Research Publications

Pediatric and Adult Physician Networks in Affordable Care Act Marketplace Plans

Research Brief
Mar. 16, 2017

In a review of ACA plans, the authors find that the proportion of narrow networks were greater for pediatric specialties than for adult specialties, highlighting the need to monitor access to specialty care for children and families.

Price Transparency in Primary Care: Can Patients Learn About Costs When Scheduling an Appointment?

Feb. 16, 2017

Brendan Saloner, Lisa Clemens Cope, Katherine Hempstead, Karin Rhodes, Daniel Polsky, Genevieve Kenney

In the Journal of General Internal Medicine, Brendan Saloner, Daniel Polsky, Karin Rhodes, and colleagues investigate whether new patients can obtain price information for a primary care visit and identify variation across insurance types, offices and geographic areas. Cost-sharing in insurance plans incentivizes patients to shop for lower prices, but can patients obtain price information when scheduling office visits? The authors used a simulated patient methodology in which trained interviewers posed as patients (with different types of insurance) seeking new primary care...

What Factors Affect Physicians’ Decisions to Prescribe Opioids in Emergency Departments?

Feb. 16, 2017

Lauren E Sinnenberg, Kathryn J Wanner, Jeanmarie Perrone, Frances K Barg, Karin Rhodes, Zachary Meisel

In MDM Policy & Practice, LDI Senior Fellows Zachary Meisel, Jeanmarie Perrone, Karin Rhodes, and colleagues assess the factors physicians consider when treating pain with opioids in the emergency department (ED).  With 42% of all ED visits in the United States related to pain, the ED is an ideal setting to target to curtail the current opioid overdose epidemic and develop opioid prescription guidelines and policies. The researchers interviewed 52 physicians at a national emergency medicine conference. They identified three main domains that contributed to the participants’...

The Emerging Market of Smartphone-Integrated Infant Physiologic Monitors

Jan. 27, 2017

Christopher P. Bonafide,  David T. Jamison,  Elizabeth E. Foglia, 

In a JAMA Viewpoint, Christopher Bonafide and colleagues discuss the efficacy and safety of smartphone apps integrated with sensors that monitor infants’ vital signs. While the performance characteristics of these sensors are unknown to the public and the regulations around them are scarce, their sales have skyrocketed, reaching 40,000 units for a single brand of “smart sock” monitors. These companies use direct-to-parent advertising to portray their products as necessary to alert parents when something is wrong with their infants’ cardiorespiratory health, even though there are...

Biomarker-Defined Subsets of Common Diseases: Policy and Economic Implications of Orphan Drug Act Coverage

Jan. 20, 2017

Aaron S. Kesselheim, Carolyn L. Treasure, Steven Joffe

In PLOS Medicine, Aaron Kesselheim and colleagues, including LDI senior fellow Steven Joffe, investigate the policy and economic implications of the Orphan Drug Act of 1983, and examine the circumstances surrounding a drug’s discovery and development, secondary approvals, off label uses, subsequent revenues, and the reported monthly cost of biomarker-defined disease subsets. The Orphan Drug Act of 1983 was intended to incentivize the development of pharmaceutical products for rare diseases by providing manufacturers with the opportunity to earn grants, tax credits, free waivers,...

A Trial of Financial and Social Incentives to Increase Older Adults’ Walking

Jan. 20, 2017

Kristin A. Harkins, Jeffrey T. Kullgren, Scarlett L. Bellamy, Jason Karlawish, Karen Glanz

In the American Journal of Preventive Medicine, Kristin Harkins and colleagues, including LDI Senior Fellows Jason Karlawish and Karen Glanz, investigate the effects of financial incentives and donations to charity separately and combined on older adults’ uptake and retention of increased levels of walking. Despite evidence that regular physical activity confers health benefits, physical activity rates among older adults remain low. Both personal and social goals may enhance older adults’ motivation to become active. Ninety-four participants aged ≥65 years participated in this...

Mental Health Conditions and Medical and Surgical Hospital Utilization

Jan. 19, 2017

Stephanie K. Doupnik, John Lawlor, Bonnie Zima, Tumaini Coker, Naomi Bardach, Matt Hall, Jay Berry

In Pediatrics, LDI Fellow Stephanie Doupnik and colleagues examine how the presence of comorbid mental health conditions affect hospitalizations and costs. Using the 2012 Kids’ Inpatient Database, the authors conducted a retrospective, cross-sectional study of 670,161 hospitalizations for 10 common medical and 10 common surgical conditions among 3- to 20-year-old patients. They estimated the association of a comorbid mental health condition with length of stay using generalized linear models and the cost of additional hospital days associated with mental health conditions using...

Comparing International and United States Undergraduate Medical Education and Surgical Outcomes Using a Refined Balance Matching Methodology

Jan. 19, 2017

Salman Zaheer, Samuel Pimentel, Kristina Simmons, Lindsay Kuo, Jashodeep Datta, Noel Williams, Douglas Fraker, Rachel Kelz

In Annals of Surgery, Salman Zaheer and colleagues, including LDI Senior Fellow Rachel Kelz, compare surgical outcomes of international medical graduates (IMGs) and United States medical graduates (USMGs). Medical education outside of the US is substantially different from that in the US and usually begins right after high school and lasts for 5 to 7 years. This is the first study to examine differences in surgical outcomes of patients treated by IMGs and USMGs. The authors used a unique dataset linking AMA Physician Masterfile data with hospital discharge claims from Florida and...

Preschool ADHD Diagnosis and Stimulant Use Before and After the 2011 AAP Practice Guideline

Jan. 17, 2017

Alexander G. Fiks, Michelle E. Ross, Stephanie L. Mayne, Lihai Song,Weiwei Liu, Jennifer Steffes, Banita McCarn, Robert W. Grundmeier, A. Russell Localio, Richard Wasserman

In Pediatrics, LDI Senior Fellow Alexander Fiks and colleagues evaluate the change in the diagnosis of attention-deficit/hyperactivity disorder (ADHD) and in the prescribing of stimulants to children 4 to 5 years old after release of the 2011 American Academy of Pediatrics guideline. The authors use electronic health record data extracted from 63 primary care practices, including preventive visits from children 48 to 72 months old receiving care from January 2008 to July 2014, to compare rates of ADHD diagnosis and stimulant prescribing before and after guideline release. Among 87...

Cost of Joint Replacement Using Bundled Payment Models

Research Brief
Amol Navathe, MD, PhD
Jan. 6, 2017

Evidence on the effects of bundled payment is more important than ever, while hospitals already in Medicare bundled payment programs need guidance in redesigning care. This observational study looks at whether bundled payment for joint replacement affected quality, hospital costs and post-acute care spending in a health system that was an early adopter of the model. Did the bundles save money, and if so, what produced those savings?

Diagnosis and Medication Treatment of Pediatric Hypertension: A Retrospective Cohort Study

Jan. 2, 2017

David C. Kaelber, Weiwei Liu, Michelle Ross, A. Russell Localio, Janeen B. Leon, Wilson D. Pace, Richard C. Wasserman, Alexander G. Fiks

In Pediatrics, David Kaelber and colleagues, including LDI Senior Fellow Alexander Fiks, evaluate the diagnosis and initial medication management of pediatric hypertension and prehypertension in primary care. Pediatric hypertension predisposes children to adult hypertension and early markers of cardiovascular disease. Hypertension and pre-hypertension are well-defined, prevalent and generally asymptomatic conditions in children and adolescents that often go undiagnosed and untreated with...

Comparing the contributions of acute and post acute care facility characteristics to outcomes after hospitalization for hip fracture

Jan. 2, 2017

Neuman, Mark D.; Silber, Jeffrey H.; Passarella, Molly R.; Werner, Rachel M.

In Medical Care, LDI Senior Fellows Mark Neuman, Jeffrey Silber and Rachel Werner and colleagues quantify the contribution of acute versus post acute care factors to survival and functional outcomes after hip fracture. This retrospective cohort study was conducted using Medicare data from previously ambulatory nursing home residents hospitalized for hip fracture between 2005 and 2009. The authors measured the associations of hospital and nursing home factors with functional and survival outcomes at 30 and 180 days among patients discharged to a nursing facility,...

False Dichotomies and Health Policy Research Designs: Randomized Trials Are Not Always the Answer

Dec. 31, 2016

Stephen B. Soumerai, Rachel Ceccarelli, and Ross Koppel

In the Journal of General Internal Medicine, Stephen Soumerai and colleagues, including LDI Senior Fellow Ross Koppel, highlight the benefits of using quasi-experimental designs and observational data when a study neither permits or requires a randomized controlled trial (RCT). Using Campbell and Stanley’s classic research design monograph, which classifies research as randomized experiments, strong quasi-experiments, and weak pre-experiments, the authors provide a simple hierarchy of common strong and weak designs, with RCTs and interrupted time series (ITS) both classified as...

Effect of a Decision Aid on Access to Total Knee Replacement for Black Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial

Research Brief
Dec. 8, 2016

An educational video on the risks and benefits of total knee replacement increased the rate of surgery among black patients, in a clinical trial of an intervention that could reduce known racial disparities in treatment of osteoarthritis.