Pioneering Ideas

C. diff Infections: Worse Than We Thought

BY RAMANAN LAXMINARAYAN, PROJECT DIRECTOR, EXTENDING THE CURE

Infections caused by the dangerous microbe Clostridium difficile, or C. diff, are much more prevalent in hospitals and health care facilities than previously reported, according to an investigative front page story in last week’s USA Today. This bug is most often seen in hospitals, nursing homes, and other medical facilities. It causes severe diarrhea and intestinal problems that can worsen and even be fatal. The story cites a scientist from the Centers for Disease Control and Prevention who says annual fatalities may be as high as 30,000 per year, more than twice as high as some recent estimates.

The article accurately points to many reasons for this problem. Many hospital infection control programs aren’t stringent enough and C. diff reporting rates are poor. Hospitals need to be more prudent in their antibiotic use. C. diff thrives when healthy bacteria usually present in the intestines are wiped out by certain antibiotics patients take. In the absence of these healthy bacteria, C. diff can take over. 

The problem is exacerbated by the overuse of antibiotics, often in place of effective infection control. All health care providers – in health care facilities and in the community –  must use antibiotics prudently in order to slow the rate at which these powerful drugs become ineffective against C. diff, MRSA, and other dangerous bacteria.

We know that the evolutionary battle with microbes is, by nature, a losing one. Bacteria will continue to become resistant faster than our efforts to stop them. So as current antibiotics become ineffective, we need new drugs at the ready. However, efforts to bring new drugs to market need to be coupled with plans to conserve their use to maintain their effectiveness.

In order to get to the root of a problem like C. diff, we need comprehensive solutions that address not just antibiotic overuse but also infection prevention (such as vaccination) and infection control.

Check out new research from Extending the Cure showing how overuse of certain antibiotics correlates with C. diff deaths and hospitalization rates in the United States.

Read about the economics of drug resistance in a recent cover story featured in the Milken Institute Review by Ramanan Laxminarayan.

Follow Extending the Cure on Twitter @ExtendgtheCure.

Ramanan Laxminarayan is director of Extending the Cure, a research effort that examines policy solutions to address the growing problem of antibiotic resistance. The project is based at the Center for Disease Dynamics, Economics & Policy (CDDEP) in Washington, D.C., and is funded in part by the Pioneer Portfolio of the Robert Wood Johnson Foundation.

Health Games Research Grantees Report Research Discoveries in the July 2012 Issue of Journal of Diabetes Science and Technology

BY DEBRA LIEBERMAN, PHD, DIRECTOR OF HEALTH GAMES RESEARCH, UC SANTA BARBARA –  @GamesResearch  @DebLieberman

This month, five grantees of the Health Games Research national program have published peer-reviewed research articles in the Journal of Diabetes Science and Technology, in a special issue symposium called “Serious Games for Diabetes, Obesity, and Healthy Lifestyle.”  Their research has discovered innovative ways to improve the design and effectiveness of active video games that require physical exertion in order to play.

The studies have identified, for example, evidence-based game design strategies that motivate college students to increase their physical activity; insights into the benefits of cooperative game play that can motivate overweight and obese adolescents to put more effort into active games; and new approaches to using teamwork in active games to increase player effort and exertion.  The studies used Wii Active and Wii Fit games, stationary bikes with video screens enabling virtual tours and racing games, a motion sensor game, and an alternate reality game.  I served as a guest co-editor of the special issue symposium along with guest co-editor Deborah Thompson, PhD, an associate professor of pediatrics at Baylor College of Medicine and a USDA/ARS scientist/nutritionist.  

In addition to the five featured studies, the symposium contains two articles that provide background related to the symposium theme.  I wrote an article that discusses 14 diabetes self-management video games and their behavioral health design strategies.  Deborah Thompson wrote an article presenting theory-based approaches to the design and future research of health games.

Here are more details about the five grantee studies:

• Staiano, A.E., Abraham, A.A., & Calvert, S.L.,  Motivating Effects of Cooperative Exergame Play for Overweight and Obese Adolescents, explored factors that motivated overweight and obese African-American high school students to play Wii Active games in a school-based lunchtime and after-school program.  The study found greater and more sustained energy expenditure over time in a cooperative play condition, compared to a competitive play condition, and found that players’ various intrinsic motivations to play also influenced their level of energy expenditure.  The study points to the advantages of cooperative game play for this population and it demonstrates that games can be especially effective when they enable players to do what is personally important, relevant, and intrinsically motivating to them.  Grantee: Georgetown University.

• Feltz, D.L., Irwin, B., & Kerr, N., Two-Player Partnered Exergame for Obesity Prevention: Using Discrepancy in Players' Ability as a Strategy to Motivate Physical Activity, examined the influence of a virtual partner who was more capable than the player in carrying out physical challenges in an EyeToy Kinetic motion sensor exergame; study participants were college students.  Each player in the study knew that the team could perform only as well as the weaker team member, and this motivated the player to strive to complete the workout challenges, to keep up with the more capable virtual partner.  The study found that the player exerted the most effort when the virtual partner was moderately more capable than the player, compared to a virtual partner that was only slightly more capable or extremely more capable.  These findings will help future game designers use avatars and other types of virtual characters more effectively as workout partners that can motivate players to exert increased physical effort and sustain it for longer periods of time.  Grantee: Michigan State University.

• Johnston, J.D., Massey, A.P., & Marker-Hoffman R.L., Using an Alternate Reality Game to Increase Physical Activity and Decrease Obesity Risk of College Students investigated effects of an alternate reality game (ARG), called The Skeleton Chase, on college students' physical activity.  An ARG is an interactive fictional game experience that takes place in the real world and uses a variety of media to reveal the story and engage the player.  The Skeleton Chase was designed to meet the learning preferences of today's college students: collaborative and social, experiential and media-rich.  The study compared the physical activity of students who were assigned either to participate in the ARG, which required a great deal of physical activity in order to play, or were assigned to use exercise equipment in weekly lab sessions.  It found that physical activity increased over time among students who played the ARG, while it decreased over the same time period for students who used exercise equipment.  The study demonstrates the power of immersive stories to motivate behavior change.  When specific health behaviors are aligned with the dramatic action of a story, players are motivated to carry out the behaviors in order to advance the plot and, in this case, to solve a mystery.  Grantee: Indiana University.

• Lyons, E.J., Tate, D.F., Komoski, S.E., Carr, P.M., & Ward, D.S., Novel Approaches to Obesity Prevention: Effects of Game Enjoyment and Game Type on Energy Expenditure in Active Video Games contrasted effects of Wii Fit active games that are exercise-themed (such as a game designed to motivate and support jogging) versus those that are entertainment-themed (such as a hula hoop game), for young adults ages 18 to 35.  The study found that exercise-themed games produced more energy expenditure, while entertainment-themed games were more enjoyable.  The researchers concluded that integrating strenuous activity into entertainment-themed games, instead of exercise-themed games, may be a more successful strategy to attract players who are not very motivated to be physically active.  Grantee: University of North Carolina.

• Anderson-Hanley, C., Arciero, P., Westen, S., Nimon, J., & Zimmerman, E., Neuropsychological Benefits of Stationary Bike Exercise and a Cybercycle Exergame for Older Adults with Diabetes: An Exploratory Analysis looked at effects of stationary biking on the cognitive functioning of older adults with and without diabetes.  Study participants included older adults ages 60 to 88 who resided in independent living facilities. The study analyzed a small dataset from a larger randomized clinical trial called the Cybercycle Study, which compared effects of traditional stationary cycling versus cybercycling that provides a video screen displaying appealing bike paths, virtual tours, and individual and team racing games with virtual competitors.  The study of the small dataset found that participants with diabetes who used stationary bikes with and without cybercycling screens significantly improved in cognitive functioning in areas such as planning and mental flexibility for shifting sets, while participants without diabetes did not improve.  The study provides evidence that exergame-based physical activity can help improve certain cognitive skills in older adults, in this case most notably for older adults who have diabetes.  Grantee: Union College.

Congratulations to our grantees for their groundbreaking work published in a leading medical journal. Also, I extend tremendous appreciation and thanks to co-editor and author Deborah Thompson for her expertise and valuable contributions to the symposium, and to the journal for featuring a special issue symposium in our field.  A growing number of top medical journals, such as the Journal of Diabetes Science and Technology, are publishing research on the design and effectiveness of health games, and so now the theoretical foundations and body of evidence to support our work are becoming more widely known among health care providers and health games researchers.  This is helping our field develop more effective health game designs, implement health games more successfully with specific target populations, and do more with digital games and game technologies to improve players’ health behaviors and outcomes – and this, of course, is our ultimate goal with health games.

Flu Season Dangers: Spikes in Antibiotic Resistance

An op-ed published Monday in Modern Healthcare describes how the overuse of antibiotics during flu season makes the growing problem of antibiotic resistance worse, even in the short-term.  This research--from a new study last month in the journal Clinical Infectious Diseases--found that spikes in prescription sales for two popular groups of antibiotics during flu season led to a rapid increase, one month later, in resistant Escherichia coli (E. coli) in hospitals. It also found a rise in methicillin-resistant Staphylococcus aureas (MRSA) linked to increases in prescriptions of other antibiotics.  

The research was conducted by Extending the Cure, a project funded by the Pioneer Portfolio that researches and examines solutions to address antibiotic resistance.

It is well-known that exposure to antibiotics leads disease-causing microbes to become resistant to these powerful drugs.  This study showing seasonal fluctuations in resistance adds a new urgency to public health efforts to combat the problem of resistance.

In the op-ed, Ramanan Laxminarayan, study author and director of Extending the Cure, calls for a joint effort among hospitals, consumers, doctors and public health officials to make wiser use of antibiotics and help fight antibiotic overuse, especially during the flu season. Among his recommendations:

• All healthy people 6 months and up, especially health care workers, should get annual flu shots (unless their doctor advises against it). Less people with the flu means fewer unnecessary antibiotic prescriptions.
• People demand antibiotics when they or their children have the flu or a cold, despite the fact that the drugs don’t work against viruses. Consumers can resist the urge to demand an antibiotic at the first sign of the illness.
• Public health officials and hospitals should coordinate their antibiotic use education campaigns when they anticipate spikes in overuse, such as during flu season.

Laxminarayan also asks all of us to start viewing antibiotics as a natural resource that can be depleted with overuse, much like oil or water, which must be conserved so these resources are there for us when we need them.

In a 2011 policy brief, Extending the Cure summarized the latest research on strategies to reduce doctor’s over-prescribing of antibiotics, such as: education programs, the use of incentives, and mandating appropriate prescribing.

Read a related post about a cover story in the Milken Institute Review on the economics of antibiotic resistance from Ramanan Laxminarayan.

Let us know what you think:  How can we conserve our use of antibiotics as individual consumers? As a society?  Leave a comment here or tweet @PioneerRWJF #SaveAbx and @CDDEP to tell us what you think.

Can Economics Solve the Antibiotic Resistance Crisis?

BY BRIAN C. QUINN, PHD, team director and senior program officer, Pioneer Portfolio -- @quinnhealth

At the Robert Wood Johnson Foundation (RWJF), we fund grantees looking for innovative solutions to seemingly intractable health problems.  We take risks to test ideas and approaches that could lead to exponential changes that improve or even save lives.

One of the ways our Pioneer portfolio grantees size up complex public health issues is by using a novel lens to view an existing problem. That’s exactly the approach taken by Extending the Cure, a project that studies the growing problem of antibiotic resistance from an environmental economics perspective.

In a cover story in latest issue of the Milken Institute Review, Ramanan Laxminarayan, director of Extending the Cure, examines the growing – and frightening – problem of antibiotic resistance.  Laxminarayan suggests that antibiotic effectiveness should be viewed as a limited natural resource, one that can be depleted with overuse.  Just as we take steps to preserve clean air and water, we must also conserve antibiotics by using them only when absolutely necessary, he says.

Using this natural resources framing, he points to the types of backwards incentives and market failures in our hospitals and research and development pipeline that have contributed to the problem. His proposal:  Create incentives for conserving current and future antibiotics while simultaneously developing new drug therapies. Laxminarayan says that the current market does not give drug companies incentives to ensure antibiotics are used judiciously.

By looking at the problem of antibiotic resistance through an environmental and economic lens, this project has identified new solutions that traditional public health approaches might have missed.

Let us know what you think on Twitter, Facebook, or by commenting below: What other strategies must be employed to solve this serious public health problem?   How else can we realign incentives to drive health improvement?

Meta Care

BY NANCY BARRAND, SENIOR ADVISOR FOR PROGRAM DEVELOPMENT

“You need a logarithmic methodology to expand capacity to match the logarithmic increase in knowledge that is occurring worldwide.”

That’s how Dr. Sanjeev Arora described the force multiplication theory at the core of Project ECHO during last week’s launch of the ECHO model throughout the VA. It’s also a call to action for how we approach medical training and health care delivery.

Knowledge is power, yes, but in health care, knowledge is life-saving. Knowledge is more pain-free hours in the day. Knowledge is quality of life.

We need to think differently about how we share knowledge.

Let’s allow Dr. Arora to walk us through the math:

"More knowledge has been created in the last 100 years than was created in the last 5,000. And more knowledge will be created in the next 50 years than has ever occurred before. So what this leads to is a very complex issue—you have an explosion of best practices and how do you take these best practices to affect underserved populations that may be living all over the world? As a result of this knowledge explosion, what is happening is there is a shortage of highly specialized expertise all over the world, not just rural areas; even urban underserved areas experience this shortage."

He’s right. What physician can be expected to keep up with the volume of medical literature being published? Yet people are suffering every day because knowledge and best practices that exist and are easily shared don’t reach them.

We need to think differently about how we share knowledge.

So, how do we meet this call to action? Dr. Arora is offering us a path forward. The problem isn’t that knowledge is being held for power, or that expertise capacity has reached its limits. The problem is that the conduits for sharing are too narrow. Or, to be more accurate, we haven’t hooked the pipes up to the faucets.

Project ECHO is a revolutionary model of knowledge-sharing brought about by a confluence of available technology, a passionate, caring soul, and a moral imperative: No one should die for lack of knowledge. The ECHO model uses technology to leverage scarce expertise that exists primarily in places like academic medical centers and shares that specialized knowledge and suite of best practices with primary care physicians and their teams through virtual case-based learning and mentorship; this sharing creates what  Dr. Arora calls a community of practice—a knowledge network of specialists, primary care physicians, nurses, and other care team members, all focused on the same issue and all learning from each other. (Learn more about how ECHO works.)

And, while you are sharing knowledge, it turns out you are also creating knowledge. These communities of practice become two-way knowledge streets—very early on, best practices emerge from the front lines, as they often do. Only now the pipes are in place, the faucets are turned on, and once best practices start emerging, Dr. Arora points out, they “flow back to the medical center, plus they flow to each other, so you are continuously improving process with new knowledge being generated in the field.”

Let’s get back to the math. “Force multiplication—we’ve defined [it] as a logarithmic expansion of capacity to deliver complex care—10 times or greater. That’s the kind of expertise expansion that is needed.”

Better care for more people.

Imagine where we’ll be when we globalize these networks of knowledge—when all the hepatitis C ECHO clinics are connected around the world and all the diabetes ECHO clinics are one connected community of practice.

 Meta ECHO. Meta Care.

Project HealthDesign and Patient-generated Data [Video]



Project HealthDesign is a national program of the Robert Wood Johnson Foundation's Pioneer Portfolio. This post originally appeared on the Project HealthDesign blog on June 26, 2012.

BY LIBBY DOWDALL, COMMUNICATIONS COORDINATOR, PROJECT HEALTHDESIGN NATIONAL PROGRAM OFFICE

 

Throughout Project HealthDesign’s history, our grantee teams have worked closely with patients in order to explore the potential of personal health records (PHRs) and personal health data. As our first nine teams worked on their projects, they listened closely to patients and began hearing patients describe their health in idiosyncratic ways. Their work led to the recognition of observations of daily living (ODLs) — information about an individual’s life that is both patient-defined and patient-generated.

Project HealthDesign's five most recent grantee teams have carried this vision forward by designing five different technical systems that allow patients to track their ODL data. In these projects, patient participants have tracked a variety of ODLs, from daily activity and stress levels to socializing and moods.

But ODLs are just one type of patient-generated data. Other types include traditional patient-reported information about signs and symptoms (e.g., blood pressure, blood glucose), sensor data, patient preference data, and patient-reported quality assessment data.

We’ve been excited to see interest in patient-generated data grow throughout the course of the program. This month, Patricia Flatley Brennan, Project HealthDesign national program director, testified before the HIT Policy Committee’s Meaningful Use and Quality Measures Workgroups and the HIT Standards Committee’s Consumer Engagement Power Team at their Patient-generated Data Hearing. (Listen to an audio recording of the hearing.)

“Patient-defined, patient-generated data can be incredibly important in helping to understand the care process of individuals,” said Dr. Brennan. Watch the video above to learn more about Project HealthDesign’s outlook on patient-generated data.

#GFH12 Update: Health Games Research Database Adds Powerful Online Search Features

BY DEBRA LIEBERMAN, PHD, DIRECTOR OF THE HEALTH GAMES RESEARCH NATIONAL PROGRAM — @GamesResearch  @DebLieberman

Each year at the Games for Health Conference, I am excited to see how the field continues to grow.  An important way our Robert Wood Johnson Foundation national program, Health Games Research, helps move the field forward is to ensure that our colleagues – game developers, health care providers, researchers, funding agencies, investors, policy-makers, parents, educators, and more – have access to the information and resources they need.  

We are pleased to announce at this year’s conference that our Health Games Research online searchable database has been updated with new search and save features that make it easier to use and a more powerful search tool.  The Health Games Research Database is the largest publicly available repository of information about health games, with extensive information about games, publications, resources, organizations, and events.

The database has received positive reviews.  Adam Dole, business planning manager at the Mayo Clinic, has noted that the database is “my go-to source for cutting-edge clinical trials and related resources.”  Dan Baden, MD, a public health expert who is a senior liaison at the Centers for Disease Control and Prevention, said, “You have collected a wealth of information here that people have been wanting for a long time.  It is easy to use and through the search mechanism I was able to find things I had no idea existed.”

With the database’s new features, users can search by keyword, category, or topic.  The database extends each search by recommending related items that may be of interest.  Furthermore, if users log in, they can save and retrieve their search results on “My Dashboard,” which provides access to items that are “New to You” since the last time they logged into the database, items they previously flagged as “Favorites,” and items in their “Saved Searches,” including their original search results plus new relevant content.

I encourage you to explore the Health Games Research Database on our website.  Here’s a preview:  a keyword search for “obesity” yields 22 games, 52 publications, and 18 organizations.  The keyword “rehabilitation” yields seven games, 58 publications, and 21 organizations.  Similarly, there are 12 games about “smoking cessation,” 21 about “autism,” 30 about “safety,” 82 about “nutrition,” and 117 about “fitness.” 

We update the database continuously and we have a queue of items almost ready to upload.  We welcome your input, so please add to the queue!  If you know of a game, publication, resource, organization, or event that is related to health games and is not in the database, please submit it through the Recommendation Form.  You can also use the same form to give feedback about the database, provide additional information about an item, or correct any inaccurate information. 

The Health Games Research Database represents the dedicated work of our colleagues and students at University of California Santa Barbara.  I especially want to thank the deputy director of Health Games Research, Erica Biely, who has been an outstanding and deeply committed database project manager, bringing her tremendous skills, ideas, creativity, and leadership to this project.  Thank you, Erica!

Erica and I look forward to seeing colleagues at the Games for Health Conference June 12-14, 2012.  I will give a talk about the research findings of several of our 21 Health Games Research grantees and another about research on games for managing chronic conditions.  You can follow Health Games Research at @GamesResearch and see updates from the conference at #gfh12.

Project HealthDesign Calls for Patient-Generated Data in Meaningful Use Stage 3 Criteria

Last Friday, Patricia Flatley Brennan, RN, PhD, Project HealthDesign’s national program director, and Nikolai Kirienko, co-project director for Project HealthDesign’s Crohnology.MD team, testified at a hearing on the incorporation of patient-generated data into Meaningful Use Stage 3 criteria. The hearing was organized by the Meaningful Use Workgroup of the Federal Health IT Policy Committee.

Meaningful Use Stage 3, scheduled to roll out in 2016, will set requirements for health care providers seeking incentive payments for the adoption of electronic health records. Brennan’s testimony drew upon the experiences of all 14 Project HealthDesign teams working with patients and clinicians to collect and track patient-generated data. Previously, Brennan provided testimony to set requirements for the first stage of Meaningful Use. 

Kirienko’s testimony drew upon the experiences of Project HealthDesign’s Chronology.MD team; he also spoke as an advocate for patient engagement in health and health care through collaboration with clinicians around patient-generated data. His testimony focused on the need for patient access to electronic health records and the need for standards for dynamic patient engagement on mobile devices.

Follow @prjhealthdesign on Twitter.

Taking Note

BY SUZANNE MINTZ, PRESIDENT AND CEO OF THE NATIONAL FAMILY CAREGIVERS ASSOCIATION

Nearly one third of adults in the U.S. provide care for a chronically ill, disabled or aged family member or friend during any given year, spending an average of 20 hours per week providing care for their loved one. Many are responsible for helping coordinate their loved one’s medical care—keeping track of doctor’s appointments, reminding care recipients to take medications and monitoring their overall health.

Asking patients to share doctors’ notes with their family caregivers can help caregivers be more effective in this role. It can also help both patient and caregiver feel more in control and allow them to more fully engage in health care decisions. Yet few patients act on their right to access and share their doctors’ notes, lab test results and other information contained in medical records.

Reminding women—who so often play the role of family caregiver and drive health care decisions in families—that this resource is available and encouraging them to ask doctors for copies of their notes is critical. That’s why I was so pleased to read about OpenNotes in the May issue of the magazine Redbook.

OpenNotes—a project funded by the Pioneer Portfolio—is making it easier for doctors to share their notes with patients. While the project is still in the pilot phase and final results won’t be out until later this year, the researchers already have a strong indication that patients want easy access to their doctors’ notes, and want to share those notes with others: In a survey conducted at the start of the OpenNotes project, half of patients said they anticipated sharing their notes with family, friends and other health professionals. That’s good news for the 65 million family caregivers out there.

Doctors’ notes can be a powerful tool for family caregivers, whether they are caring for a parent, spouse, child, other family member or friend. At their most basic, doctors’ notes can allow caregivers to use the information captured in the notes to make sure their loved ones take medications when they need to and follow the care plans that have been prescribed. The notes can also serve as a reminder of what was discussed in the doctor’s office and the rationale behind treatment plans.

Sharing visit notes can also help break down communication barriers and build trust among doctors, patients and their caregivers. Seeing notes could diminish misunderstandings by patients and those who care for them—as well as allowing them to correct mistakes made by doctors—and provides an opportunity for patients and caregivers to ask questions, and be more connected and engaged.

I hope more patients feel empowered to ask for copies of their doctors’ notes and give permission for their family caregivers to access them as well.  Sharing doctors’ notes can engage patients and loved ones in their health care and is a simple way to make health care in America more patient- and family-centered.

Read more about OpenNotes in the Spring issue of Take Care, the newsletter of the National Family Caregivers Association.

Gaming the Field

BEN SAWYER, CO-FOUNDER, DIGITALMILL AND THE GAMES FOR HEALTH PROJECT -- @bensawyer

Today starts the eighth annual Games for Health Conference - a big week for those in the health games field. For three days (June 12-14) game designers and developers, researchers, medical professionals, educators, entrepreneurs, and policy-makers will come together in Boston, Mass., to discuss and share information about the impact games and game technologies can have on health and health care.

Founded in 2004 with support from the Robert Wood Johnson Foundation’s Pioneer Portfolio, the Games for Health Project exists to make large breakthroughs. Initially that just meant increasing belief in the notion that games could result in healthy outcomes. We tried to build a greater sense that games could improve health, and then integrate others into the fold, resulting in the emergence of new work in this field. With this in mind, I thought I’d take a moment to look back on how far we’ve come in the past few years and reflect on where we need to go.

Health Games for Everyone

Throughout 2010 and 2011 we looked at new ideas in the games for health space with the potential for large-scale impact. We looked at what existed, what worked and what didn't, and discussed building a model for where health games might be headed. This work included a number of conversations with experts and many interesting health conferences like TEDMED, Connected Health Symposium, Mayo’s Transform event, and more.

Four key thoughts that emerged from this research were:

1. The games for health space had several successes, but barely any that experienced both commercial success and large-scale health impact.
2. A new strategy had to anticipate where personal health trends and health care are headed and need to head versus where they are today.
3. We needed a strategy that optimized the consumer orientation of commercial game success while also focusing on health without being specific to a particular disease state or specific patient population-state model.
4. Thinking about commercial games and who was playing them, we realized these days it’s nearly everyone, and those that weren’t playing soon would.

Today, games for health as a field and practice is accepted. The past eight years of the Games for Health Conference have shown its attendees and the public that games can play an effective role in improving individual health. That doesn't mean the work is done; more proofs and larger successes are needed. What seems missing in this ascendancy, besides success at scale, is a larger idea about how we build a new form of public health that includes a meaningful role for games we can all rally around.

These ideas and more will be discussed at this year’s Games for Health Conference, and I encourage you to register and attend. Participants will hear from experts such as Constance Steinkuehler Squire, senior policy analyst for the White House Office of Science and Technology Policy, who will discuss the opportunities for videogames to address national challenges, and Bill Crounse, senior director of worldwide health for Microsoft, who will explore how Microsoft and its partners are merging its information and game technologies to create global solutions for personal health and professional health care.

We think there is grand opportunity still largely unrealized in the development of positive health assets, generated through meaningful gameplay, by millions of players across dozens, even hundreds, of games that strengthen individuals and those around them. This is where we want to head next with the power of all we’ve learned over the past eight years.

Positioned for Transformation: Expanding the Scope of Health Care

BY DEBORAH H. BAE, SENIOR PROGRAM OFFICE, PIONEER PORTFOLIO AND JANE ISAACS LOWE, TEAM DIRECTOR, VULNERABLE POPULATIONS PORTFOLIO -- @jisaacslowe

In the Stanford Social Innovation Review’s “Realigning Health with Care,” authors Rebecca Onie, Paul Farmer and Heidi Behforouz express their collective belief that—in the United States—we need to expand our understanding of the scope of health care, where it’s delivered and who delivers it. They also make it clear that the time to do so is now if we are going to confront our country’s rising health care costs, primary care physician shortage and expansion of the ranks of those living in poverty or hovering just above it. 

Onie, Farmer and Behforouz also propose that we need to look beyond our shores and borders for models for how to do so, pointing out that “in the developing world, there is no choice but to design health care systems that account for limited financial resources, scarce health care professionals and significant poverty.” 

We couldn’t agree more.

Since 2009, the Robert Wood Johnson Foundation has supported Health Leads, the organization led by Rebecca Onie. Health Leads enables physicians and other health care providers in six U.S. cities to prescribe basic resources, such as food and heat, for their low-income patients—just as they would medication. The model recognizes that, too often, the fact that a family lives in a mold-infested apartment or doesn’t have enough food holds greater influence over whether they can improve their health than medical care or prescriptions. As Onie, Farmer and Behforouz explain, in addition to broadening the scope of health care, Health Leads broadens where it is delivered by using family resource desks in hospital waiting rooms to connect patients with these social resources. And it extends the health care workforce by relying on passionate and skilled college volunteers to work with patients to make those connections.

In addition, the Foundation’s Pioneer team has begun to look overseas for health care solutions that have the potential to be adapted here in the United States. We’re starting off slowly, trying to learn as much as possible from our peers at other foundations who have been funding health care programs overseas for years. For example, we’ve brainstormed with colleagues at the Center for Health Market Innovations, a program funded by the Bill & Melinda Gates Foundation and the Rockefeller Foundation, about scaling and replicating innovative programs and policies that are already improving health care delivery in low- and middle-income countries.  

With this same strategy in mind, we partnered with Ashoka Changemakers to conduct a competition to seek out health care solutions from abroad, announcing the winners last month. In fact, Onie, Farmer and Behforouz highlight one of the winners of the competition in their article: Brazil’s Associação Saúde Criança. Saude Crianca—like Health Leads—recognizes that health care goes beyond the doctor’s office; to be healthy, children under their care need to be able to live in safe homes where they are well-fed and the whole family is supported on a path out of poverty.

We’re also working with the International Partnership for Innovative Healthcare Delivery to explore how health care could be delivered at lower cost by using different models of where health care is delivered and by whom. As Onie, Farmer and Behforouz point out, the United States health care system often relies too heavily on doctors in circumstances where nurses or even community health care workers are skilled to be delivering services more efficiently and at lower cost.

Despite our agreement with Onie, Farmer and Behforouz, we see challenges ahead. To begin with, we need more champions—across all sectors—for programs such as Health Leads, Saude Crianca, or any other model that addresses the gap between a patient’s medical and social needs. To increase awareness and understanding and expand the pool of those willing to advocate for changes in the health care system, the Robert Wood Johnson Foundation, in partnership with Harris Interactive, released the results of a poll late last year highlighting the fact that the vast majority of physicians believe unmet social needs are leading directly to worse health for all Americans. In early April, we hosted an online discussion asking people to share their ideas on bridging the gap between physicians’ desire to address their patients’ social needs and their lack of time or sufficient staff to do so effectively.

In addition to finding champions, we need to continue to eliminate silos that make it difficult for health care providers to address the social factors that are defining their patients’ health outcomes. Hospitals are never going to become social service agencies and they shouldn’t; that's not their expertise. We need to “properly execute the solutions we already have” by building more successful integration between health care providers and those who have the know-how and capacity to respond to patients’ social needs.

As a foundation, we will continue to seek out innovative solutions—overseas and in the United States—and to evaluate the most promising to establish that they are effective and can be spread. Just because it works in Haiti does not mean it will work in Hartford. For those models and approaches we believe can be scaled, we will provide support to enable them to develop strategies for growth that reflect an understanding of which elements of the model or approach are essential for success.

We hope you’ll join us by sharing your ideas, partnering with us to help the most effective ideas achieve the scale they need to transform health on a major scale, and to champion efforts to “make sure that what we call ‘health care’ is broad enough to get the job done.”

As Rebecca Onie, Paul Farmer and Heidi Behforouz make clear, the time to do so is now.

Of Force Multipliers and Hot Spotting: RWJF-Supported Initiatives Bring Forth Innovation

BY JOHN R. LUMPKIN, SENIOR VICE PRESIDENT AND DIRECTOR OF THE HEALTH CARE GROUP, RWJF -- @JRLUMPKIN

Innovation – the process of applying new thinking to old problems – is critical to improving our health care system.

On May 8, the Department of Health and Human Services (HHS) announced its first round of Health Care Innovation Award grants to 26 organizations nationwide, including two groundbreaking initiatives that have been supported by the Robert Wood Johnson Foundation (RWJF). Together, Project ECHO and the Camden Coalition of Healthcare Providers funded through Cooper University Hospital will receive three-year HHS grants totaling more than $11 million to amplify their efforts to improve both the quality and affordability of health care.

HHS Secretary Kathleen Sebelius noted that the awards will “provide our most creative minds … with the backing they need to build the strong, effective, affordable health care system of the future.”

In the case of both Project ECHO and the Camden Coalition, these words could not be truer.

Project ECHO: Expanding Treatment Capacity by Sharing Medical Knowledge

Project ECHO, the transformative model of medical education and health care delivery led by social innovator Sanjeev Arora, MD, of the University of New Mexico Health Sciences Center in Albuquerque, brings high-quality, complex care to very sick patients wherever they live. The ECHO model teams community-based providers with specialists at university medical centers to manage patients with complex chronic conditions. Through real-time virtual clinics conducted weekly in the manner of grand rounds, Project ECHO shares medical knowledge to expand treatment capacity, producing what Dr. Arora calls a “force multiplier effect.”

RWJF is supporting Project ECHO with a three-year, $5 million grant, and believes that one day the ECHO model will be the new norm for a systems approach to delivering high-quality care. We see in ECHO the potential to save and improve millions of lives.

The model started in New Mexico and is spreading quickly, with replications in Washington state and Chicago. Government agencies, academic medical centers, health care systems, health plans, and others are also adopting the ECHO model.

With a Health Care Innovation Award grant of nearly $8.5 million, Project ECHO will significantly step up its operations in New Mexico and Washington state, training an additional 150 to 300 primary care professionals, including physicians, nurses, physician assistants, nurse assistants, and community health workers, to provide care for patients with complex, chronic diseases ranging from hepatitis C to rheumatoid arthritis to mental illness.

These newly trained “primary care intensivists” will treat 5,000 high-cost, high-utilization patients with high levels of disease severity, at an estimated savings of $11 million over the three-year grant period.

While savings are important, the notion of bringing high-quality care to an additional 5,000 high-need patients is exhilarating. It’s also the tip of the iceberg in terms of what the ECHO model can achieve for our health care system.

Camden Initiative Transforms Health Through “Hot Spotting”

Cooper University Hospital, of Camden, N.J., will receive a nearly $2.8 million Health Care Innovation Award to support its work with the nonprofit Camden Coalition of Healthcare Providers to identify and track patients with frequent emergency department visits and repeat hospitalizations and provide them with coordinated medical and social services. This practice, known as “hot spotting,” was pioneered by Jeffrey Brenner, MD, who directs the Camden Coalition and is head of the hospital’s Urban Health Institute.  

The Camden Coalition began hot spotting in 2002, collecting and using data from public and private insurance claims to identify which patients were using the most expensive services and mapping where they lived. In addition, the Coalition worked with social service providers to ensure that patients got the support they needed to manage their conditions—such as transportation to their medical appointments—as well as clear discharge plans, so that they didn’t fall through the cracks after hospital stays and end up in the emergency room.

Hot spotting provides important clues for how the health care system can improve the health of its sickest patients and keep them out of hospitals and emergency rooms. This is huge. Research shows that the sickest 5 percent of patients account for more than half of U.S. health care costs. Improving the health and outcomes of these 5 percent would free up health care resources tremendously. The Camden model will soon be tested in several communities with RWJF support.

With the Health Care Innovation Award, the Camden Coalition will use the hot-spotting model to identify and coordinate care for an additional 1,200 high-use, high-cost patients, at an estimated savings of approximately $6.1 million over the three-year period. In addition, the program will create and provide training for 14 new staff to help expand a multidisciplinary team that will support care coordination activities.

The Robert Wood Johnson Foundation is committed to supporting game-changing innovation that can dramatically improve the health and health care of all Americans. On behalf of the RWJF, I congratulate Dr. Arora, Dr. Brenner, and their colleagues – not only for receiving these very significant awards, but also for the wonderful and important work that they do.

Happiness is Hot

BY PAUL TARINI, SENIOR PROGRAM OFFICER, PIONEER PORTFOLIO - @PaulTarini

Happiness is gaining currency today, particularly in relationship to health and medicine. That’s what we’ve been hearing ever since Harvard School of Public Health researchers Julia K. Boehm and Laura Kubzansky published their report “The Heart’s Content: The Association Between Positive Psychological Well-Being and Cardiovascular Health” in the Psychological Bulletin, under a grant from Pioneer. This is the first study of its kind to look closely at how positive psychological well-being—including happiness and optimism—plays a role in heart health.

The story was indeed hot – gaining attention from USA Today, The Huffington Post, TIME’s Healthland blog,WebMD, The New York Times’ Well Blog, ABCNews.com, MensHealth.com, ModernHealthcare.com, Oprah.com, and hundreds more – and being shared throughout social networks and on the web.

This review, which bases its conclusions on more than 200 studies, taps into a larger conversation going on in health care today about the role of wellness and prevention. So often in health and medicine, we look at what is wrong and try to fix it. But more recently, attention has turned toward what we can do to get and stay healthy before things start to go wrong.

Prior research has primarily focused on how risk factors, such as anxiety and depression, are associated with heart disease and cardiovascular events. This investigation is the first to establish that health assets—such as optimism and happiness—are also associated with heart health. This most recent study fits into a new concept called Positive Health, which seeks to demonstrate that people can use and strengthen these assets to achieve a healthier life. 

The intersection of happiness and health – where we flourish both mentally and physically – is where we all want to find ourselves. The findings of this study make intuitive sense: They tell us that happy people are healthy, active, and health-conscious. They also point us toward a new health care paradigm that focuses on making the most of our inherent advantages—not just on avoiding what’s “bad for us.” The next step in this field is to establish whether or not we can design interventions that help build these health assets to help people increase their chances of living a healthier, longer, and perhaps happier life.

Read more of Paul Tarini’s thoughts on the growing evidence for Positive Health.

New Evidence Continues to Build the Field of Positive Health

BY PAUL TARINI, SENIOR PROGRAM OFFICER, PIONEER PORTFOLIO -- @PaulTarini

Today, the Psychological Bulletin published research by Julia K. Boehm and Laura Kubzansky from the Harvard School of Public Health suggesting that positive psychological well-being – such as life purpose, positive emotion, life satisfaction, happiness and optimism – can help protect against and slow the progression of heart disease.

Prior research in this area has focused on how risk factors like anxiety and depression are associated with cardiovascular disease. But this study is the first of its kind to consider how a health asset –psychological well-being – plays a role in heart health.

This investigation and other emerging research suggests that in addition to diagnosis, treatment and prevention, health care should focus on promoting positive health assets – strengths that can contribute to healthier, longer lives. Health assets could include biological factors, such as high heart rate variability; subjective factors, such as optimism; and functional factors, such as a stable marriage. Not only are these assets desirable in their own right, they could also potentially protect against disease and foster stronger, more robust health. Positive Health is a new field of study that turns our attention to understanding these health assets.

When the Pioneer Portfolio first learned about the concept of Positive Health, we were intrigued by its potential to reframe the goals of our health care system. While our current system is focused on the treatment and prevention of illness, we imagined a system that was able to help build assets that make people healthier. We are excited to see that evidence is continuing to emerge finding merit for the concept and identifying areas for additional research, particularly in the context of cardiovascular health.  

Additional research published earlier this month in the Journal of Behavioral Medicine found that having a sense of purpose in life may help protect older adults with coronary heart disease from heart attacks. You can read more about the study in the post, “Life Purpose May Help Reduce Heart Attack Risk.”

Both studies indicate that there are positive health assets that lead to better health. A logical next step would be to identify interventions to enhance these assets to improve our health. The Psychological Bulletin investigation suggests one way to improve heart health may be to increase psychological well-being. With continued research, we hope the field of Positive Health can recognize new avenues for intervention to help protect us against disease, leading to healthier lives. 

Be sure to stay tuned for more results.

Congratulations to the Winners of Innovations for Health: Solutions that Cross Borders!

Today at the World Health Care Congress, Pioneer's Team Director Brian Quinn announced the winners of the Innovations for Health: Solutions that Cross Borders competition, supported by Pioneer and Ashoka Changemakers.  Innovations for Health looked to the international health community for forward-facing, transformative ideas with the potential to change health and medicine here in the United States.

We wanted to find cutting-edge solutions from anywhere in the world that have the potential to be applied in other countries to improve health and health care. While the Robert Wood Johnson Foundation is devoted to improving the health and health care of Americans, this competition arises from what we call our “Flat World” work. That is the name we’ve given to our efforts that look around the world for innovations that could be used to solve the health and health care challenges we’re facing here in the United States.

In March, our expert panel of judges narrowed down the competition from more than 370 entries from 73 countries to 15 finalists who best met the competition criteria of innovation, social impact, and sustainability. Today, we’re proud to announce the three winners who represent some of the best ideas for bridging gaps in health models around the world.

The winning solutions are:

• E-HealthPoint: Transforming Rural Healthcare, India
• VaxTrac: Improving Immunization in Developing Countries, Benin
• Saúde Criança: Holistic Health Solutions for Low-Income Families, Brazil

Read more about the winners on the Ashoka Changemakers blog.

Pioneer Grantees Present Game-Changing Ideas at 12gurus: Health Conference

Last month’s 12gurus: Health conference brought “resources and innovation to the forefront” by convening the world’s most accomplished leaders in health care and medicine to share new ideas that can improve the health care system. The conference focused on how to enable innovation through research, data-sharing, and mobile technology to pave the way for future breakthroughs in health care.

Three former and current Pioneer grantees attended the invitation-only conference in New York City and gave 18-minute-or-less “TED.com-style” talks:

• Scott Johnson, president and founder of the Myelin Repair Foundation, presented the session, “Breaking from the Past to Breakthrough to Cures-Accelerated Collaboration Model.”  Learn more about Scott’s recent honor as the recipient of the prestigious Gordon and Llura Gund Leadership Award from Research!America.

• Jason Hwang, executive director of health care at Innosight Institute, presented the session, “Preparing for Impending Disruptive Changes: The Innovators Prescription.”  Read more about Jason’s Pioneer-funded research, "Disruptive Innovation in Integrated Care Delivery Systems."

• Lisa Schwartz and Steve Woloshin, of the Dartmouth Institute for Health Policy & Clinical Practice, presented the session, “Ingredients of Simplicity: How to present data to patients in a way they’ll understand.” Learn more about their work creating Drug Facts Boxes and read Al Shar’s perspective on their research.  

We are always on the lookout for ideas that can exponentially change our health and health care system.  Team members John Lumpkin, Brian Quinn and Paul Tarini are attending this week’s TEDMED to gain a better understanding of the great challenges in health and medicine and what we can do to overcome them.  Whether at TEDMED or 12gurus, we’re searching for great thinkers and innovators with ideas that have potential to transform health and health care.

Eight Innovative Ideas to Influence Health Behavior

The majority of my work in the Department of Research and Evaluation at the Robert Wood Johnson Foundation has been predicated on the long-held assumption that if you show people convincingly that doing one thing will create the outcome they desire, you can inspire behavior change. The problem is that when it comes to health, we consistently observe individuals acting in ways guaranteed to produce poor outcomes.

The observation of seemingly “irrational” behavior by economists, psychologists and others led to the development of the field of behavioral economics, which has, in recent years, produced insight to explain some of the perplexing health behaviors we observe in a way that the classical economic theories I learned in graduate school cannot. The Robert Wood Johnson Foundation believes these emerging insights have breakthrough potential to help people make better choices for their health. That’s why I’m excited to announce that the Pioneer Portfolio and Donaghue Foundation are now supporting a group of innovative researchers who are testing simple interventions that may have widespread impact on complex problems.

Last fall we asked behavioral economists, choice theorists, and others studying habit formation or physiological mechanisms to submit new ideas to help people make the “right” decisions for their health. After narrowing the field for our Applying Behavioral Economics to Perplexing Health and Health Care Challenges solicitation from an initial 330 responses to 25 finalists, we’ve selected the following eight grantees:

• Anne Thorndike, Massachusetts General Hospital, Feedback, incentives and point-of-purchase interventions to engage employees in healthy eating behaviors
• Elizabeth Merrick and Dominic Hodgkin, Brandeis University, Using novel patient financial incentives to improve uptake of routine mammography
• Ellen Magenheim and David Huffman, Swarthmore College, Fighting viruses with viral marketing? Using online social endorsements to enhance incentives to sign up for flu vaccinations
• Gretchen Chapman and Elliot Coups, Rutgers University and University of Medicine and Dentistry New Jersey, Walking with prospect theory
• Judd Kessler, Eric Zwick and Dmitry Taubinsky, University of Pennsylvania and Harvard University, Using behavioral economics to promote medication adherence and habit formation
• Justin Sydnor, Heather Royer and Mark Stehr, University of Wisconsin, University of California and Drexel University, Improving the structure of financial incentives for exercise: insights from behavioral economics
• Karen Glanz and Jason Karlawish, University of Pennsylvania, Social goals and individual incentives to promote walking in older adults
• Paul Resnick and Caroline Richardson, University of Michigan, Impacts of public announcements of goals and outcomes on goal completion

Typically, the phrase “pioneering ideas” brings to mind cutting edge technology, and the most advanced science. What’s pioneering about these new grantees is that they recognize how small, low-cost ideas that are easy to implement can create a big change.

We are looking forward to working with the Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute and seeing how these ideas pan out over the next 18 months. We embrace the risk that some of these great ideas will fail to produce lasting change. Stay tuned, because next year we’ll convene each research team to share their findings—expected and unexpected—and to look for ways to spread the best ideas to those who most need a breakthrough solution.

Positive Deviance Research Continues to Impact Health Care System

We are proud to see that an earlier grant supporting research into how positive deviance can be applied to methicillin-resistant Staphylococcus aureus (MRSA) prevention in hospitals continues to influence the way health care systems approach and solve challenges.

An article in last week’s Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report profiles the AtlantiCare Regional Medical Center, which participated in the CDC Hemodialysis BSI Prevention Collaborative to reduce bloodstream infections (BSIs). The medical center implemented the positive deviance method, identifying individuals within an organization who have overcome seemingly intractable problems and spreading their solutions throughout, to engage staff members in BSI prevention interventions. For example, a nurse developed a mnemonic device to meet the hand hygiene compliance that she then shared with other nurses. The program found that collaborative interventions and the use of positive deviance were associated with significant reduction in BSIs. 

Curt Lindberg, project director on a 2006 Pioneer grant to Plexus Institute to study the effect of using positive deviance to prevent hospital-acquired infections, recently served as a positive deviance coach at AtlanticCare. In his earlier research, Lindberg and other investigators developed a pilot program at six hospitals to control and reduce the rate of MRSA, one of the most virulent hospital-acquired infections in the United States. The study showed that MRSA infections rates declined by 73 percent in four of the six pilot units.

Read more about the results of the grant and learn about Pioneer’s work researching the growing problem of antibiotic resistance.

Life Purpose May Help Reduce Heart Attack Risk

Evidence continues to emerge that our psyche influences heart health.

In a new study published in the Journal of Behavioral Medicine, researchers working under a Pioneer Portfolio grant found that having a sense of purpose in life may help protect older adults with coronary heart disease from heart attacks. The article, “Purpose in Life and Reduced Risk of Myocardial Infarction among Older U.S. Adults with Coronary Heart Disease: A Two-year Follow-up,” comes from researchers at the University of Michigan and the Harvard School of Public Health.

Researchers surveyed more than 1,500 older adults with coronary heart disease and followed up after two years to investigate the association between the occurrence of a heart attack and the degree to which participants had a sense of purpose in their lives, which is typically conceptualized as a person’s sense of directedness and meaning. The study found a significantly reduced risk of heart attack among participants who reported a higher sense of meaning, regardless of socio-demographic differences. Each unit increase in purpose was associated with a 27 percent reduction in the likelihood of a myocardial infarction.

This finding is notable because adults with coronary heart disease, which is the leading cause of death among Americans, are five to seven times more likely to experience a heart attack. Most research focuses on preventive and risk factors contributing to coronary heart disease, and not on resilience factors that help promote health and longevity. The study flows from our work in Positive Health, an emerging concept that explores whether people have health assets that can be strengthened and lead to a healthier life. In contrast, traditional medicine focuses on health risk factors for disease and treatment if it occurs.

In addition to life purpose, the study investigated the association of other positive and negative psychological factors, including optimism, positive affect, anxiety, cynical hostility, and depression with risk of experiencing a heart attack. The study found that all these factors were significantly associated with myocardial infarction rates, but the sense of meaning in one’s life exhibited a protective effect on cardiovascular health above and beyond the presence of these other factors.

Researchers also noted that when people have a strong feeling of meaning in their lives, their will to live may encourage heart health-promoting behaviors, such as exercising, healthy eating, adhering to medical advice, and abstaining from excessive alcohol consumption or smoking.  

Learn more about our work in Positive Health.

Meet the Innovations for Health Competition Finalists!

Last year, the Pioneer portfolio partnered with Ashoka Changemakers to launch the Innovations for Health: Solutions that Cross Borders competition to find health care solutions from anywhere in the world that have the potential to be applied in other countries to improve health and health care.

After nearly 400 entries from 73 countries, we’re pleased to announce the finalists, and share a blog post with more details from Ashoka Changemakers. Stay tuned for the winners announcement on April 16!

Feeling Optimistic after SXSW

On Tuesday I had the privilege and the pleasure of serving as a judge on the health panel at the South by Southwest Accelerator. It's a great gig, getting to hear pitches from three startup companies that had been winnowed down from a field of dozens. And the companies were terrific—each is tackling an important challenge with imaginative solutions and great technology.

First up was Simplee. Simplee is positioning itself as the Mint.com of health care expenses. They've developed a service that reads through your insurance company accounts and displays your medical expenses in dashboard form—how much each family member has spent toward their annual deductible, for example.  They also explain the unexplainable—the "explanation" of benefits (EOB) statements we always get from our insurance companies, showing you what insurance covers, what you have to pay out of pocket, and why.  I'm on record (at last year’s Heath 2.0 conference) as saying that if Simplee can pull this off, co-founder Tomer Shomal should get a Nobel prize. While maybe not getting to that level of hyperbole, anyone who has regularly waded through these EOBs can relate to what I'm saying. They're starting with this basic problem of tracking and explaining expenses, but have the potential to go much further—facilitating bill payments, offering context-sensitive preventive reminders, and, as they get enough data, enabling comparison shopping for medical procedures. Best of all, you can try it today—Simplee.com.

Ginger.io then came on. As I've written before, I believe that the data we can capture about our day-to-day lives (observations of daily living) can greatly inform the care we receive and, as researchers start to mine it, it will become the source of new knowledge about what makes us healthy or sick. (Pioneer's Project HealthDesign has been focusing on this opportunity for the last couple of years and will soon have some research results to share.) Ginger.io focuses on a particular slice of this data—the data stored on our smartphones. They can capture social activity (calls, texts), geographic movement (GPS) and physical movement through accelerometers. Their twist is that they're really smart about processing the data and finding meaning in it. They're able to establish a behavioral signature and then identify any deviations from it, which can be important feedback for the user but also potentially for a clinician trying to improve a patient's health. Ginger.io is a spinoff from Sandy Pentland's lab at MIT (see his Pioneer- funded paper on reality mining) and by focusing on the smartphone data, they're avoiding the challenge of getting people to record anything—it's all passively collected. Currently, they're working through researchers and early adopter physicians.

The third and final presenter was Medify, which is working to bridge the gap between very high health information resources like WebMD and the medical literature. They have a robust natural language processing operation that is "reading" (crawling?) all the medical literature and coding it (i.e. intervention, disease, study population, conclusions and other attributes). The user can then get a summary along the lines of 15 studies on a total of 3,000 subjects, five of the studies showed that the intervention was safe and four showed that it was effective. You can then drill down and look at more detail and other dimensions like freshness of the research. I'm not doing it justice with this summary— you need to see it for yourself to get a feel for it. The key is that it takes the complexity of the literature on any given condition and/or treatment and starts to tame that complexity, which, as anyone who has gone Googling in search of deeper medical knowledge can attest, is a big deal. Like Simplee, you can use Medify today at medify.com.

Three exciting companies—each with the potential to bring great value to important challenges in health and health care in very different ways. In the end, the winner was... Ginger.io. Congrats to Anmol and Karan for the win, but also to the teams at Simplee and Medify for their creativity, ingenuity and terrific progress so far. These companies, along with five other excellent candidates, are cause for optimism.

Congratulations to Scott Johnson, an Inspirational Innovator

BY NANCY BARRAND, SENIOR ADVISOR FOR PROGRAM DEVELOPMENT

Tonight in Washington, Scott Johnson, the CEO of the Myelin Repair Foundation (MRF), will be honored as the recipient of the prestigious Gordon and Llura Gund Leadership Award from Research!America. The Pioneer Portfolio congratulates Scott and the MRF on what has been truly pioneering and inspiring work.

Scott, an engineer by training, is a Silicon Valley entrepreneur who has lived with multiple sclerosis since 1976. His keen desire to improve treatment led him to start MRF in 2004. Though RWJF does not fund biomedical research nor focus on specific diseases, we saw MRF’s Accelerated Research Collaboration model as pioneering a new approach to biomedical research – one that had the potential to speed the process of discovery.

With the help of RWJF’s support, MRF piloted the Accelerated Research Collaboration model. The model re-engineers the painfully slow and siloed research enterprise into a collaborative venture to accelerate discovery and move more potential candidates into the pipeline for development of new treatments. From 2005 to 2008, MRF researchers produced 50 peer-reviewed articles, pinpointed 19 new pathways and therapeutic targets for myelin repair, identified 24 new tools for neurological disease research, and filed applications for nine patents, with eight additional applications in the works.

In the process, MRF’s work shifted the field of MS research to focus on myelin repair as the more promising avenue to slow progression of the disease and develop treatments. But as significantly, his fresh view of the biomedical research process – based on how it can and should work, not how it has been traditionally conducted – will shift the future.

The RWJF Pioneer Portfolio is proud to have supported such innovative and life-changing work, and we congratulate Scott Johnson on receiving this much-deserved honor.

Q&A with Freelancers Union’s Sara Horowitz on Modernizing Health Insurance

The Centers for Medicare & Medicaid Services last month awarded $340 million in low-interest and no-interest federal loans to three organizations sponsored by Freelancers Union, a Pioneer Portfolio grantee, to create three of the first seven Consumer Operated and Oriented Plans (CO-OPs) in New York, New Jersey and Oregon. Created by the Affordable Care Act, CO-OPs are consumer-governed health plans that use profits to lower costs for consumers, improve quality of health care, and increase enrollment or benefits based on members’ needs.

We caught up with Sara Horowitz, the founder and executive director of Freelancers Union, to gain some insight on lessons she’s learned, what it means to be truly innovative, and how to put the “health” back in health insurance. The nonprofit Freelancers Union, with 171,000 members nationwide, advocates on behalf of the 42 million independent workers in the U.S. The organization provides health insurance to over 23,000 New York freelancers and their families through its social-purpose Freelancers Insurance Company.

What gave you the idea for Freelancers Union?

I wanted to figure out the next form of unionism, because people had begun working in a completely new way. Thirty percent of the workforce now earns its living as freelancers, contractors and temps.

When I began speaking with freelancers and independent workers in the mid-90s, their biggest concern was health insurance. I came into the field with no health policy background and didn’t carry any baggage. I approached the problem of changing the health care system by trying to help working people get the health insurance they need. Focusing on our members has been my North Star when deciding which strategies could work and which won’t.

When did you decide to start your own insurance company?

What we really wanted was to merge the ideas of Kaiser Permanente with union benefit funds, bringing in the best ideas out there. We recognized that you can do the most if you’re responsible for the money, and that we couldn’t accomplish our goals without creating an insurance company.

What did you learn from talking to your members about what they want from health benefits?

The biggest lesson, which we haven’t solved yet but have made strides toward, is that our members want to get more value in what they’re spending on their health and well-being, and they should. Americans pay out-of-pocket for extra efforts they make for their health, whether that means going to the gym, taking a yoga class, or purchasing healthy foods. Our health benefits should integrate efforts that keep people healthy, not only physically, but mentally, emotionally and socially. In places like northern Italy, you don’t have to be rich to eat well. We need that kind of culture change, and I like to think we can help.

What did you learn from starting your own insurance company?

I learned that you have to know what you’re trying to achieve and understand that there are risks, even if you are unsure what the risks are. You have to build a great team that can help search for what you don’t know. You need a board that has wisdom and experience in all aspects of the field. You have to always strive to do the right thing. In the short-term, you’re making changes that are central to peoples’ lives. Sometimes, this will make them very anxious and even mad at you. You have to reaffirm that there’s no alternative and stay on course to make the situation better. If you continue to communicate and build relationships with your members, their trust and support will come back.

That’s part of what I love about the Pioneer Portfolio and the zeitgeist of social entrepreneurship. When you’re working on complex issues, change and success take time. In current politics, government officials don’t have the longevity to do that right now because we’re not giving them enough space. So, the nonprofit sector has to step in and have the patience to pioneer and experiment.

What spurred you to pursue the CO-OP?

As you can imagine, trying to plan strategically during the past year has been challenging. As we looked at health reform, we thought about the opportunities and challenges for freelancers. We started tracking the CO-OP regulations two years ago because it concerned nonprofit health insurance. When the regulation passed, we applied for funding and began working with Nancy [Barrand, senior adviser for program development for RWJF’s Pioneer Portfolio].

What difference did the Pioneer Portfolio grants make?

Whether or not you support CO-OPs, there was $3.2 billion of support available and Nancy was one of the only philanthropists who even paid attention. That’s another reason I love the Pioneer Portfolio. It has a strong point-of-view about its mission, but is open to different strategies for solving problems.

What makes this strategy a pioneering idea?

Much of the focus today is on individuals, whether they have to get insurance through an individual exchange or a policy carrier. But truly, insurance works best in groups -- always has, always will. It’s important to set up these nonprofits that understand their members, and that can tailor benefits to what people actually need and make dollars go so much further. We are introducing the ideas of affinity, solidarity, and other ideals from the mutual insurance industry that built up cooperatives. I think that mindset makes our work pioneering.

Do you think this is a “disruptive idea”?

Yes. We started with freelancers, a part of the market nobody wanted or had cared about up to that point. Now freelancers and independent workers make up a third of all employees, and the workforce is moving in that direction. So I believe we’ve made an impact on how people traditionally think about the makeup of the workforce, as well as ways to offer health insurance.

What’s next?

It’s important to understand that we are not done yet. We need to move away from the fee-for-service system, go back to medical homes with integrated care, and foster thinner, curated networks. I think it’s important that we start to collect and publicly share data with members, doctors and hospitals to solve problems with health spending. We also need to integrate alternative care structures that support healthy behaviors, such as proper nutrition and exercise. We’ve structured the health system with these as fringe benefits, when they should be mainstream benefits. Freelancers Union is trying to change the culture by offering affordable, stable benefits to independent workers—showing that it can and should be done.

For more information on how Freelancers Union is expanding health insurance choices, check out last week's blog post by Nancy Barrand, senior adviser for program development for RWJF’s Pioneer Portfolio.

Hack-a-Thon for “Unmentionable” Issues in Adolescent Health

Calling all app developers! On March 31, ISIS, TechSoup and Health 2.0 are teaming up for a free, live hack-a-thon event in San Francisco to design apps to address youth health-related “unmentionable” activities, including dating violence, depression, sexually transmitted diseases and substance use. The event, sponsored by an RWJF grant, aims to create apps that will excite young people to share honest, real-time, private information about their taboo, embarrassing or “unmentionable” activities with researchers and program experts who work with youth.

The hack-a-thon will bring together developers, designers, innovators and entrepreneurs for rapid development of progressive concepts and prototypes to be developed by the participating teams following the event and at future hack-a-thons. ISIS and TechSoup will partner in the future development and distribution of the concepts and designs. The grand prize winner will be revealed at ISIS’ annual Sex::Tech conference and take home $1,000 cash.

Interested? Register now.

Pioneer’s Commitment to Health Games Profiled in New Games for Health Journal

BY PAUL TARINI, SENIOR PROGRAM OFFICER, PIONEER PORTFOLIO -- @PaulTarini

I recently had the good fortune of sitting down with Bill Ferguson to discuss the Robert Wood Johnson Foundation’s pivotal role in health games research for the inaugural issue of the Games for Health Journal. In our talk, I detailed the Foundation’s early investment in the field, the challenges to advancing health games and some grantee findings to date.

Thinking about our conversation, I’m struck by how far the field has come since the early days of our health games support in 2004. Back then, there wasn’t much intersection between the games space and the health space, but Pioneer saw potential. So we worked with Ben Sawyer (@BenSawyer) of Digitalmill to do some community building within the gaming industry around health interests and funded the first-ever Games for Health Conference.   

Now, with seven conferences behind us and the eighth scheduled for June 12-14, 2012, in Boston, Pioneer can proudly claim we helped create and sustain a way for the games and health communities to come together. But we didn’t stop there.

Pioneer expanded its support to the Health Games Research national program, directed by Debra Lieberman at UC Santa Barbara (who is featured in a roundtable discussion of health games experts in the Journal), where we are seeing our 21 grantees test some fascinating ways health games can be optimally designed. They're exploring game features such as competition, collaboration, social comparison, social support, nurturing of characters, immersion in fictional worlds and alternate realities, interacting with a human-like robots to motivate exercise, using a mobile phone game as a substitute for a cigarette, and much more. And there’s more to come.

Health Games Research's work to identify a broad range of features that make for effective health games will help to further expand the creative horizons of future developers. Well-designed and well-implemented games can motivate and support prevention, lifestyle behavior change, and self-management of chronic conditions, and Pioneer is proud to be part of this work. We are excited to see a journal devoted to the research, development, and clinical application of games and health.

Check out the inaugural issue and read about the work of Pioneer’s grantees and others in this important field on the Pioneer Health Games homepage. Tell @pioneerrwjf or @gamesresearch what you think.

New Data Reveals High Death Rates From Clostridium Difficile (C. diff)

A new Vital Signs report issued March 6 by the Centers for Disease Control and Prevention shows rates of infection with Clostridium difficile (C. diff) are at historic highs and must be curtailed. C. diff can cause cramps, severe diarrhea and, in some cases, death.

Also on March 6, Extending the Cure—a project funded by the Pioneer Portfolio that studies antibiotic resistance—released a new analysis showing high C. diff death rates in parts of New England. In fact, the Extending the Cure analysis shows that as of 2007 Rhode Island, Maine, and Connecticut had the highest death rates for C. diff in the nation.

These top three states had death rates that were more than double the national average of 2.15 deaths per 100,000 people.  The trend is visualized using the interactive mapping platform of ResistanceMap, Extending the Cure’s online tool that tracks antibiotic use and drug resistance in North America and in Europe.

At the same time, the map shows that most Southern and Western states had death rates from C. diff that were below the national average. For example, Georgia, Colorado, and Idaho reported less than one death per 100,000 people from these infections in 2007. “The geographical variation points to the need for additional research to better understand the epidemiology of C. diff infections and highlight the most effective ways of preventing their spread,” says Ramanan Laxminarayan, director of Extending the Cure, the D.C-based research project funded in part by the Robert Wood Johnson Foundation’s Pioneer Portfolio.

While C. diff has long been linked to hospitals, the CDC report finds that patients can acquire the infection in all medical settings, including nursing homes and outpatient clinics. Those most at risk are patients who take antibiotics, which can wipe out the good bacteria living in the gut, allowing C. diff to thrive.

C. diff infections can be reduced by judicious use of antibiotics, according to the CDC, which notes that about 50 percent of all antibiotics prescribed are not necessary. Reducing unnecessary antibiotic use will not only help prevent C. diff infections, but also curtail the growing problem of antibiotic resistance.

Addressing the rising rates of C. diff infections will require a multifaceted approach.  In addition to promoting antibiotic stewardship, health officials must work towards better infection control and early diagnosis at hospitals and other facilities where C. diff and other health care-associated infections can spread from patient to patient or from one facility to the next.

 In addition, policymakers, researchers, and others can use visualizations, like the map from Extending the Cure, to identify regions of the country with the most serious problems and look for targeted solutions to the rising tide of C. diff and other disease-causing bacterial pathogens.

Check out the new data and let us know what you think: Do you have a story to tell about a solution to the problem with C. diff?

Follow @ExtendgtheCure on Twitter to track coverage of this study.

Freelancers Union Expands Affordable and Stable Coverage for Independent Workers

BY NANCY BARRAND, MPA, SENIOR ADVISER FOR PROGRAM DEVELOPMENT

Some good news came our way this week -- a story unfolding the way we hoped it would.

Freelancers Union, a Pioneer Portfolio grantee, will launch three Consumer Operated and Oriented Plans (CO-OPs)--nonprofit, consumer-governed insurance companies envisioned by the Affordable Care Act to expand health insurance choices for consumers and small businesses. This is made possible by $340 million in low-interest and no-interest federal loans announced Feb. 21 by the Centers for Medicare & Medicaid Services to start three of the first seven CO-OPs in New York, New Jersey and Oregon.

We’re delighted because Freelancers Union used a 2010 grant from Pioneer to shape its existing ground-breaking model for demand-side, consumer-driven health care into a proposal for the new world of CO-OPs.

It was a natural fit. Here’s the back story.

The existence of Freelancers Union is recognition that for the 30 percent of the workforce that earns its living as freelancers, contractors and temps – so-called independent or contingent workers – there are no employer-provided benefits, including health insurance. Many of these workers earn too much to qualify for public assistance and not enough to afford the health insurance available in the individual market, typically more costly than the group market plans offered by employers.

As a Foundation, we have been concerned for 30 years about Americans’ lack of access to affordable and stable health coverage, so a partnership took shape over the course of three grants.

We first partnered with Freelancers Union in 2007, when they were looking to start a health plan for the contingent work force, but with an important twist. They wanted the benefits to reflect input from the workers. Our first grant helped the organization conduct surveys and focus groups to shape the benefit design. It learned that its members wanted a product aligned to their holistic needs on top of catastrophic coverage.

With a second grant in 2008, we joined a consortium of funders that helped launch a for-profit subsidiary, Freelancers Insurance Co., with a line of products that combine catastrophic insurance coverage with special attention paid to mental health services as well as wellness, prevention and alternative therapies.

Then with a third grant in 2010 we sought to enable Freelancers Union to expand its group purchasing health-benefits program from New York into New Jersey and Georgia. We envisioned this work might produce a prototype for the CO-OPs, and it did. All CO-OPs won’t follow the Freelancers Union model, of course, but it certainly sets a standard.

The work of Freelancers Union reflects many of the core ideas that drive Pioneer Portfolio grant-making. It is transformative and disruptive. As large insurers back away from the individual market because of the tight profit margins, some fresh thinking is badly needed, like rolling individuals into groups even though they do not work together, and then listening to them carefully to design products that meet their needs.

That’s pioneering, and we’re proud to have played a part.

Follow @FreelancersU on Twitter.

Health Games Research Profiled by Inside Healthcare IT

The Pioneer Portfolio is committed to supporting trailblazers who are changing the way we think about health and health care.  Debra Lieberman, PhD, director of Health Games Research, a national program of Pioneer and headquartered at the University of California, Santa Barbara, is breaking ground by using health games to transform the way prevention, self-care, and health care are practiced.

The February 9 issue of Inside Healthcare IT profiles Lieberman’s research on how video games can be used to improve players’ health behaviors and health outcomes, and thereby reduce the cost of care.  After two decades of research on games that improve health behaviors in areas such as smoking prevention, diabetes self-management and asthma self-management, she has found that some games can have a dramatic impact on health.

“Video games can change people in fundamental ways that can lead to better health behaviors,” Lieberman said in the article. “Well-designed games can change people’s perceived risk for experiencing serious health problems, their sense of self-efficacy, or self-confidence, that they can carry out specific health behaviors successfully, and their perceptions of social norms. These and many other changes in people’s attitudes, emotions, understanding, and skills can tip the balance toward behavior change. While games can be fun and can teach health facts, they can do a great deal more to motivate and support better health.”

Check out the article to learn more about Lieberman’s research on health games and tell @pioneerrwjf or @gamesresearch what you think on Twitter.

Making Sense of the Debate Over Patient Access to Medical Information

Lately, there’s been a lot of conversation about increasing patient access to medical information. Much of this debate was sparked when Kathleen Sebelius, secretary of the Department of Health and Human Services, stated, “When it comes to health care, information is power.” While many providers and most patients are in support of increasing patient access to medical information, there are some who feel this change will make doctors’ jobs harder.

OpenNotes, a Pioneer-supported program that makes it easy for patients to access their doctors’ notes after a visit, is at the heart of this debate, as was seen in a series of columns in February’s SGIM Forum. In this newsletter Tom Delbanco, MD,  and Jan Walker, RN, MBA,  the lead investigators working to determine the impact of sharing doctors’ notes with patients (Part 1),  debate the merits of this new level of transparency  with Douglas Olson, MD (Part 2), and well-known patient advocate e-Patient Dave (Part 3).

In a post on The Health Care Blog, John Lumpkin, MD, MPH, senior vice president and director of the Health Care Group at RWJF, weighs in on this debate.  Learn why Lumpkin thinks that increasing access is a good idea and tell us what you think.

Pioneer Grantees Top RWJF’s Most Influential Research Articles of 2011

BY BRIAN C. QUINN, PHD, team director and senior program officer, Pioneer Portfolio

And the winner is …

We were quite proud and excited by the recent news that the work of two Pioneer Portfolio grantees placed first and second in the Most Influential RWJF Research Articles of 2011, as announced by David Colby, vice president of research and evaluation at RWJF, in January’s Evidence Matters.  

Coming in at number one, The Use of Twitter to Track Levels of Disease Activity and Public Concern in the U.S. During the Influenza A H1N1 Pandemic, published in May’s PLoS ONE. Dr. Phil Polgreen and colleagues at the University of Iowa monitored disease activity during the H1N1 outbreak by analyzing public messages or "tweets" on Twitter. The study established a model for monitoring disease outbreaks in real time.

Second place went to Project ECHO’s Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers, published in June’s New England Journal of Medicine. Dr. Sanjeev Arora and colleagues demonstrated that through Project ECHO’s transformative model of health education and delivery, primary care providers can be trained via video communications and real-time, case-based learning to manage complex chronic conditions formerly outside their expertise, thus expanding their ability to bring better care to more people in their own communities. By putting the best available medical knowledge into the hands of everyday clinical practitioners, Project ECHO exponentially expands the capacity of the health care workforce to provide high-quality care in local communities.

Congratulations to these grantees for their influential and innovative work to transform health and health care. We’re proud to call you part of the Pioneer family.

And a big thank you to all who voted or helped spread the word about these and the other great research articles in 2011’s top 25 list. You can still join in the conversation by using #Final_5 on Twitter, Facebook, and LinkedIn to discuss the winners and congratulate all the grantees who participated.

While you’re reviewing the Most Influential Research Articles of 2011, take a look at the top three most viewed Pioneering Ideas blog posts from 2011:

• Focus on the Pig: RWJF Chief Technology and Information Officer Steve Downs recaps the visions of industrial designers to re-imagine the environments in which we live, work and play for better health.
• What Does mEvidence Need to Look Like?: Vice President of Information Technology Al Shar discusses the hype and hope of mHealth and the need to develop evidence that supports its potential.
• Despite Political Uncertainties, an Emerging Model Shows Health Care Transformation is Possible: John Lumpkin, senior vice president and director of the health care group, discusses how Project ECHO can help us do more through the “force multiplier effect” of knowledge networks that create a health care system “without walls.”

We look forward to exploring more pioneering ideas with you in 2012 and highlighting the important work of our grantees. Keep checking back or better yet, sign up to receive Pioneer’s content and funding alerts and future Pioneering Ideas posts.

‘Exergames’ Can Improve Cognitive Function in Older Adults

We all hear about the benefits of physical activity beyond weight management. According to the Centers for Disease Control, exercise helps to improve your ability to do daily activities, mental health and mood. This is especially important later in life to improve cognitive function protecting against the onset of dementia. However, as the CDC estimates, only 14 percent of adults aged 65 to 74 years and 7 percent of those over 75 years exercise regularly.

Health Games Research grantee Dr. Cay Anderson-Hanley and her fellow researchers from the Healthy Aging and Neuropsychology Lab at Union College, New York set, out to find new interventions motivating older adults to exercise and promote good brain health.  They tested the impact of virtual reality-enhanced exercise, or exergames, that combine pedaling a stationary bike with an interactive video game compared to traditional exercise. Researchers evaluated participants’ executive cognitive function such as their ability to multi-task, problem-solve, and working memory and attention.

What they found was that adults ages 58 to 99 who participated in ‘cybercycling’ two to three times a week for three months had significantly better executive functioning than those using a traditional stationary bike.  This is the first study to quantitatively evaluate the benefits of exergames. 

You can also check more about the research featured in The Atlantic’s “Study of the Day,” CNN’s The Chart Blog, MedpageToday.com and The Los Angeles Times Booster Shot Blog.

To learn more, see the article in the February issue of the American Journal of Preventive Medicine, or check out Pioneer’s national program Health Games Research to see what they are doing to explore ways to advance the research, design, and effectiveness of digital games and game technologies that promote health.

Shorter Antibiotic Regimens Might Counter Antibiotic Resistance

Antibiotics on the shelf today are increasingly losing their potency against resistant microbes or “superbugs” like the potentially lethal methicillin-resistant Staphylococcus aureus, or MRSA.

Extending the Cure researchers published an analysis this week that questions the conventional wisdom regarding antibiotic dosing practices and suggests rethinking the guidelines to minimize the growing public health crisis posed by antibiotic resistance. Ramanan Laxminarayan, director of Extending the Cure, and his colleagues, used mathematical models to study antibiotic treatment guidelines, the regimens physicians follow for the standard dose and duration of antibiotic treatment for common infections.

While antibiotic dosing regimens have typically been designed to cure bacterial infections, rarely have these guidelines taken antibiotic resistance into account.  All antibiotic use contributes to the development of antibiotic resistance, and the new research suggests dosing guidelines could be optimized to both treat infections and limit the spread of resistant microbes. The analysis, published January 11 in the online scientific journal PLoS ONE, indicates that in many cases, a shorter regimen of antibiotic treatment could work just as well as a longer course yet still reduce the risk of resistance.

Dosing strategies for antibiotics are not set in stone.  For example, many physicians have switched from the traditional 10-day course of antibiotics and now effectively prescribe a three-day regimen to treat otitis media, or middle ear infections. In some cases, the authors argue, shorter dosing regimens like this one could limit the selection pressure for resistant bacteria and thus reduce the threat of resistance.

Extending the Cure, a project of the Center for Disease Dynamics, Economics & Policy sponsored by the Robert Wood Johnson Foundation’s Pioneer Portfolio, is working to change how we think about antibiotics, a resource that can be depleted with overuse. This study suggests that shorter treatment regimens, in some cases, may help us preserve the power of the antibiotics we still have left.

Let us know what you think:  Are there any risks to shortening current treatment regimens? Are there any other benefits? Leave a comment here or tweet at @ExtendgTheCure and @PioneerRWJF #SaveAbx to tell us what you think.

Inviting Patients to Read Their Doctors' Notes

Will patients be more likely to seek a second or third opinion? New York Times

Will reading your doctor's notes lead to better health? USA Today

Can Patients Handle the Truth? TIME

These questions and others were posed following the release of OpenNotes’ findings about patient and doctor attitudes toward opening doctors’ medical notes to patients. The survey of nearly 38,000 patients and 173 primary care physicians revealed patients were enthusiastic about the prospect of reading their doctors’ notes while doctors were cautious.

Patients who signed up for the project, such as Linda Johnson, 63, a Harborview patient,  told The Seattle Times she found the notes helpful in recalling what she and her doctors had talked about and how she was supposed to follow up. "I have found, as I get older, I need more visits to the doctor, and there are more things we need to talk about…I find having them written down helps a lot." Patient Candice Wolk, a 39-year-old mother of twins, told the New York Times that reading her notes after a pregnancy check-up reminded her to follow-up with a dermatologist to have a dark spot on her back checked. 

Doctors enrolled in the project also shared their thoughts. David Ives, MD, an internist at Beth Israel Deaconess, told American Medical News he thinks OpenNotes is a rousing success, saying “The patients loved it, and it had absolutely no impact on me really at all. It was amazing how little impact it had.”

Bloggers chimed in too, including patient advocate Trisha Torrey who called on her readers to “continue to encourage your doctor to share your records –  to provide easy access to you” and Ted Eytan, who wrote that “here’s something in health care that most patients want to receive, but not all doctors want to provide.”

The media stories and blog posts such as those on The Health Care Blog, TIME’s Healthland Blog, NPR’s Shots Blog, and Vitals on MSNBC.com sparked conversations and debate and were shared widely through social networks.  You can join the conversation by commenting on these stories or tweeting @myopennotes or @pioneerrwjf.

Looking ahead, one thing is clear: the final results of OpenNotes, due later this year, are eagerly awaited and have the potential to spur real change in the way doctors share information with patients about their health and health care.

OpenNotes is funded by the Robert Wood Johnson Foundation’s Pioneer Portfolio. The survey results were published December 19, 2011, in the Annals of Internal Medicine.

Project HealthDesign Provides Input on Health IT Policies

BY PATRICIA FLATLEY BRENNAN, PHD, RN, Project Health Design National Program Director

Since health reform passed almost two years ago, we’ve seen the health care system begin to change quite a bit. The push for better uses of health IT has brought about many proposed rules and programs, and federal agencies have requested public input on many of these proposals.

Because Project HealthDesign has always included multi-disciplinary teams of researchers, clinicians, and patients who are helping to lay the foundation for a patient-centered health IT system, we’ve seized these opportunities to share our unique insights by commenting on several proposed policies. In the process, we’ve been able to share our thoughts about promising practices for collecting patient-generated data and incorporating it into the clinical care process.

In 2011, Project HealthDesign provided feedback on seven proposed policies. These ranged from applauding the HHS Proposed Rule on Patient Access to Lab Reports, which would allow patients to become more engaged with their health data, to calling for better distinctions between mobile apps and mobile medical apps under the FDA Mobile Medical Application Guidance. Working together to help refine these types of policy proposals is even more critical now as we enter a new era of widespread adoption and use of health IT.

Read Project HealthDesign’s policy comments, watch “How Clinicians Can Help Guide Federal Conversations About Health IT,” or visit the Project HealthDesign website to learn more.

You can also check out Dr. Roger Luckmann's post on KevinMD.com about how Project HealthDesign is helping people with chronic diseases manage pain.

OpenNotes: Mind the Gap

Last week, I contributed to The Health Care Blog about OpenNotes, a Pioneer grantee that is enabling patients to view the notes their doctors write after a medical visit. I wrote that it is a simple idea – but also a dangerous one.

OpenNotes recently completed a pre-survey published in the Annals of Internal Medicine that asked doctors and patients about their expectations of how the idea would play out in real life. What they found is fascinating. Doctors and patients are clearly divided. On a wide range of possible benefits, doctors are more skeptical than patients. But what really jumps out are the responses to questions of whether patients would find the notes more confusing than useful, and whether the notes would make them worry more. The gap is dramatic. In each case, most doctors said “yes” while less than one in six patients agreed.

Why this disconnect between doctors and their patients? Why the gap between what doctors believe their patients can handle, and what patients feel they are ready to see?

The post has generated a nice discussion on the blog, and in the comment responses you’ll find that the results of the survey are reflected in the dialogue. I recently added my own two cents to the conversation, and I’d love to see you post your thoughts, as well.

The survey results have also been covered by USA Today, MSNBC.com, and TIME’s Healthland Blog.

Pioneer Grantees Named to HealthLeaders Media’s 20 People Who Make Health Care Better

HealthLeaders Media identified 20 individuals to tell their stories of how they are changing health care for the better in its annual HealthLeaders 20 issue. Two grantees of the Pioneer Portfolio are included in this prestigious honor.

Clayton Christensen is often referred to as the father of disruptive innovation, the concept that new technologies have the potential to turn an industry upside down—but they may be difficult for established organizations to adopt. In 2011, Christensen and his team at Innosight Institute published a Pioneer-funded case study series on disruptive innovations within integrated health systems. In the summary report, researchers investigated how the seven integrated health systems think, act and innovate differently.

Nicholas A. Christakis is a well-established name in the science of human connectivity and social networks. In 2011, Christakis’ innovative Pioneer-funded research looked into how humans interact and coordinate in response to the behavior of one’s social partners in an article published in Science and in this profile.

We’re proud to call these innovating movers and shakers part of the Pioneer family. They, like all of us, are working to make a difference in health care. We encourage you to congratulate Christensen and Christakis (through his book Connected) on Twitter.

Why OpenNotes Will Open Minds

BY THOMAS FEELEY, MD, Vice President of Medical Operations, University of Texas MD Anderson Cancer Center, Houston, Tex.

Patients should know what’s going on with their health and health care. OpenNotes, which enables patients to see their doctors’ notes, is a simple idea that can help improve the patient experience and empower patients to become true partners in their care.

But OpenNotes has found that most doctors are wary of this intervention. Its survey of patients’ and doctors’ attitudes toward sharing electronic medical notes revealed doctors are worried about increased demands on their time and frightening or confusing patients.

These fears are overreactions. At the University of Texas MD Anderson Cancer Center we have been giving patients access to their electronic medical records—including their doctors’ notes—since May 2009. While initially doctors complained that they had to explain more to their patients about what was written in their records, the doctors soon came to realize the benefit of having patients who are more informed about their care plan and lab results.

Today, 84 percent of our patients have obtained access to their electronic medical records, including their doctor visit notes, via a secure Web-portal. Patients have actually become avid readers of their medical notes. 

This has been a particularly important intervention at a cancer center like ours. Our patients are treated on an outpatient basis and in one visit often travel from the lab to the doctor’s office and then to get chemo. Having their medical information as they move from location to location makes a huge difference to our doctors. And it has made a huge difference to our patients and their caregivers. Cancer is a family event. It’s rare that a patient is not accompanied by a family member when they come to our clinic.  We know they are sharing their records and doctors’ notes with their family and we think it helps them and their family members get a better understanding of what’s going on with them.  

Our experience at MD Anderson helps build the case for why this kind of transparency is a good step for patients and doctors. But what we don’t have yet is the scientific evidence and rigorous research to show that opening medical notes does not significantly impact doctors’ time and work flow, or make patients more confused or anxious. 

That’s why the OpenNotes demonstration results will be so important to mapping out the future.  Because it has been tested for 12 months in three very different sites around the country with very different sets of patients, it can provide important answers to questions and help guide future efforts to make sure this model works effectively.

Rather than spending so much time fretting about the implications of sharing information, we should be looking to projects like OpenNotes to show us how we can make it work for both patients and physicians to improve care and improve lives.

@Choo: Can Twitter Track The Flu?

Now that flu season is upon us, more and more Americans will be tweeting about aches and pains and other symptoms that could signal the onset of the flu.

Pioneer grantee Philip Polgreen and his colleagues at the University of Iowa in Iowa City suggests that social media tools such as Twitter and Foursquare could one day be used to track flu activity—and give public health officials a heads up if activity takes a turn for the worse.

Polgreen and his colleagues published a study last May in the scientific journal PLoS One that tracked millions of tweets during the 2009 swine flu pandemic. They discovered that many Americans used Twitter to express concerns about the flu or talk about early symptoms such as a fever. The researchers collected tweets that used the words “flu,” “fever,” and  other related terms and analyzed them—finding that Twitter data could be used to estimate the incidence of the flu in real time.

Currently, the system the CDC uses to track reported cases of influenza has a time lag of several weeks, giving the flu a chance to spread. Polgreen and his colleagues believe that Twitter might help speed up that process by alerting public health officials about an increase in flu symptoms in real time. The early warning might provide officials the time they need to curtail the spread of the flu or to urge more people to line up for flu shots.

And what about getting a head start on information about where the flu is spreading? The Iowa team recently analyzed data from FourSquare, a social media application that permits users to “check in” and record their current location in exchange for incentives, like coupons.

The information could also be used, the team says, to track the location of individuals infected with the flu or some other contagious disease—and then send alerts to public health officials trying to contain an emerging disease threat.

The team presented the early findings from the study at the International Society for Disease Surveillance meeting held in Atlanta on December 7-8.

Polgreen also says that the Twitter stream might be used to look for public misinformation about the flu—like the mistaken belief that antibiotics can combat it. Twitter reveals all kinds of fears, concerns and behaviors and might give public health officials insight into the myths they should address in public education campaigns.

Such real-time information could also inform the CDC about overuse of antibiotics. On November 14, the CDC launched an annual campaign to curtail the unnecessary use of antibiotics given the estimate that about 50 percent of all antibiotic use is unnecessary. Furthermore, research by Polgreen and colleagues published last July in Infection Control and Hospital Epidemiology suggests that antibiotic use goes way up during flu season.

Antibiotics, however, do nothing to combat the flu or other viral infections. Think about that—or better yet tweet about it—the next time you get an ache or pain that signals the flu.

Let us know what you think: When you feel sick this flu season, will you tweet about your experience?

You can also vote for "The Use of Twitter to Track Levels of Disease Activity and Public Concern in the U.S. During the Influenza A H1N1 Pandemic," published in PLoS ONE in May, as one of RWJF's Most Influential Research Articles of 2011.

The False Dichotomy of Nature Versus Nurture

We all attribute certain traits to nurture and others to nature. “I’m stubborn. I get that from my dad’s side. My ambition and leadership skills? I learned those.” But Pioneer grantee Nicholas A. Christakis says more of the traits we typically attribute to culture have evolutionary roots, including who we choose as friends and whether or not we practice healthy behaviors.

In this week’s TIME magazine, Christakis argues that a new synthesis of biological and social science – biosocial science –can unearth solutions to some of the world’s most vexing public health problems. He writes that we can use our understanding of biology and behavior to address problems like how to get medications or tools to remote villages, control the behavior of dangerous crowds, or predict an epidemic before it happens. Christakis, a Pioneer grantee and a professor of sociology and medicine at Harvard, contributed this essay as one in a series by TIME’s most influential people in the world.

You can also learn about Christakis’ innovative research into how humans interact and coordinate in response to the behavior of one’s social partners in a recent Pioneer-funded article published in Science and in this profile.

Read the TIME essay, review Christakis’ work on patterns of human coordination and defection, tweet your thoughts about the nature versus nurture argument, or comment below. We’d love to hear what you think.

Vote for the Most Influential Articles of the Year

It’s time for RWJF’s annual research poll! David C. Colby, vice president of Research and Evaluation, announced the 20 nominees for RWJF’s Most Influential Research Articles of 2011. We are honored that three Pioneer grantees made the list:

• Positive Health – Heart Health When Life is Satisfying: Evidence from the Whitehall II Cohort Study, published in May’s  European Heart Journal, found that satisfaction in four life domains—job, family life, sex life and self—were independently associated with a 12 percent reduced risk of total coronary heart disease. The research supports Positive Health, a new field of inquiry into whether there are assets that help people achieve and maintain good health and recover more quickly when they are sick. Vote for Article 12 or learn more about this project.
• Flu Prediction Market – The Use of Twitter to Track Levels of Disease Activity and Public Concern in the U.S. During the Influenza A H1N1 Pandemic, published in May’s PLoS ONE, followed researchers who used Twitter to effectively track public concerns about H1N1 and follow real-time disease activity. Tweets related to hygiene coincided with public health messages about the outbreak, and there was a distinct association between twitter data and the actual progression of H1N1. Vote for Article 11 and learn more about this project.
• Project ECHO – Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers, published in June’s New England Journal of Medicine, demonstrated that primary care providers can be trained via video communications technology to manage complex chronic conditions formerly outside their expertise, thus expanding their ability to bring better care to more people in their own communities. By putting the best available medical knowledge into the hands of everyday clinical practitioners, Project ECHO exponentially expands the capacity of the health care workforce to provide high-quality care in local communities. Vote for Article 17 or learn more about this project.

Vote for your top 5 Most Influential Research articles of 2011 now and use #Final_5 on Twitter, Facebook, and LinkedIn to follow the conversation and let others know which articles you think should make the top five for 2011. Voting ends on midnight of December 23 so act fast! This year’s winners will be announced in the next issue of Evidence Matters to be released in early 2012.

Pioneer Grantees Named to Forbes’ Top 30 Social Entrepreneurs List

BY BRIAN QUINN, team director of RWJF’s Pioneer Portfolio

Forbes is known for its lists – America’s richest people, most expensive zip codes, most promising companies and more. This year, for the first time in its 94-year history, Forbes released a new list – the top 30 social entrepreneurs. We’re proud to announce that Pioneer grantees made the list – twice!

Jay Coen Gilbert, Bart Houlahan and Andrew Kassoy made the list for B Lab, a nonprofit that certifies businesses as “B Corporations”—companies that adopt a legal structure requiring them to create value for a broad set of stakeholders—employees, communities and the environment–not just their shareholders.  Their hope is that certified “B Corps” will flourish by attracting consumers who are looking to support businesses that align with their values and helping investors to drive capital to higher-impact investments with greater social responsibility, as well as financial returns.  To be certified, companies must adopt the legal structure and pass an annual B Impact Assessment. Under their Pioneer-funded grant, B Lab will develop the first set of criteria to assess a corporation’s performance in areas of employee and community health and safety to be included in the annual assessment.

Sara Horowitz is listed for founding Freelancers Union, which provides affordable health insurance to freelancers, consultants and temps who don’t have access to employer coverage. Her grant from Pioneer enables the Freelancer's Union to expand its group purchasing health-benefits program from New York into New Jersey and Georgia.  A previous grant established the for-profit Freelancers Insurance Company to design a health plan model for freelancers in New York state that combines catastrophic insurance coverage with coverage for prevention and wellness services.

RWJF’s Vulnerable Populations Portfolio is also excited to see two grantees on the list. Jill Vialet made the list for founding Playworks, which improves the health and well-being of children by increasing opportunities for physical activity and safe, meaningful play. Playworks sends trained, full-time coaches to low-income, urban schools, where they transform recess and play into a positive experience that helps kids and teachers get the most out of every learning opportunity throughout the school day. Rebecca Onie is included for co-founding Health Leads, which mobilizes undergraduate volunteers to help patients fill “prescriptions” shared during provider visits for basic resources needed to be healthy, like food, heating assistance, child care or housing. Health Leads is one of many promising models addressing social needs through the health care system.

As team director of the Pioneer Portfolio, I’m thrilled to see our grantees singled out as innovative entrepreneurs. These innovators represent the kind of leadership and ingenuity that can help us tackle the tough health and health care problems we face in the U.S. Check out the story and don’t forget to congratulate Jill Vialet (@jillvialet), Rebecca Onie (@rebeccaonie), Sara (@Sara_Horowitz) and the B Lab crew (@BCorporation) on Twitter using the #Impact30 hashtag.

Innovations in Integrated Health

Posted by RWJF Blog Team
BY DR. JASON HWANG, Executive Director of Healthcare, Innosight Institute

Jason Hwang, MD, MBA is an internal medicine physician and executive director of healthcare at Innosight Institute, a nonprofit social innovation think tank he co-founded with Harvard Business School professor Clayton Christensen, the world’s foremost authority on disruptive innovation. Through a grant from the Pioneer Portfolio, Dr. Hwang has worked to apply the principles of disruptive innovation to the health care delivery system. Disruptive innovations occur when new business or delivery models displace overly complex and costly, expertise-intensive models. Highlighting work from the Pioneer-funded studies, Dr. Hwang recently described the need for innovation in health care in a post on CNBC.com and was featured in a Human Ingenuity series on Forbes.com.

Why have select integrated health systems outpaced their peers across nearly all quality and cost measures? More than one year ago, Innosight Institute–a nonprofit think tank co-founded by innovation expert Professor Clayton Christensen of Harvard Business School –set out to answer this question by identifying the critical factors and decisions that led to successful, integrated health systems.

Our findings are documented in the paper "Disruptive Innovation in Integrated Care Delivery Systems," which is the culmination of research on seven different organizations representing a wide spectrum of health systems around the country. Major observations and findings include: 

• Successful innovations that may be incorporated into today’s ongoing integration efforts, including mergers, accountable care organizations, and virtual assemblages being formed to participate in bundled payment programs and pay-for-performance contracts;
• The importance of expanding the scopes of practice of various clinical staff, including nurse practitioners and physician assistants, to ensure access to quality care through disruptive delivery models;
• Best practices in the use of electronic health records and health IT that should be implemented across all health systems as stimulus funds promote their widespread adoption.

Identifying these success factors is a crucial step forward in paving the way for similar organizations to be cultivated elsewhere and ensuring that one day every American will have access to high quality, affordable care.

Innosight Institute is also pleased to release its latest case study in conjunction with this project, which documents the experience of Sentara Healthcare in Virginia as it prepares for significant changes in how health care will be delivered and priced in the future. Pilots focusing on chronic disease management, bundled payments for procedures, and a patient-centered medical home are underway, yet Sentara is also acutely aware of the challenges these new delivery models pose to its successful, hospital-led health care system.

Not content with simply reacting to change, Sentara also created a test bed for wellness initiatives by targeting employee health with a program that includes a $500-per-employee rebate and has resulted in a return on investment of $6 for every $1 invested in the program. Meanwhile, the organization’s health plan, Optima Health, has sought to grow its consumer-directed, high-deductible health plans by first developing information and pricing tools for patients.

I invite you to read about Sentara and our other case study subjects: HealthPartners, Lancaster General Health, Presbyterian Healthcare Services, Group Health Cooperative, Grand Valley Health Plan, and Baystate Health (forthcoming).

Finally, I offer my special thanks to Robert Wood Johnson Foundation’s Pioneer Portfolio, whose financial support made this work possible.

What Do We Really Need from mHealth?

The December 5-7 mHealth Summit is approaching and I’m pleased and excited to be moderating the special session: What I Really Need from mHealth: Five Perspectives on Value.

Pioneer has been involved with multiple aspects of mHealth since very early on and has seen interest grow into what sometimes seems to me to be an “irrational exuberance,” to borrow a phrase from Alan Greenspan. I’m concerned that we’re on the way to another bubble that’s in danger of bursting with unfortunate consequences. The fact is we often don’t know what “works,” and even what “working” means. And that’s why it’s so important that we discuss the different ways value needs to be demonstrated in mHealth.

This mHealth Summit panel will talk about value from the perspectives of the individual, the provider, the payer, the regulator and the researcher. These can be different, but from time to time they converge. Rather than having a number of separate presentations, experts will engage in discussion around a hypothetic but realistic scenario of a mobile health device and what’s needed to provide enough “value” for each to adopt, approve, purchase, share, fund and embrace this as a tool for better health. It is sure to be a lively and informative discussion.

I hope that you’ll be able to join us either in person in Washington, D.C. or electronically to help us shape the dialogue.

Follow the conference discussion through #mHS11, leave a comment below, or follow me on Twitter to join in the conversation.

Discovery Channel Documentary Highlights Project ECHO

For some years now, health care innovators have been using emerging health information technologies to transform everyday clinical care. But Pioneer grantee Project ECHO applies these technologies in an entirely new and revolutionary way:  to spread medical knowledge throughout the health care workforce, and, in the process, form collaborative practices, build new professional skill sets and exponentially expand the capacity of the entire health care system.

Project leader Sanjeev Arora, MD, of the University of New Mexico Health Sciences Center, developed the ECHO model to break down medical “knowledge monopolies” so that doctors, nurses and other clinicians can deliver better care to more people who need it, right in their communities. Project ECHO uses video communications technology to create real-time virtual networks for sharing the best medical practices and knowledge between specialists at a university medical center and local primary care teams. 

A new Discovery Channel documentary, Health I.T.: Advancing Care, Empowering Patients, features ECHO amongst a handful of innovative efforts using technology to transform patient care. The segment tells the story of a primary care physician living in rural New Mexico who uses technology in a new way to address her patient’s condition. View the program online or watch it on the Discovery Channel this Saturday, November 26, at 8:00 a.m. ET.

For more information on Project ECHO:

• Read a research evaluation published in the New England Journal of Medicine
• View our Facebook infographic

Converging Ideas at the 2011 mHealth Summit

Sometimes things just come together. We funded the first mHealth Summit because it was interesting and pioneering, and it seemed to have a connection to a few of our Project HealthDesign grants. Then came our involvement with and support of Quantified Self, Open mHealth, the Stanford Mobile Health 2011 conference and the mHealth Evidence meeting. Other programs, like our national program Health Games Research, Games for Health Conference and the Reality Mining meeting that we funded at MIT in 2009, also have strong mHealth associations.

This is more than just coincidence--rather, mHealth focuses on many of the qualities that make Pioneer “pioneering.” mHealth has the potential to radically change the way health and health care is delivered, it is inherently oriented to the individual, and it is an area not yet burdened with the organizational and bureaucratic complexities of traditional health care. mHealth is a place where something radical can happen.

It is therefore particularly gratifying to see that Pioneer will be well-represented at the 2011 mHealth Summit on December 5-7 in Washington, D.C., with grantees featured in sessions on Open mHealth, The Evolution of Gaming and its Effect on Prevention and Wellness, and Wireless Patient Monitoring in Care Facilities: The Future of Wearable mHealth Applications, Devices, and Sensors, and with a  Pioneer-sponsored session, What I Really Need from mHealth: Five Perspectives on Value. This session builds on a discussion that began in August at a Pioneer co-sponsored workshop on mHealth Evidence.

I hope that you’ll be able to join us at the conference, tweet me at @alshar using #mHS11,  and help frame what I’m sure will be a very important discussion.

Why We Have to Start Cutting Back on Antibiotic Use

Up to one million antibiotics are prescribed unnecessarily every year, often for colds and other viral infections that they can’t even cure.  This overuse is a serious public health threat because it significantly reduces antibiotics’ effectiveness to combat all sorts of infections, including life-threatening ones caused by microbes like MRSA and E. coli.

As part of a national effort to reduce improper use of antibiotics, the Centers for Disease Control and Prevention (CDC) and its partners are promoting Get Smart About Antibiotics Week, a campaign to educate consumers and health care providers about appropriate antibiotic use in hospitals and throughout the community.

Pioneer grantee Extending the Cure (ETC), a partner in CDC’s campaign, also released new data this week on antibiotic use trends.  These findings are the focus of a guest blog post on CDC’s Safe Healthcare blog, where Ramanan Laxminarayan, ETC director, describes a pattern of high antibiotic consumption in the Southeastern United States, particularly in West Virginia and Kentucky.  USA Today ran a story about the new research on Wednesday.

Laxminarayan also authored an op-ed in the McClatchy Tribune, calling on public health officials to put in place strategies that address these worrisome trends, such as broader flu vaccination. The new research comes to us from ResistanceMap, an online mapping tool developed by ETC that illustrates the growing problem of antibiotic resistance. This new map provides a look at antibiotic use across the U.S. 

Also this week, ETC released a paper describing a new “Drug Resistance Index” that allows policymakers and hospitals to track changes in antibiotic effectiveness over time using a single measure.  The index, similar in concept to the consumer price index, appeared in Monday’s edition of the British Medical Journal Open.

Extending the Cure is working to change how we as a society think about antibiotics, encouraging us to think about these drugs as a shared resource—just like water, trees or oil reserves—that we rely on and should preserve so they maintain their effectiveness. 

Let us know what you think:  Do we, as a society, use antibiotics too often?  What strategies should we use to ensure a future with plenty of powerful antibiotics?  Leave a comment here or tweet @PioneerRWJF #SaveAbx and @CDDEP to tell us what you think.

OpenNotes Hints at Great News to Come

Pioneer grantees Tom Delbanco and Jan Walker, the creative and scientific minds behind OpenNotes, this week published an opinion piece in Modern Healthcare championing the need for patients to easily and securely access their doctor’s notes online and discussing early results from their project. The piece says, “We are learning that patients are overwhelmingly interested in gaining rapid access to their notes and that many doctors appreciate the potential for open records to improve care.” Check out “e-Patient” Dave deBronkart’s take on the Modern Healthcare story.  He calls the early results, “A hint of great news to come, for lovers of participatory medicine.” We couldn’t agree more, and can’t wait for an update coming later this year and final results due out later in 2012.  Stay tuned!

The Tip of the Iceberg for Science: Massive Biobank Starts Yielding Results

What do you get when you take 100,000 genotyped biological specimens and link them to longitudinal medical, environmental, behavioral and demographic data? You get Kaiser Permanente’s Research Program on Genes, Environment and Health (RPGEH), a Pioneer-supported effort that has developed the most robust and comprehensive research resource of its kind in the world.

At an unprecedented pace, researchers from the RPGEH biobank at Kaiser Permanente, in collaboration with colleagues at the University of California, San Francisco Institute for Human Genetics, have collected 170,000 samples and genotyped over 100,000 of them in just over a year. While currently the largest biobank in the United States, the ultimate goal is even more impressive: to collect data from a half million members of the Kaiser Permanente health plan linked to their electronic health records and population surveys – creating the largest, most comprehensive biobank on the planet.

Early research findings generated from the RPGEH data were presented this month at the joint annual meeting of the American Society of Human Genetics and the International Conference on Human Genetics in Montreal and are featured in the November issue of Nature Medicine. From an investigation of prostate cancer among African American men to a multi-ethnic study on bipolar disorder to a pharmacogenetic study of response to metformin, a drug used to treat type-2 diabetes, the RPGEH biobank is already starting to deliver.

But this is just the beginning - experts say that the possibilities for studying genetic and environmental influences over time thanks to this project are endless, with enormous potential for accelerating both the pace and breadth of medical research. The implications not only for the science community, but also for public health leaders and patients, are immeasurable. Stay tuned.

Early Insights from Project HealthDesign

As more patients begin using technology to manage their health, the Pioneer Portfolio's National program Project HealthDesign is helping meet the demand by designing tools that can be used by real people to improve their health and engagement with their health care providers. In the true pioneering spirit, Project HealthDesign research teams are working with real patients to create new technologies that help people living with chronic illnesses and improve their health and coordination of care. Patients are tracking observations of daily living (ODLs) about their sleep patterns, pain levels and moods. They use the resulting ODL data to better communicate with health care providers as they look to see what the trends in their ODLs might suggest, like whether they need to take a certain action to improve their health or whether past actions have made a difference. The incredible experiences these teams are having with real patients and clinicians have uncovered some preliminary lessons.

The teams have learned that new clinical workflows are needed in order to incorporate ODLs into clinical practice. Nurses, health coaches and other caregivers have emerged as the key points of contact for ODL data incorporation. And because each patient is different, personal health applications need to be customizable.

A key outcome of the teams’ work will be to determine how ODLs can be integrated into clinical care and individuals’ daily health decision-making processes. To learn more insights and lessons from Project HealthDesign, view the Early Findings and Challenges report for a quick overview or read the draft Technical Architectures and Implementations report for more detailed findings.

Warm Weather Brings Risk of Resistant Hospital Infections

Two new articles from Extending the Cure, a Pioneer-supported project that examines solutions to the growing problem of antibiotic resistance, advance our understanding of the growth and spread of certain lethal hospital infections and pose policies to address the long-term challenge of antibacterial resistance.

The first article, which appeared Sept. 26 in the online journal PLoS One, describes a new study that found certain potentially lethal hospital infections are more prevalent in warmer weather. In the study researchers examined 211,697 infections reported by 132 hospitals across the nation from 1999 to 2006. The warmer the temperature, the more hospitals reported certain hard-to-treat infections. The problem was particularly severe in the summer: For example, the researchers identified a 52 percent summer spike in bloodstream infections caused by Acinetobacter baumannii, a highly resistant “superbug.”

Hospitals should be on alert during warm weather in any season in order to identify and stop the spread of these resistant infections, the authors say.

In the second article Ramanan Laxminarayan, the director of Extending the Cure at the Center for Disease Dynamics, Economics & Policy, and John H. Powers, associate clinical professor of medicine at George Washington University School of Medicine, argues that we need incentives to crank out newer, more powerful antibiotics and at the same time, preserve the efficacy of antibiotics we have left.

Writing in October issue of the journal Nature, they say that we must start treating antibiotics as a valuable resource, one that can be depleted with overuse and nurtured with public private partnerships(PPPs).  “In our view, government intervention through PPPs that are focused on the development of antibacterials with desirable properties, in combination with incentives to encourage the conservation of antibacterials and the achievement of resistance targets, is the best way to tackle the increasingly serious public health threat of antibacterial resistance.”

Leave a comment to tell us what you think public policy should focus on in the research, development and preservation of antibiotics.