The CVP recognizes policy as a critically important vehicle to address the burden of chronic disease for vulnerable populations. Below are some examples of ways in which the CVP has advanced the public policy agenda for vulnerable populations faced with chronic disease, and in support of the practitioners and systems that disproportionately serve these populations.
New IOM Report Recommends Tighter Regulation of Dietary Salt
The FDA plans to limit salt due to coordinated efforts which include Institute of Medicine recommendations, successful efforts in New York City and CVP research.
The Institute of Medicine released a groundbreaking report recommending tighter regulations of dietary salt. Recommendations came from compelling research from CVP co-Director, Kirsten Bibbins-Domingo, PhD, MD, MAS and colleagues showing significant health benefits with moderate reductions in dietary salt.
ATSM Adapted Across Diverse Clinical Settings
CVP Director, Dean Schillinger, MD is working with the Central Coast Alliance for Health to adapt an automated telephone symptom management (ATSM) program for nearly 300 members with diabetes in the Monterrey and Merced area. Half of CCAH members are mono-lingual Spanish speakers. Additionally, Asian Health Services in Oakland is adapting the ATSM program for about 150 Cantonese speaking patients.
Health Care Innovations Exchange
Agency for Health-Related Research Quality (AHRQ) highlighted Dean Schillinger’s work in their Health Care Innovations Exchange- a national program designed to support health care professionals in sharing and adopting innovations that improve the delivery of care to patients. This resource highlights innovative strategies and quality-related tools, with the aim of improving organizations’ ability to innovate and adopt new ideas, and interact with innovators and adopters.
Computerized, Multilingual Visual Medication Schedule and Teach-Back Protocols Improve Anticoagulation Control for Low-Literacy Patients
The AHRQ recognized Dean Schillinger’s work developing and implementing a visual medical schedule (VMS) and teach-back protocol to address anticoagulation control for underserved patients at SFGH. The VMS is a single piece of paper that includes digitized images of the patient’s warfarin regimen on a weekly calendar. The words are printed in English and, if appropriate for the patient, in Spanish or Cantonese as well. After describing the updated warfarin dose illustrated on the VMS, a clinical staff member asks the patient to repeat the dosing schedule (teach-back method), and, if necessary, corrected his or her understanding one time only. The teach-back method was designed to reinforce the VMS in a manner that approximates how a typical clinician would interact with the patient, serving as a “double check” to make sure that the patient does not misinterpret the VMS, leading to potential harm. The New York University/Bellevue Medical Center adopted this innovation.
Automated, Telephone-Based Interactive, Language-Appropriate Monitoring Engages and Improves Health Behaviors of Low-Income Diabetes Patients
The Automated Telephone Diabetes Management (ATDM) program, a part of the Improving Diabetes Efforts Across Language and Literacy (IDEALL) project, provided automated telephone monitoring of individuals with poorly controlled type II diabetes who receive their care at four safety net clinics in San Francisco. An adjunct to regular clinic care, the system made weekly automated, interactive calls to participants in their native language (English, Spanish, or Cantonese), with follow up calls made as needed by a nurse care manager with appropriate language skills. Preliminary results suggest the intervention engaged patients in the self-management of their condition, improved health behaviors, increased detection of adverse and potentially adverse situations, and significantly enhanced the capacity of nurse managers to serve patients. Kaiser Medical Center in Southern California is implementing this innovation in their clinics.
The Commonwealth Fund
The Commonwealth Fund highlighted the CVP in their Spotlight newsletter. These articles discuss the results of the automated telephone self-management project.
California Diabetes Prevention and Control Program
California Safety Net Institute highlighted Dean Schillinger’s work as the new chief of the California Diabetes Prevention and Control Program, a UCSF-administered program under the auspices of the CA Department of Public Health. This role will be integral to advancing policy in diabetes.
Development of Health Communication/Health Literacy Initiatives and Reports
Dr Schillinger’s research and testimony has contributed to the development of health communication/health literacy initiatives and reports at the American College of Physicians, the Joint Commission (JCAHO), and the National Quality Forum. These reports are available upon request.
Dr. Schillinger also gave testimony to address childhood diabetes in schools to the Select Committee on Child/Adolescent Health and Safety.
Adapting the Coronary Heart Disease Policy Model to Address Disparities in Heart Disease
CVP co-director, Dr. Kirsten Bibbins-Domingo is conducting a study entitled Adapting the Coronary Heart Disease Policy Model to Address Disparities in Heart Disease. This study has great potential to drive public policy because national, state and local health policy is often evaluated for the ability to eliminate health disparities between different sub-populations. This study will be adapting the Coronary Heart Disease Policy Model to examine coronary heart disease rates by race/ethnicity and income level which will enable a more accurate description of disease trends over diverse populations and evaluation of interventions that target vulnerable groups. Dr Bibbins-Domingo has presented preliminary results and made policy recommendations regarding salt policy to the California Department of Public Health. She is also studying the impact of taxation of sugar-sweetened beverages on cardiovascular health in California.
National Collaborative for Health Information Technology for Underserved Populations
CVP faculty member, Dr. Urmimala Sarkar serves on a national committee entitled the National Collaborative for Health Information Technology for Underserved Populations. She leads the dissemination group for the Education and Outreach Workgroup, whose charge is to “Identify and develop effective practices for communicating HIT benefits to diverse underserved populations; identify or create models, practices or activities utilizing health IT; and identify/create and distribute materials to these communities that are culturally/linguistically appropriate. A focus of this task force will be educating individuals on HIT to improve health self-management and support consumer empowerment.”
Dr. Sarkar has also been advising the National Patient Safety Foundation on their new ambulatory Stand Up for Patient Safety program to improve its uptake among ambulatory providers/ health systems. She has also partnered with the California Diabetes Program to assess of practices and policies of state diabetes public health programs across the US regarding clinical guidelines for diabetes management.
Develop and Enhance the Quality of Physician Counseling About Chronic Disease
CVP faculty member, Dr. Hilary Seligman works with the American College of Physicians Foundation to develop and enhance the quality of physician counseling about chronic disease. This work has included the development of patient education guides targeted toward patients with limited health literacy. Almost a million copies of the diabetes guide have been distributed throughout the country to HMOs (including Kaiser and Blue Cross), Medicaid Programs, VA Medical Centers, hospital settings, and community health centers.
Dr. Seligman co-developed and narrated the “Ready, Set, Action Plan!” video which teaches physicians strategies for more effectively engaging patients in the behavior change process. This video is used for training in diverse settings, such as the Brigham and Women’s Hospital (Boston) Closed Circuit Patient Education System and the Louisiana State University Medical School Clinical Curriculum.
Dr. Seligman is also active in policy work in the area of food insecurity. She participates in a number of local organizations, such as the Food Security Task Force and the Southeast Food Access Program of the City and County of San Francisco. She has worked on developing a resolution to nominate San Francisco County as a candidate for the Healthy Purchase Pilot program, which would incentivize Supplemental Nutrition Assistance (formerly Food Stamps) participants to purchase more fruits and vegetables. She has prepared an Issues Brief for the California Department of Public Health regarding the implications of food insecurity on diabetes prevention and control efforts.
Surveillance system for chronic kidney disease (CKD) in the United States
CVP faculty member Laura Plantinga, ScM works with the Centers for Disease Control and Prevention (CDC) in the development and maintenance of a surveillance system for chronic kidney disease (CKD) in the United States. The data from this project, including data on the disproportionate development and progression of CKD among vulnerable groups, will provide the informational backbone for the CDC website on CKD, which will be launched in early 2010. Additionally, she also works with CDC and other partners in creating a national CKD fact sheet for use by both the public and policy makers. She has produced several papers that have influenced policy in CKD, including assessments of: awareness of CKD among those with the disease in the community, which was featured on the CDC website as part of World Kidney Day 2009 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5808a1.htm); blood pressure control according to clinical practice guidelines for those with CKD; the association of physician visit frequency with dialysis patient outcomes; and the association of patient outcomes with attainment of clinical performance targets for dialysis patients set forth by the National Kidney Foundation. She has also published an invited commentary on prevention of repeat hospitalizations in dialysis patients.