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.

Patient Demands and Requests for Cancer Tests and Treatments

Apr. 1, 2015

Keerthi Gogineni, Katherine L. Shuman, Derek Chinn, Nicole B. Gabler, Ezekiel J. Emanuel

In JAMA Oncology, Keerthi Gogineni and colleagues, including Ezekiel Emanuel, investigate how frequently patients demand or request medical tests or treatments, what types they demand, the clinical appropriateness of their demands, and how frequently clinicians comply. The authors interviewed more than 60 clinicians at three outpatient cancer treatment facilities in the Philadelphia area. They find that just one percent of encounters involve patients’ making demands for what are deemed clinically inappropriate services, frequently imaging, lab tests or palliative treatments. Physicians...

Adoption of Electronic Medical Record-Based Decision Support for Otitis Media in Children

Apr. 1, 2015

Alexander G. Fiks, Peixin Zhang, A. Russell Localio, Saira Khan, Robert W. Grundmeier, Dean J. Karavite, Charles Bailey, Evaline A. Alessandrini, Christopher B. Forrest

In Health Services Research, Alexander Fiks and colleagues, including Christopher Forrest, analyze the impact of feedback in improving adoption of clinical decision support (CDS). The work is part of a larger trial of the effectiveness of CDS for diagnosing and treating ear infections in children. While substantial investment in electronic health records (EHRs) has provided an unprecedented opportunity to use CDS, the impact of feedback on clinician use of CDS systems has not been well studied. The authors looked at EHR-based CDS adoption during 41,391 ear infection visits, and...

Perceptions of High-Risk Patients and Their Providers on the Patient-Centered Medical Home

Apr. 1, 2015

Shreya Kangovi, Katherine Kellom, Christopher Sha, Sarah Johnson, Casey Chanton, Tamala Carter, Judith A. Long, David Grande

In the Journal of Ambulatory Care Management, Shreya Kangovi and colleagues, including Judith Long and David Grande, analyze patient and primary care practice staff perceptions of patient-centered medical homes (PCMH). Through a multi-state qualitative survey, the authors explore areas of agreement and tension between the perceptions of chronically ill, low-income patients and their primary care practice staff on PCMH principles and implementation strategies. PCMH are a team-based delivery model that emphasize continuity of care and health outcomes. Kangovi and colleagues’ conclude some...

Hospital Employment of Supplemental Registered Nurses and Patients’ Satisfaction With Care

Mar. 1, 2015

Karen B. Lasater, Douglas M. Sloane, Linda H. Aiken

In the Journal of Nursing Administration, Linda Aiken and Penn colleagues from the Center for Health Outcomes and Policy Research (CHOPR) examine whether the use of supplemental registered nurses (SRNs), temporary nurses often used by hospitals to alleviate staffing shortages, has an impact on overall patient satisfaction. Using survey data from nurses and patients, they found little evidence that temporary nurses affect patient satisfaction with the hospital or with nursing care in particular. After other hospital and nursing characteristics were controlled, greater use of SRNs was not...

The Role of Training Environment Care Intensity in US Physician Cost Consciousness

Mar. 1, 2015

Kira L. Ryskina, Scott D. Halpern, Nancy S. Minyanou, Susan D. Goold, Jon C. Tilburt

In Mayo Clinical Proceedings, Kira Ryskina and colleagues, including Scott Halpern, evaluate the impact of training environment on physicians’ levels of cost-consciousness. The authors analyzed results from the Physicians, Health Care Costs, and Society survey, administered to physicians across the country in 2012. Using responses from physicians for whom information was available about the care intensity of the hospitals where they did their residency, the authors evaluated the degree to which training environment influenced the views expressed in the survey. Training intensity was...

The Quality of Hospital Work Environments and Missed Nursing Care is Linked to Heart Failure Readmissions: a Cross-Sectional Study of U.S. Hospitals

Feb. 11, 2015

J. Margo Brooks Carthon, Karen B. Lasater, Douglas M. Sloane, Ann Kutney-Lee

In BMJ Quality & Safety, J. Margo Brooks Carthon and colleagues from Penn Nursing’s Center for Health Outcomes and Policy Research (CHOPR) look at the effect of missed nursing care on 30-day readmissions for heart failure patients. Missed care are those services that nurses regard as necessary but were left undone on their last shift due to a lack of time. The authors linked nurse survey data, hospital administrative data, and patient discharge data from three states to evaluate hospital-level nursing work environments, missed care, and readmissions. They found that missed care was an...

Addressing Cost Barriers to Medications: A Survey of Patients Requesting Financial Assistance

Feb. 4, 2015

David Grande, Margaret Lowenstein, Madeleine Tardif, Carolyn Cannuscio

In the American Journal of Managed Care, David Grande and colleagues assess decision-making preferences of patients who face cost-related barriers to care or medication. Specifically, the authors evaluate which health care actors patients trust most to evaluate cost-efficacy tradeoffs and screen for cost barriers using administrative records. The authors conducted a survey of 1,400 patients (adults with a chronic disease seeking financial assistance) who rated a clinical vignette describing how a clinical decision was made in the context of a cost-efficacy tradeoff. Results show that...

Medicaid Fee Bump: Gone Too Soon?

Feb. 4, 2015

The story of the Medicaid fee bump is, first and foremost, a story of a policy to improve access to primary care for Medicaid recipients, by paying physicians more to see them. But it is also a story of how research can answer an important policy question, and how it can affect policy as it is being made. That's the story we tell here:

The Affordable Care Act and Minority Health: Part IV (Workforce Diversity)

Jan. 15, 2015

As the Affordable Care Act’s health insurance marketplaces begin their second year of open enrollment, LDI examines the current and potential impact of the ACA on the health of minority populations. This fourth post of a five-part series describes the current initiatives to diversify the health care workforce with greater minority participation.