Association of Bundled Payments for Joint Replacement Surgery and Patient Outcomes With Simultaneous Hospital Participation in Accountable Care Organizations

Amole Navathe19-head
Oct. 9, 2019

Joshua M. Liao, Ezekiel J. Emanuel, Atheendar S. Venkataramani, Qian Huang, Claire T. Dinh, Eric Z. Shan, Erkuan Wang, Jingsan Zhu, Deborah S. Cousins, Amol S. Navathe

Abstract [from journal]

Importance:  An increasing number of hospitals have participated in Medicare’s bundled payment and accountable care organization (ACO) programs. Although participation in bundled payments has been associated with savings for lower-extremity joint replacement (LEJR) surgery, simultaneous participation in ACOs may be associated with different outcomes given the prevalence of LEJR among patients receiving care at ACO participant organizations and potential overlap in care redesign strategies adopted under the 2 payment models.


Potentially Preventable Intensive Care Unit Admissions in the United States, 2006 - 2015

Oct. 4, 2019

Gary E. Weissman, Meeta Prasad Kerlin, Yihao Yuan,  Rachel Kohn,  George L. Anesi, Peter W. Groeneveld, Rachel M. Werner, Scott D. Halpern

Abstract [from journal]

Rationale: Increasing intensive care unit (ICU) beds and the critical care workforce are often advocated to address an aging and increasingly medically complex population. However, reducing potentially preventable ICU stays may be an alternative to ensure adequate capacity.

Objectives: To determine the proportions of ICU admissions meeting two definitions of being potentially preventable using nationally representative United States (US) claims databases.

Methods: We analyzed claims from 2006...

Performance of a Clinical Decision Support Tool to Identify PICU Patients at High Risk for Clinical Deterioration

Heather Wolfe, MD
Oct. 2, 2019

Maya Dewan, Naveen Muthu, Eric Shelov, Christopher Bonafide, Patrick Brady, Daniela Davis, Eric Kirkendall, Dana Niles, Robert Sutton, Danielle Traynor, Ken Tegtmeyer, Vinay Nadkarni, Heather Wolfe

Abstract [from journal]

Objectives: To evaluate the translation of a paper high-risk checklist for PICU patients at risk of clinical deterioration to an automated clinical decision support tool.

Design: Retrospective, observational cohort study of an automated clinical decision support tool, the PICU Warning Tool, adapted from a paper checklist to predict clinical deterioration events in PICU patients within 24 hours.

Setting: Two quaternary care medical-surgical PICUs—The Children’s Hospital of Philadelphia and...

Household Labor Search, Spousal Insurance, and Health Care Reform

Oct. 1, 2019

Hanming Fang, Andrew J. Shephard

Abstract [from journal]

Health insurance in the United States for the working age population has traditionally been provided in the form of employer-sponsored health insurance (ESHI). If employers offered ESHI to their employees, they also typically extended coverage to their spouse and dependents. Provisions in the Affordable Care Act (ACA) significantly alter the incentive for firms to offer insurance to the spouses of employees. We evaluate the long-run impact of ACA on firms’ insurance offerings and on household outcomes by developing and estimating an equilibrium job search...

Complete Eats: Summer Meals Offered by the Emergency Department for Food Insecurity

Oct. 1, 2019

Danielle Cullen, Abigail Blauch, Morgan Mirth, Joel Fein

Abstract [from journal]

More than 21 million low-income children rely on free or reduced-price meals during the school year. The US Department of Agriculture Summer Food Service Program (SFSP) provides meals to children during the summer months, but these programs are underused. The emergency department (ED) of urban medical centers is 1 of the few establishments that children access during the summer months, and as such, it may be a prime point of entry for such programs. This advocacy case study describes the implementation and evaluation of situating an SFSP in the


Mixed Studies Review of Factors Influencing Receipt of Pain Treatment by Injured Black Patients

Sep. 30, 2019

Shoshana V. Aronowitz, Catherine C. McDonald, Robin C. Stevens, Therese S. Richmond

Abstract [from journal]

Aim: To explore the factors that influence provider pain treatment decision making and the receipt of pain management by injured Black patients in the United States.

Design: We completed a systematic mixed studies review using a results-based convergent synthesis design.

Data source: PubMed, SCOPUS, and CINAHL were searched for articles published between 2007-2017 using the search terms "African American", "Black American", "race", "pain treatment", "pain management", and "analgesia".


8 Months to 5 Days: What Happened When Pennsylvania Changed the Vaccination Regulations for Provisional Enrollment?

Sep. 30, 2019

Salini Mohanty, Paul Delamater, Kristen Feemster, Alison M. Buttenheim

Abstract [from journal]

In March 2017, the Pennsylvania Department of Health reduced the time allowed to demonstrate compliance with school-entry vaccination requirements from eight months to five days. We describe changes in provisional enrollment, vaccine exemptions, and vaccine coverage rates before and after the new regulation. Across Pennsylvania, provisional enrollment decreased from 11.1 % in 2016/17 to 2.5% in 2017/18 (77% relative decrease). Personal belief exemptions continued a modest upward trend, similar to previous years, and medical exemptions remained steady


Variation in the Utilization of Robotic Surgical Operations

Sep. 27, 2019

Jennifer H. Fieber, Lindsay E. Kuo, Chris Wirtalla, Rachel R. Kelz

Abstract [from journal]

The appropriate use of the robot in surgery continues to evolve. Robotic operations (RO) are particularly advantageous for deep pelvic and retroperitoneal procedures, but the implementation of RO is unknown. We aimed to examine regional variation for the most commonly performed RO in general, gynecologic, and urologic surgery. A three-state inpatient database from 2008 to 2011 was used. Nine common robotic inpatient general, gynecologic and urologic surgery procedures were analyzed. States were divided into hospital service areas (HSAs). The percentage of...

The Tragedy of Wasted Funds and Broken Dreams: An Economic Analysis of Childhood Exposure to Crime and Violence

Sep. 27, 2019

Michal Gilad, Abraham Gutman

Abstract [from journal]

In 2012, Attorney General Eric E. Holder’s Task Force declared childhood exposure to crime and violence a “national crisis.” The problem of childhood crime exposure, which we previously coined the Triple-C Impact, is estimated to be one of the most damaging and costly public health and public safety problems in our society today. Yet, thus far no one knows how much it actually costs us.

This article aims to answer this daunting question and provide an empirical economic analysis of the cost of the Triple-C Impact problem to the state and to society...

The Relationship Between Exogenous Exposure to "The Real Cost" Anti-smoking Campaign and Campaign-Targeted Beliefs

Robert C. Hornik, PhD
Sep. 26, 2019

Elissa C. Kranzler, Robert C. Hornik

Abstract [from journal]

Though previous evaluations of "The Real Cost" anti-smoking campaign demonstrate effects on anti-smoking beliefs and behaviors, results rely on self-reported recall as a measure of exposure and are thus open to reverse causation concerns. Exogenous measures of exposure, assessed independently of outcomes, support stronger causal inferences. In this study, we examined the relationship between Target Rating Points (TRPs) for specific ads available over four-week periods and anti-smoking beliefs in a national sample of adolescent nonsmokers and


Characteristics and Practice Patterns of Advanced Practice Registered Nurses Caring for Older Adults: A Survey of Gerontological Advanced Practice Nurses Association Members

Sep. 25, 2019

Carolyn Clevenger, Yin Li, Katherine Evans, Pamela Cacchione

Abstract [from journal] 

Background: Advanced practice registered nurses (APRNs) play a pivotal role in meeting the increasing needs of elder care given the aging population. A good understanding of the characteristics of gerontological APRNs is important for future workforce planning.

Purpose: To understand the demographic, employment, and practice characteristics of APRNs who provide elder care.

Methods: A 34-item survey was distributed to 2,500 current members of the Gerontological Advanced Practice Nurses...

Harsh Communication: Characteristics of Caregivers and Persons with Dementia

Sep. 24, 2019

Darina V. Petrovsky, Justine S. Sefcik, Nancy A. Hodgson, Laura N. Gitlin 

Abstract [from journal]

Objectives: While ways to reduce caregiver burden have dominated dementia care research, there is little understanding of daily communication and its relationship to caregiver burden and depression. In this study, we sought to: (1) describe the frequency of harsh communication used by caregivers; (2)


Nonadherence Labeling in Primary Care: Bias by Race and Insurance Type for Adults With Type 2 Diabetes

Peter Cronholm, MD, MSCE
Sep. 24, 2019

Sourik Beltrán, Lanair A.Lett, Peter F.Cronholm

Abstract [from journal] 

Introduction: Little is known about how provider bias can influence nonadherence labeling. Therefore, a retrospective cohort analysis was conducted to assess the risk of patients with Type 2 diabetes being labeled nonadherent by sociodemographic factors.

Methods: Patients with Type 2 diabetes were identified from 4 primary care sites of the University of Pennsylvania Health System. Demographics, HbA1c, and ICD-10 codes for Type 2 diabetes and nonadherence were extracted from the electronic health


Association of Opioids With Incisional Ocular Surgery

Brian L. Vanderbeek, MD, MPH
Sep. 19, 2019

Anton M. Kolomeyer, Yinxi Yu, Brian L. VanderBeek

Abstract [from journal]

Importance: Opioid abuse has been declared a public health emergency. Currently, little is known about the association between opioids and ocular surgery.

Objective: To characterize rates of filled opioid prescriptions after incisional ocular surgeries.

Design, Setting, and Participants: This cohort study included patients with incisional ocular surgeries within a large national US insurer's administrative medical claims database. All incisional ocular surgeries from January 2000 through


Working Memory Development and Motor Vehicle Crashes in Young Drivers

Flaura K. Winston, MD, PhD
Sep. 13, 2019

Elizabeth A. Walshe, Flaura K. Winston, Laura M. Betancourt, Atika Khurana, Kristin Arena, Daniel Romer


Importance: Adolescent drivers have the highest rate of motor vehicle crashes, and among equally novice drivers, crash risk is inversely age graded. Working memory (WM), crucial to driving hazard awareness, is also age graded, with ongoing development into late adolescence. Variability in WM capacity and growth trajectory positions WM as a candidate crash risk factor for study, clinical screening, and possible preventative intervention.

Objective: To test the association between crashes and differential WM development...