Organization of Healthcare Delivery

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

Do Incentive Payments Improve Home-Based Primary Care?

Feb. 4, 2020

After five years, a small experiment to improve care for frail elderly patients receiving primary care at home has delivered some savings to Medicare—although it might be too small to know for sure. Authorized by the Affordable Care Act, the Independence at Home (IAH) Demonstration is part of a broader strategy of testing innovative ways to pay for value in health care—tying additional payment to higher quality care and cutting wasteful spending.

Fostering Belonging in Academic Anaesthesiology: Faculty and Department Chair Perspectives on Supporting Women Anaesthesiologists

Jan. 20, 2020

Meghan B. Lane-Fall, Emily K.B. Gordon, Elizabeth A. Valentine, Stephanie A. Black, Patricia A. Kapur, Lee A. Fleisher

Abstract [from journal]

An increasing number of global initiatives aim to address the disconnection between the increasing number of women entering medicine and the persistence of gender imbalance in the physician anaesthesiologist workforce. This commentary complements the global movement's efforts to increase women's representation in academic anaesthesiology by presenting considerations for fostering inclusion for women in academic anaesthesiology from both the faculty and departmental leadership perspectives in a US academic anaesthesiology department.

Female Reproductive Performance and Maternal Birth Month: A Comprehensive Meta-Analysis Exploring Multiple Seasonal Mechanisms

Jan. 17, 2020

Mary Regina Boland, Martin Fieder, Luis H. John, Peter R. Rijnbeek, Susanne Huber 

Abstract [from journal]

Globally, maternal birth season affects fertility later in life. The purpose of this systematic literature review is to comprehensively investigate the birth season and female fertility relationship. Using PubMed, we identified a set of 282 relevant fertility/birth season papers published between 1972 and 2018. We screened all 282 studies and removed 131 non-mammalian species studies on fertility and 122 studies that were on non-human mammals. Our meta-analysis focused on the remaining 29 human studies, including twelve


The Quality of End-of-Life Care Among Intensive Care Unit Versus Ward Decedents

Jan. 15, 2020

Joshua A. Rolnick, Mary Ersek, Melissa W. Wachterman, Scott D. Halpern

Abstract [from journal]

Rationale: Admissions to intensive care units (ICUs) are common during terminal hospitalizations, but little is known about how ICU care affects the end-of-life experience for patients dying in hospitals and their families.

Objectives: We measured the association between ICU care during terminal hospitalization and family ratings of end-of-life care for patients who died in 106 Veterans Affairs hospitals from 2010 to 2016.

Methods: Patients were divided into four categories: no ICU care


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.

Traveling Without a Map: An Incomplete History of the Road to Implementation Science and Where We May Go from Here

Jan. 14, 2020

David S. Mandell

Abstract [from journal]

This editorial provides a brief history of mental health services research over the last 30 years and how findings from large-scale studies shocked the field and led to the lines of inquiry culminating in current implementation science research. I review the manuscripts published in this special issue of Administration and Policy in Mental Health in light of that history and usethese studies as a way to assess the state of the field. Finally, I present five takeaways extracted from these articles that may be useful in considering future directions for


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.