Category Archives: Research

Aug 21 2014
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RWJF Scholars in the News: Costs for blood tests, dentists testing for hypertension and HIV, fudging medical history, 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:

A new study uncovers vast variation in pricing for common blood tests by California hospitals, reports the Washington Post. Renee Hsia, MD, MSc, an RWJF Physician Faculty Scholars program alumna, says she was “very surprised” to see such variation among more than 160 hospitals studied. Hsia’s research found that during 2011, some hospitals charged as little as $10 and others as much as $10,169 for a basic cholesterol test. The study found no clear explanation for the price differences for what Hsia categorized as ten “simple and standard” tests in which blood samples are inserted into a machine that performs the analysis. Time magazine, the Boston Globe and Kaiser Health News also cover Hsia’s research.

Dentists could offer a variety of medical tests in the future, including diagnostic tests for health problems such as diabetes, hypertension and HIV, Harold Pollack, PhD, tells Ozy.com. The mouth, Pollack says, “is the gateway to the human body.” He is an RWJF Investigator Award in Health Policy Research recipient.  

“There’s an overabundance of evidence that shows hospitals that have better staffing have better outcomes when we look at things like mortality,” Matthew McHugh, PhD, JD, MPH, FAAN, tells the Santa Fe New Mexican. In an article about nurse staffing ratios, McHugh, an RWJF Nurse Faculty Scholars program alumnus, says hospital readmissions, failure to rescue patients in distress, and patient satisfaction also correlate with increased staffing. “If you compare any two hospitals—one that’s good at staffing and one that has not as good staffing, but are similar in other factors—the hospital with better staffing is much less likely to be penalized” for bad patient outcomes by Medicare and Medicaid, McHugh notes. 

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Aug 20 2014
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The Importance of Emphasizing Healthy Habits for All Children

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.

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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.

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Aug 19 2014
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The Outlook for Less Educated Health Care Workers

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.)

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Aug 18 2014
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Combating Suicide in the Population Most At Risk: Older, White Men

Briana Mezuk, PhD, is an assistant professor at Virginia Commonwealth University Medical Center and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2007-2009). She recently earned the Best Early Investigator Award for the top research study from the American Association for Geriatric Psychiatry. 

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Human Capital Blog: Congratulations on your award! What led to your interest in suicide risk in long-term care facilities?

Briana Mezuk: Older adults, particularly non-Hispanic white men, have the highest risk of suicide. This risk increases exponentially after age 75, and recent data suggest that men in the Baby Boomer generation have a higher suicide risk than previous cohorts. There are many risk factors for this group, including social isolation, feelings of disconnection to society, and lack of social supports and close confidantes. Older men are often unwilling to talk about mental health problems with their physicians; they think they are supposed to ‘grin and bear it.’

HCB: What was the goal of your study?

Mezuk: We were trying to understand the epidemiology of suicide in long-term care facilities, and in nursing homes and assisted-living facilities in particular. Suicide risk in these settings may be higher, or lower, than in the general community. For example, suicide risk may be lower in supervised settings because residents would have less access to a means to self-harm. But suicide risk might be higher because residents often have health problems and, frequently, depressive symptoms that are risk factors for suicide. We used data from the Virginia Violent Death Reporting System to identify suicides that occurred among residents of, and among individuals anticipating moving into, these types of facilities.

HCB: What did you find?

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Aug 12 2014
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With IOM Report and More, Medical Education Is a Hot Topic

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.

Read the report, Graduate Medical Education That Meets the Nation’s Health Needs.

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Aug 12 2014
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Recent Research About Nursing, August 2014

This is part of the August 2014 issue of Sharing Nursing’s Knowledge.

Violence Against Emergency Nurses

For many nurses working in emergency departments, physical violence and verbal abuse is a common occurrence. One survey found that more than half of emergency nurses had experienced such incidents within the previous week. Research suggests a number of contributing factors, including long wait times and patients who have psychiatric problems or are under the influence of drugs or alcohol. According to a study published in the July 2014 issue of The Journal of Emergency Nursing, while data on the frequency of such incidents is readily available, less study has been devoted to nurses’ personal experiences with assaults, including the circumstances and consequences of the incidents.

With that in mind, a research team led by Lisa A. Wolf, PhD, RN, CEN, conducted a qualitative analysis of 46 nurses’ personal accounts of assaults. Several common themes stood out:

  • A number of nurses talked about what the researchers described as a “culture of acceptance” of an “unsafe workplace.” For example, hospitals discouraged nurses from pressing charges or prosecutors declined to pursue cases. Some nurses said safety measures such as security or panic buttons were not maintained. Others noted that despite signs being posted that warned that anyone who committed violence, made threats, or acted out in other ways would be ejected from the hospital, such behavior was tolerated.
  • Many nurses described the impact of assaults in personal terms, saying they had “lingering psychological trauma that continues to impede their ability to work in the emergency setting.” Some reported chronic pain from injuries sustained during violent incidents, but said they continued to work full time. Others reported having to leave the profession because of the extent of injuries.
  •  Nurses described what researchers identified as missed cues that violence was about to occur, usually from patients from whom such behavior might have been anticipated. One example is a patient taken to the emergency room for ingesting multiple drugs and placed only in soft restraints. Another example involved individual nurses being left alone with patients brought in for psychiatric evaluation who had been verbally abusive to paramedics.

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Aug 11 2014
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Quotable Quotes About Nursing, August 2014

“Wearable tech will provide nurses with virtual personal assistants that remind them of appointments and meetings, log professional conversations, maintain notes and serve up data and information in a matter of seconds. If nurses need to perform a procedure, wearable computers will remind them of specific steps and risks via links to videos or instant messages shared by nursing colleagues. Although wearable tech comes with limitations related to power, privacy, interface and connectivity, nurses will benefit from this game-changing innovation.”
-- Susan Sportsman, RN, PhD, ANEF, FAAN, director, Academic Consulting Group, a service of Elsevier, Nurses Will Reap the Benefits of Wearable Tech, AdvanceWeb.com, August 5, 2014

“Nurses save lives and deal with complications every day. It can be a very intense and stressful work environment, which is why humor and a good mood are integral to the nursing profession. As a nurse, it’s an art to keep your smile, which helps ensure an excellent connection to patients. Designing affordable space that is conducive to the work is a smart way to bring positive mood—like laughter— into the workplace.”
--Rana Zadeh, MArch, PhD, assistant professor, Cornell University’s College of Human Ecology, On the Sunny Side, Nurses Dispense Better Care, Cornell Chronicle, July 31, 2014

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Aug 11 2014
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Physician Characteristics Can Affect Prostate Cancer Treatment

Management of low-risk prostate cancer varies widely among urologists and radiation oncologists, with characteristics of the physicians who provide treatment playing a significant role in decisions about care, according to a study published online by JAMA Internal Medicine.

Researchers found that urologists who did not graduate from medical school recently, and who care for patients with higher-risk prostate cancer, are more likely to pursue up-front treatment for patients with low-risk prostate cancer than other urologists, who choose to observe and monitor the disease. In many cases, low-risk prostate cancer does not cause symptoms or affect survival if left untreated.

The prevailing approach in the United States, the study says, for men with low-risk prostate cancer is treatment with prostatectomy or radiotherapy, which can cause complications such as urinary dysfunction, rectal bleeding, and impotence. 

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Jul 31 2014
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RWJF Scholars in the News: Cesarean sections, hospital readmissions, nurse practitioners, 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:

RWJF Clinical Scholar Chileshe Nkonde-Price, MD, shared her experiences with the medical system  during the last week of her recent pregnancy in a video featured on Nasdaq.com. Despite have given birth via Cesarean section earlier, Nkonde-Price wished to deliver vaginally with this pregnancy if she could do so safely. C-section has become the nation’s most common major surgery, the piece says. It examines some of the factors behind the sharp increase in the number of women delivering via C-section in the United States.

In a Health Affairs Blog, José Pagán, PhD, analyzes Medicare’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with excessive 30-day readmissions for conditions such as pneumonia and heart failure. While Pagán says that not all readmissions can be avoided, hospitals can improve their performance through effective discharge planning and care coordination. With more incentive programs on the horizon, Pagán suggests that health care organizations “seek and monitor collaborative partnerships and, more importantly, strategically invest in sustaining these partnerships” so they can survive and thrive. He is an RWJF Health & Society Scholars program alumnus and recipient of an RWJF Investigator Award in Health Policy Research.

A study led by RWJF Nurse Faculty Scholar Lusine Poghosyan, PhD, RN, looks at how Nurse Practitioners (NPs) rate their work environments. It finds that those working in Massachusetts fared better that those working in New York on every topic in the survey: support and resources, relations with physicians, relations with administration, visibility and comprehension of their role, and independence of practice. The survey also found that NPs working in community health clinics and physicians’ offices rated their work experiences better than NPs working in hospital-affiliated clinics. Poghosyan told Science Codex the findings suggest “the practice environment for NPs in New York can improve once the state’s NP Modernization Act,” which will expand NPs’ scope of practice, takes effect.

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Jul 28 2014
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What Protects Our Children from the Effects of Stress?

Lorraine McKelvey, PhD, is an associate professor of family and preventive medicine and pediatrics at the University of Arkansas for Medical Sciences. She is an alumna of the Robert Wood Johnson Foundation (RWJF) New Connections program (2008-2009) whose work focuses on vulnerable populations.

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For children, stress can come from sources inside and outside the family. It was recently documented that nearly two out of every three children in the United States have witnessed or been victims of violence in their homes, schools, or communities. That’s a staggering statistic when we consider the well-established link between children’s exposure to stress and their long-term mental and physical health outcomes.

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Indeed, we know that early exposure to adverse experiences can change the way that our brains develop and function. We also know that exposure to adversity increases the likelihood that children will develop psychosocial problems, like depression, aggression, and other antisocial behaviors. There is even evidence that exposure to stressors in childhood increases the likelihood of having heart disease and cancer in adulthood!

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