care yet have better outcomes than the U.S. We attended a conference organized by the Training and Research Support Centre (TARSC), an organization supported by Charities Aid Foundation of America through a grant from the RWJF Donor-Advised Fund. TARSC provides support and training to government and civic health organizations, and the conference was the next step after its report, “Strengthening primary care in the USA to improve health: Learning from high and middle income countries.” We came away with a lot of insights from both, but were struck by several themes that were constant throughout.

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