Organization of Healthcare Delivery

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

A Mixed Methods Study Examining Teamwork Shared Mental Models of Interprofessional Teams During Hospital Discharge

Nov. 27, 2019

Kirstin Manges, Patricia S Groves, Amany Farag, Ryan Peterson, Joanna Harton, Ryan Greysen

Abstract [from journal]

Background: Little is known about how team processes impact providers' abilities to prepare patients for a safe hospital discharge. Teamwork Shared Mental Models (teamwork-SMMs) are the teams' organised understanding of individual member's roles, interactions and behaviours needed to perform a task like hospital discharge. Teamwork-SMMs are linked to team effectiveness in other fields, but have not been readily investigated in healthcare. This study examines teamwork-SMMs to understand how interprofessional teams coordinate care when


The Association Between Newly Accredited Orthopedic Residency Programs and Teaching Hospital Complication Rates in Lower Extremity Total Joint Arthroplasty

Neil Sheth, MD
Nov. 27, 2019

Kevin Pirruccio, Samir Mehta, Neil P. Sheth

Abstract [from journal]

Objective: The influence of residency programs on teaching hospital outcomes in total joint arthroplasty (TJA) has recently been debated. This study investigates how complication and readmission rates for primary elective total hip (THA) and total knee arthroplasty (TKA) changed before and after new orthopedic surgery residency programs meeting ACGME accreditation requirements were introduced at hospitals.

Design: We conducted a retrospective cohort study using the CMS Hospital Compare database, which contains


Online Reviews of Specialized Drug Treatment Facilities—Identifying Potential Drivers of High and Low Patient Satisfaction

Nov. 21, 2019

Anish K. Agarwal, Vivien Wong, Arthur M. Pelullo, Sharath Guntuku, Daniel Polsky, David A. Asch, Jonathan Muruako, Raina M. Merchant

Background: Despite the importance of high-quality and patient-centered substance use disorder treatment, there are no standardized ratings of specialized drug treatment facilities and their services. Online platforms offer insights into potential drivers of high and low patient experience.

Objective: We sought to analyze publicly available online review content of specialized drug treatment facilities and identify themes within high and low ratings.



Failure to Rescue as an Outcome Metric for Pediatric and Congenital Cardiac Catheterization Laboratory Programs: Analysis of Data From the IMPACT Registry

Nov. 5, 2019

Michael L. O'Byrne, Kevin F. Kennedy, Natalie Jayaram, Lisa J. Bergersen, Matthew J. Gillespie, Yoav Dori, Jeffrey H. Silber, Steven M. Kawut, Jonathan J. Rome, Andrew C. Glatz

Abstract [form journal]

Background: Risk-adjusted adverse event (AE) rates have been used to measure the quality of pediatric and congenital cardiac catheterization laboratories. In other settings, failure to rescue (FTR) has demonstrated utility as a quality metric.

Methods and Results: A multicenter retrospective cohort study was performed using data from the IMPACT (Improving Adult and Congenital Treatment) Registry between January 2010 and December 2016. A modified FTR metric was developed for pediatric and congenital cardiac


Understanding Surgical Care Delivery in Sub-Saharan Africa: A Cross-Sectional Analysis of Surgical Volume, Operations, and Financing at a Tertiary Referral Hospital in Rural Tanzania

Neil Sheth, MD
Oct. 26, 2019

Praveen Paul Rajaguru, Mubashir Alavi Jusabani, Honest Massawe, Rogers Temu, Neil Perry Sheth 

Abstract [from journal]

Background: Access to surgical care in Low- and Middle-Income Countries (LMICs) such as Tanzania is extremely limited. Northern Tanzania is served by a single tertiary referral hospital, Kilimanjaro Christian Medical Centre (KCMC). The surgical volumes, workflow, and payment mechanisms in this region have not been characterized. Understanding these factors is critical in expanding access to healthcare. The authors sought to evaluate the operations and financing of the main operating theaters at KCMC in Sub-Saharan Africa.


The Association of Geographic Dispersion with Outcomes among Hospitalized Pulmonary Service Patients

Oct. 16, 2019

Rachel Kohn, Michael O. Harhay, Gary E. Weissman, George L. Anesi, Brian Bayes, Hummy Song, Scott D Halpern, S. Ryan Greysen, Meeta Prasad Kerlin

Abstract [from journal]

Hospitals geographically localize clinically similar patients into wards to provide specialized care that improves patient outcomes and care and lowers costs. When these wards exceed capacity, patients become “geographically dispersed” to alternate locations. For example, critically ill patients may “board” in emergency departments (EDs) or alternate intensive care units (ICUs) when the clinically appropriate ICUs are at capacity. Such geographic dispersion has been demonstrated to be associated with increased hospital length of stay (LOS), ICU and in-...

Academic Advocacy: Opportunities to Influence Health and Science Policy Under U.S. Lobbying Law

Oct. 8, 2019

Holly Lynch, Alison Bateman-House, Suzanne Rivera

Abstract [from journal]

Medical school faculty and their colleagues in schools of nursing, public health, social work, and elsewhere often research issues of critical importance to health and science policy. When academics engage with government policymakers to advocate for change based on their research, however, they may find themselves engaged in "lobbying," thereby entering a complex environment of legal requirements and institutional policies that they may not fully understand. To promote academic advocacy, this article explains what is and is not legally permitted when


Performance of a Clinical Decision Support Tool to Identify PICU Patients at High Risk for Clinical Deterioration

Heather Wolfe, MD
Oct. 2, 2019

Maya Dewan, Naveen Muthu, Eric Shelov, Christopher Bonafide, Patrick Brady, Daniela Davis, Eric Kirkendall, Dana Niles, Robert Sutton, Danielle Traynor, Ken Tegtmeyer, Vinay Nadkarni, Heather Wolfe

Abstract [from journal]

Objectives: To evaluate the translation of a paper high-risk checklist for PICU patients at risk of clinical deterioration to an automated clinical decision support tool.

Design: Retrospective, observational cohort study of an automated clinical decision support tool, the PICU Warning Tool, adapted from a paper checklist to predict clinical deterioration events in PICU patients within 24 hours.

Setting: Two quaternary care medical-surgical PICUs—The Children’s Hospital of Philadelphia and...

Fast-tracking Behavioral Health Care

Sep. 17, 2019

Imagine struggling with a behavioral health issue, searching for a local psychiatrist, and finding out the provider you’ve chosen doesn’t accept insurance. You wouldn’t be alone: most psychiatrists in the United States don’t. But let’s say your plan has some out-of-network benefits, which means you pay the full cost up front and request an itemized receipt for every appointment.