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 Of An Emergency Department-Embedded Critical Care Unit With Hospital Outcomes And Intensive Care Unit Utilization

Jul. 22, 2020

George L. Anesi, Jayaram Chelluri, Zaffer A. Qasim, Marzana Chowdhury, Rachel Kohn, Gary E. Weissman, Brian Bayes, M. Kit Delgado, Benjamin S. Abella, Scott D. Halpern, John C. Greenwood

Abstract [from journal]

Rationale: A small but growing number of hospitals are experimenting with emergency department (ED)-embedded critical care units (ED-CCUs) in an effort to improve the quality of care for critically ill patients with sepsis and acute respiratory failure (ARF).

Objective: To evaluate the potential impact of an ED-CCU at the Hospital of the University of Pennsylvania among patients with sepsis and ARF admitted from the ED to a medical ward or intensive care unit (ICU) from January 2016 to

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Observational Study Assessing Changes In Timing Of Readmissions Around Postdischarge Day 30 Associated With The Introduction Of The Hospital Readmissions Reduction Program

Jul. 21, 2020

Ashwin S. Nathan, Joseph R. Martinez, Jay Giri, Amol S. Navathe

Abstract [from journal]

Background: The Hospital Readmissions Reduction Program (HRRP) initially penalised hospitals for excess readmission within 30 days of discharge for acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia (PNA) and was expanded in subsequent years to include readmissions for chronic obstructive pulmonary disease, elective total hip arthroplasty, total knee arthroplasty and coronary artery bypass graft surgery. We assessed whether HRRP was associated with delays in readmissions from immediately

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Clinical Supervision In Community Mental Health: Characterizing Supervision As Usual And Exploring Predictors Of Supervision Content And Process

Rinad Beidas, PhD, U of Penn
Jul. 15, 2020

Simone H. Schriger, Emily M. Becker-Haimes, Laura Skriner, Rinad S. Beidas

Abstract [from journal]

Clinical supervision can be leveraged to support implementation of evidence-based practices in community mental health settings, though it has been understudied. This study focuses on 32 supervisors at 23 mental health organizations in Philadelphia. We describe characteristics of supervisors and organizations and explore predictors of supervision content and process. Results highlight a low focus on evidence-based content and low use of active supervision processes. They underscore the need for further attention to the community

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Statewide Interventions And Covid-19 Mortality In The United States: An Observational Study

Jul. 8, 2020

Nadir Yehya, Atheendar Venkataramani, Michael O. Harhay

Abstract [from journal]

Background: Social distancing is encouraged to mitigate viral spreading during outbreaks. However, the association between distancing and patient-centered outcomes in Covid-19 has not been demonstrated. In the United States social distancing orders are implemented at the state level with variable timing of onset. Emergency declarations and school closures were two early statewide interventions.

Methods: To determine whether later distancing interventions were associated with higher mortality,

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The Role Of Staffing And Classroom Characteristics On Preschool Teachers' Use Of One-To-One Intervention With Children With Autism

Jul. 6, 2020

Victor LushinSteven Marcus, Daphney Gaston, Rinad Beidas, Ashlee Lamson, Ilene Goy, Irina Godina, Joanne Rees, Rebecca Rivera, David Mandell

Abstract [from journal]

For preschool children with autism, individual (one-to-one) behavioral interventions are among the best-tested treatments. However, they are rarely used in special education preschools. We observed formally and informally delivered one-to-one behavioral interventions use by classroom staff (n = 51) in 12 classrooms across three special education preschools for children with autism, aged 3-6 years, in a major US city. We estimated the associations between one-to-one intervention use and classroom characteristics including staff-student

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Impact Of Around-the-Clock Mental Health Staffing On Emergency Department Management of Patients Who Deliberately Self-Harm

May. 22, 2020

Sara Wiesel Cullen, Amaya Diana, Mark Olfson, Ming Xie, Steven C Marcus

Abstract [from journal]

Objective: Emergency departments (EDs) offer opportunities to deliver critical frontline suicide prevention services via assessment, safety planning, and linkages with community-based mental health care after discharge. Because mental health crises can occur at any time, this study sought to evaluate whether around-the-clock mental health staffing in the ED influences the likelihood of providing these evidence-based mental health services.

Methods: ED nursing leadership from a national sample of 406...

Transforming Mental Health Care Through Implementation of Evidence-Based Practices

Issue Brief
May. 21, 2020

Changing clinical practice is hard, and changing practices within larger organizations is even harder. Increasingly, policymakers are looking to implementation science—the study of why some changes prove more durable than others—to understand the dynamics of successful transformation. In this brief, we summarize the results of an ongoing community-academic partnership to increase the uptake of evidence-based practices in Philadelphia’s public behavioral health care system. Over five years, researchers found that widescale initiatives did successfully change the way care was delivered, albeit modestly and slowly. The evidence suggests that organizational factors, such as a proficient work culture, are more important than individual therapist factors, like openness in change, in influencing successful practice change. While practice transformation is possible, it requires focusing on underlying problems within organizations as well as championing new policies. 

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