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

{"title":"Large language models as a source of health information: Are they patient-centered? A longitudinal analysis","authors":"Kanhai Amin , Rushabh Doshi , Howard P. Forman","doi":"10.1016/j.hjdsi.2023.100731","DOIUrl":"10.1016/j.hjdsi.2023.100731","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"12 1","pages":"Article 100731"},"PeriodicalIF":2.5,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213076423000581/pdfft?md5=137b69721922ecf0447021406c1eaa4e&pid=1-s2.0-S2213076423000581-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032532","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":"Optimizing care delivery in expanding health systems: Views from clinical leaders","authors":"Adrian Diaz ,&nbsp;Karan R. Chhabra ,&nbsp;Mary E. Byrnes ,&nbsp;Abishek Rajkumar ,&nbsp;Phillip Yang ,&nbsp;Andrew Ibrahim ,&nbsp;Justin B. Dimick ,&nbsp;Hari Nathan","doi":"10.1016/j.hjdsi.2023.100722","DOIUrl":"https://doi.org/10.1016/j.hjdsi.2023.100722","url":null,"abstract":"<div><h3>Introduction</h3><p>In response to intense market pressures, many hospitals have consolidated into systems. However, evidence suggests that consolidation has not led to the improvements in clinical quality promised by proponents of mergers. The challenges to delivering care within expanding health systems and the opportunities posed to surgical leaders remains largely unexplored.</p></div><div><h3>Methods</h3><p><span>Semistructured interviews with 30 surgical leaders at teaching hospitals affiliated with health systems from August–December 2019. Interviews were transcribed verbatim and coded in an iterative process using MaxQDA software. Attitudes and strategies toward redesigning </span>health care delivery across expanding systems were analyzed using thematic analysis.</p></div><div><h3>Results</h3><p>Leaders reported challenges to redesigning care delivery across the system ranging from resource constraints (e.g. hospital beds and operating rooms) to evolving market demands (e.g., patient preferences to receive care close to home). However, participants also highlighted that system expansion provided multiple opportunities to increase access (e.g. decant low-complexity care to affiliated centers) and improve quality of care (e.g. standardize best practices) for diverse populations including the potential to leverage their health system to expand access and improve quality.</p></div><div><h3>Conclusions</h3><p>Though evidence suggests that hospital consolidation has not led to redesigned care delivery or improved clinical quality at a national level, leaders are pursuing varying sets of strategies aimed at leveraging system expansion in order to improve access and quality of care.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 4","pages":"Article 100722"},"PeriodicalIF":2.5,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138396463","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":"Lifestyle Medicine Shared Medical Appointments: A proposed framework for high value chronic disease care","authors":"Jacob Mirsky ,&nbsp;Kristi Artz","doi":"10.1016/j.hjdsi.2023.100723","DOIUrl":"https://doi.org/10.1016/j.hjdsi.2023.100723","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 4","pages":"Article 100723"},"PeriodicalIF":2.5,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136697250","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 peer comparisons to address low-value care: Lessons for a persistent challenge","authors":"Joseph H. Joo ,&nbsp;Joshua M. Liao","doi":"10.1016/j.hjdsi.2023.100721","DOIUrl":"https://doi.org/10.1016/j.hjdsi.2023.100721","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 4","pages":"Article 100721"},"PeriodicalIF":2.5,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134655363","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":"Trends in performance of hospital outpatient procedures and associated 30-day costs among medicare beneficiaries from 2011 to 2018","authors":"Laura G. Burke ,&nbsp;Ryan C. Burke ,&nbsp;E. John Orav ,&nbsp;Ava Ferguson Bryan ,&nbsp;Tynan H. Friend ,&nbsp;Damien A. Richardson ,&nbsp;Ashish K. Jha ,&nbsp;Thomas C. Tsai","doi":"10.1016/j.hjdsi.2023.100718","DOIUrl":"10.1016/j.hjdsi.2023.100718","url":null,"abstract":"<div><h3>Background</h3><p>United States healthcare has increasingly transitioned to outpatient care delivery. The degree to which Academic Medical Centers (AMCs) have been able to shift surgical procedures from inpatient to outpatient settings despite higher patient complexity is unknown.</p></div><div><h3>Methods</h3><p>This observational study used a 20% sample of fee-for-service Medicare beneficiaries age 65 and older undergoing eight elective procedures from 2011 to 2018 to model trends in procedure site (hospital outpatient vs. inpatient) and 30-day standardized Medicare costs, overall and by hospital teaching status.</p></div><div><h3>Results</h3><p>Of the 1,222,845 procedures, 15.9% occurred at AMCs. There was a 2.42% per-year adjusted increase (95% CI 2.39%–2.45%; p &lt; .001) in proportion of outpatient hospital procedures, from 68.9% in 2011 to 85.4% in 2018. Adjusted 30-day standardized costs declined from $18,122 to $14,353, (-$560/year, 95% CI -$573 to -$547; p &lt; .001). Patients at AMCs had more chronic conditions and higher predicted annual mortality. AMCs had a lower proportion of outpatient procedures in all years compared to non-AMCs, a difference that was statistically significant but small in magnitude. AMCs had higher costs compared to non-AMCs and a lesser decline over time (p &lt; .001 for the interaction). AMCs and non-AMCs saw a similar decline in 30-day mortality.</p></div><div><h3>Conclusions</h3><p>There has been a substantial shift toward outpatient procedures among Medicare beneficiaries with a decrease in total 30-day Medicare spending as well as 30-day mortality. Despite a higher complexity population, AMCs shifted procedures to the outpatient hospital setting at a similar rate as non-AMCs.</p></div><div><h3>Implications</h3><p>The trend toward outpatient procedural care and lower spending has been observed broadly across AMCs and non-AMCs, suggesting that Medicare beneficiaries have benefited from more efficient delivery of procedural care across academic and community hospitals.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 4","pages":"Article 100718"},"PeriodicalIF":2.5,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427419","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":"Development of information and communication technology (ICT) for a coordinated healthcare program serving low income, chronically ill children","authors":"Benjamin Van Voorhees ,&nbsp;Michael Gerges ,&nbsp;Garret Munoz ,&nbsp;Pinal Kanabar ,&nbsp;Joanna Tess ,&nbsp;Alex Holterman ,&nbsp;Myoung Hyun Choi ,&nbsp;Kenneth Rasinski ,&nbsp;Rachel Caskey","doi":"10.1016/j.hjdsi.2023.100720","DOIUrl":"https://doi.org/10.1016/j.hjdsi.2023.100720","url":null,"abstract":"<div><p>This case report describes the development of information and communication technology (ICT) for a large scale, federally funded demonstration healthcare Program designed to treat low-income children and adolescents with chronic medical conditions. The ICT developers faced the challenge of supporting a Program with many components to treat pediatric patients with one or more chronic health conditions. The Program's ICT provided means and materials to train and monitor Community Health Workers (CHWs) and the Care Coordination Team (CCT) and to provide disease-specific information to patients and caregivers. The Program ICT was organized into five components: (1) Data Storage Systems, (2) Care Coordination Software, (3) On-line Patient Education, (4) a Social Services Referral component, and (5) Patient Engagement software. The average cost of providing care services to the engaged population utilizing the ICT was $7.39 per member per month (PMPM) and $20.33 PMPM for the subset of children who received direct outreach and services. A description of the Program's ICT development, functioning, strengths, and weaknesses is presented.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 4","pages":"Article 100720"},"PeriodicalIF":2.5,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213076423000477/pdfft?md5=232943dd3e7d23647ce14ca6274f1559&pid=1-s2.0-S2213076423000477-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92023050","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":"A service blueprint approach to prioritize operational improvements in a new outpatient clinic","authors":"Vaughn M. Bartch ,&nbsp;Tracee L. Vetting Wolf ,&nbsp;Sooji A. Lee ,&nbsp;Sarah A. Poncelet ,&nbsp;Sheryl L. Nemec ,&nbsp;Timothy I. Morgenthaler","doi":"10.1016/j.hjdsi.2023.100715","DOIUrl":"10.1016/j.hjdsi.2023.100715","url":null,"abstract":"<div><p><span>As a US-based health care system, Mayo Clinic faced considerable challenges opening a new affiliated outpatient facility in the UK at the beginning of the COVID-19 pandemic, which severely affected patient volumes and staffing. As COVID-19 restrictions were eased, the clinic had to prioritize gradual improvements to reestablish service while using resources responsibly. To assist in understanding the current state and to isolate challenges, we elected to develop a service blueprint. We describe how we did this during the COVID-19 pandemic with the use of both face-to-face and virtual services. In many industries, service blueprints are used to help with the design, delivery, and management of new and established services. Although they share some features with value stream mapping, service blueprints often focus on human tasks and the customer's service experience, while value stream maps emphasize information or product flows and capabilities. Several themes for prioritized improvement efforts were identified for future work. In addition, the service blueprint workshops led to a much better understanding of how each person's work affected the other team members and the patient experience. We learned that service blueprints are an efficient way to identify and anticipate critical operational </span>interdependencies and team dynamics that will affect the patient experience when building new clinical services.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 4","pages":"Article 100715"},"PeriodicalIF":2.5,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41150885","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":"Frontline perspectives on adoption and non-adoption of care management tools for high-risk patients in primary care","authors":"Michael McGowan ,&nbsp;Danielle Rose ,&nbsp;Monica Paez ,&nbsp;Gregory Stewart ,&nbsp;Susan Stockdale","doi":"10.1016/j.hjdsi.2023.100719","DOIUrl":"10.1016/j.hjdsi.2023.100719","url":null,"abstract":"<div><h3>Background</h3><p><span><span><span>Population health management tools (PHMTs) embedded within </span>electronic health records (EHR) could improve management of high-risk patients and reduce costs associated with potentially avoidable </span>emergency department visits or hospitalizations. Adoption of PHMTs across the Veterans Health Administration (VA) has been variable and previous research suggests that understaffed </span>primary care (PC) teams might not be using the tools.</p></div><div><h3>Methods</h3><p>We conducted a retrospective content analysis of open-text responses (n = 1804) from the VA’s 2018 national primary care personnel survey to, 1) identify system-level and individual-level factors associated with why clinicians are not using the tools, and 2) to document clinicians’ recommendations to improve tool adoption.</p></div><div><h3>Results</h3><p>We found three themes pertaining to low adoption and/or tool use: 1) IT burden and administrative tasks (e.g., manually mailing letters to patients), 2) staffing shortages (e.g., nurses covering multiple teams), and 3) no training or difficulty using the tools (e.g., not knowing how to access the tools or use the data). Frontline clinician recommendations included automating some tasks, reconfiguring team roles to shift administrative work away from providers and nurses, consolidating PHMTs into a centralized, easily accessible repository, and providing training.</p></div><div><h3>Conclusions</h3><p>Healthcare system-level factors (staffing) and individual-level factors (lack of training) can limit adoption of PHMTs that could be useful for reducing costs and improving patient outcomes. Future research, including qualitative interviews with clinicians who use/don’t use the tools, could help develop interventions to address barriers to adoption.</p></div><div><h3>Implications</h3><p>Shifting more administrative tasks to clerical staff would free up clinician time for population health management but may not be possible for understaffed PC teams. Additionally, healthcare systems may be able to increase PHMT use by making them more easily accessible through the electronic health record and providing training in their use.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 4","pages":"Article 100719"},"PeriodicalIF":2.5,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41131364","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":"Reading the crystal ball: Primary care implications while awaiting outcomes for multi-cancer early detection tests","authors":"Grace A. Lin ,&nbsp;Kathryn A. Phillips ,&nbsp;A. Mark Fendrick","doi":"10.1016/j.hjdsi.2023.100705","DOIUrl":"10.1016/j.hjdsi.2023.100705","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 3","pages":"Article 100705"},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10285074","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 need for patient decision aids in acute care settings","authors":"Joshua E. Rosen ,&nbsp;David R. Flum ,&nbsp;Joshua M. Liao","doi":"10.1016/j.hjdsi.2022.100639","DOIUrl":"10.1016/j.hjdsi.2022.100639","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 3","pages":"Article 100639"},"PeriodicalIF":2.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10621932","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}