Organization of Healthcare Delivery

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

Racial Disparities in Nephrology Consultation and Disease Progression among Veterans with CKD: An Observational Cohort Study

Peter P. Reese, MD, MSCE
Aug. 20, 2018

Jonathan Suarez, Jordana B. Cohen, Vishnu Potluri, Wei Yang, David E. Kaplan, Marina Serper, Siddharth P. Shah, ...

Abstract [from journal]

Background: Incident rates of ESRD are much higher among black and Hispanic patients than white patients. Access to nephrology care before progression to ESRD is associated with better clinical outcomes among patients with CKD. However, it is unknown whether black or Hispanic patients with CKD experience lower pre-ESRD nephrology consultation rates compared with their white counterparts,

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Adaptations of the Evidence-based Transitional Care Model in the U.S.

Aug. 9, 2018

Mary D. Naylor, Karen B. Hirschman, Mark P. Toles, Olga F. Jarrín, Elizabeth Shaid, Mark V. Pauly

Abstract [from journal]

Despite a growing body of evidence that adaptations of evidence-based interventions (EBI) are ubiquitous, few studies have examined the nature and rationale for modifications to the components of these interventions. The primary aim of this study was to describe and classify common local adaptations of the Transitional Care Model (TCM), an EBI comprised of 10 components that has been proven in multiple clinical trials to improve the care and outcomes of chronically ill older adults transitioning from hospitals to home

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Effect of Hospital and Post-Acute Care Provider Participation in Accountable Care Organizations on Patient Outcomes and Medicare Spending

Aug. 9, 2018

Divyansh Agarwal and Rachel M. Werner

Abstract [from journal]

Objective: To test for differences in patient outcomes when hospital and post‐acute care (PAC) providers participate in accountable care organizations (ACOs).

Data/Setting: Using Medicare claims, we examined changes in readmission, Medicare spending, and length of stay among patients admitted to ACO‐participating hospitals and PAC providers.

Design: We compared changes in outcomes

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Perceptions of Factors Associated With Inclusive Work and Learning Environments in Health Care Organizations: A Qualitative Narrative Analysis

Jaya Aysola, MD, MPH
Aug. 6, 2018

Jaya Aysola, Frances K. Barg, Ana Bonilla Martinez, Matthew Kearney, ...

Abstract [from journal]

Importance: Diversifying the health care workforce remains a critical goal for health care organizations focused on reducing disparities in care. However, it remains unknown what factors create inclusive health system environments and help organizations retain a diverse workforce.

Objective: To understand from members of the health care workforce what factors contribute to inclusive work and learning environments and what can be done to improve inclusion within health care organizations.

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Acuity-Based Scheduling in Primary Care

Jul. 25, 2018

ABSTRACT [FROM JOURNAL]

Objectives: Triage algorithms are ubiquitous in emergency care settings, but the extent of their use in primary care is unknown. This study asks whether primary care practices prioritize patients with more acute service needs.

Methods: We used an audit study in which simulated patients were randomized to 2 clinical scenarios—a new patient seeking a routine check-up or a new patient seeking treatment for newly diagnosed hypertension—and attempted to schedule appointments with thousands of randomly selected primary...

Burns Calls BS on CVS-Aetna Merger

Jul. 23, 2018

[Editor's note: on August 1, 2018, California Insurance Commissioner Dave Jones recommended that the United States Department of Justice sue to block the proposed merger.]

The proposed $69 billion merger of CVS and Aetna drew sharp criticism in a June California Insurance Commission hearing, including from LDI Senior Fellow Lawton R.  Burns, PhD, MBA, Professor of Health Care Management in the Wharton School.

Redesigning Provider Payment: Opportunities and Challenges from the Hawaii Experience

Jul. 18, 2018

Kevin G. Volpp, Amol Navathe, Emily Oshima Lee, Mark Mugishii, Andrea B. Troxel, Kristen Caldarella, Amanda Hodlofski, Susannah Bernheim, Elizabeth Drye...

ABSTRACT [FROM JOURNAL]

Objectives: To describe the process of developing a new physician payment system based on value and transitioning away from a fee-for-service payment system

Study Design: Descriptive. This paper describes a recent initiative involving redesign of primary care provider payment in the State of Hawaii. While there has been extensive discussion about switching payment from volume to value in recent years, much of this change has happened at the

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How Home Health Nurses Plan Their Work Schedules: A Qualitative Descriptive Study

Jul. 9, 2018

Elliane Irani, Karen B Hirschman, Pamela Z Cacchione, Kathryn H Bowles

ABSTRACT [FROM JOURNAL]

Aims and Objectives: To describe how home health nurses plan their daily work schedules and what challenges they face during the planning process.

Background: Home health nurses are viewed as independent providers and value the nature of their work because of the flexibility and autonomy they hold in developing their work schedules. However, there is limited empirical evidence about how home health nurses plan their work schedules, including the factors they consider during the process and the challenges they face...

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.

Nurse Generated EHR Data Supports Post-Acute Care Referral Decision Making: Development and Validation of a Two-step Algorithm

Jun. 20, 2018

Kathryn H. Bowles, Sarah J. Ratcliffe, Mary D. Naylor, ...

ABSTRACT [FROM JOURNAL]

Objective: Build and validate a clinical decision support (CDS) algorithm for discharge decisions regarding referral for post-acute care (PAC) and to what site of care. 

Materials and Methods: Case studies derived from EHR data were judged by 171 interdisciplinary experts and prediction models were generated. 

Results: A two-step algorithm emerged with area under the curve (AUC) in validation of 91.5% (yes/no refer) and AUC 89.7% (where to refer). 

Discussion: CDS for...

Geographic Variation in Postpartum Prescription Opioid Use: Opportunities to Improve Maternal Safety

Jun. 6, 2018

Nora V. Becker, Karen J.Gibbins, Jeanmarie Perrone, Brandon C. Maughan

Abstract [from journal]

Background: Obstetric delivery is among the most common in-hospital procedures experienced by reproductive-age women, yet there is little literature on patterns of postpartum opioid prescriptions after such episodes.

Methods: We used claims data from 871,195 vaginal deliveries to 768,455 privately-insured women with an in-hospital delivery between June 2001 and July 2013 to examine the state- and census division-level proportions of women who

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