Organization of Healthcare Delivery

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

Diagnosis and Medication Treatment of Pediatric Hypertension: A Retrospective Cohort Study

Jan. 2, 2017

David C. Kaelber, Weiwei Liu, Michelle Ross, A. Russell Localio, Janeen B. Leon, Wilson D. Pace, Richard C. Wasserman, Alexander G. Fiks

In Pediatrics, David Kaelber and colleagues, including LDI Senior Fellow Alexander Fiks, evaluate the diagnosis and initial medication management of pediatric hypertension and prehypertension in primary care. Pediatric hypertension predisposes children to adult hypertension and early markers of cardiovascular disease. Hypertension and pre-hypertension are well-defined, prevalent and generally asymptomatic conditions in children and adolescents that often go undiagnosed and untreated with...

When Compared to Each Other, Doctors Pay Attention

Nov. 11, 2016

In two recent JAMA Viewpoints, Amol Navathe and colleagues point to the potential of social comparisons to motivate physicians to improve the care they provide. Fulfilling this potential, however, will take careful attention to how these comparisons are designed and delivered.

Penn Center for Community Health Workers: Step-by-Step Approach to Sustain an Evidence-Based Community Health Worker Intervention at an Academic Medical Center

Sep. 19, 2016

Anna U. Morgan, David T. Grande, Tamala Carter, Judith A. Long, Shreya Kangovi

In the American Journal of Public Health, Anna Morgan and colleagues, including Dave Grande, Judith Long, and Shreya Kangovi, describe the process by which Penn’s Center for Community Health Workers grew from a small grant-funded research project into a robust program serving 2,000 patients annually and funded through the health system’s operational budget. The authors describe an 8-step framework to engage both low-income patients and funders, determine outcomes, and calculate return on investment. The case illustrates a path toward sustainability for other community-based...

Acute Health Care Utilization among Food-Insecure Children in Primary Care Practices

Sep. 13, 2016

Deepak Palakshappa, Saba Khan, Chris Feudtner, and Alexander G. Fiks

In the Journal of Health Care for the Poor and Underserved, Deepak Palakshappa and colleagues, including Chris Feudtner and Alexander Fiks, investigate the relationship between food insecurity and child health care utilization. They test whether differences in child health care utilization can predict household food insecurity and whether food insecurity is associated with subsequent acute health care use. This prospective cohort study involved 3,335 children screened for food insecurity at three-year well-child visits in three urban practices. The authors evaluated acute care use...

Adoption of a portal for the primary care management of pediatric asthma: a mixed method implementation study

Aug. 19, 2016

Alexander G. Fiks ; Nathalie Du Rivage ; Stephanie L. Mayne ; Stacia Finch ; Michelle E. Ross ; Kelli Giacomini ; Andrew Suh ; Banita McCarn ; Elias Brandt ; Dean Karavite ; Elizabeth W. Staton ; Laura P. Shone ; Valerie McGoldrick ; Kathleen Noonan ; Dorothy...

In the Journal of Medical Internet Research, LDI Senior Fellows Alexander Fiks and Kathleen Noonan and colleagues evaluate the feasibility of using a patient portal for pediatric asthma in primary care, its impact on management and the barriers and facilitators of implementation success. Patient portals improve communication between families of children with asthma and their primary care providers as well as outcomes. This mixed-methods multi-site (11 states) study used 10 clinician focus groups, 22 semi-structured parent interviews and surveys that were sent to the parents...

Shared Decision Making and Treatment Decisions for Young Children with Autism Spectrum Disorder

Aug. 19, 2016

Susan E. Levy, Rosemary Frasso, Stephanie Colantonio, Hayley Reed, Gail Stein, Frances K. Barg, David S. Mandell, Alexander G. Fiks

In Academic Pediatrics, Susan Levy and colleagues including Rosemary Frasso, David Mandell and Alexander Fiks, examine the barriers to communication and shared decision-making between pediatricians and parents of young children with autism spectrum disorder (ASD). Lack of shared decision-making and communication about management decisions often results in parents’ perception of unmet needs for coordination of care and referral for specialized care. This authors interviewed 20 pediatricians from 10 primary care practices in urban and suburban areas, and 20 English-speaking parents...

What Do Hospitalized Patients Say Would Be Worse Than Death?

Aug. 16, 2016

[cross-posted with the Health Cents blog on philly.com]

In caring for hospitalized patients with serious illnesses, and in evaluating interventions designed to help them, clinicians and researchers often focus on death as the primary outcome to be avoided. We tend to pay less attention to avoiding other outcomes that may be equally or more unacceptable to some patients.

Primary Care: On the Front Lines of the Opioid Crisis

Issue Brief
Aug. 9, 2016

This issue brief discusses the role of primary care teams in identifying illicit drug use disorders in their patients, the continuum of treatments that they can offer, and opportunities for successful collaboration and integration with specialists. The authors find opportunities exist for increased patient screening and delivering medication-assisted treatment as well as established models for collaboration and integration of opioid treatments. 

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