Photo Friday: The right answer is to involve patients in every decision

By Ted Eytan | January 27, 2012
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View 2012 Care Innovations Summit DC 8505 on Flickr.com

Ted (me), Mark Scrimshire ( @ekivemark ), Kait Roe ( @kaitbr ), at the Kaiser Permanente Center for Total Health ( @kptotalhealth ), for the Care Innovations Pre-summit. Photograph taken by Jason Bhan, MD ( @gomedivo ), jackets by Regina Holliday ( @ReginaHolliday ).

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Being human and HIV care – Our generation does have the power to change it

By Ted Eytan | January 26, 2012
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Today’s announcement by Kaiser Permanente that (1) disparities in survival with HIV are a thing of the past in a coordinated, caring health system and (2) the tools and best practices can be implemented anywhere changes a lot of things.

The dawn of the AIDS epidemic predates my medical career. When I was in college, my biology graduate teaching assistant said to our class one day, “AIDS could wipe out the human race,” and he was right. It could have.

In medical school, I experienced a medical profession that was in shock, unable and in many cases, unwilling to care for people with AIDS. In my experience in training, there were few disparities – everyone received equally discriminatory care.

When papers were published that used terms like “unexplained differences” in outcomes, I could explain the differences easily. I saw with my own eyes how people were treated. For me, there were, “I can’t believe I’m seeing this, won’t anyone help?” moments.

At the same time, I learned, there was an emerging culture of empowered patients with AIDS, and the physicians/clinicians who took care of them. What I was told by one of these physicians was that they were shunned by their medical colleagues because they shared data and explored options with their patients. These are the physicians that I am descended from.

The medical profession learned a lot about treating HIV and AIDS, and then the pattern that we see with so much health care emerged – disparities based on race, ethnicity, sexual minority status. I always thought these would be the hardest to smash, because they depended less on science and more on attitudes.

The physicians/nurses/clinicians/patients and their descendants who continued to stay up to date and create models of care that work for everyone are the ones that have ushered in a new era.

I think of this photo that I took in 2007 in Dupont Circle, Washington, DC – the sign that says “Miracles can Happen” – we can wipe away the inhumanity that formerly predisposed us to being mediocre care providers for certain people and excellent ones for others.

“Miracles Happen” – Whitman Walker Clinic, December, 2007

Here are two videos that accompany today’s announcement. Enjoy. (Note, these may not embed properly until the announcement, you can access them at YouTube.com directly here and here.


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Now Reading: Don’t believe in reducing disparities in HIV Care, believe in eliminating them

By Ted Eytan | January 26, 2012
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Silverberg MJ, Leyden W, Quesenberry CP, Horberg MA. Race/Ethnicity and Risk of AIDS and Death Among HIV-infected Patients with Access to Care. Journal of General Internal Medicine. 2009;24(9):1065-1072.

Horberg M, Hurley L, Towner W, et al. HIV quality performance measures in a large integrated health care system. AIDS patient care and STDs. 2011;25(1):21-8.

Kaiser Permanente (KP) is the largest civilian provider of HIV care in the United States and is the second largest provider of HIV care in the United States (the largest provider being the Veterans Administration). There were nearly 17,000 active HIV-infected KP members in 2007. Our HIV mortality rate is 1.6%, compared to 3.4% nationwide in the United States.

These two papers provide the data behind a major announcement today, which is that you don’t have to be Black, White, Latino, Heterosexual, or Homosexual to have the best chance at HIV viral suppression, avoiding AIDS, and avoiding death anymore. You only need to be a human being.

Here are the numbers:

Kaiser Permanente has demonstrated excellence in HIV clinical care outcomes with:

  • HIV mortality rates that are half the national average
  • 94 percent median treatment adherence among patients regularly in care and on antiretroviral therapy·
  • No disparities among its black and Latino HIV-positive patients for both mortality and medication rates, compared to a 15 percent higher rate in the United States for mortality and for medication
  • 89 percent of its HIV-positive patients are in HIV-specific care within 90 days, compared to 50 percent in the U.S. within one year·
  • 69 percent of all its HIV-positive patients have maximal viral control compared to 19 percent to 35 percent nationally

The other part of the announcement is that the best practices and tools that made this possible are being shared with the nation, http://kp.org/hivchallenge

Let us never see another study that talks about “unexplained differences” in the death rate of people with HIV based on their race, ethnicity, or sexual minority status.

Let us also never see another study about anything in health care that talks about “unexplained differences” for minority populations.

Thanks to Michael Horberg, MD, and the team of clinicians, staff, and members of Kaiser Permanente for demonstrating that being successful comes from people being cared for because they are human beings first.

Tune in to watch the announcement this morning at the Care Innovations Summit, around 10:00 am EST, http://www.hcidc.org

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Siri, show me my lab test results

By Ted Eytan | January 25, 2012
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View Siri, show me my lab test results on Flickr.com

“Ted, I cannot find your lab test results. You can view them in Kaiser Permanente’s mobile optimized kp.org”

It’s here.

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Siri, email my doctor

By Ted Eytan | January 25, 2012
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View Siri, email my doctor on Flickr.com

“Ted, I cannot email your doctor. You can email her through Kaiser Permanente’s mobile optimized kp.org”

It’s here.

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DC Care Innovations Summit Viewing Party at KP Center for Total Health

By Ted Eytan | January 24, 2012
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Care Innovations Summit Viewing Party at KP Center for Total… – Eventbrite. Washington, DC is at it again!

I’ve been spending this week gearing up for the Care Innovations Summit in Washington, DC, which will be on January 26, 2012, as well as a pre-event happening the day before. From what I have seen so far, I can say that passion for innovation will be filling the DC sky this week.

As luck/serendipity would have it, the actual summit is “checked in full,” however, Kaiser Permanente is hosting a viewing party with live link to the Summit at the Center for Total Health. That’s where I’ll be.

Hashtag is #cisummit , feel free to register at the link above before it fills and we’ll see you there.

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Photo Friday: Life’s better here – It’s True, DC is diverse

By Ted Eytan | January 20, 2012
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It’s True: We Have Little Tolerance For Stupid Rankings: DCist – I slightly modified the title of the post from DCist that I am referring to. However, it turns out that the frustration with the DailyBeast’s rankings about “tolerance” provided a good platform to list all the ways Washington, DC, doesn’t tolerate, it lives diversity.

As I wrote in this post back in 2008 (See: “Diverse communities are…” ), the data shows that diversity is positively correlated with happiness and fulfillment in a community, and in business, with increased profitability. Check it out.

In the meantime, this week’s photograph, taken in Washington, DC speaks for itself. This is why we love it here, because love always wins.

View ‘Love, Support, and Acceptance in 2012 – Miss Adams Morgan’s Glorya H in the Shaw Neighborhood, Washington, DC, USA’ on Flickr.com

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Are you integrating Intensive Behavioral Therapy for Obesity into your medical practice?

By Ted Eytan | January 12, 2012
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I recently posted about the “CMS Proposed Decision Memo for Intensive Behavioral Therapy for Obesity (coverage by Medicare)” and received this query. I don’t know the answer, so I’m posting it here to see about the wisdom/experience of the crowd. Please add what you know/what you’re doing in the comments!

(we are) trying to learn more about this is being done in the real world, post ACA.  We’re just trying to learn the nuts and bolts to help providers get reimbursed for this service so that they will be encouraged to actually provide this counseling.

Incidentally, the final CMS Decision Memo for Intensive Behavioral Therapy for Obesity (CAG-00423N) – is now posted, feel free to look to it for reference, it discusses guidelines for coverage, along with the science behind the effectiveness for Intensive Behavioral Therapy for obesity (and there is documented effectiveness).

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A Patients Speakers Bureau you can use – SpeakerLink

By Ted Eytan | January 10, 2012
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SpeakerLink.org

On my walking meeting last week with Regina Holliday ( @reginaholliday ) and Kait Roe ( @kaitbr ) I left with an assignment, which was to write about SpeakerLink.

Not that long ago, a colleague said to me, “Ted, we can’t find a patient to be present at upcoming event x.”

I thought, “Out of 307,006,550 possible people in the United States, you couldn’t find anyone?”

I’m being hyperbolic; that’s not what they meant. They meant, a patient who’s available, interested, passionate, a good fit for an audience, can leave their job and family responsibilities, etc etc.

So really, the question wasn’t “does a patient exist in the world?” The question was, “Can we enter into a respectful relationship with another person who will teach us about their experience,” which we can now answer, “yes.”

Regina reminded me that my question about this was recorded by Dave deBronkart in 2009 (see: A Call for a Patients Speakers Bureau)

So now SpeakerLink exists, and it’s in full operation now. It has an engine to review potential speakers’ capabilities, requirements, and stories and enter into a respectful relationship where their contribution of time and passion is valued. In my initial complaint to Dave, I said that everyone at the meetings was getting paid to be there – except the patient.

SpeakerLink will reduce the friction of finding “the patient.” It will also broaden the field of patient speaking. All the rockstars I know are there, Regina, Sorrel King, Sue Sheridan, Dave, Trisha , as well rockstars-in-training like Kait .

What we could also see is any patient getting the chance to describe what’s needed for them to take time away from other responsibilities to share their experience. It could be a day off work and a taxi-ride (or in DC, Capital Bikeshare ). There hasn’t been a place to put these requirements together before so no matches could be made beyond the patients/people who are the most dedicated to being heard.

The network of speakers on SpeakerLink is actually patients AND professional caregivers and healthcare leaders – Regina’s gone through all of the design decisions in detail on her blog here. The site is not profit generating, and when registration fees are instituted in April, 2012, the proceeds will go to help other speakers get started. I believe all of this, because I was there in that room with all of the cameras rolling talking about it (see pic: http://flic.kr/p/9RGpBw ). Those were big cameras :) .

As Regina describes it to me, there are literally hundreds of details that impact a patient/person’s access to the podium that a health professional, with an advanced degree working in a marquee organization, takes for granted. This is also what SpeakerLink is managing behind and in front of the scenes.

Speaking of which, my next assignment is to write a letter of reference for Regina’s past work with my organization. It apparently has to be an actual letter because some health care organizations are unable/afraid to click through to hyperlinked content. I have an image in my head of a paper letter being part of the ramp onto that bridge that Regina talks about….

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Building of the global movement for health equity: what health care can do

By Ted Eytan | January 9, 2012
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ScienceDirect – The Lancet : Building of the global movement for health equity: from Santiago to Rio and beyond – Thanks to @katellington for sending this my way.

Contained within is a concise statement of where health care fits into social determinants. Worth a read to see what’s new in social determinants. And from the read, social determinants is more new than I thought….

…. there are three important roles for the health-care system (webappendix p 1). First is to ensure universal access to high-quality care, with increased focus on prevention and health promotion.13 Second, people in the health sector—from the Minister of Health to primary care professionals and medical and health organisations—should be the advocates for action on social determinants of health. There are good examples of cooperative working between health and other sectors. Third, ensure that routine monitoring systems are in place for health equity and the social determinants of health, undertake evaluation of policies on these topics, and increase the knowledge base.

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Photo Friday: A Year of Photos Edition

By Ted Eytan | January 7, 2012
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As I review my photographs from 2011, I can see what a image-filled place Washington, DC is, and how much innovation, dissent, equality, compassion, optimism, brilliance, that went on in the world touched my life personally.

Two of my photographs were selected by Washington, DC Metropolitan Blog WeLoveDC.com as bests for 2011. One of those is below, the other is the first in the series from 2011 below it ( Fireworks in Malcolm X Park )

In 2012 I have decided to take more photographs of people in Washington, DC. Let’s see how that works out. In the meantime, Enjoy my photo stream from 2011, sorted in order of “interestingness” from the Flickrnets.

2011 Occupy DC 6316

Occupy DC, McPherson Square, Washington, DC, USA, October 22, 2011

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Photo Friday: A new year with Kait and Regina

By Ted Eytan | January 6, 2012
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View Lunch with Regina and Kait 2012 8128 on Flickr.com

This week’s photograph shows Kait Roe ( @kaitbr ) and Regina Holliday ( @reginaholliday ) in front of Washington, DC’s most excellent Capital Bikeshare, in one of our most revered neighborhoods, Dupont Circle. We wanted to try the new ShopHouse Southeast Asian Kitchen, Chipotle’s New Asian Spinoff. I like prototypes :) .

I asked what we were going to do in 2012. I learned that Kait is working diligently to establish her employed presence (i.e. she’s looking for a job), and Regina is working diligently to promote the fabulous and long-awaited innovation that SpeakerLink.org is. It deserves its own post, coming shortly. It’s going to be a good year.

Isn’t Washington beautiful?

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Now Reading: Place, not race: disparities dissipate when blacks and whites live under similar conditions

By Ted Eytan | January 4, 2012
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Laveist T, Pollack K, Thorpe R, Fesahazion R, Gaskin D. Place, not race: disparities dissipate in southwest Baltimore when blacks and whites live under similar conditions. Health affairs (Project Hope). 2011;30(10):1880-7.

When I was reading about social determinants recently, I came across an error in one of Sir Michael Marmot’s writings, in this JAMA article (“Action on Health Disparities in the United States“). In it, he says:

The gap in life expectancy between men in Washington, DC, and in suburban Maryland is 17 years.

The error he made is that the 17-year gap is for African American men in Washington, DC, compared to men in Montgomery County, MD (I assume that’s the suburban he’s talking about), not the average of all men in Washington, DC. That gap is 9.1 years (as of 2007).

This paper is useful because it calls the racial distinction into question. It might be more accurate to say “a man living in Ward 8, Washington, DC” above, taking race out of the picture altogether, and therefore focus more on the Ward 8 neighborhood.

What the authors did was choose a community with a mix of African American and white residents with similar income, education, and location (they’re in the same community), interviewed 42 percent of them (1,489 people), and took their blood pressure. They then compared what they found to national statistics for the measures they assessed.

  • And….whites and African Americans with the same social determinants looked a lot more similar than different. There were a few notable differences.
  • African Americans still had higher blood pressure, albeit not as higher in this matched community
  • African Americans were no more obese, no more likely to have diabetes than their white counterparts
  • African Americans smoked less than their white counterparts
  • African Americans were  more likely to have a health care visit within the past year

With this conclusion:

When whites are exposed to the health risks of a challenging urban environment,15 their health status is compromised similarly to that of blacks, who more commonly live in such communities.

I wonder even further if whites are less able to tolerate an unhealthy neighborhood environment, given that they smoke more and use health care less. This is just speculation on my part, though.

The study points out and reinforced what’s being discussed about social determinants already, which is that local conditions have a huge bearing on health and looking to customize interventions based on an individual’s genetics or behavior may not be as useful as taking a walk down the street where they live.

Tying this all back to Washington, DC, there’s a vibrant neighborhood blog scene here, so you can electronically walk the neighborhoods in an authentic, personal way. I’ve put together a link cloud of the major ones. Anacostia is Ward 8. See if you see the differences in place. If the differences aren’t obvious there, you can check out this post on local blog TheFightBack for a more intense view of life in Ward 8.

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Economist: Blogs blamed for cheapening debate yet they have enriched economics ( my experience with JAMA )

By Ted Eytan | January 4, 2012
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I found this article in the Economist very timely in the context of a recent experience I had with a well known peer reviewed journal (more on that below).

Economics blogs: A less dismal debate | The Economist -

Research (by two blogging economists at the World Bank) suggests that academic papers cited by bloggers are far more likely to be downloaded. Blogging economists are regarded more highly than non-bloggers with the same publishing record. Blogs have given ideas that failed to prosper in the academic marketplace, such as the “Austrian” theory of the business cycle, another airing (see article). They have also given voice to once-obscure scholars advancing bold solutions to America’s economic funk and Europe’s self-inflicted crisis.

The experience i recently had was when I sent this note to Journal of the American Medical Association, and got the attached response.

On Dec 27, 2011, at 12:19, jama-comments wrote:

Thank you for your comment. If you would like to send a letter to the
editor, you are welcome to do so at http://manuscripts.jama.com.

—–Original Message—–
From: Ted Eytan, MD
Sent: Monday, December 12, 2011 11:44 AM
To: jama-comments
Subject: Inquiry re: recent editorial Should Patients See Their Lab
Results? (JAMA Feedback Form)

————————————————————
Comments sent via JAMA Feedback Page
————————————————————
TO: jama-comments@ama-assn.org
NAME: Ted Eytan, MD
PREVIOUS PAGE:

http://jama.ama-assn.org/content/early/2011/11/22/jama.2011.1797.full

PROMOTIONAL USE: (not answered)
————————————————————
COMMENTS:

Dear JAMA,

Wondering if you would entertain another editorial, co-written by a
physician and patient, entitled “Shouldn’t patients get direct access to
their lab results?” that would be based on actual data rather than on
speculation?

I wrote a blog commentary here, thanks for entertaining the idea,

http://www.tedeytan.com/2011/12/09/9637

Ted Eytan, MD
Washington, DC

The response is a reasonable one in the world of the peer-reviewed journal (“format it the way we expect and maybe we’ll publish it”), however, it leaves one wondering “why go to the effort when I can just post my response in the blogosphere?”

The JAMA article itself has multiple links to share the article out in the social media space, but no space to comment directly on the article or receive trackbacks from social media responses, to share in. In other words, there’s talking, but not listening.

For that, there are now multiple channels outside of the peer-reviewed world, and as the Economist reports is happening in the field of economics, I think there is second guessing happening about the best venue to get ideas accepted in health care. See what you think, feel free to post your experiences.

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Photo Friday: Beautiful view of the US Capitol from Eckington Neighborhood, Washington, DC

By Ted Eytan | December 30, 2011
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View ‘Morning in Eckington 8117′ on Flickr.com

This week’s photograph was taken in one of Washington, DC’s most fascinating neighborhoods-in-transition, Eckington, as the sun rises, framing the United States Capitol Dome.

North Capitol street replaced Truxton Circle, which some hope will one day be restored as this neighborhood continues its dynamic rise like so many others have in this city.

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