Healthcare-The Journal of Delivery Science and Innovation最新文献

{"title":"Finding representation for the unrepresented patient: Creating a volunteer health care agent matching program in Massachusetts","authors":"David N. Sontag ,&nbsp;Amy Hudspeth Cabell ,&nbsp;Stephanie H. Chan ,&nbsp;Jane Kavanagh ,&nbsp;Anna Gosline ,&nbsp;Rachel Russo","doi":"10.1016/j.hjdsi.2025.100769","DOIUrl":"10.1016/j.hjdsi.2025.100769","url":null,"abstract":"<div><div>A foundational principle of health care is patient autonomy – respecting an individual's right to control what happens to their body, including what care they do and do not receive. That right is not lost when an individual loses the ability to speak for themselves or make reasoned decisions. One way to ensure health care decision-making aligns with a patient's wishes is for an individual to appoint a health care agent (HCA) to make decisions on their behalf if they are unable to. However, some people are ‘unrepresented’, meaning they do not have anyone to appoint. Lack of an HCA can result in delays in care, care that does not reflect a patient's wishes, and avoidable costs to the health care system. Strategies to address this have largely focused on courts appointing a guardian after an individual has lost decision-making capacity-a lengthy process that often exacerbates delays and, most importantly, does not result in a decision-maker who knows the individual's priorities and preferences. To address this challenge, four Massachusetts organizations developed a volunteer HCA program matching employees of each organization as HCAs for ‘unrepresented’ individuals receiving care at the other organizations. This model shows promise as an approach to ensure individuals can choose their HCA and personally communicate their priorities and preferences to them. Additionally, training volunteers as HCAs for strangers and learning from their experiences may offer insights into how everyone can be better at these conversations and representing the choices of others - especially with people close to them.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 2","pages":"Article 100769"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced obstetric training to address maternity care workforce shortages in tribal, rural, and underserved communities: a case from Oklahoma","authors":"Elizabeth Charron ,&nbsp;Guimy Castor ,&nbsp;Carrigan P. Veach ,&nbsp;Renda Chubb ,&nbsp;Blake J. Lesselroth ,&nbsp;Viviane Elisabeth de Souza Santos Sachs ,&nbsp;Morgan Richards ,&nbsp;C. Michele Markey ,&nbsp;Juliana Fernandes Filgueiras Meireles ,&nbsp;Lamont E. Cavanagh ,&nbsp;Erin Jorgensen ,&nbsp;Jameca Price ,&nbsp;Karen P. Gold","doi":"10.1016/j.hjdsi.2025.100768","DOIUrl":"10.1016/j.hjdsi.2025.100768","url":null,"abstract":"<div><div>The United States is facing a shortage of pregnancy care providers, especially in tribal, rural, and underserved (TRU) communities. In Oklahoma, more than half of the state's counties are considered maternity care deserts that lack obstetric (OB) providers or services. Limited access to pregnancy care in Oklahoma's TRU areas contributes to the state's high rates of maternal morbidity and mortality. Family medicine (FM) physicians receive basic OB training during residency and are often the only providers delivering pregnancy care for geographically isolated and socially vulnerable populations in these counties. In 2021, the University of Oklahoma School of Community Medicine launched an enhanced OB training curriculum for FM residents to help address workforce shortages in Oklahoma's TRU communities. This article describes the design and implementation of the enhanced training curriculum, summarizes results from the first 2 years of implementation, and shares lessons learned for the field.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 2","pages":"Article 100768"},"PeriodicalIF":2.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between mental health professional shortages and depression and anxiety visits: a cohort study of Federally Qualified Health Centers, 2019–2022","authors":"Ann Annis ,&nbsp;Brenden Smith ,&nbsp;Wenjuan Ma ,&nbsp;Dawn Goldstein","doi":"10.1016/j.hjdsi.2025.100767","DOIUrl":"10.1016/j.hjdsi.2025.100767","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 2","pages":"Article 100767"},"PeriodicalIF":2.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming latent tuberculosis infection (LTBI) testing and treatment at a federally qualified health center","authors":"Ranjani K. Paradise ,&nbsp;Carolyn Fisher ,&nbsp;Hanna H. Haptu ,&nbsp;Deborah McManus ,&nbsp;Jennifer Cochran","doi":"10.1016/j.hjdsi.2025.100766","DOIUrl":"10.1016/j.hjdsi.2025.100766","url":null,"abstract":"<div><div><ul><li><span>•</span><span><div>The Massachusetts Department of Public Health partnered with Lynn Community Health Center (LCHC) to scale up testing and treatment for latent tuberculosis infection (LTBI) for a non-US born patient population. The project team developed a workflow to manage patients through the LTBI care cascade with screening performed in primary care and diagnostic testing, evaluation, and treatment undertaken by a TB team within the health center. To support the clinical workflow, the team implemented process improvements, addressed access barriers, and made electronic health record (EHR) enhancements.</div></span></li><li><span>•</span><span><div>LCHC successfully increased LTBI testing and treatment for non-US born patients, while sustaining engagement through the care cascade.</div></span></li><li><span>•</span><span><div>Strategic distribution of responsibilities, attention to process refinement, EHR enhancements, and collaboration with public health experts helped make the scale-up possible.</div></span></li><li><span>•</span><span><div>Three core factors kept patients more engaged, minimized gaps in treatment, and alleviated burdens associated with LTBI treatment: 1) flexibility with scheduling visits, 2) focus on building trusting, supportive relationships between care providers and patients, and 3) consistent outreach, reminders, and follow-up with patients on treatment.</div></span></li><li><span>•</span><span><div>Maintaining high testing and treatment volumes requires consistent effort, sustained attention, and staffing continuity.</div></span></li></ul></div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 2","pages":"Article 100766"},"PeriodicalIF":2.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring prescriptions dispensed from urgent care through the VA community care benefit","authors":"Alexis K. Barrett ,&nbsp;John P. Cashy ,&nbsp;John Roehm ,&nbsp;Xinhua Zhao ,&nbsp;Maria K. Mor ,&nbsp;Katie J. Suda ,&nbsp;Chester B. Good ,&nbsp;Shari S. Rogal ,&nbsp;Kelvin A. Tran ,&nbsp;Jennifer A. Hale ,&nbsp;Ron Nosek ,&nbsp;Carolyn T. Thorpe ,&nbsp;Francesca Cunningham ,&nbsp;Michael J. Fine ,&nbsp;Walid F. Gellad","doi":"10.1016/j.hjdsi.2025.100765","DOIUrl":"10.1016/j.hjdsi.2025.100765","url":null,"abstract":"<div><h3>Background</h3><div>The Department of Veterans Affairs (VA) now offers eligible Veterans an urgent care benefit covering visits and 14-day prescriptions outside of VA. Prescriptions written and dispensed outside VA lack the clinical decision support of VA-issued prescriptions, raising concerns about safety and polypharmacy. To date, there has been limited analyses of prescribing patterns through the urgent care benefit.</div></div><div><h3>Methods</h3><div>We used a repeated cross-sectional design to examine Veterans who filled non-VA urgent care prescriptions from 07/30/2019 to 03/20/2023. Data were sourced from the Community Care Reimbursement System (CCRS), which tracks all VA-paid medications dispensed by non-VA pharmacies. We identified potentially noncompliant prescriptions as those not meeting VA urgent care benefit restrictions. We also identified prescriptions continued in VA as a “new VA medication” after 30-days from the urgent care fill.</div></div><div><h3>Results</h3><div>Overall, 83,862 Veterans received 271,476 non-VA urgent care prescriptions. Veterans’ average age was 55.9, with 79.3 % male, 73.0 % White, 86.7 % non-Hispanic, and 41.4 % rural dwelling. Urgent care use increased from 341 prescription fills in March 2020 to 9738 in January 2023. Frequently filled prescriptions included antimicrobials (n = 114,492, 42.2 %) and hormones/synthetics/modifiers, like steroids (n = 44,457, 16.4 %). Potentially noncompliant prescriptions accounted for 9.3 %, with 6.7 % not on the urgent/emergent formulary and 2.6 % supplied for over 14 days. Over 70,704 (26.0 %) prescriptions were continued in VA post-urgent care visit, of which 15 % had no prior VA fill (i.e., new VA medication). Veterans with new continued VA prescriptions were more likely to be male (79.4 % vs. 73.9 %) and from urban areas (59.3 % vs. 57.5 %) (All P &lt; .001).</div></div><div><h3>Conclusions</h3><div>Veterans increasingly received non-VA prescriptions through urgent care centers in the community from 2019 to 2023, including drug classes of interest to VA due to potential risks of inappropriate prescribing (e.g., steroids) or drug interactions (e.g., antibiotics). The CCRS database can be integrated with other VA databases as a quality improvement tool to improve care coordination and drug safety.</div></div><div><h3>Implications</h3><div>This evaluation highlights the need for improved clinical decision support for non-VA prescriptions and demonstrates the potential of integrated data systems to monitor and enhance medication safety and coordination within VA.</div></div><div><h3>Level of evidence</h3><div>Cross-sectional analysis of national VA data.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 2","pages":"Article 100765"},"PeriodicalIF":2.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical decision support amidst a global pandemic: Value of near real-time feedback in advancing appropriate post-discharge opioid prescribing for surgical patients","authors":"Brendin R. Beaulieu-Jones ,&nbsp;Margaret T. Berrigan ,&nbsp;Jayson S. Marwaha ,&nbsp;Chris J. Kennedy ,&nbsp;Kortney A. Robinson ,&nbsp;Larry A. Nathanson ,&nbsp;Charles H. Cook ,&nbsp;Jordan D. Bohnen ,&nbsp;Gabriel A. Brat","doi":"10.1016/j.hjdsi.2025.100764","DOIUrl":"10.1016/j.hjdsi.2025.100764","url":null,"abstract":"<div><h3>Implementation lessons</h3><div>Non-evidence based factors influence post-surgical opioid prescribing practices. Delivering automated near real-time opioid prescribing feedback may encourage providers to prescribe opioid quantities which are more aligned with patient consumption and institutional guidelines.</div><div>COVID-19 presented unprecedented challenges to healthcare delivery. We observed a substantial deviation in guideline-concordant opioids prescribing during the initial outbreak. However, our institution's pre-existing opioid prescribing feedback system and decision aid may have helped limit the duration and magnitude of the observed deviations by informing prescribers of atypically large opioid prescriptions and encouraging use of institutional data.</div><div>Combined with provider education, a non-directive decision aid, in the form of near, real-time email feedback, may be an effective mechanism to advance evidence-based opioid prescribing, as it retains flexibility and provider autonomy while encouraging data-driven decision making.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 1","pages":"Article 100764"},"PeriodicalIF":2.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144071498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One cutoff is not enough: Assessing different area deprivation index cutoffs for insurance types on surgical Desirability of Outcome Ranking (DOOR)","authors":"Susanne Schmidt ,&nbsp;Michael A. Jacobs ,&nbsp;Daniel E. Hall ,&nbsp;Karyn B. Stitzenberg ,&nbsp;Lillian S. Kao ,&nbsp;Bradley B. Brimhall ,&nbsp;Chen-Pin Wang ,&nbsp;Laura S. Manuel ,&nbsp;Hoah-Der Su ,&nbsp;Jonathan C. Silverstein ,&nbsp;Paula K. Shireman","doi":"10.1016/j.hjdsi.2025.100762","DOIUrl":"10.1016/j.hjdsi.2025.100762","url":null,"abstract":"<div><h3>Background</h3><div>Social Determinants of Health impact health outcomes. Area Deprivation Index (ADI) is used to risk-adjust for neighborhood affluence/deprivation but guidance on choosing deprivation cutoffs is lacking. We hypothesize that different ADI cutoffs are required for different insurance types.</div></div><div><h3>Methods</h3><div>National Surgical Quality Improvement Program data 2013–2019 merged with electronic health records from three academic healthcare systems. Desirability of Outcome Ranking (DOOR) assessed the association of ADI cutoffs for different insurance types, adjusted for operative stress, frailty, and case status (elective, urgent, emergent). Secondary analyses assessed the association of ADI with case status.</div></div><div><h3>Results</h3><div>Patients with Private insurance living in areas with ADI&gt;85 had higher/worse DOOR outcomes, which lost significance after adjusting for case status. Medicare cases with ADI&gt;75 exhibited higher/worse DOOR outcomes even after adjusting for case status. ADI was not associated with outcomes in the Medicaid and Uninsured groups. High ADI was associated with increased odds of urgent and emergent cases for the Private and Medicare but not Medicaid or Uninsured groups.</div></div><div><h3>Conclusions</h3><div>ADI is a useful metric to identify at-risk patients and can be used for risk adjustment. Health systems must understand their population demographics and use their data to determine ADI cutoffs. Patients in deprived neighborhoods have higher odds of urgent and emergent surgeries, despite having Private insurance or Medicare, suggesting that delays/barriers to primary and preventive care may be a major driver of worse outcomes. While insurance coverage is important, healthcare policies supporting reductions in urgent/emergent cases could have the largest impact on improving outcomes.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 1","pages":"Article 100762"},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking handoffs to optimize continuity: Four practical lessons from a novel hospitalist model","authors":"Andrew W. Schram ,&nbsp;Caleb J. Murphy ,&nbsp;David O. Meltzer","doi":"10.1016/j.hjdsi.2025.100763","DOIUrl":"10.1016/j.hjdsi.2025.100763","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 1","pages":"Article 100763"},"PeriodicalIF":2.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delivering health equity at scale: Organizational experience with value-based care focused on marginalized populations","authors":"Michael Tang ,&nbsp;Charisse Hunter ,&nbsp;Shoshanah Brown ,&nbsp;Aarthi Rao ,&nbsp;Pooja K. Mehta ,&nbsp;Kameron Matthews","doi":"10.1016/j.hjdsi.2025.100760","DOIUrl":"10.1016/j.hjdsi.2025.100760","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 1","pages":"Article 100760"},"PeriodicalIF":2.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using codesign to engage primary care practices in a participatory change process","authors":"Sarah J. Fadem ,&nbsp;Benjamin F. Crabtree ,&nbsp;Lawrence C. Kleinman","doi":"10.1016/j.hjdsi.2025.100761","DOIUrl":"10.1016/j.hjdsi.2025.100761","url":null,"abstract":"<div><div>Healthcare has experienced significant transformation in recent years with many changes being imposed on practices from outside sources. When tailoring outside interventions to specific settings, it is important to engage practice members in participatory processes. Yet, tailoring remains a difficult and poorly understood element of implementation. Codesign is one method to achieve context-sensitive, bottom-up change by engaging stakeholders in the design process. With a complex adaptive system (CAS) perspective, codesign reframes interventions as tools to empower practices to drive change based on local challenges and experiences rather than change being imposed upon them. Observing adaptations and facilitating innovations of practice members offers insight into dynamics of the CAS, implementation context, and its limitations. Here, the codesign process is illustrated through a pediatric primary care practice adopting integrated health.</div><div>Contextual inquiry was performed using ethnographic observations to identify barriers and facilitators to integrated health. Observation findings informed codesign workshops with clinicians. Workshop transcripts and drawings were analyzed using an immersion/crystallization approach guided by the Practice Change Model (PCM), an established framework based on complexity science concepts. In these workshops, clinicians described tension between their motivations to care for complex patients and limitations imposed by the health system. Participants’ knowledge of their real-world context allowed them to identify resources and opportunities for changes they could make within their current environment. The reconciliation of the ideal and the real is a core benefit of codesign methods. This innovative approach can be applied more generally to support the development, implementation, and evaluation of interventions that reflect real world interactions and complexities.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 1","pages":"Article 100761"},"PeriodicalIF":2.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}