Category Archives: Scholars in Health Policy Research

Apr 22 2014
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Tracking the Affordable Care Act with the RAND Health Reform Opinion Study

Katherine Grace Carman, PhD, is an economist at the nonprofit, nonpartisan RAND Corporation and an alumna of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research program.

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Since September 2013, the RAND Health Reform Opinion Study (HROS) has been collecting data about both public opinion regarding the Affordable Care Act (ACA) and insurance enrollment among respondents of the RAND American Life Panel.

The HROS uses panel data to track changes in public opinion regarding the ACA and insurance coverage.  We survey the same respondents each month. This allows us to observe not only aggregate changes, but also individual respondents changing their opinion or insurance coverage over time. Respondents are split into four groups and one group is surveyed each week. This allows us to present updated information on a weekly basis, while not burdening survey respondents.

One of the most notable findings of our study has been the increase in insurance coverage between September 2013 and March 2014, with an estimated net gain of 9.3 million in the number insured. The margin of error for this estimate is 3.5 million. The newly insured have gained access to insurance through a variety of insurance types, with the largest gains through employer-sponsored insurance (ESI). One might expect larger gains through Medicaid or the exchanges than through ESI. While our data do not allow us to tease out the causes of this gain in ESI, some possible explanations include: greater take-up of previously offered benefits, an improved economy leading more people to hold jobs (or have family members with jobs) that offer ESI, or an increase in employers offering ESI. These results on insurance coverage transitions have been discussed widely in the media, so here we want to bring your attention to some of the other findings of the HROS.

The public opinion part of our survey contains three questions. First, we ask respondents to report whether their opinion of the ACA is generally favorable or unfavorable. (Click through to see related graphs.) Following an initial dip in favorable opinion in November, public opinion of the ACA has remained relatively stable, except for one week in March. Approximately 35 percent hold favorable opinions while approximately 52 percent hold unfavorable opinions. The remainder responds “don’t know.” While there have been fluctuations, nearly all are within the margin of error, suggesting very stable opinions.

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Apr 17 2014
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RWJF Scholars in the News: Education levels and bone fractures, nursing research, hospital choice, 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:

Social class may have a significant bearing on the likelihood that middle-aged African American and Asian women will suffer bone fractures, a new study suggests. Co-author Rebecca Thurston, PhD, an RWJF Health & Society Scholars alumna, found that current income level or ability to pay for care is not associated with bone-fracture risk. However, educational levels among minorities, which the authors note are tightly associated with socioeconomic status, are directly related. This suggests that socioeconomic status over the entire course of a woman’s life is more relevant to bone health than current income status, Health Canal reports.

The Richmond Times Dispatch reports on the importance and value of nursing research. Nursing “really looks at the whole person. So we consider the physiological issues in terms of health problems, as well as psychological components, which is a big part of any health problem,” Jacquelyn Campbell, PhD, RN, FAAN, director of the RWJF Nurse Faculty Scholars program, tells the Dispatch. “We also are very concerned with vulnerable populations, ending health inequalities. Some of our nurse scientists, including some of the Nurse Faculty Scholars, are actually doing physiological research in the lab, but they are very concerned with how that translates to the bedside and to the community.” 

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Apr 3 2014
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RWJF Scholars in the News: Medical debt disparities, nurses providing primary care, technologies that maximize time with patients, 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 study of women diagnosed with breast cancer, RWJF Physician Faculty Scholars alumna Reshma Jagsi, MD, PhD, found that Black and Latina patients were more than twice as likely as White patients to have medical debt and to skip treatments due to concerns about costs. Jagsi tells Reuters that “our findings suggest that racial and ethnic minority patients appear to be more vulnerable, as are those who are too young to qualify for Medicare, those who lack prescription drug coverage, those who reduce their work hours after diagnosis, and those with lower household income at the time of diagnosis.”

Expanding nurse practitioners’ role in primary care could help meet new demands on California’s health care system, as millions of previously uninsured residents gain coverage under the Affordable Care Act, according to Susan Reinhard, RN, PhD, senior vice president of the AARP Public Policy Institute. “We should make sure that the nurse practitioners can use every ounce of their talent for what is needed,” she tells the AARP Bulletin. “Consumers should have a choice of different clinicians who will suit their preferences and their needs.” Reinhard is chief strategist for the Center to Champion Nursing in America, a partnership of AARP, AARP Foundation, and RWJF and co-director of the Future of Nursing: Campaign for Action.

At a recent information technology summit, Ann O’Brien, MSN, RN, an RWJF Executive Nurse Fellow, discussed her work with Kaiser Permanente to leverage new health care technology to maximize nurses’ valuable time providing patient care. O’Brien explains that “you have to look at what can enable small amounts of change,” because saving seconds with each repeated use of rapid sign-on technology, for example, can mean gaining extra minutes in a day for a nurse to provide direct care, FierceHealthIT reports.

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Apr 2 2014
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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.

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Mar 27 2014
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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.

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Mar 20 2014
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RWJF Scholars in the News: ADHD medication, reconstruction after mastectomy, care for returning veterans, 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 News reports on a surge in the number of young adult women taking ADHD medication. An RWJF Investigator Award in Health Policy Research recipient, Stephen Hinshaw, PhD, explains that the rise in diagnoses among women in that age group may be evidence of failure to recognize the problem when the women were children. They may not have manifested symptoms as visibly as their male classmates with ADHD did, turning their distress inward rather than misbehaving in class, for example.

“How people with mental disorders are viewed by treatment providers and the general public can have a significant impact on treatment outcomes and the quality of life of clients,” Jennifer Stuber, PhD, and colleagues write in a study reported by Health Canal. The researchers presented vignettes about people with mental health problems to mental health providers and the general public, and compared their reactions. Providers had more positive attitudes, but some held views about the danger such patients might pose in the workplace that the researchers called “concerning.” Stuber is an RWJF Health & Society Scholars alumna.

More women are having breast reconstruction after mastectomies, USA Today reports. As a result of a 1998 federal law, most group insurance plans that cover mastectomies also cover breast reconstruction. Researchers found that the share of women who received reconstruction after mastectomy rose from 46 percent to 63 percent between 1998 and 2007. Author Reshma Jagsi, MD, DPhil, an RWJF Physician Faculty Scholars alumna, says the law could be contributing to the increase. The study was also covered by 9 News (Denver) and WKYC.com (Cleveland), among other outlets.

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Mar 13 2014
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RWJF Scholars in the News: Military suicides, easing the path to a BSN, early clues to lung 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:

Amid growing attention to suicide rates among members of the military, a new series of studies explores the contributing factors, the New York Times reports. One of the studies, on suicides and accidental deaths, was led by RWJF Scholars in Health Policy Research alumnus Michael Schoenbaum, PhD. He identified a host of risk factors, including demotions, low rank, and previous deployment. However, Schoenbaum did not find evidence to support the contention that relaxed recruitment standards had led to the induction of soldiers more likely to commit suicide. The study was also covered in USA Today, the Wall Street Journal, and the Guardian, among other outlets.

The North Carolina Medical Journal features an article by Polly Johnson, RN, MSN, RN, FAAN, on the Regionally Increasing Baccalaureate Nurses (RIBN) initiative. It provides an economically feasible educational pathway between community colleges and universities so that more North Carolina nursing students can achieve a baccalaureate degree at the start of their careers. RIBN is supported by RWJF’s Academic Progression in Nursing initiative.

In her work as a nurse practitioner in a pediatric ICU, Karin Reuter-Rice, PhD, CPNC-AC, has observed that some children with traumatic brain injuries improve rapidly, while others suffer grave and permanent damage, reports Duke Nursing. As a result, Reuter-Rice, an RWJF Nurse Faculty Scholar, is using her RWJF grant for a multi-year research project to determine what neurological differences account for those dramatically different outcomes. She is exploring whether vasospasm, the sudden contraction of blood vessels in the brain, might play a role.

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Mar 6 2014
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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.

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Feb 13 2014
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Human Capital News Roundup: Obesity, suicide prevention, syphilis, co-sleeping with infants, 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:

The deluge of articles, research, and books on obesity and diabetes are “the noise generated by a dysfunctional research establishment” and are not solving either epidemic, Gary Taubes, MSE, MS, writes in an opinion piece for the New York Times. “Making meaningful inroads ... requires that we know how to treat and prevent it on an individual level. We’re going to have to stop believing we know the answer, and challenge ourselves to come up with trials that do a better job of testing our beliefs.” Taubes received an RWJF Investigator Award in Health Policy Research. Read an interview with him about obesity and diabetes on the RWJF Human Capital Blog.

Finding healthy food, including fresh fruits and vegetables, lean meats, and low-fat dairy products, is more challenging for minorities living in urban areas than for others, according to research by RWJF Health & Society Scholars alumna Carolyn Cannuscio, ScD, ScM. Huffington Post’s Latino Voices features her study, which finds that most residents in urban settings have to bypass nearby corner stores offering little healthy food to find better options elsewhere.

In an opinion piece for the Seattle Times, RWJF Health & Society Scholars alumna Jennifer Stuber, PhD, writes that many health care professionals in the state do not feel prepared to handle suicide prevention and say training should be a requirement for licensure. Her piece was reprinted in Medical Xpress. Stuber’s work also was covered recently by Medical Daily and the New Republic. Read her RWJF Human Capital blog post on the subject.

In the Scientist, RWJF Health & Society Scholars alumna Kristin Harper, PhD, MPH, and colleagues analyze the origins of syphilis and discuss how understanding the history of the disease could help in developing a modern-day strategy to slow its spread.

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Feb 6 2014
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Human Capital News Roundup: Avoiding aneurysms, healthy food, gun safety, 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 Huffington Post Latino Voices blog, Harold Amos Medical Faculty Development Program alumna Paloma Toledo, MD, discusses obesity among Hispanic Americans and how parents can influence children’s behavior, particularly regarding physical activity. She also flags influences that impede efforts to improve health for Hispanic youth: “In the U.S., food advertising on Spanish-language television is more likely to promote nutritionally-poor food than English-language advertising, hindering Hispanic children.”

During months when low-income individuals have access to Earned Income Tax Credit benefits, they spend more on healthy food, according to a study by RWJF Scholars in Health Policy Research alumna Diane Whitmore Schanzenbach, PhD. The study suggests that people with low incomes also buy more healthy food when their income increases, reports the Wall Street Journal Real Time Economics blog.

Health care professionals could make a vital contribution to educating children about the dangers of gun-related injuries, according to a study by RWFJ Clinical Scholar John Leventhal, PhD. He told Fox News: “Pediatricians and other health care providers can play an important role in preventing these injuries through counseling about firearm safety, including safe storage.”

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