Renee R. ShieldClinical Professor of Health Services, Policy and Practice
Dr. Shield is a cultural/medical anthropologist whose qualitative and mixed methods research has focused on health care for the elderly; end-of-life care, culture change nursing homes; electronic health records; health information exchange; medical school curriculum development and evaluation; work, retirement and well-being among elderly diamond traders; ethical decision-making and rites of passage and reciprocity in nursing homes. Dr. Shield formerly served as the Director of Research and Education at the Jewish Home for the Aged in Rhode Island and the Director of Education at Aging 2000.
Miller SC, Lepore M, Lima JC, Shield R, Tyler DA. 2014. Does the introduction of nursing home culture change practices improve quality? J Am Geriatr Soc. Article first published online: 23 AUG 2014. DOI 10.1111/jgs.12987.
Shield R, Farrell T, Campbell SE, Nanda A, Wetle T. Professional Development and Exposure to Geriatrics: Medical Student Perspectives from Narrative Journals. J of Gerontology & Geriatrics Education, in press.
Shield R, Tyler D, Lepore M, Looze J, Miller S. 2014. “Would You Do That in Your Home?” Making Nursing Homes Homelike in Culture Change Implementation. Journal of Housing for the Elderly, Vol. 28 No. 3, in press.
Hwang D, Teno JM, Clark M, Shield R, Williams C, Casarett D, Spence C. Family perceptions of quality of hospice care in the nursing home. 2014 May 9. J Pain Symptom Manage. pii: S0885-3924(14)00249-8. doi: 10.1016/j.jpainsymman.2014.04.003. [Epub ahead of print]. PMID: 24819082.
Shield R, Rosenthal M, Wetle T, Tyler DA, Clark M, Intrator O. 2014. Medical staff involvement in nursing homes: Development of a conceptual model and research agenda. Journal of Applied Gerontology. 33 (1): 75-96. First published on November 28, 2012 doi:10.1177/0733464812463432.
Miller SC, Looze J, Shield R, Clark MC, Lepore M, Tyler D, Sterns S, Mor V. 2014. Culture Change Practice in U.S. Nursing Homes: Prevalence and Variation by State Medicaid Reimbursement Policies The Gerontologist Jun;54(3):434-45. doi: 10.1093/geront/gnt020. Epub 2013 Mar 20.
Tyler D, Lepore M, Shield RR, Looze J, Miller SC. 2013. Overcoming Resistance to Culture Change: Nursing Home Administrators’ Use of Education, Training and Communication. Journal of Gerontology & Geriatrics Education. DOI: 10.1080/02701960.2013.837049. Accepted author version posted online: 24 Sep 2013.
Farrell T, Shield RR, Nanda A, Campbell SC, Wetle T. 2013. Preparing to Care for an Aging Population: Medical Student Reflections on their Clinical Mentors within a New Geriatrics Curriculum. Journal ofGerontology & Geriatrics Education, DOI:10.1080/02701960.2013.830115
Shield R, Looze J, Tyler D, Lepore M, Miller SC. 2013. Why and How Do Nursing Homes Implement Culture Change Practices? Insights from Qualitative Interviews in a Mixed Methods Study. Journal of Applied Gerontology. 0733464813491141, first published on July 19, 2013 as doi:10.1177/0733464813491141
Nanda A, Farrell TW, Shield RR, Tomas M, Campbell SE, Wetle, T. 2013. Medical Students’ Recognition and Application of Geriatrics Principles in a New Curriculum. J of Amer Ger Soc. 61 (3):434–439. DOI:10.1111/jgs.12139.
Shield RR, Farrell TW, Nanda A, Campbell SE, Wetle T. 2012. Integrating Geriatrics into Medical School: Student Journaling as an Innovative Strategy for Evaluating Curriculum. The Gerontologist; 52 (1): 98-110. doi:10.1093/geront/gnr079.
Doyle RJ, Wang N, Anthony D, Borkan J, Shield RR, Goldman RE. 2012. Computers in the examination room and the electronic health record: Physicians’ perceived impact on clinical encounters before and after full installation and implementation. Fam Pract. Oct;29(5):601-8. Epub.Feb 29. [Epub ahead of print] PMID: 22379185.
Casarett D, Spence C, Clark MA,Shield R, and Teno JM. 2012. Defining Patient Safety in Hospice: Principles to Guide Measurement and Public Reporting. J Palliat Med. 15(10): 1120-1123. doi:10.1089/jpm.2011.0530. Aug, 2012.
Shield R, Besdine RW. Gerontology and geriatrics comes of age. 2011. Foreword. J of Gerontology & Geriatrics Education. Oct;32(4):291-4.
Besdine RW, Shield R, McNicoll L, Campbell SE, Wetle T. 2011. Integrating and evaluating geriatrics in medical school: A novel approach for the challenge. J of Gerontology & Geriatrics Education. Oct;32(4):295-308.
Tyler DA, Shield R, Rosenthal M, Miller S, Wetle T, Clark M. 2011. How valid are the responses to nursing home survey questions? Some issues and concerns. The Gerontologist.51 (2): 201-211.doi: 10.1093/geront/gnq095.
Shield R, Tong I, Tomas M, Besdine R. 2010.Teaching communication and compassionate care skills: An innovative curriculum for pre-clerkship medical students, Medical Teacher 2011;33(8):e408-16.
Brucker B, McNicoll,Shield R. Nutrition recommendations for the independent-living older person. 2010. Geriatrics for the Practicing Physician. Medicine & Health / Rhode Island. 93 (10): 322-324.Shield RR, Wetle T, Teno J, Miller SC, Welch LC. 2010. Vigilant at the end of life: Family advocacy in the nursing home, J Palliat Med. 13 (5):573-9.
Shield RR, Goldman RA, Anthony DA, Wang N, Doyle RJ, Borkan J. Gradual Electronic Health Record Implementation: New Insights on Physician and Patient Adaptation, Annals of Family Medicine. 2010; 8(4): 316‐326.
Lima JC, Miller SC, Shield RR. 2009. Palliative and hospice care in assisted living: Reality or wishful thinking? J of Housing for the Elderly 23 (1-2): 47-65. http://www.informaworld.com/smpp/section?content=a908657836&fulltext=713240928
Shield R, Borkan J, Guest editors. ANTHROPOLOGICAL PERSPECTIVES ON MEDICINE. Medicine & Health / Rhode Island 91 (12). December, 2008. http://rimed.org/2008-12.asp
Shield R, Wetle T, Besdine R. 2008. Preparing for the silver tsunami: The integration of geriatrics into the new medical curriculum at the Warren Alpert Medical School of Brown University. Medicine & Health / Rhode Island: 91 (8): 247-249.
Farrell T, Campbell C, Nanda A, Shield R Wetle T. 2008. Evaluating geriatrics in the medical school curriculum: Using Student Journals. Medicine & Health / Rhode Island 91 (12): 378-381.
Shield R, Borkan J. 2008. Anthropological perspectives on medicine: Introduction. Medicine & Health / Rhode Island 91 (12): 360. http://rimed.org/2008-12.asp
Miller SC, Shield R. 2007. Palliative care/hospice for persons with terminal and/or chronic progress illness: The role of state and federal policies in shaping access and quality for persons receiving long-term care. Brown University: Center for Gerontology and Health Care Research. Available at: http://www.chcr.brown.edu/PDFS/JEHT_4_FINALREPORT07.PDF
Shield R. 2007. Physicians' perspectives on end of life care: A qualitative inquiry. Medicine & Health / Rhode Island. 90 (12): 391-392.
Curry L, Shield R, Wetle T., Eds. IMPROVING AGING AND PUBLIC HEALTH RESEARCH: QUALITATIVE AND MIXED METHODS. 2006. Washington, DC: Gerontological Society of America/American Public Health Association.
Shield RR, Wetle T, Teno J, Miller SC, Welch L. 2005. Physicians "missing in action": Family perspectives on physician and staffing problems in end-of-life care in the nursing home. J of the American Geriatrics Society 53 (10): 1651-1657.
Wetle T, Shield R, Teno J, Miller SC, Welch L. 2005. Family perspectives on end-of-life care experiences in nursing homes. The Gerontologist 45 (5): 642-650.
Teno JM., Clarridge BR, Casey V, Welch LC, Wetle T, Shield R and Mor V. 2004. Family perspectives on end-of-life care at the last place of care. JAMA 291 (1): 88-93.
Wetle T, Teno J, Shield R, Welch L, Miller SC. 2004. END OF LIFE IN NURSING HOMES: EXPERIENCES AND POLICY RECOMMENDATIONS. Washington, D.C. AARP Public Policy Institute, #2004-14.
Shield R. and Aronson SM. 2003. AGING IN TODAY'S WORLD: CONVERSATIONS BETWEEN AN ANTHROPOLOGIST AND A PHYSICIAN. New York: Berghahn Books (Paperback issued 2005).
Shield R. 2003. Wary partners: Dynamics of interactions between nursing assistants and family members in nursing homes. In Stafford P (Ed.) Gray Areas: Ethnographic Encounters with Nursing Home Culture. Santa Fe (NM): SAR Press.
Shield R. 2002. DIAMOND STORIES: ENDURING CHANGE ON 47TH STREET. Ithaca: Cornell University Press. (Paperback issued 2005)
Shield R. 1997. Liminality in an American nursing home: The endless transition. In Sokolovsky J (Ed.) The Cultural Context of Aging: Worldwide Perspectives. NY: Bergin & Garvey. Revised 2nd edition.
Shield R. 1997. AGING 2000: CASE STUDY. Health Care Financing Administration Report.
Shield R. 1996. Managing the care of nursing home patients: The challenge of integration. In Annual Review of Gerontology and Geriatrics, Volume 16. Focus on Managed Care and Quality Assurance. Newcomer R and A Wilkinson (Eds.) NY: Springer Publishing Company. http://books.google.com/books?id=uRxeWiDnvLcC&pg=PA60&lpg=PA60&dq=renee+rose+shield&source=bl&ots=vbRpFIfH5h&sig=NpJggyI2FnTkMcRwpjX7aoe_9bE&hl=en&ei=2oeuSvOyBc7VlAf-6tnFBg&sa=X&oi=book_result&ct=result&resnum=7#v=onepage&q=renee%20rose%20shield&f=false
Shield R. 1995. Ethics in the nursing home: Dynamics of decision-making in a nursing home ethics committee. In The Culture of Long Term Care: Nursing Home Ethnography. Henderson, JN and M Vesperi (Eds.) Westport (CT): Greenwood Press.
Shield R. 1988. UNEASY ENDINGS: DAILY LIFE IN AN AMERICAN NURSING HOME. Ithaca: Cornell University Press.
Dr. Shield has long been involved in the exploration of life and work in US long term care and other health care settings using qualitative and mixed methods. Her long term care research focuses on end-of-life care; the culture change movement; ethical decision-making; communication among staff, residents and families; and the roles of physicians. Dr. Shield's research also concerns health care reform, patient-centered medical homes, and payment and quality reporting. She also works on incorporating and evaluating geriatrics in medical school education and hospital practice, and the processes and impact of electronic health records and health information exchange on patients and physicians.
Dr. Shield is a medical and cultural anthropologist with extensive qualitative and mixed methods research experience with stakeholders in long term care and other health care settings that focuses on varieties of health care practices, and beliefs and interventions in multiple settings. Dr. Shield engages stakeholders in conducting case studies, site visits, participant observation, in-depth and cognitive-based interviews, life histories, and focus groups in solo research and in mixed methods collaboration with interdisciplinary research teams. Dr. Shield’s research interests have centered on resident, family and staff experiences in long term care and other health settings; physician-patient communication; end of life care; the review of medical decision support tools; the impact of culture change practices on care processes in long term care facilities; the transformation of clinical practices into patient-centered medical homes; and the implementation and impact of electronic health records and health information exchange on patients, physicians and systems. Dr. Shield has also applied much of her research, evaluation and teaching experience in educational initiatives in medical curricular development and evaluation with medical students and specialty physicians; creating and evaluating a website of educational resources on suicide prevention; and using a focus group strategy to evaluate the development of the Health Information Exchange initiative in Rhode Island.
(Pending) Investigator, Disparities in Nursing Home Care Quality for Patients Living with HIV/AIDS NIMH (I. Wilson, PI), 12/1/15-11/30/18
Investigator, Increasing Veteran’s Use of Community-based LTC via Timely Discharge from VA CLCs (VA HSR&D CREATE) (S Allen, PI), 4/1/13-3/31/15 (extension requested to 6/30/16)
Project Director and Investigator, Next Steps Specialty Medicine, Donald W. Reynolds Foundation Geriatrics (R. Besdine, PI). 7/1/13- 6/30/17.
Investigator, Changing Long Term Care in America: Policies, Markets, Strategies, and Outcomes NIA, 2 P01 AG027296-06A1 (V. Mor, PI), 1/15/14-11/30/18
Investigator, Measuring and Improving the Quality of Care in Rhode Island Medicaid, State of Rhode Island, Executive Office of HHS (I. Wilson, PI), 1/1/14-11/30/15
Mentor, Develop Patient Centered Outcomes Scholars for Comparative Effectiveness Research AHRQ (J. Lau, PI), 8/1/14-7/31/-19
Investigator, Nursing Home Culture Change: Evaluating Change in Practice and Quality Outcomes NIA (S. Miller, PI), 4/1/15-3/31/19
Investigator, Medicaid Managed Care and the Quality of Care for Women and Children: Evaluating a Randomized Trial of Enrollment in a Medicaid-Focused or Commercial Health Insurance Plan HRSA (A. Trivedi, PI), 4/1/15-3/31/18
Suicide Prevention Program, Brown University Program in Public Health and Rhode Island Department of Health, Substance Abuse and Mental Health Services Administration (SAMHSA) (T Wetle, PI), 1/1/10-6/30/14
Developing Practice Transformation Capacity in a Family Medicine AAU (DHHS, HRSA, AAU) (J Borkan, PI), 7/1/10-6/30/15
Investigator, Developing Medication Quality Indicators in VA Community Living Centers—Career Development Award II CDA 08-280, Veteran’s Administration HSR&D (D. Dosa, PI), 11/18/13 – 4/30/14
Principal Investigator, Using Older Adults’ Experiences of Transitions to Enhance Physician Education, Picker Institute/Gold Foundation Graduate Medical Education Challenge, 8/1/12-7/31-12.
Principal Investigator, Exploration of FEHC Survey Results, Capital Hospice, VITAS Hospice, LifePath Hospice, Delaware Hospice, 2012-2013 (no-cost extension to 9/30/13).
Investigator, Innovation among High Medicaid Nursing Homes, Commonwealth Fund (D. Tyler, PI), 6/1/13 – 1/13/14.
Investigator, Education Center of Excellence, Hartford Foundation (R. Besdine, PI). The aim of this award will assist in faculty career development of advanced and junior fellows. Dr. Shield taught a course to advanced and junior fellows regarding new integrated strategies for the design and evaluation of their educational and programmatic intervention, called “Strategies for the Design and Evaluation of Your Programmatic or Educational Intervention,” 7/1/12-6/30/13.
Investigator, Evidence Practice Center IV: Task Order #2: Decision Support Tools for Cancer to produce comparative effectiveness reviews and evidence synthesis that are relevant, timely and scientifically rigorous. AHRQ (T. Trikalinos, PI), 9/25/12-3/25/14.
Investigator, Family Evaluation of Hospice Care (J Teno, PI) AHRQ, 9/30/10-07/31/12.
PI, Evaluation Plan for the RI Health Information Exchange (subcontract with RIDOH, 11/1/09-6/31/10) (P Vivier, PI, AHRQ, 9/30/04-9/20/09)
Investigator, Schwartz Communication Sessions (R Besdine, PI), 1/1/09-12/31/10)
Director, Reynolds Foundation Mandatory Geriatrics Education for Brown Medical School: Comprehensive Curriculum Redesign. Resource Center for Geriatrics Education (R Besdine, PI), 7/1/06-6/31/10
Co-Investigator, Nursing Home Culture Change: Understanding Its Implementation and Impact, Retirement Research Foundation (S Miller, PI), 6/08-5/11)
Investigator, Shaping Long Term Care in America, NIA Program Grant, Core B (V Mor, PI) 9/07-6/12Investigator, Analysis of Planetree's Long-Term Care Resident and Direct Care Staff Focus Groups (S Miller, PI), Planetree, 6/09-12/09
Investigator, Ethnography of the Impact of Information Technology in a Family Medicine Clinical Practice, Dept. Health and Human Services (R Goldman, PI), HRSA Academic Administrative Units in Primary Care, 7/1/04-6/30/07
Investigator, The Role of State and Federal Policies in Shaping Accessible High-Quality Long-Term Care for Persons with Advanced, Chronic or Terminal Illness (S Miller, PI), JEHT Foundation, 10/1/06-3/31/07
Investigator, Improving Qualitative and Mixed Methods Research (T Wetle, PI), AAN, 11/1/05-6/30/06
Investigator, Building Relationships in Bioterrorism Preparedness and Response (T Wetle, PI), RIDH, 10/1/05-6/30/06
Principal Investigator, Exploration of Physician and Patient Attitudes Regarding Referral to Hospice, VistaCare Foundation, 4/1/04-3/31/05
Investigator, Improving Qualitative and Mixed Methods Research, John A. Hartford Foundation, National Institute on Aging (T Wetle, PI), Robert Wood Johnson Foundation, 8/1/04-10/31/05
Investigator, End-of-Life Issues in Nursing Homes (T Wetle, PI), AARP, 7/1/02-12/31/02
Principal investigator, Educational development in the nursing home, RI Foundation. The Jewish Home, Providence, RI. 1987, 1988
Principal Investigator, Educational development and the Nursing Home Teaching Conferences RI Department of Elderly Affairs, The Jewish Home, Providence, RI. 1988, 1989
Watson Smith Prize in Anthropology, Brown University
Invited participant, Advanced Seminar, School of American Research, Santa Fe, NM
First Annual President's Award, The Jewish Home, Providence, RI
Community Service Award, The Alliance for Better Nursing Home Care, Providence, RI
Ollie Randall Symposium Award, Gerontological Society of America 64rd Annual Meeting
Allen, Susan Professor Emerita of Health Services, Policy and Practice
Besdine, Richard David S. Greer, M.D., Professor of Geriatric Medicine, Professor of Medicine, Professor of Health Services, Policy and Practice, Director, Center for Gerontology and Health Care Research, Director, Division of Geriatrics and Palliative Medicine
Borkan, Jeffrey Professor of Family Medicine, Professor of Medical Science, Assistant Dean for Primary Care-Population Health, Chair of Family Medicine
Clark, Melissa Adjunct Professor of Epidemiology, Professor of Obstetrics and Gynecology
Dosa, David Associate Professor of Medicine, Associate Professor of Health Services, Policy and Practice
Laws, Michael Assistant Professor of Health Services, Policy and Practice (Research)
Miller, Susan Professor of Health Services, Policy and Practice (Research)
Mor, Vincent Florence Pirce Grant University Professor, Professor of Health Services, Policy and Practice
Trivedi, Amal Associate Professor of Health Services, Policy and Practice, Associate Professor of Medicine
Tyler, Denise Assistant Professor of Health Services, Policy and Practice (Research)
Wetle, Terrie Professor of Health Services, Policy and Practice, Dean of Public Health
Wilson, Ira Professor of Health Services, Policy and Practice, Professor of Medicine, Chair of Health Services, Policy and Practice
American Anthropological Association
Society for Medical Anthropology
The Gerontological Society of America
Association for Gerontology and Anthropology
National Association for the Practice of Anthropology
UNIVERSITY TEACHING ROLES
Guest lecturer, numerous Brown undergraduate and graduate courses
MD, Ph.D., MPH and senior thesis advisor and mentor, varied departments
BI 361 Doctoring, Brown Medical School. 2005-2006
BI 371 Medical Interviewing, Brown Medical School. 2003-2005
Director (with Lynn McNicoll, MD), Scholarly Concentration in Aging Program, since 2006
Affinity Group leader, 1988-2003 for the following:
"Alternative Medicine and Health Care," Program in Liberal Medical Education (PLME), Brown University, with Mark Brody, MD, 1999-2003
"Rethinking, Reorienting, and Reforming Medicine," Program in Liberal Medical Education (PLME), Brown University, with Barrie Weisman, MD, 1992 1996
"Issues of Identity and Culture in Aging," Program in Liberal Medical Education (PLME), Brown University, with James McCartney, MD, 1988-1992
Instructor, Department of Human Development and Family Studies, University of Rhode Island, Kingston, RI, 1994-1995
Community Health Clerkship in the nursing home setting, Brown University Program in Medicine (with Henry Izeman, MD and James McCartney, MD). The Jewish Home, Providence, RI. 1987-1989.
Modes of Thought courses, "The Twilight Zone: Experiences of Aging in Cross-Cultural Perspective," Brown University, 1981-82, 1984.
OTHER TEACHING ROLES
Preconference Workshop, Qualitative and Mixed Methods Research: Improving the Quality of Science and Addressing Health Issues of Diverse Populations. Gerontological Society of America, Annual Meeting. Co-organizer and leader. 2004, 2005.
Aging 2000, Providence, RI: developed and implemented research plan for Aging 2000 study; co-author of Aging 2000 report; created Strategy for Education; developed educational curriculum for consumer education on aging; organized and presented numerous conferences, workshops, discussions, and retreats. Talks, workshops, etc. for between 20 and 150+ people each time. 1989-1994.
Developed Interfaith Health Care Ministries annual conference, with IHCM board members and led workshop. 100-150 participants. Providence, RI, c.1992.
Developed and taught "Bioethics for Nurses in Nursing Homes," with Judith Mattea, RN, MSN and Alicebelle Rubotzky, RN. 40-50 students. The Jewish Home, Providence, RI, 1989.
Organized monthly Nursing Home Teaching Conferences; developed numerous workshops and panels for staff, nursing home residents, and community members on topics related to working and living in nursing homes, such as restraints, nursing home jargon, bereavement, transitions, culture and identity, professional support, and sexuality; Workshops held 8-20 participants each time. Conferences were approximately 30-100 each month. The Jewish Home, Providence, RI 1987-1989.
Organized and ran interdisciplinary ongoing seminar on design issues in nursing homes. Fifteen participants of varied fields from nursing homes, hospitals, RISD, Brown, and URI met monthly to discuss and design better environments for the elderly. Held at the Jewish Home, Providence, RI, 1988-1989.
Organized conference with Patricia Dwyer and Henry Izeman, MD, "Decisions at the End of Life: The Limitations of Treatment." 100-150 participants. The Jewish Home, Providence, RI May, 1988.
PHP 2060 - Qualitative Methods in Health Research. Spring 2014, Spring 2015.