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.

The Association Between Obesity and Disability in Survivors of Joint Surgery: Analysis of the Health and Retirement Study

Feb. 28, 2018

Abstract [from journal]

Background
Obesity is associated with osteoarthritis and the need for joint surgery. Obese patients who undergo joint surgery may have a higher risk of morbidity compared with normal or overweight patients but less is known about their risk of postoperative disability. The primary objective of our study was to determine the association between obesity and the development of new dependence in activities of daily living within 2 years after joint surgery.

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Exploring Opportunities to Prevent Cirrhosis Admissions in the Emergency Department: A Multicenter Multidisciplinary Survey

Feb. 21, 2018

Shazia Mehmood Siddique, Meghan Lane-Fall, Matthew J. McConnell, Neha Jakhete, James Crismale, Stefanie...

In Hepatology Communications, Shazia Mehmood Siddique and colleagues investigate nonmedical factors that influence inpatient admission for patients with cirrhosis who present to the emergency department. They also explore provider perspectives on patients presenting to the emergency department with low-acuity conditions, such as ascites and hepatic encephalopathy. The authors survey emergency medicine and hepatology providers, including attending physicians, house staff, and advanced practitioners, in four liver transplant centers.

From the 186 responses analyzed, they...

Integrating Social Needs Into Health Care: A Twenty-Year Case Study Of Adaptation And Diffusion

Feb. 14, 2018

Rebecca D. Onie, Risa Lavizzo-Mourey, Thomas H. Lee, James S. Marks, and Rocco J. Perla

In Health Affairs, Rebecca Onie and colleagues, including Risa Lavizzo-Mourey, conduct a twenty-year qualitative case study of Health Leads, an organization that partners with health care institutions and communities to address patients’ basic resource needs, and its funders. The case study demonstrates the successful stages of diffusion, defined as the process by which an innovation is communicated over time within a social system, leading to increased exposure and adoption. The authors segmented the process for Health Leads into five distinct phases:

  1. Testing and
  2. ...

The Use of Individual Provider Performance Reports by US Hospitals

Feb. 13, 2018

In the Journal of Hospital Medicine, Joshua Rolnick and Kira Ryskina analyze trends in how hospitals use the electronic health record to track and provide feedback on provider performance. The authors use data from a nationally representative survey of US hospitals from 2013 to 2015 to identify hospitals that have used electronic data to create individual provider performance profiles (IPPs). They model how the odds of IPP use differ as a function of hospital characteristics, including ownership (non-profit, for-profit, or government), geographic region, teaching versus...

Association of Rideshare-Based Transportation Services and Missed Primary Care Appointments: A Clinical Trial

Research Brief
Feb. 7, 2018

In a pragmatic trial, offering complimentary ridesharing services broadly to Medicaid patients did not reduce rates of missed primary care appointments. The uptake of free rides was low, and rates of missed appointments remained unchanged at 36%. Efforts to reduce missed appointments due to transportation barriers may require more targeted approaches.

Infants in Drug Withdrawal: A National Description of Nurse Workload, Infant Acuity, and Parental Needs

Feb. 1, 2018

Jessica G. Smith, Jeannette A. Rogowski, Kathryn M. Schoenauer, ...

In the Journal of Perinatal and Neonatal Nursing, Jessica Smith and colleagues, including Jeannette Rogowski and Eileen Lake, investigate how infants in drug withdrawal compare with nondrug withdrawal infants to inform proper nurse assignments based on infant acuity and parental needs. Though not commonly recognized, a troubling aspect of the opioid epidemic is increased drug use among pregnant women, which has led to an increase in infants who are...

Association between Electronic Medical Record Implementation of Default Opioid Prescription Quantities and Prescribing Behavior in Two Emergency Departments

Research Brief
Kit Delgado, MD, MS
Jan. 30, 2018

Setting a low quantity of opioid tablets as the default option in electronic medical record prescribing orders may “nudge” clinicians to prescribe fewer opioids. When two emergency departments implemented a 10-tablet default instead of a manual entry, the proportion of 10-tablet prescriptions written more than doubled, from 20.6% to 43.3%. Conversely, 20-tablet prescriptions decreased from 22.8% to 16.1%, and prescriptions for 11-19 tablets decreased from 33.5% to 20.1%. 

New OECD Report Highlights Expanded Primary Care Role for Nurses

Jan. 9, 2018

To meet population health care needs in developed countries, health systems must shift their focus from treating acute episodes to managing chronic conditions. With the rise of chronic care comes a new set of tasks that are more time-consuming and team-oriented. Policymakers in many countries are seeking to align the size and composition of their primary care workforce to meet these new needs, by expanding the role of advanced nurses.

Physicians and Advanced Practitioners Specializing in Nursing Home Care, 2012-2015

Research Brief
Nov. 29, 2017

The number of clinicians specializing in nursing home care increased by 33.7% from 2012 to 2015, although nursing home specialists made up only 21% of nursing home clinicians in 2015. Most of these specialists were advanced practitioners (physician assistants and nurse practitioners) delivering post-acute care. The change in number of nursing home specialists varied significantly by geographic region.

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