Organization of Healthcare Delivery

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

Improving End of Life Care – Ask the Nurses

Dec. 7, 2018

Everyone wants a dignified death – yet few actually experience one. Despite preferring to remain at home, most older adults spend their final days in hospitals, where they often undergo medical care that neither improves survival, quality of life, nor satisfaction and is often incongruent with their wishes and goals. A new study in the Journal of the American Geriatrics Society describes these problems in end of life care in nearly 500 U.S.

Intensive Care Unit Capacity Strain and Outcomes of Critical Illness in a Resource-Limited Setting: A 2-Hospital Study in South Africa

Dec. 5, 2018

George L. Anesi, Nicole B. Ga...

Abstract [from journal]

Objective: To measure the association of intensive care unit (ICU) capacity strain with processes of care and outcomes of critical illness in a resource-limited setting.

Methods: We performed a retrospective cohort study of 5332 patients referred to the ICUs at 2 public hospitals in South Africa using the country’s first published multicenter electronic critical care database. We assessed the
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Detecting BS in Health Care

Issue Brief
Nov. 26, 2018

In the past several months, we have observed several notable signs of deceptive, misleading, unsubstantiated, and foolish statements — what we will call “BS” — in the health care industry. Here we present our Top 10 BS candidates, in both pictures and words. First we present each picture, untitled and without text, thereby inviting readers to discern what the BS message is and engage them in the BS detection process. Then we offer an explanation of what the picture conveys. This will help the reader become a more skilled “BS Hunter.” We reserve the option to expound further as we step in more BS in the future.

Nurses' and Patients' Appraisals Show Patient Safety in Hospitals Remains a Concern

Research Brief
Nov. 5, 2018

In the report To Err is Human (1999), the National Academy of Medicine called for national action to improve patient safety in hospitals. The report concluded that improving nurse work environments—assuring adequate nurse staffing and supporting nurses’ ability to care for patients—was critical to these efforts. Two decades later, have nurse work environments improved, and has that had a noticeable impact on patient safety? To find out, a research team led by LDI Senior Fellow Linda Aiken, PhD, RN surveyed more than 800,000 patients and 53,000 nurses in 535 hospitals in 2005, and again in 2016.

Effect of Community Health Worker Support on Clinical Outcomes of Low-Income Patients Across Primary Care Facilities: A Randomized Clinical Trial

Shreya Kangovi, MD, MS
Nov. 1, 2018

Shreya Kangovi, Nandita Mitra, Lindsey Norton, Rory Harte Xinyi Zhao, Tamala Carter, David Grande, Judith A. Long

Abstract [from journal]

Importance: Addressing the social determinants of health has been difficult for health systems to operationalize.

Objective: To assess a standardized intervention, Individualized Management for Patient-Centered Targets (IMPaCT), delivered by community health workers (CHWs) across 3 health systems.

Design, Setting, and Participants: This 2-armed, single-blind, multicenter randomized clinical trial recruited patients from 3 primary care facilities in Philadelphia, Pennsylvania,...

A Comprehensive Measure of the Costs of Caring For a Parent: Differences According to Functional Status

Research Brief
Oct. 10, 2018

Providing unpaid care for an older parent has costs that go well beyond a caregiver’s lost wages. A new estimate suggests that the median direct and indirect costs of caregiving are $180,000 over two years, about the same as full-time institutional care. This estimate accounts for lost earnings as well as non-tangible factors, such as lost leisure time and changes to the caregiver’s well-being. It suggests that informal care cost caregivers at least $277 billion in 2011, which is 20 percent higher than estimates that only consider lost wages.

Trauma-Informed Care Training in Family Medicine Residency Programs Results From a CERA Survey

Sep. 19, 2018

Melissa E. Dichter, Anne Teitelman, Heather Klusaritz, Douglas M. Maurer, Peter F. Cronholm,...

ABSTRACT [FROM JOURNAL] 

Background and Objectives: Experiences of psychological trauma are common among primary care patient populations, and adversely affect patients’ health and health care utilization. Trauma-informed care (TIC) is a framework for identifying and responding to patients’ experiences of psychological trauma to avoid retraumatization. The purpose of this study was to evaluate the current state of TIC training in family medicine residency programs in the United States in order to identify opportunities for and barriers to TIC training.

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Association between Continuity and Team-Based Care and Health Care Utilization: An Observational Study of Medicare-Eligible Veterans in VA Patient Aligned Care Team

Rachel M. Werner, MD, PhD
Sep. 19, 2018

Ashok Reddy, Edwin Wong, Anne Canamucio, Karin Nelson, Stephan D. Fihn, Jean Yoon, Rachel M. Werner

ABSTRACT [FROM JOURNAL]

Objective: It remains unknown whether high‐functioning teams can compensate for poor continuity of care to support important patient outcomes.

Data source: Linked VA administrative and Medicare claims data to measure the relationship of team‐based care and continuity of care with high‐cost utilization.

Study Design: Retrospective cohort

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Developing a Standard Handoff Process for Operating Room-to-ICU Transitions: Multidisciplinary Clinician Perspectives from the Handoffs and Transitions in Critical Care (HATRICC) Study

Sep. 5, 2018

Meghan B. Lane-Fall, Jose L. Pascual, Scott Massa, Meredith L. Collard, Hannah G. Peifer, Laura J. Di Taranti, Megan Linehan, Lee A. Fleisher...

Abstract [from journal]

Background: Operating room (OR)–to-ICU handoffs place patients at risk for preventable harm. Numerous studies have described standardized handoff procedures following cardiac surgery, but no existing literature describes a general OR-to-ICU handoff system.

Methods: As part of the Handoffs and Transitions in Critical Care (

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