The What's Next Health series features leading thinkers and visionaries. Stanford social scientist & innovator BJ Fogg discusses his model f...
Jeff Kullgren, M.D., M.P.H., (’09) and colleagues found that high-deductible health plans cause patients to forego care—no matter their income level. Among higher-income families, 42 percent reported that they had delayed or foregone care in the previous six months due to cost. The study, “Health Care Use and Decision-Making among Lower-Income Families in High-Deductible Health Plans” was published in the Archives of Internal Medicine on November 22, 2010 and received significant media coverage in the New York Times, NPR, Philadelphia Inquirer, UPI, Reuters, and Los Angeles Times, among others. Kullgren was also interviewed for a feature in the “Patient Money” column of the New York Times, (January 7, 2011). He answered questions about how patients can talk with their doctors to make health care more affordable.
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In a study published online in Medical Care, John Hollingsworth, M.D., (’08) assistant professor of urology at the University of Michigan Medical School, and colleagues explored the reallocation of routine follow-up care currently provided by specialists to primary care providers. They found that specialists spend a significant amount of time each year on routine follow-up care for patients with common chronic conditions such as asthma, diabetes and low back pain. Redistributing half of that workload could require either thousands of new primary care doctors or an extra three weeks of work a year from the primary care physicians in the current workforce. The study received media coverage in American Medical News, Healthcare Finance News, and Health Leaders Media, among others. Hollingsworth and colleagues also published “Imaging Use Among Employed and Self-Employed Urologists,” in the December issue of The Journal of Urology. They found that self-employed urologists are twice as likely to use diagnostic imaging as urologists employed in a practice. The study received media coverage in HealthDay News and Doctor’s Lounge.
The Journal of Vascular Surgery published an article by Nicholas Osborne, M.D., M.S., (’08) and UCLA Clinical Scholars Associate Director, Clifford Ko, M.D., on the weaknesses in the reliability of hospital rankings data. In “The Impact of Adjusting for Reliability on Hospital Quality Rankings in Vascular Surgery,” Osborne, Clifford, and colleagues recommend that reliability adjustment, which reduces statistical noise, should be standard when comparing hospitals. The study received media coverage in MedPage Today.
In a study published in the December 2010 issue of Academic Emergency Medicine, Clinical Scholars alumnus, Mitesh Rao, M.D., M.H.S., (’07) and colleagues, including Yale program co-director and Clinical Scholars alumnus Cary P. Gross, M.D., (’97) found that most U.S. hospital emergency departments are short on on-call specialty physician care. Rao and colleagues found that 21 percent of emergency department deaths and permanent injury can be linked to shortages in specialty physician care. The study, “Shortage of On-Call Surgical Specialist Coverage: A National Survey of Emergency Department Directors,” received media coverage in Health Leaders Media, Modern Healthcare, Newsroom America and UPI, among others.
In “Examining the Evidence: A Systematic Review of the Inclusion and Analysis of Older Adults in Randomized Controlled Trials,” a study published in the Journal of General Internal Medicine, Department of Veterans Affairs (VA) scholar Donna Zulman, M.D., (’08), Jeremy Sussman M.D., M.S., (’08) and colleagues, including Michigan Program Director Rodney A. Hayward, M.D., found that clinical trial evidence to guide the treatment of older adults with multimorbidity is lacking and could be improved. They suggest eliminating upper age limits for study inclusion by reducing the use of eligibility criteria that disproportionately affect older individuals with multimorbidity. They also suggest encouraging adherence to recommended analytic methods for evaluating differential treatment effects by age.
In “Comparison Between U.S. Preventive Services Task Force Recommendations and Medicare Coverage,” a study published in the Annals of Family Medicine on January 17, 2011, Lenard Lesser, M.D., (’09) and colleagues found that Medicare covers only a fraction of the preventive care services recommended by the U.S. Preventive Services Task Force (USPSTF). Health care reform, however, should be able to mend the current disconnect between Medicare reimbursement policies and the recommendations of the USPSTF. In particular, the study points to the need to improve coordination between assessing the risk for certain illnesses and ensuring that patients receive the appropriate tests and follow-up clinical services. In addition, Lesser finds a persistent and disturbing lack of coverage for obesity and nutritional services, both of which are recommended by the task force and are important for maintaining good health. Lesser received media coverage in the Wall Street Journal, the Wall Street Journal Health Blog and Reuters, among other outlets.
Health & Society Scholars
Michael Bader, Ph.D., (’09) released a study determining that Google’s Street View feature can be used to conduct audits of neighborhood environments to better understand the influence of neighborhood factors on health. The study, “Using Google Street View to Audit Neighborhood Environments,” appears in the January 2011 issue of the American Journal of Preventive Medicine. Research indicates that neighborhood environment characteristics such as physical disorder influence health and health behavior. Google Street View may allow auditing of neighborhood environments more easily and at lower cost than in-person methods. Field audit and Street View data were collected for 143 items associated with seven neighborhood environment constructions: aesthetics, physical disorder, pedestrian safety, motorized traffic and parking, infrastructure for active travel, sidewalk amenities, and social and commercial activity. The data analyses found high levels of concordance for 54.3 percent of the items.
Sarah Burgard, Ph.D., M.S., M.A., (’03) will release a study in Social Forces that suggests women are more likely to have their sleep interrupted than men, mainly due to child-tending duties. The study finds that women are awakened more frequently and that their sleep interruptions last 15 minutes longer than men’s. For the study, researchers examined sleep diaries from 20,000 working parents from 2003 to 2007. In households where both parents worked and had a child younger than one year old, 32 percent of women reported routine sleep interruptions, compared to 11 percent of men. Burgard, a researcher at the University of Michigan Institute for Social Research (ISR), notes that this disproportionate burden may not only affect the health and well-being of women, but may also contribute to continuing gender inequality in earnings and career advancement.
Keely Cheslack-Postava, Ph.D., M.S.P.H., (’08) and Peter Bearman, Ph.D., Health & Society Scholars site director at Columbia University and a 2005 Investigator Awards in Health Policy Research grantee, published a study finding that closely spaced pregnancies are associated with an increased risk of autism. “Closely Spaced Pregnancies Are Associated With Increased Odds of Autism in California Sibling Births” was published online in Pediatrics on January 10, 2011. Cheslack-Postava and colleagues analyzed birth records for all first- and second-born full siblings, excluding twins and other multiple births, born in California between 1992 and 2002, as well as records of autism diagnoses from the state’s department of developmental services. The study included 662,730 second-born children in all. The researchers found that children conceived within one year of a sibling were three times more likely to be diagnosed with autism than those conceived three years or more after a sibling’s birth. Moreover, they concluded that the increased chances of autism persisted even when they controlled for factors already known to increase the risk of autism. The research received media coverage in USA Today, Wall Street Journal, Associated Press, and WebMD.
Wizdom Powell Hammond, Ph.D., M.P.H., M.S., (’05) released a study that suggests that Black men delay going to the doctor because they do not trust the health care system, not because they associate doctor visits with a lack of perceived masculinity. “We’ve seen in other studies that men with strong commitment to traditional masculine role norms delay health care because they don’t want to seem weak. But this study shows that the opposite may be true for African-American men,” said Hammond, assistant professor of health behavior and health education at the UNC Gillings School of Global Public Health and a member of UNC’s Lineberger Comprehensive Cancer Center. The study, “Masculinity, Medical Mistrust and Preventive Health Services Delays Among Community-Dwelling African-American Men,” appears in the December 2010 issue of the Journal of General Internal Medicine, and was based on surveys of 610 Black men, aged 20 and older, recruited primarily in barbershops in the North, South, Midwest and West regions of the United States.
Investigator Awards in Health Policy Research
In a New England Journal of Medicine article titled, “Medical Malpractice Liability in the Age of Electronic Health Records,” published on November 18, 2010, Michelle Mello, J.D., Ph.D., M.Phil., (’07) and colleagues consider the potential risks and benefits for medical liability as electronic health records are implemented and diffused widely.
A special issue of the Journal of Health and Social Behavior was recently published with support from RWJF to mark the 50th anniversary of the American Sociological Association’s Section on Medical Sociology. The issue includes papers by five investigators, including alumnus and Program Director David Mechanic, Ph.D., (’94) Jo Phelan, Ph.D., (’95) David Williams, Ph.D., (’94) Charles Bosk, Ph.D., (’05) and Health & Society Scholars Program Site Co-Director Bruce Link, Ph.D. (’95).
Shawn Bediako, Ph.D., (’08) published the study, “Predictors of Employment Status among African Americans with Sickle Cell Disease” in the November 2010 issue of the Journal of Health Care for the Poor and Underserved. Adults living with sickle cell disease (SCD) have extremely high rates of unemployment; however, very little is known about factors that contribute to their vocational outcomes. This study examined demographic, illness perception, and psychological variables as predictors of employment status among 115 adults. Gender, assertiveness and perceived impact of SCD were found to be unique predictors of employment status. The results suggest that demographic and psychosocial factors may play a more important role in predicting employment outcomes in adults with SCD than previously recognized.
Physician Faculty Scholars
Kristen Copeland, M.D., F.A.A.P., (’08), also a 2004 Clinical Scholars alumna, published “Wide Variability in Physical Activity Environments and Weather-Related Outdoor Play Policies in Child Care Centers Within a Single County of Ohio” in Archives of Pediatric and Adolescent Medicine (online January 3, 2011). The study examined the variability of physical activity environments and outdoor play policies in child care centers to determine whether this variability is associated with the demographic characteristics of the child care centers surveyed. It found considerable variability in the indoor and physical environments offered by child care centers within this single county. Depending on a center’s outdoor play policy and indoor options for physical activity, children’s opportunities for this activity can be curtailed as a result of subfreezing temperatures or light rain. Policy changes and education of teachers and parents may be needed to ensure that children have ample opportunity for daily physical activity.
Marie Crandall, M.D., M.P.H., (’08) published “Analysis of Compliance and Outcomes in a Trauma System With a 2-Hour Transfer Rule” in the December 2010 issue of Archives of Surgery. The study analyzed data from the Illinois state trauma registry from 1999 to 2003. Over the study period, there was a transfer rate of about 10.4 percent, and the overall median time to transfer was approximately two hours and 21 minutes, showing that in a state trauma system where transfer of patients thought to require a higher level of care is mandated to occur within two hours, the majority of transfers do not comply with this time standard. Despite this, it seemed that because the most seriously injured patients were reaching care within a two-hour time frame, a provider-determined transfer time exceeding two hours has no adverse effect on patient outcome.
Two studies by Renee Hsia, M.D., M.Sc., (’09) appeared in the January 2011 Archives of Surgery; Hsia is lead author on both studies. In “Possible Geographical Barriers to Trauma Center Access for Vulnerable Patients in the United States: An Analysis of Urban and Rural Communities,” the authors found that a significant portion of the U.S. population does not have access to trauma care within an hour’s drive, with certain vulnerable groups at higher risk of worse access. In the second study, “Factors Associated With Trauma Center Use for Elderly Patients With Trauma: A Statewide Analysis, 1999–2008,” Hsia and colleagues found that elderly patients in California have a decreased likelihood of receiving trauma center level care for their injuries, even after controlling for injury severity and injury mechanism.
Caroline Richardson, M.D., (’06) published a two-part study in the Journal of Medical Internet Research (October–December 2010). “An Online Community Improves Adherence in an Internet-Mediated Walking Program” showed that adding online community features to an Internet-mediated walking program did not increase average daily step counts but did reduce participant attrition. Participants with low-baseline social support used the online community features more than those with high-baseline social support. The authors concluded that online communities may be a promising approach to reducing attrition from online health behavior change interventions, particularly in populations with low social support. The second part of the study detailed strategies for encouraging participation in online communities, including having a limited number of separate conversation spaces on the sites and holding contests with small prizes around participation in the forums and meeting walking goals.
Scholars in Health Policy Research
Erika Franklin Fowler, Ph.D., (’07) co-authored the study “Advertising Trends of 2010” for the fourth-quarter 2010 issue of The Forum, which focused on the 2010 midterm elections. The authors analyzed a comprehensive database of political ads aired during the elections to shed light on campaign strategies. They found that with the increase in competitive races, the volume of advertising rose too, as did its negativity. While the parties agreed that employment was the top issue, there was much divergence in issue priorities, with Republicans mentioning health care and “change.” The high volume of advertising suggests a greater potential for voter learning, but the high levels of ad negativity could have had both positive and negative consequences on the electorate. Fowler is assistant professor of government at Wesleyan University.
In the same issue of The Forum, Robert Saldin, Ph.D., (’10) published “Healthcare Reform: A Prescription for the 2010 Republican Landslide?” Less than two years ago, Saldin observes, Barack Obama was sworn in as president amidst proclamations of a partisan realignment, but in the 2010 elections, scores of his fellow Democrats lost their jobs. The best evidence suggests that Obama’s signature accomplishment—passage of a health care reform bill that had long eluded progressives—played a key role in the historic defeat. It also highlighted the delicacy of partisan regimes, particularly those prematurely designated as realignments by academic or popular observers. Saldin is on leave from the University of Montana, where he is an assistant professor in the political science departmen
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