Sutter Maternity & Surgery Center Receives Press Ganey Summit Award

SMSC one of three hospitals in California to receive prestigious patient satisfaction award

Santa Cruz, Calif. — Sutter Maternity & Surgery Center (SMSC) is proud to announce that Press Ganey Associates, Inc. has named it a 2009 Summit Award Winner. Press Ganey currently partners with more than 10,000 health care facilities—including over 40% of U.S. hospitals—to measure and improve the quality of their care. The company’s databases are the largest in the industry, and allow facilities nationwide to benchmark their results against peer organizations. The Summit Award recognizes top performing facilities that sustain the highest level of customer satisfaction for three or more consecutive years. The Press Ganey Summit Award is the health care satisfaction industry’s most coveted symbol of achievement bestowed annually, and SMSC is just one of the nation’s 74 organizations to receive this prestigious honor in 2009. SMSC is one of only three hospitals in California to receive the award.

According to Jacci Sterling, SMSC’s assistant administrator, chief nursing officer and perinatal director, the award was as much a result of SMSC’s culture as its specific policies and practices. New hires and all staff are coached in Patient/Family Centered Care principles that teach the importance of the patient’s perception of quality and care and gives them the tools to handle conflicts. Staff satisfaction drives patient satisfaction and SMSC’s excellence in this area is evidenced by their recent ranking as 20th in Modern Healthcare magazine’s “Best Places to Work in Healthcare.”

“We know that employee satisfaction goes hand in hand with patient satisfaction,” Sterling says. “And we have a very satisfied staff as shown in annual staff surveys. We truly believe that patient satisfaction must be an institutional goal that is modeled from top management down and included as a performance expectation for the staff.”

SMSC also maintains some environmental choices to promote healing and caring, including:

• No overhead paging, except for codes

• Twenty-four hour room service for all patient meals, no food tray lines

• “Guest Services” employees are members of the Patient Centered Health Care Team who welcome patients, clean rooms, and deliver meals

For more information, contact:

Mark Riley
Palo Alto Medical Foundation
831-460-6034
rileym1@pamf.org

More than $2 Million in Grants Given to PAMF Research Institute

Funds from the 2009 American Recovery and Reinvestment Act

Mountain View, Calif. – The Palo Alto Medical Foundation’s (PAMF) Research Institute has received more than $2 million in grants through the American Recovery and Reinvestment Act (ARRA) of 2009 to support several diverse medical research projects and new research positions.

The projects and professionals the grants will fund include:

• Pan Asian Cohort Study: Identifying Disparities in Type 2 Diabetes Among Asian Americans
• Mental Health Communication in Elderly Primary Care Visits
• Prostate Cancer Navigator Project
• Breathe Easier through Weight Loss Lifestyle Intervention (Be Well)
- Support for one post-doctoral Fellow for two years, with focus on pulmonary (lung) medicine
- Support for one summer college student intern for two summers

Details of each of these grants follow in this release.

“These grants provide external validation of the importance of the studies we are conducting. The extra funding will allow us to add critical resources to move forward research on several fronts.” said Hal Luft, Ph.D., director of the PAMF Research Institute. “Our studies not only will help increase knowledge of these important issues, but could also lead to new methods of treatment.”

Details of Medical Research Grants

Prostate Cancer Navigator Project
Principal Investigator: Nancy Brown, Ph.D.
Co-investigators: Frank dela Rama, R.N., and Gordon Ray, M.D.
Grant of $275,000

The goal of this two-year research project is to reduce the confusion and anxiety many patients experience during and following decisions associated with a prostate cancer diagnosis and/or treatment. The project will focus on keeping participants well-informed about their treatment options. Outcomes of two groups will be measured to assess decisional conflict, the interval between the diagnosis and treatment decision, prostate cancer-specific quality of life and related anxiety, general health-related quality of life, and health resource utilization.

Mental Health Communication in Elderly Primary Care Visits and Economic Outcomes
Principal Investigator: Ming Tai-Seale, Ph.D., MPH
Grant of $1 million

As many as one half of older adult patients with a recognized mental disorder fail to receive any mental health services, and even fewer receive evidence-based treatments. Using previously collected data from an integrated healthcare delivery system in the Midwest, this research will study what occurs during the medical office visit to examine the impact of time and effort spent on addressing mental health and physical health on subsequent clinical outcomes and treatment costs. The study is funded by the National Institute of Mental Health.

Pan Asian Cohort Study: Identifying Disparities in Type 2 Diabetes among Asian Americans
Principal Investigator: Latha Palaniappan, M.D., M.S.
Grant for $613,584

The Pan Asian Cohort Study is a five-year project designed to examine diabetes and its risk factors among Asian Americans by specific race/ethnicity. Asians, although they consist of more than 30 ethnic groups from more than 20 countries of origin, have always been grouped together in previous diabetes studies and reports. Therefore, the prevalence of diabetes and related risk factors, such as obesity, remains largely unknown in specific Asian ethnic groups. The study is funded by the National Institute of Diabetes and Digestive Kidney Diseases of the National Institutes of Health.

Breathe Easier through Weight Loss Lifestyle Intervention (Be Well) Study
Principal Investigator: Jun Ma, M.D., Ph.D.
PAMF RI Co-Investigator, Sandra Wilson, Ph.D.
Supplement of $297,132

Be Well is a multi-million, five-year, randomized controlled clinical trial funded by the National Heart, Lung and Blood Institute of the National Institutes of Health. In this trial, PAMF RI is collaborating with researchers from Kaiser Permanente, Stanford and Harvard to study whether weight loss, in addition to improving overall health, also improves control of asthma. Supplemental funding was obtained through ARRA to support for two years one post-doctoral fellow with a focus on pulmonary (lung) medicine and one summer college student intern for two summers. Through their involvement in a wide range of research activities in the Be Well trial, these trainees will acquire important knowledge and skills required for future success in patient-oriented research.

Nationwide, $200 million dollars were awarded as part of the ARRA. More details of this national program are available at: http://grants.nih.gov/recovery/

For more information, contact:

Cynthia Greaves
PAMF Public Affairs
650-934-8614
greavec@pamf.org

PAMF Race/Ethnicity and Language Collection Study May Help Reduce Health Disparities

Article on study to be published in prestigious Health Services Journal

Palo Alto, Calif. – The Palo Alto Medical Foundation’s (PAMF’s) Palo Alto and Camino Divisions began collecting race/ethnicity and language information in May 2008 when scientific reports and studies showed that collection of such information improved quality of service and care by helping reduce racial/ethnic disparities.

An article documenting the collection efforts, which will serve as a model for other large, outpatient health care organizations, will be released in the October issue of Health Services Research, a top industry publication. Dr. Latha Palaniappan, Eric Wong, and Jessica Shin from the PAMF Research Institute’s Health Policy Research Department partnered with Maria Moreno, MPH, from Sutter Health Institute of Research and Education (SHIRE) and Regina Otero-Sabogal, PhD, from University of California, San Francisco, to author the paper.

“Government reports have documented that racial and ethnic minorities experience disparities in health, such as receiving poorer treatment for heart attacks or being more likely to be diagnosed with late-stage breast cancer and colorectal cancer,” said Moreno, a researcher at SHIRE. “If data on patients’ race/ethnicity and primary language are available, disparities in health care can be addressed.”

“The Patient Demographic Questionnaire is a one-time, optional questionnaire that a patient fills out when they are checking in for their appointment. It enables the patient to provide self-reported, demographic-specific information about themselves for their doctors, so that the doctors in turn can provide an even higher level of quality care to the patient depending on the prevalence of health conditions associated with their race/ethnicity,” said Michael Fagan, project manager in PAMF’s Palo Alto Division who worked closely with Kim MacIntosh, his counterpart in PAMF’s Camino Division, to implement the process.

Currently nearly one-third of PAMF patients have their race/ethnicity and language information linked to their electronic health records. This information minus the identity of the patient is being used to investigate health disparities in the treatment of diseases, such as diabetes and cardiovascular disease.

“PAMF is a pioneer in collecting race/ethnicity and language in a clinic setting. This study provides a pathway for implementation of race/ethnicity and language collection at other health care delivery systems,” says Dr. Palaniappan, a PAMF physician and research investigator. “Our goal is to use this study to develop a standard of care that takes into account the unique risk factors inherent in people of different races/ethnicities. The bottom line is that if we know a patient’s race/ethnicity, we can provide them with even better preventive care.”

As part of the study, PAMF conducted pilot programs on how to best collect patients’ race/ethnicity and language information, and decided to collect the optional form during patient registration. Mailing the questionnaire and a telephone questionnaire were also studied, but had a lower rate of completion.

“Implementing this data collection process was not easy or simple. We considered every aspect of the process very carefully including how the questions were presented, how Patient Service Representatives at the front desk would introduce the questionnaire, and how to best protect patient privacy,” said Wong, a senior statistician at the PAMF Research Institute. “Collecting this information from the patient right before their visit proved to be the most effective method and it freed up time for the doctor and the patient, enabling them to spend more time together discussing the reason for the appointment.”

To see the full article in print, please visit www.hsr.org.

For more information, contact:

Ben Drew
Palo Alto Medical Foundation
650-691-6228
drewb1@pamf.org

PAMF Research Institute Receives Nearly $5 Million in Grants

Funding to investigate treatment for obesity-related illnesses

Palo Alto, Calif. – The Palo Alto Medical Foundation’s (PAMF’s) Research Institute has received grants totaling nearly $5 million, including a five-year, $4 million grant from the National Heart Lung and Blood Institute to study the relationship between obesity and asthma and a three-year, $800,000 grant from the National Institute of Diabetes and Digestive and Kidney Diseases and American Heart Association to study the effectiveness of lifestyle intervention strategies in primary care to prevent overweight or obese individuals with pre-diabetes from developing diabetes.

“Chronic diseases, such as diabetes and asthma, have increased in prevalence and had a significant impact on people’s overall health, as well as health care costs in this country," said Sandra Wilson, Ph.D., chair of the Department of Health Services Research at the PAMF Research Institute. “Both of these studies will help to determine whether theories about weight loss and controlling asthma; and lifestyle interventions in the prevention of diabetes are backed by scientific evidence. They have the potential to help patients better manage their conditions and change the treatment guidelines and protocols for these chronic illnesses.”

Obesity and Asthma Study

PAMF will collaborate with researchers from Kaiser Permanente, Stanford, Harvard, and Oregon Health & Science University to study whether weight loss, in addition to improving overall health, also improves control of asthma. In the United States, the prevalence of obesity has doubled in adults and approximately tripled in children and adolescents since 1980. The latest population surveys have found that two-thirds of U.S. adults and one in six children and adolescents are overweight or obese. At the same time, the prevalence of asthma has increased significantly. Obesity may directly cause or worsen asthma through its effects on lung function, systemic inflammation, and/or other bio-physiological mechanisms. While asthma is often mistakenly viewed as a disease that only originates in childhood, compared with normal-weight adults, asthma incidence increases by an average of 38 percent in overweight and 92 percent in obese adults.

“We know that weight loss reduces the risk of several other major obesity comorbidities such as diabetes and hypertension, but this will be the first study of an evidence-based, state-of-the-art, lifestyle approach to weight loss in improving asthma outcomes for obese patients who also have asthma,” said Jun Ma, M.D., Ph.D., associate scientist and investigator at the PAMF Research Institute. “While the clinical treatment of asthma should continue to emphasize proven pharmacological and patient self-management strategies, the available evidence is already sufficient to warrant the investigation of including evidence-based weight loss strategies as an additional treatment strategy for obese asthma patients.

“If we can establish the benefits of weight loss in the treatment of obese asthma patients, we have the chance to positively impact the health of many people and develop clear clinical guidelines for providers.”

Effectiveness of Lifestyle Interventions on Pre-Diabetic Patients in Primary Care Study

This three-year study conducted in coordination with PAMF’s Los Altos Center will evaluate the acceptability, feasibility and potential effectiveness of translating an evidence-based weight reduction program for preventing or delaying the onset of type 2 diabetes to ongoing primary care of overweight or obese adults with pre-diabetes. About two-thirds of U.S. adults are overweight or obese, and 57 million people are estimated to have pre-diabetes – a condition characterized by blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. Many of these individuals also have co-existing cardiovascular risk factors, such as abdominal obesity, dyslipidemia, and hypertension.

“Preventive health care is a major goal in primary care, but prevention of obesity and the management of associated risk factors in primary care settings has thus far been lagging substantially behind the evidence on effective treatment strategies for these conditions,” said Dr. Ma. “This study will examine whether proven, cost effective, lifestyle weight reduction models can be delivered successfully in a primary care setting and what impact this has on health outcomes.”

Research has demonstrated that intensive lifestyle interventions focusing on diet, physical activity and behavioral self-management, can help patients lose weight and delay or prevent the onset of type 2 diabetes. Face-to-face, individual counseling has proven to be one effective tool to help patients sustain their behavior changes and weight loss. However, the substantial resources required for sustained, one-on-one counseling are a barrier to widespread implementation. This trial will examine Internet-based assistance for patients and Internet-based assistance combined with individualized counseling by a dietician and exercise specialist in comparison to the usual care being provided now in primary care.

“We need to determine whether what we believe to be successful weight loss methods can be translated into routine clinical care on a much broader scale, both efficiently and cost effectively. The results of our study could help shape future primary care-based models of obesity management for the prevention of diabetes and cardiovascular disease,” said Dr. Ma.

For more information, contact:

Ben Drew
Public Affairs
Palo Alto Medical Foundation
650-691-6228
drewb1@pamf.org

Patients Keeping Weight Off, Regaining Health with PAMF’s HMR Weight Management Program

Mountain View, Calif. – Most fad diets don’t work because the five pounds you may lose quickly return when you go back to your old eating habits. One key to success is adapting your eating habits in a way that you can successfully sustain for your lifetime.

The Palo Alto Medical Foundation (PAMF) offers a range of programs to help people of all ages achieve healthier results. One of these programs – the HMR® (Health Management Resources) Weight Management Program – has yielded measurable success for its patients and has just released the cumulative results of their patients’ weight loss, weight maintenance and subsequent health benefits (see below).

“These results show that patients not only lose weight with our program, but truly develop the skills to keep the weight off they worked so hard to lose,” said Karen Handy, PAMF’s manager of Nutrition Services and the HMR Weight Management Program. “We see their results on the scale every week, and it was gratifying to learn about the very significant ways their health has been improved overall.”

HMR® is a medically supervised program that has helped thousands of people lose weight by emphasizing the skills and behaviors needed to live a healthier, more active life. This is a research-based, medically-supervised weight management program designed for those, ages 16 and up, who would like to lose between 10 and 200 or more pounds. There are three different diet options with weekly health behavior classes to promote lifelong weight management.

This year, PAMF’s HMR® program won seven national Gold Standard Awards for excellence for the program’s low drop-out rates and patients’ improved and sustained weight management efforts.

Changes in Medical Risk Factors*

• The average participant is keeping off 43 pounds.
• Sixty three percent of patients are keeping off an average of 59 pounds. That’s 22 percent of their initial body weight being kept off.
• Total cholesterol/HDL dropped nearly 15 percent.
• Thirty six percent of participants were able to discontinue medications needed initially (e.g. blood pressure and cholesterol control medications).
• More than 45 percent of diabetes patients on medication came completely off those medications as a result of their weight loss.
  

*Data are from 91 patients who participated in PAMF’s HMR® program for an average of three years.

“We repeatedly hear how happy patients are to be off their diabetes, cholesterol and high blood pressure medications. It’s both a cost savings and a significant and meaningful change to their quality of life when they don’t have to take multiple pills, run to the pharmacy for refills, or structure their days around their medication regimens,” Handy said.

All of the weight loss programs offered by PAMF are based on credible research, approved by physicians and presented by licensed, credentialed professionals.

The HMR department is located 700 El Camino Real, across the street from the Palo Alto Medical Foundation Mountain View Center. Their phone number is 650-404-8260.

Additional information on PAMF’s nutrition and weight loss programs is available online at www.pamf.org/healtheducation/classes/weight.html and at the HMR Weight Management Program Web site.

For more information, contact:

Cynthia Greaves
PAMF Public Affairs
650-934-8614
greavec@pamf.org

PAMF Named Top Performer in California for 6th Consecutive Year

Integrated Healthcare Association Announces Pay for Performance Program Winners

Mountain View, Calif. – The Integrated Healthcare Association (IHA) has named the Palo Alto Medical Foundation (PAMF) as one of the most outstanding physician groups in California based on its Pay-for-Performance (P4P) program measures.

In overall performance, PAMF ranked as a “top performer” and is listed in the top 20 percent of physician groups, based on the statewide P4P program measures. IHA’s P4P program is the largest physician incentive program in the United States. It assesses physician groups based on objective measures that include clinical quality measures (e.g., cancer screenings, immunizations, diabetes care), patient satisfaction measures (timely access to care, doctor-patient communication, etc.), and use of health information technology (including supporting clinical decision making and use of systems to ensure patients received evidence-based care).

“This past year was one of tremendous change for the physicians that make up the Palo Alto Foundation Medical Group (PAFMG). This was the first year that the three historical medical groups that make up PAFMG – Camino Medical Group, the Palo Alto Medical Clinic and the Santa Cruz Medical Clinic – submitted performance data as a single unified organization,” said Philip Brosterhous, M.D., chief medical officer of PAFMG. “The fact that we continue to be in the top 20 percent of California physician groups based on state-wide Pay for Performance program measures is a tremendous honor and confirmation of the excellence and quality of our physicians and our organization.”

The California P4P program is in its sixth year. One or all of PAMF’s historic medical groups have been on the winners list every year since the program began. PAMF is one of five affiliated Sutter Health medical groups, including Mills-Peninsula Medical Group its counterpart in Sutter’s Peninsula Coastal Region, named by the IHA as top performers this year.

On the whole, P4P initiatives give medical groups the opportunity to demonstrate how well they do caring for their patients, and prompt them to examine how they can continue to do better. Patients benefit from this scrutiny and continual improvement. In addition, the 2008 measurement year results are used by seven health plans – Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA HealthCare of California, Health Net of California, Western Health Advantage, and United Healthcare – to calculate incentive payments for distribution to physician groups in 2009.

Results for the clinical, patient experience, and IT measures are available at the IHA Web site: www.iha.org. Scores for each participating physician group reflecting 2009 performance on P4P measures will be posted on the California Office of Patient Advocate Web site, http://www.opa.ca.gov/, by November.

For more information, contact:

Cynthia Greaves
PAMF Public Affairs
650-934-8614
greavec@pamf.org

Cindy Ernst
IHA
510-208-1740
cernst@iha.org

PAMF and Research Partners Receive Grant to Help Patients Share in Decisions About Their Health Care

Foundation for Informed Medical Decision Making Funds Sites Around the Country

Boston, MA and Palo Alto, CA – The Palo Alto Medical Foundation (PAMF), the Palo Alto Medical Foundation Research Institute (PAMFRI) and the University of California, San Francisco (UCSF) recently received one of a handful of grants from the Boston-based Foundation for Informed Medical Decision Making. PAMF, a multispecialty medical group in the San Francisco Bay Area, will serve as the clinical site and PAMFRI and UCSF will coordinate the research aspect of the project.

The one-year, $200,000 grant will fund efforts at PAMF to explore the best ways to use innovative audio-visual decision aids, such as DVDs, to improve the ability of patients to partner with their physicians to make complex medical decisions. PAMF is one of a number of demonstration sites across the country that are part of a national effort by the Foundation for Informed Medical Decision Making to make patients full participants in their own health care decisions.

“We are pleased to be working with health care organizations such as PAMF, PAMFRI and UCSF who are committed to changing the face of health care by inviting patients to play an active role, working with their providers, in deciding what care is best for them,” said Michael Barry, M.D., president of the Foundation for Informed Medical Decision Making.

Each year, the Foundation for Informed Medical Decision Making funds organizations it believes have the greatest commitment to patient-centered care and the infrastructure to make decision aids part of daily medical practice. The decision aids, co-produced with Health Dialog and created with the assistance of world-class medical experts in a variety of specialties, consist of booklets and DVDs that thoroughly examine a patient's treatment options and include real patients discussing their choices. Each demonstration site incorporates the decision aids into the physician/patient relationship in its own way to foster what is now known as a “Shared Medical Decision Making” process.

“We are very excited about this funding,” said Harold Luft, Ph.D., director of PAMFRI. “It will allow us to begin building a system that enhances the information we give our patients and their ability to participate fully in their own health care.”

With the Foundation for Informed Medical Decision Making grant, project leaders will fund a point person (a shared decision-making navigator) who will communicate with patients referred by health care providers about their preferred method for receiving information for shared decision-making. Patients will have several options for accessing the decision aids. They will be able to view the DVDs at PAMF’s Palo Alto Community Health Resource Center and speak with an on-site nurse about their questions. Patients will also have the option of borrowing the DVDs from the Resource Center or receiving them by mail to view at home before speaking with a nurse or physician by phone. Some patients may also choose to join others with similar conditions in scheduled shared medical appointments during which they can view the decision-making aids and speak with physicians or nurses.

Other recent grant recipients include Dartmouth-Hitchcock Medical Center, White River Junction VA Medical Center; Pittsburgh VA Health Care System; Massachusetts General Hospital - John D. Stoeckle Center for Primary Care Innovation; Mercy Clinics Inc. (Des Moines, Iowa); Oregon Rural Practice-Based Research Network; The Stillwater Medical Group; and the University of North Carolina-Sheps Center for Health Services Research.

To view more detailed summaries of all the grant recipient projects, go to http://www.informedmedicaldecisions.org/.

To view a sample of a decision aid video, go to http://sdm.healthdialog.com/index.html.

To learn more about the Foundation, the portfolio of decision aids and research demonstrating the need for an informed and involved patient, visit http:/www.informedmedicaldecisions.org/index.html.

For more information, contact:

Ben Drew
Palo Alto Medical Foundation
650-691-6228
drewb1@pamf.org

Patti Jacobs
617-864-2712
pjacobs12@comcast.net