Organization of Healthcare Delivery

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

Early Impact Of Pennsylvania Act 112 On Follow-Up Of Abnormal Imaging Findings

Hanna M. Zafar, MD, MHS
Jun. 21, 2020

Govind S. Mattay, Gregory S. Mittl, Hanna M. Zafar, Tessa S. Cook

Abstract [from journal]

Objective: Pennsylvania Act 112 requires diagnostic imaging facilities to directly notify outpatients about significant imaging abnormalities that require follow-up care within 3 months. The effects of Act 112 on patient care are unclear. We sought to characterize follow-up discussions and care received by outpatients with significant imaging abnormalities as defined by Act 112.

Methods: We evaluated findings flagged for patient notification under Act 112 at our institution over a 1-month


Association Among Surgeon Experience, Patient Risk, And Outcomes In Coronary Artery Bypass Grafting

Jun. 13, 2020

Jason J. Han, Markian M. Bojko, Matthew M. Duda, Amit Iyengar, John J. Kelly, William L. Patrick, Mark R. Helmers, Pavan Atluri

Abstract [from journal]

Background: There is an association between surgeon experience and outcomes following cardiac surgery. However, this association is not well studied in the context of patient risk. The purpose of this single-center, retrospective, observational study was to describe how surgeon experience relates to patient risk in isolated coronary artery bypass graft (CABG) surgery and how this impacts patient outcomes.

Methods: Surgeon experience was defined as time between the surgeon finishing fellowship


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


Predictors Of Change Over Time In Subjective Daytime Sleepiness Among Older Adult Recipients Of Long-Term Services And Supports

Jun. 11, 2020

Darina V. PetrovskyKaren B. Hirschman, Miranda Varrasse McPhillips, Justine S. Sefcik, Alexandra L. Hanlon, Liming Huang, Glenna S. Brewster, Nancy A. HodgsonMary D. Naylor

Abstract [from journal]

Objectives: Daytime sleepiness is associated with multiple negative outcomes in older adults receiving long-term services and supports (LTSS) including reduced cognitive performance, need for greater assistance with activities of daily living and decreased social engagement. The purpose of this study was to identify predictors of change in subjective daytime sleepiness among older adults during their first 2 years of receiving LTSS.

Design and setting: Secondary analysis of data from a


Association Of A Novel Index Of Hospital Capacity Strain With Admission To Intensive Care Units

Jun. 10, 2020

George L. Anesi, Marzana Chowdhury, Dylan S Small, M. Kit Delgado, Rachel Kohn, Brian Bayes, Wei Wang, Erich Dress, Gabriel J. Escobar, Scott D. Halpern, Vincent X Liu

Abstract [from journal]

Rationale: Prior approaches to measuring healthcare capacity strain have been constrained by using individual care units, limited metrics of strain, or general, rather than disease-specific, populations.

Objectives: We sought to develop a novel composite strain index and measure its association with ICU admission decisions and hospital outcomes.

Methods: Using more than 9.2 million acute care encounters from 27 Kaiser Permanente Northern California and Penn Medicine


Clinical Exposure To Cardiothoracic Surgery For Medical Students And General Surgery Residents

Jun. 7, 2020

Maxwell F. Kilcoyne, Chi Chi Do-Nguyen, Jason J. Han, Garrett N. Coyan, Ibrahim Sultan, Michael B. Roberts, Andrea J. Carpenter

Abstract [from journal]

Background: The introduction of integrated 6-year cardiothoracic surgery (CTS) residency programs has shifted recruitment efforts to encompass not only general surgery (GS) residents, but also medical students.

Objective: The aim of this paper is to assess medical student and GS resident clinical exposure to CTS.

Design: Data from the Association of American Medical Colleges Visiting Student Application Service and the Accreditation Council for Graduate Medical Education


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


The Role Of The Interview In Residency Selection: A Mixed Methods Study

May. 20, 2020

Emily K B Gordon, Justin T Clapp, Sarah J Heins, Timothy G Gaulton, Meghan B Lane-Fall, Jaya Aysola, Dimitri Y Baranov, Lee A Fleisher

Abstract [from journal]

Context: Residency programs invest considerable time and resources in candidate interviews due to their perceived ability to reveal important social traits. However, studies examining the ability of interviews to predict resident performance have shown mixed findings, and the role that the interview plays in candidate evaluation remain unclear. This mixed methods study, conducted in an anesthesiology residency program at a large academic medical center, examines how interviews contributed to candidate