In JAMA Surgery, Mila Jiu and colleagues, including Charles Bosk, compare surgical site infection (SSI) monitoring systems, discrepancies in their implementation, and their relationship to infection rates. The researchers compared the National Health and Safety Network (NHSN), which is required by most states, and the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), which is not. The study looks at how the NHSN or ACS NSQIP was implemented in 16 hospitals. It also observes rates of colon SSIs at these same hospitals. The data were collected...
How can we redesign physician incentives to improve their impact on behavior and performance? Recently, the Commonwealth Fund published a round-up of expert views on reforming physician incentives, and one of the experts was LDI Senior Fellow Amol Navathe, MD, PhD. Navathe, a physician, health economist, and engineer, studies how to apply behavioral economic principles to physician financial and non-financial incentives.
In Diagnosis, John Barbieri, Benjamin French and Craig Umscheid investigate whether the use of a differential diagnosis (DDX) generator within a health care system leads to an increase in unnecessary testing and specialty consultation. By providing access to a broad differential, DDX generators can potentially help clinicians overcome cognitive biases by directing them to diagnoses they might not have considered otherwise. However, as the tool suggests numerous potential diagnoses, its use could result in an increase in unnecessary testing and specialty consultation, and...
I recently attended the AcademyHealth Annual Research Meeting (ARM) thanks to the support of the Alice S. Hersh Scholarship and the Leonard Davis Institute (LDI). At the ARM, two themes stood out for me: the re-emergence of managed care as a vehicle for replacing volume with value, and behavioral economics.
Although the supply of nurses is likely to meet overall demand, the nature of a nurse’s job is changing dramatically as nurses assum expanded roles in redesigned health care systems for a broad range of patients in ambulatory settings and community-based care.
In a new LDI/INQRI Research Brief, Erin Fraher, Joanne Spetz, and LDI Senior Fellow Mary Naylor analyze the challenges and opportunities that health system transformation presents to the country’s 2.9 million registered nurses. They explore the new roles and responsibilities for nurses in alternate delivery models such as Accountable Care Organizations and medical homes, and call for changes in nurse education, regulation, and policy.
In a new NEJM Perspective, LDI Fellow Ari Friedman, Brendan Saloner, and Renee Hsia analyze different policies to reduce emergency department (ED) use in Medicaid patients. They advocate strongly for providing Medicaid patients with better alternatives to the ED, rather than discouraging nonemergency ED use by imposing steep copayments.
Recently we’ve noticed a great deal of emerging research evidence and analysis on provider consolidation and integrated care. An abundance of riches! Here we’ve pulled out the angles of the different analyses and brought together key resources.
Update May 2015
Understanding Low-Income African American Women's Expectations, Preferences, and Priorities in Prenatal Care
In Family and Community Health, Judy Shea and colleagues seek to better understand low-income African-American women’s views on prenatal care. The analysis is the result a focus group study using a community-based participatory research framework. Shea and colleagues find that that friends/family and the baby’s health were the top factors that encouraged prenatal care attendance. Barriers to getting prenatal care included insurance, transportation, and ambivalence as to its importance. Facilitators included transportation services, social support, and education about available resources....