Category Archives: Research
Charlene A. Wong, MD, is a pediatrician and a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Pennsylvania and the Children’s Hospital of Philadelphia.
“This plan is $20 to see a primary doctor, and this one is 10 percent coinsurance after deductible—and I just don’t understand that. What is the deductible to see my primary doctor?” asked a 29-year-old uninsured Philadelphian as she shopped for health insurance on HealthCare.gov in February.
As she tried to make sense of the plans being offered to her, she realized—as most people who have chosen a health insurance plan for themselves or their families know—that health insurance is complicated. This young woman found the process particularly challenging and overwhelming as she was choosing her own health insurance for the first time. Though she wished “a good plan could be recommended for me, based on my needs,” she did ultimately select a new health insurance plan on HealthCare.gov.
She was one of 33 young adults, ranging from 19 to 30, who participated in our study at the University of Pennsylvania from January to March 2014. The study explored the young adult user experience with the federal health insurance exchange website. We asked these so called “young invincibles” to focus not on the technical failures of the website, which were being covered and criticized extensively by the media, but rather on how the website could be improved to better support them in choosing a health insurance plan that was right for them.
RWJF Scholars in the News: Antibiotic overuse, sexual assault nurse examiners, diaper banks, 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 Investigator Award in Health Policy Research recipient Anthony So, MD, MPA, co-authors a piece in the News & Observer (Raleigh, North Carolina) about the need to reduce the overuse of antibiotics, in both humans and animals. Overuse accelerates the development of antibiotic-resistant bacteria. The Centers for Disease Control and Prevention estimates that half of human antibiotic use and much animal antibiotic use is unnecessary, the article says. So calls for public policies that create incentives for farmers to decrease use of antibiotics and that limit antibiotic use in animals to disease treatment, rather than growth-promotion or as a substitute for hygiene and infection-control.
In Chicago, most children with asthma or food allergies do not have a health management form on file at school, leaving their schools without information they might need in emergencies, according to a study by RWJF Physician Faculty Scholars alumna Ruchi Gupta, MD, MPH that was covered by Reuters Health. Researchers analyzed 2012-13 school year data on more than 400,000 Chicago schoolchildren, including 18,287 with asthma and 4,250 with a food allergy. Only a quarter of the asthmatic students and half of those with a food allergy had a health management plan on file. The study was also covered by The Chicago Tribune, Fox News, The Baltimore Sun, and Red Orbit, among other outlets.
RWJF Nurse Faculty Scholars alumna Angela Frederick Amar, PhD, RN, FAAN, publishes an op-ed on Talking Points Memo about the report from the White House Task Force to Protect Students from Sexual Assault, Not Alone. Amar notes that effective response to campus sexual assault should include medical care for survivors, and that Sexual Assault Nurse Examiners (SANEs) are trained to tend to the medical and emotional needs of survivors and collect forensic evidence. In other institutions with high rates of sexual violence, such as the military, SANEs are considered an essential part of treatment for victims of sexual violence, Amar writes.
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Roderic I. Pettigrew, PhD, MD, is director of the National Institute of Biomedical Imaging and Bioengineering (NIBIB) at the National Institutes of Health (NIH). He was a member of the inaugural class of the Robert Wood Johnson Foundation (RWJF) Harold Amos Medical Faculty Development Program.
On a fateful day in 2006, 20 year-old Rob Summers, a standout collegiate baseball pitcher at Portland State with aspirations to play in the big leagues, was a victim of a hit-and-run accident while standing in his own driveway. His injuries left him paralyzed below the chest, and his doctors informed him he would never move his legs again.
I first met Rob at NIBIB’s ten-year anniversary celebration. It had been just four years since his accident, and he had already broken new ground in spinal cord injury recovery. During the event, Rob shared his incredible story about the experimental procedure he had recently undergone as part of an NIBIB-funded research trial. In the trial, Rob became the first human to have an electrical stimulator implanted on his spinal cord with the goal of restoring some function to previously paralyzed muscles.
Rob spoke about how, in just weeks after implantation, the stimulation enabled him to hold himself in a standing position for the first time since his injury. In addition, he began to sense when he was uncomfortable in his wheelchair. Rob went on to describe how, seven months into the trial, he discovered he was able to move his toes, ankles, and legs on command, a feat that shocked the researchers, as they never expected Rob to regain voluntary movement.
Alexander Tsai, MD, PhD, is an assistant professor of psychiatry at Harvard Medical School, a staff psychiatrist in the Massachusetts General Chester M. Pierce, MD Division of Global Psychiatry, and an honorary lecturer at the Mbarara University of Science and Technology in Uganda. He is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2010-2012), and a member of the core faculty in the Health & Society Scholars program at Harvard University.
When Robin Williams ended his life last month, his suicide sparked a raft of online and print commentary about the dangers of depression and the need to inject more resources into our mental health care system. I strongly agree with these sentiments. After all, as a psychiatrist at the Massachusetts General Hospital, I regularly speak with patients who have been diagnosed with depression or who are actively thinking about ending their lives.
But what if suicide prevention isn’t just about better screening, diagnosis and treatment of depression? What if there were a better way to go about preventing suicides?
It is undeniable that people with mental illnesses such as depression and bipolar disorder are at greater risk for suicidal thinking or suicide attempts. But not everyone with depression commits suicide, and not everyone who has committed suicide suffered from depression. In fact, even though depression is a strong predictor of suicidal thinking, it does not necessarily predict suicide attempts among those who have been thinking about suicide. Instead, among people who are actively thinking about suicide, the mental illnesses that most strongly predict suicide attempts are those characterized by anxiety, agitation and poor impulse control.
This is part of the September 2014 issue of Sharing Nursing’s Knowledge.
Lower Hospitalization Rates Linked to Broader NP Scope of Practice
New research correlating state-by-state hospitalization rates with state policies on nurse practitioner (NP) scope of practice offers a revealing conclusion: Medicare and Medicaid patients are less likely to require hospitalization in states that allow NPs a broader scope of practice.
A team of researchers from the University of Missouri Sinclair School of Nursing examined hospitalization data from a range of sources that sorted data by state, and then compared it with American Association of Nurse Practitioners data on state laws and regulations governing NP scope of practice. They found “a significant relationship between full practice of NPs and decreased hospitalization rates of Medicare and Medicaid beneficiaries in the United States and improved health outcomes of states.”
The researchers caution that the data do not prove a causal relationship between scope of practice and hospitalization rates, but write, “Our findings support the increasing call of facilitating Advanced Practice Registered Nurses [APRNs] to fulfill their full scope of practice in providing access and care to patients without direct or indirect supervision from physicians. The outcomes support the Institute of Medicine recommendation that APRNs practice to their full scope of practice including functioning as primary care providers.”
The study was published online by Nursing Outlook on August 4, 2014.
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.
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.)
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.
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?