Although health reform has reduced many financial barriers to care, it has done little to overcome geographic barriers. Two recent studies by LDI Senior Fellows examine disparities in geographic access to specialty care in the United States, specifically gynecologic cancer care and comprehensive stroke treatment. They assess the potential impact of these disparities on health outcomes, and suggest population-based planning as a way to improve access to specialty care.
Twitter has been abuzz with commentary about ProPublica’s Surgeon Scorecard, which reports on how individual surgeons perform on in-hospital mortality and readmission (complication) rates for eight common elective procedures. Amidst the pointed criticisms of the Scorecard, there exists moderate agreement that it provides some value in helping consumers select a surgeon.
Not every health system can be Kaiser Permanente, but many try. Kaiser’s model of integrated health delivery is highly regarded for high-quality and efficient health care.
I recently attended the AcademyHealth Annual Research Meeting (ARM) thanks to the support of the Alice S. Hersh Scholarship and the Leonard Davis Institute (LDI). At the ARM, two themes stood out for me: the re-emergence of managed care as a vehicle for replacing volume with value, and behavioral economics.
There’s been a lot of talk about "narrow" networks in ACA plans, which trade off limited provider coverage for lower premiums. Using a new integrated dataset of physician networks in plans on the federal and state marketplaces, our latest LDI/RWJF Data Brief describes the breadth of physician networks across all silver plans sold in 2014.
The Affordable Care Act (ACA) has prompted health plans to increase their use of “narrow networks” of providers as a cost containment strategy. The Leonard Davis Institute of Health Economics (LDI) has assembled the first integrated dataset of physician networks for the plans offered on the ACA marketplace. This data brief uses this new resource to describe the breadth of the physician networks in plans sold on the state and federal marketplaces.
Recently we’ve noticed a great deal of emerging research evidence and analysis on provider consolidation and integrated care. An abundance of riches! Here we’ve pulled out the angles of the different analyses and brought together key resources.
Update May 2015
Depending on your neighborhood in Philadelphia, you may face a 10-fold difference in the supply of primary care practices located close to your home. This is the finding of a new study commissioned by the Philadelphia Department of Public Health and conducted by a research team that I headed.
In Health Services Research, Alexander Fiks and colleagues, including Christopher Forrest, analyze the impact of feedback in improving adoption of clinical decision support (CDS). The work is part of a larger trial of the effectiveness of CDS for diagnosing and treating ear infections in children. While substantial investment in electronic health records (EHRs) has provided an unprecedented opportunity to use CDS, the impact of feedback on clinician use of CDS systems has not been well studied. The authors looked at EHR-based CDS adoption during 41,391 ear infection visits, and...
A new study by LDI Senior Fellow Lawton Burns and colleagues challenges the conventional wisdom about the societal benefits and comparative advantages of integrated delivery networks (IDNs). A literature review and detailed analysis of financial and quality indicators found “scant evidence” of improved quality, lower cost per case, or greater societal benefit.
In Annals of Internal Medicine, LDI's Zachary Meisel and colleagues examine patient handoffs from emergency medical services (EMS) to hospital emergency departments to learn more about what can be done to improve the structure and process of these high-risk events. The authors conducted focus group interviews with EMS providers around the country to learn more about their perspectives on the professional and interpersonal factors that contribute to the effectiveness of handoffs. EMS providers identified four potential ways of improving the handoff system: communicating directly with the...
In JAMA Internal Medicine, Kit Delgado and colleagues investigate characteristics of opioid overdose presentations to emergency departments. Opioid overdose is a leading cause of injury-related mortality in the United States. They analyze data from 2010 on 135,971 patients with opioid overdoses who were treated in emergency departments. The authors evaluate opioid type, patient characteristics, care utilization and clinical outcomes. They find that: two thirds of overdose cases involved prescription opioids, mortality was higher for overdoses with multiple opioids, most...
In the Journal of Rehabilitation Research & Development, Margaret Stineman and colleagues compare outcomes of postacute stroke patients provided with comprehensive rehabilitation with those provided with consultative rehabilitation services. Of the nearly 3000 patients in the study, 23 percent received comprehensive rehabilitation while the remaining patients received consultative services. The researchers found that those who received comprehensive rehabilitation compared with consultative gained on average 12.8 more points of physical independence on a 78-point scale and...
As a past, present, or future patient, you might hope that your health care providers are consistently and reliably involved in your care. Just like you, though, your providers need rest and time off. When they go off-duty, responsibility for you is transferred, or "handed off", to someone else.