Health Care Delivery: Research

Geographic Variation in Postpartum Prescription Opioid Use: Opportunities to Improve Maternal Safety

Jun. 6, 2018

Nora V. Becker, Karen J.Gibbins, Jeanmarie Perrone, Brandon C. Maughan

Abstract [from journal]

Background: Obstetric delivery is among the most common in-hospital procedures experienced by reproductive-age women, yet there is little literature on patterns of postpartum opioid prescriptions after such episodes.

Methods: We used claims data from 871,195 vaginal deliveries to 768,455 privately-insured women with an in-hospital delivery between June 2001 and July 2013 to examine the state- and census division-level proportions of women who

...

The Effect of Workforce Assignment on Performance: Evidence from Home Health Care

Research Brief
May. 22, 2018

In this study of more than 43,000 home health episodes following a hospitalization, handoffs between skilled nursing providers—a marker of discontinuity of care—substantially increased hospital readmissions, and were more detrimental for sicker patients. The estimates imply that a single handoff increases the likelihood of 30-day hospital readmission by 16% and that one in four hospitalizations during home health care could be avoided if handoffs were eliminated.

Understanding Pediatric Caretakers’ Views On Obtaining Medical Care for Low‐Acuity Illness

May. 17, 2018

Whitney V. Cabey, Judy A. Shea, Shreya Kangovi, Danielle Kennedy, Chiamaka Onwuzulike, Joel Fein
 

Abstract [from journal]

Background: A significant proportion of low acuity emergency department (ED) visits are by patients under 18 years of age. Results from prior interventions designed to reduce low acuity pediatric ED use have been mixed or poorly sustained, perhaps because they were not informed by patient and caretakers’ perspectives. The objective of this study was to explore caretaker decision‐making processes, values and priorities when deciding to seek care.

Methods

...

Preventable Hospitalizations, Barriers to Care, and Disability

May. 17, 2018

Liliana E. Pezzin, Hillary R. Bogner, Jibby E. Kurichi, Pui L. Kwong, Joel E. Streim, Dawei Xie, Ling Na, Sean Hennessy

Abstract [from journal]

The AHRQ's Prevention Quality Indicators assume inpatient hospitalizations for certain conditions, referred as ambulatory-care sensitive (ACS) conditions, are potentially preventable and may indicate reduced access to and a lower quality of ambulatory care. Using a cohort drawn from the Medicare Current Beneficiary Survey (MCBS) linked to Medicare claims, we examined the extent to which barriers to healthcare are associated with ACS hospitalizations and related costs, and whether these associations differ by beneficiaries' disability status. Our results...

Outcomes of Care for Ischemic Heart Disease and Chronic Heart Failure in the Veterans Health Administration

May. 17, 2018

Peter W. Groeneveld, Elina L. Medvedeva, Lorrie Walker, Andrea G. Segal, Diane M. Richardson, Andrew J. Epstein

Abstract [from journal]

Importance: The Department of Veterans Affairs (VA) operates a nationwide system of hospitals and hospital-affiliated clinics, providing health care to more than 2 million veterans with cardiovascular disease. While data permitting hospital comparisons of the outcomes of acute cardiovascular care (eg, myocardial infarction) are publicly available, little is known about variation across VA medical centers (VAMCs) in outcomes of care for populations of patients with chronic, high-risk cardiovascular conditions.

Objective: ...

Failure-to-Rescue After Acute Myocardial Infarction

May. 10, 2018

Jeffrey H. Silber, Alexander F. Arriaga, Bijan A. Niknam, Alexander S. Hill, Richard N. Ross, and Patrick S. Romano

Abstract [from journal]

Background: Failure-to-rescue (FTR), originally developed to study quality of care in surgery, measures an institution’s ability to prevent death after a patient becomes complicated.

Objectives: Develop an FTR metric modified to analyze acute myocardial infarction (AMI) outcomes.

Research Design: Split-sample design: a random 20% of hospitals to develop FTR definitions, a second 20% to validate test characteristics, and an out-of-sample 60% to validate results.

Subjects...

Association of Race and Socioeconomic Status with Automatic External Defibrillator Training Prevalence in the United States

May. 10, 2018

D. Daphne Owen, Shaun K. McGovern, Andrew Murray, Marion Leary, Marina del Rios, Raina M.Merchant, Benjamin S.Abella, David Dutwin, Audrey L. Blewer...

Abstract [from journal]

Aim of the Study: Automated external defibrillators (AEDs) improve survival from out-of-hospital cardiac arrest (OHCA), however bystander use remains low. Limited AED training may contribute to infrequent use of these devices, yet no studies have assessed AED training nationally. Given previously documented racial disparities among Latinos in CPR provision and OHCA outcomes, we hypothesized that racial and socioeconomic differences exist in AED training, with Whites having increased training compared to Latinos and higher

...

Organizational Processes and Patient Experiences in the Patient-Centered Medical Home

May. 10, 2018

Abstract [from journal]

Background: There is increasing emphasis on the use of patient-reported experience data to assess practice performance, particularly in the setting of patient-centered medical homes. Yet we lack understanding of what organizational processes relate to patient experiences.

Objective: Examine associations between organizational processes practices adopt to become PCMH and patient experiences with care.

Research Design: We analyzed visit data from patients (n=8356) at adult primary care practices...

Best Practices for Reducing Unplanned Acute Care for Patients with Cancer

Research Brief
May. 3, 2018

Reducing preventable and unplanned emergency department visits and hospitalizations is a major challenge in cancer care. In this review of best practices and supporting evidence, the authors identified five strategies that health systems and cancer programs can use to reduce acute care: (1) identify patients at high risk of unplanned acute care; (2) enhance access and care coordination; (3) standardize clinical pathways for symptom management; (4) develop new sites for urgent cancer care, and; (5) use early palliative care. 

The Developmental Check-In: Development and Initial Testing of an Autism Screening Tool Targeting Young Children From Underserved Communities

May. 3, 2018

Yvette M. Janvier, Caroline N. Coffield, Jill F. Harris, David S. Mandell, Zuleyha Cidav

Abstract [from journal]

Children with autism spectrum disorder from low-income, minority families or those with limited English proficiency are diagnosed at a later age, or not at all, compared with their more advantaged peers. The Developmental Check-In is a new tool that could potentially be used to screen for autism that uses pictures to illustrate target behaviors. It was developed to enhance early identification of autism spectrum disorder in low literacy groups. The Developmental Check-In was tested in a sample of 376 children between the ages of 24 and 60 months, from...

Clinical Outcomes After Cardiac Stress Testing Among US Patients Younger Than 65 Years

May. 2, 2018

Vinay Kini, Elias J. Dayoub, Paul L. Hess, Lucas N. Marzec, Frederick A. Masoudi, P. Michael Ho, Peter W. Groeneveld

Abstract [from journal]

Background: Scientific statements have championed the measurement of clinical outcomes after cardiac stress testing to better define their value. Using contemporary national data, we sought to describe the characteristics of patients who experience outcomes after stress testing.

Methods and Results: Using administrative claims from a large national private insurer, we conducted an observational cohort study of

...

The Harold Amos Medical Faculty Development Program: Evaluation of a National Program to Promote Faculty Diversity and Health Equity

May. 1, 2018

James P. Guevara, Melissa Wright, Nancy W. Fishman, David M. Krol, Johnson Jerry

Abstract [from journal]

Purpose: The Harold Amos Medical Faculty Development Program (AMFDP), a national program of the Robert Wood Johnson Foundation, seeks to support academic physicians from historically disadvantaged backgrounds and...

US National Trends in Mortality From Acute Myocardial Infarction and Heart Failure: Policy Success or Failure?

Apr. 26, 2018

Paula Chatterjee, Karen E. Joynt Maddox

Abstract [from journal]

Importance: Hospitals in the United States have been subject to mandatory public reporting of mortality rates for acute myocardial infarction (AMI) and heart failure (HF) since 2007 and to value-based payment programs for these conditions since 2011. However, whether hospitals with initially poor baseline performance have improved relative to other hospitals under these programs, and whether patterns of improvement differ by condition, is unknown. Understanding trends within...

Pages