Organization of Healthcare Delivery

Streamlining how health care is delivered in the U.S.’s fragmented system.

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

Christopher Bonafide, MD
Dec. 20, 2020

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...

The Value of Teaching Hospitals

Jan. 14, 2020

One benefit of teaching hospitals is obvious: they train the next generation of clinicians. But that training comes at a cost: teaching hospitals tend to have higher-priced clinical care than other hospitals. In the era of value-based care, the question is whether the additional spending produces better patient outcomes, and if so, whether the clinical benefit is worth the cost.

Hospital Financial Incentives to Improve Care After Opioid Overdose

Jan. 6, 2020

Two patients are treated for opioid overdose at two different hospitals, just a few miles apart. The first hospital provides life-saving treatment to reverse the overdose and watches the patient for an hour, discharging them when deemed “medically stable.” The second hospital also provides life-saving treatment but then offers counseling, medication to prevent recurrent overdose and treat opioid withdrawal, and assistance navigating to outpatient treatment for the next day.

Moving Organizational Theory in Health Care Forward: A Discussion with Suggestions for Critical Advancements

Jan. 1, 2020

Ingrid M Nembhard, Ann Barry Flood, John R Kimberly, Anthony R Kovner, Stephen M Shortell, Jacqueline S Zinn

Abstract [from journal] 

In May 2019, scholars in management and organization of health care organizations and systems met. The opening plenary was a moderated discussion with five distinguished scholars who have exemplified pushing the frontier of organizational theory and practice throughout their careers: Ann Barry Flood of Dartmouth College, John Kimberly of the University of Pennsylvania, Anthony (Tony) Kovner of New York University, Stephen (Steve) Shortell of University of California at Berkeley, and Jacqueline (Jackie) Zinn of Temple University. The discussion was...

Variability in Transitional Care Outcomes Across Hospitals Discharging Veterans to Skilled Nursing Facilities

Kira Rysinka, MD
Dec. 30, 2019

Robert E. Burke, Anne Canamucio, Thomas J. Glorioso, Anna E. Barón, Kira L. Ryskina

Abstract [from journal]

Background: The period after transition from hospital to skilled nursing facility (SNF) is high-risk, but variability in outcomes related to transitions across hospitals is not well-known.

Objectives: Evaluate variability in transitional care outcomes across Veterans Health Administration (VHA) and non-VHA hospitals for Veterans, and identify characteristics of high-performing and low-performing hospitals.

Research Design: Retrospective observational study using the 2012-2014 Residential

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Setting the PACE for Frail Older Adults in the Community: An Underused Opportunity for Furthering Medical-Dental Integration

Joan I. Gluch, PhD
Dec. 24, 2019

Matthew M. Oishi, Elizabeth T. Momany, Pamela Z. Cacchione, Robert J. Collins, Joan I. Gluch, Howard J. Cowen, Peter C. Damiano, Leonardo Marchini

Abstract [from journal]

Background: The integration of dentistry into comprehensive and long-term care has occurred infrequently and with limited success. The authors aim to describe how the Program of All-Inclusive Care for the Elderly (PACE) has the potential for such incorporation for the growing population of nursing home–appropriate older adults preferring to age in place.

Methods: The authors used a 56-item online survey to explore aspects of oral health care within

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Live Discharge From Hospice Due to Acute Hospitalization: The Role of Neighborhood Socioeconomic Characteristics and Race/Ethnicity

Dec. 24, 2019

David Russell, Elizabeth Luth, Miriam Ryvicker, Kathryn Bowles, Holly Prigerson

Abstract [from journal]

Background: Acute hospitalization is a frequent reason for live discharge from hospice. Although risk factors for live discharge among hospice patients have been well documented, prior research has not examined the role of neighborhood socioeconomic characteristics, or how these characteristics relate to racial/ethnic disparities in hospice outcomes.

Objective: To examine associations between neighborhood socioeconomic characteristics and risk for live discharge from hospice because of acute hospitalization. The...

A Conceptual Model of Barriers and Facilitators to Primary Clinical Teams Requesting Pediatric Palliative Care Consultation Based Upon a Narrative Review

Jennifer K. Walter, MD, PhD, MS
Dec. 21, 2019

Jennifer K. Walter, Douglas L. Hill, Concetta DiDomenico, Shefali Parikh, Chris Feudtner 

Abstract [from journal]

Background: Despite evidence that referral to pediatric palliative care reduces suffering and improves quality of life for patients and families, many clinicians delay referral until the end of life. The purpose of this article is to provide a conceptual model for why clinical teams delay discussing palliative care with parents.

Discussion: Building on a prior model of parent regoaling and relevant research literature

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Assessing Nurses' Adherence to the See-and-Treat Guidelines of Botswana's National Cervical Cancer Prevention Programme

Dec. 20, 2019

Lauren G. Johnson, Doreen Ramogola-Masire, Anne M. Teitelman, John B. Jemmott, Alison M. Buttenheim

Abstract [from journal]

The see-and-treat approach for cervical cancer screening (VIA followed by immediate cryotherapy) was first pilot tested in Botswana in 2009. Botswana's Ministry of Health and the Botswana-UPenn Partnership collaborated to expand see-and-treat to 5 additional sites throughout the country in 2014. The purpose of this study was to evaluate whether nurses' adherence to guideline-based screening was maintained during scale-up. Therefore, we compared nurses' adherence between the pilot and scaled-up sites and determined main drivers of nonadherence...

Readmissions After Hospital Care for Meningitis in the United States

Allison Willis, MD
Dec. 18, 2019

Darcy E. Ellis, Theoklis Zaoutis, Dylan P. Thibault, James A.G. Crispo, Danielle S. Abraham, Allison W. Willis

Abstract [from journal] 

Background: Our objectives were to (1) characterize patient and clinical characteristics of adults hospitalized with meningitis; (2) describe meningitis hospitalization outcomes, including 30- and 90-day readmissions; and (3) determine whether clinical, patient, or index hospitalization characteristics are associated with readmission and readmission outcomes.

Methods: This retrospective study of the 2014 National Readmissions Database extracted data

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Variability in Clinician Intentions to Implement Specific Cognitive-Behavioral Therapy Components

Dec. 18, 2019

Courtney Benjamin Wolk, Emily M. Becker-Haimes, Jessica Fishman, Nicholas W. Affrunti, David S. Mandell, Torrey A. Creed 

Abstract [from journal]

Background: CBT comprises many discrete components that vary in complexity, but implementation and training efforts often approach CBT as a single entity. We examined variability in clinician intentions to use different structural and interventional components of CBT for three different clinical groups: clients receiving CBT, clients with depression, and clients with anxiety.

Methods: Clinicians (n = 107) trained in

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