Delivery Innovation

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

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,...

Comparison of Pharmacy Claims and Electronic Pill Bottles for Measurement of Medication Adherence Among Myocardial Infarction Patients

Aug. 2, 2018

Shivan J. MehtaDavid A. Asch, Andrea B. Troxel, Raymond Lim, Jennifer Lewey, Wenli Wang, Jingsan Zhu, Laurie Norton, Noora Marcus, ...

ABSTRACT [FROM JOURNAL]

Background: Medication adherence after myocardial infarction remains low. Pharmacy claims have typically been used to measure medication adherence, but electronic pill bottles may offer additional information.

Objective: The main objectives of this study were to compare the association of adherence measured by prescription claims and remote monitoring technologies with cardiovascular events.

Research Design: This study was a secondary analysis of a remote monitoring intervention to increase...

Association Between 5-Star Nursing Home Report Card Ratings and Potentially Preventable Hospitalizations

Aug. 2, 2018

Kira L. Ryskina, Tamara Konetzka, Rachel M. Werner

ABSTRACT [FROM JOURNAL]

Nursing homes’ publicly reported star ratings increased substantially since Centers for Medicare & Medicaid Services’s Nursing Home Compare adopted a 5-star rating system. Our objective was to test whether the improvements in nursing home 5-star ratings were correlated with reductions in rates of hospitalization. We hypothesized that increased attention to 5-star star ratings motivated nursing homes to make changes that improved their star ratings but did not affect their hospitalization rate, resulting in a weakened association between ratings and...

Acuity-Based Scheduling in Primary Care

Jul. 25, 2018

ABSTRACT [FROM JOURNAL]

Objectives: Triage algorithms are ubiquitous in emergency care settings, but the extent of their use in primary care is unknown. This study asks whether primary care practices prioritize patients with more acute service needs.

Methods: We used an audit study in which simulated patients were randomized to 2 clinical scenarios—a new patient seeking a routine check-up or a new patient seeking treatment for newly diagnosed hypertension—and attempted to schedule appointments with thousands of randomly selected primary...

Burns Calls BS on CVS-Aetna Merger

Jul. 23, 2018

[Editor's note: on August 1, 2018, California Insurance Commissioner Dave Jones recommended that the United States Department of Justice sue to block the proposed merger.]

The proposed $69 billion merger of CVS and Aetna drew sharp criticism in a June California Insurance Commission hearing, including from LDI Senior Fellow Lawton R.  Burns, PhD, MBA, Professor of Health Care Management in the Wharton School.

A Randomized Controlled Trial of Opt-in Versus Opt-Out Colorectal Cancer Screening Outreach

Jul. 9, 2018

Shivan J. Mehta, Tanya Khan, Carmen Guerra, Catherine Reitz, Timothy McAuliffe, ...

ABSTRACT [FROM JOURNAL]

Objectives: Colorectal cancer (CRC) screening uptake is suboptimal, despite national efforts to increase screening rates. Behavioral economic approaches such as changing defaults may increase participation. We compare response rates to opt-in or opt-out messaging in mailed fecal immunochemical test (FIT) outreach.

Methods: This is a two-arm randomized controlled trial among 314 patients aged 50–74 years who had at least two primary care visits in the 2...

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