Organization of Healthcare Delivery

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

The Perfect Storm: Collision of the Business of Mental Health and the Implementation of Evidence-Based Practices

Mar. 29, 2016

Rebecca Steward, Danielle Adams, David Mandell, Trevor Hadley, Arthur Evans, Ronnie Rubin, Joan Erney, Geoffrey Neimark, Matthew Hurford, Rinad Beidas

In Psychiatric Services, Rebecca Stewart and colleagues, including David Mandell, Trevor Hadley and Rinad Beidas examine how financial factors affect the implementation of evidence-based practices (EBPs) in a large urban publicly funded mental health system. They interviewed 33 agency leaders and 16 policymakers, who described financial distress in community mental health agencies, and reported concerns about complex and expensive implementation of EBPs. These stakeholders agree that the cost of implementing EBPs should be shared between the agencies and the health system; however...

Independent Contractors in Public Mental Health Clinics: Implications for Use of Evidence-Based Practices

Mar. 29, 2016

Rinad Beidas, Rebecca Stewart, Courtney Wolk, Dainelle Adams, Steven Marcus, Arthur Evans, Kamilah Jackson, Geoffrey Neimark, Matthew Hurford, Joan Erney, Ronnie Rubin, Trevor Hadley, Frances Barg, David Mandell

In Psychiatric Services, Rinad Beidas and colleagues, including Steven Marcus, Trevor Hadley and David Mandell analyze the associations of utilizing independent contractors with clinician knowledge and attitudes toward evidence-based practices (EBP), and organizational culture and climate. They also describe the impact of using independent contractors on mental health services delivery from the perspective of organizational leadership. Community mental health clinics are increasingly utilizing independent contractors to provide clinical services. At the same time, many...

Choosing Wisely in Emergency Medicine: A National Survey of Emergency Medicine Academic Chairs and Division Chiefs

Mar. 14, 2016

Brandon Maughan, Jill Baren, Judy Shea, Raina Merchant

In Academic Emergency Medicine, Brandon Maughan and colleagues, including Judy Shea and Raina Merchant, assess whether leaders of academic emergency medicine departments are aware of the Choosing Wisely campaign, and their attitudes about the campaign. The Choosing Wisely campaign seeks to promote collaboration and communication between patients and physicians regarding the appropriateness of common tests and procedures. For this study, the researchers used a web-based survey of emergency department chairs and division chiefs to examine awareness of the campaign, anticipated...

Liver transplant center variability in accepting organ offers and its impact on patient survival

Feb. 17, 2016

David Goldberg, Benjamin French, James Lewis, Frank Scott, Ronac Mamtani, Richard Gilroy, Scott Halpern, Peter Abt

In the Journal of Hepatology, David Goldberg and colleagues, including Benjamin French, James Lewis and Scott Halpern, explore whether transplant centers vary in their propensities to decline organs for the highest priority patients, and how these decisions impact patient outcomes. The authors analyzed Organ Procurement and Transplantation Network (OPTN) data from 2007-2013, and evaluated acceptance rates of liver offers for the highest ranked patients and their subsequent waitlist mortality. Even after adjusting for organ quality and recipient severity of illnesses, the study...

Retainer-Based Medicine: Where is the Research?

Feb. 8, 2016

About 10 years ago, my primary care physician decided that she would no longer take insurance, and left the practice.  Patients could pay directly to continue in her care in her new practice, or see another physician in the existing practice.  I chose to stay in the practice with another physician.

The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis

Jan. 29, 2016

David Lee, Brendan Carr, Tony Smith, Van Tran, Daniel Polsky, Charles Branas

In Population Health Management, David Lee and colleagues, including Brendan Carr, Daniel Polsky and Charles Branas, test the association of hospital and population characteristics and the effect of nearby hospital closures with increases in emergency department volume. The researchers used data from cost reports and administrative databases to analyze emergency department volume at 192 New York State hospitals from 2004 to 2010. They find an overall increase in emergency department visits, but with wide variation. Emergency volume increased nearly twice as fast at tertiary...

A Qualitative Evaluation of Patient-Perceived Benefits and Barriers to Participation in a Telephone Care Management Program

Jan. 29, 2016

Lindsay Jubelt, Kevin Volpp, Dana Gatto, Joelle Friedman, Judy Shea

In the American Journal of Health Promotion, Lindsay Jubelt and colleagues, including Kevin Volpp and Judy Shea, try to better understand the low participation rate of high-risk individuals in a targeted telephone care management program. Researchers interviewed patients who were recruited to participate in the care management program but had dropped out or never participated despite recruitment efforts. The most commonly cited barriers to participation were a lack of perceived need and a sense of distrust toward the program and its staff. These findings could help care management...

Comparison of the Value of Nursing Work Environments in Hospitals Across Different Levels of Patient Risk

Research Brief
Jan. 20, 2016

In this study, LDI Senior Fellow Jeffrey Silber and colleagues at the Children’s Hospital of Philadelphia and the University of Pennsylvania look at how better nurse working environments influence the “value” of care, which is defined as the quality of care relative to the cost of providing it. Past studies of nurse work environments have looked at their impact on either quality or cost, but not on both. This study asks whether selecting hospitals based solely on excellent nursing environments identifies a set of hospitals that display better outcomes and value, a question most relevant to a patient seeking advice on where to go for care.

Hospice Care in Assisted Living Facilities Versus at Home: Results of a Multisite Cohort Study

Jan. 11, 2016

Meredith Dougherty, Pamela Harris, Joan Teno, Amy Corcoran, Cindy Douglas, Jackie Nelson, Deborah Way, Joan Harrold, David Casarett

In the Journal of the American Geriatrics Society, Meredith Dougherty and colleagues, including David Casarett, compare residents of assisted living facilities receiving hospice with people receiving hospice care at home. The researchers conducted an electronic health record-based retrospective cohort study to compare the difference in the two groups’ length of stay in hospice, use of opioids for pain, and site of death. The authors find the assisted living population was more likely than the home hospice population to have a diagnosis of dementia (23.5% vs 4.7%) and enroll in...

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