Medical Decision Making

How health professionals and patients make treatment decisions, and the barriers to, and facilitators of, effective decision making.

Views From Patients With Cancer In The Setting Of Unplanned Acute Care: Informing Approaches To Reduce Health Care Utilization

Jun. 23, 2020

Tara L. Kaufmann, Katharine A. Rendle, Erin Aakhus, Vivek Nimgaonkar, Arnav Shah, Andrea Bilger, Peter E. Gabriel, Rebecca Trotta, Jennifer Braun, Lawrence N. Shulman, Justin E. Bekelman, Frances K. Barg

Abstract [from journal]

Purpose: New oncology care delivery models that avoid preventable acute care are needed, yet it is unclear which interventions best meet the needs of patients and caregivers. Perspectives from patients who experienced unplanned acute care events may inform the successful development and implementation of care delivery models.

Methods: We performed a qualitative interview study of patients with solid tumors on active treatment who experienced the following 3 types of unplanned acute care events


Parkinson Disease Associated Differences In Elective Orthopedic Surgery Outcomes: A National Readmissions Database Analysis

Allison Willis, MD
Jun. 22, 2020

Michelle Fullard, Dylan Thibault, Hanan Zisling, James A. Crispo, Allison Willis

Abstract [from journal]

Background: Advances in the treatment of Parkinson's disease (PD) have allowed for improvements in mortality and quality survival, making the management of comorbid conditions of aging, such as osteoarthritis, crucial.

Objective: To determine the extent to which PD impacts hospitalization outcomes after an elective orthopedic procedure.

Methods: This retrospective cohort study used data from the National Readmissions Database and included adults ages 40 and above with


Low Health Literacy Is Associated With Frailty And Reduced Likelihood Of Liver Transplant Listing: A Prospective Cohort Study

Jun. 21, 2020

Therese Bittermann, Kristen Dwinnells, Sakshum Chadha, Michael S. Wolf, Kim M. Olthoff, Marina Serper

Abstract [from journal]

The effect of low health literacy (HL) on outcomes in end-stage liver disease (ESLD) is largely unknown. The association of low HL on clinical outcomes was investigated in a prospective cohort of outpatients with ESLD undergoing liver transplant (LT) evaluation. From 2014-2017, 276 patients underwent LT evaluation with assessments of liver disease severity, medical and psychosocial comorbidities, physical frailty, and malnutrition. Literacy was measured with the Newest Vital Sign (NVS), a brief validated assessment. Multivariable


COVID-19 And Cardiac Arrhythmias

Jun. 20, 2020

Anjali Bhatla, Michael M. Mayer, Srinath Adusumalli, Matthew C. Hyman, Eric Oh, Ann Tierney, Juwann Moss, Anwar A. Chahal, George Anesi, Srinivas Denduluri, Christopher M. Domenico, Jeffrey Arkles, Benjamin S. Abella, John R. Bullinga, David J. Callans, Sanjay Dixit, Andrew E....

Abstract [from journal]

Background: Early studies suggest that coronavirus disease 2019 (COVID-19) is associated with a high incidence of cardiac arrhythmias. SARS-CoV-2 infection may cause injury to cardiac myocytes and increase arrhythmia risk.

Objective: To evaluate the risk of cardiac arrest and arrhythmias including incident atrial fibrillation (AF), bradyarrhythmias, and nonsustained ventricular tachycardia (NSVT) in a large urban population hospitalized for COVID-19. We also evaluated correlations between the


Preferences For Predictive Model Characteristics Among People Living With Chronic Lung Disease: A Discrete Choice Experiment

Jun. 12, 2020

Gary E. Weissman, Kuldeep N. Yadav, Trishya Srinivasan, Stephanie Szymanski, Florylene Capulong, Vanessa Madden, Katherine R. Courtright, Joanna L. Hart, David A. Asch, Sarah J. Ratcliffe, Marilyn M....

Abstract [from journal]

Background. Patients may find clinical prediction models more useful if those models accounted for preferences for false-positive and false-negative predictive errors and for other model characteristics. Methods. We conducted a discrete choice experiment to compare preferences for characteristics of a hypothetical mortality prediction model among community-dwelling patients with chronic lung disease recruited from 3 clinics in Philadelphia. This design was chosen to allow us to quantify "exchange


Nature Prescriptions For Health: A Review Of Evidence And Research Opportunities

Jun. 12, 2020

Michelle C. Kondo, Kehinde O. Oyekanmi, Allison Gibson, Eugenia C. South, Jason Bocarro, J Aaron Hipp

Abstract [from journal]

Nature prescription programs have emerged to address the high burden of chronic disease and increasingly sedentary and screen-based lifestyles. This study examines the base of evidence regarding such programs. We conducted a narrative review of published literature using four electronic databases. We included case studies, research design articles, and empirical studies that discussed any type of outdoor exposure or activities initiated by a health-care provider from an outpatient clinic. We examined articles for information on target


Recent Trends In Medicare Utilization And Reimbursement For Lumbar Spine Fusion And Discectomy Procedures

Jun. 10, 2020

Cesar D. Lopez, Venkat Boddapati, Joseph M. Lombardi, Nathan J. Lee, Comron Saifi, Marc Dyrszka, Zeeshan Sardar, Lawrence G. Lenke, Ronald A Lehman

Abstract [from journal]

Background context: Understanding the scope of the volume and costs of lumbar fusions and discectomy procedures, as well as identifying significant trends within the Medicare system, may be beneficial in enhancing cost-efficiency and care delivery. However, there is a paucity of studies which analyze recent trends in lumbar fusion volume, utilization, and reimbursements.

Purpose: This study seeks to define the costs of lumbar fusions and discectomy procedures and identify trends and variations


Paying Participants In COVID-19 Trials

May. 29, 2020

Emily A. Largent, Holly Fernandez Lynch

Abstract [from journal]

A variety of trials are in development and underway to examine potential interventions for the treatment and prophylaxis of novel coronavirus disease 2019 (COVID-19). How should we think about offering payment to participants in these trials? Payment for research participation is ethically contentious even under ideal circumstances, and pandemics are far from ideal. Here, we review the three functions of research payment-reimbursement, compensation, and incentive-and identify heightened and novel ethical concerns in the context of a


Costs And Reimbursements For Mental Health Hospitalizations At Children’s Hospitals

Stephanie Doupnik, MD
May. 20, 2020

Alison C Herndon, Derek Williams, Matt Hall, James C Gay, Whitney Browning, Heather Kreth, Greg Plemmons, Kate Morgan, Maya Neeley, My-Linh Ngo, Lisa Clewner-Newman, Evan Dalton, Hannah Griffith, Travis Crook, Stephanie K Doupnik

Abstract [from journal]

The financial impact of the rising number of pediatric mental health hospitalizations is unknown. Therefore, this study assessed costs, reimbursements, and net profits or losses for 111,705 mental health and non–mental health medical hospitalizations in children’s hospitals with use of the Pediatric Health Information System and Revenue Management Program. Average financial margins were calculated as (reimbursement per day) – (cost per day), and they were lowest for mental health hospitalizations ($136/day), next lowest for suicide attempt ($518/day), and...

Applying NUDGE To Inform Design Of EBP Implementation Strategies In Community Mental Health Settings

Rebecca Stewart, Penn Center for Mental Health
May. 19, 2020

Rebecca E Stewart, Rinad S Beidas, Briana S Last, Katelin Hoskins, Y Vivian Byeon, Nathaniel J Williams, Alison M Buttenheim

Abstract [from journal]

We demonstrate the application of NUDGE (Narrow, Understand, Discover, Generate, Evaluate), a behavioral economics approach to systematically identifying behavioral barriers that impede behavior enactment, to the challenge of evidence-based practice (EBP) use in community behavioral health. Drawing on 65 clinician responses to a system-wide crowdsourcing challenge about EBP underutilization, we applied NUDGE to discover, synthesize and validate specific behavioral barriers to EBP utilization that directly inform the design of tailored...

Nudging Clinicians Toward Higher-Value Cancer Care

May. 5, 2020

In a new study published in JAMA Oncology, my colleagues and I find that behavioral nudges can promote high-value, evidence-based prescribing of specialty drugs in cancer care. For patients with breast, lung, and prostate cancer with bone metastases, clinicians face a decision between two therapies of comparable effectiveness but dramatically different cost.

Volume Of Frail Patients Predicts Outcome In Frail Patients After Cardiac Surgery

Nimesh Desai, MD, PhD
May. 4, 2020

Nicholas J. Goel, Amit Iyengar, John J. Kelly, Jason J. HanChase R. BrownNimesh D. Desai

Abstract [from journal]

Objective: Recent data from major noncardiac surgery suggest that outcomes in frail patients are better predicted by a hospital's volume of frail patients specifically, rather than overall surgical volume. We sought to evaluate this "frailty volume-frailty outcome relationship" in patients undergoing cardiac surgery.

Methods: We studied 72,818 frail patients undergoing coronary artery bypass grafting or valve replacement surgery from 2010 to 2014 using the Nationwide Readmissions Database.


Nerve Block Use after Hip Fracture Versus Elective Hip or Knee Arthroplasty: Retrospective Analysis

Meghan Lane-Fall, MD, MSHP
Mar. 3, 2020

Mark D. Neuman, Nabil M. Elkassabany, Jason Ochroch, Craig Newcomb, Colleen Brensinger, Samir Mehta, Lakisha J. Gaskins, Meghan B. Lane‐Fall

Abstract [from journal]

Objectives: Although peripheral nerve blocks are associated with improved pain control and end outcomes among older adults with hip fracture, their current utilization among US hip fracture patients is not well understood. We characterized contemporary use of peripheral nerve blocks after hip fracture over time and identified predictors of nerve block receipt.

Design: Retrospective cohort study of claims data from one large national private US insurer.

Setting: US acute care hospitals.