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.

Advancing LGBTQ Health – Hot topics on the national stage

Dec. 9, 2015

Although Section 1557 of the ACA may not be well known to the public, it took center stage at the recent Gay and Lesbian Medical Association (GLMA) annual conference in Portland, Oregon. The conference educates practitioners and students about the unique health needs of lesbian, gay, bisexual, transgender and queer (LBGTQ) individuals and families, and reports on the latest research on LGBTQ health. Here are some of the latest research and policy developments emerging from the conference.

Section 1557 of the ACA

Outcomes Registries: An Untapped Resource for Use in Surgical Education.

Nov. 5, 2015

Rebecca Hoffman, Edmund Bartlett, Rachel Medbery, Joseph Sakran, Jon Morris, Rachel Kelz

In the Journal of Surgical Education, Rebecca Hoffman, Rachel Kelz and colleagues examine the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) to see whether its database could also be used to study the experience of surgical residents and evaluate resident exposure to adverse events. The authors examined the 2011 general surgery data, which included 52,257 surgeries from 315 hospitals. They studied whether each surgery was assisted by a resident, and if so, what year the resident was and what the specific procedure and outcome were. The...

Physician Incentives - Making Performance Measures Meaningful

Oct. 30, 2015

How can we redesign physician incentives to improve their impact on behavior and performance?  Recently, the Commonwealth Fund published a round-up of expert views on reforming physician incentives, and one of the experts was LDI Senior Fellow Amol Navathe, MD, PhD. Navathe, a physician, health economist, and engineer, studies how to apply behavioral economic principles to physician financial and non-financial incentives.

Freelisting on Costs and Value in Health Care by Pediatric Attending Physicians

Oct. 29, 2015

Jennifer Jonas, Eleanor Davies, Shimrit Keddem, Frances Barg, Evan Fieldston 

In Academic Pediatrics, Evan Fieldston and colleagues assessed pediatricians’ perceptions about the concepts of “costs” and “value” as part of curriculum development on the subject. An online survey asked physicians at the Children’s Hospital of Philadelphia to generate a list of words that came to mind when thinking about “costs” and “value” and topics to include in a curriculum. More than 200 physicians generated a list of topics through this freelisting exercise, and those topics were ranked for their salience, or relative importance. The most salient term for the cost prompt,...

Preterm Infant Attendance at Health Supervision Visits

Oct. 29, 2015

Jo Ann D’Agostino, Molly Passarella, Philip Saynisch, Ashley Martin, Michelle Macheras, Scott Lorch

In Pediatrics, Jo Ann D’Agostino and colleagues, including Scott Lorch, evaluate to what extent premature infants adhere to the American Academy of Pediatric’s (AAP) health supervision visit schedule, what factors affect adherence, and how adherence associates with receiving suggested preventive care. The AAP recommends periodic health supervision visits throughout childhood to monitor growth and development, and to screen for illnesses.  Using data from a 30-site primary care network, the authors find less than half of the infants received all expected health supervision visits....

Carrots and Sticks: Achieving High Healthcare Personnel Influenza Vaccination Rates without a Mandate

Oct. 22, 2015

Marci Dreesa, Kathleen Wrotena, Mary Smedley, Tabe Masea, J. Sanford Schwartz

In Infection Control and Hospital Epidemiology, Marci Drees and colleagues, including J. Sanford Schwartz, evaluate the efficacy of implementing a multimodal campaign to increase influenza vaccination among healthcare personnel (HCP) without a mandate. The authors implemented an integrated multimodal approach incorporating peer pressure, accountability, and financial incentives to improve the HCP influenza vaccination rate. Employee compliance, vaccination, exemption and declination rates were compared with those of the seasons prior to the intervention. The authors find that...

Barriers to the Use of PPE to Prevent Pertussis Exposures in a Pediatric Primary Care Network

Oct. 22, 2015

Julie Fierro, Maria Middleton, Adrienne Smallwood, Susan Rettig, Chris Feudtner, Susan Coffin, Kristen Feemster

In the Journal of Pediatric Infectious Diseases, Julie Fierro and colleagues, including Chris Feudtner and Kristen Feemster, identify barriers to healthcare workers (HCW) use of personal protection equipment (PPE) to prevent pertussis transmission in ambulatory pediatric settings. The authors examined the knowledge, attitudes, and beliefs about pertussis and the use of inflection control measures among HCW. Their results show that although the majority of HCWs reported using PPE for patients with suspected pertussis, only a minority used PPE for patients with any respiratory...

Influence of provider mix and regulation on primary care services supplied to US patients

Oct. 15, 2015

Michael Richards, Daniel Polsky

In Health Economics, Policy and Law, Michael Richards and Daniel Polsky explore the link between provider mix and access for different patient types. The authors use data from a field study spanning 10 states where trained audit callers were randomly assigned an insurance status and then contacted primary care physician practices seeking new patient appointments. Clinics with more non-physician clinicians are associated with better access for Medicaid patients and lower prices for office visits. However, the authors only find this association in states granting full practice...

Increasing the Value of Health Care: The Role of Nurses

Issue Brief
Oct. 15, 2015

Increasing health care value has become a central objective of payment policies, insurance design and purchasing, and patient and provider decision-making. The word “value” appeared in the title of seven sections of the Affordable Care Act (ACA), and earlier this year CMS set a goal of having 50 percent of reimbursement based on value. 

Changes in Patient and Nurse Outcomes Associated With Magnet Hospital Recognition

Oct. 1, 2015

Ann Kutney-Lee, Amy Witkoski Stimpfel, Douglas Sloane, Jeannie Cimiotti, Lisa Quinn, Linda Aiken

In Medical Care, Ann Kutney-Lee, Linda Aiken and colleagues analyze patient and nurse outcomes in Magnet and non-Magnet hospitals in order to establish whether there is a causal link between Magnet designation and improved outcomes.  Magnet hospitals are accredited by the American Nurses Credentialing Center for excellence in nursing. The authors analyzed retrospective data for a sample of hospitals in Pennsylvania that attained Magnet recognition between 1999 and 2007 and compared it to hospitals that remained non-Magnet. The outcome measures were surgical 30-day deaths, failure-...

Asking the Patient About Patient-Centered Medical Homes: A Qualitative Analysis

Sep. 21, 2015

Jaya Aysola, Rachel M. Werner, Shimrit Keddem, Richard SoRelle, and Judy A. Shea

In the Journal of General Internal Medicine, Jaya Aysola and colleagues, including Rachel Werner and Judy Shea, assess patients’ perspectives of the patient-centered medical home (PCMH) model and compare responses by degree of practice-level PCMH adoption and patient race/ethnicity. The authors interviewed 48 patients with diabetes and/or hypertension enrolled in PCMHs within the University of Pennsylvania Health System. They purposively sampled minority and non-minority patients from the four highest-ranked and four lowest-ranked PCMH-adopting practices to determine whether...

Effect of Attending Practice Style on Generic Medication Prescribing by Residents in the Clinic Setting: An Observational Study

Sep. 17, 2015

Kira L. Ryskina, C. Jessica Dine, Esther J. Kim, Tara F. Bishop, Andrew J. Epstein

In the Journal of General Internal Medicine, Kira Ryskina and colleagues, including Jessica Dine and Andrew Epstein, assess whether the prescribing practices of attending physicians influence residents’ likelihood to prescribe brand-name medications. The authors assessed the effect of the supervising attending’s rate of brand-name prescribing in the preceding quarter on the likelihood of a resident prescribing a brand-name statin. After adjusting for patient-, physician-, and practice-level factors, the supervising attending’s brand-name prescribing rate in the quarter preceding...