Timothy Landers, RN, CNP, PhD, is an assistant professor at The Ohio State University and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar.

The Great Challenges Program is an ongoing effort by the TEDMED community to provide innovative, interdisciplinary perspectives on the most complex and challenging issues in health care. A year-long dialogue facilitated through social media tools and panels of experts continued at the annual gathering of TEDMED 2013.

One of the themes of TEDMED 2013 was the creative and thoughtful use of big data and small data to improve health and health care.

Small data includes individual level information specific to an individual or circumstance. In small data, “n=ME.” A vast amount of individual level information is now routinely collected. However, a large volume of data is not required for small data to be useful—in the words of one TEDMED speaker, it’s not the volume of the data, but the complexity of existing data. Data must be available and accessible in order to be useful as well.

Big data refers to patterns of data and information available at the population level. The goal of big data is to use information and take a “macroscopic” view of health. It includes the ability to recognize patterns that are not obvious or readily apparent. Big data analysis permits us to go from pieces of data to collective wisdom, a theme of TEDMED 2013.

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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:

RWJF Clinical Scholar Alan Teo, MD, MS, is the lead author of a study that finds the quality of a person’s social relationships influences the person's risk of major depression, regardless of how frequently their social interactions take place. “The magnitude of these results is similar to the well-established relationship between biological risk factors and cardiovascular disease,” Teo told Health Canal. “What that means is that if we can teach people how to improve the quality of their relationships, we may be able to prevent or reduce the devastating effects of clinical depression.”

RWJF recently announced the selection of 30 primary care practices as exemplary models of workforce innovation. The practices will serve as the basis for a new project: The Primary Care Team: Learning from Effective Ambulatory Practices (LEAP). Among them is CareSouth Carolina, the Hartsville Messenger reports. Learn more about the LEAP project and the practices selected for the program.

Low-income Oregonians who received access to Medicaid over the past two years used more health care services, and had higher rates of diabetes detection and management, lower rates of depression, and reduced financial strain than those without access to Medicaid, according to a study co-authored by RWJF Investigator Award in Health Policy Research recipient Amy N. Finkelstein, PhD, MPhil. The study found no significant effect, however, on the diagnosis or treatment rates of hypertension or high cholesterol levels.  Among the outlets to report on the findings: Forbes, the New York Times, the Washington Post Wonk blog, Health Day, and the Boston Globe Health Stew blog. Read more about Finkelstein’s research on the Oregon Medicaid system.

Lori Melichar Gadkari, PhD, MA, is a senior program officer at the Robert Wood Johnson Foundation (RWJF), in the Research and Evaluation Unit.

Yesterday the New England Journal of Medicine published the results of a study co-funded by the Robert Wood Johnson Foundation, Johnson & Johnson, and the Gordon and Betty Moore Foundation. “Perspectives of Physicians and Nurse Practitioners on Primary Care Practice” finds that 96 percent of nurse practitioners and 76 percent of physicians agreed with the Institute of Medicine report recommendation that “nurse practitioners should be able to practice to the full extent of their education and training.” The new study is authored by Karen Donelan, ScD, EdM, Catherine M. DesRoches, DrPH, Robert S. Dittus, MD, MPH, and Peter Buerhaus, PhD, RN.

When asked how increasing the supply of nurse practitioners would potentially affect the United States health care system, the authors found that the majority of physicians (73%) said increasing the supply of primary care nurse practitioners (PCNPs) would lead to improvements in the timeliness of care. A much smaller majority of physicians (52%) said increasing the supply of PCNPs would lead to improvements in access to care for people in the country. 

However, the new survey found significant disagreement between primary care physicians and PCNPs about whether increasing the supply of PCNPs would improve patient safety and the effectiveness of care, and whether it would reduce costs. There was also a large professional divide about proposed changes to PCNPs’ scope of practice, putting PCNPs in leadership roles, and the quality of care that PCNPs provide.

Olga Yakusheva, PhD, is an associate professor of economics at Marquette University. Richard C. Lindrooth, PhD, is an associate professor at the University of Colorado Anschutz Medical Campus. Both are grantees of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative.

Technological innovation is rapidly transforming patient care. A new generation of innovations will potentially change the most fundamental aspect of the patient experience – patients’ interactions with physicians and nurses. The FDA recently approved the first autonomous telemedicine robot for use in acute care hospitals. Even more advanced technologies, some capable of processing up to tens of millions of pages of plain medical text per second, are being tested and may soon be used to diagnose conditions and recommend treatment, with limited input from clinicians.

"We suggest that nurses should embrace rather than fear these innovations."

This new technology has the potential to perform several tasks more efficiently than clinicians, albeit with some limitations. It can quickly and effectively sift through large amounts of information and, based on a complex set of guidelines, create a probability-weighted list of diagnoses and recommendations. The result will be purely evidence-based and free of human cognitive decision-making biases.  The technology can drastically speed diffusion of new research and guidelines through electronic dissemination, similar to automatic software updates, and make most novel treatment regimens instantly available to patients.

Ann Marie P. Mauro, PhD, RN, CNL, CNE, is a clinical associate professor, fellow with the Hartford Institute for Geriatric Nursing, and the program liaison and project director for the Robert Wood Johnson Foundation New Careers in Nursing scholarship program at the New York University (NYU) College of Nursing, which has made extensive use of simulation. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.

For students in the health professions, the beauty of simulation is the ability to apply their critical thinking and assessment skills in a safe environment where they can learn without fear of harming a patient. Sometimes I think people learn much better from their mistakes. While simulation does not completely replace traditional clinical experiences, it is a great teaching strategy to help standardize students’ learning experiences, at both the undergraduate and graduate levels.

You can achieve targeted learning outcomes for students who have the opportunity to work with patients with specific health concerns. When we take students into a traditional clinical setting, we do not have control over which patients might be available and what students might be able to do. It is getting particularly challenging not only to find clinical sites, because of competition among schools, but to deal with health care organizations that have transitioned to electronic health records and electronic medication administration records, which are difficult for faculty and students to access. Furthermore, it is time-consuming and costly for faculty to be trained on different systems.

Ying Xue, DNSc, RN, is an associate professor at the University of Rochester School of Nursing and an alumnus of the Robert Wood Johnson Foundation Nurse Faculty Scholars program. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.

For the past two decades, supplemental nurses have been about 4 percent of the nursing workforce. These are nurses hired from staffing agencies to temporarily fill vacant nursing positions. The business of supplemental nurse staffing began in the 1970s as a symptom and a response to the nursing shortage. A central concern over the decades has been whether quality of patient care provided by supplemental nurses is the same as that provided by permanent nurses.

On the one hand, some argue that the temporary nature of the position (which varies from per-diem to a few months) might have an adverse effect on patient outcomes due to supplemental nurses’ lack of familiarity with unit policies and health care providers, and disruption in continuity of care. Others contend that supplemental nurses might have a positive effect on patient outcomes because they alleviate deficiencies in nurse staffing. 

What’s the answer to this decades’ old question?  Surprisingly, relatively little research has been conducted to provide a definitive answer, but several recent studies not only are shedding light on the issue, but helping to reframe the question by challenging some old myths.

Lynne M. Dunphy, PhD, FNP, is the founding nurse co-lead of the Rhode Island Action Coalition and an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program. She is a professor and associate dean of external affairs at the University of Rhode Island’s College of Nursing, where she also holds the Routhier Chair of Practice. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.

At the University of Rhode Island, I teach a graduate course in health care policy. Rhode Island Lt. Governor Elizabeth Roberts recently spoke to my class about health reform, and I showed her around our college of nursing. As we walked through rooms with high-tech simulation equipment and other labs that imitate real-life practice, she raised a question that resonated with me: Are your students getting out into the community? This is where our health care needs of the future will be.

So many of our nursing students want to go into acute care, and I am concerned that they have not had enough exposure to the entire health care system. The following questions keep coming to mind:

• Do they learn enough about all the settings they could work in?
• Do they understand what their responsibilities and day-to-day activities would be in various settings, such as in a community health center or long-term care facility?
• Do they understand how to implement population-based care?  
• Are they ready for the challenging work of visiting patients in home care settings?  
• Are they truly prepared?

In the more than two years since the launch of the Future of Nursing: Campaign for Action, state-based coalitions around the country have been working to strengthen the nursing profession to improve health and health care. These Action Coalitions have identified priorities and strategies specific to their states, and forged diverse partnerships to help reach their goals.

A new series of videos on RWJF.org features leaders from some of those Action Coalitions discussing their work and successes, and some of the unique challenges and opportunities they’ve faced.

Watch the videos.

Carolyn Hayes, PhD, RN, NEA-BC, is associate chief nurse for Adult Inpatient and Integrative Oncology at Dana-Farber Cancer Institute and Brigham & Women’s Hospital (BWH) in Boston, MA. She is a Robert Wood Johnson Foundation Executive Nurse Fellow (2012). Here, Hayes reflects on how nurses provided quality care to patients and others traumatized by the bombing at the Boston Marathon. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.

I remember a brief report on television, just after the Newtown shootings, when an emergency department (ED) physician in Connecticut said his emotional pain started with his realization that his ED was not getting any victims. It clearly overwhelmed him not to be able to help. At the time I felt for him but on Monday, April 15, after the Boston Marathon bombing, I truly understood him. I, along with other highly-skilled members of the health care and support teams at Brigham & Women’s Hospital, had the privilege of making a difference for the victims of that tragic event.

That Monday, I was the operations section chief—the role designed to ensure staff, materials, supplies, and systems are in place to address whatever is occurring. On Friday the 19th, the day that Boston and surrounding towns were instructed to “shelter in place,” I was incident commander.

We saved lives and limbs in our ED that day. But we also tended to the anxiety, fear, and confusion created by an attack on our city. We addressed with patients, their families, family members of unidentified marathon victims, and ourselves, the existential gap created by the “why” of it all. We lived out what we had trained for, yet couldn’t comprehend. And we did it all as a community.