Blog & Bloggers

clinicshot

Improving Health Through Investments in Safety Net Clinics

The second installment of the Kaiser Permanente Institute for Health Policy’s Research Roundup showcases contributions to safety net clinics. In 2013, Kaiser Permanente invested $1.9 billion in a variety of ways in its communities, including support for 113 federally qualified health centers (FQHCs) and 63 free clinics. The integrated health care system continues to bolster its investment in safety net clinics to improve care delivery and access to services for vulnerable and underserved populations.

Community Health Centers’ New Medication Protocol

Rachel Gold and a team of researchers in Portland, Oregon recently received media coverage for their study on Kaiser Permanente’s Aspirin, Lisinopril, and Lipid-lowering medication (ALL) quality improvement protocol. The protocol uses EHR tools to remind providers to prescribe these medications to patients with diabetes who are at high risk for heart attacks and strokes. In an earlier study (Dudl, 2009), these drugs were shown to reduce the risk of these cardiovascular events. The health organization’s internal success with uptake of ALL medications led to a reworking of the model for use in community health clinics. To date 55 community clinics have adopted a modified ALL protocol. In Gold’s study, the percentage of diabetic patients who received the drugs at these sites grew from 45 to 63 percent from June 2011 through May 2013.

Mid-Atlantic Safety-Net Clinics

This spring, researchers from the Mid-Atlantic region published a study in the Permanente Journal reporting the results of Kaiser Permanente’s Community Ambassador Program (CAP). CAP places employees in safety net clinics in northern Virginia, Washington, D.C., and suburban Maryland to share best practices and provide resources to expand care. The results of this study showed CAP’s early successes: nearly 95 percent of clinics reported advances in patient care delivery, with quality improvements in weight screenings, adult tobacco use assessments, cervical cancer screenings, and breast cancer screenings. Clinics also reported offering more same day appointments and new services. As a result of CAP, many clinics adopted Kaiser Permanente’s evidence-based practices, and clinics were able to offer an additional 32,000 encounters.

Colorectal Cancer Screenings in Community Health Centers

Gloria Coronado and a team from Portland, Oregon were featured in a story highlighting their work to expand cancer services in federally qualified health clinics (FQHCs). Because these health centers have limited resources, many of their patients have never been screened for colon cancer or received a colonoscopy. Kaiser Permanente’s Center for Health Research investigators conducted a pilot study in one FQHC, which showed that mailing safety-net patients at-home fecal immunochemical test (FIT) kits increased colon cancer screenings rates by 40 percent. The study’s success encouraged researchers to expand their outreach from one clinic to 26 clinics, which plan to mail 20,000 FIT kits to safety net patients this year. Researchers are also helping FQHCs adopt EHR tools to track test results and follow up with patients, as well as assisting FQHCs in finding resources to provide colonoscopies to patients who have a positive result on the at-home FIT test.

Next month’s research roundup will feature research studies about interventions to maximize wellbeing. For more information on the research studies in this month’s Research Roundup, please contact Al Martinez at Albert.Martinez@kp.org.

Q&A with Felicia E. Mebane, PhD, MSPH — AcademyHealth Innovator in Residence

Dr. Felicia E. Mebane (introduced in this post earlier this week) understands the power of a good podcast. That’s why she created Health Services Unplugged for her fellowship with the Kaiser Permanente-funded AcademyHealth Innovators-in-Residence Program. This blog and podcast series features interviews with researchers and professionals who investigate ways to improve care for vulnerable and safety net populations.

“Podcasts are really popular right now, so I wanted to explore how that format could be used to disseminate health services research,” Mebane said.

In a recent Q&A, Dr. Mebane discussed her past and her goals for this project.

Tell us a bit about the Innovators-in-Residence program, and why you were interested in being involved.

Through its Innovators-in-Residence Program, AcademyHealth invites professionals who have interesting, creative, or innovative skills, experience, or ideas to spend one to three months completing a project and working with AcademyHealth’s staff. Financial support allows innovators to take time from their regular responsibilities, whether they already focus on health services or come from other industries.

I wanted to participate in this program because of my background and focus. As a public health communications expert with health policy training, I am always looking for opportunities to help researchers disseminate their work. Also, I think the field of health services research can be more creative so that we can better engage in public debates and influence policy.

As you mentioned, each Innovator is tasked with working on an independent project. Would you mind providing an overview of your project, Health Services Unplugged?

The current series features a recent research publication or project and connects it to something in the news or popular culture. The approach is for me and/or another guest (for example, a student or community member) to chat with the researcher about their work and a little bit about themselves. The goal is to inform audiences and to inspire them to learn more.

We also wanted to see how people would respond to this format, including how much traffic the site would get and how willing folks would be to participate. I hope this project will continue and encourage others to leverage different media tools and forums to reach their stakeholders.

Who did you interview, what projects are they focusing on, and how did you select the interviewees?

My approach was to present a broad mix of research and researchers. I started my list of potential guests by looking at recent issues of Health Affairs and Health Services Research, talking with AcademyHealth staff, and connecting with my networks. For example, the series includes professors at the Johns Hopkins Bloomberg School of Public Health and the University of Wisconsin’s School of Public Health and a director of research from the Colorado Health Institute. Guests included a grade school teacher, a graduate student and a DC Councilman. Topics included health disparities, access to care and Medicare payments to physicians.

I also wanted each episode to include something you won’t hear in a typical interview. Additional themes include career advice, interesting translation and dissemination tools, and fun facts about the researchers.

Did you intend for your podcast series to reach patients in the populations, or were you focusing on impacting the perspective of providers, policymakers, and other health professionals who serve these patients?

I initially targeted students and early career professionals engaged in health services or policy. I also see the audience including journalists, staff who support policymakers and anyone else interested in these issues. Though patients were not our initial focus, I am excited about the possibility of finding partners who want to communicate directly with them.

What advice would you offer someone interested in being involved with Health Services Unplugged (HSU) or helping translate and disseminate health services research?

If you are interested in supporting HSU or working with us, please contact me via our webpage. In addition to volunteer opportunities, we hope to eventually offer internships and other opportunities. Stay tuned to our website for announcements.

For folks who are thinking about a career in health services research, I encourage you to take a seminar or workshop or even class on communications. ALL researchers have to write and talk about their work. Being able to do both well will serve you in your career and help the field. If you are already a great communicator, think about health services as a career. Some health services or policy programs also give you a chance to focus on public relations, broadcasting or other aspects of communications.

You can listen to Dr. Mebane’s full podcasts via iTunes, Android, or RSS.

Categories: Guest Blogger
Tags: , ,

Meet the 2014-2015 AcademyHealth Innovators-in-Residence

Academy_HealthIn 2014, AcademyHealth’s Translation and Dissemination Institute (TDI) launched the Innovators-in-Residence Program. Funded by Kaiser Permanente, the Innovators-in-Residence program offers health professionals paid fellowships to assist AcademyHealth with distributing evidence-based health services research. During their fellowships, Innovators act as AcademyHealth consultants with responsibilities, such as leading committees and special groups, contributing to the AcademyHealth blog, and conducting seminars. Innovators also complete and present an independent project about original ways to transform research into policy and practice. Projects completed during the first year of the program focused on care delivery in safety net clinics and improving care for vulnerable populations.
 
Three fellows were selected between June 2014 and June 2015.
 

Ernest Moy, MD, MPH

Ernest Moy, MD, MPH

 
The first fellow was Ernest Moy, MD, MPH, a Medical Officer with the Center for Quality Improvement and Patient Safety at the Agency for Healthcare Research and Quality. For his independent project, Dr. Moy developed a tool that assessed geographic and demographic characteristics in order to examine health disparities. Dr. Moy hopes that his model will be used in various cities to help policymakers design stronger disparity interventions.
 
AcademyHealth elected its second fellow, Linda Cummings, PhD, in January 2015. Dr. Cummings was previously Vice President for Research for America’s Essential Hospital, during which she gained experience with safety net hospitals and health disparities. For her fellowship project, which she will complete in the fall, Dr. Cummings is creating profiles outlining how three different safety net delivery systems approach research. She will release these profiles at the end of the summer. In the fall, Dr. Cummings will moderate a meeting about her project, and she will interview professionals from each of the three delivery systems. Links to her work will be posted to this page later this year.
 
Felicia Mebane, PhD, MSPH

Felicia Mebane, PhD, MSPH

 
The final 2015 fellow is Dr. Felicia Mebane, CEO of Mebane Media Communications and adjunct professor at the University of North Carolina at Chapel Hill Gillings School of Global Public Health. During her time as an Innovator-in-Residence from April to June 2015, Dr. Mebane began working on a project called Health Services Unplugged, a podcast and blog series about health services research and the professionals involved in the field.
 

Supplementing Care with Telehealth

Imagine getting health care in the comfort of your home, using a smart phone to have a conversation with your physician, and even showing the doctor your physical symptoms with the phone’s camera. Telehealth is making this kind of care possible. It supplements in-person visits by allowing for more frequent communication with physicians using visual or audio technologies and helps physicians regularly monitor their patients.

Kaiser Permanente has seen the advantages of this technology and is implementing telehealth in primary care, neurology, inpatient rounding, mental health, and dermatology. One quickly developing area is teledermatology. KP members can send photos of their moles, lesions, and rashes or show them to their doctors via video chat.  (Watch the Thrive ad on telehealth.) Physicians can view these images and talk to their patients during the video chat or phone call. They can also send patients an email with a diagnosis and treatment options.

The availability of telehealth is valuable to both patients and physicians. Patients can save the cost and time of traveling to the doctor’s office. In Colorado, two out of three patients who participated in a teledermatology video visit did not need an in-person follow-up visit because their issue was resolved. It also allows physicians to provide efficient care. They can quickly diagnose and follow up with patients. Physicians can then spend more time focusing on patients who have to visit in-person for more serious issues.

While some may consider telehealth as a means to deliver care to patients in remote and rural areas, telehealth is valuable for everyone. It allows for more frequent and convenient communication with physicians that ultimately leads to higher quality care.

Read the KP Institute for Health Policy’s new Policy Story to learn more about telehealth and the policy changes that must be made to accommodate the growing need for this technology.

Research Roundup: Staying One Step Ahead of Your Health

Close to 2,000 studies involving Kaiser Permanente (KP) clinicians and researchers are in progress at any given time across the organization’s seven regional research centers. This work helps to shape policy and practice for KP and the health care system at large as it strives to improve patient quality and satisfaction, population health, and reduce the per capita cost of care. To further this goal, each month the KP Institute for Health Policy will highlight several research studies with policy implications as part of our new research roundup series. The inaugural summary includes three studies that examine the effectiveness of steps that patients can take to help control the symptoms of a variety of health conditions.

Scanning for Alzheimer’s Disease

Rachel Whitmer from Northern California is part of a national leadership team for a study titled Imaging Dementia – Evidence for Amyloid Scanning (IDEAS), led by the Alzheimer’s Association, managed by the American College of Radiology and the ACR Imaging Network, and funded by the Centers for Medicare and Medicaid Services. Researchers will be examining a positron emission tomography (PET) scan that detects brain plaques associated with Alzheimer’s disease. The research group will determine how this scan affects doctors’ treatment plans and patient outcomes. If the PET scan is shown to be beneficial, Medicare may decide to cover it. With an early diagnosis of Alzheimer’s disease, patients can receive proper care sooner to avoid accidents from cognitive impairments and to potentially slow the progression of the disease.

Supplements for Menopause

Another study examined whether vitamin D and calcium supplements help to alleviate menopausal symptoms. Erin LeBlanc from the KP research center based in Portland, Oregon conducted a longitudinal study and found that women who took these supplements had the same number of menopausal symptoms as those who did not. Some of the symptoms included sleep disturbance, emotional well-being, and fatigue. The average age of women at the beginning of the study was 64. Dr. LeBlanc suggests that future research on the effects of supplements on menopause should include younger women to see if the results are different based on age.

Lessening the Pain of Shingles

A study from Southern California was published this month about an additional benefit of the shingles vaccination. Hung Fu Tseng and his team found that those who get shingles after receiving the vaccination (herpes zoster) have a lower risk of developing a painful complication from the condition called post-herpetic neuralgia (PHN). The Advisory Committee on Immunization Practices currently recommends the vaccination for adults over 60 years old. This research provides additional support for the vaccination, both to decrease the likelihood of getting shingles and to reduce the severity of PHN and the mental health consequences from long-term pain.

Kaiser Permanente continues to set the bar for evidence-based care. Look for next month’s research roundup: the Institute will look at three studies about investing in community clinics. If you’d like to learn more about the research studies, please contact Al Martinez at Albert.Martinez@kp.org.

Medicare: Examining Care Coordination and Evolving Payment Structures

Designing a Better, Greener, More Sustainable Hospital

Interview with Robin Guenther, Architect and Expert in Sustainable Design

Robin Guenther doesn’t just design pretty hospitals. She designs spaces that resonate health and well-being from the ground up.

As the sustainable healthcare leader at global architecture and design firm Perkins+Will, Guenther understands that every aspect of health and sustainability needs to be considered in the design of hospitals and healing spaces. It’s not enough to build hospitals with the latest healthcare technology. Rather, we need to be considering all aspects of a hospital’s building design and how that design lends itself to healing people and healing the planet.

“There’s something ironic about physicians, nurses and caregivers working to keep people alive and healthy in buildings that feel dead and that are built of materials that contribute to disease,” explains Guenther. “We need to build healthcare facilities that inspire health, that are built with healthy materials, that use as little energy as possible and that connect us with our living environments.”

Guenther was one of the keynote speakers at the CleanMed conference in Portland, Ore. this year. The conference is held annually for hospital and business leaders working at the forefront of sustainable healthcare.

In this video, Guenther shares some of her insights on the current trends in sustainable healthcare design – from building low-energy and net-zero hospitals to designing for the impacts of a changing climate.

Learning from Leading Performers to Improve Depression Outcomes

Editor’s Note: May is Mental Health Month, and Kaiser Permanente has joined forces with the National Council for Behavioral Health, Mental Health America, and other organizations across the country to help raise awareness around the importance of early identification of symptoms and reducing stigma around mental illness.  Guest blogger Christina Kerby spoke with several people from the Kaiser Permanente Care Management Institute for the following post.

Mental Health OutcomesWhen we think about cancer, heart disease, or diabetes, we begin with prevention. When people begin to show signs such as a persistent cough, high blood pressure, or high blood sugar, we try immediately to identify the problem and reverse these symptoms. We don’t ignore them. In fact, we develop a plan of action to reverse and sometimes stop the progression of the disease. So why aren’t we doing the same for individuals who are dealing with potentially serious mental illness?

Mental health conditions should be addressed long before they reach the most critical points in the disease process. One of the best ways to identify early symptoms is through routine use of tools in primary care settings that can aid in diagnosis and gauging effectiveness of treatment. One such tool is the Patient Health Questionnaire-9, or PHQ-9, a brief questionnaire that can be administered by any clinician as part of routine office visits or online via secure messaging.

The PHQ‐9 has been shown to be a useful tool not only for assessment and diagnosing, but also for monitoring treatment of major depression. To understand how this tool can be best used across the continuum of care, and how consistent use can improve depression control rates, we turned to our Seattle-based affiliate Group Health, which has experienced excellent results through its Depression Care Program.

To better understand Group Health’s success, we interviewed patients and care providers, collected and analyzed performance data, observed care settings, and pulled together the results in this case study.

“We found that Group Health consistently outperforms external benchmarks for six-month remission rates after a new diagnosis of depression,” said Andrew Bertagnolli, PhD, Senior Manager for Behavioral Health at Kaiser Permanente’s Care Management Institute.

Kaiser Permanente’s use of the PHQ-9 to assess symptom severity at the beginning of a depression episode has improved, helped by tools within our electronic medical record to enable easier administration and capture of the PHQ-9. The Northwest Region, in particular, has seen an improvement from 20% to 77% of members being assessed at the beginning of their episode.

“This is powerful data that shows the integration of behavioral health into primary care settings improves outcomes for patients by helping to identify symptoms early on,” said Dr. Bertagnolli.

In addition to improving assessment rates and outcomes, we can use Group Health’s performance to inform the way we spread and operationalize practices that improve care and outcomes for our members and patients. The case study examines how to generate will, change a culture, and support and sustain the practice. The case study is a rich resource for other organizations also wanting to learn from a leading performer in depression care.

“Kaiser Permanente’s integrated system enables us to spread leading practices quickly,” said Scott Young, MD, of the Permanente Federation. “This case study represents our commitment to learning and sharing for the benefit of providers and patients everywhere.”

Care at Home: Meeting Patients Where They Are

Care at home strategies seek to establish a win-win situation in which patient satisfaction goes up while use of health care services and spending go down. In some cases, seniors may be able to maintain their independence living at home longer, while reducing spending on nursing home care and hospitalizations. In other cases, the programs can help to avoid acute care episodes and readmissions.

To bring care to where patients are—and where they prefer to be—Kaiser Permanente Northwest has established an innovative program called Primary Care @ Home, and a ground-breaking pilot program called Mobile Health Partners (MHP). Primary Care @ Home originated as a pilot and is now an ongoing program. The MHP pilot has seen consistent growth since its inception in 2013.

These initiatives have showed positive results from patients and have demonstrated that home-based primary care can provide personalized care that maintains patient comfort and dignity, provides safe, high-quality care in a way that patients and families prefer, and lowers costs.

The Institute for Health Policy’s latest KP Policy Story highlights the two programs aimed at providing efficient care that best meets patients’ needs. You can check it out here.

For National Healthcare Decisions Day, a Conversation with Daniel Johnson, MD, FAAHPM, on Planning for Your Care

The Denver Hospice.   (Photo by ELLEN JASKOL)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.

To learn more, check out this article on the Kaiser Permanente Share site, or find additional resources available from NHDD.

Explore the Center for Total Health Take Video Tour