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Tag: Robert Wood Johnson Foundation

OpenNotes: The Results Are In

A few years ago, Tom Delbanco and Jan Walker pitched us with a simple idea: Patients should routinely be able to see the notes that physicians write about them.  Now it’s true that we all have the legal right to see these notes, but obtaining them is anything but routine. The process involves phone calls, faxes (sic), duplicating fees and all sorts of other demoralizing steps. The net result is that reviewing your doctor’s notes about you is a rare experience.

Tom and Jan said that the physicians with whom they had spoken about this idea were split. Some were interested, some were resigned: They recognized that transparency was an increasingly powerful wave and that the world seemed to be heading this way, and the others thought they were crazy―notes were for documentation and communication among doctors and were never intended for patients.  The arguments were of a religious quality―they were about belief and values.  The obvious solution was to test the idea and let data help sort it out.  Today, with the publication of the study results in the Annals of Internal Medicine, that debate is now illuminated.

One hundred and five primary care doctors, more than 19,000 patients and 12-months of testing at three sites has brought us to some striking findings: Patients overwhelmingly support open notes; they report significant benefits from it; and doctors reported that the effects on their practice have been minor. I encourage you to read the full paper so you get the full context (and do pay attention to the limitations section). You’ll find a number of interesting results. Here are three that I think are especially worth reflecting upon:

1. 60-78% of patients (depending on the study location) reported that they took their medications better. This is self-reported data, so the numbers might be exaggerated, but this finding, along with other results related to taking better care of oneself and understanding one’s health conditions better, suggests there’s a significant potential for clinical benefit.

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Conference Highlights Rapid Growth of Health Impact Assessments in the United States

According to a recent poll in Washington State, 71 percent of voters supported a bill that would require the state to consider impacts on people’s health when planning new transportation projects. This poll speaks to the growing recognition that illnesses like asthma, obesity, and diabetes, as well as injuries are shaped by the conditions in the places where we live and work. To address this, we need to factor health into decisions in fields like transportation, energy, housing, and agriculture.

The level of interest in the inaugural National Health Impact Assessment (HIA) Meeting held April 3 and 4 in Washington, D.C., highlights that this approach has become a centerpiece of community, state, and national efforts to improve Americans’ wellness. An HIA is a type of study that allows decision makers to factor health into projects like planning roads, passing agriculture policy, and siting schools. I have been using HIAs for over eight years, and until recently, I knew most of the people in the field. In organizing the National HIA Meeting, I worried that we might not find 200 people to attend. Instead, we had to close registration six weeks early: more than 430 leaders in public health, urban planning, housing, transportation, agriculture, and environmental regulation participated, and many more were on the waiting list.

The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, sponsored the two-day meeting, along with The California Endowment, the Centers for Disease Control and Prevention, and the National Network of Public Health Institutes.

Keynote speaker Jonathan Fielding, the director of the Los Angeles County Department of Public Health who also chairs the U.S. Community Preventive Services Task Force, gave an overview of the fast-growing approach. “The first HIAs were done roughly 12 years ago in the United States,” he said. “There has been huge progress in this field.”

At the Health Impact Project, we are tracking this growth. Today, nearly 200 HIAs have been completed or are ongoing. In 2007, there were only 27 such studies on the books.

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The Heart’s Content

The field of medicine has long focused on how negative psychological functioning is associated with disease – for example, how anxiety and depression increase the risk of heart attacks.

Health, however, is more than the mere absence of disease. In an article published this week in the Psychological Bulletin, my colleague Laura Kubzansky and I demonstrate that positive psychological well-being – which includes feeling optimistic, happy, satisfied, and purposeful – is beneficial for cardiovascular health.

In an investigation of more than 200 studies, we found that these psychological assets are associated with a reduced risk of cardiovascular disease, the leading cause of death in the United States. This relationship was present regardless of a person’s age, socioeconomic status, smoking status, or body mass index.

Moreover, positive psychological well-being seems to be connected to better cardiovascular outcomes because people with greater well-being tend to engage in healthier behaviors like exercising and have healthier biological function like low cholesterol. These findings align with the American Heart Association’s recent emphasis on ideal cardiovascular health, which it defines as more than the absence of risk factors.

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A Win-Win: Job Creation Will Grow the Economy and Improve Health

The current economic recovery effort presents an opportunity to build stronger, healthier communities. That’s a central goal for the Create Jobs for USA Fund that Opportunity Finance Network (OFN) and Starbucks launched late last year to support job creation and retention.

Economic growth and job creation provide more than income and the ability to afford health insurance and medical care.  They also enable us to live in safer homes and neighborhoods, buy healthier food, have more leisure time for physical activity, and experience less health-harming stress.  The research clearly shows that health starts in our homes and communities and not in the doctor’s office.

In that way, economic policy is, in fact, health policy.

Since 1985, OFN’s national network of community development financial institutions (CDFIs) has loaned more than $23 billion to benefit low-income, low-wealth, and other disadvantaged communities.  The Robert Wood Johnson Foundation (RWJF), with an endowment of around $8.5 billion, is the nation’s largest philanthropy focused solely on improving health and health care for all Americans.  Marrying the business acumen of CDFIs and others to health philanthropy’s ability to supply the research, analysis, and expertise to make sure community development activities improve residents’ health is a powerful union.

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