Impact of an Interprofessional Transition of Care Service on 30-Day Hospital Reutilizations
Shelley Otsuka, Jennifer N. Smith, Laura Pontiggia, Radha V. Patel, Susan C. Day and David T. Grande
ABSTRACT [FROM JOURNAL]
The objective of this study was to evaluate the impact of an interprofessional Transitions of Care (TOC) service on 30-day hospital reutilization inclusive of hospital readmissions and ED visits. This was a retrospective cohort study including patients discharged from an academic medical center between September 2013 and October 2014. Patients scheduled for a hospital follow-up visit in the post-acute care clinic (PACC) were included in the intervention group and patients without a post-discharge interprofessional TOC service were included in the comparison...
Mergers and Marginal Costs: New Evidence on Hospital Buyer Power
Abstract [from journal]
We estimate the effects of horizontal mergers on marginal cost efficiencies – an ubiquitous merger justification – using data containing supply purchase orders from a large sample of US hospitals 2009-2015. The data provide a level of detail that has been difficult to observe previously, and a variety of product categories that allows us to examine economic mechanisms underlying “buyer power.” We find that merger target hospitals save on average $176 thousand (or 1.5 percent) annually, driven by geographically local efficiencies in price negotiations for...
Amol Navathe Wins AcademyHealth 'Best Abstract' Award
Measuring Emergency Care Survival: The Implications of Risk-Adjusting for Race and Poverty
Kimon L.H. Ioannides, Avi Baehr, David N. Karp, Douglas J. Wiebe, Brendan G. Carr,...
ABSTRACT [FROM JOURNAL]
Objectives: We determined the impact of including race, ethnicity, and poverty in risk adjustment models for emergency care sensitive conditions mortality that could be used for hospital pay‐for‐performance initiatives. We hypothesized that adjusting for race, ethnicity, and poverty would bolster rankings for hospitals that cared for a disproportionate share of non‐white, Hispanic, or poor patients.
Methods: We performed a cross‐sectional analysis
...Trends in hospital-SNF relationships in the care of Medicare beneficiaries
Joshua M. Liao, R. Tamara Konetzka, Rachel M. Werner
Abstract [from journal]
Improving the value of post-acute care at skilled nursing facilities (SNFs) has become a Medicare policy priority. Anecdotally, hospitals have responded by formally acquiring or pursuing tighter informal connections with SNFs. We evaluated the trend in connections between US acute care hospitals and Medicare-certified SNFs between 2000 and 2013 using vertical integration and two novel network-based measures (number of SNF partners, and...
Where Patients Go After Hospital Discharge: Trends in Post-Acute Care
As the largest single source of health care spending, hospitals have drawn considerable attention from policymakers. Efforts to reduce costs have led to decreased lengths of hospital stays, but far less attention has been paid to where those patients go immediately after discharge. Medicare payment reforms implemented in the wake of the Affordable Care Act, such as hospital readmissions penalties and bundled payments, have made hospitals accountable for care beyond their walls, including institutional post-acute care.
An Afternoon with Atul Gawande at Penn Medicine
The 340B Program Hits a Crisis Point
As the Centers for Medicare & Medicaid Services (CMS) implement nearly $1.6 billion in cuts to the 340B Drug Pricing Program, a new study looks at the consequences of the program, and questions whether it has had its intended effect of helping safety-net hospitals serve poor and vulnerable populations.
The Use of Individual Provider Performance Reports by US Hospitals
In the Journal of Hospital Medicine, Joshua Rolnick and Kira Ryskina analyze trends in how hospitals use the electronic health record to track and provide feedback on provider performance. The authors use data from a nationally representative survey of US hospitals from 2013 to 2015 to identify hospitals that have used electronic data to create individual provider performance profiles (IPPs). They model how the odds of IPP use differ as a function of hospital characteristics, including ownership (non-profit, for-profit, or government), geographic region, teaching versus...
LDI 2018 Pilot Study Grants Announced
What Every Graduating Resident Needs to Know About Quality Improvement and Patient Safety: A Content Analysis of 26 Sets of ACGME Milestones
Meghan Lane-Fall, Joshua J. Davis, Justin Clapp, Jennifer S. Myers, Lee Ann Riesenberg
In the Journal of the Association of American Medical Colleges, Meghan Lane-Fall and colleagues analyze milestones – competency-based outcomes assessing graduate medical trainees – across 26 specialties to identify common expectations related to quality improvement (QI) and patient safety (PS). The purpose of this work is to move toward a consensus around what every medical trainee needs to know in QI and PS, irrespective of specialty.
The authors performed a content analysis of 612 published milestones from the Accreditation Council for Graduate Medical Education (ACGME)....
Regional Variation in Standardized Costs of Care at Children’s Hospitals
Jennifer A. Jonas, Samir S. Shah, Isabella Zaniletti, Matthew Hall, Jeffrey D. Colvin, Laura M. Gottlieb, Marion R. Sills, Jessica Bettenhausen, Rustin B. Morse, Michelle L. Macy, Evan S. Fieldston
In the Journal of Hospital Medicine, Evan Fieldston and colleagues investigated regional cost variation for three inpatient pediatric conditions, assessed the potential drivers of variation, and estimated the cost savings that could result from reducing variation. With some areas of the country spending close to three times more on health care than others, regional variation in health care spending has been a focus of national attention.
The authors analyzed hospitalizations for asthma, diabetic ketoacidosis (DKA), and acute gastroenteritis (AGE) at 46 children’s hospitals...
Pediatric Price Transparency: Still Opaque With Opportunities for Improvement
Laura J. Faherty, Charlene A. Wong, Jordyn Feingold, Joan Li, Robert Town, Evan Fieldston, Rachel M. Werner
In Hospital Pediatrics, Laura J. Faherty and colleagues, including Evan Fieldston and Rachel Werner, describe online price transparency data for pediatric care and the consumer experience of obtaining an out-of-pocket estimate from children’s hospitals for a common procedure. Price transparency is gaining importance as families’ portion of health care costs rise.
The study consisted of three parts: an audit of 45 children’s hospital Web sites, "secret shopper" calls to the hospitals to request price estimates for a common pediatric procedure (a tonsillectomy-adenoidectomy...
Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study
Jane E. Ball, Luk Bruyneel, Linda H. Aiken, Walter Sermeus, Douglas M. Sloane, Anne Marie Rafferty, Rikard Lindqvist, Carol Tishelman, Peter Griffiths, RN4CAST Consortium
In International Journal of Nursing Studies, Jane Ball and colleagues, including Linda Aiken, examine if missed nursing care explains the observed association between nurse staffing levels and mortality. Previous research has shown that higher postoperative mortality rates are associated with lower nurse staffing levels. When nurse staffing levels are lower, there is a higher incidence of necessary but missed nursing care. The authors collected data from 422,730 patients from 300 general acute hospitals, and administered surveys to 26,516 registered nurses to understand staffing...
Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status
Pooja K. Mehta, Tamala Carter, Cjloe Vinoya, Shreya Kangovi, Sindhu K. Srinivas
In Women’s Health Issues, Pooja Mehta and colleagues, including Shreya Kangovi and Sindhu Srinivas, seek to understand maternal preference for unscheduled hospital-based obstetric care, in order to inform interventions and improve value of publicly funded care during pregnancy. Previous research has shown that pregnant high utilizers of unscheduled care may be at particular risk for poor perinatal outcomes; however drivers of this association are unknown. The authors conducted a comparative qualitative analysis of in-depth semi structured interviews. Low-income pregnant women...