E-cigarette poisonings & more in the new edition of Public Health Law News

From the CDC’s Office for State, Tribal, Local, & Territorial Support:

The new edition of Public Health Law News reprints an article from USA Today on the rise in reports of poisonings in children by e-cigarettes.

Other stories include reports from the states on changes in public health laws and an interview with Chester Antone, Councilman of the Tohono O’odham Nation Legislature.

Read the complete newsletter here.

For mothers-to-be, finding health care in a group

From the Fixes Blog at the New York Times:

Recently in a nondescript conference room near Union Square in Manhattan, eight very pregnant women, husbands, boyfriends and a sister sat in a circle around a small patchwork quilt for two hours and talked about managing the discomforts of pregnancy.

The remedies discussed ranged from the ultimate — epidural: yes or no? — to the prosaic, including that cliché of pregnancy: “I don’t get acid reflux if I have a pickle,” said a woman named Kimberly, to general laughter. “I have two pickles right before bed and it’s fine.”

They drank seltzer and ate strawberries, bananas, hummus and carrots and cereal bars. They watched videos about labor pain and interviewed doulas. The meeting looked like a social gathering or a support group.

It did not look like what it was: a doctor’s appointment.

The Institute for Family Health runs the group, using a model created by the Centering Healthcare Institute. Centering Pregnancy sites provide group medical visits for pregnant women; Centering Parenting sites gather new mothers and their babies for the first year of life.

When they arrived, one by one the patients rotated through stations to get their regular prenatal checkups. They took their own blood pressure, weighed themselves, stretched out on a cot behind a screen so Dr. Insung Min could listen to the baby’s heartbeat, and sat with Dr. Rachel Rosenberg (no relation) in another corner for the traditional chat with the doctor. The usual checkups, however, are only part of the health care the group provides. Being part of a community, the research shows, is also good medicine.

The idea behind Centering (the name refers to care that is centered on the patient) is to help mothers — especially low-income mothers — become more involved in their own care, to acquire the skills and confidence to take care of themselves and their babies, and to have a community.

Read more here.

Most health outcomes following surgery are worse for low-income patients

From the Agency for Healthcare Research & Quality (AHRQ):

A new AHRQ study of 12 measures of outcomes following surgical procedures found that outcomes for patients from both high- and low-income geographic areas improved between 2000 and 2009. In fact, survival following two surgical procedures—coronary angioplasty and carotid endarterectomy—improved for both high- and low-income patients, and the disparity between the two groups narrowed. However, in nine of the remaining 10 outcomes studied, patients from low-income areas fared worse than patients from high-income areas across both years. For example, low-income patients had significantly increased risks for postoperative complications involving respiratory failure and lower survival rates following abdominal aortic aneurysm repair and coronary artery bypass graft. Prior research has shown that low-income patients were more likely to be either uninsured or covered by Medicaid as well as belong to a racial or ethnic minority group, the study said, noting that those characteristics were associated with poorer surgical outcomes. The study, “Despite Overall Improvement in Surgical Outcomes Since 2000, Income-Related Disparities Persist,” co-authored by AHRQ’s Roxanne Andrews and Mehwish Qasim, a doctoral candidate at the University of Iowa, appeared in the October issue of Health Affairs.

To read more articles in the most recent edition of the AHRQ Electronic Newsletter, click here.

Making New York the healthiest state

From the Health Affairs Blog:

In early December, the New York State Health Foundation and the New York State Department of Health cosponsored a summit focused on improving population health, with the title, “Making New York the Healthiest State: Achieving the Triple Aim.” We had hoped to convince a critical mass of health sector leaders to come together for a day to begin to understand a simple but difficult task: how can we get to be as good at keeping New Yorkers healthy as we are at getting them better after they experience significant medical problems? . . .

[W]ithin two weeks of our announcement of the conference, we had 250 people filling the allocated slots and another 300 people on a waiting list hoping to attend the meeting. It turns out that the issue of keeping people healthy has taken hold. Also, to our surprise, there were as many people who were health care providers interested in attending as there were public health leaders.

What explains the interest? The presentations at the conference brought at least two answers. First, health care providers know that they are going to benefit financially from keeping people healthy and out of hospitals as capitated payment systems become more important in medical care financing.

Second, our city and state are getting refocused on the challenge of dealing with inequities, as a new mayor in New York City has struck a popular chord in saying that we are “two cities”—one challenged by low incomes, poor education access, and substantial chronic health problems and the other enjoying an exciting, vibrant economy and culture.

To read more, click here.

Hispanic women successfully navigate computer-based bilingual breastfeeding education program

From the AHRQ Electronic Newsletter (13 December 2013):

Research supported by AHRQ evaluated the usability of a computerized learning program to provide breastfeeding education to Hispanic women residing in rural areas. “An interactive, bilingual touch-screen program to promote breastfeeding among Hispanic rural women: usability study” was published online on November 7 by the Journal of Medical Internet Research (JMIR) Research Protocols. According to the study and journal abstract, usability evaluation participants were asked to complete a set of tasks while explaining out loud what they were thinking. They also answered questions about their experience with the program. Participants were able to complete the assigned tasks without help and reported a positive experience, according to the study.

Food and Nutrition Creating Equal Opportunities for a Healthy Weight

New from the National Academies Press:

Creating Equal Opportunities for a Healthy Weight is the summary of a workshop convened by the Institute of Medicine’s Standing Committee on Childhood Obesity Prevention in June 2013 to examine income, race, and ethnicity, and how these factors intersect with childhood obesity and its prevention. Registered participants, along with viewers of a simultaneous webcast of the workshop, heard a series of presentations by researchers, policy makers, advocates, and other stakeholders focused on health disparities associated with income, race, ethnicity, and other characteristics and on how these factors intersect with obesity and its prevention. The workshop featured invited presentations and discussions concerning physical activity, healthy food access, food marketing and messaging, and the roles of employers, health care professionals, and schools.

The IOM 2012 report Accelerating Progress in Obesity Prevention acknowledged that a variety of characteristics linked historically to social exclusion or discrimination, including race, ethnicity, religion, socioeconomic status, gender, age, mental health, disability, sexual orientation or gender identity, geographic location, and immigrant status, can thereby affect opportunities for physical activity, healthy eating, health care, work, and education. In many parts of the United States, certain racial and ethnic groups and low-income individuals and families live, learn, work, and play in places that lack health-promoting resources such as parks, recreational facilities, high-quality grocery stores, and walkable streets. These same neighborhoods may have characteristics such as heavy traffic or other unsafe conditions that discourage people from walking or being physically active outdoors. The combination of unhealthy social and environmental risk factors, including limited access to healthy foods and opportunities for physical activity, can contribute to increased levels of chronic stress among community members, which have been linked to increased levels of sedentary activity and increased calorie consumption. Creating Equal Opportunities for a Healthy Weight focuses on the key obesity prevention goals and recommendations outlined in Accelerating Progress in Obesity Prevention through the lens of health equity. This report explores critical aspects of obesity prevention, while discussing potential future research, policy, and action that could lead to equity in opportunities to achieve a healthy weight.

Click here to order a copy or download a free PDF.

Better care at lower cost: Is it possible?

From the Commonwealth Fund:

Evidence continues to pour in that America’s sky-high health care spending is not only unsustainable, it isn’t making us any healthier either—especially compared with other advanced countries. But what are we to do about it?

In Better Care at Lower Cost: Is It Possible?, we examine the sources of high costs in the United States, the obstacles to getting them under control, and the promising public and private efforts under way to uncover the pathway to high-value health care.

Read more posts in the series Health Reform & You on the Commonwealth Fund web site.

Life expectancy approach for measuring disparities

From the Agency for Healthcare Research & Quality (AHRQ):

As a new way to measure health care disparities, a new AHRQ study proposes analyzing health insurance status and medical need over a typical lifetime by ethnic group. This life expectancy approach can estimate the number of years that racial/ethnic groups are subject to “health insurance double jeopardy,” which authors James Kirby from AHRQ and Toshiko Kaneda from the Population Reference Bureau describe as the state of being uninsured while also in lesser health and therefore at higher risk of needing medical care.

The researchers found that the expected years of life spent in “double jeopardy” were 11 years for Hispanics, 6 years for blacks, and 4 years for whites. The authors suggest this approach as a new way to monitor progress in eliminating disparities in insurance coverage, as called for by the Affordable Care Act.

The study, “‘Double Jeopardy’ Measure Suggests Blacks and Hispanics Face More Severe Disparities Than Previously Indicated,” appeared in the October issue of Health Affairs.

Health Literate Care Model

From the Agency for Healthcare Research & Quality (AHRQ):

HealthLiterateCareModelIn 2012, Health Affairs published an article proposing a Health Literate Care Model that weaves health literacy strategies into the widely adopted Care Model (formerly known as the Chronic Care Model). The article describes how health care organizations can infuse health literacy into all aspects of planning and operations, including self-management support, delivery system design, shared decision-making support, clinical information systems to track and plan patient care, and helping patients access community resources. The article is by HHS Assistant Secretary for Health Howard Koh, AHRQ researcher Cindy Brach, Linda Harris from the Office of Disease Prevention and Health Promotion, and Michael Parchman who is the Director of the McColl Center for Health Care Innovation.

Now a graphic of the Health Literate Care Model has been developed. Viewers familiar with the Care Model will recognize the health system elements that lead to productive interactions between health care teams and patients and their families. New is set of health literacy strategies that mediate those health system elements to ensure that interactions are not only productive, but are also health literate.

Access the graphic and the article here.

Inequality at the core of high health care spending: A view from the OECD

From the Health Affairs blog:

It is commonly said that the US spends more than twice as much on health care as other developed countries, yet its outcomes are worse. The inference is that too much care is provided, to no good end.

Such international comparisons are drawn from the Organization of Economic Cooperation and Development (OECD), a group of 34 developed countries. Analyzing these data is a multi-step process, like peeling an onion, and the truth resides deep within its core.

The process starts by adjusting health care spending for “purchasing power parity” (PPP) and expressing it in US dollars. By that measure, per capita spending in the US is 160 percent more than the OECD mean (Panel A, left bracket), and this is the basis for the notion that the US spends more than twice as much. But it is only the first layer.

The second layer is the economy. The US spends more principally because it is wealthier (Panel A, right bracket), but even in proportion to its gross domestic product (GDP), the US spends more, about 60 percent more. But that is only the second layer.

The third layer is price. Health care prices are inordinately high in the US and inordinately low in many other countries, particularly those that exercise price controls. Therefore, to understand how much care is given, comparisons of health care spending must be adjusted for the purchasing power parity of health care (HC-ppp). When so adjusted, spending in the US is still higher relative to its GDP, but by only 31 percent (Panel B). This represents the core difference in services. Some are administrative, but most are health care services.

What explains this 31 percent? A large body of evidence suggests that it results from poverty and income inequality, which are more prevalent in the US than in any other OECD country except Chile, Mexico and Turkey. And poverty is associated with substantial increments in spending. For example, the poorest decile of Medicare beneficiaries spends 30-40 percent more than the wealthiest; overall hospital utilization rates in large urban areas are 25-35 percent more than in their wealthiest Zip codes; and hospital readmissions are most prevalent from poor neighborhoods and in safety-net hospitals.

Read the complete post here.