Author Archives: RWJF Blog Team

Cutting Calories: Good for Health, Good for Business

Sep 16, 2014, 12:58 PM, Posted by RWJF Blog Team

Family shopping together in grocery store.

Four years ago, 16 companies, acting together as part of the Healthy Weight Commitment Foundation (HWCF), announced an ambitious pledge—to remove 1.5 trillion calories from the U.S. marketplace by 2015. They wanted to help reduce obesity in America, especially childhood obesity. Research published today in the American Journal of Preventive Medicine confirms that the companies far exceeded their pledge, and are making a difference that’s helping families buy fewer calories.

Collectively, these companies sold 6.4 trillion fewer calories in 2012 than they did in 2007, which we announced in early 2014. What’s new in these studies tells us that, during that same pledge period, families with children bought fewer calories from packaged foods and beverages—and the biggest cuts were from major sources of excess calories in kids’ diets, such as sweets, snacks, and soft drinks.

Why is this pledge so important, and what’s the next step for industry leaders who want to help reverse the childhood obesity epidemic? RWJF senior vice president Jim Marks and lead study author Barry Popkin, PhD, of the School of Public Health at the University of North Carolina at Chapel Hill, share their views.

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Another reason to get your flu shot - It can help reduce antibiotic resistance

Aug 17, 2011, 2:33 AM, Posted by RWJF Blog Team

Pioneer grantee Ramanan Laxminarayan, director of Extending the Cure, recently shared his perspective on The Health Care Blog about a new study published in the July issue of Infection Control and Hospital Epidemology. The study shows that antibiotic prescriptions tend to spike during the flu season, even though influenza is caused by a virus and cannot be treated with antibiotics.

According to Extending the Cure, between 500,000 to one million antibiotic prescriptions are filled each year during the flu season for patients who have the flu and no bacterial illness. This overuse is one of the many causes of the recent spike in antibiotic resistant bacteria.

Laxminarayan proposes a simple solution to this problem – get your flu vaccine this year. If you do not contract the flu, then there is no possible way your care provider will needlessly prescribe you antibiotics to treat it.

 What are some other  ways to curtail the epidemic of drug-resistant bacteria, both during this year’s flu season and beyond? We’re interested in hearing your thoughts – leave a comment here or on THCB.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Accentuating the Positives: Positive Health

Aug 2, 2011, 12:44 PM, Posted by RWJF Blog Team

What comes to mind when you think of medicine? If you’re like most people, it is preventing disease and treating them when they are sick.

But health is more than the mere absence of disease. So what if there were options for medicine beyond the prevention, diagnosis, treatment and cure of disease?

Researchers who work in the emerging field of Positive Health are exploring the possibility that people have and can develop positive health assets that keep them healthier and help them recover more quickly when they are sick. The research is taking an empirical approach to developing the field. Positive Health research explores associations between health assets -- including subjective factors like optimism, functional factors like stable marriage, and biological factors like high heart rate variability – and people’s health.

The research is starting to gain traction in health and medical literature.

  • Health Psychology published a study finding that positive psychological well-being – defined as emotional vitality and optimism – was associated with lower levels of risk for heart disease. The study re-analyzed existing data from a survey of 7,942 middle-aged men and women over five years who were measured through their responses to statements about purpose in life, mental energy and the expectation of more good things than bad to occur in the near future. Positive psychological well-being was associated with a modest, but consistent reduced risk of fatal heart disease, first heart attack or first definite angina. 
  • The European Heart Journal published a study stating that higher levels of life satisfaction were associated with lower risk of heart disease. The study re-analyzed existing data from a survey of 7,956 British civil servants who rated their satisfaction with eight domains of life: love relationships, leisure activities, standard of living, job, health, family, sex life and self. Four of these life domains—job, family life, sex life and self satisfaction—were independently associated with a 12 percent reduced risk of heart disease, as was higher overall life satisfaction.
  • The journal Stroke published a study linking higher levels of optimism to lower risk for stroke. The study assessed 6,044 American adults for optimism and tracked their incidence of stroke. Participants rated items such as “In uncertain times, I usually expect the best” on a six-point scale, resulting in an overall score between 3 and 18. Each unit increase in optimism correlated to a 9 percent decrease in stroke risk during a two-year follow-up period.

Positive Health changes the way we think about health and health care—it reframes the goal of our health care system from treating and preventing disease to building more robust health. This  innovative approach to health and well-being  promotes people’s positive health assets—their strengths that can help protect against disease and lead to a healthier, longer life. The focus is not on prevention or treatment of disease, but instead on building an individual’s “good” assets that are desirable in their own right.

With the support of the Pioneer Portfolio, Martin Seligman, Ph.D., project director and director of the Positive Psychology Center at the University of Pennsylvania, and a team of researchers are working to identify these assets. If identified and validated, the next step would be to design potent, low-cost approaches to enhance well-being and help protect against physical and mental illness.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Project ECHO: A Game-Changer for Patient Care?

Jun 16, 2011, 4:32 AM, Posted by RWJF Blog Team

Note: This post originally appeared on The Health Care Blog June 14, 2011

By Brian Quinn, RWJF assistant vice president, Research and Evaluation:

I met Sanjeev Arora as part of the RWJ crowd at TEDMED last year and was pretty impressed with his approach–especially given the lack of access to care in poor and minority regions. Now there’s proof his approach works –Matthew Holt

On June 1 the New England Journal of Medicinepublished a study about how primary care providers can treat very sick patients who previously did not have access to specialty care.  The piece described Project ECHO, a disruptive model of health care delivery based on collaborative practice that has the potential to transform health care.  Supported by Robert Wood Johnson’s Pioneer Portfolio and based at the University of New Mexico Health Sciences Center (UNMHSC), Project ECHO was developed by Sanjeev Arora, M.D., a hepatologist at UNMHSC and leading social innovator.

The ECHO model organizes community-based primary care clinicians into disease-specific knowledge networks that meet through weekly videoconferencing to present patient cases.  These “virtual grand rounds” are led by specialists at academic medical centers who train providers to provide specialized care, share best practices and co-manage complex chronic illness care for patients with the local care team. Under this model, primary care providers treat patients in their own communities – burdens on academic center capacity are reduced, poor access to care is eliminated  (patients are no longer limited by geography when seeking quality care), and the health care systems’ capacity to provide high quality care to more patients, sooner, is dramatically expanded.

In the NEJM study, patients with hepatitis C treated by primary care clinicians working through Project ECHO achieved results that were identical to patients treated by UNMHSC specialists.  The evaluation also showed that the ECHO model can reduce racial and ethnic disparities in treatment outcomes.

Project ECHO offers promise as a game-changer for how patients with complex illnesses are treated.  Dr. Arora describes the power of ECHO’s knowledge networks as a “force multiplier,” which “transforms the dynamics and the capacity of health care delivery and the spread of best practices.”

In an accompanying editorial, Thomas D. Sequist, M.D., associate professor of medicine and of health care policy at Harvard Medical School and Brigham and Women’s Hospital, said Project ECHO “represents an important step forward” in addressing barriers to accessing specialty care.  He notes that the NEJM study raises several issues, including the need for  adequate health information technology to implement the ECHO model successfully, the critical role of academic medical centers in supporting the model and the potential for meeting local community health care needs by extending the model to additional chronic diseases.

Sequist makes excellent points, and Project ECHO is already addressing them head-on.

The ECHO model harnesses communications technology to form truly collaborative provider partnerships that permit care in home communities.  It connects the wealth of knowledge and expertise housed at academic medical centers and the desire of primary care providers to do more for their patients.  And although the findings from theNEJM evaluation focus on hepatitis C, the Project ECHO model has spread to include asthma, mental illness, chronic pain, diabetes and cardiovascular risk reduction, high-risk pregnancy, HIV/AIDS, pediatric obesity, rheumatology and substance abuse.

ECHO represents a fundamental rethinking of how we use our limited supply of physicians, how we engage a full care team in chronic disease management, how we teach best practices and how we provide access to quality care for all.  We know we have physician shortages, an aging population and 32 million more Americans who are going to become insured in the coming years.  Dr. Arora has developed a disruptive innovation that addresses these challenges.

Through ECHO, providers – not just doctors, but nurses, nurse practitioners, physician assistants and community health workers – are teamed to work together to the benefit of patients who receive accessible, high quality care.

Isn’t that what we all are striving to deliver?

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Project ECHO: Transforming Health Care Education and Delivery

Jun 2, 2011, 6:05 AM, Posted by RWJF Blog Team

Findings from an evaluation of Project ECHO published June 1 online by the New England Journal of Medicine demonstrate that primary care providers can be trained via videoconferencing technology to manage complex chronic conditions formerly outside their expertise – in this case, hepatitis C – thus expanding their ability to treat very sick patients.

Project ECHO (Extension for Community Healthcare Outcomes) is a disruptive model for health care training and delivery that shows how health care providers everywhere can work collaboratively to provide better care. 

In the NEJM study, primary care providers across a variety of settings in New Mexico were able to treat – and even cure – patients with hepatitis C who previously couldn’t get treatment.  In fact, cure rates for patients treated through ECHO were the same as those for patients treated at a university medical center.  Project ECHO’s videoconferencing clinics also address asthma, mental illness, chronic pain, diabetes and cardiovascular risk reduction, high-risk pregnancy, HIV/AIDS, pediatric obesity, rheumatology and substance.

Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation (RWJF), calls the model “the future of health care for those who aspire to excellence.” Project ECHO, she says, “demonstrates how health care providers everywhere can—and should—work collaboratively to provide better care.”

With the support of a three-year grant from RWJF’s Pioneer Portfolio, the ECHO model is spreading across the United States.  Replications of ECHO are already underway in Washington state and Chicago, and other potential sites are actively exploring the model.  Several government agencies have expressed strong interest in ECHO, as well.

To learn more about the study and Project ECHO, we encourage you to read some  of the excellent coverage on nextgov and HealthcareITNews.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Games For Health Conference: A Q&A with Dan Baden, Centers for Disease Control and Prevention

May 20, 2011, 9:46 AM, Posted by RWJF Blog Team

Before this week's Games for Health Conference kicked-off, NewPublicHealth had the opportunity to interview panelist Dan Baden, M.D., director of the Centers for Disease Control and Prevention, Division of Public Health Practice, about gaming for health. Below is the full Q&A, which originally appeared on NewPublicHealth earier in the week. 

NPH: You’re a panelist at the conference. What will you be speaking about?

Baden: I’m talking about an overview of CDC and some of the activities that we’ve done in the past. We have several simulations that I’m going to focus on.  One is for people training miners–how they can safely evacuate mines during emergencies.  We’ve got a health policy game that I’m going to highlight.  And we have some flu activities for people to participate in, such as giving out information about  flu vaccines.

NPH: What is the critical mass that you need in order for the games to be able to deliver public health messages?

Baden: I think that they can be used to deliver public health messages at any size.  But actually the number of people involved in games is enormous.  The organizer of the conference was speaking in the same panel as I was in earlier today and was saying that of all demographic groups, only males over age 55 indicate that they watch more TV than use  the computer.  All the other demographic groups say they use the computer for multiple purposes  and more than they watch TV. And the largest group of people to use what are called “‘casual games” is women between the age-mid 20s to mid 50s.  There are lots of people that are doing this right now.

Back to the other part of your question, an individual game I think can have an impact.  There is one called Madden Football. It’s a video game where you have a football team and you run them through different games.  But for this year’s version they are incorporating a new concussion policy.  So if your player has a concussion during the game, your player is out for the game, and you’re not allowed to bring them in.  Whereas in the past you could bring them in the next quarter. [The new rules of the game are ]consistent with current concussion therapy.

NPH:  Can you think of other examples where the game isn’t set up to be a public health game–but what you can do is incorporate appropriate, correct, accurate, vetted public health messages in almost any game?

Baden: There are many.  There are lots of car race games, for example.  And you can have people in the race game who are using seat belts and restraints or helmets. Or if you want to twist it the other way–I don’t know if this is out there–but if you have a game where someone’s driving around recklessly in their car–if they don’t wear their seat belt–maybe they have a higher chance of being ejected from the car and having consequences from not following that preventive measure. There’s many ways you can incorporate public health messages into these games without converting or corrupting the game itself.

NPH:  What’s something at next year’s conference you’d like to see–a game that has a larger message or a particular message–maybe HIV prevention?

Baden: I would like to see games that focus on other winnable battles that CDC has  priorities such as tobacco control, improved nutrition, increased physical activity and tobacco control, for example.

NPH: You were talking about men over 55 not being a particular demographic group that uses computers more than they watch television.  But that is a demographic group that could use some of the benefits you have shown in the games–like seat belt protection, safe driving, safe sex.  Will that be a goal for you do you think?  To figure out how to engage men in that age group in using these games for positive impact as well?

Baden: I think we’ll probably stick with our traditional methods for now. We’re already having outreach to them–rather than try and drive people to games. Though they’re probably going to go there eventually on their own, and at that point are likely to find even more public health messages than now.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Project ECHO Profiled in Health Affairs

May 19, 2011, 12:18 PM, Posted by RWJF Blog Team

 Project ECHO, a Pioneer supported project, is fundamentally changing the way health care is provided across the United States, bringing best-practice specialty care to patients with chronic health conditions, wherever they are. Millions of Americans suffering from serious chronic illnesses have severely limited access to specialty care because they live in underserved areas, both rural and urban. At the University of New Mexico Health Sciences Center, social innovator Sanjeev Arora, M.D., developed this disruptive model of health education and delivery to eliminate the distance barrier so that primary care doctors in underserved areas can provide top-quality care for complex conditions locally.

A Health Affairs Web First, released online today and appearing in the June edition of the journal, provides an in-depth profile of Project ECHO as an example of delivery system innovation, describing how the program leverages videoconferencing technology to train primary care doctors to deliver specialty care in their local settings and create large, real-time knowledge networks. In this way, ECHO exponentially expands the capacities of the health care workforce, providing “health care without walls.”

This commentary originally appeared on the RWJF Pioneering Ideas blog.

mHealth Evidence: Call for Whitepapers

May 9, 2011, 3:44 AM, Posted by RWJF Blog Team

Mobile health (mHealth) has the potential to simultaneously reduce the cost of health care and improve our health by encouraging healthy behaviors, providing continuous monitoring to prevent or reduce health problems, reducing acute health care visits, and providing personalized, real-time intervention in the mobile environment. However, traditional methods of evaluation needed to address efficacy and safety in mHealth are not well aligned to the pace of technological development.

 To address this need, we’ve formed a partnership with the McKesson Foundation, the National Science Foundation and the Office of Behavioral and Social Sciences Research at NIH. As part of this partnership, we are issuing a call for white papers on alternative research designs to the traditional randomized control trial that could be applied to mHealth intervention research or in analyses of rich longitudinal data sets that could be applied to analyzing the data obtained from mHealth applications.

Authors of accepted whitepapers will be invited to attend the August 2011 mHealth Evidence Meeting in Bethesda, MD, which will bring together individuals with diverse expertise in data analysis and experimental design to identify innovative methods that can accelerate the evaluation of the efficacy and safety of mHealth technologies. Travel will be reimbursed by the event’s sponsors. Results from the workshop will be used to define the research agenda for evaluation of mobile health technology.

A couple of important dates to keep in mind:

Deadline for submission: May 27 (11:59 EST)

Notification of Invitation: June 10

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Pioneer Heads to Mobile Health 2011: What Really Works Conference

May 3, 2011, 11:50 AM, Posted by RWJF Blog Team

On Wednesday, Pioneer team members Brian Quinn and Al Shar will be attending Stanford University’s two-day Mobile Health 2011: What Really Works conference (Pioneer is also a sponsor of the event). This event, which is being led by Stanford’s B.J. Fogg, promises to be yet another great opportunity to explore how mobile technologies are improving the health of everyday people.

If you’re on Twitter, you can follow along with Brian and Al as they live tweet from the event. You can also join the conversation by using the hashtag #MH11. We will post a few key takeaways from the event next week, so check back on Pioneering Ideas often and be sure to let us know your thoughts by leaving a comment. 

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Are We Underestimating Why People Engage in Unhealthy Behaviors?

Apr 8, 2011, 3:42 AM, Posted by RWJF Blog Team

This post was contributed to Pioneering Ideas by Kevin Volpp, MD, PhD. Kevin is the director of the Leonard Davis Institute of Health Economics. 

At the Leonard Davis Institute of Health Economics Center for Health Incentives 2011 Symposium on Behavioral Economics  (sponsored by RWJF), we pulled together about 50 behavioral economists, clinical health services researchers, and funders from across the United States to talk about the state of behavioral economics in developing applications to health. During the symposium, we matched people into one of eight workgroups in areas like obesity, medication adherence, and provider payment, where we combined content experts with smart people who had never worked in those areas.  Our hopes being that they would bring fresh insights to areas that are big public health or economic problems with large, unsolved challenges.

We gave each group two hours to put together a group presentation assessing the state of the field in their area and to come up with ideas for future studies. Surprisingly, nearly all the groups actually chose to spend more time than what was allotted, spending about three hours working on this task. The presentations were much more refined than I expected and seemed to reflect an intense dialogue about where behavioral economics could help, and where it is perhaps being oversold. Overall, the workgroups worked out better than I had hoped.

One of the key themes that emerged from the groups is that we – the academic community or others like public health policy makers – often think we know what is best for people, but may underestimate the degree to which people actually prefer to engage in unhealthy behavior. We need to do a better job of systematically building in assessments of why people don't do things whenever we try to develop interventions so that we can understand what works in whom, and, in the future, better target our efforts.

In situations where interventions are appropriate due to either externalities (costs our actions impose on others) or internalities (costs our actions impose on our future selves due to under-appreciation of the future costs of our actions) we should also consider broader use of mandates. For example, it seems reasonable to say that health care workers should be mandated to get flu shots rather than relying on encouragement, or encouragement plus incentives, to get the rates up.

I am hoping that new collaborations will be forged from the discussions that happened. The level of enthusiasm among the researchers in attendance seems high and people are optimistic that behavioral economics can lead to significant improvements in health similar to the contributions that have been made in improving savings behavior.

This commentary originally appeared on the RWJF Pioneering Ideas blog.