Risa Lavizzo-Mourey

Obesity Prevention in the Information Age: Caloric Information at the Point of Purchase

in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355(3):251-259. 4. Fonarow GC, Stough WG, Abraham WT, et al. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry. J Am Coll Cardiol. 2007;50 (8):768-777. 5. Yancy CW, Lopatin M, Stevenson LW, De Marco T, Fonarow GC. Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) Database. J Am Coll Cardiol. 2006;47(1):76-84. 6. Ahmed A, Rich MW, Fleg JL, et al. Effects of digoxin on morbidity and mortality in diastolic heart failure: the Ancillary Digitalis Investigation Group trial. Circulation. 2006;114(5):397-403. 7. Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARMPreserved Trial. Lancet. 2003;362(9386):777-781. 8. Hogg K, McMurray J. The treatment of heart failure with preserved ejection fraction (“diastolic heart failure”). Heart Fail Rev. 2006;11(2):141-146. 9. Judge KW, Pawitan Y, Caldwell J, Gersh BJ, Kennedy JW. Congestive heart failure symptoms in patients with preserved left ventricular systolic function: analysis of the CASS registry. J Am Coll Cardiol. 1991;18(2):377-382. 10. O’Connor CM, Gattis WA, Shaw L, Cuffe MS, Califf RM. Clinical characteristics and long-term outcomes of patients with heart failure and preserved systolic function. Am J Cardiol. 2000;86(8):863-867. 11. Philbin EF, Rocco TA Jr, Lindenmuth NW, Ulrich K, Jenkins PL. Systolic versus diastolic heart failure in community practice: clinical features, outcomes, and the use of angiotensin-converting enzyme inhibitors. Am J Med. 2000;109(8):605-613. 12. Tribouilloy C, Rusinaru D, Mahjoub H, et al. Prognosis of heart failure with preserved ejection fraction: a 5 year prospective population-based study. Eur Heart J. 2008;29(3):339-347. 13. Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005;112(12):e154-e235. 14. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensinconverting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288(23):2981-2997. 15. Beckett NS, Peters R, Fletcher AE, et al; HYVET Study Group. Treatment of hypertension in patients 80 years of age or older [published ahead of print March 31, 2008]. N Engl J Med. 2008;358(18):1887-1898.

Making the Case for Active Living Communities

At first glance, a dearth of sidewalks may not seem like a significant public health concern. However, the disappearance of sidewalks is one of many environmental barriers to active living that transform the health of American communities in powerful ways. Evidence shows that physical activity brings substantial health benefits to people of all ages. However, much more needs to be done to create opportunities and enhance existing community structures to support physical activity. Environments that promote active living help us all--from children who need safe routes for walking and biking to school, to busy adults who might leave cars at home if they had pathways linking them to local destinations, to older adults who can maintain functional independence longer through routine walking. In each scenario, the critical role of something as basic as sidewalks becomes clear. Through research and demonstration programs, The Robert Wood Johnson Foundation is focusing on active living as a top-priority health concern. This emphasis has evolved primarily in response to Americas overweight and obesity crisis, and the serious associated health risks. KW: SR2S Read More: http://ajph.aphapublications.org/doi/full/10.2105/AJPH.93.9.1386

Aligning Forces For Quality: A Program To Improve Health And Health Care In Communities Across The United States

The Robert Wood Johnson Foundations Aligning Forces for Quality program features partnerships with leaders in targeted communities. The program is working to achieve dramatic, sustainable improvements in quality across the continuum of care by 2015. These improvements will affect patients of all races and ethnicities.

Dissemination and characteristics of acute care for elders (ACE) units in the United States

OBJECTIVE The objective of this paper is to determine prevalence and characteristics of acute care for elders (ACE) units and hospital characteristics associated with the presence of an ACE unit. METHODS Data on characteristics and prevalence of ACE units were obtained by surveying all established geriatric medical divisions across U.S. medical schools. Data on hospital characteristics such as number of beds, revenue, number of Medicare inpatients, and average length of stay were obtained from the 1999 American Hospital Association Annual Survey Data. Descriptive statistics and t test were used to analyze the characteristics of ACE units. Stepwise logistic regression was used to analyze the hospital characteristics associated with the presence of an ACE unit. RESULTS The survey identified 16 geriatric divisions and programs with ACE units. Hospitals that have ACE units differ significantly with respect to number of beds and total revenue, compared with institutions that do not have an ACE unit. Stepwise logistic regression indicated total hospital revenue was the only factor significantly associated with the presence of an ACE unit. CONCLUSIONS ACE units are attractive interdisciplinary models to address the particular needs of the elderly during their hospital stay. Low presence of ACE units warrants further research as to reasons more hospitals have not included them, given the available evidence for clinical, functional, and economic benefits.

Fighting Unequal Treatment The Robert Wood Johnson Foundation and a Quality-Improvement Approach to Disparities

Ensuring that all Americans have access to quality health care is one of the major goals of The Robert Wood Johnson Foundation (RWJF), as is improving the quality of health care for people with chronic conditions. Working toward this goal means that we must eliminate the embarrassing and unacceptable gaps in health care experienced by racial and ethnic minorities. Research indicates that Americans do not receive half of the care that experts recommend,1 but the evidence also indicates that these quality gaps are even worse for racial and ethnic minorities.2 Disparities in treatment exist across a wide range of chronic conditions, and the evidence of differential treatment is particularly strong with regard to treatment for cardiovascular conditions such as myocardial infarction and congestive heart failure.3 Even though disparities in care have not been conclusively linked to disparities in health outcomes, many experts believe that persistent patterns of lower-quality care for minority Americans do contribute to worse health outcomes, which could explain in part the disproportionate impact of heart disease on minority Americans. Mortality rates from cardiovascular disease are higher among blacks than whites,4 and one study found that heart disease accounted for nearly one third of the overall mortality difference between black and white patients.5 For all of these reasons, efforts to reduce disparities in cardiovascular care are likely to be particularly important in closing gaps in care and will be a high priority for RWJF in the next half decade. This editorial describes the foundation’s approach to reducing racial and ethnic disparities in health care and the underlying rationale for the strategy. For RWJF, developing a new targeted strategy for funding work to reduce racial and ethnic disparities in care required an immediate emphasis on discovering or helping to develop replicable solutions. We believe …

Clinical Competence in Electrocardiography

The selective granting of clinical staff privileges to physicians is one of the primary mechanisms used by institutions to uphold the quality of care. The Joint Commission on Accreditation of Healthcare Organizations requires that the granting of initial or continuing medical staff privileges be based on assessments of applicants against professional criteria that are specified in the medical staff bylaws. Physicians themselves are thus charged with identifying the criteria that constitute professional competence and with evaluating their peers on the basis of such criteria. Yet the process of evaluating a physician’s knowledge and competence is often constrained by the evaluator’s own knowledge base and ability to elicit the appropriate information, a problem that is compounded by the growing number of highly specialized procedures for which privileges are requested. This recommendation is one in a series developed to assist in the assessment of physician competence on a procedure-specific basis. The minimal education, training, experience, and cognitive skills necessary for proper interpretation of electrocardiography are specified; whenever possible, these are based on published data linking these factors with competence in certain procedures and, in the absence of such data, on consensus of expert opinion. They are applicable to any practice setting and can accommodate a variety of pathways that physicians might take to attain competence in the performance of specific procedures (see also Guide to the use of ACP statements on clinical competence. Ann Intern Med . 1987;107:588-589.) Introduced in 1903 by Einthoven, electrocardiography is the most commonly used laboratory procedure for the diagnosis of heart disease. As a record of electrical activity of the heart, it is a unique technology that provides information not readily obtained by other methods. The procedure is safe, there being essentially no risk to the patient; it is simple and reproducible; the record lends itself to …

From Unequal Treatment to Quality Care

We congratulate the American College of Physicians (ACP) on its position on racial and ethnic disparities (1). The position is comprehensive and consistent with the ACPs mission and can be a model for other specialties and disciplines. The emphasis on enhancing cultural competency is worthy of note because of the role such competency can play in improving outcomes. As noted in the position statement, competency among all health care professionals and support personnel is critical to achieving better outcomes. Not only must practicing physicians be diligent in acquiring cultural competency skills through continuing education, they must ensure that those supporting them in their practices do the same. Translation services are essential to providing culturally competent care because they are key to communication when the clinician and the patient do not speak the same language. Evidence shows that professional translation services are associated with improved patient satisfaction and adherence, as well as improved provider satisfaction (2). For these reasons, clinicians should use professional translators and should consider them to be essential participants in clinical encounters with patients who do not speak the same language. We should not rely on volunteers, who are often family members, friends, or untrained support staff, because this is not consistent with best practices for culturally competent care. Unfortunately, payers do not reimburse for interpretive services, but this shortsightedness does not absolve clinicians of the professional responsibility to provide them. The ACP has taken a strong and commendable position on reimbursement of translation services, especially for Medicare, Medicaid, and the State Childrens Health Insurance Program (SCHIP). To make progress on its agenda for racial and ethnic disparities, the College must place this issue at the top of its policy agenda. Effective communication is a prerequisite for high-quality care. Cultural competency training and interpretive services are good foundations for eliminating racial disparities in health care, but they are just a good beginning. We must also focus our efforts on addressing the subtle forms of bias, such as stereotyping. Many aspects of bias are based on an unconscious cognitive adaptive strategystereotypingthat enables people to make sense of a complex environment. But stereotyping can also negatively affect communication between the patient and physician. As noted in the Institute of Medicine report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (3), research on stereotyping and practical approaches to eliminating it is an essential part of the comprehensive, long-term set of solutions required to eradicate racial and ethnic disparities. Closing the gap by eliminating the disparities in care between racial and ethnic groups and white populations in the United States is not enough. Unfortunately, even when we close the gap, we will not achieve an acceptable level of care for many conditions. For example, Cooper and Hickson (4) demonstrated disparities between minority and white children enrolled in Medicaid in getting corticosteroid therapy after an emergency department visit. Sadly, the rates of follow-up therapy for all groups fell far short of the ideal. The ACPs leadership and strong commitment to closing the gap and raising the bar are commendable. If the ACP can translate its excellent position statement into a sustained program to change practice, it can make a difference for all patients in this country.

Opportunities for public health to increase physical activity among youths

Despite the well-known benefits of youths engaging in 60 or more minutes of daily physical activity, physical inactivity remains a significant public health concern. The 2008 Physical Activity Guidelines for Americans (PAG) provides recommendations on the amount of physical activity needed for overall health; the PAG Midcourse Report (2013) describes effective strategies to help youths meet these recommendations. Public health professionals can be dynamic change agents where youths live, learn, and play by changing environments and policies to empower youths to develop regular physical activity habits to maintain throughout life. We have summarized key findings from the PAG Midcourse Report and outlined actions that public health professionals can take to ensure that all youths regularly engage in health-enhancing physical activity.

The nurse education imperative

Introduction from the Editor: In August, Sue Hassmiller from Robert Wood Johnson Foundation presented at the International Academy for Nurse Editors conference (INANE) in San Francisco and spoke about the unique role editors play in the future of nursing. After that conference a small group of editors from INANE talked with Elaine Arkin and Melissa Blair at RWJF about the possibilities of following up on Dr. Hassmiller’s charge to the editors. After much discussion it was decided that Elaine and Melissa would invite members of the IOM panel to hold a webinar specifically for editors of nursing journals on December 5. The IOM panel members would be asked to talk specifically about the impact they believe the report has had on various aspects of the profession and then field questions from the editors. The webinar was taped and the proceedings were posted on INANE website for access by those not able to attend. In addition, it was decided that Risa Lavisso-Mourey, MD, MBA, President of the Robert Wood Johnson Foundation, would be invited to write an editorial about the IOM report and share her thoughts about where the profession should focus efforts in the future. The editorial would be published in the March-April issue of Nursing Outlook, and made available for reprint with permission for any editor in INANE to reprint. To date, 16 editors have chosen to reprint the editorial. This focused initiative was an exciting opportunity for both the editors and their readerships and is clearly a reflection of how collaborations and collective wisdom can have such a widespread impact in the profession. d Marion E. Broome

Halfway There? Health Reform Starts Now

Five-plus years after the Affordable Care Act became law, the US health care system is finally undergoing the changes it needs to care for all of its patients. Regardless of politics, the law has spurred substantial gains in coverage and catalyzed new models for managing the delivery and payment of care. Even the most optimistic agree that the promise of affordable, comprehensive, person-centered care is still a point on the horizon. However, this destination can be reached, but the road is long and everyone, regardless of politics, needs to share the journey. According to an old African proverb, “If you want to go fast, go alone; if you want to go far, go together.”