Category Archives: Research & Analysis

Apr 24 2014
Comments

RWJF Scholars in the News: Markers for PTSD, inexcusable morbidity, nurse education, cigarette marketing, 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:

Neuroscientists at Harvard University studying trauma and the adolescent brain have identified markers that might help predict susceptibility to post-traumatic stress syndrome (PTSD), New England Public Radio (NEPR) reports. Kate McLaughlin, PhD, an RWJF Health & Society Scholars alumna, and colleagues were studying young people who’d been through serious adversity when the Boston Marathon bombing occurred. They surveyed some study participants who had already had brain scans about how much media coverage of the tragedy they’d watched and how they reacted emotionally, learning that children with certain neurobiological markers or previous trauma were more likely to report symptoms of PTSD. “The more that we can understand the neurobiological markers as well as the psychological and social markers ... the better able we’ll be to deliver early and effective interventions to prevent the onset of mental health problems,” she tells NEPR. Listen here.

“People think about asthma and think we must have a handle on it in the United States, but the grim reality is that most patients’ asthma in this country is uncontrolled,” David Van Sickle, PhD, MA, an RWJF Health & Society Scholars alumnus tells Nonprofit Quarterly in an interview. Van Sickle points to little progress in reducing asthma-related hospitalizations, and what he describes as “inexcusable morbidity” from the condition.  

RWJF Executive Nurse Fellows alumna Jane Kirschling, RN, PhD, FAAN, is featured in Nurse.com on the importance of nurse education. “We’re the largest single group of health care providers in the United States, and we’re there 24-7, 365 days a year for the care that’s provided,” Kirschling said. “That’s in hospitals, community settings and long-term care settings. So, we have to make that commitment as a discipline and as professional nurses to continue to expand our knowledge and our critical thinking skills, and we do that through advancing nursing education.”

Read More

Apr 22 2014
Comments

Tracking the Affordable Care Act with the RAND Health Reform Opinion Study

Katherine Grace Carman, PhD, is an economist at the nonprofit, nonpartisan RAND Corporation and an alumna of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research program.

file

Since September 2013, the RAND Health Reform Opinion Study (HROS) has been collecting data about both public opinion regarding the Affordable Care Act (ACA) and insurance enrollment among respondents of the RAND American Life Panel.

The HROS uses panel data to track changes in public opinion regarding the ACA and insurance coverage.  We survey the same respondents each month. This allows us to observe not only aggregate changes, but also individual respondents changing their opinion or insurance coverage over time. Respondents are split into four groups and one group is surveyed each week. This allows us to present updated information on a weekly basis, while not burdening survey respondents.

One of the most notable findings of our study has been the increase in insurance coverage between September 2013 and March 2014, with an estimated net gain of 9.3 million in the number insured. The margin of error for this estimate is 3.5 million. The newly insured have gained access to insurance through a variety of insurance types, with the largest gains through employer-sponsored insurance (ESI). One might expect larger gains through Medicaid or the exchanges than through ESI. While our data do not allow us to tease out the causes of this gain in ESI, some possible explanations include: greater take-up of previously offered benefits, an improved economy leading more people to hold jobs (or have family members with jobs) that offer ESI, or an increase in employers offering ESI. These results on insurance coverage transitions have been discussed widely in the media, so here we want to bring your attention to some of the other findings of the HROS.

Read More

Apr 18 2014
Comments

New on the RWJF Website

Two stories on the Robert Wood Johnson Foundation (RWJF) website report on new research by RWJF scholars.

An Incentive for Healthier Living: RWJF Scholars Find a Stronger Link Between Obesity and Kidney Disease

Vanessa Grubbs, MD, MPH, and Kirsten Bibbins-Domingo, MD, PhD, both alumnae of the Harold Amos Medical Faculty Development Program (AMFDP), have discovered that obesity appears to be a driver of diminished kidney function, independent of a number of common kidney conditions. This suggests that overweight patients could face kidney troubles even if they avoid hypertension, diabetes, or other such conditions. The researchers also found that the standard measure used to gauge kidney function might miss early signals of deterioration that a more sensitive test can detect. This suggests that clinicians could identify emerging problems in otherwise asymptomatic patients, and help steer them toward healthier habits early in life.

Reducing Adolescents’ Risky Behaviors

New studies from RWJF scholars seek early markers for substance abuse, explore young adult sleep patterns, and gather data on health care providers’ counseling. RWJF Health & Society Scholar Julie Maslowsky, PhD, and colleagues found that mental health problems in eighth graders are a likely marker for subsequent substance abuse issues. In a separate study, Maslowsky’s research team studied the sleep patterns of more than 15,000 teens, because getting too little or too much sleep is related to a number of mental and physical health problems, including depression and anxiety. The same story reports on a survey by Aletha Akers, MD, MPH, an AMFDP alumna, examining the counseling health care providers give to parents of adolescent patients. The topics parents most frequently recalled discussing were the ones least associated with adolescent morbidity.

Apr 17 2014
Comments

RWJF Scholars in the News: Education levels and bone fractures, nursing research, hospital choice, 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:

Social class may have a significant bearing on the likelihood that middle-aged African American and Asian women will suffer bone fractures, a new study suggests. Co-author Rebecca Thurston, PhD, an RWJF Health & Society Scholars alumna, found that current income level or ability to pay for care is not associated with bone-fracture risk. However, educational levels among minorities, which the authors note are tightly associated with socioeconomic status, are directly related. This suggests that socioeconomic status over the entire course of a woman’s life is more relevant to bone health than current income status, Health Canal reports.

The Richmond Times Dispatch reports on the importance and value of nursing research. Nursing “really looks at the whole person. So we consider the physiological issues in terms of health problems, as well as psychological components, which is a big part of any health problem,” Jacquelyn Campbell, PhD, RN, FAAN, director of the RWJF Nurse Faculty Scholars program, tells the Dispatch. “We also are very concerned with vulnerable populations, ending health inequalities. Some of our nurse scientists, including some of the Nurse Faculty Scholars, are actually doing physiological research in the lab, but they are very concerned with how that translates to the bedside and to the community.” 

Read More

Apr 15 2014
Comments

Media Exposure and Acute Stress Following the Boston Marathon Bombings

E. Alison Holman, PhD, FNP, is an associate professor in nursing science at the University of California, Irvine and a Robert Wood Johnson Foundation Nurse Faculty Scholar.

file

A year ago today, on April 15, 2013, in the first major terror attack on U.S. soil since September 11, 2001, Dzhokhar and Tamerlan Tsarnaev planted two pressure cooker bombs near the finish line of the Boston Marathon. Three people died and more than 260 were injured. For a week authorities searched for the perpetrators, shootouts occurred, and Boston was locked down. As reporters and spectators filmed the mayhem, graphic images were shown repeatedly in both traditional and social media around the world. Like the September 11, 2001 (9/11) terrorist attacks, the population of the United States was the terrorists’ intended psychological target. Yet most research on reactions to such events focuses on individuals directly affected, leaving the public health consequences for populations living outside the immediate community largely unexplored.

Tens of thousands of individuals directly witnessed 9/11, but millions more viewed the attacks and their aftermath via the media. In our three-year study following 9/11, my colleagues and I found that people who watched more than one hour of daily 9/11-related TV in the week following the attacks experienced increases in post-traumatic stress (PTS) symptoms (e.g., flashbacks, feeling on edge and hyper vigilant, and avoidance of trauma reminders) and physical ailments over the next three years (Silver, Holman et al., 2013).

Read More

Apr 14 2014
Comments

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.

Read More

Apr 10 2014
Comments

RWJF Scholars in the News: Electronic health records, nurse mentoring, ‘longevity gaps,’ 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:

The California Action Coalition has developed a mentorship program that is helping prepare the next generation of nurses to serve as leaders on health care reform. The state’s mentorship program dovetails with the 2014 leadership focus of the Future of Nursing: Campaign for Action, a national effort backed by RWJF and AARP that is working to transform health care through nursing. “Mentoring is key to strengthening any leader,” Mary Dickow, MPA, tells Nurse Zone. “Having strong mentors in my life helped me think differently and advance. I wouldn’t be where I am today without them.” Dickow is statewide director of the California Action Coalition.

A recent interview in the Atlantic with David Blumenthal, MD, MPP, has generated numerous comments from readers weighing in on the merits of electronic health records (EHRs). Blumenthal is former national coordinator for health information technology at the U.S. Department of Health and Human Services and a recipient of an RWJF Investigator Award in Health Policy Research. He points out in the interview that EHRs offer “substantial” benefits for patients, but notes that in the short-term, providers incur significant costs and that it will take time to make the transition to EHRs. The Atlantic has now published several articles highlighting reader comments, which can be found here, here, and here. FierceEMR published a story about the give-and-take, which notes that many of the commenters who are skeptical about the value of EHRs are physicians.

RWJF Health & Society Scholars program University of Wisconsin-Madison Site Director David Kindig, MD, PhD, appeared on the Kojo Nnamdi Show on Washington, D.C.’s WAMU radio to discuss the “longevity gap,”—the growing gap in life expectancy between the rich and the poor. Kindig and other guests explore how health care reform and policies to address income inequality might affect the gap.

Read More

Apr 3 2014
Comments

RWJF Scholars in the News: Medical debt disparities, nurses providing primary care, technologies that maximize time with patients, 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 study of women diagnosed with breast cancer, RWJF Physician Faculty Scholars alumna Reshma Jagsi, MD, PhD, found that Black and Latina patients were more than twice as likely as White patients to have medical debt and to skip treatments due to concerns about costs. Jagsi tells Reuters that “our findings suggest that racial and ethnic minority patients appear to be more vulnerable, as are those who are too young to qualify for Medicare, those who lack prescription drug coverage, those who reduce their work hours after diagnosis, and those with lower household income at the time of diagnosis.”

Expanding nurse practitioners’ role in primary care could help meet new demands on California’s health care system, as millions of previously uninsured residents gain coverage under the Affordable Care Act, according to Susan Reinhard, RN, PhD, senior vice president of the AARP Public Policy Institute. “We should make sure that the nurse practitioners can use every ounce of their talent for what is needed,” she tells the AARP Bulletin. “Consumers should have a choice of different clinicians who will suit their preferences and their needs.” Reinhard is chief strategist for the Center to Champion Nursing in America, a partnership of AARP, AARP Foundation, and RWJF and co-director of the Future of Nursing: Campaign for Action.

At a recent information technology summit, Ann O’Brien, MSN, RN, an RWJF Executive Nurse Fellow, discussed her work with Kaiser Permanente to leverage new health care technology to maximize nurses’ valuable time providing patient care. O’Brien explains that “you have to look at what can enable small amounts of change,” because saving seconds with each repeated use of rapid sign-on technology, for example, can mean gaining extra minutes in a day for a nurse to provide direct care, FierceHealthIT reports.

Read More

Mar 27 2014
Comments

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.

Read More

Mar 27 2014
Comments

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.

Read More