From Public Health Research to Real-World Impact: A Conversation with Melinda Rushing

In our final episode of EJB Talks for this semester, Dean Stuart Shapiro speaks with Professor Melinda Rushing, a new faculty member in the school’s health administration program. They discuss her winding journey from social work to public health and how her passion for research, particularly around sickle cell disease and healthcare access, shaped her academic journey. Melinda’s research uses data science to uncover patterns in healthcare utilization among sickle cell patients to better understand patient behavior and improve health outcomes. She shares how teaching has been especially rewarding for her because it allows her to bring her research experiences into the classroom, where she emphasizes the importance of experiential learning, critical thinking, and leadership development. Melinda aims to prepare her students with knowledge as well as the practical skills, enthusiasm, and mindset needed to tackle real-world healthcare challenges.

Transcript

Stuart Shapiro
Welcome to EJB Talks. I’m Stuart Shapiro, the Dean of the Bloustein School and the purpose of this podcast is to highlight the work that my colleagues and our alumni in the fields of planning, policy, and health are doing to make the world a better place.  

Today I am speaking with one of our newer professors in the Health Administration program, Professor Melinda Rushing. Welcome to the podcast, Melinda. 

Melinda Rushing
Thank you. I’m excited to contribute! 

Stuart Shapiro
So longtime listeners know, we always start with an origin question, particularly with first time guests. So, tell me a little bit about your history and I’m particularly interested in your progression from studying social work to getting a PhD in public health. 

Melinda Rushing
Yeah. So, I think it’s a…this is a pretty interesting story. I think it is at least! Because it was not a direct link at all. It was…there’s multiple like, I guess, stops along the way. So I actually, within my first semester of my master’s in social work degree, realized that I was on the wrong track. And it was because I took a research course. And I fell in love with the research. But I was on a clinical path, so I also was doing a child welfare fellowship. It was called the CWET program. I don’t know if it’s still, if it’s still called out or it’s still there.  

But when I took that course, I decided I said OK, I’m going to finish my fellowship because it’s paying for my school and I’ve already accepted the money, so I have to I have to finish it. And when I finished my payback time, which was a 3 1/2 year commitment to work in the child welfare program in the state of Texas, then I was going to go back to school to get a PhD because I wanted to be a researcher. But, I did it. I just knew I wanted to research. I didn’t really know what that was, and so it went from social work to child welfare to traumatic brain injuries.  

And then I had a professor while I was getting my masters, when I was telling him, like, what I’m interested in. Which I I’m still a little bit in contact with him. And he said, well have you considered public health? And I was just so new to academia in general. I was like what is that? And so he was like, well, I think you really should consider it. And I was like, hmmm, I’ll never do public health. I didn’t tell him that I just told myself that.  

And so as I was working and I just saw the different challenges that the kids in the welfare system were facing, that’s what led me to consider abuse and then traumatic brain injuries or stress. And then I ended up having a family member that was born. One of my little cousins. And she had sickle cell. And so I saw like, what was happening as she was navigating the healthcare system.  

And then I ended up getting a position in hospital social work. I mean, in the hospital as a social worker and my first one was in the adult side and then I ended up working in a pediatric sickle cell clinic. And so, seeing what was happening with my family member as well, that’s what I was seeing in the clinic with the patients and families that I was working with, it all started to make sense. And so, public health and sickle cell and health care started, it, I don’t know. It’s just like illuminated. I was like, oh, this is what I want to do. This is what I want to research. And so that led me… finally I had a reason to go back to school. 

Actually, my first try, I was not accepted to any programs, and I was super disappointed because I was just so certain that I was on the right track. But I’m glad I had that about two-year gap from applying to actually getting into a program, because I needed to get that additional experience to figure out what I actually wanted to do. So, I feel like I was very naïve to all of it, but thankfully, my path it like, aligned and showed me eventually what I was passionate about and what I could do through research. 

Stuart Shapiro
That’s great. It amazes me how many of these stories, including my own are, “I was on the wrong path and then I eventually figured out what mattered to me and what I wanted to do.” And I think that’s one of the most valuable lessons for students, frankly, is that you’re allowed to be wrong. And that, making changes is okay.  

So you came to us from a postdoc at the University of Michigan. Where, in accordance with the interests you just talked about, you worked on something called the Sickle Cell Data Collection Project. What’s that? 

Melinda Rushing
Yeah. So this is, I think.. this is another interesting story. So again, like, I was very naïve to all academia. So I just stumbled into a lot of the great opportunities that I ended up having across my career so far. But when…as I was preparing to graduate or finishing up my last semester… Or I’m sorry, I’d started my dissertation, I was also studying data science because I just happen to have to take a biostat course and an epi course.  

And I realized when I was in the field, and when I started my my PhD program because I was under the health promotion side. And it’s a little bit, I’m a little bit long winded right now, but it’s going to make sense when I get to the end. But in these courses, I kept asking myself, I don’t have the tools. Like I don’t really quite understand like, how to address these issues even though I’m seeing them and I’m kind of getting an idea of these issues. And so through epi, the epi course and the biostat course, I started to understand data. Which led me to data science. And then I started to see, here’s a way that I can use, or find tools to use, through data and understanding trends and patterns and developing these predictive models, we then can get a better understanding of what’s happening and actually apply what we need to apply to address these different issues we’re seeing.  

So I’m on this data science track now and with my dissertation, my chair was telling me, you need to find a large data set. And there wasn’t a lot of data on sickle cell. At least, not large data sets. And it was maybe like 50 patients here or 200 patients there. And so, what what I wanted to do with these secondary data analyses, I needed a large data set. So I did like a Hail Mary e-mail to this program that I just got a random e-mail about for their data collection program. And I didn’t hear back from them for, I don’t know, maybe six months or so? And so my chair was like, well, maybe you can pick something else. I said okay, I can look at something that’s more general like childhood nutrition, or maybe cancer or something like that. And well, maybe I’ll get back to sickle cell another day. 

But I ended up getting a response. And the PI for the California line of that reached out to me. We talked, she saw that I understood the data, that I understood the disease and I ended up being the first student that they agreed to partner with to allow me to have access to their data. So that was my introduction to the sickle cell data collection program. 

And what this is is a CDC-funded sickle cell surveillance. And at the time when I was looking at it, there were only two states. And it has grown now to, I believe, there’s 17 states. And the whole purpose is to understand where are individuals with sickle cell living within these states, and how are they accessing healthcare. And then what outcomes are we seeing. And by understanding these different measures, they then are able to inform practice as well as policy. And we’ve seen too, where some states they like, the number of individuals that they thought had sickle cell were grossly underestimated within their states. And that these individuals are actually living in areas that they didn’t know they were there.  

And there are also areas that lack resources to care for, to care and manage this disease. So by this surveillance, it’s heavy, heavy on the epi side. But the impact, though, of it is huge. Because we now know that we underestimated how many individuals are living with this disease in our country. And by getting more accurate numbers, we’re now able to deploy—I say we, but I’m not with them anymore… I’m done with my post doc—we’re not able to deploy resources and like, interventions accordingly to meet the needs of these individuals, so that wherever they’re living, they’re able to get the care that they’re needing. 

Stuart Shapiro
That’s great. And not that everything has to be a lesson, but I also love how you, you know, you see something that interests you, you reach out. You see, you know, maybe I can be a part of this. And I think that’s important for people to know. Because even if it’s a long shot, sometimes it works out and it can really fit with what you want to do. 

Melinda Rushing
Yeah, I think on that note. I think it’s like, it’s a numbers game. Like you, what do they say? You lose 100% of what you don’t ask for? I think I’m like, butchering it. But yeah, like if you don’t ask, it’s going to be, no. You never know when that ask can end up being a yes. And it’s like, aim for anything because you just, you never know when it’s actually going to lead to a door. And for me with that situation, like, that door led to me getting a postdoc at like this amazing college within our country. And I learned so much during that postdoc. And had so much exposure, which I think that prepared me for my current role. But if I’d never asked, I wouldn’t have had this trajectory. 

Stuart Shapiro
Yeah, that’s great. And I hope everyone takes that to heart. So, I do want to give you a chance to talk about at least one piece of your research there. And you sent me a paper. Can you sort of both tell me what is “hydroxyur-aya?” Hopefully I’m pronouncing that correctly! And what you found about its treatment of sickle cell patients? 

Melinda Rushing
Yeah. So “hydroxyur-eea” and it took me a while before I was able to get it. ((laughing)) There’s a sickle cell drug, I said that wrong for a while, a long time. But hydroxyurea is, I believe it’s the first FDA approved therapy, disease modifying therapy, for sickle cell. And it’s pretty amazing because originally, this was a cancer drug. But, and this is a little bit of background with sickle cell. So when individuals, people are born, we have what’s called fetal hemoglobin. And so it’s a hemoglobin that’s present but as you like, exit infancy this percentage decreases.  

And so, if you have sickle cell, this fetal hemoglobin is actually protective against the blood cell sickling, which is the issue with sickle cell. So they found that hydroxyurea can increase the percentage of fetal hemoglobin throughout the lifespan. So it has like this… So now you have an increased percentage of fetal hemoglobin, you are able to have this long-term protection against their red blood cells sickling. So when they discovered this, they did the clinical trials and they saw amazing results. So, it became like FDA approved. And they also tested it in children and then infants. And so it became like the standard of care really for managing sickle cell.  

Now the challenge with that though, is although this drug is amazing, there are side effects with it. And so patients have to do their own like, cost benefit analysis when it comes to taking the medication. And despite it being effective there’s really, really low adherence to this medication. And some of the side effects could be nausea, skin discoloration, or nail discoloration. Because it was a chemo drug it also can impact fertility. And so for some… for, I think, honestly for many, taking the drug and having these symptoms does not outweigh the benefit because, just because it’s mitigating the likelihood of your red blood cells sickling, it doesn’t necessarily completely resolve pain. So they may be experiencing pain, still having these side effects. And although hydroxyurea has mitigated the damage to their organs because of sickle cells are not… well, the blood cells are not turning into these sickle shapes, they’re still like, what they’re feeling…. So it’s as though the drug is not working.  

So with this paper what I wanted to do. Just knowing that everybody, although it’s an effective drug—and we also have more drugs that have been approved in the more recent years—but for this one particular, it’s still like kind of standard of care. I knew that there were people that used it differently and I wanted to understand. I wanted to see if we could capture distinct patterns of utilization. And I’m saying “utilization” because we couldn’t get the exact measure of adherence. So we use “utilization” as a proxy measure for adherence. And we looked at Medicaid claims.  

So in this analysis, we applied this model called a group-based trajectory modeling. And what it does is based off of how individuals follow a pattern and a behavior—and for me, I’m looking at hydroxyurea utilization—it then is able to identify distinct patterns. And it groups these individuals into these patterns. So in this analysis we found three distinct patterns. And one was, individuals that were consistently using the medication and others that were started and then they started to taper off. And then those that started off really low in utilization and then they end up going down to zero. And so, these patterns are not unique to hydroxyurea adherence. But what is something that we need to take into consideration or really, I guess, look more into, is that in two groups—which was two-thirds of our sample population—their adherence dropped within the first four months of them starting the medication.  

And so now we have like, this window of opportunity, potentially. Of course you have those start low and they end up going down to zero utilization. And for those there’s probably a different intervention because they’re starting off not appearing as though they don’t really want to take the medication. But for those that were moderate and then they tapered off, if we can figure out what causes the taper off, we can now, potentially, have turned those into those consistently high by offsetting whatever that barrier was that prevented them from maintaining adherence to the medication.  

And so, this was like the beginning of what was to come. I wanted to first understand these patterns. And now the next step is, what are the factors and beliefs and like, lifestyles or life events that predict whether somebody follows these different patterns? So that we could start to really zero in on, how can we support individuals that start off and then taper off, or those that never really start using it, so that we can improve adherence to the medication. And I feel like, a lot of this is probably going to be around perceptions. And then also there could be individuals to where, they may not be responding to the medication the way we would want. And there’s probably, maybe, possibly like a genetic component to that, I don’t know. But it just, this is the beginning for more work to be done. 

Stuart Shapiro
So you’re in our Health Administration program, so I have to ask. What does this mean for hospitals and doctors and how they should be behaving? 

Melinda Rushing
Yeah. So I think this is pretty insightful for hospitals and doctors because it keeps… our goal when it comes to managing sickle cell is, get them on hydroxyurea, get them to adhere to it, and then things will be good. But knowing that two-thirds of your population are likely to start off… oh, I should say it’s one-third of your population is likely to start off and then drop off, another third is likely to start with very low adherence and then end up stop adhering. it now shows that we need to identify these individuals as outpatient providers and then see, figure out what it is, what’s going on within those first four months of them initiating hydroxyurea therapy. So that they may just need more support. Or maybe they need more education. Or maybe they need to like see that, okay, these symptoms may not last and maybe there’s something else that can offset these—I’m sorry, not symptoms these side effects—or maybe something that can offset these side effects? Either way it goes like, within those four months, now providers can look and monitor their patients more closely to help them to maintain this utilization of this medication. So that we’re able to have better long term outcomes. 

Stuart Shapiro
That’s great. So, let’s bring it back to health administration now. You’ve been here almost a year. I can’t believe the academic year is almost over at this point. Tell me a little bit about your, you know, your experience and teaching in a health administration program. And how your research has informed that. And what you hope students get out of classes. I know that’s like three questions in one, but do whatever you want with it. 

Melinda Rushing
Okay. Alright. I probably should have written them down ((laughing))  Okay,  I’ll go over what I remember. Teaching, actually, it’s been a lot of fun. The students have been engaged. And I feel like, it’s nice to be able to, like, translate the things that I’ve learned and the things that I’ve seen to the next generation so that they can be prepared to go into the field. A lot of…I like to do these kind of—I think I call them affirmations of just like calling them leaders—and like when you get into these leadership positions or as health administrators, things like to kind of, like, start to… I’m going to say prime them to think as a leader. And we have these different in-class activities that I do where they’re having to, like, solve these kind of issues, situations that simulate real life challenges that they may face or decisions they have to make. And I’ve gotten a lot of good feedback from the students on these activities. And it’s been fun to go from building out, how do I lecture? How do I balance lecturing in a way, kind of mentoring, and then also providing experiential learning? And that experiential learning piece I’m finding is extremely important in the class setting. And it helps these concepts stick. So it’s been a lot of fun being able to teach.  

Because as a postdoc, I was in the School of Medicine, so I was strictly focused on research. But here I get to, I guess, have this outlet as well. And I’m able to talk about my research during my class for different examples. And I ended up getting some funding and I recruited one of my students to come on as a RA [research assistant]. And I guess a heart warming moment was when he told me that he was enjoying this, and enjoying the role, and he was having a lot of fun. And like, to see the eagerness of, like, how he approaches these questions—well, I have two students—how both of them like, they’re approaching these questions that I’m asking. And even, like, giving them opportunities to think about like these results with me. And hearing like their perspective and just showing them like, I don’t know, like showing them how to think critically about these issues from…. It’s been,  I’ve been… I’m enjoying it a lot. It’s been a lot of fun. And I feel like I’m giving back in two ways. One through my research of helping a patient population I’m passionate about, but also by working with students and helping support them in their passions and showing them, how do I pursue these different careers and interests that I have with this? With the idea of like, improving healthcare or contributing to the improvement of our healthcare system? 

Stuart Shapiro
That is a great note to end on. I love the tie between research and teaching. I love the fact that in a world where we are… where many are questioning the role of research, how it fits hand-in-glove with teaching is an important thing for people to remember. Melinda, thank you so much for coming on today. 

Melinda Rushing
Yes, thank you. It was a pleasure! 

Stuart Shapiro
Also thank you to Tamara Swedberg and Karyn Olsen, who make this podcast happen. This is our final episode of this season and this academic year. We’ll be back in the fall with another season of talks with experts from the Bloustein School. Until then, catch up on some old episodes and stay safe!