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.

Neurodegenerative Disease Is Associated With Increased Incidence Of Epilepsy: A Population Based Study Of Older Adults

Allison Willis, MD
Oct. 7, 2020

Leah J. Blank, Emily K. Acton, Dylan Thibault, Allison W. Willis 

Abstract [from journal]

Objective: To determine the incidence of epilepsy among Medicare beneficiaries with a new diagnosis of Alzheimer dementia (AD) or Parkinson disease (PD).

Methods: Retrospective cohort study of Medicare beneficiaries with an incident diagnosis of AD or PD in the year 2009. The 5-year incidence of epilepsy was examined by sociodemographic characteristics, comorbidities and neurodegenerative disease status. Cox regression models examined the association of neurodegenerative disease with incident


Differences In Transitional Care Processes Among High-Performing And Low-Performing Hospital-SNF Pairs: A Rapid Ethnographic Approach

Sep. 21, 2020

Kirstin A. Manges, Roman Ayele, Chelsea Leonard, Marcie Lee, Emily Galenbeck, Robert E. Burke

Abstract [from journal]

Background: Despite the increased focus on improving patient's postacute care outcomes, best practices for reducing readmissions from skilled nursing facilities (SNFs) are unclear. The objective of this study was to observe processes used to prepare patients for postacute care in SNFs, and to explore differences between hospital-SNF pairs with high or low 30-day readmission rates.

Design: We used a rapid ethnographic approach with intensive multiday observations and key informant interviews at


Prognosticating Outcomes And Nudging Decisions With Electronic Records In The ICU (PONDER-ICU) Trial Protocol

Katherine Courtright, MD, MSHP
Sep. 16, 2020

Katherine R. Courtright, Erich M. Dress, Jaspal Singh, Brian A. Bayes, Marzana Chowdhury, Dylan S. Small, Timothy Hetherington, Lindsay Plickert, Michael E. Detsky, Jason N. Doctor, Michael O. Harhay, Henry L. Burke, Michael B....

Abstract [from journal]

Expert recommendations to discuss prognosis and offer palliative options for critically ill patients at high risk of death are variably heeded by intensive care unit (ICU) clinicians. How to best promote such communication to avoid potentially unwanted aggressive care is unknown. The Prognosticating Outcomes and Nudging Decisions with Electronic Records in the ICU (PONDER-ICU) study is a 33-month pragmatic, stepped-wedge, cluster randomized trial testing the effectiveness of two electronic health record (EHR) interventions designed


Improving Emergency Care For Children With Medical Complexity: Parent & Physicians' Perspectives

Sep. 15, 2020

Christian D. Pulcini, Zoe Belardo, Tara Ketterer, Joseph J. Zorc, Cynthia Mollen

Abstract [from journal]

Objectives: Children with medical complexity (CMC) have high rates of emergency department (ED) utilization, but little evidence exists on the perceptions of parents and pediatric emergency medicine (PEM) physicians about emergency care. We sought to explore parent and PEM physicians' perspectives about 1) ED care for CMC, and 2) how emergency care can be improved.

Methods: We performed semi-structured interviews with parents and PEM physicians at a single academic, children's hospital.


How Context Influences Hospital Readmissions From Skilled Nursing Facilities: A Rapid Ethnographic Study

Sep. 14, 2020

Roman AyeleKirstin A. Manges, Chelsea Leonard, Marcie Lee, Emily Galenbeck, Mithu Molla, Cari Levy, Robert E. Burke

Abstract [from journal]

Introduction: Improving hospital discharge processes and reducing adverse outcomes after hospital discharge to skilled nursing facilities (SNFs) are gaining national recognition. However, little is known about how the social-contextual factors of hospitals and their affiliated SNFs may influence the discharge process and drive variations in patient outcomes. We sought to categorize contextual drivers that vary between high- and low-performing hospitals in older adult transition from hospitals to SNFs.


Case For Hospital Nurse-To-Patient Ratio Legislation In Queensland, Australia, Hospitals: An Observational Study

Sep. 6, 2020

Matthew D. McHugh, Linda H. Aiken, Carol Windsor, Clint Douglas, Patsy Yates

Abstract [from journal]

Objectives: To determine whether there was variation in nurse staffing across hospitals in Queensland prior to implementation of nurse-to-patient ratio legislation targeting medical-surgical wards, and if so, the extent to which nurse staffing variation was associated with poor outcomes for patients and nurses.

Design: Analysis of cross-sectional data derived from nurse surveys linked with admitted patient outcomes data.

Setting: Public hospitals in Queensland.


Long-Term Care, Residential Facilities, And COVID-19: An Overview Of Federal And State Policy Responses

Angela Chen, MA
Sep. 1, 2020

Angela T. ChenKira L. Ryskina, Hye-Young Jung

Abstract [from journal]

The COVID-19 pandemic has disproportionately affected residents and staff at long-term care (LTC) and other residential facilities in the United States. The high morbidity and mortality at these facilities has been attributed to a combination of a particularly vulnerable population and a lack of resources to mitigate the risk. During the first wave of the pandemic, the federal and state governments received urgent calls for help from LTC and residential care facilities; between March and early June of 2020, policymakers responded


Perspectives Of Urban Adolescent Black Males And Their Parents On Well Care

Aug. 27, 2020

George Dalembert, Ima Samba, Victoria A. Miller, Carol A. Ford, Alexander G. Fiks

Abstract [from journal]

Objective: Adolescents have fewer well-care visits than all other age groups. Males and ethnic minorities are seen least often. We elicited, from Black adolescent males and their parents, key drivers of teen well-care seeking.

Methods: We conducted separate semi-structured interviews with Black adolescent males and their parents. We recruited parent-teen dyads from West Philadelphia. Eligible teens were age 13-18, with no complex chronic health conditions. We purposively sampled teens who had


Patterns Of Postpartum Ambulatory Care Follow-Up Care Among Women With Hypertensive Disorders Of Pregnancy

Aug. 27, 2020

Jennifer Lewey, Lisa D. Levine, Lin Yang, Jourdan E. Triebwasser, Peter W. Groeneveld 

Abstract [from journal]

Background Preeclampsia and gestational hypertension are hypertensive disorders of pregnancy (HDP) that identify an increased risk of developing chronic hypertension and cardiovascular disease later in life. Postpartum follow-up may facilitate early screening and treatment of cardiovascular risk factors. Our objective is to describe patterns of postpartum visits with primary care and women's health providers (eg, family medicine and obstetrics) among women with and without HDP in a nationally representative sample of commercially


Chronic Hospital Nurse Understaffing Meets COVID-19

Research Brief
Aug. 18, 2020

A study of hospitals in New York and Illinois at the start of the COVID-19 pandemic found that most did not meet benchmark patient-to-nurse staffing ratios for medical-surgical or intensive care units. New York City hospitals had especially low staffing ratios. Understaffed hospitals were associated with less job satisfaction among nurses, unfavorable grades for patient safety and quality of care, and hesitance by nurses and patients to recommend their hospitals. 

Intersectionality and Health Inequities For Gender Minority Blacks In The U.S.

Aug. 10, 2020

Elle Lett, Nadia L. Dowshen, Kellan E. Baker

Abstract [from journal]

Introduction: Gender minority blacks represent the intersection of multiply marginalized populations that experience severe health inequities in the U.S. However, few studies focus on the unique health experiences of this multiply disadvantaged population. This study quantifies the health inequities experienced by gender minority blacks in the U.S. using an intersectional framework.

Methods: This cross-sectional study analyzed data in 2018/2019 from the Behavioral Risk Factor Surveillance System, including all...