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

{"title":"How alignment between health systems and their embedded research units contributes to system learning","authors":"Michael I. Harrison ,&nbsp;Amanda E. Borsky","doi":"10.1016/j.hjdsi.2023.100688","DOIUrl":"10.1016/j.hjdsi.2023.100688","url":null,"abstract":"<div><h3>Background</h3><p>There is growing interest in the contributions of embedded, learning health system<span> (LHS), research within healthcare delivery systems. We examined the organization of LHS research units and conditions affecting their contributions to system improvement and learning.</span></p></div><div><h3>Methods</h3><p>We conducted 12 key-informant and 44 semi-structured interviews in six delivery systems engaged in LHS research. Using rapid qualitative analysis, we identified themes and compared: successful versus challenging projects; LHS units and other research units in the same system; and LHS units in different systems.</p></div><div><h3>Results</h3><p>LHS units operate both independently and as subunits within larger research centers. Contributions of LHS units to improvements and learning are influenced by alignment of facilitating factors within units, within the broader system, and between unit and host system. Key alignment factors were availability of internal (system) funding directing researchers’ work toward system priorities; researchers’ skills and experiences that fit a system’s operational needs; LHS unit subculture supporting system improvement and collaboration with clinicians and other internal stakeholders; applications of external funding to system priorities; and executive leadership for system-wide learning. Mutual understanding and collaboration between researchers, clinicians, and leaders was fostered through direct consultation between LHS unit leaders and system executives and engagement of researchers in clinical and operational activities.</p></div><div><h3>Conclusions</h3><p>Embedded researchers face significant challenges to contributing to system improvement and learning. Nevertheless, when appropriately led, organized, and supported by internal funding, they may learn to collaborate effectively with clinicians and system leaders in advancing care delivery toward the learning health system ideal.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 2","pages":"Article 100688"},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9608793","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 equity-focused approach to improving access to COVID-19 vaccination using mobile health clinics","authors":"Carlene A. Mayfield ,&nbsp;Jennifer S. Priem ,&nbsp;Michael Inman ,&nbsp;Trent Legare ,&nbsp;Jennifer Snow ,&nbsp;Elizabeth Wallace","doi":"10.1016/j.hjdsi.2023.100690","DOIUrl":"10.1016/j.hjdsi.2023.100690","url":null,"abstract":"<div><p>This article describes the implementation of an equity-focused strategy to increase the uptake of COVID-19 vaccination among communities of color and in traditionally underserved geographic areas using mobile health clinics (MHCs). The MHC Vaccination Program was implemented through a large integrated healthcare system in North Carolina using a grassroots development and engagement strategy along with a robust model for data-informed decision support to prioritize vulnerable communities. Several valuable lessons from this work can replicated for future outreach initiatives and community-based programming:</p><p>•Health systems can no longer operate under the assumption that community members will come to them, particularly those experiencing compounding social and economic challenges. The MHC model had to be a proactive outreach to community members, rather than a responsive delivery mechanism.</p><p>•Barriers to access included financial, legal, and logistical challenges, in addition to mistrust among historically underserved and marginalized communities.</p><p>•A MHC model can be adaptable and responsive to data-informed decision-making approaches for targeted service delivery.</p><p>•A MHC model is not a one-dimensional solution to access, but part of a broader strategy to create diverse points of entry into the healthcare system that fall within the rhythm of life of community members.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 2","pages":"Article 100690"},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10033254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9596679","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":"Lessons on regulation and implementation from the first FDA-cleared autonomous AI - Interview with Chairman and Founder of Digital Diagnostics Michael Abramoff","authors":"Kaushik P. Venkatesh,&nbsp;Gabriel Brito","doi":"10.1016/j.hjdsi.2023.100692","DOIUrl":"10.1016/j.hjdsi.2023.100692","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 2","pages":"Article 100692"},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9979180","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 use of primary care-based behavioral health programs differ by race and ethnicity? Evidence from a multi-site collaborative care model","authors":"Benjamin Kovachy ,&nbsp;Trina Chang ,&nbsp;Christine Vogeli ,&nbsp;Suzanne Tolland ,&nbsp;Susan Garrels ,&nbsp;Brent P. Forester ,&nbsp;Vicki Fung","doi":"10.1016/j.hjdsi.2023.100676","DOIUrl":"10.1016/j.hjdsi.2023.100676","url":null,"abstract":"<div><h3>Background</h3><p>Collaborative care models (CoCM) that integrate mental health and primary care<span> improve outcomes and could help address racial and ethnic mental health disparities. We examined whether use of these programs differs by race/ethnicity.</span></p></div><div><h3>Methods</h3><p>This retrospective study examined two CoCM interventions implemented across primary care clinics in a large health system in Massachusetts: 1) a primary care-based behavioral health program for depression or anxiety (IMPACT model) and 2) referral to community-based specialty care services (Resource-finding). Outcomes included enrollment, non-completion, and symptom screening rates, and discharge status for Black, Hispanic and White patients referred for CoCM, 2017–2019.</p></div><div><h3>Results</h3><p><span>Black and Hispanic vs. White patients referred to CoCM (n = 17,280) were more likely to live in high poverty ZIP codes (34% and 40% vs. 9%). Rates of program enrollment, non-completion, and symptom screening were similar across groups (e.g., 76%, 77%, and 75% of Black, Hispanic, and White patients enrolled). Hispanic vs. White patients were more likely to be enrolled in IMPACT (56%) vs. Resource-finding (43%). Among those completing IMPACT, Hispanic vs. White patients were more likely to be stepped to </span>psychiatry vs. discharged to their primary care provider (51% vs. 20%, aOR = 1.55, 95% CI: 1.02–2.35).</p></div><div><h3>Conclusions</h3><p>Black and Hispanic patients referred to CoCM were similarly likely to use the program as White patients. Hispanic patients completing IMPACT were more frequently referred to psychiatry.</p></div><div><h3>Implications</h3><p>These results highlight the promise of CoCMs for engaging minority populations in mental healthcare. Hispanic patients may benefit from additional intervention or earlier linkage to specialty care.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 2","pages":"Article 100676"},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10257753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9669596","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":"Improving primary care team functioning through evidence based quality improvement: A comparative case study","authors":"Helen Ovsepyan ,&nbsp;Emmeline Chuang ,&nbsp;Julian Brunner ,&nbsp;Alison B. Hamilton ,&nbsp;Jack Needleman ,&nbsp;MarySue Heilemann ,&nbsp;Ismelda Canelo ,&nbsp;Elizabeth M. Yano","doi":"10.1016/j.hjdsi.2023.100691","DOIUrl":"10.1016/j.hjdsi.2023.100691","url":null,"abstract":"<div><h3>Background</h3><p><span>Provision of team-based primary care (PC) is associated with improved care quality, but limited empirical evidence guides practices on how to optimize team functioning. We examined how evidence-based quality improvement (EBQI) was used to change PC team processes. EBQI activities were supported by research-clinical partnerships and included multilevel </span>stakeholder engagement, external facilitation, technical support, formative feedback, QI training, local QI development and across-site collaboration to share proven practices.</p></div><div><h3>Methods</h3><p>We used a comparative case study in two VA medical centers (Sites A and B) that engaged in EBQI between 2014 and 2016. We analyzed multiple qualitative data sources: baseline and follow-up interviews with key stakeholders and provider team (“teamlet”) members (n = 64), and EBQI meeting notes, reports, and supporting materials.</p></div><div><h3>Results</h3><p>Site A's QI project entailed engaging in structured daily huddles using a huddle checklist and developing a protocol clarifying team member roles and responsibilities; Site B initiated weekly virtual team meetings that spanned two practice locations. Respondents from both sites perceived these projects as improving team structure and staffing, team communications, role clarity, staff voice and personhood, accountability, and ultimately, overall team functioning over time.</p></div><div><h3>Conclusion</h3><p>EBQI enabled local QI teams and other stakeholders to develop and implement innovations to improve PC team processes and characteristics in ways that improved teamlet members’ perceptions of team functioning.</p></div><div><h3>Implications</h3><p>EBQI's multi-level approach may empower staff and facilitate innovation by and within teams, making it an effective implementation strategy for addressing unique practice-based challenges and supporting improvements in team functioning across varied clinical settings.</p></div><div><h3>Level of evidence</h3><p>VI.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 2","pages":"Article 100691"},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9597772","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":"Implementing real-time prescription benefit tools: Early experiences from 5 academic medical centers","authors":"Jing Luo ,&nbsp;Rachel Wong ,&nbsp;Tanvi Mehta ,&nbsp;Jeremy I. Schwartz ,&nbsp;Jeremy A. Epstein ,&nbsp;Erika Smith ,&nbsp;Nitu Kashyap ,&nbsp;Fasika A. Woreta ,&nbsp;Kristian Feterik ,&nbsp;Michael J. Fliotsos ,&nbsp;Bradley H. Crotty","doi":"10.1016/j.hjdsi.2023.100689","DOIUrl":"10.1016/j.hjdsi.2023.100689","url":null,"abstract":"<div><h3>Background</h3><p>Medication price transparency tools are increasingly available, but data on their use, and their potential effects on prescribing behavior, patient out of pocket (OOP) costs, and clinician workflow integration, is limited.</p></div><div><h3>Objective</h3><p>To describe the implementation experiences with real-time prescription benefit (RTPB) tools at 5 large academic medical centers and their early impact on prescription ordering.</p></div><div><h3>Design</h3><p>and Participants: In this cross-sectional study, we systematically collected information on the characteristics of RTPB tools through discussions with key stakeholders at each of the five organizations. Quantitative encounter data, prescriptions written, and RTPB alerts/estimates and prescription adjustment rates were obtained at each organization in the first three months after “go-live” of the RTPB system(s) between 2019 and 2020.</p></div><div><h3>Main measures</h3><p>Implementation characteristics, prescription orders, cost estimate retrieval rates, and prescription adjustment rates.</p></div><div><h3>Key results</h3><p>Differences were noted with respect to implementation characteristics related to RTPB tools. All of the organizations with the exception of one chose to display OOP cost estimates and suggested alternative prescriptions automatically. Differences were also noted with respect to a patient cost threshold for automatic display. In the first three months after “go-live,” RTPB estimate retrieval rates varied greatly across the five organizations, ranging from 8% to 60% of outpatient prescriptions. The prescription adjustment rate was lower, ranging from 0.1% to 4.9% of all prescriptions ordered.</p></div><div><h3>Conclusions</h3><p>In this study reporting on the early experiences with RTPB tools across five academic medical centers, we found variability in implementation characteristics and population coverage. In addition RTPB estimate retrieval rates were highly variable across the five organizations, while rates of prescription adjustment ranged from low to modest.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 2","pages":"Article 100689"},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9977045","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":"Courage to Quit® rolling group: Implementation in an urban medical center in primarily low-income Black smokers","authors":"Emma I. Brett ,&nbsp;Abigayle R. Feather ,&nbsp;Zoe Lee ,&nbsp;Daniel J. Fridberg ,&nbsp;Yasmin Asvat ,&nbsp;Andrea C. King","doi":"10.1016/j.hjdsi.2023.100674","DOIUrl":"10.1016/j.hjdsi.2023.100674","url":null,"abstract":"<div><h3>Background</h3><p>Continuous “rolling” tobacco group treatments may help reduce cessation disparities<span> by increasing access among underserved people who smoke cigarettes. We evaluated the implementation of a rolling enrollment adaptation of an evidence-based tobacco treatment group intervention, Courage to Quit®-Rolling (CTQ®-R).</span></p></div><div><h3>Methods</h3><p><span>The 4-session CTQ®-R incorporating psychoeducation, motivational enhancement, and cognitive behavioral skills was evaluated by examining feasibility and preliminary program outcomes with a pre-post design using the SQUIRE method in a sample of 289 primarily low-income, Black people who smoke. Feasibility was measured by examining program retention. Paired </span><em>t</em><span>-tests evaluated changes in behavioral intentions and knowledge about smoking cessation and differences in average daily cigarettes smoked from first to last session attended.</span></p></div><div><h3>Results</h3><p>CTQ-R was feasible to implement in an urban medical center program enrolling primarily low-income Black people who smoke, with 52% attending at least 2 sessions and 24% completing the full program. Participants demonstrated improvements in knowledge of smoking cessation strategies and confidence in quitting (<em>p</em>s &lt; .004). Preliminary effectiveness analyses showed a 30% reduction in average daily cigarette use, with group completers reporting greater reduction than non-completers.</p></div><div><h3>Conclusions</h3><p>CTQ®-R is feasible and showed preliminary effectiveness for increasing knowledge about stop smoking skills and reducing cigarette smoking.</p></div><div><h3>Implications</h3><p>A rolling enrollment smoking group treatment is feasible and may be effective among people who smoke who face historical and systemic barriers to tobacco treatment engagement. Evaluation in other settings and over longer periods of time is needed.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 2","pages":"Article 100674"},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10330217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9759848","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":"Designing a public access naloxone program for public transportation stations","authors":"Sajeev Kohli ,&nbsp;Jay Garg ,&nbsp;David E. Velasquez ,&nbsp;Scott G. Weiner","doi":"10.1016/j.hjdsi.2023.100694","DOIUrl":"10.1016/j.hjdsi.2023.100694","url":null,"abstract":"<div><p>The opioid overdose epidemic has caused over 600,000 deaths in the U.S. since 1999. Public access naloxone<span> programs show great potential as a strategy for reducing opioid overdose-related deaths. However, their implementation within public transit stations, often characterized as opioid overdose hotspots, has been limited, partly because of a lack of understanding in how to structure such programs. Here, we propose a comprehensive framework for implementing public access naloxone programs at public transit stations to curb opioid overdose-related deaths. The framework, tailored to local contexts, relies on coordination between local public health organizations to provide naloxone at public access points and bystander training, local academic institutions to oversee program evaluation, and public transit organizations to manage naloxone maintenance. We use the city of Cambridge, Massachusetts as a case study to demonstrate how it and other municipalities may implement such an initiative.</span></p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 2","pages":"Article 100694"},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9608374","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":"Promoting learning health systems using learning science","authors":"Joshua M. Liao","doi":"10.1016/j.hjdsi.2023.100693","DOIUrl":"10.1016/j.hjdsi.2023.100693","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 2","pages":"Article 100693"},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9962831","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":"Achieving greater value for veterans through full cost transparency in primary care","authors":"Victor C. Agbafe ,&nbsp;Nora Metzger ,&nbsp;Brittani R. Garlick ,&nbsp;Tanner Caverly ,&nbsp;Sameer Saini ,&nbsp;Eve Kerr ,&nbsp;Sana Matloub ,&nbsp;Jeffrey T. Kullgren","doi":"10.1016/j.hjdsi.2023.100687","DOIUrl":"10.1016/j.hjdsi.2023.100687","url":null,"abstract":"<div><p>The COVID-19 pandemic has led to increased use of telephone and video encounters in the Veterans Health Administration and many other healthcare systems. One important difference between these virtual modalities and traditional face-to-face encounters is the different cost-sharing, travel costs, and time costs that patients face. Making the full costs of different visit modalities transparent to patients and their clinicians can help patients obtain greater value from their primary care encounters. From April 6, 2020 to September 30, 2021 the VA waived all copayments for Veterans receiving care from the VA, but since this policy was temporary it is important that Veterans receive personalized information about their expected costs so they can obtain the most value from their primary care encounters.</p><p>To test the feasibility, acceptability, and preliminary effectiveness of this approach, our team conducted a 12 week pilot project at the VA Ann Arbor Healthcare System from June–August 2021 in which we made personalized estimates of out-of-pocket, travel, and time costs available and transparent to patients and clinicians in advance of scheduled encounters and at the point of care. We found that it was feasible to generate and deliver personalized cost estimates in advance of visits, that this information was acceptable to patients, and that patients who used cost estimates during a visit with a clinician found this information helpful and would want to receive it again in the future. To achieve greater value in healthcare, systems must continue to pursue new ways to provide transparent information and needed support to patients and clinicians. This means ensuring clinical visits provide the highest levels of access, convenience, and return on patients’ healthcare-associated spending while minimizing financial toxicity.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 2","pages":"Article 100687"},"PeriodicalIF":2.5,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9979772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9595687","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}