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.

Better Nurse Staffing and Nurse Work Environments Associated With Increased Survival of In-Hospital Cardiac Arrest Patients

Feb. 17, 2016

Matthew McHugh, Monica Rochman, Douglas Sloane, Robert Berg, Mary Mancini, Vinay Nadkarni, Raina Merchant, Linda Aiken

In Medical Care, Matthew McHugh and colleagues, including Linda Aiken and Raina Merchant, explore the association between nurse staffing, nurse work environments, and survival rates for in-hospital cardiac arrest (IHCA). Nurses are likely the first responders to IHCA, thus playing a critical role in improving outcomes from these events. Using data from the American Heart Association, the University of Pennsylvania Multi-State Nursing Care and Patient Safety survey, and the American Hospital Association annual survey, the authors modeled the association of nursing features –...

Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care

Feb. 17, 2016

Ezekiel Emanuel, Peter Ubel, Judd Kessler, Ralph Muller, Amol Navathe, Pankaj Patel, Robert Pearl, Meredith Rosenthal, Lee Sacks, Aditi Sen, Paul Sherman, Kevin Volpp

In Annals of Internal Medicine, Ezekiel Emanuel and colleagues, including Judd Kessler, Ralph Muller, Amol Nayathe, and Kevin Volpp, discuss several principles of behavior economics, including inertia, loss aversion, choice overload, and relative social ranking. Designing physician incentives based on behavioral economics principles can improve their effectiveness through better alignment with performance goals. The study includes anecdotal examples of successful incentive programs that apply behavioral economics principles. Though the effectiveness of behavioral economic-based...

Comparison of Site of Death, Health Care Utilization, and Hospital Expenditures for Patients Dying With Cancer in 7 Developed Countries

Feb. 17, 2016

Justin Bekelman, Scott Halpern, Carl Rudolf Blankart, Julie Bynum, Joachim Cohen, Robert Fowler, Stein Kaasa, Lukas Kwietniewski, Hans Olav Melberg, Bregie Onwuteaka-Philipsen, Mariska Oosterveld-Vulg, Andrew Pring, Joans Schreyogg, Connie Ulrich...

In The Journal of the American Medical Association, Justin Bekelman and colleagues, including Scott Halpern, Connie Ulrich and Ezekiel Emanuel compare site of death, health care utilization and hospital expenditures in 7 countries: Belgium, Canada, England, Germany, the Netherlands, Norway and the United States. Using administrative and registry data, the researchers measured deaths in acute care hospital, along with inpatient and outpatient measures, and hospital expenditures paid by insurers. They find that a smaller proportion of decedents, older than 65, died in acute...

Liver transplant center variability in accepting organ offers and its impact on patient survival

Feb. 17, 2016

David Goldberg, Benjamin French, James Lewis, Frank Scott, Ronac Mamtani, Richard Gilroy, Scott Halpern, Peter Abt

In the Journal of Hepatology, David Goldberg and colleagues, including Benjamin French, James Lewis and Scott Halpern, explore whether transplant centers vary in their propensities to decline organs for the highest priority patients, and how these decisions impact patient outcomes. The authors analyzed Organ Procurement and Transplantation Network (OPTN) data from 2007-2013, and evaluated acceptance rates of liver offers for the highest ranked patients and their subsequent waitlist mortality. Even after adjusting for organ quality and recipient severity of illnesses, the study...

Changes in Consumer Demand Following Public Reporting of Summary Quality Ratings: An Evaluation in Nursing Homes

Research Brief
Feb. 16, 2016

A new study by LDI Senior Fellows Rachel Werner and Daniel Polsky and their colleague, R. Tamara Konetzka, find that consumers responded when a nursing home report card converted 12 measures of quality into a simple 5-star system. One-star facilities typically lost 8 percent of their market share and 5-star facilities gained more than 6 percent of their market share. These results support the use of summary measures in report cards.

The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis

Jan. 29, 2016

David Lee, Brendan Carr, Tony Smith, Van Tran, Daniel Polsky, Charles Branas

In Population Health Management, David Lee and colleagues, including Brendan Carr, Daniel Polsky and Charles Branas, test the association of hospital and population characteristics and the effect of nearby hospital closures with increases in emergency department volume. The researchers used data from cost reports and administrative databases to analyze emergency department volume at 192 New York State hospitals from 2004 to 2010. They find an overall increase in emergency department visits, but with wide variation. Emergency volume increased nearly twice as fast at tertiary...

A Qualitative Evaluation of Patient-Perceived Benefits and Barriers to Participation in a Telephone Care Management Program

Jan. 29, 2016

Lindsay Jubelt, Kevin Volpp, Dana Gatto, Joelle Friedman, Judy Shea

In the American Journal of Health Promotion, Lindsay Jubelt and colleagues, including Kevin Volpp and Judy Shea, try to better understand the low participation rate of high-risk individuals in a targeted telephone care management program. Researchers interviewed patients who were recruited to participate in the care management program but had dropped out or never participated despite recruitment efforts. The most commonly cited barriers to participation were a lack of perceived need and a sense of distrust toward the program and its staff. These findings could help care management...

Inpatient Hospital Charge Variability of U.S. Hospitals

Jan. 29, 2016

James Park, Edward Kim, Rachel Werner

In the Journal of General Internal Medicine, James Park and colleagues, including Rachel Werner, describe hospital charge variability in the U.S. and examine its relationship to local health factors. The researchers evaluated 2011 Medicare Inpatient Charge data against 29 county-level measures of health, environmental and socioeconomic status. The authors find no association between any community health measures and hospital charges. However, higher charges were associated with higher rates of uninsured status. The authors conclude that overall, hospital charges lack an...

Are Patients With Cancer Less Willing to Share Their Health Information? Privacy, Sensitivity, and Social Purpose

Jan. 29, 2016

David Grande, David Asch, Fei Wan, Angela Bradbury, Reshma Jagsi, Nandita Mitra

In the Journal of Oncology Practice, David Grande and colleagues, including David Asch and Nandita Mitra, assess patient views on use of health information to build population cancer databases for research and care delivery. Participants with and without cancer were randomly assigned to rate scenarios based on their willingness to share their electronic health information in each scenario. The research finds that participants with and without cancer had a similar willingness to share health information. Both patient groups identified the purpose of information use as the most...

Effect of Financial Incentives to Physicians, Patients, or Both on Lipid Levels: A Randomized Clinical Trial

Research Brief
Jan. 15, 2016

To whom should financial incentives be targeted to achieve a desired clinical or health outcome—physicians or patients? Using insight from behavioral economics, a research team led by LDI Senior Fellows David Asch and Kevin Volpp sought to determine whether physician financial incentives, patient incentives, or shared physician and patient incentives are more effective in promoting medication adherence and reducing cholesterol levels of patients at high risk for cardiovascular disease. Though physician and patient incentives are becoming more common, they are rarely combined, and effectiveness of these approaches is not well-established. This study offers insight into what incentive structure leads to the greatest impact on health promotion. 

Hospice Care in Assisted Living Facilities Versus at Home: Results of a Multisite Cohort Study

Jan. 11, 2016

Meredith Dougherty, Pamela Harris, Joan Teno, Amy Corcoran, Cindy Douglas, Jackie Nelson, Deborah Way, Joan Harrold, David Casarett

In the Journal of the American Geriatrics Society, Meredith Dougherty and colleagues, including David Casarett, compare residents of assisted living facilities receiving hospice with people receiving hospice care at home. The researchers conducted an electronic health record-based retrospective cohort study to compare the difference in the two groups’ length of stay in hospice, use of opioids for pain, and site of death. The authors find the assisted living population was more likely than the home hospice population to have a diagnosis of dementia (23.5% vs 4.7%) and enroll in...