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.

Fighting Hunger During the Holiday

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We know that “total health” is about more than absence of sickness, it’s about having a safe place to live, food to eat and nurturing, supportive relationships among other things. The holidays are always a great time to do what we can for our communities to support their total health. At the Center for Total Health, one community partner we wanted to call out this upcoming holiday is DC Central Kitchen. We offer a guest post from DC Central Kitchen’s Alex Moore below. Alex is featured in our Farmers Market display where we talk about food as a strategy for designing healthier communities. Keep his thoughts in mind as you think about giving back to the community this holiday season.

Happy holidays,

Keith Montgomery

 

Fighting Hunger During the Holiday Season

Alex Moore, Chief Development Officer at DC Central Kitchen

The holiday season is a time for giving back and helping others. At DC Central Kitchen, for example, we fight hunger by providing meals for our community each day while making longer-term investments in career training and job creation that strengthen local food systems and reduce disparities in health and economic opportunity, but we can’t do it alone! Here are some fun ways that you can help us and other food resource programs reach our goals:

  • Organize a turkey drive with your co-workers – Turn it into a friendly competition by making teams to see who can collect and/or donate the most turkeys! This will help provide the ultimate Thanksgiving meal for those in need.
  • Help plan a food drive through in your neighborhood or apartment building – By collecting staples such as beans, brown rice and canned goods, you can really food resource programs prepare daily meals on a large-scale.
  • Register to volunteer – Volunteers are needed daily – not just during the holidays to help prepare meals for our community 365 days a year.
  • Make a donation – If you are interested in making a financial contribution, check to see if there are matching donation programs to make you financial gift go further.

Whether you choose to support an organization like DC Central Kitchen or another important community organization, partnerships like the one with Kaiser Permanente’s Center for Total Health, help to highlight the many initiatives underway that are needed to address real problems in our community. I’m even featured in the Center’s farmers market display where you can hear me talk about my perspective on solving hunger, as well as the perspectives of others on food as a strategy for healthy communities. Check it out for yourself by visiting the Center for a tour!

About DC Kitchen:

DC Central Kitchen, located near Union Station in Washington D.C., is a nonprofit developer of innovative social ventures that break the cycle of hunger and poverty. Our mission is to use food as a tool to strengthen bodies, empower minds, and build communities. At DC Central Kitchen, we do more than just feed those in need. We run a 14-week culinary job training program to create economic stability for unemployed adults so they can leave hunger behind. Our social ventures provide 1.8 million meals for our community as well as healthy, locally-sourced meals to students at 15 low-income schools in DC.
If you would like to drop off items to DCCK, here are a few drop-off guidelines to follow, once you have successfully collected your items, you can drop them off during our regular hours, as follows:

  • Our regular hours for drop-offs are 8 a.m. – 4 p.m. on weekdays and 8 a.m. – 3 p.m. on weekends.
  • DC Central Kitchen’s physical address is 425 2nd St. NW, Washington, DC 20001. Please ensure that you receive a receipt for your donation from our on-site staff as we need to keep track of all food we receive. Donations are tax-deductible.
  • DC Central Kitchen is often able to pick up especially large donations. However, we greatly appreciate it if you are able to bring donations to our location. Please contact our food recovery team (foodrecovery@dccentralkitchen.org or 202-400-2804) in advance if you need to schedule a pick-up.

 

The dirty truth about receipts

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Guest blogger Joel Sigler is senior manager for Kaiser Permanente National Environmental, Health & Safety

The Center for Total Health has a self- service health assessment machine that provides visitors a printed receipt indicating their weight and body mass index (BMI). Recently, a visitor asked a great question about whether the receipt paper is coated with Bisphenol A (BPA).

BPA is an endocrine disrupter that mimics estrogen in the body. Studies have found that BPA exposure is potentially linked to a number of health concerns including breast cancer, diabetes, heart disease, sexual dysfunction, and obesity (kind of ironic if present in a machine that tells you your BMI). There are many sources of BPA exposure, it is found in many products including food can linings and plastic bottles. Unfortunately, receipt paper is one of the many items that can also potentially contain BPA. Receipt paper is of particular concern because it can easily be absorbed into the body when the receipt is handled. Absorption of BPA is sped up even more if hand sanitizer has been applied before handling a receipt.

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We promptly called the manufacturer of the self-service health assessment machine to find out if they knew if the receipt paper contained BPA. The good news is that the manufacturer was very responsive. Within a day they had contacted their receipt paper supplier and verified that it was “BPA free.” They even provided KP a letter from the receipt paper supplier. Kaiser Permanente is continuing to communicate with them to find out about any BPA alternatives that they may be using. Bisphenol S (BPS) and Bisphenol F (BPF) are chemicals commonly used as substitutes for BPA. They are less studied than BPA and haven’t gotten the same attention. But because BPS and BPF are similar in chemical structure to BPA, experts have concern that they could represent similar health risks.

It is important to recognize that product manufacturers aren’t always this responsive. It often takes a lot of effort to get an answer to whether a product contains chemicals of concern, either because they don’t know, or because they don’t think it is important enough to find out. In this case, the question had gotten to the President of the manufacturing company and apparently he had gotten similar questions from other customers. So just asking the question helps drive action. It is unfortunate though that when it comes to chemicals of concern, the onus is on the customer/consumer (and not on manufacturers) to drive efforts to find out if a product is “safe.” Kaiser Permanente puts significant effort into identifying and eliminating chemicals of concern like BPA in the products that the organization purchases and uses.

The Environmental Working Group provides the following recommendations to reduce exposure to BPA from receipt paper:

-Minimize receipt collection by declining receipts at gas pumps, ATMs and other machines when possible.

-Store receipts separately in an envelope in a wallet or purse.

-Never give a child a receipt to hold or play with.

-After handling a receipt, wash hands before preparing and eating food (a universally recommended practice even for those who have not handled receipts).

-Do not use alcohol-based hand cleaners after handling receipts.

-Take advantage of store services that email or archive paperless purchase records.

-Do not recycle receipts and other thermal paper. BPA residues from receipts will contaminate recycled paper.

More information on all of Kaiser Permanente’s environmental stewardship program can be found at kp.org/green

Physician Leadership in the Movement Toward Accountable Care

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Blog by Elizabeth Keating
Senior Project Manager, Council of Accountable Physician Practices

“It will not be possible to move the country toward accountable, value-based care without strong physician leadership at all levels of the organization.”

This statement was made by Robert Pearl, M.D., CEO of the Permanente Medical Group and the Mid-Atlantic Permanente Medical Group. Dr. Pearl recently moderated a panel at the CAPG Colloquium held in Washington, DC, on September 29, 2016.

The panel, “Physician Leadership in the Movement Toward Accountable Care,” was hosted by the Council of Accountable Physician Practices (CAPP) and featured CAPP leaders discussing best practices in recruiting, training and developing physician leaders.

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“Healthcare systems should view physician leadership as a capital investment for the future with huge ROI,” said Dr. Pearl, who also serves as the chairman of the board of CAPP. “The CAPP medical groups are committed to sharing their considerable experience to help all provider organizations face the challenges ahead.”

Over the course of the discussion, the panel touched on key aspects of their physician leadership development approaches. All agreed that leadership development starts at the moment of recruitment into the organization.

“Every physician is a leader. We start with that assumption,” said Marc Klau, MD, Assistant Medical Director of SCPMG. “Take every physician on as a leader and then expand their capability, because you never know when you will need them.

Dr. Klau described how SCPMG’s expansive geography allows for unique leadership development opportunities because programs begin at the medical center level. He explained that each medical center allows emerging physician leaders to build programs that work toward the Triple Aim goal. He stressed that this display of clinical excellence is critical to growing as a physician leader, because it builds trust among peers.
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Dr. Klau also discussed how SCPMG’s leadership programs are geared toward training leaders in Permanente culture, not just administrative practices.

“It’s not about learning to log in to our electronic health record,” he said. “It’s about anchoring people in our history, quality expectations and developing communication skills.”

The panelists overwhelmingly agreed that physician leaders must possess emotional intelligence to be effective.

“The best leaders are going to be visionary but anchored in reality,” said Dr. Klau. “People who have a passion for doing something are the people who will move and change the world.”

The panelists agreed that physicians who are aspiring to lead their health systems or who think they might want to take on a more comprehensive role should start small. Emerging physician leaders could join clinical improvement committees or the first stage of a leadership program to determine if the track is right for them.

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.

Can you see me now? Video Visits at Kaiser Permanente

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Dennis Truong, MD, is an emergency medicine specialist and the telemedicine director for the Mid-Atlantic Permanente Medical Group.

Smart phones and tablets are everywhere. Adoption of these devices now largely spans age, income, race and ethnicity. Americans, of all stripes, are emailing, tweeting, posting, banking, gaming, navigating, checking weather and so much more almost nonstop. Yet when it comes to using those nearly ubiquitous devices, only 2 percent report having access to video visits with their doctor.

In stark contrast, almost 9 in 10 family physicians believe telehealth – the suite of technologies and tactics to deliver virtual medical, health, and education services – is a way to increase access to care. Putting two and two together, that means far more than 2 percent of people should have access to video visits – a core component of telehealth.

Dr. Truong conducts a simulated video visit with a member.

Dr. Truong conducts a simulated video visit.

Why this disconnect? Telehealth regulatory policy for one. From the patchwork of state by state rules to privacy protections to reimbursement rules. Doctors (and some patients) also worry that telehealth has limited diagnostic and treatment value relative to face-to-face care and will adversely impact the day-to-day practice of an office. Not only does it interfere with the routine of quickly moving from one prepped patient to the next, it changes how you chart, plan for space in your office, bill and collect, and so much more.

The regulatory and payment framework must evolve, and technological advances in remote capabilities can help validate telehealth as a reliable solution. But it is easy to overlook the fact that none of it matters if doctors don’t want to change their norms. And, that adoption will fail if the consumer satisfaction barometer is not met as a result of a fragmented experience. At the Mid-Atlantic Permanente Medical Group (MAPMG), and all the Permanente groups of Kaiser Permanente, video visits have become a key part of our clinical offering. Making it work has been a case study in careful planning rather than chasing a “sexy” concept without judiciously working out all the details.

Since launching video visits three years ago, we carefully worked through the legal and regulatory steps. We put in the necessary equipment, trained every provider, collaboratively chose the specified set of clinical chief complaints that should be eligible for video, and slowly built video visit appointments into the schedule that gave physicians dedicated time for the care. The “competition” isn’t other providers. It is the doctor’s frame of reference. Is this as easy as when the patient is sitting in the exam room ready and waiting with forms completed, vitals collected, and nursing tasks done?

As the industry saw more platforms and pure-play video offerings emerge, we worked to stay true to a principle that says video care shouldn’t be fragmented from the normal care patients receive. Patients do not want to repeat themselves, pay for redundant tests, or fail to get a diagnosis because the doctor doesn’t have enough information to definitively make one. Nor do they want to have their “regular” doctor fail to provide care in consideration of what is known from any previous video encounters.

We purposefully integrated our solution into the same integrated electronic medical record we use for every face-to-face visit, telephone, or email visit. All the information is there to make the right clinical call. The ordering and referring process is identical (and can be done for the patient by the provider). The activity is visible to the patient’s regular provider(s).

When practiced right, it becomes as clear as the face on that smart phone screen that video visits are a powerful tool to improve access and patient satisfaction. The medical community needs to invest in making it not simply available to more patients, but making it available in a way that allows them to integrate that care with their overall primary and specialty care.

Why You Should Reflect on Your Health This September

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When was the last time you reflected on your total health journey? From your childhood experiences to your future in old age, what phase of life are you in and how do you envision your health moving forward?

At the Center for Total Health, we believe that having a dialogue about your health is critical, which is why we’re encouraged by the following health-related observances in September and the wisdom they provide us. Along with each observance, we’ve provided questions for reflection and would love to hear your thoughts in the comments section below.

Fruits and Veggies—More Matters and Childhood Obesity

Whether it’s through physical movement or eating more fruits and vegetables, teaching children and adults the importance of leading a healthy lifestyle has the power to end childhood obesity and create a positive ripple effect from the local to the national level.

We observe Fruits and Veggies – More Matters Month and Childhood Obesity Month in September to spread awareness about how people can live healthier lives. In alignment with this mission, CTH showcases work being done across the country to make this goal a reality. Through our immersive exhibits we display change in action —like the implementation of the “Let’s Move! Active Schools” campaign in Miami, featured on our Health Discovery Wall. Our interactive map highlights the locations in Miami that have increased physical activity in schools, showcasing how individual or local change can make a difference.

Health Reflection: What foods and exercise currently support your total health – physically, mentally and emotionally?

Healthy Aging and World Alzheimer’s

Life can be challenging for Leo and Rosemary – two elderly personas featured at CTH. Leo shows signs of cognitive impairment and Rosemary, his wife and caregiver, has to ensure that he takes his medication and goes to his appointments, while also having to care for her own emotional health. With Rosemary’s help, Leo is aging in place, able to live in the comfort of his own home and community.

The month of September provides us the opportunity to address both the challenges as well as the positive aspects of growing older by observing both World Alzheimer’s Month and Healthy Aging Month. These observances touch on a delicate, yet immensely important phase of life – how we age and the responsibilities that come with growing older. We’re reminded to be more intentional with our actions and how they can affect our health later in life.

Health Reflection: In our busy, every day lives how often do we pause to think about how we’d like to age? What are we doing (or not doing) now that could help us age in a stronger, healthier way?

Regardless of age, we can all benefit from discussing what these observances mean for us, our family members and our community.

What’s one way to start prioritizing your health and the health of your friends, family or colleagues? By visiting and hosting a meeting or event at the Center for Total Health. You can find more information here.

I Want To Be The Next Summer Intern!

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This summer, I interned at the Center for Total Health through the Kaiser Permanente Mid-Atlantic Summer Internship Program. I am currently a senior at James Madison University majoring in Health Science and with minor in Health Communications.  After graduation in May 2017, I plan on attending graduate school to obtain a Master’s in Public Health.  My future career goal is to educate disadvantaged populations in the United States about various health topics to help eliminate current health disparities in our country.  The Kaiser Permanente Mid-Atlantic Summer Internship Program has tremendously prepared me for success in the future and in an industry-leading healthcare company.

On July 22, 2016, I provided tours to the youth participants of the 2016 DC Summer Youth Employment Program. [Photo By: O Grant]

On July 22, 2016, I provided tours to the youth participants of the 2016 DC Summer Youth Employment Program.
[Photo By: O Grant]

I was given various projects this summer that have honed my skills and knowledge of health.  One project I was given was to provide informative tours of the Center for Total Health to guests.  The tour consists of content exploring topics including Kaiser Permanente’s history, different aspects of total health, and advancements in telemedicine.  Not only have my presentation skills improved, I am now equipped with conversation starters to engage in meaningful dialogues with professionals in health related fields. Another project I was given, also my personal favorite, was the honor to design a display showcasing African-American history throughout Kaiser Permanente.  It will be displayed at a VIP luncheon hosted for top employers and partners of Kaiser Permanente Foundation Health Plan and Hospitals, held in September.  Kaiser Permanente Foundation Health Plan and Hospitals demonstrates and embraces diversity in the workplace, therefore the company is a proud financial contributor to the new African-American History Smithsonian in Washington, DC.  To complete the project, I researched the content, contacted Kaiser Permanente diversity committees, and wrote a creative brief for the display.  This project allowed me to take the initiative and utilize the leadership skills I have learned throughout college.

As a participant of the Kaiser Permanente Mid-Atlantic Summer Internship Program, I also attended weekly professional development forums organized by current Kaiser Permanente employees. The forums were interactive, informative and a key to my professional growth this summer. We discussed resume writing, networking skills, interview tips, professional dress and much more.  In addition to the professional development forums, we attended a Nationals’ baseball game in July and spent an afternoon volunteering with SOME (So Others Might Eat), a community based organization in DC to help poor and homeless residents.

The ten-week program has placed me a step ahead of my peers entering the workforce after graduation in May.  At the conclusion of the program, I have taken away valuable items to place into a portfolio, strong communication skills, confidence in my work ability and strengthened my soft skills in professional office setting.  I am very thankful for this opportunity and appreciate the Center for Total staff for welcoming me on board this summer.  In the future, I would love to work for Kaiser Permanente after completing my education.

If you are interested in being an undergrad intern through the Kaiser Permanente Mid-Atlantic Summer Internship Program next summer, please visit www.kaiserpermanentejobs.org to learn more!

This Week in Total Health: Sweating the Details

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Another busy week has drawn to a close at the Center for Total Health.

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Brendan O’Grady, WELL AP, explains initial readings to Kathy Gerwig, vice president of Employee Safety, Health and Wellness, and environmental stewardship officer and Carol Corr, AIA, LEED GA, EDAC, Design Program Manager, National Planning and Design, National Facilities Services

On Monday and Tuesday, the center welcomed Delos (@DelosLiving)for the first step of our WELL Building Standard Certification.  Ted Eytan (@tedeytan) wrote an in-depth summary of the experience.

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Kathy Porter

Our team was thrilled to meet Kathy Porter, who is the face of the original Alexandra persona used by our design teams, and Cathryn Burby from the American Cancer Society this week.

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Cathryn Burby, Senior Director, Community Engagement at the American Cancer Society

August brings heat and humidity to our nation’s capital, making it a notoriously quiet month across the city. Our team is taking advantage of this time to get our ducks in a row for a busy fall. If you’d like to come the Center for Total Health for a tour or event, please let us know!

How do you measure a WELL building? Our Preliminary Audit

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We’ve completed our preliminary audit on the way to full WELL (@WELLCertified) certification.

The WELL Building Standard® is an evidence-based system for measuring, certifying and monitoring the performance of building features that impact health and well-being.

The audit includes testing of air, sound, light, and water, performed by an objective third party, in this case Delos (@DelosLiving). As most things I have encountered as a physician in the total health space, I learned that there is much more in our environments that can be measured and managed that we are taught about in medical school.

Fortunately though, there are fellow professionals in health, who are working along side us to make all of our work more impactful. You can see from the photos that the work involves applied science and the judgement to understand what is the best environment for the task. Many of the improvements to be made are not costly, all that’s needed is to know what’s needed.

The Preliminary Audit is a stage in the process to full WELL Building Certification. The Center for Total Health is the perfect place, on many levels, to go through the process, with many experts here to help us!

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Left to Right: Brendan O’Grady, WELL AP, Delos; Madeline Evans, WELL AP, LEED Green Associate, Delos; Kathy Gerwig, vice president of Employee Safety, Health and Wellness, and Environmental Stewardship Officer at Kaiser Permanente, and Carol Corr, AIA, LEED GA, EDAC, design program manager, National Planning and Design, National Facilities Services, Kaiser Permanente