Category Archives: Clinical care
The federal government announced on July 7 it had awarded more than $83 million to expand access to care by training hundreds of new primary care providers.
The money will be used to support primary care residency programs in family medicine, internal medicine, pediatrics, obstetrics and gynecology, psychiatry, geriatrics, and general dentistry at 60 health centers across the country. The expanded residency programs will help train more than 550 residents in coming academic year—about 200 more than were trained in the previous academic year, according to the U.S. Department of Health and Human Services (HHS). The funds will also be used to boost the number of states with teaching health centers from 21 to 24.
“This program not only provides training to primary care medical and dental residents, but also galvanizes communities,” said Mary K. Wakefield, PhD, RN, head of the Health Resources and Services Administration, a division of HHS. “It brings hospitals, academic centers, health centers, and community organizations together to provide top-notch medical education and services in areas of the country that need them most.”
CDC Study: Nurses, Physician Assistants More Likely to Provide Education in Chronic Disease Management than Doctors
Proper patient management of chronic diseases is increasingly important to the nation’s health care system, as the Baby Boom generation reaches the stage of life where such conditions are common. From diabetes, arthritis, and asthma to obesity, hypertension, and depression, the health care system is looking to train patients to take steps mapped out for them in discussions with their health care providers. A new study from the Centers for Disease Control and Prevention (CDC), however, finds that a minority of patients with chronic conditions receive education in managing their problems, and that some practitioners—nurses and physician assistants (PAs), in particular—are considerably more likely to provide such education than others.
“Disease self-management is an essential component of care for patients with most chronic conditions,” writes a team of researchers led by Tamara S. Ritsema, MPH, MMSc, PA-C. “Patients cannot perform daily self-management tasks if they have poor understanding of the disease process, medications used, or the practical tasks they need to accomplish to care for themselves. Health education is, therefore, a vital preventive element in the patient visit.”
The researchers examined five years of CDC data, accounting for more than 136,000 patients who had been diagnosed with asthma, chronic obstructive pulmonary disease (COPD), depression, diabetes, hyperlipidemia, hypertension, ischemic heart disease, or obesity. The records indicated whether the patients’ doctors, nurse practitioners (NPs), or PAs had provided education to the patients in the self-management of their conditions during each visit.
The largest study to examine the relationship between nurse staffing and patient care reveals that patients get the best care when they are treated in hospital units staffed by teams of nurses who have extensive experience in their current jobs. The study, conducted by an interdisciplinary team including Patricia Stone, PhD, RN, FAAN, Centennial Professor of Health Policy at the Columbia University School of Nursing and Ciaran Phibbs, PhD, research economist at the Health Economics Resource Center at the Palo Alto Veterans Administration Health Care System, was funded by the Interdisciplinary Nursing Quality Research Initiative (INQRI).
The research team reviewed more than 900,000 patient admissions over four years (from 2003 through 2006) at hospitals in the Veterans Administration Health Care System. They analyzed nurses’ payroll records and patients’ medical records to see how nurse staffing affected patients’ length of stay. Longer hospital stays tend to be associated with delays and errors in care delivery, so shorter stays indicate better care. Shorter stays also reduce the cost of care.
Researchers found that a one-year increase in the average tenure of registered nurses (RNs) on a hospital unit was associated with a 1.3 percent decrease in the average length of stay.
Brendan Carr, MD, MA, MS, directs the Emergency Care Coordination Center and is on the faculty of the Perelman School of Medicine at the University of Pennsylvania. He is an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program (2008-2010).
Human Capital Blog: The Emergency Care Coordination Center (ECCC) was created in 2006 by presidential directive in response to pressing needs in the nation’s emergency medical care system. Can you describe those needs?
Brendan Carr: I’ll try my best. While the landmark Institute of Medicine (IOM) report on the future of emergency care really brought much of this into focus in 2006, the story of the emergency care system’s struggles extends back well before that. The IOM reports on the health care system’s response to injuries (Accidental Death and Disability in 1966 and Injury in America in 1985) really foreshadowed the shortcomings of acute care delivery. At the time, we understood that rapid intervention in trauma was lifesaving and that our delivery system wasn’t keeping pace with the science of emergency care.
Over the last few decades, we’ve really come face to face with this reality on a broader scale. Our growing appreciation for the importance of early diagnostics and intervention, combined with increased awareness about the importance of creating a patient-centered health care system, have highlighted the mismatch between the demand for care and the product that we deliver. The emergency care system’s crisis is really the health system’s crisis.
Susan B. Hassmiller, PhD, RN, FAAN, is senior adviser for nursing at the Robert Wood Johnson Foundation, and director of the Future of Nursing: Campaign for Action.
I flew to Florida years ago to be with my father at the end of his life. He lay in a hospital bed, at times conscious of the family members gathered at his side and other times unaware of his loved ones surrounding him. I watched a nurse I didn’t know lean over and kiss his forehead.
At another hospital bed years later, I watched a nurse comfort my daughter as she labored to bring my first granddaughter into the world. “You’ll be okay,” she whispered to my daughter, giving her a hug.
The end of life and the beginning of life, marked by a compassionate nurse keeping vigil and offering comfort. In the midst of machines, a nurse provides a human touch and caring to patients and their family members.
The essence of caring is what first attracted me to the nursing profession. Now, more than 35 years later, the essence of caring still propels me in my work as the director of the Future of Nursing: Campaign for Action, a joint initiative of RWJF and AARP to transform health through nursing. One of the Campaign’s major focus areas is promoting nursing leadership.
In recent years, millions of Americans have had medical devices implanted in their bodies—artificial hips and knees; pins, rods and screws used to support fractured bones as they heal; stents that help carry blood from the heart; and more. The U.S. Food & Drug Administration is charged with regulating the devices for safety and effectiveness, but in the latest Robert Wood Johnson Foundation (RWJF) Clinical Scholars video podcast, Sharon-Lise Normand, PhD, explains that the United States lacks a device identifier system that would help track the specific devices implanted in patients. Such data would be invaluable in cases of product recalls, as well as to gauge effectiveness. In the podcast, David Grande, MD, MPA, Associate Director of the University of Pennsylvania's RWJF Clinical Scholars program, interviews Normand about her work with the FDA to build a tracking database.
Normand is a professor of health care policy (biostatistics) in the Department of Health Care Policy at Harvard Medical School and in the Department of Biostatistics at the Harvard School of Public Health. The video podcast is part of a series of RWJF Clinical Scholars Health Policy Podcasts, co-produced with Penn’s Leonard Davis Institute of Health Economics.
The video is republished with permission from the Leonard Davis Institute.
This is part of the March 2014 issue of Sharing Nursing’s Knowledge.
It took Arnold S. Relman, MD, one of the nation’s foremost medical thinkers, nine decades and a full-blown medical catastrophe to fully appreciate the value of nurses, according to an essay he penned in the Feb. 6 edition of the New York Review of Books.
Relman, 90, a doctor, a professor emeritus at Harvard Medical School, and a former editor of the New England Journal of Medicine, learned this lesson the hard way: as a patient. Last summer, Relman fell down the stairs and suffered life-threatening injuries—and discovered the critical role nurses play in health and health care during his lengthy recovery.
He shared his late-in-life epiphany in his recent essay: “I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled,” he wrote. “This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.”
Relman’s remarks spawned a surprise reaction from Lawrence K. Altman, MD, who begged the following question in a post on the New York Times Well Blog: “How is it that a leading medical professor like Dr. Relman—who has taught hundreds of young doctors at Boston University, the University of Pennsylvania (where he was chairman of the department of medicine) and Harvard—might not have known about the value of modern-day Florence Nightingales?”
What do you think? Do medical educators and scholars fully appreciate the contributions nurses make? Register and leave a comment.
Nicole Lurie, MD, MSPH, is the assistant secretary for preparedness and response at the U.S. Department of Health and Human Services (HHS), and Kacey Wulff, MPH, is special assistant to the assistant secretary, at HHS. An alumna of the Robert Wood Johnson Foundation Clinical Scholars program, Lurie is the co-author of “The U.S. Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready for Disasters,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. This is part of a series of posts featuring RWJF Scholars who authored articles in the issue.
As we approach the Affordable Care Act’s March 31 enrollment deadline, data is starting to emerge about how these reforms are making care more accessible, cost less, and, ultimately, Americans healthier. As these reforms take effect, and make our day-to-day health care system stronger, they also result in strengthening communities across the country to become more resilient and disaster-ready.
The gaps that inspired and propelled health reform like untreated chronic conditions and mental illness, and health disparities plague our health care system every single day. During a crisis, like a hurricane, earthquake, or attack, these issues can become magnified. As a result, the ability for individuals and communities to prepare, respond, and recover successfully is intrinsically linked to the strength of the underlying health care system.
The Affordable Care Act expands mental health and substance use disorder benefits and federal parity protections for 60 million Americans. As a result, many Americans who previously have not had coverage for mental health care will have greater access to this and other important aspects of health care. This will help to make the tools that support recovery from injuries sustained during disasters, whether illness, injury, or trauma, more accessible.
This boost in preparedness is important for responding to disasters big and small: the biggest indicator of how a person or community will fare during a disaster is how they were doing before the crisis struck. While health insurance doesn’t guarantee that you will be healthier, it does make health much more likely.
This is part of the January 2014 issue of Sharing Nursing’s Knowledge.
Hush!!! Testing nurse-designed noise-reduction strategies for hospital wards
A common complaint of hospital patients is that just when their bodies need it the most, they can't get a good night's sleep because of noise and interruptions. A new initiative of three nurses at Beth Israel Deaconess Medical Center in Boston takes direct aim at the problem.
In response to patient satisfaction surveys that highlighted the problem of nighttime noise, Gina Murphy, BSN, RN, Anissa Bernardo, LCSW, and Joanne Dalton, PhD, RN, studied existing literature on the topic, developed a program they call Quiet at Night, and tested it on a 44-bed medical-surgical unit. The program includes a number of strategies for reducing noise, including closing doors at night when medically appropriate, supplying earplugs to patients, keeping patients by themselves in semi-private rooms when the census permits, using mini-flashlights when performing overnight checks to avoid turning on the lights, performing change-of-shift conversations in the break room rather than in hallways or at the nurses' station, providing headphones to patients who need the television on at night, and using beep-free keypads on doors. In addition, after 9 p.m., they implemented a number of “quiet hours” practices, including dimming lights, turning pagers to vibrate, avoiding overhead pages and hallway conversations, and more.
After implementing the strategies, the trio compared before and after surveys. In the three survey periods before the program, 43 to 47 percent of patients reported that their rooms were “always” quiet at night. After the program was in place, that jumped to 60 percent, which is the goal the nurses had set.
Zane Gates, MD, is a Robert Wood Johnson Foundation (RWJF) Community Health Leader and medical director of Altoona Regional Partnering for Health Services in Altoona, Pennsylvania. Gates and Patrick Reilly, president of Impact Health Solutions, founded the Empower3 Center for Health program, which is the model for a new health care law in Pennsylvania.
The Commonwealth of Pennsylvania has recently adopted a law to fund community-based clinics that can demonstrate real impact to the community with regard to increased access, reduced costs, lower emergency room (ER) visits, and improved behavioral health outcomes for the low-income working uninsured. It is modeled on community-based clinics featuring a unique structure that I created along with Patrick Reilly, an insurance consultant from western New York:— Empower3 Center for Health program.
The model we created features an “insurance-less” office concept that allows patients to come in as frequently as needed without worrying about being billed or having any balances to pay. The program has no co-pays, deductibles or balance billing when the patients use the participating community hospital that partners with the program. Since there is no billing at the point of service, there is more face time with the medical professionals to spend creating a true relationship that focuses on care and provides dignity to the patients seeking quality medical care. The office is open five days a week to provide access to patients as needed.