Monday, July 25, 2016

Identifying “Bright Spot” Regions in Healthcare

Today HealthLandscape is releasing the Geospatial Brief, “Where are “Bright Spots” for AppropriateDiabetes Preventive Care?” Using appropriate Diabetes preventive care as a case study, Brief #3 provides an example of how geospatial methods can be used to identify high-performing (“bright spot”) regions. This blog reviews “bright spots” approaches that have been previously used in the healthcare field.

A recent Editorial by long-time primary care advocate Thomas Bodenheimer advocates for finding the “bright spots” in primary care, so that we can “learn from them, and arrange for the bright spots to illuminate the dark corners,” (Bodenheimer, 2014).  Bodenheimer and his colleagues at Stanford’s Clinical Excellence and Research Center (CERC) define “bright spots” as physician groups that are successful at providing high quality care while keeping healthcare costs low. In-depth study of these “bright spots” allowed CERC to identify ten features of primary care delivery associated with higher quality care and lower spending (CERC, 2014). The work of CERC builds from the positive deviance (PD) approach, which is an asset-based framework for identifying organizations or individuals that are successful despite facing more difficult or similar circumstances than others, determining the features which make them successful, and applying the features to other organizations or individuals (Pascale et al., 2010).  The PD framework has been applied in several different healthcare settings, including medical homes (Gabbay et al., 2013), hospitals (Bradley et al., 2009), and local health departments (Klaiman et al., 2014). While they are not referred to as PD or “bright spot” approaches, the Veterans Affairs (VA) is also pushing forward with innovative strategies for improving care for the Veteran population (Elnahal and Littlefield, 2016).

Positive deviance approaches offer great potential in the healthcare field. By identifying successful strategies for improving care and reducing costs, we can apply these strategies and target scarce resources to areas of need.  Using appropriate Diabetes preventive care as a case study, Geospatial Brief #3 details geospatial approaches for identifying “bright spot” regions. This research builds on the first two HealthLandscape Geospatial Research Briefs, which explore the relationship between preventive care, preventable hospitalizations, and spending, and identify priority regions for improving preventive care (Topmiller, 2016a; Topmiller, 2016b).  Future research can use the results of these geospatial briefs for in-depth study of “bright spot” regions, and then apply lessons learned to priority regions.

Michael Topmiller
GIS Strategist 

Bodenheimer, Thomas S., (2014). Find the" bright spots." Joint Commission journal on quality and patient safety/Joint Commission Resources40(4), pp.147-147.

Bradley, Elizabeth H., Leslie A. Curry, Shoba Ramanadhan, Laura Rowe, Ingrid M Nembhard, and Harlan M Krumholz, 2009. Research in action: using positive deviance to improve quality of health care. Implementation Science 4:25.

Clinical Excellence Research Center (CERC), Stanford University, 2014. “America’s Most Valuable Care: Primary Care.” Clinical Excellence Research Center at Stanford University, Bright Spots Research.

Elnahal, Shereef, and Patrick Littlefield. “VA Diffision – spreading and implementing best practices to improve care for our nation’s Veterans.” (blog, March 2, 2016). Accessed at

Gabbay, Robert A., Mark W. Friedberg, Michelle Miller-Day, Peter F. Cronholm, Alan Adelman, and Eric C. Schneider, 2013. A Positive Deviance Approach to Understanding Key Features to Improving Diabetes Care in the Medical Home. Annals of Family Medicine 11(S1): S99-S107.

Klaiman, Tamar A., Athena Pantazis, and Betty Bekemeier, 2014. A Method for Identifying Positive Deviant Local Health Departments in Maternal and Child Health. Frontiers in Public Health Services and Systems Research 3(2).

Pascale, Richard, Jerry Sternin, and Monique Sternin, 2010. The Power of Positive Deviance: How Unlikely Innovators Solve the World’s Toughest Problems. Harvard Business Press, United States of America.

Topmiller, Michael, 2016a. “Do Regions with More Preventive Care Have Lower Spending and Fewer Hospitalizations?”  HealthLandscape Geospatial Research Brief #1. 
Accessed at

Topmiller, Michael, 2016b. “Where are “Hot Spots” of Medicare Spending and Preventable Hospitalizations and “Cold Spots” for Preventive Care?”  HealthLandscape Geospatial Research Brief #2. 

Accessed at

Friday, July 1, 2016

Fact: I Like Food and I Like Eating

I like food and I like eating.  I've been known do it several times a day.  Sometime MORE than several times.

Some of my favorite foods include: Kiwifruit, Bacon, Watermelon, Cantaloupe, Pumpkin, Zucchini, Bacon, Cashew, Cucumber, Bacon, Buckwheat, Fennel, Apple, Bacon, Mango, Avocado, Bacon, Apricot, Sweet Cherry, Sour cherry, Bacon, Almond, Peach, Bacon, Pear, Raspberry, Blackberry, Bacon, Blueberry.

Notice anything in common across this list?  Exactly.  A LOT of these foods require POLLINATION, especially from Bees!  Not only do bees do the heavy lifting of pollination, they make delicious honey.
My daughter getting ready to harvest honey!

For the past three years my neighbor and I have split the cost and labor of maintaining a bee hive, and have made some delicious honey.  To be honest, we actually only collected the honey, it was produced by our highly skilled agricultural labor force of about 30,000 Honey Bees.

Unfortunately, for the second year running, we've lost our bees to one pestilence or another.  We're working hard to find out if it's neighborhood insecticide use, or mites, or what.  Very sad.

Needless to say, we're spending a good deal of time looking into the cause of hive collapse, with the complete loss of bees.

Our bees ('our' meaning the world's bees) are at risk from multiple sources including mites, insecticides, and other threats.  In the First Quarter of 2016, the United States lost over 16 percent of it's bee colonies -- that's 427,900 colonies in the first three months of 2016.  That's a staggering number.

The maps below show the distribution of colonies, the areas hit hardest by colony loss, and the stressors that are impacting the colonies.

Number of Colonies, by State.  First Quarter, 2016

Number of Lost Colonies, by State.  First Quarter, 2016

Percent of Colonies Lost, by State.  First Quarter, 2016.
Percent of Colonies Impacted by Varroa Mite Stressors, by State.  First Quarter, 2016
Percent of Colonies Impacted by Insecticide Stressors, by State.  First Quarter, 2016
Percent of Colonies Impacted by Unknown Stressors, by State.  First Quarter, 2016

It's hard to emphasize the importance of bees and other pollinators to our food supply.  How can I help?

Additional Readings:
USDA: Bee Basics An Introduction to Our Native Bees
National Academy of Sciences -- Resources on Pollinators

Mark A. Carrozza,  MA
Director, HealthLandscape
American Academy of Family Physicians