Physicians

The supply, distribution, specialty mix, and other characteristics of the nearly 900,000 professionally-active U.S. physicians

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’...

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.

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...

Pennsylvania Launches its Prescription Drug Monitoring Program

Aug. 25, 2016

Prescribers are drawing a lot of attention as a key target of initiatives to combat the opioid crisis. This week, the US Surgeon General, Vivek Murthy, took the unprecedented step of sending 2.3 million clinicians a letter calling for a national movement to turn the tide on the opioid crisis.

Shared Decision Making and Treatment Decisions for Young Children with Autism Spectrum Disorder

Aug. 19, 2016

Susan E. Levy, Rosemary Frasso, Stephanie Colantonio, Hayley Reed, Gail Stein, Frances K. Barg, David S. Mandell, Alexander G. Fiks

In Academic Pediatrics, Susan Levy and colleagues including Rosemary Frasso, David Mandell and Alexander Fiks, examine the barriers to communication and shared decision-making between pediatricians and parents of young children with autism spectrum disorder (ASD). Lack of shared decision-making and communication about management decisions often results in parents’ perception of unmet needs for coordination of care and referral for specialized care. This authors interviewed 20 pediatricians from 10 primary care practices in urban and suburban areas, and 20 English-speaking parents...

Physicians’ Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities

Research Brief
Aug. 8, 2016

Early evidence suggests that accountable care organizations (ACOs) - networks of doctors and hospitals whose members share responsibility for providing coordinated care to patients - improve health care quality and constrain costs. ACOs are increasingly common in the U.S., both for Medicare and commercially insured patients. However, there are concerns that ACOs may worsen existing disparities in health care quality if disadvantaged patients have less access to physicians who participate in them. Does physicians’ ACO participation relate to the sociodemographic characteristics of their patient population, and if so, why?

Chart of the Day: Medical Debtor Nation

Jul. 22, 2016

This chart on the educational debt level of medical school graduates was tucked away in supplementary material for an excellent article by Ari Friedman and colleagues in the Journal of General Internal Medicine on loan forgiveness programs:

Generic Medication Prescription Rates After Health System–Wide Redesign of Default Options Within the Electronic Health Record

May. 19, 2016

Mitesh Patel, Susan Day, Scott Halpern, William Hanson, Joseph Martinez, Steven Honeywell Jr, Kevin Volpp

In JAMA Internal Medicine, Mitesh Patel and colleagues, including Scott Halpern and Kevin Volpp, evaluate how changing electronic health record (EHR) defaults affects physician prescribing of generic drugs. For the study, the researchers utilized a systemic change to the University of Pennsylvania Health System’s EHR defaults. As part of this change, an opt-out checkbox labeled “dispense as written” was added to the prescription screen, and if left unchecked the generic-equivalent medication was prescribed. The authors find that generic prescribing rates increased significantly...

Gender of the Clinician, Child, and Guardian and the Association With Receipt of Routine Adolescent Vaccines

May. 17, 2016

Laura Johnson Faherty, Benjamin French, Alexander Fiks

In the Journal of Adolescent Health, Laura Johnson Faherty and colleagues, including Benjamin French and Alexander Fiks, investigate the relationship of the gender of the clinician, child and guardian to the child’s receipt of human papilloma virus (HPV) vaccine compared to tetanus, diphtheria, acellular pertussis (Tdap) and meningococcal dose 1 (MCV4) vaccines. Faherty and colleagues used electronic health record data from visits by adolescents to 27 primary care practices from 2009 to 2014 and stratified visits by type (preventive/acute). Adolescents were more likely to be...

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