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.

Health Systems and Social Determinants

Dec. 1, 2016

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.

Recurrent Violent Injury: Magnitude, Risk Factors and Opportunities For Intervention From a Statewide Analysis

Research Brief
Oct. 24, 2016

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. 

Emergency Department Length-Of-Stay For Psychiatric Visits Was Significantly Longer Than For Nonpsychiatric Visits, 2002–11

Sep. 22, 2016

Jane M. Zhu, Astha Singhal, Renee Hsia

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

Sep. 19, 2016

Anna U. Morgan, David T. Grande, Tamala Carter, Judith A. Long, Shreya Kangovi

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...

Pennsylvania Launches its Prescription Drug Monitoring Program

Aug. 25, 2016

Prescribers are drawing a lot of attention as a key target of initiatives to combat the opioid crisis. This week, the US Surgeon General, Vivek Murthy, took the unprecedented step of sending 2.3 million clinicians a letter calling for a national movement to turn the tide on the opioid crisis.

Adoption of a portal for the primary care management of pediatric asthma: a mixed method implementation study

Aug. 19, 2016

Alexander G. Fiks ; Nathalie Du Rivage ; Stephanie L. Mayne ; Stacia Finch ; Michelle E. Ross ; Kelli Giacomini ; Andrew Suh ; Banita McCarn ; Elias Brandt ; Dean Karavite ; Elizabeth W. Staton ; Laura P. Shone ; Valerie McGoldrick ; Kathleen Noonan ; Dorothy...

In the Journal of Medical Internet Research, LDI Senior Fellows Alexander Fiks and Kathleen Noonan and colleagues evaluate the feasibility of using a patient portal for pediatric asthma in primary care, its impact on management and the barriers and facilitators of implementation success. Patient portals improve communication between families of children with asthma and their primary care providers as well as outcomes. This mixed-methods multi-site (11 states) study used 10 clinician focus groups, 22 semi-structured parent interviews and surveys that were sent to the parents...

Shared Decision Making and Treatment Decisions for Young Children with Autism Spectrum Disorder

Aug. 19, 2016

Susan E. Levy, Rosemary Frasso, Stephanie Colantonio, Hayley Reed, Gail Stein, Frances K. Barg, David S. Mandell, Alexander G. Fiks

In Academic Pediatrics, Susan Levy and colleagues including Rosemary Frasso, David Mandell and Alexander Fiks, examine the barriers to communication and shared decision-making between pediatricians and parents of young children with autism spectrum disorder (ASD). Lack of shared decision-making and communication about management decisions often results in parents’ perception of unmet needs for coordination of care and referral for specialized care. This authors interviewed 20 pediatricians from 10 primary care practices in urban and suburban areas, and 20 English-speaking parents...

States Worse Than Death Among Hospitalized Patients with Serious Illnesses

Aug. 15, 2016

Emily B. Rubin, Anna E. Buehler, Scott D. Halpern

In JAMA Internal Medicine, Emily Rubin and colleagues, including Scott Halpern, investigate how hospitalized patients with serious illnesses evaluate states of cognitive or functional debility relative to death. The authors conducted structured interviews with 180 patients, 60 years and older, who were hospitalized between July 2015 and March 2016 at an academic medical center in Philadelphia. All patients were asked to evaluate health states with specific physical and cognitive debilities, dependencies on forms of life support and dependencies on others to perform various...

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