Organization of Healthcare Delivery

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

Adolescents, Psychiatric Hospitalization, and COVID-19

Sep. 15, 2020

As we approach the sixth month of widespread community transmission of COVID-19 in the United States, our focus must shift beyond acute management of disease to the broader effects of this pandemic on health and wellbeing. In particular, it is important that we understand the consequences of the COVID-19 pandemic on the mental health of children and adolescents.

These Key Telehealth Policy Changes Would Improve Buprenorphine Access While Advancing Health Equity

Sep. 11, 2020

[Original post: Utsha Khatri, Corey S. Davis, Noa Krawczyk, Michael Lynch, Justin Berk, Elizabeth A. Samuels, These Key Telehealth Policy Changes Would Improve Buprenorphine Access While Advancing Health Equity, Health Affairs Blog, September 11, 2020. Copyright ©2020 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.]

FDA Restrictions on Mifepristone: Time for a Change?

Issue Brief
Sep. 10, 2020

Mifepristone, a drug used to manage early miscarriage or end an early pregnancy, carries unique restrictions imposed by the U.S. Food and Drug Administration (FDA). Patients are required to pick up the drug in person
from a doctor or a clinic, even though they can take the drug at home. In July, a federal court ruled that the FDA must suspend these restrictions during the COVID-19 pandemic, for patients seeking an early abortion,
although the ruling did not apply to women with an early pregnancy loss. But the challenges to FDA restrictions on mifepristone predate the pandemic. This Issue Brief provides the context for this ongoing controversy, and
reviews recent evidence on the clinical and cost effectiveness of mifepristone for the medical management of first trimester miscarriage.

Organizational Change or Non-Change?

Sep. 2, 2020

On August 3, 2020, The New York Times ran an article entitled “Is Telemedicine Here to Stay?” The article presented various reasons to answer "yes" to that question, and reasons to answer "no." The question, and its answers, offer a powerful and useful example of organizational change generally, as well as change in health care specifically.

Assessment Of Receipt Of The First Home Health Care Visit After Hospital Discharge Among Older Adults

Sep. 1, 2020

Jun Li, Mingyu Qi, Rachel M. Werner

Abstract [from journal]

Importance: Home health care is one of the fastest growing postacute services in the US and is increasingly important in the era of coronavirus disease 2019 and payment reform, yet it is unknown whether patients who need home health care are receiving it.

Objective: To examine how often patients referred to home health care at hospital discharge receive it and whether there is evidence of disparities.

Design, setting, and participants: This cross-sectional study used


Problem Solving Therapy For Home-Hospice Caregivers: A Pilot Study

Zvi D. Gellis, PhD
Aug. 30, 2020

Christin Gregory and Zvi Gellis

Abstract [from journal]

This pilot study examined the effects of Brief Problem-Solving Therapy on caregiver quality of life, depression, and problem-solving in family caregivers of hospice patients. Thirty-seven family caregivers to home-based hospice patients (mean age 62.8 [SD = 12.32]) were randomized to the study group (PST-Hospice), for a 45 minute per week/5 week intervention or comparison group of usual care plus caregiver education (UC + CE). The severity of depressive symptoms, caregiver quality of life and problem-solving functioning were assessed


Chronic Hospital Nurse Understaffing Meets COVID-19

Research Brief
Aug. 18, 2020

A study of hospitals in New York and Illinois at the start of the COVID-19 pandemic found that most did not meet benchmark patient-to-nurse staffing ratios for medical-surgical or intensive care units. New York City hospitals had especially low staffing ratios. Understaffed hospitals were associated with less job satisfaction among nurses, unfavorable grades for patient safety and quality of care, and hesitance by nurses and patients to recommend their hospitals. 

Pervasive Risk Avoidance: Nursing Staff Perceptions Of Risk In Person-Centered Care Delivery

Liza L. Behrens, PhD, RN
Aug. 6, 2020

Liza L. Behrens, Marie Boltz, Ann Kolanowski, Mark Sciegaj, Caroline Madrigal, Katherine Abbott, Kimberly Van Haitsma

Abstract [from journal]

Background and objectives: Nursing home (NH) staff perceptions of risks to residents' health and safety is a major barrier to honoring resident preferences, the cornerstone of person-centered care delivery. This study explored direct-care nursing staff perceptions of risk (possibilities for harm or loss) associated with honoring residents' preferences for everyday living and care activities.

Research design and methods: Qualitative, descriptive design using sequential focus group methodology


Achieving Better Postpartum Care

Jul. 30, 2020

The year after giving birth is an important one for mothers and their infants. Care delivered during this period is critical to improving mother and infants’ long-term health and reducing future health risks. However, a recent study shows that all too often, this is a missed opportunity to deliver important preventive care to adult women.

What Do Parents Value Regarding Pediatric Palliative And Hospice Care In The Home Setting?

Mary Ersek
Jul. 30, 2020

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

Abstract [from journal]

Context: Children with life-shortening serious illnesses and medically complex care needs are often cared for by their families at home. Little, however, is known about what aspects of pediatric palliative and hospice care in the home setting (PPHC@Home) families value the most.

Objective: To explore how parents rate and prioritize domains of PPHC@Home as the first phase of a larger study that developed a parent-reported measure of experiences with PPHC@Home.



Association Of An Emergency Department-Embedded Critical Care Unit With Hospital Outcomes And Intensive Care Unit Utilization

Jul. 22, 2020

George L. Anesi, Jayaram Chelluri, Zaffer A. Qasim, Marzana Chowdhury, Rachel Kohn, Gary E. Weissman, Brian Bayes, M. Kit Delgado, Benjamin S. Abella, Scott D. Halpern, John C. Greenwood

Abstract [from journal]

Rationale: A small but growing number of hospitals are experimenting with emergency department (ED)-embedded critical care units (ED-CCUs) in an effort to improve the quality of care for critically ill patients with sepsis and acute respiratory failure (ARF).

Objective: To evaluate the potential impact of an ED-CCU at the Hospital of the University of Pennsylvania among patients with sepsis and ARF admitted from the ED to a medical ward or intensive care unit (ICU) from January 2016 to


Institutional Review Board Quality, Private Equity, And Promoting Ethical Human Subjects Research

Holly Fernandez Lynch 160
Jul. 21, 2020

Holly Fernandez Lynch, Stephen Rosenfeld

Abstract [from journal]

Evaluating the quality and effectiveness of the institutional review boards (IRBs) responsible for overseeing research involving human participants is critically important but perpetually challenging. Seemingly common-sense measures, such as the number of proposals approved with and without major modifications and the number of unexpected adverse events occurring in approved protocols, can be misleading indicators of participant protection, and regulatory compliance may not correspond to achieving ethical goals. These measurement