Category Archives: Research & Analysis

Jun 30 2014
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Keystone State Study Looks at Impact of Worker Fatigue on Patient Safety

Health care worker fatigue was a factor in more than 1,600 events reported to the Pennsylvania Patient Safety Authority, according to an analysis in the June issue of the Pennsylvania Patient Safety Advisory. Thirty-seven of those events, which occurred over a nine-year period, were categorized as harmful, with four resulting in patient deaths.

“Recent literature shows that one of the first efforts made to reduce events related to fatigue was targeted to limiting the hours worked,” Theresa V. Arnold, DPM, manager of clinical analysis for the Authority, said in a news release. “However, further study suggests a more comprehensive approach is needed, as simply reducing hours does not address fatigue that is caused by disruption in sleep and extended work hours.”

In the Pennsylvania analysis, the most common medication errors involving worker fatigue were wrong dose given, dose omission, and extra dose given. The most common errors related to a procedure, treatment, or test were lab errors. Other errors included problems with radiology/imaging and surgical invasive procedures.

Read the article “Healthcare Worker Fatigue: Current Strategies for Prevention.”

More information on health care worker fatigue and patient safety is available here.

Jun 19 2014
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RWJF Scholars in the News: Debt and health, tax exemption controversy, peer influence on adolescent smokers, 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 the context of the Obama administration’s efforts to ease student loan debt, TIME reports on a study by RWJF Health & Society Scholars program alumna Elizabeth Sweet, PhD, that explores the toll debt takes on the borrower’s physical health. Past studies have focused on mental health issues, TIME writes, but Sweet’s research links debt not just to mental health, but also to high blood pressure and general health problems. Sweet says the problem has long-term implications. “These health issues are a warning for more health problems down the road,” she says, “so we have to think about this as a long-term phenomenon.” Forbes also highlights her research.

A Medscape story about a study that shows a direct correlation between vaccinating health care personnel against influenza and reducing cases of flu in the community quotes Mary Lou Manning, PhD, RN, CPNP, an RWJF Executive Nurse Fellows alumna. “We now actually have evidence indicating that higher health care worker vaccination rates in hospitals are having a community effect; they’re actually resulting in lower rates of influenza in the community. That’s remarkably exciting,” says Manning, who is president-elect of the Association for Professionals in Infection Control and Epidemiology. The article is available here (free login required).

Modern Healthcare reports on federal efforts to address concerns about tax exemption for certain nonprofit hospitals, citing research by Gary Young, JD, PhD, recipient of an RWJF Investigator Award in Health Policy Research. In order to obtain tax-exempt status, the Affordable Care Act requires nonprofit hospitals to track and report the charity care and community benefits they provide. Young found wide variation in the contributions of nonprofit hospitals. “The current standards and approach to tax exemption for hospitals is raising concerns about a lack of accountability for hospitals,” he says, and creating problems because “hospitals don’t really know what’s expected of them.” The Internal Revenue Service has proposed a rule to address the issue. (Free registration is required to view the article.)

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Jun 16 2014
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Should There Be Public Access to Data from Clinical Trials?

Michelle Mello, JD, PhD, is a professor of law and public health at the Harvard School of Public Health, and a fellow with the Edmond J. Safra Center for Ethics at Harvard University. She is a recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research.

Michelle Mello

For years, pharmaceutical companies have been lambasted in the media and government prosecutions for concealing information about the safety and efficacy of their products. In one particularly splashy example, GlaxoSmithKline (GSK) agreed to pay $3 billion in 2012 to settle criminal charges that it failed to report safety data concerning its antidepressant drug, Paxil, and its diabetes drug, Avandia, and engaged in unlawful marketing of these products and one other drug. One mechanism proposed for avoiding such problems is to establish a system through which participant-level data from clinical trials, stripped of identifying information about patients, would be available to the public.

A potential benefit of sharing clinical trial data would be that independent scientists could re-analyze data to verify the accuracy of reports prepared by trial sponsors, which might deter sponsors from mischaracterizing or suppressing findings. Data sharing would also allow analysts both within and outside drug companies to pool data from multiple studies, creating a powerful database for exploring new questions that can’t be addressed within any given trial because the sample is too small to support such analyses. 

The potential value of shared data in improving our understanding of the safety and efficacy of drugs, medical devices, and biologics has sparked considerable discussion about how to make data sharing happen. Earlier this year, the European Medicines Agency—the counterpart to the U.S. Food and Drug Administration (FDA) in the European Union—decided to start making data from trials of approved products available in 2014. This begs the question, should the FDA follow suit?

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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 5 2014
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RWJF Scholars in the News: Diversity in the nursing workforce, barriers to breast-feeding, child maltreatment, 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:

HealthLeaders Media features New Careers in Nursing (NCIN), a joint initiative of RWJF and the American Association of Colleges of Nursing (AACN) that is increasing diversity in the nursing workforce. “The reason [increasing diversity] is important, of course, is because the population of nursing does not really reflect the population at large,” Polly Bednash, PhD, RN, FAAN, says in the story. “We are now working very aggressively to have the number of people entering the profession look more like the population of the United States.” Bednash is NCIN program director and AACN’s CEO.

In an opinion piece for the Philadelphia Inquirer, Jooyoung Lee, PhD, writes that, in the aftermath of mass shootings, the media and public often focus chiefly on the shooters and forget about the families of those slain. “Instead of fixating on the shooter, or retreating into our own lives, let’s remember and honor those who are left behind. Their lives are often difficult and grinding; their grief is immeasurable. Healing from murder is rarely—if ever—a quick or complete process,” writes Lee, an RWJF Health & Society Scholars program alumnus. Read more about Lee’s work.

Living in neighborhoods with high rates of violence can affect students’ academic performance, according to a study from RWJF Health & Society Scholars program alumnus from Patrick Sharkey, PhD. The Washington Post reports that the study found that neighborhood violence that occurred within seven days of a test appeared to reduce Black children’s performance on language arts assessments. “When violence is in the air, when the threat of violence is in the air, then it becomes something that spills over to affect not just people who are involved, but everyone who lives in the community,” Sharkey says.

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May 29 2014
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RWJF Scholars in the News: Scandals and reforms at the VA, excluding the elderly from medical studies, 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 Washington Post opinion piece, RWJF Scholars in Health Policy Research alumnus Colin Moore, PhD, writes that the budding scandal over patient waiting times at regional Department of Veterans’ Affairs medical centers (VA) could lead to positive reforms, if past troubles at the VA are any guide. “Throughout its history, the VA’s very public failures have shaped its development as profoundly as its successes,” Moore writes. For example, previous failures led to the adoption of the 1996 Veterans’ Health Care Eligibility Reform Act, which transformed the VA by opening more outpatient clinics and embracing new ways to track and measure health care outcomes. The recent scandal involving falsified reporting on patient waiting times could lead to another cycle of much-needed improvements, Moore writes.

“Doctors are often in the dark” when prescribing medications or procedures to older patients, because the elderly are routinely excluded from medical research, Donna Zulman, MD, MS, co-writes in an opinion piece for the New York Times. Studies have shown that 40 percent of medical research excluded individuals over the age of 65. “Clinicians consequently have to extrapolate findings about diseases as diverse as cancer, heart attacks, and mental illness from studies of younger and often healthier people, potentially putting their older patients at risk.” Older patients should be included in medical studies because age can affect the way a person’s body processes medication and other treatments, according to Zulman, an RWJF Clinical Scholars alumna.

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May 22 2014
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RWJF Scholars in the News: DNA and depression, health impact of foreclosures, 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:

Hurricanes Katrina and Rita significantly increased the number of stillbirths in the Louisiana parishes most affected by the storms, according to a study by RWJF Health & Society Scholar Sammy Zahran, PhD. The research team concluded that 117 to 205 fetal deaths could be attributed to distress caused by the storms, the New York Times blog Well reports. “You can have two mothers with equal characteristics—age, race, and so on,” Zahran said. “[B]ut if one happens to be in a more severely destroyed area, the risk of stillbirth is higher.” The study was also covered by Daily Mail and HealthDay. Read more about Zahran’s work on the Human Capital Blog.

Genetics play an important role in whether stress makes people depressed, and in how quickly they recover, Madison.com reports. RWJF Health & Society Scholars alumnus Jason Fletcher, PhD, looked at data before and after the 9/11 attacks and correlated it with DNA information reported by survey respondents. He found that 60 percent of participants who carried a particular gene appeared to be at an increased risk for sadness after the attacks. “Overall, the evidence suggests that genetic endowments are an important source of variation in response to a stressful event, in producing some depressive symptoms in young adults,” Fletcher said. MedicalXpress also covered the study.

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May 16 2014
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New Participants in RWJF Health & Society Scholars Program to Study Determinants of Population Health

The Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program has announced the selection of 12 new scholars who will investigate how connections among biological, genetic, behavioral, social, economic, and environmental conditions impact the population’s health.

“We’re pleased to announce our newest class of Health & Society Scholars. These new scholars will continue to advance the program’s decade-long mission to answer the questions critical to guiding health policy and improving our nation’s health,” said Jo Ivey Boufford, MD, co-director with Christine Bachrach, PhD, of the national program office for the Health & Society Scholars program, and president of the New York Academy of Medicine.

The program seeks to improve the nation’s health by better understanding and acting on the determinants that can reduce population health disparities. Among many topics, the new scholars will study social factors underlying infectious disease transmission, as well as possible interventions designed to improve urban health. Previous cohorts of scholars have researched how health is influenced by civic engagement, discrimination, human happiness, work environment, public health policies, and many other societal factors.

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May 15 2014
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RWJF Scholars in the News: Budget cuts and babies’ health, nurse engineers, 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:

New research led by RWJF Clinical Scholar Nicole Brown, MD, MPH, suggests that children with attention deficit hyperactivity disorder (ADHD) are more likely to be from families affected by such stressors as poverty, divorce, neighborhood violence, or substance abuse, HealthDay reports. Researchers analyzed survey responses from parents of more than 65,000 children. Approximately 12 percent of the children had been diagnosed with ADHD, and their parents reported higher rates of those stressors than other respondents. “Knowledge about the prevalence and types of adverse experiences among children diagnosed with ADHD may guide efforts to address trauma in this population and improve ADHD screening, diagnostic accuracy and management," Brown said. The HealthDay article was republished in Philly.com, U.S. News & World Report, and WebMD.

RWJF Nurse Faculty Scholar Betty Bekemeier, PhD, MPH, RN, examined 11 years of data on budget cuts at 100 county health departments in Washington state and Florida in order to understand and quantify how the cuts affected children’s health, My Northwest (Washington) reports. She focused on the impact of funding reductions to such services as the Women, Infants and Children program and nutrition advice for mothers. Bekemeier found a direct correlation between budget cuts for such programs and the number of low birthweight babies. Children born with low birthweight, she notes, often have greater health care needs that may end up costing counties as much or more than the money saved by the original budget cuts.

Duquesne University is pioneering the nation’s first dual degree in nursing and biomedical engineering this fall, according to the Tribune-Review (Pittsburgh). Mary Ellen Glasgow, PhD, RN, ACNS-BC, dean and professor of the Duquesne University School of Nursing, said the dual major will provide engineers with hands-on clinical experience in patient care that will give them a better perspective on the practical applications of solutions to health care problems. “We aren’t going to be putting out millions of nurse engineers,” Glasgow, an RWJF Executive Nurse Fellow, said, predicting that nurse engineers will help pioneer advances and efficiencies in health care through their direct experience with patient care.

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May 1 2014
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RWJF Scholars in the News: Worldwide diabetes epidemic, covering birth control services, 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:

“[D]iabetes has become a full-blown epidemic in India, China, and throughout many emerging economies,” writes Kasia Lipska, MD, an RWJF Clinical Scholars program alumna, in a New York Times opinion piece. Lipska details her experience treating patients in India, explaining that the country’s recent economic transition has created a “perfect storm of commerce, lifestyle, and genetics” that has led to a rapid growth in diabetes cases. She highlights how costly the disease is to manage, as well as the shortcomings of India’s health care infrastructure, warning that, without reforms, India will have to provide chronic care for more than 100 million diabetics in a few decades.

RWJF Scholars in Health Policy Research alumnus Michael Greenstone, PhD, co-authored an op-ed piece in the Los Angeles Times that praises a recent appellate court decision to uphold the U.S. Environmental Protection Agency’s mercury standards. The court’s majority ruled that the EPA had factored in costs when deciding how stringent the regulation should be, and that the monetized environmental benefits of the rule outweighed the costs, Greenstone writes.

A majority of Americans—69 percent—support the Affordable Care Act requirement that health insurance plans pay for birth control, according to a survey by Michelle Moniz, MD, a Clinical Scholar. The survey included more than 2,000 respondents, NBC News reports. The U.S. Supreme Court is expected to rule by June in a case in which two for-profit corporations assert that paying for insurance coverage of certain forms of birth control conflicts with the companies’ religious beliefs. Moniz’s survey was also covered by MSNBC and Newsweek, among other outlets.

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