Delivery Innovation

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

System Redesign and the Health Care Workforce

Oct. 19, 2017

An interdisciplinary panel of experts from health care management, economics, and nursing came together at LDI’s 50th Anniversary Symposium to discuss their perspectives on how “organizational innovation” can be used to redesign health care systems and care delivery.

Moderator:
Linda Aiken, PhD, RN, University of Pennsylvania

Addressing Gaps in Evidence-Based Opioid Policy and Practice

Aug. 29, 2017

Although evidence from health policy research should inform policymaking, researchers and policymakers don’t always communicate. A conference sponsored by the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH) – a NIDA-funded Center of Excellence – and hosted by the Leonard Davis Institute of Health Economics (LDI) sought to close this gap…if even for a day.

The Exaggerated Life of Death Panels? The Limited but Real Influence of Elite Rhetoric in the 2009-2010 Health Care Debate

Jul. 25, 2017

Daniel Hopkins

In Political Behavior, Daniel Hopkins analyzes the ability of American elites to frame political issues to sway public opinion, as well as the real-world constraints on that ability. Previous experiments demonstrate that elites can influence public opinion through framing, yet those experiments may not account for limitations on that ability. The author uses the 2009-2010 health care debate, along with automated content analyses of elite- and general population language, to study real-world effects of framing. He finds that the language Americans use to explain their opinions is...

Cost Offset Associated With Early Start Denver Model for Children With Autism

Jul. 19, 2017

Zuleyha Cidav, Jeff Munson, Annette Estes, Geraldine Dawson, Sally Rogers, David Mandell

In Child and Adolescent Psychiatry, Zuleyha Cidav and colleagues, including David Mandell, examine the effect of the Early Start Denver Model (ESDM) for treatment of young children with autism on health care service use and costs. ESDM is a comprehensive behavioral intervention for young children with autism that utilizes teaching strategies based on applied behavior analysis. Such early interventions have previously been associated with significant behavioral outcome improvements and long-term cost savings.

The authors find that, while ESDM is more expensive than community...

Performance Improvement in Health Care Organizations

Jul. 19, 2017

Hummy Song, Anita Tucker

In Foundations and Trends in Technology, Information, and Operations Management, Hummy Song and Anita Tucker present a framework for performance improvement in health care organizations. Performance improvement is an important organizational capability that is essential for health care organizations to achieve excellence on the three components of the Triple Aim: patient experience, health, and cost. The authors’ model, called the Model of Transformational Performance Improvement, takes a system-level approach to performance improvement and comprises six key components. These...

Development and Validation of the Primary Care Team Dynamics Survey

Jul. 19, 2017

Hummy Song, Alyna T. Chien, Josephine Fisher, Julia Martin, Antoinette S. Peters, Karen Hacker, Meredith B. Rosenthal, Sara J. Singer

In Health Services Research, Hummy Song and colleagues develop and validate a survey instrument designed to measure team dynamics in primary care. The authors study 1,080 physician and non-physician health care professionals at 18 primary care practices participating in a learning collaborative to improve team-based care. They administer a cross-sectional survey addressing team dynamics, and assessed reliability and discriminant validity of survey factors, as well as the overall survey’s goodness-of-fit. They find that this model demonstrated adequate fit, scale reliability, and...

Unicompartmental Knee Arthroplasty Vs. Total Knee Arthroplasty for Medial Compartment Arthritis in Patients Older Than 75 Years: Comparable Reoperation, Revision, and Complication Rates

Jul. 11, 2017

Homayoun Siman, Atul F. Kamath, Nazly Carrillo, William S. Harmsen, Mark W. Pagnano, Rafael J. Sierra

In The Journal of Arthroplasty, Homayoun Siman and colleagues, including Atul Kamath, assess the effectiveness of unicompartmental knee arthroplasty (UKA) vs. total knee arthroplasty (TKA) in similar patients. Prior studies have shown that UKA procedures have advantages over TKA, including preservation of bone stock, shorter and easier recovery, lower overall cost, lower morbidity, better functional outcome, and subjective feeling of a more natural knee. The authors conducted a retrospective review of patients 75 years and older who underwent UKA or TKA over a 10-year period in...

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

Jul. 10, 2017

Linda H. Aiken, Douglas Sloane, Peter Griffiths, Anne Marie Rafferty, Luk Bruyneel, Matthew McHugh, Claudia B. Maier, Teresa Moreno-Casbas, Jane E. Ball, Dietmar Ausserhofer, Walter Sermeus

In BMJ Quality & Safety, Linda Aiken and colleagues, including Matthew McHugh examine the association of hospital nursing skill mix with patient mortality, patient ratings of care, and indicators of quality care among European hospitals. As policymakers around the world seek to reduce health spending, a popular target in Europe has been to transition from more professional nurses to fewer high-cost nurses supported by more lower-wage assistants. The authors analyzed how nursing skill mix affects indicators of quality patient care. The authors utilized cross-sectional patient...

Components of Comprehensive and Effective Transitional Care

Jul. 10, 2017

Mary D. Naylor, Elizabeth C. Shaid, Deborah Carpenter, Brianna Gass, Carol Levine, Jing Li, Ann Malley, Kathleen Mccauley, Huong Q. Nguyen, Heather Watson, Jane Brock, Brian Mittman, Brian Jack, Suzanne Mitchell, Becky Callicoatte, John Schall, Mark V. Williams

In Journal of the American Geriatrics Society, Mary Naylor and colleagues identify components of the Transitional Care model that provide the desired patient and caregiver outcomes. For decades, the Transitional Care (TC) model has worked to prevent re-hospitalizations and their associated costs, however little is known about the specific factors that make TC effective. The authors formed a workgroup to identify a preliminary set of components. The workgroup conducted focus groups and interviews with patients and caregivers, and created an advisory group comprised of patient and...

Nurses’ Perceptions of In-Hospital Versus Telephone Availability of an Intensivist at Night in an Intensive Care Unit

Jul. 10, 2017

Emily S. Stanton, Cary Hilbert, Stephanie Maillie, Jessica Dine, Scott D. Halpern, and Meeta Prasad Kerlin

In American Journal of Critical Care, Emily Stanton and colleagues, including Jessica Dine, Scott Halpern, and Meeta Prasad Kerlin, investigate nurses' perceptions about nighttime intensivist staffing. The authors conducted semi-structured interviews of 13 night-shift nurses in an academic medical intensive care unit to elicit perceptions of nighttime staffing with attending intensivists, versus residents with attending intensivists on call remotely. Eight themes emerged from these interviews: efficiency, communication, job place comfort, quality of patient care, procedures,...

Treatment seeking as a mechanism of change in a randomized controlled trial of a mobile health intervention to support recovery from alcohol use disorders

Jul. 10, 2017

Joseph E. Glass, James R. McKay, David H. Gustafson, Rachel Kornfield, Paul J. Rathouz, Fiona M. McTavish, Amy K. Atwood, Andrew Isham, Andrew Quanbeck, Dhavan Shah

In Journal of Substance Abuse Treatment, Joseph Glass and colleagues, including James McKay, assessed the efficacy of an Addiction-Comprehensive Health Enhancement Support System (A-CHESS) in increasing the use of services for addiction. This model is an electronic health framework that has been applied to a diverse set of health problems, including pediatric asthma and breast and lung cancer, and was previously adopted to alcohol addiction in a randomized-controlled trial. The authors conducted secondary data analyses of this trial, including 349 adults with alcohol use disorders...

Bringing Rounds Back to the Patient: A One-Year Evaluation of the Chiefs’ Service Model for Inpatient Teaching

Jul. 5, 2017

Nadia L. Bennett, Judd D. Flesch, Peter Cronholm, James B. Reilly, Jack Ende

In Academic Medicine, Nadia Bennett and colleagues, including Peter Cronholm and Jack Ende, evaluate the impact of a new approach to inpatient teaching on both patient care and resident education. This model, called the Chiefs’ Service (CS), is a structured approach to inpatient teaching rounds, and has five key elements: morning huddles, bedside rounds, diagnostic “time-outs”, day-of-discharge rounds, and postdischarge follow-up rounds. The authors conducted end-of-rotation evaluation questionnaires among 183 residents after the program’s first year, and compared residents’...

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