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

{"title":"Addressing rural hospital challenges through integration","authors":"Adam C. Powell , Ronald C. Whiting","doi":"10.1016/j.hjdsi.2025.100776","DOIUrl":"10.1016/j.hjdsi.2025.100776","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"14 1","pages":"Article 100776"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927698","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":"Does increasing primary care team panel size affect health care costs: Findings from a VHA pilot program","authors":"Edwin S. Wong ,&nbsp;Leslie L. Taylor ,&nbsp;Jorge Rojas ,&nbsp;Alaina M. Mori ,&nbsp;Ashok Reddy ,&nbsp;Jami J. Falk ,&nbsp;Traci Solt ,&nbsp;Katherine Laurenzano ,&nbsp;Karin M. Nelson","doi":"10.1016/j.hjdsi.2026.100778","DOIUrl":"10.1016/j.hjdsi.2026.100778","url":null,"abstract":"<div><h3>Background</h3><div>In the Veterans Health Administration (VHA), primary care is delivered through a team-based medical home called the Patient Aligned Care Team (PACT). Increasing team panel size is one approach to addressing staffing challenges in primary care.</div></div><div><h3>Objective</h3><div>To examine whether alternate staffing models that expand team panel size results in greater medical costs.</div></div><div><h3>Design</h3><div>Quasi-experimental approach comparing pre-post changes in costs between patients assigned to PACT teams with expanded and standard panel sizes, respectively. We analyzed data from VHA's Corporate Data Warehouse linked to cost data from the Managerial Cost Accounting System. Costs were analyzed using two-part modeling to account for the high proportion of zero-cost observations, and adjusted for patient demographics and comorbidity.</div></div><div><h3>Subjects</h3><div>VHA patients assigned to the PACT team panels at three geographically diverse medical centers between October and December 2021.</div></div><div><h3>Measures</h3><div>Total medical costs were measured as expenditures on all health care services delivered in VHA facilities or from contract providers in the community. Secondary analysis separately examined costs of VHA delivered and contract care.</div></div><div><h3>Results</h3><div>At each medical center, implementation of staffing models that increased panel size did not result in statistically significant changes in total medical costs and costs of care delivered by VHA facilities but was associated with a decrease in costs of contract care at one site.</div></div><div><h3>Conclusions</h3><div>Increasing PACT team panel size above standard levels in VHA did not increase patient-level costs. These results can help guide health system leaders to determine appropriate panel sizes and support staffing needed to meet the needs of patient populations.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"14 1","pages":"Article 100778"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327247","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":"Pivoting to serious illness conversations to meet advance care planning quality measures in academic primary care clinics","authors":"Grant M. Smith ,&nbsp;Anuradha Phadke ,&nbsp;Briththa Seevaratnam ,&nbsp;Rebecca Fong ,&nbsp;Ana Calugar ,&nbsp;Winifred G. Teuteberg ,&nbsp;Rachelle E. Bernacki","doi":"10.1016/j.hjdsi.2026.100777","DOIUrl":"10.1016/j.hjdsi.2026.100777","url":null,"abstract":"<div><h3>Purpose</h3><div>As novel payment models incentivize advance care planning (ACP) in primary care, conversation-focused models of ACP that prioritize serious illness conversations (SICs), which focus on discussing patients’ understanding of their illness and their goals and values, can make meeting quality measures more clinically impactful.</div></div><div><h3>Methods</h3><div>We implemented the Serious Illness Care Program (SICP), an evidence-based ACP intervention, in academic primary care clinics. SICP supports healthcare systems to increase SICs through clinician training, coaching, and integrating a documentation module within the electronic medical record. Key facilitators of our implementation included adapting SICP training to accommodate primary care providers’ (PCPs) schedules, financial incentives for PCPs to complete SICP training and SICs, support of a physician ACP quality lead role, leadership support, and information technology collaboration.</div></div><div><h3>Results</h3><div>Throughout the 2023 and 2024 fiscal years, 59 of the 84 faculty PCPs (70%) in our primary care clinics completed SICP training. Of the SICP-trained PCPs, 41 (69%) completed at least one SIC. During the implementation, 340 SICs were documented for 238 unique patients.</div></div><div><h3>Conclusion and implications</h3><div>While additional work is needed to increase rates of PCPs completing SICs, we found that implementing SICP in academic primary care clinics is feasible when incentives, leadership support, and champions are in place.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"14 1","pages":"Article 100777"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146207945","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":"Evaluating the integration of a COVID-19 symptom checker into an asthma-focused mHealth application","authors":"Dinah Foer ,&nbsp;Jorge Alberto Sulca Flores ,&nbsp;Jessica L. Sousa ,&nbsp;Anuj K. Dalal ,&nbsp;Savanna Plombon ,&nbsp;David W. Bates ,&nbsp;Robert S. Rudin","doi":"10.1016/j.hjdsi.2025.100774","DOIUrl":"10.1016/j.hjdsi.2025.100774","url":null,"abstract":"<div><div>Symptom checkers are tools designed to aid self-triage and used in various contexts including acute disease exposures. However, their utility within mobile health (mHealth) applications, particularly those used for long-term disease management, is unclear. This study evaluates the integration of a COVID-19 symptom checker into an asthma-focused mHealth application. Among users of the application, over 75 % engaged with the symptom checker at least once. Notably, patients prompted by the application with a nudge to use the symptom checker—triggered due to problematic scores on their weekly asthma questionnaires—were significantly more likely to complete it compared to those with non-problematic scores who did not receive the nudge. Qualitative analysis of semi-structured patient interviews explained reasons underlying patient symptom checker use which included reassurance that symptoms were not suggestive of COVID-19. Findings support the integration of symptom checkers into mHealth apps that offer continuous monitoring between clinical visits, especially for patients with chronic conditions vulnerable to acute disease triggers. Symptom checker integration can also facilitate timely dissemination of public health information.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"14 1","pages":"Article 100774"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145821272","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":"An introduction to North Carolina Integrated Care for Kids (NC InCK): A model to support whole-child health","authors":"Charlene A. Wong ,&nbsp;Sarah Allin ,&nbsp;Chelsea Swanson ,&nbsp;Richard J. Chung ,&nbsp;Kristen Dubay ,&nbsp;Kori Flower ,&nbsp;Josie Hatley ,&nbsp;Alicia Reynolds Reddi ,&nbsp;Michael J. Steiner ,&nbsp;Eleanor Wertman ,&nbsp;Rushina Cholera","doi":"10.1016/j.hjdsi.2025.100773","DOIUrl":"10.1016/j.hjdsi.2025.100773","url":null,"abstract":"<div><div>We describe the design of the North Carolina Integrated Care for Kids (NC InCK) model. NC InCK is one of seven nationwide CMMI-funded pediatric health care delivery models that integrate services to promote whole-child health.</div><div>NC InCK was collaboratively designed by health care systems, the state Medicaid agency, Medicaid managed care organizations, child-serving organizations across multiple sectors, and families. The model uses three key approaches to integrate care: 1) a risk stratification algorithm using data across healthcare, education, and social systems to holistically understand needs and identify children who may benefit from additional supports; 2) a family-centered, longitudinal care management model to integrate cross-sector services for children and youth needing clinical and nonclinical support; and 3) an alternative payment model with innovative measures around social needs and school readiness to drive investment in child and family well-being.</div><div>Early success designing NC InCK has been driven by cross-sector and multi-level governance from the start of model design, garnering deep trust and alignment around shared goals. NC InCK is a step toward supporting whole-child health via cross-sector service integration and timely identification of children and families experiencing medical and social complexity. Lessons learned from design of this demonstration model can be applied to pediatric health initiatives nationwide.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"14 1","pages":"Article 100773"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792269","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":"Reversing health care innovation through technology","authors":"Joshua M. Liao ,&nbsp;Kavita Bhavan ,&nbsp;Brett Moran","doi":"10.1016/j.hjdsi.2025.100772","DOIUrl":"10.1016/j.hjdsi.2025.100772","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"14 1","pages":"Article 100772"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999214","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":"Knocking down silos and herding apps: Digital health governance at a large health system","authors":"Brian D'Anza ,&nbsp;Tayana Williams ,&nbsp;Stacy Porter ,&nbsp;Robert Eardley ,&nbsp;Jeff Sunshine","doi":"10.1016/j.hjdsi.2025.100775","DOIUrl":"10.1016/j.hjdsi.2025.100775","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"14 1","pages":"Article 100775"},"PeriodicalIF":2.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927699","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":"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":"2025-12-01","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":"Investing in health care AI: Decision-making traps","authors":"Danielle S. Browne ,&nbsp;Chieh-Liang Wu ,&nbsp;Joshua M. Liao","doi":"10.1016/j.hjdsi.2025.100770","DOIUrl":"10.1016/j.hjdsi.2025.100770","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 2","pages":"Article 100770"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281075","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":"2025-12-01","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}