Partnership Creates Blueprint for Better Health

Leaders of Durham Health Innovations (DHI), a unique partnership between Duke University Health System and the Durham community, today announced funding of a major effort to improve the health of the entire population of Durham County.

The plan includes 10 individual projects aimed at reducing death or disability from specific diseases or disorders prevalent in the community.

All of the projects will be driven by novel approaches to providing care and connected through innovative information technologies. Funding for the projects comes from the National Institutes of Health and Duke Medicine.

“These projects represent the essence of health care reform,” says Victor Dzau, MD, president and CEO of the Duke University Health System and chancellor for health affairs at Duke University.

“They reflect a community that is taking charge of its own health and making sure that new health care solutions will be fully integrated with the resources that only an academic medical center can offer. I care deeply about the Durham community, and I look forward to seeing how these planning projects advance our shared goal of better health for everybody.”

The projects emerged after months of meetings and consultation among hundreds of representatives from Duke and over 90 community agencies, organizations, businesses and residents.

Broadly, the projects cover adolescent health, asthma, cancer, heart disease, diabetes, HIV and sexually transmitted diseases, maternal health, pain management, substance abuse and seniors’ health.

Each of the projects will receive up to $100,000 to be used by the end of the year. At that point, plans for the projects will be presented and evaluated to determine how to move forward with a new approach to improving health in Durham.

Lloyd Michener, MD, chair of the department of community and family medicine at Duke, says three characteristics will define health care of the future: “It will be closer to work or home, connected to robust information technologies and accountable to all, meaning that prevention and treatment strategies will improve measurable outcomes.”

Michener says no other community in the U.S. is doing what Durham is doing. He expressed hope that the project could become a model for the country.

The grant money comes from Duke’s contribution to the Clinical and Translational Science Award, a major grant from the National Institutes of Health grant that enabled the creation of the Duke Translational Medicine Institute (DTMI) and other programs like it across the country. The DTMI created the Duke Center for Community Research, and the grant money will be managed through that center.

DHI team leaders expect work among the projects to be multidisciplinary and tightly coordinated. “Durham’s health does not measure up to evolving standards, but it is certainly not for lack of money or effort,” says Robert Califf, MD, director of the DTMI and a co-chair of the DHI oversight committee.

“There are many community organizations that are already hard at work improving health care in Durham, but we know it is not enough. The solution is not going to be more money; the solution will come from better coordination of effort, use of more effective information technology and working together to identify and implement the best practices from around the world.”

DHI leaders point out that Durham residents’ health status is comparable to that of most other residents in other parts of the state. But North Carolina ranks in the bottom 20 percent of all the states in terms of life expectancy and functional status.

“We firmly believe that changing this is not just a matter of having more doctors or nurses on the ground. Durham has over twice the number of physicians per 100,000 people, compared to other communities of comparable size in the state,” says Gayle Harris, RN, director of the Durham County Health Department and co-chair of the DHI oversight committee.

“Creating better health care means rethinking what we are doing now. We envision a very different way of taking care of people,” says Michener.

“Ideally, these projects will lead to changes such as more widespread and convenient screening, education and clinical care, better tracking about how and where people access the health care system, what care they need, what it costs and what the outcomes are. All of this information will be housed in an institutional data warehouse and shared with the community, and we’ll use that data to continually refine the system to make it as efficient and as effective as possible. We are all very excited about the possibilities these projects offer us.”

The grants were announced at the eighth health summit hosted by Duke University Health System and health leaders throughout the Durham community. Conference participants also received a report, Partners in Care, that details the $229 million in community benefit and uncompensated care Duke provided the citizens of North Carolina in 2008.

Holiday Health Tips From Packard Children’s Hospital

Happy holidays mean happy eating. And lots of it. But what can parents do when their kids are offered one yummy treat after another? And what about keeping kids active and limiting screen time during bad weather? Internationally-known researcher and pediatrician Thomas Robinson, MD, MPH, director of the center for healthy weight at Lucile Packard Children’s Hospital, offers these tips to families trying to maintain a healthy lifestyle throughout the holiday season and beyond.

Start new, healthier traditions

“Traditions guide a lot of what we eat and serve, and unfortunately, many of those traditions focus on high-fat, high-calorie foods,” said Robinson. “Most of these traditions are driven by advertising and marketing, which is an attempt to make certain foods more prevalent during the holidays.” Robinson, who has led first-of-its-type research reflecting the impact of branding on children’s eating preferences, added that “Families can fight back by starting new, healthier traditions, and these traditions can stay with your family for many years.”

Making fruit fun

“Instead of making sweet, high-calorie holiday desserts,” said Robinson, “parents can think about planning a meal using fresh fruit as a dessert.” Robinson said there are lots of ways to make fruit more fun for the kids. “There are plenty of different types of fruit around this time of year, from Asian pears to star fruit. You can even cut them into unusual shapes. They’re low-calorie, fun to eat and kids love the taste.”

Healthy snacking around the house

Again, Dr. Robinson stresses alternatives. “When it’s time to snack, instead of having all those leftovers and sweets around, replace them with foods like pomegranates, which can be a cool surprise for kids.” Robinson also suggests an out-of-sight, out-of-mind approach. “Often, candies and sweets are only eaten because they’re just sitting there, right out in the open.”

Working calories off during bad weather

“We sometimes hesitate before letting kids outside when the weather is cold and wet,” said Robinson, who offers advice that may be surprising to some parents. “But families need to know that kids don’t get colds from being in the cold. They get colds from viruses. Sending kids out to play in the cold, or even a little bit of rain, will not get them sick.”

How to limit screen time

Make a budget. “Our team suggests a budget of seven hours a week total screen time, which includes TV, DVDs, videogames and computers,” said Robinson, who’s led multiple research efforts into the relationship between screen time and children’s eating habits, weight gain and effects on education. “This means an hour a day, which is easy for kids to understand. And it allows kids to discover alternatives on their own, which is more motivating than being directed to do so by their parents.”

Doctor shortage in Oklahoma hampers affordable health care

As reported in Tulsa World, there is a current shortage of primary care doctors in Oklahoma. Over 70 counties do not meet the standard to have 1 general practioner per 3,500 patients. This can lead to high health care costs for consumers and long waits for appointments. This is a barrier for affordable health insurance, as well.

There are many facets that add up the costs of health care. A few such factors include gas, time and money involved in seeing your primary care physician (PCP). With Oklahoma State University (OSU) not being able to afford to train enough physicians, there will continue to be a doctor shortage in the state in the foreseeable future. If one cannot find a local PCP, he or she will have to travel to an office, sometimes up to fifty miles or more away for routine care.

This has hidden costs such as gas in the tank, wear and tear on vehicles necessitating costly car repairs and more frequent maintenance, as well as more time taken off from work to attend the appointment. Some residents are choosing to move where the doctors are which results in higher rents sometimes. But because the shortage is felt all over the state, patients are having to wait weeks and sometimes months for their regular appointments and are resorting to using the emergency room visits instead.

Not being able to see a doctor when illnesses first strike leads to more serious complications down the road. That means additional time off work and more costly tests and treatments. Some illnesses can be prevented with early intervention but will lead to death if a patient cannot access affordable health care.
All of the above contribute to the higher health care costs and higher health insurance premiums for everyone making affordable health care that much further from reach.

President Barack Obama is working hard this week trying to build a consensus around the Health Care Reform Bill that he supports. He takes his case today to Portsmouth in NH organizing a town hall meeting with the local residents. Will he be greeted by supporters of his health insurance reform bill or protesters? Probably both. In any case Section 1233 has become a stumbling block for many.

Fox news reports that nearly one thousand eight hundred people have gathered in Portsmouth, New Hampshire from around the country. They are waiting to enter the gymnasium of a high school where Obama will hold his town hall meeting on health insurance reform. Interestingly, people who support this Health Care Reform Bill have gathered on the right side of the street in front of the local High School. Those who don’t favor this health insurance reform have gathered on the left side of the street.

Consumers, haves and have nots of health insurance coverage are very much divided on health care reform bill. Last week it was the information found on page 58 of health care bill that had created much debate. Now it is the section 1233.

Indeed section 1233 has become a major stumbling block for those who don’t support the current Health Care Reform Bill. It’s about Advanced Care Planning and starts on page 424 of the bill. Former Alaska Governor Sarah Palin had raised her concerns about Section 1233, thus bringing it up for debate. Today, Washington Post correspondent Ezra Klein has reached to a Republican Senator Johnny Isakson, who alled Palin’s interpretation of End Of Life Advanced Planning of the Health Care Reform “nuts.”

He says this issue has been a topic of debate for already 25-30 years. “In the health-care debate mark-up, one of the things I talked about was that the most money spent on anyone is spent usually in the last 60 days of life and that’s because an individual is not in a capacity to make decisions for themselves. So rather than getting into a situation where the government makes those decisions, if everyone had an end-of-life directive or what we call in Georgia “durable power of attorney,” you could instruct at a time of sound mind and body what you want to happen in an event where you were in difficult circumstances where you’re unable to make those decisions,” the senator told WashPost correspondent.

Many observers now today write in the media that erroneous interpretations of Section 1233 of Health Care Reform Bill is very “egregious,” as it involves the lives of our senior citizens. The erroneous interpretation is that the government will counsel the senior citizens every five years on how to end their lives early. This is outrageous interpretation of end of life planning.

What the Section 1233 of the Health Care Reform Bill really reads is that “Medicare will pay for an “advance care planning consultation” once every five years. Section 1233 is actually creating a new benefit for seniors that will be paid for by Medicare. It will only pay for one consultation every five years unless the patient’s health changes. If that happens, the provision then calls for Medicare to pay for a new consultation when the change in health occurs,” explains SV Herald.

In the meanwhile, president Obama has made its top priority to get the Health Care Reform Bill passed in 2009. Town Hall Meetings are intended to build consensus on issues ranging from health insurance to how to cover the cost of health care reform and other issues that rise during the debate such as Section 1233.

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