Hospitals

The tertiary care medical facilities that account for about a third of national health expenditures.  Almost 80% of hospitals are non-profit. 

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...

New Study Details Savings from Bundled Payments

Jan. 13, 2017

This is the way it is supposed to work. You develop policy and processes to drive innovation. You design and test innovative ideas in a small, efficient way. You learn and adapt. Successful innovation drives new policy. Rinse and repeat.

And this is the way it appears to have worked, in the case of Medicare bundled payment. Start small with a pilot. Expand in reach and scope if promising. Scale up if successful.

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?

Health Systems and Social Determinants

Dec. 1, 2016

The election of Donald Trump has ushered in an uncertain future for the Affordable Care Act (ACA), from modification to total repeal. While many policy experts are concerned about people losing the coverage they gained through the ACA, other aspects of the ACA are also under threat: specifically, provisions that address the social determinants of health.

Recurrent Violent Injury: Magnitude, Risk Factors and Opportunities For Intervention From a Statewide Analysis

Research Brief
Oct. 24, 2016

Recurrent injury is a promising target for prevention, as prior injury is a strong predictor of future violent injury and death. But the incidence of recurrent violent injury, on an area-wide level, is unknown, and the risk factors contributing to it are not well understood. 

Deaths from Unintentional Injury, Homicide, and Suicide During or Within 1 Year of Pregnancy in Philadelphia

Oct. 14, 2016

Pooja K. Mehta, Marcus A. Bachhuber, Roy Hoffman, Sindhu K. Srinivas

In the American Journal of Public Health, Pooja Mehta and colleagues seek to understand the effect of unintentional injuries, suicide, and homicide on pregnancy-associated death. The authors find that about half of of pregnancy-associated deaths - occurring during or within one year of pregnancy - in Philadelphia between 2010 and 2014 were due to unintentional injuries, homicide, or suicide. Of these deaths, more than 50% were directly or indirectly associated with substance use, more than 40% were associated with serious mental illness, and more than 20% were associated with...

Emergency Department Length-Of-Stay For Psychiatric Visits Was Significantly Longer Than For Nonpsychiatric Visits, 2002–11

Sep. 22, 2016

Jane M. Zhu, Astha Singhal, Renee Hsia

In Health Affairs, Jane Zhu and colleagues investigate wait times and discharge outcomes among psychiatric patients in the emergency department (ED). This study is a retrospective comparison of more than 230,000 psychiatric and non-psychiatric visits across 350-400 US EDs between 2002 and 2011. They analyzed length-of-stay (a standard measure of ED crowding and access to services) as well as rates of admissions, discharges, and transfers. Length-of-stay was defined as the difference between the time of triage and time of departure from the ED for a given patient. Patients seen in...

What Do Hospitalized Patients Say Would Be Worse Than Death?

Aug. 16, 2016

[cross-posted with the Health Cents blog on philly.com]

In caring for hospitalized patients with serious illnesses, and in evaluating interventions designed to help them, clinicians and researchers often focus on death as the primary outcome to be avoided. We tend to pay less attention to avoiding other outcomes that may be equally or more unacceptable to some patients.

States Worse Than Death Among Hospitalized Patients with Serious Illnesses

Aug. 15, 2016

Emily B. Rubin, Anna E. Buehler, Scott D. Halpern

In JAMA Internal Medicine, Emily Rubin and colleagues, including Scott Halpern, investigate how hospitalized patients with serious illnesses evaluate states of cognitive or functional debility relative to death. The authors conducted structured interviews with 180 patients, 60 years and older, who were hospitalized between July 2015 and March 2016 at an academic medical center in Philadelphia. All patients were asked to evaluate health states with specific physical and cognitive debilities, dependencies on forms of life support and dependencies on others to perform various...

Practice Patterns in Medicaid and Non-Medicaid Asthma Admissions

Aug. 5, 2016

Jeffrey H. SilberPaul R. Rosenbaum, Wei Wang, Shawna Calhoun, James P. Guevara, Joseph J. Zorc, Orit Even-Shoshan

In Pediatrics, Jeffrey Silber and colleagues investigate whether Medicaid and non-Medicaid patients admitted to the hospital for asthma are treated differently in major children’s hospitals. Medicaid provider reimbursement levels can be significantly lower than private insurance reimbursements, making it important to analyze whether this impacts the health care received by Medicaid beneficiaries. The authors used data from 40 children’s hospitals to analyze more than 17,000 matched pairs of Medicaid to non-Medicaid children admitted for asthma in the same hospital over three years...

Urgent Care Needs Among Nonurgent Visits to the Emergency Department

May. 11, 2016

Renee Hsia, Ari Friedman, Matthew Niedzwiecki

In JAMA Internal Medicine, Renee Hsia and colleagues, including Ari Friedman, investigate whether nonurgent status determined in the emergency department effectively ruled out the possibility of serious pathologic conditions, and compared these findings with visits deemed as urgent from triage. The authors used data from the National Hospital Ambulatory Medical Care Survey to compare characteristics and outcomes of nonurgent visits with those of urgent visits. They find that a nontrivial proportion of ED visits that were deemed nonrurgent arrived by ambulance, received diagnostic...

Common and Costly Hospitalizations Among Insured Young Adults Since the Affordable Care Act

May. 11, 2016

Alexander Bain, Charlene Wong, Gail Slap, Daniel Polsky, Raina Merchant, Yaa Akosa Antwi, David Rubin, Carol Ford

In the Journal of Adolescent Health, Alexander Bain and colleagues, including Charlene Wong, Daniel Polsky, Raina Merchant, and David Rubinm, identify the most prevalent and costly inpatient hospitalizations in a national cohort of privately insured young adults since the implementation of the Affordable Care Act. The researchers analyzed 158,777 hospitalizations among 4.7 million young adults from January 2012 to June 2013. They find that the top diagnoses for young adult female hospitalizations were pregnancy related (71.9%) and mental illness (8.9%). The top diagnoses for young...

Click Worthy: Stories Encourage Emergency Physicians to Learn More About Opioid Prescribing Guidelines

Research Brief
Zachary F. Meisel, MD
May. 5, 2016

New study finds that narrative vignettes outperform standard summaries in promoting engagement with opioid prescription guidelines among a national sample of emergency physicians. 

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