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.
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.
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.
Physician assistants (PAs) received high marks from patients in a recent survey conducted by Harris Poll for the American Academy of Physician Assistants (AAPA). Among 680 Americans (out of more than 1,500 surveyed) who have interacted with a PA in the past year, 93 percent see PAs as part of the solution to the nation’s shortage of health care providers; 93 percent regard PAs as trusted health care providers; and 91 percent agree that PAs improve health outcomes for patients.
“The survey results prove what we have known to be true for years: PAs are an essential element in the health care equation and America needs PAs now more than ever,” AAPA President John McGinnity, MS, PA-C, DFAAPA, said in a news release. “When PAs are on the health care team, patients know they can count on receiving high-quality care, which is particularly important as the system moves toward a fee-for-value structure.”
The AAPA points out that more than 100,000 PAs practice medicine in the United States and on U.S. military bases worldwide. A typical PA will treat 3,500 patients in a year, the association says, conducting physical exams, diagnosing and treating illnesses, ordering and interpreting tests, prescribing medication, and assisting in surgery.
Timothy Landers, PhD, CNP, and Jason Farley, PhD, MPH, CRNP, are Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars. In his work, Landers focuses on the epidemiology and prevention of antibiotic-resistant infections, including the use of hand hygiene as a means of prevention. Farley evaluates treatment outcomes in multi-drug resistant infections including tuberculosis (TB) and Methicillin-Resistant Staphylococcus aureus (MRSA) in patients with HIV, with a focus on sub-Saharan Africa.
The recent outbreak of Ebola virus in West Africa is a stark reminder that we live in a globally connected world and that outbreaks can occur without warning. As infection prevention specialists, we are acutely aware of the risks health care workers face in caring for the public, both now and in times of relatively less chaos.
The good news is that despite media reports, nurses, physicians, infection prevention specialists and other health care workers are in an ideal position to lead the global response to this disease.
Our experience with measures to address hospital-acquired infections—isolation precautions, hand hygiene, contact tracing and public health measures—are also the same methods necessary to contain the spread of Ebola.
Building on experience addressing these infections, along with recognition of the differences in Ebola virus transmission, the Centers for Disease Control & Prevention (CDC) regularly updates the guidelines and is currently recommending enhanced versions of isolation precautions, including enhanced standard precautions, contact precautions, and droplet precautions.
Twelve talented early-career nurse faculty have been selected as the seventh cohort of Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars. The award is given to individuals who show outstanding promise as future leaders in academic nursing.
Each scholar receives a three-year $350,000 award to pursue research, leadership training in all aspects of the faculty role, and mentoring from senior faculty at his or her institution. The scholars chosen this year are using their grants to study a range of issues, from pediatric asthma to dementia care to health literacy to HIV treatment to the use of technology to improve access and outcomes for rural and uninsured individuals.
At a time when many schools of nursing are turning away qualified applicants because they do not have the faculty to teach them, RWJF’s Nurse Faculty Scholars program is helping more junior faculty succeed in, and commit to, academic careers. The program also is strengthening the academic productivity and overall excellence of nursing schools by developing the next generation of leaders in academic nursing.
Swet Patel is a sophomore at the College of New Jersey, majoring in psychology. He is a graduate of Project L/EARN, a 10-week summer internship that provides training, experience and mentoring to undergraduate college students from socioeconomic, ethnic and cultural groups that traditionally have been underrepresented in graduate education. Project L/EARN is a project of the Robert Wood Johnson Foundation (RWJF), the Institute for Health, Health Care Policy and Aging Research, and Rutgers University.
On May 27, 2014, I finally ended my teens and entered my 20s. But I will forever remember this date as more than just my birthday. This was the first day of Project L/EARN.
Like my peers entering the program, I expected to gain research exposure that would be a great résumé booster. Little did I know I would gain so much more than just research experience. Although the 10-week program was intensive, and at some points it made me question why I was doing it, I never imagined I would be able to achieve so much in such a short period of time. I realized after seeing the fruits of my labor—the poster, the oral presentation, and the paper—that this program was beyond worth it.
Project L/EARN boosted my confidence. I actually feel like a researcher. And it was truly remarkable that I was able to meet such diverse individuals from a wide range of fields during the guest lecture series. I learned a great deal from these esteemed professionals regarding the different aspects of health care. The networking the program provided gave me lifelong relationships that I will forever cherish.
Patricia Drehobl, MPH, RN, is associate director for program development at the Centers for Disease Control & Prevention (CDC). She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2007-2010).
Human Capital Blog: CDC is engaging in new partnerships with the American Association of Colleges of Nursing (AACN) to promote public health nursing. How did the new collaboration come about?
Pat Drehobl: CDC has funded some national academic associations for many years, including the Association of Schools of Public Health, the Association of Prevention Teaching and Research, and the Association of American Medical Colleges. We recognized the need to include nursing representation because nursing is the largest discipline in the public health workforce. We added AACN as a partner in 2012 when we developed our funding opportunity announcement to work with academic partners.
HCB: Why did CDC decide to reach out to the nursing community in 2012?
RWJF Scholars in the News: CPR for Ebola patients, freezing women’s eggs, the inevitability of failure, 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 New York Times reports on remarks by medical ethicist Joseph J. Fins, MD, in which he calls for clearer guidance on whether clinicians should administer cardiopulmonary resuscitation (CPR) to Ebola patients whose hearts stop beating. In a commentary published on the Hastings Center Report website, and cited by the Times, Fins argues against administering CPR because of the danger of transmission of the virus to clinicians, the slim likelihood that Ebola patients will recover, and other clinical factors. Fins, an RWJF Investigator Award in Health Policy Research recipient, urges a dialogue on the question leading to clear guidelines from hospitals and government officials.
In an article for CNN, Rene Almeling, PhD, and co-authors say that while Apple and Facebook made headlines last week for offering to cover costs for their female employees to freeze their eggs, people should be suspicious of egg-freezing as a “solution.” The technology carries risk and has high rates of failure, they write. “But even if the technology were perfect, the proposal to help women put motherhood on ice so they can focus on their jobs is shortsighted,” they add. “[R]ather than making fundamental changes to the structure of work in our society to accommodate women’s reproductive years, technological optimists reach for an engineering solution. ... Instead, the goal should be to build systems of production that allow us to live our lives without constantly watching the clock.” Almeling is an RWJF Scholars in Health Policy Research alumna.
The consumption of sugar-sweetened soda might be promoting disease independent of its role in obesity, according to a study co-authored by RWJF Health & Society Scholars program alumni Belinda Needham, PhD, MA, and David Rehkopf, ScD, MPH. The study shows that telomeres—the protective units of DNA that cap the ends of chromosomes in cells—were shorter in the white blood cells of survey participants who reported drinking more soda, Science Blog reports. Shorter telomeres have been linked to a number of chronic diseases, including heart disease, diabetes and some types of cancer.
Tune in to the sixth episode of RWJF’s Pioneering Ideas podcast to hear from RWJF Investigator Award in Health Policy Research recipient, premier medical historian and Princeton educator Keith Wailoo, PhD. RWJF’s Steve Downs, SM, joins Keith to discuss how deeply held cultural narratives influence our perceptions of health, and how today’s wild ideas are often tomorrow’s cutting edge innovations.
Visit iTunes to download this episode and subscribe to future episodes.
In this episode, we also look at innovations that ask, “What if?” and explore simple shifts in perspective:
- OpenNotes’ Tom Delbanco and Jan Walker talk to RWJF’s Emmy Ganos about why they decided getting health care providers to share their notes with patients was an essential innovation—and where their work is headed next.
- Founder and CEO of LIFT Kirsten Lodal talks to RWJF’s Susan Mende and shares some simple ideas with the potential to revolutionize our approach to helping people achieve economic stability and well being.
Heather J. Kelley, MA, is deputy director of the Robert Wood Johnson Foundation (RWJF) Future of Nursing Scholars program.
“Being selected as a Robert Wood Johnson Foundation Future of Nursing Scholar was such an honor! I was already excited about starting my PhD program, but this took that excitement to another level. I wasn't sure what to expect from the boot camp, but it was truly transformative.” - Laren Riesche, a Future of Nursing Scholar attending the University of Illinois at Chicago.
Riesche was one of the 16 new scholars I was privileged to meet on August 5 and 6 at our program’s first-ever scholars’ event. In addition to providing financial support to nurses to complete their PhDs in three years, the Future of Nursing Scholars program will also provide a series of leadership development activities. One of these activities is a boot camp which will be held for each cohort prior to the start of their doctoral programs.
The first-ever boot camp was a two-day event at which the scholars were able to meet and connect with one another, and begin the work of developing skills that will serve them well as they pursue their PhDs. Sessions addressed crucial issues, including developing strategies for peer coaching, and identifying and understanding one’s own approach to change and exerting influence. The new scholars met with current doctoral students to discuss a variety of issues and were given time to network with program leaders, guest speakers, and each other. A workshop served as an introduction to scholarly writing and the event closed with a panel on selecting and working with mentors.
New guidelines from the American Association of Medical Colleges (AAMC) are intended to close the gap between expectations and the reality of what medical students are prepared to do at the start of their residencies.
Known as the Core Entrustable Professional Activities for Entering Residency, the guidelines include 13 activities—such as performing physical exams, forming clinical questions, and handing off patients to other physicians when residents go off duty—that all medical students should be able to perform, regardless of specialty, in order to be better prepared for their roles as clinicians. In August, AAMC launched a five-year implementation pilot with 10 institutions.
Ensuring that the nation’s medical school graduates “have the confidence to perform these activities is critical for clinical quality and safety,” AAMC President and CEO Darrell G. Kirch, MD, said in a news release earlier this year. “These guidelines take medical education from the theoretical to the practical as students think about some of the real-life professional activities they will be performing as physicians.”