Category Archives: Clinical Scholars

Nov 18 2014
Comments

Research by RWJF Clinical Scholars Explores Antibiotic Overuse, Weight-Loss Smartphone Apps, More

New studies conducted by Robert Wood Johnson Foundation (RWJF) Clinical Scholars and published as part of a special November supplement of the Annals of Internal Medicine offer fresh insights on a range of topics, including: How hospitals can improve antibiotic prescribing practices; how a simple change to the format of electronic health records can encourage the use of money-saving generic drugs; how a lottery-based incentive program for patients could increase participation in colon cancer screening; and whether a popular smartphone weight-loss app actually helps patients lose weight.

The supplement was published with the support of RWJF. Studies in the issue include:

Special Training for Physicians in Antibiotics Decreases Inappropriate Use and C. difficile Infections

With growing concerns about increasing antibiotic-resistant bacteria, the Centers for Disease Control and Prevention (CDC) has been urging hospitals to adopt antibiotic “timeouts.” Nearly 50 percent of antibiotic use is unnecessary or inappropriate, according to the CDC, so what can hospitals and physicians do to ensure that antibiotics continue to be effective? The McGill University Health Centre (MUHC) in Montreal tested a simple approach: provide monthly in-person trainings for physicians and residents in appropriate antibiotic use and implement a weekly review of all patients receiving antibiotics. This approach decreased inappropriate antibiotic use and resulted in a mild decline in Clostridium difficile infections. “Our pilot program led to significant savings in the cost of antibiotics paid out of our hospital budget,” said RWJF Clinical Scholars alumna and Louise Pilote, MD, PhD, MPH, Chief of Internal Medicine at the MUHC and McGill University. “This is good news for anyone concerned about antibiotic effectiveness and reducing health care costs.”

Read more

Nov 12 2014
Comments

Connected Health Approaches to Improve the Health of Veterans

Mitesh S. Patel, MD, MBA, MS, is an assistant professor of medicine and health care management at the Perelman School of Medicine and the Wharton School at the University of Pennsylvania. He is a staff physician and core investigator at the Center for Health Equity Research and Promotion at the Philadelphia Veterans Administration (VA) Medical Center. Patel is an alumnus of the VA/Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program at the University of Pennsylvania (2012-2014).

Mitesh Patel

Cardiovascular disease is the number one cause of hospitalizations, morbidity and mortality among the veteran population. Building a Culture of Health could address this issue by focusing on individual health behaviors that contribute to risk factors associated with cardiovascular disease such as physical inactivity, diet, obesity, smoking, hyperlipidemia and hypertension.

The current health system is reactive and visit-based. However, veterans spend most of their lives outside of the doctor’s office. They make everyday choices that affect their health such as how often to exercise, what types of food to eat, and whether or not to take their medications.

Connected health is a model for using technology to coordinate care and monitor outcomes remotely. By leveraging connected health approaches, care providers have the opportunity to improve the health of veterans at broader scale and within the setting in which veterans spend most of their time (outside of the health care system). The Veteran’s Health Administration (VHA) is a leader in launching connected health technologies. VHA efforts began in 2003 and included technologies such as My HealtheVet (serving approximately 2 million veterans) and telemedicine (serving about 600,000 veterans).

Read more

Nov 12 2014
Comments

Improving Mental Health Care for Veterans is Vital

Ilse Wiechers, MD, MPP, MHS is associate director at the Northeast Program Evaluation Center in the Office of Mental Health Operations of the U.S. Department of Veterans Affairs and faculty with the Yale Geriatric Psychiatry Fellowship. She is an alumna of the Yale Robert Wood Johnson Foundation (RWJF)/VA Clinical Scholars Program (2012-2014).

Ilse Wiechers

Health and disease are on a continuum.  We are at a point in time where we are trying to understand the constituents of health, whereas historically our focus has been on understanding disease. It is important to recognize that veterans have unique determinants of health not shared with the rest of the population, such as exposure to combat and prolonged time spent away from social support networks during deployment.

These exposures can put veterans at increased risk for mental health problems, such as posttraumatic stress disorder, depression, and substance use problems. The U.S. Department of Veterans Affairs (VA) has a health care system uniquely positioned to help improve the overall health of veterans because of its expertise in addressing these unique mental health needs.

I have the privilege to serve our nation’s veterans through my work as a geriatric psychiatrist conducting program evaluation for the Office of Mental Health Operations (OMHO) at the VA. My work provides me an opportunity to directly participate in several of the key components of the comprehensive mental health services the VA provides for veterans.

Read more

Nov 11 2014
Comments

Let’s Put Veterans in Charge of Their Pain Care

Erin Krebs, MD, MPH, is the women’s health medical director at the Minneapolis VA Health Care System and associate professor of medicine at the University of Minnesota Medical School. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Physician Faculty Scholars program and the RWJF Clinical Scholars program.

Erin Krebs (Veterans Day)

How can we create a Culture of Health that effectively serves veterans? We can put veterans in charge of their pain care.

Chronic pain is an enormous public health problem and a leading cause of disability in the United States. Although 2000-2010 was the “decade of pain control and research” in the United States, plenty of evidence suggests that our usual approaches to managing chronic pain aren’t working. Veterans and other people with chronic pain see many health care providers, yet often describe feeling unheard, poorly understood, and disempowered by their interactions with the health care system.

Evidence supports the effectiveness of a variety of “low tech-high touch” non-pharmacological approaches to pain management, but these approaches are not well aligned with the structure of the U.S. health care system and are often too difficult for people with pain to access. Studies demonstrate that patients with chronic pain are subjected to too many unnecessary diagnostic tests, too many ineffective procedures, and too many high-risk medications.

Read more

Nov 6 2014
Comments

RWJF Scholars in the News: Simulating combat conditions for medical and nursing students, enriched maternity care, GMO confusion 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:

An article on dcmilitary.com describes a recent training exercise conducted for medical and nursing students at the Uniformed Services University of the Health Sciences (USU). The students cared for “patients” under simulated combat conditions that included mock explosions and casualties, operational problems, and reality-based missions. Arthur Kellermann, MD, MPH, dean of the F. Edward Hébert School of Medicine of USU, noted that while the exercise is focused on enhancing leadership and patient care skills, students are also practicing cultural sensitivity and problem-solving abilities. “All of this is wrapped into an incredibly challenging series of unfolding scenarios,” Kellermann said. “They are constantly being thrown problems. They have to adapt and learn to work with one another in a variety of ways and a variety of combinations.” Kellerman is an alumnus of the RWJF Clinical Scholars and Health Policy Fellows programs. Read more from Kellermann on the Human Capital Blog.

A study by Sara Rosenbaum, JD, examines the challenge of maintaining and coordinating “enriched health care” for pregnant women in California who purchase subsidized coverage from Covered California, the state’s health care exchange, and are also eligible for the state’s Medicaid program (Medi-Cal) and the Comprehensive Perinatal Services Program (CPSP) it offers. Science Daily reports that CPSP makes enriched maternity care available to pregnant women facing elevated health, environmental and social risks due to their economic status. Researchers compared maternity care under the two programs and identified a number of care coordination and integration challenges. Rosenbaum is an RWJF Investigator Award in Health Policy Research recipient. 

Read more

Oct 31 2014
Comments

RWJF Milestones, October 2014

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

Linda Aiken, PhD, FAAN, FRCN, RN, has won the Institute of Medicine’s Leinhard Award in recognition of her “rigorous research demonstrating the importance of nursing care and work environments in achieving safe, effective, patient-centered, and affordable health care.” The director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, Aiken serves on the National Advisory Committee of the RWJF Interdisciplinary Nursing Quality Research Initiative and is a research manager for the Future of Nursing National Research Agenda.

A number of RWJF Scholars and Fellows were recently elected to membership in the Institute of Medicine:

Read more

Oct 30 2014
Comments

RWJF Scholars in the News: Scapegoating EHRs, Ebola fears, children fighting cancer, 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 article published in Healthcare IT News, David Blumenthal, MD, MPP, writes that health care providers may be too quick to blame Electronic Health Records (EHR) for medical errors. Blumenthal notes that EHRs are still imperfect and that improvements will take time, but argues: “There is no going back in the electronic health information revolution. No physician or hospital, however loud their complaints, has ever thrown out their EHR and returned to paper. The dissatisfaction with the technology will recede as EHRs improve, and as a new generation of young clinicians, raised in the electronic world, populates our health care system.”  Blumenthal is president of The Commonwealth Fund, former National Coordinator for Health Information Technology, and an RWJF Investigator Award in Health Policy Research recipient.

In a blog published by the Washington Post’s “Monkey Cage,” Shana Gadarian, PhD, and her co-author write that Ebola anxiety, while potentially misplaced and harmful, is likely to have an impact on whom Americans trust to handle the disease and what kinds of policies they will support to fight it. The authors have studies society’s reactions to small pox and H1N1 flu. “In general we find that anxiety makes people more supportive of government playing an expansive role in protecting them during a health crisis ... we think our study and the current Ebola outbreak both emphasize that people will rally around experts and increase their support for policies that fight the contagion, even if they hurt civil liberties. Let us hope that the U.S. health system is ultimately worthy of the confidence the public has in it.” Gadarian is an RWJF Scholars in Health Policy Research alumna.

Read more

Oct 29 2014
Comments

Primary Care and the Next Phase of Health Care Reform

Michael Hochman, MD, MPH, is medical director for innovation at AltaMed Health Services, the largest independent federally qualified health center in the United States. AltaMed has enrolled more than 30,000 Southern Californians in Medi-Cal and Covered California, the state health care exchange. Hochman is an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program at the University of California, Los Angeles, and the U.S. Department of Veterans Affairs. Martin Serota, MD, is AltaMed’s chief medical officer.

Michael Hochman Michael Hochman

Although the dust is still settling, most indicators suggest that the first wave of national health care reform was a success, particularly in California.  More than 8 million Americans enrolled in commercial health plans under the Affordable Care Act, surpassing targets set by the Obama administration. Many more will qualify for plans under Medicaid expansion. As leaders at a community health center that serves a large population of low-income patients—many of whom currently lack coverage—we could not be happier about the new opportunities for our patients.

Martin Serota Martin Serota

But we also know that the work is far from complete. Health care reform will only be a success if coverage expansion results in improvements in quality and efficiency, and better health for the population. As we know from the Massachusetts experience, it took time and a lot of effort for these benefits to ensue. Only now, several years after health care reform began in Massachusetts, are residents of the state starting to reap the benefits.

Read more

Oct 16 2014
Comments

RWJF’s Clinical Scholars Program: A Proud Legacy of Creating Change

Encouraging physicians to be not only agents of care, but agents of change: That’s the challenge the Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program has embraced for 45 years, and it’s a challenge the Foundation has met with “great success,” writes Bharat Kumar, MD, in an article in the American Medical Association’s ethics journal, Virtual Mentor.

In an era of increased activism and access to health care as evidenced by the creation of Medicare and Medicaid, a group of medical school professors envisioned the Clinical Scholars Program as a way to move beyond “the detached and passive model of medical practice” and instead “train physicians to become agents of change, not only in the clinic and in the hospital, but also in communities, in classrooms, and the halls of power,” Kumar writes. Three years after the program was launched in 1969 at five universities, with support from the Carnegie Corporation and the Commonwealth Fund, it came under the auspices of RWJF.

The article describes the program’s current objective—to provide post-doctoral training for young physicians in health services research, community-based participatory research and health policy research—and its current structure: training sites at the University of Michigan, the University of Pennsylvania, Yale University, and the University of California, Los Angeles; a national program office at the University of North Carolina; and a longtime collaboration with the U.S. Department of Veterans Affairs that supports positions for Clinical Scholars via affiliated Veterans Affairs medical centers.

The program’s final cohort of scholars, selected this year, will follow in the footsteps of more than 1,200 alumni, many of whom “have become leaders in health care policy and delivery,” Kumar writes, with roles in all levels of government and notable advancements in the fields of pediatrics, internal medicine, and emergency medicine.

Alumna Stacey Lindau, MD, says in the article that the program’s “traditions of promoting excellence, critical thinking, and service extend beyond the two to three years of training, effectively creating a pipeline of alumni dedicated to service.”

Read “The Robert Wood Johnson Clinical Scholars Program: Four Decades of Training Physicians as Agents of Change.”

Sep 25 2014
Comments

RWJF Scholars in the News: Unintended consequences of shorter ER wait times, Ebola response, vaccinations 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:

Policies aimed at shortening emergency departments waiting times may have unintended consequences, including unnecessary admission of patients who might be better off being discharged, RWJF Physician Faculty Scholars alumna Renee Hsia, MD, MSc, tells Health Day. Hsia published two research letters in JAMA Internal Medicine on emergency wait times at urban and rural hospitals. RWJF Clinical Scholar alumnus Jeremiah Schuur, MD, MHS, author of an accompanying editorial, seconds Hsia’s concerns. “Medicare started advertising waiting times at ERs about a year ago. And that will be a strong incentive for hospitals to work on and improve their waiting times...[h]owever, some of the hospitals with longer waiting times, like teaching hospitals, care for the most complex patients who often don’t have access to regular care. And these places are, by nature and necessity, going to have longer waiting times,” he warned. The article was republished by U.S. News & World Report and Health.com, among other outlets.

CBS Detroit interviews Howard Markel, MD, PhD, FAAP, recipient of an RWJF Investigator Award in Health Policy Research, for a story on President Obama’s decision to send American troops and medical and logistical support to Africa to stop Ebola from spreading. “It is a humanitarian gesture,” Markel said. “I applaud the president for doing it. Do I wish as a physician and an epidemiologist it was done earlier? Yes, of course.” Markel says he does not expect the virus to spread to the United States. He is also quoted in the New Republic and Politico.

In an op-ed for the New York Times, Jason Karlawish, MD, explores the balance between risk-avoidance and enjoying life as we age. Noting that 3.6 percent of the population is 80 or older, he writes that as Americans age, “life is heavily prescribed not only with the behaviors we should avoid, but the medications we ought to take.” Aging in the 21st century is all about risk reduction, but “[w]e desire not simply to pursue life, but happiness” and “medicine is important, but it’s not the only means to this happiness,” Karlawish writes. National investment in communities and services that improve the quality of our aging may be one answer, he adds. Karlawish is a recipient of an RWJF Investigator Award in Health Policy Research.

Read more