Category Archives: Health care delivery system

Oct 2 2014
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In the Media: New Annual Event Honors Federal Nurses

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

Every May, the news media zooms in on nurses during National Nurses Week, held the second week of the month in honor of Florence Nightingale’s birthday.

Now, nurses are getting another turn in the media spotlight—but this time in September.

Or at least that’s the goal of Federal Nurses Week, a new annual event held in recognition of the nation’s 100,000 federally employed nurses. The event, held this year between Sept. 22 and Sept. 28, is sponsored by the American Federation of Government Employees (AFGE). J. David Cox, RN, national president of AFGE, is a nurse and also serves on the national executive board of the AFL-CIO.

During the week, supporters were encouraged to host an event to recognize a federal nurse or nurses and spread the word about the importance of federal nurses through posts to social media sites or letters to the editor of newspapers or other publications. AFGE is also urging Congress to pass a resolution recognizing the federal nurse workforce.

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Oct 1 2014
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New Journal Covers Emerging Field of Health Economics

Deborah Haas-Wilson, PhD, is a visiting professor of public policy at the John F. Kennedy School of Government at Harvard University and a member of the editorial board of the forthcoming American Journal of Health Economics. In 1994, she received a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research to study antitrust policy and the transformation of health care markets.

Deborah Haas-Wilson

Human Capital Blog: Congratulations on your appointment to the editorial board of the American Journal of Health Economics. Can you tell us about the journal’s mission?

Deborah Haas-Wilson: I am very pleased to be serving on the editorial board of the American Journal of Health Economics (AJHE), along with many distinguished health economists, including Frank Sloan, PhD, who is the editor-in-chief.

A little about the AJHE: The plan is to publish quarterly with the first issue scheduled for the winter of 2015. The mission of the AJHE is to provide a forum for theoretical and empirical analyses of health care systems and health behaviors.

HCB: What topics will the AJHE cover?          

Haas-Wilson: Topics of particular interest include the impact of the Accountable Care Act, pharmaceutical regulation, the supply of medical devices, the increasing obesity rate, the influence of an aging and more diverse population on health care systems, and competition and competition policy in the markets for hospital services, physician services, pharmaceuticals and health care financing.

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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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May 9 2014
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Diversity Forges Possibilities and Paths to Leadership

Deidre Walton, JD, MSN, RN-PHN, is the 11th president of the National Black Nurses Association. She is a graduate of the U.S. Army Command and General Staff College with more than 30 years managed care experience in nursing practice, education, and administration. Walton is a retired commissioned officer for the U.S. Army, holding the rank of Lieutenant Colonel, an ordained elder in the African Methodist Episcopal Church, and the founder of the Imani Community.

Deidre Walton

I fully embrace the American Nurses Association’s 2014 theme for National Nurses Week: Nurses Leading the Way. This theme flows from the clarion call from the Institute of Medicine that nurses should be full partners with physicians and other health professionals in redesigning health care in the United States.

Strong leadership is critical if the vision of a transformed health care system is to be realized. Because the demographics of the United States are increasingly more diverse, it is also imperative that the field considers not only leaders from diverse backgrounds but also how to lead diverse constituents as partners in our mission.

National Nurses Week HC Blog Logo

Strong leadership is also tied to the achievement of a transformed health care system. But the transformation can only come by the field embracing diversity. That is the essential first step. What follows is greater success in combatting health disparities, and supporting development and growth of new leaders.

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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 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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