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

{"title":"Rethinking handoffs to optimize continuity: Four practical lessons from a novel hospitalist model","authors":"Andrew W. Schram , Caleb J. Murphy , 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":"2025-06-01","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":"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":"2025-06-01","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":"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":"2025-06-01","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":"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":"2024-12-01","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":"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":"2024-12-01","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}

{"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":"2024-12-01","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":"2024-12-01","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":"The role of framing in managing EHR portal messages","authors":"Ahmad Anshasi ,&nbsp;Eduardo Mulanovich ,&nbsp;Joshua M. Liao","doi":"10.1016/j.hjdsi.2024.100747","DOIUrl":"10.1016/j.hjdsi.2024.100747","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"12 3","pages":"Article 100747"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471148","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":"Enhancing cultural humility in food is medicine services: A mixed-methods investigation of patient food and dietary preferences","authors":"Olivia W. Thomas ,&nbsp;Lorrin Liang ,&nbsp;Emily Getzoff ,&nbsp;Santana Silver ,&nbsp;Jessica Peters ,&nbsp;Liza Fuentes","doi":"10.1016/j.hjdsi.2024.100749","DOIUrl":"10.1016/j.hjdsi.2024.100749","url":null,"abstract":"<div><p>Dietary inequities, influenced by sociocultural and economic factors, significantly affect health outcomes, particularly among underserved communities. To address these disparities, the Food is Medicine (FIM) movement strives to enhance access to nutritious food, provide education, and encourage behavioral changes. Boston Medical Center (BMC) ‘s Nourishing Our Community Program (NOCP) exemplifies this mission by offering FIM services such as an on-site food pantry, rooftop farm, and teaching kitchen. However, persistent barriers hinder the effectiveness of programs like NOCP. This quality improvement (QI) project employed mixed methods to refine existing and develop new patient-generated nutrition education materials and resources across various FIM services.</p></div><div><h3>Methods</h3><p>This QI project included surveys and focus groups conducted electronically and in person between January and May 2023. We analyzed the data using descriptive statistics and qualitative content analysis.</p></div><div><h3>Results</h3><p>The analysis of results revealed patient preferences and experiences regarding dietary patterns, food choices, and nutrition education. These findings enhanced existing handouts, websites, and group class curricula and forged new partnerships with local community-based organizations.</p></div><div><h3>Conclusion</h3><p>Our findings underpin the importance of co-designing interventions, dynamic and multimodal resources, and cultural humility in care to meet individual needs.</p></div><div><h3>Implications</h3><p>This initiative is a model for hospitals aiming to improve educational resources within FIM services and tailor content to the specific needs of diverse patient populations. This project is the first step in programmatic improvement, and continuous refinement is crucial for sustained improvements and advancing health equity at our institution.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"12 3","pages":"Article 100749"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903107","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":"Race disparities in emergency department utilization: Analyzing the role of value-based payment among Medicare Advantage beneficiaries","authors":"Melanie Canterberry,&nbsp;Jeremiah S. Rastegar,&nbsp;Shireen Haq,&nbsp;Gosia Sylwestrzak,&nbsp;Emily Boudreau","doi":"10.1016/j.hjdsi.2024.100748","DOIUrl":"10.1016/j.hjdsi.2024.100748","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"12 3","pages":"Article 100748"},"PeriodicalIF":2.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213076424000150/pdfft?md5=1ebf272e07c633c55f38e48026f353ea&pid=1-s2.0-S2213076424000150-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471147","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}