Blog & Bloggers

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.

Leading Transformative Change in Medicine: Highlights from the 2015 Lown Conference

Lown“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.

An Uncomfortable Truth: Screening for Colorectal Cancer Can Prevent a Deadly Disease

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.

What Exactly IS the Trail Modeling & Assessment Platform, and Why Do We Care?

Our guest blogger today is Tracy Hadden Loh with the Rails to Trails Conservancy.

Tracy Hadden Loh (right) and colleague with the pedestrian counter outside the CTH.

Tracy Hadden Loh (right) and colleague with the pedestrian counter outside the CTH. The counter was installed on one of the coldest days of this winter (high of 10 degrees!).

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.

 

Data from the CTH Pedestrian Counter

Data from the CTH Pedestrian Counter | February 15, 2015

Three Ways to Improve Digital Health for the Underserved

“Nothing is more important than your health.  Not money, not anything.  Without your health you can’t do anything.  Emotionally, socially, at work; everything goes with health.…”   – Focus group participant.

“Nothing is more important than your health.  Not money, not anything.  Without your health you can’t do anything.  Emotionally, socially, at work; everything goes with health.…” – Focus group participant.

A new report from Oakland-based non-profit ZeroDivide reveals three ways in which low income women of color use digital technology to access health care for themselves and their families, as well as how they would like to use it in the future.

To determine the current use and usability of consumer-facing electronic health tools (“eHealth”) by low-income communities and communities of color, and to identify opportunities to improve the use of eHealth to address persistent health disparities in these target communities, ZeroDivide held six focus groups with over 60 diverse women in four American cities during June 2014.

In spite of a revolution in new health technologies, advancements that economically and socially privileged populations enjoy, however, have in many instances eluded underserved populations and underserved women in particular.

Through these discussions, participants shared their perceived value of eHealth tools, as well as challenges they face to eHealth adoption.

“The translation of health on the websites are atrocious, they are terrible,” one participant said. Another remarked, “You have to go through so many phases just to get to where you’re trying to go, and it’s like, I have to remember this too? My Mom ends up being more confused.”

The report offers three policy recommendations.

  1. Improve the digital and eHealth literacy of underserved consumers and safety net providers and outreach to these populations;
  2. Support eHealth tools for underserved populations that feature user-centered design and design that enhances communication with providers; and
  3. Support technology capacity building for safety net providers to strengthen the eHealth equity infrastructure.

Read the full report here.

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