Payment & Delivery

How insurers and providers are organized and paid to deliver care. Research by LDI Senior Fellows examines the shift from fee-for-service payments to newer models of paying for and delivering value, such as Accountable Care Organizations and Patient-Centered Medical Homes.

Can Social Impact Bonds Deliver For Health?

Nov. 5, 2015

Social impact bonds (SIBs), also known as "pay for success financing," are a relatively new way to attract private investment in public goods and social programs. The potential to draw new revenue streams that can fund programs with significant upfront costs but long-term savings has made these bonds attractive in the health care sector.

A Comparison of 2 Surgical Site Infection Monitoring Systems

Nov. 5, 2015

Mila Ju, Clifford  Ko, Bruce Hall, Charles Bosk, Karl Bilimoria, Elizabeth Wick

In JAMA Surgery, Mila Jiu and colleagues, including Charles Bosk, compare surgical site infection (SSI) monitoring systems, discrepancies in their implementation, and their relationship to infection rates. The researchers compared the National Health and Safety Network (NHSN), which is required by most states, and the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), which is not. The study looks at how the NHSN or ACS NSQIP was implemented in 16 hospitals. It also observes rates of colon SSIs at these same hospitals. The data were collected...

Physician Incentives - Making Performance Measures Meaningful

Oct. 30, 2015

How can we redesign physician incentives to improve their impact on behavior and performance?  Recently, the Commonwealth Fund published a round-up of expert views on reforming physician incentives, and one of the experts was LDI Senior Fellow Amol Navathe, MD, PhD. Navathe, a physician, health economist, and engineer, studies how to apply behavioral economic principles to physician financial and non-financial incentives.

Freelisting on Costs and Value in Health Care by Pediatric Attending Physicians

Oct. 29, 2015

Jennifer Jonas, Eleanor Davies, Shimrit Keddem, Frances Barg, Evan Fieldston 

In Academic Pediatrics, Evan Fieldston and colleagues assessed pediatricians’ perceptions about the concepts of “costs” and “value” as part of curriculum development on the subject. An online survey asked physicians at the Children’s Hospital of Philadelphia to generate a list of words that came to mind when thinking about “costs” and “value” and topics to include in a curriculum. More than 200 physicians generated a list of topics through this freelisting exercise, and those topics were ranked for their salience, or relative importance. The most salient term for the cost prompt,...

Linking social media and medical record data: a study of adults presenting to an academic, urban emergency department

Oct. 15, 2015

Kevin A Padrez, Lyle Ungar, Hansen Schwartz, Robert J Smith, Shawndra Hill, Tadas Antanavicius, Dana Brown,  Patrick Crutchley, David AschRaina Merchant

In BMJ Quality and Safety, Kevin Padrez and colleagues, including David Asch and Raina Merchant, explore the acceptability to patients and potential utility to researchers of a database linking patients’ social media content with their electronic medical record (EMR) data. The authors approached adult Facebook/Twitter users who presented to an emergency department. Many patients were willing to share and link their social media data with EMR data. Patients that shared their social media data were younger, more likely to post at least once a day, and more likely to present to the...

The Impact of Inpatient Palliative Care Consultations on 30-Day Hospital Readmissions

Oct. 5, 2015

Nina O'Connor, Mary Moyer, Maryam Behta, David Casarett

In the Journal of Palliative Medicine, Nina O’Connor, and colleagues, including David Casarett, show that palliative care consults at the Hospital of the University of Pennsylvania facilitate goals discussions which in turn are associated with reduced 30-day readmissions. Of the 35,541 hospitalizations included in the study, 4.1% involved a palliative care consult. After adjusting for propensity score, patients who had a consultation with a palliative care specialist had a lower 30-day readmission rate: 10.3% for palliative care versus 15.0% for usual care. Among all palliative...

Changes in Patient and Nurse Outcomes Associated With Magnet Hospital Recognition

Oct. 1, 2015

Ann Kutney-Lee, Amy Witkoski Stimpfel, Douglas Sloane, Jeannie Cimiotti, Lisa Quinn, Linda Aiken

In Medical Care, Ann Kutney-Lee, Linda Aiken and colleagues analyze patient and nurse outcomes in Magnet and non-Magnet hospitals in order to establish whether there is a causal link between Magnet designation and improved outcomes.  Magnet hospitals are accredited by the American Nurses Credentialing Center for excellence in nursing. The authors analyzed retrospective data for a sample of hospitals in Pennsylvania that attained Magnet recognition between 1999 and 2007 and compared it to hospitals that remained non-Magnet. The outcome measures were surgical 30-day deaths, failure-...

Asking the Patient About Patient-Centered Medical Homes: A Qualitative Analysis

Sep. 21, 2015

Jaya Aysola, Rachel M. Werner, Shimrit Keddem, Richard SoRelle, and Judy A. Shea

In the Journal of General Internal Medicine, Jaya Aysola and colleagues, including Rachel Werner and Judy Shea, assess patients’ perspectives of the patient-centered medical home (PCMH) model and compare responses by degree of practice-level PCMH adoption and patient race/ethnicity. The authors interviewed 48 patients with diabetes and/or hypertension enrolled in PCMHs within the University of Pennsylvania Health System. They purposively sampled minority and non-minority patients from the four highest-ranked and four lowest-ranked PCMH-adopting practices to determine whether...

The Elusive Digital Doctor

Sep. 17, 2015

Along with being Interim Chair of the Department of Medicine at the University of California and ranked by Modern Healthcare as the most influential physician-executive in the U.S., Robert Wachter, MD, is the author of 250 articles and 6 books, the latest of which has become a New York Times Best Seller. Entitled The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine's Computer Age, the book is being hailed across the country as the most compelling one yet written on its subject.

Impact of the Patient-Centered Medical Home on Veterans’ Experience of Care

Sep. 14, 2015

Ashok Reddy, Anne Canamucio, Rachel Werner

In the American Journal of Managed Care, Ashok Reddy and colleagues, including Rachel Werner, assess whether the adoption of patient-centered medical homes improves patient experiences of care. Using a linear probability model they tested whether the adoption of the medical home model is associated with changes in patient experiences of care, looking at primary care sites in one region of the Veterans Health Administration. Despite a significant increase in medical home implementation, the authors find no association between medical home adoption and five domains of patient...

What do patients say about emergency departments in online reviews? A qualitative study

Sep. 14, 2015

Austin S. Kilaru, Zachary F. Meisel, Breah Paciotti, Yoonhee P. Ha, Robert J. Smith, Benjamin L. Ranard, Raina M. Merchant

In BMJ Quality and Safety, Austin Kilaru and colleagues, including Zachary Meisel and Raina Merchant, seek to better understand how patients’ use of web-based tools to reflect on their health care experiences compares with in-patient surveys. They analyzed online reviews for U.S. emergency departments (EDs) posted on the consumer ratings website Yelp. The authors collected reviews describing experiences of ED care for a random sample of 100 U.S. hospitals. They analyzed the content of the reviews against themes from the Hospital Consumer Assessment of Healthcare Providers and...

The Effect of Primary Care Provider Turnover on Patient Experience of Care and Ambulatory Quality of Care

Aug. 27, 2015

Ashok Reddy, Craig E. Pollack, David A. Asch, Anne Canamucio, Rachel M. Werner

In JAMA Internal Medicine, Ashok Reddy and colleagues, including David Asch and Rachel Werner, measure the effect of primary care provider (PCP) turnover on patient experiences of care and ambulatory care quality. For the study, the authors used a nationwide sample of primary care patients in the Veterans Health Administration (VHA). They assessed how many patients experienced PCP turnover and looked at five patient care experience measures and 11 measures of quality of ambulatory care. They find that 9% of patients experienced PCP turnover. Those who’d experienced turnover were...