Category Archives: Clinical Scholars

Oct 30 2014
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RWJF Scholars in the News: Scapegoating EHRs, Ebola fears, children fighting cancer, 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 article published in Healthcare IT News, David Blumenthal, MD, MPP, writes that health care providers may be too quick to blame Electronic Health Records (EHR) for medical errors. Blumenthal notes that EHRs are still imperfect and that improvements will take time, but argues: “There is no going back in the electronic health information revolution. No physician or hospital, however loud their complaints, has ever thrown out their EHR and returned to paper. The dissatisfaction with the technology will recede as EHRs improve, and as a new generation of young clinicians, raised in the electronic world, populates our health care system.”  Blumenthal is president of The Commonwealth Fund, former National Coordinator for Health Information Technology, and an RWJF Investigator Award in Health Policy Research recipient.

In a blog published by the Washington Post’s “Monkey Cage,” Shana Gadarian, PhD, and her co-author write that Ebola anxiety, while potentially misplaced and harmful, is likely to have an impact on whom Americans trust to handle the disease and what kinds of policies they will support to fight it. The authors have studies society’s reactions to small pox and H1N1 flu. “In general we find that anxiety makes people more supportive of government playing an expansive role in protecting them during a health crisis ... we think our study and the current Ebola outbreak both emphasize that people will rally around experts and increase their support for policies that fight the contagion, even if they hurt civil liberties. Let us hope that the U.S. health system is ultimately worthy of the confidence the public has in it.” Gadarian is an RWJF Scholars in Health Policy Research alumna.

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Oct 29 2014
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Primary Care and the Next Phase of Health Care Reform

Michael Hochman, MD, MPH, is medical director for innovation at AltaMed Health Services, the largest independent federally qualified health center in the United States. AltaMed has enrolled more than 30,000 Southern Californians in Medi-Cal and Covered California, the state health care exchange. Hochman is an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program at the University of California, Los Angeles, and the U.S. Department of Veterans Affairs. Martin Serota, MD, is AltaMed’s chief medical officer.

Michael Hochman Michael Hochman

Although the dust is still settling, most indicators suggest that the first wave of national health care reform was a success, particularly in California.  More than 8 million Americans enrolled in commercial health plans under the Affordable Care Act, surpassing targets set by the Obama administration. Many more will qualify for plans under Medicaid expansion. As leaders at a community health center that serves a large population of low-income patients—many of whom currently lack coverage—we could not be happier about the new opportunities for our patients.

Martin Serota Martin Serota

But we also know that the work is far from complete. Health care reform will only be a success if coverage expansion results in improvements in quality and efficiency, and better health for the population. As we know from the Massachusetts experience, it took time and a lot of effort for these benefits to ensue. Only now, several years after health care reform began in Massachusetts, are residents of the state starting to reap the benefits.

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Oct 16 2014
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RWJF’s Clinical Scholars Program: A Proud Legacy of Creating Change

Encouraging physicians to be not only agents of care, but agents of change: That’s the challenge the Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program has embraced for 45 years, and it’s a challenge the Foundation has met with “great success,” writes Bharat Kumar, MD, in an article in the American Medical Association’s ethics journal, Virtual Mentor.

In an era of increased activism and access to health care as evidenced by the creation of Medicare and Medicaid, a group of medical school professors envisioned the Clinical Scholars Program as a way to move beyond “the detached and passive model of medical practice” and instead “train physicians to become agents of change, not only in the clinic and in the hospital, but also in communities, in classrooms, and the halls of power,” Kumar writes. Three years after the program was launched in 1969 at five universities, with support from the Carnegie Corporation and the Commonwealth Fund, it came under the auspices of RWJF.

The article describes the program’s current objective—to provide post-doctoral training for young physicians in health services research, community-based participatory research and health policy research—and its current structure: training sites at the University of Michigan, the University of Pennsylvania, Yale University, and the University of California, Los Angeles; a national program office at the University of North Carolina; and a longtime collaboration with the U.S. Department of Veterans Affairs that supports positions for Clinical Scholars via affiliated Veterans Affairs medical centers.

The program’s final cohort of scholars, selected this year, will follow in the footsteps of more than 1,200 alumni, many of whom “have become leaders in health care policy and delivery,” Kumar writes, with roles in all levels of government and notable advancements in the fields of pediatrics, internal medicine, and emergency medicine.

Alumna Stacey Lindau, MD, says in the article that the program’s “traditions of promoting excellence, critical thinking, and service extend beyond the two to three years of training, effectively creating a pipeline of alumni dedicated to service.”

Read “The Robert Wood Johnson Clinical Scholars Program: Four Decades of Training Physicians as Agents of Change.”

Sep 25 2014
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RWJF Scholars in the News: Unintended consequences of shorter ER wait times, Ebola response, vaccinations 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:

Policies aimed at shortening emergency departments waiting times may have unintended consequences, including unnecessary admission of patients who might be better off being discharged, RWJF Physician Faculty Scholars alumna Renee Hsia, MD, MSc, tells Health Day. Hsia published two research letters in JAMA Internal Medicine on emergency wait times at urban and rural hospitals. RWJF Clinical Scholar alumnus Jeremiah Schuur, MD, MHS, author of an accompanying editorial, seconds Hsia’s concerns. “Medicare started advertising waiting times at ERs about a year ago. And that will be a strong incentive for hospitals to work on and improve their waiting times...[h]owever, some of the hospitals with longer waiting times, like teaching hospitals, care for the most complex patients who often don’t have access to regular care. And these places are, by nature and necessity, going to have longer waiting times,” he warned. The article was republished by U.S. News & World Report and Health.com, among other outlets.

CBS Detroit interviews Howard Markel, MD, PhD, FAAP, recipient of an RWJF Investigator Award in Health Policy Research, for a story on President Obama’s decision to send American troops and medical and logistical support to Africa to stop Ebola from spreading. “It is a humanitarian gesture,” Markel said. “I applaud the president for doing it. Do I wish as a physician and an epidemiologist it was done earlier? Yes, of course.” Markel says he does not expect the virus to spread to the United States. He is also quoted in the New Republic and Politico.

In an op-ed for the New York Times, Jason Karlawish, MD, explores the balance between risk-avoidance and enjoying life as we age. Noting that 3.6 percent of the population is 80 or older, he writes that as Americans age, “life is heavily prescribed not only with the behaviors we should avoid, but the medications we ought to take.” Aging in the 21st century is all about risk reduction, but “[w]e desire not simply to pursue life, but happiness” and “medicine is important, but it’s not the only means to this happiness,” Karlawish writes. National investment in communities and services that improve the quality of our aging may be one answer, he adds. Karlawish is a recipient of an RWJF Investigator Award in Health Policy Research.

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Sep 24 2014
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Helping ‘Care Partners’ Help Patients with Diabetes

Ann-Marie Rosland, MD, MS, is a research scientist at the VA Ann Arbor Center for Clinical Management Research, an assistant professor at the University of Michigan Medical School, and an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program (2006-2009). She recently received a U.S. Department of Veterans Affairs Merit Award to test a family engagement intervention for patients with diabetes.

Ann Marie Rosland

Human Capital Blog: Congratulations on your Veterans Health Administration (VA) Merit Award! The award recognizes your research into a family engagement intervention in the context of the VA’s patient-centered medical home program. How did your study work, and what did you find?

Ann-Marie Rosland: This study is unique in that we work with family member/patient pairs in managing diabetes. We call these family members “care partners.” This study asks the question:  “How we can best recognize and support the vital roles that patients’ family members often take in the care of chronic illnesses, so these care partners can have the largest positive impact on patients’ health and medical care?”

Our prior work has shown that the majority of people with diabetes, heart disease and other chronic conditions have a family member who is regularly involved with the care of these conditions. Some help to keep track of medications and refill them, some help to track and manage symptoms or sugar readings, many come to medical appointments and help patients communicate with their medical teams, and some help patients navigate the health care system. In general, patients who have support from family members tend to be more successful at managing chronic illness, particularly with eating healthier and exercising more. Yet patients and family tell us that care partners face barriers in helping with the medical side of care; for example, they can’t easily find out what medications or tests the patient’s medical team is recommending, or what health system programs are available to the patient.

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Sep 22 2014
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Young Adults Offer Suggestions to Improve HealthCare.gov

Charlene A. Wong, MD, is a pediatrician and a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Pennsylvania and the Children’s Hospital of Philadelphia.  

Charlene Wong

“This plan is $20 to see a primary doctor, and this one is 10 percent coinsurance after deductible—and I just don’t understand that.  What is the deductible to see my primary doctor?” asked a 29-year-old uninsured Philadelphian as she shopped for health insurance on HealthCare.gov in February. 

As she tried to make sense of the plans being offered to her, she realized—as most people who have chosen a health insurance plan for themselves or their families know—that health insurance is complicated.  This young woman found the process particularly challenging and overwhelming as she was choosing her own health insurance for the first time. Though she wished “a good plan could be recommended for me, based on my needs,” she did ultimately select a new health insurance plan on HealthCare.gov.

She was one of 33 young adults, ranging from 19 to 30, who participated in our study at the University of Pennsylvania from January to March 2014.  The study explored the young adult user experience with the federal health insurance exchange website.  We asked these so called “young invincibles” to focus not on the technical failures of the website, which were being covered and criticized extensively by the media, but rather on how the website could be improved to better support them in choosing a health insurance plan that was right for them.  

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Sep 4 2014
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RWJF Scholars in the News: The nursing shortage, ADHD, meaningful online communications 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:

NBC 2 (Buffalo, New York) interviewed Carol S. Brewer, PhD, RN, FAAN, co-director of RWJF’s RN Work Project, for a story about the nursing shortage and job prospects for nurses early in their careers. “We are not seeing as much demand for brand new graduates,” Brewer said. However, the anticipated retirement of many older nurses and the increasing demand for health care as a result of the Affordable Care Act could combine to create a 19-percent increase in demand for nurses in the near future, Brewer said. In the meantime, she suggests that new nurses be willing to relocate and look for nursing jobs in rural communities, where demand is greater.

It is important to keep media and public focus on the Affordable Care Act, Jake Haselswerdt, PhD, an RWJF Scholar in Health Policy Research, tells the Independent Voters Network website, because some states are still blocking full implementation of the law. “In order for the more stubborn states to move forward with implementation and expanding care, there may need to be some continued pressure,” he said. “That’s going to require the media to pay attention to the big disparities that are emerging between states that tried to implement the law and those that resisted.”

Tina Bloom, PhD, RN, an RWJF Nurse Faculty Scholar, led training for nurses in Columbia, Missouri, aimed at helping them identify the risk factors and symptoms of domestic violence, and then to support victims, ABC17 News reports. The training is consistent with preventive care provisions in the Affordable Care Act, the article says. Among other things, Bloom teaches nurses to look for certain types of injuries and for issues in patients’ medical histories that do not make sense.

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Aug 28 2014
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RWJF Scholars in the News: Medical marijuana’s unanticipated benefits, infant sleep pods, 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:

States that have legalized medical marijuana have seen nearly 25 percent fewer deaths from overdoses involving prescription painkillers than states that have not, according to a study led by Marcus Bachhuber, MD. ABC News reports on it, noting that 23 states and the District of Columbia have such laws. Researchers found that while opioid overdose rates continued to climb, the increase was much slower in states with medical marijuana laws, resulting in 25 percent fewer deaths from opioid overdose. “This study raises the possibility that there is an unintended public health benefit of medical marijuana laws, but we still need to collect more information to confirm or refute what we’ve found,” says Bachhuber, an RWJF/Veterans Administration Clinical Scholar at the Philadelphia Veterans Affairs Medical Center. Outlets covering Bachhuber’s study include CNN, Washington Post, Business Insider, Health Day and Vox.

An infant “sleep pod” designed by Jennifer Doering, PhD, RN, is one of 11 projects funded through new grants from the University of Wisconsin Extension and the Wisconsin Economic Development Corporation, the Milwaukee Journal Sentinel reports. The $25,000 Ideadvance grants are intended to move good ideas more quickly to the marketplace. Doering’s I-SleepPod, developed as a result of her work in the RWJF Nurse Faculty Scholars program, would allow an infant to sleep next to an adult while remaining safe, thanks in part to an alarm that wakes the adult in the event of an unsafe sleeping position. “We designed the sleep pod to minimize hazards because, if we don’t move in that direction of reducing sleep-related infant deaths, then [society] is essentially saying it’s acceptable to have 600 babies die every year that way,” Doering said.

Nutrition rating systems in supermarkets may encourage shoppers to purchase less junk food, according to a study led by John Cawley, PhD, an RWJF Scholars in Health Policy Research alumnus and Investigator Award in Health Policy Research recipient. The study coupled sales data from Hannaford Supermarkets in the northeastern United States from January 2005 to December 2007 with the Guiding Stars nutritional rating system. The ratings system assigns zero to three stars to food items, based on their nutritional value. Researchers found that sales of less healthy foods—such as highly processed snack foods—fell by 8.31 percent when branded with a low nutrition rating, while healthy food purchases rose by 1.39 percent, Medical Xpress reports.

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Aug 5 2014
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2015 Cohort of RWJF Clinical Scholars Announced

The Robert Wood Johnson Foundation (RWJF) Clinical Scholars program has announced the 31 physician leaders selected as the program’s final cohort. The new Clinical Scholars are physicians who were selected competitively from medical and surgical residencies across the United States. The 2015 cohort includes physicians specializing in primary care, emergency care, pediatrics, surgery, and psychiatry.

This is the program’s largest cohort in more than five years. Clinical Scholars spend two years examining the delivery, impact, and organization of health care.

RWJF will fully fund 10 of the 31 scholars. Through a partnership of more than 30 years, the U.S. Department of Veterans Affairs (VA) will jointly support 13 scholars through VA Medical Centers affiliated with the participating universities. Those universities will fund six scholars, and for the first time, two scholars at UCLA will receive funding support from the Los Angeles County Department of Mental Health.

Read more about the 2015 Clinical Scholars and the funders that are supporting them.

For more information about the program, visit http://rwjcsp.unc.edu/.

Aug 1 2014
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The Imperative to Engage Surgical Residents in Quality Improvement

Charles D. Scales Jr., MD, MSHS, an alumnus of the Robert Wood Johnson Foundation/VA Clinical Scholars program (UCLA 2011-2013), is a health services researcher at the Duke Clinical Research Institute and assistant professor in the division of urologic surgery at Duke University School of Medicine.  He is also assistant program director for quality improvement and patient safety for the urology residency training program at Duke University Hospital.  

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Young doctors training to become surgeons, also called surgical residents, are increasingly caring for patients in an environment that links quality, safety, and value to patient outcomes. Over a decade ago, the Institute of Medicine highlighted the need for improving care delivery in the landmark report, Crossing the Quality Chasm, suggesting that high-quality care should be safe, effective, patient-centered, timely, efficient (e.g., high value), and equitable. Just this week, the Institute of Medicine followed with a clarion call for training new physicians to participate in and lead efforts to continually improve both care delivery and the health of the population, while simultaneously lowering costs of care.

To support this imperative, the Accreditation Council for Graduate Medical Education, which accredits all residency training programs in the United States, mandates that all doctors-in-training receive education in quality improvement. Despite this directive, a number of substantial barriers challenge delivery of educational programs around quality improvement.  Health care is increasing complex, driving residents to focus on learning the medical knowledge and surgical skills for their field.  Patient care demands time and attention, which can limit opportunities to learn about quality improvement within the context of 80-hour duty limits. This barrier particularly challenges surgeons-in-training, who often spend 12 or more hours daily learning surgical skills in the operating room, leaving little time for a traditional lecture-format session about quality improvement. Finally, many surgical training programs lack faculty with expertise in the skills required to systematically improve the quality, safety, and value of patient care, since these skills were simply not taught to prior generations of surgeons.

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