Research Publications

Transforming Mental Health Delivery Through Behavioral Economics and Implementation Science: Protocol for Three Exploratory Projects

Rinad Beidas head shot
Feb. 14, 2019

Rinad S. BeidasKevin G VolppAlison N Buttenheim, Steven C Marcus, Mark Olfson, Melanie Pellecchia, Rebecca E Stewart, Nathaniel J Williams, Emily M Becker-Haimes, Molly Candon, Zuleyha Cidav...

ABSTRACT [from journal]

Background: Efficacious psychiatric treatments are not consistently deployed in community practice, and clinical outcomes are attenuated compared with those achieved in clinical trials. A major focus for mental health services research is to develop effective and cost-effective strategies that increase the use of evidence-based assessment, prevention, and treatment approaches in community settings.

Objective: The goal of this program of research is to apply insights from behavioral...

Factors Underlying Racial Disparities in Sepsis Management

Feb. 14, 2019

Matthew DiMeglio, John Dubensky, Samuel Schadt, Rashmika Potdar, and Krzysztof Laudanski

Abstract [from journal]

Sepsis, a syndrome characterized by systemic inflammation during infection, continues to be one of the most common causes of patient mortality in hospitals across the United States. While standardized treatment protocols have been implemented, a wide variability in clinical outcomes persists across racial groups. Specifically, black and Hispanic populations are frequently associated with higher rates of morbidity and mortality in sepsis compared to the white population. While this is often attributed to systemic bias against...

Association of Nurse Engagement and Nurse Staffing on Patient Safety

Feb. 14, 2019

J. Brooks Carthon, Linda Hatfield, Colin Plover, Andrew Dierkes, Lawrence Davis, Taylor Hedgeland, Anne Sanders, Frank Visco, Sara Holland, Jim Ballinghoff, Mary Del Guidice, Linda Aiken

ABSTRACT [from journal]

Background: Nurse engagement is a modifiable element of the work environment and has shown promise as a potential safety intervention.

Purpose: Our study examined the relationship between the level of engagement, staffing, and assessments of patient safety among nurses working in hospital settings.

Methods: A secondary analysis of linked cross-sectional data was conducted using survey data of 26 960 nurses across 599 hospitals in 4 states. Logistic regression models were used to examine the...

Patients’ Perspectives on Approaches to Facilitate Completion of Advance Directives

Jan. 31, 2019

Joshua A. Rolnick, Judy A. Shea,  Joanna L. Hart, Scott D. Halpern


Background: Little is understood about the different ways patients complete advance directives (ADs), which is most commonly through lawyers and increasingly using websites.

Objective: To understand patients’ perspectives on different approaches to facilitating AD completion, the value of legal regulation of ADs, and the use of a web-based platform to create an AD.

Design: Semi-structured interviews with patients.

Setting/Participants: We purposively sampled 25


What Motivates Mental Health Clinicians-in-Training to Implement Evidence-Based Assessment? A Survey of Social Work Trainees

Jan. 31, 2019

Viktor Lushin, Emily M. Becker-Haimes, David Mandell, Jordan Conrad, Victor Kaploun, Sophia Bailey, Ai Bo, Rinad S. Beidas


Mental health clinicians do not consistently use evidence-based assessment (EBA), a critical component of accurate case conceptualization and treatment planning. The present study used the Unified Theory of Behavior to examine determinants of intentions to use EBA in clinical practice among a sample of Masters’ level social work trainees (N = 241). Social norms had the largest effect on intentions to use EBA. Injunctive norms in reference to respected colleagues accounted for the most variance in EBA intentions. Findings differed for respondents over 29 ...

Using Behavioral Economics to Encourage Parent Behavior Change: Opportunities to Improve Clinical Effectiveness

Jan. 31, 2019


Pediatric clinical practice often involves improving child health by changing parents’ behavior. Strategies from behavioral economics—a field that leverages predictable patterns in human decision making to overcome barriers to behavior change—can improve health outcomes in adults. Although more research is needed, the application of these approaches to parent behavior change in pediatric settings has the potential to improve the clinical effectiveness of child health care. We review the foundational concepts of behavioral economics and identify the unique...

The Impact of Intimate Partner Violence, Depressive Symptoms, Alcohol Dependence, and Perceived Stress on 30-year Cardiovascular Disease Risk Among Young Adult Women: A Multiple Mediation Analysis

Jan. 31, 2019

Elizabeth Novack Wright, Alexandra Hanlon, Alicia Lozano, Anne M. Teitelman


Intimate partner violence (IPV), the physical, sexual, psychological abuse or control by a former or current intimate partner, affects almost one-third of women in the United States. IPV exposure can result in many negative outcomes including physical injury, increased stress, and depression. Currently, there is a small, but, growing body of literature examining the link between IPV victimization and increased cardiovascular disease (CVD) risk among young adult women. To better prevent this negative outcome, it is imperative to understand what factors...

How Liability Insurers Protect Patients and Improve Safety

Tom Baker, JD
Jan. 29, 2019

Tom Baker, Charles Silver

Abstract [from journal]

Forty years after the publication of the first systematic study of adverse medical events, there is greater access to information about adverse medical events and increasingly widespread acceptance of the view that patient safety requires more than vigilance by well-intentioned medical professionals. In this essay, we describe some of the ways that medical liability insurance organizations contributed to this transformation, and we catalog the roles that those organizations play in promoting patient safety today. Whether liability insurance in fact...

Are Recessions Good for Staffing in Nursing Homes?

Jan. 28, 2019

R. Tamara Konetzka, Karen B. Lasater, Edward C. Norton, Rachel M. Werner


The quality and cost of care in nursing homes depend critically on the number and types of nurses. Recent research suggests that the nursing supply adjusts to macroeconomic conditions. However, prior work has failed to consider the effect of macroeconomic conditions on demand for nurses through the effect on revenues. We test how county-level unemployment rates affect direct-care staffing rates in nursing homes using California data. We exploit the wide variation in the unemployment rates across counties and over time in 2005–2012. We also test whether...

The Effect of Implementation Climate on Program Fidelity and Student Outcomes in Autism Support Classrooms

David S. Mandell, ScD
Jan. 23, 2019

Hilary E. Kratz, Aubyn Stahmer, Ming Xie, Steven C. Marcus, Melanie Pellecchia, Jill J. Locke, Rinad Beidas,...


Objective: An organization's implementation climate, or the extent to which use of an intervention is expected, supported, and rewarded by colleagues and supervisors, has been identified as critical to successful intervention implementation and outcomes. The effect of implementation climate has not been well studied in special education settings. The present study examines the association between teachers' perceptions of implementation climate, teacher fidelity to a school-based program for students with autism, and student outcomes (...

Construct Validity of Six Sentiment Analysis Methods in the Text of Encounter Notes of Patients With Critical Illness

Jan. 23, 2019


Sentiment analysis may offer insights into patient outcomes through the subjective expressions made by clinicians in the text of encounter notes. We analyzed the predictive, concurrent, convergent, and content validity of six sentiment methods in a sample of 793,725 multidisciplinary clinical notes among 41,283 hospitalizations associated with an intensive care unit stay. None of these approaches improved early prediction of in-...

The Association of the Nurse Work Environment and Patient Safety in Pediatric Acute Care

Eileen Lake, PhD, RN
Jan. 23, 2019

Eileen T. LakeKathryn E. Roberts, Paula D. Agosto, Elizabeth Ely, Amanda P. BettencourtElizabeth S....


Objectives: Eighteen years ago, the Institute of Medicine estimated that medical errors in hospital were a major cause of mortality. Since that time, reducing patient harm and improving the culture of patient safety have been national health care priorities. The study objectives were to describe the current state of patient safety in pediatric acute care settings and to assess whether modifiable features of organizations are associated with better safety culture.

Methods: An observational cross-sectional study used...

Pathways to Abortion at a Tertiary Care Hospital: Examining Obesity and Delays

Jan. 23, 2019

Alhambra Frarey, Courtney Schreiber, Arden McAllister, Allison Shaber, Sarita Sonalkar, Mary D. Sammel,...


Context: Advancing gestational age can increase the cost of an abortion and is a significant risk factor for complications. While obesity is not associated with increased risks, anecdotal evidence suggests that obese women seeking services at freestanding abortion clinics are often referred for hospital‐based care, which can lead to delays.

Methods: In 2016, a cross‐sectional survey collected data on the experiences of 201 women who had obtained abortions at a hospital‐based clinic in Philadelphia; rates of medical...

Financial Fraud Among Older Americans: Evidence and Implications

Jan. 23, 2019

Marguerite DeLiema, Martha Deevy, Annamaria Lusardi, Olivia S Mitchell


Objectives: The consequences of poor financial capability at older ages are serious and include making mistakes with credit, spending retirement assets too quickly, and being defrauded by financial predators. Because older persons are at or past the peak of their wealth accumulation, they are often the targets of fraud.

Methods: Our project analyzes a module we developed and fielded on people aged 50 an older years in the 2016 Health and...

Trends in Opioid Prescribing and Dispensing by Veterinarians in Pennsylvania

Jan. 17, 2019

Dana L. Clarke, Kenneth J. Drobatz, Chloe Korzekwa, Lewis S. Nelson, Jeanmarie Perrone

Abstract [from journal]

Importance: Veterinarians are a subset of opioid prescribers.

Objective: To assess the quantity and trends in prescribing and dispensing of several different opioids in the past 11 years in a large veterinary hospital in Philadelphia, Pennsylvania.

Design, Setting, and Participants: This cross-sectional study inventoried all opioid tablets and/or patches dispensed or prescribed by veterinarians practicing in a multispecialty academic veterinary teaching hospital in Philadelphia...