Category Archives: Clinical Scholars

Apr 8 2014
Comments

Preventing Youth Violence May Cost Less Than You Think…

Adam L. Sharp, MD, MS is an emergency physician and recent University of Michigan Robert Wood Johnson Foundation Clinical Scholar (2011-2013). He works for Kaiser Permanente Southern California in the Research and Evaluation Department performing acute care health services and implementation research.

file

Violence is a leading cause of death and injury in adolescents. Recent studies show effective interventions can prevent violent behavior in youth seen in the Emergency Department (ED). Adoption of this type of preventive care has not been broadly implemented in EDs, however, and cost concerns frequently create barriers to utilization of these types of best practices. Understanding the costs associated with preventive services will allow for wise stewardship over limited health care resources. In a recent publication in Pediatrics, "Cost Analysis of Youth Violence Prevention," colleagues and I predict that it costs just $17.06 to prevent an incident of youth violence.

The violence prevention intervention is a computer-assisted program using motivational interviewing techniques delivered by a trained social worker. The intervention takes about 30 minutes to perform and was evaluated within an urban ED for youth who screened positive for past year violence and alcohol abuse. The outcomes assessed were violence consequences (i.e., trouble at school because of fighting, family/friends suggested you stop fighting, arguments with family/friends because of fighting, felt cannot control fighting, trouble getting along with family/friends because of your fighting), peer victimization (i.e., hit or punched by someone, had a knife/gun used against them), and severe peer aggression (i.e., hit or punched someone, used a knife/gun against someone).

Read More

Apr 2 2014
Comments

RWJF Milestones, April 2014

The following are among the many honors received recently by Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, grantees and alumni:

Susan B. Hassmiller, PhD, RN, FAAN, RWJF’s senior advisor for nursing and director of its Future of Nursing: Campaign for Action, has been named co-chair of the newly formed External Nurse Advisory Board (ENAB) for the Center for Nursing Advancement (CFNA) at UnitedHealth Group. The goal of the ENAB is to “inform, create and evolve nursing best practices, and advance the nursing profession.”

Angelina Jolie has signed on as executive producer of Difret, a film by RWJF Health & Society Scholars alumna Mehret Mandefro, MD, MSc, AB. The film premiered at the Sundance Film Festival in January, where it won the World Cinema Dramatic Audience Award, then went on to receive the Audience Award at the Berlin International Film Festival in February. The film tells the story of a young Ethiopian girl who challenges the tradition of “telefa,” the practice of abduction in marriage, usually of young girls. Read more about Mandefro’s film.

The American Association of Colleges of Nursing (AACN) has voted Juliann Sebastian, PhD, MSN, its president-elect. Sebastian, an RWJF Executive Nurse Fellows alumna, is dean of the University of Nebraska Medical Center College of Nursing. She will serve as president of AACN from 2016 to 2018. The organization represents more than 740 nursing schools nationwide.

RWJF Scholars in Health Policy Research alumna Jacqueline Stevens, PhD, has been named a 2013 Guggenheim Fellow for the Humanities. Her fellowship is in U.S. History.

Read More

Mar 28 2014
Comments

Merging Social Media with Art to Improve Cardiovascular Health

Raina Merchant, MD, MSHP, is a Robert Wood Johnson Foundation (RWJF) Clinical Scholars program alumna and an assistant professor at the University of Pennsylvania Department of Emergency Medicine. She recently launched a venture that challenges citizen designers to make automated external defibrillators (AEDs) more visible.

file

Human Capital Blog: Congratulations on the launch of your new research venture at the University of Pennsylvania. Can you describe it?

Raina Merchant: In June, 2013, we launched the Social Media and Health Innovation Lab. It’s a multidisciplinary group of physicians, computer scientists, demographers, communications specialists, policy scientists, designers, and more.

The group has expertise in crowdsourcing, app development, Twitter analyses, Facebook analyses, Foursquare engagement, Gigwalk analyses, Yelp analyses, and gaming. The Lab disseminates multidisciplinary research at the intersection of social media, mobile technology, and health—and uses digital tools to improve individual and population health behaviors and outcomes. One of the Lab’s recent projects merges social media with art to improve cardiovascular health.

file

HCB: How does your current project build off of your previous one, which located and digitally mapped AEDs in Philadelphia?

Merchant: Our initial project, the MyHeartMap Challenge, used crowdsourcing and social media to locate life-saving AEDs in Philadelphia. Through this project we located and documented more than 1,400 AEDs in Philadelphia and created an AED map. Through this effort we learned how difficult it is for AEDs to be identified when they are suddenly needed. AEDs are often hidden in plain sight.

To explore ways to make AEDs more visible, we launched the Defibrillator Design Challenge. Specifically, it’s an online crowdsourcing contest for individuals to create designs around the space of AEDs so they are more noticeable. We’ve allotted more than $1,000 for the winner with the most votes and social media “shares.”

Through this work we hope to accomplish two things: First, we want to make AEDs more visible so that people will know where they are when needed; and second, we want to empower people to look for AEDs in public places and notice them.

Read More

Mar 27 2014
Comments

RWJF Scholars in the News: Cultural barriers to care, medical conspiracies, parenting, 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:

In a Talking Points Memo opinion piece, Harold Amos Medical Faculty Development Program alumna Paloma Toledo, MD, MPH, writes that while the Affordable Care Act holds the promise of greatly increasing access to care, language and cultural barriers could still stand between Hispanic Americans and quality care. Toledo’s research into why greater numbers of Hispanic women decline epidurals during childbirth revealed that many made the choice due to unfounded worries that it would leave them with chronic back pain or paralysis, or that it would harm their babies. “As physicians, we should ensure that patients understand their pain management choices,” she writes.

More than one in three patients with bloodstream infections receives incorrect antibiotic therapy in community hospitals, according to research conducted by Deverick J. Anderson, MD, an RWJF Physician Faculty Scholars alumnus. Anderson says “it’s a challenge to identify bloodstream infections and treat them quickly and appropriately, but this study shows that there is room for improvement,” reports MedPage Today. Infection Control Today, FierceHealthcare, and HealthDay News also covered Anderson’s findings.

People’s health and wellness can be linked to their zip codes as much as to their genetic codes, according to an essay in Social Science and Medicine co-authored by Helena Hansen, MD, PhD. As a result, Hansen argues, physicians should be trained to understand and identify the social factors that can make their patients sick, HealthLeaders Media reports. Hansen is an RWJF Health & Society Scholars alumna.

Read More

Mar 14 2014
Comments

‘Teamwork Works’: Lessons Learned From the Front Line of Team-Based Care

As the patient-centered medical home (PCMH) has emerged as a model for providing effective team-based care that can help offset the impending primary care provider shortage, so, too, is there a growing need for educational strategies that promote interprofessional collaboration. A short report published online by the Journal of Interprofessional Care describes the strategies in place at the VA Connecticut Healthcare System Center of Excellence in Primary Care Education (CoEPCE) and indicates promising results in just one year: doubled productivity in patient care delivered by faculty providers, and a marked increase in same-day clinic access for patients receiving care from an interprofessional team.

The Connecticut CoEPCE, like four other program sites funded through the U.S. Department of Veterans Affairs Office of Academic Affiliations, builds on the VA’s system-wide PCMH model, known as Patient Aligned Care Teams (PACT). It seeks to develop exportable models of interprofessional education and patient care, according to the report, “Moving From Silos to Teamwork: Integration of Interprofessional Trainees Into a Medical Home Model.” The CoEPCE sites share four core curricular domains—shared decision-making, sustained relationships, interprofessional collaboration, and performance improvement—and the Connecticut center groups together physician, nurse practitioner (NP), pharmacy, and health psychology trainees.

The trainees divide their time evenly between interactive educational sessions and caring for patients, guided by faculty who provide supervision, mentorship, and collaborative shared care. Additionally, the Connecticut center incorporates a one-year post-master’s adult NP interprofessional clinical fellowship, to further enhance clinical proficiency and teamwork experience for NPs.

Read More

Mar 11 2014
Comments

Challenges Facing the Nation’s Emergency Care System: From Everyday Care to Disaster Preparedness

An interview with Nicole Lurie, MD, MSPH, the assistant secretary for preparedness and response at the U.S. Department of Health and Human Services, and an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program. She is the co-author of “The U.S. Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready for Disasters,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. The interview is part of a series of posts featuring RWJF Scholars who authored articles in the issue.

file

Human Capital Blog: You write that the nation’s emergency care system is in trouble. What are the challenges facing emergency departments (EDs)?

Nicole Lurie: We’ve understood for at least a decade that the emergency system is in trouble.   We ask a lot of this system, and as a result we have EDs that are really crowded and with long wait times, boarding times and throughput times. It’s become a de facto access point for many people who lack access to primary care or insurance, which wasn’t what it was originally set up for. Now, EDs have evolved to be more than places to treat life and limb threats and serve as default diagnostic and therapeutic entry points. But many people who end up in an emergency department may be willing to be treated in a different kind of environment. It is really up to us to build a system that accommodates their needs and ensure our emergency care system can do its important work.

And remember: We changed the way we deliver care in the U.S. from a hospital-based focus to an outpatient focus over the last few decades, but we never really built the infrastructure for it. Outpatient providers have had their visits shortened and group practice environments have changed the relationship between patients and their primary care providers. We hear about the shortage of primary care providers and the crisis of crowding and boarding in emergency departments, but we don’t always connect the dots to understand how we got here. It is a good time to start to have this conversation as payment models are encouraging us to recognize that generating health for our patients is a team effort.

HCB: How do you see the emergency care system evolving, particularly with respect to disaster preparedness?

Read More

Mar 6 2014
Comments

RWJF Scholars in the News: Nurse staffing and patient mortality, communicating about vaccines, specialized HIV training for NPs, 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:

A study led by Linda H. Aiken, PhD, FAAN, FRCN, RN, and covered by CNN.com, finds that hospital nurse-patient ratios and the share of nurses with bachelor’s degrees both have an important impact on patient mortality. Aiken, a research manager supporting the Future of Nursing: Campaign for Action and a member of the RWJF Interdisciplinary Nursing Quality Research Initiative (INQRI) National Advisory Committee, found that increasing a hospital nurse’s workload by one patient increased by 7 percent the likelihood of an inpatient death within 30 days of admission. The same research revealed that a 10-percent increase in the number of nurses with bachelor’s degrees at a given hospital reduces the likelihood of a patient death by 7 percent. Aiken’s study has also been covered by the Guardian, Philly.com, and FierceHealthcare, among other outlets.

Public health messages aimed at boosting childhood vaccination rates may be backfiring, according to a new study led by RWJF Scholars in Health Policy Research alumnus Brendan Nyhan, PhD. Campaigns that use studies, facts, and images of ill children increased fears about vaccine side-effects among some parents, NBC News reports. In fact, messaging that debunked myths about links between vaccines and autism actually made parents less inclined to have their children inoculated. Time magazine online also covered the study.

The Johns Hopkins University School of Nursing has developed a new curriculum that provides specialized HIV training to nurse practitioners, with funding from the Health Resources and Services Administration, Medical Xpress reports. “The design of our program starts with the recognition that HIV care cannot be provided in a silo, that it needs to be integrated holistically into primary care," RWJF Nurse Faculty Scholar Jason Farley, PhD, MPH, said in a statement. Farley is the developer of the curriculum.

Read More

Mar 5 2014
Comments

The Affordable Care Act Bolsters Disaster Readiness

Nicole Lurie, MD, MSPH, is the assistant secretary for preparedness and response at the U.S. Department of Health and Human Services (HHS), and Kacey Wulff, MPH, is special assistant to the assistant secretary, at HHS. An alumna of the Robert Wood Johnson Foundation Clinical Scholars program, Lurie is the co-author of “The U.S. Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready for Disasters,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. This is part of a series of posts  featuring RWJF Scholars who authored articles in the issue.

Nicole Lurie, MD, MSPH Nicole Lurie

As we approach the Affordable Care Act’s March 31 enrollment deadline, data is starting to emerge about how these reforms are making care more accessible, cost less, and, ultimately, Americans healthier. As these reforms take effect, and make our day-to-day health care system stronger, they also result in strengthening communities across the country to become more resilient and disaster-ready.

The gaps that inspired and propelled health reform like untreated chronic conditions and mental illness, and health disparities plague our health care system every single day. During a crisis, like a hurricane, earthquake, or attack, these issues can become magnified. As a result, the ability for individuals and communities to prepare, respond, and recover successfully is intrinsically linked to the strength of the underlying health care system.

Kacey Wulff, MPH Kacey Wulff

The Affordable Care Act expands mental health and substance use disorder benefits and federal parity protections for 60 million Americans. As a result, many Americans who previously have not had coverage for mental health care will have greater access to this and other important aspects of health care. This will help to make the tools that support recovery from injuries sustained during disasters, whether illness, injury, or trauma, more accessible.

This boost in preparedness is important for responding to disasters big and small: the biggest indicator of how a person or community will fare during a disaster is how they were doing before the crisis struck. While health insurance doesn’t guarantee that you will be healthier, it does make health much more likely. 

Read More

Feb 28 2014
Comments

The Role of Community Health Workers in Promoting Health: 'Talk to Me About Anything'

Shreya Kangovi, MD, is an assistant professor of medicine at the University of Pennsylvania Perelman School of Medicine, executive director of the Penn Center for Community Health Workers, and a Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholars program alumna.

file

“What do you think will help you stay healthy after discharge?”

Mr. Manzi, a soft-spoken man in his early 60s, paused to consider. No one had asked him this question before. He had come to the hospital because of blurry vision and thirst too severe to ignore. The doctors told him that he had severe diabetes and hypertension, and that he needed to adhere to a long list of new medications, tests, and appointments.  

“Not just medical stuff,” Anthony, the community health worker, continued. “Talk to me about anything. Dealing with shut-off notices, housing issues, whatever you think you need to stay healthy.”

Mr. Manzi opened up. He explained that he was originally from Ghana but had been living and working odd jobs in Philadelphia for 20 years as an undocumented immigrant. He had not had a job in six months and twice, his home had gone into foreclosure. Mr. Manzi was uninsured and had not been able to get outpatient care before coming to the hospital.

“I’m willing to do whatever it takes to stay healthy,” he concluded. “But I need to make sure I can pay for all of these medications and a doctor. And I need some help with the foreclosure—I can’t take care of myself if I lose my home.” 

Mr. Manzi’s answers became the basis for his tailored intervention. IMPaCT (Individualized Management for Patient-Centered Targets) is an innovative model of care in which community health workers (CHWs) provide tailored support to help patients achieve individualized goals. Anthony, an IMPaCT CHW, shares socioeconomic background with patients like Mr. Manzi. He and other IMPaCT CHWs are selected for traits such as empathy, active listening, and reliability.  

Read More

Feb 27 2014
Comments

Human Capital News Roundup: Risk of increased ADHD labeling, unnecessary emergency department scans, food labeling, 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:

In an op-ed for the New York Times, RWJF Investigator Award in Health Policy Research recipients Stephen Hinshaw, PhD, and Richard Scheffler, PhD, discuss how a major expansion of early childhood education could have an unintended consequence: a dramatic increase in the number of pre-school age children, particularly from low-income families, who are wrongly diagnosed with attention deficit hyperactivity disorder (ADHD). The writers recently authored a book, The ADHD Explosion: Myths, Medication, Money, and Today's Push for Performance. The Wall Street Journal also covered the book release, among other outlets.

A study by RWJF Clinical Scholars alumnus, Jeremiah Schurr, MD, MHS, identifies five tests commonly performed in emergency departments that are unnecessary for some patients. In an article in Long Island Newsday, Schurr explains that curtailing their use for patients who do not exhibit specific symptoms could reduce health care costs. Schurr’s research shows that the information gleaned from the tests—CT scans and MRIs for certain patients and blood tests for others—can be derived just as effectively through less expensive procedures.

MedPage Today interviews Jason Karlawish, MD, an RWJF Investigator Award recipient, on the treatment of Alzheimer’s disease. Karlawish emphasizes the importance of accurate diagnosis, proper medication, and family involvement and education. Read more about Karlawish’s work on Alzheimer’s disease on the Human Capital Blog.

Read More