Investigator Awards in Health Policy Research
A groundbreaking study co-authored by Amy Finkelstein, Ph.D., M.Phil., (’03) a professor of economics at the Massachusetts Institute of Technology, found that when poor people are given medical insurance, they not only find regular doctors and see doctors more often, they also feel better, are less depressed and are better able to maintain financial stability. Scholars and pundits have long debated how government-provided health insurance affects people who otherwise would be uninsured, how it affects on their access to health care, and how it affects their health and well-being. The study, published by the National Bureau of Economic Research (July 2011), became possible in 2008 when a budget crisis led Oregon lawmakers to create a waiting list to select Medicaid recipients and draw names by lottery. This gave Finkelstein and her co-authors the raw data they needed for a randomized controlled design study. The findings received significant news coverage, including articles in the New York Times, NPR, and the RWJF HC Blog and HC Web site.

Read More Research Roundup

• Clinical Scholars
• Harold Amos Medical Faculty Development Program
• Health & Society Scholars
• Investigator Awards in Health Policy Research
• Nurse Faculty Scholars
• Physician Faculty Scholars

Clinical Scholars
A study by Colin Cooke, M.D., M.Sc., (’09) reveals that black heart attack patients wait longer for advanced treatment than white heart attack patients after arriving at some hospital emergency rooms. The differences in care may be explained by hospital quality, rather than the race of individual patients. Black patients were much more likely to go to slow hospitals than were white patients. As a result, some waited six hours longer to get life-saving procedures. The study was published in the July 2011 issue of Medical Care and received coverage in a number of trade media, including ScienceDaily, Cardiovascular Imaging, and e! Science News. Read the press release.

Evan Fieldston, M.D., M.B.A., M.S.H.P., (’07) Clinical Scholars alumnus and a pediatric researcher at the Children’s Hospital of Philadelphia (CHOP), led a CHOP study that found that in order to reduce crowded conditions at the admissions stage, hospitals can adopt a “smoothing” approach to admissions by scheduling more patients to be admitted on days with lighter schedules. The study, published in the Journal of Hospital Medicine, evaluated inpatient information from 39 children’s hospitals during 2007 and found high midweek occupancy and substantial unused weekend capacity.

Clinical Scholar Jeff Kullgren, M.D., M.P.H. (’09) and colleagues used data from a nationally representative survey to identify the prevalence and predictors of nonfinancial access barriers to health care among U.S. adults. Nonfinancial barriers include patients’ difficulty finding a primary care physician or being unable to go to a doctors’ office during regular business hours; other barriers involve doctors who are not accepting new patients or who do not accept the patient’s insurance carrier. The study found that nonfinancial barriers are more common among U.S. adults than financial barriers, and that these two types of access barriers frequently overlap. Kullgren and colleagues argue that these results have important implications for the implementation of health reform, as they suggest that nonfinancial barriers may limit the impact of the Affordable Care Act on access to care unless policy-makers take additional steps to address them. The study, titled “Nonfinancial Barriers and Access to Care for U.S. Adults,” was published in Health Services Research (August 2011).

In the first analysis of national in-hospital cardiac arrest rates, Raina Merchant, M.D., M.S., Clinical Scholars alumna (’07) and assistant professor of emergency medicine at the University of Pennsylvania Perelman School of Medicine, and colleagues found that 200,000 patients are treated for cardiac arrest annually in U.S. hospitals. Merchant and colleagues argue that the study, published in Critical Care Medicine, underscores the need to identify preventable causes and implement best practices in resuscitation care.

In a study published in the Archives of Internal Medicine, Marcella Nuñez-Smith, M.D., M.H.S., Clinical Scholars alumna (’04) and assistant director of the Yale program, found that hospitals in the U.S. territories see more deaths after heart attacks, heart failure and pneumonia than those in the states. Nuñez and her co-authors suggest that lack of federal funding may be a factor. For example, 2003 Medicare spending per beneficiary was just $2,800 in the territories, compared to $6,300 in the states. They argue that because Medicare reimbursement makes up a substantial part of hospital revenues, its implications reach beyond Medicare patients. The study received media coverage in Reuters, FoxNews.com, and MedPageToday, among other outlets.

Harold Amos Medical Faculty Development Program
Rhonda Bentley-Lewis, M.D., M.B.A., (’10) co-authored a new study that finds that gestational diabetes, or pregnancy-related diabetes, may not raise the risk of heart disease independent of other cardiovascular risk factors except in certain high-risk populations, such as Hispanics. The results were presented at the Endocrine Society’s 93rd Annual Meeting in Boston. “The prevalence of gestational diabetes is increasing, and its impact for the mother can extend well beyond pregnancy by raising her risk of developing type 2 diabetes and heart disease,” said Bentley-Lewis in a June 6 press release issued by the Endocrine Society. “However, we found that gestational diabetes does not confer the same cardiovascular risk to every woman,” she said. Hispanic women with past gestational diabetes were 70 percent more likely to develop heart disease than their Hispanic counterparts without pregnancy-related diabetes. Bentley-Lewis called this large population study the first to examine the racial impact on the risk of heart disease after gestational diabetes.

Health & Society Scholars
Jason Fletcher, Ph.D., (’09) published a study, “Soft Drink Taxes an Effective Mechanism for Reducing Obesity,” online on April 27 in the Journal of Policy Analysis and Management. The analysis determines that “comprehensive interventions that reduce access to soda, increase the price of soda, and inform the public about the potentially negative health consequences are likely to be more effective than relying solely on excise taxes.” The article also describes the known research on the relationship between soft drink consumption and obesity, and how the relationship changes as people age.

Mark Pachucki, Ph.D., (’10) released a study that finds that incremental shifts in eating patterns can either improve or contribute to obesity. The study, “Food Pattern Analysis Over Time: Unhealthful Eating Trajectories Predict Obesity,” was published July 26, 2011, in the International Journal of Obesity. The study categorizes seven eating patterns: meat and soda, sweets, alcohol and snacks, light, caffeine-avoidant, offsetting, and healthier. The study found that certain diet transitions were more likely to lead to weight change. For instance, a change from “caffeine-avoidant” to a “healthier” pattern was associated with weight loss and a change from “meat and soda” to “sweets,” and from “sweets” to “alcohol and snacks,” was associated with weight gain. “Contextualizing an individual’s current eating behaviors with an eye towards diet history may be an important boon in the reduction of obesity. Although it may not be realistic for many people to shift from the least to the most healthful diet, results from this study suggest that consistent movement in an overall healthier direction is associated with less weight gain,” the study concludes.

Summer Hawkins, Ph.D., (’09) and Lisa Berkman, Ph.D., site director of the Health & Society Scholars program at Harvard University and director of the Harvard Center for Population and Development Studies, released a study linking both ear infections and asthma to secondhand smoke in the home. In their study, “Increased Tobacco Exposure in Older Children and Its Effect on Asthma and Ear Infections,” published in the June 11 Journal of Adolescent Health, the authors examined data collected from over 90,000 parents of children up to 17 years of age in the 2007 National Survey of Children’s Health. According to their findings, all children were more likely to have asthma if someone in their household used tobacco. The older children in the study (age 12 to 17) were nearly 70 percent more likely to have recurrent ear infections if there were smokers in their home.

Americans are estimated to have a longer life expectancy than previous government projections have found, according to a new study, “The Future of Death in America,” published July 1, 2011, in Demographic Research. The study is co-authored by Samir Soneji, Ph.D., (’08). The researchers estimate an increase in male life expectancy at birth from 76.2 years in 2010 to 79.9 years in 2030, which is 1.8 years greater than the U.S. Social Security Administration projections and 1.5 years more than the U.S. Census projections. For females, there are more modest gains in life expectancy. Women’s life expectancy at birth over the next 20 years climbs from 80.5 years to 81.9 years, which is nearly identical to the Social Security Administration projections and 2.0 years less than the U.S. Census projections.

Investigator Awards in Health Policy Research
In a study published in PLoS Medicine, Aaron Kesselheim, M.D., J.D., M.P.H., professor of medicine at Harvard Medical School and a primary care physician based in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital, and colleagues found that pharmaceutical drug company marketing to medical students is common and may cloud students’ ethical judgment. Their findings suggest that strategies to educate medical students about interactions with drug makers should directly address widely held misconceptions about the effects of marketing. They also suggest that medical schools need to introduce reforms, such as rules limiting contact between students and drug company representatives. The study received media coverage in HealthDay, U.S. News & World Report, and MSN.com, among other media. Kesselheim wrote a blog post about the study on the RWJF Human Capital Blog.

Kesselheim is also co-author of a study published in the New England Journal of Medicine, where he reviews the legal basis for the variation in appearance of generic drugs and explores the public health implications of these variations. Kesselheim and his co-author argue that a system of more uniform drug appearance could be designed to reduce medical error and promote patient adherence to treatment regimens that involve generic drugs. The study received coverage in the New York Times, MedPage Today, and on the American Council of Science and Health Web site, among other outlets.

Nurse Faculty Scholars
Nancy Hanrahan, R.N., Ph.D., (’08) the Dr. Lenore H. Kurlowicz Memorial Term Chair and associate professor of nursing at the University of Pennsylvania School of Nursing, was co-investigator of a new study published in the May 2011 issue of Nursing Research and Practice, which finds that having an advanced practice psychiatric nurse (APRN) to oversee and organize care can help improve the care and quality of life of psychiatric patients. The study found that when APRNs were highly involved in overseeing the community-based care of people with both serious mental illness and HIV, those patients had significant reductions in symptoms. APRNs provided education and medication management and acted as advocates for their patients in the health care system.

Physician Faculty Scholars
Ruchi Gupta, M.D., M.P.H., (’09) published “The Prevalence, Severity, and Distribution of Childhood Food Allergy in the United States” in the July 1, 2011, issue of Pediatrics. Findings suggested that the prevalence and severity of childhood food allergy is greater than previously reported, and that disparities exist in the clinical diagnosis of disease. While previous studies have estimated that anywhere between two and eight of every 100 kids in the United States have a food allergy, Gupta’s study noted that the statistic may be one in 12 kids. This discrepancy could be based on how past studies have been designed. The study received news coverage on MSNBC.com, Los Angeles Times Online, USA Today Online, Boston Globe Online, FOXNews.com, Reuters, Huffington Post, and Baltimore Sun Online.

Reshma Jagsi, M.D., D.Phil., (’09) published a study online in Cancer on June 29, 2011. “Underascertainment of Radiotherapy Receipt in Surveillance, Epidemiology, and End Results Registry Data” found that Surveillance Epidemiology and End Results (SEER) registry data, as currently collected, may not be an appropriate source for documentation of rates of those receiving radiotherapy or of rates of geographic variation in the radiation treatment of breast cancer. In fact, more breast cancer patients than previously believed may be receiving radiation treatments after breast-conserving surgery. SEER is maintained by the National Cancer Institute and collects information on cancer incidence, prevalence and survival.