Research Roundup: Staying One Step Ahead of Your Health

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Close to 2,000 studies involving Kaiser Permanente (KP) clinicians and researchers are in progress at any given time across the organization’s seven regional research centers. This work helps to shape policy and practice for KP and the health care system at large as it strives to improve patient quality and satisfaction, population health, and reduce the per capita cost of care. To further this goal, each month the KP Institute for Health Policy will highlight several research studies with policy implications as part of our new research roundup series. The inaugural summary includes three studies that examine the effectiveness of steps that patients can take to help control the symptoms of a variety of health conditions.

Scanning for Alzheimer’s Disease

Rachel Whitmer from Northern California is part of a national leadership team for a study titled Imaging Dementia – Evidence for Amyloid Scanning (IDEAS), led by the Alzheimer’s Association, managed by the American College of Radiology and the ACR Imaging Network, and funded by the Centers for Medicare and Medicaid Services. Researchers will be examining a positron emission tomography (PET) scan that detects brain plaques associated with Alzheimer’s disease. The research group will determine how this scan affects doctors’ treatment plans and patient outcomes. If the PET scan is shown to be beneficial, Medicare may decide to cover it. With an early diagnosis of Alzheimer’s disease, patients can receive proper care sooner to avoid accidents from cognitive impairments and to potentially slow the progression of the disease.

Supplements for Menopause

Another study examined whether vitamin D and calcium supplements help to alleviate menopausal symptoms. Erin LeBlanc from the KP research center based in Portland, Oregon conducted a longitudinal study and found that women who took these supplements had the same number of menopausal symptoms as those who did not. Some of the symptoms included sleep disturbance, emotional well-being, and fatigue. The average age of women at the beginning of the study was 64. Dr. LeBlanc suggests that future research on the effects of supplements on menopause should include younger women to see if the results are different based on age.

Lessening the Pain of Shingles

A study from Southern California was published this month about an additional benefit of the shingles vaccination. Hung Fu Tseng and his team found that those who get shingles after receiving the vaccination (herpes zoster) have a lower risk of developing a painful complication from the condition called post-herpetic neuralgia (PHN). The Advisory Committee on Immunization Practices currently recommends the vaccination for adults over 60 years old. This research provides additional support for the vaccination, both to decrease the likelihood of getting shingles and to reduce the severity of PHN and the mental health consequences from long-term pain.

Kaiser Permanente continues to set the bar for evidence-based care. Look for next month’s research roundup: the Institute will look at three studies about investing in community clinics. If you’d like to learn more about the research studies, please contact Al Martinez at Albert.Martinez@kp.org.

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.

Leading Transformative Change in Medicine: Highlights from the 2015 Lown Conference

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Lown“There’s a thread you follow. It goes among things that change. But it doesn’t change…” reads first line from the poem The Way It Is, by William Stafford, which was recited by panelist David Hirsh, MD, at the 2015 Lown Annual Conference.  Medical students, he explained, are often surprised by the breadth and depth of the unique challenges they encounter in the U.S health care system. Holding on to their ‘thread’ is a reminder to focus on the human compassion that led them to the field in the first place.

The notion that physicians of all stages in their careers are a critical part of transforming the health care system represented a key theme of the conference, which focused on advancing change through grass roots movements in communities and health care settings. Patient advocates also told personal stories of how their lives were affected by a culture of inappropriate use in medicine coupled with unjustified prices for health care services.   Other themes included a renewed focus on primary care, overcoming the ‘more is better’ approach to medicine, and bringing dignity and choice to decision making around end-of-life care.

Titled, “Road to RightCare: Engage, Organize, Transform,” the conference was held March 9 through 11 in San Diego, California, and co-funded by Kaiser Permanente.  It brought together clinicians, researchers, advocates, patients, and community leaders, many of whom were members of the RightCare Alliance, an organization devoted to reducing overuse, underuse, and misuse of medical tests and treatments while restoring  the trusted clinician-patient relationship.  United States health care spending is expected to exceed $3 trillion in 2014, with inappropriate use accounting for as much as $1 trillion of that spending.  Addressing this crisis is fundamental to achieving the goal of delivering compassionate medicine that benefits both people and their communities.

For more details about the conference, check out this longer post on the Kaiser Permanente Institute for Health Policy website.

A Visit from George Washington University Nursing Students

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Last week, the Center for Total Health — along with Lu Casa, MSN, CRNP, CTTS — welcomed accelerated students from George Washington University School of Nursing (@gwNURSING). As always, we enjoyed hosting the future leaders of health, and hearing their ideas and questions about health care delivery. You can read more about the visit here.

GWU Nursing Students visit the CTH.

GWU Nursing Students visit the CTH

To see more pictures of their visit, click here.

Three Ways to Improve Digital Health for the Underserved

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“Nothing is more important than your health.  Not money, not anything.  Without your health you can’t do anything.  Emotionally, socially, at work; everything goes with health.…”   – Focus group participant.

“Nothing is more important than your health.  Not money, not anything.  Without your health you can’t do anything.  Emotionally, socially, at work; everything goes with health.…” – Focus group participant.

A new report from Oakland-based non-profit ZeroDivide reveals three ways in which low income women of color use digital technology to access health care for themselves and their families, as well as how they would like to use it in the future.

To determine the current use and usability of consumer-facing electronic health tools (“eHealth”) by low-income communities and communities of color, and to identify opportunities to improve the use of eHealth to address persistent health disparities in these target communities, ZeroDivide held six focus groups with over 60 diverse women in four American cities during June 2014.

In spite of a revolution in new health technologies, advancements that economically and socially privileged populations enjoy, however, have in many instances eluded underserved populations and underserved women in particular.

Through these discussions, participants shared their perceived value of eHealth tools, as well as challenges they face to eHealth adoption.

“The translation of health on the websites are atrocious, they are terrible,” one participant said. Another remarked, “You have to go through so many phases just to get to where you’re trying to go, and it’s like, I have to remember this too? My Mom ends up being more confused.”

The report offers three policy recommendations.

  1. Improve the digital and eHealth literacy of underserved consumers and safety net providers and outreach to these populations;
  2. Support eHealth tools for underserved populations that feature user-centered design and design that enhances communication with providers; and
  3. Support technology capacity building for safety net providers to strengthen the eHealth equity infrastructure.

Read the full report here.

International Efforts to Improve Quality and Efficiency in Health Care

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Murray Ross, PhD, vice president, Kaiser Permanente's Institute for Health Policy

Murray Ross, PhD, vice president, Kaiser Permanente’s Institute for Health Policy

Health systems across the world share a common responsibility to improve care. Rising health care costs and a growing drive for better outcomes create a need to spend health care funds efficiently and in accordance with each country’s priorities.

A response to this urgent demand requires, first, an understanding of which technologies and interventions—drugs, devices, diagnostics, and health care services—increase the quality and value of health care and, second, knowledge of policy levers that could encourage health care systems to adopt such technologies.

Comparative Effectiveness Research (CER) and Health Technology Assessment (HTA) are important tools used in different ways by countries to achieve these goals.

With support from the Kaiser Permanente Institute for Health Policy and the National Institute for Health Care Management, AcademyHealth researchers have produced a new report, “Improving Quality and Efficiency in Health Care through Comparative Effectiveness Analyses: An International Perspective,” that explores these issues. The report describes how the United States and other high-income countries assess effectiveness of new drugs, devices, procedures, diagnostics, and health care services and coverage decisions based on these assessments. The report also provides an overview of HTA activities in Europe, Canada, and Australia and examines the new public investments in CER in the United States.

The report calls for further engagement by international researchers and stakeholders to promote mutual learning.  You can read the report here.

A Perfect Storm Brings Health Care, Government and Business Together for a More Sustainable DC

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There was a “perfect storm” of activity in the nation’s capital last week, and if you weren’t tuned in closely, you might have missed it.

The Sustainable DC pledge awaits formal signatures from health care representatives signifying their commitment.

The Sustainable DC pledge awaits formal signatures from health care representatives signifying their commitment.

This perfect storm was not another Superstorm Sandy. In fact, one might argue that one of the aims of this perfect storm was to build resilience to any such storms in the future. This perfect storm brought together representatives from 21 different health care organizations and local government officials at Kaiser Permanente’s Center for Total Health pledging to make the District of Columbia “the most sustainable city in the United States.

So what makes this newsworthy? The health care sector is certainly no stranger to coming together under the umbrella of sustainability. Over the past 20 years, the sector has been leading its very own “green revolution,” with hospitals and health care systems of all sizes looking hard at their contributions to environmental waste and pollution and what they must do to flip the equation and support more environmentally sustainable health care approaches.

What makes the Sustainable DC effort special is its focus on a single urban community, on bringing together leaders from health care, government and business sectors in a particular place, concentrating their efforts across governance, jobs and the economy, equity and diversity with the goal that, “By 2032, the District will be the healthiest, greenest, most livable city in the nation by using sustainability solutions to address core challenges.” The Sustainable DC plan outlines specific goals, targets and actions to get there. And the plan makes it clear that health care organizations to be at the table to bring the mighty vision to fruition.

Hospitals in America contribute an estimated 8 percent of greenhouse gas emissions, generate more than 2 million tons of waste each year and draw upon natural resources like water in ways that often counteract efforts to support the health of individuals and communities. Recognizing this paradox, many health care leaders have joined efforts like the Healthier Hospitals Initiative, Practice Greenhealth and Health Care Without Harm to green their own health care systems.

Kathy Gerwig, chief environmental stewardship officer for Kaiser Permanente, chronicles this green movement in her recent book, Greening Health Care: How Hospitals Can Heal the Planet. In the book, she notes the reasoning behind why health care organizations would move to join forces with each other and government to move the needle on environmental health:

“In the final analysis, most health systems engage with their communities not because they are incented to do so by federal and state tax law, but because they are mission-driven organizations that care deeply about the health of their communities. They know that individuals’ health depends on the health of the communities in which they live, work, learn, and play, and that the health of those communities depends on a healthy environment—health-sustaining air, water, soil, and all natural resources. They strongly believe, on the basis of compelling evidence, that when they invest their dollars and their expertise in promoting healthy social and physical environments, they are benefiting their communities and contributing to the health of everyone.”

That mission-driven energy was palpable on October 23, 2014. The energy in the room was exciting, collegial and activated. There was much talk of the sustainability progress that is already converging in DC – from an extensive array of green roofs and LEED-certified buildings across DC to the build out of the Metropolitan Trail to provide safe, physical activity and active transportation options. And there was a clear conviction expressed by health care leaders who were gathered, as well as the Mayor’s office, that this coming together for a more sustainable DC was just setting the stage for a convergence of efforts that would echo progress even beyond DC limits.

We can only hope that, as DC leads the way in sustainability, so goes the rest of the country.

Representatives from DC area health care organizations gather with Mayor Vincent Gray at the Center for Total Health after the signing of the Sustainable DC pledge.

Representatives from DC area health care organizations gather with Mayor Vincent Gray at the Center for Total Health after the signing of the Sustainable DC pledge.

Kaiser Permanente applauds the Sustainable DC plan, and we are pleased to be among the pledge-signers and the hosts for this momentous step forward. We have pledged our support and look forward to working with fellow health care system leaders to advance the goals outlined in the plan.

Kaiser Permanente physician director for the Center for Total Health, Ted Eytan, along with Keith Montgomery, executive director for the Center, nicely set the stage for the day’s event in their welcome remarks. Ted offered his follow-up reflections in a blog post that summarized the vision for total health that everyone in the room intuitively if not concretely echoed that morning. He writes, the Sustainable DC plan is “not just about the environment, it’s about everything that goes into creating an ‘equitable, prosperous, society.’”

You can watch the full signing ceremony in this video.

Informing the Next Generation of Accountable Care Organizations

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Some of the biggest buzz in health reform lies in the potential that Accountable Care Organizations (ACOs) have to help to reduce costs, improve care, and move away from fee-for-service to population-based payment.   But questions remain as to whether or not they will result in comprehensive delivery system and payment reform that is sustainable.

Joy Lewis, MSW, MPH, of the Kaiser Permanente Institute for Health Policy, attended a July 13th convening in Washington D.C., hosted by the National Health Policy Forum, that highlighted some of the successes and challenges of early ACOs.

Kaiser Permanente has been supportive of this movement since the concept was first introduced in 2009.  While not technically an ACO, many elements of our care system – such as use of electronic health records, team-based care, and population management tools – ideally will be a part of ACOs.

Read the Kaiser Permanente Institute for Health Policy Observation describing Lewis’ highlights of the meeting, which include tactics for improving quality, increasing savings and overcoming the fee-for-service chassis.

Secretary Hunt with NHS and Kaiser Permanante delegations

NHS and Secretary of State for Health, Jeremy Hunt, Visit the CTH

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Representatives from the National Health Service of England, along with British Secretary of State for Health, Jeremy Hunt, paid a visit to the Kaiser Permanente Center for Total Health on June 2. This marks the second visit to Kaiser Permanente for the Secretary.

This time, he spent a half-day contemplating many issues in health care which we all acknowledge are global in nature. Representatives from Kaiser Permanente shared the health care organization’s deep knowledge and experience regarding topics such as management of complex patients with chronic disease, leveraging technology to augment care, and physician management.  The exchange was interactive and lively.

Taking part in the discussion from Kaiser Permanente were Kim Horn, president of the Mid-Atlantic States region; Bernadette Loftus, MD, associate executive director of The Permanente Medical Group; Philip Fasano, executive vice president and chief information officer; Murray Ross, vice president and director of the Institute for Health Policy;  Ted Eytan, MD, physician director for the Center for Total Health;  and Walter Suarez, MD, executive director of health IT policy and strategy.

Phil Fasano, CTO of Kaiser Permanante, leads discussion.

Philip Fasano, executive vice president and CIO of Kaiser Permanente, leads discussion.

We all agreed that we work for the patients and our decisions should be guided by that core belief. For our British colleagues, the afternoon session triggered new ways of thinking about and approaching the challenges faced “back home.”

Kaiser Permanente is committed to helping shape the future of health care globally. Sessions like this one and other international learning forums are coordinated by Kaiser Permanente International (KPI).