Category Archives: Health Care Education and Training
As health reform increases access to care for people with chronic conditions at a time when the supply of primary care physicians is decreasing, one viable alternative is nurse-managed protocols for outpatient treatment of adults with diabetes, high blood pressure and high cholesterol, according to a study published in the Annals of Internal Medicine.
The research team reviewed 18 studies on the effectiveness of registered nurses (RNs) in leading the management of those three chronic conditions. In all 18 studies, nurses could adjust medication dosage; and in 11 studies, they could independently start patients on new medications. The review showed that patients with nurse-managed care had improved A1C levels, lower blood pressure and steeper reductions in LDL cholesterol.
“The implementation of a patient-centered medical home model will play a critical role in reconfiguring team-based care and will expand the responsibilities of team members,” the researchers wrote. “As the largest health care workforce group, nurses are in an ideal position to collaborate with other team members in the delivery of more accessible and effective chronic disease care.”
Carolyn Montoya, PhD, PNP, is associate professor and interim practice chair at the University of New Mexico College of Nursing and a recent graduate of the Robert Wood Johnson Foundation (RWJF) Nursing and Health Policy Collaborative at the University of New Mexico College of Nursing.
Human Capital Blog: Congratulations on your award from the Western Institute of Nursing! The award honors new nurse researchers. What does it mean for you and for your career?
Carolyn Montoya: In addition to being quite an honor, receiving the Carol Lindeman Award for new researchers from the Western Institute of Nursing motivates me to continue to pursue my research. I am sure people can relate to the fact that being in the student mode is so very intense that once you finish you need some recovery time. Then you start wanting to use the research skills you worked so hard to obtain, and this award has helped to re-energize my commitment to research.
HCB: The award recognizes your study on children’s self-perception of weight. Please tell us what you found.
Montoya: I was very interested to see if there was a difference between how Hispanic children viewed their self-perception in regard to weight compared with white children. Seventy percent of my study population was Hispanic, and my overall response rate was 42 percent. I found that Hispanic children, ages 8 to 11, are not better or worse than white children in their ability to accurately perceive their weight status. Most surprising, and a bit concerning, was the fact that one-third of the sample expressed a desire to be underweight.
Health care workers who have not attained bachelor’s degrees will have an opportunity for expanded roles and upward mobility in the changing health care landscape, which emphasizes increased efficiency and lower costs, according to a new Brookings Institution report. Less educated workers can take on more responsibility for screening, patient education, health coaching and care navigation, the report says, freeing up physicians and other advanced practitioners to focus on more complex medical issues.
The report examines health care occupations with high concentrations of pre-baccalaureate workers in the nation’s top 100 metropolitan areas. Those workers in the 10 largest occupations—including nursing aides, associate-degree registered nurses, personal care aides, licensed practical and licensed vocational nurses, medical assistants, and paramedics—number 3.8 million, accounting for nearly half of the total health care workforce in those metro areas. (The report notes that, “in the near future, the registered nurse may not be considered a ‘pre-baccalaureate’ occupation, given the Institute of Medicine’s recommendation that 80 percent of RNs have bachelor’s degrees by 2020.)
Adefemi Betiku was a junior at Rutgers University when he noticed that he wasn’t like the other students.
During a physics class, he raised his hand to answer a question. “Something told me to look around the lab,” he remembers. “When I did, I realized that I was the only black male in the room.”
In fact, he was one of the few black men in his entire junior class of 300.
“There’s a huge problem with black males getting into higher education,” says Betiku, currently a Doctor of Physical Therapy (DPT) student at New York University (NYU). “That has a lot to do not just with being marginalized but with how black men perceive themselves and their role in society.”
U.S. Department of Education statistics show that black men represent 7.9 percent of 18-to-24-year-olds in America but only 2.8 percent of undergraduates at public flagship universities. According to the Pew Research Center, 69 percent of black female high school graduates in 2012 enrolled in college by October of that year. For black male high school graduates, the college participation rate was 57 percent—a gap of 12 percent.
Betiku’s interest in the issues black men face, especially in education, deepened at Project L/EARN, a Robert Wood Johnson Foundation-funded initiative with the goal of increasing the number of students from underrepresented groups in the fields of health, mental health and health policy research.
A new report from the Institute of Medicine (IOM) criticizes an absence of transparency and accountability in the nation’s graduate medical education (GME) financing system, which was created in conjunction with the Medicare and Medicaid programs nearly five decades ago. The 21-member IOM committee behind the report says there is “an unquestionable imperative to assess and optimize the effectiveness of the public’s investment in GME,” and it recommends “significant changes to GME financing and governance to address current deficiencies and better shape the physician workforce for the future.”
Because the majority of public financing for GME comes from Medicare and is rooted in statutes and regulations from 1965 that don’t reflect the state of health care today, the committee’s recommendations include a modernization of payment methods to “reward performance, ensure accountability, and incentivize innovation in the content and financing of GME,” with a gradual phase-out of the current Medicare GME payment system.
Charles D. Scales Jr., MD, MSHS, an alumnus of the Robert Wood Johnson Foundation/VA Clinical Scholars program (UCLA 2011-2013), is a health services researcher at the Duke Clinical Research Institute and assistant professor in the division of urologic surgery at Duke University School of Medicine. He is also assistant program director for quality improvement and patient safety for the urology residency training program at Duke University Hospital.
Young doctors training to become surgeons, also called surgical residents, are increasingly caring for patients in an environment that links quality, safety, and value to patient outcomes. Over a decade ago, the Institute of Medicine highlighted the need for improving care delivery in the landmark report, Crossing the Quality Chasm, suggesting that high-quality care should be safe, effective, patient-centered, timely, efficient (e.g., high value), and equitable. Just this week, the Institute of Medicine followed with a clarion call for training new physicians to participate in and lead efforts to continually improve both care delivery and the health of the population, while simultaneously lowering costs of care.
To support this imperative, the Accreditation Council for Graduate Medical Education, which accredits all residency training programs in the United States, mandates that all doctors-in-training receive education in quality improvement. Despite this directive, a number of substantial barriers challenge delivery of educational programs around quality improvement. Health care is increasing complex, driving residents to focus on learning the medical knowledge and surgical skills for their field. Patient care demands time and attention, which can limit opportunities to learn about quality improvement within the context of 80-hour duty limits. This barrier particularly challenges surgeons-in-training, who often spend 12 or more hours daily learning surgical skills in the operating room, leaving little time for a traditional lecture-format session about quality improvement. Finally, many surgical training programs lack faculty with expertise in the skills required to systematically improve the quality, safety, and value of patient care, since these skills were simply not taught to prior generations of surgeons.
The Robert Wood Johnson Foundation (RWJF) has announced the nine state “Action Coalitions” that will share $2.7 million to advance strategies aimed at creating a more highly educated, diverse nursing workforce. The nine states that are receiving two-year, $300,000 grants through RWJF’s Academic Progression in Nursing (APIN) program are California, Hawaii, Massachusetts, Montana, New Mexico, New York, North Carolina, Texas, and Washington state. For each, this is the second two-year APIN grant and it will be used to continue encouraging strong partnerships between community colleges and universities to make it easier for nurses to transition to higher degrees.
In its groundbreaking 2010 report, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine (IOM) recommended that 80 percent of the nursing workforce be prepared at the baccalaureate level or higher by the year 2020. Right now, about half the nurses in the United States have baccalaureate or higher degrees.
Physicians who have both doctor of medicine (MD) and master of business administration (MBA) degrees reported that their dual training had a positive professional impact, according to a study published online by Academic Medicine. The study, one of the first to assess MD/MBA graduates’ perceptions of how their training has affected their careers, focused on physician graduates from the MBA program in health care management at the University of Pennsylvania.
The MD was more often cited as conveying professional credibility, while 40 to 50 percent of respondents said the MBA conveyed leadership, management, and business skills. Respondents also cited multidisciplinary experience and improved communication between the medical and business worlds as benefits of the two degrees.
“Our findings may have significant implications for current and future physician-managers as the landscape of health care continues to change,” lead author Mitesh S. Patel, MD, MBA, a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Pennsylvania, said in a news release. “A study published in 2009 found that among 6,500 hospitals in the United States, only 235 were run by physicians. Moving forward, changing dynamics triggered by national health care reform will likely require leaders to have a better balance between clinical care and business savvy. Graduates with MD and MBA training could potentially fill this growing need within the sector.”
Juliann Sebastian, PhD, RN, FAAN, is dean of the University of Nebraska Medical Center College of Nursing and president-elect of the American Association of Colleges of Nursing. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (1998-2001).
Human Capital Blog: Congratulations on your recent election as president-elect, and future president, of the American Association of Colleges of Nursing (AACN)! What is your vision for the 2014-2016 term?
Juliann Sebastian: I am honored to have been selected by the members of AACN to serve in this role for an organization that is pivotal to the future of baccalaureate and higher degree nursing education. I support the president and the board in advancing our shared vision of excellence in nursing education, research, and practice.
I look forward to working with the entire board to address issues of concern to AACN’s member schools. Because AACN’s membership encompasses large/small, public/private institutions, we have the special advantage of incorporating diverse voices into shaping the organization’s vision. I am enthusiastic about deepening my opportunity to support the vision AACN has identified for itself and the profession.
- AACN’s own vision is: “By 2020, as a driving force for quality health care, AACN will leverage member schools in meeting the demand for innovation and leadership in nursing education, research and practice.”
- AACN’s vision statement for the profession is: “By 2020, highly educated and diverse nursing professionals will lead the delivery of quality health care and the generation of new knowledge to improve health and the delivery of care services.”
The Robert Wood Johnson Foundation (RWJF) has announced the first 14 schools of nursing selected to receive grants to support nurses as they pursue their PhDs. Each of the inaugural grantees of the Future of Nursing Scholars program will select one or more students to receive financial support, mentoring, and leadership development over the three years during which they pursue their PhDs.
The Future of Nursing Scholars program is a multi-funder initiative. In addition to RWJF, United Health Foundation, Independence Blue Cross Foundation, Cedars-Sinai Medical Center, and the Rhode Island Foundation are supporting grants this year.
The program plans to support up to 100 PhD nursing candidates over its first two years.
In its landmark future of nursing report, the Institute of Medicine recommended that the country double the number of nurses with doctorates in order to support more nurse leaders, promote nurse-led science and discovery, and address the nurse faculty shortage. Right now, fewer than 30,000 nurses in the United States have doctoral degrees in nursing or a related field.