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  • Lancet Series Highlights Consequences of Physical Inactivity; Calls for Global Action

    The high prevalence and consequences of physical inactivity should be recognized as a global pandemic, according to the fifth and final paper in The Lancet series on physical activity published last week. The article outlines key strategies and resources needed to make physical activity a global public health priority.

    "Although regular physical activity is critical for weight control, it is equally or more important for lowering risk of many different chronic diseases such as heart disease, some cancers, osteoporosis, and diabetes," said lead author Harold W. Kohl, III, PhD, professor of epidemiology at The University of Texas School of Public Health.

    In the paper, the researchers call on ministries of health to "Make physical activity an integral part of an overall disease prevention and health promotion model, including screening for physical inactivity, counseling about physical activity in prevention and disease treatment and management strategies as well as increased investment in comprehensive physical activity promotion policies, action plans, and implementation programs."

    According to Kohl, research on physical activity needs to be its own priority within public health research of noncommunicable diseases. "The response to physical inactivity has been incomplete, unfocused, understaffed, and underfunded compared with other risk factors for non-communicable diseases," he said. "This has put physical activity in reverse gear compared with population trends and advances in tobacco and alcohol control and diet."

    Speaking to members of the National Physical Activity Plan on Friday, Chair Russell Pate, PhD, said, "The Lancet has labeled physical inactivity a global pandemic, and it has documented the enormity of the human and financial costs associated with this public health crisis. Physical inactivity kills, and it is high time we respond to physical inactivity as the lethal force it is." APTA is a member of the National Physical Activity Plan Coordinating Committee

    Other papers in the series address why some people are more physically active than others and how megatrends in information and communication technology and transportation directly and indirectly affect levels of physical activity across countries of low, middle, and high income. Researchers also describe physical activity levels of adults worldwide and review physical activity interventions.

    Call for Comments on Long Term Care Accreditation Program

    APTA members who work in skilled nursing facilities are encouraged to submit comments on proposed requirements for the Joint Commission's Long Term Care Accreditation program. The Joint Commission is in the process of reinventing the program to focus on the most critical issues supporting safety and quality of care for patients and residents in the nursing home setting. Highlights of the new approach are:

    • a single core set of accreditation requirements relating to quality and safety for all nursing homes
    • new accreditation requirements that focus on person-centered care
    • a new optional certification module for special programs or services, such as post acute care (including rehabilitation services), memory care, and other critical specialties

    An online survey of the proposed requirements is available until August 13.The survey is organized into 3 areas—core requirements, person-centered care requirements, and post acute rehabilitation services requirements (optional certification). 

    Prostheses Not Meeting Needs of Farmers and Ranchers

    Artificial hands, arms, legs, and feet, and other prostheses used by agricultural workers with a major limb amputation are not durable, affordable, or adaptable enough for their lifestyles, says a Medical News Today  article based on a study published online in Disability and Rehabilitation: Assistive Technology.

    Researchers conducted interviews with 40 American farmers and ranchers with amputations to gather information about how current and past prostheses were used, prosthetic failures, and their ability to complete farm tasks while using a prosthesis. They also interviewed 26 prosthetists who provide services to farmers and ranchers.

    The study found that:

    • Farmers' prostheses seem to deteriorate faster and fail more frequently than those of nonfarmers with amputations.
    • Farmers reported many falls and secondary injuries due to use of their prosthesis.
    • Farmers make additional changes in routines, farm equipment, and in attitude to successfully return to farming after an amputation.
    • In addition to inadequate medical insurance coverage for devices, some farmers in rural areas have to travel great distances to get to a prosthetist's clinic, which also adds to costs.
    • Prosthetists are not typically trained about the needs and lifestyles of farmers and ranchers and may prescribe inappropriate prosthetic choices. However, some prosthetists reported that farmers had unrealistic expectations of their prosthesis.

    The study is part of a larger research project at the Northwestern University Prosthetics-Orthotics Center that aims to design educational materials tailored to the specific needs of farmers and ranchers with amputations and work with prosthesis manufacturers to develop and reengineer more robust products and components. Results of this ongoing research could benefit people with amputations who work in other physically demanding professions such as the military, construction, forestry, commercial fishing, mining, and manufacturing, the article says.

    Private Health Care Purchasers Begin Shift to Value-based Payment Model

    Prominent national and regional business and labor health care purchasers are working together to change the way they and other private purchasers pay for health benefits to be based on the value, rather than the volume of services delivered by health care providers. The effort, known as Buying Value, takes advantage of major reforms in Medicare. By 2017, the Centers for Medicare and Medicaid Services will attach 9% of Medicare payments to some form of value purchasing.

    Buying Value is a collaboration of 18 diverse organizations that either represent or are themselves large health care purchasers—including Fortune 500 corporations, union health funds, and national and regional business coalitions. National consumer organizations also are also involved.

    The initiative is designed to encourage and assist private purchasers in making the switch from the traditional health care purchasing model of paying for care based on the number of individual tests or procedures performed, to a payment model based on the value or outcome of the overall care.

    The Buying Value project will develop a toolkit to help private purchasers rethink their health plans, as well as launch a public database showing different payment methods that purchasers can use to drive improvements in health care quality and safety. Organizers also will provide education and presentation materials and offer guidance on avoiding antitrust issues present in active purchasing. In addition to creating tools and resources that can be used by health care purchasers to guide their benefits plans, Buying Value organizers will conduct outreach at the local level to educate regional purchasers and consumer organizations.

    In order to facilitate and simplify alignment between private purchasers and Medicare, Buying Value has secured Medicare's commitment to support a common set of core measures for value purchasing in both areas. Development of the core measure set is under way at the independent Measures Application Partnership under a Medicare contract. The first phase of the project is due to be completed by October 1.