Archive

Archive for the ‘Robert Wood Johnson Foundation’ Category

Reform in Action: Can Publicly Reporting the Performance of Health Care Providers Spur Quality Improvement?

August 8, 2012 Comments off

Reform in Action: Can Publicly Reporting the Performance of Health Care Providers Spur Quality Improvement?
Source: Robert Wood Johnson Foundation

Aligning Forces for Quality (AF4Q) Alliances have been pioneers in collecting and publicly reporting data on the care provided by local physicians and hospitals, and are beginning to see their impact when it comes to improving quality. The real challenge is turning the idea of transparency into the reality of quality improvement on the ground.

In less than a decade, the push for transparency in health care has come a long way. There are public reports on the quality or cost of care provided by hospitals or physicians in every state except Alaska, Idaho, and the District of Columbia.

Measuring and publicly reporting on the quality and cost of care is crucial to improving quality and lowering health care costs nationwide, and serves three important purposes: 1) it enables patients to make informed choices about their care and be better partners with their doctors; 2) it allows health care professionals to see where they can improve and motivates them to improve their performance; and 3) it allows consumers and purchasers to see the value they are getting for their money.
Aligning Forces for Quality is the Robert Wood Johnson Foundation’s signature effort to lift the overall quality of health care in 16 targeted communities, as well as reduce racial and ethnic disparities and provide tested local models that help propel national reform.

Medicare and Medicaid — Care for Dual Eligibles

June 23, 2012 Comments off

Care for Dual Eligibles
Source: Robert Wood Johnson Foundation

Medicare and Medicaid are the main government programs that provide health insurance to a range of individuals, including the elderly, people with low incomes, and those with certain disabilities. The programs have different funding sources, covered benefits, and management systems.

People who qualify for benefits under both programs, some nine million beneficiaries, are commonly referred to as “dual eligibles.” They frequently have multiple chronic conditions and more than half have cognitive or mental impairments. Yet because of the separate nature of Medicare and Medicaid, care provided to the “duals” is often poorly managed.

The Affordable Care Act created a new Medicare-Medicaid Coordination Office within the Centers for Medicare and Medicaid Services (CMS) in an attempt to make the two programs work together more effectively. The office is testing various approaches to doing so.

This brief describes those efforts and the debate over how they should be structured and how likely they will be to lower costs.

Center to Advance Palliative Care

June 4, 2012 Comments off
Source:  Robert Wood Johnson Foundation
Dates of Support: 1999–2011
Field of Work: Palliative and end-of-life care
Problem Synopsis: Advances in public health, preventive medicine, and medical technology have led to dramatic increases in the number of Americans living longer. While many people over age 65 enjoy good health for some time, eventually most adults will have one or more chronic illnesses often characterized by pain and frailty. The nation’s health care system is not well suited to address the array of medical, social, emotional, and other needs of patients living for long periods with serious, but not immediately terminal, conditions.
Synopsis of the Work: During 1999–2011, the Center to Advance Palliative Care (CAPC) at the Mount Sinai School of Medicine undertook a range of initiatives to increase the number of hospitals able to provide palliative care, make hospital-based palliative care standard practice, and develop standards for palliative care programs.
To achieve these goals, CAPC selected and supported nine Palliative Care Leadership Centers (six funded by RWJF) based at hospitals across the country, led a consortium of organizations in developing consensus standards of palliative care, and demonstrated cost savings attributable to palliative care. In addition, CAPC provided ongoing in-person and online resources, and training via national seminars, audio grand rounds, and guidebooks.
Key Results: CAPC developed a new understanding of palliative care that shaped the thinking of physicians, patients, and policy-makers. By distinguishing palliative care from end-of-life or hospice care, CAPC expanded its audience to include patients with serious, but not immediately life-threatening, conditions. Physicians and their patients could work simultaneously on providing care aimed at both curing the condition and ensuring that patients were comfortable and stable.
  • By 2009, the number of hospitals providing palliative care increased by 138 percent, from 658 to 1,568.
  • The Palliative Care Leadership Centers had trained 1,029 teams from hospitals across the country, 80 percent of which had established their own palliative care programs within two years.
  • In 2006, the National Quality Forum endorsed a framework for preferred practices in palliative and hospice care. In 2011, the Joint Commission launched a Palliative Care Advanced Certification program.

Center to Advance Palliative Care

June 3, 2012 Comments off
Source:  Robert Wood Johnson Foundation
Dates of Support: 1999–2011
Field of Work: Palliative and end-of-life care
Problem Synopsis: Advances in public health, preventive medicine, and medical technology have led to dramatic increases in the number of Americans living longer. While many people over age 65 enjoy good health for some time, eventually most adults will have one or more chronic illnesses often characterized by pain and frailty. The nation’s health care system is not well suited to address the array of medical, social, emotional, and other needs of patients living for long periods with serious, but not immediately terminal, conditions.
Synopsis of the Work: During 1999–2011, the Center to Advance Palliative Care (CAPC) at the Mount Sinai School of Medicine undertook a range of initiatives to increase the number of hospitals able to provide palliative care, make hospital-based palliative care standard practice, and develop standards for palliative care programs.
To achieve these goals, CAPC selected and supported nine Palliative Care Leadership Centers (six funded by RWJF) based at hospitals across the country, led a consortium of organizations in developing consensus standards of palliative care, and demonstrated cost savings attributable to palliative care. In addition, CAPC provided ongoing in-person and online resources, and training via national seminars, audio grand rounds, and guidebooks.
Key Results: CAPC developed a new understanding of palliative care that shaped the thinking of physicians, patients, and policy-makers. By distinguishing palliative care from end-of-life or hospice care, CAPC expanded its audience to include patients with serious, but not immediately life-threatening, conditions. Physicians and their patients could work simultaneously on providing care aimed at both curing the condition and ensuring that patients were comfortable and stable.
  • By 2009, the number of hospitals providing palliative care increased by 138 percent, from 658 to 1,568.
  • The Palliative Care Leadership Centers had trained 1,029 teams from hospitals across the country, 80 percent of which had established their own palliative care programs within two years.
  • In 2006, the National Quality Forum endorsed a framework for preferred practices in palliative and hospice care. In 2011, the Joint Commission launched a Palliative Care Advanced Certification program.

Examining the Evidentiary Basis of Congress’s Commerce Clause Power To Address Individuals’ Health Insurance Status

February 22, 2012 Comments off
Source:  Robert Wood Johnson Foundation (BNA Health Policy Report)
The Patient Protection and Affordable Care Act (ACA) requires individuals to buy minimum health insurance coverage or pay a penalty. Whether or not Congress has the power to require this will be decided by the U.S. Supreme Court. One of the chief arguments made by ACA advocates is that Congress has the right to regulate interstate commerce—the “commerce clause.” But first, the court must decide whether being uninsured substantially affects interstate commerce.
These authors assert that the economic spillover effects of being uninsured impacts not only the individuals and their families, but more importantly, community and regional health care systems and the economy as a whole. Among the consequences of uninsurance gleaned from vital statistics data: (1) a quarter of pregnant women are uninsured for part or all of their pregnancies, putting pressure on the health system and public programs like Medicaid; and (2) ten percent of nonfatal injuries are treated in the emergency department, without regard to patients’ ability to pay.
Given the inevitable and universal need for health care, the authors believe that “the framework for analyzing the constitutionality of the minimum essential coverage requirement should be the stability of the larger health care economy, of which insurance plays a crucial financial role.”

Full Report (PDF)

2011 Physicians’ Daily Life Report

January 9, 2012 Comments off
Source:  Robert Wood Johnson Foundation
This report presents the findings of the 2011 Physicians’ Survey conducted by Harris Interactive®, on behalf of the Robert Wood Johnson Foundation. This online survey of 1,000 physicians was comprised of 690 primary care physicians and 310 pediatricians and was conducted between September 16 and October 13, 2011.
The sample source was the American Medical Association Masterfile. The methodology used to conduct this survey has been made available here (see Physicians’ Daily Life Report), in addition to the survey instrument.

Addressing Nutrition, Overweight and Obesity Among Latino Youth

January 1, 2012 Comments off

Addressing Nutrition, Overweight and Obesity Among Latino Youth (PDF)
Source: Robert Wood Johnson Foundation

Latino youth are more likely to be overweight or obese than their white peers. According to current estimates, more than 38 percent of Latino youth ages 2-19 in the United States are overweight and almost 21 percent are obese. The higher prevalence of overweight and obesity among Latino youth places them at greater risk for developing health and psychological problems such as cardiovascular disease, asthma, type 2 diabetes, liver disease, sleep apnea, depression, anxiety and psychological stress.

These negative effects on Latino youth—and the nation as a whole—cannot be understated, as Latinos currently represent the most populous and fastest growing ethnic minority in the United States. In 2010, the 50.5 million Latinos in the United States comprised 16 percent of the total population—a figure that grew by 43 percent between 2000 and 2010.

In the coming years, the negative effects felt in this large minority population will likely ripple through the health of the nation as a whole, resulting in greater health care expenditures, higher disability rates, lost work productivity, stunted economic growth, and perhaps even threats to national security.

A complex interplay of environmental, socioeconomic and cultural factors contributes to the higher rates of overweight and obesity among Latino youth. The modern urban environment, replete with convenience stores and fast-food restaurants, has provided easy access to generally unhealthy foods and beverages while not always providing access to healthy ones. This imbalance is further driven by the fact that calories tend to be cheaper in unhealthy foods than in healthy ones.

Low rates of physical activity also contribute to this imbalance. Studying this epidemic in the Latino population entails an additional challenge, since the word “Latino” encompasses more than one culture. Latinos come from many different countries and have adapted to American culture to varying degrees. These differences may be among the factors that account for variation in obesity among Latino youth. To fully appreciate the scope of the problem and counteract the growing tide of overweight and obesity among Latino youth, we need a clear understanding of the factors underlying the phenomenon.

This research brief examines the environmental, socioeconomic and cultural factors that influence nutrition, overweight and obesity among Latino youth.

The State of Quality Improvement Science in Health

December 1, 2011 Comments off

The State of Quality Improvement Science in Health
Souce: Urban Institute (via Robert Wood Johnson Foundation)

The well-documented problem of quality, the Affordable Care Act’s numerous quality provisions, and economic realities for public and private payers have increased pressure on providers to improve health care quality. This paper reviews the evolution of QI initiatives, the current evidence about whether QI interventions work, QI’s promise for the future, and how to help it find success in health care.

The paper makes recommendations for enhancing QI efforts in health care, including providing stronger incentives for health care providers and organizations to prioritize quality; improving education, training, and technical assistance for providers; leveraging electronic health records or other health information technology that can support QI efforts; and increasing collaboration between federal agencies, foundations, private purchasers, professional associations, and industry groups.

+ Summary (PDF)
+ Full Document (PDF)

After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries

October 20, 2011 Comments off

After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries (PDF)
Source: Robert Wood Johnson Foundation

This is the first national report to look at how effectively communities and hospitals coordinate care for some of their sickest patients—those leaving the hospital after a stay to treat an acute or chronic illness. Without high-quality care coordination, patients can bounce from home to the emergency room and back into the hospital, sometimes repeatedly. Hospital readmission rates are increasingly seen as markers of local health care systems’ ability to coordinate care for patients across the full continuum of care settings: hospitals, rehabilitation and skilled nursing facilities, nursing homes, clinician offices, hospice and home. Better care coordination promises to reduce readmission rates and improve patients’ lives while reducing costs. Improving care coordination for patients is also important to Medicare and to hospitals.

Medicare patients returning to the hospital shortly after they are discharged impose an enormous cost to Medicare that could be avoided with better post-discharge care. In its patient safety and quality initiative, the Centers for Medicare and Medicaid Services has estimated the cost of avoidable readmissions at more than $17 billion a year. Medicare plans to reduce payments for readmissions, exposing hospitals to considerable financial risks. In fiscal year 2013, hospitals face a penalty equal to 1% of their total Medicare billings if an excessive number of patients are readmitted in fiscal 2012. The penalty rises to 2% in 2014 and 3% in 2015.

This Dartmouth Atlas report reveals striking variation in 30-day readmission rates across hospital referral regions and academic medical centers. Little progress was seen in reducing readmission rates over the five-year period 2004 to 2009. In fact, for some conditions, readmission rates have increased for the nation and for many regions and hospitals.

U.S. Hospitals, Facing New Medicare Penalties, Show Wide Room for Improvement at Reducing Readmission Rates

September 29, 2011 Comments off

U.S. Hospitals, Facing New Medicare Penalties, Show Wide Room for Improvement at Reducing Readmission Rates
Source: Robert Wood Johnson Foundation

As scorekeeping begins for new Medicare penalties for hospitals with excessive numbers of patients returning shortly after they are discharged, a new Dartmouth Atlas Project report shows little progress over a five-year period in reducing these hospital readmissions and improving care coordination for Medicare patients. On the contrary, readmission rates for some conditions have increased nationally and for many regions and hospitals, including some of America’s most elite academic medical centers. The report shows that roughly one in six Medicare patients wind up back in the hospital within a month after being discharged for a medical condition.

In an examination of the records of 10.7 million hospital discharges for Medicare patients, researchers found striking variation in 30-day readmission rates across regions and academic medical centers. Researchers also found that more than half of Medicare patients discharged home do not see a primary care clinician within two weeks of leaving the hospital, and that facilities and regions with general patterns of high use of hospitals for medical conditions were frequently the same places with high readmission rates, an indication that some communities are more likely than others to rely on the hospital as a site of care across the board.

+ After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries (PDF)
+ Care About Your Care: Tips for Patients When They Leave the Hospital (PDF)
+ Lessons Learned in Performance Measurement: A Community’s Approach to Reducing Readmissions (PDF)

Lessons Learned in Public Reporting: Crossing the Cost and Efficiency Frontier

September 10, 2011 Comments off

Lessons Learned in Public Reporting: Crossing the Cost and Efficiency Frontier
Source: Robert Wood Johnson Foundation

This issue brief details “lessons learned” about how to effectively measure and report on the cost and value of specific aspects of medical care delivered by hospitals and physicians. Lessons Learned in Public Reporting: Crossing the Cost and Efficiency Frontier is the third installment in a series that shares the challenges and successes from Aligning Forces for Quality communities that have begun public reporting efforts to lift the quality of health care in 16 communities across the country.

Public reporting of cost and efficiency measures can help engage a community in a conversation about the value of their health care that might otherwise be missed. However, the topic is difficult for consumers as well as providers and purchasers. Before taking on the challenge of compiling and sharing this information, community organizations must make important decisions about which measures to report and how to effectively deliver the messages. This paper explores difficult, hot-button issues such as how shortening the average length of stay in a hospital can be perceived by various stakeholders—from pushing people out of the hospital to an important cost-saving step.

+ Full Document (PDF)

RWJF, Trust for America’s Health Release F as in Fat 2011

July 8, 2011 Comments off

RWJF, Trust for America’s Health Release F as in Fat 2011
Source: Robert Wood Johnson Foundation

Adult obesity rates increased in 16 states over the last year and did not decrease in any, according to F as in Fat: How Obesity Threatens America’s Future 2011, a report from Trust for America’s Health and the Robert Wood Johnson Foundation (RWJF). The obesity epidemic continues to be most dramatic in the South, which includes nine of the 10 states with the highest adult obesity rates.

For the first time, the report tracks adult obesity rates in each state over the last two decades. Twenty years ago, no state had a rate above 15 percent. Today, more than two out of three states, 38 total, have obesity rates over 25 percent, and just one has a rate lower than 20 percent.

Included in the report are recommendations for how policymakers can make it easier for children and families to be active and eat healthier foods, including:

  • protecting the Public Health and Prevention Fund;
  • implementing the Healthy, Hunger-Free Kids Act;
  • implementing the National Physical Activity Plan; and
  • restoring cuts to programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children.

+ Full Report (PDF)

Childhood Obesity — New Research Briefs Examine how Playgrounds, Trails can Support Physical Activity

June 4, 2011 Comments off

New Research Briefs Examine how Playgrounds, Trails can Support Physical Activity
Source: Robert Wood Johnson Foundation

Two new research briefs produced by Active Living Research, a national program of the Robert Wood Johnson Foundation, examine the impact neighborhood playgrounds and trails can have on physical activity.

The first brief shows that when playgrounds are safe to use and easy to access, they’re more likely to help children be active. Locating playgrounds close to home and ensuring that they have safe, well-maintained equipment brings more kids to the playground and helps them get more physical activity while they’re there. One study compared school playgrounds in two New Orleans neighborhoods—one was kept open and supervised after school and on the weekends, and the other was closed when school was closed. The number of local kids who were outside and active was 84 percent higher in the neighborhood that kept the playground open longer. Joint-use agreements between local governments and school districts can help more kids and families have access to school facilities that support activity, such as playgrounds.

The second brief notes that a growing body of research shows walking, biking and hiking trails to be a cost-effective way to promote physical activity and potentially even reduce medical costs. It also finds that more research on children’s use of trails is needed.

+ The Potential of Safe, Secure and Accessible Playgrounds to Increase Children’s Physical Activity (PDF)
+ The Power of Trails for Promoting Physical Activity in Communities (PDF)

State Variation in Primary Care Physician Supply: Implications for Health Reform Medicaid Expansions

April 13, 2011 Comments off

State Variation in Primary Care Physician Supply: Implications for Health Reform Medicaid Expansions
Source: Robert Wood Johnson Foundation

This study finds that in much of the country, Medicaid enrollment expansion under health reform is likely to greatly outpace growth in the number of primary care physicians (PCPs) willing to treat these new patients. Funded by the Robert Wood Johnson Foundation and authored by Peter J. Cunningham, Ph.D., senior fellow, Center for Studying Health System Change (HSC), the study finds that under federal health reform, Medicaid eligibility will expand to cover as many as 16 million more poor and low-income adults by 2019—an increase of more than 25 percent. Nationally, 42 percent of PCPs in 2008 were accepting all or most new Medicaid patients, compared with 61 percent accepting all or most new Medicare patients, and 84 percent accepting all or most privately insured patients.

Nationwide, PCP supply varies considerably by region. States with the largest number of PCPs per capita are concentrated almost entirely in the Mid-Atlantic and Northeast. Conversely, states with the smallest number of PCPs per capita are concentrated largely in the South and Mountain West—those regions that will potentially see the largest percentage increases in Medicaid enrollment in the years ahead. Cunningham also notes that the temporary increases in reimbursement meant to entice more PCPS to accept new Medicaid patients are unlikely to make a significant difference in states facing the biggest enrollment jumps. The study was based on HSC’s nationally representative 2008 Health Tracking Physician Survey, which includes responses from more than 4,700 physicians.

+ Full Document (PDF)

2011 County Health Rankings

March 30, 2011 Comments off

2011 County Health Rankings
Source: Robert Wood Johnson Foundation
From press release:

How healthy is your county? A new set of reports released today rank the health of nearly every county in the nation and show that much of what affects health occurs outside of the doctor’s office. For the second year, the County Health Rankings confirm the critical role that factors such as education, jobs, income, and environment play in how healthy people are and how long they live. This year, the Rankings allow people in more than 3,000 counties and the District of Columbia to compare the overall health of their counties against other counties in their state, and also compare their performance on specific health factors against national benchmarks of top-performing counties.

Published on-line at www.countyhealthrankings.org by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation, the Rankings help counties understand what influences how healthy residents are and how long they will live. The Rankings look at a variety of measures that affect health such as the rate of people dying before age 75, high school graduation rates, access to healthier foods, air pollution levels, income, and rates of smoking, obesity and teen births.

The Rankings, based on the latest data available for each county, is the only tool of its kind that measures the overall health of each county in all 50 states on the multiple factors that influence health. It includes snapshots of nearly every county with a color-coded map that compares each county’s overall health with other counties in each of the 50 states. People can compare how their county is doing in areas like diabetes screening rates or number of uninsured adults to national benchmarks.

Each county’s rank reveals a pattern of strengths and weaknesses. And, the Rankings reveal that all counties have areas where they can improve, even those that are the healthiest. Some highlights of what counties look like nationally:

  • People are nearly twice as likely to be in fair or poor health in the unhealthiest counties;
  • Unhealthy counties have significantly lower high school graduation rates;
  • Unhealthy counties have more than twice as many children in poverty;
  • Unhealthy counties have much fewer grocery stores or farmer’s markets; and
  • Unhealthy counties have much higher rates of unemployment

An Urgent Matter: Resources to Measure and Improve America’s EDs

March 5, 2011 Comments off

An Urgent Matter: Resources to Measure and Improve America’s EDs
Source: Robert Wood Johnson Foundation

In today’s increasingly strained health care environment, America’s hospital emergency departments (EDs) provide a critical primary and emergency care safety net for every community. Yet over the last decade, studies have deemed the country’s EDs to be at a breaking point, weighed down by crowding as patient volumes have steadily increased and capacity to handle them has decreased.

Recognizing this growing crisis, in 2002 the Robert Wood Johnson Foundation (RWJF) started the Urgent Matters initiative aimed at developing and spreading innovations designed to eliminate or reduce ED crowding. Housed at the Center for Health Care Quality at George Washington University Medical Center (GWU), the initiative has launched two pioneering learning networks with 16 participating hospitals working together to identify, test and implement strategies for improving patient flow and reduce ED crowding.

In the recently concluded second Urgent Matters Learning Network II (LN II), RWJF and GWU partnered with the Agency for Healthcare Research and Quality (AHRQ), and the Health Research & Educational Trust (HRET) of the American Hospital Association to develop and field-test the first ever standardized performance measures for EDs. Unlike other clinical areas, such as cardiac care, that have performance measures covering the full continuum of a patient’s journey through the health care system, the field of emergency care has lacked a universally followed set of performance metrics.

Urgent Matters LN II had three significant goals:

  1. Rigorously evaluate the implementation of strategies for improving patient flow and reducing ED crowding within the context of a hospital learning network;
  2. Advance the development of standard performance measurement in the ED; and
  3. Promote the spread of promising practices to a wider audience and variety of hospitals.

This final report details the success of and lessons learned by the Urgent Matters LN II hospitals in meeting these goals, presenting case studies of the six participating hospitals’ use of different strategies to improve flow in their facilities. While a formal, external evaluation of these strategies is being conducted by HRET, the case studies provide first hand observations of the challenges and preliminary successes as reported directly to UM by the hospitals. The case studies are followed by a discussion of the results of the field test of the ED performance measures and concludes by detailing the dissemination of the learnings from Urgent Matters.

+ Full Report (PDF)

Improving Patient Decision-Making in Health Care

February 25, 2011 Comments off

Improving Patient Decision-Making in Health Care
Source: Robert Wood Johnson Foundation (Dartmouth Atlas Project)

Whether Medicare patients undergo elective surgery depends largely on where they live and the clinicians they see, according to a new report from the Dartmouth Atlas Project and the Foundation for Informed Medical Decision Making. Researchers found remarkably wide regional variations in elective surgery for Medicare patients even though they had similar conditions.

The report compares the rates of elective, or “preference-sensitive,” procedures across regions and suggests that differences in clinicians’ personal beliefs and opinions contribute to the variation. It also highlights variations in Minnesota to demonstrate how patients, policymakers and others can use the report to understand where treatments are more aggressive. Medicare patients in St. Cloud, Minn., for example, are half as likely to undergo cardiac bypass surgery than patients in Detroit Lakes, but more than twice as likely to undergo back surgery than patients in Rochester.

To address these variations, the report’s authors advocate for shared decision-making, a process that helps patients better understand and discuss their choices. Shared decision-making helps the patient become a fully informed partner in the choice, and knowledgeable about the risk and benefit trade-offs of each treatment option.

+ Full Report (PDF)

Follow

Get every new post delivered to your Inbox.

Join 361 other followers