Oct 21, 2015, 1:11 PM, Posted by
Kathleen Grimm, Vikas Saini
Two physicians describe how they are mobilizing patients, providers and others, to change the culture of overuse in health care, to one that is individualized, compassionate and just.
The end of life can be fraught with emotion and excruciating decisions for families. It is a time when overuse of treatments and interventions occurs far too frequently. The culture of medicine teaches physicians to “do everything you can” to keep patients alive, with an underlying message that more is better when it comes to treatments and interventions. For doctors, patients and their families, making the decision to refuse extraordinary measures can feel like giving up.
As physicians who are active in the Lown Institute’s RightCare Alliance, we are dedicated to changing this culture. We know that a range of practices persist as standards that don’t improve the length or quality of life. Overuse and inappropriate care are baked into how we do things to the point that they are almost invisible. From frequent blood draws in the hospital to unneeded imaging for a normal pregnancy and futile chemotherapy in end-stage cancer, our goal is to keep patients safe from unnecessary diagnosis, treatment, and ultimately, harm. We think that it is critical to combine an understanding of the true benefits and risks of procedures and therapies with a respect for a patient’s wishes. Such a thoughtful approach that individualizes care, promotes doing more for the patient and less to the patient.
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Oct 19, 2015, 8:00 AM, Posted by
Emmy Ganos, Tara Oakman
Healthcare professionals, patients, and allies across the nation are banding together to promote an understanding of what good medical care can and should be with RightCare Action Week.
Sometimes, more is definitely better. Getting that extra hour of sleep can greatly benefit your mind, body and day. Cars that get more miles per gallon are cheaper and cleaner to run. And who would argue against more vacation time?
But when it comes to health care, more is not always better. Unnecessary diagnostic tests, treatments or hospitalizations can drive up health care costs, and in some cases, actually harm patients. For example, excess imaging increases exposure to radiation. Overuse of screening and diagnostic tests can lead to stressful false positives. And unnecessary treatments, drugs or procedures increase the risk of serious complications. In the larger picture, the estimated $200 billion spent on inappropriate care each year diverts resources away from services that are actually needed both within and outside of the health system—in mental health, housing, and infrastructure, for example—that can help all Americans lead healthier lives.
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Oct 6, 2015, 11:05 AM, Posted by
In recent years, cross-jurisdictional sharing has been a focus for policymakers and public health officials wishing to increase effectiveness and efficiency in the delivery of public health services. Measuring its impact is next.
Well-functioning, high-value public health departments are critically important to ensuring the conditions for good health in communities. In recent years, however, health departments have been faced with exceptional financial challenges mostly in the form of repeated reductions in state and local funding for public health budgets. At the same time, expectations for their roles and responsibilities—as monitors and chief health strategists for communities and as partners within and beyond the health sector—are growing.
In 2012, RWJF launched a program to investigate a potential strategy for strengthening health departments that could be especially effective in times of financial or administrative hardship, and importantly, could also help to augment the capabilities of health departments serving particularly small or rural jurisdictions: cross-jurisdictional sharing (or more simply, publicly authorized sharing of public health services across jurisdictions). The Center for Sharing Public Health Services (CSPHS) was designed to help build the evidence for how cross-jurisdictional sharing (CJS) arrangements can be planned for and implemented in different environments.
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Sep 15, 2015, 10:16 AM, Posted by
Aligning Forces for Quality not only transformed care in 16 communities, but it provided insights to help shape efforts building a national Culture of Health through high value care.
In a Culture of Health, how can communities improve the quality and value of health care? What happens when people who get, give, and pay for health care locally work together? In 2007, the Robert Wood Johnson Foundation (RWJF) set out to answer these questions when it launched Aligning Forces for Quality with an audacious goal: To transform the quality, equality, and value of regional health care markets.
Along the way, we explored what happens when the people who get, give, and pay for health care locally, work together. Our investment sparked deep and meaningful change in 16 very different communities across America, and important lessons learned in each and every one. But three lessons in particular helped drive success and can be applied to our work to build a national Culture of Health.
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Aug 3, 2015, 1:57 PM, Posted by
In this era of value-based payment, we need to consider how different players within health care approach the value equation.
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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Jul 23, 2015, 10:45 AM, Posted by
When it comes to bridging health and health care delivery, the U.S. has an opportunity to learn from global innovations that link the public health, social services, and health care systems.
It started with three hundred Boy Scouts from across Uganda being trained as “social monitors”. They were tasked with reporting the conditions of their communities to Uganda’s Ministry of Health through their mobile phones. In less than a year, these “U-reporters” grew to over 89,000. The U-report itself is a free SMS-based system that allows young Ugandans to share what’s happening in their communities and work with community leaders and government to affect positive change. The information gathered is disseminated through radio, TV, websites, youth events, community dialogue and other ways.
This system of real time surveillance is a vital new development for the world’s fifth-fastest growing country. Reliable health information in Uganda can mean the difference between life and death. As has been seen recently, epidemics like Ebola or West Nile thrive on information delays. Furthermore, U-reports are empowering Ugandans to share responsibility for creating healthier conditions within their communities.
The U-report is just one of the many exciting global innovations highlighted in a report by the Robert Wood Johnson Foundation (RWJF) and AcademyHealth. Written by Margo Edmunds and Ellen Albritton at AcademyHealth, the report showcases innovations that link public health, social services, and health care systems. These initiatives serve as examples of bridging otherwise disparate elements of health and health care delivery. The authors deliberately selected racially, ethnically and economically diverse regions around the world to ensure that their innovations were applicable to and reflected the diversity of the United States. A Google Hangout also convened several experts to discuss the report’s findings.
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Jun 29, 2015, 4:43 PM, Posted by
Health care is centered around human relationships, which is why it's so important the voices of the people the system is designed to help—patients and their families—are heard by those defining and measuring care.
Summer has come at last! Along with all the usual endings and beginnings that come with this time of year, there’s an important new opportunity for those of us who are passionate about improving health care. The Medicare Access and CHIP Reauthorization Act of 2015 threw out Medicare’s old rules for paying physicians and substituted a new system, one that’s supposed to reward physicians for delivering high quality, high value care. This is a game-changer many years in the making, but as with any complex new law, the details matter. How will Medicare define and measure high quality, high value care? We can get some hints from CMS’ new strategic vision for physician quality reporting.
If I were granted just one wish by the people who are going to define and measure high value care, I know what I’d say: listen to our voices, the voices of patients and families, the ultimate health care consumers. Listening to patient voices and providing care that is patient-centered can improve clinical outcomes, reduce “waste” in health care by reducing unnecessary testing, and increase the overall care experience for both patients and providers. Health care is centered around human interactions and relationships—it is critically important that those defining and measuring care truly hear the voices of the people the system is designed to help—patients and their families.
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Jun 9, 2015, 4:58 PM, Posted by
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.
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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May 4, 2015, 10:01 AM, Posted by
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.
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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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.
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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