This Week in Total Health: Tours Rule

This week, we were delighted by a surprise visit from James Hamrick, MD (@HJamesHamrick), an oncologist from Kaiser Permanente’s Georgia Region. In town for a congenital heart defect summit, he took a few minutes to come see the renovations from last summer.


James Hamrick, MD, and Ted Eytan, MD

We were also glad to welcome Elizabeth Fowler, of Johnson & Johnson, and Marci Nelson, of Patient Centered Primary Care Coalition, in town for a conference. It was inspirational to hear about the work underway!

Elizabeth Fowler (Johnson & Johnson) and Marci Nielsen (Patient Centered Primary Care Colaborative) with Ann Kempski (Kaiser Permanente) at the Center for Total Health

Elizabeth Fowler (Johnson & Johnson) and Marci Nielsen (Patient Centered Primary Care Colaborative) with Ann Kempski and Ted Eytan, MD (Kaiser Permanente)


See all the photos from this week at the Center for Total Health here.


This Week in Total Health: Maintenance Rules

Last week, the Center was closed to the public to allow for upgrades to our conference room audio visual equipment, so we don’t have the usual number of pictures to share. We are, however, very excited for the changes!

We were lucky to host a special tour for two colleagues visiting from California: Annette Guido, MD, and Carolyn Ofiara, RN. Dr. Guido is the Medical Director, Health Information and Payment Policy, for the Permanente Federation.

Annette Guido and Carolyn Ofiara

Ted Eytan, MD, with Annette Guido, MD, and Carolyn Ofiara, RN

This Week in Total Health: Innovation and Transportation Rule the Week

After being closed to the public for a few weeks for maintenance work, the Center for Total Health was delighted to host several tours this week.

The Transportation Research Board’s Annual Meeting brought tens of thousands of transportation experts to Washington. We got to spend time with two experts who are innovating public spaces and transportation in very exciting ways – Sam Piper (Boston-based Senior Planner at Alta Planning + Design, @altaplanning) and Leah Shahum (San Francisco-based Director of the Vision Zero Network, @visionzeronet).

CTH Team with Sam Piper, Alta Planning & Design

CTH Team with Sam Piper, Alta Planning & Design


CTH Team with Leah Shahum, Vision Zero Network, and Celeste James, Kaiser Permanente Community Benefit

CTH Team with Leah Shahum, Vision Zero Network, and Celeste James, Kaiser Permanente Community Benefit

We also had the opportunity to spend time with the Veterans Administration’s Innovation Specialists (@VAInnovation), who were in town from all over the US for a series of meetings and site visits. Of course, they chose to take their photograph with Dominique, the CTH’s resident veteran.

VA Innovation Specialists

VA Innovation Specialists with Dominique

To see photographs from all the great visitors we had this week, check out this album.

This Week In Total Health

Another exciting week at the Center for Total Health has come to an end. We had a great week, capped off by a full house today that highlighted how diverse the facets of total health can be. Today’s meetings were hosted by the International Federation of Health Plans, Kaiser Permanante’s Institute for Health Policy, and Kaiser Permanente’s local Human Resources. We were thrilled to host all of this week’s guests, and even more excited that they got to meet one another.

Check out all of the photos from this week here.

Kaiser Permanente Mid-Atlantic Human Resources with the International Federation of Health Plans


Kaiser Permanente Mid-Atlantic Healthworks Team


Juice Tasting Party

Community-Based Organizations Remain Integral to Reduce HIV/AIDS Disparities


For World AIDS Day (Dec. 1, 2015), we offer this following post written by community practitioners, advocates, activists and researchers with the Kaiser Permanente Community-Based HIV Test and Treat Initiative. Through the initiative they have found that community-based organizations play a critical role in serving people living with HIV when they are able to link their medical care with social, economic and behavioral support services – the total health of an individual. 


In July 2015, the White House updated its National HIV/AIDS Strategy for the United States, with a vision to ensure that new infections are rare and all people living with HIV (PLWH) have equal and unfettered access to HIV clinical care. Central to achieving this vision for the country’s 1.2 million PLWH are recommendations for widespread linkage to and retention in comprehensive HIV care, support for HIV medical adherence, and achievement of viral suppression. Unfortunately, racial/ethnic disparities persist in linkage to care, retention in care, and viral suppression. Community-based organizations (CBOs), and particularly AIDS Service Organizations, may be better able to provide more tailored approaches to reach and support socially vulnerable and minority PLWH, but there is little guidance in the national strategy regarding how CBOs can support these goals.

For World AIDS Day 2015, we offer our recommendations for CBOs to achieve these National Strategy goals, as a collective of community practitioners, advocates, activists and researchers with the Kaiser Permanente (KP) Community Based HIV Test and Treat Initiative. The Kaiser Permanente HIV initiative began in 2013 and involves implementation and evaluation of innovative community-based and CBO-led interventions to increase linkage to and retention in HIV care among Black and Hispanic men who have sex with men (MSM) in Los Angeles, CA; African American women and transgender women in Oakland, CA; African Americans in the rural and suburban southeast; and people who use drugs and those recently released from prison in the New York metropolitan area. While outcome evaluation findings are not yet available, our collective experience over the past three years demonstrates the following findings to support more effective CBO interventions:


  1. Community-based organizations (CBOs) can play an instrumental role in reaching PLWH, but require strong relationships with clinics to support linkage to and retention in care.

CBOs connected to racial/ethnic minority or socially vulnerable groups (e.g., prison releases, MSM of color, transgender women) and holistic AIDS services may have better reach to PLWH within these communities, than may non-community-based HIV clinics. Through partnership with CBOs, clinics may extend their reach for linkage and retention in care. CBOs with in-house clinical services and those effectively partnered with clinics appear to be most successful in recruiting and retaining patients who have fallen out of care. Culturally and linguistically tailored services were uniformly identified as central to meeting the needs of these clients.


  1. CBOs can support more effective HIV care by helping clients understand and recall medications and information on clinical indicators, such as CD4 and viral load.

While clinical care and initiation of and adherence to antiretroviral therapy (ART) can improve quality and longevity of life, meaningful engagement in HIV care and treatment requires understanding and recall of medication regimens and clinical indicators of health. Many participants reached through this initiative reported recent receipt of CD4 counts and viral load but could not recall the numbers, impeding their use of this information as a means of tracking their health. Low health literacy was also a concern, with participants reporting difficulties reading their medication bottle labels or understanding when to take their medications. CBOs can support patients’ health literacy related to medications and reinforce strategies for recall and interpretation of health indicators following clinical care appointments.

  1. CBOs’ promotion of effective engagement in HIV care for socially vulnerable populations requires support for clients’ linkage to care for key comorbidities, as well.

Vulnerable PLWH commonly present with multiple comorbidities, including substance use and mental health issues, as well as chronic diseases increasingly faced by the nation’s aging HIV-positive population. Linking clients to clinical care broadly, not just HIV care, is critical and may better support more cost-effective funding streams to help sustain CBOs working with PLWH by extending these health support services to vulnerable populations regardless of HIV status.

  1. Life-stabilizing wraparound services and trauma-informed care are needed to support HIV care utilization and medical adherence given the social vulnerabilities faced by PLWH.

HIV care utilization can only be prioritized when their clients’ diverse range of non-medical social needs are simultaneously supported through wrap-around services, including transportation assistance, housing, food security, and group support. A disproportionate burden of abuse histories across the lifespan is also reported among populations served through this initiative, and trauma-informed care and social services have been identified as requirements to support broader HIV and other health care utilization.

  1. Social support as part of palliative care remains an important CBO service for PLWH.

Life-enhancing benefits of ART are not reflected in the health status of our most socially and medically vulnerable PLWH, some of whom learn of their HIV status when they are already at Stage 3 disease progression, rendering a need for complementary palliative care support well into the 3rd decade of the epidemic. Too often social support networks are inadequate for PLWH, and end of life social support from CBO representatives may offer the only non-clinical social support available to these clients. Training and support for CBO staff providing these services is vitally important to help sustain CBO continuity of care.

We offer these recommendations for CBOs to support their capacities to extend the reach of clinical care and link and retain racial/ethnic minority and socially vulnerable PLWH in care, as we believe that elimination of health disparities in care utilization, medical adherence and HIV-related life expectancy requires a community-centered approach best achieved via CBOs. We believe that engagement of CBOs in partnership with HIV clinical care can accelerate the progress of the National HIV Strategy and achieve the Strategy’s vision with regard to “unfettered access to high quality, life-extending care, free from stigma and discrimination.”


Kaiser Permanente, National Community Benefit, Oakland CA

Alexandra Caraballo, National Manager, Philanthropy

John Edmiston, National Manager, Community Engagement

Pamela Schwartz, MPH, Director Program Evaluation

Melissa Ramos, Evaluation Consultant


UC San Diego Center on Gender Equity and Health- UCSD GEH, San Diego CA

Anita Raj, PhD, Professor of Medicine and Global Public Health

Lianne Urada, PhD, Assistant Professor of Medicine and Global Public Health

Laramie Smith, PhD, Assistant Professor of Medicine and Global Public Health

Sankari Ayyaluru, Research Coordinator


John Wesley Community Health (JWCH) Institute, Los Angeles CA

Sergio Avina, Division Director

Christopher Hucks-Ortiz, MPH, Evaluation Specialist


Institute for Public Health Innovation (IPHI), Prince Georges County MD

Bradley Boekeloo, PhD, Evaluator, University of Maryland

Abby Charles, MPH, Senior Program Manager


Public Health Institute (PHI), Oakland CA

Tooru Nemoto, PhD, Research Program Director

Mariko Iwamoto, Project Director


The Fortune Society, Long Island City NY

Nilda Ricard, Director Drop in Center-Health Services, Fortune Society

Brendan O’Connell, MSW, Senior Program Analyst

Jahad Robinson, Transitional Specialist


North Jersey Community Research Initiative (NJCRI), Newark NJ

Corey Rosmarin-DeStefano, Director of Clinical Services

Sharif Hall, Data Coordinator

Liliane Windsor, PhD, MSW, Assistant Professor, The University of Illinois at Urbana-Champaign


ASK4Care/Duke University, North Carolina

Beth Stringfield, Project Coordinator

Sara LeGrand, PhD, Assistant Research Professor of Global Health


Women Organized to Respond to Life Threatening Diseases (WORLD), Oakland CA

Cynthia Carey-Grant, Executive Director

Stephanie Cornwell, MA, Program Services Director

Samantha Feld, MPH, Evaluation Data Manager, Cardea Services, Oakland CA




Joanne Schottinger, MD, at Cancer Care Delivery in a Rapidly Changing Healthcare System

ESRI 2015 00172

Left to Right: Carolyn Clancy, MD (U.S Department of Veterans Affairs) Ann Geiger, PhD (National Cancer Institute), Joanne Schottinger, MD (Kaiser Permanente) (View on

Washington, D.C was host to ECRI Institute’s Cancer Care Delivery in a Rapidly Changing Healthcare System, which featured Joanne Schottinger, MD, representing Kaiser Permanente in “How do integrated delivery systems provide cancer care?”

And the answer is…comprehensively, as the data shows, for example: Kaiser Permanente Share | Reducing Disparities in Colon Cancer Through Integrated Care which is part of the larger Complete Care Program: Kaiser Permanente Share | ‘Complete Care’ Improves Patient Outcomes

Schottinger noted that Kaiser Permanente delivers 250,000 chemotherapy treatments per year, 4,000 of which are part of clinical trials. This along with our electronic health record system allows greater insight into caring for patients in real world situations that supplements the latest research-based evidence used to guide care.

Transit, Health, and Gardens, with Greenbuild, American Institute of Architects, and District Department of Transportation

2015 Greenbuild Tour Bike DC- Transit, Health, and Gardens Kaiser Permanente Center for Total Health 00238

2015 Greenbuild Tour Bike DC- Transit, Health, and Gardens Kaiser Permanente Center for Total Health 00238 (View on

Following on a similar bike tour in September (see: Buildings, Bikes, and Gardens with DesignDC ), the Kaiser Permanente Center for Total Health (@KPTotalHealth) hosted this one, as part of the very large Greenbuild International Conference and Expo that was in Washington, DC this year.

In addition to demonstrating the ways that health care contributes to a healthier built environment (who, us?) the following speakers dialogued with the group on work to promote bicycling:

  • Jim Sebastian of @DDOTDC
  • Steve White, director of Fentress Architects and president of AIA DC (@steve_aiadc)
  • Paul Balmer, legislative assistant to Congressman Earl Blumenauer from Oregon on the Congressional Bike Caucus (@PBalms)
  • Caron Whitaker from the Bike League (@CaronWhitaker)

A lot of where this comes together at Kaiser Permanente can be found at our Westside Medical Center, in Hillsborough, Oregon, which is one of the few (less than 60) LEED Gold certified medical centers in the world. You can read more about it here.

Thanks for letting us take part in Greenbuild!

How to mutate your DNA, and how health systems can heal the planet, with American University’s PUBH115 students

2015.11.16 American University Class PubHealth 115- Why Aren't We Dead Yet? Role of Public Health in Society at Center for Total Health 00150

2015.11.16 American University Class PubHealth 115- Why Aren’t We Dead Yet? Role of Public Health in Society at Center for Total Health 00150 (View on

Because we are The Center for Total Health (@KPTotalHealth), everything health related is in scope. Because we are Kaiser Permanente, healing people and the planet is in scope.

With that in mind we were happy to tour American University’s Professor Lynne Arneson and students in her undergraduate course “PubHealth 115: Why Aren’t We Dead Yet? Role of Public Health in Society

The great thing for total health is that all of these concepts are accessible to everyone in the health system. My colleague Erin Meade (@erinm81) remarked as we prepped for the tour that our endocrine systems are better off without disruption. I agree, so I’m glad we’re doing all the things we are to allow people’s hormones to work as intended.

Kathy Gerwig (@KathyGerwig), our environmental stewardship officer for Kaiser Permanente – wrote this blog post which was perfectly timed for the students’ experience: 10 ways hospitals can heal the planet | OUPblog

Joel Sigler, CSP, HEM, from Kaiser Permanente National Environmental Health & Safety, discussed KP’s efforts to remove harmful chemicals and reduce waste in the Kaiser Permanente System, a good family doctor knows what they don’t know, and invites those who do know to join the conversation…

I’m really glad that we’re able to tell a story about how public health and health care work together to heal people and communities at Kaiser Permanente – it’s something that didn’t seem possible during my medical training, and now it clearly is. One more reason why I love this century :).

2015.11.16 American University Class PubHealth 115- Why Aren't We Dead Yet? Role of Public Health in Society at Center for Total Health 00146

Getting ready to host American University Class PubHealth 115- Why Aren’t We Dead Yet? Role of Public Health in Society at Center for Total Health – with Elena, a parent with a child who has asthma (View on

Delving into the Data of Diabetes – A Research Roundup

By Muriel LaMois and Natalie Kish

The Centers for Disease Control and Prevention recognizes November as National Diabetes Month. It represents a time to increase awareness for and understanding of living with diabetes. Nationwide, nearly one out of 11 people has diabetes, and more than one-third of adults are pre-diabetic. Kaiser Permanente treats many of its members with these conditions, and researchers across the organization study diabetes-related health issues to determine how to better serve these individuals.

Stabilizing Trends in New Cases of Diabetes

Several Kaiser Permanente regions participated in a study published in January 2015 aimed at determining trends in new diabetes cases in 11 integrated health systems from 2006 through 2011. After analyzing the health records of approximately seven million newly diagnosed diabetic patients aged 20 and older, researchers found no statistically significant increase in the number of diabetes cases between 2006 and 2010 – with the exception of a small rise in cases in 2011. However, they found significant increases in diabetes cases for certain groups, including racial and ethnic minorities, older adults, males, and people with higher body mass indices. Despite the relatively stable overall rate of new cases, these results suggest that new cases of diabetes are appearing more often in certain populations than in others. Gregory Nichols, PhD, Senior Investigator with Kaiser Permanente’s Center for Health Research, led the study.

Regional Trends in Existing Cases of Diabetes: In Northern California Ethnic Disparities Reduced

Andrew Karter, PhD, and researchers from the Division of Research, conducted a study to evaluate ethnic differences in the severity of existing diabetes-related complications. Study participants included Kaiser Permanente Northern California members with diabetes who were at least 60 years old in 2010. The complications included: myocardial infarction, stroke, heart failure, amputation, end-stage renal disease, advanced diabetic eye disease, and hypoglycemic events. Among those who were studied, 32 percent of patients had at least one complication in the past two years, with eye disease and heart failure occurring most often. Karter and his team also found that certain ethnic groups were more likely to have diabetes-related complications. According to the research, Whites have the highest prevalence for most diabetes-related complications and Asians and Filipinos have the lowest prevalence. The differences in the prevalence of complications between ethnic minorities were modest. These results suggest Northern California is making progress toward reducing health disparities of diabetes-related complications among existing patients who already have diabetes.

Kaiser Permanente Southern California Improves Detection of Diabetes-Related Eye Disease

Diabetic retinopathy is the leading cause of blindness among adults in the United States. A project conducted in Kaiser Permanente’s Southern California medical centers sought to improve diagnostic accuracy of this condition by implementing a centralized reading center that assigned a single team of technicians to assess images for diabetic retinopathy for all of the region’s facilities. The center allowed for physicians to have more time for patients who needed to see them; specially trained technicians to provide more consistent and accurate readings; and photographers to get feedback that improved their images. Most importantly, it allowed more patients with diabetes to learn whether they have potentially sight-threatening retinopathy, and receive appropriate education and treatment. Recently the retinopathy center initiative received the David M. Lawrence Patient Safety Award in recognition of the project’s impact on improving the safety of care for patients and accelerating the rate and scope of patient-safety improvements at Kaiser Permanente.


Walking, Talking, Ward 8 Visualizing at the Walking Summit

Walking Summit Ward 8 Walk and Talk Washington DC USA00281

Walking Summit Ward 8 Walk and Talk Washington DC USA00281 Left to Right: Rosemary Agostini, MD, Kim Holland, MD, Group Health Cooperative, Jojo Cambronero, Seattle Police Department (View on

Sometimes you can’t take people passionate about walking anywhere — that is, unless you are interested in changing everything, then you should go with them everywhere :) .

Thanks to community colleague Khadijah Tribble (@TribbleME) and fellow organizers, a group of nurses, doctors, law enforcement professionals, and other civic leaders walked in Washington, DC’s Ward 8.

If you don’t know what is meant about Ward 8, not to worry, the blog way-back machine will bring you back to my very first meeting with Khadijah, where she walked us through her community (see: The People of Washington, DC’s Anacostia are Building a Culture of Health ).

What I love about yesterday, though, is that Khadijah instructed us to not focus on what wasn’t right with the community as we walked it. Instead, she asked us to focus on its beauty. And there’s a lot of beauty.

We were joined by a team from Seattle, including my physician colleagues Rosemary Agostini, MD, and Kim Holland, MD, who are community health evangelists as part of the magical health system of the future, Group Health Cooperative (@GroupHealth). They’ve been doing a ton of work to engage people around walking in their city, and have engaged collaborators in the Seattle Police Department, who also joined us.

And that’s when our learning experience went to the next level…

In true Rosemary Agostini fashion, she engaged a group of Washington’s Metropolitan Police Department officers in Congress Heights to talk about community and engagement and safety. As you can tell from the photographs, it was a meaningful, authentic conversation.

On the way back to Ward 6, I got to learn about how community engagement and crime fighting work together to support a healthy community.

As it was said to me, “you don’t get information from people when you arrest them, you learn by engaging them.”

As usual, I see a lot of similarities to medicine and health care – disease fighting (or disease pre-emption) + member, patient, community involvement go a long way to understanding what creates health, and what prevents it.

I was really impressed by what I saw, by all the people involved. I obviously love learning, and I love learning how similar our perspectives are when it comes to ensuring that every person and community achieves their full potential. What is health care here for, and law enforcement, and civic leaders, and …. :)