Mitesh Patel, MD, MBA (Internal Medicine) is a 2nd year UPenn Robert Wood Johnson Clinical Scholar. One area of his work is focuses on how to address cardiovascular risk factors such as obesity and physical inactivity to improve population health. He is the lead investigator of several clinical trials that leverage innovations in technology to passively monitor activity and utilizes financial, social incentives, and comparative feedback to motivate behavior change. The UPHS Weight Loss Study is a 12-month randomized controlled trial that evaluates how innovations in health benefit design incentives can motive obese employees to lose weight. This project is supported by a grant from the University of Pennsylvania Health System. Dr. Patel is also interested in evaluating how health policy design can impact health behaviors at a national level. More about this work can be found here.
Dr. Patel also studies how to improve the delivery of high-value, cost-conscious health care. His prior work has been published in the New England Journal of Medicine, JAMA Internal Medicine and featured in the New York Times. He was a member of the ACP’s Curriculum Development Committee on High-Value, Cost-Conscious Care and has published The VALUE Framework as a tool for physicians to integrate these concepts into patient care. He is currently evaluating national adoption of physician workforce training on cost-conscious care initiatives and how information technology interventions can be leveraged to reduce the use of low-value services. More about this work can be found here.
During Summer 2013, the 2013-2015 University of Pennsylvania Robert Wood Johnson Clinical Scholars set out to provide recommendations to improve the quality of life for residents at long-term care facilities. Working in partnership with the Pennsylvania Empowered Expert Residents (PEERs) of Inglis House and the Center for Advocacy for the Rights and Interests of the Elderly (CARIE), the Scholars created a set of recommendations in in response to the following charge:
Inglis House is a specialty nursing care facility providing long-term, residential care for 297 adults with physical disabilities, including multiple sclerosis, cerebral palsy, spinal cord injury and stroke, among others. Residents receive rehabilitative medical and nursing care; physical, occupational and speech therapies; and a selection of more than 20 social enrichment and therapeutic recreation programs every day.
The Scholars conducted a needs assessment through interviews with Inglis House residents, staff, and community stakeholders. Through this process, three core principles relating to quality of life were identified: communication, autonomy, and accountability. Subsequent recommendations were organized around these core principles:
Communication. The Scholars recommended using one or more of the following approaches to improving communication:
Autonomy. The Scholars recommended implementing the following changes to increase resident autonomy:
Accountability. Inglis House residents, staff, and administrators believed that accountability to each other, and to themselves, was critically important to quality of life. The Scholars therefore recommended clarifying the feedback options and training the PEERS as guides to facilitate residents working through the feedback loop:
The newly proposed suggestions to improve quality of life at Inglis House were presented to the Inglis House community at the end of the summer. After the final presentation, the Scholars used a community-engaged model (learning circle composed of residents, staff, and administrators) to discuss prioritization of recommendation implementation. Out of this meeting, the following recommendations were identified as community priorities:
Since the summer, the PEERs have reported that the administration, staff, and PEERS have been working as a team to implement the changes suggested in the Scholars’ report, The View from Here: Resident Quality of Life at Long-Term Care Facilities.
Matthew O’Brien, MD, MSc (Internal Medicine) is an alumnus of the UPenn Robert Wood Johnson Clinical Scholars Program (2007-2010). Dr. O’Brien is currently an Assistant Professor of Medicine and Public Health at Temple University in its Center for Obesity Research and Education. While a Clinical Scholar, Dr. O’Brien co-founded Puentes de Salud (“Bridges of Health”), a nonprofit organization providing primary health care and a variety of other health-related programs in the South Philadelphia Latino community. He currently serves as a regular provider at Puentes de Salud and is also the medical director, overseeing its clinical programs. Dr. O’Brien has developed a research agenda around this work to improve general knowledge about Latino health and generate best practices to reduce Latino health disparities nationwide. As part of a 5-year NIH grant, his group is currently developing and studying an intervention to prevent diabetes delivered by Puentes de Salud’s community health workers. Starting in 2007, Puentes de Salud’s community health worker program was the first of its kind in Philadelphia. And since then, Dr. O’Brien and his community health workers have helped organizations throughout the region develop similar health outreach and education programs.
Chileshe Nkonde-Price, MD (Cardiology) is a 2nd year UPenn Robert Wood Johnson Clinical Scholar who is pursing research designed to improve the health and healthcare of African American Women with heart disease. Dr Nkonde-Price is conducting a study of women enrolled in the VIRGO study that seeks to highlight the patient and community level factors that influence outcomes in women recovering from MI. The VIRGO study is the first prospective study of young black and white women hospitalized and recovering from MI. This project is supported by grants from the Eisenberg Award and Robert Wood Johnson Clinical Scholars Grant.
Dr Nkonde-Price is also the principal investigator on a community based qualitative study “Using storytelling and digital technology to understand and promote ideal cardiovascular health: The ChangeMySteps Project”. This study involves interviewing African Amercian women in hair salons to understand the barriers and design the promising solutions to physical inactivity, healthy eating and smoking cessation. Using data from the project, Dr Nkonde-Price conducted a pilot study, The ChangeMySteps Walking Challenge that tested the ability to use mobile technology (namely mobile phones applications) and twitter to promote physical activity among African American women. This project is supported by grants from the Eisenberg Award and Robert Wood Johnson Clinical Scholars Grant and a Robert Wood Johnson Health and Society Scholars Grant.
More information about the ChangeMySteps Project can be found here.
Shreya Kangovi, MD (Internal Medicine/Pediatrics) is a 2nd-Year UPenn Robert Wood Johnson Clinical Scholar who is pursuing community-based research that will lay the groundwork for establishing an infrastructure of community health workers (CHW) who can improve health outcomes for socioeconomically vulnerable patients. During her time on the program, Shreya has designed and implemented a randomized-controlled trial of The Patient-Centered Transition (PaCT) Project. PaCT is a novel intervention which utilizes community health workers (CHWs) to provide socioeconomically vulnerable patients with advocacy, social support and navigation through the transition from hospital to primary care. PaCT is supported by grants from the Bach Fund, the Clinical and Translational Sciences Award for Community-Based Research Small Grants Program, the Eisenberg Award, the Penn Medicine Department of Internal Medicine and the Presbyterian Medical Center Department of Medicine Fund. More information about the PaCT program can be found here.
Dr. Kangovi is also the principal investigator on a qualitative study, 'Patient Perceptions of Transition'. This study explores the perceptions that underinsured patients have of their post-hospital transition to primary care. This study is supported by a grant from the Leonard Davis Institute. In addition, Dr. Kangovi has created a survey instrument focused on the challenges patients face after being discharged from the hospital. This survey is currently being administered by nurses, social workers and clinical resources managers to all patients readmitted to any Penn Medicine hospital. Read more about Shreya’s work in the Philadelphia Inquirer and NPR’s Marketplace.
Brandi Kaye Freeman, MD (Pediatrics) is a 2nd year UPenn Robert wood Johnson Clinical Scholar who is pursuing research in two areas that are grounded in trying improve care delivery in the 21st century. Dr. Freeman is conducting a pilot study to try to improve the pediatric telephone triage process using videos obtained by parents via mobile phones. This study is grounded in trying to integrate how we use available technology (namely mobile phones) to provide visual information to clinicians to improve communication in care delivery. This project is supported by grants from the Eisenberg Award and a Robert Wood Johnson Health and Society Scholars Pilot Grant.
Dr. Freeman is also the principal investigator on a qualitative study, “Understanding Challenges in the Health Professional Pipeline.” This work inspired by Dr. Freeman’s advocacy efforts geared at supporting and improving diversity in the health professional pipeline. The project is in partnership with the grassroots organization formed by formed medical student leaders, Tour for Diversity in Medicine, which brings physicians, dentists, medical students and health professions advisors from diverse backgrounds to disadvantaged undergraduate institutions to “inspire, cultivate and mentor” students.
More information about the Tour for Diversity in Medicine can be found here (www.tour4diversity.org). The goal of Dr. Freeman’s work with the Tour for Diversity is not only improve this program but to influence the institutions and policymaking bodies that train and support the healthcare workforce.
Zachary Meisel, MD, MPH, MS (Emergency Medicine) is an alumnus of the UPenn Robert Wood Johnson Clinical Scholar program (2008-2010) and is now a faculty member at the University of Pennsylvania and a frequent contributor to discussions on health services, both in peer-reviewed journals and online forums like Time.com. Dr. Meisel’s areas of interest and research expertise include Narrative Medicine, Health Services Research, Emergency Care Access and Utilization, Patient Safety, Emergency Medical Services, Medical Journalism, Medical Writing, Communication, Dissemination and Translation of Health Services Research Results, Comparative Effectiveness Research Funding and Federal Policy. Beginning in Summer 2013, Dr. Meisel will co-teach HPR 600: Introduction to Health Policy and Health Services Research for all incoming RWJ Clinical Scholars and his roles at UPenn include Senior Scholar in the Leonard Davis Institute of Health Economics, Medical Editor of The Health Economist, a policy journal from the Leonard Davis Institute of Health Economics, and Patient Safety Officer at the Hospital of the University of Pennsylvania. In addition, he is an Associate Editor at Academic Emergency Medicine and an advisor to the PCORI methods committee for incorporating narratives in to methodology standards for comparative effectiveness research.
Dr. Meisel contributes to a regular Medical Insider column for Time.com. His articles have included:
He has also published work in JAMAabout the importance of storytelling in the world of health service research. Dr. Meisel and Dr. Jason Karlawish wrote: "Evidence from social psychology research suggests that narratives, when compared with reporting statistical evidence alone, can have uniquely persuasive effects in overcoming preconceived beliefs and cognitive biases. Therefore, although narrative is often maligned as anecdote and thus scrubbed from the toolbox of guideline developers, epidemiologists and regulatory scientists, these experts should consider narrative to develop and translate evidence-based policies."
Raina Merchant, MD (Emergency Medicine) is an alumna of the UPenn Robert Wood Johnson Clinical Scholar program (2007-2010) and is now a faculty member at the University of Pennsylvania and a Penn RWJ CSP Associate Director. Dr. Merchant’s research is focused on improving survival from cardiac arrest. She is specifically interested in implementation of existing resuscitation therapies and tracking the diffusion of cardiac arrest interventions. In the in-patient setting, she is interested in using administrative data sets to identify disparities in post-resuscitation care.
On January 31, 2012, Dr. Merchant kicked off National Heart Month by launching the MyHeartMap Challenge (MHMC). The MyHeartMap Challenge was a social media, mobile media, crowdsourcing contest to find automated external defibrillators (AEDs) in Philadelphia. Through this initiative, Dr. Merchant hopes to create a map and database that can be used to help victims of cardiac arrest, improve access to emergency care, and hopefully save lives. Contestants won by submitting the most AEDs ($10,000) or select special unmarked "Golden" AEDs ($50 per AED). More information about the contest can be found at myheartmap.org.
Follow the MyHeartMap Challenge on Twitter (@myheartmap) or read how the contest has gone global in the Philadelphia Inquirer.
Working in partnership with Covenant House Pennsylvania (CHPA) this past summer, the 2012-2014 UPenn Robert Wood Johnson Clinical Scholars set out to develop a life skills curriculum for homeless youth entering CHPA. Specifically, their aim was to create an evidence-informed life skills curriculum that could be delivered over a 30-day period (the average length of stay for residents at CHPA) to help youth transition to stable housing and employment.
The Scholars conducted a needs-assessment through interviews with CHPA residents, staff, and community stakeholders and identified three main content areas for the life skills curriculum: personal hygiene, budgeting/finance, and soft skills (including motivation, handling conflicts, adjusting to change, and responding to external pressures). Based on the community input, the Scholars provided CHPA with a sustainable and engaging life skills curriculum incorporating web-based resources, youth-generated educational content, and peer mentorship in partnership with Rights of Passage, CHPA’s transitional living program. Each content area with the corresponding recommendations are summarized below:
Personal hygiene. The Scholars recommended using one or more of the following approaches to teaching personal hygiene:
Budgeting and Finance. The Scholars recommended implementing a new budgeting/finance curriculum using the following strategies:
Soft Skills. The Scholars recommended a new peer mentor-facilitated curriculum addressing four domains felt to be essential for youth transitioning to stable housing and employment:
Lastly, recommendations for evaluating the efficacy of the proposed life skills curriculum were outlined.
The new proposed life skills curriculum was presented to CHPA at the end of the summer. Since then, the RWJ Scholars helped to set up a training of CHPA staff and youth by Dr. Powell. The one day training included topics and activities on group facilitation, self esteem building, leadership development, life skills and soft skills. The CHPA staff and youth who attended the training have partnered to begin to facilitate various groups. In early March, the staff and youth completed a practice run of the groups. It is expected that the groups will be in full swing by the end of the month.
A copy of the Scholars’ full report can be found here.
Working in partnership with Bartram High School and Tilden Middle School this past summer, the 2011-2013 Robert Wood Johnson Clinical Scholars at University of Pennsylvania set out to develop a comprehensive understanding of bullying in selected schools in Southwest Philadelphia and to identify strategies and best practices for bullying prevention and remediation. To achieve this, they conducted stakeholder interviews of teachers, administrators, parents, local community organizations, government and national bullying experts, as well as focus groups of local middle and high school students. They supplemented these perspectives with a review of the relevant biomedical and social science literature. From these sources, they identified a number of common themes, potential leverage points for intervention and resources that could support implementation of anti-bullying best practices and program development at Bartram and Tilden.
The themes from stakeholders generated five specific target areas on which the Scholars’ recommendations focus: measurement and reporting, prevention, remediation, awareness, and cyber-bullying. In their full report, the Scholars provided background from content experts and recent literature on each theme followed by recommendations specific to Bartram and Tilden. Each theme and its corresponding recommendation are summarized below:
A copy of the full report can be found here.