The Future of Care Delivery

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You walk in, verify at a kiosk that you’ve already checked in and paid, plug in your laptop at the charging station, and soon get a text that it’s your turn. No — you’re not at Starbucks — you’re at Kaiser Permanente’s new Signal Hill Medical Office in Southern California for your medical appointment.

Signal HillSignal Hill exemplifies Kaiser Permanente’s most recent effort of evolving its care model to better integrate into members’ lives.

“Granddad’s medical office building doesn’t cut it anymore,” said Don Orndoff, senior vice president, National Facilities Services.  “We’ve all now become accustomed to the Amazon and Uber experience and that’s our new expectation.”

The medical office of the future at Kaiser Permanente means harnessing design, technology and workflow to create an intuitive and convenient experience for members and care teams. It also means developing a much more agile and flexible environment that meets the evolving technology and service needs of those increasingly tech-savvy members and care teams.

Convenience and care under one roof

Signal Hill opened to Kaiser Permanente members on June 29, 2016, and its sleek architectural design doesn’t disappoint. But it’s the convenient technology features and efficient spaces inside that really impress. When you walk inside the building, you enter into the “public square.”

Since members have the option of checking in and handling their copayments at home, a quick visit to the kiosk allows them to take advantage of a number of options available to them in the public square. They can engage with others at the community table or use computers at the docking station. Or, they can decompress in a quiet spot on the upstairs “porch.” In fact, members can use their time wherever they wish because once the provider is ready, the member will receive a text message.

At the pharmacy, there is also no need to wait around. You’ll receive a text when your medication is ready.

signalhill2The exam rooms don’t look traditional either. Instead of the long, awkward exam table and steel chairs, there’s a comfortable reclining chair and a couch for family seating. The care team also uses hand-held tablets, which is not only easier for them, but avoids having the member stare at the back of a big computer monitor. On the wall, there’s a large monitor for virtual visits or patient education programs.

Read more of this story here. 

How do you measure a WELL building? Our Preliminary Audit

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KPCTH -2016.08.09 Delos Living Preliminary Audit 01027

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!

KPCTH -2016.08.09 Delos Living Preliminary Audit 01044

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

Vision Zero for Who? #MoveEquity chat

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What opportunities exist to create safer, more equitable streets and neighborhoods?

How can law enforcement be applied more effectively to improve safety in low-income communities and communities of color?

What about the use of safety cameras to lessen the chance of racial profiling?

Last week, we at Vision Zero Network held a twitter chat,  co-hosted with Safe Routes to School Partnership. Lots of people participated and we got many good ideas. A summary of the chat can be found here.

The Vision Zero Network is committed to helping communities reach their goal of Vision Zero — eliminating all traffic fatalities and severe injuries — while increasing safe, healthy, equitable mobility for all.

The Vision Zero Network is a collaborative campaign aimed at building the momentum and advancing this game-changing shift toward safe, healthy, equitable mobility for all. Focusing initially on leading-edge cities demonstrating commitment and potential, the Network will bring together local leaders in health, traffic engineering, police enforcement, policy and advocacy to develop and share winning strategies and to support strong, distributed leadership for policies and practices that make Vision Zero a reality.

We believe a strong, successful Vision Zero campaign can set a new standard for safety on our streets — and build toward a nationwide movement that prioritizes safe, healthy, equitable mobility for all.

You can see how many cities have committed to Vision Zero goals — 18 U.S. cities in just the last 2.5 years– by visiting here.

 

 

National HIV Testing Day

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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. 

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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

Don’t Let a Failing Heart Relegate You to Endless Doctor and Hospital Visits

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Dr. Ameya Kulkarni is an interventional cardiologist with the Mid-Atlantic Permanente Medical Group.

No one wants to spend their days in a hospital room. For the more than 5 million people in America who live with heart failure, a hospital stay is an unfortunate fact of life. In fact, it is estimated that there are over 1 million hospitalizations for people with this condition every year. The burden on patients, their families and their communities is immense. And the cost of this care is so high that there is a currently a national focus on trying to drive down admissions to the hospital for heart failure.

The Kaiser Permanente Center for Total Health regularly updates the information in our displays in collaboration with our health systems partners in Kaiser Foundation Health Plan and the Permanente Medical Groups. The Q1 2016 update focuses on Quality & Expert medicine, as led and delivered by the Mid-Atlantic Permanente Medical Group.

The Kaiser Permanente Center for Total Health regularly updates the information in our displays in collaboration with our health systems partners in Kaiser Foundation Health Plan and the Permanente Medical Groups. The Q1 2016 update focuses on Quality & Expert medicine, as led and delivered by the Mid-Atlantic Permanente Medical Group.

So far, the ideas on how to solve this problem mostly treaded old paths – exchanging hospitalizations for more doctor office visits. We know that patients end up in the hospital when they fill with fluid. Signs of this fluid buildup (increased weight, decreased activity) usually show up well before the need for a hospitalization. Our solution so far has been to have patients come to the doctor’s office more frequently for weight and activity checks. Although cumbersome for both the patient and the clinical care team, at least coming to the doctor every week keeps these patients out of the hospital.

It does not, however, make patients happier. Although no one wants to be in a hospital, few long for frequent battles with traffic only to pay a copay and wait for a doctor to review their weight and activity and make a small medication adjustment.

The innovation team at the Mid-Atlantic Permanente Medical Group – the independent medical group that exclusively serves Kaiser Permanente members in Washington, D.C., Maryland, and Virginia – has a vision of using 21st century technology to keep a close watch on our patients without the burdens of the traditional face-to-face visit.

We know that an early signal that a patient with congestive heart failure (CHF) will land in a hospital is a decrease in activity or an increase in weight. So we are giving our patients connected monitors that measure these parameters and send them to the care team automatically. We do the rest. When patients are doing fine, we don’t bother them. But when we get a signal that things aren’t going so well, we can reach out to make an adjustment before the fluid retention gets out of hand.

Meet the 2014-2015 AcademyHealth Innovators-in-Residence

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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

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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.

Designing a Better, Greener, More Sustainable Hospital

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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.

Using New Technology and Innovation to Improve Care

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robotRoving about the hospital on wheels, the InTouch Health® RP-VITA® robot lets doctors see and talk with patients, families, and staff in the intensive care unit in the middle of the night. From their home computers, doctors guide the robot, connect via secure video, and virtually respond to urgent needs in a matter of minutes.

The Kaiser Permanente Institute for Health Policy’s latest Policy Story shows how a three-month pilot of InTouch® helped physicians improve communications and respond to after-hours emergencies at a Kaiser Permanente hospital in Fremont, CA. Champions of this new technology are attempting to spread its use across the organization.

This exciting development is just one innovation being tested at Kaiser Permanente, where an extensive support system enables physicians and front-line staff to bring new ideas to life.

The Story also suggests ways to overcome innovation road blocks in health care when trying to get ideas moving. Here’s one of the tips:  Share best practices to generate enthusiasm through blogging, email updates, and demonstrations.

We’re following our own advice with this blog thanks to the Center for Total Health. Please pass it on.

What is a ‘wired’ hospital — and what does it mean for patients?

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Today’s post is authored by guest blogger Samantha DuPont, with the Kaiser Permanente Institute for Health Policy.

For the second year in a row, Kaiser Permanente’s California hospitals have been named “Health Care’s Most Wired” by Hospitals & Health Networks magazine. The honor recognizes our excellence in technology integration across the health care spectrum — infrastructure, procurement, human resources, security, clinical quality and safety, patient access, care continuum and health information exchange.

Kaiser Permanente has long been recognized as a leader in using technology to deliver high quality care. By 1970, we had implemented an electronic health record (EHR) for over 1 million patients. Today, our EHR, Kaiser Permanente HealthConnect®, connects 9.3 million members to their providers, and is one of the most advanced in the nation. By integrating comprehensive patient data, best practice research, treatment recommendations and other provider tools in one record, KP HealthConnect® ensures that patients receive the best care at every encounter.

We were also an early adopter of online health services for patients, as chronicled in an informative Kaiser Permanente Institute for Health Policy Story. In 1996 we began offering online prescription refills and appointment scheduling. Since then, our patient portal, My Health Manager, has grown a bevy of features, allowing patients to:

• view personal health information, including lab results, immunizations, past office visits,
• prescriptions, allergies, and health conditions;
• view, schedule, or cancel appointments;
• refill prescriptions;
• securely email doctors, pharmacists, and member services staff;
• take health assessments and programs that support healthy lifestyle changes and find information about health topics; and,
• manage health benefits, including viewing drug formularies and estimating the cost of treatments.

As of 2014, more than 4.4 million members are registered for My Health Manager on kp.org, nearly double the number in 2008. To learn more about how we’ve achieved success in getting patients online – and how that has improved health outcomes – read, “Engaging Patients Online with My Health Manager.”