Category Archives: Quality of care

May 23 2014
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Emergency Care: A Story of Extraordinary Success and Lingering Challenge

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).

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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.  

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Apr 29 2014
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How Can Health Systems Effectively Serve Minority Communities? Shift the Cost-Access-Quality Axis.

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Italo M. Brown, MPH, a rising fourth-year medical student at Meharry Medical College, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Brown holds a BS from Morehouse College and an MPH from Boston University, School of Public Health. He is an alumnus of the Health Policy Scholars Program at the RWJF Center for Health Policy at Meharry Medical College.

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In our domestic health care system, we nurture the drive to improve patient outcomes, and apply evidence-based knowledge to solve contemporary health care challenges. Yet, studies have demonstrated that minorities are disproportionately affected by chronic conditions, and on average are less likely to receive ongoing care/management of their comorbidities. In addition, public health experts have asserted that social determinants of health (e.g., education level, family income, social capital) directly impact the minority community, and effectively convolute the pathway to care. 

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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 9 2014
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Guide to Nursing’s Role in Care Coordination

A new guide, Care Coordination: The Game Changer—How Nursing Is Revolutionizing Quality Care, explores how care coordination is positioned in the context of health reform. It was published by the American Nurses Association (ANA).

Care coordination has long been an integral part of nursing practice, the ANA said in a news release, with registered nurses leading the way in designing and delivering successful team-based care coordination programs that improve patient care and reduce costs. In the book, editor Gerri Lamb, PhD, RN, FAAN, and 23 leaders in care coordination explore topics including:

  • A historical perspective on nursing and quality care;
  • The role of care coordination in quality and safety;
  • Models and tools for improving quality and safety;
  • The role of nurse leaders in advancing care coordination;
  • The care coordinator’s role in reducing avoidable hospital stays;
  • Partnering with patients and families for better outcomes; and
  • Community-based care transitions.

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Dec 5 2013
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Human Capital News Roundup: Light-based defibrillators, the primary care workforce, how women change men, 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 strong primary care system is essential to improving health care in the United States, and front-line clinicians, staff, and leaders need to re-examine traditional roles and responsibilities, Maryjoan Ladden, PhD, RN, FAAN, told Medical Home News. Ladden is senior program officer for RWJF’s Human Capital portfolio. To investigate primary care workforce transformation, RWJF funded The Primary Care Team: Learning from Effective Ambulatory Practices (LEAP), Ladden said.  Her full interview is available at: http://medicalhomenews.com/ (subscription required.)

Women with post-traumatic stress disorder (PTSD) gain weight more rapidly and are more likely to be overweight or obese than other women, according to a study co-authored by RWJF Health & Society Scholars alumna Magdalena Cerda, DrPH. The study, featured in Health Canal, is the first to look at the relationship between PTSD and obesity over time.

New tools such as the Omnibus Risk Estimator, which the American Heart Association recommends doctors use instead of cholesterol tests to determine whether to prescribe statins, are developed with little regulatory authority over their design and use, Jason Karlawish, MD, writes in a New York Times op-ed. Karlawish, recipient of an RWJF Investigator Award in Health Policy Research, encourages better oversight and regulations to monitor such tools.

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Dec 4 2013
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The Importance of Nursing in Achieving the “Best Care at Lower Cost”

Richard C. Lindrooth, PhD, is an associate professor at the University of Colorado Anschutz Medical Campus. Olga Yakusheva, PhD, is an associate professor of economics at Marquette University. Both are grantees of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative.

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The Institute of Medicine (IOM) released the findings of its Committee on the Learning Health Care System in America in a report entitled “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America[i] in September, 2012. The report recognized that the complexity of clinical decision-making is rapidly increasing and that clinicians need to continuously update their skills in order to keep up with (1) rapidly expanding diagnostic and treatment options and (2) the increasingly complex and chronic clinical condition of patients.  Given the growing external demands placed on nurses, the IOM reports that a critical determinant of the success of an organization in dealing with these demands is how “a learning health care organization harnesses its internal wisdom—staff expertise, patient feedback, financial data, and other knowledge—to improve its operations.”

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Nurses in particular are in an excellent position to play a central role in creating a virtuous feedback loop such that it is feasible to continuously adjust and incrementally improve systems in response to rapidly changing external demands.  The report, supported by the results of a growing and increasingly robust body of academic research, stresses the important role of leadership and management in fostering and maintaining an environment within which continuous learning could take hold.

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Nov 26 2013
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Empathy and Appreciation for the Impact of the Social Determinants of Health

Gretchen Hammer, MPH, is executive director of the Colorado Coalition for the Medically Underserved. She works with local and state health care leaders and policy-makers to improve Colorado’s health care system.

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Healing is both an art and a science. On one hand, clinicians are intensely driven by the quantifiable, the measurable, and the evidence-based algorithms that lead to accurate diagnosis and treatment as well as allow us to develop new innovations in medicine. However, healing is also an art. Patients are not just a collection of systems that can be separated out and managed in isolation of the whole patient. Each patient and their family has a unique set of values, life experiences, and resources that influence their health and ability to heal. Recognizing the wholeness and uniqueness of each patient is where the art of healing begins.

Empathy is defined as “the ability to understand and share the feelings of another.” It takes presence of mind and time to be empathetic. For clinicians, finding the balance between the necessary detachment to allow for good clinical decision making and empathy can challenging.  This balance can be particularly difficult for students and new clinicians.

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Oct 15 2013
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A Journey Well Worth Taking

Linda Burnes Bolton, DrPH, RN, FAAN, is vice president for nursing, chief nursing officer, and director of nursing research at Cedars-Sinai Medical Center in Los Angeles. She was vice chair of the Institute of Medicine Commission on the Future of Nursing, and is a trustee of the Robert Wood Johnson Foundation. It has been three years since the Institute of Medicine issued Future of Nursing: Leading Change, Advancing Health.

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Developing the Institute of Medicine report, Future of Nursing: Leading Change, Advancing Health and working to implement its recommendations has been a magnificent journey. It hasn’t been about nursing, but rather about health and health care. We focus on nursing, because it is one of the keys to improving health and health care. But our success, and the reason people are joining us on this journey, is because the report and its recommendations mean better health for the public and a stronger health care system for the country.

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What began as a report has become a groundswell.  It is doing exactly what we hoped it would do, bringing people together to strengthen our health care system. Today a large, multidisciplinary, national movement is engaging nurses, consumers, and other health professionals in local and regional efforts to bring this report to life. There are great examples, for instance, of people from diverse fields coming together to remove practice barriers, physicians saying they believe medicine must be a “team sport,” consumers working to improve care in their communities—and much more.

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May 15 2013
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Will Dr. Robot Open New Doors for Nurses?

Olga Yakusheva, PhD, is an associate professor of economics at Marquette University. Richard C. Lindrooth, PhD, is an associate professor at the University of Colorado Anschutz Medical Campus. Both are grantees of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative.

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Technological innovation is rapidly transforming patient care. A new generation of innovations will potentially change the most fundamental aspect of the patient experience – patients’ interactions with physicians and nurses. The FDA recently approved the first autonomous telemedicine robot for use in acute care hospitals. Even more advanced technologies, some capable of processing up to tens of millions of pages of plain medical text per second, are being tested and may soon be used to diagnose conditions and recommend treatment, with limited input from clinicians.

"We suggest that nurses should embrace rather than fear these innovations."

This new technology has the potential to perform several tasks more efficiently than clinicians, albeit with some limitations. It can quickly and effectively sift through large amounts of information and, based on a complex set of guidelines, create a probability-weighted list of diagnoses and recommendations. The result will be purely evidence-based and free of human cognitive decision-making biases.  The technology can drastically speed diffusion of new research and guidelines through electronic dissemination, similar to automatic software updates, and make most novel treatment regimens instantly available to patients.

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May 11 2013
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Challenging Myths About Supplemental Nurses

Ying Xue, DNSc, RN, is an associate professor at the University of Rochester School of Nursing and an alumnus of the Robert Wood Johnson Foundation Nurse Faculty Scholars program. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.

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For the past two decades, supplemental nurses have been about 4 percent of the nursing workforce. These are nurses hired from staffing agencies to temporarily fill vacant nursing positions. The business of supplemental nurse staffing began in the 1970s as a symptom and a response to the nursing shortage. A central concern over the decades has been whether quality of patient care provided by supplemental nurses is the same as that provided by permanent nurses.

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On the one hand, some argue that the temporary nature of the position (which varies from per-diem to a few months) might have an adverse effect on patient outcomes due to supplemental nurses’ lack of familiarity with unit policies and health care providers, and disruption in continuity of care. Others contend that supplemental nurses might have a positive effect on patient outcomes because they alleviate deficiencies in nurse staffing. 

What’s the answer to this decades’ old question?  Surprisingly, relatively little research has been conducted to provide a definitive answer, but several recent studies not only are shedding light on the issue, but helping to reframe the question by challenging some old myths.

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