Organization of Healthcare Delivery

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

Expanding Scope of Practice After COVID-19

Feb. 15, 2021

To expand access to health care during the COVID-19 pandemic, many states relaxed or waived regulations that define the scope of health professional practice. This experience highlights the need to ensure that all health care professionals practice to the full extent of their capabilities—an issue that predates and will outlast the pandemic. In a virtual conference on November 20, 2020, Penn LDI and Penn Nursing brought together experts in law, economics, nursing, medicine, and dentistry to discuss current gaps in health professional scope of practice, what we have learned from COVID-19, and how to rethink scope of practice to better meet community and public health needs.

Post-Acute Stays in Skilled Nursing Facilities: Patient Experiences

Feb. 10, 2021

What kind of care do patients expect after they are discharged from a hospital to a skilled nursing facility (SNF)? And how do those expectations align with care they actually receive from physicians and advanced practitioners? We know surprisingly little about the patient care experience in these post-acute settings, even though 1.5 million people in the U.S. are discharged to them each year. One fourth of those people die or are readmitted to the hospital within 30 days.

Police Transport of Injured People to Trauma Centers in Philadelphia

Feb. 9, 2021

Through a policy known as “scoop and run,” Philadelphia police play an integral and growing role in the emergency medical transport of victims of the city’s gun violence epidemic. Blood loss is the most critical threat to survival after a serious penetrating wound. Rapid transport to a nearby trauma center by police can be life-saving.

Pennsylvania Scope of Practice Policy Brief

Jan. 28, 2021

Pennsylvania is one of 28 states that has not expanded the scope of practice in its licensure laws for certified registered nurse practitioners (NPs), who must maintain formal collaborative agreements with physicians to practice. For many years, proposals to update licensure and adapt it to make it more compatible with current models of collaborative care could not overcome legislative logjams. Recognizing an opportunity to break the logjam, the University of Pennsylvania held a virtual workshop on November 20, 2020, bringing together researchers, health professionals, and consumers to chart a new path forward. This policy brief summarizes their recommendations to update scope of practice regulation to better meet the primary care needs of Pennsylvanians.

The Cost of Quarantine: Projecting the Financial Impact of Canceled Elective Surgery on the Nation’s Hospitals

Jan. 22, 2021

Sourav K. Bose, Serena Dasani, Sanford E. Roberts, Chris Wirtalla, Ronald P. DeMatteo, Gerard M. Doherty, Rachel R. Kelz

Abstract [from journal]

Objective: We sought to quantify the financial impact of elective surgery cancellations in the United States (US) during COVID-19 and simulate hospitals' recovery times from a single period of surgery cessation.

Background: COVID-19 in the United States (US) resulted in cessation of elective surgery-a substantial driver of hospital revenue-and placed patients at risk and hospitals under financial stress. We sought to quantify the financial impact of elective surgery


Prioritization of Pediatric Palliative Care Field-Advancement Activities in the United States: Results of a National Survey

Jan. 21, 2021

Chris Feudtner, Jennifer A. Faerber, Abby R. Rosenberg, Kathie Kobler, Justin N. Baker, Brynn A. Bowman, Joanne Wolfe, Sarah Friebert

Abstract [from journal]

Background: The field of pediatric palliative care (PPC) continues to encounter challenges and opportunities to improving access to high-quality PPC services. In early 2019, a workshop identified eleven potential "next step" actions, and subsequently a national survey-based poll of members of the PPC community was conducted to prioritize these potential actions in terms of their "actionable importance."

Methods: Invitations to the survey were distributed in October 2019 to interdisciplinary


Developing a Family-Reported Measure of Experiences With Home-Based Pediatric Palliative and Hospice Care: A Multi-Method, Multi-Stakeholder Approach

Mary Ersek
Jan. 14, 2021

Jackelyn Y. Boyden, Chris Feudtner, Janet A. Deatrick, Kimberley Widger, Gwenn LaRagione, Blyth Lord, Mary Ersek

Abstract [from journal]

Background: Many children with serious illnesses are receiving palliative and end-of-life care from pediatric palliative and hospice care teams at home (PPHC@Home). Despite the growth in PPHC@Home, no standardized measures exist to evaluate whether PPHC@Home provided in the U.S. meets the needs and priorities of children and their families.

Methods: We developed and conducted a preliminary evaluation of a family-reported measure of PPHC@Home experiences using a multi-method, multi-stakeholder


Bringing Gynecologic Cancer Care Closer to Patients

Jan. 13, 2021

For patients with gynecologic cancers, treatment by a specialist—a gynecologic oncologist—is crucial for improving chances of survival. However, in 2015, as many as 10% of women in the U.S. lived in a county that was more than 50 miles from the closest gynecologic oncologist.

Impact of Past Surgical History on Perioperative Outcomes in Gynecologic Surgery

Jan. 9, 2021

Emily M. Ko, Diego Aviles, Nathanael C. Koelper, Mark A. Morgan, Lori Cory

Abstract [from journal]

Objective: We sought to determine if past surgical history is associated with perioperative outcomes for patients undergoing hysterectomy.

Methods: A retrospective cohort study was conducted at a single, tertiary, academic health system of women who underwent hysterectomy from May 2016 - May 2017. Past surgical history (PSH) involving any abdominal or pelvic surgery, baseline demographics and perioperative outcomes were collected. For purposes of analyses, PSH was defined using three