Category Archives: Health & Health Care Policy

Feb 24 2014
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Generation Y’s Role in Making the Marketplaces Work and Advancing a Culture of Health

Sue No, RN, BSN, is a fellow in the Robert Wood Johnson Foundation Nursing and Health Policy Collaborative at the University of New Mexico (2013-2017). She is working toward her PhD in nursing with a concentration in health policy. This post is part of the “Health Care in 2014” series.

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Every New Year brings New Year’s resolutions. It is a time for reflection on years past and to develop actionable changes needed for a hopeful and productive new year. Clearly 2014 is no exception. With the New Year already in full swing, I encourage people—yes, this also includes you, Generation Y—to enroll in a health insurance plan and take advantage of the Affordable Care Act’s (ACA) current and new coverage opportunities in an effort to advance our nation’s culture of health.

You might be asking yourself a few questions such as: Who is Generation Y and why are they important? I am happy to provide answers.

The largest generation, Generation Y, or Millennials, consists of young adults born between 1977 and 1994. This important demographic is key to obtaining a sustainable health care exchange system with affordable insurance plans. Healthy Millennials must enroll in the marketplace to offset the high costs acquired by the disproportionate number of Americans with high medical costs. Unfortunately, only a small number of young adults have participated in the health care exchange since open enrollment. This isn’t surprising. 

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Jun 27 2013
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The Role of Emergency Departments

Emergency departments (EDs) play a key role in the nation’s health care system, according to a RAND Corporation study commissioned by the Emergency Medicine Action Fund, and policy-makers should pay closer attention to their operations—particularly their role as a “gateway to inpatient treatment.” It also is important to better integrate EDs into inpatient and outpatient settings, the new report says.

EDs have become an important source for hospital admissions. Nearly all of the inpatient admissions growth between 2003 and 2009 was due to an increase in scheduled admissions from EDs, the report finds, particularly among Medicare beneficiaries. As a result of this shift, ED physicians served as the major decision makers for approximately half of all hospital admissions.

The study also finds that most patients visited the ED for a non-emergent health problem because they believed they lacked a viable alternative or because they were sent by a health care provider. “Almost all of the physicians we interviewed—specialist and primary care alike—confirmed that office-based physicians increasingly rely on EDs to evaluate complex patients with potentially serious problems, rather than managing these patient themselves,” the report says. EDs also support primary care practices by performing complex diagnostic workups.

“Evidence generated by our study and other published work indicates that efforts to reduce non-emergent and non-urgent use of EDs are most likely to succeed if they focus on providing convenient and affordable options outside the ED, rather than directing ED staff to turn patients away,” the study concludes. EDs should be better integrated into inpatient and outpatient settings through more interconnected health information technology, greater user of care coordination, and interprofessional collaboration.

Read the report.

Nov 9 2012
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Health Issues on Ballots Across the Country

Voters across the country were presented Tuesday with more than 170 ballot initiatives, many on health-related issues. Among them, according to the Initiative & Referendum Institute at the University of Southern California:

- Assisted Suicide: Voters in Massachusetts narrowly defeated a “Death with Dignity” bill.

- Health Exchanges: Missouri voters passed a measure that prohibits the state from establishing a health care exchange without legislative or voter approval.

- Home Health Care: Michigan voters struck down a proposal that would have required additional training for home health care workers and created a registry of those providers.

- Individual Mandate: Floridians defeated a measure to reject the health reform law’s requirement that individuals obtain health insurance. Voters in Alabama, Montana and Wyoming passed similar measures, which are symbolic because states cannot override federal law.

- Medical Marijuana: Measures to allow for medical use of marijuana were passed in Massachusetts and upheld in Montana, which will make them the 18th and 19th states to adopt such laws. A similar measure was rejected by voters in Arkansas.

- Medicaid Trust Fund: Voters in Louisiana approved an initiative that ensures the state Medicaid trust fund will not be used to make up for budget shortfalls.

- Reproductive Health: Florida voters defeated two ballot measures on abortion and contraceptive services: one that would have restricted the use of public funds for abortions; and one that could have been interpreted to deny women contraceptive care paid for or provided by religious individuals and organizations. Montanans approved an initiative that requires abortion providers to notify parents if a minor under age 16 seeks an abortion, with notification to take place 48 hours before the procedure.

- Tobacco: North Dakota voters approved a smoking ban in public and work places. Missouri voters rejected a tobacco tax increase that would have directed some of the revenue to health education.

Oct 26 2012
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Human Capital News Roundup: Cost-efficient care, income stagnation, nurses’ workloads, 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 and grantees. Some recent examples:

Following the announcement of the 2012 RWJF Community Health Leaders, many media outlets have covered the awardees. Among them: Kay Branch, MA, in the Anchorage Daily News, Ifeanyi Anne Nwabukwu, RN, BSN, in the Washington Informer, and Fred Brason in the Winston-Salem Journal.

A 2004 Community Health Leader also was in the news: Rabbi Elimelech Goldberg was named one of People Magazine’s “Heroes Among Us” for his work with Kids Kicking Cancer, a nonprofit that uses martial arts therapy to empower young cancer patients and help them manage pain.

RWJF Physician Faculty Scholar Deverick J. Anderson, MD, MPH, and colleagues conducted a single-center pilot study that finds ultraviolet light kills more than 90 percent of pathogens, when hospital rooms are flooded with the light from a robotic device. "We are now performing a study to determine if use of the device can actually prevent patients from acquiring these infections in the hospital," Anderson told MedPage Today. The findings were presented at the IDWeek 2012 conference.

Ruchi S. Gupta, MD, MPH, also a Physician Faculty Scholar, did a Q&A with the Chicago Tribune offering guidance for parents of children with food allergies, especially on Halloween. Read a post Gupta wrote for the RWJF Human Capital Blog about her professional—and personal—experience with child food allergies.

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Oct 24 2012
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Palliative Care Nurse Has 'Phenomenal' Experience at New Palliative Nursing Leadership Institute

By Sally Welsh, MSN, RN, NEA-BC, Chief Executive Officer, The Alliance for Excellence in Hospice and Palliative Nursing

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On July 15, 2012, the Palliative Nursing Leadership Institute became a reality.

The institute was a joint project supported by the Hospice and Palliative Nursing Association (HPNA) and the Hospice and Palliative Nursing Foundation (HPNF). Leadership development is a cornerstone of HPNA’s mission statement, which is: “Leading the way to promote excellence in the provision of palliative nursing care through leadership development, education, and the support of research in the field.”

The guiding vision for the Palliative Nursing Leadership Institute is “a national health care system in which every patient has access to quality palliative nursing care.” The mission of the institute is to “develop leaders who will embrace, utilize, and integrate palliative nursing concepts into professional nursing practices throughout the health care system, as achieved through a model of education and mentoring.”

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Oct 22 2012
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How Job Insecurity, The Decline in 'Good' Jobs, and an Uncertain Safety Net Affect Health

Sarah Burgard, PhD, MS, MA, is an alumna of the RWJF Health & Society Scholars program, and an associate professor of sociology and epidemiology and research associate professor at the Population Studies Center at the University of Michigan. Burgard recently co-authored a study that finds perceived job insecurity is linked with significantly higher odds of fair or poor self-reported health, symptoms of depression, and anxiety attacks.

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Human Capital Blog: What got you interested in researching the working lives and health outcomes of adults? Was there anything in particular that sparked your curiosity about job insecurity?

Sarah Burgard: I was interested in the excellent research being done by health disparities researchers that focused on socioeconomic position and its strong and persistent relationship with health. My dissertation looked at race and socioeconomic position and how they shaped children's health in different societies. When I started looking at the lives of adults in wealthy economies and focusing on health disparities in these groups, it struck me that most scholars were focused on education and income as stratifying factors, but not looking deeply at what connected them: paid employment.

Careers characterized by stimulating and satisfying work versus dangerous, monotonous or insecure work are of considerable interest in their own right to sociologists of stratification, but they could also be important for understanding divergence in health, as considerable research in occupational psychology and epidemiology has suggested. Many of the projects I've done have been aimed at bringing together the strong work in each of these fields to build even stronger explanations of the way work (or lack of work) influence health. I've been interested in less explored aspects of work, such as perceptions of job insecurity among those still employed, and in taking better account of the multitude of psychosocial aspects of work that affect individuals at a given point in time and the ways these could change over the career.

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Sep 19 2012
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HRSA Names New Center for Interprofessional Education and Collaborative Practice

The Health Resources and Services Administration (HRSA) last week announced that the University of Minnesota Academic Health Center will lead its new Coordinating Center for Interprofessional Education and Collaborative Practice. The Center will have a mission to accelerate teamwork and collaboration among nurses, doctors and other health professionals, with a particular focus on medically underserved areas.

“Health care delivered by well-functioning coordinated teams leads to better patient and family outcomes, more efficient health care services, and higher levels of satisfaction among health care providers,” said HRSA Administrator Mary K. Wakefield, PhD, RN, in a news release issued Friday.  “We all share the vision of a U.S. health care system that engages patients, families, and communities in collaborative, team-based care.  This coordinating center will help us move forward to achieve that goal.”

The Robert Wood Johnson Foundation (RWJF) and three other leading foundations this summer announced their support for the Center and committed up to $8.6 million over five years. RWJF, the Josiah Macy Jr. Foundation, the Gordon and Betty Moore Foundation, and The John A. Hartford Foundation aim to help make the Center the “go to” coordinating and connecting body for efforts to promote interprofessional education and collaborative practice, as well as a place to convene key stakeholders, develop interprofessional education programs, and identify and disseminate best practices and lessons learned.

“Interest in interprofessional education and team-based care has increased in recent years but we need to move faster,” Maryjoan Ladden, PhD, RN, FAAN, senior program officer at RWJF, said in announcing support from the four foundations. “We hope this Center will foster collaborations between educators and practice organizations to advance the field and improve how care is delivered to patients and families.”

Read the news release from the four foundations.
Read the news release from HRSA.

Sep 14 2012
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The Need for Pluralism

The Robert Wood Johnson Foundation (RWJF) Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? This post is by RWJF Investigator Award in Health Policy Research recipients Robert L. Wears, MD, PhD, a professor in the Department of Emergency Medicine at the University of Florida, and Kathleen M. Sutcliffe, PhD, The Gilbert and Ruth Whitaker Professor of Business Administration at the University of Michigan’s Ross School of Business.

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There are many aspects to the problem of what is or is not working in health professionals’ education today, and the changes needed to address them.  From our view as researchers studying issues of safety, resilience, and managing for the unexpected, some of the more important are that health professionals’ education is seriously deficient in the social sciences; is limited almost exclusively to largely positivist ideas about what counts as scientific activity; and is almost totally devoid of the humanities. 

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None of these deficiencies are new, and that is what concerns us.  The lack of engagement with the sciences of safety, and of human and organizational performance, has implications for practice, for safety, and for understanding and creating actionable knowledge.

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With respect to practice, for example, without sufficient exposure to humanities and social sciences we risk socializing people to become authoritative but inhuman techno-nerds, even if they didn’t start out that way.  

With respect to safety, we risk training people in positivistic methods and research approaches that oversimplify and even miss local contextual specifics that create real threats to safety. 

With respect to understanding and knowledge creation, we risk training people to revere scientific and technical rationality and ‘objectivity’ at the expense or even denial of any sort of constructivist or interpretive understanding.

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Sep 13 2012
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Human Capital News Roundup: September 11th, Medicaid, an Egyptian boy king, 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 and grantees. Some recent examples:

RWJF/ U.S. Department of Veterans Affairs Clinical Scholar Charles D. Scales, Jr., MD, spoke to NPR about a kidney stone “epidemic.” Scales led a study that finds the prevalence of kidney stones has nearly doubled since the mid-1990s, likely due to dietary and lifestyle changes that have led to increasing rates of obesity, diabetes, and gout. Read more about his research.

RWJF Investigator Award in Health Policy Research recipient Matthew C. Nisbet, PhD, MS, also spoke to NPR about his research on how to frame the climate change debate to best persuade and move people to action. Nisbet conducted the research with fellow Investigator Edward W. Maibach, PhD, MPH. Read more about their research, and read a Q&A with Nisbet about framing public health issues.

Separately, the Christian Science Monitor spoke to Maibach, director of the Center for Climate Change Communication at George Mason University, about a poll the Center conducted last spring on global warming and how much of a priority the issue should be for the President and Congress.

 “After 9/11, America’s about 10 million Arab and Muslim Americans, who were too often the victims of association with the perpetrators of the attacks, were—and continue to be—subjects of suspicion, discrimination, and abuse,” Clinical Scholars alumnus Aasim Padela, MD, MSc, writes on CNN’s Global Public Square blog. “As researchers who study the health of Arab and Muslim Americans, we regularly see the toll this climate of discrimination takes upon these communities… Healing our country after 9/11 must mean healing all Americans affected by that day, and the memory of 9/11 should not be used to discriminate against or marginalize any American. Ensuring that this is the case is the only way this country can continue to work to heal the gaping wound those attacks left on the social fabric of our entire country.” Read a post Padela wrote for the RWJF Human Capital Blog.

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Sep 7 2012
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Finding an AED in an Emergency

Raina Merchant, MD, MSHP, is a Robert Wood Johnson Foundation (RWJF) Clinical Scholars program alumna and an assistant professor at the University of Pennsylvania Department of Emergency Medicine. She recently led the MyHeartMap Challenge, a community improvement initiative and research project to identify and map automated external defibrillators (AEDs) in Philadelphia. Read a post she wrote for the RWJF Human Capital Blog about the Challenge.

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Human Capital Blog: Why was it important to collect information about the location of AEDs?

Raina Merchant: Currently there is no comprehensive map or database of where all the AEDs are located—in Philadelphia or really anywhere. So when someone collapses, we have to rely on people remembering where they last saw an AED. In fact, most 911 centers don’t have databases of where AEDs are located. So, the likelihood of being able to find one in an emergency is pretty low, and as a result we have these lifesaving devices that are rarely used. We used the MyHeartMap Challenge, an innovation tournament to have the public find AEDs in Philadelphia, take a photo using a smartphone app, and tag their location so we can make this information available to anyone who needs it.

HCB: How many people or teams participated in the Challenge? How many AEDs were identified?

Merchant: We were really excited about the results. We had more than 330 participants (individuals and teams) who contributed data to the Challenge. They reported more than 1,500 locations of AEDs in the city of Philadelphia. We’re still trying to sort out who exactly participated, but we had representation from schools and health organizations, as well as a lot of individuals who recruited their friends, neighbors and colleagues.  We were worried that people would make up devices, submit false locations or send low-quality pictures, but we were really impressed with the quality of data we received. Every one took this challenge very seriously. The challenge had two winners who were each awarded $9,000 for reporting more than 430 AEDs each. Both winners were also over the age of 40.

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