Comparative Effectiveness Research / PCORI

The analysis of the relative effectiveness of different medical treatments. The Patient-Centered Outcomes Research Institute (PCORI) is a government-sponsored organization set up to fund this analysis.  

The Value of Value Frameworks

Oct. 26, 2017

“Value” is more than a buzzword. In response to rising costs, payers, physicians, and patients have turned to value assessment frameworks to inform treatment plans and design sustainable budgets. However, the usefulness and potential of these tools remain murky. LDI’s 50th anniversary symposium convened a panel to elucidate key questions for the future of value frameworks—what does value mean to different stakeholders in the health care system? How should payers, doctors, and patients appraise the value of the care they receive?

Unicompartmental Knee Arthroplasty Vs. Total Knee Arthroplasty for Medial Compartment Arthritis in Patients Older Than 75 Years: Comparable Reoperation, Revision, and Complication Rates

Jul. 11, 2017

Homayoun Siman, Atul F. Kamath, Nazly Carrillo, William S. Harmsen, Mark W. Pagnano, Rafael J. Sierra

In The Journal of Arthroplasty, Homayoun Siman and colleagues, including Atul Kamath, assess the effectiveness of unicompartmental knee arthroplasty (UKA) vs. total knee arthroplasty (TKA) in similar patients. Prior studies have shown that UKA procedures have advantages over TKA, including preservation of bone stock, shorter and easier recovery, lower overall cost, lower morbidity, better functional outcome, and subjective feeling of a more natural knee. The authors conducted a retrospective review of patients 75 years and older who underwent UKA or TKA over a 10-year period in...

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

Jul. 10, 2017

Linda H. Aiken, Douglas Sloane, Peter Griffiths, Anne Marie Rafferty, Luk Bruyneel, Matthew McHugh, Claudia B. Maier, Teresa Moreno-Casbas, Jane E. Ball, Dietmar Ausserhofer, Walter Sermeus

In BMJ Quality & Safety, Linda Aiken and colleagues, including Matthew McHugh examine the association of hospital nursing skill mix with patient mortality, patient ratings of care, and indicators of quality care among European hospitals. As policymakers around the world seek to reduce health spending, a popular target in Europe has been to transition from more professional nurses to fewer high-cost nurses supported by more lower-wage assistants. The authors analyzed how nursing skill mix affects indicators of quality patient care. The authors utilized cross-sectional patient...

Nurses’ Perceptions of In-Hospital Versus Telephone Availability of an Intensivist at Night in an Intensive Care Unit

Jul. 10, 2017

Emily S. Stanton, Cary Hilbert, Stephanie Maillie, Jessica Dine, Scott D. Halpern, and Meeta Prasad Kerlin

In American Journal of Critical Care, Emily Stanton and colleagues, including Jessica Dine, Scott Halpern, and Meeta Prasad Kerlin, investigate nurses' perceptions about nighttime intensivist staffing. The authors conducted semi-structured interviews of 13 night-shift nurses in an academic medical intensive care unit to elicit perceptions of nighttime staffing with attending intensivists, versus residents with attending intensivists on call remotely. Eight themes emerged from these interviews: efficiency, communication, job place comfort, quality of patient care, procedures,...

Bringing Rounds Back to the Patient: A One-Year Evaluation of the Chiefs’ Service Model for Inpatient Teaching

Jul. 5, 2017

Nadia L. Bennett, Judd D. Flesch, Peter Cronholm, James B. Reilly, Jack Ende

In Academic Medicine, Nadia Bennett and colleagues, including Peter Cronholm and Jack Ende, evaluate the impact of a new approach to inpatient teaching on both patient care and resident education. This model, called the Chiefs’ Service (CS), is a structured approach to inpatient teaching rounds, and has five key elements: morning huddles, bedside rounds, diagnostic “time-outs”, day-of-discharge rounds, and postdischarge follow-up rounds. The authors conducted end-of-rotation evaluation questionnaires among 183 residents after the program’s first year, and compared residents’...

The association between urban tree cover and gun assault: a case-control and case-crossover study

Jun. 30, 2017

Michelle C. Kondo, Eugenia C. South, Charles C. Branas, Therese S. Richmond, Douglas J. Wiebe      

In American Journal of Epidemiology, Michelle Kondo and colleagues, including Eugenia South, Therese Richmond, and Douglas Wiebe, investigate relationships between being in urban green space and experiencing gun violence. The authors conducted interviews with Philadelphia males aged 10-24, including victims of gun violence. They used statistical analyses to compare tree locations with gun assaults. They found that, when participants were under tree cover, they were less likely to experience gun violence. Numerous analyses and comparative models confirmed that being under tree...

Association Between Hospital Participation in a Medicare Bundled Payment Initiative and Payments and Quality Outcomes for Lower Extremity Joint Replacement Episodes

Jun. 29, 2017

Laura A. Dummit, Daver Kahvecioglu, Grecia Marrufo, Rahul Rajkumar, Jaclyn Marshall, Eleonora Tan, Matthew J. Press, Shannon Flood, L. Daniel Muldoon, Qian Gu, Andrea Hassol, David M. Bott, Amy Bassano, Patrick H. Conway

In JAMA, Laura Dummit and colleagues, including Matthew Press, evaluate whether a Centers for Medicare and Medicaid Services (CMS) bundled payment pilot program is associated with a reduction in Medicare payments. Specifically, the authors assess if Bundled Payments for Care Improvement (BPCI) reduced Medicare payments and maintained quality in lower extremity joint replacement. This CMS program was launched in 2013 to test whether linking payments for services provided during an episode of care can reduce Medicare payments and maintain quality. The authors used a difference-in-...

Financial Incentives for Adherence to Hepatitis C Virus Clinical Care and Treatment: A Randomized Trial of Two Strategies

Jun. 29, 2017

David A. Wohl, Andrew G. Allmon, Donna Evon, Christopher Hurt, Sarah Ailleen Reifeis, Harsha Thirumurthy, Becky Straub, Angela Edwards, Katie R. Mollan

In Open Forum Infectious Diseases, David Wohl and colleagues, including Harsha Thirumurthy, assess the feasibility of two strategies for financially incentivizing adherence to Hepatitis C (HCV) care among patients with substance use disorders. Previous research has shown that, although rates of a sustained response to the virus (SVR) surpass 90%, patients experiencing substance use disorders may struggle to adhere to HCV care. The authors randomly assigned participants to either a fixed or lottery-based monetary incentive for attending clinic appointments, adhering to medications...

Association of Provider Specialty and Multidisciplinary Care With Hepatocellular Carcinoma Treatment and Mortality

Jun. 28, 2017

Marina Serper, Tamar H. Taddei, Rajni Mehta, Kathryn D'Addeo, Feng Dei, Ayse Ayatman, Michelle Baytarian, Rena Fox, Kristel Hunt, David S. Goldberg, Adriana Valderrama

In Gastroenterology, Marina Serper and colleagues, including David Goldberg, assess how various health care system factors affect survival rates in hepatocellular carcinoma (HCC). These factors included uptake of historically underutilized curative therapies, access to a hepatologist, and presentation of the case to a multidisciplinary tumor board. The authors found that, while curative treatments of HCC increased survival rates, only 25% of newly diagnosed HCC patients received treatment intended to cure the disease. Additionally, those who received care from only...

Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States

Jun. 22, 2017

Maryam Y. Naim, Rita V. Burke, Bryan F. McNally, Lihai Song, Heather M. Griffis, Robert A. Berg, Kimberly Vellano, David Markenson, Richard N. Bradley, Joseph W. Rossano

In JAMA Pediatrics, Maryam Naim and colleagues, including Joseph Rossano, investigate effects of bystander cardiopulmonary resuscitation (CPR) on pediatric out-of-hospital cardiac arrest. The authors analyze data from the Cardiac Arrest Registry to Enhance Survival, and find that out of 3,900 instances of out-of-hospital cardiac arrests, bystander CPR was provided in 1,814. Children who were treated with either conventional bystander CPR or compression-only CPR had higher survival rates and more favorable neurological outcomes than did those who were not treated with CPR....

Economic evaluation of a behavioral intervention versus brief advice for substance use treatment in pregnant women: results from a randomized controlled trial

Jun. 22, 2017

Xiao Xu, Kimberly A. Yonkers, and Jennifer Prah Ruger

In BMC Pregnancy and Childbirth, Xiao Xu and colleagues, including Jennifer Ruger, assess the economic impact of motivational enhancement therapy and cognitive behavioral therapy (MET-CBT) among substance-using pregnant women. The study was performed alongside a clinical trial that compared the intervention to brief advice about the risks of substance use and found no significant differences in the outcomes such as drug and alcohol use. As such, the authors conducted a cost minimization analysis, from the perspective of the health system. They found that, while the intervention...

A comparative effectiveness education trial for lifestyle health behavior change in African-Americans

Jun. 20, 2017

Chanita Hughes Halbert, Scarlett Bellamy, Vanessa Briggs, Ernestine Delmoor, Joseph Purnell, Rodney Rogers, Benita Weathers, Jerry C. Johnson

In Health Education Research, Chanita Hughes Halbert and colleagues, including Jerry Johnson, compared the effects of an education trial about risk factors for cancer and cardiovascular disease (CVD) within an African-American community. Participants were randomized to receive either integrated education about shared risk factors between cancer and CVD, or disease-specific education about CVD risk factors only. The authors assessed whether the type of education received affected fruit and vegetable intake or physical activity level. They find that when participants with less than...

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