Organization of Healthcare Delivery

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

Toward More Optimal Birth Outcomes

Dec. 1, 2020

Women want to have a good birth, in which both they and the baby are healthy and happy at the end. For most women, the optimal birth outcome is a spontaneous vaginal birth (SVB), one without forceps or a vacuum. Some women may be surprised to learn that the hospital where they give birth has a significant effect on the kind of birth they will have.

Are There Enough Experienced Physicians to Treat Patients Hospitalized With COVID?

Research Brief
Kira Rysinka, MD
Nov. 16, 2020

In this national study of 438,895 physicians, 45% provided care to hospitalized patients and 7% provided critical care. At the high estimate of patients requiring hospitalization at the projected peak of the pandemic, 18 states and Washington, DC would have patient to physician ratios greater than 15:1 (a level associated with poor outcomes among hospitalized patients). There was considerable geographic variation in the availability of physicians: 41% of hospital service areas did not have a physician with critical care experience.

Identifying Cohabiting Couples In Administrative Data: Evidence From Medicare Address Data

Nov. 12, 2020

Sasmira Matta, Joanne W. Hsu, Theodore J. Iwashyna, Micah Y. Baum, Kenneth M. Langa & Lauren Hersch Nicholas 

Abstract [from journal]

Objectives: Assess whether frequently‐used claims‐based end‐of‐life (EOL) measures are associated with higher ratings of care quality.

Design: Retrospective cohort study.

Setting/Pariticpants: Deceased fee‐for‐service Medicare beneficiaries with cancer who underwent chemotherapy during July 2016 to January 2017 and died within 12 


Predictors of Mental Health During the COVID-19 Pandemic in the U.S.: Role Of Economic Concerns, Health Worries and Social Distancing

Nov. 11, 2020

Fabrice Kämpfen, Iliana V. Kohler, Alberto Ciancio, Wändi Bruine de Bruin, Jürgen Maurer, Hans-Peter Kohler

Abstract [from journal]

Despite the profound health and economic implications of Covid-19, there is only limited knowledge to date about the role of economic concerns, health worries and social distancing for mental health outcomes during the pandemic. We analyze online survey data from the nationally representative "Understanding America Study" (UAS) covering the period of March 10-31st 2020 (sample size: 6,585). Mental health is assessed by the validated PHQ-4 instrument for measuring symptoms of depression and anxiety. About 29% (CI:


Disruptions in Preventive Care: Mammograms During the COVID-19 Pandemic

Nov. 4, 2020

Hummy Song, Alon Bergman, Angela T. Chen, Dan Ellis, Guy David, Ari B. Friedman, Amelia M. Bond, Julie M. Bailey, Ronald Brooks, Aaron Smith‐McLallen

Abstract [from journal]

Objective: To measure the extent to which the provision of mammograms was impacted by the COVID‐19 pandemic and surrounding guidelines.

Data Sources: De‐identified summary data derived from medical claims and eligibility files were provided by Independence Blue Cross for women receiving mammograms.

Study Design:


Assessment of Perceptions of Professionalism Among Faculty, Trainees, Staff, and Students in a Large University-Based Health System

Nov. 2, 2020

Dominique A. Alexis, Matthew D. Kearney, J. Corey Williams, Chang Xu, Eve J. Higginbotham, Jaya Aysola

Abstract [from journal]

Importance: With a renewed focus on medical professionalism, an opportunity exists to better define its standards and application to meet the needs of an increasingly diverse workforce given the important association between interprofessional behavior and patient care.

Objective: To examine the context of how professionalism is operationalized and perceived in diverse health care work and learning environments.

Design, setting, and participants: A qualitative mixed-


Hospital Safety-Net Status and Performance on Publicly Reported Episode Spending Measures

Amole Navathe, MD, PhD
Nov. 1, 2020

Amol S. Navathe, Lingmei Zhou, Joshua M. Liao

Abstract [from journal]

Objectives: As part of its strategy to improve health care value and contain hospital costs, Medicare trialed public reporting for episode-based spending via 6 novel Clinical Episode-Based Payment (CEBP) measures for cellulitis, kidney/urinary tract infection, gastrointestinal hemorrhage, spinal fusion, cholecystectomy, and aortic aneurysm. Because safety-net hospitals may fare more poorly than other hospitals under value-based reforms, we evaluated the relationship between safety-net status and


Hospital and ICU Patient Volume per Physician at Peak of COVID Pandemic: State-Level Estimates

Kira Rysinka, MD
Oct. 22, 2020

Anjali Bhatla, Kira L. Ryskina

Abstract [from journal]

Background: In anticipation of patient surge due to COVID-19, many states are working to increase the available healthcare workforce. To help inform state policies and initiatives aimed at physician deployment during COVID-19, we used predictions of peak patient volume for hospitals and intensive care units (ICU) and regional physician workforce estimates to measure patient to physician ratios at the peak of the pandemic for each state.

Methods: We


Using Medicare Claims In Identifying Alzheimer's Disease And Related Dementias

Oct. 8, 2020

Siddharth JainPaul R. Rosenbaum, Joseph G. Reiter, Geoffrey Hoffman, Dylan S. Small, Jinkyung Ha, Alexander S. Hill, David A. Wolk, Timothy GaultonMark D. Neuman, Roderic G. Eckenhoff, Lee A....

Abstract [form journal]

Introduction: This study develops a measure of Alzheimer's disease and related dementias (ADRD) using Medicare claims.

Methods: Validation resembles the approach of the American Psychological Association, including (1) content validity, (2) construct validity, and (3) predictive validity.

Results: We found that four items-a Medicare claim recording ADRD 1 year ago, 2 years ago, 3 years ago, and a total stay of 6 months in a nursing home-exhibit a pattern of association