Durham Health Innovations Localizes Health Care Reform

On the heels of the passage of historic national health care reform legislation, nearly 500 stakeholders throughout Durham met Monday to take the next major steps in a one-of-a-kind community-driven effort they believe is a local expression of health care reform that will improve the community’s overall health.

Last year, Durham Health Innovations announced the creation of 10 community-based planning and risk assessment teams that were supported by $1 million from a Duke Medicine investment in the Duke Translational Medicine Institute (DTMI).

This effort is part of a major national program of the National Institutes of Health through its Clinical and Translational Sciences Award (CTSA) program.

During the past year, the teams worked closely with Durham public service agencies, conducting in-depth analyses of existing services, identifying redundancies, and pinpointing where more services are needed. Their exhaustive reports, which are still being compiled, aim to reach a community-wide consensus for an innovative, collaborative approach to health improvement.

“We know that health indices vary from state to state,” says Gayle Harris, Durham County Health Director. “Our collaborative research shows it varies just as much on a neighborhood level. That’s where changes need to take place. Working in partnership with Duke Medicine, we have identified some key opportunities for improving the health of our residents and will now start designing a method to address those opportunities.”

Durham’s approach to a community-based health improvement plan is consistent with the views of U.S. Surgeon General Regina Benjamin, MD, who provided the meeting’s keynote address.

“To be successful, this effort will require the kind of unprecedented commitment, collaboration, participation, creativity, and trust among all of the many stakeholders that has been evident in this process to date,” says Victor J. Dzau, MD, Chancellor for Health Affairs, Duke University, and CEO of Duke University Health System. “Duke Medicine is but one of many, many participants in this initiative, but we are fully committed to playing our role in improving the health of the people of Durham.”

Durham Health Innovations puts the health disparities encountered in Durham front and center. While the county is among the top quarter of North Carolina counties for health outcomes, the state of North Carolina ranks among the nation’s bottom half in health outcomes.

For example, only 46 percent of adults with diabetes in North Carolina receive needed preventive care, and the hospitalization rate for children with asthma is three times the rate of that seen in the top-ranked state.

At the same time, availability of medical services is not necessarily the challenge.  “Access is not always the issue,” says Lloyd Michener, MD, chairman of the department of community and family medicine at Duke. “Many people who have insurance still do not seek care and, ultimately, have poor health outcomes. Working with community-based agencies, we took the initiative to identify how we can work together to make a difference.”

That interaction is crucial, agrees Rob Califf, MD, a cardiologist and director the Duke Translational Medicine Institute. “Every community is going to have a different combination of assets, resources, and issues to work through. Engaging with the community, having them identify their specific needs, and planning side-by-side with local agencies allows us to work on the development of a new system that will be close, connected, and accountable.”

The 10 DHI teams addressed conditions that included adolescent health, maternal health and senior health, as well as specific diseases such as asthma, cancer, heart disease, diabetes, HIV and sexually transmitted diseases, pain management, and substance abuse.

Team members spent the past year conducting a county-wide analysis of health care patterns. They spoke to community residents, analyzed utilization data, and factored in socio-economic, environmental, and biological influences, which all play a role in the population’s health. Geospatial mapping pinpointed each area’s health care needs.

The endeavor was challenging, says Michener. “We knew this would be a learning process at every level, from the amount of work involved, to the gathering of different thoughts and ideas. But our efforts have been worth it. We’ve gotten to a level of detail that far exceeded our expectations.”

Toward that end, several of the teams have already garnered enough data to pursue additional funding. The next step will be the formation of an implementation team charged with taking much of the teams’ research and planning to the execution level.

Health Law Will Demand Calorie on Menus Nationwide

As part of the new healthcare reform, more than 200,000 chain will have to include calorie counts on menus, menu boards, buffets, vending machines, alcoholic drink menus and even drive-throughs making it harder for diners to ignore what they are eating. Apart from calorie counts the menus will need to inform the customer about sodium, carbohydrates, fiber and protein contained in the food item and portion.

“The nutrition information is right on the menu or menu board next to the name of the menu item, rather than in a pamphlet or in tiny print on a poster, so that consumers can see it when they are making ordering decisions,” says Iowa Sen. Tom Harkin, chairman of the Health, Education, Labor and Pensions Committee, who wrote the provision. “That growing patchwork of regulations and legislation in different parts of the country has been a real challenge, and this will allow operators to better be able to provide their information,” she said.

The purpose of this directive is to create awareness among customers and stop food stores from hiding the calories. At present many restaurants give the calories counts and nutritional information in a hallway, food wrapper or on their websites. This new law will make such information more readily available. This will also help aid in the fight of obesity in our country.

Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest, said it’s one step in the fight against obesity. “Coffee drinks can range from 20 calories to 800 calories, and burgers can range from 250 calories to well over 1,000 calories,” she said.

Some portions of the law will go into effect immediately. Experts estimated that it could take up to two years before the menu guidelines are issued.

“While it’s a huge victory for consumers, it’s just one of dozens of things we will need to do to reduce rates of obesity and diet-related disease in this country.” The National Restaurant Association dropped its longstanding objection to menu-labeling last year and supported the language passed in Congress, Wootan said.

Back-To-School Preparation Includes Health Insurance

With summer vacation coming to an end and Kentucky children headed back to school, it’s a good time to make sure health insurance is part of your child’s preparation for the new school year.

Kentucky Children’s Health Insurance Program (KCHIP) representatives have been visiting schools to spread the word about KCHIP, and back-to-school promotional materials, including bookmarks for students, are being distributed through Family Resource and Youth Services Centers (FRYSCs) in schools. A statewide radio campaign, in addition to other promotional efforts, reminds parents to make sure their children have health insurance.

“This month is a good time for parents to think about making sure their children have the tools they need to learn and succeed in the classroom, and nothing is more important than health care,” said Gov. Steve Beshear.

“It’s easy for parents to lose track of health insurance needs for children over the summer,” said Cabinet for Health and Family Services (CHFS) Secretary Janie Miller. “With school starting, it’s the perfect opportunity to take that extra step to make sure your child is covered for both routine and emergency care.”

As of the end of July, 22,212 additional children were enrolled in the KCHIP or Medicaid programs, an average of more than 2,500 children per month, since the end of October 2008. The Beshear Plan to dramatically cut the number of children without health coverage by removing barriers to KCHIP and Medicaid enrollment kicked off Nov. 1, 2008, and aims to enroll 35,000 eligible children by the end of fiscal year 2010.

The statewide initiative includes a simplified mail-in application, available online, and targeted outreach efforts. Efforts have included a focus on training community partners to assist with completion of applications; availability of enrollment materials at local health departments, Department for Community Based Services (DCBS) offices and FRYSCs; and outreach through health care providers, community action agencies, day care centers, faith-based organizations and many others. Approximately 250,000 mail-in applications, in both English and Spanish, have been distributed through these partnerships. In addition, CHFS has intensified efforts to re-enroll children who had previously been covered through the programs, including making policy changes to allow families an additional 30 days to return renewal information.

The KCHIP program provides health insurance to children whose family income is below 200 percent of the federal poverty level, about $44,100 a year for a family of four.

Nintendo Issues Health Warning for Children Playing 3D Games

Nintendo will launch a new portable 3D video game player in 2011 but warns that it may not be suitable for children under the age of 6. The Japanese company warns that the use of such a device in 3D mode could potentially impact the development of children’s eyes.

The company states that experts have found that the delivery of different artificial images to the left and right eye, as what occurs in all 3D images, whether from television, movies or games, can affect the neural processing that is still in development in the eyes of young children.

Read: 3D Movies May Cause or Reveal Vision Issues

3D images are particularly of concern in children with amblyopia, or “lazy eye”. Dr. Michael Ehrenhaus, an ophthalmologist in New York, tells Fox News “amblyopia and the additional eye strain of 3D may not be a safe combination.”

Other negative health effects that can occur include altered vision, eye or muscle twitches, involuntary movements, loss of awareness and disorientation. About one player in 4,000 may suffer seizures or blackouts.

Read: Physical Activity Cannot Compensate for Excessive Screen Time

The Nintendo 3DS will be released in Japan in February of next year with launches planned for the US in March. The device will sell for about $300.

The technology of the system allows the gamer to play without the use of special glasses. It will still feature the trademark DS dual screens with the upper screen providing 3D images and the other controlled by touch with a stylus.

Games can be played in both 2D and 3D, and the device will have a parental control feature so that parents can restrict young children to only 2D games. Nintendo also recommends that all users take breaks every 30 minutes when playing 3D to prevent eyestrain and headaches from prolonged use.

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