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How a Swedish Model of Care is Making an Impact in the U.S.

Oct 5, 2016, 9:35 AM, Posted by Laura Leviton, Susan Mende

Disease registries designed to support clinical research can be reimagined to create a new and more effective kind of patient-centered care. Just take a look at Sweden.

The Karolinska Institutet building in Sweden. The Karolinksa Institutet in Solna, Sweden. Photo by Pelle Sten via Flickr.

Large-scale collection of patient data into disease-specific databases, or registries, is vital to research. These registries house standardized information on patients’ diagnoses, care, and outcomes, supporting large-scale comparison and analysis which can lead to better population health management and interventions. But can disease registries also help to move us closer to patient-centered care?

We’re learning from examples overseas that, with the help of new interactive technologies, they can.

Sweden created a disease registry for rheumatology that is much more than a data storage house. The Swedish Rheumatology Quality Registry (SRQ) is an interactive tool that helps patients and doctors prepare for and make better use of their office visits. It helps them to work like a team—to “co-produce” care together.

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How Social Spending Affects Health Outcomes

Aug 17, 2016, 9:00 AM, Posted by Elizabeth H. Bradley, Lauren A. Taylor

The United States spends more on health care than any other developed nation, yet a recent study suggests social services could have a greater impact on health outcomes.

A hundred dollar bill. Modified image. Original photo by Ervins Strauhmanis.

In a blog post for The New York Times, Dr. Dhruv Khullar, a resident physician at Massachusetts General Hospital, detailed important—and importantly nonmedical—barriers to health that he had witnessed in his patients: a man who couldn’t fathom worrying about his blood pressure when he needed to find food and a place to sleep, a diabetic without reliable access to a refrigerator to store insulin, a mother fretting that mold and cockroaches in her apartment were exacerbating her son’s asthma. Medical care might be necessary for these patients. But that care alone is unlikely to be sufficient.

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How to Help Students by Helping Their Parents

Jul 27, 2016, 12:00 PM, Posted by Abbey Cofsky, Kristin Schubert

Communities share the specific steps they took to maximize academic success by supporting parents and families.

We’re all well aware that education leads to better jobs and higher income. Just as important, research also links education to reduced risk of illness, increased vitality, longevity and academic success that extends to future generations.

That’s why the situation for schools in Lawrence, Mass., was particularly concerning back in 2010. At the time, more than one out of every four Lawrence kids dropped out of high school. This led the Massachusetts Department of Education to put Lawrence’s schools into receivership by 2012, placing them under new management to safeguard state assets. The state-appointed “receiver,” was granted authority to develop an intervention plan to overhaul the schools through steps you might expect such as expanding the school day and replacing half the districts’ principals.

But the district also took one critical step by acknowledging that a family’s financial stability strongly influences how well children do in school—and whether they drop out.

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Wanted: Creative Research—From Any Field—Revealing What Makes Everyone In America Healthier

Jul 6, 2016, 11:00 AM, Posted by Claire Gibbons

Researchers: RWJF wants to fund your best ideas, and most rigorous study designs, to help us learn what works to promote the health of everyone in America.

What does it take for Americans to lead healthier lives? Seems like a simple question, but it takes research to get answers we can act on.

Research is how we will discover what happens to resident and community health when a low-income community in Seattle—pocked with aging infrastructure and troubled, publicly subsidized housing—is transformed into one that sports mixed-income housing, new parks and services that support well-being. It’s a way we can measure the value of litigation aimed at forcing school districts in California to comply with state requirements for physical education in schools. Through research, we can pinpoint whether the presence of children in a defendant’s life influences sentencing decisions. And only through research can we further understand how criminal sentences impact the overall health and living arrangements of these children.

The Robert Wood Johnson Foundation (RWJF) is funding these and other studies through its Evidence for Action (E4A) National Program, now in its second year. We want to continue making grants through E4A, which is why we invite you to explore our Call for Proposals (CFP).

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Costs of Care: Getting the Patient-Provider Conversation Right

Jun 15, 2016, 9:00 AM, Posted by Emmy Ganos

Doctors and patients want to talk transparently about the costs and value of health care, but it’s easier said than done. A new funding opportunity from RWJF seeks to address this challenge by surfacing best practices.

Health care is too often the most stressful part of the American family's budget. In a 2015 survey from the Kaiser Family Foundation, 42 percent of respondents reported that it is somewhat or very difficult to afford health services. This difficulty ranked higher than monthly utilities, housing, food expenses and transportation costs. In the same survey, more than half of respondents said that making information about the price of medical appointments, procedures and tests more available to patients should be a “top health care priority” for the President and Congress.

Rising out-of-pocket costs helped shape these attitudes, and they are hitting patients in the U.S. at all levels. For people with job-based insurance, the number of individuals with plan deductibles—and the size of those deductibles—has grown rapidly in recent years. In 2015, the rate of covered workers enrolled in a plan with an annual deductible of $1,000 or more for single coverage was 63 percent, a significant jump from 10 percent in 2006. This year, deductibles in marketplace plans are even higher than employer insurance, averaging $3,064 for coverage in the popular "silver" tier. For low-income marketplace enrollees, they might qualify for cost-sharing reductions, but they aren’t completely shielded from out-of-pocket expenses.

How can we lower the burden of health care costs in the U.S.?

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A Portrait of Women with Health Insurance

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

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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OpenNotes: Mind the Gap

Jan 4, 2012, 9:00 AM, Posted by Steve Downs

Last week, I contributed to The Health Care Blog about OpenNotes, a Pioneer grantee that is enabling patients to view the notes their doctors write after a medical visit. I wrote that it is a simple idea – but also a dangerous one.

OpenNotes recently completed a pre-survey published in the Annals of Internal Medicine that asked doctors and patients about their expectations of how the idea would play out in real life. What they found is fascinating. Doctors and patients are clearly divided. On a wide range of possible benefits, doctors are more skeptical than patients. But what really jumps out are the responses to questions of whether patients would find the notes more confusing than useful, and whether the notes would make them worry more. The gap is dramatic. In each case, most doctors said “yes” while less than one in six patients agreed.

Why this disconnect between doctors and their patients? Why the gap between what doctors believe their patients can handle, and what patients feel they are ready to see?

The post has generated a nice discussion on the blog, and in the comment responses you’ll find that the results of the survey are reflected in the dialogue. I recently added my own two cents to the conversation, and I’d love to see you post your thoughts, as well.

The survey results have also been covered by USA Today and TIME’s Healthland Blog.

This commentary originally appeared on the RWJF Pioneering Ideas blog.