Category Archives: Investigator Awards in Health Policy Research

Oct 16 2014
Comments

RWJF Scholars in the News: Ebola safeguards, pay-for-performance, brain development 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:

PBS NewsHour interviews Howard Markel, MD, PhD, FAAP, on whether hospitals, doctors and nurses are sufficiently prepared to handle Ebola cases in the United States, and what measures should be taken to increase safety. “As someone who studies epidemics, there’s always lots of fear, scapegoating and blame,” Markel, an RWJF Investigator Award in Health Policy Research recipient, said. “American tolerance for anything less than perfection has only shortened. The incredible thing to focus on is that so little has happened, so few cases have spread here.” The video is available here and an accompanying article is available here. Markel is also quoted in an Ebola story in the New Republic and wrote a blog for the Huffington Post.

In an article for Forbes magazine, RWJF Investigator Award in Health Policy Research recipient Peter Ubel, MD, discusses whether pay-for-performance health care models can lead to overdiagnosis and overuse of antibiotics. He cites recent journal articles suggesting that sepsis may be over diagnosed in hospitals because the institutions receive higher reimbursements for sepsis patients than for those with milder infections. “In other words, it pays not to miss sepsis diagnoses,” Ubel writes. “Because of the inherent subjectivity of medical diagnoses, those groups that assess health care quality need to remain on the alert for the unintended consequences of their measures. And those insurers and regulators eager to establish clinical care mandates? They need to slow down and make sure their administrative fixes do not create undue side effects.” Ubel also wrote a separate Forbes article on health insurance turnover.

Recent research on children who began life in overcrowded Romanian orphanages shows that early childhood neglect is associated with changes in brain structure, Science Times reports. A study co-authored by RWJF Health & Society Scholars program alumna Margaret Sheridan, PhD, finds that children who spent their early years in Romanian orphanages have thinner brain tissue in cortical areas that correspond to impulse control and attention, providing support for a link between the early environment and Attention Deficit Hyperactivity Disorder (ADHD). Researchers compared brain scans from 58 children who spent at least some time in institutions with scans of 22 non-institutionalized children from nearby communities, all between the ages of 8 and 10. The article notes that the study is among the first to document how social deprivation in early life affects the thickness of the cortex.

Read more

Oct 9 2014
Comments

RWJF Scholars in the News: The nurse faculty shortage, teaching empathy, a link between overtime and diabetes, 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:

ABC News explores the nation’s nursing workforce shortage, focusing specifically on the faculty shortage at nursing schools. “Suddenly, we turned around and realized we’re not attracting enough nurses to go into teaching,” said Kimberly Glassman, PhD, RN, chief nursing officer at NYU Langone Medical Center. “The fear is we will have to shrink the number of nurses we can prepare for the future at a time when we need to prepare more.” Glassman is an RWJF Executive Nurse Fellow. The article was republished by Yahoo News and ABC News Radio.

RWJF Health & Society Scholars program alumnus Allison Aiello, PhD, MS, is interviewed for an NBC News story on Enterovirus D-68. She recommends that parents consider getting flu shots for their children, noting that preventing children from getting the flu should help make Enterovirus less complicated to diagnose and treat. The video is available here.

RWJF Harold Amos Medical Faculty Development Program scholar Paloma Toledo, MD, co-authors a Huffington Post blog entry on the need for medical schools to teach students to be empathetic. Over the course of their training, they become less empathetic, as opposed to more empathetic, and the reasons for this are unclear,” Toledo writes, recommending lectures on active listening and communication skills, among other measures. 

Read more

Oct 2 2014
Comments

RWJF Scholars in the News: Autism and birth order, nurse staffing and underweight infants, long-term care insurance, 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:

There is an increased risk of Autism Spectrum Disorders (ASD) among children born less than one year or more than five years after the birth of their next oldest sibling, Forbes reports. The study, led by RWJF Health & Society Scholars program alumna Keely Cheslack-Postava, PhD, MSPH, analyzed the records of 7,371 children born between 1987 and 2005, using data from the Finnish Prenatal Study of Autism. About a third of the children had been diagnosed with ASD by 2007. Researchers found that the risk of ASD for children born less than 12 months after their prior sibling was 50 percent higher than it was for children born two to five years after their prior sibling. “The theory is that the timing between pregnancies changes the prenatal environment for the developing fetus,” Cheslack-Postava said. 

The health outcomes and quality of care for underweight black infants could greatly improve with more nurses on staff at hospitals with higher concentrations of black patients, according to a study funded by RWJF’s Interdisciplinary Nursing Quality Research Initiative (INQRI). The study, led by Eileen Lake, PhD, RN, FAAN, found that nurse understaffing and practice environments were worse at hospitals with higher concentrations of black patients, contributing to adverse outcomes for very low birthweight babies born in those facilities, reports Health Canal. More information is available on the INQRI Blog. The study was covered by Advance Healthcare Network for Nurses, among other outlets.

Because of a “medical-industrial complex” that provides financial incentives to overuse and fragment health care, patients nearing the end of their lives need an advocate to fight for their interests, Joan Teno, MD, MS, writes in an opinion piece for the New York Times. Teno encourages readers to “find a family member or friend who can advocate for the health care that you want and need. Find someone to ask the hard questions: What is your prognosis? What are the benefits and risks of treatments? Find someone not afraid of white coats.” Teno is an RWJF Investigator Award in Health Policy Research recipient. 

Read more

Oct 1 2014
Comments

New Journal Covers Emerging Field of Health Economics

Deborah Haas-Wilson, PhD, is a visiting professor of public policy at the John F. Kennedy School of Government at Harvard University and a member of the editorial board of the forthcoming American Journal of Health Economics. In 1994, she received a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research to study antitrust policy and the transformation of health care markets.

Deborah Haas-Wilson

Human Capital Blog: Congratulations on your appointment to the editorial board of the American Journal of Health Economics. Can you tell us about the journal’s mission?

Deborah Haas-Wilson: I am very pleased to be serving on the editorial board of the American Journal of Health Economics (AJHE), along with many distinguished health economists, including Frank Sloan, PhD, who is the editor-in-chief.

A little about the AJHE: The plan is to publish quarterly with the first issue scheduled for the winter of 2015. The mission of the AJHE is to provide a forum for theoretical and empirical analyses of health care systems and health behaviors.

HCB: What topics will the AJHE cover?          

Haas-Wilson: Topics of particular interest include the impact of the Accountable Care Act, pharmaceutical regulation, the supply of medical devices, the increasing obesity rate, the influence of an aging and more diverse population on health care systems, and competition and competition policy in the markets for hospital services, physician services, pharmaceuticals and health care financing.

Read more

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

Sep 18 2014
Comments

RWJF Scholars in the News: Antibiotic overuse, sexual assault nurse examiners, diaper banks, 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 Investigator Award in Health Policy Research recipient Anthony So, MD, MPA, co-authors a piece in the News & Observer (Raleigh, North Carolina) about the need to reduce the overuse of antibiotics, in both humans and animals. Overuse accelerates the development of antibiotic-resistant bacteria. The Centers for Disease Control and Prevention estimates that half of human antibiotic use and much animal antibiotic use is unnecessary, the article says. So calls for public policies that create incentives for farmers to decrease use of antibiotics and that limit antibiotic use in animals to disease treatment, rather than growth-promotion or as a substitute for hygiene and infection-control.

In Chicago, most children with asthma or food allergies do not have a health management form on file at school, leaving their schools without information they might need in emergencies, according to a study by RWJF Physician Faculty Scholars alumna Ruchi Gupta, MD, MPH that was covered by Reuters Health. Researchers analyzed 2012-13 school year data on more than 400,000 Chicago schoolchildren, including 18,287 with asthma and 4,250 with a food allergy. Only a quarter of the asthmatic students and half of those with a food allergy had a health management plan on file. The study was also covered by The Chicago Tribune, Fox News, The Baltimore Sun, and Red Orbit, among other outlets.

RWJF Nurse Faculty Scholars alumna Angela Frederick Amar, PhD, RN, FAAN, publishes an op-ed on Talking Points Memo about the report from the White House Task Force to Protect Students from Sexual Assault, Not Alone. Amar notes that effective response to campus sexual assault should include medical care for survivors, and that Sexual Assault Nurse Examiners (SANEs) are trained to tend to the medical and emotional needs of survivors and collect forensic evidence. In other institutions with high rates of sexual violence, such as the military, SANEs are considered an essential part of treatment for victims of sexual violence, Amar writes.

Read more

Sep 11 2014
Comments

RWJF Scholars in the News: Mental health and returning service members, children of incarcerated parents, nurse turnover, 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:

When reserve service members return to civilian life, such stresses as marriage and health care problems are more likely to trigger drinking problems than traumatic events that occurred during deployment, according to a study reported by Fox News. When it comes to the “long-term mental health for National Guard members, what matters is what happens after they come home,” said lead author Magdalena Cerdá, PhD, MPH, an RWJF Health & Society Scholars program alumna. “Financial difficulties, re-integrating, difficulties accessing quality health care, all of those seem to matter.” But deployment stress also has an impact. “[T]he more traumatic events they are exposed to during or after combat, the more problems they have in daily life when they come home,” she said. RWJF Investigator Award in Health Policy Research recipient Sandro Galea, MD, MPH, DrPH, co-authored the study. Health Canal also reported on it.

An estimated 17.5 percent of newly licensed RNs leave their first nursing job within the first year, and one in three leave within two years, according to research conducted by RWJF’s RN Work Project. Advance for Nurses quotes co-directors Christine T. Kovner, PhD, RN, FAAN, and Carol Brewer, PhD, RN, FAAN. “One of the biggest problems we face in trying to assess the impact of nurse turnover on our health care system as a whole is that there’s not a single, agreed-upon definition of turnover,” Kovner said. “A high rate of turnover at a hospital, if it's voluntary, could be problematic,” Brewer added, “but if it’s involuntary or if nurses are moving within the hospital to another unit or position, that tells a very different story.” Nurse.com also covered the study.

Having incarcerated parents is associated with significant health problems and behavioral issues, and may be more harmful to children’s health than divorce or the death of a parent, USA Today reports. “These kids are saddled with disadvantages,” said Kristin Turney, PhD, author of the study that reached those conclusions. She is an RWJF Health & Society Scholars program alumna. “They’re not only dealing with parental incarceration, but also mental health issues.” The study found that having a parent in prison was associated with such conditions as attention deficit hyperactivity disorder, learning disabilities, speech or language problems, and developmental delays. Turney’s study was also covered by US News and World Report, Salon, Psych Central, Healthline and Mother Jones, among other outlets. 

Read more

Sep 4 2014
Comments

RWJF Scholars in the News: The nursing shortage, ADHD, meaningful online communications 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:

NBC 2 (Buffalo, New York) interviewed Carol S. Brewer, PhD, RN, FAAN, co-director of RWJF’s RN Work Project, for a story about the nursing shortage and job prospects for nurses early in their careers. “We are not seeing as much demand for brand new graduates,” Brewer said. However, the anticipated retirement of many older nurses and the increasing demand for health care as a result of the Affordable Care Act could combine to create a 19-percent increase in demand for nurses in the near future, Brewer said. In the meantime, she suggests that new nurses be willing to relocate and look for nursing jobs in rural communities, where demand is greater.

It is important to keep media and public focus on the Affordable Care Act, Jake Haselswerdt, PhD, an RWJF Scholar in Health Policy Research, tells the Independent Voters Network website, because some states are still blocking full implementation of the law. “In order for the more stubborn states to move forward with implementation and expanding care, there may need to be some continued pressure,” he said. “That’s going to require the media to pay attention to the big disparities that are emerging between states that tried to implement the law and those that resisted.”

Tina Bloom, PhD, RN, an RWJF Nurse Faculty Scholar, led training for nurses in Columbia, Missouri, aimed at helping them identify the risk factors and symptoms of domestic violence, and then to support victims, ABC17 News reports. The training is consistent with preventive care provisions in the Affordable Care Act, the article says. Among other things, Bloom teaches nurses to look for certain types of injuries and for issues in patients’ medical histories that do not make sense.

Read more

Aug 29 2014
Comments

Pediatricians Need to Take Community-Based Approach to Addressing Chronic Conditions in Children

James Perrin, MD, FAAP, began a one-year term as president of the American Academy of Pediatrics (AAP) in January. A professor in the department of pediatrics at MassGeneral Hospital for Children and Harvard Medical School, Perrin received a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research in 1997.

James Perrin

Human Capital Blog: Congratulations on your new role as president of the American Academy of Pediatrics! What is your vision for the organization?

James Perrin: We are focused on addressing three main areas, which have really driven a lot of our thinking and, more importantly, our activity and change in the last several years.

First, we are working to help pediatric practices take on more community-based interventions to help young families raise their kids more effectively. There is a tremendous growth in the number of chronic diseases among children in four major areas: asthma, obesity, mental health, and neurodevelopmental disorders. We recognize these are not classic health conditions; they arise from and within communities, and both their prevention and their treatment are really community-based endeavors, as opposed to office-based activities.

Our second, and highly related priority, is an increased focus on early childhood development. We have understood the tremendous importance of early childhood for years, but there is now so much more science behind it. We know a lot more about how negative experiences and toxic stress can affect child development and how it can affect brain growth and neuroendocrine function. On the positive side, we also have more knowledge about the importance of reading to children, increasing language in the home, and other early-childhood interventions.

Thirdly, we have a better understanding of the tremendous impact of poverty on child health. Almost a quarter of American children live in households below the federal poverty line, and almost 45 percent live in households with incomes less than twice the federal poverty line. So a large number of American children are poor or near poor, and we know that poverty affects essentially everything related to child health. It makes those four categories of chronic conditions—asthma, obesity, mental health, and neurodevelopmental disorders—more prevalent and more serious, and it affects children’s responses to treatment. Lower-income kids with leukemia or cystic fibrosis, for example, have higher death rates than kids with the same diseases who are middle class. It’s impossible not to see on a daily basis how poverty affects child health.

Read more

Aug 28 2014
Comments

RWJF Scholars in the News: Medical marijuana’s unanticipated benefits, infant sleep pods, 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:

States that have legalized medical marijuana have seen nearly 25 percent fewer deaths from overdoses involving prescription painkillers than states that have not, according to a study led by Marcus Bachhuber, MD. ABC News reports on it, noting that 23 states and the District of Columbia have such laws. Researchers found that while opioid overdose rates continued to climb, the increase was much slower in states with medical marijuana laws, resulting in 25 percent fewer deaths from opioid overdose. “This study raises the possibility that there is an unintended public health benefit of medical marijuana laws, but we still need to collect more information to confirm or refute what we’ve found,” says Bachhuber, an RWJF/Veterans Administration Clinical Scholar at the Philadelphia Veterans Affairs Medical Center. Outlets covering Bachhuber’s study include CNN, Washington Post, Business Insider, Health Day and Vox.

An infant “sleep pod” designed by Jennifer Doering, PhD, RN, is one of 11 projects funded through new grants from the University of Wisconsin Extension and the Wisconsin Economic Development Corporation, the Milwaukee Journal Sentinel reports. The $25,000 Ideadvance grants are intended to move good ideas more quickly to the marketplace. Doering’s I-SleepPod, developed as a result of her work in the RWJF Nurse Faculty Scholars program, would allow an infant to sleep next to an adult while remaining safe, thanks in part to an alarm that wakes the adult in the event of an unsafe sleeping position. “We designed the sleep pod to minimize hazards because, if we don’t move in that direction of reducing sleep-related infant deaths, then [society] is essentially saying it’s acceptable to have 600 babies die every year that way,” Doering said.

Nutrition rating systems in supermarkets may encourage shoppers to purchase less junk food, according to a study led by John Cawley, PhD, an RWJF Scholars in Health Policy Research alumnus and Investigator Award in Health Policy Research recipient. The study coupled sales data from Hannaford Supermarkets in the northeastern United States from January 2005 to December 2007 with the Guiding Stars nutritional rating system. The ratings system assigns zero to three stars to food items, based on their nutritional value. Researchers found that sales of less healthy foods—such as highly processed snack foods—fell by 8.31 percent when branded with a low nutrition rating, while healthy food purchases rose by 1.39 percent, Medical Xpress reports.

Read more