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.

Toward A Practice-Informed Agenda For Hospice Intervention Research: What Are Staff Members' Biggest Challenges?

George Demiris, Penn Nursing School
Aug. 6, 2020

Karla T. Washington, Leticia M. Alaniz Staner, Benjamin E. Collie, Kevin W. Craig, George Demiris, Debra Parker Oliver

Abstract [from journal]

The translation of evidence-based interventions into routine hospice care is impeded by numerous barriers, including a disconnect between research priorities and clinical care. To inform the development of a more practice-informed agenda for hospice intervention research, our team conducted a qualitative descriptive study, posing the following research questions: 1) How do hospice staff members describe their most significant work-related challenges? and 2) What regulatory changes do hospice staff members report would most improve

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Mobility Action Group: Using Quality Improvement Methods To Create A Culture Of Hospital Mobility

Aug. 5, 2020

Songprod Jonathan Lorgunpai, Bruce Finke, Isaac Burrows, Cynthia J. Brown, Fred H. Rubin, Heidi R. Wierman, Susan J. Heisey, Sarah Gartaganis, Shari M. Ling, Matthew Press, Sharon K. Inouye

Abstract [from journal]

Background/objectives: To describe the Mobility Action Group (MACT), an innovative process to enhance implementation of hospital mobility programs and create a culture of mobility in acute care.

Design: Continuous quality improvement intervention with episodic data review.

Setting: Inpatient units including medical, surgical, and intensive care settings.

Participants: A total of 42 hospitals of varying sizes across the United States.

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The Psychological Experience Of Obstetric Patients And Health Care Workers After Implementation Of Universal SARS-CoV-2 Testing

Aug. 5, 2020

Whitney R. Bender, Sindhu Srinivas, Paulina Coutifaris, Alexandra Acker, Adi Hirshberg

Abstract [from journal]

Objective: This study was aimed to describe the hospitalization and early postpartum psychological experience for asymptomatic obstetric patients tested for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) as part of a universal testing program and report the impact of this program on labor and delivery health care workers' job satisfaction and workplace anxiety.

Study design: This is a cohort study of asymptomatic pregnant women who underwent SARS-CoV-2 testing between April 13,

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Clinical Research In Hepatology In The COVID-19 Pandemic And Post-Pandemic Era: Challenges And The Need For Innovation

Aug. 2, 2020

Elizabeth C. Verna,  Marina Serper,  Jaime Chu,  Kathleen Corey,  Oren K. Fix,  Karen Hoyt,  Kimberly A. Page,  Rohit Loomba,  Ming Li,  Gregory T. Everson,  Michael W. Fried,  Guadalupe Garcia‐Tsao,  Norah Terrault,  Anna S. Lok,  Raymond T. Chung,  K. Rajender Reddy

Abstract [from journal]

The SARS-CoV-2 pandemic has drastically altered all facets of clinical care and research. Clinical research in hepatology has had a rich tradition in several domains, including the discovery and therapeutic development for diseases such as hepatitis B and C, and studying the natural history of many forms of chronic liver disease. NIH, foundation and industry funding has provided important opportunities to advance the academic careers of young investigators while they strived to make contributions to the field. Instantaneously,

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A Passive Monitoring Tool Using Hospital Administrative Data Enables Earlier Specific Detection Of Healthcare-Acquired Infections

Jul. 31, 2020

Jeffrey Rewley, Laura Koehly, Christopher Steven Marcum, Felix Reed-Tsochas

Abstract [from journal]

Background: Healthcare-associated infections impose a significant burden on the health care system. Current methods for detecting these infections are constrained by combinations of high cost, long processing times, and imperfect accuracy, reducing their effectiveness.

Methods: We examine whether the quantity of time a patient spends in a ward with other patients clinically-suspected of infection, which we call co-presence, can be used as a tool to predict subsequent healthcare-associated

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What Do Parents Value Regarding Pediatric Palliative And Hospice Care In The Home Setting?

Mary Ersek
Jul. 30, 2020

Jackelyn Y. Boyden, Mary Ersek, Janet A. Deatrick, Kimberley Widger, Gwenn LaRagione, Blyth Lord, Chris Feudtner

Abstract [from journal]

Context: Children with life-shortening serious illnesses and medically complex care needs are often cared for by their families at home. Little, however, is known about what aspects of pediatric palliative and hospice care in the home setting (PPHC@Home) families value the most.

Objective: To explore how parents rate and prioritize domains of PPHC@Home as the first phase of a larger study that developed a parent-reported measure of experiences with PPHC@Home.

Methods: 

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High-Performance Trauma Centers In A Single-State Trauma System : Big Saves Or Marginal Gains?

Elinore Kaufman, MD
Jul. 29, 2020

Justin S. Hatchimonji, Elinore J. Kaufman, Andrew J. Young, Brian P. Smith, Ruiying Xiong, Patrick M. Reilly, Daniel N. Holena

Abstract [from journal]

Background: Trauma centers with low observed:expected (O:E) mortality ratios are considered high performers; however, it is unknown whether improvements in this ratio are due to a small number of unexpected survivors with high mortality risk (big saves) or a larger number of unexpected survivors with moderate mortality risk (marginal gains). We hypothesized that the highest-performing centers achieve that status via larger numbers of unexpected survivors with moderate mortality risk.

Methods: 

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Pediatrician Delivered Smoking Cessation Messages For Parents: A Latent Class Approach To Behavioral Phenotyping

Brian Jensson, MD
Jul. 27, 2020

Brian P. Jenssen, Mary Kate Kelly, Jennifer Faerber, Chloe Hannan, David A. Asch, Justine Shults, Robert A. Schnoll, Alexander G. Fiks

Abstract [from journal]

Objective: Message framing can be leveraged to motivate adult smokers to quit, but its value for parents in pediatric settings is unknown. Understanding parents' preferences for smoking cessation messages may help clinicians tailor interventions to increase quitting.

Methods: We conducted a discrete choice experiment in which parent smokers of pediatric patients rated the relative importance of 26 messages designed to increase smoking cessation treatment. Messages varied on who the message

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Stakeholder Perspective On Opioid Stewardship After Prostatectomy: Evaluating Barriers And Facilitators From The Pennsylvania Urology Regional Collaborative

Jul. 22, 2020

Daniel J. Lee, Ruchika Talwar, James Ding, Thenappan Chandrasekar, Kaynaat Syed, Claudette Fonshell, John Danella, Serge Ginzburg, Thomas Lanchoney, Jeffrey Tomaszewski, Edouard Trabulsi, Adam Reese, Marc Smaldone, Robert Uzzo, Jay D. Raman, ...

Abstract [from journal]

Objective: To evaluate existing practice patterns and potential barriers to implementing opioid stewardship protocols after robot-assisted prostatectomies among providers in the Pennsylvania Urology Regional Collaborative.

Methods: The Pennsylvania Urology Regional Collaborative (PURC) is a voluntary quality improvement initiative of 11 academic and community urology practices in Pennsylvania and New Jersey representing 97 urologists. PURC distributed a web-based survey of 24 questions, with

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Stakeholder Perspective On Opioid Stewardship After Prostatectomy: Evaluating Barriers And Facilitators From The Pennsylvania Urology Regional Collaborative

Jul. 22, 2020

Daniel J. LeeRuchika Talwar, James Ding, Thenappan Chandrasekar, Kaynaat Syed, Claudette Fonshell, John Danella, Serge Ginzburg, Thomas Lanchoney, Jeffrey Tomaszewski, Edouard Trabulsi, Adam Reese, Marc Smaldone, Robert Uzzo, Jay D. Raman, Thomas J. Guzzo

Abstract [from journal]

Objective: To evaluate existing practice patterns and potential barriers to implementing opioid stewardship protocols after robot-assisted prostatectomies among providers in the Pennsylvania Urology Regional Collaborative.

Methods: The Pennsylvania Urology Regional Collaborative (PURC) is a voluntary quality improvement initiative of 11 academic and community urology practices in Pennsylvania and New Jersey representing 97 urologists. PURC distributed a web-based survey of 24 questions, with

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Association Of An Emergency Department-Embedded Critical Care Unit With Hospital Outcomes And Intensive Care Unit Utilization

Jul. 22, 2020

George L. Anesi, Jayaram Chelluri, Zaffer A. Qasim, Marzana Chowdhury, Rachel Kohn, Gary E. Weissman, Brian Bayes, M. Kit Delgado, Benjamin S. Abella, Scott D. Halpern, John C. Greenwood

Abstract [from journal]

Rationale: A small but growing number of hospitals are experimenting with emergency department (ED)-embedded critical care units (ED-CCUs) in an effort to improve the quality of care for critically ill patients with sepsis and acute respiratory failure (ARF).

Objective: To evaluate the potential impact of an ED-CCU at the Hospital of the University of Pennsylvania among patients with sepsis and ARF admitted from the ED to a medical ward or intensive care unit (ICU) from January 2016 to

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An Analysis Of The US News & World Report Methodology For Attribution Of Specialty Care In Otolaryngology And Urology

Ankur Shah, MD
Jul. 21, 2020

Ankur A. Shah, Ryan M. Carey, Jason A. Brant, Gregory E. Tasian, Justin B. Ziemba

Abstract [from journal]

US News & World Report (USNWR) rankings can assist patients with choosing where to receive their specialty care. USNWR methodology assumes that the specialty caring for hospitalized patients is equivalent to the specialty assigned by administrative coding. We examined the frequency of discordance between USNWR methodology-assigned specialty and the actual specialty care received for 2 surgical specialties, otolaryngology (ENT) and urology (GU). Our analysis included inpatient deaths identified by USNWR coding for these

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Observational Study Assessing Changes In Timing Of Readmissions Around Postdischarge Day 30 Associated With The Introduction Of The Hospital Readmissions Reduction Program

Jul. 21, 2020

Ashwin S. Nathan, Joseph R. Martinez, Jay Giri, Amol S. Navathe

Abstract [from journal]

Background: The Hospital Readmissions Reduction Program (HRRP) initially penalised hospitals for excess readmission within 30 days of discharge for acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia (PNA) and was expanded in subsequent years to include readmissions for chronic obstructive pulmonary disease, elective total hip arthroplasty, total knee arthroplasty and coronary artery bypass graft surgery. We assessed whether HRRP was associated with delays in readmissions from immediately

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Clinical Supervision In Community Mental Health: Characterizing Supervision As Usual And Exploring Predictors Of Supervision Content And Process

Rinad Beidas, PhD, U of Penn
Jul. 15, 2020

Simone H. Schriger, Emily M. Becker-Haimes, Laura Skriner, Rinad S. Beidas

Abstract [from journal]

Clinical supervision can be leveraged to support implementation of evidence-based practices in community mental health settings, though it has been understudied. This study focuses on 32 supervisors at 23 mental health organizations in Philadelphia. We describe characteristics of supervisors and organizations and explore predictors of supervision content and process. Results highlight a low focus on evidence-based content and low use of active supervision processes. They underscore the need for further attention to the community

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Statewide Interventions And Covid-19 Mortality In The United States: An Observational Study

Jul. 8, 2020

Nadir Yehya, Atheendar Venkataramani, Michael O. Harhay

Abstract [from journal]

Background: Social distancing is encouraged to mitigate viral spreading during outbreaks. However, the association between distancing and patient-centered outcomes in Covid-19 has not been demonstrated. In the United States social distancing orders are implemented at the state level with variable timing of onset. Emergency declarations and school closures were two early statewide interventions.

Methods: To determine whether later distancing interventions were associated with higher mortality,

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