Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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Watch Live: Health Policy through 2020: The ACA, Payment Reform and Global Challenges.

The event begins at 1 p.m. PST and will end at approximately 5:45 p.m. PST. For details about the speakers and agenda, please see this page.

The stream will be turned on about 30 minutes before the event begins. Be sure Adobe Flash is turned on and updated.

 

 

 

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Abstract:  Conventional wisdom suggests that if private health insurance plans compete alongside a public option, they may endanger the latter's financial stability by cream-skimming good risks. This paper argues that two factors may contribute to the extent of cream-skimming: (i) degree of horizontal differentiation between public and private options when preferences are heterogeneous; (ii) whether contract design encourages choice of private insurance before information about risk is revealed. I explore the role of these factors empirically within the unique institutional setting of the German health insurance system. Using a fuzzy regression discontinuity design to disentangle adverse selection and moral hazard, I find no compelling support for extensive cream-skimming of public option by private insurers despite their ability to fully underwrite risk. A model of demand for private insurance supports the idea that heterogeneity in non-pecuniary preferences and long-term structure of private insurance contracts may be muting cream-skimming in this setting.

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A study of health insurance claims showed that patients undergoing 11 of the most common types of surgery were at an increased risk of becoming chronic users of opioid painkillers, according to researchers at the Stanford University School of Medicine.

But the slight overall increase in risk of 0.5 percent in no way suggests that patients should skip surgery over concern of becoming addicted to opioids, the study said. Instead, it’s a reminder that surgeons and physicians should closely monitor patients’ use of opioids after surgery — even patients with no history of using the pain-relieving drugs — and use alternate methods of pain control whenever possible.

The study was published July 11 in JAMA Internal Medicine.

“For a lot of surgeries there is a higher chance of getting hooked on painkillers,” said the study’s lead author, Eric Sun, MD, PhD, a Stanford Health Policy researcher and instructor in anesthesiology at Stanford. Sean Mackey, MD/PhD, professor of anesthesiology, is the senior author of the study and SHP's Laurence Baker was another co-author of the study.

Patients who had knee surgery had the largest risk, as they were roughly five times more likely than a control group of nonsurgical patients to end up using opioids chronically, followed by those undergoing gall bladder surgery, whose risk was three-and-a-half times greater than those in the control group.

“We also found an increased risk among women following cesarean section, which was somewhat concerning since it is a very common procedure,” adding that the risk was 28 percent higher than among the control group, Sun said.

Other factors that contributed to an increased risk for chronic opioid use included being male, elderly, taking antidepressants or abusing drugs.

Eric Sun

The opioid abuse epidemic

Since prescription painkillers became cheap and plentiful in the mid-1990s, drug overdose death rates in the United States have more than tripled, according to the Centers for Disease Control and Prevention. Seventy-eight Americans die every day from an opioid overdose, it reported.

Previous studies have shown increased risks of chronic opioid use post-surgery, but unlike past studies, Sun and colleagues set out to examine patients who hadn’t received prescriptions for opioids for at least one year prior to surgery. Among the opioid prescription drugs examined in the study were hydrocodone, oxycodone and fentanyl — the drug responsible for the recent accidental overdose death of legendary musician Prince.

The researchers examined health claims from 641,941 privately insured patients between the ages of 18 and 64 who had not filled an opioid prescription in the year prior to surgery, then compared them with about 18 million nonsurgical patients, who also hadn’t received opioid prescriptions for at least a year. The claims were filed between 2001 and 2013 and provided by Marketscan, a database of 35 million beneficiaries.

Except for the minor procedures known to be somewhat pain-free, such as a cataract surgery and laparoscopic appendectomy, all 11 types of surgery were associated with an increased risk of chronic opioid use, the study said.

Other pain-control measures

“The message isn’t that you shouldn’t have surgery,” Sun said. “Rather, there are things that anesthesiologists can do to reduce the risk by finding other ways of controlling the pain and using replacements for opioids when possible.”

Sun said he and his colleagues in surgery and anesthesia at Stanford try to use regional anesthetics when possible to reduce the need for opioids post-surgery. He added that patients should also be encouraged to use pain-management alternatives such as Tylenol following surgery.

Sun is featured in this CBS news story:

 

“Even when taken exactly as prescribed, opioids carry significant risks and side effects,” said study co-author Beth Darnall, PhD, clinical associate professor of anesthesiology and author of the book Less Pain, Fewer Pills: Avoid the Dangers of Prescription Opioids and Gain Control over Chronic Pain. “Ideally, opioids are avoided in treating chronic pain, and pain treatment should emphasize comprehensive care, including physical therapy, pain psychology and self-management strategies.”

As a pain psychologist and clinician-scientist, Darnall emphasizes alternate methods of pain management based on evidence-based techniques that can help calm the nervous system such as diaphragmatic breathing, progressive muscle relaxation and mindful meditation.

She is studying the use of a pain psychology class at Stanford for women undergoing surgery for breast cancer called “My Surgical Success” designed to help patients develop a personalized pain-management plan to control the anxiety associated with anticipating surgical pain.

“It turns out that a lot of chronic pain develops from surgery, and pre-surgical pain ‘catastrophizing’ is a major risk factor for having a lot of pain,” Darnall said. “We hope that by optimizing patients’ psychology — and giving them skills to calm their own nervous system — they will have less pain after surgery, need fewer opioids and recover quicker.”

The research was funded by a grant from the Foundation for Anesthesia Education and Research and the Anesthesia Quality Institute.

Stanford’s Department of Anesthesiology also supported the work.

 

Tracie White is a science writer for the medical school’s Office of Communication & Public Affairs. Email her at tracie.white@stanford.edu.

 

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The Asia Health Policy Program at Stanford’s Shorenstein Asia-Pacific Research Center, in collaboration with scholars from Stanford Health Policy's Center on Demography and Economics of Health and Aging, the Stanford Institute for Economic Policy Research, and the Next World Program, is soliciting papers for the third annual workshop on the economics of ageing titled Financing Longevity: The Economics of Pensions, Health Insurance, Long-term Care and Disability Insurance held at Stanford from April 24-25, 2017, and for a related special issue of the Journal of the Economics of Ageing.

The triumph of longevity can pose a challenge to the fiscal integrity of public and private pension systems and other social support programs disproportionately used by older adults. High-income countries offer lessons – frequently cautionary tales – for low- and middle-income countries about how to design social protection programs to be sustainable in the face of population ageing. Technological change and income inequality interact with population ageing to threaten the sustainability and perceived fairness of conventional financing for many social programs. Promoting longer working lives and savings for retirement are obvious policy priorities; but in many cases the fiscal challenges are even more acute for other social programs, such as insurance systems for medical care, long-term care, and disability. Reform of entitlement programs is also often politically difficult, further highlighting how important it is for developing countries putting in place comprehensive social security systems to take account of the macroeconomic implications of population ageing.

The objective of the workshop is to explore the economics of ageing from the perspective of sustainable financing for longer lives. The workshop will bring together researchers to present recent empirical and theoretical research on the economics of ageing with special (yet not exclusive) foci on the following topics:

  • Public and private roles in savings and retirement security
  • Living and working in an Age of Longevity: Lessons for Finance
  • Defined benefit, defined contribution, and innovations in design of pension programs
  • Intergenerational and equity implications of different financing mechanisms for pensions and social insurance
  • The impact of population aging on health insurance financing
  • Economic incentives of long-term care insurance and disability insurance systems
  • Precautionary savings and social protection system generosity
  • Elderly cognitive function and financial planning
  • Evaluation of policies aimed at increasing health and productivity of older adults
  • Population ageing and financing economic growth
  • Tax policies’ implications for capital deepening and investment in human capital
  • The relationship between population age structure and capital market returns
  • Evidence on policies designed to address disparities – gender, ethnic/racial, inter-regional, urban/rural – in old-age support
  • The political economy of reforming pension systems as well as health, long-term care and disability insurance programs

 

Submission for the workshop

Interested authors are invited to submit a 1-page abstract by Sept. 30, 2016, to Karen Eggleston at karene@stanford.edu. The authors of accepted abstracts will be notified by Oct. 15, 2016, and completed draft papers will be expected by April 1, 2017.

Economy-class travel and accommodation costs for one author of each accepted paper will be covered by the organizers.

Invited authors are expected to submit their paper to the Journal of the Economics of Ageing. A selection of these papers will (assuming successful completion of the review process) be published in a special issue.

 

Submission to the special issue

Authors (also those interested who are not attending the workshop) are invited to submit papers for the special issue in the Journal of the Economics of Ageing by Aug. 1, 2017. Submissions should be made online. Please select article type “SI Financing Longevity.”

 

About the Next World Program

The Next World Program is a joint initiative of Harvard University’s Program on the Global Demography of Aging, the WDA Forum, Stanford’s Asia Health Policy Program, and Fudan University’s Working Group on Comparative Ageing Societies. These institutions organize an annual workshop and a special issue in the Journal of the Economics of Ageing on an important economic theme related to ageing societies.

 

More information can be found in the PDF below.


 

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Geir H. Holom, MD, is a Visiting Scholar at Stanford School of Medicine (CHP/PCOR) from the University of Oslo. His research focuses on the expansion of private for-profit hospitals in the Nordic countries and its effect on prices, quality of care and selection of patients. He received a BSc in Economics and Business Administration from the Norwegian School of Economics and an MD from the University of Bergen. While in medical school, he conducted research on patients diagnosed with head and neck cancer who underwent head and neck reconstruction using microsurgery. Since receiving his MD, he has worked as a physician in both primary care and specialized health services. Prior to entering the field of medicine, he worked in the business and finance sector.

Adjunct Affiliate at the Center for Health Policy and the Department of Medicine
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Stanford pediatrician Paul Wise stooped below the black tarp roof of a cinderblock house in Guatemala to offer his condolences to a mother who had just lost her child.

“Doctor Pablo,” as he is known in the communities around San Lucas Tolimán, talked softly as he relayed his sympathies to the mother, whose 9-year-old son had been a patient of his.

Stanford’s Children in Crisis Initiative seeks to save the lives of children in areas of poor governance. In Guatemala, their efforts work toward eliminating death by malnutrition for children under 5.

The boy’s genetic disorder would have been terminal anywhere, but thanks to Wise and local health promoters, the boy’s family had years with him instead of months.

They found the doctor through the Guatemala Rural Child Health and Nutrition Program, a collaboration between Wise and the health promoters to eliminate death by malnutrition for children under 5.

While Wise spoke to the heartbroken mother, his Stanford research assistant Alejandro Chavez helped the promoters set up inside a local community center to measure the weight and height of local kids to determine their nutrition level.

Chavez and the promoters had worked together for months to create an app for tablets that will make it easier to find malnourished children.

The app they designed will decrease training time for new health promoters and allow the program to expand. The goal is to distribute the app globally to help programs in other countries tackle malnutrition.

Children in crisis

As recently as 2005, about one of every 20 children in this rural area of Guatemala died before their 5th birthday. Almost half the deaths were associated with severe malnutrition.

“The death of any child is always a tragedy, but the death of any child from preventable causes is always unjust,” said Wise, a Stanford Health Policy core faculty member.

Along with other faculty from the Freeman Spogli Institute for International Studies (FSI) and the School of Medicine, Wise created the Children in Crisis Initiative to save the lives of children in areas of poor governance. The program brings together Stanford researchers and students across disciplines.

Nowhere are their efforts better illustrated than in the rural communities around San Lucas Tolimán, in the central mountains of Guatemala.

The program’s effectiveness rests on a deep respect for the local communities merged with innovation by Stanford researchers.

“It’s absolutely essential to any program that the people in need be part of the solution,” said Wise. Unlike many nongovernmental organizations and health programs, Wise believes the way to create a sustainable health system is for the locals to run it, so the health promoters manage the program’s day-to-day activities.

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This leaves the Stanford team free to focus on innovation – such as the new app. They believe the technology could change child health programs around the world. Wise’s team has partnered with Medic Mobile – a nonprofit that creates open-source software for health care workers – which plans to distribute the app to other areas suffering from malnutrition.

The six Android tablets purchased by Children in Crisis are enough to monitor the program’s 1,500 kids through the app.

Role of nutrition

When done well, nutrition surveillance is very effective at decreasing child mortality in poor countries.

“Nutrition contributes enormously to health and well-being,” Wise said as he walked through Tierra Santa, a small community near San Lucas, making house calls. “So the focus of our work turned to improving young child nutrition. It’s not an easy thing to do in a place that’s extremely poor.”

Wise and his colleagues – Stanford medical student Tori Bawel and Stanford professor of pediatrics Lisa Chamberlain – made their rounds during their visit in March. Evidence of poverty was everywhere.

Here, clean tap water is a dream and even the sturdier homes often lack four walls or paned windows, though the children were neatly dressed in T-shirts or colorful traje, traditional Mayan clothing.

It’s hard to provide proper nutrition when most families can’t find enough work to buy adequate food. But a little help can make a big difference.

Bawel, a first-year medical student who plans a career improving health in areas of poverty, was struck by the impact the promoter program has had on the community.

“There are children who need supplements and nutrition to stay alive,” she said. “Without this program, that infrastructure does not exist.”

With FSI’s assistance, the nutrition program distributes Incaparina, a supplement of cornmeal, soy and essential nutrients. The sweet, mealy drink helps the program’s most malnourished children get back on track.

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Every two months, the promoters gather each community’s children to measure their weight and height. Children and their mothers sit patiently, waiting for their turn. The children enjoy a cup of Incaparina, and their mothers eagerly listen to the promoters’ tips for keeping their children healthy.

“It’s very important to me,” said Elsira Rosibel Samayoa, who brought her 2-year-old to be measured. “There are mothers who don’t understand the importance of monitoring their children’s weight, but I do.”

Since its implementation in 2009, the Stanford program has slashed nutrition-based mortality in the participating communities by about 80 percent and decreased severe malnutrition by more than 60 percent – saving hundreds of children’s lives.

However, nutrition surveillance and intervention isn’t easy. Tracking nutrition takes training and expertise, and when the local population rarely exceeds a fourth-grade education, learning these skills is especially challenging. Detailed graphs on a standard growth chart are essential to identifying malnourished children.

“The community health workers are extremely capable and smart, but some have never seen a graph before,” said Wise. “Think about what it is to try to explain a graph to someone for the first time.”

It takes the health workers about three years to learn to graph and then interpret the results for intervention.

Wise said, “So we all got together and said, ‘How do we make this easier to do?’”

The app was the answer.

‘Let’s create an app’

Enter Alejandro Chavez, a recent Stanford computer science graduate and Stanford Health Policy research assistant. He developed the app to collect child health data, then determine the child’s degree of malnutrition and suggest intervention.

“The major goal was to lower training requirements and make programs like this simpler to start and maintain,” said Chavez, who now lives and works in Guatemala, where he gets daily feedback from the health promoters.

“I feel like they’ve been very honest with me about things I need to improve,” he said.

Cesia Lizeth Castro Chutá is a senior coordinator for the program who has worked with Chavez to ensure that the app meets the promoters’ needs.

“The tablet automatically generates the information we need to know,” she said. “It becomes easier to confirm that a child is malnourished and needs supplements.”

Looking forward
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With the app’s launch, it looks like training time for the promoters will be reduced from three years to less than six months. That means new communities can be incorporated into the program quickly, creating broader access to care.

Meanwhile, many health programs around the world are waiting to see how well the Stanford app works in Guatemala.

Josh Nesbit, a Stanford alumnus and Medic Mobile CEO, said, “As more health programs recognize the importance of nutrition and implement community-based interventions, screening and surveillance tools will be critical. We must learn from Dr. Wise’s success.”

 

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Millions of people in the developing world could be spared from lifelong disability — or possible death — from parasitic worm diseases under a vastly expanded treatment program that is cost-effective, according to a new analysis led by Stanford University School of Medicine researchers.

The modeling analysis suggests that current World Health Organization guidelines may need to be revised to more effectively combat parasitic worm disease, which afflicts some 1.5 million people across the globe. It points the way to a sweeping new program in which more than 1 billion doses of two low-cost drugs — often donated — could be dispensed in sub-Saharan Africa to largely knock out these infections.

Using prevalence and cost-effectiveness models, the researchers found it would be economically worthwhile to make these drugs available to schoolchildren every year in communities where as few as 5 percent have schistosomiasis, as opposed to the 50 percent threshold now recommended by WHO. It would also be feasible to expand treatment to adults and preschool-aged children, who often aren’t included in WHO guidelines, and to combine treatment in areas heavily afflicted by the two most common types of worm infections, which are caused by schistosomes and the soil-transmitted helminths, said Nathan Lo, a Stanford MD-PhD student and lead author of the study.

“If we incorporate this new evidence, we can start to consider elimination of this as a public health problem,” Lo said. “Substantial populations are not receiving treatment under current guidelines that could benefit under a cost-effective program.”

A prevalent ailment

Based on the analysis, it would make economic sense to increase treatment for schistosomiasis by six times the current estimated needs and twice current estimates for soil-transmitted helminth infections in sub-Saharan Africa, said Jason Andrews, MD, assistant professor of medicine and the senior author of the study.

“These worms cause an array of health effects from anemia, malnutrition and growth stunting to infertility, cancer of the urinary tract and liver cirrhosis,” Andrews said. “Mass drug administration of the scale we’ve proposed could prevent many of these problems. Our analysis indicates that this would not only be effective but also a cost-effective investment when compared alongside other health interventions.”

The study was published online June 7 in The Lancet Infectious Diseases.

The other Stanford co-author of the paper is Eran Bendavid, MD, assistant professor of medicine and a core faculty member at Stanford Health Policy. Researchers in Switzerland, Canada and the Ivory Coast also contributed to the study.

Parasitic worm diseases are among the most prevalent ailments in the developing world, with documented transmission in 78 countries, according to WHO. About 150,000 people die of complications every year from these parasitic infections.

The two major categories of parasitic worms are the Schistosoma worms and the soil-transmitted helminths. The Schistosoma parasites reproduce in freshwater snails and can penetrate the skin of people who swim in contaminated lakes or rivers or who walk in muddy fields. The helminth worms, such as roundworm, whipworm and hookworm, are mainly found in soil. These worms may produce small eggs in the body that are expelled in human feces and can be transmitted to others through ingestion of this material in soil or water supplies.

Low-cost treatments

Both diseases are easily treated with low-cost drugs that have relatively few side effects, Lo said. Schistosomiasis is typically treated with praziquantel, which costs about 21 cents a pill and can reduce egg production by 98 percent, he said. The helminths can be readily treated with albendazole, which costs about 3 cents a pill and can reduce the number of worm eggs by as much as 95 percent.

In the past 15 years, there has been a significant reduction in the global prevalence of these infections and greater access to medication, with 15 to 45 percent of those who need it getting treatment, according to WHO. Yet these diseases remain a persistent problem in many parts of the world, including Africa, South America and South Asia.

In February, WHO issued a press release urging further expansion of treatment where the disease is most endemic, with a goal of reaching 75 percent coverage in preschool- and school-age children by 2020. However, the WHO guidelines were written a decade ago and have not been updated to address changing goals and information. 

“The guidelines were based on the best judgment of experts at the time, but I think there’s fairly broad agreement that it’s time to revisit these in view of new data, analyses and priorities,” Andrews said.

He and his colleagues decided to take a systematic look at how best to control these infections, using a variety of models to examine prevalence and transmission patterns across Africa, as well as a cost-effectiveness model to determine what made the most economic sense.

They found that it would be most cost-effective to treat Schistosoma worm infections annually when prevalence among children was as low as 5 percent — well below WHO’s current threshold of 50 percent prevalence. In the case of helminth infections, they found it would be economically worthwhile to treat school-age children when prevalence was 20 percent — the same level currently recommended by WHO.

Their analysis also shows that it would be feasible to include preschool-age children and adults in the treatment program, as both age groups may experience the disabling symptoms of parasitic infection but have not been traditionally included in these treatment programs. Moreover, adults can easily reinfect children through fecal contamination in the household environment, Lo said.

Finally, the researchers found that it would save money to treat the two diseases at the same time, rather than as separate programs because most of the cost is involved in delivering the treatment, not in the pills themselves.

“It makes sense to work together to treat multiple diseases when they are in a single setting,” Lo said. “If you have health-care workers who go into a village to do one treatment, they will have go back to the village for a different treatment, and the second visit costs just as much.”

If these proposed recommendations for sub-Saharan Africa were followed, it would require a sixfold increase in treatment for Schistosoma infections — from about 120 million to more than 750 million doses annually — and a doubling of the number of doses for helminth infections from 335 million to nearly 660 million a year, the researchers estimate.

Question of affordability

The scientists did not calculate the cost of the total proposed program, and it’s unclear whether current funders would be willing to increase their support. These programs are currently funded by the U.S. Agency for International Development, local ministries of health and various nonprofits, as well as pharmaceutical companies that donate the drugs.

In scaling up treatment, it would also be important to be mindful of the potential for drug resistance, although the proposed guidelines meet the best practices for avoiding the emergence of resistance, Lo said. He said resistance with these drugs has been documented in animals, though not in human populations.

The research was funded by the Doris Duke Charitable Foundation, the Mount Sinai Hospital-University Health Network AMO Innovation Fund and the Stanford University Medical Scholars Program. 

 

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Nancy Lonhart is the calm at the center of the storm for the 70 people working at Stanford Health Policy.

When Nancy Lonhart arrives at her office in Encina Commons she is ready to “hit the ground running” while maintaining a patient and understanding demeanor with everyone – faculty, researchers, fellows, students, staff, visiting VIPs, the janitor and the UPS delivery person.

She is the calm at the center of the storm for the 70 people working at the Center for Health Policy at the Freeman Spogli Institute for International Studies, and the Center for Primary Care & Outcomes Research in the Department of Medicine at Stanford School of Medicine.

Nancy Lonhart, associate director of the Center for Health Policy at the Freeman Spogli Institute for International Studies, and division manager of the Center for Primary Care & Outcomes Research in the Department of Medicine, is one of three winners of the 2016 Amy J. Blue Award. (Image credit: L.A. Cicero)

The two centers, which are part of a multidisciplinary enterprise known as Stanford Health Policy, conduct rigorous research to lay the foundation for better domestic and international health policy and health care in the United States and around the world.

Lonhart is associate director of the Center for Health Policy, and division manager of the Center for Primary Care & Outcomes Research. She provides administrative and financial leadership, guidance and oversight to the centers, including strategic planning and development, finance and research administration, human resources and student affairs.

“My goal is to make everyone’s life, work and research run as smoothly and as efficiently as possible,” said Lonhart, who joined the organization in 2007.

Lonhart is one of this year’s winners of the Amy J. Blue Award, which honors staff members who are exceptionally dedicated, supportive of colleagues and passionate about their work.

The other two winners are Lynn Dixon, faculty data systems specialist in Faculty Affairs, which is part of the Office of the Provost; and Jörg Grawert, a lead maintenance multicraft trade technician in Student Housing, which is part of Residential & Dining Enterprises.

President John Hennessy will present each recipient with an Amy J. Blue Award on Tuesday, May 17, in the Gunn Atrium of Bing Concert Hall, which is located at 327 Lasuen Street, at Museum Way. The ceremony, which is open to families, friends and colleagues of the recipients, is scheduled for 3:30 p.m. Refreshments will be served.

Work, family, life

After graduating from the University of California, Davis, Lonhart “followed her heart” to the Bay Area for her boyfriend, Hal, now her husband of 32 years. She landed a job in nursing administration at Stanford Hospital, then known as Stanford Health Services.

In 1992, after a 12-year battle with kidney disease, a routine blood test revealed that her kidneys were failing. Four months later, Lonhart received a kidney from her brother, Bill.

“When it came time for the transplant surgery, all I had to do was walk downstairs and check myself into C-2, the transplant unit at the time,” Lonhart said with a laugh. “It’s been a glorious 23-year journey since then to become who I am and what I am – much of it thanks to the people and the profound sense of community I have here at Stanford.”

Lonhart and her husband, Hal Lonhart, have two daughters – Rita and Julia.

In 2001, Lonhart became the administrator for the Department of Anthropological Sciences at Stanford and moved into an office on the Main Quad. Six years later, she joined Stanford Health Policy.

Lonhart, who was a member of the track team in high school, still puts on her running shoes – and her swimsuit – for the Transplant Games of America, a multi-sport event for individuals who have undergone life-saving transplant surgeries. She has competed in the 100-, 200- and 400-meter races and the long jump and in swimming events. In 1998, she was named “Female Athlete of the Games.”

“We took the girls all over the United States and Europe – that’s what made the games so much fun,” Lonhart said. “Of course, the games are much more than the competitions. They are the chance to share your story with people who have struggled through the common, everyday motions of life. At the games you hear about dreams. You hear about hope. You talk with families who made the extraordinary decision to save a life through donation. It is an incredibly powerful, indescribable experience. Those years were a beautiful and wonderful journey we shared with the girls as they were growing up.”

Praise from colleagues

Colleagues said Lonhart has an “unwavering can-do attitude” and inspires the best in everyone who works at the center. In addition, colleagues said Lonhart is always looking for ways to enhance the skills and further the careers of her staff.

Kathryn McDonald, executive director and senior scholar of the Center for Primary Care & Outcomes Research, said Lonhart works many hours – tirelessly – because she cares so deeply about the work and the people.

“When Nancy asks, ‘How are you?’ her earnestness elicits how I am really doing,” McDonald said. “It opens up exchanges that we need to have – and work problems get solved. She does this with everyone. She is grounded, and ever so capable in knowing just what is needed to work in a customized fashion with each and every person she works with. Nancy is the heart, soul and engine of our centers. Many people look to our centers and wonder how it is possible to have such a great work environment with such incredible faculty productivity. Nancy. She makes it all possible, in an incredibly humble way.”

David Studdert, a professor of medicine and of law at Stanford, said Lonhart has been instrumental in helping Stanford Health Policy to grow over the last decade into “one of the best, most vibrant places in the world” to do health policy research and teaching. He said Lonhart has played an important role in creating the atmosphere of collaboration and intellectual excitement that characterizes the Center for Health Policy.

“Nancy is calm, unfailingly positive and amazingly good at what she does,” he said. “She is a patient teacher who understands the way university administration works – no small feat. She is a diplomat and expert negotiator. She believes very strongly in the mission and work of the center and this belief clearly shapes the way she approaches her job. Despite all of this talent and accomplishment, Nancy seeks no limelight. She is a quiet achiever.”

Douglas Owens, a professor of medicine and director of the Center for Primary Care & Outcomes Research and the Center for Health Policy, said Lonhart has been instrumental in helping develop and implement the strategic plan for the centers, and for assessing and guiding their progress.

“Nancy works with all of the faculty in the two centers daily, managing a broad range of issues with the Department of Medicine, the Department of Pediatrics and other campus research groups,” Owens said.

“The skill and talent she brings to her work with the faculty is reflected in the universal acclaim our faculty have for Nancy’s work. She manages exceptionally complex grants, contracts and human resources both in the School of Medicine and on the main campus, particularly in the Freeman Spogli Institute for International Studies. Nancy’s work has contributed immeasurably to the mission of our centers, to the success of our faculty, and to building a truly extraordinary staff. She is richly deserving of the Amy J. Blue Award.”

 

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Please note: All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Abstract:

Emergency Departments (ED) are critical to the U.S. health care system, and ED closures can have a profound effect on a community.  On one hand, prior literature has documented some adverse effects of ED closures. On the other hand, it has been posited that closures of EDs could improve acute care by removing poor-performers from the market. Moreover, permanent closure of a local ED could have an amplified effect for patients experiencing time-sensitive illnesses requiring prompt intervention, such as acute myocardial infarction (AMI). In this study using nationally representative data, we explore the mechanisms through which permanent ED closure affects patient access, treatment, and health outcomes in a community.  Specifically, we compare changes in access to cardiac technology (availability of cath lab, cardiac care unit, and cardiac surgery capacity), treatment received (PTCA and thrombolytic therapy), and health outcomes (30-day, 90-day, and 1-year mortality, and 30-day all cause readmission) among Medicare AMI patients whose communities experience varying degrees of increase in driving time to their next available ED when the closest ED to the community shuts down, relative to patients from communities that do not experience any permanent ED closure.

In collaboration with Renee Hsia, UCSF.

Yu-Chu Shen
Seminars
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All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Abstract:

Efforts to understand the dramatic declines in mortality over the past century have focused on life expectancy. However, understanding changes in disparity in age of death is important to understanding mechanisms of mortality improvement and to devising policy to promote health equity. We derive a novel decomposition of variance in age of death, a measure of inequality, and apply it to cause-specific contributions to the change in variance among the G7 countries from 1950 to 2010. We find that the causes of death that contributed most to declines in the variance are different from those that contributed most to increase in life expectancy, in particular they affect mortality at younger ages. We also find that for two leading causes of death, cancers and CVD, there are no consistent relationships between changes in life expectancy and variance either within countries over time or between countries. These results show that promoting health at younger ages is critical for health equity and that policies to control cancer and CVD may have differing implications for equity.

Benjamin Seligman
Seminars
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