Health Care Delivery: Research

Penn’s Gant Family Precision Medicine Consortium Takes on Sustainable Targeted Oncology

Sep. 20, 2018

Biomedical advances in genomics and oncology, combined with rising costs for targeted cancer therapies, challenge the way we currently deliver and pay for cancer care. To foster the economic sustainability of targeted therapies, the University of Pennsylvania convened the Gant Family Precision Cancer Medicine Consortium, a multidisciplinary work group of experts from health care economics, policy, law, regulation, biomedical research, patient advocacy, and the pharmaceutical and insurance industry.

Cost-effective Screening and Treatment of Hepatitis C

Issue Brief
Sep. 17, 2018

In just five years, hepatitis C has changed from a difficult-to-treat chronic condition to one that is readily cured by a short course of medication. Medical breakthroughs have now created the possibility of eliminating the transmission of HCV, but also bring a new challenge for the health system—how to identify individuals carrying the hepatitis C virus (HCV), and how to pay for life-saving treatments. This Issue Brief reviews recent evidence on the cost-effectiveness of screening and treatment strategies, and makes the case for universal, one-time HCV screening for all US adults.

Racial/Ethnic Disparities in US Pediatric Growth Hormone Treatment

Adda Grimberg, MD
Sep. 13, 2018

Adda Grimberg, Anders Lindberg, Michael Wajnrajch, Andrew J. Cucchiara, Cecilia Camacho-Hübner

Abstract [from journal]

Background/Aims: To compare racial/ethnic proportions of subjects receiving growth hormone (GH) treatment to the expected proportions, and secondarily, to assess racial/ethnic differences in subject characteristics at GH treatment initiation. 

Methods: Race/ethnicity-based expected frequencies of height <–2.25 SD were determined by applying relative risks for short stature, calculated from a regional population of 189,280 pediatric primary care patients, to US census data, and compared to racial/...

Mandatory Health Care Provider Counseling For Parents Led To A Decline In Vaccine Exemptions In California

Sep. 10, 2018

Malia Jones, Alison M. Buttenheim, Daniel Salmon, and Saad B. Omer

ABSTRACT [FROM JOURNAL] 

Receipt of childhood vaccinations in the US has been declining, and outbreaks of preventable infectious diseases have become more common. In response, in 2014 California implemented a policy change for exemptions from mandatory vaccines for school enrollment. Data on fifteen successive cohorts of kindergarteners enrolled in public and private schools between school years 2001–02 and 2015–16 were analyzed for changes in vaccination trends. The results show an increase in the prevalence and clustering of vaccine exemptions from 2001–02 through 2013–14,...

Impact of an Interprofessional Transition of Care Service on 30-Day Hospital Reutilizations

David T. Grande, MD, MPA
Sep. 10, 2018

Shelley Otsuka, Jennifer N. Smith, Laura Pontiggia, Radha V. Patel, Susan C. Day and David T. Grande

ABSTRACT [FROM JOURNAL]

The objective of this study was to evaluate the impact of an interprofessional Transitions of Care (TOC) service on 30-day hospital reutilization inclusive of hospital readmissions and ED visits. This was a retrospective cohort study including patients discharged from an academic medical center between September 2013 and October 2014. Patients scheduled for a hospital follow-up visit in the post-acute care clinic (PACC) were included in the intervention group and patients without a post-discharge interprofessional TOC service were included in the comparison...

Feasibility and Effects of Digital Interventions to Support People in Recovery From Substance Use Disorders: Systematic Review

Sep. 5, 2018

Sverre Nesvåg and James R. McKay 

Abstract [from journal]

Background: The development and evaluation of digital interventions aimed at preventing or treating substance use–related problems and disorders is a rapidly growing field. Previous reviews of such interventions reveal a large and complex picture with regard to targeted users, use, and efficacy.

Objective: The objective of this review was to investigate the feasibility and effects of interventions developed specifically for digital platforms. These interventions are focused on supporting people in recovery from...

A Policy Analysis of Legally Required Supervision of Nurse Practitioners and Other Health Professionals

Sep. 5, 2018

Ashley Z. Ritter, Kathryn H. Bowles, Ann L. O'Sullivan, ...

Abstract [from journal]

The use of legally required supervision occurs across health professionals who provide similar services. Legally required supervision has the potential to disrupt the production of high-quality, cost-efficient, accessible health services across disciplines.

This paper examines the effects of nurse practitioner collaborative practice agreements and similar

...

Developing a Standard Handoff Process for Operating Room-to-ICU Transitions: Multidisciplinary Clinician Perspectives from the Handoffs and Transitions in Critical Care (HATRICC) Study

Sep. 5, 2018

Meghan B. Lane-Fall, Jose L. Pascual, Scott Massa, Meredith L. Collard, Hannah G. Peifer, Laura J. Di Taranti, Megan Linehan, Lee A. Fleisher...

Abstract [from journal]

Background: Operating room (OR)–to-ICU handoffs place patients at risk for preventable harm. Numerous studies have described standardized handoff procedures following cardiac surgery, but no existing literature describes a general OR-to-ICU handoff system.

Methods: As part of the Handoffs and Transitions in Critical Care (

...

Association of Hospital Participation in a Medicare Bundled Payment Program With Volume and Case Mix of Lower Extremity Joint Replacement Episodes

Sep. 5, 2018

Abstract [from journal]

Importance: Medicare’s Bundled Payments for Care Improvement (BPCI) initiative for lower extremity joint replacement (LEJR) surgery has been associated with a reduction in episode spending and stable-to-improved quality. However, BPCI may create unintended effects by prompting participating hospitals to increase the overall volume of episodes paid for by Medicare, which could potentially eliminate program-related savings or prompt them to shift case mix to lower-risk patients.

Objective: To evaluate...

Association of Pregnancy History and Cervical Cancer Screening in a Community Sample of Sexual Minority Women

Aug. 23, 2018

Madelyne Z. Greene,Tonda L. Hughes, Marilyn S. Sommers, Alexandra Hanlon, and Salimah H. Meghani

Abstract [from journal]

Background: Sexual minority women (SMW) face barriers to healthcare that may result in lower utilization of cervical cancer screening. Previous experiences with the healthcare system-specifically reproductive health-related encounters-have the potential to affect future use of screening services. This study aimed to examine the association between pregnancy history and cervical cancer screening in a diverse sample of SMW. Anderson's Behavioral Model of Health Services Use guided the selection of variables included in the study.

...

Associations of ICU Capacity Strain with Disposition and Outcomes of Patients with Sepsis Presenting to the Emergency Department

Aug. 23, 2018

George L. Anesi, Vincent X. Liu, Nicole B. Gabler, M. Kit Delgado, ...

Abstract [from journal]

Rationale: Intensive care unit (ICU) capacity strain refers to the potential limits placed on an ICU's ability to provide high-quality care for all patients who may need it at a given time. Few studies have investigated how fluctuations in ICU capacity strain might influence care outside of the ICU.

Objective: To determine whether intensive care unit (ICU) capacity strain is associated with initial level of inpatient care and outcomes for emergency department (ED) patients being hospitalized for sepsis.

...

Mergers and Marginal Costs: New Evidence on Hospital Buyer Power

Aug. 21, 2018

Abstract [from journal]

We estimate the effects of horizontal mergers on marginal cost efficiencies – an ubiquitous merger justification – using data containing supply purchase orders from a large sample of US hospitals 2009-2015. The data provide a level of detail that has been difficult to observe previously, and a variety of product categories that allows us to examine economic mechanisms underlying “buyer power.” We find that merger target hospitals save on average $176 thousand (or 1.5 percent) annually, driven by geographically local efficiencies in price negotiations for...

Racial Disparities in Nephrology Consultation and Disease Progression among Veterans with CKD: An Observational Cohort Study

Peter P. Reese, MD, MSCE
Aug. 20, 2018

Jonathan Suarez, Jordana B. Cohen, Vishnu Potluri, Wei Yang, David E. Kaplan, Marina Serper, Siddharth P. Shah, ...

Abstract [from journal]

Background: Incident rates of ESRD are much higher among black and Hispanic patients than white patients. Access to nephrology care before progression to ESRD is associated with better clinical outcomes among patients with CKD. However, it is unknown whether black or Hispanic patients with CKD experience lower pre-ESRD nephrology consultation rates compared with their white counterparts,

...

Twelve-Month Outcomes After Transplant of Hepatitis C–Infected Kidneys Into Uninfected Recipients: A Single-Group Trial

Peter P. Reese, MD, MSCE
Aug. 13, 2018

Peter P. Reese, Peter L. Abt, Emily A. Blumberg, Vivianna M. Van Deerlin, Roy D. Bloom, Vishnu S. Potluri, Matthew Levine, Paige Porrett, Deirdre Sawinski, Susanna M. Nazarian, Ali Naji, Richard Hasz, Lawrence...

Abstract [from journal]

BackgroundOrgans from hepatitis C virus (HCV)–infected deceased donors are often discarded. Preliminary data from 2 small trials, including THINKER-1 (Transplanting Hepatitis C kidneys Into Negative KidnEy Recipients), suggested that HCV-infected kidneys could be safely transplanted into HCV-negative patients. However, intermediate-term data on quality of life and renal function are needed to counsel patients about risk....

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