Cross-posted with US News
Cross-posted with the Field Clinic blog
Over the past two years, one of the top health care priorities in Philadelphia has been getting people signed up for health insurance. That is still a huge, unfinished task, but alongside it we need to make sure we have enough doctors in the right places to deliver care. For health care reform to deliver on its promise, people need good access to primary care.
Recently we’ve noticed a great deal of emerging research evidence and analysis on provider consolidation and integrated care. An abundance of riches! Here we’ve pulled out the angles of the different analyses and brought together key resources.
Update May 2015
Depending on your neighborhood in Philadelphia, you may face a 10-fold difference in the supply of primary care practices located close to your home. This is the finding of a new study commissioned by the Philadelphia Department of Public Health and conducted by a research team that I headed.
In 1997, the consultant Tom Peters proclaimed in his book The Circle of Innovation “the system is the solution”. Fifteen years later, Peters recanted, stating “systems have their place: SECOND place.” What was now more important was leadership and culture.
At the same time (roughly, 1993-2015), hospital executives have been busy building bigger hospital chains that aggregate freestanding facilities and smaller systems. The promise has always been economies of scale and lower-cost operations that justify their growing market power and reduced competition.
Understanding Low-Income African American Women's Expectations, Preferences, and Priorities in Prenatal Care
In Family and Community Health, Judy Shea and colleagues seek to better understand low-income African-American women’s views on prenatal care. The analysis is the result a focus group study using a community-based participatory research framework. Shea and colleagues find that that friends/family and the baby’s health were the top factors that encouraged prenatal care attendance. Barriers to getting prenatal care included insurance, transportation, and ambivalence as to its importance. Facilitators included transportation services, social support, and education about available resources....
In the Journal of Ambulatory Care Management, Shreya Kangovi and colleagues, including Judith Long and David Grande, analyze patient and primary care practice staff perceptions of patient-centered medical homes (PCMH). Through a multi-state qualitative survey, the authors explore areas of agreement and tension between the perceptions of chronically ill, low-income patients and their primary care practice staff on PCMH principles and implementation strategies. PCMH are a team-based delivery model that emphasize continuity of care and health outcomes. Kangovi and colleagues’ conclude some...
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.
In the Journal of Nursing Administration, Linda Aiken and Penn colleagues from the Center for Health Outcomes and Policy Research (CHOPR) examine whether the use of supplemental registered nurses (SRNs), temporary nurses often used by hospitals to alleviate staffing shortages, has an impact on overall patient satisfaction. Using survey data from nurses and patients, they found little evidence that temporary nurses affect patient satisfaction with the hospital or with nursing care in particular. After other hospital and nursing characteristics were controlled, greater use of SRNs was not...
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...