Organization of Healthcare Delivery

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

Sizing Narrow Networks

Jun. 23, 2015

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 Skinny on Narrow Networks in Health Insurance Marketplace Plans

Data Brief
Jun. 23, 2015

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. 

Adoption of Electronic Medical Record-Based Decision Support for Otitis Media in Children

Apr. 1, 2015

Alexander G. Fiks, Peixin Zhang, A. Russell Localio, Saira Khan, Robert W. Grundmeier, Dean J. Karavite, Charles Bailey, Evaline A. Alessandrini, Christopher B. Forrest

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...

Do Integrated Delivery Systems Deliver on Costs and Quality?

Mar. 10, 2015

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.

Optimizing the Patient Handoff Between Emergency Medical Services and the Emergency Department

Mar. 1, 2015

Zachary Meisel, Judy A. Shea, Nicholas J. Peacock, Edward T. Dickinson, Breah Paciotti, Roma Bhatia, Egor Buharin, Carolyn C. Cannuscio

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...

Presentation of Prescription and Nonprescription Opioid Overdoses to U.S. Emergency Departments

Feb. 26, 2015

Michael A. Yokell, M. Kit Delgado, Nicholas D. Zaller, N. Ewen Wang, Samuel K. McGowan, Traci Craig Green

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...

Comprehensive Versus Consultative Rehabilitation Services Postacute Stroke: Outcomes Differ

Feb. 24, 2015

Margaret Stineman, Dawei Xie, Jibby Kurichi, Pui Kwong, W. Bruce Vogel, Diane Cowper Ripley, Barbara Bates

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...

Patient Handoffs: A High-Stakes Game of Telephone

Nov. 20, 2014

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.

Storified! Health Care Reform in 2015

Oct. 11, 2014

We've gathered a collection of live tweets from our joint PennLDI-Wharton Public Policy Institute event held October 9.  Three panels of researchers and policymakers shared results and insights about how the research could help improve implementation of health care reform. 

Sit back, read more, and enjoy the story!

Carrots and Sticks to Reduce Readmissions and Improve Home Health Care

Oct. 1, 2014

The Affordable Care Act has generated carrots and sticks for hospitals to reduce readmissions. With the goal of achieving the Triple Aim (improving quality of patient care, improving population health, and reducing overall cost of care), innovative care delivery models are being tested locally and nationally, including the roll-out of Accountable Care Organizations and bundled payment programs. These programs create incentives in terms of shared savings for health care systems that provide high quality, coordinated care.