Organization of Healthcare Delivery

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

‘Sharing things with people that I don’t even know’: Help-seeking for Psychological Symptoms in Injured Black Men in Philadelphia

Apr. 12, 2018

Sara Jacoby, John A. Rich, Jessica L. Webster, Therese S. Richmond

Abstract [from journal]

Objectives: Psychological distress is common in survivors of traumatic injury, yet across United States’ trauma systems, it is rare that standard injury care integrates psychological evaluation and professional...

Lower Postsurgical Mortality for Individuals with Dementia with Better-Educated Hospital Workforce

Research Brief
Apr. 11, 2018

Surgical patients age 65 and over with Alzheimer’s disease and related dementias (ADRD) were more likely to die within 30 days of admission and to die after a complication than those without ADRD. Having better-educated nurses in the hospital improved the likelihood of good outcomes for all surgical patients, but had a much greater effect in individuals with ADRD. Specifically, a 10% increase in the proportion of nurses with a Bachelor of Science in Nursing (BSN) degree or higher was associated with 10% lower odds of death and 10% lower odds of dying after a complication for surgical patients with ADRD.

Value Based Payment: Is This Time Actually Different?

Mar. 8, 2018

Practice transformation and payment reform are defining features of contemporary health policy debates. The story goes like this: new provider organizations, such as Accountable Care Organizations (ACOs) are transforming care delivery from fragmented and volume driven to integrated and optimized for quality; meanwhile, innovative payment models, such as bundled payments and risk-based contracting, herald a national transition from fee-for-service (FFS) to value-based payments.

The Association Between Obesity and Disability in Survivors of Joint Surgery: Analysis of the Health and Retirement Study

Feb. 28, 2018

Abstract [from journal]

Background
Obesity is associated with osteoarthritis and the need for joint surgery. Obese patients who undergo joint surgery may have a higher risk of morbidity compared with normal or overweight patients but less is known about their risk of postoperative disability. The primary objective of our study was to determine the association between obesity and the development of new dependence in activities of daily living within 2 years after joint surgery.

...

Exploring Opportunities to Prevent Cirrhosis Admissions in the Emergency Department: A Multicenter Multidisciplinary Survey

Feb. 21, 2018

Shazia Mehmood Siddique, Meghan Lane-Fall, Matthew J. McConnell, Neha Jakhete, James Crismale, Stefanie...

In Hepatology Communications, Shazia Mehmood Siddique and colleagues investigate nonmedical factors that influence inpatient admission for patients with cirrhosis who present to the emergency department. They also explore provider perspectives on patients presenting to the emergency department with low-acuity conditions, such as ascites and hepatic encephalopathy. The authors survey emergency medicine and hepatology providers, including attending physicians, house staff, and advanced practitioners, in four liver transplant centers.

From the 186 responses analyzed, they...

Infants in Drug Withdrawal: A National Description of Nurse Workload, Infant Acuity, and Parental Needs

Feb. 1, 2018

Jessica G. Smith, Jeannette A. Rogowski, Kathryn M. Schoenauer, ...

In the Journal of Perinatal and Neonatal Nursing, Jessica Smith and colleagues, including Jeannette Rogowski and Eileen Lake, investigate how infants in drug withdrawal compare with nondrug withdrawal infants to inform proper nurse assignments based on infant acuity and parental needs. Though not commonly recognized, a troubling aspect of the opioid epidemic is increased drug use among pregnant women, which has led to an increase in infants who are...

New OECD Report Highlights Expanded Primary Care Role for Nurses

Jan. 9, 2018

To meet population health care needs in developed countries, health systems must shift their focus from treating acute episodes to managing chronic conditions. With the rise of chronic care comes a new set of tasks that are more time-consuming and team-oriented. Policymakers in many countries are seeking to align the size and composition of their primary care workforce to meet these new needs, by expanding the role of advanced nurses.

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