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.

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...

Nursing leading change to advance health

Jun. 22, 2017

Patricia Polansky, Mary Sue Gorski, Alexia Green, G. Adriana Perez, Robert P. Wise

In Nursing Outlook, Patricia Polansky and colleagues, including Adriana Perez, review current and previous leadership initiatives to increase the number of nurse leaders in health- and health care-related boardrooms. The authors discuss the lack of nurse leaders who are involved in boardroom service, and review efforts that have been made to increase the number of nurses in boardrooms. They focus on three main themes – “Step up and Lead”, “Get a Seat at the Table”, and “Support and Leverage Board Service”, and stress the importance of a clear action plan to elevate nurse...

Vital Directions for Health and Health Care: Priorities from a National Academy of Medicine Initiative

Jun. 21, 2017

Victor J. Dzau, Mark B. McClellan, J. Michael McGinnis, Sheila P. Burke, Molly J. Coye, Angela Diaz, Thomas A. Daschle, William H. Frist, Martha Gaines, Margaret A. Hamburg, Jane E. Henney, Shiriki Kumanyika, Michael O. Leavitt, Ruth M. Parker, Lewis G. Sandy, Leonard D....

In a JAMA Special Communication message, Victor Dzau and colleagues, including Shiriki Kumanyika, review the most salient health challenges and opportunities facing the United States, and seek to identify practical priorities and policy initiatives essential to health progress. The authors assess 19 National Academy of Medicine-commissioned white papers, and review publicly available data on health care costs and outcomes. They find that, of the $3.2 trillion spent annually on health care, an estimated 30% is related to waste, inefficiencies, and excessive price. Major health...

Missed Nursing Care in Pediatrics

Jun. 19, 2017

Eileen T. Lake, Pamela B. de Cordova, Sharon Barton, Shweta Singh, Paula D. Agosto, Beth Ely, Kathryn E. Roberts, Linda H. Aiken

In Hospital Pediatrics, Eileen Lake and colleagues, including Shweta Singh and Linda Aiken, examine patterns of missed nursing care in inpatient pediatric settings to determine whether it is associated with unfavorable work environments and high nurse workloads. The authors used registered nurse data from over 200 pediatric hospitals. The data shows that nurses reported missed care on their last shift for twelve nursing activities due to time constraints. More than half of pediatric nurses missed care on their previous shift, and missed care was more prevalent in poor work...

Improved Availability and Quality of Care with Epilepsy Nurse Practitioners

Jun. 19, 2017

Chloe E. Hill, Bethany Thomas, Kimberly Sansalone, Kathryn A. Davis, Judy A. Shea, Brian Litt, and Nabila Dahodwala

In Neurology, Chloe Hill and colleagues, including Judy Shea and Nabila Dahodwala, investigate the quality of care delivered by nurse practitioner (NP)–physician teams developed to serve patients with epilepsy, and improve their appointment availability.  The authors observed a cohort of patients with epilepsy who were cared for by either an NP-physician team or a physician only. These care models were compared with regard to adherence to the 2014 American Academy of Neurology epilepsy quality measures. The authors also looked at seizure frequency, presentations to the Emergency...

How Patients Experience the Trauma Bay

Jun. 16, 2017

After a shooting, a stabbing, a car crash, or a fall, emergency services rush an injured patient to the emergency room. They bypass the waiting room and come directly to a specialized area called the trauma bay, where a team of clinicians performs a fast, intense, full-body exam and initiates treatment for injury. Trauma providers have organized this protocol, known as trauma resuscitation, to identify and treat life-threatening injuries as quickly as possible. Or at least that’s how we see it.

The Initiation of Chronic Opioids: A Survey of Chronic Pain Patients

Jun. 15, 2017

Catherine E. Callinan, Mark D. Neuman, Kim E. Lacy, Claudia Gabison, and Michael A. Ashburn

In The Journal of Pain, Catherine Callinan and colleagues, including Mark Neuman and Michael Ashburn, examine the connection between reasons for opioid initiation and risk factors for chronic usage. The investigators interviewed participants who received opioid therapy for more than 90 days, and who had a non-cancer pain diagnosis. They asked them about reason for opioid initiation, original intent of prescription, length of time on opioids, and demographic data including co-morbidities. Many patients who initiated opioid therapy after surgery experienced postoperative...

Discriminative Accuracy of Physician and Nurse Predictions for Survival and Functional Outcomes 6 Months After an ICU Admission

May. 22, 2017

Michael E. Detsky, Michael O. Harhay, Dominique F. Bayard, Aaron M. Delman, Anna E. Buehler, Saida A. Kent, Isabella V. Ciuffetelli, Elizabeth Cooney, Nicole B. Gabler, Sarah J. Ratcliffe, Mark E. Mikkelsen, Scott D. Halpern 

In JAMA, Michael Detsky and colleagues, including Michael Harhay and Scott Halpern, examine the accuracy of intensive care unit (ICU) physician and nurses’ predictions about patients’ survival and functional outcomes. Clinician predictions about a patient's chance of survival have been shown to influence decision-making for critically ill patients, yet little is known regarding their accuracy. The study was conducted in five ICUs in three hospitals in Philadelphia, and enrolled patients who spent at least three days in the ICU and required mechanical ventilation, vasopressors, or...

Diversity in the Emerging Critical Care Workforce: Analysis of Demographic Trends in Critical Care Fellows From 2004 to 2014

May. 13, 2017

Meghan B Lane-Fall; Todd A Miano; Jaya Aysola; John G T Augoustides

In Critical Care Medicine, Meghan Lane-Fall and colleagues, including Jaya Aysola, analyzed demographic trends in critical care fellowship programs from 2004-2014. They used logistic regression models to compare annual trends in the representation of women and racial/ethnic groups across critical care fellowship types. From 2004 to 2014, the number of critical care fellows increased annually, up 54.1% from 1,606 in 2004-2005 to 2,475 in 2013-2014. The proportion of female critical care fellows increased from 29.5% (2004-2005) to 38.3% (2013-2014).The absolute number of black...

43 Ways to Leave Your Technology

Feb. 14, 2017

We recently convened an expert roundtable to tackle how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable. This got us thinking - while the process by which ineffective practices or technologies are abandoned is neither simple nor automatic, even the language used to describe it is not clear. And language matters. It often reflects an unstated focus on one mechanism or one level of decision-making. Here we review, and potentially clarify, the terminology.

Comparing International and United States Undergraduate Medical Education and Surgical Outcomes Using a Refined Balance Matching Methodology

Jan. 19, 2017

Salman Zaheer, Samuel Pimentel, Kristina Simmons, Lindsay Kuo, Jashodeep Datta, Noel Williams, Douglas Fraker, Rachel Kelz

In Annals of Surgery, Salman Zaheer and colleagues, including LDI Senior Fellow Rachel Kelz, compare surgical outcomes of international medical graduates (IMGs) and United States medical graduates (USMGs). Medical education outside of the US is substantially different from that in the US and usually begins right after high school and lasts for 5 to 7 years. This is the first study to examine differences in surgical outcomes of patients treated by IMGs and USMGs. The authors used a unique dataset linking AMA Physician Masterfile data with hospital discharge claims from Florida and...

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