Organization of Healthcare Delivery

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

The “value” of value in gynecologic oncology practice in the United States: Society of Gynecologic Oncology evidence-based review and recommendations

Jun. 20, 2017

David E. Cohn, Emily Ko, Larissa A. Meyer, Jason D. Wright, Sarah M. Temkin, Jonathan Foote, Nathaniel L. Jones, Laura J. Havrilesky

In Gynecologic Oncology, David Cohn and colleagues, including Emily Ko, examine trends in gynecologic oncology health care expenditures, and assess how costs may be affected by new models of health care delivery and payment. The authors conduct a review on behalf of the Society of Gynecologic Oncology, and discuss the financial burden of increasing co-payments for cancer patients. They emphasize the need for gynecologic oncology practitioners to prepare for new models of cancer care delivery, such as Oncology Patient-Centered Medical Homes (OCPHM), as well as newer pay for...

Defining Value in Radiation Oncology: Approaches to Weighing Benefits vs. Costs

Jun. 20, 2017

Andre Konski

In Oncology, Andre Konski considers health care payment models and the transition from fee-for-service to value-based payment as it applies to radiation oncology. Konski examines difficulties in determining value, pointing out that both patients and payers could be considered health care ‘customers’ . He assesses how traditional cost-effective analyses may not be suitable for novel radiation oncology therapies, especially as consumers are increasingly conscious of the costs of treatment plans. He argues that radiation oncologists must consider the cost to patients when designing...

Missed Nursing Care in Pediatrics

Jun. 19, 2017

Eileen T. Lake, Pamela B. de Cordova, Sharon Barton, Shweta Singh, Paula D. Agosto, Beth Ely, Kathryn E. Roberts, Linda H. Aiken

In Hospital Pediatrics, Eileen Lake and colleagues, including Shweta Singh and Linda Aiken, examine patterns of missed nursing care in inpatient pediatric settings to determine whether it is associated with unfavorable work environments and high nurse workloads. The authors used registered nurse data from over 200 pediatric hospitals. The data shows that nurses reported missed care on their last shift for twelve nursing activities due to time constraints. More than half of pediatric nurses missed care on their previous shift, and missed care was more prevalent in poor work...

Improved Availability and Quality of Care with Epilepsy Nurse Practitioners

Jun. 19, 2017

Chloe E. Hill, Bethany Thomas, Kimberly Sansalone, Kathryn A. Davis, Judy A. Shea, Brian Litt, and Nabila Dahodwala

In Neurology, Chloe Hill and colleagues, including Judy Shea and Nabila Dahodwala, investigate the quality of care delivered by nurse practitioner (NP)–physician teams developed to serve patients with epilepsy, and improve their appointment availability.  The authors observed a cohort of patients with epilepsy who were cared for by either an NP-physician team or a physician only. These care models were compared with regard to adherence to the 2014 American Academy of Neurology epilepsy quality measures. The authors also looked at seizure frequency, presentations to the Emergency...

How Patients Experience the Trauma Bay

Jun. 16, 2017

After a shooting, a stabbing, a car crash, or a fall, emergency services rush an injured patient to the emergency room. They bypass the waiting room and come directly to a specialized area called the trauma bay, where a team of clinicians performs a fast, intense, full-body exam and initiates treatment for injury. Trauma providers have organized this protocol, known as trauma resuscitation, to identify and treat life-threatening injuries as quickly as possible. Or at least that’s how we see it.

Evaluating the Impact of the Laborist Model of Obstetric Care on Maternal and Neonatal Outcomes

Research Brief
Apr. 26, 2017

Implementation of the laborist model was associated with a 15% decrease in the odds of the induction of labor and a 17% decrease in the odds of preterm birth.

Issues at the Heart of Advancing the De-Adoption of Low-Value Care

Issue Brief
Apr. 18, 2017

A diverse set of national leaders and stakeholders representing industry, think-tanks, provider and patient groups, and academic experts discussed how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable.

Evaluating the Role of Payment Policy in Driving Vertical Integration in the Oncology Market

Apr. 3, 2017

Abby Alpert, Helen Hsi, and Mirelle Jacobson 

In Health Affairs, Abby Alpert and colleagues evaluate the reasons behind the increase in vertical integration in the market for cancer care. Much of the move towards consolidation over the past decade has been vertical - hospitals acquiring physician practices - instead of horizontal - physician practices or hospitals merging with similar entities. The authors' analysis shows that the rate of hospital or health system ownership of practices doubled from about 30...

43 Ways to Leave Your Technology

Feb. 14, 2017

We recently convened an expert roundtable to tackle how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable. This got us thinking - while the process by which ineffective practices or technologies are abandoned is neither simple nor automatic, even the language used to describe it is not clear. And language matters. It often reflects an unstated focus on one mechanism or one level of decision-making. Here we review, and potentially clarify, the terminology.

Pages