Aug 1 2014
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The Imperative to Engage Surgical Residents in Quality Improvement

Charles D. Scales Jr., MD, MSHS, an alumnus of the Robert Wood Johnson Foundation/VA Clinical Scholars program (UCLA 2011-2013), is a health services researcher at the Duke Clinical Research Institute and assistant professor in the division of urologic surgery at Duke University School of Medicine.  He is also assistant program director for quality improvement and patient safety for the urology residency training program at Duke University Hospital.  

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Young doctors training to become surgeons, also called surgical residents, are increasingly caring for patients in an environment that links quality, safety, and value to patient outcomes. Over a decade ago, the Institute of Medicine highlighted the need for improving care delivery in the landmark report, Crossing the Quality Chasm, suggesting that high-quality care should be safe, effective, patient-centered, timely, efficient (e.g., high value), and equitable. Just this week, the Institute of Medicine followed with a clarion call for training new physicians to participate in and lead efforts to continually improve both care delivery and the health of the population, while simultaneously lowering costs of care.

To support this imperative, the Accreditation Council for Graduate Medical Education, which accredits all residency training programs in the United States, mandates that all doctors-in-training receive education in quality improvement. Despite this directive, a number of substantial barriers challenge delivery of educational programs around quality improvement.  Health care is increasing complex, driving residents to focus on learning the medical knowledge and surgical skills for their field.  Patient care demands time and attention, which can limit opportunities to learn about quality improvement within the context of 80-hour duty limits. This barrier particularly challenges surgeons-in-training, who often spend 12 or more hours daily learning surgical skills in the operating room, leaving little time for a traditional lecture-format session about quality improvement. Finally, many surgical training programs lack faculty with expertise in the skills required to systematically improve the quality, safety, and value of patient care, since these skills were simply not taught to prior generations of surgeons.

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Jul 31 2014
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Grants to Build a More Highly Educated Nursing Workforce

The Robert Wood Johnson Foundation (RWJF) has announced the nine state “Action Coalitions” that will share $2.7 million to advance strategies aimed at creating a more highly educated, diverse nursing workforce. The nine states that are receiving two-year, $300,000 grants through RWJF’s Academic Progression in Nursing (APIN) program are California, Hawaii, Massachusetts, Montana, New Mexico, New York, North Carolina, Texas, and Washington state.  For each, this is the second two-year APIN grant and it will be used to continue encouraging strong partnerships between community colleges and universities to make it easier for nurses to transition to higher degrees. 

In its groundbreaking 2010 report, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine (IOM) recommended that 80 percent of the nursing workforce be prepared at the baccalaureate level or higher by the year 2020. Right now, about half the nurses in the United States have baccalaureate or higher degrees.

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Jul 31 2014
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RWJF Scholars in the News: Cesarean sections, hospital readmissions, nurse practitioners, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

RWJF Clinical Scholar Chileshe Nkonde-Price, MD, shared her experiences with the medical system  during the last week of her recent pregnancy in a video featured on Nasdaq.com. Despite have given birth via Cesarean section earlier, Nkonde-Price wished to deliver vaginally with this pregnancy if she could do so safely. C-section has become the nation’s most common major surgery, the piece says. It examines some of the factors behind the sharp increase in the number of women delivering via C-section in the United States.

In a Health Affairs Blog, José Pagán, PhD, analyzes Medicare’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with excessive 30-day readmissions for conditions such as pneumonia and heart failure. While Pagán says that not all readmissions can be avoided, hospitals can improve their performance through effective discharge planning and care coordination. With more incentive programs on the horizon, Pagán suggests that health care organizations “seek and monitor collaborative partnerships and, more importantly, strategically invest in sustaining these partnerships” so they can survive and thrive. He is an RWJF Health & Society Scholars program alumnus and recipient of an RWJF Investigator Award in Health Policy Research.

A study led by RWJF Nurse Faculty Scholar Lusine Poghosyan, PhD, RN, looks at how Nurse Practitioners (NPs) rate their work environments. It finds that those working in Massachusetts fared better that those working in New York on every topic in the survey: support and resources, relations with physicians, relations with administration, visibility and comprehension of their role, and independence of practice. The survey also found that NPs working in community health clinics and physicians’ offices rated their work experiences better than NPs working in hospital-affiliated clinics. Poghosyan told Science Codex the findings suggest “the practice environment for NPs in New York can improve once the state’s NP Modernization Act,” which will expand NPs’ scope of practice, takes effect.

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Jul 30 2014
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MBA Degrees Give Physicians a Career Boost

Physicians who have both doctor of medicine (MD) and master of business administration (MBA) degrees reported that their dual training had a positive professional impact, according to a study published online by Academic Medicine. The study, one of the first to assess MD/MBA graduates’ perceptions of how their training has affected their careers, focused on physician graduates from the MBA program in health care management at the University of Pennsylvania.

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The MD was more often cited as conveying professional credibility, while 40 to 50 percent of respondents said the MBA conveyed leadership, management, and business skills. Respondents also cited multidisciplinary experience and improved communication between the medical and business worlds as benefits of the two degrees.

“Our findings may have significant implications for current and future physician-managers as the landscape of health care continues to change,” lead author Mitesh S. Patel, MD, MBA, a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Pennsylvania, said in a news release. “A study published in 2009 found that among 6,500 hospitals in the United States, only 235 were run by physicians. Moving forward, changing dynamics triggered by national health care reform will likely require leaders to have a better balance between clinical care and business savvy. Graduates with MD and MBA training could potentially fill this growing need within the sector.”

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Jul 29 2014
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Childhood Trauma: A Public Health Problem that Requires a Robust Response

Cindy A. Crusto, PhD, is a Robert Wood Johnson Foundation (RWJF) New Connections grantee, an associate professor of psychology in psychiatry, Yale University School of Medicine, and a Public Voices Fellow with The OpEd Project.

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Were the findings really a surprise? The recent release of the report The Burden of Stress in America commissioned by NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health, highlights the major role that stress plays in the health and well-being of American adults. As a researcher who studies the impact of emotional or psychological trauma on children’s health, I immediately thought about the findings in the context of trauma and the associated stress in the lives of children. That trauma can include violence in the home, school, and community.

Two decades of research has produced clear findings on this significant public health problem: Psychological trauma can have a powerful influence in the lives of children, and if not detected and addressed early, it can (and often does) have long-lasting physical and mental health effects into adulthood. Despite this strong evidence, I have encountered the sheer resistance of some advocates who work with or on behalf of vulnerable children to fully engage in this topic. Perhaps it’s because of the belief that this talk about trauma is a fad—a hot topic that will fade as soon as something “sexier” comes along.

There is also a concern that an emphasis on trauma further stigmatizes children and the cultural groups to which they belong, reinforcing existing negative stereotypes. You can understand their caution that children’s trauma histories could be used against them, that children might automatically be diagnosed with a mental health disorder, or that they would be seen as a danger to society and in need of the highest, most restrictive level of care. That care often takes children away from their families to secure facilities outside of their communities and even outside of their states.

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Jul 28 2014
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What Protects Our Children from the Effects of Stress?

Lorraine McKelvey, PhD, is an associate professor of family and preventive medicine and pediatrics at the University of Arkansas for Medical Sciences. She is an alumna of the Robert Wood Johnson Foundation (RWJF) New Connections program (2008-2009) whose work focuses on vulnerable populations.

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For children, stress can come from sources inside and outside the family. It was recently documented that nearly two out of every three children in the United States have witnessed or been victims of violence in their homes, schools, or communities. That’s a staggering statistic when we consider the well-established link between children’s exposure to stress and their long-term mental and physical health outcomes.

Indeed, we know that early exposure to adverse experiences can change the way that our brains develop and function. We also know that exposure to adversity increases the likelihood that children will develop psychosocial problems, like depression, aggression, and other antisocial behaviors. There is even evidence that exposure to stressors in childhood increases the likelihood of having heart disease and cancer in adulthood!

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Jul 25 2014
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Working to Improve Nursing Education and Promote Academic Progression

Juliann Sebastian, PhD, RN, FAAN, is dean of the University of Nebraska Medical Center College of Nursing and president-elect of the American Association of Colleges of Nursing. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (1998-2001).

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Human Capital Blog: Congratulations on your recent election as president-elect, and future president, of the American Association of Colleges of Nursing (AACN)! What is your vision for the 2014-2016 term?

Juliann Sebastian: I am honored to have been selected by the members of AACN to serve in this role for an organization that is pivotal to the future of baccalaureate and higher degree nursing education. I support the president and the board in advancing our shared vision of excellence in nursing education, research, and practice.

I look forward to working with the entire board to address issues of concern to AACN’s member schools. Because AACN’s membership encompasses large/small, public/private institutions, we have the special advantage of incorporating diverse voices into shaping the organization’s vision. I am enthusiastic about deepening my opportunity to support the vision AACN has identified for itself and the profession.

  •  AACN’s own vision is: “By 2020, as a driving force for quality health care, AACN will leverage member schools in meeting the demand for innovation and leadership in nursing education, research and practice.”
  • AACN’s vision statement for the profession is: “By 2020, highly educated and diverse nursing professionals will lead the delivery of quality health care and the generation of new knowledge to improve health and the delivery of care services.”

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Jul 24 2014
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RWJF Scholars in the News: Stereotype threat, hand hygiene, misbehaving science, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

Anxiety caused by “stereotype threat” could help explain health disparities that persist across race, suggests research co-authored by Cleopatra Abdou, PhD, an RWJF Health & Society Scholars program alumna. News Medical covers the study, describing it as the first of its kind to empirically test, in the context of health sciences, the impact of the “threat of being judged by or confirming a negative stereotype about a group you belong to.” Abdou’s research offers a possible explanation for ethnic and socioeconomic differences in morbidity and mortality between Black and White women because, as Abdou says, the research goes beyond nature vs. nurture, “bringing situation and identity into the equation.” For example, in the study, Black women with a strong connection to their race had the highest anxiety levels when in waiting rooms filled with posters that displayed negative health-related racial stereotypes dealing with such topics as unplanned pregnancy and AIDS.

Having health insurance improves access to medical care for pregnant, low-income women, and results in long-term health benefits for their babies, according to a study by RWJF Scholar in Health Policy Research Sarah Miller, PhD, and RWJF Health & Society Scholar Laura Wherry, PhD, that was reported by Vox. Miller and Wherry found the expansion of Medicaid in the 1980s made prenatal care much more accessible to low-income women, many of whom would otherwise have been without insurance. The result was improvements in obesity, preventable hospitalizations, and preventable, chronic disease-related hospitalizations among children. 

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Jul 24 2014
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Sharing Nursing’s Knowledge: The July 2014 Issue

Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of the Foundation’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other essential nursing issues. Following are some of the stories in the July issue.

Nurses Lead Innovations in Geriatrics and Gerontology
As the nation becomes older and more diverse, and more people are living with chronic health problems, nurses are developing innovations in geriatric care. They are finding new ways to improve the quality of care for older adults; increase access to highly skilled health care providers with training in geriatrics; narrow disparities that disproportionately affect older minorities; avoid preventable hospital readmissions; and more. Nurse-led innovations are underway across the nation to improve care for older Americans.

Improving Care for the Growing Number of Americans with Dementia
By 2050, 16 million Americans—more than triple the current number—will have Alzheimer’s disease. RWJF Nurse Faculty Scholars are working now to get ahead of the problem. “We’re all well aware of our aging population and how we’re going to see more individuals with Alzheimer’s disease or some other form of dementia,” says alumna Elizabeth Galik, PhD, CRNP, who is researching ways to improve functional and physical activity among older adults with dementia.

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Jul 23 2014
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Facebook: Friend or Foe?

Linda Charmaraman is a research scientist at the Wellesley Centers for Women at Wellesley College and a former National Institute of Child Health and Human Development postdoctoral scholar. She is a Robert Wood Johnson Foundation (RWJF) New Connections grantee, examining the potential of social media networks to promote resiliency in vulnerable populations.

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If you were stressed out and wanted to vent to your friends about it, how would you let them know? Would you pick up the phone and talk, or text? Would you set up time to grab coffee or go for a brisk walk? Or would you post to Facebook why your day just couldn’t get any worse?

As I logged into the recent RWJF/NPR/Harvard School of Public Health-sponsored Stress in America discussion, I identified with the panelists who were dispelling stereotypes about “highly stressed” individuals being high-level executives or those at the top of the ladder. Instead of finding work-related stress as a top concern, as is often played out in the media and popular culture, the researchers were finding that individuals with health concerns, people with disabilities, and low-income individuals were experiencing the highest levels of stress. The panelists talked about the importance of qualities like resiliency and the ability to turn multiple, competing stressors into productive challenges to overcome, and the integral role of communities in shaping, buffering, and/or exacerbating stress.

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