Steven J. Palazzo, PhD, MN, RN, CNE, is an assistant professor in the College of Nursing at Seattle University, and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2013 – 2016. ) His research focuses on evaluating the effectiveness of the Teen Take Heart program in mitigating cardiovascular risk factors in at-risk high school students.
Difficult problems demand innovative solutions. Teen Take Heart (TTH) is a program I’ve worked to develop, in partnership with The Hope Heart Institute and with support from the RWJF Nurse Faulty Scholars Program, to address locally a problem we face nationally: an alarming increase in obesity and other modifiable cardiovascular risk factors among teenagers. The problem is substantial and costly in both economic and human terms. We developed TTH as a solution that could, if it proves effective in trials that begin this fall in my native Washington state, be translated to communities across the country.
The State of Obesity: Better Policies for a Healthier America, released recently by the Trust for America’s Health and RWJF, makes it clear that as a nation we are not winning the battle on obesity. The report reveals that a staggering 31.8 percent of children in the United States are overweight or obese and only 25 percent get the recommended 60 minutes of daily physical activity. The report also finds that only 5 percent of school districts nationwide have a wellness program that meets the physical education time requirement.
Earlier this month, the U.S. Department of Health and Human Services (HHS) announced it is investing $283 million in the National Health Service Corps (NHSC), which provides scholarship and loan repayment services to health care providers who work in underserved areas.
The funds were authorized under the Affordable Care Act and will be used to boost the number of health care providers in underserved areas, which will increase access to care.
“Thanks to the Affordable Care Act, programs like the National Health Service Corps increase the primary care workforce in communities that need it most,” HHS Secretary Sylvia Burwell, AB, BA, said in a release. “These investments are another example of how the law is working to deliver accessible, affordable, quality care.”
The NHSC was founded in 1972 and provides care to nearly 10 million people across the nation.
In fiscal 2014, more than 5,100 loan repayment and scholarship awards were made to clinicians and students and 38 states received grants to support loan repayment programs, according to Mary Wakefield, PhD, RN, FAAN, head of the Health Resources and Services Administration.
“Primary care clinicians are the backbone of our health system, and thanks to the Affordable Care Act, programs like the National Health Service Corps increase the primary care workforce in medically underserved urban, rural and Tribal communities,” Wakefield said.
Read the news release.
For more information about NHSC programs, please visit NHSC.hrsa.gov.
Sara Shostak, PhD, MPH, is an associate professor of sociology at Brandeis University and author of Exposed Science: Genes, the Environment, and the Politics of Population Health. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2004-2006).
Human Capital Blog: Your book, Exposed Science, won two awards from the American Sociological Association: the Eliot Freidson Outstanding Publication Award from the Medical Sociology Section and the Robert K. Merton Book Award from the section on Science, Knowledge, and Technology (SKAT). Congratulations! What do these awards mean for you and your work?
Sara Shostak: Thank you! I am deeply honored that Exposed Science won those awards. This kind of recognition from one’s colleagues is tremendously meaningful on a personal level, especially as there are many scholars in these sections whose work has inspired me for years.
More broadly, the dual awards signal something important about the connection between these two domains of inquiry—medical sociology and the sociology of science. That is, science and the politics of science are important foci of analysis for sociologists concerned with population health. The conditions under which scientists do their research—the political economy of knowledge production—is a critical context for what we do and do not know about human health and illness.
Population health researchers often observe that in the United States, health disparities research tends to focus on differences between racial and ethnic groups, while in the United Kingdom the focus tends to be on variations by social class (or what U.S. researchers more often call socioeconomic status). Scholars of science, knowledge, and technology can help us understand how and why these differences emerged, and with what consequences. My book raises questions also about how any of these determinants get operationalized in laboratory-based research. All of these aspects of how science is done have direct implications for public policy, as well.
For the 25th anniversary of the Robert Wood Johnson Foundation’s Summer Medical and Dental Education Program (SMDEP), the Human Capital Blog is publishing scholar profiles, some reprinted from the program’s website. SMDEP is a six-week academic enrichment program that has created a pathway for more than 22,000 participants, opening the doors to life-changing opportunities. Following is a profile of Gloria Sanchez, MD, a member of the 1993 class.
Can a person thrive in a community ravaged by poverty? Are seemingly impossible dreams attainable?
Gloria Sanchez, MD, grapples with these questions every day, both in her medical practice and while teaching aspiring physicians.
Sanchez is associate program director of the Department of Family Medicine at Harbor–UCLA Medical Center, a publicly funded hospital in Los Angeles. She also oversees UCLA’s PRIME MSIII Primary Care Longitudinal course, which trains medical students to be medical leaders in underserved communities.
The lives of patients Sanchez treats are shaped by social determinants of health—forces that dictate poor health outcomes based on ZIP code more than genetic code. Where you live, work, and play has a profound effect on individual, family, and community health, she says.
“How can someone who doesn’t have a level playing field still attain their goals?” she asks, citing research showing that the stress of social and economic disadvantage contributes to chronic disease. “Poverty can literally change your brain, and your health.”
Noting that Harbor–UCLA Family Medicine’s mission is to advocate for disenfranchised populations, Sanchez says, “That’s why I entered medicine. It may sound impossible, but I’m here to help people attain good health so they can achieve their dreams.”
Theresa Yera is a senior at the State University of New York (SUNY) at Buffalo. A project of the Robert Wood Johnson Foundation (RWJF), the Institute for Health, Health Care Policy and Aging Research, and Rutgers University, Project L/EARN is 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.
When I applied to the 2014 Project L/EARN cohort, I was seeking exposure to anthropological research that would lead me into a career of public health service. I wanted to pursue L/EARN because of my strong interest in anthropology and medicine. My previous experience in health care included studying for the Emergency Medical Technician (EMT) examinations, volunteering as a Campus Health Educator (CHE), and participating in qualitative and quantitative research projects for almost three years.
The training as an EMT introduced me to patient and health care provider interaction and raised questions on streamlining the process. It also trained me to think critically and quickly, sharpen my leadership skills, and develop interview questions. Patients complained of many chronic and acute health problems that stemmed from their health behaviors and environment. The CHE initiative led me to value a community approach for health problems. In CHE, I worked to end racial disparities in organ donation and increase awareness of the need for organ donation and a healthy lifestyle. I met many individuals with personal stories that explained why they either did or did not want to donate.
The following are among the many honors received recently by Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, grantees and alumni:
Linda Aiken, PhD, FAAN, FRCN, RN, has won the Institute of Medicine’s Leinhard Award in recognition of her “rigorous research demonstrating the importance of nursing care and work environments in achieving safe, effective, patient-centered, and affordable health care.” The director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, Aiken serves on the National Advisory Committee of the RWJF Interdisciplinary Nursing Quality Research Initiative and is a research manager for the Future of Nursing National Research Agenda.
A number of RWJF Scholars and Fellows were recently elected to membership in the Institute of Medicine:
- RWJF Clinical Scholars alumni Robert Aronowitz, MD; Patrick Conway, MD, MSc; A. Mark Fendrick, MD; and Mitchell Katz, MD. Aronowitz is also an alumnus of the RWJF Physician Faculty Scholars program, and a recipient of an RWJF Investigator Award in Health Policy Research.
- RWJF Executive Nurse Fellow alumna Margaret Heitkemper, PhD, RN, FAAN.
- RWJF Harold Amos Medical Faculty Development Program alumna Paula Johnson, MD, MPH.
- RWJF Health Policy Fellow Linda Degutis, DrPH, MSN.
- RWJF Investigator Awards in Health Policy Research recipients Mark Hall, JD, and Richard Kronick, PhD.
With so many aspects of the nation’s health care system undergoing significant change, many of the nation’s nursing schools have implemented curricular innovations aimed at ensuring that new nursing graduates are fully prepared for the challenges they’ll face in practice. These include working collaboratively in teams, providing evidence-based care, managing chronic conditions, coordinating complex care, and promoting a culture of health—and much more transformation lies ahead.
According to the latest issue of Charting Nursing’s Future, the Robert Wood Johnson Foundation’s (RWJF) issue brief series focused on the future of nursing, most clinical nursing education programs still emphasize hospital-based care, as they have for decades, even though much care has shifted to community settings. This results in a widening gap between clinical nursing education and the 21st-century competencies nurses need.
The brief highlights curricular innovations at a number of nursing schools around the nation, including re-sequencing of the curriculum, using a “concept-based” approach, a “coach model” supporting an online baccalaureate (BSN) degree, new types of academic/practice partnerships, and more. Increasingly, nursing schools are restructuring their students’ clinical experiences, embracing:
- Simulation, using actors posing as patients, complex high-fidelity mannequins, or virtual reality. A newly released and eagerly awaited study by the National Council of State Boards of Nursing (NCSBN) offers powerful support for the trend toward simulation. It found no differences in licensure pass rates or other measures of overall readiness for practice between new graduates who had traditional clinical experiences and those who spent up to 50 percent of their clinical hours in simulation.
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 an article published in Healthcare IT News, David Blumenthal, MD, MPP, writes that health care providers may be too quick to blame Electronic Health Records (EHR) for medical errors. Blumenthal notes that EHRs are still imperfect and that improvements will take time, but argues: “There is no going back in the electronic health information revolution. No physician or hospital, however loud their complaints, has ever thrown out their EHR and returned to paper. The dissatisfaction with the technology will recede as EHRs improve, and as a new generation of young clinicians, raised in the electronic world, populates our health care system.” Blumenthal is president of The Commonwealth Fund, former National Coordinator for Health Information Technology, and an RWJF Investigator Award in Health Policy Research recipient.
In a blog published by the Washington Post’s “Monkey Cage,” Shana Gadarian, PhD, and her co-author write that Ebola anxiety, while potentially misplaced and harmful, is likely to have an impact on whom Americans trust to handle the disease and what kinds of policies they will support to fight it. The authors have studies society’s reactions to small pox and H1N1 flu. “In general we find that anxiety makes people more supportive of government playing an expansive role in protecting them during a health crisis ... we think our study and the current Ebola outbreak both emphasize that people will rally around experts and increase their support for policies that fight the contagion, even if they hurt civil liberties. Let us hope that the U.S. health system is ultimately worthy of the confidence the public has in it.” Gadarian is an RWJF Scholars in Health Policy Research alumna.
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.