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

{"title":"Delivering health equity at scale: Organizational experience with value-based care focused on marginalized populations","authors":"Michael Tang , Charisse Hunter , Shoshanah Brown , Aarthi Rao , Pooja K. Mehta , 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}

{"title":"Looking at military health system surgical procedures through the lens of an episode grouper","authors":"Beth A. Hawks ,&nbsp;Jennifer Perloff ,&nbsp;V.S. Senthil Kumar ,&nbsp;Mary Jo Larson ,&nbsp;John D. Chapman","doi":"10.1016/j.hjdsi.2025.100759","DOIUrl":"10.1016/j.hjdsi.2025.100759","url":null,"abstract":"<div><h3>Background</h3><div>With mounting accountability pressure on their publicly funded health system and the demand for a medically ready military force, the military health system (MHS) employs a strategy to optimize care delivery. Research suggests that analysis of episodes of care is a valuable tool for identifying the relative resource use for a given procedure and can direct enhancements in care delivery.</div></div><div><h3>Methods</h3><div>This proof-of-concept study investigates the feasibility of grouping services for surgical patients into episodes of care. These episodes of care served as a unit of analysis for evaluating resource use within a public healthcare system. Borrowing from a grouping tool developed for the Centers for Medicare and Medicaid Services by Brandeis University, we developed methods to employ it with MHS clinical encounter and claims data. Data included all care paid for by the MHS from FY2009-2015, including care delivered inside and outside of their facilities.</div></div><div><h3>Results</h3><div>Using this analytic grouping tool, we grouped 49 percent of our administrative data into episodes of care. In these episodes, we see variation in both the care provided directly by the MHS and care provided by the network of private sector providers in rates of sequelae based on the service area for specific surgical procedures.</div></div><div><h3>Conclusions</h3><div>We offer a novel tool for health systems to evaluate their practice patterns, which can generate valuable strategies for efficiency gains and slowing spending.</div></div><div><h3>Implications</h3><div>Outside of the traditional population-based metrics to evaluate efficiency, episodes of care are a valuable tool for identifying the mix of services used to produce a given surgical outcome.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 1","pages":"Article 100759"},"PeriodicalIF":2.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892157","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":"Changes in primary care encounter rates during the veteran health administration’s electronic health record transition","authors":"Ashok Reddy ,&nbsp;Jonathan Staloff ,&nbsp;Jorge Rojas ,&nbsp;Eric Gunnink ,&nbsp;Scott Hagan ,&nbsp;Alisa Becker ,&nbsp;John Geyer ,&nbsp;Stefanie A. Deeds ,&nbsp;Karin Nelson ,&nbsp;Edwin S. Wong","doi":"10.1016/j.hjdsi.2025.100758","DOIUrl":"10.1016/j.hjdsi.2025.100758","url":null,"abstract":"<div><h3>Background</h3><div>Electronic health record (EHR) transitions can cause major disruptions in the provision of primary care services. Veteran Health Administration (VHA), one of the largest integrated healthcare systems, underwent a major EHR transition at two sites. To date, there is limited data on the experience of primary care service lines at EHR transition sites.</div></div><div><h3>Objective</h3><div>To describe and quantify changes in the provision of primary care services at two sites that have experienced EHR transition.</div></div><div><h3>Design</h3><div>We conducted a retrospective study of primary care encounters 12 months before and after EHR transition. In addition, we applied economic structural change analysis using the expanded length of time (10 years of prior primary care encounters at sites) to understand how the transition of EHR compares to other major changes in primary care encounter volume during this time period.</div></div><div><h3>Data source and main measure</h3><div>Primary care encounters were measured using algorithms pre- and post-EHR transition from the national VHA Corporate Data Warehouse (CDW) and Cerner Millennium (CDW2) Databases.</div></div><div><h3>Key results</h3><div>In Spokane, the average number of monthly primary care encounters decreased from 7155 (SD = 682) in the 12 months prior to October 2020 (transition date) to 4181 (SD = 813) in the 12 months after implementation, a decrease of 41.6 %. The average number of monthly primary care encounters decreased from 8029 (SD = 511) in the 12 months prior to April 2022 (transition date) to 6495 (SD = 1152) in the 12 months after implementation, a decrease of 19.1 %. The structural change analysis identified EHR transition dates at both sites, including a major decrease in volume of primary care encounters.</div></div><div><h3>Conclusions</h3><div>Given the substantial decrease in primary care services, VHA must identify strategies to mitigate both the amount and the duration of reduced primary care encounters during the EHR transition.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 1","pages":"Article 100758"},"PeriodicalIF":2.0,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-enabled decision support: The convergence of technology and decision science","authors":"Danielle S. Browne ,&nbsp;Ling Chu ,&nbsp;Michael Burton ,&nbsp;Joshua M. Liao","doi":"10.1016/j.hjdsi.2025.100757","DOIUrl":"10.1016/j.hjdsi.2025.100757","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 1","pages":"Article 100757"},"PeriodicalIF":2.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068195","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":"Corrigendum to \"Reading the crystal ball: Primary care implications while awaiting outcomes for multi-cancer early detection tests\" [Healthcare 11 (2023) 100705].","authors":"Grace A Lin, Kathryn A Phillips, A Mark Fendrick","doi":"10.1016/j.hjdsi.2024.100755","DOIUrl":"https://doi.org/10.1016/j.hjdsi.2024.100755","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":" ","pages":"100755"},"PeriodicalIF":2.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819414","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":"The national ambulatory medical care survey (NAMCS) at fifty: Past and future","authors":"John D. Goodson ,&nbsp;Sara Shahbazi","doi":"10.1016/j.hjdsi.2024.100754","DOIUrl":"10.1016/j.hjdsi.2024.100754","url":null,"abstract":"<div><h3>Introduction</h3><div>NAMCS, sponsored by the Centers for Disease Control and Prevention, is an annual nationally representative sample survey of visits to non-federal office-based physicians, excluding anesthesiologists, radiologists, and pathologists. NAMCS has collected physician-reported ambulatory care encounter-specific content over five decades. We assessed trends in the use of the data by the health services research community, response rates, and questionnaire changes.</div></div><div><h3>Methods</h3><div>We extracted all peer-reviewed journal articles using NAMCS data published between 1973 and 2020 and categorized publications into high- and low-impact groups, with high impact considered as the top 25 % of journals. We then examined the annual number of journal publications using NAMCS, data according to the year collected, by impact score groups for 50 years. We compared response rates and the information requested by NAMCS questionnaires from 1973 to the present.</div></div><div><h3>Results</h3><div>There has been a significant decline in the overall use of NAMCS data by the non-federal health services research community for publication in both high and lower-impact journals. Data used for high impact publications peaked in 1998, at 87, remained high at 58 in 2008 but then sharply declined. Concurrently, there was a substantial decline in NAMCS survey response rates (highest: 80.5 % in 1975 vs. lowest: 28.8 % in 2015). These changes came in the context of increasing questionnaire complexity.</div></div><div><h3>Conclusion</h3><div>Over the last two decades, annual publication rates citing NAMCS data have declined, coincident with lower response rates and more detailed questionnaires. Nationally representative encounter-specific data verified by the clinician of record will likely have renewed value for those who develop, implement, and assess healthcare policy if response rates improve, and questionnaire review and finalization are streamlined. Though multispecialty data offer unique opportunities for comparisons, sampling a subset of clinicians, such as those providing primary care, would complement national efforts to improve access to continuous comprehensive care.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"12 4","pages":"Article 100754"},"PeriodicalIF":2.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation and adaptation of clinical quality improvement opioid measures","authors":"Catherine Hersey ,&nbsp;Sarah Shoemaker-Hunt ,&nbsp;Michael Parchman ,&nbsp;Ellen Childs ,&nbsp;John Le ,&nbsp;Wesley Sargent","doi":"10.1016/j.hjdsi.2024.100753","DOIUrl":"10.1016/j.hjdsi.2024.100753","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"12 4","pages":"Article 100753"},"PeriodicalIF":2.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378393","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":"Association between patient-reported financial burden and catastrophic health expenditures in cancer survivors","authors":"Nishant Uppal ,&nbsp;Jordan M. Broekhuis ,&nbsp;Jorge L. Gomez-Mayorga ,&nbsp;Hao Wei Chen ,&nbsp;Natalia Chaves ,&nbsp;Benjamin C. James","doi":"10.1016/j.hjdsi.2024.100752","DOIUrl":"10.1016/j.hjdsi.2024.100752","url":null,"abstract":"<div><h3>Purpose</h3><div>To measure rates of patient-reported financial burden, compare them across cancer types, and determine whether they are predictive of catastrophic health expenditures (CHE).</div></div><div><h3>Methods</h3><div>We extracted data from the Medical Expenditures Panel Survey from 2011 to 2017 to conduct a retrospective population-based cohort study and multivariable logistic regression to assess the financial burden of cancer across 16 cancer types and compare patient-reported metrics to CHE rates.</div></div><div><h3>Results</h3><div>Patients with ovarian cancer were most likely to report inability paying bills (34.5 %) and filing for bankruptcy (9.4 %), while patients with thyroid cancer were most likely to incur debt (22.4 %). Patients with kidney cancer had the highest mean debt ($46,915). CHEs were independently predicted by inability to pay medical bills (OR [95 % CI], 1.96 [1.14–3.35]) and bankruptcy filing (OR [95 % CI], 3.90 [1.21–12.60].</div></div><div><h3>Conclusions and implications</h3><div>We report important variations in the financial burden across cancer types and underscore the importance of assessing how patient-reported measures are related to CHEs. Policy implications. The financial burden of cancer care could explain the lack of improved outcomes with increased national health spending.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"12 4","pages":"Article 100752"},"PeriodicalIF":2.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312598","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":"Outpatient remdesivir treatment program for hospitalized patients with coronavirus disease-2019: Patient perceptions, process and economic impact","authors":"Supavit Chesdachai ,&nbsp;Christina G. Rivera ,&nbsp;Jordan K. Rosedahl ,&nbsp;Lindsey M. Philpot ,&nbsp;Ruchita Dholakia ,&nbsp;Bijan J. Borah ,&nbsp;Evan W. Draper ,&nbsp;Richard Arndt ,&nbsp;Ravindra Ganesh ,&nbsp;Jennifer J. Larsen ,&nbsp;Molly J. Destro Borgen ,&nbsp;Raymund R. Razonable","doi":"10.1016/j.hjdsi.2024.100750","DOIUrl":"10.1016/j.hjdsi.2024.100750","url":null,"abstract":"<div><h3>Background</h3><p>Remdesivir is FDA-approved for the treatment of hospitalized patients with severe COVID-19. Many patients improve clinically to allow for hospital dismissal before completing the 5-day course. In a prior work, patients who continued remdesivir in an outpatient setting experienced better 28-day clinical outcomes. Here, we assessed patients' perspectives and the economic impact of this outpatient practice.</p></div><div><h3>Methods</h3><p>Hospitalized patients who received remdesivir for COVID-19 at Mayo Clinic, Rochester, from 11/6/2020 to 11/5/2021 and were dismissed to continue remdesivir in the outpatient setting were surveyed. The cost of care was compared between those who remained hospitalized versus those who were dismissed.</p></div><div><h3>Results</h3><p>93 (19.8 %) among 470 eligible patients responded to the electronic survey. Responders were older than non-responders. The majority (70.5 %) had symptoms resolved by the time of the survey. Ten (11.4 %) patients had persistent symptoms attributed to long COVID-19. The majority were satisfied with the quality of care (82.3 %) and overall experience (76.0 %) in the infusion clinic. After adjusting for gender, comorbidity score, and WHO severity scale, the predicted costs for the groups were $16,544 (inpatient) and $9,097 (outpatient) per patient (difference of $7,447; p &lt; .01). An estimate of 1,077 hospital bed-days were made available to other patients as a result of this transition to outpatient.</p></div><div><h3>Conclusion</h3><p>An outpatient remdesivir program that allowed for early dismissal was perceived favorably by patients. The program resulted in significant cost and resource savings, the latter in terms of the availability of hospital beds for other patients needing critical services.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"12 4","pages":"Article 100750"},"PeriodicalIF":2.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213076424000174/pdfft?md5=46142016be627eec552c4319212a099e&pid=1-s2.0-S2213076424000174-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141978370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}