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.

Impact of the Patient-Centered Medical Home on Veterans’ Experience of Care

Sep. 14, 2015

Ashok Reddy, Anne Canamucio, Rachel Werner

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

Aug. 27, 2015

Ashok Reddy, Craig E. Pollack, David A. Asch, Anne Canamucio, Rachel M. Werner

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...

Re: Nurses

Jun. 26, 2015

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.

LDI Poster Spotlight at AcademyHealth

Jun. 16, 2015
The University of Pennsylvania's Leonard Davis Institute of Health Economics (LDI) has more than 300 Senior Fellows and Fellows investigating the medical, economic, social and behavioral issues that influence how health care is financed, managed and delivered across the U.S. The annual AcademyHealth Research Meeting's poster hall provides a convenient way for nearly two dozen of these Penn experts to share their research aimed at improving the country's health care system.

Variability Among US Intensive Care Units in Managing the Care of Patients Admitted With Preexisting Limits on Life-Sustaining Therapies

Jun. 1, 2015

Joanna Hart, Michael Harhay, Nicole Gabler, Sarah Ratcliffe, Caroline Quill, Scott Halpern

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...

Does Philadelphia Have Primary Care Deserts?

May. 19, 2015

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.

Suggestibility of Oncologists’ Clinical Estimates

May. 1, 2015

David I. Shalowitz, John O. Schorge

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...

Cost Outcomes of Supplemental Nurse Staffing in a Large Medical Center

Apr. 1, 2015

Ying Xue, Linda H. Aiken, Andre R. Chappel, Deborah A. Freund, Katia Noyes

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

Apr. 1, 2015

Rinad S. Beidas, Steven Marcus, Gregory A. Aarons, Kimberly E. Hoagwood, Sonja Schoenwald, Arthur C. Evans, Matthew O. Hurford, Trevor Hadley, Frances K. Barg, Lucia M. Walsh, Danielle R. Adams, David S. Mandell

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...