In the American Journal of Managed Care, Ashok Reddy and colleagues, including Rachel Werner, assess whether the adoption of patient-centered medical homes improves patient experiences of care. Using a linear probability model they tested whether the adoption of the medical home model is associated with changes in patient experiences of care, looking at primary care sites in one region of the Veterans Health Administration. Despite a significant increase in medical home implementation, the authors find no association between medical home adoption and five domains of patient...
The Effect of Primary Care Provider Turnover on Patient Experience of Care and Ambulatory Quality of Care
In JAMA Internal Medicine, Ashok Reddy and colleagues, including David Asch and Rachel Werner, measure the effect of primary care provider (PCP) turnover on patient experiences of care and ambulatory care quality. For the study, the authors used a nationwide sample of primary care patients in the Veterans Health Administration (VHA). They assessed how many patients experienced PCP turnover and looked at five patient care experience measures and 11 measures of quality of ambulatory care. They find that 9% of patients experienced PCP turnover. Those who’d experienced turnover were...
[cross-posted with US News]
Twitter has been abuzz with commentary about ProPublica’s Surgeon Scorecard, which reports on how individual surgeons perform on in-hospital mortality and readmission (complication) rates for eight common elective procedures. Amidst the pointed criticisms of the Scorecard, there exists moderate agreement that it provides some value in helping consumers select a surgeon.
Not every health system can be Kaiser Permanente, but many try. Kaiser’s model of integrated health delivery is highly regarded for high-quality and efficient health care.
Although the supply of nurses is likely to meet overall demand, the nature of a nurse’s job is changing dramatically as nurses assum expanded roles in redesigned health care systems for a broad range of patients in ambulatory settings and community-based care.
In a new LDI/INQRI Research Brief, Erin Fraher, Joanne Spetz, and LDI Senior Fellow Mary Naylor analyze the challenges and opportunities that health system transformation presents to the country’s 2.9 million registered nurses. They explore the new roles and responsibilities for nurses in alternate delivery models such as Accountable Care Organizations and medical homes, and call for changes in nurse education, regulation, and policy.
Variability Among US Intensive Care Units in Managing the Care of Patients Admitted With Preexisting Limits on Life-Sustaining Therapies
In JAMA Internal Medicine, Scott Halpern and colleagues investigate variance in end-of-life care in intensive care units (ICUs) by looking at a group of patients with presumably similar care preferences. The authors compared the care received at 141 ICUs by patients with pre-existing limits on life-sustaining treatments, and the proportions of such patients who received aggressive care. The care outcomes measured were: provision of cardiopulmonary resuscitation, new forms of life support, and the addition or removal of treatment limitations. Of the ICU admissions evaluated, 4.8% of...
Cross-posted with US News
Cross-posted with the Field Clinic blog
Over the past two years, one of the top health care priorities in Philadelphia has been getting people signed up for health insurance. That is still a huge, unfinished task, but alongside it we need to make sure we have enough doctors in the right places to deliver care. For health care reform to deliver on its promise, people need good access to primary care.
In JAMA Oncology, David Shalowitz and John Schorge (Massachusetts General Hospital), assess the degree to which oncologists’ clinical estimates might be biased by extraneous information. For their study the authors sent surveys of different clinical scenarios to members of the New England and Mid-Atlantic Association of Gynecological Oncologists. Respondents were asked to assess the scenarios and provide an estimated life expectancy, evaluate other providers’ assessments, and indicate what treatments they would opt for. Results of the study show that clinicians are influenced by anchoring...
In the Journal of Nursing Care Quality, Ying Xue (University of Rochester) and colleagues, including Linda Aiken, assess the effects of using agency-employed supplemental nursing staff on overall personnel costs at large academic medical centers. Through analysis of data from 19 medical centers, the investigators find that the modest use of supplemental nursing staff is a cost-efficient way to keep up with demand for personnel during peak periods. However, heavy reliance on supplemental nurses to meet staffing needs is not cost-efficient in terms of overall personnel costs.
Predictors of Community Therapists’ Use of Therapy Techniques in a Large Public Mental Health System
In JAMA Pediatrics, Rinad Beidas and colleagues explore the effects of individual and organizational characteristics on therapists’ self-reported use of different therapy techniques - cognitive behavioral therapy (CBT), family therapy, and psychodynamic therapy techniques. The study focuses on the Philadelphia public mental health system, currently engaged in a large-scale effort to increase the use of CBT. The study results show that although both individual and organizational factors are important, the relative significance of the factors varies by treatment type. Key findings include...