At the 2011 meeting of the American Public Health Association (APHA), Karin Rhodes, MD, MS, a 1999-2001 Robert Wood Johnson Foundation (RWJF) Clinical Scholar, received the American Public Health Association's Student Assembly Public Health Mentoring Award. A teacher at the University of Pennsylvania School of Social Policy and Practice, researcher and physician in the emergency department at the University's hospital, Rhodes was nominated by a group of graduate students who had worked with her over a period of five years. In their letters to the nominating committee, Rhode's students wrote that they were grateful to her for offering them "unparalleled opportunities to hone their research skills, meet and collaborate with other experts in the field." They lauded her "generosity of spirit," while remarking that "her promotion of student's professional growth was absolutely unmatched." Here, Rhodes talks to RWJF.org about her work and being honored.
Q: What do you think contributed to you receiving the APHA award?
When I found out that a group of my PhD students got together and nominated me for this award, it was a surprise and really moving for me. I can't think of an award I would rather receive, because one of the things that I like to do is to help grow the next generation of health services researchers, which includes mentoring current RWJF Clinical Scholars, junior faculty and PhD students. I have been very, very lucky that a lot of people find me and I can include them in research projects and give them some ownership. [Rhodes has been known to give students lead author credit on published research, when appropriate]. They're smart, young and excited about the work. Mentoring them is one of the most gratifying parts of what I do.
In my own career, I felt very fortunate to have had a chance to be an RWJF Clinical Scholar, in part because I benefitted from mentoring. Wendy Levinson, MD, who was the director of the Clinical Scholars program at the University of Chicago, was one of my mentors and she helped me begin working on doctor/patient communication. At Penn, Paul Crits-Christoph, PhD, in the Department of Psychiatry, helped me to become an independent investigator.
Q: What is the scope of your current work?
I conduct research that looks at health care from the patient's perspective. That involves trying to measure what patients need compared to what they're getting. I've looked, for example, at psychosocial issues among patients who present to emergency departments. I've also looked at the holes in doctor/patient communication and quality indicators of care in the emergency department from the patient's point of view. I'm very interested in a systems level approach, setting up the system so it makes it easy for doctors to do the right thing.
I've written a number of papers about the impact of computer screening on rates and quality of emergency provider/patient discussions about sensitive psychosocial issues such as: domestic violence, smoking and depression.
While conducting that research, I discovered that even my study participants had a very difficult time getting follow-up care for mental and physical health problems. And that got me interested in studying access to follow-up care.
I discovered that many of my patients could not get through to doctors, even with referrals, to schedule an appointment. And, when they did get through, the rates at which they were able to get appointments were radically different if they were uninsured, had Medicaid or private insurance. So, I conducted a number of audit or "mystery shopper" studies.
In one of my most recent studies, "Auditing Access to Specialty Care for Children with Public Insurance," [published in the June 2011 issue of the New England Journal of Medicine] co-authored with one of my students, Joanna Bisgaier, we used an experimental design to measure access for children who needed specialty care. We identified all possible providers who could provide that care in the area and called a random sample of them twice, varying the insurance status of simulated child patients.
We found that 66 percent of publicly insured children were unable to get a doctor's appointment for medical conditions requiring outpatient specialty care, including diabetes and seizures, while children with identical symptoms and private insurance were turned away only 11 percent of the time. In a similar study with adults, we likewise found disparities in access for publicly insured adults in need of follow up care after an emergency department visit for an urgent condition. Notably, in that study, having private insurance did not guarantee access; only two thirds of privately insured patients were able to get timely follow-up appointments with providers. The results demonstrated serious capacity constraints in access to primary care for all Americans.
Q: How did your time as an RWJF Clinical Scholar impact your career?
By the time I became an RWJF Clinical Scholar, I was already interested in how to use information technology to improve patient care, but I didn't have the research skills to study it. As a Clinical Scholar, I learned how to design a research project and to analyze data. My study on follow-up care after emergency visits was developed in a research design course I took with one of directors of the Clinical Scholars program, Nicholas Christakis, MD, PhD, MPH.
Once I designed the study, I collaborated with another Clinical Scholar, Brent Asplin, MD, to carry it out. The computer screening study of provider/patient discussions about domestic violence study was funded through an NIH R01 grant to Levinson, my mentor in the RWJF Clinical Scholars program. Essentially, I am still wrestling with the big issues I was working on as a scholar. The RWJF Clinical Scholars program really launched my career as a health services researcher. My hope is that this investment will contribute to improving equitable accessible patient-centered care for all Americans.
The Robert Wood Johnson Foundation Clinical Scholars program advances the development of physicians who are leaders in transforming health care through positions in academic medicine, public health and other roles. The program trains clinicians in the program development and research methods that will enable them to find solutions to the many challenges posed by the health care system, community health and health services research.