Primary Care Efforts to Involve Patients in Decision Making
What Do 'Engaged' Patients Do?
The Perils of Medical Jargon
Turning Health Data Into Information
New Health Care Jobs: How Healthy?
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"content": "\u003cfigure id=\"attachment_8222\" class=\"wp-caption alignleft\" style=\"max-width: 277px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/CTmachine_Flickr_DerekKMiller.jpg\">\u003cimg class=\"size-medium wp-image-8222\" title=\"A CT imaging system. (Derek K. Miller: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/CTmachine_Flickr_DerekKMiller-300x324.jpg\" alt=\"A CT imaging system. (Derek K. Miller: Flickr)\" width=\"277\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">CT imaging system. (Derek K. Miller: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Looking for unique ways to spend your money? Straight outta Compton this week, an announcement: CT scans available at a local medical center for people who are at risk for lung cancer. Cost is $295.\u003c/p>\n\u003cp>Or, if you live near San Jose, you can walk into a free-standing imaging center that will charge you $349, but according to the center's website, “check for promotional pricing.” The private imaging center started offering this test six years ago, even though the test was only validated by the medical community last year.\u003c/p>\n\u003cp>\u003cspan style=\"color: #333333\">CT -- Computed Tomography -- is a type of powerful X-ray that makes 3-D images. It has been successfully used since the 1970s to visualize structures inside the body, including abnormalities like tumors. These exams are usually painless.\u003c/span>\u003c/p>\n\u003cp>Only some insurers cover the scan. The rush to provide the test was reignited in June with the publication in JAMA of \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1163892\" target=\"_blank\">findings\u003c/a> from several studies. There was good news, for sure: as previously reported the National Lung Screening Trial (NLST) showed that lung cancer deaths could be reduced by 20 percent by screening people at high risk -- mostly those with a serious cigarette addiction.\u003c!--more-->\u003c/p>\n\u003cp>But the report also contained caution. The test can only be assumed helpful for high risk individuals -- those over 55 who have smoked the equivalent of a pack a day for 30 years. Those who choose the test should understand the potential risks, including radiation exposure from the CT. The radiation from a CT scan causes problems of its own.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"color: #333333\">According to the \u003ca href=\"http://www.radiologyinfo.org/en/safety/index.cfm?pg=sfty_xray\">\u003cspan style=\"color: #333333\">American College of Radiology\u003c/span>\u003c/a>, the test delivers approximately the same amount of radiation a person gets from the sun in 2 years and could cause one additional fatal cancer for each thousand people tested.\u003c/span>\u003c/p>\n\u003cp>As with most cancer screening, the risks also include a false positive scan, which can result in a fearful, anxious patient. The imaging may reveal other, unexpected concerns outside the lung. Either of those results can lead to invasive follow up procedures, such as biopsy -- “a significant risk” for patients, said \u003ca href=\"http://people.healthsciences.ucla.edu/institution/personnel?personnel_id=8390\" target=\"_blank\">UCLA Radiology Professor Denise Aberle\u003c/a> in an interview. Aberle was one of a handful of authors of the NLST results \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1102873#t=articleBackground\" target=\"_blank\">reported in NEJM\u003c/a> last year.\u003c/p>\n\u003cp>The magnitude of the problem creates tremendous pressure for solutions. Lung cancer kills \u003ca href=\"http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-032011.pdf\" target=\"_blank\">23 percent of Californians\u003c/a> who die of cancer. Since most people with early stage lung cancer don’t suspect a thing, until now the disease has been diagnosed almost exclusively in its late stages. This is particularly true among people of lower socio-economic status. Despite lower smoking rates, African Americans are \u003ca href=\"http://www.lung.org/about-us/our-impact/top-stories/african-americans-and-lung-cancer.html\" target=\"_blank\">more likely\u003c/a> to die of lung cancer than whites, for example.\u003c/p>\n\u003cp>The cost of a spiral CT, according to the \u003ca href=\"http://www.nationallungcancerpartnership.org/lung-cancer-info/lung-cancer-facts/screening-faqs\" target=\"_blank\">National Lung Cancer Partnership\u003c/a>, “varies but is usually in the range of $300 to $500 and Medicare may not currently pay for this test “because the guidelines are so new.”\u003c/p>\n\u003cp>But Medicare may not cover this test for another reason, too: the value of the test is still controversial to policy makers who must consider the health of whole populations. Some limitations of the NLST may mean the data is not perfectly applicable to the real world.\u003c/p>\n\u003cp>Still, the Department of Veterans Affairs (VA), for example, has agreed to move forward on CT screening for veterans at high risk for lung cancer – a move Aberle supports. But if Medicare and other commercial insurers do not cover the cost of the test only people who can pay out of pocket will get it. People without means to pay for the test “will be disproportionately adversely affected by lung cancer,” Aberle said.\u003c/p>\n\u003cp>With budgets already strained, the policy decisions about coverage for CT lung cancer screening will be complicated. Lung cancer is stigmatized, in part because much of lung cancer is preventable. And California’s efforts to reduce smoking were given a poor grade last year by the \u003ca href=\"http://www.stateoftobaccocontrol.org/state-grades/california/grade-summary.html\">American Lung Association\u003c/a>, indicating substantial room for improvement.\u003c/p>\n\u003cp>\u003ca href=\"http://profiles.ucsf.edu/ProfileDetails.aspx?Person=5351029\" target=\"_blank\">UCSF Radiology Professor Rebecca Smith-Bindman\u003c/a> examined the NLST data and is one author of the JAMA paper. In an email, she said the decision about whether or not CT lung cancer screening should be a covered expense is a discussion that “needs to weigh the benefits and costs and competing demands. … If the goal was to reduce lung cancer deaths, probably investing in smoking cessation would be much more effective.”\u003c/p>\n\u003cp>Aberle believes both approaches are necessary. “We will have a hugely missed opportunity if screening is not 'tied at the waist' with smoking cessation,” she said. \"That’s a powerful combination.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>This post was updated to show that some insurers cover the test. Prior versions of this post had indicated that only the VA covered the test.\u003c/strong>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_8222\" class=\"wp-caption alignleft\" style=\"max-width: 277px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/CTmachine_Flickr_DerekKMiller.jpg\">\u003cimg class=\"size-medium wp-image-8222\" title=\"A CT imaging system. (Derek K. Miller: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/CTmachine_Flickr_DerekKMiller-300x324.jpg\" alt=\"A CT imaging system. (Derek K. Miller: Flickr)\" width=\"277\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">CT imaging system. (Derek K. Miller: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Looking for unique ways to spend your money? Straight outta Compton this week, an announcement: CT scans available at a local medical center for people who are at risk for lung cancer. Cost is $295.\u003c/p>\n\u003cp>Or, if you live near San Jose, you can walk into a free-standing imaging center that will charge you $349, but according to the center's website, “check for promotional pricing.” The private imaging center started offering this test six years ago, even though the test was only validated by the medical community last year.\u003c/p>\n\u003cp>\u003cspan style=\"color: #333333\">CT -- Computed Tomography -- is a type of powerful X-ray that makes 3-D images. It has been successfully used since the 1970s to visualize structures inside the body, including abnormalities like tumors. These exams are usually painless.\u003c/span>\u003c/p>\n\u003cp>Only some insurers cover the scan. The rush to provide the test was reignited in June with the publication in JAMA of \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1163892\" target=\"_blank\">findings\u003c/a> from several studies. There was good news, for sure: as previously reported the National Lung Screening Trial (NLST) showed that lung cancer deaths could be reduced by 20 percent by screening people at high risk -- mostly those with a serious cigarette addiction.\u003c!--more-->\u003c/p>\n\u003cp>But the report also contained caution. The test can only be assumed helpful for high risk individuals -- those over 55 who have smoked the equivalent of a pack a day for 30 years. Those who choose the test should understand the potential risks, including radiation exposure from the CT. The radiation from a CT scan causes problems of its own.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"color: #333333\">According to the \u003ca href=\"http://www.radiologyinfo.org/en/safety/index.cfm?pg=sfty_xray\">\u003cspan style=\"color: #333333\">American College of Radiology\u003c/span>\u003c/a>, the test delivers approximately the same amount of radiation a person gets from the sun in 2 years and could cause one additional fatal cancer for each thousand people tested.\u003c/span>\u003c/p>\n\u003cp>As with most cancer screening, the risks also include a false positive scan, which can result in a fearful, anxious patient. The imaging may reveal other, unexpected concerns outside the lung. Either of those results can lead to invasive follow up procedures, such as biopsy -- “a significant risk” for patients, said \u003ca href=\"http://people.healthsciences.ucla.edu/institution/personnel?personnel_id=8390\" target=\"_blank\">UCLA Radiology Professor Denise Aberle\u003c/a> in an interview. Aberle was one of a handful of authors of the NLST results \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1102873#t=articleBackground\" target=\"_blank\">reported in NEJM\u003c/a> last year.\u003c/p>\n\u003cp>The magnitude of the problem creates tremendous pressure for solutions. Lung cancer kills \u003ca href=\"http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-032011.pdf\" target=\"_blank\">23 percent of Californians\u003c/a> who die of cancer. Since most people with early stage lung cancer don’t suspect a thing, until now the disease has been diagnosed almost exclusively in its late stages. This is particularly true among people of lower socio-economic status. Despite lower smoking rates, African Americans are \u003ca href=\"http://www.lung.org/about-us/our-impact/top-stories/african-americans-and-lung-cancer.html\" target=\"_blank\">more likely\u003c/a> to die of lung cancer than whites, for example.\u003c/p>\n\u003cp>The cost of a spiral CT, according to the \u003ca href=\"http://www.nationallungcancerpartnership.org/lung-cancer-info/lung-cancer-facts/screening-faqs\" target=\"_blank\">National Lung Cancer Partnership\u003c/a>, “varies but is usually in the range of $300 to $500 and Medicare may not currently pay for this test “because the guidelines are so new.”\u003c/p>\n\u003cp>But Medicare may not cover this test for another reason, too: the value of the test is still controversial to policy makers who must consider the health of whole populations. Some limitations of the NLST may mean the data is not perfectly applicable to the real world.\u003c/p>\n\u003cp>Still, the Department of Veterans Affairs (VA), for example, has agreed to move forward on CT screening for veterans at high risk for lung cancer – a move Aberle supports. But if Medicare and other commercial insurers do not cover the cost of the test only people who can pay out of pocket will get it. People without means to pay for the test “will be disproportionately adversely affected by lung cancer,” Aberle said.\u003c/p>\n\u003cp>With budgets already strained, the policy decisions about coverage for CT lung cancer screening will be complicated. Lung cancer is stigmatized, in part because much of lung cancer is preventable. And California’s efforts to reduce smoking were given a poor grade last year by the \u003ca href=\"http://www.stateoftobaccocontrol.org/state-grades/california/grade-summary.html\">American Lung Association\u003c/a>, indicating substantial room for improvement.\u003c/p>\n\u003cp>\u003ca href=\"http://profiles.ucsf.edu/ProfileDetails.aspx?Person=5351029\" target=\"_blank\">UCSF Radiology Professor Rebecca Smith-Bindman\u003c/a> examined the NLST data and is one author of the JAMA paper. In an email, she said the decision about whether or not CT lung cancer screening should be a covered expense is a discussion that “needs to weigh the benefits and costs and competing demands. … If the goal was to reduce lung cancer deaths, probably investing in smoking cessation would be much more effective.”\u003c/p>\n\u003cp>Aberle believes both approaches are necessary. “We will have a hugely missed opportunity if screening is not 'tied at the waist' with smoking cessation,” she said. \"That’s a powerful combination.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>This post was updated to show that some insurers cover the test. Prior versions of this post had indicated that only the VA covered the test.\u003c/strong>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "In Medicine, Don't Believe Everything You Know",
"title": "In Medicine, Don't Believe Everything You Know",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_8104\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/MedicalTextbooks_Pmccormi_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-8104\" title=\"(Pmccormi: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/MedicalTextbooks_Pmccormi_Flickr-300x225.jpg\" alt=\"(Pmccormi: Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Pmccormi: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Eve Harris\u003c/strong>\u003c/p>\n\u003cp>How do you know your doctor is right? Ideally you and your doctor have a relationship based on trust. That is, you believe she knows the best options to recommend to you. \u003cem>You\u003c/em> may think your doctor is right, but -- how does \u003cem>your doctor \u003c/em>know she's right? We'd like to think physicians are relying on the latest evidence of medical practice. But not all physicians do that.\u003c/p>\n\u003cp>I recently joined in a robust, four-day discussion designed to address this issue at the \u003ca title=\"http://www.cochrane.org/news/tags/authors/14th-rocky-mountain-workshop-how-practice-evidence-based-health-care-steamboat-spr\" href=\"http://www.cochrane.org/news/tags/authors/14th-rocky-mountain-workshop-how-practice-evidence-based-health-care-steamboat-spr\" target=\"_blank\">14th Rocky Mountain Workshop on How to Practice Evidence-Based Health Care\u003c/a>. Doctors, policy makers and yes, journalists gathered to explore what many patients might have thought they were already getting: evidence-based health care, also called evidence based medicine.\u003c/p>\n\u003cp>In evidence based medicine, a hierarchy of evidence\u003cem> \u003c/em>guides decisions about patient care. But at the same time, evidence based medicine recognizes that \u003cem>evidence alone is not sufficient\u003c/em>. That's because treatment options come with risks, and different patients will react differently to different risks. It's not a simple matter of \"Drug X\" or \"Treatment Y\" has a five percent higher likelihood of success. If \"Treatment Y\" involves a risk or side effect a patient finds unacceptable, then this patient's preference is part of the decision process.\u003c/p>\n\u003cp>Decision makers \u003ca title=\"http://www.ncbi.nlm.nih.gov/pubmed/8963526\" href=\"http://www.ncbi.nlm.nih.gov/pubmed/8963526\" target=\"_blank\">must always acknowledge these trade offs\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>The emphasis on patients’ considerations makes evidence based medicine a patient-centered practice, ideal for the coming age of healthcare reform. It’s imperative that both providers and patients learn to properly evaluate their sources of medical information. Even tougher -- old habits die hard, as we all know. Earlier this year in the \u003ca title=\"http://jama.jamanetwork.com/article.aspx?articleid=1104821\" href=\"http://jama.jamanetwork.com/article.aspx?articleid=1104821\" target=\"_blank\">Journal of the American Medical Association\u003c/a>, Stanford professor \u003ca href=\"http://med.stanford.edu/profiles/John_Ioannidis/\">John Ioannidis\u003c/a> (and others) wrote of just how hard it is to reverse established medical practice:\u003c/p>\n\u003cblockquote>\u003cp>\u003cem>\u003c/em>Ideally, good medical practices are replaced by better ones, based on robust comparative trials in which new interventions outperform older ones and establish new standards of care. Often, however … what was thought to be beneficial was not. In these cases, it becomes apparent that clinicians, encouraged by professional societies and guidelines, have been using medications, procedures, or preventive measures in vain.\u003c/p>\u003c/blockquote>\n\u003cp>Factors beyond science -- including bias -- can alter the outcome of a study. They can even affect what research is conducted and published. Ioannidis is well known for exposing ways this happens and why it is harmful to patients and physicians.\u003c/p>\n\u003cp>One take-away from the workshop I particularly endorse came from the U.S. Preventive Services Task Force chair \u003ca href=\"http://www.uspreventiveservicestaskforce.org/tflongbios.htm\">Virginia Moyer\u003c/a>: researchers should stop designing research around outcomes that don't matter to patients! One example we discussed was bone density. What patients care about is preventing fractures. But studies looked at bone density, believing bone density was linked to fractures. Turns out it's not. In this case, studies that look at fractures are what's needed.\u003c/p>\n\u003cp>But overall it appears that patient perspectives and values are increasingly part of research design. The Patient Centered Outcomes Research Institute (PCORI) is funding innovative new studies. In a recent article, PCORI explains \"\u003ca href=\"http://www.pcori.org/blog/why-methods-matter/\" target=\"_blank\">Why Methods Matter\u003c/a>.\" Today, patients have more treatment options than ever, and changes in the way we receive our healthcare today – shorter hospital stays, for example -- may affect outcomes. So although difficult, it’s crucial for patients and providers to understand and use the most relevant information when making decisions.\u003c/p>\n\u003cp>Doctors and patients are making progress in defining and trying out new ways of communicating about treatment decisions. Achieving the best outcomes via this newer, more participatory practice of medicine requires attention not only to the evidence provided by high quality studies but also clinical judgment and the bottom line: patient values.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area writer. Check out her health blog, \u003ca href=\"http://eve-harris.blogspot.com/\">A Healthy Piece of My Mind\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "How do you know your doctor is right? Ideally you and your doctor have a relationship based on trust. That is, you believe she knows the best options to recommend to you. You may think your doctor is right, but -- how does your doctor know she's right? We'd like to think physicians are relying on the latest evidence of medical practice. But not all physicians do that.\r\n\r\nI recently joined in a robust, four-day discussion designed to address this issue at the 14th Rocky Mountain Workshop on How to Practice Evidence-Based Health Care. Doctors, policy makers and yes, journalists gathered to explore what many patients might have thought they were already getting: evidence-based health care, or evidence based medicine.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_8104\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/MedicalTextbooks_Pmccormi_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-8104\" title=\"(Pmccormi: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/08/MedicalTextbooks_Pmccormi_Flickr-300x225.jpg\" alt=\"(Pmccormi: Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Pmccormi: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Eve Harris\u003c/strong>\u003c/p>\n\u003cp>How do you know your doctor is right? Ideally you and your doctor have a relationship based on trust. That is, you believe she knows the best options to recommend to you. \u003cem>You\u003c/em> may think your doctor is right, but -- how does \u003cem>your doctor \u003c/em>know she's right? We'd like to think physicians are relying on the latest evidence of medical practice. But not all physicians do that.\u003c/p>\n\u003cp>I recently joined in a robust, four-day discussion designed to address this issue at the \u003ca title=\"http://www.cochrane.org/news/tags/authors/14th-rocky-mountain-workshop-how-practice-evidence-based-health-care-steamboat-spr\" href=\"http://www.cochrane.org/news/tags/authors/14th-rocky-mountain-workshop-how-practice-evidence-based-health-care-steamboat-spr\" target=\"_blank\">14th Rocky Mountain Workshop on How to Practice Evidence-Based Health Care\u003c/a>. Doctors, policy makers and yes, journalists gathered to explore what many patients might have thought they were already getting: evidence-based health care, also called evidence based medicine.\u003c/p>\n\u003cp>In evidence based medicine, a hierarchy of evidence\u003cem> \u003c/em>guides decisions about patient care. But at the same time, evidence based medicine recognizes that \u003cem>evidence alone is not sufficient\u003c/em>. That's because treatment options come with risks, and different patients will react differently to different risks. It's not a simple matter of \"Drug X\" or \"Treatment Y\" has a five percent higher likelihood of success. If \"Treatment Y\" involves a risk or side effect a patient finds unacceptable, then this patient's preference is part of the decision process.\u003c/p>\n\u003cp>Decision makers \u003ca title=\"http://www.ncbi.nlm.nih.gov/pubmed/8963526\" href=\"http://www.ncbi.nlm.nih.gov/pubmed/8963526\" target=\"_blank\">must always acknowledge these trade offs\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>The emphasis on patients’ considerations makes evidence based medicine a patient-centered practice, ideal for the coming age of healthcare reform. It’s imperative that both providers and patients learn to properly evaluate their sources of medical information. Even tougher -- old habits die hard, as we all know. Earlier this year in the \u003ca title=\"http://jama.jamanetwork.com/article.aspx?articleid=1104821\" href=\"http://jama.jamanetwork.com/article.aspx?articleid=1104821\" target=\"_blank\">Journal of the American Medical Association\u003c/a>, Stanford professor \u003ca href=\"http://med.stanford.edu/profiles/John_Ioannidis/\">John Ioannidis\u003c/a> (and others) wrote of just how hard it is to reverse established medical practice:\u003c/p>\n\u003cblockquote>\u003cp>\u003cem>\u003c/em>Ideally, good medical practices are replaced by better ones, based on robust comparative trials in which new interventions outperform older ones and establish new standards of care. Often, however … what was thought to be beneficial was not. In these cases, it becomes apparent that clinicians, encouraged by professional societies and guidelines, have been using medications, procedures, or preventive measures in vain.\u003c/p>\u003c/blockquote>\n\u003cp>Factors beyond science -- including bias -- can alter the outcome of a study. They can even affect what research is conducted and published. Ioannidis is well known for exposing ways this happens and why it is harmful to patients and physicians.\u003c/p>\n\u003cp>One take-away from the workshop I particularly endorse came from the U.S. Preventive Services Task Force chair \u003ca href=\"http://www.uspreventiveservicestaskforce.org/tflongbios.htm\">Virginia Moyer\u003c/a>: researchers should stop designing research around outcomes that don't matter to patients! One example we discussed was bone density. What patients care about is preventing fractures. But studies looked at bone density, believing bone density was linked to fractures. Turns out it's not. In this case, studies that look at fractures are what's needed.\u003c/p>\n\u003cp>But overall it appears that patient perspectives and values are increasingly part of research design. The Patient Centered Outcomes Research Institute (PCORI) is funding innovative new studies. In a recent article, PCORI explains \"\u003ca href=\"http://www.pcori.org/blog/why-methods-matter/\" target=\"_blank\">Why Methods Matter\u003c/a>.\" Today, patients have more treatment options than ever, and changes in the way we receive our healthcare today – shorter hospital stays, for example -- may affect outcomes. So although difficult, it’s crucial for patients and providers to understand and use the most relevant information when making decisions.\u003c/p>\n\u003cp>Doctors and patients are making progress in defining and trying out new ways of communicating about treatment decisions. Achieving the best outcomes via this newer, more participatory practice of medicine requires attention not only to the evidence provided by high quality studies but also clinical judgment and the bottom line: patient values.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area writer. Check out her health blog, \u003ca href=\"http://eve-harris.blogspot.com/\">A Healthy Piece of My Mind\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_7616\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/Doctor_Patient_MercyHealth_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-7616\" title=\"(Mercy Health: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/Doctor_Patient_MercyHealth_Flickr-300x256.jpg\" alt=\"(Mercy Health: Flickr)\" width=\"300\" height=\"256\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Mercy Health: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>All day, every day, people make medical choices that have repercussions for common yet dangerous conditions like asthma, heart disease and diabetes. Although chronic disease takes a \u003ca title=\"http://www.cdph.ca.gov/programs/cvd/Documents/CHDSP-BurdenReport-LowRes.pdf\" href=\"http://www.cdph.ca.gov/programs/cvd/Documents/CHDSP-BurdenReport-LowRes.pdf\" target=\"_blank\">greater toll\u003c/a> [PDF] on people with lower socioeconomic status, chronically ill patients are part of every community. In California and across the country, public health officials and physicians keep searching for the best way to get patients involved in improving their health.\u003c/p>\n\u003cp>Some patients naturally want to be \u003ca title=\"http://ww2.kqed.org/stateofhealth/2012/07/23/what-do-engaged-patients-do/\" href=\"http://ww2.kqed.org/stateofhealth/2012/07/23/what-do-engaged-patients-do/\" target=\"_blank\">involved with their care\u003c/a>. Other times it's doctors and nurses who must try to encourage more engagement by their patients. “Whether to exercise or change their diet, take medication,\" \u003ca title=\"http://familymedicine.medschool.ucsf.edu/faculty/bios/thom_d.aspx\" href=\"http://familymedicine.medschool.ucsf.edu/faculty/bios/thom_d.aspx\" target=\"_blank\">Dr. David Thom\u003c/a> told me recently, \"those are the bread and butter decisions that go into primary care.\"\u003c/p>\n\u003cp>Thom, director of research in the UC San Francisco department of Family and Community Medicine, is launching a new study, exploring how patients make decisions when they work with a “health coach.\" Often health coaches are trained medical assistants who join the primary care team. “Our belief is that health coaches are going to have a fairly different relationship with patients than providers do,” he says. “Their role in helping the patients make decisions will be clearly different than the providers’ role.”\u003c!--more-->\u003c/p>\n\u003cp>For example, coaches may help patients prepare questions in order to make the best use of limited face time with their doctors. Coaches might also accompany patients to appointments or help them navigate between multiple departments in a medical center.\u003c/p>\n\u003cp>Many \u003ca title=\"http://www.naph.org/Homepage-Sections/Explore/Innovations/Minority-Health/SFGH-Language-Concordant-Health-Coaches.aspx\" href=\"http://www.naph.org/Homepage-Sections/Explore/Innovations/Minority-Health/SFGH-Language-Concordant-Health-Coaches.aspx\" target=\"_blank\">coaches\u003c/a> are bilingual and for Thom's research some are already trained and in place. \u003ca href=\"http://www.mnhc.org/\" target=\"_blank\">Mission Neighborhood Health Center\u003c/a> and \u003ca href=\"http://www.sfdph.org/dph/comupg/oservices/medSvs/hlthCtrs/SEHlthCtr.asp\" target=\"_blank\">Southeast Health Center\u003c/a>, both part of the healthcare safety net in San Francisco, will be the first sites studied. Coaches meet with patients and sometimes patients’ families, follow up on the phone, and sometimes sit in on appointments. They have access to the doctors and other members of the primary care team.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>As part of the \u003ca title=\"http://www.healthcare.gov\" href=\"http://www.healthcare.gov\" target=\"_blank\">Affordable Care Act\u003c/a>, the federal health care overhaul, patient engagement is linked to reimbursement for providers. Hospitals and outpatient providers alike have new incentives to successfully educate their patients and demonstrate that their patients are participating in their own treatment. With a two-year grant from the newly formed \u003ca href=\"http://www.pcori.org/\" target=\"_blank\">Patient-Centered Outcomes Research Institute \u003c/a>the UCSF researchers hope to discover which elements of coaching improve patients’ abilities to make medical decisions, improve clinical practice and improve the patient's experience of care. \u003cem>\u003c/em>\u003c/p>\n\u003cp>And it's not just safety net patients who can benefit from coaches. In the heart of Silicon Valley, researchers studied a group of patients to determine how confidently patients were engaged in discussing their care with their healthcare providers.\u003c/p>\n\u003cp>Nearly all the patients in \u003ca title=\"http://archinte.jamanetwork.com/article.aspx?articleid=1212630\" href=\"http://archinte.jamanetwork.com/article.aspx?articleid=1212630\" target=\"_blank\">this study\u003c/a> by the\u003ca title=\"http://www.pamf.org/\" href=\"http://www.pamf.org/\" target=\"_blank\"> Palo Alto Medical Foundation\u003c/a> (PAMF) were well-educated and had health insurance. More than a third had a chronic illness. These patients could easily envision asking questions and discussing preferences with their doctors. About 70 percent said they preferred a shared decision-making role, one in which patients and doctors contribute equally to medical decisions.\u003c/p>\n\u003cp>But drill down a bit more and that shared decision-making gets more difficult. Only 14 percent of patients said they would \"voice disagreement\" with their doctor if their own preferences conflicted with the doctor's recommendations.\u003c/p>\n\u003cp>According to PAMF researchers, patients want to participate with their physicians in decision-making, but worry they might be perceived as “difficult” and that their care in the future would be compromised.\u003c/p>\n\u003cp>Forget the future -- patients' care might be compromised right now, if they disagree with a recommended treatment, but say nothing. \"Reluctance to express disagreement in the office may correlate with poor adherence outside the office,\" the researchers noted. \"The findings point to the need to test interventions that explicitly allow patients to voice disagreement with their physicians.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area writer. Check out her health blog, \u003ca href=\"http://eve-harris.blogspot.com/\">A Healthy Piece of My Mind\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As part of the \u003ca title=\"http://www.healthcare.gov\" href=\"http://www.healthcare.gov\" target=\"_blank\">Affordable Care Act\u003c/a>, the federal health care overhaul, patient engagement is linked to reimbursement for providers. Hospitals and outpatient providers alike have new incentives to successfully educate their patients and demonstrate that their patients are participating in their own treatment. With a two-year grant from the newly formed \u003ca href=\"http://www.pcori.org/\" target=\"_blank\">Patient-Centered Outcomes Research Institute \u003c/a>the UCSF researchers hope to discover which elements of coaching improve patients’ abilities to make medical decisions, improve clinical practice and improve the patient's experience of care. \u003cem>\u003c/em>\u003c/p>\n\u003cp>And it's not just safety net patients who can benefit from coaches. In the heart of Silicon Valley, researchers studied a group of patients to determine how confidently patients were engaged in discussing their care with their healthcare providers.\u003c/p>\n\u003cp>Nearly all the patients in \u003ca title=\"http://archinte.jamanetwork.com/article.aspx?articleid=1212630\" href=\"http://archinte.jamanetwork.com/article.aspx?articleid=1212630\" target=\"_blank\">this study\u003c/a> by the\u003ca title=\"http://www.pamf.org/\" href=\"http://www.pamf.org/\" target=\"_blank\"> Palo Alto Medical Foundation\u003c/a> (PAMF) were well-educated and had health insurance. More than a third had a chronic illness. These patients could easily envision asking questions and discussing preferences with their doctors. About 70 percent said they preferred a shared decision-making role, one in which patients and doctors contribute equally to medical decisions.\u003c/p>\n\u003cp>But drill down a bit more and that shared decision-making gets more difficult. Only 14 percent of patients said they would \"voice disagreement\" with their doctor if their own preferences conflicted with the doctor's recommendations.\u003c/p>\n\u003cp>According to PAMF researchers, patients want to participate with their physicians in decision-making, but worry they might be perceived as “difficult” and that their care in the future would be compromised.\u003c/p>\n\u003cp>Forget the future -- patients' care might be compromised right now, if they disagree with a recommended treatment, but say nothing. \"Reluctance to express disagreement in the office may correlate with poor adherence outside the office,\" the researchers noted. \"The findings point to the need to test interventions that explicitly allow patients to voice disagreement with their physicians.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area writer. Check out her health blog, \u003ca href=\"http://eve-harris.blogspot.com/\">A Healthy Piece of My Mind\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_7553\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/DoctorsWithPatient_SeattleMunicipalArchives_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-7553\" title=\"(Seattle Municipal Archives: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/DoctorsWithPatient_SeattleMunicipalArchives_Flickr-300x197.jpg\" alt=\"(Seattle Municipal Archives: Flickr)\" width=\"300\" height=\"197\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Seattle Municipal Archives: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Desiree Basila was 52 when her stage zero breast cancer -- also called ductal carcinoma in situ -- was diagnosed. While her cancer was found very early, she was ultimately diagnosed with the disease in both breasts. In addition, it was found in several locations. For Basila, doctors said her only realistic treatment option was double mastectomy -- which Basila opposed. “If I die at 75 instead of 95 I think I can live with that,\" she told me recently. \"I did not really want to have a double mastectomy.\"\u003c/p>\n\u003cp>Basila is strong evidence that individuals react differently to their treatment choices\u003cem>. \u003c/em>The new healthcare buzzword is the \u003cem>engaged\u003c/em> patient, generally referring to someone who is collaborating with doctors in the decision-making process and, conversely, where a patient's individual preferences are respected.\u003c/p>\n\u003cp>Basila became just such an engaged patient. After a cancer diagnosis, people usually have a few weeks to investigate treatment options, options that may be life altering. While Basila had little prior experience with cancer, she had been a science teacher and put her skills to use, digging into the research. She sought a second opinion at UC San Francisco and discovered a new \u003c!--more-->research trial which appealed to her. Instead of double mastectomy, she enrolled in a trial on \"\u003ca title=\"http://www.cancer.gov/dictionary?cdrid=616060\" href=\"http://www.cancer.gov/dictionary?cdrid=616060\" target=\"_blank\">Active Surveillance\u003c/a>\" of her slow-growing cancer. As part of the trial, she would go in twice a year for mammograms and she also received MRI images of her breasts once a year. “If it starts showing signs of aggression we can catch it and start more treatment at that point,” she said.\u003c/p>\n\u003cp>In addition to the trial, Basila had support from the \u003ca href=\"http://www.decisionservices.ucsf.edu/\" target=\"_blank\">Decision Services\u003c/a> group at UCSF. There, a newly-diagnosed cancer patient can elect to work with specially trained interns. These interns are often recent college graduates on their way to medical school or other health professions. They help patients find and review accurate information, determine their priorities, and create lists of questions. An intern may also accompany a patient as a note taker during medical appointments.\u003c/p>\n\u003cp>Such strategies have been been shown to improve patients’ understanding of their cancer as well as their sense of engagement in their care. In a \u003ca title=\"http://www.cancersupportcommunity.org/Press-Releases/2012/Open-to-Options.pdf\" href=\"http://www.cancersupportcommunity.org/Press-Releases/2012/Open-to-Options.pdf\" target=\"_blank\">pilot program,\u003c/a> [PDF] nine out of ten patients felt that the list of questions, concerns and expectations contributed to a more productive appointment with their doctor. Both patients and physicians reported satisfaction with these techniques.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But this decision support was available only to a fraction of the nation’s cancer patients until earlier this summer, when the \u003cem>Open to Options\u003c/em>\u003ca href=\"http://www.cancersupportcommunity.org/MainMenu/About-Cancer/Treatment/Making-a-Treatment-Decision/Open-to-Options-2\" target=\"_blank\"> program\u003c/a> was launched by the \u003ca href=\"http://www.cancersupportcommunity.org/\" target=\"_blank\">Cancer Support Community\u003c/a>. This new program was inspired by UCSF’s decision-support service, and its counselors were trained by\u003ca title=\"http://cancer.ucsf.edu/people/profiles/belkora_jeffrey.3767\" href=\"http://cancer.ucsf.edu/people/profiles/belkora_jeffrey.3767\" target=\"_blank\"> Professor Jeffrey Belkora\u003c/a>, Director of Decision Services for the UCSF Breast Care Center.\u003c/p>\n\u003cp>The nonprofit Cancer Support Community (CSC) has a network of 150 locations across the country. The \u003cem>Open to Options \u003c/em>program adds a toll-free phone number and other engagement tools to dramatically expand the reach of the services.\u003c/p>\n\u003cp>The new program targets patients who are “newly diagnosed, facing recurrence or at some other point during their survivorship when they’re faced with making decisions,” Belkora said. “After diagnosis but before treatment is a very vulnerable time for people. … They’re overloaded and overwhelmed.\"\u003c/p>\n\u003cp>Meanwhile, it's been five years since the self-described “risk-tolerant” Basila made her own decision. She admits her background in science made her diagnosis somewhat less confusing for her. After collaborating with decision-support interns, Basila said she felt she could “ask the right questions and give real thought to the answers. ... I didn’t want my decision to be a reaction to fear.\" Although she lives with an “ongoing process” of decision, she hasn’t wavered for the past five years. Her early stage breast cancer has not progressed and she is \"thrilled\" with her choice.\u003c/p>\n\u003cp>Active surveillance is common in prostate cancer but considered experimental for breast cancer. The outcome, while under study, is unknown. “Every one of us,” Basila said, “has to decide what will be our quality vs. quantity of life.”\u003c/p>\n\u003cp>\u003cem>\u003cstrong>This blog has been updated to remove estimates of how many people might be served by the new service.\u003c/strong>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area health writer. Check out her blog, \u003ca href=\"http://eve-harris.blogspot.com/\">A Healthy Piece of My Mind\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "Desiree Basila was 52 when her stage zero breast cancer was diagnosed. While her cancer was found very early, she was ultimately diagnosed with the disease in both breasts. In addition, it was found in several locations. For Basila, this meant her only treatment option was double mastectomy -- which Basila opposed. “If I die at 75 instead of 95 I think I can live with that,\" she told me recently. \"I did not really want to have a double mastectomy.\"\r\n\r\nBasila is strong evidence that individuals react differently to their treatment choices. The new healthcare buzzword is the engaged patient, generally referring to someone who is collaborating with doctors in the decision-making process and, conversely, where a patient's individual preferences are respected.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_7553\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/DoctorsWithPatient_SeattleMunicipalArchives_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-7553\" title=\"(Seattle Municipal Archives: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/DoctorsWithPatient_SeattleMunicipalArchives_Flickr-300x197.jpg\" alt=\"(Seattle Municipal Archives: Flickr)\" width=\"300\" height=\"197\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Seattle Municipal Archives: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Desiree Basila was 52 when her stage zero breast cancer -- also called ductal carcinoma in situ -- was diagnosed. While her cancer was found very early, she was ultimately diagnosed with the disease in both breasts. In addition, it was found in several locations. For Basila, doctors said her only realistic treatment option was double mastectomy -- which Basila opposed. “If I die at 75 instead of 95 I think I can live with that,\" she told me recently. \"I did not really want to have a double mastectomy.\"\u003c/p>\n\u003cp>Basila is strong evidence that individuals react differently to their treatment choices\u003cem>. \u003c/em>The new healthcare buzzword is the \u003cem>engaged\u003c/em> patient, generally referring to someone who is collaborating with doctors in the decision-making process and, conversely, where a patient's individual preferences are respected.\u003c/p>\n\u003cp>Basila became just such an engaged patient. After a cancer diagnosis, people usually have a few weeks to investigate treatment options, options that may be life altering. While Basila had little prior experience with cancer, she had been a science teacher and put her skills to use, digging into the research. She sought a second opinion at UC San Francisco and discovered a new \u003c!--more-->research trial which appealed to her. Instead of double mastectomy, she enrolled in a trial on \"\u003ca title=\"http://www.cancer.gov/dictionary?cdrid=616060\" href=\"http://www.cancer.gov/dictionary?cdrid=616060\" target=\"_blank\">Active Surveillance\u003c/a>\" of her slow-growing cancer. As part of the trial, she would go in twice a year for mammograms and she also received MRI images of her breasts once a year. “If it starts showing signs of aggression we can catch it and start more treatment at that point,” she said.\u003c/p>\n\u003cp>In addition to the trial, Basila had support from the \u003ca href=\"http://www.decisionservices.ucsf.edu/\" target=\"_blank\">Decision Services\u003c/a> group at UCSF. There, a newly-diagnosed cancer patient can elect to work with specially trained interns. These interns are often recent college graduates on their way to medical school or other health professions. They help patients find and review accurate information, determine their priorities, and create lists of questions. An intern may also accompany a patient as a note taker during medical appointments.\u003c/p>\n\u003cp>Such strategies have been been shown to improve patients’ understanding of their cancer as well as their sense of engagement in their care. In a \u003ca title=\"http://www.cancersupportcommunity.org/Press-Releases/2012/Open-to-Options.pdf\" href=\"http://www.cancersupportcommunity.org/Press-Releases/2012/Open-to-Options.pdf\" target=\"_blank\">pilot program,\u003c/a> [PDF] nine out of ten patients felt that the list of questions, concerns and expectations contributed to a more productive appointment with their doctor. Both patients and physicians reported satisfaction with these techniques.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But this decision support was available only to a fraction of the nation’s cancer patients until earlier this summer, when the \u003cem>Open to Options\u003c/em>\u003ca href=\"http://www.cancersupportcommunity.org/MainMenu/About-Cancer/Treatment/Making-a-Treatment-Decision/Open-to-Options-2\" target=\"_blank\"> program\u003c/a> was launched by the \u003ca href=\"http://www.cancersupportcommunity.org/\" target=\"_blank\">Cancer Support Community\u003c/a>. This new program was inspired by UCSF’s decision-support service, and its counselors were trained by\u003ca title=\"http://cancer.ucsf.edu/people/profiles/belkora_jeffrey.3767\" href=\"http://cancer.ucsf.edu/people/profiles/belkora_jeffrey.3767\" target=\"_blank\"> Professor Jeffrey Belkora\u003c/a>, Director of Decision Services for the UCSF Breast Care Center.\u003c/p>\n\u003cp>The nonprofit Cancer Support Community (CSC) has a network of 150 locations across the country. The \u003cem>Open to Options \u003c/em>program adds a toll-free phone number and other engagement tools to dramatically expand the reach of the services.\u003c/p>\n\u003cp>The new program targets patients who are “newly diagnosed, facing recurrence or at some other point during their survivorship when they’re faced with making decisions,” Belkora said. “After diagnosis but before treatment is a very vulnerable time for people. … They’re overloaded and overwhelmed.\"\u003c/p>\n\u003cp>Meanwhile, it's been five years since the self-described “risk-tolerant” Basila made her own decision. She admits her background in science made her diagnosis somewhat less confusing for her. After collaborating with decision-support interns, Basila said she felt she could “ask the right questions and give real thought to the answers. ... I didn’t want my decision to be a reaction to fear.\" Although she lives with an “ongoing process” of decision, she hasn’t wavered for the past five years. Her early stage breast cancer has not progressed and she is \"thrilled\" with her choice.\u003c/p>\n\u003cp>Active surveillance is common in prostate cancer but considered experimental for breast cancer. The outcome, while under study, is unknown. “Every one of us,” Basila said, “has to decide what will be our quality vs. quantity of life.”\u003c/p>\n\u003cp>\u003cem>\u003cstrong>This blog has been updated to remove estimates of how many people might be served by the new service.\u003c/strong>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area health writer. Check out her blog, \u003ca href=\"http://eve-harris.blogspot.com/\">A Healthy Piece of My Mind\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_7086\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/ColonCancerScreening101811.jpg\">\u003cimg class=\"size-medium wp-image-7086\" title=\"in California low health literacy predicts lack of medical insurance. (American Cancer Society/Getty Images)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/ColonCancerScreening101811-300x207.jpg\" alt=\"in California low health literacy predicts lack of medical insurance. (American Cancer Society/Getty Images)\" width=\"300\" height=\"207\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">In California, low health literacy predicts lack of medical insurance. (American Cancer Society/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>When a doctor can’t explain their patients' diagnoses and treatments in plain language, people suffer.\u003c/p>\n\u003cp>\u003cem> \u003c/em>Poor health literacy -- a patient’s inability to understand health information – \u003ca href=\"http://www.ahrq.gov/clinic/epcsums/litupsum.htm\">was first linked\u003c/a> to poor health a decade ago. People who find their doctor’s advice confusing don’t manage their chronic diseases as well and are more likely to wind up hospitalized; among the elderly, the death rate is higher.\u003c/p>\n\u003cp>The public budget also suffers when patient and doctor don’t understand one another: in California low health literacy predicts lack of medical insurance, according to a first-of-its-kind \u003ca href=\"http://content.healthaffairs.org/content/31/5/1039.short?related-urls=yes&legid=healthaff%3b31/5/1039\" target=\"_blank\">survey\u003c/a> published in the May issue of \u003cem>Health Affairs. \u003c/em>Regardless of ethnicity, income or availability of employment-based insurance, if someone can’t understand their doctor or their pharmacist, they are less likely to have medical insurance. At the national level, health care expenses are increased \u003ca href=\"http://www.chcs.org/usr_doc/Health_Literacy_Fact_Sheets.pdf\" target=\"_blank\">three to six percent\u003c/a> [pdf] by low health literacy; of that increase,\u003cstrong> \u003c/strong>66 percent is public money, either Medicaid or Medicare.\u003c/p>\n\u003caside class=\"pullquote alignright\">Routine screening makes cervical cancer a highly preventable cancer in countries like the US, but American Latinas are nearly twice as likely to be diagnosed and to die of the disease.\u003c/aside>\n\u003cp>Health literacy is also correlated to other types of literacy -- almost \u003ca href=\"http://nces.ed.gov/naal/factsheets.asp\" target=\"_blank\">one in four\u003c/a>\u003cstrong> \u003c/strong>California adults cannot use written English at a basic level. That means more than nine million people and their children are at increased risk of missing out on important health screenings, and are more likely to wind up in the emergency room.\u003c/p>\n\u003cp>With such a pervasive problem, improvement will likely result from a mix of approaches rather than a single magic bullet. Several strategies have proven effective. For example, patient education is more successful when the essential information is presented first and with a minimum of distraction. Another successful strategy, called “teach back,” increases comprehension during appointments. Patients “teach back” by using their own words to explain what they just heard their doctor say. This gives the doctor a valuable opportunity to correct misunderstandings.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>But “teaching back” takes a little longer, and physicians are under pressure to adhere to a schedule of appointments. Nearly a third of doctors in \u003ca href=\"http://worldofdtcmarketing.com/consumers-trust-online-health-information-to-inform-self-diagnose/health-information-online/\" target=\"_blank\">a recent survey\u003c/a> admitted that their own inability to convert medical jargon into “plain English” creates a problem for their patients.\u003c/p>\n\u003cp>“Physicians have limited time to devote to patient education,” and their capabilities vary, said \u003ca title=\"http://teamlab.usc.edu/about/lourdes-baezconde-garbanati.html\" href=\"http://teamlab.usc.edu/about/lourdes-baezconde-garbanati.html\" target=\"_blank\">Lourdes Baezconde-Garbanati\u003c/a>, in an interview. Baezconde is the director of patient education at the \u003ca title=\"http://ccnt.hsc.usc.edu/\" href=\"http://ccnt.hsc.usc.edu/\" target=\"_blank\">USC Norris Comprehensive Cancer Center\u003c/a>.\u003c/p>\n\u003cp>Another way to boost retention is adding video to verbal narratives, according to the\u003ca href=\"http://www.ahrq.gov/clinic/epcsums/litupsum.htm\" target=\"_blank\"> Agency for Healthcare Research and Quality\u003c/a>. Baezconde and Associate Professor Sheila Murphy of the Annenberg School for Communications are studying if a short narrative film can teach women about cervical cancer screening better than a more traditional “talking heads” program.\u003c/p>\n\u003cp>Routine screening makes cervical cancer a highly preventable cancer in countries like the US, but American Latinas are nearly twice as likely to be diagnosed and to die of the disease. The researchers also knew that health literacy is generally lower among the elderly, ethnic minorities, adults who spoke a language other than English before starting school, and people living in poverty. With those things in mind they worked with professional filmmakers to create \u003ca href=\"http://www.youtube.com/watch?v=-s4fm1DaAG0\" target=\"_blank\">Tamale Lesson\u003c/a>\u003cem> (excerpt):\u003c/em> a frank, multigenerational discussion about Pap smears that takes place among Latinas working together in their kitchen. The script includes key points such as where the test is available and at what age a woman should start getting it.\u003c/p>\n\u003cp>[youtube http://www.youtube.com/watch?v=-s4fm1DaAG0]\u003c/p>\n\u003cp>\u003cem>Tamale Lesson \u003c/em>is designed to be used in multiple ways: individually and in small groups, onsite in clinics and out in the community. Although the story is about a Latino family the video has also tested well with non-Latinos. Early findings indicate that \u003cem>Tamale Lesson\u003c/em> does in fact lead to better retention of information than a video without a story.\u003c/p>\n\u003cp>Baezconte and Murphy believe the storytelling approach may be particularly effective. They wrote: \u003cstrong>“\u003c/strong>The power and perseverance of a narrative or story structure has been recognized and utilized for thousands of years.”\u003c/p>\n\u003cp>Ultimately, Baezconde said, the goal is for people to understand and remember the information their physicians provide.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area writer. Check out her health blog, \u003ca href=\"http://eve-harris.blogspot.com/\" target=\"_blank\">A Healthy Piece of My Mind\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "When a doctor can’t explain their patients diagnoses and treatments in plain language, people suffer.\r\n\r\nPoor health literacy -- a patient’s inability to understand health information – was first linked to poor health a decade ago. People who find their doctor’s advice confusing don’t manage their chronic diseases as well and are more likely to wind up hospitalized; among the elderly, the death rate is higher.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_7086\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/ColonCancerScreening101811.jpg\">\u003cimg class=\"size-medium wp-image-7086\" title=\"in California low health literacy predicts lack of medical insurance. (American Cancer Society/Getty Images)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/07/ColonCancerScreening101811-300x207.jpg\" alt=\"in California low health literacy predicts lack of medical insurance. (American Cancer Society/Getty Images)\" width=\"300\" height=\"207\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">In California, low health literacy predicts lack of medical insurance. (American Cancer Society/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>When a doctor can’t explain their patients' diagnoses and treatments in plain language, people suffer.\u003c/p>\n\u003cp>\u003cem> \u003c/em>Poor health literacy -- a patient’s inability to understand health information – \u003ca href=\"http://www.ahrq.gov/clinic/epcsums/litupsum.htm\">was first linked\u003c/a> to poor health a decade ago. People who find their doctor’s advice confusing don’t manage their chronic diseases as well and are more likely to wind up hospitalized; among the elderly, the death rate is higher.\u003c/p>\n\u003cp>The public budget also suffers when patient and doctor don’t understand one another: in California low health literacy predicts lack of medical insurance, according to a first-of-its-kind \u003ca href=\"http://content.healthaffairs.org/content/31/5/1039.short?related-urls=yes&legid=healthaff%3b31/5/1039\" target=\"_blank\">survey\u003c/a> published in the May issue of \u003cem>Health Affairs. \u003c/em>Regardless of ethnicity, income or availability of employment-based insurance, if someone can’t understand their doctor or their pharmacist, they are less likely to have medical insurance. At the national level, health care expenses are increased \u003ca href=\"http://www.chcs.org/usr_doc/Health_Literacy_Fact_Sheets.pdf\" target=\"_blank\">three to six percent\u003c/a> [pdf] by low health literacy; of that increase,\u003cstrong> \u003c/strong>66 percent is public money, either Medicaid or Medicare.\u003c/p>\n\u003caside class=\"pullquote alignright\">Routine screening makes cervical cancer a highly preventable cancer in countries like the US, but American Latinas are nearly twice as likely to be diagnosed and to die of the disease.\u003c/aside>\n\u003cp>Health literacy is also correlated to other types of literacy -- almost \u003ca href=\"http://nces.ed.gov/naal/factsheets.asp\" target=\"_blank\">one in four\u003c/a>\u003cstrong> \u003c/strong>California adults cannot use written English at a basic level. That means more than nine million people and their children are at increased risk of missing out on important health screenings, and are more likely to wind up in the emergency room.\u003c/p>\n\u003cp>With such a pervasive problem, improvement will likely result from a mix of approaches rather than a single magic bullet. Several strategies have proven effective. For example, patient education is more successful when the essential information is presented first and with a minimum of distraction. Another successful strategy, called “teach back,” increases comprehension during appointments. Patients “teach back” by using their own words to explain what they just heard their doctor say. This gives the doctor a valuable opportunity to correct misunderstandings.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>But “teaching back” takes a little longer, and physicians are under pressure to adhere to a schedule of appointments. Nearly a third of doctors in \u003ca href=\"http://worldofdtcmarketing.com/consumers-trust-online-health-information-to-inform-self-diagnose/health-information-online/\" target=\"_blank\">a recent survey\u003c/a> admitted that their own inability to convert medical jargon into “plain English” creates a problem for their patients.\u003c/p>\n\u003cp>“Physicians have limited time to devote to patient education,” and their capabilities vary, said \u003ca title=\"http://teamlab.usc.edu/about/lourdes-baezconde-garbanati.html\" href=\"http://teamlab.usc.edu/about/lourdes-baezconde-garbanati.html\" target=\"_blank\">Lourdes Baezconde-Garbanati\u003c/a>, in an interview. Baezconde is the director of patient education at the \u003ca title=\"http://ccnt.hsc.usc.edu/\" href=\"http://ccnt.hsc.usc.edu/\" target=\"_blank\">USC Norris Comprehensive Cancer Center\u003c/a>.\u003c/p>\n\u003cp>Another way to boost retention is adding video to verbal narratives, according to the\u003ca href=\"http://www.ahrq.gov/clinic/epcsums/litupsum.htm\" target=\"_blank\"> Agency for Healthcare Research and Quality\u003c/a>. Baezconde and Associate Professor Sheila Murphy of the Annenberg School for Communications are studying if a short narrative film can teach women about cervical cancer screening better than a more traditional “talking heads” program.\u003c/p>\n\u003cp>Routine screening makes cervical cancer a highly preventable cancer in countries like the US, but American Latinas are nearly twice as likely to be diagnosed and to die of the disease. The researchers also knew that health literacy is generally lower among the elderly, ethnic minorities, adults who spoke a language other than English before starting school, and people living in poverty. With those things in mind they worked with professional filmmakers to create \u003ca href=\"http://www.youtube.com/watch?v=-s4fm1DaAG0\" target=\"_blank\">Tamale Lesson\u003c/a>\u003cem> (excerpt):\u003c/em> a frank, multigenerational discussion about Pap smears that takes place among Latinas working together in their kitchen. The script includes key points such as where the test is available and at what age a woman should start getting it.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/-s4fm1DaAG0'\n title='//www.youtube.com/embed/-s4fm1DaAG0'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cem>Tamale Lesson \u003c/em>is designed to be used in multiple ways: individually and in small groups, onsite in clinics and out in the community. Although the story is about a Latino family the video has also tested well with non-Latinos. Early findings indicate that \u003cem>Tamale Lesson\u003c/em> does in fact lead to better retention of information than a video without a story.\u003c/p>\n\u003cp>Baezconte and Murphy believe the storytelling approach may be particularly effective. They wrote: \u003cstrong>“\u003c/strong>The power and perseverance of a narrative or story structure has been recognized and utilized for thousands of years.”\u003c/p>\n\u003cp>Ultimately, Baezconde said, the goal is for people to understand and remember the information their physicians provide.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area writer. Check out her health blog, \u003ca href=\"http://eve-harris.blogspot.com/\" target=\"_blank\">A Healthy Piece of My Mind\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cem>Healthcare is not a science problem; it’s an information problem\u003c/em>. Thomas Goetz, TEDMED 2010\u003c/p>\n\u003cfigure id=\"attachment_6626\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/Todd_Park.jpg\">\u003cimg class=\"size-medium wp-image-6626\" title=\"Todd_Park\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/Todd_Park-300x300.jpg\" alt=\"\" width=\"300\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Todd Park speaks at the Commonwealth Club in SF. (Photo: gobemore.com)\u003c/figcaption>\u003c/figure>\n\u003cp>Bank and airline customers rely on sophisticated systems that allow them to personalize and track complex data. \u003cstrong>\u003c/strong>\u003cstrong>\u003c/strong>But consumers of the services and products that comprise modern\u003cem> health care\u003c/em> – the patients -- currently are offered much more rudimentary data handling.\u003cspan style=\"color: #000000\"> Faxed prescriptions, paper medical charts and X-rays on film -- though not uncommon -- are examples of outdated methods of recording and sharing data.\u003c/span>\u003c/p>\n\u003cp>The forces needed to improve patient information systems are gaining momentum, said \u003ca href=\"http://www.whitehouse.gov/administration/eop/ostp/about/leadershipstaff/park\" target=\"_blank\">Todd Park, US Chief Technology Officer\u003c/a> (CTO). Speaking June 18 at The Commonwealth Club in San Francisco, Park acknowledged the movement is in its infancy but said the nation’s healthcare information system is “light years ahead of where it was two years ago.”\u003c/p>\n\u003cp>Park’s trademark enthusiasm was also evident as he talked about the campaign to provide newly-authorized access to government data to software developers and entrepreneurs. The federal \u003ca href=\"http://www.hhs.gov/open/initiatives/hdi/\">Health Data Initiative\u003c/a> seeks to provide Health and Human Services (HHS) data to the public, free and with no strings attached, in effort to trigger the creation of health-related applications.\u003c/p>\n\u003cp>The campaign has precedent in other government bodies. For example, The Weather Channel exists because \u003ca href=\"http://www.noaa.gov/\" target=\"_blank\">National Oceanic and Atmospheric Administration\u003c/a> (NOAA) data was made public. Location-based services such as real-time driving directions rely on GPS, a system of satellites also owned by the government.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->The HHS effort began in 2010 when the agency published its \u003ca href=\"http://www.hhs.gov/open/plan/opengovernmentplan/index.html\" target=\"_blank\">Open Government plan\u003c/a>, which says in part that its “vast stores of data” are:\u003c/p>\n\u003cblockquote>\u003cp>…a remarkable national resource which can be utilized…to increase awareness of health and human services issues, generate insights into how to improve health and well-being, spark public and private sector innovation and action, and provide the basis for new products and services that can benefit the American people.\u003c/p>\u003c/blockquote>\n\u003cp>Two key elements necessary to turn this public data resource into better health and financial reward are 1) a robust private/public partnership and 2) a rethinking of the traditional roles of doctors and patients, \u003cspan style=\"color: #000000\">who are increasingly taking greater responsibility for making decisions about their care.\u003c/span>\u003c/p>\n\u003cp>Creative and business partnerships are gaining momentum in spurts of work known as “hackathons” and “\u003ca href=\"http://www.hdiforum.org/\">datapaloozas\u003c/a>,” and in business incubators across the country. Software coders and engineers are collaborating with healthcare providers to unlock the information contained in the data.\u003c/p>\n\u003cp>To create something useful, designers need to ask the right questions: of the data, of healthcare providers and of the public. Although patients couldn't previously see it, HHS has collected data about patient satisfaction and safety in US hospitals for years, primarily for hospital administrators to use. HHS also knows that \u003ca href=\"http://pewinternet.orghttp/pewinternet.org/Trend-Data-%28Adults%29/Online-Activites-Total.aspx/Trend-Data-%28Adults%29/Online-Activites-Total.aspx\">80 percent\u003c/a> of adult Internet users now search online for health information and nearly 90 percent of Americans have a cell phone. Under the new initiative, they asked what the data could mean to patients.\u003c/p>\n\u003cp>Creating a new purpose and meaning for the data --\u003cspan style=\"color: #000000\"> enabling informed patient choice –\u003c/span> led to “\u003ca href=\"http://www.hospitalcompare.hhs.gov/\">Hospital Compare\u003c/a>.” The site allows users to easily search for hospitals by zip code and to compare patient satisfaction and safety scores using a familiar interface that works like comparison shopping.\u003c/p>\n\u003cp>But the biggest driver of change is the private sector, which has enthusiastically taken up the “free the data” challenge. Park estimated that 90 percent of the more than 200 groups who competed at the June \u003ca href=\"http://www.hdiforum.org/page/show/462529-health-datapalooza-agenda\" target=\"_blank\">Datapalooza\u003c/a> were startups. \u003cspan style=\"color: #000000\">Park raved about the results achieved by some of the coders. The teams with the least healthcare experience tackled some of the toughest public health challenges because \"they didn’t understand that some healthcare problems are considered intractable,” Park said with a chuckle.\u003c/span> Successful healthcare app designers bring consumers user-experience knowledge: they know how to unlock the potential of the data, he said. After all, “we have a deluge of data, but a paucity of information.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area writer and patient advocate blogging at \u003ca href=\"http://eve-harris.blogspot.com/\" target=\"_blank\">www.eveharris.com\u003c/a>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Healthcare is not a science problem; it’s an information problem\u003c/em>. Thomas Goetz, TEDMED 2010\u003c/p>\n\u003cfigure id=\"attachment_6626\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/Todd_Park.jpg\">\u003cimg class=\"size-medium wp-image-6626\" title=\"Todd_Park\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/06/Todd_Park-300x300.jpg\" alt=\"\" width=\"300\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Todd Park speaks at the Commonwealth Club in SF. (Photo: gobemore.com)\u003c/figcaption>\u003c/figure>\n\u003cp>Bank and airline customers rely on sophisticated systems that allow them to personalize and track complex data. \u003cstrong>\u003c/strong>\u003cstrong>\u003c/strong>But consumers of the services and products that comprise modern\u003cem> health care\u003c/em> – the patients -- currently are offered much more rudimentary data handling.\u003cspan style=\"color: #000000\"> Faxed prescriptions, paper medical charts and X-rays on film -- though not uncommon -- are examples of outdated methods of recording and sharing data.\u003c/span>\u003c/p>\n\u003cp>The forces needed to improve patient information systems are gaining momentum, said \u003ca href=\"http://www.whitehouse.gov/administration/eop/ostp/about/leadershipstaff/park\" target=\"_blank\">Todd Park, US Chief Technology Officer\u003c/a> (CTO). Speaking June 18 at The Commonwealth Club in San Francisco, Park acknowledged the movement is in its infancy but said the nation’s healthcare information system is “light years ahead of where it was two years ago.”\u003c/p>\n\u003cp>Park’s trademark enthusiasm was also evident as he talked about the campaign to provide newly-authorized access to government data to software developers and entrepreneurs. The federal \u003ca href=\"http://www.hhs.gov/open/initiatives/hdi/\">Health Data Initiative\u003c/a> seeks to provide Health and Human Services (HHS) data to the public, free and with no strings attached, in effort to trigger the creation of health-related applications.\u003c/p>\n\u003cp>The campaign has precedent in other government bodies. For example, The Weather Channel exists because \u003ca href=\"http://www.noaa.gov/\" target=\"_blank\">National Oceanic and Atmospheric Administration\u003c/a> (NOAA) data was made public. Location-based services such as real-time driving directions rely on GPS, a system of satellites also owned by the government.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->The HHS effort began in 2010 when the agency published its \u003ca href=\"http://www.hhs.gov/open/plan/opengovernmentplan/index.html\" target=\"_blank\">Open Government plan\u003c/a>, which says in part that its “vast stores of data” are:\u003c/p>\n\u003cblockquote>\u003cp>…a remarkable national resource which can be utilized…to increase awareness of health and human services issues, generate insights into how to improve health and well-being, spark public and private sector innovation and action, and provide the basis for new products and services that can benefit the American people.\u003c/p>\u003c/blockquote>\n\u003cp>Two key elements necessary to turn this public data resource into better health and financial reward are 1) a robust private/public partnership and 2) a rethinking of the traditional roles of doctors and patients, \u003cspan style=\"color: #000000\">who are increasingly taking greater responsibility for making decisions about their care.\u003c/span>\u003c/p>\n\u003cp>Creative and business partnerships are gaining momentum in spurts of work known as “hackathons” and “\u003ca href=\"http://www.hdiforum.org/\">datapaloozas\u003c/a>,” and in business incubators across the country. Software coders and engineers are collaborating with healthcare providers to unlock the information contained in the data.\u003c/p>\n\u003cp>To create something useful, designers need to ask the right questions: of the data, of healthcare providers and of the public. Although patients couldn't previously see it, HHS has collected data about patient satisfaction and safety in US hospitals for years, primarily for hospital administrators to use. HHS also knows that \u003ca href=\"http://pewinternet.orghttp/pewinternet.org/Trend-Data-%28Adults%29/Online-Activites-Total.aspx/Trend-Data-%28Adults%29/Online-Activites-Total.aspx\">80 percent\u003c/a> of adult Internet users now search online for health information and nearly 90 percent of Americans have a cell phone. Under the new initiative, they asked what the data could mean to patients.\u003c/p>\n\u003cp>Creating a new purpose and meaning for the data --\u003cspan style=\"color: #000000\"> enabling informed patient choice –\u003c/span> led to “\u003ca href=\"http://www.hospitalcompare.hhs.gov/\">Hospital Compare\u003c/a>.” The site allows users to easily search for hospitals by zip code and to compare patient satisfaction and safety scores using a familiar interface that works like comparison shopping.\u003c/p>\n\u003cp>But the biggest driver of change is the private sector, which has enthusiastically taken up the “free the data” challenge. Park estimated that 90 percent of the more than 200 groups who competed at the June \u003ca href=\"http://www.hdiforum.org/page/show/462529-health-datapalooza-agenda\" target=\"_blank\">Datapalooza\u003c/a> were startups. \u003cspan style=\"color: #000000\">Park raved about the results achieved by some of the coders. The teams with the least healthcare experience tackled some of the toughest public health challenges because \"they didn’t understand that some healthcare problems are considered intractable,” Park said with a chuckle.\u003c/span> Successful healthcare app designers bring consumers user-experience knowledge: they know how to unlock the potential of the data, he said. After all, “we have a deluge of data, but a paucity of information.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Eve Harris is a Bay Area writer and patient advocate blogging at \u003ca href=\"http://eve-harris.blogspot.com/\" target=\"_blank\">www.eveharris.com\u003c/a>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_6155\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/PatientMoved_05252012_MilitaryHealth_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-6155\" title=\"(US Navy: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/05/PatientMoved_05252012_MilitaryHealth_Flickr-300x232.jpg\" alt=\"(US Navy: Flickr)\" width=\"300\" height=\"232\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Hospital team moves patient from one bed to another. (U.S. Navy: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>California stands to reap tens of thousands of jobs because of the federal health care overhaul -- according to a new \u003ca title=\"BACEI Report\" href=\"http://www.bayareaeconomy.org/media/files/pdf/AffordableCareActWeb.pdf\" target=\"_blank\">report \u003c/a>[PDF] by the\u003ca title=\"http://www.bayareaeconomy.org/\" href=\"http://www.bayareaeconomy.org/\" target=\"_blank\"> Bay Area Council Economic Institute \u003c/a>(BACEI).\u003c/p>\n\u003cp>Researchers compared the state’s 2010 workforce to what it might have been if the \u003ca title=\"http://www.healthcare.gov/law/index.html\" href=\"http://www.healthcare.gov/law/index.html\" target=\"_blank\">Affordable Care Act\u003c/a> had been fully implemented in that year. They concluded that once the ACA is fully in place in 2014 almost 99,000 new jobs will be created as a result of the law, most of them in Southern California. The Sacramento Valley will see the largest increase rate: a 1.3 percent boost in job opportunities.\u003c/p>\n\u003cp>But ironically, health care jobs are not always healthy for the worker. Odd hours, ergonomics, and environmental factors contribute to specific risks for hospital and clinic workers.\u003c/p>\n\u003cp>By its nature health care is a 24-hour enterprise. \u003ca title=\"http://hospitalmedicine.ucsf.edu/facstaff/catherinelau.html\" href=\"http://hospitalmedicine.ucsf.edu/facstaff/catherinelau.html\" target=\"_blank\">Dr. Catherine Lau\u003c/a> works nights almost exclusively as director of Nighttime Hospitalist Service at the UC San Francisco Medical Center. In an interview Lau said that while she appreciates the quiet, it can be \"a little disorienting\" to work at night in a windowless space. Shift-working nurses show higher rates of \u003ca title=\"breast cancer risk\" href=\"http://www.ncbi.nlm.nih.gov/pubmed/22473669\" target=\"_blank\">breast cancer,\u003c/a> obesity and \u003ca title=\"type 2 diabetes risk\" href=\"http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001141\" target=\"_blank\">type 2 diabetes\u003c/a>.\u003c!--more-->\u003c/p>\n\u003cp>Nurses, physical therapists, and other health care workers push, pull, reach, bend, lift, and carry – and too often from positions and postures that challenge good body mechanics. Nursing aides, orderlies, and attendants are \u003ca title=\"injury risk\" href=\"http://hchcw.org/9-reasons-to-care/the-most-dangerous-job-in-the-nation\" target=\"_blank\">four times more likely\u003c/a> to be injured on the job than the average worker in the United States. The \u003ca title=\"http://www.aroundthecapitol.com/Bills/AB_1136/20112012/\" href=\"http://www.aroundthecapitol.com/Bills/AB_1136/20112012/\" target=\"_blank\">California Safe Patient Handling Act\u003c/a> regulates the lifting and transfer of hospital patients, however, it has been in effect less than year – not long enough to measure improvements.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Hospital air exposes patients and staff to potentially hundreds of toxins including formaldehyde from out-gassing building materials, medical waste and cleaning products. In a 2009 survey by the \u003ca title=\"Center for Health Design\" href=\"http://www.healthdesign.org/\" target=\"_blank\">Center for Health Design\u003c/a>, two-thirds of providers in both hospitals and ambulatory care centers called indoor air quality “a major problem.” In fact, it was singled out as the most urgent design problem. Hospitals will always have bad smells, but Lau said in her current hospital \"the air quality in general is pretty good\" though some floors are better than others.\u003c/p>\n\u003cp>Employee \u003ca title=\"SEIU\" href=\"http://www.seiu.org/a/members/safety-and-health.php\" target=\"_blank\">unions\u003c/a>, healthcare systems and regional organizations are working toward healthier health care environments across the state. California-based Dignity Health and Kaiser Permanente are part of the \u003ca title=\"HHI\" href=\"http://healthierhospitals.org/about-hhi/who-we-are\" target=\"_blank\">Healthier Hospitals Initiative\u003c/a>, a project sponsored in part by \u003ca title=\"Health Care Without Harm\" href=\"http://www.noharm.org/\" target=\"_blank\">Health Care Without Harm\u003c/a>, an international advocacy organization promoting sustainable healthcare.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>With the state unemployment rate hovering around 11 percent, the Employment Development Department has projected that healthcare jobs will grow 24 percent by 2018. The Affordable Care Act was not designed to be an economic stimulus bill, but the BACEI report calls the ACA an “economic boon” -- albeit with some known risks to workers -- for California.\u003c/p>\n\n",
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"excerpt": "California stands to reap tens of thousands of jobs because of the federal health care overhaul -- according to a new report [PDF] by the Bay Area Council Economic Institute (BACEI).\r\n\r\nResearchers compared the state’s 2010 workforce to what it might have been if the Affordable Care Act had been fully implemented in that year. They concluded that once the ACA is fully in place in 2014 almost 99,000 new jobs will be created as a result of the law, most of them in Southern California. The Sacramento Valley will see the largest increase rate: a 1.3 percent boost in job opportunities.",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"marketplace": {
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"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
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"source": "American Public Media"
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"masters-of-scale": {
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},
"mindshift": {
"id": "mindshift",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"morning-edition": {
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"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
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"onourwatch": {
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"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"on-the-media": {
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"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"link": "/radio/program/on-the-media",
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},
"pbs-newshour": {
"id": "pbs-newshour",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
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},
"link": "/radio/program/pbs-newshour",
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"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
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},
"perspectives": {
"id": "perspectives",
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"order": 14
},
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"planet-money": {
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
"airtime": "SUN 3pm-4pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
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},
"link": "/radio/program/planet-money",
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"apple": "https://itunes.apple.com/us/podcast/planet-money/id290783428?mt=2",
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},
"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
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"order": 5
},
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
"subscribe": {
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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"source": "PRI"
},
"link": "/radio/program/pri-the-world",
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"tuneIn": "https://tunein.com/podcasts/News--Politics-Podcasts/PRIs-The-World-p24/",
"rss": "http://feeds.feedburner.com/pri/theworld"
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
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