Adoption and Diffusion

How the latest clinical, technological, and policy advances are incorporated into clinical practice and health care delivery.

43 Ways to Leave Your Technology

Feb. 14, 2017

We recently convened an expert roundtable to tackle how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable. This got us thinking - while the process by which ineffective practices or technologies are abandoned is neither simple nor automatic, even the language used to describe it is not clear. And language matters. It often reflects an unstated focus on one mechanism or one level of decision-making. Here we review, and potentially clarify, the terminology.

Choosing Wisely in Emergency Medicine: A National Survey of Emergency Medicine Academic Chairs and Division Chiefs

Mar. 14, 2016

Brandon Maughan, Jill Baren, Judy Shea, Raina Merchant

In Academic Emergency Medicine, Brandon Maughan and colleagues, including Judy Shea and Raina Merchant, assess whether leaders of academic emergency medicine departments are aware of the Choosing Wisely campaign, and their attitudes about the campaign. The Choosing Wisely campaign seeks to promote collaboration and communication between patients and physicians regarding the appropriateness of common tests and procedures. For this study, the researchers used a web-based survey of emergency department chairs and division chiefs to examine awareness of the campaign, anticipated...

Predictors of Community Therapists’ Use of Therapy Techniques in a Large Public Mental Health System

Apr. 1, 2015

Rinad S. Beidas, Steven Marcus, Gregory A. Aarons, Kimberly E. Hoagwood, Sonja Schoenwald, Arthur C. Evans, Matthew O. Hurford, Trevor Hadley, Frances K. Barg, Lucia M. Walsh, Danielle R. Adams, David S. Mandell

In JAMA Pediatrics, Rinad Beidas and colleagues explore the effects of individual and organizational characteristics on therapists’ self-reported use of different therapy techniques - cognitive behavioral therapy (CBT), family therapy, and psychodynamic therapy techniques. The study focuses on the Philadelphia public mental health system, currently engaged in a large-scale effort to increase the use of CBT. The study results show that although both individual and organizational factors are important, the relative significance of the factors varies by treatment type. Key findings include...

Adoption of Electronic Medical Record-Based Decision Support for Otitis Media in Children

Apr. 1, 2015

Alexander G. Fiks, Peixin Zhang, A. Russell Localio, Saira Khan, Robert W. Grundmeier, Dean J. Karavite, Charles Bailey, Evaline A. Alessandrini, Christopher B. Forrest

In Health Services Research, Alexander Fiks and colleagues, including Christopher Forrest, analyze the impact of feedback in improving adoption of clinical decision support (CDS). The work is part of a larger trial of the effectiveness of CDS for diagnosing and treating ear infections in children. While substantial investment in electronic health records (EHRs) has provided an unprecedented opportunity to use CDS, the impact of feedback on clinician use of CDS systems has not been well studied. The authors looked at EHR-based CDS adoption during 41,391 ear infection visits, and...

The Role of Training Environment Care Intensity in US Physician Cost Consciousness

Mar. 1, 2015

Kira L. Ryskina, Scott D. Halpern, Nancy S. Minyanou, Susan D. Goold, Jon C. Tilburt

In Mayo Clinical Proceedings, Kira Ryskina and colleagues, including Scott Halpern, evaluate the impact of training environment on physicians’ levels of cost-consciousness. The authors analyzed results from the Physicians, Health Care Costs, and Society survey, administered to physicians across the country in 2012. Using responses from physicians for whom information was available about the care intensity of the hospitals where they did their residency, the authors evaluated the degree to which training environment influenced the views expressed in the survey. Training intensity was...

The Role of Technical Advances in the Adoption and Integration of Patient-Reported Outcomes in Clinical Care

Feb. 1, 2015

Roxanne E. Jensen, Nan E. Rothrock, Esi M. DeWitt, Brennan Spiegel, Carole A. Tucker, Heidi M. Crane, Christopher B. Forrest, Donald L. Patrick, Rob Frederickson, Lisa M. Shulman, David Cella, Paul K. Crane

In Medical Care, Roxanne E. Jensen (Georgetown University) and colleagues, including LDI’s Christopher Forrest, explore the changing role of patient-reported outcomes (PROs) in clinical treatment. PROs, assessments of a patient’s experiences in a structured and standardized format directly from the patient themselves, are gaining recognition as key measures for improving the quality of patient care in clinical care settings. The authors examine five case studies across diverse health care settings and patient populations to explore how implementation barriers were addressed to promote the...

Physician Referrals, Delivery System Reform, and The Diffusion of Information

Jan, 2015
Principal Investigator:
Lawton R. Burns, PhD, MBA

Abstract: Physician-to-physician referrals play a central role in the health care systems and are drives of costs and quality. There is evidence that referrals are currently misused and overused and recognition that they will have to change if health reform objectives such as care coordination and cost reduction are to be achieved (Son et al., 2014). Indeed, many of the models of care supported by the Affordable Care Act (e.g., accountable care organizations (ACOs), patient-centered medical homes, bundled payments) depend on physicians making high-value referrals.

Development, implementation, and impact of an automated early warning and response system for sepsis

Jan. 1, 2015

Craig Umscheid, Joel Betesh, Christine VanZandbergen, Asaf Hanish, Gordon Tait, Mark Mikkelsen, Benjamin French, Barry Fuchs

In the Journal of Hospital Medicine, Craig Umscheid, Benjamin French, and other Penn colleagues investigate electronic health record (EHR)-based interventions aimed at reducing sepsis-related mortality. Severe sepsis affects as many as three million patients in the U.S. annually and kills 750,000. Earlier intervention could help to lower the mortality rate, but identifying at-risk patients is a challenge. Umscheid and colleagues propose that a better screening mechanism would help providers recognize and treat sepsis right away. To test this, they conduct a study where the EHRs of adult...

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