Health AGEnda

Chris Langston

About Chris Langston

Christopher A. Langston, PhD, is the Program Director of the John A. Hartford Foundation, and is responsible for the Foundation’s grantmaking in support of its mission to improve the health of older Americans.

Hartford Grantees Recognized at GSA

2014_GSA_Meeting_Logo_300pFor almost 20 years, the Gerontological Society of America (GSA) has been one of the John A. Hartford Foundation’s key grantee partners.

The organization served first as the home of the Geriatric Social Work Initiative (GSWI), then as the coordinating center for the National Hartford Center of Gerontological Nursing Excellence (NHCGNE) , and most recently, as the basecamp of the Hartford Change AGEnts Initiative.

So the GSA annual meeting, being held this week in Washington, DC, is a tremendous opportunity to connect with long-standing friends and meet new ones in the field of aging, as well as to check in on long-ago grants and plan new ones.

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Health Services Research Needs Good Theory to Turn into Better Practice

HospitalOlderWoman_400pLast week, the Journal of the American Medical Association (JAMA) published a large and well-designed study of a post-hospital readmission reduction program called the “virtual ward,” which grew up in the UK and was tested by our cousins to the north in Toronto.

The model partakes of some elements of other evidence-based work done by John A. Hartford Foundation grantees, including Mary Naylor’s Transitional Care Model, the Society of Hospital Medicine’s Project BOOST, and Eric Coleman’s Care Transitions Intervention.

A press release and JAMA Report video are available for those who don’t subscribe to JAMA.

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Happy Birthday SIF! Celebrating Five Years of Public-Private Partnership

From left: Rebecca Brune, VP of Strategic Planning and Growth, Methodist Healthcare Ministries of San Antonio; Regina Bonnevie, MD, Medical Director, Peninsula Community Health Services in Port Orchard, WA; Peggy Cary, Senior VP of Finance & Internal Audit, Methodist Healthcare Ministries; and Diane Powers, Associate Director, Division of Integrated Care and Public Health, University of Washington AIMS Center, Seattle WA, talk following presentations at the Eisenhower Executive Office Building in Washington, DC.

From left: Rebecca Brune, VP of Strategic Planning and Growth, Methodist Healthcare Ministries of San Antonio; Regina Bonnevie, MD, Medical Director, Peninsula Community Health Services in Port Orchard, WA; Peggy Cary, Senior VP of Finance & Internal Audit, Methodist Healthcare Ministries; and Diane Powers, Associate Director, Division of Integrated Care and Public Health, University of Washington AIMS Center, Seattle WA, talk following presentations at the Eisenhower Executive Office Building in Washington, DC.

Last week, the Social Innovation Fund of the Corporation for National and Community Service celebrated its 5th Birthday. There was cake.

More importantly, there was a celebration of the good that philanthropy can do to address the pressing problems facing the country. The goal of the Social Innovation Fund is to bring federal and private money together to scale up the best, evidence-based innovations to address problems of education, poverty, and health.

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Dying in America: There Must Be a Better Way

DyingInAmericaCover400pLast week, the Institute of Medicine released a new report titled Dying in America.

The committee that worked on the report included some long-time grantees and friends of the John A. Hartford Foundation,  such as June Simmons  of the Partners in Care Foundation, Jean Kutner, a Beeson Scholar  and faculty member at the University of Colorado, Diane Meier, leader of the Center to Advance Palliative Care, Patricia Bomba  of Rochester, NY’s Excellus Blue Cross/Blue Shield, and Joan Teno of the Center of Excellence in Geriatric Medicine at Brown University.

As always, we are proud to be associated with leaders who give their time to explore such urgent issues.

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Of Knights, Knaves, and Pawns: Physician Disillusionment and the Need to Realign Our Health Priorities

Doctored_Book_Cover_300pEver since I began working as a program officer at the John A. Hartford Foundation, I’ve tried to do my best to put myself in the shoes of the health professionals with whom we’ve worked and whose education and training historically has been one of our main concerns.

I’ve often found memoirs and other lightly fictionalized accounts to be the best way to get into the culture and daily experience of these health professionals. I’ve read Samuel Shem’s The House of God, countless memoirs of nurses and physicians, and even a very affecting memoir of a nurse’s aide in a nursing home.

One of the tricks of such reading is that we experience what our imagination and the author’s words together conjure in a special state of willing suspension of disbelief. Psychological research suggests that this process of imagination and purposeful lowering of critical skepticism is, in fact, what makes fiction so persuasive and engenders the feeling that novelists understand a truth about human character that other ways of knowing can’t match.

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Public Reporting Alone Will Not Fix Nursing Home Problems

NYT_Capture_NursingHomes400Yesterday, the New York Times had an interesting piece looking at the star rating system that Medicare has been using to evaluate long-term care facilities.

Coincidentally, I was moved to learn that a family friend, my “Aunt Betsy,” has been in an institution for going on 10 years, exceeding almost every expectation for longevity in advanced dementia.

The Times writer, Katie Thomas, observes that much of the data that drives this public reporting system, Nursing Home Compare,  of “hotel-like,” 1- to 5-star ratings comes from institutional self-report and seems susceptible to gaming—including staffing up for the critical two weeks that are the basis of reporting for the year’s rating, and then letting the staff go immediately afterward. Sort of the way that television shows pump up their ratings with guest stars during sweeps week and then fall back to meh afterwards.

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Poll Briefing Makes Voices of Older Americans Heard in DC

From left, featured experts Peggy O'Kane, Robert Berenson, and Caroline Blaum listen intently.

From left, featured experts Peggy O’Kane, Robert Berenson, and Caroline Blaum listen intently.

Like so many stakeholders in health care, we at the John A. Hartford Foundation  have many of our hopes pinned on enhanced primary care as a way of improving health outcomes, particularly for older Americans who face multiple chronic conditions.

Primary care providers will need more skills, more teammates, community partners, and, of course, more money, to live up to these hopes. But we believe that better primary care can prevent some of the acute and expensive events such as hospitalizations that they experience, and thereby also lower total costs of health care.

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Equality Does Not Equal Lowering Health Care Standards for the Poor

FrenchRevolution_177737175July is an important month in history, with Bastille Day, on July 14, coming just 10 days after our own 4th of July. So what better time to consider issues of justice and equality?

There are lots of different ways to interpret equality: equality of outcomes, equality of opportunity, or perhaps—as an even more complex relative equality—matching of resources to individuals’ needs.

In the context of improving health care delivery to older adults, there are several important examples of these principles of equality in what is called “risk adjustment.” And I find myself with very different reactions to the different kinds.

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Coming to Terms with the Concept of Population Health

Crowd_481008763_400Like a lot of new concepts, population health seems to be on everyone’s lips and there seems to be a lot of excitement to “do” population health. It sure sounds good and yet I am entirely unclear about the specifics and I’m pretty sure that everyone is feeling a different part of the elephant.

Unfortunately, a recent paper published on BMJ Open suggests that these divergent views are common.

We can all understand the goals of the triple aim: better care—higher quality health care with fewer defects; better health—a related but independent goal that the population at large is actually healthier; and lower cost, at least on a per capita basis—reducing total costs of care.

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New Grants Target Policy and Practice Change

One of the Hartford Foundation's new grants will support an additional 44 Health and Policy Fellows over the next three years who will bring geriatric expertise to policymakers and in turn receive intensive training in policymaking through placements at key agencies and offices in the federal government.

One of the Hartford Foundation’s new grants will support an additional 44 Health and Policy Fellows over the next three years.

While the two new grants approved by the John A. Hartford Foundation Board of Trustees last week continue to move us forward in our new strategic direction, which includes a focus on health policy and practice change, they also build on partnerships and successful work we have engaged in for years.

The grants totaling $2.13 million will support an additional 44 Health and Aging Policy Fellows (HAPF) over the next three years and help co-support a new Institute of Medicine (IOM) study on family caregiving of older adults. Both projects also offer great opportunities for our new Hartford Change AGEnts to bring their talents, expertise, and skills to bear on important issues related to creating policy and practice change that improves the health of older Americans.

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