Health Care Delivery: Research

Integrating Social Needs Into Health Care: A Twenty-Year Case Study Of Adaptation And Diffusion

Feb. 14, 2018

Rebecca D. Onie, Risa Lavizzo-Mourey, Thomas H. Lee, James S. Marks, and Rocco J. Perla

In Health Affairs, Rebecca Onie and colleagues, including Risa Lavizzo-Mourey, conduct a twenty-year qualitative case study of Health Leads, an organization that partners with health care institutions and communities to address patients’ basic resource needs, and its funders. The case study demonstrates the successful stages of diffusion, defined as the process by which an innovation is communicated over time within a social system, leading to increased exposure and adoption. The authors segmented the process for Health Leads into five distinct phases:

  1. Testing and
  2. ...

The Use of Individual Provider Performance Reports by US Hospitals

Feb. 13, 2018

In the Journal of Hospital Medicine, Joshua Rolnick and Kira Ryskina analyze trends in how hospitals use the electronic health record to track and provide feedback on provider performance. The authors use data from a nationally representative survey of US hospitals from 2013 to 2015 to identify hospitals that have used electronic data to create individual provider performance profiles (IPPs). They model how the odds of IPP use differ as a function of hospital characteristics, including ownership (non-profit, for-profit, or government), geographic region, teaching versus...

Association of Rideshare-Based Transportation Services and Missed Primary Care Appointments: A Clinical Trial

Research Brief
Feb. 7, 2018

In a pragmatic trial, offering complimentary ridesharing services broadly to Medicaid patients did not reduce rates of missed primary care appointments. The uptake of free rides was low, and rates of missed appointments remained unchanged at 36%. Efforts to reduce missed appointments due to transportation barriers may require more targeted approaches.

Infants in Drug Withdrawal: A National Description of Nurse Workload, Infant Acuity, and Parental Needs

Feb. 1, 2018

Jessica G. Smith, Jeannette A. Rogowski, Kathryn M. Schoenauer, ...

In the Journal of Perinatal and Neonatal Nursing, Jessica Smith and colleagues, including Jeannette Rogowski and Eileen Lake, investigate how infants in drug withdrawal compare with nondrug withdrawal infants to inform proper nurse assignments based on infant acuity and parental needs. Though not commonly recognized, a troubling aspect of the opioid epidemic is increased drug use among pregnant women, which has led to an increase in infants who are...

Association between Electronic Medical Record Implementation of Default Opioid Prescription Quantities and Prescribing Behavior in Two Emergency Departments

Research Brief
Kit Delgado, MD, MS
Jan. 30, 2018

Setting a low quantity of opioid tablets as the default option in electronic medical record prescribing orders may “nudge” clinicians to prescribe fewer opioids. When two emergency departments implemented a 10-tablet default instead of a manual entry, the proportion of 10-tablet prescriptions written more than doubled, from 20.6% to 43.3%. Conversely, 20-tablet prescriptions decreased from 22.8% to 16.1%, and prescriptions for 11-19 tablets decreased from 33.5% to 20.1%. 

Patient satisfaction with hospital care and nurses in England: an observational study

Jan. 11, 2018

Linda H. Aiken, Douglas M. Sloane, Jane Ball, Luk Bruyneel, Anne Marie Rafferty, Peter Griffiths

In BMJ Open, Linda Aiken and colleagues examine how patient perceptions of hospital care are associated with confidence in nurses and doctors, nurse staffing levels, and hospital work environments in National Health Service (NHS) hospitals in England. The authors use national survey data from over 66,000 hospital patients and nearly 3,000 inpatient nurses for their analysis.

The authors find that patients have a high level of trust and confidence in RNs, but only 60 percent of patients indicated that there were enough RNs to care for them. The importance of adequate RN...

New OECD Report Highlights Expanded Primary Care Role for Nurses

Jan. 9, 2018

To meet population health care needs in developed countries, health systems must shift their focus from treating acute episodes to managing chronic conditions. With the rise of chronic care comes a new set of tasks that are more time-consuming and team-oriented. Policymakers in many countries are seeking to align the size and composition of their primary care workforce to meet these new needs, by expanding the role of advanced nurses.

Physicians and Advanced Practitioners Specializing in Nursing Home Care, 2012-2015

Research Brief
Nov. 29, 2017

The number of clinicians specializing in nursing home care increased by 33.7% from 2012 to 2015, although nursing home specialists made up only 21% of nursing home clinicians in 2015. Most of these specialists were advanced practitioners (physician assistants and nurse practitioners) delivering post-acute care. The change in number of nursing home specialists varied significantly by geographic region.

What Every Graduating Resident Needs to Know About Quality Improvement and Patient Safety: A Content Analysis of 26 Sets of ACGME Milestones

Nov. 29, 2017

Meghan Lane-Fall, Joshua J. Davis, Justin Clapp, Jennifer S. Myers, Lee Ann Riesenberg

In the Journal of the Association of American Medical Colleges, Meghan Lane-Fall and colleagues analyze milestones – competency-based outcomes assessing graduate medical trainees – across 26 specialties to identify common expectations related to quality improvement (QI) and patient safety (PS). The purpose of this work is to move toward a consensus around what every medical trainee needs to know in QI and PS, irrespective of specialty.

The authors performed a content analysis of 612 published milestones from the Accreditation Council for Graduate Medical Education (ACGME)....

Regional Variation in Standardized Costs of Care at Children’s Hospitals

Nov. 8, 2017

Jennifer A. Jonas, Samir S. Shah, Isabella Zaniletti, Matthew Hall, Jeffrey D. Colvin, Laura M. Gottlieb, Marion R. Sills, Jessica Bettenhausen, Rustin B. Morse, Michelle L. Macy, Evan S. Fieldston

In the Journal of Hospital Medicine, Evan Fieldston and colleagues investigated regional cost variation for three inpatient pediatric conditions, assessed the potential drivers of variation, and estimated the cost savings that could result from reducing variation. With some areas of the country spending close to three times more on health care than others, regional variation in health care spending has been a focus of national attention.

The authors analyzed hospitalizations for asthma, diabetic ketoacidosis (DKA), and acute gastroenteritis (AGE) at 46 children’s hospitals...

Pediatric Price Transparency: Still Opaque With Opportunities for Improvement

Oct. 25, 2017

Laura J. Faherty, Charlene A. Wong, Jordyn Feingold, Joan Li, Robert Town, Evan Fieldston, Rachel M. Werner

In Hospital Pediatrics, Laura J. Faherty and colleagues, including Evan Fieldston and Rachel Werner, describe online price transparency data for pediatric care and the consumer experience of obtaining an out-of-pocket estimate from children’s hospitals for a common procedure. Price transparency is gaining importance as families’ portion of health care costs rise.

The study consisted of three parts: an audit of 45 children’s hospital Web sites, "secret shopper" calls to the hospitals to request price estimates for a common pediatric procedure (a tonsillectomy-adenoidectomy...

Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study

Aug. 28, 2017

Jane E. Ball, Luk Bruyneel, Linda H. Aiken, Walter Sermeus, Douglas M. Sloane, Anne Marie Rafferty, Rikard Lindqvist, Carol Tishelman, Peter Griffiths, RN4CAST Consortium

In International Journal of Nursing Studies, Jane Ball and colleagues, including Linda Aiken, examine if missed nursing care explains the observed association between nurse staffing levels and mortality. Previous research has shown that higher postoperative mortality rates are associated with lower nurse staffing levels. When nurse staffing levels are lower, there is a higher incidence of necessary but missed nursing care. The authors collected data from 422,730 patients from 300 general acute hospitals, and administered surveys to 26,516 registered nurses to understand staffing...

Community Health Worker Support For Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial

Research Brief
Aug. 21, 2017

Community health worker interventions hold promise for improving outcomes of low-income patients with multiple chronic diseases.

Twitter Accounts Followed by Congressional Health Staff

Aug. 7, 2017

David Grande, Zachary F. Meisel, Raina M. Merchant, Jane Seymour, and Sarah E. Gollust

In American Journal of Managed Care, David Grande and colleagues, including Zachary Meisel and Raina Merchant, assess who Congressional health policy staff follow on Twitter. While health policy research should inform policymaking, the communication gap between researchers and policymakers limits successful translation. Social media represents a new opportunity to connect researchers and policymakers. The authors measured Congressional health policy staff’s use of Twitter and the types of individuals and organizations they follow. To focus on more influential Twitter accounts,...

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