We recently convened an expert roundtable to tackle how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable. This got us thinking - while the process by which ineffective practices or technologies are abandoned is neither simple nor automatic, even the language used to describe it is not clear. And language matters. It often reflects an unstated focus on one mechanism or one level of decision-making. Here we review, and potentially clarify, the terminology.
This is the way it is supposed to work. You develop policy and processes to drive innovation. You design and test innovative ideas in a small, efficient way. You learn and adapt. Successful innovation drives new policy. Rinse and repeat.
And this is the way it appears to have worked, in the case of Medicare bundled payment. Start small with a pilot. Expand in reach and scope if promising. Scale up if successful.
Evidence on the effects of bundled payment is more important than ever, while hospitals already in Medicare bundled payment programs need guidance in redesigning care. This observational study looks at whether bundled payment for joint replacement affected quality, hospital costs and post-acute care spending in a health system that was an early adopter of the model. Did the bundles save money, and if so, what produced those savings?
The election of Donald Trump has ushered in an uncertain future for the Affordable Care Act (ACA), from modification to total repeal. While many policy experts are concerned about people losing the coverage they gained through the ACA, other aspects of the ACA are also under threat: specifically, provisions that address the social determinants of health.
Last week the Surgeon General, Dr. Vivek Murthy, released the groundbreaking, comprehensive report Facing Addiction in American: The Surgeon General’s Report on Alcohol, Drugs, and Health. The report comes at a critical juncture, with more than 27 million Americans misusing illicit and prescription drugs, and more than 66 million misusing alcohol.
The notion of value is at once one of the most widely invoked and variably interpreted in American health care.
Recurrent Violent Injury: Magnitude, Risk Factors and Opportunities For Intervention From a Statewide Analysis
Recurrent injury is a promising target for prevention, as prior injury is a strong predictor of future violent injury and death. But the incidence of recurrent violent injury, on an area-wide level, is unknown, and the risk factors contributing to it are not well understood.
[cross-posted from the Health Cents blog on philly.com]
Emergency Department Length-Of-Stay For Psychiatric Visits Was Significantly Longer Than For Nonpsychiatric Visits, 2002–11
In Health Affairs, Jane Zhu and colleagues investigate wait times and discharge outcomes among psychiatric patients in the emergency department (ED). This study is a retrospective comparison of more than 230,000 psychiatric and non-psychiatric visits across 350-400 US EDs between 2002 and 2011. They analyzed length-of-stay (a standard measure of ED crowding and access to services) as well as rates of admissions, discharges, and transfers. Length-of-stay was defined as the difference between the time of triage and time of departure from the ED for a given patient. Patients seen in...
Penn Center for Community Health Workers: Step-by-Step Approach to Sustain an Evidence-Based Community Health Worker Intervention at an Academic Medical Center
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...