Chenjuan Ma

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

Chenjuan Ma's additional information

Chenjuan Ma is an assistant professor and health services researcher at NYU Rory Meyers College of Nursing. Her program of research focuses on understanding how to optimize nursing care and patient safety and outcomes across settings with a particular focus of home healthcare and vulnerable populations (e.g., persons with dementia and minorities). Her research utilizes theories and methodologies from various disciplines, including but not limited to nursing, sociology, medicine, statistics and data science. Ma also has expertise in large data and quantitative methods. She is currently working on a project with the National Institute on Aging titled Racial/Ethnic Disparities in Home Health Care for Persons with Alzheimer’s Disease and Related Dementias.

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

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

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

Nursing workforce
Home care
Health Policy
Research methods
Health Services Research

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

Faculty Honors Awards

Vivian G. Prins Global Scholar, New York University (2021)
New Investigator Award, Interdisciplinary Research Group of Nursing Issues (IRGNI), Academy Health (2020)
Vivian G. Prins Global Scholar, New York University (2020)
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)
ThinkSwiss Award, University of Basel, Switzerland (2011)
Rising Star, Sigma Theta Tau International Honor Society of Nursing Xi Chapter (2011)

Publications

Risk factors for infection in home health care: Analysis of national Outcome and Assessment Information Set data

Shang, J., Wang, J., Adams, V., & Ma, C. (2020). Research in Nursing and Health, 43(4), 373-386. 10.1002/nur.22053
Abstract
Abstract
Patients in home health care (HHC), a rapidly growing healthcare sector, are at high risk for infections. This study aimed to identify risk factors for infections among HHC patients using the Outcome and Assessment Information Set (OASIS) data. We used a 5% random sample of the 2013 national OASIS data. Infections were identified if records indicated that patients were hospitalized or received emergency care for one of three types of infections (respiratory, wound site, and urinary tract infection). Multivariate logistic regression models were used to identify risk factors for each individual infection type. The final analysis included 128,163 patients from 8,255 HHC agencies nationwide. Approximately 3.2% of the patients developed infections during their HHC stay that led to hospitalization or emergency care treatment. We found that associations between demographics and infection risk are specific to the type of infection. In general, a history of multiple hospitalizations in past 6 months, comorbidity, having a severe condition at HHC admission, and impaired physical functioning increased HHC patients' risk of infections. We also identified that HHC patients with caregivers who needed training in providing medical procedure or treatment are at higher risk for wound-site infections. Our findings suggest that patients with underlying medical conditions and limited physical function status are more likely to develop infection. The caregiver's lack of training in providing needed care at home also places HHC patients at high risk for infection. Education for patients and caregivers should be tailored based on their health literacy level to ensure complete understanding.

Transition-to-U.S. Practice Experiences of Internationally Educated Nurses: An Integrative Review

Ghazal, L. V., Ma, C., Djukic, M., & Squires, A. (2020). Western Journal of Nursing Research, 42(5), 373-392. 10.1177/0193945919860855
Abstract
Abstract
Internationally educated nurses (IENs) are an important part of the U.S. nursing workforce. Optimizing their transition-to-practice (TTP) experiences in the United States is crucial for ensuring high-quality patient and IENs’ outcomes. The purpose of this integrative review is to analyze and synthesize the current evidence surrounding IEN TTP experiences in the United States from 2000 to 2018 to inform improvements in TTP. Eighteen studies were included. TTP was defined through IENs’ description of facilitators and barriers of the transition process and presented in seven themes. Two themes were facilitators: support from family and nursing colleagues, and perceptions of self-efficacy. The remaining five themes were barriers: (a) the stigma associated with educational preparation, (b) communication and language, (c) differences in culture, (d) differences in nursing practice, and (e) legal issues. Findings are important for improving TTP programs. Further research focusing on the outcomes of transition programs is needed to inform policymaking surrounding IEN recruitment and retention.

Unit Utilization of Internationally Educated Nurses and Collaboration in U.S. Hospitals.

Ma, C., Ghazal, L., Chou, S., Ea, E., & Squires, A. (2020). Nursing Economic$, 38(1), 33-40.
Abstract
Abstract
Employing internationally educated nurses (IENs) to address the nursing workforce shortage is common in many countries, including the United States. This study examined the relationship between unit utilization of IENs and collaboration in U.S. hospitals. Results indicated more IENs on a unit did not significantly affect the collaboration among nurses and between nurses and physicians. The presence of IENs significantly influenced unit nursing characteristics, such as education attainment and unit tenure.

Unit Utilization of Internationally Educated Nurses and Collaboration in US Hospitals

Ma, C., Ghazal, L., Chou, S., Ea, E., & Squires, A. (2020). Nursing Economics, 38(1), 33-+.

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, 32(1), 28-33. 10.1177/1084822319865546
Abstract
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.

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, 34(8), 1170-1184. 10.1002/gps.5140
Abstract
Abstract
Objective: Hospital readmission in persons with dementia is becoming a critical safety and cost issue. The purpose of this review is to systematically assess published evidence on hospital readmissions in persons with dementia, including rate, clinical reasons, risk factors, and prevention programs. Methods: A systematic review of relevant literature was conducted. Literature were searched in PubMed, CINAHL, PsycINFO, and Embase as well as hand searching. Quality of reviewed studies were assessed independently by reviewers using quality assessment checklists. Results: Nineteen studies met the inclusion criteria and were reviewed. In persons with dementia, all-cause 30-day readmission rate was most frequently reported and ranged from 7% to 35%. Compared with those without dementia, persons with dementia had significantly higher rate of readmission. Reported risk factors of readmission varied across studies from patient sociodemographic and clinical status, history of health care utilization, to family caregivers. Reasons for readmission were rarely documented. Programs of home-based individualized care and interdisciplinary team care were used for preventing readmissions. Findings from some of the studies were limited by small sample sizes, single data source, and other methodologic flaws. Conclusions: Persons with dementia are at high risk for hospital readmission, but many of the readmissions are potentially preventable. Multiple strategies such like identifying high-risk individuals and the clinical reasons for index admission and readmission and implementing home-based individualized care by interdisciplinary team can reduce preventable hospital readmissions. Future studies should use multiple national data sources and advanced methodology to identify risk factors and clinical reasons of hospital readmissions.

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
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. W. (2018). Journal of Nursing Administration, 48(6), 335-341. 10.1097/NNA.0000000000000624
Abstract
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
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, 50(6), 722-730. 10.1111/jnu.12434
Abstract
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.