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.
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.
Please join the Robert Wood Johnson Foundation (RWJF) this Friday, October 3 from 12 p.m. – 1 p.m. ET for a First Friday Google+ Hangout. Panelists will discuss a new approach to medical education in which much basic content is delivered online, thus freeing up classroom time for more interactive sessions and learning what really “sticks” with students.
Susan Dentzer, senior policy adviser to the Foundation, will lead the discussion, sharing visions for the present and future of medical education that better serve emerging physicians and patients. This event is the ninth in the #RWJF1stFri series—a platform to inform RWJF audiences about lessons our partners are learning as we all work to create a Culture of Health.
Speakers will be:
- Michael Painter, MD, JD, Robert Wood Johnson Foundation
- Charles Prober, MD, Stanford School of Medicine
- Rishi Desai, MD, MPH, Khan Academy
- Jennifer DeCoste-Lopez, Stanford School of Medicine
- Shiv Gaglani, Osmosis and Medgadget
Prior to the Hangout, you can join the conversation and ask questions on Twitter at #RWJF1stFri. RSVP and learn more.
This is part of the October 2014 issue of Sharing Nursing’s Knowledge.
“I’ve learned over the last couple of years, as my mother came to rely more on nursing assistance at home for daily tasks, that health care is all about what happens between people. It’s the relationship of trust between the patient and family members and a universe of medical professionals. Nowhere is the relationship more vital than between patient and nurse.
Nurses are the front line of care. Doctors parachute into our world and we into theirs, but nurses stay on the ground from crucial moment to moment.”
--Marsha Mercer, independent journalist, They Put the ‘Care’ in Health Care, The (Lynchburg, Va.) News & Advance, Sept. 28, 2014
“Unfortunately, due to the culture of the health care industry, nurses have usually taken a back seat to physicians and administrators when it comes to changing the policies and practices of optimizing care. However, there is a wealth of evidence that points to the vital and increasing leadership role nurses are taking in health care practices around the country. ... The message to hospital administrators should be clear—if you’re looking to improve the quality of care and reduce costs, try talking to the people working on the front lines every day—talk to a nurse.”
--Rob Szczerba, PhD, MS, CEO of X Tech Ventures, Looking to Transform Healthcare? Ask a Nurse, Forbes, September 23, 2014
“I’ve been a nurse for 25 years and love what I do. But when we are forced to work overtime, it adds unnecessary stress, frustration and fatigue that can impair your ability to function at your best. You can’t think straight when you’ve been working 16 hours.”
--Terri Menichelli, Nurse., State Auditor Will Look into Health Care Overtime Law, The Citizen’s Voice (Wilkes-Barre, Pennsylvania), Sept. 19, 2014
The Robert Wood Johnson Foundation’s (RWJF) LEAP National Program is working to create a culture of health by discovering, documenting and sharing innovations in the primary care workforce. To advance this goal, the program is holding a series of six webinars that highlight best practices. Summaries of the first two webinars in the series are available here and here. The third webinar in the series focused on building an effective primary care team. Speakers included leaders from three primary care sites around the country that the LEAP program has deemed exemplars.
LEAP Director Ed Wagner, MD, MPH, began the webinar by framing the question for participants: Patients need multiple forms of contact across a primary care team, he observed. Given that, how does an organization build an effective team? How does an organization go from a collection of employees to a coherent, high-functioning team?
Charles Burger, MD, Medical Director Emeritus at Martin’s Point Health Care in Bangor, Maine, discussed the importance of recruitment and training.
He began by describing the members of Martin’s Point’s teams: a medical provider, practice administrator, collaborative care nurses, medical assistants, and care team patient service representatives.
The recruiting process is quite rigorous, he explained. “We invite the whole team in reviewing and selecting new team members,” he said. “Really what we are looking for are certain behavioral characteristics.” He said training is similarly rigorous: a six- to eight-week competency-based training period for each new team member, working one-on-one with a trainer and moving steadily through a number of modules. Each new team member moves through each module at his or her own pace, and move on when they demonstrate competence with the material in each module.
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of the Foundation’s nursing programs, and the latest news, research and trends relating to academic progression, leadership and other essential nursing issues. Following are some of the stories in the September issue.
Advocates Work to Recruit Latinos to Nursing
Latinos comprised only 3 percent of the nation’s nursing workforce in 2013, according to a survey by the National Council of State Boards of Nursing and the National Forum of State Workforce Centers, and 17 percent of the nation’s population, according to the U.S. Census Bureau. More Latino nurses can help narrow health disparities, experts say. “Having a culturally competent nurse really makes a difference in terms of compliance and patient outcomes,” said Elias Provencio-Vasquez, PhD, RN, FAAN, FAANP, an RWJF Executive Nurse Fellows program alumnus. “Patients really respond when they have a provider who understands their culture.”
New Careers in Nursing Program Helps Minnesota College Expand and Diversify While Improving Care in Rural Communities
Since its 2008 launch, the RWJF New Careers in Nursing program (NCIN) has kept a tight focus on attracting a diverse group of “second-career” students to nursing. Along the way, NCIN has had a profound effect on many of the institutions themselves. One such school, the College of St. Scholastica (CSS), saw its overall program change and grow substantially, in great measure because of its participation. NCIN has supported scholarships to 40 CSS accelerated-degree nursing students over the last seven years.
A. Monique Clinton-Sherrod, PhD, is a 2008 alumna of the Robert Wood Johnson Foundation’s New Connections program. She is an RTI research psychologist with extensive experience in prevention research associated with a variety of psychosocial issues.
Recently while watching ESPN with my two children, we saw nonstop coverage of the Ray Rice incident, including the video of Mr. Rice violently assaulting Janay Palmer, his then-fiancée. I was peppered with questions from my children.
“Did he get arrested? Why did he do that? What did she do? Is that something they shouldn’t show on television because it’s private?”
The recurring images and my children’s questions were all the more jarring because I recently lost a sorority sister in a murder-suicide by her former husband. These experiences have served as an unfortunate but teachable moment for my daughter and son, and reinforced the importance of my life’s work—both for my children and for society as a whole.
Michael K. Gusmano is a research scholar at the Hastings Center in Garrison, New York and former president of the American Political Science Association’s Organized Section on Health Politics and Policy. After completing his PhD in political science at the University of Maryland at College Park, Gusmano was a Robert Wood Johnson Foundation (RWJF) Scholar in Health Policy Research at Yale University from 1995 to 1997.
The nation’s 11 million undocumented immigrants constitute a “medical underclass” in American society. [1,2] Apart from their eligibility for emergency Medicaid, undocumented immigrants as a population are ineligible for public health insurance programs, including Medicare, Medicaid, the Child Health Insurance Program (CHIP), and subsidies available to purchase private health insurance under the Patient Protection and Affordable Care Act (ACA) of 2010, because they are not “lawfully present” in the United States.  Federal health policy does provide undocumented immigrants with access to safety-net settings, such as an acute-care hospital’s emergency department (ED), or a community health center (CHC). Since 1986, the Emergency Medical Treatment and Active Labor Act (EMTALA) has required that all patients who present in an ED receive an appropriate medical screening and, if found to be in need of emergency medical treatment (or in active labor), to be treated until their condition stabilizes. CHCs such as Federally Qualified Health Centers and other nonprofit or public primary care clinics serving low-income and other vulnerable populations trace their origins to health policy that includes the Migrant Health Act of 1962. 
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.
Ann-Marie Rosland, MD, MS, is a research scientist at the VA Ann Arbor Center for Clinical Management Research, an assistant professor at the University of Michigan Medical School, and an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program (2006-2009). She recently received a U.S. Department of Veterans Affairs Merit Award to test a family engagement intervention for patients with diabetes.
Human Capital Blog: Congratulations on your Veterans Health Administration (VA) Merit Award! The award recognizes your research into a family engagement intervention in the context of the VA’s patient-centered medical home program. How did your study work, and what did you find?
Ann-Marie Rosland: This study is unique in that we work with family member/patient pairs in managing diabetes. We call these family members “care partners.” This study asks the question: “How we can best recognize and support the vital roles that patients’ family members often take in the care of chronic illnesses, so these care partners can have the largest positive impact on patients’ health and medical care?”
Our prior work has shown that the majority of people with diabetes, heart disease and other chronic conditions have a family member who is regularly involved with the care of these conditions. Some help to keep track of medications and refill them, some help to track and manage symptoms or sugar readings, many come to medical appointments and help patients communicate with their medical teams, and some help patients navigate the health care system. In general, patients who have support from family members tend to be more successful at managing chronic illness, particularly with eating healthier and exercising more. Yet patients and family tell us that care partners face barriers in helping with the medical side of care; for example, they can’t easily find out what medications or tests the patient’s medical team is recommending, or what health system programs are available to the patient.
In the last 15 years, the availability of high-fidelity simulation has slowly begun to transform the clinical education of the nation’s nursing students. Schools that once relied on the combination of classroom education and hands-on experience in a clinical environment began to mix in time in a simulation lab, where nursing students could work with highly sophisticated mannequins able to display a range of symptoms and react in real-time to treatment.
Such simulation labs offer many advantages to nurse educators, including the ability to replicate a range of patient situations, thus allowing students to practice specific nursing skills without having to practice their budding skills on actual patients.
But how effective are simulators at training the next generation of nurses? That’s a question that the National Council of State Boards of Nursing (NCSBN) has a particular interest in answering, because the state boards it represents are asked with increasing frequency to permit nursing schools to replace on-the-ground clinical time with simulation.
In pursuit of an answer, NCSBN conducted a full-scale study, tracking 666 nursing students for two academic years, beginning in Fall 2011, and then for six months longer as they began their work in the nursing profession. During their nursing school experience, one-quarter of the students had traditional clinical experiences with no simulation, another quarter had 25 percent of their clinical hours replaced by simulation, and the remaining half had 50 percent of their clinical hours replaced by simulation. At various points during their training and subsequent work as nurses, all study participants were assessed for clinical competency and nursing knowledge.