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.

IRB Oversight of Patient-Centered Outcomes Research: A National Survey of IRB Chairpersons

Jun. 27, 2018

Joel S. Weissman, Eric G. Campbell, I. Glenn Cohen, Holly Fernandez LynchEmily A. Largent, Avni Gupta,Ronen Rozenblum, ...

ABSTRACT [FROM JOURNAL]

Patient-centered outcomes research (PCOR) is becoming increasingly common. However, there is little evidence regarding what novel ethical challenges, if any, are posed by PCOR with relevance to institutional review board (IRB) oversight and human subjects protections. This article reports the results of a national survey of all IRB chairpersons from research-intensive institutions in the United States. Findings address the responsibilities of IRBs and the challenges associated with PCOR review and oversight. IRB chairpersons varied in their judgment of PCOR...

Modernizing Medicare Funding for Nurse Education

Jun. 21, 2018

With policies rooted in the 1960s, it’s time to change how Medicare pays for nurse education. In a New England Journal of Medicine Perspective, LDI Senior Fellow Linda Aiken and colleagues present a compelling case for funding a new consortium model that trains nurse practitioners (NPs) in the community settings where they are a crucial source of primary care.

Lower Postsurgical Mortality for Individuals with Dementia with Better-Educated Hospital Workforce

Research Brief
Apr. 11, 2018

Surgical patients age 65 and over with Alzheimer’s disease and related dementias (ADRD) were more likely to die within 30 days of admission and to die after a complication than those without ADRD. Having better-educated nurses in the hospital improved the likelihood of good outcomes for all surgical patients, but had a much greater effect in individuals with ADRD. Specifically, a 10% increase in the proportion of nurses with a Bachelor of Science in Nursing (BSN) degree or higher was associated with 10% lower odds of death and 10% lower odds of dying after a complication for surgical patients with ADRD.

Moving Beyond Duty-Hours

Apr. 2, 2018

If you want to start an intense debate within the medical community, just talk about duty-hours – the length of a physician-in-training’s shift.

Education Outcomes in a Duty-Hour Flexibility Trial in Internal Medicine

Mar. 21, 2018

Sanjay V. Desai, David A. Asch, Lisa M. Bellini, Krisda H. Chaiyachati, Manqing Liu, Alice L. Sternberg, James Tonascia, Alyssa...

Abstract [from journal]

Background 
Concern persists that inflexible duty-hour rules in medical residency programs may adversely affect the training of physicians.

Methods
We randomly assigned 63 internal medicine residency programs in the United States to be governed by standard duty-hour policies of the 2011 Accreditation Council for Graduate Medical Education (ACGME) or by more flexible policies that did not specify limits on shift length or mandatory time off...

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