Lauren A Taylor – Integration of Healthcare and Social Services

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Today we’re joined by Lauren A Taylor, a health services researcher based at Harvard Business School, where is she is earning her doctorate in health policy and management. Prior to joining HBS, Lauren co-authored The American Health Care Paradox, which has become required reading at a variety of medical and public health schools across the country. Our discussion spans a range of topics and should excite clinician and policymaker listeners alike, especially those interested in addressing upstream factors that affect health in our American society.

We start with reviewing the initial research paper that lay the groundwork for her book and what other countries show us about how government spending on social services can affect health outcomes, as well as what she learned interviewing caregivers and social services workers in the US.  We also talk on how American sociopolitical factors influence our discourse on the distribution and allocation of resources as well as how research is done in her field. We discuss whether health systems are moving in the right direction addressing social determinants of health through ACOs, why management gets overlooked and undervalued as a key ingredient in healthcare delivery, and why it’s just so hard to get all of this right.

Lauren’s work focuses on organizational theory and strategy in health care, with a particular emphasis on the integration of health and social services. She holds a BA in the History of Medicine and a Master in Public Health from Yale University. She has also worked as a health care chaplain and studied ethics as a Presidential Scholar at Harvard’s Divinity School.

If you like the show, please subscribe on our website www.rospod.org, and rate us on iTunes and Stitcher and share us on social media. Get in touch via twitter @RoSpodcast or drop us a line at contact@rospod.org. Thanks for listening!

Journal Club – How do Pregnant Women Use Quality Measures when Choosing Their Obstetric Provider?

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Today we’re discussing a paper published in the January 2017 issue of Birth titled: How do pregnant women use quality measures when choosing their obstetric provider? by Rebecca A. Gourevitch MS, Ateev Mehrotra MD, MPH, Grace Galvin MPH, Melinda Karp MBA, Avery Plough BA, Neel T. Shah MD, MPP.

The researchers utilized an online forum for pregnant women, Ovia Pregnancy to survey women about how and why they chose their obstetric provider. Interestingly, they found that most women did not utilize quality measures such as c-section rate or obstetric infection rates when choosing a provider. These fascinating findings were widely covered in the media and led to a great discussion. Please have a listen!

Please tweet us your thoughts @RoSpodcast, or drop us a line at contact@rospod.org. And, let us know what manuscripts you think we should look at in journal clubs and who we should have on to talk about their work. We look forward to hearing from you, and thanks for listening!

Lisa Sanders – Patient Stories & Zebras

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This week, we are joined by Lisa Sanders. You may recognize her name from the monthly “Diagnosis” column that she writes for the New York Times Magazine. She writes about unusual cases and diagnostic dilemmas, exploring both a patient’s experience of disease but also their journey through the healthcare system. She is the author of a book exploring similar themes, Every Patient Tells a Story. Her column was the inspiration for the popular TV show House, and she served as a technical advisor for the show. Dr. Sanders is an associate professor of medicine and a clinician educator in the primary care internal medicine residency program at Yale University School of Medicine.

Today, we talk about her journey in medicine, going from outsider to insider in medicine, and using English rather than medicalese. She talks about what it is like to live in a world of zebras when most of us are used to horses, and how she finds her fantastic cases. Lastly, she shares what it is like to work as a technical advisor on a hit TV show.

Send your interesting cases to Dr. Sanders for her column: lisa.sandersmdATgmail.com.

If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Dennis Dimitri – Supervised Injection Facilities

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Today we are joined by Dr. Dennis Dimitri, the immediate past-president of the Massachusetts Medical Society (MMS) and current chair of the society’s Task Force on Opioid Prescribing and Physician Communication, to discuss supervised injection facilities, or SIFs. A SIF is a location where individuals may use illegal drugs under the supervision of a medical professional ready to assist in case of an overdose requiring treatment.

Later this month, the MMS will vote on whether to advocate for a task force to assess the feasibility of a pilot SIF in the state of Massachusetts. If the proposal is approved, the MMS will become the first statewide physician organization in the Bay State to advocate for such a pilot program.

We discuss with Dr. Dimitri what it would mean should the MMS advocate for SIFs. We review the evidence on the effect of SIFs on rates of fatal overdoseuptake of Substance Use Disorder treatment, and rates of transmission of HIV and HCV. We talk about the ethical considerations of such a program, whether SIFs enable behaviors harmful to people’s health or they represent harm reduction, and the complex legal considerations involved with a potential pilot program.

Major events of the opioid epidemic in the last few years, such as business owners planning for the possibility of overdose in bathrooms and a recent HIV outbreak stemmed by a needle exchange program in Indiana, raise the potential benefits of SIFs. If you’re interested in reading more, check out recent guest Dr. Sarah Wakeman‘s compassionate and evidence-based case for SIFs in this recent NEJM article. You can also listen to our past episode Dr. Jessie Gaeta on the SPOT program (supportive place for observation and treatment) when she also gave her thoughts on SIFs.

Dr. Dimitri is a family physician and Vice Chair of the Department of Family Medicine at University of Massachusetts and the UMass Memorial Medical Center.

What do you think? In the face of the opioid epidemic, could pilot SIFs in the US also reduce overdose deaths as in Canada and Australia? Tweet us your thoughts at @rospodcast or leave a comment on our facebook page at www.facebook.com/reviewofsystems.  Or, drop us a line directly at contact@rospod.org. We’d love to hear from you – and thanks for listening.

Graphic from of Centers for Disease Control, Opioid Overdose.

Seth Berkowitz – Food Insecurity and Chronic Disease

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This week we are joined by Seth Berkowitz to talk about his research examining the associations between food insecurity and health outcomes. Seth is a primary care physician, Instructor of Medicine, and is on faculty in the Division of General Internal Medicine and the Diabetes Research Center at Massachusetts General Hospital.

Seth’s research interests include population management, food insecurity, cost-related medication underuse and the impact of adverse social circumstances on chronic disease management. His goal is to develop and disseminate interventions and care delivery models that address social and economic needs.

Today he joins us to talk about a recent collaboration, funded by an award from the Robert Wood Johnson Foundation Evidence for Action Program, with Community Servings. Community Servings is a Boston-based non-profit organization dedicated to bringing medically tailored meals to chronically ill adults. The study aims to assess whether individuals receiving the medically tailored meals have lower rates of inpatient hospitalization, ED utilization, and medical expenditures.

You can find a piece co-authored by Seth and David Waters, the CEO of Community Servings here, and the Health Affairs article Seth and I talked about examining the effect of eliminating use of SNAP, or food stamps, for sugary sweetened beverages here.

Lastly, if you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

 

Less AND More Are Needed to Assess Primary Care – Rebecca S. Etz et al

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On this week’s journal club, David Rosenthal, Audrey Provenzano, and Thomas Kim discuss Less AND More are Needed to Assess Primary Care, which was recently published in the Journal of the American Board of Family Medicine by Rebecca Etz, PhD, Martha M. Gonzalez, BS, E. Marshall Brooks, PhD, and Kurt C. Stange, MD PhD.

The study utilized surveys to assess the lacuna between current quality measures and attributes of high quality primary care, and make the case that as policymakers and payers work to reduce the administrative burden of quality measurement more attention should be paid to measuring domains of high quality primary care.

What do you think? How do you know good primary care when you see it? How should the quality of primary care be assessed?

Please tweet us your thoughts @RoSpodcast, or drop us a line at contact@rospod.org. And, let us know what manuscripts you think we should look at in journal clubs and who we should have on to talk about their work. We look forward to hearing from you, and thanks for listening!

Andrew Schutzbank – Iora Health

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This week we are joined by Andrew Schutzbank, the Vice President of Product and Technology at Iora Health. His passion for revolutionizing health care began as a medical student at Tulane in pre- and post-Katrina New Orleans and continued during his Internal Medicine & Primary Care residency at the Beth Israel Deaconess Medical Center. He writes at schutzblog.com and joins us today to talk his work at Iora Health.

We discuss how the idea of completely starting over brought him to Iora Health after his residency, how Iora Health’s model works and how they navigate risk, the central role of Health Coaches in the care team, what challenges Iora is still grappling with, about Iora Health’s novel EHR, Chirp, and finish up with his reflections on how software development and patient care are similar.

Please rate and review us on itunes or stitcher, and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Emma Sandoe – Update on the AHCA & ACA

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This week, we are publishing the show a few days early to bring you a timely AHCA and ACA update. We are joined once again by Emma Sandoe, a PhD candidate in Health Policy & Political Analysis at Harvard University, for a discussion of the AHCA, the most recent attempt to repeal the ACA. You can find our prior episode with Emma, about the ACA, here. Prior to starting her PhD program, Emma spent six years in Washington, DC working on the passage and implementation of the ACA. She served as the spokesperson for Medicaid and HealthCare.gov at the Centers for Medicare & Medicaid Services and worked on ACA coordination at the HHS Budget Office.

We start with a summary of what happened this week and what were key factors in the ACHA’s demise (2:45), in particular the key Essential Health Benefits (9:00), talk about the future of the ACA (14:05), and ways that opponents of the law may try to sabotage it’s success over the next few years (15:25), and finally how lawmakers might address some of the very real problems with the law (16:57).

It turns out that healthcare reform is complicated, and advocacy does work as this Washington Post article shows. Listen to a show all about block grants and per capita caps on Medicaid featuring Matt Broaddus of the Center on Budget and Priorities here.

If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

David Buck – Caring for High Need, High Cost Patients

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This week, Thomas Kim hosts the show and interviews Dr. David Buck, a family physician and professor of family and community medicine at the Baylor College of Medicine.  He is the founder and president of Patient Care Intervention Center (PCIC), an organization that uses advanced population health methods to target super-utilization of the health care system and intervenes through intensive care coordination and case management. It’s based in Houston, Texas and recently opened a branch in Dallas, and they were recently featured on PBS NewsHour. Prior to Dr. Buck’s work at PCIC, he founded Healthcare for the Homeless – Houston (HHH), now a federally qualified health center for over 7,000 homeless in Harris County, as well as the associated Houston Outreach Medicine Education and Social Services (HOMES) clinic, a student-managed clinic at HHH in conjunction with BCM and the University of Texas Health Science Center. He is a co-founder of the Houston-based physician advocacy group Doctors for Change, and founded the Houston-Galveston Albert Schweitzer Fellowship. He helped found the international street medicine institute, and was appointed to the 15-member Consumer Operated and Oriented Plan Program advisory board created as part of the Patient Protection and Affordable Care Act in 2012.
You can find some CDC resources about Adverse Childhood Experiences, or ACEs here, and a New Yorker article about the effects of ACEs on health here.
Dr. Buck is a graduate of the Baylor College of Medicine and the University of Texas School of Public Health, as well as family medicine residency at the University of Rochester.

Journal Club: Association Between PCMHs & Adherence to Chronic Disease Medications

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On today’s Journal Club, we discuss a paper published in Annals of Internal Medicine in November 2016, entitled Association Between Patient-Centered Medical Homes and Adherence to Chronic Disease Medications, by Julie Lauffenburger and colleagues.

The North Carolina Medicaid study that Thomas mentions can be found here, and an interesting systematic review of strategies to improve medication adherence from 2012 here.

If you enjoy the show, please rate and review us on itunes or stitcher and share us on social media. Tweet us your thoughts @rospodcast and check out our Facebook page. Or, you can email us at contact@rospod.org. We’d love to hear from you. And thanks for listening.