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.

Effect Of Patient Education On Palliative Care Knowledge And Acceptability Of Outpatient Palliative Care Services Among Gynecologic Oncology Patients: A Randomized Controlled Trial

Feb. 1, 2020

Ashley Graul, Ashley Haggerty, Carolyn Stickley, Knashawn Morales, Hillary Bogner, Robert Burger, Mark Morgan, Emily Ko

Abstract [from journal]

Objectives: A randomized control trial (RCT) to estimate the effect of an interventional video on improving palliative care knowledge, acceptability and attendance to outpatient services in gynecologic oncology patients.

Methods: Women receiving treatment for gynecologic malignancy recruited at an academic tertiary care center were randomized to: palliative care educational video or non-directive cancer center video. The primary outcome was referral to

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Gender Differences in Authorship of Critical Care Literature

Jan. 22, 2020

Kelly C. Vranas, David Ouyang, Amber L. Lin, Christopher G. Slatore, Donald R. Sullivan, Meeta Prasad Kerlin, Kathleen D. Liu, Rebecca M. Baron, Carolyn S. Calfee, Lorraine B. Ware, Scott Halpern, Michael A. Matthay, Margaret Herridge, Sangeeta Mehta,  Angela J...

Abstract [from journal]

Rationale: Gender gaps exist in academic leadership positions in critical care. Peer-reviewed publications are crucial to career advancement, yet little is known regarding gender differences in authorship of critical care research.

Objectives: To evaluate gender differences in authorship of critical care literature.

Methods: We used a validated database of author gender to analyze authorship of critical care articles indexed in PubMed between 2008-2018 in 40 frequently-cited journals.

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The Relationship Between Hospital and Community Psychiatry: Complements, Not Substitutes?

Jan. 3, 2020

Isabel M. Perera

Abstract [from journal]

Community-based psychiatric services are essential to mental health. For decades, researchers, advocates, and policy makers have presumed that expanding the supply of these services hinges on reducing the supply of hospital-based care. Cross-national data from the World Health Organization call this presumption into question. Community and hospital psychiatry appear to be complements, not substitutes.

Association Between Mobile Telephone Interruptions and Medication Administration Errors in a Pediatric Intensive Care Unit

Christopher Bonafide, MD
Dec. 20, 2019

Christopher P. Bonafide, Jeffrey M. Miller, A. Russell Localio, Amina Khan, Adam C. Dziorny, Mark Mai, MD, Shannon Stemler, Wanxin Chen, John H. Holmes, Vinay M. Nadkarni, Ron Keren

Abstract [from journal]

Importance: Incoming text messages and calls on nurses’ mobile telephones may interrupt medication administration, but whether such interruptions are associated with errors has not been established.
 

Objective: To assess whether a temporal association exists between mobile telephone interruptions and subsequent errors by pediatric intensive care unit (PICU) nurses during medication administration.

Design, Setting, and Participants: A retrospective cohort study was...

Physician Consolidation and the Spread of Accountable Care Organizations

Research Brief
Nov. 4, 2019

Accountable Care Organizations (ACOs) are groups of physicians and hospitals that jointly contract to care for a patient population. ACO contracts incentivize coordination of care across providers. This can lead to greater consolidation of physician practices, which can in turn generate higher costs and lower quality. Given this, the study asks, as ACOs enter health care markets, do physician practices grow larger?

A National Comparison of Operative Outcomes of New and Experienced Surgeons

Research Brief
Oct. 25, 2019

In this national study, Medicare beneficiaries treated by new surgeons had poorer outcomes than those treated by experienced ones in the same hospitals. However, the type of operation and the patient’s emergency status – rather than physician inexperience – explains nearly all poorer outcomes. Higher-risk cases are disproportionately treated by new surgeons.

The Association of Geographic Dispersion with Outcomes among Hospitalized Pulmonary Service Patients

Oct. 16, 2019

Rachel Kohn, Michael O. Harhay, Gary E. Weissman, George L. Anesi, Brian Bayes, Hummy Song, Scott D Halpern, S. Ryan Greysen, Meeta Prasad Kerlin

Abstract [from journal]

Hospitals geographically localize clinically similar patients into wards to provide specialized care that improves patient outcomes and care and lowers costs. When these wards exceed capacity, patients become “geographically dispersed” to alternate locations. For example, critically ill patients may “board” in emergency departments (EDs) or alternate intensive care units (ICUs) when the clinically appropriate ICUs are at capacity. Such geographic dispersion has been demonstrated to be associated with increased hospital length of stay (LOS), ICU and in-...

Health Care Safety-Net Programs After The Affordable Care Act

Issue Brief
Oct. 1, 2019

Prior to the Affordable Care Act (ACA), health care safety-net programs were the primary source of care for over 44 million uninsured people. While the ACA cut the number of uninsured substantially, about 30 million people remain uninsured, and many millions more are vulnerable to out-of-pocket costs beyond their resources. The need for the safety net remains, even as the distribution and types of need have shifted. This brief reviews the effects of the ACA on the funding and operation of safety-net institutions. It highlights the challenges and opportunities that health care reform presents to safety-net programs, and how they have adapted and evolved to continue to serve our most vulnerable residents.

Trends in Racial/Ethnic Representation Among US Medical Students

Sep. 4, 2019

Lanair Amaad Lett, H. Moses Murdock, Whitney U. Orji, Jaya Aysola, Ronnie Sebro

Abstract [from journal]

Importance: With increasing efforts to create a diverse physician workforce that is reflective of the demographic characteristics of the US population, it remains unclear whether progress has been made since 2009, when the Liaison Committee on Medical Education set forth new diversity accreditation guidelines.

Objective: To examine demographic trends of medical school applicants and matriculants relative to the overall age-adjusted US population.

Design, Setting, and Participants:

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