Healthcare Workforce

The mix and distribution of health care providers. LDI Senior Fellows study how to transform health care delivery through the optimal training, mix, and placement of health care professionals and allied health workers to deliver cost-effective care.

Association Between Mobile Telephone Interruptions and Medication Administration Errors in a Pediatric Intensive Care Unit

Christopher Bonafide, MD
Dec. 20, 2020

Christopher P. Bonafide, Jeffrey M. Miller, A. Russell Localio, Amina Khan, Adam C. Dziorny, Mark Mai, MD, Shannon Stemler, Wanxin Chen, John H. Holmes, Vinay M. Nadkarni, Ron Keren

Abstract [from journal]

Importance: Incoming text messages and calls on nurses’ mobile telephones may interrupt medication administration, but whether such interruptions are associated with errors has not been established.
 

Objective: To assess whether a temporal association exists between mobile telephone interruptions and subsequent errors by pediatric intensive care unit (PICU) nurses during medication administration.

Design, Setting, and Participants: A retrospective cohort study was...

Physician Consolidation and the Spread of Accountable Care Organizations

Research Brief
Nov. 4, 2019

Accountable Care Organizations (ACOs) are groups of physicians and hospitals that jointly contract to care for a patient population. ACO contracts incentivize coordination of care across providers. This can lead to greater consolidation of physician practices, which can in turn generate higher costs and lower quality. Given this, the study asks, as ACOs enter health care markets, do physician practices grow larger?

A National Comparison of Operative Outcomes of New and Experienced Surgeons

Research Brief
Oct. 25, 2019

In this national study, Medicare beneficiaries treated by new surgeons had poorer outcomes than those treated by experienced ones in the same hospitals. However, the type of operation and the patient’s emergency status – rather than physician inexperience – explains nearly all poorer outcomes. Higher-risk cases are disproportionately treated by new surgeons.

The Association of Geographic Dispersion with Outcomes among Hospitalized Pulmonary Service Patients

Oct. 16, 2019

Rachel Kohn, Michael O. Harhay, Gary E. Weissman, George L. Anesi, Brian Bayes, Hummy Song, Scott D Halpern, S. Ryan Greysen, Meeta Prasad Kerlin

Abstract [from journal]

Hospitals geographically localize clinically similar patients into wards to provide specialized care that improves patient outcomes and care and lowers costs. When these wards exceed capacity, patients become “geographically dispersed” to alternate locations. For example, critically ill patients may “board” in emergency departments (EDs) or alternate intensive care units (ICUs) when the clinically appropriate ICUs are at capacity. Such geographic dispersion has been demonstrated to be associated with increased hospital length of stay (LOS), ICU and in-...

Health Care Safety-Net Programs After The Affordable Care Act

Issue Brief
Oct. 1, 2019

Prior to the Affordable Care Act (ACA), health care safety-net programs were the primary source of care for over 44 million uninsured people. While the ACA cut the number of uninsured substantially, about 30 million people remain uninsured, and many millions more are vulnerable to out-of-pocket costs beyond their resources. The need for the safety net remains, even as the distribution and types of need have shifted. This brief reviews the effects of the ACA on the funding and operation of safety-net institutions. It highlights the challenges and opportunities that health care reform presents to safety-net programs, and how they have adapted and evolved to continue to serve our most vulnerable residents.

Trends in Racial/Ethnic Representation Among US Medical Students

Sep. 4, 2019

Lanair Amaad Lett, H. Moses Murdock, Whitney U. Orji, Jaya Aysola, Ronnie Sebro

Abstract [from journal]

Importance: With increasing efforts to create a diverse physician workforce that is reflective of the demographic characteristics of the US population, it remains unclear whether progress has been made since 2009, when the Liaison Committee on Medical Education set forth new diversity accreditation guidelines.

Objective: To examine demographic trends of medical school applicants and matriculants relative to the overall age-adjusted US population.

Design, Setting, and Participants:

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Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital

Jennifer K. Walter, MD, PhD, MS
Aug. 31, 2019

Amy Trowbridge, Tara Bamat, Heather Griffis, Eric McConathey, Chris FeudtnerJennifer K. Walter
 

Abstract [from journal]

Objectives: Pediatric residents are expected to be competent in end of life (EOL) care. We aimed to quantify pediatric resident exposure to patient deaths, and the context of these exposures.

Methods: Retrospective chart review of all deceased patients at one children's hospital over three years collected patient demographics, time and location of death. Mode of death was determined after chart review. Each death was cross-referenced with pediatric resident call schedules to determine residents involved within

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#Shemergency: Use of a Professional Development Group to Promote Female Resident Recruitment and Retention

Aug. 27, 2019

Utsha Khatri, Jennifer Love, Amy Zeidan, Cindy Hsu, Angela Mills

Abstract [from journal]

Problem: Gender inequity in academic medicine is a pervasive challenge. Recommendations have been implemented to reduce inequities for female faculty. However, there are no well-established guidelines for the recruitment and retention of female residents.

Approach: To address challenges faced by female physicians and support the recruitment and retention of female residents, female emergency medicine residents and attending

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