Amal Trivedi, MD, MPH, is an alumnus of the Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Physician Faculty Scholars program. He is an assistant professor of health services, policy and practice at Brown University and a hospitalist at the Providence VA Medical Center. His co-author, Danya Qato, PharmD, MPH, is a pharmacist and doctoral candidate in health services research at Brown University. They recently published a study that finds older patients are routinely prescribed potentially harmful drugs, particularly in the South.

Human Capital Blog: Why did you decide to look at this particular topic? And why are some drugs considered high-risk for elderly patients?

Danya Qato and Amal Trivedi: Adverse drug events are an important public health problem. For the elderly, such events are often precipitated by use of potentially inappropriate or high-risk medications. Over the past several decades, clinicians and researchers have sought to identify medications that should be used with caution in the elderly. These high-risk medications should be avoided among people 65 years of age or older because the associated adverse effects outweigh potential benefits or because safer alternatives are available. Elderly patients are susceptible to these medications because they have more chronic illness, greater frailty, and an altered ability to metabolize drugs. The Centers for Medicare and Medicaid Services now require all Medicare Advantage plans to report on the use of high-risk medications among their enrollees.

We undertook this study because successful efforts to reduce high-risk medication use in the elderly require knowledge of how prescribing of these agents varies geographically and the factors that predict their use. Half of persons aged 65 and older use three or more prescription medications a day. Therefore, potentially inappropriate use of medications in the elderly has important implications for health care spending and quality.

Jennifer Bellot, PhD, RN, MHSA, is an assistant professor at Thomas Jefferson University and a Robert Wood Johnson Foundation Nurse Faculty Scholar. Yesterday, she blogged about the death of her beloved grandmother, Tootsie, due to complications from medical error that began with an overdose of Synthroid.  This is Part Two of Bellot’s blog post.

In 2010, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) joined resources and released The Future of Nursing: Leading Change, Advancing Health. This landmark report included many recommendations, and a full-scale Campaign for Action is in place that will transform nursing for years to come. Among the many themes advocated in this report is the tenet that nurses should be the very core of reinventing the American health care system. The report encourages the health care system to lean, and lean heavily, upon the skill set and resources of nurses to facilitate access to higher quality care at a lower cost.

At present, we have a health care system that is technology and intervention heavy when we know our population demographics are rapidly changing and technological intervention is not always the right answer. We have a growing need for a system that instead focuses on addressing chronic disease management, prevention and wellness care. Nurses are well positioned to support a system with these foci, managing care of the older adult in the community before inpatient care becomes necessary. Specifically in the outpatient setting, nurse coordinated care that is, by definition, proactive, holistic and comprehensive will help shift the focus of care from acute and episodic to chronic and preventive.

Jennifer Bellot, PhD, RN, MHSA, is an assistant professor at Thomas Jefferson University and a Robert Wood Johnson Foundation Nurse Faculty Scholar. This is Part One of a two-part blog about the death of her beloved grandmother.

Just over a year ago, our family lost our beloved matriarch and my grandmother, “Tootsie,” to complications from a medical error.  It’s hard to believe that it’s been over a year now and each day, we feel her loss—or presence—in different ways.  I write about this remarkable woman in this month’s issue of Professional Case Management.

Tootsie was an amazing example of strength, generosity, and perhaps most characteristically, of someone who spent her life caring for others.  She bore eight children in nine years, raised them almost single-handedly after her husband died prematurely, and managed a 160-acre farm—all without a high school degree. Tootsie and I had an especially close relationship, blossoming one summer when I lived with her as a preschooler while my mother pursued her graduate degree.

As I grew older, I would become involved in Tootsie’s medical management. She would regularly send me copies of her lab reports and medical records. Medical talk became our currency of love. We chatted about her latest cardiology consultation like others might chat about celebrity gossip. Following and safeguarding her health was how we shared our love best.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows and grantees. Some recent examples:

The New York Times Well blog reports on a study by RWJF Health & Society Scholar Jason Fletcher, PhD, MS, that finds that about half of smokers carry a specific genetic characteristic associated with susceptibility to tobacco taxes and other health policy approaches intended to deter smoking. The other half have a different genetic mix and are largely unaffected by such measures. Medical XPress also reported on the findings. Read more about the study.

A study led by RWJF Investigator Award in Health Policy Research recipient Michelle Mello, JD, PhD, MPhil, finds that “patients who are offered disclosure, explanations, apologies and monetary compensation for medical errors may be more likely to accept lower rather than maximum compensation, apparently due to distrust of the motives behind a full compensation offer,” Cardiovascular Business reports.

People who frequently use the Internet to get health or medical information are more likely to have a positive outlook on cancer prevention and diagnosis, a study co-authored by Health & Society Scholars alumnus Jeff Niederdeppe, PhD, MA, finds. United Press International reports on the findings.

Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) scholars, fellows and grantees. Some recent examples:

A study led by Robert Wood Johnson Foundation (RWJF) Clinical Scholar Stephen W. Patrick, MD, MPH, MS, has received coverage in a number of major media outlets. The first-of-its-kind study examined the increasing trend of drug withdrawal in newborns and its impact on the U.S. health care system. The number of babies born experiencing drug withdrawal increased nearly three-fold between 2000 and 2009, the study finds, and the number of pregnant women using opiate drugs at the time of delivery increased nearly five-fold. During the same period, the cost of health care for these babies nearly quadrupled. Among the outlets to cover the findings: The New York Times, Wall Street Journal, U.S. News & World Report, USA Today, NPR, CNN’s The Chart blog, and Fox News. Read more about the study.

The Post-Standard (Syracuse, N.Y.) featured the work of RWJF Executive Nurse Fellows alumna Luvenia Cowart, EdD, RN, one of nine 2012 Post-Standard Achievement Award winners, for her efforts to eliminate health disparities experienced by Syracuse’s African American community. “Since 1999 Cowart has been using black barbershops and churches as her classroom to educate people about prostate cancer, diabetes and other diseases, and the importance of exercise and healthy eating,” the newspaper reports. The winners will be honored at a luncheon May 9.

A study co-authored by RWJF Physician Faculty Scholar H. Shonna Yin, MD, MS, finds parents with poor math and reading skills are more likely than others to give their children incorrect doses of medicine, Health Day reports. The researchers found that parents with math skills at the third-grade level were nearly five times more likely to make a medication-dosing error than those with math skills at the sixth-grade level or higher. “Dosing liquid medications correctly can be especially confusing, as parents may need to understand numerical concepts such as how to convert between different units of measurement, like milliliters, teaspoons and tablespoons,” Yin said.

Ten years ago, the Institute of Medicine (IOM) issued Crossing the Quality Chasm, a landmark report calling for major quality and safety improvements in the nation’s health care system. It came on the heels of the IOM’s 1999 To Err Is Human Report, which estimated that there are 44,000 to 98,000 error-induced hospital deaths each year. That report made an urgent and compelling case that improvement was needed.

In the years since, quality and safety have been top-of-the-agenda priorities for researchers, clinicians and policy-makers alike. With funding from the Robert Wood Johnson Foundation (RWJF), this April’s issue of Health Affairs takes a look at where things stand today, assessing a decade’s worth of progress toward safer, more effective, patient-centered health care. In a series of articles, several by RWJF scholars and alumni, the issue examines a range of related topics supporting the theme of the issue, “still crossing the quality chasm.” In an overview, Editor-in-Chief Susan Dentzer writes,

As a number of articles in the issue demonstrate, there’s no doubt we’ve made progress—but it’s also clear that making any headway has been agonizingly slow. If ever the state of high-quality health care appeared to be an achievable end point, we recognize now that—to paraphrase Ralph Waldo Emerson—quality, like life, is not a destination but a journey.