Faculty

Chenjuan Ma headshot

Chenjuan Ma

PhD

Assistant Professor

1 212 992 7173

433 First Avenue
New York, NY 10010
United States

Accepting PhD students

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Professional overview

Chenjuan Ma is an assistant professor and health services researcher at NYU Rory Meyers College of Nursing. Her research, which focuses on understanding how to optimize nursing care and patient outcomes, particularly in the home healthcare setting, utilizes theories and methodologies from different disciplines, including but not limited to sociology, statistics, medicine, and nursing. Ma also has expertise in large data sets and quantitative methods.

Prior to joining the NYU Rory Meyers faculty, Ma was a post-doctoral fellow in the National Database of Nursing Quality Indicators at the University of Kansas.

Ma holds a PhD from University of Pennsylvania and MSN and BSN from Xi'an Jiaotong University, China.

Education

PhD - University of Pennsylvania (2012)
MSN - Xi'an Jiaotong University, China (2008)
BSN - Xi'an Jiaotong University, China (2005)

Honors and awards

Scholarship, Columbia University Epidemiology and Population Health (2019)
Fellowship, NYU CTSI Mentor Development Program (2018)
President Gutmann Leadership Award for Travel, University of Pennsylvania (2011)
Rising Star, Sigma Theta Tau International Honor Society of Nursing Xi Chapter (2011)
ThinkSwiss Award, University of Basel, Switzerland (2011)

Specialties

Nursing workforce
Home care
Policy
Research methods

Professional membership

AcademyHealth
American Nurses Association (ANA)
Eastern Nursing Research Society (ENRS)
Sigma Theta Tau International Honor Society of Nursing (STTI)

Publications

Publications

Detecting Disparities in Medication Management Among Limited English Proficient and English Proficient Home Health Patients

Miner, S. M., Squires, A. P., Ma, C., McDonald, M. V., & Jones, S. A. (2019). Home Health Care Management and Practice. 10.1177/1084822319865546
Abstract
According to the U.S. census Bureau, close to 20% of the U.S. population speaks a language other than English at home. Home health care (HHC) patients who speak English less than very well or have limited English proficiency (LEP) are at an increased risk for medication mismanagement and serious health consequences. The purpose of this study was to examine if there were differences in medication management between English-speaking patients and patients with LEP receiving HHC services. Data for this cross-sectional observation study were collected from 2010 to 2014. Medication management was measured by two items in the Centers for Medicare and Medicaid Services–mandated Outcomes Assessment Information Set (OASIS). All patients in the database who were taking medications and had a valid admission and discharge assessment from HHC were included in the analysis. Inverse probability of treatment weighting (IPTW) with a marginal structural model was used to address potential imbalances in observed patient characteristics when estimating the effect of having LEP or being an English-speaking HHC patient on changes in medication management over the course of a HHC episode. Estimates from marginal structural model with inverse probability weighting indicate that being LEP was associated with less improvement in medication management and increased likelihood of getting worse over the course of a HHC episode. This study is one of the first to demonstrate that patients with LEP experience disparities in medication management when compared to English-speaking patients in HHC.

Extended afternoon naps are associated with hypertension in women but not in men

Yang, Y., Liu, W., Ji, X., Ma, C., Wang, X., Li, K., & Li, J. (2019). Heart and Lung. 10.1016/j.hrtlng.2019.09.002
Abstract
Background: The impact of afternoon napping duration on the risk of hypertension has not been well established, particularly with regards to sex and age differences. Objective: To examine the association between afternoon napping duration and hypertension stratified by sex and age among Chinese adults over 45 years of age. Methods: The 2011–2012 survey of the China Health and Retirement Longitudinal Study (CHARLS) was used, including 7,980 participants. We conducted logistic regression models in the overall sample, and then stratified by sex and age groups. Results: Middle-aged and older women who napped over 90 min were 39% and 54% more likely to have hypertension, respectively; however, the associations were not significant in middle-aged and older men. Conclusion: Extended afternoon napping (≥90 min) was associated with hypertension in both the middle-aged women and older women but not in men. Future studies are needed to further examine the association and possible mechanisms.

Home health care services to persons with dementia and language preference

Ma, C., Herrmann, L., Miner, S., Stimpfel, A. W., & Squires, A. (2019). Geriatric Nursing. 10.1016/j.gerinurse.2019.08.016
Abstract
Despite the rapid increase in the number of persons with dementia (PWD) receiving home health care (HHC), little is known of HHC services patterns to PWD of varied backgrounds, including language preference other than English. Analyzing data of 12,043 PWD from an urban home health agency, we found on average PWD received 2.48 skilled visits or 1.88-hour skilled care and 5.81 aide visits or 24.13-hour aide care weekly. Approximately 63% of the skilled visits were from nurses. More non-English preferred PWD received aide visits, compared to English preferred PWD (44% vs. 36%). The type and intensity of HHC services were associated with language preference; when stratified by insurance, non-English preference was still significantly associated with more HHC aide care. Our study indicated that HHC services (both type and amount) varied by language preference and insurance type as an indicator of access disparities was a significant contributor to the observed differences.

Hospital readmission in persons with dementia: A systematic review

Ma, C., Bao, S., Dull, P., Wu, B., & Yu, F. (2019). International Journal of Geriatric Psychiatry. 10.1002/gps.5140

How language barriers influence provider workload for home health care professionals: A secondary analysis of interview data

Squires, A., Miner, S., Liang, E., Lor, M., Ma, C., & Witkoski Stimpfel, A. (2019). International Journal of Nursing Studies, 99. 10.1016/j.ijnurstu.2019.103394
Abstract
BackgroundIncreasingly, patients with limited English proficiency are accessing home health care services in the United States. Few studies have examined how language barriers influence provider role implementation or workload in the home health care setting.ObjectivesTo explore home health care professionals’ perspectives about how workload changes from managing language barriers influence quality and safety in home health care.DesignA qualitative secondary data analysis using a summative content analysis approach was used to analyze existing semi-structured interview data.SettingA large urban home health care agency located on the East Coast of the United States.ParticipantsThirty five home health care providers [31 registered nurses, 3 physical therapists, 1 occupational therapist].ResultsA total of 142 discrete incidents emerged from the analysis. Overall, home health care providers experienced distinct shifts in how they implemented their roles that added to their workload and time spent with Limited English Proficiency patients and family members. Providers were concerned about interpretation accuracy and perceived it as potentially posing risks to patient safety. Changes in work patterns, therefore, sought to maximize patient safety.ConclusionsHome health care providers decision-making about how they adapt practice when faced with a language barrier is a sequence of actions based on awareness of the patient’s language preference and if they spoke another language. Subsequent choices showed proactive behaviors to manage increased workload shaped by their perceived risk of the threats posed by the quality of interpreter services. Future research should develop quantitative models examining differences in workload when caring for limited English proficiency versus English speaking patients as well as the relationship between visit length and patient outcomes to determine optimal quality models.

The association between nurse shift patterns and nurse-nurse and nurse-physician collaboration in acute care hospital units

Ma, C., & Stimpfel, A. (2018). Journal of Nursing Administration, 48(6), 335-341. 10.1097/NNA.0000000000000624
Abstract
OBJECTIVE The aim of this study was to examine the impact of nurse shift patterns on nurses' collaboration with nurses and physicians in US acute care hospital units. BACKGROUND Collaboration between nurses and other healthcare providers is critical for ensuring quality patient care. Nurses perform collaboration during their shift work; thus, nurse shift patterns may influence collaboration. However, there is a dearth of empirical evidence of the relationship between nurse shift patterns and collaboration of nurses with other healthcare providers. METHODS This is a cross-sectional study using data from 957 units in 168 acute care hospitals. Measures of collaboration include nurse-nurse collaboration and nurse-physician collaboration. Measures of shift patterns included shift length and overtime. Multilevel linear regressions were conducted at the unit level, controlling unit and hospital characteristics. RESULTS Overtime (more nurses working overtime or longer overtime hours) was associated with lower collaboration at the unit level; however, shift length was not. CONCLUSIONS Working overtime may negatively influence nurses' collaboration with other healthcare providers.

Inter- and intra-disciplinary collaboration and patient safety outcomes in U.S. acute care hospital units: A cross-sectional study

Ma, C., Park, S. H., & Shang, J. (2018). International Journal of Nursing Studies, 85, 1-6. 10.1016/j.ijnurstu.2018.05.001
Abstract
Background: Collaboration among healthcare providers has been considered a promising strategy for improving care quality and patient outcomes. Despite mounting evidence demonstrating the impact of collaboration on outcomes of healthcare providers, there is little empirical evidence on the relationship between collaboration and patient safety outcomes, particularly at the patient care unit level. Objectives: The purpose of this study is to identify the extent to which interdisciplinary collaboration between nurses and physicians and intradisciplinary collaboration among nurses on patient care units are associated with patient safety outcomes. Methods: This is a cross-sectional study using nurse survey data and patient safety indicators data from U.S. acute care hospital units. Collaboration at the unit level was measured by two 6-item scales: nurse-nurse interaction scale and nurse-physician interaction scale. Patient outcome measures included hospital-acquired pressure ulcers (HAPUs) and patient falls. The unit of analysis was the patient care unit, and the final sample included 900 units of 5 adult unit types in 160 hospitals in the U.S. Multilevel logistic and Poisson regressions were used to estimate the relationship between collaboration and patient outcomes. All models were controlled for hospital and unit characteristics, and clustering of units within hospitals was considered. Results: On average, units had 26 patients with HAPUs per 1000 patients and 3 patient falls per 1000 patient days. Critical care units had the highest HAPU rate (50/1000 patients) and the lowest fall rate (1/1000 patient days). A one-unit increase in the nurse-nurse interaction scale score led to 31% decrease in the odds of having a HAPU (OR, 0.69; 95% CI, 0.56–0.82) and 8% lower patient fall rate (IRR, 0.92; 95% CI, 0.87–0.98) on a nursing unit. A one-unit increase in the nurse-physician interaction scale score was associated with 19% decrease in the odds of having a HAPU (OR, 0.81; 95% CI, 0.68–0.97) and 13% lower fall rates (IRR, 0.87; 95% CI, 0.82–0.93) on a unit. Conclusions: Both nurse-physician collaboration and nurse-nurse collaboration were significantly associated with patient safety outcomes. Findings from this study suggest that improving collaboration among healthcare providers should be considered as an important strategy for promoting patient safety and both interdisciplinary and intradisciplinary collaboration are critical for achieving better patient outcomes.

Practice Environment Characteristics Associated With Missed Nursing Care

Park, S. H., Hanchett, M., & Ma, C. (2018). Journal of Nursing Scholarship. 10.1111/jnu.12434
Abstract
Purpose: To examine which characteristics of the practice environment were associated with missed nursing care in U.S. acute care hospital units. Design: A descriptive, correlational study used secondary analysis of the 2015 National Database of Nursing Quality Indicators® Registered Nurse (RN) Survey data. Subscales of the Practice Environment Scale of the Nursing Work Index were used to measure practice environment characteristics. The sample included 1,583 units in 371 hospitals, containing survey responses from 31,650 RNs. Methods: Multilevel logistic regression was performed to estimate the effects of the practice environment characteristics on missed care, controlling for hospital and unit characteristics. Results: About 84.1% of unit RNs reported missing at least one of the 15 necessary care activities. Good environment units had 63.3% significantly lower odds of having RNs miss care activities than poor environment units. Units had 81.5% lower odds of having RNs miss any necessary activities with 1 point increase of the staffing and resource adequacy score; 21.9% lower odds for 1 point increase in the nurse–physician relations score; and approximately 2.1 times higher odds with 1 point increase in the nurse participation in hospital affairs score. Conclusions: Good environments were significantly associated with lower levels of missed care. The impact on missed care differed by the characteristics of the practice environment. Clinical Relevance: Hospital and nursing administrators should maintain good practice environments for nurses to reduce missed care activities and thus potentially improve patient outcomes. Specifically, their efforts should be targeted on improving staffing and resource adequacy and nurse–physician relations and on reducing workloads on hospital affairs.

Recent Trends in Baccalaureate-Prepared Registered Nurses in U.S. Acute Care Hospital Units, 2004–2013: A Longitudinal Study

Ma, C., Garrard, L., & He, J. (2018). Journal of Nursing Scholarship, 50(1), 83-91. 10.1111/jnu.12347
Abstract
Purpose: To examine the trends in baccalaureate (bachelor of science in nursing)–prepared registered nurses (BSN RNs) in U.S. acute care hospital units and to project the growth in the number of BSN RNs by 2020. Design: This is a longitudinal study using the Registered Nurse Education Indicators data (2004–2013) from the National Database of Nursing Quality Indicators. Methods: The level of BSN RNs in each unit was operationalized as the proportion of nurses holding a baccalaureate degree or higher among all the nurses in a unit. Our sample included 12,194 unit-years from 2,126 units of six cohorts in 377 U.S. acute care hospitals. A hierarchical linear regression model was used to examine the trends in BSN RNs and to project future growth in the number of BSN RNs when controlling for hospital and unit characteristics and considering repeated measures in units over time and clustering of units within hospitals. Results: The proportion of BSN RNs in U.S. acute care hospital units increased from 44% in 2004 to 57% in 2013 (a 30% increase); when combining all cohorts, this rate increased from 44% in 2009 to 51% in 2013. On average, the proportion of BSN RNs in a unit increased by 1.3% annually before 2010 and by 1.9% each year from 2010 on. The percentage of units having at least 80% of their nurses with a baccalaureate degree or higher increased from 3% in 2009 to 7% in 2013. Based on the current trends, 64% of the nurses working in a hospital unit will have a baccalaureate degree by 2020, and 22% of the units will reach the 80% goal by 2020. Conclusions: There was a significant increase in the proportion of BSN RNs in U.S. acute care hospital units over the past decade, particularly after 2010. However, given the current trends, it is unlikely that the goal of 80% nurses with a baccalaureate degree will be achieved by 2020. Clinical Relevance: The U.S. nursing workforce is under educational transformation in order to meet the increasing healthcare needs. To help accelerate this transformation, further advocacy, commitment, and investment are needed from all healthcare stakeholders (e.g., policymakers, executives and managers of healthcare facilities, nursing schools, etc.).

Hospital Magnet Status, Unit Work Environment, and Pressure Ulcers

Ma, C., & Park, S. H. (2015). Journal of Nursing Scholarship, 47(6), 565-573. 10.1111/jnu.12173
Abstract
Purpose: To identify how organizational nursing factors at different structural levels (i.e., unit-level work environment and hospital Magnet status) are associated with hospital-acquired pressure ulcers (HAPUs) in U.S. acute care hospitals. Design: A cross-sectional observational study used data from the National Database of Nursing Quality Indicators®. Responses from 33,845 registered nurses (RNs) were used to measure unit work environments. The unit of analysis was the nursing unit, and there were 1,381 units in 373 hospitals in the United States. Methods: Unit work environment was measured by the Practice Environment Scale of Nurse Working Index (PES-NWI). Multilevel logistic regressions were used to estimate the effects of unit work environment and hospital Magnet status on HAPUs. All models were controlled for hospital and unit characteristics when considering clustering of units within hospitals. Results: Magnet hospital units had 21% lower odds of having an HAPU than non-Magnet hospital units (95% confidence interval [CI], 0.64-0.98). With one unit increase of the PES-NWI score, units had 29% lower odds of having an HAPU (95% CI, 0.55-0.91). When including both hospital Magnet status and unit work environment in the model, hospital Magnet status no longer had a significant effect on HAPUs (odds ratio [OR] = 0.82; 95% CI, 0.66-1.02), whereas the significant effect of unit work environment persisted (OR = 0.73; 95% CI, 0.56-0.93). Conclusions: Both hospital and unit environments were significantly associated with HAPUs, and the unit-level work environment can be more influential in reducing HAPUs. Clinical Relevance: Investment in the nurse work environments at both the hospital level and unit level has the potential to reduce HAPUs; and additional to hospital-level initiatives (e.g., Magnet recognition program), efforts targeting on-unit work environments deserve more attention.