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.

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...

The Association Between Urban Tree Cover and Gun Assault: a Case-Control and Case-Crossover Study

Jun. 30, 2017

Michelle C. Kondo, Eugenia C. South, Charles C. Branas, Therese S. Richmond, Douglas J. Wiebe      

In American Journal of Epidemiology, Michelle Kondo and colleagues, including Eugenia South, Therese Richmond, and Douglas Wiebe, investigate relationships between being in urban green space and experiencing gun violence. The authors conducted interviews with Philadelphia males aged 10-24, including victims of gun violence. They used statistical analyses to compare tree locations with gun assaults. They found that, when participants were under tree cover, they were less likely to experience gun violence. Numerous analyses and comparative models confirmed that being under tree...

Association of Provider Specialty and Multidisciplinary Care With Hepatocellular Carcinoma Treatment and Mortality

Jun. 28, 2017

Marina Serper, Tamar H. Taddei, Rajni Mehta, Kathryn D'Addeo, Feng Dei, Ayse Ayatman, Michelle Baytarian, Rena Fox, Kristel Hunt, David S. Goldberg, Adriana Valderrama

In Gastroenterology, Marina Serper and colleagues, including David Goldberg, assess how various health care system factors affect survival rates in hepatocellular carcinoma (HCC). These factors included uptake of historically underutilized curative therapies, access to a hepatologist, and presentation of the case to a multidisciplinary tumor board. The authors found that, while curative treatments of HCC increased survival rates, only 25% of newly diagnosed HCC patients received treatment intended to cure the disease. Additionally, those who received care from only...

Economic Feasibility of Staffing the Intensive Care Unit with a Communication Facilitator

Jun. 27, 2017

Nita Khandelwal, David Benkeser, Norma B. Coe, Ruth A. Engelberg, and J. Randall Curtis

In Annals of the American Thoracic Society, Nita Khandelwal and colleagues, including Norma Coe, assess the economic feasibility of staffing intensive care units (ICUs) with a communication facilitator. This person assists families in complex decision-making, improves patient-provider communication, and ensures that care is consistent with patient values and goals. The authors conducted a randomized trial with an ICU communication facilitator, and also looked at financial hospital records. Units that had a facilitator saw significantly reduced daily average ICU costs, and maximal...

Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States

Jun. 22, 2017

Maryam Y. Naim, Rita V. Burke, Bryan F. McNally, Lihai Song, Heather M. Griffis, Robert A. Berg, Kimberly Vellano, David Markenson, Richard N. Bradley, Joseph W. Rossano

In JAMA Pediatrics, Maryam Naim and colleagues, including Joseph Rossano, investigate effects of bystander cardiopulmonary resuscitation (CPR) on pediatric out-of-hospital cardiac arrest. The authors analyze data from the Cardiac Arrest Registry to Enhance Survival, and find that out of 3,900 instances of out-of-hospital cardiac arrests, bystander CPR was provided in 1,814. Children who were treated with either conventional bystander CPR or compression-only CPR had higher survival rates and more favorable neurological outcomes than did those who were not treated with CPR....

Creating an Evidence-Based Progression for Clinical Advancement Programs

Jun. 19, 2017

Kathleen G. Burke, Tonya Johnson, Christine Sites, Jane Barnsteiner 

In American Journal of Nursing, Kathleen Burke and colleagues validate core competencies and knowledge, skills, and attitudes (KSAs) that were previously developed for professional nursing practice. The researchers then assess the integration and progression of these competencies in clinical advancement programs. Clinical experts from 13 Magnet hospitals participated in quality improvement rounds aimed at reaching consensus on how much the KSAs have been incorporated into clinical advancement. The group found that all of the core competencies assessed were essential at all levels...

Comparative effectiveness of prostate cancer treatments for patient-centered outcomes: A systematic review and meta-analysis

Jun. 11, 2017

Ravishankar Jayadevappa, Sumedha Chhatre, Yu-Ning Wong, Marsha N. Wittink, Ratna Cook, Knashawn H. Morales, Neha Vapiwala, Diane K. Newman, Thomas Guzzo, Alan J. Wein, Stanley B. Malkowicz, David I. Lee, Jerome S. Schwartz, and Joseph J. Gallo

In Medicine, Jayadevappa, Schwartz, and colleagues analyzed the comparative effectiveness of localized prostate cancer treatments (active surveillance, radical prostatectomy, and radiation therapy) through systematic review and meta-analysis. They focused on outcomes that matter most to newly diagnosed patients: mortality; cancer recurrence; disease and treatment complications; side effects; and patient-reported outcomes such as health-related quality of life, satisfaction with care, and decision regrets. The systematic review included 58 articles published from 1995-2016, (29...

Surgical Site Infection and Colorectal Surgical Procedures: A Prospective Analysis of Risk Factors

Jun. 10, 2017

E. Carter Paulson, Earl Thompson, Najjia Mahmoud

In Surgical Infections, Paulson and colleagues identify risk factors for surgical site infections in patients undergoing elective colorectal surgery. They analyzed data prospectively collected as part of a randomized, blinded trial of skin anti-sepsis, using photodocumentation, patient questionnaires, and blinded review by an attending surgeon to identify infections within 30 days of discharge. From 2011 to 2015, 787 patients undergoing colorectal surgery were analyzed, with an overall infection rate of 21.5%. Four variables--incision length, surgical indication, body mass index,...

Pages