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.

Built Environment Assessment: Multidisciplinary Perspectives

Apr. 19, 2016

Karen Glanz, Susan Handy, Kathryn Henderson, Sandy Slater, Erica Davis, Lisa Powell

In SSM Population Health, Karen Glanz and colleagues examine how different disciplinary perspectives can contribute to environmental context-based assessment related to obesity.  The authors also make recommendations for encouraging effective advances in built-environment assessment. A multidisciplinary team of experts convened in 2013 to discuss how their respective disciplines can collaborate to integrate environmental assessment to prevent obesity. There has been significant progress in collaboration across key disciplines that contribute to studies of built environments and...

Detecting Potential Overbilling in Medicare Reimbursement via Hours Worked

Research Brief
Apr. 18, 2016

Overbilling for physician services under Medicare Part B has long been a concern, as some estimates show that fraudulent “upcoding” or “overcharging” might have cost the program tens of billions of dollars per year. Existing methods to detect the prevalence and financial cost of overbilling have various limitations, so the authors developed a novel approach: create estimates of actual hours worked as implied by the medical service codes that providers submit to Medicare. In an NBER Working Paper, LDI Senior Fellow Hanming Fang and co-author Qing Gong examine whether this method can generate a quicker and more robust estimation of overbilling across medical specialties and geographic areas.

Change In Length of Stay and Readmissions Among Hospitalized Medical Patients after Inpatient Medicine Service Adoption of Mobile Secure Text Messaging

Apr. 13, 2016

Mitesh Patel, Neha Patel, Dylan Small, Roy Rosin, Jeffrey Rohbach, Nathaniel Stromberg, C. William Hanson, David Asch

In the Journal of General Internal Medicine, Mitesh Patel and colleagues, including Dylan Small, Roy Rosin, and David Asch, evaluate the association between an inpatient medicine service’s adoption of mobile secure text messaging and patient length of stay and readmissions. The authors observed the change in length of stay and 30-day readmissions between a control site and one that implemented text messaging. They find a significant decrease in length of stay for the intervention site during and after the rollout of inpatient text communication. There was no significant difference...

Educating Health Professionals on Social Determinants of Health

Apr. 6, 2016

Health professionals are ill-prepared to address social factors that contribute to poor health, because these factors often lie beyond the scope of medical education. But just as addressing social determinants of health (SDH) involves stretching beyond traditional medical practices, educating health professionals involves stretching beyond traditional medical education.

Independent Contractors in Public Mental Health Clinics: Implications for Use of Evidence-Based Practices

Mar. 29, 2016

Rinad Beidas, Rebecca Stewart, Courtney Wolk, Dainelle Adams, Steven Marcus, Arthur Evans, Kamilah Jackson, Geoffrey Neimark, Matthew Hurford, Joan Erney, Ronnie Rubin, Trevor Hadley, Frances Barg, David Mandell

In Psychiatric Services, Rinad Beidas and colleagues, including Steven Marcus, Trevor Hadley and David Mandell analyze the associations of utilizing independent contractors with clinician knowledge and attitudes toward evidence-based practices (EBP), and organizational culture and climate. They also describe the impact of using independent contractors on mental health services delivery from the perspective of organizational leadership. Community mental health clinics are increasingly utilizing independent contractors to provide clinical services. At the same time, many...

The Perfect Storm: Collision of the Business of Mental Health and the Implementation of Evidence-Based Practices

Mar. 29, 2016

Rebecca Stewart, Danielle Adams, David Mandell, Trevor Hadley, Arthur Evans, Ronnie Rubin, Joan Erney, Geoffrey Neimark, Matthew Hurford, Rinad Beidas

In Psychiatric Services, Rebecca Stewart and colleagues, including David Mandell, Trevor Hadley and Rinad Beidas examine how financial factors affect the implementation of evidence-based practices (EBPs) in a large urban publicly funded mental health system. They interviewed 33 agency leaders and 16 policymakers, who described financial distress in community mental health agencies, and reported concerns about complex and expensive implementation of EBPs. These stakeholders agree that the cost of implementing EBPs should be shared between the agencies and the health system; however...

Nurse staffing and the work environment linked to readmissions among older adults following elective total hip and knee replacement

Mar. 14, 2016

Karen Lasater, Matthew McHugh

In the International Journal for Quality in Health Care, Karen Lasater and Matthew McHugh examine the effect of nurse staffing and the work environment on 10- and 30-day unplanned readmissions for Medicare patients following elective total hip and knee replacement. The authors conducted a cross-sectional secondary data analysis using patient administrative data, nurse survey data, and hospital organizational data from acute care hospitals in California, Florida, New Jersey and Pennsylvania. Nurse survey responses were aggregated to construct hospital measures of nurse staffing and...

Choosing Wisely in Emergency Medicine: A National Survey of Emergency Medicine Academic Chairs and Division Chiefs

Mar. 14, 2016

Brandon Maughan, Jill Baren, Judy Shea, Raina Merchant

In Academic Emergency Medicine, Brandon Maughan and colleagues, including Judy Shea and Raina Merchant, assess whether leaders of academic emergency medicine departments are aware of the Choosing Wisely campaign, and their attitudes about the campaign. The Choosing Wisely campaign seeks to promote collaboration and communication between patients and physicians regarding the appropriateness of common tests and procedures. For this study, the researchers used a web-based survey of emergency department chairs and division chiefs to examine awareness of the campaign, anticipated...

Nurse Staffing in Neonatal Intensive Care Units in the United States

Mar. 4, 2016

Jeannette Rogowski, Douglas Staiger, Thelma Patrick, Jeffrey Horbar, Michael Kenny, Eileen Lake
 

In Research in Nursing & Health, Jeannette Rogowski and colleagues, including Eileen Lake, provide the first report of national data on nurse-to-patient ratios in the neonatal intensive care unit (NICU) by infant acuity level.  Data were collected in two sequential studies in 104 NICUs. The study finds most NICU infants were low-acuity, and that 12% of infants were high-acuity.  The average nurse cared for two infants, but the nurse-to-infant ratio ranged from 1 nurse to 3 infants for low acuity, to almost 1-to-1 ratio for the highest acuity.  The study found that infant...

Better Nurse Staffing and Nurse Work Environments Associated With Increased Survival of In-Hospital Cardiac Arrest Patients

Feb. 17, 2016

Matthew McHugh, Monica Rochman, Douglas Sloane, Robert Berg, Mary Mancini, Vinay Nadkarni, Raina Merchant, Linda Aiken

In Medical Care, Matthew McHugh and colleagues, including Linda Aiken and Raina Merchant, explore the association between nurse staffing, nurse work environments, and survival rates for in-hospital cardiac arrest (IHCA). Nurses are likely the first responders to IHCA, thus playing a critical role in improving outcomes from these events. Using data from the American Heart Association, the University of Pennsylvania Multi-State Nursing Care and Patient Safety survey, and the American Hospital Association annual survey, the authors modeled the association of nursing features –...

Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care

Feb. 17, 2016

Ezekiel Emanuel, Peter Ubel, Judd Kessler, Ralph Muller, Amol Navathe, Pankaj Patel, Robert Pearl, Meredith Rosenthal, Lee Sacks, Aditi Sen, Paul Sherman, Kevin Volpp

In Annals of Internal Medicine, Ezekiel Emanuel and colleagues, including Judd Kessler, Ralph Muller, Amol Nayathe, and Kevin Volpp, discuss several principles of behavior economics, including inertia, loss aversion, choice overload, and relative social ranking. Designing physician incentives based on behavioral economics principles can improve their effectiveness through better alignment with performance goals. The study includes anecdotal examples of successful incentive programs that apply behavioral economics principles. Though the effectiveness of behavioral economic-based...

Patient satisfaction and non-UK educated nurses: a cross-sectional observational study of English National Health Service Hospitals

Jan. 29, 2016

Hayley Germack, Peter Griffiths, Douglas Sloane, Anne Marie Rafferty, Jane Ball, Linda Aiken

In BMJ Open, Hayley Germack and colleagues, including Linda Aiken, examine the association between patient satisfaction with nursing care in National Health Service (NHS) hospitals in England and the proportion of non-UK educated nurses providing care. The authors used data from the 2010 NHS Adult Inpatient Survey merged with data from nurse and hospital administrator surveys. They found a significant association between the percentage of non-UK educated nurses providing bedside care and patient satisfaction; hospitals with higher percentages of non-UK educated nurses had lower...

Effect of Financial Incentives to Physicians, Patients, or Both on Lipid Levels: A Randomized Clinical Trial

Research Brief
Jan. 15, 2016

To whom should financial incentives be targeted to achieve a desired clinical or health outcome—physicians or patients? Using insight from behavioral economics, a research team led by LDI Senior Fellows David Asch and Kevin Volpp sought to determine whether physician financial incentives, patient incentives, or shared physician and patient incentives are more effective in promoting medication adherence and reducing cholesterol levels of patients at high risk for cardiovascular disease. Though physician and patient incentives are becoming more common, they are rarely combined, and effectiveness of these approaches is not well-established. This study offers insight into what incentive structure leads to the greatest impact on health promotion. 

Diversity in the Health Professions: a 'Leaky Pipeline'

Jan. 14, 2016

Despite decades of calls for increased representation of minorities in the health professions workforce, we are very far away from a workforce that reflects this nation’s diversity. Underrepresented minorities make up 31% of the general population, but just 15% of medical school students and 13% of dental students. A new study helps us understand the barriers minority college students face in pursuing medical and dental careers.

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