Delivery Innovation

The search for new and innovative ways to deliver health care more efficiently and effectively. 

Micro-Costing in Health and Medicine: A Critical Appraisal

Jennifer Prah Ruger, PhD, MSc, MA, MSL
Jan. 6, 2021

Xiao Xu, Christina M. Lazar, Jennifer Prah Ruger

Abstract [from journal]

Background: Concerns about rising health care costs require rigorous economic study to inform clinical and policy decision-making. Micro-costing is a cost estimation methodology employing detailed resource utilization and unit cost data to generate precise estimates of economic costs. Micro-costing studies have not been critically appraised.

Methods: Critical appraisal of micro-costing studies in English. Studies fully or predominantly employing micro-costing were appraised for methodological


Choice Architecture in Physician-Patient Communication: A Mixed-Methods Assessments of Physicians’ Competency

Joanna Hart, MD, MSHP
Jan. 5, 2021

Joanna HartKuldeep Yadav, Stephanie Szymanski, Amy Summer, Aaron Tannenbaum, Julian Zlatev, David Daniels, Scott D. Halpern

Abstract [from journal]

Background: Clinicians' use of choice architecture, or how they present options, systematically influences the choices made by patients and their surrogate decision makers. However, clinicians may incompletely understand this influence.

Objective: To assess physicians' abilities to predict how common choice frames influence people's choices.

Methods: We conducted a prospective mixed-methods study using a scenario-based competency questionnaire and semistructured


Patient-Reported Outcomes 12 Months After Hepatitis C Treatment with Direct-Acting Antivirals: Results from the PROP UP Study

Jan. 2, 2021

Marina Serper, Donna M. Evon, Jipcy Amador, Paul W. Stewart, Souvik Sarkar, Anna S. Lok, Richard K. Sterling, Bryce B. Reeve, Carol E. Golin, K. Rajender Reddy, Joseph K. Lim, Nancy Reau, David R. Nelson, Adrian M. Di Bisceglie, Michael W. Fried

Abstract [from journal]

Background and aims: The long-term impact of hepatitis C virus (HCV) therapy with all-oral direct-acting antivirals (DAAs) on patient-reported outcomes (PROs) has not been well-described. We characterized changes in PROs from pre-treatment to 12 months post-treatment in a real-world cohort.

Methods: PROP UP was a multi-center observational cohort study of 1,601 patients treated with DAAs at 11 U.S. gastroenterology/hepatology practices from 2015-2017. PROs were evaluated pre-treatment (T1) and


Patient Characteristics Associated With Telemedicine Access for Primary and Specialty Ambulatory Care During the COVID-19 Pandemic

Lauren Eberly
Dec. 29, 2020

Lauren A. Eberly, Michael J. Kallan, Howard M. Julien, Norrisa Haynes, Sameed Ahmed M. Khatana, Ashwin S. Nathan, Christopher Snider, Neel P. Chokshi, Nwamaka D. Eneanya, Samuel U. Takvorian, Rebecca Anastos-Wallen, Krisda Chaiyachati...

Abstract [from journal]

Importance: The coronavirus disease 2019 (COVID-19) pandemic has required a shift in health care delivery platforms, necessitating a new reliance on telemedicine.

Objective: To evaluate whether inequities are present in telemedicine use and video visit use for telemedicine visits during the COVID-19 pandemic.

Design, Setting, and Participants: In this cohort study, a retrospective medical record review was conducted from March 16 to May 11, 2020, of all patients scheduled for...

Pediatric/Congenital Cardiac Catheterization Quality: An Analysis of Existing Metrics

Dec. 28, 2020

Michael L. O'Byrne, Jing Huang, Ivor Asztalos, Christopher L. Smith, Yoav Dori, Matthew J. Gillespie, Jonathan J. Rome, Andrew C. Glatz

Abstract [from journal]

Objectives: The aim of this study was to enumerate and categorize quality metrics relevant to the pediatric/congenital cardiac catheterization laboratory (PCCL).

Background: Diagnostic and interventional catheterization procedures are an increasingly important part of the care of young patients with cardiac disease. Measurement of the performance of PCCL programs in a stringent and consistent fashion is a crucial step toward improving outcomes. To the best of our knowledge, a systematic


Enhanced Recovery After Surgery for Head and Neck Free Flap Reconstruction: A Systematic Review and Meta-Analysis

Dec. 23, 2020

Kevin Chorath, Beatrice Go, Justin R. Shinn, Leila J. Mady, Seerat Poonia, Jason Newman, Steven Cannady, Peter C. Revenaugh, Alvaro Moreira, Karthik Rajasekaran

Abstract [from journal]

Introduction: Head and neck free flap reconstruction requires multidisciplinary and coordinated care in the perioperative setting to ensure safe recovery and success. Several institutions have introduced enhanced recovery after surgery (ERAS) protocols to attenuate the surgical stress response and improve postoperative recovery. With multiple studies demonstrating mixed results, the success of these interventions on clinical outcomes has yet to be determined.

Objective: To evaluate the impact


Barriers and Facilitators to Guideline-Adherent Pulse Oximetry Use in Bronchiolitis

Dec. 23, 2020

Courtney Benjamin Wolk, Amanda C. Schondelmeyer, Frances K. Barg, Rinad Beidas, Amanda Bettencourt, Patrick W. Brady, Canita Brent, Whitney Eriksen, Grace Kinkler, Christopher P. Landrigan, Rebecca Neergaard, Christopher P. Bonafide

Abstract [from journal]

Objective: Continuous pulse oximetry monitoring (cSpO2) in children with bronchiolitis does not improve clinical outcomes and has been associated with increased resource use and alarm fatigue. It is critical to understand the factors that contribute to cSpO2 overuse in order to reduce overuse and its associated harms.

Methods: This


Health Economic Design for Cost, Cost-Effectiveness and Simulation Analyses in the HEALing Communities Study

Dec. 1, 2020

Arnie P. Aldridge, Carolina Barbosa, Joshua A. Barocas, Joshua L. Bush, Jagpreet Chhatwal, Kristin J. Harlow, Ayaz Hyder, Benjamin P. Linas, Kathryn E. McCollister, Jake R. Morgan, Sean M. Murphy, Caroline Savitzky, Bruce R. Schackman, Eric E. Seiber, Laura E. Starbird, Jennifer...

Abstract [from journal]

Background: The HEALing Communities Study (HCS) is designed to implement and evaluate the Communities That HEAL (CTH) intervention, a conceptually driven framework to assist communities in selecting and adopting evidence-based practices to reduce opioid overdose deaths. The goal of the HCS is to produce generalizable information for policy makers and community stakeholders seeking to implement CTH or a similar community intervention. To support this objective, one aim of the HCS is a health economics study (HES), the


Maternal Morbidity and Birth Satisfaction After Implementation of a Validated Calculator to Predict Cesarean Delivery During Labor Induction

Nov. 13, 2020

Rebecca F. Hamm, Jennifer McCoy, Amal Oladuja, Hilary R. Bogner, Michal A. Elovitz, Knashawn H. Morales, Sindhu K. Srinivas, Lisa D. Levine

Abstract [from journal]

Importance: A previously created and validated calculator provides an individualized cesarean delivery risk score for women undergoing labor induction. A higher predicted risk of cesarean delivery on the calculator has been associated with increased maternal and neonatal morbidity regardless of ultimate delivery mode. The effect of this calculator when implemented in clinical care has yet to be evaluated.

Objective: To determine whether implementation of a validated calculator that predicts the...

Adolescents, Psychiatric Hospitalization, and COVID-19

Sep. 15, 2020

As we approach the sixth month of widespread community transmission of COVID-19 in the United States, our focus must shift beyond acute management of disease to the broader effects of this pandemic on health and wellbeing. In particular, it is important that we understand the consequences of the COVID-19 pandemic on the mental health of children and adolescents.