Evidence Development & Decision Science

The systematic production and application of medical knowledge to clinical practice. LDI Senior Fellows analyze the process by which data affect coverage and clinical decisions, and conducts comparative effectiveness and cost effectiveness studies.

The Value of Value Frameworks

Oct. 26, 2017

“Value” is more than a buzzword. In response to rising costs, payers, physicians, and patients have turned to value assessment frameworks to inform treatment plans and design sustainable budgets. However, the usefulness and potential of these tools remain murky. LDI’s 50th anniversary symposium convened a panel to elucidate key questions for the future of value frameworks—what does value mean to different stakeholders in the health care system? How should payers, doctors, and patients appraise the value of the care they receive?

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.

Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study

Aug. 28, 2017

Jane E. Ball, Luk Bruyneel, Linda H. Aiken, Walter Sermeus, Douglas M. Sloane, Anne Marie Rafferty, Rikard Lindqvist, Carol Tishelman, Peter Griffiths, RN4CAST Consortium

In International Journal of Nursing Studies, Jane Ball and colleagues, including Linda Aiken, examine if missed nursing care explains the observed association between nurse staffing levels and mortality. Previous research has shown that higher postoperative mortality rates are associated with lower nurse staffing levels. When nurse staffing levels are lower, there is a higher incidence of necessary but missed nursing care. The authors collected data from 422,730 patients from 300 general acute hospitals, and administered surveys to 26,516 registered nurses to understand staffing...

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...

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...

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...

The Role of Stewardship in Addressing Antibacterial Resistance: Stewardship and Infection Control Committee of the Antibacterial Resistance Leadership Group

Jul. 5, 2017

Deverick J. Anderson, Timothy C. Jenkins, Scott R. Evans, Anthony D. Harris, Robert A. Weinstein, Pranita D. Tamma, Jennifer H. Han, Ritu Banerjee, Robin Patel, Theoklis Zaoutis, Ebbing Lautenbach

In Clinical Infectious Diseases, Deverick Anderson and colleagues, including Jennifer Han and Ebbing Lautenbach, describe the activities of the Antibacterial Resistance Leadership Group (ARLG) in the area of antibacterial stewardship. Antibacterial resistance is increasing globally and has been recognized as a major public health threat. Antibacterial stewardship is the coordinated effort to improve the appropriate use of antibiotics with the aim to decrease selective pressure for multidrug-resistant organisms in order to preserve the utility of antibacterial agents. To date, the...

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