Delivery Innovation

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

A Comparison of 2 Surgical Site Infection Monitoring Systems

Nov. 5, 2015

Mila Ju, Clifford  Ko, Bruce Hall, Charles Bosk, Karl Bilimoria, Elizabeth Wick

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...

Physician Incentives - Making Performance Measures Meaningful

Oct. 30, 2015

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.

Uptake and Impact of a Clinical Diagnostic Decision Support Tool at an Academic Medical Center

Aug. 24, 2015

John S. Barbieri, Benjamin French, Craig A. Umscheid

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...

Re: Nurses

Jun. 26, 2015

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.

Reducing ED Use in Medicaid Patients

Jun. 18, 2015

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.

Understanding Low-Income African American Women's Expectations, Preferences, and Priorities in Prenatal Care

Apr. 1, 2015

Brownsyne Tucker Edmonds, Marjie Mogul, Judy Shea

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....

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