RoS: Review of Systems

RoS: Opioid Use Disorder Care in Primary Care

contact@rospod.org (Audrey Provenzano, Adele Ojeda, Stephen Martin) — Tue, 3 Sep 2019 02:09:46 +0000

Welcome to Recovery Month! In celebration of primary care’s role in addiction care, we are featuring a show about caring for patients with addiction.

Our guests this week are Adele Ojeda, the office based opioid treatment (or OBOT) nurse for Barre Family Health Center and Dr. Stephen Martin. Dr. Martin is Associate Professor of Family Medicine and Community Health at University of MA Medical School and a faculty physician at Berry Family Health Center, and affiliate faculty for the HMS Center for Primary Care.

They share their experiences caring for patients with OUD in the primary care setting, and we also discuss an article Dr. Martin published with several colleagues in Annals of Internal Medicine in November 2018 entitled The Next Stage of Buprenorphine Care for Opioid Use Disorder that focuses on a number of widely accepted, yet not evidence-based, and potentially harmful practices in buprenorphine care.

If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at reviewofsystemspod@gmail.com.

RoS Reprise: Understanding the Association of Primary Care Physician Supply and Mortality in the US

contact@rospod.org (Russell Phillips, Audrey Provenzano) — Tue, 20 Aug 2019 04:03:59 +0000

This week, we are joined by Russ Phillips! Dr. Russell Phillips is Director of the Center for Primary Care and the William Applebaum Professor of Medicine and Professor of Global Health and Social Medicine at Harvard Medical School. He is a devoted primary care general internist at Beth Israel Deaconess Medical Center (BIDMC) where he manages a panel of patients. Within the Center for Primary Care, he leads programs that are transforming education and care systems, developing entirely new approaches to improving primary care and health, and performing research on high performing health systems and practices, and the impact of changes in payment and primary care practice structure on the finances of primary care practices. He joins us to talk about a recent publication in JAMA IM that he wrote with a number of collaborators including other Center for Primary Care faculty, entitled: Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015. We also reference the accompanying editorial by Zabar et al and the paper that inspired their work, by Starfield, Shi and collaborators.

This interview has been lightly edited for length and clarity.

RoS: Understanding the Health Effects of Homelessness with Dr. Margot Kushel

Tue, 6 Aug 2019 02:34:17 +0000

Our guest this week is Dr. Margot Kushel, a Professor of Medicine at UCSF and Director of the UCSF Center for Vulnerable Populations, as well as the Director of the UCSF Benioff Homelessness and Housing Initiative. Dr. Kushel’s research focuses on homelessness among older adults and the adverse health effects associated with homelessness. She developed and continues to follow the HOPE HOME cohort, an ongoing longitudinal cohort study examining the causes and effects of homelessness among adults 50 and over in Oakland, CA.

RoS: Understanding Increasing Mid-Life Mortality in the US with Steven Woolf

Tue, 23 Jul 2019 02:13:55 +0000

Our guest this week is Dr. Steven Woolf. He is the C. Kenneth and Dianne Wright Distinguished Chair in Population health and Health Equity at VCU as well as Director Emeritus and Senior Advisor to the VCU Center on Society and Health. He joins us this week to talk about his work improving our understanding of the increasing death rates among mid-life Americans, on which he published a crucial paper about in 2018 in BMJ, entitled Changes in midlife death rates across racial and ethnic groups in the United States: systematic analysis of vital statistics, as well as authoring in an extensive report entitled US Health in International Perspective: Shorter Lives, Poorer Health.

RoS: Understanding the Costs of PAs with Chris Morley

Mon, 8 Jul 2019 20:30:07 +0000

Christopher Morley joins us this week to talk about prior authorizations, or PAs – a bureaucratic headache well known to anyone in primary care in which a physician’s office must complete additional paperwork or phone calls to a patient’s insurance company in order to get a medication or procedure covered by the insurance. This used to be a fairly rare occurrence, but it has dramatically increased in frequency over the last 20 years or so. Dr. Morley set out with some colleagues to try to quantify how much the PA process may cost, and moreover, to help us all think about who pays those costs in reality – ultimately, it is our patients.

Dr. Morley is the Chair of the Department of Public Health and Preventive Medicine at SUNY Upstate Medical University, as well as the Vice Chair for Research in the Department of Family Medicine. He is a medical social scientist with principal interests in health disparities, particularly those that occur in primary care settings; health workforce development and medical education.

Review of Systems is a podcast hosted by Audrey Provenzano featuring conversations about the changing healthcare landscape from the Harvard Center for Primary Care. Check out our website, primarycare.hms.harvard.edu to find our podcast library, subscribe in your favorite podcast app, and find us at @rospodcast and @audreymdmph

Tweet us feedback and suggestions or email us at reviewofsystemspod@gmail.com. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues.

RoS: Design Thinking & Clinics with No Waiting Rooms with Stacey Chang

Tue, 25 Jun 2019 13:23:51 +0000

Our guest this week is Stacey Chang. He is the executive Director of the Design Institute for Health at Dell Medical School. He joins us today to talk about design in medicine and how we can use design thinking as a tool to improve healthcare, and in particular how he and colleagues went about designing a series of clinics at Dell Medical School without any waiting rooms!

I hope you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast, @HMSPrimaryCare, @audreymdmph or drop us a line at reviewofsystemspodATgmail.com.

RoS: Transitions in Care from Pedi to Adult Care for Medically Complex Patients

Tue, 11 Jun 2019 21:51:03 +0000

What happens when a medical complex young person turns 18, and then, suddenly, they make their own medical decisions rather than their parents? How does one navigate the sometimes very thorny issues of sexual health and fertility? What about insurance issues?

This week, we have a very special show for you featuring a number of guests on this topic talking about the Weitzman Family Bridges Adult Transition Program at Boston Children’s Hospital and how the program addresses these questions.

We have Kitty O’Hare, a practicing med-peds primary care physician and Assistant Professor of Medicine and Pediatrics, Harvard Medical School; Ahmet Uluer, the Medical Director of the Weitzman Family Bridges Adult Transition Program; Amy, a patient who helped give input in the design of the program, helped to write the transition in care guide One Step at a Time, and has gone on to become a nurse; Susan Shanske, MSW, LICSW, the Director of Transitional Care Support; and Julia Roboff, a Nurse Practitioner with the program.

Thanks for listening!

RoS The effects of neighborhood greening on mental health with Eugenia South & Michelle Kondo

Mon, 27 May 2019 18:38:35 +0000

In this reprise episode, Michelle Kondo and Eugenia South join us to talk about their research looking at how neighborhood contexts impact health and safety in urban environments, and their recent publication in JAMA Network Open looking at the relationship between neighborhood greening and mental health. Dr. South and Dr. Kondo collaborate from two different perspectives – Dr. South is an emergency physician and health services researcher at UPenn; and Dr. Kondo is a PhD research social scientist with the USDA-Forest Service, Philadelphia Field Station.

RoS Addressing Food Insecurity among diabetic patients at Geisinger with Allison Hess

Mon, 27 May 2019 18:37:55 +0000

This week, we are joined by Allison Hess, VP of Health for the Steele Institute for Innovation at Geisinger to talk about Geisinger’s Fresh Food Farmacy, a program that provides food insecure patients with poorly controlled diabetes access to fresh healthy foods as part of a comprehensive diabetes care plan. Read more about the Fresh Food Farmacy and also check out the feature about their program on Care Zooming, a social enterprise company aimed at connecting healthcare professionals and disseminating innovative programs. Tweet us your thoughts at @RoSpodcast or you can email us at contactATrospod.org.

RoS: Understanding the association of primary care physician supply & mortality in the US with Russ Phillips

Mon, 27 May 2019 18:34:28 +0000

This interview has been lightly edited for length and clarity.

RoS Gender Equality in Medicine with Cheryl Pritlove & Elizabeth Metraux

Mon, 27 May 2019 18:34:26 +0000

This week, we have two amazing guests, Cheryl Pritlove and Elizabeth Metraux. They are joining us to talk about gender disparities in medicine. Cheryl Pritlove is a Research Scientist at the Applied Health Research Centre at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Ontario, Canada. She is a qualitative methodologist and health equity researcher with specific interests in gender disparities. Please read her recent Lancet article The good, the bad, and the ugly of implicit bias that we discuss on the show.

Elizabeth Metraux is the founder of the Boston-based start-up, Women Writers in Medicine, with a mission to break glass ceilings using the power of the pen. Formerly at the National Institutes of Health, she worked in the Office of the NIH Director as communications lead for Workforce Diversity. Prior to jumping into healthcare, she served in the Middle East and Central Asia in civil society development through the State Department, USAID, and a number of local NGO’s and media outlets. Elizabeth’s work has appeared in The New England Journal of Medicine, Health Affairs, STAT, Medium, and more. She regularly speaks across the country, hosts the healthcare podcast “Relational Rounds,” and the live storytelling series, “Scrubs, Spirits, and Stories: Tales from the Trenches of Healthcare,” both sponsored by Primary Care Progress.

We’d love to hear from you! Please tweet at us @RoSpodcast or @HMSPrimaryCare or drop us a line at contact@rospod.org.

This interview has been lightly edited for length and clarity.

RoS: The Psychology of Change with Kate Hilton of IHI, Ep 2

Mon, 27 May 2019 18:28:45 +0000

Why is change so difficult? So often, we know what needs to be done – but actually making change is where we get stuck. Kate Hilton, our guest last week and this week for a 2-part series, is on the Faculty of the Institute for Healthcare Improvement and is the lead author of a new white paper entitled The IHI Psychology of Change Framework. Kate Hilton is also on the leadership of a 100 Million Healthier Lives, a founding director of ReThink Health, and Leadership Faculty for the Atlantic Fellows for Health Equity.

If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. You can find our guest Kate on twitter @katebhilton, and you can find me at @audreymdmph and our show @rospodcast. Tweet us feedback and suggestions, or email me at contactATrospod.org. Thanks for listening!

This interview has been lightly edited for length and clarity.

RoS: The Psychology of Change with Kate Hilton of IHI, Ep 1

Mon, 27 May 2019 18:28:01 +0000

Why is change so difficult? So often, we know what needs to be done – but actually making change is where we get stuck. Kate Hilton, our guest this week and next for a 2-part series, is on the Faculty of the Institute for Healthcare Improvement and is the lead author of a new white paper entitled The IHI Psychology of Change Framework. Kate Hilton is also on the leadership of a 100 Million Healthier Lives, a founding director of ReThink Health, and Leadership Faculty for the Atlantic Fellows for Health Equity.

This interview has been lightly edited for length and clarity.

RoS Racism and Inequity in Healthcare with Utibe Essien

Mon, 27 May 2019 18:27:32 +0000

Utibe Essien, a Health Equity researcher, primary care physician in the VA Pittsburgh Health System, and Assistant Professor of Medicine at University of Pittsburgh School of Medicine joins us this week. Dr. Essien studies racial disparities in healthcare, and recently published a major study in JAMA Cardiology, demonstrating significant racial disparities in the management of atrial fibrillation. He also recently published an important commentary about the dramatic racial disparities in outcomes seen among pregnant and postpartum women in the United States. We talk about his research, and how it is connected with some of the larger instances of racial discrimination and high-profile deaths of predominantly black men that we see so often and have become part of our discourse about racial discrimination in our country. We also read and discuss the poem Martin Luther King Jr Mournes Trayvon Martin by Lauren Alleyne.

Follow Utibe on twitter at @UREssien, me @audreymdmph and our show @rospodcast. Tweet us feedback and suggestions, or email us at contactATrospod.org. Thanks for listening!

RoS Gun Violence – A View from the Trauma Bay & Public Health w Megan Ranney & David Hemenway

Mon, 27 May 2019 18:27:30 +0000

This week, we have a very special collaborative show with the Harvard T.H. Chan School of Public Health’s podcast, This Week in Health. We are featuring perspectives on gun violence from the trauma bay of the emergency room with Megan Ranney, and from public health, with David Hemenway. Megan Ranney, MD MPH is currently an Associate Professor in the Department of Emergency Medicine at Rhode Island Hospital/Alpert Medical School of Brown University and also Chief Research Officer for the American Foundation for Firearm Injury Reduction in Medicine, a non-partisan philanthropy focused on filling the funding gap for high-quality, medically-focused, firearm injury research. David Hemenway is Professor of Health Policy, is Director of the Harvard Injury Control Research Center at the TH Chan School of Public Health. Dr. Hemenway teaches classes on injury and on economics. Dr. Hemenway has written widely on injury prevention, including articles on firearms, violence, suicide, child abuse, motor vehicle crashes, fires, falls and fractures.

This interview has been lightly edited for length and clarity.

RoS Journal Club: letters and quetiapine rx, an RCT of CHWs & primary care, levels of prenatal education

Mon, 27 May 2019 18:21:58 +0000

This week, Thomas Kim, David Rosenthal, and Audrey Provenzano bring you a journal club episode. Audrey talks about: Effect of Peer Comparison Letters for High-Volume Primary Care Prescribers of Quetiapine in Older and Disabled Adults: A Randomized Clinical Trial by Adam Sacarny, PhD, Michael L. Barnett, MD, MS, Jackson Le, PharmD, Frank Tetkoski, RPh, David Yokum, PhD & Shantanu Agrawal, MD. David Rosenthal talks about Effect of Community Health Worker Support on Clinical Outcomes of Low-Income Patients Across Primary Care Facilities: A randomized Control trial By Shreya Kangovi , Nadita Mitra, Lindsey Norton, Rory Harte, Xinzi Zhao, Tamala Carter, David Grande, and Judith Long. Thomas Kim brings us a discussion of Women from racial or ethnic minority and low socioeconomic backgrounds receive more prenatal education: Results from the 2012 to 2014 Pregnancy Risk Assessment Monitoring System by Minh N. Nguyen PhD, Mohammad Siahpush PhD, Brandon L. Grimm PhD, Gopal K. Singh PhD & Melissa K. Tibbits PhD.

If you enjoy the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audrey@rospod.org. We’d love to hear from you, and thanks for listening.

RoS: Barriers to accessing medical records for patients & providers, and how that harms care

Mon, 27 May 2019 18:21:08 +0000

How long have we all, collectively in healthcare, spent on hold with medical records departments, listening to mind-numbing muzac or assembled around the fax machine, waiting for your patient’s crucial imaging reports or culture results from another hospital to come through? Way too long. Difficulty accessing medical records can be extremely difficult, which we explore today with two guests. Ilana Yurkiewicz is a physician and writer, and recently published an article on Undark, entitled Paper Trails: Living and Dying with Fragmented Medical Records, which explores how poor communication of medical records resulted in harm to one of her patients. Carolyn Lye, a medical student and law student at Yale, also joins us; she is lead author of an article published in JAMA Open, entitled Assessment of US Hospital Compliance With Regulations for Patients’ Requests for Medical Records, which studied the difficulties patients experience in requesting medical records through a secret shopper study model.

They both join us today to talk about how difficult it is to access medical records. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. You can find me at @audreymdmph and our show @rospodcast. Tweet us feedback and suggestions, or email me at contactATrospod.org. Thanks for listening!

This interview has been lightly edited for length and clarity.

RoS Reprise: Policies affecting the care of pregnant women with SUDs with Center on Addiction’s Lindsey Vuolo & Sarah Dauber

Mon, 27 May 2019 18:21:07 +0000

In this reprise episode, our guests are Sarah Dauber, Ph.D & Lindsey Vuolo JD, MPH of Center on Addiction, a science-based non-profit, non-partisan organization dedicated to finding and promoting solutions to end addiction. They join us to discuss policies that affect how pregnant women with substance use disorders may or may not access care and how we can better align policy with evidence-based care of women with substance use disorders.

Lindsey is the associate director of health law and policy at Center on Addiction and specializes in legal, regulatory and policy work related to addiction prevention and treatment with a focus on health care system reform. Sarah is the associate director of adolescent and family research at Center on Addiction. Her work is focused on evaluating the implementation of empirically-supported interventions for substance use and co-occurring mental health and family risk in usual care settings. In addition, a primary focus of her work is on developing and testing strategies for improving access to quality substance use and mental health treatment for pregnant and postpartum women. You can find the Vice article we discussed about Melissa here. You can find the data on policies surrounding pregnant women and substance use disorders that we discussed here.

Be sure to go back in your feed or click here and here for the first two shows in this series featuring a program providing SUDs care to pregnant women at Lynn Community Health Center. Please tweet us @RoSPodcast or @HMSPrimarycare, or send us an email with comments and suggestions at contact@rospod.org. Thanks for listening!

RoS: The Effects of Alternative Payment Models (APMs) on Primary Care with Mark Friedberg

Mon, 27 May 2019 18:14:34 +0000

Our guest this week is Dr. Mark Friedberg. Mark is a senior physician policy researcher at the RAND corporation and a practicing primary care physician at Brigham and Women’s Hospital, where he trained in primary care after attending medical school at Harvard. RAND is a non-profit, non-partisan research organization that develops solutions to public policy challenges to make communities healthier and more prosperous. Mark’s research covers a range of topics but focuses in particular on quality measurement and pay for performance. He joins us today to talk about his work, and in particular an exhaustive report he recently published with colleagues from RAND and also the AMA, looking at the effects of alternative payment models on the practice of medicine in the US, a follow up study from work initially done in 2014.

If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. Follow Mark and Audrey on twitter, and tweet your feedback and suggestions to us at Review of Systems. Or, you can email me at contactATrospod.org. Thanks for listening!

Reprise: Sunflower Team at Lynn Community Health Center part 2 – Building Teams That Reach Their Fullest Potential

Mon, 27 May 2019 18:10:34 +0000

In this reprise series on the care of pregnant women with substance use disorders, Landrey Fagan and Pat Lee join us to talk about their experience forming their team called the Sunflower team at Lynn Community Health Center, which provides full-spectrum care for women suffering from SUDs during and after pregnancy in an effort to reduce stigma, reduce fragmentation of care, and keep women engaged in care throughout their pregnancy, delivery, and in the post-partum period. They developed this care program while participating in the Harvard Center for Primary Care’s Advancing Teams in Community Health program.

Landrey Milton Fagan, MD is a board-certified Family Physician who provides full spectrum family care including surgical obstetrics. She has been working at Lynn Community Health Center in Lynn, MA for the past six years and has recently relocated to Boulder, Colorado where she will be
joining Salud Family Medical Center in nearby Longmont. Patrick Lee, MD is Chair of Medicine at North Shore Medical Center in Salem, MA and Assistant Professor of Medicine at Harvard Medical School. He has dedicated his career to solving two problems: helping individuals and teams reach their fullest potential, and creating health systems that deliver the safe, kind, and timely care that patients deserve. Dr. Lee believes “the secret of quality is love” and tries to deepen his understanding of, and align his daily actions to, this essential lesson.

Reprise: Sunflower Team at Lynn Community Health Center part 1 – Care For Pregnant Women With Opioid Use Disorder

Mon, 27 May 2019 18:08:53 +0000

RoS Drs Christine Riedy & Tien Jiang from the Center for Integration of PCare & Oral Health, CIPCOH

Mon, 27 May 2019 18:08:51 +0000

As everyone in primary care knows, oral health care in the US can be very difficult to access. Tien Jiang, DMD MEd, an instructor of oral health policy and epidemiology at Harvard School of Dental Medicine and Christine Riedy, PhD MPH a researcher with the Center for the Integration of Primary Care and Oral Health, or CIPCOH, and the Delta Dental Associate Professor of Oral Health Policy and Epidemiology at the Harvard School of Dental Medicine join us today to talk about their work at CIPCOH, their research, and their vision of oral health and primary care integration.

If you are interested in oral health and missed it previously, have a listen to Audrey talk with Mary Otto, a healthcare journalist who published a book about oral health in the US called Teeth.

If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @rospodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audreyATrospod.org. We’d love to hear from you, and thanks for listening.

RoS Reprise – Teams in Primary Care with Ann O’Malley and Patricia Satterstrom, Part 2

Mon, 27 May 2019 17:38:07 +0000

These days, primary care is all about teamwork. We are all asking ourselves – how can we make our teams function better? And – a question we should ask, but often don’t: should this task be done by the team? Or is this task actually better understood as sequential interdependence or pooled interdependence?

Our guests this week and last, Ann O’Malley and Patricia Satterstrom, join us for the second of a two week series about teams and can help us start to answer some of those questions. If you missed last week’s show, go back in your feed and listen to the first. Patricia, who goes by Pat, is an Assistant Professor at the NYU Wagner Graduate School of Public Service and an affiliate of the Management and Organizations Department at the NYU School of Business and she studies how to enable team members to collaborate despite power differences arising from professional and demographic boundaries, and how to facilitate improved collaboration in health care organizations. Ann O’Malley is a physician and a Senior Fellow with Mathematica Policy research. Her work focuses on quality of care and primary care, and part of her research, which we focus on in the show involves qualitative interviews with primary care stakeholders on teamwork. You can find the qualitative study we discussed at length on the show here; some of Pat Satterstrom’s publications here; here is the Bodenheimer and Ghorob paper Ann referenced putting forward pillars for teamwork in primary care; and here is the paper from Dr. Sam Edwards showing that delegating some tasks from PCPs reduced burnout in PCPs but increased burnout in nurses.

If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We love to hearing from you, so please tweet at us @RoSpodcast or @HMSPrimaryCare – we got some great comments from folks on twitter about teamwork that we are including in this series – so thank you to everyone who commented! Or you can drop me a line at contact@rospod.org.

RoS Reprise – Teams in Primary Care with Ann O’Malley and Patricia Satterstrom, Part 1

Mon, 27 May 2019 17:36:54 +0000

Our guests this week and next, Ann O’Malley and Patricia Satterstrom, join us for a two week series about teams and can help us start to answer some of those questions. Patricia, who goes by Pat, is an Assistant Professor at the NYU Wagner Graduate School of Public Service and an affiliate of the Management and Organizations Department at the NYU School of Business and she studies how to enable team members to collaborate despite power differences arising from professional and demographic boundaries, and how to facilitate improved collaboration in health care organizations. Ann O’Malley is a physician and a Senior Fellow with Mathematica Policy research. Her work focuses on quality of care and primary care, and part of her research, which we focus on in the show involves qualitative interviews with primary care stakeholders on teamwork. You can find the qualitative study we discussed at length on the show here; some of Pat Satterstrom’s publications here; here is the Bodenheimer and Ghorob paper Ann referenced putting forward pillars for teamwork in primary care; and here is the paper from Dr. Sam Edwards showing that delegating some tasks from PCPs reduced burnout in PCPs but increased burnout in nurses.

RoS Community Building Among Clinicians to Counteract Burnout with Nic Nguyen

Mon, 27 May 2019 17:36:52 +0000

Dr. Nicolas Nguyen is our guest this week. Dr. Nguyen is a practicing Family Physician and the Director of Physician Experience and Provider Development at Beth Israel Deaconess HealthCare. He has created a model for clinician community building, which was highlighted and published in NEJM Catalyst, and he joins us to talk about his initiative.

If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @audreymdmph, or drop me a line at contactATrospod.org.

RoS The effects of neighborhood greening on mental health with Eugenia South & Michelle Kondo

Mon, 27 May 2019 17:36:50 +0000

This week, Michelle Kondo and Eugenia South join us to talk about their research looking at how neighborhood contexts impact health and safety in urban environments, and their recent publication in JAMA Network Open looking at the relationship between neighborhood greening and mental health. Dr. South and Dr. Kondo collaborate from two different perspectives – Dr. South is an emergency physician and health services researcher at UPenn; and Dr. Kondo is a PhD research social scientist with the USDA-Forest Service, Philadelphia Field Station.

RoS Journal Club Opioid OD among pregnant women, midlife deaths in the US & assn of scribes with MD workflow & patient experience

Mon, 27 May 2019 17:28:50 +0000

This week, Thomas, Audrey, and David bring you a journal club featuring discussion of three recent papers: Fatal and Nonfatal Overdose Among Pregnant and Postpartum Women in Massachusetts by Davida M Shiff, Timothy Nielsen, Mishka Terplan, Malena Hood, Dana Bernson, Hafsato Diop, Monica Bharel, Timothy Wilens, Marc LaRochelle, Alexander Walley, and Thomas Land; Changes in midlife death rates across racial and ethnic groups in the United States: systematic analysis of vital statistics by Steven H Woolf, Derek Chapman, Jeanine Buchanich, Kendra Bobby, Emily Zimmerman, and Sarah Blackburn; and Association of Medical Scribes in Primary care with physician workflow and patient experience by Pranita Mishra, Jacquelin Kiang and Richard Grant. Links for our pearls: amazing fish and an excellent commentary from John Frey on loneliness.

RoS Reprise: Understanding the inadequate state of gun violence research in the US with Dr. Mark Rosenberg

Mon, 27 May 2019 17:28:43 +0000

For the second show in our series about gun violence, we are joined by Dr. Mark Rosenberg. Dr. Rosenberg worked for many years at the CDC, and helped to found the National Center for Injury Prevention and Control, or the NCIPC, and was it’s first permanent director in 1994. He oversaw the agency during the now-notorious hearings about findings of firearms research that at the time was funded by the NCIPC, and the later passage of the Dickey Amendment in 1996, which prevented the CDC from using funding to advocate or promote gun control. He tells us all about that time in his life, and his later surprising friendship with his foe at that time, Arkansas Congressman Jay Dickey. Dr. Rosenberg is now the president and CEO of the Task Force for Global Health. You can find the op-ed that Dr. Rosenberg wrote with Jay Dickey calling for restoration of funding specifically to examine gun violence research here.

Last week, we spoke with student leaders who organized an op-ed writing contest for health professionals students on gun violence, and talked about advocacy as health professionals and with the winner of the contest, Mike Rose. You can find that show here.

If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contact@rospod.org.

RoS Policies affecting the care of pregnant women with SUDs with Center on Addiction’s Lindsey Vuolo & Sarah Dauber

Mon, 27 May 2019 17:28:41 +0000

This week, our guests are Sarah Dauber, Ph.D & Lindsey Vuolo JD, MPH of Center on Addiction, a science-based non-profit, non-partisan organization dedicated to finding and promoting solutions to end addiction. They join us to discuss policies that affect how pregnant women with substance use disorders may or may not access care and how we can better align policy with evidence-based care of women with substance use disorders.

You can find the Vice article we discussed about Melissa here. You can find the data on policies surrounding pregnant women and substance use disorders here.

Sunflower Team at Lynn Community Health Center part 2 – Building Teams That Reach Their Fullest Potential

Mon, 27 May 2019 17:24:27 +0000

In the second of our series on the care of pregnant women with substance use disorders, Landrey Fagan and Pat Lee join us to talk about the hard work that went into forming the Sunflower team at Lynn Community Health Center. The Sunflower Team provides full-spectrum care for women suffering from SUDs during and after pregnancy in an effort to reduce stigma, reduce fragmentation of care, and keep women engaged in care throughout their pregnancy, delivery, and in the post-partum period.

Landrey Milton Fagan, MD is a board-certified Family Physician who provides full spectrum family care including surgical obstetrics. She has been working at Lynn Community Health Center in Lynn, MA for the past six years and has recently relocated to Boulder, Colorado where she will be
joining Salud Family Medical Center in nearby Longmont. Patrick Lee, MD is Chair of Medicine at North Shore Medical Center in
Salem, MA and Assistant Professor of Medicine at Harvard Medical School. He has dedicated his career to solving two problems: helping
individuals and teams reach their fullest potential, and creating health systems that deliver the safe, kind, and timely care that patients
deserve. Dr. Lee believes “the secret of quality is love” and tries to deepen his understanding of, and align his daily actions to, this essential lesson.

Sunflower Team at Lynn Community Health Center part 1 – Care For Pregnant Women With Opioid Use Disorder

Mon, 27 May 2019 17:23:04 +0000

In the first of our series on the care of pregnant women with substance use disorders, Landrey Fagan and Pat Lee join us to talk about their experience forming their team called the Sunflower team at Lynn Community Health Center, which provides full-spectrum care for women suffering from SUDs during and after pregnancy in an effort to reduce stigma, reduce fragmentation of care, and keep women engaged in care throughout their pregnancy, delivery, and in the post-partum period.

Landrey Milton Fagan, MD is a board-certified Family Physician who provides full spectrum family care including surgical obstetrics. She has been working at Lynn Community Health Center in Lynn, MA for the past six years and has recently relocated to Boulder, Colorado where she will be joining Salud Family Medical Center in nearby Longmont. Patrick Lee, MD is Chair of Medicine at North Shore Medical Center in Salem, MA and Assistant Professor of Medicine at Harvard Medical School. He has dedicated his career to solving two problems: helping
individuals and teams reach their fullest potential, and creating health systems that deliver the safe, kind, and timely care that patients deserve. Dr. Lee believes “the secret of quality is love” and tries to deepen his understanding of, and align his daily actions to, this essential lesson.

RoS Understanding the new CMS proposed rules with Shari Erickson of ACP

Mon, 27 May 2019 17:17:49 +0000

Shari Erickson, MPH is our guest this week. She with us about the proposed rules recently released by CMS that would drastically change how physicians bill, especially in primary care, how these proposed changes could help decrease administrative burdens on physicians, and where ACP, the largest physician advocacy organization in the US, landed on these policy proposals.

Shari is the VP of Governmental Affairs and Medical Practice with the American College of Physicians (ACP). Among other things, Shari manages ACP’s overall advocacy and policy initiatives relating to federal regulatory agencies, including HHS, CMS, CMMI, and other federal bodies. Click here for ACP’s statement on the proposed billing rule changes, and the rules overall.

If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or @audreymdmph or drop me a line at contact@rospod.org.

Re-imagining primary care in the US & what we can learn from Costa Rica with Asaf Bitton

Mon, 27 May 2019 17:17:47 +0000

Asaf Bitton MD, MPH is our guest this week. Asaf talks with us about what he sees as crucial steps in improving primary care in the US and what we can learn from primary care systems globally, particularly drawing on a recent healthcare system reform in Costa Rica which he wrote about last year in Health Affairs. We also talk about a noteworthy editorial he wrote in the Annals of Family Medicine laying out what he sees as a path forward in primary care, with parsimony and also being clear-eyed about the limits of current capitation efforts.

Dr. Bitton is the Director of Primary Health Care at Ariadne Labs where he leads the Primary Health Care Performance Initiative, a joint effort with the Bill and Melinda Gates Foundation, The World Bank, the World Health Organization, and The Results for Development Institute. He is also a senior advisor to the Center for Medicare and Medicaid Innovation (CMMI) on their Comprehensive Primary Care Plus initiative. He practices primary care in the Boston area.

We love to hear from our listeners, so please tweet us @RoSPodcast or @HMSPrimary care, leave us a message on facebook, or send us an email with comments and suggestions at contact@rospod.org. Thanks for listening!

Audio Player

RoS Understanding Career Plans of Primary Care IM Residents w Sonja Solomon, Krisda Chaiyachati, and John Moriarty

Mon, 27 May 2019 17:17:44 +0000

This week, Drs. Sonja Solomon, Krisda Chaiyachati, and John Moriarty join us to discuss a paper they published in JGIM in 2016 entitled Why Aren’t More Primary Care Residents Going into Primary Care? A Qualitative Study. They interviewed residents from three primary care internal medicine programs across the country to better understand what factors within primary care training programs may influence the residents’ career choices.

If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contact@rospod.org.

RoS: Improving Primary Care at Various Levels of Scale with Ted Long

Mon, 27 May 2019 17:17:42 +0000

This week, Ted Long, the VP for Primary Care at NYC Health + Hospitals joins us to talk about how we can make primary care better for patients and for physicians at various levels of scale. He previously served as the Senior Medical Officer for the Quality Measurement and Value-Based Incentives Group at the Centers for Medicare and Medicaid Services, which covers over 20 federal programs including the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Hospital Readmission Reduction Program, and the Hospital Value-Based Purchasing Program. Earlier, he served as Medical Director at the Rhode Island State Department of Health. He is a practicing primary care physician and is also on the faculty at the Harvard Medical School Center for Primary Care.

We love to hear from our listeners, so please tweet us @RoSPodcast or @HMSPrimaryCare, or send us an email with comments and suggestions at contact@rospod.org. Thanks for listening!

RoS Community Health Workers with Shreya Kangovi & Lisa Kidd reprise

Mon, 27 May 2019 17:14:29 +0000

This week, we have two very exciting guests: Shreya Kangovi, an internist/pediatrician and researcher who studies CHW interventions and developed a multi-stakeholder team-based CHW model called IMPaCT (Individualized Management towards Patient-Centered Targets), and went on to found the Penn Center for Community Health Workers. These organizations work to deliver care to patients in Philadelphia, provide training and capacity building, as well as performing ongoing research. Our second guest, Lisa Kidd, is a CHW who works at the Penn Center and will join us to talk about her experiences as a CHW. You can find some of Dr. Kangovi’s publications here.

If you enjoy the show, please rate and review us wherever you find us, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contactATrospod.org.

RoS Primary Care Through the Lens of an Anthropologist w Scott Stonington reprise

Mon, 27 May 2019 17:10:46 +0000

Dr. Scott Stonington is a medical and cultural anthropologist, and an internist. He studies decision-making at the end of life in Thailand and spent many years accompanying Thai patients at the end of life and in particular trying to understand pain, suffering, and the role of pain medications from these patient’s points of view. Dr. Stonington also studies medical epistemology in the U.S., specifically looking at how health practitioners decide what constitutes true and/or useful knowledge and how this affects patients.

Please read his Perspective in the New England Journal of Medicine about the concept of the debt of life, The Debt of Life – Thai Lessons on a Process-Oriented Ethical Logic, and his article in JAMA entitled Whose Autonomy?, a meditation on how he thinks about decision-making, pain, and pain control. In addition, he wrote further about how his work in Thailand has changed his thought process on pain in The (f)utility of pain, published in the Lancet.

Also, a quick note that the day we recorded this show I was still recovering from an upper respiratory infection and you can hear me coughing which is distracting so I apologize about that.

If you enjoy the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast or @HMSprimarycare and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audreyATrospod.org. We’d love to hear from you, and thanks for listening.

RoS: How the system gets in the way of taking care of patients with Elisabeth Rosenthal

Mon, 27 May 2019 17:10:44 +0000

Elisabeth Rosenthal is a physician and a noted writer and Editor In Chief of Kaiser Health News. She recently published An American Sickness, a book exploring how the business of medicine has gotten in the way of doctors delivering great care to patients and made the system increasingly complex and expensive for patients to navigate. She joins us this week!

If you enjoy the show, please rate, review & subscribe to us wherever you listen. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contact@rospod.org.

RoS Women in Medicine in the Era of #MeToo with Nwando Olayiwola and Elisabeth Poorman

Mon, 27 May 2019 17:10:42 +0000

Our society is coming to a reckoning with how we treat women, and medicine has it’s own reckoning too. This week, we have two guests: Nwando Olayiwola, a family physician, corporate leader, researcher, and author; and Elisabeth Poorman, an internist, speaker, and writer.

First, we’ll speak with Dr. Poorman about an article she published in The Guardian about the challenges that women physicians face. We also discuss a paper published by Mark Linzer and Eileen Harwood in JGIM on what particular challenges women face in practicing medicine owing to different expectations of male and female physicians; and the importance of understanding and distinguishing sympathy, empathy, and compassion.

Then, we’ll talk with Dr. Olayiwola about an organization she started, Society for Women Minority Professionals, to respond to the specific challenges that she and other minority professional women face. We also talk about imposter syndrome, a feeling so many qualified and successful women can identify with, recently written about in NEJM by Dr. Suzanne Koven. Lastly, Dr. Olayiwola shares with us some experiences of discrimination she experienced in her life and wrote about in her new book, Papaya Head.

If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contact@rospod.org.

RoS: Journal Club – High Levels of Capitation Payments & Proactive Team & Non-Visit Care w Sanjay Basu and Bruce Landon

Mon, 27 May 2019 16:59:05 +0000

Primary care practices across the US are starting to change the way we practice, incorporating more non-visit types of care such as e-visits or telephonic or even skype visits. Adding these modalities to a practice require investment: in technology, in training staff, in developing, testing, and implementing workflows – and at what point does all of this become financially sustainable? What is the question that Drs. Sanjay Basu and Bruce Landon, along with colleagues Russ Phillips, Zirui Song, and Asaf Bitton set out to look at in their 2017 Health Affairs paper entitled: High Levels Of Capitation Payments Needed To Shift Primary Care Toward Proactive Team And Non-visit Care.

Sanjay and Bruce join us today to talk about their research question and their findings. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contactATrospod.org.

RoS: SNAP and the Farm Bill – Food Insecurity in the clinic & as a public health issue with Sara Bleich and Hilary Seligman

Mon, 27 May 2019 16:59:01 +0000

This week, Review of Systems joins forces with Harvard Chan This Week in Health for a crossover podcast episode! We’re talking about food stamps, or SNAP, and how upcoming legislation in the Farm Bill will shape SNAP policy over the next five years. Changes in SNAP policy will have important public health implications and affect the food insecure patients we see in our clinics in primary care – so it’s a perfect topic for us to examine together. Audrey Provenzano and Noah Leavitt, the host of Harvard Chan This Week in Health talk with our two guests for this week: Sara Bleich, who is a Professor of Public Health Policy at the Harvard T.H. Chan School of Public Health in the Department of Health Policy and Management. She is also the Carol K. Pforzheimer Professor at the Radcliffe Institute for Advanced Study and is an expert in obesity and food policy; and Hilary Seligman, who is a primary care physician and Associate Professor of Medicine and of Epidemiology and Biostatistics, UCSF. She is also a Senior Medical Advisor for Feeding America, Director of CDC’s Nutrition and Obesity Policy Research and Evaluation Network and the founder of EatSF: A Healthy Food Voucher Program for Low-Income Residents of San Francisco.

If you enjoy the show, please rate, review & subscribe to both of our shows wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or @HarvardChanSPH.

RoS: Understanding the Importance of Adverse Childhood Events on Health w Audrey Stillerman part 2

Mon, 27 May 2019 16:58:58 +0000

There is a growing recognition of the role of trauma, particularly childhood trauma or adverse childhood events on health and health outcomes. Family physician Audrey Stillerman joins Thomas Kim for a two-part series about ACEs and the effects they have on health, and what we as health professionals should know about them.

Dr. Stillerman is the Associate Director of Medical Affairs for the University of Illinois Office of Community Engagement and Neighborhood Health Partnerships and the medical director for the School Health Center Program at UI Health as well as at PCC Steinmetz. She is a Clinical Assistant Professor in the UIC Department of Family Medicine. She is board-certified in both Family Medicine and Integrative Medicine; since 1991 she has been providing comprehensive care for the whole family, from babies to senior citizens

Dr. Stillerman serves as a steering committee member of the Illinois ACEs Response Collaborative and co-chair of its Health Committee as well as a co-investigator for a multi-site primary care ACE screening project. She is a founding member of the Center for the Collaborative Study of Trauma, Health Equity, and Neurobiology (THEN). She has recommended the following resources for further reading:

SAMHSA’s 4 R’s of trauma-informed approached:

https://www.samhsa.gov/nctic/trauma-interventions

Center for Health Care Strategies 10 key ingredients:

https://www.chcs.org/resource/10-key-ingredients-trauma-informed-care/

RWJ Self-Healing Communities:

https://www.rwjf.org/en/library/research/2016/06/self-healing-communities.html

Center for Center for Collaborative Study of Trauma, Health Equity and Neurobiology (THEN) – www.thencenter.org

ACEs Too High: https://acestoohigh.com/

ACEs Connection: https://www.acesconnection.com/

If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show. You can write to us at contact@rospod.org or tweet us @RoSpodcast, or leave a message on our facebook page at facebook.com/reviewofsystems.

All of us like to think that we provide high-value care for our patients; but the truth is, just like the rest of the health care system, primary care provides a lot of low value care too – and we drive a lot of overuse. John Mafi joins us this week to talk about his leading research into these thorny, complex issues.

Mon, 27 May 2019 16:57:51 +0000

SAMHSA’s 4 R’s of trauma-informed approached:

https://www.samhsa.gov/nctic/trauma-interventions

Center for Health Care Strategies 10 key ingredients:

https://www.chcs.org/resource/10-key-ingredients-trauma-informed-care/

RWJ Self-Healing Communities:

https://www.rwjf.org/en/library/research/2016/06/self-healing-communities.html

Center for Center for Collaborative Study of Trauma, Health Equity and Neurobiology (THEN) – www.thencenter.org

ACEs Too High: https://acestoohigh.com/

ACEs Connection: https://www.acesconnection.com/

RoS: Understanding High Value and Low Value Care with John Mafi

Mon, 27 May 2019 16:57:49 +0000

All of us like to think that we provide high-value care for our patients; but the truth is, just like the rest of the health care system, primary care provides a lot of low value care too – and we drive a lot of overuse. John Mafi joins us this week to talk about his leading research into these thorny, complex issues.

If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @rospodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audrey@rospod.org. We’d love to hear from you, and thanks for listening.

RoS: Teams in Primary Care with Ann O’Malley and Patricia Satterstrom, Part 2

Mon, 27 May 2019 16:49:52 +0000

RoS: Teams in primary care with Ann O’Malley and Pat Satterstrom part 1

Mon, 27 May 2019 16:47:00 +0000

RoS: Gun Violence Research in the US with Dr. Mark Rosenberg

Mon, 27 May 2019 16:46:57 +0000

For the second show in our series about gun violence, we are joined by Dr. Mark Rosenberg. Dr. Rosenberg worked for many years at the CDC, and helped to found the National Center for Injury Prevention and Control, or the NCIPC, and was it’s first permanent director in 1994. He oversaw the agency during the now-notorious hearings about findings of firearms research that at the time was funded by the NCIPC, and the later passage of the Dickey Amendment in 1996, which prevented the CDC from using funding to advocate or promote gun control. He tells us all about that time in his life, and his later surprising friendship with his foe at that time, Arkansas Congressman Jay Dickey.Dr. Rosenberg is now the president and CEO of the Task Force for Global Health. You can find the op-ed that Dr. Rosenberg wrote with Jay Dicky calling for restoration of funding specifically to examine gun violence research here.

If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contact@rospod.org.

RoS: Gun Violence as a Public Health Issue & Health Professionals as Advocates

Mon, 27 May 2019 16:46:54 +0000

This week, we have several guests. Joining us now are members of the HMS center for primary care student leadership committee, Galina Gheihman, Megan Townsend, and Andreas Mitchell. With the recent national focus on gun violence, the leadership council decided to hold an op-ed contest on the issue of gun violence. They are joining us today to talk about the contest with the winner, Mike Rose, and the students’ work on this important public health issue, and opportunities for advocacy as health professionals. Take a moment to read Mike’s winning op-ed, Do we love ducks more than we love children?

Be sure to tune in next week to hear from Dr. Mark Rosenberg about his time as Director of the National Center for Injury Prevention and Control, his thoughts on the Dickey Amendment, and his unlikely friendship with Congressman Jay Dickey.

If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contact@rospod.org.

RoS: Reprise – Oral Health in the United States with Mary Otto

Mon, 27 May 2019 16:25:37 +0000

How many times have you treated a dental infection in your primary care office, or spent 10 minutes after a visit googling a dentist that takes your patient’s insurance? We’ve all done it too many times. There is an epidemic of dental disease in the United States – dental care is expensive and difficult to access. Mary Otto, a journalist, author, and our guest this week, has written a book called Teeth. In it, Mary explores the oral health crisis and explains its wide-reaching effects, such as decreased social mobility and fewer opportunities for employment; also, she talks about how oral health has become so segmented apart from the rest of the healthcare system and what can be done about it.

Click here to find more information about Mary Otto, winner of The Studs and Ida Terkel Award, which is dedicated to supporting authors who are committed to exploring aspects of American life that are not adequately represented by the mainstream media. You can find more information about Teeth here. You can find many of Mary’s articles here.

If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @rospodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audrey@rospod.org. We’d love to hear from you, and thanks for listening.

RoS: Narratives of Life & Death with Daniela Lamas

Mon, 27 May 2019 16:25:34 +0000

We spend lots of our time in medicine communicating through research – standardized, peer-reviewed, and of course crucial! But medicine is full of compelling humanistic narratives. The great Marshall Ganz once wrote, in an article entitled “Why Stories Matter,” that “A story communicates fear, hope, and anxiety, and because we can feel it, we get the moral not just as a concept, but as a teaching of our hearts. That’s the power of story.” This week, we focus on narrative medicine and we are joined by a master physician storyteller, Daniela Lamas, who just published her first book, called You Can Stop Humming Now: A Doctor’s Stories of Life, Death, and In Between.

Also, we want to hear from you! To entice you to talk to us, we are going to give away a signed copy of Daniela’s book to a randomly selected commenter or emailer who sends us feedback, suggestions, or comments! You can write to us at audreyATrospod.org or tweet us @RoSpodcast or @HMSPrimaryCare, or leave a message on our facebook page. Just write to us or tweet at us or leave a facebook comment or email us, and your name will go into the hat for a random drawing. We’ll announce the randomly drawn winner next week!

RoS: The Changing Primary Care Workforce with Bianca Frogner

Mon, 27 May 2019 16:25:32 +0000

As everyone in primary care tries to shift to team based models of care, task shift, and deliver value rather than volume, we are all looking at staffing and workforce issues. What is the best way to staff a clinic? Should we hire more MAs or LPNs or nurses or NPs? How should we think about these decisions?

Our guest today to talk about workforce is Bianca Frogner, PhD. Dr. Frogner is an Associate Professor and health economist in the Department of Family Medicine in University of Washington’s School of Medicine. Dr. Frogner is also the Director of the Center for Health Workforce Studies. She publishes extensively about workforce issues, particularly in the community health center setting. You can find many of her publications here.

RoS: A neighborhood view of health with Prabhjot Singh

Mon, 27 May 2019 16:16:07 +0000

In 2011, Dr. Prabhjot Singh attended the funeral of one of his patients, whom he calls Ray. He describes in his book, Dying and Living in the Neighborhood, a Street-Level View of America’s Healthcare Promise, how Ray, a veteran, struggled mightily with a host of chronic illnesses, unemployment, and isolation in his neighborhood, and how he thinks all of those factors both medical related and non-medically related, contributed to Ray’s early death. We all can call to mind patients for whom factors completely outside of healthcare determined their poor or good health outcomes. In his book, Dr. Singh puts forward a neighborhood vision of healthcare and how we can achieve a healthcare system that can meet our patient’s needs.

Prabhjot Singh is the Director of the Arnold Institute for Global Health and Chair of Health System Design & Global Health at the Mount Sinai Health System, as well as Special Advisor for Strategy and Design at the Peterson Center for Healthcare. If you enjoy the show, please rate, review & subscribe to us wherever you listen, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contactATrospod.org.

RoS: Getting Social Determinants of Health Right with Krisda Chaiyachati

Mon, 27 May 2019 14:30:43 +0000

How many times have you had a patient no-show to an appointment, or show up 20 minutes late because of difficulties with transportation? We’ve all been there. Dr. Krisda Chaiyachati wondered whether providing transportation for patients with the ride service Lyft might cut down on the no-shows in his clinic, which typically run at around 50% among the Medicaid patient population. He decided to investigate this further with a pilot study and then a larger prospective trial. We talk about his surprising findings, as well as the larger questions that still surround social determinants of health – which ones really matter most? How should we measure them? How do we use them to risk-adjust accurately, and not penalize hospitals or health systems that care for the most vulnerable patients?

You can find Dr. Chaiyachati and his colleagues’ commentary from Annals of Internal Medicine about social determinants of health and risk adjustment here. You can learn more about Krisda here.

RoS: Understanding Medicaid Work Requirements with Sara Rosenbaum, JD

Mon, 27 May 2019 14:23:45 +0000

Over the last few months, you’ve probably heard about a few states making changes to their Medicaid programs that will require able-bodied Medicaid recipients to work. This is a major policy shift which could have profound consequences – and we’re going to talk about it today. We talk about what the changes might mean in terms of people losing coverage, how the requirements may be operationalized, ethical concerns for medical professionals, and the current situation with some of the many lawsuits filed against these policies, in particular Stewart vs. Azar.

Our guest is Sara Rosenbaum, JD. Professor Rosenbaum is the Harold and Jane Hirsh Professor of Health Law and Policy and Founding Chair of the Department of Health Policy at the Milken Institute School of Public Health at George Washington University. Professor Rosenbaum has devoted her career to issues of health justice for populations who are medically underserved as a result of race, poverty, disability, or cultural exclusion and is a nationally known expert on Medicaid. You can find the Health Affairs blog that we referenced in our conversation here.

RoS: The importance of management in healthcare with Raffaella Sadun

Mon, 27 May 2019 14:22:39 +0000

Raffaella Sadun is the Thomas S. Murphy Associate Professor of Business Administration in the Strategy Unit at Harvard Business School. Her research focuses on management and organizational change, particularly in healthcare. She speaks and writes about the importance of management in healthcare and how at times good management fundamentals may be overlooked.

If you are interested in improving your management skills and learning more, please sign up for the HMS CPC’s upcoming course, the Medical Director Leadership Institute, which will be held May 10-12. You can find more information on our website.

If you enjoy the show, check out our website for an archive of our old shows, and please rate and review us wherever you find us, it helps others find the show, and share us on social media and with our friends and colleagues. We’d love to hear feedback and suggestions, so you can tweet at us @RoSpodcast or @HMSPrimaryCare or drop me a line at contactATrospod.org.

RoS: Community Health Workers with Shreya Kangovi & Lisa Kidd from the Penn Center for CHWs

Mon, 27 May 2019 14:19:00 +0000

This is our first episode of Review of Systems in partnership with the Harvard Center for Primary Care – we are very excited – our website has moved to https://primarycare.hms.harvard.edu, or you can go to our old address if you have it bookmarked and you’ll be redirected to our new site.

A new partnership: RoS & The Harvard Center for Primary Care

Mon, 27 May 2019 14:08:25 +0000

Dear listeners,

We have a brief and very exciting update for you today about the podcast! We are joining forces with the Harvard Center for Primary Care! We are so excited to be working together and know that our partnership will allow us to bring more great content to you through the podcast and the CPC programming. Please check out our website: https://primarycare.hms.harvard.edu for more, and if you click on the podcast tab along the top that will bring you to the new Review of Systems website. Or, just go to our old site and it will redirect you over. Our show will continue to come to your feed every Tuesday – we’ve got lots of fascinating guests coming up: Shreya Kangovi and Lisa Kidd from the Penn Center for CHWs, Katherine Gottlieb from the South Central Foundation, Prabjot Singh, author of Living and Dying in the Neighborhood, and lots more! So stay tuned, and thanks for listening!

Primary care through an anthropologist’s lens

Mon, 27 May 2019 13:40:21 +0000

Also, a quick note that the day we recorded this show I was still recovering from an upper respiratory infection and you can hear me coughing which is distracting so I apologize about that.

If you enjoy the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audreyATrospod.org. We’d love to hear from you, and thanks for listening.

The Healing Power of Narrative with Annie Brewster

Mon, 27 May 2019 13:39:35 +0000

Dr. Annie Brewster found herself frustrated as a primary care physician. There simply was not enough time to hear her patients’ stories and feel that she got to know them. Her belief in the meaning of stories and the healing power of narrative, as well as her own experience as a patient after a diagnosis of multiple sclerosis, have animated her career, as she went on to found an organization, the Health Story Collaborative. The Health Story Collaborative aims to collect, share, and honor stories of illness and healing, with the goal to create a forum for story sharing to make the process of navigating illness less isolating, and to empower individuals and families facing health challenges. Annie joins us today to talk about her career and the healing power of narrative. Dr. Brewster regularly writes for WBUR’s Commonhealth Blog, and you can see her talk about her work here.

If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audreyATrospod.org. We’d love to hear from you, and thanks for listening.

CareMore Health with Sachin Jain

Mon, 27 May 2019 13:28:06 +0000

Over the last 25 years, CareMore health has been a leader in innovative care models for chronic disease. The company serves 100,000 patients in 8 states through Medicare Advantage programs and more recently expanded into Medicaid. CareMore particularly aims to take on patients with chronic disease through an intensive, high-touch care program.

Today, Sachin Jain, CareMore’s president and CEO joins us to talk about CareMore’s model, their approach in joining new markets, their outcomes, and their unique programming aiming to reduce loneliness among their members. You can find the Commonwealth fund article we discussed here, and Sachin’s article in Forbes here. Also, we previously did a journal club about CareMore’s collaboration with Lyft to improve transportation to appointments – you can find that here.

Sachin H. Jain, MD, MBA is chief executive officer (CEO) at CareMore Health, an innovative healthcare delivery system with $1.2B revenue & over 100,000 patients in 8 states. He is also a consulting professor of medicine at the Stanford University School of Medicine and a contributor at Forbes. Dr. Jain was previously CareMore’s chief medical officer (CMO) and chief operating officer (COO).

Prior to joining CareMore Health, Dr. Jain was Chief Medical Information & Innovation Officer at Merck & Co. He also served as an attending physician at the Boston VA-Boston Medical Center and a member of faculties at Harvard Medical School and Harvard Business School. From 2009-2011, Dr. Jain worked in the Obama Administration, where he was the senior advisor to Donald Berwick when he led the Centers for Medicare & Medicaid Services (CMS). Dr. Jain was the first deputy director for policy and programs at the Center for Medicare and Medicaid Innovation (CMMI). He also served as special assistant to David Blumenthal when he was the National Coordinator for Health Information Technology.

Journal Club: Medical Legal Partnerships at VA Medical Centers Improved Housing and Psychosocial Outcomes for Vets

Mon, 27 May 2019 13:27:21 +0000

This month’s journal club, we discuss the article Medical Legal Partnerships At VA Medical Centers Improved Housing and Psychosocial Outcomes for Vets by Jack Tsai, Margaret Middleton, Jennifer Villegas, Cindy Johnson, Randye Retkin, Alison Seidman, Scott Sherman, and Robert A Rosenheck. David Rosenthal and Audrey Provenzano are joined by the lead authors of the study Jack Tsai and Margaret Middleton. If you would like to learn more about medical legal partnerships, please review the website of the National Center for Medical Legal Partnerships.

Reprise: Design Thinking with Bon Ku

Mon, 27 May 2019 13:25:08 +0000

This week we are featuring a reprise show with Bon Ku, the Assistant Dean for Health and Design and an Associate Professor at the Sidney Kimmel Medical College at Thomas Jefferson University, to talk about design thinking and medicine. Bon is a practicing emergency medicine physician and the founder and director of JeffDESIGN, a first-of-its-kind program in a medical school that teaches future physicians to apply human-centered design to healthcare challenges. Bon has spoken widely on the intersection of health and design thinking (TEDx, South by Southwest, Mayo Clinic Transform, Stanford Medicine X, Association of Collegiate Schools of Architecture) and serves on the Design and Health Leadership Group at the American Institute of Architects. Bon talks with us about what design thinking is, how he got into it, why he thinks physicians would benefit from learning to think in this way, and how to apply it to common primary care challenges, like walk-ins. He also directs listeners to the following resources to learn more about design thinking in medicine: the Stanford Dschool, and ideou.

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

Understanding the Opioid Epidemic with Dan Ciccarone

Mon, 27 May 2019 13:24:03 +0000

The opioid epidemic is the greatest public health crisis of our time. It is estimated that about 64,000 people died of opioid overdoses in 2016 – more than died in the Vietnam war or in 1 year at the height of the AIDs epidemic. Dan Ciccarone, our guest this week, and a Professor at UCSF School of Medicine, has spent his career trying to improve our understanding of substance use disorders and their health consequences. He and his collaborators look at this question both up-close, through ethnographic research in the community, and hours and hours of interviews with people who use injection drugs, and also by stepping back and sifting through huge datasets, looking at the larger epidemiologic and economic forces shaping the epidemic. He has spent years studying heroin specifically, and is currently the PI of the Heroin in Transitions study, which continues this vital work.

We talk specifically about a study led by one of his collaborators, Dr. Sarah Mars, “Every ‘Never’ I Ever Said Came True”: Transitions from opioid pills to heroin injecting; his group’s study of trends in hospitalizations and what that tells us about the epidemic in a 2013 Plos One publication, Intertwined Epidemics: National Demographic Trends in Hospitalizations for Heroin- and Opioid-Related Overdoses, 1993–2009. We also discuss his recent look at some of the larger factors influencing the epidemic with collaborators Nabarun Dasgupta and Leo Belitsky in Opioid Crisis: No Easy Fix to Its Social and Economic Determinants.

You can find more information about the book Dr. Ciccarone mentioned, Dreamland by Sam Quinones, here. And you can find the American Society for Addiction Medicine’s waiver training here.

Andrew Bazemore – Community Vital Signs: Achieving Equity through Primary Care Means Checking More than Blood Pressure

Mon, 27 May 2019 13:16:34 +0000

In this episode, another in a series with speakers from the 2017 second Starfield Summit, we talked with Dr. Andrew Bazemore about how primary care occupies the juncture between public health and health care. Andrew believes achieving health equity necessarily involves harnessing the democratization of data by pairing aggregated population health data to patient data in EHRs. We talked about his vision of Community Vital Signs and the challenges to getting there; the legacy of Sidney Kark, H. Jack Geiger, Gene Farley, and Curtis Hames and how they would drool at modern geographic information systems; how Community Vital Signs could help triage patients and help them achieve better health; and the potential for ecological fallacy in the work.

Andrew Bazemore is a practicing family physician and the Director of the Robert Graham Center, which he joined in 2005. He oversees and participates in the Center’s research with a particular interest in access to care for underserved populations, health workforce & training, and spatial analysis. He has authored over 150 peer-reviewed publications, while leading the Center’s emphasis on developing tools that empower primary care providers, leaders, and policymakers. He also serves on the faculties of the Departments of Family Medicine at Georgetown University and Virginia Commonwealth University, and in the Department of Health Policy at George Washington University School of Public Health. He is an elected member of the National Academy of Medicine(NAM), and appointed member of the federal Council on Graduate Medical Education (COGME).

The Starfield Summit brought together leaders in primary care, clinicians, experts, advocates, patients, and community members in 2017 to collaborate in paving paths towards health equity and social accountability. The Summit was primarily sponsored by FMAHealth, OH&SU, and OCHIN. Stay tuned in upcoming weeks for more speakers from the Starfield Summit.

If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at thomasATrospod.org. We’d love to hear from you, and thanks for listening.

Understanding how to address social determinants of health with Laura Gottlieb

Mon, 27 May 2019 13:15:45 +0000

These days, we hear about social determinants of health constantly – more of us are screening for social needs in our clinics and payers are searching for effective ways to address them as an avenue to improve outcomes and ideally reduce costs. Dr. Laura Gottlieb, a family physician and researcher at UCSF joins us today to talk about her research, which focuses on evaluating interventions to identify and address social factors in health care.

You can find many of Dr. Gottlieb’s publications here, as well as the Health Affairs blog post by Drs. Toyin Ajayi and Iyah Romm mentioned in the podcast. You can also use this link to the SIREN website to find more resources on the intersection of social and medical care.

A little more about our guest: Dr. Gottlieb is Associate Professor of Family and Community Medicine at the University of California, San Francisco and director of the Social Interventions Research and Evaluation Network (SIREN). Dr. Gottlieb’s current research focuses on evaluating interventions that identify and address social factors as part of health care delivery. These interventions include volunteer-powered social services Help Desks, payment reforms that support social programs, and other efforts that support responding to patients’ social needs in medical practice, like re-designing electronic medical records to incorporate social determinants data. Dr. Gottlieb also is an Associate Director of the Robert Wood Johnson Foundation Evidence for Action National Program and was a co-founder of HealthBegins, a non-profit organization providing education, consulting, networking, and technology services to health care providers interested in joining the effort to move medicine upstream. Prior to her current appointment, Dr. Gottlieb was a Robert Wood Johnson Health and Society Scholar at UCSF/UCB. She completed her MD at Harvard Medical School and both her MPH and residency training at the University of Washington.

If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audrey@rospod.org. We’d love to hear from you, and thanks for listening.

Journal Club Lightning Round: evidence based policy and vaccine rates, municipal non-health spending and health rankings, and is less really more?

Mon, 27 May 2019 13:14:29 +0000

For this week’s journal club, David, Thomas, and Audrey bring listeners short overviews of three articles. Audrey discusses an article published in the journal Pediatrics Dec 18 2017, called Exemptions from Mandatory Immunization After Legally Mandated Parental Counseling by Saad Omer, Kristen Allen, DH Chang, Beryl Guterman, Robert Bednarczyk, Alex Jordan, Alison Buttenheim, Malia Jones, Claire Hannan, Patricia deHart, and Daniel Salmon. David chats about the Dec 14, 2017 commentary published in New England Journal of Medicine by Dr. Lisa Rosenbaum entitled The Less is More Crusade – Are we Overmedicalizing or Oversimplifying. And Thomas shares a Health Affairs article, Government spending health and nonhealth sectors associated with improvement in county health rankings, published in their November 2016 issue.

Nwando Olayiwola – primary care, tech, and leadership

Mon, 27 May 2019 13:13:09 +0000

How can we use tech to make healthcare better and more accessible? Dr. Nwando Olayiwola, a family physician, faculty member at UCSF, and Chief Clinical Transformation Officer for RubiconMD, a leading provider of electronic consultations between primary care and specialty care providers, has spent many years thinking about that question. She joins us this week to tell us about her career in primary care, tech, and leadership. We also discuss her powerful essay, Racism in Medicine: Shifting the Power, and her research looking at various aspects of tech and care delivery.

Thank you to the Harvard Center for primary care for helping to facilitate this interview. I did make a few recording snafus on this interview – so my apologies for the sub-optimal audio quality in a few sections.

A little more about our guest: Dr. Nwando Olayiwola is a family physician and the inaugural Chief Clinical Transformation Officer for RubiconMD, a leading provider of electronic consultations between primary care and specialty care providers. She is also currently an Associate Clinical Professor in the Department of Family and Community Medicine at University of California, San Francisco. She served as the Director of the UCSF Center for Excellence in Primary Care until February 2017. In that role, she supported the Center in achieving strategic objectives around primary care transformation and systems redesign regionally, nationally and internationally. Prior to her work at UCSF, Dr. Olayiwola served as the Chief Medical Officer of the largest Federally Qualified Health Center system in Connecticut, Community Health Center, Inc. (CHCI), where she developed expertise in medical administration, translational and implementation research, professional development, systems based and quality improvement and practice transformation of twelve primary care practices into Patient-Centered Medical Homes. Her work led to CHCI being one of the first organizations in the United States to receive both the NCQA Level 3 PCMH and Joint Commission PCMH Recognitions. She has been a leader in harnessing technology to increase access to care for underserved and disenfranchised populations and is an expert in the areas of health systems reform, practice transformation, health information technology and primary care redesign. She is on the advisory board of Primary Care Progress and the Robert Graham Center for Family Medicine and Primary Care Policy.

Reprise – Population Health Management with Dave Chokshi

Mon, 27 May 2019 13:10:56 +0000

This week, we are joined by Dave Chokshi. Dave is the Chief Population Health Officer of OneCity Health and Senior Assistant Vice President at New York City Health + Hospitals—the largest public health care system in the U.S. He practices primary care at Bellevue Hospital and is a Clinical Associate Professor of Population Health and Medicine at the NYU School of Medicine.

We talk about what population health is, how it is distinct from public health, and what value it adds to our healthcare system. We also talk about how in some ways it might contribute to the erosion of relationships between primary care providers and patients, how that can be remedied, and how the small 1 or 2 doctor practice may fit into a population health management vision. We talk about a piece he wrote with Neil Calman and Diane Hauser about what they call the “expanded denominator,” and how that may further goals of public health and accountable care. Lastly, we talk about population health approaches in urban and rural settings, and how we should think about the opioid epidemic from a population health vantage point.

We reference a few articles throughout our conversation: Christine Sinsky’s already classic Annals paper detailing that physicians spend two hours on administrative tasks for every hour they see patients, and our journal club on that paper. Robin Williams’ and colleagues Health Affairs blog on utilizing the HIV cascade of care to battle the opioid epidemic, and Lawrence Casalino and colleagues work calculating what we spend measuring the care we provide. In addition, we reference the Surgeon General Vivek Murthy’s landmark report on addiction.

A quick note about a word we use frequently but didn’t pause to define for listeners – attribution. Attribution is the assignment of a specific patient to a specific primary care physician in a health system. Once a patient is attributed to a PCP or health system, that PCP and health system is held accountable for the patient’s quality measures and healthcare costs within ACOs or other alternative payment contracts. This still applies patients who do not frequently access the healthcare system through traditional channels or most frequently see specialists, who perhaps have never seen the assigned PCP, and is therefore at times controversial.

A little more background on Dr. Dave Chokshi: He was Assistant Vice President of Ambulatory Care Transformation at NYC Health + Hospitals and director of Population Health Improvement at NYU School of Medicine. In 2012-13, he served as a White House Fellow at the U.S. Dept. of Veterans Affairs, where he was the principal health advisor in the Office of the Secretary. His prior work experience spans the public, private, and nonprofit sectors, including positions with the New York City and State Departments of Health, the Louisiana Department of Health, a startup clinical software company, and the nonprofit Universities Allied for Essential Medicines, where he was a founding member of the Board of Directors.

If you enjoy the show, please rate and review us wherever you listen, and share us on social media. Tweet us your thoughts @rospodcast and check out our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audreyATrospod.org. We’d love to hear from you, and thanks for listening.

Reprise – How does architectural design influence c-section rates? With Mass Design & Ariadne Labs

Fri, 24 May 2019 01:18:47 +0000

This episode starts with a question: “what if the architectural design of an obstetric unit influenced the c-section rate in that unit?”

That question occurred to obstetrician/gynecologist Neel Shah when he attended a presentation by Michael Murphy, the co-founder and executive director of Mass Design, an architectural design and research firm that focuses particularly on healthcare architecture. Neel thinks about c-section rates all the time and is a leading researcher in the field of maternal health. C-section rates vary widely throughout the US – from 7 to 70%, and where a woman delivers better predicts whether she will get a c-section than her own personal risk factors. So, Michael Murphy’s contention that “Architecture is never neutral. It either heals or hurts” stayed with Neel and inspired him to pursue a research initiative between Mass Design and his research group, Ariadne Labs.

Neel Shah and two of his collaborators, Amie Shao and Deb Rosenberg, researchers and architects with Mass Design, join us to talk about their collaboration and the report they produced.

Amie Shao is a director with MASS Design Group, where she oversees research focusing on health infrastructure planning and evaluation. In addition to guiding impact research for MASS built projects, she coordinated the production of National Health Infrastructure Standards for the Liberian Ministry of Health and has been involved in the design and evaluation of healthcare facilities in Haiti, Africa, and the United States. Deb Rosenberg joined MASS in 2015, with a unique background in healthcare and architecture. Throughout her career in nursing and architecture is a common ambition to promote health and well-being, and she believes that the spaces where people live, work and heal have the capacity to greatly support or restrict our human potential. Neel Shah, MD, MPP, is Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School, and director of the Delivery Decisions Initiative at Ariadne Labs. His team is currently collaborating with hospitals across the United States, and using methods from design, systems engineering, and management to reduce the epidemic of avoidable c-sections.

If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast and check out our facebook page at www.facebook.com/reviewofsystems. Or, you can email us at audreyATrospod.org. We’d love to hear from you, and thanks for listening.

Can CHW support improve outcomes for patients with multiple chronic diseases? Kangovi et al, Journal Club

Fri, 24 May 2019 00:46:10 +0000

Thomas Kim, David Rosenthal, and Audrey Provenzano discuss a recent article from the American Journal of Public Health called Community Health Worker Support for Disadvantaged Patients with Multiple Chronic Diseases: A Randomized Controlled Trial, by Shreya Kangovi, Nandita Mitra, David Grande, Hairong Huo, Robyn Smith, and Judith Long. This important work comes from researchers associated with the Penn Center for Community Health Workers. You can find more about the research here, and more about Dr. Kangovi, the lead researcher on the study, here. Dr. Kangovi also recently penned an article in Stat News reflecting on the meaning of her research, which you can find here.

Understanding how to return joy to practice with Christine Sinsky

Fri, 24 May 2019 00:45:04 +0000

In order to make primary care better, we have to understand what is working and what isn’t – and not just in broad strokes, but in granular detail. Dr. Christine Sinsky is on the cutting edge of this type of research, and publishes prolifically on what is driving burnout in primary care, what specific steps we can take to fix it, and how to return joy to practice. Dr. Sinsky is the VP of Professional Satisfaction at the AMA and has practiced as a general internist for 30 years in Dubuque, Iowa. We talk about her landmark work with Tom Bodenheimer, which introduced the idea of the quadruple aim in 2013, how new EHR metrics can improve how we deliver care and improve the experience of caregivers and patients, and the extent of the burnout crisis in medicine at large, not just primary care. You can find the call for research that Dr. Sinksy referenced and collaborated on with Dr. Lotte Dyrbye and other leaders in this field here. We previously featured one of Dr. Sinksy’s publications, which showed that physicians spend about 2 hours doing clerical work for every 1 hour they see patients in a journal club, which you can find here.

If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audrey@rospod.org. We’d love to hear from you, and thanks for listening.

Caring for high need, high cost patients with Jeffrey Brenner

Fri, 24 May 2019 00:45:02 +0000

Jeffrey Brenner is best known for his ground-breaking work with high-need patients in Camden, New Jersey, where he founded the Camden Coalition and changed how we all think about caring for this subset of our patients. He joins us this week and talks with us about how a shooting and subsequent relationship with the Camden police led him to a physician breakfast club and then the coalition; what it was like to catapult to fame after being featured in Atul Gawande’s hotspotter article in The New Yorker; his decision to join United Health Care to continue his work caring for the most vulnerable patients; and what he thinks the future of primary care should look like.

I’d like to thank the Harvard Center for Primary Care for helping to facilitate this interview; and just a warning in case you are listening around young ears, there is some adult language in this episode.

If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audrey@rospod.org. We’d love to hear from you, and thanks for listening.

Our Oral Health Crisis with Mary Otto, author of Teeth

Fri, 24 May 2019 00:39:32 +0000

If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @rospodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audrey@rospod.org. We’d love to hear from you, and thanks for listening.

Reprise – Journal Club: Sinsky et al, Allocation of Physician Time in Ambulatory Practice

Fri, 24 May 2019 00:38:03 +0000

David Rosenthal, Thomas Kim, and Audrey Provenzano discuss the landmark study published in Annals of Internal Medicine by Sinsky and colleagues, Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties.

Have you ever wondered how much time you spend each month fighting with technology or filling out VNA forms? Well, Christine Sinsky and her colleagues studied this and have some answers for us…all of which raise more fascinating questions about how we practice medicine.

Tweet us your thoughts @RoSpodcast, and send us feedback at audrey@rospod.org!

Partnering Primary Care & Public Health — Lloyd Michener

Fri, 24 May 2019 00:36:29 +0000

Can we solve chronic disease using a medical model? In this episode, the first in a series with speakers from the 2017 second Starfield Summit, we talked with Dr. Lloyd Michener – the principal investigator of the Practical Playbook, which facilitates the integration of primary care and public health – about why primary care clinicians need to collaborate with public health agencies to tackle chronic disease, how to look at data differently to identify what’s really happening in our communities, and how primary care can be a better partner in community collaborations.

Lloyd Michener is a professor of Community and Family Medicine at Duke, the department’s former chair, and one of the country’s pre-eminent authorities on reducing health disparities through community health, community engagement, and practice redesign. Lloyd also leads the technical support service of the BUILD Health Challenge (bold, upstream, integrated, local, and data-driven), a national competitive award program aimed at improving hospital, community, and public health collaborations that improve health. He has also served as President of the Association for Prevention Teaching & Research, Chair of the Council of Academic Societies and as a member of the Board of the Association of Academic Medical Colleges. You can also learn more about his personal and professional journey here.

The Starfield Summit brought together leaders in primary care, clinicians, experts, advocates, patients, and community members – this year in order to collaborate in paving paths towards health equity and social accountability. The Summit was primarily sponsored by Family Medicine for America’s Health, Oregon Health & Science University, and OCHIN. Stay tuned in upcoming weeks for more speakers from the Starfield Summit.

A Career in Public Service & Drafting the ACA – John McDonough

Fri, 24 May 2019 00:35:39 +0000

We are tremendously lucky to welcome health policy expert John McDonough as our guest this week. He has had a long and distinguished career in public service as well as a scholar and advocate. We talk about his work as a member of the MA state legislature for 13 years (discussed in his book Experiencing Politics), as well as his efforts between 2008 and 2010, when he served as a Senior Advisor on National Health Reform to the U.S. Senate Committee on Health, Education, Labor and Pensions where he worked on the development and passage of the Affordable Care Act. He wrote about his experiences during that time in Inside National Health Reform. He is now a Professor of Public Health Practice in the Department of Health Policy & Management at the Harvard T.H. Chan School of Public Health, and you can find his academic publications here, and a collection of his lay-press publications on his blog.

Reprise: Integration of Healthcare & Social Services with Lauren Taylor

Fri, 24 May 2019 00:33:08 +0000

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

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

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

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

Journal Club: Lightning Round! Primary care vs Specialty care, Doorknob moments & Cost effectiveness of buprenorphine initiation in the ED

Fri, 24 May 2019 00:31:29 +0000

This week Thomas Kim, David Rosenthal, and Audrey Provenzano talk about three recently published manuscripts for a lightning round edition of Journal Club. Thomas shares a paper by Bynum et al, Outcomes in Older Adults with Multimorbidity Associated with Predominant Provider of Care Specialty, examining outcomes among patients primarily cared for by specialists vs primary care providers. David shares a paper describing a novel technology for agenda setting and evaluation of social determinants of health by Wittink et al, entitled Patient priorities and the doorknob phenomenon in primary care: Can technology improve disclosure of patient stressors? (H/T Primary Care Progress for tweeting it!). Lastly, Audrey shares a paper entitled Cost effectiveness of emergency department initiated treatment for opioid dependence by Susan Busch et al, which is a cost-effectiveness analysis of an RCT of ED-initiated buprenorphine performed at Yale, previously featured on the podcast in an interview with Gail D’Onofrio.

Integrating Primary Care & Behavioral Health at Lynn CHC: Kiame Mahaniah & Mark Alexakos

Fri, 24 May 2019 00:30:03 +0000

Primary care models integrating behavioral health services are being adopted across the country. This week, we talked with two leaders at the Lynn Community Health Center (LCHC), Dr. Mark Alexakos and Dr. Kiame Mahaniah, about their experience with integration.

LCHC is unique among community health centers in that it started out as a mental health counseling center, and now has the largest community health center-based behavioral health program in Massachusetts. In this conversation, we talk about what it means to integrate behavioral health services with primary care clinical services – how it can reduce the fragmentation of services to better meet the needs of patients and the demand for mental health care (2:40), why it may better position clinics participating in accountable care (7:40), what successes they’ve seen (8:45), and the resources it has required (12:28). Along the way, our guests make it clear that the staff at LCHC love working in integrated teams. You can learn more about various other models of integrated behavioral health here.

Mark Alexakos MD, MPP, is the chief behavioral health officer of LCHC. He has a joint degree in medicine and public policy and developed an early interest in the interface between policy, research, and service delivery as they relate to access barriers, health disparities, and community health. Before working at LCHC, he spent seven years developing intensive, school-based mental health services that combined health promotion and prevention with quick access to behavioral health treatment in five Boston Public Schools.

Kiame Mahaniah, MD, is the chief executive officer of LCHC, though at the time of this interview, he served as the chief medical officer. His passion resolves around social and restorative justice, in the context of healthcare. His twin clinical interests are teaching—he holds an appointment at the Tufts University School of Medicine—and integrating opioid addiction treatment into the primary care/behavioral health matrix.

How do we improve the value of care delivered in primary care? with John Mafi

Fri, 24 May 2019 00:29:00 +0000

We talk about the definitions of high-value and low value care, his 2016 study in Annals of Internal Medicine examining rates of high and low value care among physicians, NPs, and PAs in the primary care setting, how practice setting may affect the delivery of high and low value care, and the essential truth that there is no free lunch in trying to solve some of the challenges in fixing primary care in the US. You can find Shah et al, which John referenced here; a recent study relevant to our conversation by Hong et al looking at clinician characteristics and frequent ordering of low-value imaging studies; and an extremely important new paper that John published recently in Health Affairs looking at the the impact of low-cost, high-volume studies on unnecessary health spending.

A little bit more about our guest: John N. Mafi, MD, MPH is an assistant professor of medicine in the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at UCLA where he also practices and teaches. He also serves as an Affiliated Natural Scientist in Health Policy at RAND Corporation. Dr. Mafi trained in internal medicine at Beth Israel Deaconess Medical Center in 2012, where he also served as Chief Medical Resident and completed the Harvard Medical School Fellowship in General Internal Medicine and Primary Care in 2015. Dr. Mafi’s research focuses on quality and value measurement and how electronic health records can improve the value of care.

Lori Tishler of Commonwealth Care Alliance – Caring for the Most Vulnerable Patientsc

Fri, 24 May 2019 00:27:59 +0000

Have you ever felt lonely and overwhelmed in a clinic room with a patient whose needs are far beyond your skills and ability to meet? I have, many times, and so has our guest this week, Dr. Lori Tishler. Dr. Tishler is the Vice President of Medical Affairs at Commonwealth Care Alliance, a not-for-profit organization that cares for more than 20,000 of the most vulnerable patients in Massachusetts, duals, or individuals who have both Medicare and Medicaid.

We talk about how CCA’s member-centered approach (as opposed to a physician-centered approach) has helped her feel more effective in caring for these vulnerable patients. We talk about the range of services that CCA offers, the role of their care partners, and the freedom that their financial model permits – for example, they provide 90% of care to patients in their homes.

You can find the Atlantic Magazine article we referenced featuring CCA here, and find a few Health Affairs blogs featuring CCA here, and a blog post focusing on building the business case for a community paramedicine program here.

A bit more about our guest: Lori Tishler is the Vice President of Medical Affairs at Commonwealth Care Alliance, a not-for-profit organization that cares for more than 20,000 of the most vulnerable patients in Massachusetts, people who have both Medicare and Medicaid. She oversees CCA’s physicians and is involved with clinical aspects of quality, utilization, and pharmacy. In addition, she is an Assistant Professor at Harvard Medical School and an active member of the General Medicine Faculty at Brigham and Women’s Hospital, As a caring and connected physician leader, mentor, and educator, Dr. Tishler’s passion has been providing care for the medically and socially vulnerable and making a difference in health systems for all. Tishler has found that the most rewarding way to help change and grow our health care systems is to mentor learners who are interested in clinical care, leadership, and innovation.

Her leadership roles have extended outside of the clinic and outside of primary care. She served on the Partners Healthcare Board of Directors, the Board of Directors for the Office for Women’s Careers, and the Board of the Schwartz Rounds while at the Brigham. At Commonwealth Care Alliance, she teaches and presents nationally about our care model and innovations.

In addition to her leadership work, she continues to provide clinical care Tishler feels that working as a clinician informs her choices and decisions as a leader. Outside of work, Dr. Tishler loves to spend time with her husband and teenaged daughter, to travel, read, and knit. She is honored to have been interviewed on Review of Systems.

If you enjoyed the show, please give us 5 stars wherever you listen. Tweet us your thoughts @rospodcast and check out our facebook page at www.facebook.com/reviewofsystems. Or, you can email us at audreyATrospod.org. We’d love to hear from you, and thanks for listening.

Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status – Mehta et al

Fri, 24 May 2019 00:24:50 +0000

This week, we are discussing an article from the Journal Women’s Health Issues, entitled: Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status, by Pooja Mehta, Tamala Carter, Cjloe Vinoya, Shreya Kangovi, and Sindhu Srinivas. Pooja Mehta, the lead author of the study, joins us for our conversation.

You can find the interview with Dr. David Buck referenced in our conversation here.

Dr. Mehta is Director of Maternal & Women’s Health Policy for the Consortium for Health Care Transformation, and Assistant Professor of Health Policy and Systems Management and Obstetrics and Gynecology at the Louisiana State University Health Sciences Center, advising the Louisiana Department of Health and Medicaid Program.

Dr. Mehta’s interests are in the use of health care delivery innovation and community-engaged accountable care models to reduce reproductive health disparities, pregnancy-associated mortality, and low-value care, and to support patients with complex health and social needs. Her research has been supported by the Health Resources and Services Administration, the American College of Obstetricians and Gynecologists, and the Leonard Davis Institute of Health Economics.

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

Listen at the end of the episode for a promo code to receive 15% off registration fees for an upcoming conference from the Harvard Center for Primary Care: Primary Care in 2020 – Future Challenges, Tips for Today.

Tom Bodenheimer – Building Blocks of High-Performing Primary Care and the Quadruple Aim

Fri, 24 May 2019 00:22:53 +0000

Dr. Tom Bodenheimer is one of the world’s foremost experts in primary care re-design, having recently written about high-performing primary care clinics and the Quadruple Aim, which are articles consistently in the most-read list for the Annals of Family Medicine and among his most cited work. We focused much of our conversation on his work visiting 23 high-performing primary care practices, what he and co-authors learned, how resident teaching sites can also be high-performing, and why we should be seeking a fourth aim in addition to IHI’s famed Triple Aim.

A general internist who received his medical degree at Harvard and completed his residency at the University of California-San Francisco, Dr. Tom Bodenheimer spent 32 years in primary care practice in San Francisco’s Mission District, a primarily low-income, Latino community—ten years in community health centers and 22 years in private practice. He is currently Professor of Family and Community Medicine at UCSF and Founder and Co-Director of the Center for Excellence in Primary Care. He has written extensively in journals such as the New England Journal of Medicine, JAMA, Annals of Family Medicine, and Health Affairs, on health policy and health care delivery for chronic disease management, including patient self-management, health coaching, and team-based care. He is also co-author of the books Improving Primary Care: Strategies and Tools for a Better Practice, and the health policy text book Understanding Health Policy.

How does architectural design impact c-section rates? Mass Design & Ariadne Labs

Fri, 24 May 2019 00:22:46 +0000

This episode starts with a question: “what if the architectural design of an obstetric unit influenced the c-section rate in that unit?”

Neel Shah and two of his collaborators, Amie Shao and Deb Rosenberg, researchers and architects with Mass Design, join us to talk about their collaboration and the report they produced.

Frederick Chen – Teaching Health Centers

Fri, 24 May 2019 00:20:38 +0000

Teaching health centers (THCs) are primary care residency training sites in community-based organizations, often in federally qualified health centers (FQHCs), in contrast to traditional tertiary care hospital-based training. Federal funding for the THC program, created by the ACA in 2010 and renewed through MACRA in 2015, is set to expire on September 30, 2017.

THCs may be a key part in solving the primary care workforce shortage, so we talked with Dr. Frederick Chen, Professor of Family Medicine at the University of Washington and a recent senior advisor to HRSA’s Bureau of Health Professions for the Teaching Health Center program.

We review flaws in traditional methods of funding graduate medical education in the US (2:50) then discuss Freddy’s research (8:15) showing that residents trained in FQHCs are 3-4 times more likely to go work in underserved settings. He also describes the key factors in creating community health center-family medicine residency partnership (12:20). Freddy’s work led to the THC graduate medical education program, an innovative federal policy that aims to increase access to primary care where it is needed the most, and we talk about some of the early lessons since its inception (18:50). You can also find the controversial 2014 Institute of Medicine report mentioned by Freddy in our conversation here. Finally, Freddy shares about how his academic career led him to help shape national health policy (23:07).

Journal Club – Association Between Process Measures & Mortality in Individuals with Opioid Use Disorders

Fri, 24 May 2019 00:17:03 +0000

This week, we are discussing a recent article from the journal Drug and Alcohol Dependence, entitled: Association between process measures and mortality in individuals with opioid use disorders, by Katherine Watkins and colleagues: Susan Paddock, Teresa Hudson, Songthip Ounpraseuth, Amy Schrader, Kimberly Hepner, and Bradley Stein. We are also joined by a guest discussant, Gabriel Wishik. Gabriel Wishik is a clinician educator in general and addiction medicine, and is an instructor at Boston University and Boston Medical Center. He is the clinic medical director at Boston’s Healthcare for the Homeless Program’s largest clinical site and practices harm reduction in primary care with a population at the front lines of the current opioid epidemic. You can find the obituary we shared on the show here.

Dave Chokshi – Population Health Management

Fri, 24 May 2019 00:10:48 +0000

Danielle Ofri – Communication Between Patients & Doctors

Fri, 24 May 2019 00:09:32 +0000

This week, we are joined by Danielle Ofri. Danielle is a primary care physician at Bellevue Hospital and a prolific essayist and author. We start out talking about her most recent book, What Patients Say, What Doctors Hear. We talk about communication between patients and doctors and why it can be so challenging, and how physician communication can be evaluated and more effectively taught to trainees. Danielle talks about the power dynamics of the medical interview and how it can be uncomfortable for us as physicians to have the tables turned when the patient is more empowered in the conversation. We also talk about the campaign that Danielle has spearheaded to get physicians and other medical professionals involved in the health care reform efforts of the last few months in Washington DC with her House Calls Campaign.

Danielle is a physician at Bellevue Hospital and associate professor of medicine at NYU. She writes about medicine and the doctor-patient connection for the New York Times, Slate Magazine, and other publications. Danielle is co-founder and Editor-in-Chief of the Bellevue Literary Review, the first literary journal to arise from a medical setting. She is the author of a collection of books about the world of medicine. She’s given TED Talks on Deconstructing Perfection and When Doctors Face Fear, and has performed at The Moth.

If you enjoy the show, please rate and review us wherever you listen, and share us on social media. Tweet us your thoughts @rospodcast and check out our facebook page at www.facebook.com/reviewofsystems. Or, you can email us at contact@rospod.org. We’d love to hear from you, and thanks for listening.

Joshua Freeman – Designing a Fair & Equitable Healthcare System

Fri, 24 May 2019 00:08:30 +0000

Dr. Joshua Freeman is a family physician, health policy researcher, social justice activist, and writer. He publishes a widely-read blog, “Medicine and Social Justice”, and in 2015 published a book, Health, Medicine and Justice: Designing a fair and equitable healthcare system (Copernicus Healthcare press), which is available on Amazon and other sites, in both softcover and electronic versions.

This week, Thomas Kim chats with Dr. Freeman about some of the major themes of the book: why the US health care system fails to produce a healthy population, the role of profit in American medicine, why he uses social justice to frame his analyses and commentary, and how the American health care system could become more primary care-centered.

Dr. Freeman is Professor Emeritus at the University of Kansas Medical Center in Kansas City, where he served as the Alice M. Patterson MD and Harold L. Patterson MD Professor and Chair of the Department of Family Medicine from 2002-2016, and was also Professor in the Departments of Preventive Medicine and Public Health and of Health Policy and Management. He was a Fulbright Scholar in São Paulo, Brazil in 2003 and served nationally as Treasurer of the Society of Teachers of Family Medicine and the Association of Departments of Family Medicine. He received STFM’s highest honor, the Recognition Award, in 2006. He served as a member of the board of trustees of Roosevelt University in Chicago, as assistant editor of the journal Family Medicine, and also on the board of Southwest Boulevard Family Health Center in Kansas City, KS.

Dr. Freeman is a graduate of the Loyola-Stritch School of Medicine, family medicine residency at Cook County Hospital in Chicago, and faculty development fellowship and Preventive Medicine residency at the University of Arizona.

Journal Club – Exploring the Patient and Staff Experience with the Process of Primary Care

Fri, 24 May 2019 00:07:28 +0000

This week, we bring you a journal club on the manuscript: Exploring the Patient and Staff Experience with the Process of Primary Care, which was published in Annals of Family Medicine in the July/August 2015 issue by Elizabeth J Brown, Shreya Kangovi, Christopher Sha, Sarah Johnson, Casey Chanton, Tamala Carter, and David Grande.

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

How to Prevent Burnout with Diane Shannon & Paul DeChant

Fri, 24 May 2019 00:01:08 +0000

This week, in the second of our series about physician burnout, our guests focus on solutions. Diane Shannon and Paul DeChant, both physicians, join us to talk about their recent book Preventing Physician Burnout, Curing the Chaos and Returning Joy to the Practice of Medicine.

Diane and Paul talk about their experiences with burnout and how they came to work on this project together, how they contend that organizational and structural factors are more important than individual factors in driving burnout, how compensation and intangible rewards can reduce burnout, how leadership in healthcare can address the epidemic of burnout. We also talk about how they have come to believe that the LEAN principles, most especially the pillar of respect for people, is key in transforming healthcare organizations into places where primary care physicians can thrive, why change is so difficult, and some other resources that can help.

Diane Shannon is a general internist who left clinical medicine due to burnout and turned to a career in medical writing and public health. Paul DeChant is a family physician and experienced healthcare executive who has previously worked in organizations such as The Paulo Alto Medical Foundation, Sutter Gould Medical Foundation, and is now a senior advisor with Simpler Healthcare.

If you’ve missed it, have a listen to the first in our burnout series with Colin West, researcher at Mayo Clinic who has done foundational research on burnout and physician well-being. Please rate and review us on itunes, google play, or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems. Please drop us a line at contact@rospod.org. We’d love to hear from you, and thanks for listening.

Colin West – The Evidence Behind Burnout

Thu, 23 May 2019 23:58:08 +0000

This week, we are joined by Colin West, professor of Medicine, Biostatistics and Medical Education at Mayo Clinic. Colin’s research focuses primarily on physician well-being, evidence based medicine and medical education. We talk today about his extensive research in the area of physician well-being and burnout.

We talk about what researchers mean precisely by burnout and how it is measured, what the implications are for patient care and quality of care that the primary care workforce is increasingly burdened with burnout, and his findings in an important 2016 study that physicians with significant burnout scores cut back on patient care over time. We also talk about the EMR, and what specific features of EMR most correlate with user dissatisfaction. Lastly, we talk about what questions he most wants to answer in his field. This is part 1 of a 2-part series on burnout. Today we focus on the evidence behind burnout, and in part 2 we will talk about what can be done to alleviate the problem.

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

David Himmelstein – Blending Research & Advocacy

Thu, 23 May 2019 23:57:25 +0000

Our guest this week is David Himmelstein. He is a distinguished professor of public health and health policy in the CUNY School of Public Health at Hunter College, adjunct clinical professor at Albert Einstein College of Medicine, and lecturer in medicine at Harvard Medical School. He has served as chief of the division of social and community medicine at Cambridge Hospital.

David has authored or co-authored more than 100 journal articles and three books, including widely cited studies of medical bankruptcy and the high administrative costs of the U.S. health care system. His 1984 study of patient dumping led to the enactment of EMTALA, the law that banned that practice. He is also a co-founder of Physicians for a National Health Program and is a principal author of PNHP articles published in the JAMA and the New England Journal of Medicine in conjunction with Dr. Steffie Woolhandler.

We talk about how he got his start in research by looking at patient dumping practices as a trainee, and how he views advocacy as a natural outgrowth of his research findings. We also talk about his work as a leader in advocacy for a national health insurance program and talk about a few common arguments against such policy changes. Lastly, he gives some advice for folks early in their career who would like to follow his model of research blended with advocacy.

Journal Club – Do On-Site Mental Health Professionals Change Pediatricians’ Responses to Children’s Mental Health Problems?

Thu, 23 May 2019 23:56:19 +0000

On our journal club this week, we talk about an article published in September 2016 in the journal Academic Pediatrics: Do On-Site Mental Health Professionals Change Pediatricians’ Responses to Children’s Mental Health Problems? By Sarah McCue Horwitz and colleagues.

Gail D’Onofrio, Initiation of Suboxone Treatment for Opiate Use Disorder in the ED

Thu, 23 May 2019 23:50:23 +0000

This week we are again looking at the opioid crisis, but this time from the perspective of an emergency room physician. Gail D’Onofrio, MD, MS is Physician-in Chief of Emergency Services at Yale-New Haven Hospital; she and her colleagues published a randomized controlled trial in JAMA in April 2015 looking at an intervention initiating suboxone treatment for patients with substance use disorders in the ED. Gail is Professor and Chair of the Department of Emergency Medicine at Yale University and is internationally known for her work in substance use disorders, women’s cardiovascular health, and mentoring physician scientists in research careers, and she is a founding board member of the American Board of Addiction Medicine.

We talk about her perspective on the opioid epidemic as an ED physician; her RCT; how people could set up a similar program in their local ED and community; and her thoughts on ED utilization for primary care complaints, which is the subject of a recently issued report from the Massachusetts Health Policy Commission.

Please rate and review us on iTunes or Stitcher and share us on social media. Tweet us your thoughts @RoSpodcast and check out our Facebook page at www.facebook.com/reviewofsystems. Or, you can email us at contact@rospod.org. We’d love to hear from you.

Harold Pollack – ACA and AHCA Update

Thu, 23 May 2019 23:48:17 +0000

This week we are joined a few days early by Harold Pollack to bring you a timely update on the Affordable Care Act (ACA) repeal and American Health Care Act (AHCA) legislation that is moving quickly through congress.

Harold has published widely at the interface between poverty policy and public health including the effects of health reform and the ACA. Today we talk about the current state of the repeal and replace effort in the Senate and what effects their bill would have in terms of individuals who would lose coverage or find it much more expensive should the bill pass. We also discussed the very dramatic changes the bill would likely make to Medicaid and how that might affect the poor and vulnerable people that the program serves, and in particular how it might impact the raging opiate epidemic. Lastly, we talk about what a bipartisan solution to many of the very real problems of the ACA might look like, and what impact individuals can have on policy by calling congress. You can find more information about the unusual legislative process here, and the lack of information available on the bill here. Read about the effects that changes to Medicaid might make for disabled individuals here, and listen to Matt Broaddus of the Center on Budget and Policy Priorities discuss block granting and per capita caps on Medicaid here. If you would like to reach out to your Senator to talk with him or her about the legislation and how it might affect you or your patients, you can find your Senator’s contact information here.

Harold is the Helen Ross Professor at the School of Social Service Administration, an Affiliate Professor in the Biological Sciences Collegiate Division and the Department of Public Health Sciences and Co-Director of The University of Chicago Crime Lab and a committee member of the Center for Health Administration Studies (CHAS) at the University of Chicago. He tweets @haroldpollack.

Bon Ku – Design Thinking in Healthcare

Thu, 23 May 2019 23:46:56 +0000

This week we are joined by Bon Ku, the Assistant Dean for Health and Design and an Associate Professor at the Sidney Kimmel Medical College at Thomas Jefferson University, to talk about design thinking and medicine. Bon is a practicing emergency medicine physician and the founder and director of JeffDESIGN, a first-of-its-kind program in a medical school that teaches future physicians to apply human-centered design to healthcare challenges. Bon has spoken widely on the intersection of health and design thinking (TEDx, South by Southwest, Mayo Clinic Transform, Stanford Medicine X, Association of Collegiate Schools of Architecture) and serves on the Design and Health Leadership Group at the American Institute of Architects. Bon talks with us about what design thinking is, how he got into it, why he thinks physicians would benefit from learning to think in this way, and how to apply it to common primary care challenges, like walk-ins. He also directs listeners to the following resources to learn more about design thinking in medicine: the Stanford Dschool, and ideou.

Journal Club – Los Angeles Safety Net Program eConsult System Was Rapidly Adopted and Decreased Wait Times to See Specialists

Thu, 23 May 2019 23:45:21 +0000

For this week’s journal club, we are talking about a recent paper from Health Affairs entitled: Los Angeles Safety Net Program eConsult System Was Rapidly Adopted and Decreased Wait Times to See Specialists by Michael Barnett, Hal F. Yee Jr, Ateev Mehotra, and Paul Giboney. The paper describes and analyzes data from an e-consult system that was rolled out to a network of hundreds of safety-net clinics in Los Angeles County. We are thrilled to have the lead author, Michael Barnett, join us for our discussion! Michael is an Assistant Professor at Harvard T.H. Chan School of Public Health and a primary care physician at Brigham and Women’s Hospital. He publishes prolifically on a variety of topics, and is particularly interested in the primary care-specialty care interface.

Do you use e-consults in your practice? Or do you wish you had access to such a system? Please tweet us your thoughts @RoSpodcast, or drop us a line at contact@rospod.org. And, let us know what manuscripts you think we should look at in future journal clubs or who we should have on to talk about their work. We look forward to hearing from you, and thanks for listening.

Reprise – David Buck, Caring for High-Need, High-Cost Patients

Thu, 23 May 2019 23:40:59 +0000

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

You can find some CDC resources about Adverse Childhood Experiences, or ACEs here, and a New Yorker article about the effects of ACEs on health here.
Dr. Buck is a graduate of the Baylor College of Medicine and the University of Texas School of Public Health, as well as family medicine residency at the University of Rochester.

Reprise – Natalie Spicyn, Unionizing Clinicians

Thu, 23 May 2019 23:40:02 +0000

This week we are joined by Natalie Spicyn, an internist and pediatrician at Chase Brexton, a Federally Qualified Community Health Center in Baltimore. Like all FQHCs, Medicaid patients are a large portion of the Chase Brexton payor mix, but the clinic also provides specialized care for a large and active LGBT and HIV positive community in the city. Last year, caregivers and administrators faced conflict regarding proposed workflow, volume, and compensation restructuring. Several employees were terminated during early efforts at unionization; ultimately, clinicians voted to unionize and attempt collective bargaining. Natalie published an op-ed in the Baltimore Sun during this tumultuous period, and joins us to talk about her experiences with unionizing, fair compensation practices in primary care, and how all of this affects patient care.

Lauren A Taylor – Integration of Healthcare and Social Services

Thu, 23 May 2019 23:38:23 +0000

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

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

Thu, 23 May 2019 23:36:38 +0000

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

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

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

Lisa Sanders – Patient Stories & Zebras

Thu, 23 May 2019 23:35:03 +0000

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

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

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

Dennis Dimitri – Supervised Injection Facilities

Thu, 23 May 2019 23:20:08 +0000

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

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

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

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

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

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

Seth Berkowitz – Food Insecurity and Chronic Disease

Thu, 23 May 2019 23:20:05 +0000

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

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

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

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

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

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

Thu, 23 May 2019 23:20:02 +0000

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

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

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

Andrew Schutzbank – Iora Health

Thu, 23 May 2019 23:20:00 +0000

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

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

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

Emma Sandoe – Update on the AHCA & ACA

Thu, 23 May 2019 23:19:57 +0000

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

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

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

David Buck – Caring for High Need, High Cost Patients

Thu, 23 May 2019 23:19:53 +0000

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

Thu, 23 May 2019 23:19:50 +0000

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

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

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

Sarah Wakeman: Treating Patients With Substance Use Disorders & the Opioid Crisis

Thu, 23 May 2019 23:19:46 +0000

Today we are joined by Sarah Wakeman to talk about substance use disorders, one of the most pressing public health issues of our time. Sarah is the Medical Director of the Massachusetts General Hospital Substance Use Disorder Initiative. She designs systems of care that draw on the strengths of communities to care for patients and residents with addictions. Sarah also practices in the Adult Medicine Department of the MGH Charlestown HealthCare Center.

We talk about the importance of language and discourse on the care for patients with substance use disorders (4:00), how an approach of compassion has proven more effective than the popularized tough love style (7:30) and how rewarding it can be to witness a patient have a Lazarus moment (10:00) in a journey to recovery. We also talk about the very real challenges of caring for this patient population (13:00), the complexities and power dynamics of monitoring (16:15), and what needs to be done to turn around the epidemic (20:45).

You can find the landmark report on the opioid epidemic from our Surgeon General Vivek Murthy here, which is full of helpful information on this topic.

Natalie Spicyn: Unionizing Clinicians

Thu, 23 May 2019 23:19:44 +0000

Matt Broaddus: What are Medicaid Block Grants?

Thu, 23 May 2019 23:19:30 +0000

This week we are joined by Matt Broaddus to talk about block granting Medicaid, which is a major health policy change that the Trump administration plans to pursue in the coming months. Matt is a Research Analyst in the Health Division at The Center on Budget and Policy Priorities, a non-partisan research and policy institute in Washington DC. His policy, research, and analytical work is conducted in the areas of Medicaid and the State Child Health Insurance Programs.

We start with an overview of the Medicaid program, the largest insurance program in the US. We touch on the possible benefits of block granting (19:00), and how it may affect other industry stakeholders such as health systems, hospitals, community health centers, and insurers that offer Medicaid managed care products (23:20). Lastly we discuss another block granted program, CHIP and why many see it as a successful block grant program (29:00), and one other suggestion that has been made for Medicaid reform, per-capita funding (32:45).

You can find the article we mentioned by Sara Rosenbaum here, as well as some additional resources on block grants from Kaiser Health News and The Commonwealth Fund.

Journal Club: Powers et al – Non-Emergency Medical Transportation; Delivering Care in the Era of Uber and Lyft

Thu, 23 May 2019 23:19:17 +0000

This week we’re excited to bring you a journal club episode, highlighting a study published in the September 2016 issue of JAMA by Brian Powers and colleagues Scott Rhinefort and Sachin Jain from Caremore Health, entitled NonEmergency Medical transportation, Delivering care in the Era of Lyft and Uber. Powers and colleagues report on their pilot study of Caremore Health patients utilizing Uber and Lyft for non-emergency medical transportation to and from appointments.

Jessie Gaeta: SPOT – Supportive Place for Observation and Treatment

Thu, 23 May 2019 23:16:55 +0000

Today our guest is Jessie Gaeta, the Chief Medical Officer of Boston Health Care for the Homeless Program. She is a leading advocate for supportive housing for chronically homeless individuals, and has led BHCHPs efforts in responding to the opiate use disorder and overdose crisis, which is what we discussed.

Dr. Gaeta and her colleagues found themselves confronting the reality of opiate overdose as the leading cause of death among Boston’s homeless individuals day after day on their campus. In reaction to this, Gaeta and her colleagues opened SPOT, or Supportive Place for Observation and Treatment – a space within their building where individuals can come after using to ride out a high while being monitored by a nurse for overdose, and for opiate reversal if necessary.

Andrew Morris-Singer: Organizing & Advocacy

Thu, 23 May 2019 23:16:49 +0000

We are joined this week by Andrew Morris-Singer, a general internist and founder of Primary Care Progress. Primary Care Progress is a national non-profit organization dedicated to building a stronger primary care system. Working with current and future healthcare professionals from across disciplines and career stages – from students and faculty to providers and health systems leaders – PCP offers leadership development and support that emphasizes relational skills, individual resiliency, and advocacy. Andrew has a unique background as a community organizer with more than 15 years of experience. He is a lecturer in Global Health and Social Medicine at Harvard Medical School, an Assistant Professor in the Dept of Family Medicine at OHSU and an Adjunct Professor in the Department of Family and Preventive Medicine at the University of Utah. He currently sees patients in Portland, Oregon. On the show, we talk about relational leadership, advocacy and activism in primary care.

Emma Sandoe: Affordable Care Act Repeal Update

Thu, 23 May 2019 23:16:41 +0000

Emma Sandoe, a PhD student in Health Policy Political Analysis at Harvard University, joins us for a discussion of the Affordable Care Act. Prior to starting her PhD program, Emma spent six years in Washington, DC working on the passage and implementation of the ACA. She served as the spokesperson for Medicaid and HealthCare.gov at the Centers for Medicare & Medicaid Services and worked on ACA coordination at the HHS Budget Office.

We start with an overview of the ACA and then review key players in the repeal and replace efforts thus far (5:25); the recent CBO report and the possibility of an insurance premium death spiral (15:00); the likelihood of Trump’s ability to keep his promise to retain the popular provisions of the ACA and what a replacement law might look like (18:00); the ACA’s flaws and some historic context for them (24:12); and give some well-hedged predictions for the coming weeks (32:05).

We discuss a report released last week by the Congressional Budget Office projecting what might happen if the ACA is repealed without a replacement, and two articles from healthcare reporter Sarah Kliff looking at potential ACA replacement plans and a story about discontent with the ACA among beneficiaries. Here is a helpful article from New York Times reporter Margot Sanger-Katz looking at what President Trump’s executive order against the ACA might mean. You can find the resources for getting involved Emma mentioned here.

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Journal Club: Sinsky et al, Allocation of Physician Time in Ambulatory Practice

Thu, 23 May 2019 23:16:32 +0000

David Rosenthal, Thomas Kim, and Audrey Provenzano discuss the recent manuscript published in Annals of Internal Medicine by Sinsky and colleagues, Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties.

David Levine: Home Hospital Research

Thu, 23 May 2019 23:12:29 +0000

On our premier show, Dr. David Levine, a general internist and research fellow in the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital and Harvard Medical School talks about his research looking at home hospitalization. Instead of admitting patients to the floors from the ED, he admits them back home. He also reflects on some of his other research and interests in the quality of outpatient care, digital health technology, and novel methods of care delivery.