Category Archives: Health care delivery system

Mar 27 2014
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RWJF Scholars in the News: Cultural barriers to care, medical conspiracies, parenting, 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:

In a Talking Points Memo opinion piece, Harold Amos Medical Faculty Development Program alumna Paloma Toledo, MD, MPH, writes that while the Affordable Care Act holds the promise of greatly increasing access to care, language and cultural barriers could still stand between Hispanic Americans and quality care. Toledo’s research into why greater numbers of Hispanic women decline epidurals during childbirth revealed that many made the choice due to unfounded worries that it would leave them with chronic back pain or paralysis, or that it would harm their babies. “As physicians, we should ensure that patients understand their pain management choices,” she writes.

More than one in three patients with bloodstream infections receives incorrect antibiotic therapy in community hospitals, according to research conducted by Deverick J. Anderson, MD, an RWJF Physician Faculty Scholars alumnus. Anderson says “it’s a challenge to identify bloodstream infections and treat them quickly and appropriately, but this study shows that there is room for improvement,” reports MedPage Today. Infection Control Today, FierceHealthcare, and HealthDay News also covered Anderson’s findings.

People’s health and wellness can be linked to their zip codes as much as to their genetic codes, according to an essay in Social Science and Medicine co-authored by Helena Hansen, MD, PhD. As a result, Hansen argues, physicians should be trained to understand and identify the social factors that can make their patients sick, HealthLeaders Media reports. Hansen is an RWJF Health & Society Scholars alumna.

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Mar 21 2014
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The Lucky One

Vanessa Grubbs, MD, MPH, is an assistant professor at the University of California, San Francisco, School of Medicine, and a scholar with the RWJF Harold Amos Medical Faculty Development Program. She is writing a book about what she calls the “sometimes irrational use of dialysis in America,” which will include a version of this narrative essay.

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It is a Monday afternoon like any other and time to make my weekly rounds at the San Francisco General Hospital outpatient dialysis center. I push my cart of medical charts down the long aisle of our L-shaped dialysis unit and see Mr. Rojas, my dialysis patient for over a year now. He is in his mid-40s and slender, sitting in the burgundy-colored vinyl recliner. His blue-jeaned legs and sneakered feet are propped up on the extended leg rest. The top of his head shines through thinning salt and pepper hair. White earbud headphones peek through gray sideburns. He is looking intently at his Kindle, rarely glancing up at the activity around him.

I roll my cart up to his recliner, catching his eye. His right hand removes the earbuds as the left pauses his movie. He looks up at me, smiling. “Hola, Doctora. How are you?” he says with emphasis on the “are.”

“I am good. How are you doing?” I smile back at him as I grab his chart from the rack. I write down his blood pressure and pulse—both normal—and the excellent blood flow displayed on the dialysis machine. My eyes shift to his fistula, the surgically thickened vein robustly coursing halfway up his left forearm like a slithering garden snake. It is beautiful to me. Through it, Mr. Rojas is connected to the dialysis machine.

“I am good, Doctora. No problems. I feel healthy. Strong.” His brown eyes glint.

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Mar 20 2014
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Oncologist Shortage Could Put Cancer Care in Critical Condition by 2025

Nearly 450,000 new cancer patients are likely to have difficulty accessing oncology care in just over a decade, according to a report, “The State of Cancer Care in America: 2014,” released this month by the American Society of Clinical Oncology (ASCO).

The report is described by ASCO as the first-ever comprehensive assessment of challenges facing the U.S. cancer care system. It projects that new cancer cases could increase by 42 percent by 2025, but the number of oncologists will likely grow by only 28 percent, creating a deficit of nearly 1,500 physicians.

“We’re facing a collection of challenges, each one of which could keep cancer treatment advances out of reach for some individuals,” ASCO President Clifford A. Hudis, MD, FACP, said in a news release. “Collectively, they are a serious threat to the nation’s cancer care system, which already is straining to keep up with the needs of an aging population.”

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Feb 27 2014
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Human Capital News Roundup: Risk of increased ADHD labeling, unnecessary emergency department scans, food labeling, 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:

In an op-ed for the New York Times, RWJF Investigator Award in Health Policy Research recipients Stephen Hinshaw, PhD, and Richard Scheffler, PhD, discuss how a major expansion of early childhood education could have an unintended consequence: a dramatic increase in the number of pre-school age children, particularly from low-income families, who are wrongly diagnosed with attention deficit hyperactivity disorder (ADHD). The writers recently authored a book, The ADHD Explosion: Myths, Medication, Money, and Today's Push for Performance. The Wall Street Journal also covered the book release, among other outlets.

A study by RWJF Clinical Scholars alumnus, Jeremiah Schurr, MD, MHS, identifies five tests commonly performed in emergency departments that are unnecessary for some patients. In an article in Long Island Newsday, Schurr explains that curtailing their use for patients who do not exhibit specific symptoms could reduce health care costs. Schurr’s research shows that the information gleaned from the tests—CT scans and MRIs for certain patients and blood tests for others—can be derived just as effectively through less expensive procedures.

MedPage Today interviews Jason Karlawish, MD, an RWJF Investigator Award recipient, on the treatment of Alzheimer’s disease. Karlawish emphasizes the importance of accurate diagnosis, proper medication, and family involvement and education. Read more about Karlawish’s work on Alzheimer’s disease on the Human Capital Blog.

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Feb 3 2014
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Evidence to Improve the Quality of Care

Richard Kronick, PhD, was named director of the Agency for Healthcare Research and Quality (AHRQ) in August 2013. Kronick is a health policy researcher with a background in academia as well as in federal and state government. He received a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research in 1998.

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Human Capital Blog: Congratulations on your new position at AHRQ. This is an exciting time for health care. What do you see as AHRQ’s place in the U.S. health care universe?

Richard Kronick: Thank you! You’re right—this is an exciting time.

We have an almost $3 trillion health care system. We pour tremendous resources into the delivery of medical care—but comparatively little effort into trying to understand how health care can be delivered more safely, with higher quality, and be more accessible and affordable. AHRQ’s role is to produce evidence that can be used to make health care safer, higher quality, more accessible, equitable, and affordable, and to work with the U.S. Department of Health and Human Services (HHS) and other partners to make sure that the evidence is understood and used.

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Jan 10 2014
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The Primary Care Technician: A New Class of Health Care Providers

Arthur Kellermann, MD, MPH, FACEP, an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars and Health Policy Fellows programs, is dean of the F. Edward Hébert School of Medicine at the Uniformed Services University of the Health Sciences. He wrote an article in the November issue of Health Affairs calling for a new class of health care provider—the primary care technician—to improve accessibility to and affordability of primary care.

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Human Capital Blog: What is the thrust of your idea?

Arthur Kellermann: We’ve had a decades-long shortage of primary care physicians in this country and, up until now, it has defied solution. One definition of insanity is to continue to do the same thing over and over again and expect a different result. My article suggests a rethinking, and literally a reengineering, of how we deliver primary care in this country. It makes the case for a new class of providers—primary care technicians (PCTs)—who would work remotely, under the online supervision of primary care physicians or nurse practitioners (NPs), to manage stable chronic disease patients, treat minor illnesses and injuries, and provide basic preventive services. These PCTs would make primary care more accessible, more convenient, and more affordable to Americans, wherever they live.

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Dec 26 2013
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Reshaping Today’s Bedside Care Team to Meet Tomorrow’s Challenges

The traditional bedside care team must evolve over the next five years in response to significant changes facing the U.S. health care system, according to the American Hospital Association (AHA), which recently convened a roundtable devoted to the issue.

“Reconfiguring the Bedside Care Team of the Future,” a white paper summarizing the discussion, points to several factors driving changes, including 25 million new patients entering the system as a result of the Affordable Care Act, an aging and increasingly diverse population, and more patients experiencing multiple conditions and acute episodes.

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Dec 19 2013
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Human Capital News Roundup: Body mass index and kidney function, impact of health spending on life expectancy, 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:

The Food & Drug Administration issued a proposed rule on December 16 that would require makers of antimicrobial and antibacterial soaps and body washes to demonstrate the safety and effectiveness of their products, the Examiner reports. Scientists have long been concerned that the common anti-bacterial ingredient triclosan may harm health. Allison Aiello, PhD, MS, concluded in a 2007 report that soaps containing triclosan “were no more effective than plain soap at preventing infectious illness symptoms and reducing bacterial levels on the hands.” Aiello is an RWJF Health & Society Scholars alumna. Read her post on the RWJF Human Capital Blog.

In the first study to estimate health spending efficiency by gender across industrialized nations, RWJF Health & Society Scholars program alumnus Arijit Nandi, PhD, and others discovered significant disparities within countries. The research team found that increased spending on health brought stronger gains in life expectancy for men than for women in nearly every nation, Newswise reports. The United States ranked 25th among the 27 countries studied when it came to reducing women’s deaths.

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Dec 18 2013
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RWJF Clinical Scholars Podcast: NY Health Commissioner Discusses Health Reform

In his first two years in office, New York State Health Commissioner Nirav Shah, MD, MPH, has been deeply engaged in the state’s ambitious Medicaid redesign process. Shah oversees the $50 billion state public health agency and has been praised for his health system reform efforts. Moving forward, he is focusing on issues such as securing federal funding for “supportive housing” to offer chronically ill, low-income individuals subsidized living quarters in building complexes that also contain in-house medical and social services.

Shah, an RWJF Clinical Scholar alumnus, discusses this and more in the latest Robert Wood Johnson Foundation (RWJF) Clinical Scholars Health Policy Podcast, a monthly series co-produced with Penn’s Leonard Davis Institute of Health Economics and hosted by RWJF Clinical Scholar Chileshe Nkonde-Price, MD.

The video is republished with permission from the Leonard Davis Institute.

Dec 9 2013
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Do Mergers with State Medicaid Programs Result in Cuts to State Public Health Department Funding?

Paula Lantz, PhD, is professor and chair of the Department of Health Policy in the School of Public Health and Health Services at the George Washington University (GW).  Before joining the GW faculty, she was professor and chair of health management and policy at the University of Michigan School of Public Health, where she served as the director of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research Program. In addition, Lantz is an alumna of the Scholars in Health Policy Research Program. She recently co-authored a study with Jeffrey Alexander, PhD, professor emeritus at the University of Michigan, where he was the Richard Jelinek Professor of Health Management and Policy in the School of Public Health.*

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It is not uncommon for state governments to periodically reorganize, and this often involves creating new agencies/departments or consolidating ones that already exist. Some in the health field have voiced concerns about such reorganizations when they involve the consolidation of a state’s public health department and the Medicaid agency. The main fear has been that when public health functions are combined with the invariably larger and growing Medicaid program, public health loses out in terms of economic resources and a sustained focus on disease prevention and health promotion. By virtue of the sheer size and focus on medical care, there would be a “giant sucking sound” of economic resources and priority attention going to the Medicaid program and away from the smaller and often less visible activities of public health.

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