Organization of Healthcare Delivery

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

A Comprehensive Measure of the Costs of Caring For a Parent: Differences According to Functional Status

Research Brief
Oct. 10, 2018

Providing unpaid care for an older parent has costs that go well beyond a caregiver’s lost wages. A new estimate suggests that the median direct and indirect costs of caregiving are $180,000 over two years, about the same as full-time institutional care. This estimate accounts for lost earnings as well as non-tangible factors, such as lost leisure time and changes to the caregiver’s well-being. It suggests that informal care cost caregivers at least $277 billion in 2011, which is 20 percent higher than estimates that only consider lost wages.

Trauma-Informed Care Training in Family Medicine Residency Programs Results From a CERA Survey

Sep. 19, 2018

Melissa E. Dichter, Anne Teitelman, Heather Klusaritz, Douglas M. Maurer, Peter F. Cronholm,...

ABSTRACT [FROM JOURNAL] 

Background and Objectives: Experiences of psychological trauma are common among primary care patient populations, and adversely affect patients’ health and health care utilization. Trauma-informed care (TIC) is a framework for identifying and responding to patients’ experiences of psychological trauma to avoid retraumatization. The purpose of this study was to evaluate the current state of TIC training in family medicine residency programs in the United States in order to identify opportunities for and barriers to TIC training.

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Association between Continuity and Team-Based Care and Health Care Utilization: An Observational Study of Medicare-Eligible Veterans in VA Patient Aligned Care Team

Rachel M. Werner, MD, PhD
Sep. 19, 2018

Ashok Reddy, Edwin Wong, Anne Canamucio, Karin Nelson, Stephan D. Fihn, Jean Yoon, Rachel M. Werner

ABSTRACT [FROM JOURNAL]

Objective: It remains unknown whether high‐functioning teams can compensate for poor continuity of care to support important patient outcomes.

Data source: Linked VA administrative and Medicare claims data to measure the relationship of team‐based care and continuity of care with high‐cost utilization.

Study Design: Retrospective cohort

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Developing a Standard Handoff Process for Operating Room-to-ICU Transitions: Multidisciplinary Clinician Perspectives from the Handoffs and Transitions in Critical Care (HATRICC) Study

Sep. 5, 2018

Meghan B. Lane-Fall, Jose L. Pascual, Scott Massa, Meredith L. Collard, Hannah G. Peifer, Laura J. Di Taranti, Megan Linehan, Lee A. Fleisher...

Abstract [from journal]

Background: Operating room (OR)–to-ICU handoffs place patients at risk for preventable harm. Numerous studies have described standardized handoff procedures following cardiac surgery, but no existing literature describes a general OR-to-ICU handoff system.

Methods: As part of the Handoffs and Transitions in Critical Care (

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Associations of ICU Capacity Strain with Disposition and Outcomes of Patients with Sepsis Presenting to the Emergency Department

Aug. 23, 2018

George L. Anesi, Vincent X. Liu, Nicole B. Gabler, M. Kit Delgado, ...

Abstract [from journal]

Rationale: Intensive care unit (ICU) capacity strain refers to the potential limits placed on an ICU's ability to provide high-quality care for all patients who may need it at a given time. Few studies have investigated how fluctuations in ICU capacity strain might influence care outside of the ICU.

Objective: To determine whether intensive care unit (ICU) capacity strain is associated with initial level of inpatient care and outcomes for emergency department (ED) patients being hospitalized for sepsis.

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Patient and Physician Predictors of Hyperlipidemia Screening and Statin Prescription

Aug. 23, 2018

Sneha Kannan, David A. Asch, Gregory W. Kurtzman, Steve Honeywell Jr, Susan C. Day, and Mitesh S. Patel

ABSTRACT [from journal]

Objectives: Appropriate lipid management has been demonstrated to reduce cardiovascular events, but rates of hyperlipidemia screening and statin therapy are suboptimal. We aimed to evaluate patient and physician predictors of guideline-concordant hyperlipidemia screening and statin prescription.

Study Design: Retrospective study of patients with primary care provider (PCP) visits from 2014 to 2016 at the University of Pennsylvania Health System.

Methods: Data on patients, screening orders, and...

Mergers and Marginal Costs: New Evidence on Hospital Buyer Power

Aug. 21, 2018

Abstract [from journal]

We estimate the effects of horizontal mergers on marginal cost efficiencies – an ubiquitous merger justification – using data containing supply purchase orders from a large sample of US hospitals 2009-2015. The data provide a level of detail that has been difficult to observe previously, and a variety of product categories that allows us to examine economic mechanisms underlying “buyer power.” We find that merger target hospitals save on average $176 thousand (or 1.5 percent) annually, driven by geographically local efficiencies in price negotiations for...

Racial Disparities in Nephrology Consultation and Disease Progression among Veterans with CKD: An Observational Cohort Study

Peter P. Reese, MD, MSCE
Aug. 20, 2018

Jonathan Suarez, Jordana B. Cohen, Vishnu Potluri, Wei Yang, David E. Kaplan, Marina Serper, Siddharth P. Shah, ...

Abstract [from journal]

Background: Incident rates of ESRD are much higher among black and Hispanic patients than white patients. Access to nephrology care before progression to ESRD is associated with better clinical outcomes among patients with CKD. However, it is unknown whether black or Hispanic patients with CKD experience lower pre-ESRD nephrology consultation rates compared with their white counterparts,

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Adaptations of the Evidence-based Transitional Care Model in the U.S.

Aug. 9, 2018

Mary D. Naylor, Karen B. Hirschman, Mark P. Toles, Olga F. Jarrín, Elizabeth Shaid, Mark V. Pauly

Abstract [from journal]

Despite a growing body of evidence that adaptations of evidence-based interventions (EBI) are ubiquitous, few studies have examined the nature and rationale for modifications to the components of these interventions. The primary aim of this study was to describe and classify common local adaptations of the Transitional Care Model (TCM), an EBI comprised of 10 components that has been proven in multiple clinical trials to improve the care and outcomes of chronically ill older adults transitioning from hospitals to home

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Effect of Hospital and Post-Acute Care Provider Participation in Accountable Care Organizations on Patient Outcomes and Medicare Spending

Aug. 9, 2018

Divyansh Agarwal and Rachel M. Werner

Abstract [from journal]

Objective: To test for differences in patient outcomes when hospital and post‐acute care (PAC) providers participate in accountable care organizations (ACOs).

Data/Setting: Using Medicare claims, we examined changes in readmission, Medicare spending, and length of stay among patients admitted to ACO‐participating hospitals and PAC providers.

Design: We compared changes in outcomes

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Perceptions of Factors Associated With Inclusive Work and Learning Environments in Health Care Organizations: A Qualitative Narrative Analysis

Jaya Aysola, MD, MPH
Aug. 6, 2018

Jaya Aysola, Frances K. Barg, Ana Bonilla Martinez, Matthew Kearney, ...

Abstract [from journal]

Importance: Diversifying the health care workforce remains a critical goal for health care organizations focused on reducing disparities in care. However, it remains unknown what factors create inclusive health system environments and help organizations retain a diverse workforce.

Objective: To understand from members of the health care workforce what factors contribute to inclusive work and learning environments and what can be done to improve inclusion within health care organizations.

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