Source: Opioid Prescribing: Where you live matters
Download Opioid Factsheet
The amount of opioids prescribed in the US peaked in 2010 and then decreased each year through 2015. However, prescribing remains high and vary widely from county to county. Healthcare providers began using opioids in the late 1990s to treat chronic pain (not related to cancer), such as arthritis and back pain. As this continued, more opioid prescriptions were written, for more days per prescription, in higher doses. Taking opioids for longer periods of time or in higher doses increases the risk of addiction, overdose, and death. In 2015, six times more opioids per resident were dispensed in the highest-prescribing counties than in the lowest-prescribing counties. County-level characteristics, such as rural versus urban, income level, and demographics, only explained about a third of the differences. This suggests that people receive different care depending on where they live. Healthcare providers have an important role in offering safer and more effective pain treatment.
Healthcare providers can:
- Follow the CDC Guideline for Prescribing Opioids for Chronic Pain, which includes recommendations such as:
- Use opioids only when benefits are likely to outweigh risks.
- Start with the lowest effective dose of immediate-release opioids. For acute pain, prescribe only the number of days that the pain is expected to be severe enough to require opioids.
- Reassess benefits and risks if considering dose increases.
- Use state-based prescription drug monitoring programs (PDMPs) which help identify patients at risk of addiction or overdose.
Source: CMS.Gov & Florida Disability and Health Program
The CMS Office of Minority Health Issue Briefs offer insight and examination into a variety of health and health disparity topics. The briefs are a concise summary of a particular issue and examine policies that impact the quality of and access to health care for minority and disadvantaged populations. Issue Briefs evaluate CMS programs, including Medicare and Medicaid, to include recommendations and suggestions relating to the issue at hand.
Adults with disabilities are almost twice as likely as other adults to report unmet health care needs due to problems with the accessibility of a doctor’s office or clinic.9 Structural, financial, and cultural barriers persist for people with disabilities when trying to access care.10 Many individuals with mobility disabilities face difficulties locating or otherwise traveling a burdensome distance to physically accessible services.11 Providing equal access to health care for people with physical disabilities involves many factors including, but not limited to:
- Facility access. This includes accessible routes from parking or bus stops into the building, accessible parking, accessible entry doors with the required clearance width, clear floor space, and maneuvering clearance, accessible restrooms, and accessible signage for people who are blind or have low vision.12
- Health care services access. This includes accessible scales and exam tables to facilitate a medical exam, accessible treatment and diagnostic equipment (including infusion chairs, mammography machines, and radiology equipment), appropriate resources for individuals with visual and auditory disabilities, and staff trained to assess patient needs and safely help patients move in between and transfer on and off medical equipment.
Racial Disparities in Age-Specific Mortality Among Blacks or African Americans — United States, 1999–2015
Source: Vital Signs: Racial Disparities in Age-Specific Mortality Among Blacks or African Americans — United States, 1999–2015 | MMWR
Background: Although the overall life expectancy at birth has increased for both blacks and whites and the gap between these populations has narrowed, disparities in life expectancy and the leading causes of death for blacks compared with whites in the United States remain substantial. Understanding how factors that influence these disparities vary across the life span might enhance the targeting of appropriate interventions.
Methods: Trends during 1999–2015 in mortality rates for the leading causes of death were examined by black and white race and age group. Multiple 2014 and 2015 national data sources were analyzed to compare blacks with whites in selected age groups by sociodemographic characteristics, self-reported health behaviors, health-related quality of life indicators, use of health services, and chronic conditions.
Results: During 1999–2015, age-adjusted death rates decreased significantly in both populations, with rates declining more sharply among blacks for most leading causes of death. Thus, the disparity gap in all-cause mortality rates narrowed from 33% in 1999 to 16% in 2015. However, during 2015, blacks still had higher death rates than whites for all-cause mortality in all groups aged <65 years. Compared with whites, blacks in age groups <65 years had higher levels of some self-reported risk factors and chronic diseases and mortality from cardiovascular diseases and cancer, diseases that are most common among persons aged ≥65 years.
Conclusions and Implications for Public Health Practice: To continue to reduce the gap in health disparities, these findings suggest an ongoing need for universal and targeted interventions that address the leading causes of deaths among blacks (especially cardiovascular disease and cancer and their risk factors) across the life span and create equal opportunities for health.
Source: Lessons from High Performing Hospitals
Lessons from High Performing Hospitals: Achieving Patient and Family-Centered Care
Patient-Centered Care In A Nutshell
- Providers partner with patients to anticipate and satisfy the full range of patient needs and preferences
- Hospitals support staff in achieving their professional aspirations and personal goals
A Consistent Finding: It’s All About Culture
- High performing sites credited their HCAHPS success not to specific practices, but to a well-established culture of patient-centered care
- High performing sites had implemented a comprehensive approach to patient engagement, family involvement and staff engagement
- Improvement Guide reflects this key finding, providing guidance for implementing practices within a broader framework of organizational culture change
“Bite Sized” Exercises and Discussion Prompts to Reinforce Culture
Below is a collection of discussion prompts and exercises designed to engage the hearts and minds of all members of the team in the practice patient-centered transformation effort. These exercises are designed to be concise enough to be incorporated into brief huddles or team meetings. Specifically, these exercises are designed to:
- Help all members of the team reconnect to the joy of practice
- Re-sensitize them to the patient experience.
- Learn specific techniques for connecting with patients, remaining present and delivering care with compassion – even when it is most difficult to do so.
- It is recommended that exercises like these be regularly incorporated into operations as a means of nurturing an understanding of patient-centered care and the responsibility and opportunity for each member of the care team to embody those values.
Exercises to Understand the Patient Experience
- Trace the path a patient takes from arrival at the office through to registration to the waiting room to the exam room and to check-out. What do they see? What barriers may then encounter? Is the signage they encounter informative? Does the environment (including the signage) convey warmth and compassion? Trace patients’ steps using a walker and/or a wheelchair. Ask yourselves the same questions. Better yet, do this exercise alongside patient representatives.
- Pair up with a colleague. Share a brief personal story with your partner (2-3 minutes, does not need to be overly personal). Initially, tell the story with your partner sitting down and you standing up; then both sitting at the same level. Switch roles. Together, identify specific behaviors that created a sense of connection as you shared.
- Role play a typical patient interaction in your exam rooms. Observe how the set-up of the room either facilitates eye contact and personal connection or inhibits it, specifically in consideration of how you use the EHR. Consider placement of the computer screen, availability and height of chairs, etc. Better yet, complete this exercise alongside patient representatives.
- Sit in an exam room on the table for 10 minutes, just as a patient would (though they wouldn’t know in advance how long they would be waiting.) Take note of the environment of the exam room. Is there anything to keep you occupied? What can you hear going on outside the room? How does it feel to sit there?
Patient-Centered Primary Care Collaborative (PCPCC)
Questions to ask your doctor about patient-centered care
- What type of information will you provide to me about my condition and treatment options?
- Will you provide me with decision aids that will help me to make the best individualized care decisions?
- Am I able to access a patient portal to help me manage my personal health information?
- Am I able to update and contribute to the information in the patient portal or just review it?
- Am I able to review the doctor’s notes in my record? Do I have the option of adding my own information and perspectives into my record for the doctor to read and review?
- When my care team meets to discuss my plan of care, will I be invited to participate in those discussions?
- Is there a way for me to securely send questions/messages to my doctor in advance of (or outside of) a scheduled appointment?
Source: Improving Your Person and Family Engagement Metrics in TCPI | Patient-Centered Primary Care Collaborative
The Patient Centered Primary Care Collaborative Support and Alignment Network (PCPCC SAN) was created to assist staff and leaders in Practice Transformation Networks, along with enrolled clinicians, to successfully transform their practices to deliver person and family centered care. In 2017 the TCPI is adopting 6 measures of person and family engagement (PFE). On this page, we describe the measures and offer links to websites where you can download tools, information, and other educational materials.
“Bite Sized” Exercises and Discussion Prompts to Reinforce Culture
Questions to ask your doctor about patient-centered care
Download: Atlas on the Primary Care of Adults with Developmental Disabilities in Ontario
Lunsky Y, Klein-Geltink JE, Yates EA, editors. December 2013
Ontario’s Action Plan for Health Care focuses on becoming healthier, with improved access to integrated family/primary care and a major emphasis on the provision of the right care at the right time and in the right place. These priorities are particularly relevant to individuals with developmental disabilities: research from other jurisdictions would suggest that they have higher rates of preventable diseases, greater challenges obtaining guideline-recommended primary care3 and higher associated health care costs.4 However, the health status and
health care of adults with developmental disabilities have not been well studied in Ontario, due to the absence of population-based data. The work of the Health Care Access Research and Developmental Disabilities (H-CARDD) Program is in direct response to Ontario’s call to action through addressing this data gap. The first H-CARDD project, conducted in partnership with decision makers and clinicians from the health and social services sectors, has focused on primary care.
The Atlas on the Primary Care of Adults with Developmental Disabilities in Ontario provides, for the first time in Canada, descriptive information on the health of adults with developmental disabilities in Ontario and examines the quality of their primary care relative to adults without developmental disabilities. Findings have relevance in Ontario and in other jurisdictions where there is interest in improving health care and the health status of those with developmental disabilities.
House Republicans are close to agreeing on an amended version of the American Health Care Act, their proposed repeal and replacement of the Affordable Care Act. David Blumenthal, M.D., and Sara Collins say that, based on the summaries circulated by the media, the revised bill will significantly increase the numbers of uninsured Americans while raising insurance costs for many of the nation’s most vulnerable citizens. At the same time, the bill’s restructuring of the Medicaid program is likely to hurt state economies and enrollees.
Source: Revised ACA Repeal and Replace Bill Likely to Increase the Uninsured Rate and Health Insurance Costs for Many – The Commonwealth Fund
News outlets report that House Republicans are close to agreeing on an amended version of the American Health Care Act (AHCA), their proposed repeal and replacement of the Affordable Care Act (ACA). The all-important legislative language for the revised bill is not yet available, nor are Congressional Budget Office (CBO) projections of its effects on coverage and the budget, so any analyses are necessarily tentative.
Nevertheless, the summaries leaked to the media offer insight on the amended bill. If accurate, those summaries suggest that the revised AHCA will significantly increase the numbers of uninsured Americans, raise the cost of insurance for many of the nation’s most vulnerable citizens, and, as originally proposed in the AHCA, cut and reconfigure the Medicaid program. The new amendment specifically allows states to weaken consumer protections by, for example, permitting insurers to charge people with preexisting conditions higher premiums.