Organization of Healthcare Delivery

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

IRB Oversight of Patient-Centered Outcomes Research: A National Survey of IRB Chairpersons

Jun. 27, 2018

Joel S. Weissman, Eric G. Campbell, I. Glenn Cohen, Holly Fernandez LynchEmily A. Largent, Avni Gupta,Ronen Rozenblum, ...

ABSTRACT [FROM JOURNAL]

Patient-centered outcomes research (PCOR) is becoming increasingly common. However, there is little evidence regarding what novel ethical challenges, if any, are posed by PCOR with relevance to institutional review board (IRB) oversight and human subjects protections. This article reports the results of a national survey of all IRB chairpersons from research-intensive institutions in the United States. Findings address the responsibilities of IRBs and the challenges associated with PCOR review and oversight. IRB chairpersons varied in their judgment of PCOR...

Modernizing Medicare Funding for Nurse Education

Jun. 21, 2018

With policies rooted in the 1960s, it’s time to change how Medicare pays for nurse education. In a New England Journal of Medicine Perspective, LDI Senior Fellow Linda Aiken and colleagues present a compelling case for funding a new consortium model that trains nurse practitioners (NPs) in the community settings where they are a crucial source of primary care.

Nurse Generated EHR Data Supports Post-Acute Care Referral Decision Making: Development and Validation of a Two-step Algorithm

Jun. 20, 2018

Kathryn H. Bowles, Sarah J. Ratcliffe, Mary D. Naylor, ...

ABSTRACT [FROM JOURNAL]

Objective: Build and validate a clinical decision support (CDS) algorithm for discharge decisions regarding referral for post-acute care (PAC) and to what site of care. 

Materials and Methods: Case studies derived from EHR data were judged by 171 interdisciplinary experts and prediction models were generated. 

Results: A two-step algorithm emerged with area under the curve (AUC) in validation of 91.5% (yes/no refer) and AUC 89.7% (where to refer). 

Discussion: CDS for...

Geographic Variation in Postpartum Prescription Opioid Use: Opportunities to Improve Maternal Safety

Jun. 6, 2018

Nora V. Becker, Karen J.Gibbins, Jeanmarie Perrone, Brandon C. Maughan

Abstract [from journal]

Background: Obstetric delivery is among the most common in-hospital procedures experienced by reproductive-age women, yet there is little literature on patterns of postpartum opioid prescriptions after such episodes.

Methods: We used claims data from 871,195 vaginal deliveries to 768,455 privately-insured women with an in-hospital delivery between June 2001 and July 2013 to examine the state- and census division-level proportions of women who

...

The Effect of Workforce Assignment on Performance: Evidence from Home Health Care

Research Brief
May. 22, 2018

In this study of more than 43,000 home health episodes following a hospitalization, handoffs between skilled nursing providers—a marker of discontinuity of care—substantially increased hospital readmissions, and were more detrimental for sicker patients. The estimates imply that a single handoff increases the likelihood of 30-day hospital readmission by 16% and that one in four hospitalizations during home health care could be avoided if handoffs were eliminated.

Understanding Pediatric Caretakers’ Views On Obtaining Medical Care for Low‐Acuity Illness

May. 17, 2018

Whitney V. Cabey, Judy A. Shea, Shreya Kangovi, Danielle Kennedy, Chiamaka Onwuzulike, Joel Fein
 

Abstract [from journal]

Background: A significant proportion of low acuity emergency department (ED) visits are by patients under 18 years of age. Results from prior interventions designed to reduce low acuity pediatric ED use have been mixed or poorly sustained, perhaps because they were not informed by patient and caretakers’ perspectives. The objective of this study was to explore caretaker decision‐making processes, values and priorities when deciding to seek care.

Methods

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Preventable Hospitalizations, Barriers to Care, and Disability

May. 17, 2018

Liliana E. Pezzin, Hillary R. Bogner, Jibby E. Kurichi, Pui L. Kwong, Joel E. Streim, Dawei Xie, Ling Na, Sean Hennessy

Abstract [from journal]

The AHRQ's Prevention Quality Indicators assume inpatient hospitalizations for certain conditions, referred as ambulatory-care sensitive (ACS) conditions, are potentially preventable and may indicate reduced access to and a lower quality of ambulatory care. Using a cohort drawn from the Medicare Current Beneficiary Survey (MCBS) linked to Medicare claims, we examined the extent to which barriers to healthcare are associated with ACS hospitalizations and related costs, and whether these associations differ by beneficiaries' disability status. Our results...

Organizational Processes and Patient Experiences in the Patient-Centered Medical Home

May. 10, 2018

Abstract [from journal]

Background: There is increasing emphasis on the use of patient-reported experience data to assess practice performance, particularly in the setting of patient-centered medical homes. Yet we lack understanding of what organizational processes relate to patient experiences.

Objective: Examine associations between organizational processes practices adopt to become PCMH and patient experiences with care.

Research Design: We analyzed visit data from patients (n=8356) at adult primary care practices...

Best Practices for Reducing Unplanned Acute Care for Patients with Cancer

Research Brief
May. 3, 2018

Reducing preventable and unplanned emergency department visits and hospitalizations is a major challenge in cancer care. In this review of best practices and supporting evidence, the authors identified five strategies that health systems and cancer programs can use to reduce acute care: (1) identify patients at high risk of unplanned acute care; (2) enhance access and care coordination; (3) standardize clinical pathways for symptom management; (4) develop new sites for urgent cancer care, and; (5) use early palliative care. 

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