Home Care Hospitalization: An Experiment with Promise


November 11, 2016; Forbes

As the cost of healthcare, particularly in hospitals, continues to skyrocket, a few are exploring alternative methods of providing high quality care for lesser costs. One nonprofit in particular is reintroducing a method of care from decades ago: home visits from doctors.

When Dr. William Terry arrived at Boston’s Brigham and Women’s Hospital with violent chills and a high fever, emergency room staff determined he needed hospital care. Instead of being admitted, however, Dr. Terry became part of a study where he would receive the same care at home, including at least one home visit from his doctor plus two nurse visits every day.

The Brigham and Mass. General studies are limited to patients living within five miles from the hospital who present with heart failure, pneumonia, chronic obstructive pulmonary disease, or infections. (Terry’s chest x-ray showed a “suspicious spot.”) The study is focusing on these conditions because patients do not normally require intensive care or major procedures.

The preliminary results of the Brigham study were published in a recent issue of JAMA Internal Medicine. Patients were found to suffer from lower infection and readmission rates. The cost savings was an average of $2,000 per patient as compared to a hospital stay. More importantly, patients receiving care at home reported feeling happier. Perhaps that is not surprising, given hospitals’ reputations for awful food, harsh lighting, loss of privacy, snoring roommates disturbing sleep, and nurses on a schedule that works for the hospital system rather than the patient. The list goes on.

The study is part of a larger movement led by Hospital at Home, a program created by the Johns Hopkins School of Medicine and Public Health. Their research found the model lowered costs by almost a third and reduced complications of hospital stays. Surprisingly, the first study of these types of programs was conducted in 1997, leaving a supporter to describe the treatment plan as the “most studied innovation in health care.”

Although common in England, France, and Australia, in-home care is not widespread in the U.S., mainly because most insurance companies and Medicare do not cover it. Many of the treatment providers, such as Brigham and Women’s Hospital, are picking up program costs. New York City’s Mount Sinai Hospital is part of a $9.6 million, three-year similar study funded by the Centers for Medicare and Medicaid Services.

Overall, due to technology and revolutionary research, plus the emerging population health and wellness reimbursement structure of the Affordable Care Act, medical care is shifting. As research and technology has disrupted once-deadly diseases like HIV-AIDS and we continue to live longer and healthier, some are describing the hospital of the future as a “NASCAR pit-stop.”—Gayle Nelson

Original cite: https://nonprofitquarterly.org/2016/11/16/home-care-hospitalization-experiment-promise/

Sesame Street Explores New Frontiers in Education



February 1, 2016; Fast Company

In the 1960s, creating educational programming for children on television was innovative. Today there are more channels than ever before, and more children first meet Big Bird and other Sesame Street friends on phones and tablets. At the same time, children’s educational needs continue to grow, from obesity to autism, and parent deployment to bullying. Leaders at Sesame Workshop, the parent of Sesame Street, are exploring creative methods of reaching out, educating, and helping children thrive.

Although its programming began on television, Sesame Workshop quickly realized the medium was just the beginning. Sesame Workshop developed websites, cable shows and networks, and 16 million “outreach kits” and events that reach hundreds of thousands of children and their parents through partnerships with over 3000 organizations. With a budget of $104 million, though, more work is needed to fulfill its mission of helping kids grow smarter, stronger, and kinder.

Sesame Workshop recently announced the creation of Sesame Ventures, a partnership with a venture capital firm called Collaborative Ventures, and the subsequent creation of a new fund, Collab + Sesame. The $10 million fund will invest in startups developed by corporations and other for-profit organizations in six broad areas: entertainment and media, food, health and wellness, family development, education tools, and social and emotional development.

We are in the midst of an extraordinary time in the history of how digital technology can change the education, health and welfare of kids around the world,” Jeffrey D. Dunn, Sesame Workshop’s CEO, said in a statement. “History suggests that much of that change will spring from new companies. By partnering with some of these startups, Sesame Workshop can help grow the next wave of kid-focused innovation and improve the lives of children everywhere.”

The Workshop’s funds for its half of this new venture stem from the sale of its stakes in Noggin and Sprout. Both projects were innovative activities of their times: Noggin, the first all-educational cable channel for children, was launched in 1999 in partnership with Nickelodeon, while Sprout, a cable network targeting preschoolers, was developed in 2005 in partnership with PBS, HIT Television Ventures, and NBC Universal.

Projects funded through Collab + Sesame will be offered technical assistance and the opportunity to make use of Sesame Street characters and branding, as well as $1 million each. Although few would give up these perks, Sesame Workshop CEO Dunn places no preconditions that might make one suspect that the group is simply trying to extend their brand on the use of the funds.

Original site: https://nonprofitquarterly.org/2016/02/04/sesame-street-explores-new-frontiers-in-education/

Using Technology to Improve Healthcare in Rural Maine



September 23, 2015; Portland Press Herald

Rural Washington County is located on the Maine coastline. The county contains some of the most majestic landscape as well as the highest childhood poverty rate in the state. Close to 60 percent of school children in the county are eligible for free or reduced lunch. As a whole, Maine has more residents over the age of 65 than any other state, and Washington County has the second-oldest Maine county. Not surprisingly, this population has substantial health needs.

Recently, the Nonprofit Quarterly examined the issues people living in rural areas experience particularly in their ability to access to healthcare. And these issues are growing to crisis levels: 57 rural hospitals have closed in the last year. Only ten percent of America’s doctors practice in the rural areas where one quarter of the country’s population lives. This lack of access to medical care leads to a disproportionately high rate of deaths from things like unintentional injuries and motor vehicle accidents among rural residents compared to those living in urban areas.

Harrington Family Health Center is at the center of the health crisis in Maine. Patients depend on the nonprofit to provide medical, dental, and mental health services. Many of the patients served at the Center suffer from multiple conditions requiring a complex medical regimen. According to its CEO, Lee Umphrey, its patients have the highest instances of diabetes, heart disease, and cancer in the state. In 2014, the Center provided over 14,000 medical visits treating about 3,500 patients.

Brock Slabach, senior vice president of member services for the National Rural Health Association (based in Kansas), describes helping patients manage chronic conditions as “imperative” as the number and types of medical services baby boomers require continues to grow. Better management means fewer hospital stays and less expensive treatment in the patient’s home community.

As nonprofits providing these services struggle to serve, a new pilot program offers medical staff technology to bridge the gap between resources and need. In July, the Harrington Center’s healthcare providers began utilizing tablets loaded with medical apps to deliver more effective services as part of a pilot project. The tablets were developed in Haiti by Health eVillages, a collaboration between Physicians Interactive and the Robert F. Kennedy Center for Justice & Human Rights. They are used in some of the “most challenging clinical environments around the world.”

Although the tablets were developed millions of miles away, the apps they are loaded with are tailored to the needs of rural Maine. The list begins with searchable medical encyclopedias, a dosage calculator, lists of dangerous drug combinations and interactions, and a pill identifier, as well as a symptom checker listing potential conditions after the provider enters a patient’s symptoms. The tablet’s apps supportdiabetes care, too.

The founder of Physicians Interactive, Donato Tramuto, created the pilot because he knows firsthand the challenges rural areas face. After all, rural Maine is the area he calls home. “You’d be surprised in our country how technology is behind the eight ball in terms of healthcare,” he said.

Funders are focused on using technology to bridge the gap in other countries. The Bill & Melinda Gates Foundation is funding projects using apps loaded onto mobile devices to improve healthcare for people living in poverty in Africa. Among their interests areprojects in Nairobi to decrease the number of women dying in childbirth, fighting malaria in Mozambique, and supporting overall rural healthcare in Kenya.

One of the challenges is pinpointing the apps that best support medical care in the community from the thousands of apps available. Projects like the one in Harrington have the potential to begin to identify how medical providers can use these resources to better serve.


Small Open Source Nonprofit Defeats Groupon in Trademark Fight


In May, Groupon created a tablet to help merchants process and serve Groupon customers. They called it Gnome. The hitch? GNOME was already trademarked as a worldwide, open source computer operating system. The GNOME foundation and its thousands of supporters mobilized to protect its name. Thanks to crowdfunding and social media, Groupon backed down and will develop a new name.

GNOME and the GNOME Foundation were created seventeen years ago and its trademark was registered in 2006. Located in California, the foundation’s mission is to open technology up to everyone through crowd-developing open source operating systems. Their products are translated into a number of different languages and include accessibility features supporting and encouraging users from underdeveloped countries. The egalitarian community includes computer programmers from around the world, including employees from one hundred different companies.

No doubt Groupon was aware of their work. In fact, Groupon’s own company blog describes the company as a “strong” supporter of open source programs. Additionally, GNOME products are used in the retail space as well as in “common software everywhere” and in many consumer devices, including televisions, tablets, and phones. Further, GNOME staff reached out to Groupon, advising them of their almost two decades of use of the name GNOME.

Instead, Groupon thought they could ignore GNOME’s efforts and FLOSS principles by filing for U.S. trademark protection. (FLOSS, or free/libre open source software—like GNOME—is created to encourage the use of technology by developing software that can be freely shared, used, and distributed. This is particularly helpful for people living in undeveloped countries who cannot afford to pay for essential computer software.) The conflict started out as a typical David and Goliath battle: Groupon ignored GNOME and filed 28 trademark applications. After all, the GNOME Foundation’s revenue stream of less than $600,000 does not compare with Groupon’s $2.5 million.

GNOME sounded the social media alarm and mobilized thousands of developers and supporters. Using the same crowdsourcing principles it uses to develop software, GNOME looked to crowdfunding to finance its battle against Groupon. Five thousand GNOME supporters fundraised over $102,000—thousands more than the $80,000 GNOME attorneys estimated they would need to contest the first ten trademarks. More importantly, thousands more people used social media to voice their anger toward Groupon.

Last week, Groupon raised the white flag and agreed to find a new name for their tablet. In a joint statement, Groupon and GNOME announced the parties would continue to work together to develop a solution.

Original cite: https://nonprofitquarterly.org/policysocial-context/25181-small-open-source-nonprofit-defeats-groupon-in-trademark-fight.html