Thursday, April 16th, was another busy day for the Center for Total Health team, including four tours. We kicked off the morning with a group of regional health care leaders from Australia, then met a retired Kaiser Permanante nurse and information technology maven, a group of Robert Wood Johnson Foundation fellows, and Kaiser Permanante IT specialists from California. As always, we learned as much (if not more) from our visitors as they did from us.
In recognition of National Healthcare Decisions Day on April 16, we spoke with Dr. Dan Johnson, national physician lead for palliative care at Kaiser Permanente’s Care Management Institute, to demystify health care decision making and understand the importance of advance care planning.
Q: What is advance care planning and why is it so important?
A: Advance care planning (ACP) is the process of planning for future medical decisions. ACP enables you to better inform and direct your care in situations where you’re not able to speak for yourself. Importantly, ACP:
- starts with reflection and conversation around personal values, goals, and beliefs;
- includes others – loved ones, family members and your health care team; and
- often results in completion of an advance directive – a written plan for future medical care regarding goals of care or desired treatments for a possible or probable event.
It’s not easy to think about serious illness, much less plan for it. Yet we must. Advance care plans protect us when we cannot speak for ourselves. It’s a precious gift to our loved ones. Instead of guessing, our families and doctors have much needed guidance to ensure the right care.
Q: Why do I need to do this, especially if I’m healthy?
A: Accidents and serious illness sometimes strike suddenly. Terri Schiavo never planned for a cardiac arrest at age 26. Without prior plans or an appointed decision maker, her health care team and family were left to guess her wishes around prolonged life support. Sadly, the guessing irreparably divided her family.
Not everyone is ready to fill out an advance directive. Having a conversation with your health care team is still helpful in these instances to communicate the things that matter most to you. Appointing an agent – someone to speak for you if you cannot speak for yourself – is a crucial step at any time, even when you’re not fully sure of your wishes for future care.
Q: I already filled out an advance directive. Do I need to do this again?
A: Possibly. This question is best answered by your doctor and health care team. For example, sometimes documents filled out in one state are not valid in all states. Documents completed in the absence of informed discussions are rarely helpful (and often confusing). I would recommend re-doing your advance directives if you know your plans have changed or if you did not include your loved ones in your original planning discussions.
Q: Do I need to use any specific forms for an advance directive — from a particular care provider, for example?
A: No. For instance, many Kaiser Permanente regions are beginning to offer our members advance care planning classes or one-on-one facilitated sessions — but no one is required to use a Kaiser Permanente advance directive form. Talk with your doctor and health care team to learn about your options.
Anyone can use Kaiser Permanente forms. Regardless of the form you use, be sure to discuss your values, preferences and documents with your health care team.
Q: How can I be reassured that the health care provider will look at my advance directive and follow my wishes?
I’d recommend two things. First, insist on including your health care team in discussions. Your physician and other providers will help you ask the right questions, explore your values, and pose important “what ifs” to help you communicate treatment preferences. The team will help you complete a written directive and assure that directive is correctly stored in your medical record. Second, include your loved ones. Ensure your appointed “agent” is present during actual conversations and completion of directives. Give copies of completed directives to your doctor, agent and other loved ones so that those who are most important to you know your wishes.
A: What happens if I want to update my advance directive? Do I need to fill out a new one?
Remember, advance care planning is not a single event. Rather, it is a series of conversations that start when we’re healthy and continue throughout our lives. Yes, refresh your discussions and directives with major changes in your relationships, personal values or health status. Your doctors (in concert with your appointed health care agent) will always use the most recently completed documents to direct your care.
“There’s a thread you follow. It goes among things that change. But it doesn’t change…” reads first line from the poem The Way It Is, by William Stafford, which was recited by panelist David Hirsh, MD, at the 2015 Lown Annual Conference. Medical students, he explained, are often surprised by the breadth and depth of the unique challenges they encounter in the U.S health care system. Holding on to their ‘thread’ is a reminder to focus on the human compassion that led them to the field in the first place.
The notion that physicians of all stages in their careers are a critical part of transforming the health care system represented a key theme of the conference, which focused on advancing change through grass roots movements in communities and health care settings. Patient advocates also told personal stories of how their lives were affected by a culture of inappropriate use in medicine coupled with unjustified prices for health care services. Other themes included a renewed focus on primary care, overcoming the ‘more is better’ approach to medicine, and bringing dignity and choice to decision making around end-of-life care.
Titled, “Road to RightCare: Engage, Organize, Transform,” the conference was held March 9 through 11 in San Diego, California, and co-funded by Kaiser Permanente. It brought together clinicians, researchers, advocates, patients, and community leaders, many of whom were members of the RightCare Alliance, an organization devoted to reducing overuse, underuse, and misuse of medical tests and treatments while restoring the trusted clinician-patient relationship. United States health care spending is expected to exceed $3 trillion in 2014, with inappropriate use accounting for as much as $1 trillion of that spending. Addressing this crisis is fundamental to achieving the goal of delivering compassionate medicine that benefits both people and their communities.
For more details about the conference, check out this longer post on the Kaiser Permanente Institute for Health Policy website.
March is coming to a close, and with it, Colorectal Cancer Awareness Month. But when the clock strikes midnight on the 31st, we shouldn’t lose sight of the devastation that colorectal cancer can cause. A new story from the Kaiser Permanente Institute for Health Policy explores Kaiser Permanente’s journey towards improving screening rates, and outlines what it will take for the nation to do the same.
Colorectal cancer is the third most common cancer in America and the second leading cause of cancer-related deaths, with an estimated 49,700 Americans who may lose their lives to the disease in 2015. The good news is that it is highly treatable if caught early; up to 80 percent of deaths can be prevented if everyone over 50 receives a recommended screening. The bad news is that many people — about a third of all Americans and even more in certain racial or ethnic groups, such as Latinos — still aren’t getting screened.
Over the past 10 years, Kaiser Permanente has been leading the charge to improve colorectal cancer screening rates and reduce deaths due to the disease. By reminding people to get screened at every point of care, improving access to the Fecal Immunochemical Test (an easy, home-based colorectal cancer test) and focusing on disparities, Kaiser Permanente has nearly doubled screening rates — from 43 percent in 2004 to 82 percent in 2013.
If you are over 50 or at risk of colorectal cancer, please remember to get screened. And check out the Institute for Health Policy story for more information.
Environmental health and the health of individuals and communities are strongly connected. As a health care provider, Kaiser Permanente feels a special responsibility to address the impacts of climate change on health and to reduce pollutants that can lead to disease. It’s all part of how we look at the total health of people and communities, considering all of the factors that influence their health outside of the doctor’s office.
That definition for total health became richer with the recent announcement that Kaiser Permanente was joining the august ranks of Apple, Google, and other large, environmentally-conscious companies that choose to be leaders in the green energy arena.
Kaiser Permanente announced last month that we completed several agreements to purchase enough renewable energy to reduce our greenhouse gas emissions by 30 percent nationwide by the beginning of 2017. These agreements mean that about 50 percent of the electricity used at our facilities in California will come from renewable energy sources.
The health care sector is poised, perhaps better than most, to plug in to the conversation about the health impacts of climate change and help direct the next stages of climate action. The health care industry carries a considerable environmental footprint, and Kaiser Permanente is partnering with Health Care Without Harm and the Business Renewables Center, launched recently by nonprofit Rocky Mountain Institute, to help not only the health care industry, but the entire U.S. business sector, move toward more abundant clean energy solutions.
“Climate change isn’t a distant threat,” said Kathy Gerwig, Kaiser Permanente’s environmental stewardship
officer. “The health impacts of a changing climate can be felt today in the form of increasing rates of asthma and other respiratory ailments, spread of infectious diseases, heat stress, and injuries from severe weather events. By addressing climate change for the future, we are improving the health of communities today.”
Purchasing renewable energy supports KP’s core mission of total health, and it also makes good business sense.
“We expect this energy purchase to be cost neutral over the term of the contracts,” said Ramé Hemstreet, Kaiser Permanente’s chief energy officer. “By locking in rates, we can better forecast energy costs, and by using diverse fuel sources, we can protect our business from escalating and volatile energy prices. That’s great news for our members.”
So, the next time you see or visit a Kaiser Permanente facility, rest assured that green energy is making a major contribution to powering our facilities, addressing climate change and improving the total health of our members and communities.
With March being Colorectal Cancer Awareness Month, it’s a good time for each of us to pause and consider the health of our digestive system.
“All About Our Guts,” one of the most popular episodes in the Total Health Radio series, helps with that. Expert guest T.R. Levin, MD, a gastroenterologist with Kaiser Permanente in Northern California, covers all the topics you’re wondering about: Irritable Bowel Syndrome, the potential benefits of an anti-inflammatory diet, why fiber is so important — even colonoscopies (and how to help encourage the one you love to go ahead and have that procedure done).
Here is exclusive bonus content.
Still want more? Check out the episode’s official page. And you can hear Dr. Levin talk about the FIT test – a non-invasive screening for colorectal cancer you can do in the privacy of your own home – in this video.
Did you know that the second-leading cause of cancer deaths among men and women combined is colorectal cancer? According to the Centers for Disease Control and Prevention, 140,000 people are diagnosed with it each year, and more than 50,000 die from it. Those are some sobering statistics.
The good news? This type of cancer is highly preventable, mainly due to screenings — starting at age 50 — that can often find precancerous polyps and early-stage cancer. Early diagnosis allows treatment to be most effective.
We can each further reduce our risk by staying physically active, maintaining a healthy weight, drinking alcohol in moderation, and not smoking.
March is Colorectal Cancer Awareness Month, and if you are looking for ways to get the word out and encourage screenings among friends and loved ones, Healthfinder.gov has a great toolkit. Web resources and sample communications are available, as well as a quiz that assesses your risk of developing colorectal cancer and a calculator that helps identify how much fiber you should consume each day.
For a first-hand account of how an at-home screening test (yes, they are available!) saved one woman’s life, check out this video from Kaiser Permanente’s Care Stories site.
Last week, the Center for Total Health — along with Lu Casa, MSN, CRNP, CTTS — welcomed accelerated students from George Washington University School of Nursing (@). As always, we enjoyed hosting the future leaders of health, and hearing their ideas and questions about health care delivery. You can read more about the visit here.
To see more pictures of their visit, click here.
Our guest blogger today is Tracy Hadden Loh with the Rails to Trails Conservancy.
The Rails-to-Trails Conservancy is a national membership-based nonprofit dedicated to creating a nationwide network of trails from former rail lines and connecting corridors to build healthier places for healthier people. We serve as the national voice for more than 160,000 members/supporters, 30,000 miles of rail and multi-use trails, and over 8,000 miles of potential trail. When RTC was founded in 1986, there were less than 250 miles of rail-trail in the United States. Today, there are more than 21,000 miles of trails of serving some tens of millions of people each year.
However, that mileage number is about all we’ve measured with any precision. We don’t actually know how many people in the United States use trails each year. We know that these miles of trail are a great way to create healthier places and healthier people – for example, a recent meta-analysis of published research on the cost-effectiveness of population-level interventions to promote physical activity found that a rail-trail was the #1 most effective intervention. On the basis of similar evidence, the Centers for Disease Control and Prevention recognize trails as a proven strategy that works to increase physical activity, reduce risk of chronic disease, and improve mental health and wellness. So we know we’re on to something good – but how good? When it comes time to make room for trails in the budget, can we show a dollars-and-cents return on investment?
To that end, RTC has launched the Trail Modeling and Assessment Platform (T-MAP), a three-year research initiative to measure, model, and value trail use in the United States. The first phase of this project involves establishing a national network of trail traffic monitoring stations, so that we can continuously measure trail use across the different climactic zones of the US. We’ll use these data to develop two tools: a trail use demand forecasting model to estimate traffic volumes on existing trails or predict volumes on future trails; and a health impact assessment calculator for estimating health care costs avoided due to physical activity on trails.
Taken literally, RTC’s focus on “health” means that there are times when our mission overlaps with that of hospitals and health care systems. Under the Affordable Care Act, non-profit hospitals are now faced with a requirement to assess the health needs of the community, and based on that assessment draw up an implementation plan. We see that as an opportunity to make the case for trails!
Our partners at the Kaiser Permanante Center for Total Health already get it. Located in the heart of downtown Washington, DC right on the Metropolitan Branch Trail, the CTH is helping us implement T-MAP through the installation and maintenance of their very own trail traffic monitoring station, contributing critical data to the project from a unique trail location that is co-located with an urban sidewalk, and dominated by pedestrians. As they learn about how the trail relates to their facility, we’re learning about the trail and collecting the data necessary to accurately estimate the true magnitude of trail use in the United States, and what it’s worth.
Q: What does Total Health mean to you?
A: Total Health means a lifestyle where I am happy and feel capable enough to do the things I want!
Q: What is your first health-related memory?
A: Jump Rope for Heart was probably the highlight of my grade school gym events. We had an assembly every year where we got to jump rope in the gym and learn fancy tricks!
Q: Which person, living or dead, is your health hero or role model?
A: My dad. He is an amazing role model of how to be truly strong both mentally and physically. He is supportive of everyone’s health and fitness, no matter what level. He has an amazing balance of fitness in his life and is always doing big things! Someday we are going to bike across the US!
Q: What is your favorite food?
A: Sweet potatoes!
Q: If you could change one thing in health care, what would it be?
A: A focus on prevention and establishing healthy lifestyles!
Q: In your opinion, what is the most underrated way to improve health for individuals?
A: A balanced diet.
Q: Where would you most like to live?
A: Somewhere by the water and my parents.
Q: What do you consider your greatest achievement so far?
A: Making amazing friends and having a supportive network of people that I can surround myself with and lean on everyday.
Q: If you could have dinner with any three people, living or dead, who would you pick?
A: Audrey Hepburn, Michele Obama and my grandma.
Read more about Food Corps DC here.