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

{"title":"COBALT: Supporting the mental well-being of the health care workforce with technology-facilitated care during Covid-19 and beyond","authors":"Cecilia Livesey,&nbsp;Kelley Kugler,&nbsp;Jack J. Huang,&nbsp;Eleanor Burton,&nbsp;Avanti Rangnekar,&nbsp;Grace Vojta,&nbsp;Maria A. Oquendo,&nbsp;Lisa Bellini,&nbsp;David A. Asch","doi":"10.1016/j.hjdsi.2022.100640","DOIUrl":"10.1016/j.hjdsi.2022.100640","url":null,"abstract":"<div><p>Two-thirds of health professionals facing the clinical demands of responding to the Covid-19 pandemic experience psychiatric symptoms, including post-traumatic stress, anxiety, substance use, depression, insomnia, and suicide.¹^,² Compounding matters, access to mental health services is poor, quality is variable, and stigma is prevalent. COBALT, a digital mental health and wellness platform developed at Penn Medicine, was designed to support health care workers, offering a combination of self-directed resources, virtual group sessions, and individual appointments with a stepped care model of providers, including peers, resilience coaches, psychotherapists, and psychiatrists. In COBALT's first 11 months, the platform saw approximately 10,000 users, 200,000 page views, 1,400 one-on-one appointment bookings, over 1,000 group appointment reservations, and 158 interceptions of employees contemplating self-harm. COBALT reveals the unmet demand for mental health support among health professionals and provides a model for both expanding the supply of and streamlining access to services.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 3","pages":"Article 100640"},"PeriodicalIF":2.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9257144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40595934","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":"Putting the design in health system redesign: Accounting for anchoring effects","authors":"Joseph H. Joo ,&nbsp;Joshua M. Liao","doi":"10.1016/j.hjdsi.2022.100644","DOIUrl":"10.1016/j.hjdsi.2022.100644","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 3","pages":"Article 100644"},"PeriodicalIF":2.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40679669","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":"Patient selection strategies in an intensive primary care program","authors":"Elizabeth Hulen ,&nbsp;Avery Z. Laliberte ,&nbsp;Marian L. Katz ,&nbsp;Karleen F. Giannitrapani ,&nbsp;Evelyn T. Chang ,&nbsp;Susan E. Stockdale ,&nbsp;Jessica A. Eng ,&nbsp;Elvira Jimenez ,&nbsp;Samuel T. Edwards","doi":"10.1016/j.hjdsi.2022.100627","DOIUrl":"10.1016/j.hjdsi.2022.100627","url":null,"abstract":"<div><h3>Background</h3><p>Intensive primary care programs have had variable impacts on clinical outcomes, possibly due to a lack of consensus on appropriate patient-selection. The US Veterans Health Administration (VHA) piloted an intensive primary care program, known as Patient Aligned Care Team Intensive Management (PIM), in five medical centers. We sought to describe the PIM patient selection process used by PIM teams and to explore perspectives of PIM team members regarding how patient selection processes functioned in context.</p></div><div><h3>Methods</h3><p>This study employs an exploratory sequential mixed-methods design. We analyzed qualitative interviews with 21 PIM team and facility leaders and electronic health record (EHR) data from 2,061 patients screened between July 2014 and September 2017 for PIM enrollment. Qualitative data were analyzed using a hybrid inductive/deductive approach. Quantitative data were analyzed using descriptive statistics.</p></div><div><h3>Results</h3><p>Of 1,887 patients identified for PIM services using standardized criteria, over half were deemed inappropriate for PIM services, either because of not having an ambulatory care sensitive condition, living situation, or were already receiving recommended care. Qualitative analysis found that team members considered standardized criteria to be a useful starting point but too broad to be relied on exclusively. Additional data collection through chart review and communication with the current primary care team was needed to adequately assess patient complexity. Qualitative analysis further found that differences in conceptualizing program goals led to conflicting opinions of which patients should be enrolled in PIM.</p></div><div><h3>Conclusions</h3><p>A combined approach that includes clinical judgment, case review, standardized criteria, and targeted program goals are all needed to support appropriate patient selection processes.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 2","pages":"Article 100627"},"PeriodicalIF":2.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45346683","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":"Effects of opioid addiction risk information on Americans’ agreement with postoperative opioid minimization and perceptions of quality","authors":"Irene Y. Zhang ,&nbsp;David R. Flum ,&nbsp;Nidhi Agrawal ,&nbsp;Joshua M. Liao","doi":"10.1016/j.hjdsi.2022.100629","DOIUrl":"10.1016/j.hjdsi.2022.100629","url":null,"abstract":"<div><h3>Background</h3><p>Judicious opioid prescribing and patient counseling, including in the postoperative context, are important efforts to address the U.S. opioid crisis. In discussions with patients and loved ones, there is commonly an emphasis on addiction risk. From a behavioral science standpoint, presenting addiction risk information represents a fear appeal. Clinicians may also seek to build trust and confidence by presenting balanced views of benefits and risks. However, little is known about if and how addiction risk information evokes negative emotions, affects perceptions of quality, and influences perspectives on judicious opioid prescribing.</p></div><div><h3>Methods</h3><p>We conducted a four-arm, randomized survey of U.S. adults involving a vignette about post-appendectomy pain management for a friend, including the quantity of opioids commonly prescribed. Participants were given either no additional information (control), addiction risk information, addiction plus health risk information, or addiction plus death risk information. We compared evoked affect, agreement with a reduced opioid prescription compared to common practice, and perceptions of quality.</p></div><div><h3>Results</h3><p>Among 1,546 participants (56% men, mean age 39), 78% agreed with reducing the quantity of opioids prescribed, relative to common practices. Compared to the control, providing addiction risk information did not impact the degree of evoked negative emotions or the likelihood of agreement with reduced opioid prescriptions. Providing opioid risk information increased the likelihood of high surgeon quality ratings.</p></div><div><h3>Conclusions</h3><p>Among a sample of U.S. adults, presenting addiction risk did not effectively appeal to fear, nor increase agreement with judicious opioid prescribing. Alternative communication strategies may be needed for those purposes.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 2","pages":"Article 100629"},"PeriodicalIF":2.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44486094","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":"Putting the design in health system redesign: Minimizing cognitive load","authors":"Joshua M. Liao","doi":"10.1016/j.hjdsi.2022.100625","DOIUrl":"10.1016/j.hjdsi.2022.100625","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 2","pages":"Article 100625"},"PeriodicalIF":2.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45337556","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":"Increasing value and facilitating adoption of telehealth in the post-COVID era: An interview with chair of the American Telemedicine Association Joseph Kvedar","authors":"Kaushik P. Venkatesh MBA, MPH,&nbsp;Nathan Mallipeddi BS","doi":"10.1016/j.hjdsi.2022.100624","DOIUrl":"10.1016/j.hjdsi.2022.100624","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 2","pages":"Article 100624"},"PeriodicalIF":2.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45411603","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":"International Medical Graduates and practice rates in underserved communities in Florida","authors":"Nishant Uppal ,&nbsp;Elizabeth T. Chin ,&nbsp;Caroline H. Lee ,&nbsp;Parsa Erfani ,&nbsp;Katherine R. Peeler","doi":"10.1016/j.hjdsi.2022.100628","DOIUrl":"10.1016/j.hjdsi.2022.100628","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 2","pages":"Article 100628"},"PeriodicalIF":2.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42102313","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":"Engaging frontline employees using innovation contests: Lessons from Massachusetts General Hospital","authors":"Olivia S. Jung PhD ,&nbsp;Julia Jackson MBA ,&nbsp;Maulik Majmudar MD ,&nbsp;Paula McCree MS ,&nbsp;Eric M. Isselbacher MD, MSc","doi":"10.1016/j.hjdsi.2022.100615","DOIUrl":"10.1016/j.hjdsi.2022.100615","url":null,"abstract":"<div><p>In this article, we describe how innovation contests—a vehicle to crowdsource ideas and problem-solving efforts—propelled frontline employees to exert discretionary efforts in organizational problem-solving at Massachusetts General Hospital. As designers and administrators of four innovation contests in three disease centers, we share firsthand knowledge of how the contests enabled clinicians and administrative staff, whose primary job is delivering high-quality patient care, to become involved in ideation, selection, and implementation of their own ideas. We describe the processes that we designed and implemented, ideas that these processes generated, and findings from interviewing employees about their experiences afterwards. Our findings suggest that the benefits of implementing innovation contests were multifaceted. To employees, the contests provided a platform to voice suggestions and participate in any aspect of the innovation process that they found interesting. To managers, the contests revealed real, empirical issues affecting operation and patient care based on frontline employees’ knowledge. To the organization as a whole, the contests promoted collaborative problem-solving among likeminded, innovative employees.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 2","pages":"Article 100615"},"PeriodicalIF":2.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47539637","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":"Information exchange among providers and patient-centeredness in transitional care: A five-year retrospective analysis","authors":"Jing Li ,&nbsp;Glen Mays ,&nbsp;Jessica Miller Clouser ,&nbsp;Gaixin Du ,&nbsp;Arnold Stromberg ,&nbsp;Brian W. Jack ,&nbsp;Huong Q. Nguyen ,&nbsp;Mark V. Williams","doi":"10.1016/j.hjdsi.2022.100626","DOIUrl":"10.1016/j.hjdsi.2022.100626","url":null,"abstract":"<div><h3>Background</h3><p>Responding to the shift toward value-based care, hospitals engaged in widespread experimentation of implementing transitional care (TC) strategies to improve patient experience and reduce unnecessary readmissions. However, which groups of these strategies are most strongly associated with better outcomes remains unknown.</p></div><div><h3>Methods</h3><p>Using a retrospective longitudinal design, we collected hospitals' TC strategy implementation data for 370 U S. hospitals and obtained claims data for 2.4 million Medicare fee-for-service beneficiaries hospitalized at them from 2009 to 2014. We applied estimated mixed-effects regression models controlling for patient, hospital, and community covariates to assess relationships between TC strategy groups and trends in hospitals’ 30-day hospital readmissions, with observation stay and mortality rates as secondary outcomes.</p></div><div><h3>Results</h3><p>Hospitals' adoption of TC groups was associated with higher readmission rates at baseline and larger readmission rate reductions compared to not adopting any of 5 TC groups. The TC group including timely information exchange across care settings, engaging patients and caregivers in education, and/or identifying and addressing patients’ transition needs was associated with the largest reductions. Hospitals not implementing any of the 5 TC groups had higher mortality rates and lower observation stay rates throughout the study period.</p></div><div><h3>Conclusions</h3><p>Our findings suggest that timely information sharing among providers across the care continuum and engaging patients in discharge planning and education may correspond with reduced readmissions.</p></div><div><h3>Implications</h3><p>Our research suggests that hospitals responded to shifts in policy by implementing a diversity of TC strategy combinations; it also provides guidance regarding which combinations of TC strategies corresponded with larger readmission reductions.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 2","pages":"Article 100626"},"PeriodicalIF":2.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40314237","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 racism impact healthcare quality? Perspectives of Black and Hispanic/Latino Patients","authors":"Mary G. Findling ,&nbsp;Laurie Zephyrin ,&nbsp;Sara N. Bleich ,&nbsp;Motunrayo Tosin-Oni ,&nbsp;John M. Benson ,&nbsp;Robert J. Blendon","doi":"10.1016/j.hjdsi.2022.100630","DOIUrl":"10.1016/j.hjdsi.2022.100630","url":null,"abstract":"<div><p>This analysis of a 2020 nationally representative sample of 1003 U.S. Black and Hispanic/Latino households shows that experiencing racism in healthcare is associated with significantly worse quality of healthcare and lower trust in doctors reported by patients. These findings emphasize that improving healthcare for Black and Hispanic/Latino patients will require major efforts to eliminate racism on the part of health professionals and healthcare institutions.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 2","pages":"Article 100630"},"PeriodicalIF":2.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47785232","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}