Lisa Ross DeCamp, MD, MSPH, is an alumna of the Robert Wood Johnson Foundation Clinical Scholars program. She is an assistant professor of pediatrics at Johns Hopkins University School of Medicine and a researcher with the Center for Child and Community Health Research.

Good communication is critical for development of an effective partnership between patient and provider.  However, for the more than 25 million people in the United States who report speaking English less than very well and are classified as having limited English proficiency (LEP), access to the most basic aspect of communication—a common language with the provider—may be limited.

It is easy to imagine how language barriers may compromise the quality and safety of health care. Research consistently demonstrates that physicians falter in many aspects of communication, compromising health care quality and lowering patient satisfaction even when they speak the same language.  Quality and satisfaction gaps stemming from poor communication are only magnified when a language barrier is present. Health care safety requires understanding instructions, again an impossible task if the patient and provider do not share a common language. 

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:

The number of emergency department visits by adults in California increased 13 percent between 2005 and 2010, with the biggest increase seen among those on Medicaid, according to a research letter by RWJF Physician Faculty Scholar Renee Y. Hsia, MD, MSc, and colleagues. The researchers say Californians with Medicaid may be having trouble finding primary care, forcing them to rely on emergency departments.

African American medical school students anticipate having significantly higher debts from their years in school than students of other races and ethnicities, according to a study co-authored by RWJF Investigator Awards in Health Policy Research recipient Sandro Galea, MD, MPH, DrPH. The findings “also underscore the belief that the high cost of medical school deters qualified minority students from applying and enrolling, especially among African American students,” U.S. News & World Report says.

A study co-authored by RWJF Health & Society Scholars alumnus Haslyn Hunte, PhD, MPH, finds that people of all races who perceive they have been discriminated against—whether everyday discrimination or a single instance of "major" discrimination—have higher levels of drug use than people who have not had such experiences. "Mental health and substance abuse providers should consider treating experiences of unfair treatment/discrimination as a risk factor for drug use as they do other experiences of stress, such as the death of a loved one," Hunte told Medical XPress. "They should also not assume that discrimination is only a problem for racial/ethnic minorities."

Although more hospitals and health care systems have been hiring physicians in recent years, more than half of the nation’s physicians are still self-employed. A survey from the American Medical Association finds that 53.2 percent of physicians were self-employed in 2012 and 60 percent worked in practices that were wholly owned by physicians.

The survey also found that only 5.6 percent of physicians were directly employed by a hospital. Twenty-three percent worked in practices that were at least partially owned by a hospital.

Although the researchers conclude hospital employment is part of a national trend, the data “offers an update on the status of physician practice arrangements, and allows for a nationally representative response to the numerous articles of the past several years that have highlighted a surge in the employment of physicians by hospitals and the ‘death’ of private practice.”

The data comes from the 2012 Physician Practice Benchmark Survey, a nationally representative random sample of post-residency physicians who provide at least 20 hours of patient care per week.

Read the study.

David S. Jones, MD, PhD, is the A. Bernard Ackerman Professor of the Culture of Medicine at Harvard Medical School's Department of Global Health & Social Medicine. He is a 2007 recipient of a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research, and the author of Broken Hearts: The Tangled History of Cardiac Care.

Every day, all over America, people visit their doctors with chest pain and other symptoms of coronary artery disease. Each year, more than a million of them choose to undergo bypass surgery or angioplasty. Are these decisions good ones? Even though modern medicine has committed itself to an ideal of evidence-based medicine, with its clinical trials, meta-analyses, and practice guidelines, the answer is not always clear. By looking closely at the history of these procedures, it is possible to understand some of the reasons why this is the case. With support from a RWJF Investigator Award in Health Policy Research, I looked at three specific questions: the role of evidence and intuition in medical decisions, the reasons why it can be so difficult to determine the risks of medical interventions, and the problem of “unwarranted variation” in medical practice.

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:

Jennifer Stuber, PhD, an alumna of the RWJF Health & Society Scholars program, was a guest on KING’s New Day (Seattle, Wash.) to discuss Forefront, an organization she co-founded to advance suicide prevention through policy change, professional training, campus and school-based interventions, media outreach and ongoing evaluation. Stuber has been an advocate for suicide prevention since her husband took his own life in 2011, and supports suicide-assessment training for medical professionals as part of continuing education. Read a post Stuber wrote for the RWJF Human Capital Blog about that legislation.

Nearly 60 percent of the 5.1 million patients who were prescribed a psychotropic medication in 2009 had received no psychiatric diagnosis, according to a study led by RWJF/U.S. Department of Veterans Affairs Clinical Scholar Ilse Wiechers, MD, MPP. The study also finds that 67 percent of those prescriptions were given to patients who did not receive any specialized mental health care, Medscape reports, meaning the medications were prescribed in primary care, general medical, or surgical settings.

Minnesota Public Radio and MinnPost.com report on a study co-authored by Health & Society Scholars alumni Sarah Gollust, PhD, and Jeff Niederdeppe, PhD, MA, examining how different messages about the consequences of childhood obesity could affect public attitudes about obesity-prevention policy. The researchers found that tapping into core values beyond health—like the need for a strong and ready military—appealed to conservatives, sometimes causing them to revise their views on how the problem should be addressed and which public and private entities should play a role.

The Accreditation Council for Graduate Medical Education’s decision to limit the working hours of medical residents has not increased patient mortality rates, but it has decreased the time residents spend on direct patient care, according to two studies published in the August issue of the Journal of General Internal Medicine.

Researchers from the University of Pennsylvania studied 13.7 million Medicare patients admitted to hospitals between 2000 and 2008. In the first three years after the Accreditation Council enacted an 80-hour work week for residents in 2003, the researchers found no significant changes in patient mortality within 30 days of admission.

“We can reassure the public that patients did not appear to be harmed by the initial duty hour reform of 2003,” senior study author Jeffrey Silber, MD, PhD, told American Medical News. “We have published many papers prior to this looking at other outcomes [including prolonged length of stay following 2003 duty hour reform], and we have found similar results.”

A second change in resident hours came in 2011, when the Accreditation Council limited residents’ maximum shift length to 16 hours, down from 30. Researchers at Johns Hopkins University and the University of Maryland found that this change contributed to a reduction in the amount of time residents spent on direct patient care. Studies conducted in 1989 and 1993 found an average of 18 to 22 percent of residents’ time was spent on direct patient care; the new study finds residents only spent 12 percent of their time on direct patient care—or about eight minutes per patient, per day—in 2012.

Residents spent most of their time (64 percent) on indirect patient care tasks, such as talking with other health professionals, reviewing charts, and handoffs, the study concluded. Lead author Lauren Block, MD, MPH, told American Medical News that while residents aren’t spending as much time eating and sleeping at hospitals, “that time is not being made up spending time with patients, because they spend that time instead working at their computer stations.”

Read more about the studies in American Medical News.

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:

People who will be newly eligible for Medicaid after expansion under the Affordable Care Act will be younger and healthier than those currently enrolled in the program, according to a study by RWJF Clinical Scholars alumna Tammy Chang, MD, MPH, and program site co-director Matthew Davis, MD, MAPP. The researchers found that the new Medicaid enrollees will also be less likely to be obese or to suffer from depression, although more of them will be smokers and drinkers. Among the outlets to report on the findings: Reuters, Kaiser Health News, NBC News, NPR’s Shots blog, and Medpage Today.

Medpage Today reports on a study led by RWJF Physician Faculty Scholars alumnus Craig Newgard, MD, MPH, finding that nearly one-third of patients sent to major trauma centers by first responders did not need that level of care and could have been sent elsewhere for diagnosis and treatment. This “overtriaging" raises per-patient health care costs by as much as 40 percent, the study finds. Read more about it.

While in Australia for a conference on reforming health care systems to meet the challenges of aging populations, RWJF Harold Amos Medical Faculty Development Program alumna Alicia Arbaje, MD, MPH, sat down for two interviews—one with The Australian Financial Review on how stereotypes about aging are changing, and one with Australian Broadcasting Corporation Radio about transitional care and reducing readmissions among older adults after they leave hospitals. Read a post Arbaje wrote for the RWJF Human Capital Blog about navigating care across settings and the role of caregivers.

For years, medical students have been choosing specialties over primary care at a rate that has alarmed experts concerned about a shortage of primary care providers. Two new surveys shed light on the primary care workforce.

Primary care physicians were the most actively recruited professionals within the physician and advanced practitioner recruiting market by the health care staffing firm Merritt Hawkins & Associates from April 1, 2012 to March 31, 2013. Merritt Hawkins recently released a report summarizing the trends among its 3,097 recruiting assignments in 48 states conducted during that time period. For the seventh consecutive year, family physicians and general internists were the top two most requested physicians, the report says.

The firm also notes a rise in demand for physician assistants and nurse practitioners, as well as an acute shortage of psychiatrists.

In addition to being in high demand, another survey from the Hays Group, a global management consulting firm, finds primary care physicians could see a higher salary increase than specialists in 2014. The growth will be even greater for primary care physicians in hospital-based settings, the report says.

Read a summary of the Merritt Hawkins report.
Read a news release about the Hays Group survey.

Mark I. Neuman, MD, MPH, is director of fellowship research and research education for the division of emergency medicine at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. The following blog, adapted from a commentary he co-authored in Pediatrics, originally appeared on Vector, the science and innovation blog of Boston Children's Hospital.

It’s no secret that the U.S. health care system is in the midst of a financial crisis. As a nation, we spend nearly 18 percent of our Gross Domestic Product on health care, and health care costs remain the largest contributor to the national debt. In 2011 alone, the cost of maintaining the nation’s 5,700 hospitals exceeded $770 billion.

If ever there was a time for a societal mandate to reduce health care costs, that time is now.

It’s widely accepted that one of the first steps to reining in runaway health care costs is reducing variability in the manner in which care is delivered. Well-defined and well-disseminated best practice guidelines can improve the reproducibility and standardization of care. In time, these guidelines may reduce costly and unnecessary tests and hospitalizations, while providing a platform on which to measure and enhance quality. More consistency may also allow providers to be more efficient with their time, space and personnel.

If it’s so costly, why is health care variability so abundant?

Robin Whittemore, PhD, APRN, FAAN, is an associate professor at Yale School of Nursing. Whittemore has received national and international recognition for her work in behavioral interventions for type 1 and type 2 diabetes. One focus of her work has been to examine ways to improve access to health programs for vulnerable high-risk populations. She is the primary investigator on a study funded by the RWJF Interdisciplinary Nursing Quality Research Initiative to prevent diabetes among at-risk adults in public housing. This post originally appeared on the U.S. Department of Health and Human Services’ National Partnership for Action blog.

Minority adults are at a disproportionate risk for developing type 2 diabetes, a challenging illness to manage that is a leading cause of morbidity and mortality in the U.S. Evidence indicates that lifestyle change programs, which incorporate healthy eating, physical activity and modest weight loss, can prevent or delay the development of type 2 diabetes. Yet, access to diabetes prevention programs is limited, particularly among minority and low-income adults.

To help address the issues with access to diabetes prevention programs, we designed a study to link existing community resources—public housing communities and a homecare agency— to minority and low-income adults at-risk for type 2 diabetes. Public housing communities provide housing at reduced rental costs for families of low socioeconomic status. We chose this setting because these communities often have the space and personnel to support a community-based program. The homecare agency consists of nurses who monitor and implement healthcare in a home environment, and are trusted health professionals in public housing communities.