Medicaid Expansion & Colorectal Surgery
As the remaining non-expansion states consider expanding Medicaid eligibility, a new study offers encouraging evidence that Medicaid patients’ access to surgical care can be maintained even when enrollment surges.
Rachel Werner Interviews OptumHealth CEO about COVID-19, Value-based Payment, and Health Equity
Does Collective Bargaining by Physicians Hurt Consumers?
Prices for health care services are a function of negotiations between insurers and providers—and both sides are always trying to gain advantages.
Expanding Scope of Practice After COVID-19
To expand access to health care during the COVID-19 pandemic, many states relaxed or waived regulations that define the scope of health professional practice. This experience highlights the need to ensure that all health care professionals practice to the full extent of their capabilities—an issue that predates and will outlast the pandemic. In a virtual conference on November 20, 2020, Penn LDI and Penn Nursing brought together experts in law, economics, nursing, medicine, and dentistry to discuss current gaps in health professional scope of practice, what we have learned from COVID-19, and how to rethink scope of practice to better meet community and public health needs.
Post-Acute Stays in Skilled Nursing Facilities: Patient Experiences
What kind of care do patients expect after they are discharged from a hospital to a skilled nursing facility (SNF)? And how do those expectations align with care they actually receive from physicians and advanced practitioners? We know surprisingly little about the patient care experience in these post-acute settings, even though 1.5 million people in the U.S. are discharged to them each year. One fourth of those people die or are readmitted to the hospital within 30 days.
Bringing Gynecologic Cancer Care Closer to Patients
For patients with gynecologic cancers, treatment by a specialist—a gynecologic oncologist—is crucial for improving chances of survival. However, in 2015, as many as 10% of women in the U.S. lived in a county that was more than 50 miles from the closest gynecologic oncologist.
Clarifying the Role of the Modern General Surgeon: The Effect of Specialization on Inpatient Practice Patterns in General Surgery
Catherine L. Mavroudis, Christopher Wirtalla, Jason Tong, Ezra S. Brooks, Cary B. Aarons, Rachel R. Kelz
Abstract [from journal]
Objective: The growing concentration of fellowship-trained and integrated residency-trained subspecialty surgeons has encroached on the breadth and volume of a so-called "true" general surgery practice, leaving the role of new general surgeons in flux. We aimed to describe the surgical practice of new general surgeons with and without subspecialty fellowship training.
Design: In this retrospective cohort study, state discharge data was linked to American Medical Association Masterfile and
...Choice Architecture in Physician-Patient Communication: A Mixed-Methods Assessments of Physicians’ Competency
Joanna Hart, Kuldeep Yadav, Stephanie Szymanski, Amy Summer, Aaron Tannenbaum, Julian Zlatev, David Daniels, Scott D. Halpern
Abstract [from journal]
Background: Clinicians' use of choice architecture, or how they present options, systematically influences the choices made by patients and their surrogate decision makers. However, clinicians may incompletely understand this influence.
Objective: To assess physicians' abilities to predict how common choice frames influence people's choices.
Methods: We conducted a prospective mixed-methods study using a scenario-based competency questionnaire and semistructured
...Interprofessional Training and Communication Practices Among Clinicians in the Postoperative ICU Handoff
Scott Massa, Jasmine Wu, Cecilia Wang, Hannah Peifer, Meghan B. Lane-Fall
Abstract [from journal]
Background: Operating room (OR)-to-ICU handoffs require coordinated communication between clinicians with different professional backgrounds. However, individual studies have not simultaneously evaluated handoff training and OR-to-ICU handoff practices among interprofessional clinicians that participate in these team-based handoffs.
Methods: The objective of this study was to characterize communication training, practices, and preferences of interprofessional clinicians who engage in OR-to-ICU
...Duty Hour Reform and the Outcomes of Patients Treated by New Surgeons
Despite concerns that duty hour reform might adversely affect the performance of new surgeons, this national study found no impact on patient outcomes, including 30-day mortality rates, failure-to-rescue, length of stay, and use of intensive care units. These findings should allay fears that reduced work hours during residency would produce surgeons less prepared for practice than their more experienced colleagues.
Prevalence and Geographic Distribution of Obstetrician-Gynecologists Who Treat Medicaid Enrollees and Are Trained To Prescribe Buprenorphine
Max Jordan Nguemeni Tiako, Jennifer Culhane, Eugenia South, Sindhu K. Srinivas, Zachary F. Meisel
Abstract [from journal]
Importance: The incidence of opioid use during pregnancy is increasing, and drug overdoses are a leading cause of postpartum mortality. Most women who are pregnant do not receive medications for treatment of opioid use disorder, despite the mortality benefit that these agents confer. Furthermore, buprenorphine is associated with milder symptoms of neonatal abstinence syndrome (NAS) compared with methadone.
Objective: To describe the prevalence and geographic distribution
Scope of Practice Restrictions and Vulnerable Populations
Are There Enough Experienced Physicians to Treat Patients Hospitalized With COVID?
In this national study of 438,895 physicians, 45% provided care to hospitalized patients and 7% provided critical care. At the high estimate of patients requiring hospitalization at the projected peak of the pandemic, 18 states and Washington, DC would have patient to physician ratios greater than 15:1 (a level associated with poor outcomes among hospitalized patients). There was considerable geographic variation in the availability of physicians: 41% of hospital service areas did not have a physician with critical care experience.
How Machine Learning-Based Nudges Can Improve Cancer Care
For patients with cancer, serious illness conversations (SICs)—structured conversations about prognosis, goals, and wishes—can reduce depression and anxiety, improve quality of life, and avoid unnecessary acute care utilization.
Hospital and ICU Patient Volume per Physician at Peak of COVID Pandemic: State-Level Estimates
Anjali Bhatla, Kira L. Ryskina
Abstract [from journal]
Background: In anticipation of patient surge due to COVID-19, many states are working to increase the available healthcare workforce. To help inform state policies and initiatives aimed at physician deployment during COVID-19, we used predictions of peak patient volume for hospitals and intensive care units (ICU) and regional physician workforce estimates to measure patient to physician ratios at the peak of the pandemic for each state.
Methods: We
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