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A Prescription to Move (#Rx2Move): How Health Care Providers Can Encourage Physical Activity for Patients and Communities

Only about half of Americans meet the recommended 150 minutes a week of moderate aerobic activity. To help get people moving, health care providers need to become better health advocates. The first step is spreading the word, which is why the Kaiser Permanente Institute for Health Policy and American College of Sports Medicine are offering three strategies for health care leaders to promote physical activity and to shape environments to support active living. These include: encouraging physical activity in conversations with patients, redesigning health care environments, and investing in community health.

“Health care providers are under pressure to find new and more effective ways to help patients address obesity and other chronic diseases that are influenced by inactivity,” said Brian Raymond, MPH, senior health policy consultant at Kaiser Permanente. “This campaign is about changing how health care providers perceive their role in improving physical activity and ultimately encouraging innovative action.”

Titled, A Prescription to Move (hashtag #Rx2Move), the campaign includes three webinars, a policy brief, and a series of infographics that highlight the various ways that providers can promote active living and make environments more suitable for physical activity. Here’s a little more on the three core principles.

  1. Having Conversations with Patients – Making Exercise a Vital Sign: Conversations between primary care providers and patients about physical activity and more active lifestyles can improve health.
  2. Designing Active Health Care Environments: Design innovations adopted by hospitals and health systems can encourage physical activity and give patients, visitors, and staff opportunities to engage in “active transportation” (walking, biking, and using public transit).
  3. Investing in Community Health: By advocating for and investing in active transportation, public recreational spaces, and school-based health initiatives, health care providers can promote more active, healthier communities.

There are three ways you can support #Rx2Move:

  1. Join the #Rx2Move Webinar Series and Pass along the Invite

The first of a three-part Rx2Move webinar series, Making Physical Activity a Vital Sign, is scheduled on Tuesday, October 13, 12:30-1:30 PM Pacific/ 3:30-4:30 PM Eastern. Registration and additional information is available at:

  1. Spread the Word about the #Rx2Move Online Issue Brief

Our new online issue brief, How Health Care Providers Can Encourage Physical Activity for Patients and Communities, highlights emerging strategies health care providers are using to encourage exercise amongst their patients and the communities they serve. The issue brief is available at:

  1. Participate in the #Rx2Move Social Media Campaign

Join us in using Twitter, Facebook and Linkedin to raise awareness about the #Rx2Move key messages. Infographic banners and sample messages supporting the social media campaign are available at:   ‎We encourage you to use the #Rx2Move hashtag in your digital conversations.

Empowering Patients to Drive Their Own Care: A Conversation with Kaiser Permanente’s Terhilda Garrido

Health information technology (IT) is revolutionizing how patients and physicians interact. Electronic health records (EHRs), such as Kaiser Permanente’s KP HealthConnect, allow physicians to have a more complete view of patient health information. EHRs also enable patients to have more access to their physicians through secure emails, phone calls, and video visits. To learn more about the ways KP HealthConnect impacts members and providers across Kaiser Permanente, the Institute for Health Policy spoke with Terhilda Garrido, vce president for health information technology transformation & analytics at Kaiser Permanente.

Health information technology is changing the practice of medicine across the nation. What are the most profound changes KP HealthConnect has brought to Kaiser Permanente?

Terhilda Garrido, Kaiser Permanente

Terhilda Garrido, Kaiser Permanente

Physicians now go to the computer as opposed to paper records for checking medical history, taking notes, and ordering prescriptions. Providers are alerted about patient issues and in some locations can bring in added expertise through a function called eConsult. Increasingly, our patients drive care. Patients have the ability to access their health information through They have extremely high satisfaction with the patient portal, and those who use are 2.6 times more likely to remain Kaiser Permanente members than are non-users. Once people experience the convenience of accessing care online, they tend to stay with Kaiser Permanente.

As a result of these capabilities, outpatient primary care has changed. Half of primary care visits are now virtual. Secure emails and phone calls represent about 30 percent and 20 percent, respectively, of primary care contacts. In absolute terms, face-to-face visits per member per year are slightly decreasing, but our secure email visits per member are substantially increasing. Primary care access has improved because technology allows more contact with patients. Virtual visits replace some face-to-face visits, but primarily virtual visits occur after a face-to-face encounter has already taken place.

Have clinicians in Kaiser Permanente embraced KP HealthConnect and the changes that have come with it?

The organization has embraced the changes, but the impact on physicians is mixed. Some physicians embrace the technology because they feel it improves care for their patients, while some are still reconciling this new workflow with their already busy calendars. We are such a huge organization, so it’s not out of the ordinary to have such varying reactions. We are still trying to understand and support the best use of our providers’ time.

You have been involved with research exploring the unintentional health care disparities that can emerge with Health IT. Can you explain why these disparities occur?

We’ve conducted a few studies on eHealth disparities. After controlling for various factors, including age, sex, comorbidities, distance to a medical center, income, and education levels, researchers found that Asians, African Americans, and Latinos have lower levels of use of the patient portal. This finding shows us that there are underlying biases between non-Hispanic whites and other ethnic groups.

Recently, we’ve done focus groups with African Americans and Latinos to explore the reasons for their lower levels of enrollment. One reason for not using MyChart is the belief that the site is not secure. Other explanations include login difficulties and language issues, which Southern California has attempted to address by turning on Spanish MyChart. Fewer people cite lack of access to the technology as their reason for not using MyChart.

Are there any policies that could be implemented to help reduce eHealth disparities?

General education campaigns showing that virtual care augments rather than substitutes for in-person care would be beneficial. There are people who think virtual care is cheaper care used to keep patients out of physicians’ offices. There should be broader understanding that many of people are benefiting from virtual care, and it is still high quality care.

Also, the Centers for Medicare and Medicaid Services (CMS) could help to support appropriate funding for virtual care to help it become more mainstream. Despite the fact that the Office of the National Coordinator for Health IT (ONC) is encouraging organizations to adopt virtual care, CMS still only pays for face-to-face visits. This is contrary to the direction in which ONC is pushing healthcare. Acknowledging that virtual care is beneficial and reimbursing for it could make it more widely available and help reduce eHealth disparities.

What is the next frontier in health IT and care transformation, and how are we preparing for it?

The next improvements will encourage self-service for patients and help them be more engaged in their care. Social networking and apps, such as glucose measurers, weight monitors, and fitness trackers, will help patients be more involved. Apple’s Health Kit is an app that combines health information from various health apps. Video visits will also become more common as we move forward. Finally, we will see more machine learning in healthcare. Technology like IBM’s Watson – a machine that can observe, interpret, evaluate, and decide – may be used to help support clinical care.

Research Roundup: Considering the Mind, Body and Spirit in Health Care

Health care is not just about diagnosing and treating patients in the exam room and helping them avoid illnesses. It is also about considering the “mind, body, and spirit” together in order to encourage both physical and mental wellness. At Kaiser Permanente, our focus is the total health of patients. In this month’s research roundup, the Institute for Health Policy highlights KP research on ways to improve the well-being of our members.

Service Dogs for Veterans

Dr. Carla Green testified to an Oregon legislative subcommittee about the benefits of providing service dogs to veterans. Initial findings from the Pairing Assistance-Dogs with Soldiers (PAWS) Study showed that veterans with service dogs had fewer symptoms of post-traumatic stress disorder (PTSD), lower levels of depression, better personal relationships, and lower rates of substance abuse. In her testimony, Dr. Green described one veteran’s experience with a dog that would regularly wake him from nightmares of past traumatic events. Each dog has a one-time cost of $10,000 to breed and train. However, that may be small compared to the $5,635 to $31,695 spent on care for a veteran with PTSD, major depression, or co-occurring PTSD and major depression in the first two years after returning from combat. In order to support this kind of intervention, lawmakers need more data that service dogs are beneficial. Dr. Green’s research shows promise, and the U.S. Department of Veterans Affairs has also resumed its own research on service dogs and PTSD. With additional evidence, the government may decide to provide services dogs to veterans in the future.

Reducing the Risk of Depression Among Pregnant Women

Women with a history of depression are at greater risk of encountering the illness in the weeks before and after childbirth. Researchers in Colorado, including Dr. Arne Beck, recently published a study about using mindfulness-based cognitive theory (MBCT) for pregnant women at risk of a depressive relapse. MBCT combines mindfulness, meditation, and cognitive behavioral strategies. It also helps individuals become more aware of negative thoughts and feelings and respond to these states before they lead to depression. The intervention includes brief exercises that women can use even while handling the demands of caring for a newborn. Women who went through the intervention had a lower risk (18% compared to 30%) of developing depressive symptoms during pregnancy and six months postpartum. A larger study needs to be conducted to ensure the efficacy of this approach and to see if it is helpful for other pregnant women at risk of depression.

Mindfulness Training for Cancer Patients

In Northern California, Dr. Ai Kubo is building on the work of other Kaiser Permanente researchers who found that mindfulness-based stress reduction (MBSR) training improved the mood and quality of life of cancer patients. Standard MBSR requires over 30 hours of in-person training over 8 weeks, making it nearly impossible for busy and highly stressed caregivers or patients actively undergoing chemotherapy. Therefore the Kaiser Permanente study provided trainings through audio recordings on CDs, so that patients could listen during treatment and at home. Due to the success of this pilot study, Dr. Kubo is currently conducting a follow-up study. She is collaborating with a popular mindfulness app company, Headspace, to test if mindfulness training provided on a mobile app is accepted and helpful among cancer patients and caregivers. Dr. Kubo hopes to examine whether an 8-week regimen of mobile mindfulness exercises result in better quality of life and sleep, as well as lower levels of stress and fewer side effects from treatment.

Strategies to improve the well-being of patients can be provided alongside traditional office-based care to maintain the total health of patients. Look for next month’s research roundup on improving screenings. For more information about the research studies, please contact Al Martinez at


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

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.

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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

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.

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