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.

Alzheimer’s Dementia After Exposure to Anesthesia and Surgery in the Elderly: A Matched Natural Experiment Using Appendicitis

Jeffrey H. Silber, MD, PhD
Nov. 17, 2020

Jeffrey H. SilberPaul R. Rosenbaum, Joseph G. Reiter, Alexander S. Hill, Siddharth Jain, David A. Wolk, Dylan S. Small, Sean Hashemi, Bijan A. Niknam, Mark D. NeumanLee A. Fleisher, Roderic...

Abstract [from journal]

Objective: To determine if surgery and anesthesia in the elderly may promote Alzheimer's Disease and Related Dementias (ADRD).

Background: There is a substantial conflicting literature concerning the hypothesis that surgery and anesthesia promotes ADRD. Much of the literature is confounded by indications for surgery or has small sample size. This study examines elderly patients with appendicitis, a common condition that strikes mostly at random after controlling for some known associations.

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Using Nationally Representative Percentiles to Interpret PROMIS Pediatric Measures

Christopher B. Forrest, MD, PhD
Nov. 17, 2020

Adam C. Carle, Katherine B. Bevans, Carole A. Tucker, Christopher B. Forrest 

Abstract [from journal]

Purpose: This study's aim was to use a representative sample of the US pediatric population to estimate percentiles for several PROMIS pediatric measures: Anger, Anxiety, Depressive Symptoms, Family Relationships, Fatigue, Global Health, Life Satisfaction, Meaning and Purpose, Pain Behavior, Pain Interference, Physical Activity, Physical Function Mobility, Physical Function Upper Extremity, Physical Stress Experiences, Positive Affect, Psychological Stress Experiences, Sleep Disturbance, Sleep Impairment, and Peer

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Are There Enough Experienced Physicians to Treat Patients Hospitalized With COVID?

Research Brief
Kira Rysinka, MD
Nov. 16, 2020

In this national study of 438,895 physicians, 45% provided care to hospitalized patients and 7% provided critical care. At the high estimate of patients requiring hospitalization at the projected peak of the pandemic, 18 states and Washington, DC would have patient to physician ratios greater than 15:1 (a level associated with poor outcomes among hospitalized patients). There was considerable geographic variation in the availability of physicians: 41% of hospital service areas did not have a physician with critical care experience.

Expectations and Experiences With Physician Care Among Patients Receiving Post-Acute Care in U.S. Skilled Nursing Facilities

Kira Rysinka, MD
Nov. 10, 2020

Kira L. Ryskina, Kierra A. Foley, Jason H. Karlawish, Joshua D. Uy, Briana Lott, Erica Goldberg, Nancy A. Hodgson

Abstract [from journal]

Background: In the US, post-acute care in skilled nursing facilities (SNFs) is common and outcomes vary greatly across facilities. Little is known about the expectations of patients and their caregivers about physician care during the hospital to SNF transition. Our objectives were to (1) describe the experiences and expectations of patients and their caregivers with SNF physicians in SNFs, and (2) identify patterns that differed between patients with vs. without cognitive impairment.

Methods:

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When A Family Seeks To Exclude Residents From Their Child's Care

Nov. 5, 2020

Emily A. Largent, Ross Newman, Christopher E. Gaw, John D. Lantos

Abstract [from journal]

A primary goal of our medical education system is to produce physicians qualified to promote health, prevent and treat disease, and relieve suffering. Although some aspects of the practice of medicine can be learned in classrooms, from textbooks, or with simulators, other aspects can only be learned through the direct provision of patient care. Residency programs therefore offer essential educational experiences that support residents' acquisition of knowledge, skills, and professional judgment through the assumption of progressive

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Assessment of Perceptions of Professionalism Among Faculty, Trainees, Staff, and Students in a Large University-Based Health System

Nov. 2, 2020

Dominique A. Alexis, Matthew D. Kearney, J. Corey Williams, Chang Xu, Eve J. Higginbotham, Jaya Aysola

Abstract [from journal]

Importance: With a renewed focus on medical professionalism, an opportunity exists to better define its standards and application to meet the needs of an increasingly diverse workforce given the important association between interprofessional behavior and patient care.

Objective: To examine the context of how professionalism is operationalized and perceived in diverse health care work and learning environments.

Design, setting, and participants: A qualitative mixed-

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Hospital Safety-Net Status and Performance on Publicly Reported Episode Spending Measures

Amole Navathe, MD, PhD
Nov. 1, 2020

Amol S. Navathe, Lingmei Zhou, Joshua M. Liao

Abstract [from journal]

Objectives: As part of its strategy to improve health care value and contain hospital costs, Medicare trialed public reporting for episode-based spending via 6 novel Clinical Episode-Based Payment (CEBP) measures for cellulitis, kidney/urinary tract infection, gastrointestinal hemorrhage, spinal fusion, cholecystectomy, and aortic aneurysm. Because safety-net hospitals may fare more poorly than other hospitals under value-based reforms, we evaluated the relationship between safety-net status and

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Hospital and ICU Patient Volume per Physician at Peak of COVID Pandemic: State-Level Estimates

Kira Rysinka, MD
Oct. 22, 2020

Anjali Bhatla, Kira L. Ryskina

Abstract [from journal]

Background: In anticipation of patient surge due to COVID-19, many states are working to increase the available healthcare workforce. To help inform state policies and initiatives aimed at physician deployment during COVID-19, we used predictions of peak patient volume for hospitals and intensive care units (ICU) and regional physician workforce estimates to measure patient to physician ratios at the peak of the pandemic for each state.

Methods: We

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Neurodegenerative Disease Is Associated With Increased Incidence Of Epilepsy: A Population Based Study Of Older Adults

Allison Willis, MD
Oct. 7, 2020

Leah J. Blank, Emily K. Acton, Dylan Thibault, Allison W. Willis 

Abstract [from journal]

Objective: To determine the incidence of epilepsy among Medicare beneficiaries with a new diagnosis of Alzheimer dementia (AD) or Parkinson disease (PD).

Methods: Retrospective cohort study of Medicare beneficiaries with an incident diagnosis of AD or PD in the year 2009. The 5-year incidence of epilepsy was examined by sociodemographic characteristics, comorbidities and neurodegenerative disease status. Cox regression models examined the association of neurodegenerative disease with incident

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Differences In Transitional Care Processes Among High-Performing And Low-Performing Hospital-SNF Pairs: A Rapid Ethnographic Approach

Sep. 21, 2020

Kirstin A. Manges, Roman Ayele, Chelsea Leonard, Marcie Lee, Emily Galenbeck, Robert E. Burke

Abstract [from journal]

Background: Despite the increased focus on improving patient's postacute care outcomes, best practices for reducing readmissions from skilled nursing facilities (SNFs) are unclear. The objective of this study was to observe processes used to prepare patients for postacute care in SNFs, and to explore differences between hospital-SNF pairs with high or low 30-day readmission rates.

Design: We used a rapid ethnographic approach with intensive multiday observations and key informant interviews at

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Prognosticating Outcomes And Nudging Decisions With Electronic Records In The ICU (PONDER-ICU) Trial Protocol

Katherine Courtright, MD, MSHP
Sep. 16, 2020

Katherine R. Courtright, Erich M. Dress, Jaspal Singh, Brian A. Bayes, Marzana Chowdhury, Dylan S. Small, Timothy Hetherington, Lindsay Plickert, Michael E. Detsky, Jason N. Doctor, Michael O. Harhay, Henry L. Burke, Michael B....

Abstract [from journal]

Expert recommendations to discuss prognosis and offer palliative options for critically ill patients at high risk of death are variably heeded by intensive care unit (ICU) clinicians. How to best promote such communication to avoid potentially unwanted aggressive care is unknown. The Prognosticating Outcomes and Nudging Decisions with Electronic Records in the ICU (PONDER-ICU) study is a 33-month pragmatic, stepped-wedge, cluster randomized trial testing the effectiveness of two electronic health record (EHR) interventions designed

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Improving Emergency Care For Children With Medical Complexity: Parent & Physicians' Perspectives

Sep. 15, 2020

Christian D. Pulcini, Zoe Belardo, Tara Ketterer, Joseph J. Zorc, Cynthia Mollen

Abstract [from journal]

Objectives: Children with medical complexity (CMC) have high rates of emergency department (ED) utilization, but little evidence exists on the perceptions of parents and pediatric emergency medicine (PEM) physicians about emergency care. We sought to explore parent and PEM physicians' perspectives about 1) ED care for CMC, and 2) how emergency care can be improved.

Methods: We performed semi-structured interviews with parents and PEM physicians at a single academic, children's hospital.

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