Category Archives: Health Care Quality

May 1 2014
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RWJF Scholars in the News: Worldwide diabetes epidemic, covering birth control services, 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:

“[D]iabetes has become a full-blown epidemic in India, China, and throughout many emerging economies,” writes Kasia Lipska, MD, an RWJF Clinical Scholars program alumna, in a New York Times opinion piece. Lipska details her experience treating patients in India, explaining that the country’s recent economic transition has created a “perfect storm of commerce, lifestyle, and genetics” that has led to a rapid growth in diabetes cases. She highlights how costly the disease is to manage, as well as the shortcomings of India’s health care infrastructure, warning that, without reforms, India will have to provide chronic care for more than 100 million diabetics in a few decades.

RWJF Scholars in Health Policy Research alumnus Michael Greenstone, PhD, co-authored an op-ed piece in the Los Angeles Times that praises a recent appellate court decision to uphold the U.S. Environmental Protection Agency’s mercury standards. The court’s majority ruled that the EPA had factored in costs when deciding how stringent the regulation should be, and that the monetized environmental benefits of the rule outweighed the costs, Greenstone writes.

A majority of Americans—69 percent—support the Affordable Care Act requirement that health insurance plans pay for birth control, according to a survey by Michelle Moniz, MD, a Clinical Scholar. The survey included more than 2,000 respondents, NBC News reports. The U.S. Supreme Court is expected to rule by June in a case in which two for-profit corporations assert that paying for insurance coverage of certain forms of birth control conflicts with the companies’ religious beliefs. Moniz’s survey was also covered by MSNBC and Newsweek, among other outlets.

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Apr 30 2014
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How Can Health Systems Effectively Serve Minority Communities? Use Electronic Health Records to Discover How to Improve Outcomes.

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, Bonnie L. Westra, PhD, RN, FAAN, an associate professor at the University of Minnesota School of Nursing, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Westra is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program. 

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Electronic health records (EHRs) are rapidly proliferating and contain data about health or the lack thereof for minority communities. Evidence-based practice (EBP) guidelines can be embedded in EHRs to support the use of the latest scientific evidence to guide clinical decisions.  However, scientific evidence may not reflect differences in minority communities served.

As a first step to compare the effectiveness of EBP guidelines for minority populations, practicing nurses and nurse leaders need to advocate for implementation of EBP nursing guidelines in EHRs. Additionally, EBP guidelines must be coded with national nursing data standards to compare effectiveness within and across minority communities. Nurse researchers need to conduct comparative effectiveness research to learn how to optimize EBP guidelines for minority communities through the reuse of EHR data and to derive patient-driven evidence.

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Apr 28 2014
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Seven Days After Discharge: Studies Show Unintended Costs and Complications of Routine Surgery in the United States

New research shows that where you receive surgical care does matter, and the quality measures driving patient care may not be telling the whole story.

Supported by the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program, 12 studies were selected for inclusion in the May issue of Surgery. These studies provide important insights into the risks and benefits of different procedures, fresh insights into surgical outcomes, and reasons hospitals may adopt treatment therapies despite a lack of evidence about their effectiveness.

Unintended consequences of routine surgery are greater than current measures report.

Researchers studied nearly 4 million patients treated at 1,295 ambulatory surgery centers in California, Florida, and Nebraska. While 95 percent of these patients were discharged and sent home, researchers discovered that nearly 32 out of every 1,000 patients needed hospital care within a week after leaving the ambulatory center. “Hospital transfer immediately after ambulatory surgery care is a rare event, but one week later is a far different story,” said lead author Justin P. Fox, MD, who conducted the research as an RWJF Clinical Scholar at Yale University. “The rate of ambulatory patients who need acute care after they have gone home is nearly 30 times higher and varies across centers, so it may be a more meaningful measure of assessing quality.”

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Apr 14 2014
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Improvements to Dermatology Curriculum and Residency Training Could Improve Patient Safety, Study Finds

Modifications to curricula, systems, and teacher development may be needed to bring down medical error rates among dermatology residents, according to a study published online by JAMA Dermatology.

The survey of 142 dermatology residents from 44 residency programs in the United States and Canada draws attention to several areas of concern. According to the survey:

  • Just over 45 percent of the residents failed to report needle-stick injuries incurred during procedures;
  • Nearly 83 percent reported cutting and pasting a previous author’s patient history information into a medical record without confirming its validity;
  • Nearly 97 percent reported right-left body part mislabeling during examination or biopsy; and
  • More than 29 percent reported not incorporating clinical photographs of lesions sampled for biopsy in the medical records at their institutions. 

Also, nearly three in five residents reported working with at least one attending physician who intimidates them, reducing the likelihood of reporting safety issues. More than three-quarters of residents (78 percent) have witnessed attending physicians ignoring required safety steps.

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Apr 9 2014
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Heavy Workloads for Hospitalists Correlate to Longer Patient Stays

When workloads increase for hospitalists—the physicians who care exclusively for hospitalized patients—length of stay (LOS) and costs increase, too, according to a study published by JAMA Internal Medicine.

Researchers at Christiana Care Health System, a large academic community hospital system in Delaware, analyzed 20,241 inpatient admissions for 13,916 patients over a three-year period. Hospitalists had an average of 15.5 patient encounters per day, and LOS increased from 5.5 to 7.5 days as workloads increased at hospitals with occupancies under 75 percent.

Each additional patient seen by hospitalists increased costs by $262, although increasing workload did not affect outcomes such as mortality, 30-day readmission rates, and patient satisfaction.

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Mar 27 2014
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One in Five Health Care Facilities Falling Short on Hand Sanitizer

In a time of progress against hospital-acquired infections, a new nurse-led study offers a reminder of the work that remains to be done. The study finds that approximately one in five U.S. health care facilities fails to place alcohol-based hand sanitizer at every point of care, missing an opportunity to prevent the spread of infectious diseases.

A research team jointly led by Laurie Conway, RN, MS, CIC, a PhD student at the Columbia University School of Nursing, and Benedetta Allegranzi, MD, of the World Health Organization (WHO), surveyed compliance with WHO hand-hygiene guidelines at 168 facilities in 42 states and Puerto Rico. Just over 77 percent reported that alcohol-based sanitizer was continuously available at every point of care. They also found that only about half of the hospitals, ambulatory care, and long-term care facilities had allocated funds for hand-hygiene training.

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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 25 2014
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Sharing Nursing’s Knowledge: The March 2014 Issue

Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of the Foundation’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other essential nursing issues. Following are some of the stories in the March issue.

Nurses Need Residency Programs Too, Experts Say
Health care experts, including the Institute of Medicine in its report on the future of nursing, tout nurse residency programs as a solution to high turnover among new graduate nurses. Now, more hospitals are finding that these programs reduce turnover, improve quality, and save money. Success stories include Seton Healthcare Family in Austin, Texas, which launched a residency program to help recent nursing school graduates transition into clinical practice. Now, three out of four new graduate nurses make it to the two-year point, and five or six new nurse graduates apply for each vacant position.

Iowa Nurses Build Affordable, Online Nurse Residency Program
Some smaller health care facilities, especially in rural areas, cannot afford to launch nurse residency programs to help new nurses transition into clinical practice. A nursing task force in Iowa has developed an innovative solution: an online nurse residency program that all health care facilities in the state—and potentially across the country—can use for a modest fee. The task force was organized by the Iowa Action Coalition and supported by an RWJF State Implementation Program grant.

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Mar 13 2014
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Residents’ Work Hours Have Gotten Better, but Patient Safety Hasn’t

Improved patient safety and educational environments at academic medical centers were the goals of work-hour reforms adopted for first-year residents in 2011. A study published online by the Journal of Hospital Medicine shows that progress on the patient-safety front has been slow going.

Researchers examined data on patients discharged from the Johns Hopkins Hospital in Baltimore from 2008 to 2012 and analyzed safety outcomes for those seen by resident and non-resident hospitalists. The analysis revealed no significant differences—before and after the 2011 reforms that reduced the maximum length of residents’ on-duty shifts from 30 hours to 16—in areas including length of stay, 30-day readmission, inpatient mortality, ICU admission, and hospital-acquired-conditions.

The study concludes that, as noted by the Institute of Medicine, improving patient safety requires a significant focus on keeping residents’ caseloads manageable, ensuring adequate supervision of first-year residents, training residents on safe handoffs in care, and conducting ongoing evaluations of patient safety and any unintended consequences of work-hour reforms.

Feb 28 2014
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The Role of Community Health Workers in Promoting Health: 'Talk to Me About Anything'

Shreya Kangovi, MD, is an assistant professor of medicine at the University of Pennsylvania Perelman School of Medicine, executive director of the Penn Center for Community Health Workers, and a Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholars program alumna.

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“What do you think will help you stay healthy after discharge?”

Mr. Manzi, a soft-spoken man in his early 60s, paused to consider. No one had asked him this question before. He had come to the hospital because of blurry vision and thirst too severe to ignore. The doctors told him that he had severe diabetes and hypertension, and that he needed to adhere to a long list of new medications, tests, and appointments.  

“Not just medical stuff,” Anthony, the community health worker, continued. “Talk to me about anything. Dealing with shut-off notices, housing issues, whatever you think you need to stay healthy.”

Mr. Manzi opened up. He explained that he was originally from Ghana but had been living and working odd jobs in Philadelphia for 20 years as an undocumented immigrant. He had not had a job in six months and twice, his home had gone into foreclosure. Mr. Manzi was uninsured and had not been able to get outpatient care before coming to the hospital.

“I’m willing to do whatever it takes to stay healthy,” he concluded. “But I need to make sure I can pay for all of these medications and a doctor. And I need some help with the foreclosure—I can’t take care of myself if I lose my home.” 

Mr. Manzi’s answers became the basis for his tailored intervention. IMPaCT (Individualized Management for Patient-Centered Targets) is an innovative model of care in which community health workers (CHWs) provide tailored support to help patients achieve individualized goals. Anthony, an IMPaCT CHW, shares socioeconomic background with patients like Mr. Manzi. He and other IMPaCT CHWs are selected for traits such as empathy, active listening, and reliability.  

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