Category Archives: Clinical Scholars

Jul 18 2014
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Building a Culture of Health at AcademyHealth Annual Research Meeting

RWJF Leadership Reception at the AcademyHealth annual meeting in San Diego in June 2014 RWJF Leadership Reception at the AcademyHealth annual meeting in San Diego in June 2014

At this year’s AcademyHealth Annual Research Meeting, held in San Diego, California June 8–10, the Robert Wood Johnson Foundation (RWJF) hosted “Building a Culture of Health: An RWJF Leadership Reception.” More than 100 RWJF scholars, fellows, and alumni representing 14 RWJF Human Capital programs joined with colleagues and friends of the Foundation for the gathering at the Hilton San Diego Bayfront. There, health providers, clinicians, researchers, and graduate students made and renewed the important professional connections that RWJF facilitates.

Among those attending the reception were RWJF Health & Society Scholars alumnus and RWJF Clinical Scholars Associate Program Director (University of Pennsylvania program site) David Grande, MA, MPA, who presented his paper, “How Do Health Policy Researchers Perceive and Use Social Media to Disseminate Science to Policymakers?,” at the meeting; RWJF Nurse Faculty Scholars Lusine Poghosyan, PhD, MPH, RN, and J. Margo Brooks Carthon, PhD, APRN, who chaired and served as a panelist, respectively, at a health care workforce session; and Clinical Scholars Tammy Chang, MD, MPH, MS, and Katherine A. Auger, MD, M.Sc., who were both chosen as recipients of the AcademyHealth Presidential Scholarship for New Health Services Researchers. This scholarship provides financial support to attend the meeting, and recognizes early-career researchers who demonstrate leadership ability and potential to contribute to the field of health services research.

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Jul 10 2014
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RWJF Scholars in the News: Healthcare.gov, depression and mortality, stress among nurses, 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:

Young adult users of Healthcare.gov, the health insurance marketplace established under the Affordable Care Act, recommend that the site offer better explanations of terminology, more clarity about the benefits various plans offer, and checkboxes and other features that make it easier to compare plans. Those are among the findings of a study conducted by RWJF Clinical Scholar Charlene Wong, MD, along with alumni David Asch, MD, MBA, and Raina Merchant, MD, that looked at the experiences of young adults who used the website. The scholars write about their findings in the Philadelphia Inquirer. Wong told the Leonard Davis Institute of Health Economics blog that these users “may not know what insurance terms mean but they have a lot of expertise and insights about maximizing the usability of the digital platforms that have always been such an integral part of their lives.”

Major depression (also known as “clinical depression”) is associated with an elevated risk of death from cardiovascular disease, according to research covered by Kansas City InfoZine. The study, co-authored by Patrick Krueger, PhD, an RWJF Health & Society Scholars program alumnus, also found that the relationship between depression and early non-suicide mortality is independent of such factors as smoking, exercise, body mass, education, income, and employment status. The authors say the findings indicate that the relationship between depression and mortality is not due solely to the interplay between depression and health-compromising risk factors.

Expanding scope of practice for advanced practice nurses and implementing better management practices could alleviate some stress factors for nurses and improve patient care, Matthew McHugh, PhD, JD, MPH, FAAN, tells Healthline News. For example, in some medical facilities, nurses are empowered to decide if a patient’s urinary catheter should be removed without consulting a doctor, thus preventing delays in care. “Lots of things that don’t require policy change” can have an important impact on patient outcomes and nurses’ job satisfaction, said McHugh, an RWJF Nurse Faculty Scholars alumnus.

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Jul 8 2014
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Transforming Communities to Reduce Stress and Improve Health

Brita Roy, MD, MPH, MS, is a Robert Wood Johnson Foundation (RWJF)/U.S. Department of Veterans Affairs Clinical Scholar, and Carley Riley, MD, MPP, is an RWJF Clinical Scholar. 

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You awake to the sound of your alarm, not feeling as rested as you’d hoped. Hurriedly bathing and dressing, you then grab a breakfast bar and stumble over your long-neglected bicycle to climb into your car, joining other anonymous drivers enduring their morning commutes.

file Brita Roy, MD, MPH, MS

Unfortunately, these sorts of mornings, all too common to Americans, create negative stress and worsen health. Under time constraints and other pressures, stressed individuals engage in less healthy behaviors: eating more unhealthy foods, exercising less, smoking more, and sleeping less than their less stressed counterparts. And the persistent assault of low-grade stressors, such as air and noise pollution, constant rush, lack of nature, and social isolation repeatedly trigger our bodies’ stress responses, promote persistent low-level inflammation, and subsequently undermine our cardiovascular and overall health.

file Carley Riley, MD, MPP

Beyond these familiar stressors, emerging research is showing how the nature of our communities and our relationships within them—our social environment—also influence our health. We are learning that living in neighborhoods in which residents do not know or trust each other increases negative stress levels. And how living in communities in which residents do not have confidence in their government or do not believe they can affect change to better their lives also creates stress.

We have greater understanding of how people living in neighborhoods with high crime and violence rates experience more chronic stress. And we are finding that living and working in environments in which we feel powerless augments the negative health effects of stress. 

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Jul 3 2014
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Reengineering Medical Product Innovation

Arthur Kellermann, MD, MPH, an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars and Health Policy Fellows programs, is professor and dean of the F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD. He is co-author of the new RAND report, “Redirecting Innovation in U.S. Health Care: Options to Decrease Spending and Increase Value.” Here, he shares recommendations for a brave new world of medical technology.

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Americans take justifiable pride in our capacity for innovation. From putting the first men on the moon to developing the Internet, we lead the world in developing innovative technologies. Health care is no exception. The United States holds more Nobel prizes in medicine than any other nation.

Novel drugs, biologics, diagnostics, and medical devices have transformed American health care, but not always for the better.

Some innovations have made a big difference. Combination antiretroviral therapy changed HIV infection from a death sentence to a treatable, chronic disease. Before an effective vaccine was developed, Hemophilus Influenze type b, a bacterial disease, was a major cause of death and mental disability in young children. Today, it is virtually eradicated here and in Western Europe.

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Jun 27 2014
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A Commitment to Making the Emerging Field of Pediatric Palliative Care the Very Best It Can Be

Chris Feudtner, MD, PhD, MPH, is a pediatrician, epidemiologist, historian, and ethicist at The Children’s Hospital of Philadelphia (CHOP) and professor of pediatrics at the University of Pennsylvania. He is an alumnus of the Robert Wood Johnson Foundation Clinical Scholars program.

Chris Feudtner

Living in a situation beyond almost-unbearable imagination: This is the reality that children with life-threatening conditions and their parents confront, and that the rapidly emerging field of pediatric palliative care seeks to address with compassionate and specialized medical and psychosocial expertise.1

A bit of background:  just over half of the 45,000 children who die in the United States each year are infants, who often die within hours of their birth. Others die after traumatic injuries, usually quite suddenly. And a substantial proportion of the children die after a prolonged illness trajectory, due to a wide range of chronic conditions, ranging from cancer to congenital anomalies to neurodegenerative diseases. Most of these children spend days or weeks in hospitals, with frequent hospitalizations, and with the likelihood of hospitalization going up as the condition worsens.

To meet the needs of these patients and their families, many children’s hospitals in the United States have created dedicated pediatric palliative care teams. These interdisciplinary teams—composed of physicians, nurses, social workers, child life and art therapists, chaplains, and other specialists—pursue three core tasks on behalf of these patients. First, they manage pain and other symptoms, using both pharmacologic and complementary methods. Second, they support patients and parents in the often overwhelming process of receiving medical information and making treatment decisions. Third, they help coordinate care both across specialty disciplines within the health system, and across different sites of care, from the hospital setting to home or other residential sites, often in partnership with hospice or home nursing. All of this is done in coordination with the patient’s primary medical or surgical team2—palliative care adds and never subtracts.

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Jun 23 2014
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RWJF Milestones, June 2014

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

Emery Brown, MD, PhD, an alumnus of the Harold Amos Medical Faculty Development Program has been elected a member of the National Academy of Sciences.

RWJF Investigator Award in Health Policy Research recipient James Perrin, PhD, is the new president of the American Academy of Pediatrics. He took office on January 1, 2014, beginning a one-year term.

The American Association of Colleges of Nursing (AACN) has named Deborah E. Trautman, PhD, RN, as its new chief executive officer, effective June 16. Trautman, an RWJF Health Policy Fellows program alumna, currently serves as executive director of the Center for Health Policy and Healthcare Transformation at Johns Hopkins Hospital.

The American College of Physicians (ACP), the nation’s largest medical specialty organization, has voted Wayne Riley, MD, MPH, MBA, its president-elect. Riley is a former RWJF senior health policy associate.

Kenneth B. Chance, Sr., D.D.S. has been appointed dean of the Case Western Reserve University School of Dental Medicine and will begin his duties on July 1, 2014. He is an alumnus of the RWJF Health Policy Fellows program, and served on its national advisory committee. His is a current member of the national advisory committee of the RWJF Summer Medical and Dental Education Program.

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Jun 19 2014
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RWJF Clinical Scholars Video Podcast: Joshua Sharfstein on Hospital Incentives

One of the challenges of health care reform is to realign financial incentives so that providers and hospitals have economic inducements to keep patients healthy, rather than just treating them when they’re ill.

In the latest Robert Wood Johnson Foundation (RWJF) Clinical Scholars Health Policy Podcast, Maryland Secretary of Health & Mental Hygiene Joshua Sharfstein, MD, discusses a hospital in Hagerstown, Md., that took charge of the local public school health program, hiring school nurses and more “because it’d be an economic winner for them.” The hospital’s economic incentives were such that, “If they did it well, and helped kids with asthma control their asthma so they didn’t need to go to the emergency room, [the hospital] would save money on ER visits,” Sharfstein explains.

Sharfstein is interviewed by Clinical Scholar Loren Robinson, MD. The video podcast is part of a series of RWJF Clinical Scholars Health Policy Podcasts, co-produced with Penn’s Leonard Davis Institute of Health Economics.

The video is republished with permission from the Leonard Davis Institute.

Jun 12 2014
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RWJF Scholars in the News: Alzheimer’s disease, violence against women, drug marketing, 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:

Jason Karlawish, MD, participated in the design of new research that offers “an opportunity to study the future of the way we’re going to think about, talk about and live with the risks of Alzheimer’s disease,” he tells the Associated Press. The study is aimed at testing an experimental drug to see if it can protect seniors who are healthy but whose brains “harbor silent signs” of risk, such as a sticky build-up of proteins that can be a precursor to Alzheimer’s. Karlawish is an RWJF Investigator Award in Health Policy Research recipient. Read more about his work on Alzheimer’s disease here and here.

The work of RWJF Scholars in Health Policy Research alumni Ted Gayer, PhD, and Michael Greenstone, PhD, is featured in an Economist article about incorporating into federal cost-benefit analyses the global benefits of regulation to reduce carbon emissions, rather than benefits that accrue only to the United States. Agencies conduct such analyses before promulgating regulations to test whether the estimated benefits of a regulation exceed the estimated costs. Typically, estimated benefits include only those that accrue to the United States, but because global warming reaches far beyond U.S. borders, the Obama Administration’s calculations include global benefits. Greenstone was also recently cited in the New York Times.

Chris Uggen, PhD, an RWJF Investigator Award recipient, writes about the decline in the incidence of sexual violence and intimate partner violence against women since 1993 in a Pacific Standard article. Rates of sexual violence and intimate partner violence decreased from almost 10 per 1,000 in 1994 to 3.2 per 1,000 in 2012, Uggen writes. While those numbers are encouraging, “misogyny and violence against women remain enormous social problems—on our college campuses and in the larger society,” he says. Uggen’s post also appeared on Sociological Images, a Pacific Standard partner site.

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Jun 11 2014
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Social Media Use in Health Policy Research

Health policy researchers shy away from using social media to share findings with policy-makers, according to a study published online by Health Affairs. Only 14 percent of the 215 researchers surveyed reported tweeting, and 21 percent reported blogging about their research or related health policy in the past year.

Compared with communications channels such as traditional media and direct outreach, social media were not perceived as ineffective, but survey respondents rated social media lower in three key areas: self-confidence to use social media, peer respect, and perceptions of social media in academic promotion.

“We were encouraged by the view that researchers thought social media could be an effective way to communicate research,” David Grande, MD, MPA, the study’s lead author, said in an interview. “But we were surprised by the fears we heard many people express, particularly about making mistakes with social media and getting into trouble with their academic institutions for doing so.”

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May 30 2014
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A Table for Change at the Center of a 'Culture of Health'

Justin List, MD, MAR, is a Robert Wood Johnson Foundation/VA Clinical Scholar and primary care general internist at the University of Michigan. His research interests include community health worker evaluation, social determinants of health, and improving how health systems address the prevention and management of non-communicable diseases.

Justin List

Recently, the Robert Wood Johnson Foundation announced a shift from its focus on health care toward building a “culture of health.” As a buzz phrase, “culture of health” carries promise to transform how Americans think about health, but it carries a risk to mean so many things as to dilute its meaning. For example, I saw a recent picture on Twitter where two people anonymously answered “what does the culture of health mean to you?” with “feeling guilty for not taking a sick day.” If we think of the culture of health as a web of health experiences, that answer might be best placed somewhere along an outer ring of the web. But what would be at the center of the phrase’s web of meaning?

To start, a culture of health goes beyond the health care system and incorporates every day experiences and choices people make that affect their health. Building a culture of health means not only looking at clinics and hospitals under the microscope but also looking more closely at how our communities impact health. The culture of health concept offers every person in America a larger vision and momentum for changing how Americans experience health, and it requires everyone’s participation to make change happen.

As a physician, I struggle with what role my colleagues and I play in building a true culture of health. Recent obesity statistics may suggest we’re not so effective. Obesity rates fell for children ages 2 to 5 years old since 2003-2004, according to researchers from the Centers for Disease Control and Prevention. Meanwhile, obesity rates remained essentially unchanged for most other age groups and even higher in women in over 60. From the health system side of the equation, why might that be?

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