Chart of the Day: Nurse Practitioners in Primary Care
A new study in Health Affairs by Hilary Barnes, Matthew McHugh, and colleagues, demonstrates the increasingly important role nurse practitioners (NPs) have in primary care in the United States.
Yelp Reviews and Opioids
Researchers are discovering that social media offers a window into the lived experience of patients and their caregivers. Using Yelp reviews about US hospitals, our team at Penn’s Center for Health Care Innovation attempted to give voice to these experiences related to pain management and opioids during recent hospital visits.
Moving Beyond Duty-Hours
If you want to start an intense debate within the medical community, just talk about duty-hours – the length of a physician-in-training’s shift.
Physician-Level Variation in Outcomes of Mechanically Ventilated Patients
Meeta Prasad Kerlin, Andrew Epstein, Jeremy M. Kahn, Theodore J. Iwashyna, ...
Abstract [from journal]
Rationale: Physicians are increasingly being held accountable for patient outcomes, yet their specific contribution to the outcomes remains uncertain....
Education Outcomes in a Duty-Hour Flexibility Trial in Internal Medicine
Sanjay V. Desai, David A. Asch, Lisa M. Bellini, Krisda H. Chaiyachati, Manqing Liu, Alice L. Sternberg, James Tonascia, Alyssa...
Abstract [from journal]
Background
Concern persists that inflexible duty-hour rules in medical residency programs may adversely affect the training of physicians.
Methods
We randomly assigned 63 internal medicine residency programs in the United States to be governed by standard duty-hour policies of the 2011 Accreditation Council for Graduate Medical Education (ACGME) or by more flexible policies that did not specify limits on shift length or mandatory time off...
Video Excerpt: Ingrid Nembhard - Testing a New Role for Nurses as Care Coordinators
Video Excerpt: Matthew Press - Anatomy of a Care Coordination Case
Video Excerpt: Karen Lasater on Improving End-of-Life Care
Exploring Opportunities to Prevent Cirrhosis Admissions in the Emergency Department: A Multicenter Multidisciplinary Survey
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...
Pennsylvania Declares a State of Emergency for the Opioid Epidemic
Last week Pennsylvania became the sixth state in the country to declare a state of emergency for the heroin and opioid epidemic. With over 4,600 drug overdose deaths in 2016 alone, and over 5,000 deaths estimated for 2017, this declaration comes at a critical time for Pennsylvanians.
When Physicians Support Financial Penalties to Reduce Low-Value Care (and When They Don’t)
Despite professional consensus, guidelines, and national campaigns, physicians continue to provide many low-value services. These services are defined as having little to no benefit, little benefit relative to their cost, or outsized potential harm compared to their benefit. Policies have tried to promote high-value care by altering physician compensation, but have had limited success in part because they are rarely based on theories of physician behavior.
Physicians and Advanced Practitioners Specializing in Nursing Home Care, 2012-2015
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.
What Every Graduating Resident Needs to Know About Quality Improvement and Patient Safety: A Content Analysis of 26 Sets of ACGME Milestones
Meghan Lane-Fall, Joshua J. Davis, Justin Clapp, Jennifer S. Myers, Lee Ann Riesenberg
In the Journal of the Association of American Medical Colleges, Meghan Lane-Fall and colleagues analyze milestones – competency-based outcomes assessing graduate medical trainees – across 26 specialties to identify common expectations related to quality improvement (QI) and patient safety (PS). The purpose of this work is to move toward a consensus around what every medical trainee needs to know in QI and PS, irrespective of specialty.
The authors performed a content analysis of 612 published milestones from the Accreditation Council for Graduate Medical Education (ACGME)....
Changing Antibiotic Prescribing in a Primary Care Network: The Role of Readiness to Change and Group Dynamics in Success
Suratha Elango, Julia E. Szymczak, Ian M. Bennett, Rinad S. Beidas, Rachel M. Werner
In the American Journal of Medical Quality, Suratha Elango and colleagues, including Rinad Beidas and Rachel Werner, studied factors important to combating overuse of broad-spectrum antibiotics in outpatient pediatric practices. Primary care clinics in the Children’s Hospital of Philadelphia network completed surveys and then semi-structured interviews on barriers and facilitators to improving their antibiotic prescribing practices, perceptions and reactions to the initiative, and the climate surrounding its implementation.
Practices with a high willingness...