Organization of Healthcare Delivery

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

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. 

Physicians’ Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities

Research Brief
Aug. 8, 2016

Early evidence suggests that accountable care organizations (ACOs) - networks of doctors and hospitals whose members share responsibility for providing coordinated care to patients - improve health care quality and constrain costs. ACOs are increasingly common in the U.S., both for Medicare and commercially insured patients. However, there are concerns that ACOs may worsen existing disparities in health care quality if disadvantaged patients have less access to physicians who participate in them. Does physicians’ ACO participation relate to the sociodemographic characteristics of their patient population, and if so, why?

Pennsylvania’s Medical Home Initiative: Reductions in Healthcare Utilization and Cost Among Medicaid Patients with Medical and Psychiatric Comorbidities

Jun. 27, 2016

Karin V. Rhodes, Simon Basseyn, Robert Gallop, Elizabeth Noll, Aileen Rothbard, and Paul Crits-Christoph

The Chronic Care Initiative (CCI) was a large state-wide patient-centered medical home (PCMH) initiative in Pennsylvania in place from 2008–2011. At its height, it included 783 providers and served more than 1.18 million patients. Evaluation of the program, in terms of quality, utilization, and cost outcomes has been mixed. This study assessed whether the CCI had an impact on the utilization and costs for Medicaid patients with chronic medical conditions and comorbid psychiatric or substance use disorders. The investigators analyzed Medicaid claims to compare changes in utilization and...

Selective Hearing: Physician Ownership and Physicians’ Response to New Evidence

Jun. 4, 2016

David H. Howard, Guy David, and Jason Hockenberry

In the Journal of Economics & Management Strategy, Guy David and colleagues examine whether physicians who own their surgical practices respond to new medical evidence differently from physicians who work in hospital-owned practices. In 2002, a clinical trial demonstrated that knee surgery did not benefit patients with osteoarthritis, which led to an overall decrease in knee surgeries. The authors took advantage of this “information shock” in 2002 to whether assess the impact of physician vs. hospital ownership status on these surgical practice patterns. They identified all...

Urgent Care Needs Among Nonurgent Visits to the Emergency Department

May. 11, 2016

Renee Hsia, Ari Friedman, Matthew Niedzwiecki

In JAMA Internal Medicine, Renee Hsia and colleagues, including Ari Friedman, investigate whether nonurgent status determined in the emergency department effectively ruled out the possibility of serious pathologic conditions, and compared these findings with visits deemed as urgent from triage. The authors used data from the National Hospital Ambulatory Medical Care Survey to compare characteristics and outcomes of nonurgent visits with those of urgent visits. They find that a nontrivial proportion of ED visits that were deemed nonrurgent arrived by ambulance, received diagnostic...

Improving the Lives of Fragile Newborns: What Does Nursing Have to Offer?

Issue Brief
Eileen Lake, PhD, RN
Apr. 25, 2016

This Issue Brief summarizes evidence of nursing’s effects on NICU outcomes and recommends policies to bolster and support nursing practice in NICUs. Adequate staffing and a supportive work environment are associated with better outcomes for very low birth weight infants.

The Nursing Home Compare Report Card: Perceptions of Residents and Caregivers Regarding Quality Ratings and Nursing Home Choice

Apr. 19, 2016

Marilyn Schapira, Judy Shea, Katia Duey, Carly Kleiman, Rachel Werner

In Health Services Research, Marilyn Schapira and colleagues, including Judy Shea and Rachel Werner, evaluate the perceived usefulness of publicly reported nursing home quality indicators. Shapira and colleagues interviewed a sample of individuals or family members recently admitted to or anticipating admission to a nursing home. Participants were asked about the understandability and relevance of information on the Nursing Home Compare website, which includes star ratings, clinical quality measures, and benchmarking of individual nursing home quality with state and national data...