Raising H.E.A.L.T.H. at TEDMED

RaisingHealth-DC-20

Among the many activities at TEDMED 2014, Delegates were invited to contribute their thoughts to “Raising Health” – ideas on how to approach some of the most broad-based, intractable issues of health today, from childhood obesity to medical costs.

On Day One of TEDMED, Delegates focused a great deal of attention in the space to the changing role of the patient in healthcare.  They were asked to discuss and respond to the following questions: How do we empower patients to make healthier decisions? What is the patient’s role from his or her perspective? What is the role of healthy people  (non-patients) in healthcare?

Answers centered on a number of themes:  What are the best ways to develop a strong doctor-patient conversation? How can we include family, caregivers and community in patient care? An informed patient is an empowered patient. What’s the best way to go about that?Screen Shot 2014-09-11 at 9.32.15 AM

“Bring intuition and knowledge of your own body to your healthcare team,” answered one Delegate. “Make the patient the source of applied innovation,” said another. And, “Ask each patient for his or her goal for each visit or what he/she wants to accomplish.”

Click here for a recap of more thoughts on this critical issue, and stay tuned as we cover more thoughts on the Challenges throughout TEDMED. You can also share your own thoughts on Twitter at #greatchallenges.

Here’s a Challenge for you: How can we Raise Health?

shutterstock_180808967We’ve seen the power of collective creativity and goodwill for a good cause recently, so we’re asking our health and medicine community to dig deep once more, this time for a thought experiment: Can we rebuild some of health and medicine’s most complex and critical issues – our Great Challenges – by creatively rethinking their foundations? What do we truly understand about these factors that limit health —and their possible solutions— today?

As we move into the third year of our Great Challenges program, Delegates on site at TEDMED 2014 in Washington, DC and San Francisco will be tackling these issues and more in a special area devoted to exploring the six Challenges we’ve focused on this year. Together, we’re aiming to shake up the status quo, rethink assumptions, and raise health to new heights to meet our evolving needs.

Your input will also help guide direction for the Great Challenges program in the coming year, so be sure to stop by.

Below, find 18 critical questions as determined by our community.  Answer them, validate them, reframe them. We need your input, so please respond here, via Twitter #GreatChallenges, on Facebook and Google+, or on our tumblr.

Impact of Poverty on Health

What’s the best way to invest in poverty reduction to improve health?

Are other people’s health problems everyone’s business?

How should doctors “treat” socioeconomic factors that impact health?

Reducing Childhood Obesity

How can we change our 24/7 food-everywhere culture?

Obesity risk begins in the womb. How can we deliver this message?

How much of obesity is about personal responsibility?

Achieving Medical Innovation

When should patients get to enter higher-risk clinical trials?

How can we align public and private interests to drive innovation?

How can patients be partners in medical innovation?

Making Prevention Popular

Where could health policy go farther to nudge preventive behavior?

Why do we so often do what we know isn’t good for us?

Is prevention about individuals, populations, or both? Why?

Role of the Patient

How do we empower patients to make healthier decisions?

What is the patient’s role from his or her perspective?

What is the role of healthy people  (non-patients) in healthcare?

Addressing Healthcare Costs

How do we create smart “healthcare consumers”?

What kind of system adapts to the changing needs of healthier patients?

How can we align stakeholders to reduce healthcare costs?

Special thanks to the Robert Wood Johnson Foundation for their support of this program.

New York City and Philadelphia: A Tale of Two Obesity Declines

By Risa Lavizzo-Mourey and Nancy Brown

“Severe Childhood Obesity Shows a Decline in New York City.” You might have seen the headlines earlier this month.

It wasn’t long ago that we never saw stories like that.

For decades, it was nothing but bad news – one story after another about a rapidly growing epidemic. Just two years ago, the Robert Wood Johnson Foundation and Trust for America’s Health predicted that, if trends continued the way they seemed to be going, more than 60% of adults in 13 states would be obese by the year 2030 – and have the extremely high medical bills to prove it.

But now, we’re finally starting to see signs of progress against an epidemic that was once feared to be unstoppable. Overall childhood obesity rates have stabilized. For the first time in a decade, data show a downward trend in obesity rates among young children from low-income families in many states. And, we’re seeing reports from cities and states that their overall rates of childhood obesity are decreasing: from California to West Virginia; from Anchorage, Alaska to New York City.

New York is a great example of a place taking a comprehensive, community-wide approach to reducing childhood obesity. The city has required group child-care centers to improve nutrition and nutrition education, increase physical activity, and limit screen time. “Health Bucks” enable lower-income families to maximize their purchasing power for fresh fruits and vegetables at local farmers’ markets. The city’s Department of Design and Construction provides architects and urban designers with guidelines for designing buildings, streets and urban spaces that support physical activity. Chain restaurants are required to post calorie information on menus, enabling customers to make more informed decisions. The education and health departments have collaborated on the “Move-to-Improve” program, which helps teachers incorporate physical activity through the school day.

We’re thrilled that these approaches appear to be paying off, but here’s the thing about that recent study on the most severe obesity cases: White children saw a more significant decrease than Latino or African-American kids.

This was true for overall obesity rates as well: Childhood obesity rates among White K-8 students in New York dropped from 17.6% in 2006 to 15.4% in 2010 – an impressive 2.2 percentage point decline. But the drop among Hispanic and African-American students was far less, just 0.9 and 0.4 percentage points, respectively. The disparity among upper- and lower-income students was even greater, a 1.4 percentage point decline compared to 0.7 percentage points.

This means that despite the overall progress, the disparities gap may actually be widening in New York.

In this respect, New York City truly illustrates where we are in this epidemic. Progress is possible, and happening, but this progress runs the risk of leaving some of our young people behind, and too many of those at greatest risk.

There is one notable exception to this rule—Philadelphia.  In Philadelphia, they’ve managed to reduce childhood obesity prevalence while also reducing obesity-related disparities.

Philadelphia Decreases Childhood Obesity: Learning to Eat Healthy

 

Like New York, Philadelphia has addressed the obesity problem from many angles. The city, along with groups like the Food Trust, pioneered new financing strategies to bring full-service grocery stores back to underserved neighborhoods. The city improved food and physical activity in schools, and was one of the first jurisdictions in the country to remove all sodas and other sugar-sweetened drinks from public school vending machines.  In schools with American Heart Association Teaching Gardens, children grow their own healthy produce, and learn about the value of good eating habits. Complete streets policies make it easy and appealing for people to walk and bike throughout the city. More farmers’ markets are opening all the time across the city, and they use smart incentives to help lower-income residents afford fresh produce. Corner stores are offering healthy products and using in-store placement and marketing techniques that are boosting sales.

And guess what? Childhood obesity there fell 4.7 percent – and the biggest declines were reported for African American boys and Hispanic girls: 7.6 percent and 7.4 percent, respectively.

The challenge for all of us is this: How do we make the Philadelphia story everyone’s story, in every community?  How do we give every child in America an equal opportunity to grow up at a healthy weight?

On July 22, we’ll be addressing those questions and more at a TEDMED Google Hangout. Here’s who will be speaking:

  • Risa Lavizzo-Mourey, President and CEO of the Robert Wood Johnson Foundation
  • Nancy Brown, CEO of the American Heart Association
  • Don Schwarz, former Health Commissioner and Deputy Mayor for Health and Opportunity, City of Philadelphia
  • Elissa Epel, Associate Professor, UCSF School of Medicine
  • Lisa Simpson, President and CEO, Academy Health

Our conversation will be moderated by Richard Besser, Chief Health and Medical Editor for ABC News.

Do you have a question or comment for the speakers? A story about what’s happening in your community to promote healthy eating, or physical activity? An idea for helping kids achieve and maintain a healthy weight? We’d love to hear from you! Just comment on this post, or tweet using the hashtag #GreatChallenges.

We’re really looking forward to a lively, candid chat, and we hope you’ll tune in and contribute to the conversation!

 

Live online event: A candid conversation about childhood obesity

On Tuesday, July 22nd at 2pm ET, TEDMED will host a special live online discussion with our nation’s forward-thinking health leaders to take measure of the progress and challenges in our ongoing struggle with childhood obesity. Guests include representatives from Robert Wood Johnson Foundation, the American Heart Association, Academy Health, the University of California, San Francisco and the City of Philadelphia. Dr. Richard Besser of ABC News will moderate.

Screen Shot 2014-07-15 at 1.30.35 PM

The national childhood obesity rate has leveled off. Cities and states that have been taking on this issue comprehensively are starting to see their childhood obesity rates drop. A CDC study published in February showed that national rates may be declining among our nation’s youngest children.

This is good news, but challenges remain. Rates are still far too high overall, and racial, ethnic, and socioeconomic disparities persist.

What needs to happen to show bigger results, faster? How do we make sure all children can grow up at a healthy weight? What are some of the underlying environmental and societal causes that must be addressed? What could corporate, community and policy leaders do to further address this critical public health issue?

Click here to RSVP for the Hangout and view more information on this important conversation. We’ll be taking audience questions via #greatchallenges and will answer as many as possible on air.

Community hospital starts its own patient-centered innovation center

Nick Dawson, who moderated last week’s Great Challenges Googe+ Hangout on medical innovation, is also the new Executive Director of Innovation at Johns-Hopkins Sibley Memorial hospital. He’s helped to run a new onsite Innovation Hub, a cross-disciplinary design studio set to launch this fall at Sibley. We talked to him about the Hub and its goals.

TEDMED: What are the Hub’s goals?

Dawson: The Hub will primarily foster a culture of patience and human centered innovation for everybody in the organization to take part in problem solving, improving processes and thinking about how we do our day-to-day work. The Hub will also engage in cutting and leading edge innovation and design work in health care to improve everything from patient experience to clinical process flow. We maybe even invent new products and services.  We’ll be changing culture plus doing classic innovation and design work.

Sibley's Innovation Hub features new perspectives: Pictured: Nick Dawson and Joe Sigrid

Sibley’s Innovation Hub features new perspectives: Pictured: Nick Dawson and Joe Sigrin


TEDMED: Why now?

Dawson: There are some pragmatic realities. Healthcare costs have risen. Clinical quality, despite really well intentioned and impactful work, can be improved.  We may not have enough providers the future,  Above all, it’s become part of our collective discussion to question if we are delivering truly human centered healthcare and meeting the needs of our population, making them healthier and keeping them from being admitted to the hospital and from having serious chronic conditions. We’re having that conversation as country, and we ought to have that conversation within health systems.

TEDMED: Do recent statistics about poor outcomes in the U.S. fuel the fire, despite all the money we spend on healthcare?

Dawson: They are disappointing, and I’m certainly one to help beat that drum and say we need to be doing a better job. At the same time, [numbers] can be misleading because we really do some things incredibly well.  We pioneer techniques and procedures and we’re innovative as a medical community. For example, laproscopic procedures were developed in part right here at Sibley Hospital. A lot of new drug therapies come out of American pharmaceuticals.  So, while we do need to be having a serious discussion about outcomes, we should be proud taht we do have a high performing healthcare system.

TEDMED: You’ll have an embedded innovation team. Who’s on it?

The idea of “team” is loosely defined for us. Dr. Chip Davis, the CEO here at SIbley, and his team deserve the credit for championing the Hub’s vision, and having it be the first community hospital in the nation to have an embedded, well-thought through and resourced innovation center.  There are two of us running the Sibley Innovation Hub, myself and a colleague, Joe Sigrin, who is our Innovation Experience Advisor, and an advisory board.  We’re also developing a physician advisory board to provide clinical direction, and then we have the goal of trying to create widespread culture change. If we’re successful in our job, the whole organization will be part of the team and will be doing mini-projects and even full blown design on their own. We have a wonderful space I which to going to grow that army of design thinkers. It’s a space for everybody that comes into Sibley, whether they’re staff, medical staff or patients.

TEDMED: Will patients be involved?

Dawson: One of our driving goals is including patients in the process, and not just as end users, but as part of the design team.  Frankly, that’s the only way innovation is going to work. Once you co-design, it just feel so right.  It’s the only way that makes sense.

TEDMED: Who or what do you credit with launching a design revolution in healthcare?

That’s a fun one to ponder. There are the IDEOs and the Stanfords; we’ve seen design and innovation centers in many large academic institutions. They gave prominence to the idea.

Another partner, though, and one who ought to get more credit, is patients, those who have said, ‘My health and my condition, and my experience and my interaction with my doctor — that’s my responsibility, and here’s what I’m going to do to own it.  I may have to hack the system.’  They’re designing for themselves ultimately.

And then there are nurses.  All you have to do is shadow any nurse and they have hacks and workarounds for everything.  They don’t call it design thinking, but they have empathy for their patients and their peers and they’re always thinking about how to make things just a little bit better. We see that in doctors, too. Some doctor said, ‘I’m going to try this laproscopic thing, and I’m going to invent a prototype for it.’

There’s a culture in health that who has always existed.  It’s just now becoming a formal process.

- Interview by Stacy Lu

Q2 Checkup: What Is Shaping Digital Health Innovation in 2014?

By Aman Bhandari

With 2014 halfway behind us, it’s time for a bi-annual look back at digital health innovation so far.  What have been our major influencers?

Six months is a very short time span in which to say anything is shaping a sector, but it’s also a good time frame for a snapshot. It wasn’t until I started thinking about what’s happened recently that I realized how dizzying the activity has been across the spectrum and potentially at scale. This is critical. In this year alone we are seeing some of the biggest players make bets and shifts, from the Office of the National Coordinator for Health Information Technology (ONC) to Apple, which means the digital health ecosystem will be impacted, and it could happen at scale.

-1First, look at the activity and record levels of venture funding in the digital health space; $700M in Q1 2014 alone, an 87% year over year increase according to Rock Health. This recent Harvard Business Review piece nicely summarizes why the time to be in digital health is now. There has (finally) been some chatter that we are approaching bubble territory in digital health, and while that may be true, there are at least three areas of optimism thanks to the infrastructure and ecosystem evolving at all levels: Continued Federal activity, Fortune 500/Wall Street involvement, and diversified venture funding.

1. Federal Government: Continued Data Liquidity Push
The federal activity from this year is across the board. Some highlights that will challenge entrepreneurs to develop a continued drive for enhanced data and information liquidity with an improved consumer experience over the long run include the following:

  • ONC releases 10 year interoperability vision
  • ONC re-organizes and creates an API committee. This wouldn’t have happened as recently as two years ago.
  • Medicare announces an historic data release of physician payment data revises other data related guidelines, potentially opening more access to commercial entities
  • FDA Open Data releases millions of files to entrepreneuers in a more accessible format
  • Healthcare.gov helps enroll millions of people

2. Digital Health at Scale: Fortune 500 Involvement

Following on CMS data transparency efforts, some of the largest health insurers, including Aetna, United Health and Humana, announced they will release payment data to consumers. And speaking of consumers, technology companies including Intel, Samsung, and Apple have entered in a big way, and it’s clear that wearables have gone mainstream. The Fortune 500 are paying attention and are also forming collaborations across silos, such as the Apple Epic and Mayo partnership, including:

  • Intel’s $100M+ acquisition of Basis
  • Samsung’s $50M digital health fund + S Health launch
  • The Apple Health Kit
  • Health insurance giants making payment data public

3. Startup Diversification & Investment: New Entrants

The third signal flare from 2014 to watch is the increased diversity of players including some who haven’t been as involved previously. This includes investments this year from venture funds Social+Capital and Andreessen Horowitz (a16z). Some of the new entrants are driving record amounts of funding and are bringing greater assets to bear.  Here are some highlights of startup activity:

  • Flatiron Health had one of the largest series B rounds in the digital health space ($130M)
  • Omada Health gets $28M series B lead by a16z
  • Better raises $5M from Social+Capital
  • Nant Health receives $100M from the Kuwait Investment Authority
  • 16 digital health acquisitions to date

Digital health innovation is still the wild West, admittedly, and there are many hurdles. What’s clear is that these three areas have backing from actors who can scale and bring on the best talent in the world. They’re creating a robust ecosystem that is shaping innovation in digital health. Across the board, there is a larger theme taking shape of capturing, aggregating and democratizing access to data, which is spurring entrepreneurial activity and the consumerization of health. In addition, novel cross-silo partnerships are forming. Collaboration across the health and tech sectors is no longer an option; it is a necessity if we are going to drive meaningful change in healthcare.

Which three things would you point to as harbingers for 2014?   TMIcon

 

Aman Bhandari has worked in corporate, non-profit and government organizations. He formerly worked for Todd Park, the US CTO, at the White House, where he helped to launch a variety of global and national health policy initiatives at the intersection of health IT, data, and innovation. He also co-launched the Health2.0 code-a-thon and developer challenge series. Follow him @GHideas.

 

Reshaping the healthcare workforce: Two case studies

Healthcare is calling for all hands on deck.  Most pundits are anticipating a primary care shortage thanks to greater usage of primary care under the Affordable Care Act.  And with the rise in demand comes increased costs from an already bloated system.

What’s the remedy?  Among suggested strategies on how to add workers, like making it easier and less expensive to train doctors, are innovative initiatives that address the problem from inside out:  Making better use of the staff already in place – like allowing nurse practitioners to practice independently – or adding help at the clinician or community level.

Following are two case studies of care systems that have overhauled delivery with significant results.

Union Health Center: Modeling the A-ICU

Audrey Lum, Chief Clinical Officer of Union Health Center (UHC) in New York City, began reforming Union’s health care team along with Union administrators following a 2005 white paper from the California Health Care Foundation talking about how to serve the highest-cost patients – those with chronic health conditions – who were also under- or uninsured, low-income and not eligible for Medicare or Medicaid. Could these patients be better served, while reducing overall health costs at the same time?

The paper offered a solution: the Ambulatory Intensive Care Unit (A-ICU), which uses nurses, medical assistants, health coaches, community health workers, pharmacists, dietitians and others working at the very top of their capabilities and licensure as the front line of patient assistance and coaching, to allow physician and nurse practitioners to do more of what they’re best at: diagnosing, prescribing and managing care of complex cases.

Audrey Lum and Troy Trygstad discussed their patient home models on a recent Great Challenges Hangout about rethinking the healthcare work force.  Watch a recap:

TEDMED Great Challenges: Shifting Work: Can rethinking the healthcare workforce drive down medica…

UHC was the perfect petri dish for its experiment, a health center with diverse patient base and unique history. Established in 1914 by the International Ladies’ Garment Workers’ Union, its patients are mainly still union members – laundry workers; porters; doormen – and unions subsidize their care, including operations costs. Around 30 percent of their patients are privately insured.

The center created health care teams staffed by physicians, patient care assistants, two health coaches, assistants and support staff. Teams work off of patient education templates created by clinicians, with input from all.

“It’s about educating patients and helping them learn how to take care of themselves.  If you have a chronic disease, you live with it 365 days a year; you only go to the doctor when you’re very sick. How could we incorporate the preventative part of that in our care model?” Lum says.

Hiring culturally proficient health coaches and assistants helped make patients feel comfortable; the staff seem to be de facto community health workers. Staffers speak Spanish, Chinese and Creole, among other languages.

“They’re in the same neighborhoods and they shop in the stores, so there’s that separate connection. It speak to the relationship model of,  ‘We’re in this together. Let’s get better as a team,’ “ she says.

Results are good. A 2014 case study review found that the total per member, per month costs for UHC as of 2013 were 17 percent lower than non-UHC patients, and that emergency room costs were 50 percent less. Patient time in the office decreased from 2 hours to an average of 48 minutes.

Training workers was an investment, Lum allows. It takes up to nine months for assistants to complete, with time dedicated specifically for staff to train with nurses and nutritionists. Union had the help of a grant from The Hitachi Foundation to set its change in motion. Still, the results beg the question: Why aren’t more practices doing this?

“It takes a lot of effort, and it takes a lot of time. People don’t realize that when you give a lot upfront, you get it back at the end.  But when you’re trying to see as many patients as possible and get your fees-for-service, you want instant gratification,” Lum says.

Community Care Workers Calling

In the Community Care of North Carolina (CCNC) model, the patient home extends to the front door. In 2008, the state initiated a population-based transitional care initiative to prevent recurrent hospitalizations among high-risk Medicaid recipients with complex chronic medical conditions. Today, the community-based program establishes a medical home for more than 1.4 million patients.

Under the program, care managers follow patients, including home visits, with a special eye to medication adherence, reporting back to a primary care medical home; 90 percent of primary care providers in the state – and every hospital – participate, as do local health and social services departments. Physicians oversee care and share data on a dedicated network.

“We need health workforce reorganization to move from ‘when a patient who has a problem, they come to me’ to ‘a patient has a problem and we’re going to manage it no matter what.’ It becomes more about what happens outside of an encounter with a physician,” Trygstad says.

CCNC patient admission rates are consistently 40-50% lower than non-CCNC Medicaid patients. In a study of patients hospitalized during 2010–11, CCNC found that those who received transitional care were 20 percent less likely to have a readmission the following year compared to clinically similar patients who received usual care.  As measured in 2011, resulting four-year savings to the state for hospital costs and other services were estimated at nearly $1 billion.  In fact, North Carolina is the only state with consistent declining growth rates in medical spending over a decade.

Oregon, Colorado and Oklahoma have similar programs, but Troy Trygstad, Vice President of Pharmacy Programs for CCNC, says:

There were three key ingredients in the primordial goo in North Carolina that resulted in this DNA. There’s a strong historical culture of primary care and public health and population management by virtue of a strong emphases on rural health, supported by medical centers and big universities.

The second thing is that it happened early enough that a lot of the traditional barriers of entry weren’t established. There are certain stakeholders in health system that want to do care coordination and control infomatics, and they’re not going to be interested in an organic provider model that can take on risk.

The third thing is true championship. If you didn’t have strong personalities going to battle over time you wouldn’t be able to maintain [a program like this].

Live event: Can rethinking the healthcare workforce help drive down medical costs?

There’s no shortage of news, or worry, about the coming scarcity of healthcare workers. But is there really a problem? What if we’ve got enough hands, but just need to align tasks better?

shutterstock_172496525According to a study from the Annals of Family Medicine, one doctor can reasonably help 983 patients in a year working solo. As part of a team and delegating some tasks to others, that same doctor could potentially reach 1, 947 patients.

As Ed Salsberg, a research professor at the George Washington University Center for Health Workforce Research and Policy, said:

How we use workers also directly impacts costs, efficiency and quality. If we only allow highly educated practitioners to provide certain services…we are likely to drive up costs and may limit access. If we allow a lesser-educated caregiver to provide services, it may be beyond their skills and training. So how do we know who is qualified to provide what services?

What needs to happen on all fronts to make that work? How can we handle rural and under served areas? Who should play bigger roles: Nurses, pharmacists, technicians? What would that mean for costs? What are our future healthcare needs, and how can we meet them?

Join a TEDMED Great Challenges live event this Tuesday, May 20 at noon ET with Salsberg and others on the forefront of rethinking the healthcare workforce. Kick off the conversation today by tweeting your questions and comments to #GreatChallenges and we’ll discuss them on air.

Disordered: What causes kids to lose control over eating?

An 11-year-old boy – let’s call him Enrico – had a tough day at school. He’d done poorly on a math test – again – and some boys picked on him during gym because he’d missed an important free throw. Enrico walked home from the bus, let himself into the house and grabbed an unopened extra-large package of chips. He took one, then another; he ended up methodically eating the entire package, even though he’d even felt a little sick half way through. He simply couldn’t stop himself. It wasn’t the first time it had happened; in fact, it had gone on long enough that Enrico had started to become overweight.

shutterstock_39643708A hypothetical story, but not an unusual one. Loss of control (LOC) eating is the most common disordered eating behavior in overweight kids, even pre-adolescents. A mental disorder that causes people to lose control of the amount or type of food they ingest, binge eating is also the most common eating disorder in the United States. Up to half of adults who seek weight loss treatment may suffer from it – and those who do often report that they began having weight problems at a younger age. In some cases, binge eating promotes excess weight gain and obesity.

Marian Tanofsky-Kraff, an Associate Professor at the Uniformed Services University of the Health Sciences, says many of the issues that predict obesity are also linked to eating disorders. It’s an evolving field; binge eating was only last year classified as a disorder by the American Psychiatric Association. Like the obesity epidemic itself, the causes of binge eating in kids are varied and complex, from anxiety to environmental triggers.

“Our obesogenic environment promotes loss of control. When we were in school, there weren’t birthday cupcakes every day of the month. We weren’t surrounded by junk food. I’ll hear about kids in a Saturday morning dance class whose moms make a list of who’s bringing brownies for the next class,” she says.

Eating disorders in children have been associated with depression and anxiety, yet younger kids have a harder time pinpointing emotions or realizing triggers, Tanofsky-Kraff says. She conducts interpersonal therapy with children to help them express their experiences, as it’s often upon reflection that they realize the trigger of an unhappy experience like Enrico’s.

Primary care clinicians could help, too, by asking about eating patterns rather than just noting height and weight, which could help pinpoint LOC eating.

“We can focus on that excessive intake instead of saying, well, just jog an extra mile and eat healthier, which is quite difficult to do. We don’t live in a society that promotes moderation. We live in a society of extremes,” Tanofsky-Kraff says.

Super Heroes: Role Models Help Keep Kids on Track

The best places to begin to teach moderation and healthy eating are in homes and schools, says Lynn James, a Senior Extension Educator at Penn State Extension in Sunbury, PA.

“Children are not going to make good connections or changes if they don’t see the adults around them walking the walk themselves. If healthy food’s not in the home, there’s no chance they’re going to eat it at home,” she says.

The Extension, part of Penn State’s College of Agricultural Sciences, runs many group education programs, including Family Fitness, in which parents attend classes on how to make healthy food choices right along with their kids. Another called Cook Smart, Eat Smart teaches basic food prep and planning to young adults and parents of teens, and Nutrition Links helps low-income families eat well on a budget.

Proud2BMe is a youth outreach project of the National Eating Disorders Association (NEDA) that tackles another big influence on what kids see and hear: the media. Claire Mesko, who runs the project, says that uphill battle is only compounded by social media, which means kids can be bombarded virtually 24/7 by airbrushed images that convey the ideal that only a certain kind of face and body is attractive and only perfection will do. Boys hear about extreme workouts and bulking up.

“There are lot of mixed messages about food body weight and health, and its very difficult to intuitively know how to eat healthfully. Phrases like ‘sinfully delicious’ promote the idea that there are good and bad foods and things to avoid, and that if we indulge we are slipping up,” she says.

Proud2BMe counters with stories and webinars explaining just how images and messages are manipulated, and provides a forum for a lively online community of bloggers and boards where kids can share thoughts or stories of their own struggles with disordered eating. NEDA is also working on public policy to expand mental health coverage for eating disorders.

“We have several states now that have made eating disorders information mandatory for parents, and we would like them to conduct eating disorder screenings right along with BMI tests,” Mesko says.

Join a Great Challenges Google + Hangout Tuesday, May 6 at 12pm ET to talk about disordered eating in children and ways to help keep them healthy through empowerment and effective role modeling.

Better outcomes for engaged patients may start with an empathic doctor

An engaged patient, one who is knowledgeable about his condition and feels confident in his skills to help manage his own care, may in turn contribute to improved outcomes and reduced costs for himself and for the system.  There are even ways to measure their ability to take a stake, including the Patient Activation Measure (PAM).

On last Tuesday’s Great Challenges Hangout, we gathered a team of thought leaders to explore PAM and how well it measured patient engagement. Of course, getting patients to take a more active role is a two-way street; well-managed care involves solid clinician-patient collaboration.

TEDMED Great Challenges: Making the Grade: Examining the Case for Patient Activation Measures

What, then, can providers do to make this happen, and who tracks how well they do it?  We’re not talking about best-doctor magazines or web site rankings, but an across-the-board measure of how doctors succeed in relating to patients – a “doctor activation measure,” as one of our Community Members called it in his tweet.

As it turns out, there’s no universally used rating for clinician engagement. But there is one trait that has, in study after study, shown to positively affect patient engagement and outcome: empathy.

Clinician empathy leads to greater patient satisfaction, increased compliance and better outcomes. It boosts job satisfaction for providers.  It may be particularly helpful in cases of chronic illness; In one study, patients with diabetes had measurably better outcomes when their doctors scored higher on the Jefferson Scale of Empathy, a tool that measures patients’ perceptions of physician caring. A recent systemic review and meta-analysis concluded that the patient-physician relationship had a small but measurable effect on patient health outcomes.

Yet with so many patients seen in limited time increments, and the increasing specialization of medicine, how can doctors get – and remain – empathetic?

Here’s the neat part:  They can be taught. Researchers as Massachusetts General Hospital gave residents three 60-minute empathy training modules. The courses explained the neurobiology of empathy, showing physiological responses to dismissive comments. Based on another scale, the Consultation and Relational Empathy (CARE) measure, the group with training showed higher scores than those without.

Understanding how our brains process and respond to verbal and physical cues is key to shaping behavior, says Helen Riess, a psychiatrist who developed the modules and led the study. As grounded in science as clinicians are, they can forget their autonomic nervous systems may lead them to act in ways they don’t intend.

That doesn’t mean a physician needs to or should feel deeply emotional about a patient’s outcome. More important is an awareness of how actions might be perceived.

“Empathy has cognitive, emotional, behavioral and moral components. Sometimes we really feel for another person; another time we cognitively understand what they’re going through, but we may not feel it because we’re tired. That still leaves us a choice to behave in a more empathic and caring way,” Riess says.

Empathy among med students tends to erode in the third year.  Perhaps this is where intervention can begin; as this blog has reported, some schools, including Harvard Medical, are exploring ways for doctors to learn to see patients holistically, including a curriculum called the Longitudinal Integrated Clerkship in which students follow a patient’s case from beginning to conclusion.

In the end, showing empathy can start with measures as sitting down to listen to a patient and making eye contact.

“If you can learn empathic behaviors and be respectful and kind, that’s really what the patient is going to remember at the end of the day,” Riess says.