Honoring National Diabetes Month and World Diabetes Day

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In honor of National Diabetes Month and World Diabetes Day, we wanted to highlight important research available at the Center for Total Health.  The study is one of the largest and most ethnically diverse to look at maternal diabetes as a risk factor for autism.  Many have probably heard of other suspected causes, but time and time again guests at the center are surprised to hear that children whose mothers developed gestational diabetes by the 26th week of pregnancy were at increased risk of developing autism later in life, according to a Kaiser Permanente study published in the Journal of the American Medical Association on April 14, 2015.  And that’s just a sample of the power of an electronic health record (EHR).

“Kaiser Permanente is uniquely qualified to conduct large scale studies in a real-word setting with the power of our integrated, comprehensive electronic health record,” said lead author Anny Xiang, of the Kaiser Permanente Southern California Department of Research and Evaluation.  “We can follow many women through the electronic health records and assess potential links between historical information and their own health outcomes, and their children’s health outcomes. The large size is particularly important to study rare diseases such as autism spectrum disorders. Appropriate analysis of these data can reveal important findings which could impact our approach to patient care.” She noted that this was an observational study, therefore the findings reveal associations between gestational diabetes and risk of a child developing autism rather than proving a cause and effect relationship.

Researchers examined the electronic health records of more than 322,000 ethnically diverse children born between 28 and 44 weeks at Kaiser Permanente Southern California medical centers between January 1995 and December 2009.  They followed the children for an average of 5.5 years and found that those exposed to gestational diabetes by the 26th week of pregnancy had a 63% increased risk of being diagnose with an autism spectrum disorder than children who were not exposed.  After taking into account maternal age, education, race and ethnicity, household income and other factors, the increased risk of autism associated with gestational diabetes was 42 percent.

For more information on the study, click here.

To learn more about this and other innovation at Kaiser Permanente, visit the Center for Total Health.

Health Care Topics Candidates Ought to Discuss

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Dr. Robert Pearl, MD, Chairman and CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group, was recently interviewed by Bloomberg BNA’s Alex Ruoff about a primer on health care issues produced by the Council of Accountable Physician Practices (CAPP), which Dr. Pearl chairs. The primer was written for political candidates at all levels of elected office, and encouraged candidates to think beyond the success or failure of the Affordable Care Act (ACA) when considering health care policy.

The primer identified three issues that all elected officials should learn about to make the best policy decisions for their constituents. These include value-based reimbursement for doctors and hospitals, robust and coordinated use of health information technology, and improved quality measurement and reporting.

Dr. Pearl said in the article that neither Democratic candidate Hillary Clinton or Republican Donald Trump has spent much time discussing these topics during their speeches or in their official platforms.

“Both candidates have commented on the exchanges and the price of drugs, but there hasn’t been a discussion about the big changes needed in health care,” he said.

According to the article, although Medicare is already moving doctors into value-based payment systems, CAPP wants the candidates to commit to accelerating the pace of change and push for global capitation in which doctors are paid a flat rate based on the size and health of their patient population instead of for each service they provide.

The article goes on to assert that this shift could help to reduce the annual growth in Medicare spending, which according to the 2016 Medicare Trustees Report, is expected to increase as a portion of overall gross domestic product from its current level of 3.6 percent to 5.6 percent by 2040.

“When you look at what we’re spending on health care, it’s unclear why we’re not talking about changing payments,” Pearl said.

 

Source: Ruoff, Alex. Why Hasn’t Clinton or Trump Talked About Health IT? Bloomberg BNA, 31 August 2016.

National HIV Testing Day

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national_hiv_testing_day138
For National HIV Testing Day, 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.”

Authors:

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

Health Care That Targets Unmet Social Needs

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Targeting the social determinants of health is a critical piece in improving an individual’s overall well-being and total health, according to an article written by a couple Kaiser Permanente physicians in Southern California. The article appeared recently in the New England Journal of Medicine.

The authors say this doesn’t mean Kaiser Permanente should, for instance, build affordable housing for their homeless patients. But it does mean taking on the responsibility for the full scope of their patients’ needs, consistent with Kaiser Permanente’s social mission and business imperative to improve the health of the communities it serves. Kaiser Permanente has begun to bolster that effort by aiming to target their members’ unmet social needs as part of their overall health care. After all, social, environmental, and behavioral factors account for an estimated 60% of health, compared with just 10% from factors traditionally defined as “clinical.” And research shows that nations that focus on food insecurity, housing, transportation, and other “nonmedical” factors spend less overall on health care while improving quality and quantity of life.

 To achieve this goal, Kaiser Permanente is partnering with existing community organizations, identify gaps in linking with those resources, and (in the process) demonstrate the value of directly addressing the social determinants of health.

You can see the article in full here and learn more about a pilot project the organization is doing with Health Leads,  a social enterprise organization that aims “to address all patients’ basic resource needs as a standard part of quality care.”

 

Health Care as Part of the Climate Problem and Part of the Climate Solution

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Hospitals and health systems, particularly in the most industrialized settings, make a significant impact on the climate. In the United States alone, health care contributes 8 percent of the country’s greenhouse gas emissions.

Globally, communities are already suffering health impacts of climate change as a result of extreme weather, disruption of food and water supplies, wildfires, air pollution, mass migration and changes in prevalence of diseases — such as those borne by insects — all resulting in health consequences including asthma, cardiovascular disease and mental health problems, among many others.

Read more of this article here

 

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

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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.”

Authors:

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

 

 

 

Kaiser Permanente Encourages Mental Health Awareness for National Depression Screening Day

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After his wife died, Tom found himself in a very dark place and he didn’t know how to get out.

He knew he needed to do two things: Get a mental health evaluation, and if it confirmed what he already suspected was the case, he needed to get care.

“I was having some trouble with depression and anxiety,” said Tom, a Kaiser Permanente member whose real name is not being used to protect his privacy. “I was distraught after my wife passed away. I really needed someone to say, ‘Hey man, do this because you are screwing up.’ I wanted to get a handle on myself. I wanted to be less depressed. I just wanted to get a grip again.” 

October 8 is a day dedicated to helping people like Tom get the help they need. This year marks the 25th observance of National Depression Screening Day, dedicated to raising awareness about the importance of screenings for depression and related mood and anxiety disorders.

blue background with circular green that makes a tree. The blue inside the green makes a person with arms raised which is the trunk of the tree with leaves. National Depression Screening Day logo.

According to Screening for Mental Health, the non-profit organization that established this annual screening day, depression screening is effective in linking at-risk individuals with treatment options. A 2009 independent research study by the University of Connecticut and commissioned by Screening for Mental Health showed that 55 percent of participants who completed an online depression screening and who agreed to participate in a follow-up survey sought depression treatment within three months of the screening.

Kaiser Permanente’s offers an online self-assessment tool that can be used by members and non-members to help identify signs of depression and learn more about it.

Committed to total health

Kaiser Permanente members like Tom can be assured that providing high-quality mental health care is a key priority for the largest integrated non-profit health care system in the nation. With its mental health therapists, psychiatrists, primary care physicians, and pharmacists coordinating care for its patients, the organization is well-positioned to meet the needs of the growing population of Americans in need of mental health care, and ultimately provide a model for the delivery of such care in the community.

“We are committed to the total health of our members, and that means caring for the mind, body and spirit,” said Patrick Courneya, MD, executive vice president and chief medical officer at Kaiser Permanente. “The goals of National Depression Screening Day are the same ones our primary care physicians and behavioral health specialists pursue every day. We strive to eliminate any stigma associated with depression, anxiety and any other similar conditions and to provide the tools and care our members need for emotional and mental well-being.”

Learn more about Kaiser Permanente’s integrated approach to health care by reading the rest of the article here.

 

Caffeine: How Much is Too Much?

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Sure, many of us love our cup of joe every morning.  Some might like it so much that one cup becomes three or four.  We joke about it.  We laugh about it.  It is part of our culture as Americans.

But what about caffeine and kids?  Not only are kids drinking soda, they are also downing caffeinated energy drinks and coffee-based beverages.

feature-boy-doing-homework-274x168As kids head back to school, it’s a good time to consider just how much caffeine our kids are consuming; more importantly, how much is safe.  As school gets underway and kids must manage not only their academics but also extracurricular activities and jobs, it is easy to turn to caffeinated beverages for a quick pick me up.  But that habit can quickly grow out of control.

This episode of Total Health Radio can help.  Called Caffeine and Kids: What’s the Buzz?, the show shares one family’s personal story of the risks of caffeine consumption in kids.  It also features tips from a physician on recognizing signs of excessive caffeine — and for helping your kids know how much is enough…versus too much.

Keeping the Men in Your Life Healthy

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Screen Shot 2015-06-29 at 4.22.59 PMMany men avoid visiting the doctor. We often joke about it, but when our dads, brothers, partners or friends put off having something looked at, it can result in very real consequences. Even though women on average visit the doctor 20 percent more often than men, it is men who have much higher hospitalization rates for preventable conditions.

So why do men seem to go out of their way to prevent calling the doc? Many men simply aren’t used to communicating about how they feel and aren’t comfortable asking for help.

Total Health Radio has dedicated an entire podcast episode to this topic, including tips for supporting the men in your life in staying healthy. You can check it out — along with additional information and resources — at its official web page. You can also listen to it here, via Stitcher
.

And to see the above infographic in its entirety, click here for the full-sized version.