Monday, May 18, 2015

Can Patients Choose Their Hospital in a Pandemic?

by Bonnie Eissner

With the outbreak of Ebola in Africa and the looming threat of avian flu and other highly transmissible diseases, the threat of a pandemic has taken on a new urgency, at least in the public consciousness. According to Jiang Zhang, Ph.D., an associate professor at the Robert B. Willumstad School of Business, the U.S. government has been concerned for some time about the possibility of an influenza or avian influenza outbreak. What would this look like? The Centers for Disease Control and Prevention estimates that it could mean from just shy of a million to more than nine and a half million hospitalized victims...

Recently, Dr. Zhang, an operations management expert, teamed up with a colleague, Lihui Bai, an assistant professor in the Department of Industrial Engineering at the University of Louisville, to examine how patients can be enticed to choose the hospitals that will best serve them.

At the heart of the issue is the unequal distribution of hospitals and hospital beds. Urban areas, such as New York City, have larger, more prominent hospitals. But the demand for beds is much greater. During a pandemic, this imbalance could lead to bottlenecks at city and suburban hospitals, while rural hospitals remain underutilized.

How do you spur people to travel to the hospitals that will serve them most efficiently? One option is for the government to assign people to particular hospitals. Another is to entice them.

Dr. Zhang and Dr. Bai showed that an incentive-based model is as effective as an assignment-based model. And it’s likely to be more palatable. 

They used a simple incentive: shorter wait times. According to the model, shorter wait times can be used to offset the time spent traveling to more distant hospitals. The model is akin to using tolls to encourage drivers to use less crowded roads, bridges and tunnels.

The study, published in 2014 in the International Journal of Mathematics in Operational Research, has drawn significant attention. Dr. Zhang said, “The reason our paper has been picked by the journal and sent out was because it’s relatively new…in this type of setting.”

Dr. Zhang noted that as hospitals and doctors focus more on service delivery and cost savings, operations management models and expertise will become more relevant. Already, he is working on another hospital-related study, and he said that the physicians who participate in Adelphi’s M.B.A. program are showing increased interest in understanding how to apply business models to their own work. Both are examples of how operations management is becoming more interdisciplinary. 

This article appeared in the Spring 2015 issue of Erudition. 

Monday, May 11, 2015

How Do Parents Help Kids Cope?

by Bonnie Eissner

It is intuitive and proven that secure parent-child relationships benefit children. But questions remain to be answered about why this is true or the precise ways in which parent-child attachment impacts child development.

Laura Brumariu, Ph.D., an assistant professor at the Gordon F. Derner Institute of Advanced Psychological Studies, explores these questions in her research.

Dr. Brumariu explained that a secure parent-child attachment is a relationship in which children perceive their caregivers as available, sensitive to their needs and havens of safety in times of distress.

One question she is now addressing is: “Why does having a secure relationship with a parent help somebody have lower anxiety?”

She is primarily focused on how parent-child attachment affects a child’s ability to regulate emotions and cope with stressful or unexpected situations. In a series of studies involving children of different ages, she showed that children in secure relationships are better at identifying and managing emotions and have better peer relationships.

According to her findings, children with disorganized-insecure attachments, by contrast, have more difficulty managing emotions and have poorer peer relationships. They also tend to evaluate ambiguous situations more negatively and, when they encounter difficulties, are less likely to seek support or engage in problem solving.

“In turn, difficulties with emotion regulation and peer relationships have been linked with more anxious feelings in children,” Dr. Brumariu explained.

Dr. Brumariu readily acknowledges that attachment is not the be-all, end-all of childhood happiness. She and her colleagues are also looking at how temperament and parent-child communication relate to child anxiety.

For example, in one study in which child-mother pairs were asked to discuss a conflict, mothers of less anxious children were more supportive, exhibited more warmth and interest in the child and were more elaborative during conversations. Further, more anxious children showed heightened emotion and were less engaged in the conversation.

“I’m trying to look at it all in a context because we don’t believe in a vacuum,” Dr. Brumariu said. “There are other pieces to this puzzle of why some kids are anxious and some are not, including genetics.”

This article appeared in the Spring 2015 issue of Erudition

Monday, May 4, 2015

100 and Not Retiring

by Sophia Conti

In honor of Older Americans Month, we are sharing a profile of a 100-year-old alumna of Adelphi University. 

Sylvester at the Freeport Memorial Library. 
When Belle Sylvester ’33 attended Adelphi 80 years ago, students roller-skated to class.

“It was like a club,” said the 100-year-old coordinator of classical programming at the Freeport (New York) Memorial Library. “It was a lot of fun.”

There was more space to roller-skate then, with only three buildings on the brand-new Garden City campus, which opened in 1929. Sylvester arrived a year later at age 15, completing her psychology degree in just three years. She also studied French and German, receiving medals for her work in both languages.

In addition to her studies, Sylvester brought music to Adelphi’s weekly chapel services. “We didn’t have an orchestra, but I organized a trio,” she said. Sylvester selected the pieces the trio would perform and also played the violin, which she continued playing until just a few years ago.

“It was really a wonderful three years,” Sylvester said of her time at Adelphi. “We had wonderful professors. And there was a lot of camaraderie going on. The people at Adelphi made a very close-knit community.”

Sylvester’s 100th birthday last October coincided with the 23rd anniversary of her being hired to coordinate classical music programming at the Freeport Memorial Library.

She told Newsday at the time, “Its no big deal that Ill be 100. A lot of people are doing that. But that Im still working, well, that might be unusual.”

She was similarly modest and witty when AU VU caught up with her in January, musing “I can’t believe that I have reached the age of 100 and some things still stick in my mind.”

Her recollection is remarkable, and, as she shared her past, it became evident that she has fashioned a memorable life.

After Adelphi, Sylvester pursued a master’s in psychology at Columbia University and later studied cryptography at Brooklyn College. “I always loved figures,” she said. “When I took [the course], I had the highest rating that they ever had.”

Sylvester never used her degrees professionally, instead taking time to raise her two children and pursue her love of music and dance. She organized a quartet that performed for many years, and she also took part in folk dancing.

“Folk dancing was one of my pleasures,” she said. “I did it for years with the same partner. We used to entertain at the Russian Bear [a nightclub]…they would give us vodka and lots of food.”

In her years at the Freeport Memorial Library, Sylvester has arranged numerous classical music concerts, ranging from chamber music trios to world-famous harmonica players.

“I love what I do,” she said, explaining why she has yet to retire.

Sylvester is loved as well. She can hardly cross the library without receiving a flurry of smiles, hellos and even hugs from her co-workers.

This article appeared in the Spring 2015 issue of AU VU.  

Tuesday, April 28, 2015

Adelphi University Center for Health Innovation Selected for a PCORI Pipeline to Proposal Award for Capacity and Partnership Building

Focused on Native American Health and Wellness: 
Reservation-Based Diabetes and Obesity Prevention

By Elizabeth Cohn 
Director of the Adelphi University Center for Health Innovation; primary investigator for the project

Native Americans develop diabetes at a rate of 33%--three times greater than Whites and twice that of African Americans. People of all races living with diabetes experience are two to four times greater risk of developing stroke, hypertension, kidney disease, dental and periodontal disease, and blindness. Recently, the members of the Unkechaug Nation have become increasingly concerned about the exponentially rising rate of diabetes on their reservation, as the numbers reflect the national trends. But a window of opportunity exists when lifestyle modifications can stop or significantly delay the progression of disease from pre-diabetes to diabetes type 2. These changes in diet and exercise are best initiated at the community–level, tailored so that they meet the needs of those who are using them.

To understand how to modify an existing set of evidence-based recommendations from the Centers for Disease Control and Prevention, a three-way collaboration has been developed between the Unkechaug Nation, Adelphi University Center for Health Innovation and Winthrop-University Hospital Diabetes and Obesity Institute. The Unkechaug Nation’s Initiative to End Diabetes (UNITED) collaborative proposes to:

(1) outline a set of partnership steps for a community-based effort focused on education and lifestyle modification

(2) explore and design infrastructure for community-engaged research on the reservation

(3) develop a governance structure that would support applications for future funding opportunities

(4) formulate metrics for a measurable outreach plan

(5) develop a guide for other reservations who wish to adapt pre-diabetes and diabetes prevention programs.

Co-investigator of the project is Harry B. Wallace, the chief of the Unkechaug Nation. Virginia Peragallo-Dittko, executive director of the Diabetes and Obesity Institute at Winthrop-University Hospital in Mineola to serve as a consultant.

Monday, April 27, 2015

Fixing Hospital Care is a Matter of Life or Death

by Bonnie Eissner

Running a hospital well or badly has life or death consequences. Wei Liu, Ph.D., and Susan Zori, D.N.P., know this all too well from their long experiences as hospital nurses and their more recent pursuits as academic researchers.

Prior to joining the Adelphi faculty as an assistant professor in the College of Nursing and Public Health, Dr. Liu worked for more than a decade as an emergency room nurse in China and Australia. Dr. Liu became fascinated by the complexities of how nurses, doctors and pharmacists communicate across their various disciplines in order to dispense medications.

What does it mean, for example, that doctors make medication decisions at the central staff station, away from patients’ bedsides? Or that they make their medical ward rounds when nurses are absent? What is the impact on patient care when doctors, nurses and pharmacists conduct separate staff meetings? 

Through interviews with and observations of doctors, pharmacists, nurses and patients, Dr. Liu documented patterns of communication and miscommunication in medication management at a major metropolitan hospital in Melbourne, Australia.

As a nurse in a separate ward at the hospital, Dr. Liu was able to establish credibility and rapport with the professionals and patients she was studying, to the point that they allowed her to videotape their clinical interactions.

Dr. Liu’s ultimate goal was to improve patient safety at the hospital. In addition to publishing papers based on her research, she took her findings back to the hospital professionals. In focus groups, she shared her data and a DVD she produced and encouraged discussion. Her aim, she said, was to “have them look at their own practices to see where the communication gaps might be and how we could improve our interdisciplinary communication and then improve our patient safety.”

Dr. Zori, a clinical assistant professor at Adelphi’s College of Nursing and Public Health, has practiced nursing for 40 years, many of them as a nursing director at prominent hospitals in New York City and on Long Island. During decades of overseeing teams of nurses, she grew curious about why some teams exuded positive energy and excelled while others seemed disgruntled and performed less well. She suspected that the nurse managers’ critical thinking abilities and attitudes played a significant role.

In an often-cited study of nurse managers and their staffs, Dr. Zori and her colleagues validated this hunch. Nurse managers who scored high in seven categories of critical thinking disposition, ranging from open-mindedness and inquisitiveness to truth seeking and cognitive maturity, had staffs who felt better about their work and, as a result, were more likely to provide safer and more effective patient care.

Dr. Zori has since been testing ways to boost the critical thinking skills of up-and-coming nurses. Working with administrators at North Shore LIJ Health System’s Center for Learning and Innovation, for example, she created a critical thinking class for nurses in the system’s fellowship program. From journals that the nurses kept, Dr. Zori observed that many had become more attuned to the importance of being inquisitive and analytical in their work.

In her classes at Adelphi, Dr. Zori encourages critical thinking by emphasizing case studies and interaction. “For me, it’s constantly challenging myself to find a way to get [students] to critically think and to be creative and interactive so that they’re not just learning information, they’re applying it to real-life situations,” she said. 

This article appeared in the Spring 2015 issue of Erudition.

Monday, April 20, 2015

Learning the Principles of Social Network Analysis (SNA) to Better Understand Mexican Migration

By Jacqueline Olvera 

When the Center for Health Innovation (CHI) announced its Summer Scholar Program in 2014, I jumped at the opportunity to apply. CHI made it possible for AU faculty to enroll in a variety of summer skill building courses and seminars offered at the Mailman School of Public Health at Columbia University.  Since I had been working on a project on Mexican migration, I was particularly interested in the Social Network Analysis (SNA) course. I had conducted in-depth interviews with migrants from Tlaxcala, Mexico with funding from the Russell Sage Foundation and was interested in finding out if network analysis would enrich my study. Based on preliminary analysis of these interviews, the data revealed that relationships between migrants were meaningful structures. That is, I was finding that social ties are how migrants find housing, jobs, and information about community resources. And equally as important, the formalized structures of these relationships seemed to be the basis for inclusion and exclusion when forming community. Given my interests in social relationships, I was delighted when I found out that I would indeed be able to enroll in the SNA course. 
The course I participated in provided an excellent introduction to the conceptual and computational principles of SNA. On our first day, we covered what Social Network Analysis is and is not, what counts as network data, and how to collect it.  We spent time using R, a language and platform for statistical computing and graphing in order to manipulate network matrices and visualize network data.  Thereafter, we quickly moved on to a discussion of ego-networks and the meaning of distance, density, and balance within an individual’s networks.  By day three, we covered higher-order network structures: the group and entire networks. All the while, we focused on important network structural features such as equivalence, clustering, centrality, and cohesion.  For example, in a migrant network computing centrality indices might tell us which individual in a network is the most central or popular.  
The fourth day of the course was by the best part – we put our knowledge to work by focusing on applications of SNA.  We explored examples from epidemiological research such as the transmission of AIDS, the structure of adolescent romantic and sexual networks, and the dynamics of smoking in large networks.  Each of these empirically motivated problems gave us a glimpse into how network analysis is applied.  More specifically, we focused on three network processes: Search, Diffusion, and Influence.  And, we replicated analyses of classic studies that examine how network ties facilitate the exchange of employment information as well as the efficiency of job search strategies in networks.

On the final day of the course, we covered statistical models and worked through tutorials in R.  The instructor introduced network autocorrelation and stochastic actor oriented (SIENA) models. Since I had experience with spatial analytic techniques, the network autocorrelation model was familiar. In a recently published paper, I used neighborhood-level data to estimate spatial lag models that follow similar autocorrelation properties.
After completing the course, I have spent much time thinking more about how I might use the insights of network analysis to ask, what network practices in the small migrant community I have been studying might tell us something about the raising and blurring ethnic boundaries? My hope is that by integrating social network analysis into my research I will make new inroads into the ways in which migrant communities come to make sense of the places they live and work in.

A New Approach to Mental Healthcare

by Bonnie Eissner

For too many people with mental illness, crisis medical care has become the norm—a trend that has a great personal and financial toll. In 2013, hospitalizations for Nassau County residents who received Medicaid mental health services cost the agency more than $35 million. The fact that many patients are rehospitalized within 30 days of discharge calls into question the effectiveness of this crisis approach to mental healthcare.

To address this issue, New York State is now working with physicians and health clinics to provide health homes for Medicaid recipients who suffer from chronic mental and physical illness. The health home concept is to offer an integrated system of care in which a patient’s needs—from scheduling medical appointments to providing transportation to those appointments to setting up social services—are coordinated by a small interdisciplinary team or an individual care manager.  

Central Nassau Guidance & Counseling Services, Inc., based in Hicksville, New York, is one agency that offers health home services. Last year, with funds from a New York State Innovation Fund grant, the agency established its Stability at Home pilot program to help Medicaid recipients with serious mental health conditions transition from hospitalization or haphazard community care into a more stable health home system of care.

Chrisann Newransky, Ph.D., an assistant professor at Adelphi’s School of Social Work, explained that a primary goal of this new approach is to facilitate the many healthcare responsibilities and tasks that seem routine to the rest of us. “If people stay connected to the system—they don’t drop out of the system—then they’re less likely in general to use emergency care, which we know is completely expensive and not all [that] effective,” she said.

After consulting with Adelphi’s Center for Nonprofit Leadership and its faculty director, Peter Chernack, Ph.D., Central Nassau Guidance & Counseling tapped Dr. Newransky, whose primary research interests are disease prevention and health disparities, to be the external evaluator of Stability at Home.

Dr. Newransky is advising on the best sources of data and approaches to data collection for evaluating the program’s effectiveness for the nearly 150 participants and their families. She is also conducting independent follow-up research with the participants and families.

“What’s unique about the [program] design is that different organizations are coming together,” she said, noting that the Long Island Crisis Center and Options for Community Living, Inc. are also involved in the project. This coming summer, Dr. Newransky plans to interview the leaders of the three organizations in order to document this model of interagency collaboration and understand what worked well and what improvements can be made.

This article appeared in the Spring 2015 edition of Erudition