Organization of Healthcare Delivery

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

Performance Improvement in Health Care Organizations

Jul. 19, 2017

Hummy Song, Anita Tucker

In Foundations and Trends in Technology, Information, and Operations Management, Hummy Song and Anita Tucker present a framework for performance improvement in health care organizations. Performance improvement is an important organizational capability that is essential for health care organizations to achieve excellence on the three components of the Triple Aim: patient experience, health, and cost. The authors’ model, called the Model of Transformational Performance Improvement, takes a system-level approach to performance improvement and comprises six key components. These...

Development and Validation of the Primary Care Team Dynamics Survey

Jul. 19, 2017

Hummy Song, Alyna T. Chien, Josephine Fisher, Julia Martin, Antoinette S. Peters, Karen Hacker, Meredith B. Rosenthal, Sara J. Singer

In Health Services Research, Hummy Song and colleagues develop and validate a survey instrument designed to measure team dynamics in primary care. The authors study 1,080 physician and non-physician health care professionals at 18 primary care practices participating in a learning collaborative to improve team-based care. They administer a cross-sectional survey addressing team dynamics, and assessed reliability and discriminant validity of survey factors, as well as the overall survey’s goodness-of-fit. They find that this model demonstrated adequate fit, scale reliability, and...

Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status

Jul. 14, 2017

Pooja K. Mehta, Tamala Carter, Cjloe Vinoya, Shreya Kangovi, Sindhu K. Srinivas

In Women’s Health Issues, Pooja Mehta and colleagues, including Shreya Kangovi and Sindhu Srinivas, seek to understand maternal preference for unscheduled hospital-based obstetric care, in order to inform interventions and improve value of publicly funded care during pregnancy. Previous research has shown that pregnant high utilizers of unscheduled care may be at particular risk for poor perinatal outcomes; however drivers of this association are unknown. The authors conducted a comparative qualitative analysis of in-depth semi structured interviews. Low-income pregnant women...

Association between aggressive care and bereaved families’ evaluation of end-of-life care for veterans with non-small cell lung cancer who died in Veterans Affairs facilities

Jul. 11, 2017

Mary Ersek, Susan C. Miller, Todd H. Wagner, Joshua M. Thorpe, Dawn Smith, Cari R. Levy, Risha Gidwani, Katherine Faircy-Anderson, Karl A. Lorenz, Bruce Kinosian, Vincent Mor

In Cancer, Mary Ersek and colleagues, including Bruce Kinosian, assess the relationship between aggressive end-of-life care and patient and family satisfaction. The authors focused on patients requiring an episode of aggressive care (such as chemotherapy, mechanical ventilation, acute hospitalizations, and intensive care unit admissions) within the last 30 days of life among patients with non-small cell lung cancer who died in a Veterans Affairs facility. They used data including Veterans Affairs administrative and clinical data, Medicare claims, and the Bereaved Family Survey....

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

Jul. 10, 2017

Linda H. Aiken, Douglas Sloane, Peter Griffiths, Anne Marie Rafferty, Luk Bruyneel, Matthew McHugh, Claudia B. Maier, Teresa Moreno-Casbas, Jane E. Ball, Dietmar Ausserhofer, Walter Sermeus

In BMJ Quality & Safety, Linda Aiken and colleagues, including Matthew McHugh examine the association of hospital nursing skill mix with patient mortality, patient ratings of care, and indicators of quality care among European hospitals. As policymakers around the world seek to reduce health spending, a popular target in Europe has been to transition from more professional nurses to fewer high-cost nurses supported by more lower-wage assistants. The authors analyzed how nursing skill mix affects indicators of quality patient care. The authors utilized cross-sectional patient...

Components of Comprehensive and Effective Transitional Care

Jul. 10, 2017

Mary D. Naylor, Elizabeth C. Shaid, Deborah Carpenter, Brianna Gass, Carol Levine, Jing Li, Ann Malley, Kathleen Mccauley, Huong Q. Nguyen, Heather Watson, Jane Brock, Brian Mittman, Brian Jack, Suzanne Mitchell, Becky Callicoatte, John Schall, Mark V. Williams

In Journal of the American Geriatrics Society, Mary Naylor and colleagues identify components of the Transitional Care model that provide the desired patient and caregiver outcomes. For decades, the Transitional Care (TC) model has worked to prevent re-hospitalizations and their associated costs, however little is known about the specific factors that make TC effective. The authors formed a workgroup to identify a preliminary set of components. The workgroup conducted focus groups and interviews with patients and caregivers, and created an advisory group comprised of patient and...

Nurses’ Perceptions of In-Hospital Versus Telephone Availability of an Intensivist at Night in an Intensive Care Unit

Jul. 10, 2017

Emily S. Stanton, Cary Hilbert, Stephanie Maillie, Jessica Dine, Scott D. Halpern, and Meeta Prasad Kerlin

In American Journal of Critical Care, Emily Stanton and colleagues, including Jessica Dine, Scott Halpern, and Meeta Prasad Kerlin, investigate nurses' perceptions about nighttime intensivist staffing. The authors conducted semi-structured interviews of 13 night-shift nurses in an academic medical intensive care unit to elicit perceptions of nighttime staffing with attending intensivists, versus residents with attending intensivists on call remotely. Eight themes emerged from these interviews: efficiency, communication, job place comfort, quality of patient care, procedures,...

Bringing Rounds Back to the Patient: A One-Year Evaluation of the Chiefs’ Service Model for Inpatient Teaching

Jul. 5, 2017

Nadia L. Bennett, Judd D. Flesch, Peter Cronholm, James B. Reilly, Jack Ende

In Academic Medicine, Nadia Bennett and colleagues, including Peter Cronholm and Jack Ende, evaluate the impact of a new approach to inpatient teaching on both patient care and resident education. This model, called the Chiefs’ Service (CS), is a structured approach to inpatient teaching rounds, and has five key elements: morning huddles, bedside rounds, diagnostic “time-outs”, day-of-discharge rounds, and postdischarge follow-up rounds. The authors conducted end-of-rotation evaluation questionnaires among 183 residents after the program’s first year, and compared residents’...

Is American Pet Health Care (Also) Uniquely Inefficient?

Jun. 29, 2017

Liran Einav, Amy Finkelstein, Atul Gupta

In American Economic Review, Liran Einav and colleagues, including Atul Gupta, examine similarities between human and pet health care in the U.S.. The authors note similarities in rapid growth in spending in both industries, with wealthier families spending significantly more on both human and pet health. They also note a rapid increase in employment of health care providers in both industries, an increase in medical technology use, and a similar propensity for high spending at the end of life. While human and pet health care share a number of similarities, they also note...

Reimagining the Risk of Long-Term Care

Jun. 29, 2017

Allison K. Hoffman

In Yale Journal of Health Policy, Law, and Ethics, Allison Hoffman argues that current U.S policy does not adequately address the needs of families facing prolonged illness. Hoffman notes that prolonged disability creates two types of insecurity – the insecurity faced by the disabled person, and the insecurity faced by the ill person’s caregivers – and argues that current policy only addresses the former. The author argues that, while attempting to mitigate risks faced by the recipient of care, current policy has expanded the insecurity of caregivers by reinforcing a structure of...

Association of Provider Specialty and Multidisciplinary Care With Hepatocellular Carcinoma Treatment and Mortality

Jun. 28, 2017

Marina Serper, Tamar H. Taddei, Rajni Mehta, Kathryn D'Addeo, Feng Dei, Ayse Ayatman, Michelle Baytarian, Rena Fox, Kristel Hunt, David S. Goldberg, Adriana Valderrama

In Gastroenterology, Marina Serper and colleagues, including David Goldberg, assess how various health care system factors affect survival rates in hepatocellular carcinoma (HCC). These factors included uptake of historically underutilized curative therapies, access to a hepatologist, and presentation of the case to a multidisciplinary tumor board. The authors found that, while curative treatments of HCC increased survival rates, only 25% of newly diagnosed HCC patients received treatment intended to cure the disease. Additionally, those who received care from only...

Economic Feasibility of Staffing the Intensive Care Unit with a Communication Facilitator

Jun. 27, 2017

Nita Khandelwal, David Benkeser, Norma B. Coe, Ruth A. Engelberg, and J. Randall Curtis

In Annals of the American Thoracic Society, Nita Khandelwal and colleagues, including Norma Coe, assess the economic feasibility of staffing intensive care units (ICUs) with a communication facilitator. This person assists families in complex decision-making, improves patient-provider communication, and ensures that care is consistent with patient values and goals. The authors conducted a randomized trial with an ICU communication facilitator, and also looked at financial hospital records. Units that had a facilitator saw significantly reduced daily average ICU costs, and maximal...

Penn SUMR Scholars Arrive at New Orleans AcademyHealth Research Meeting

Jun. 24, 2017
[content_elements:element:0] NEW ORLEANS (JUNE 24, 2017) -- Twenty University of Pennsylvania Leonard Davis Institute of Health Economics' Summer Undergraduate Minority Researc h (SUMR) scholars arrived at the 2017 AcademyHealth Research Meeting (ARM) here this morning to continue their summer-long immersion into the health services research community. The University of Pennsylvania group was also the largest contingent from any school attending the National Research Service Awards (NRSA) Conference that takes place in tandem with the annual AcademyHealth Annual Research Meeting. NRSA is part...

Sustained improvement in intraoperative efficiency following implementation of a dedicated surgical team for pediatric spine fusion surgery

Jun. 22, 2017

Wallis Muhly, John McCloskey, Jeff Feldman, Barbara Dezayas, Michael Blum, Blair Kraus, Vaidehi Mehta, Devika Singh, Ron Keren, John Flynn

In Perioperative Care and Operating Room Management, Wallis Muhly, Ron Keren, and colleagues assess if dedicated surgical teams can improve and sustain intraoperative efficiency for pediatric posterior spine fusion (PSF). The authors compared OR efficiency data and total time spent in the OR before and after adoption of a dedicated surgical team model. The quality improvement model including developing a multidisciplinary team of surgeons, anesthesiologists nurses, and technicians, structuring weekly team meetings to understand and map the OR process, and identifying areas where...

Pages