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Jarrod Basto, Rani Chahal, Bernhard Riedel
BACKGROUND: Value-based healthcare is strongly advocated to reduce the spiralling rise in healthcare expenditure. Operating room efficiency is an important focus of value-based healthcare delivery due to high costs and associated hospital revenue derived from procedural streams of care. A parallel induction design, utilising induction rooms for anesthetising patients, may improve operating room efficiency and optimise revenue. We used time-driven activity-based costing (TDABC) to model personnel costs for a high-turnover operating list to assess value of parallel induction redesign...
February 12, 2019: Healthcare
Miriam C Tepper, Ekta Taneja, Kristin M King
No abstract text is available yet for this article.
February 11, 2019: Healthcare
Karleen F Giannitrapani, Hector Rodriguez, Alexis K Huynh, Alison B Hamilton, Linda Kim, Susan E Stockdale, Jack Needleman, Elizabeth M Yano, Lisa V Rubenstein
BACKGROUND: The Veterans Health Administration (VA) primary care is organized as a Patient Centered Medical Home (PCMH) that is based on continuity management of patient panels by interdisciplinary "teamlets" consisting of primary care providers, nurses, and clerical associates. While the teamlets are envisioned as interdisciplinary in this model, teamlet members may continue to report separately to middle management supervisors within their respective disciplines. Little is known about the role of middle managers in medical home implementation; therefore, the study purpose is to examine and characterize teamlet members' perceptions of middle managers' role in primary care operations and teamlet functioning in an outpatient setting...
February 11, 2019: Healthcare
Neel M Butala, Michael K Hidrue, Arthur J Swersey, Jagmeet P Singh, Jeffrey B Weilburg, Timothy G Ferris, Katrina A Armstrong, Jason H Wasfy
BACKGROUND: As physician groups consolidate and value-based payment replaces traditional fee-for-service systems, physician practices have greater need to accurately measure individual physician clinical productivity within team-based systems. We compared methodologies to measure individual physician outpatient clinical productivity after adjustment for shared practice resources. METHODS: For cardiologists at our hospital between January 2015 and June 2016, we assessed productivity by examining completed patient visits per clinical session per week...
February 7, 2019: Healthcare
Association Of Rural Surgeons Of India-Lancet Commission On Global Surgery Arsi-LCoGS Consensus Committee
In India, 90% of the rural population is estimated to lack access to safe, affordable, and timely surgical care. Surgical care in these settings is often characterized by limited resources. Provision of rural surgical care often requires novel approaches as compared to those in higher income urban sectors, specifically in areas of infrastructure, workforce, and blood. This consensus statement draws upon the wealth of experience held by India's rural surgeons to identify key problems and lay forth actionable solutions in the areas of surgical infrastructure, workforce, and blood supply...
January 29, 2019: Healthcare
Susan Koch-Weser, Kenneth Chui, Sarah Hijaz, Amy Lischko, David Auerbach
OBJECTIVE: Policies that aim to steer patients from higher to lower cost providers of comparable quality have potential to impact health care cost growth - but their effectiveness depends, in part, on consumer perceptions of value and willingness to make tradeoffs. We sought to understand what was required to shift substantial numbers of consumers to higher-value care settings for several "shoppable" conditions. METHODS: A discrete choice experiment (DCE) was conducted to elicit patient preferences for hospital type...
January 11, 2019: Healthcare
Adrienne Faerber, Alice Andrews, Ano Lobb, Eric Wadsworth, Katherine Milligan, Robert Shumsky, Elliott Fisher, Tim Lahey
Health care delivery science focuses on ways to improve health and health care services provided to individuals and populations. Health care professionals must be trained in health care delivery science in order to diagnose and treat the sources of health care system dysfunction and achieve better outcomes while controlling costs. The ideal model for health care delivery science training has not been fully defined, but doing so is critical especially for frontline mid-career health care professionals whose original clinical training omitted these concepts...
January 4, 2019: Healthcare
Nathaniel Z Counts, Justin Dean Smith, Daniel Max Crowley
No abstract text is available yet for this article.
January 3, 2019: Healthcare
Michael P Thompson, Ilana Graetz
BACKGROUND: The seamless transmission of patient health information across health care settings, commonly referred to as interoperability, is a focal point of federal electronic health record (EHR) incentive programs. The objective of this study was to examine the extent to which interoperability functions outlined in Promoting Interoperability Stage 3 (PI3) requirements have been adopted by US hospitals, and barriers to interoperability. METHODS: We conducted a cross-sectional analysis of 2781 non-federal, acute-care hospitals responding to the 2015 American Hospital Association Information Technology (IT) Supplement survey...
December 27, 2018: Healthcare
Michael L Millenson, David B Muhlestein, Emily M O'Donnell, Daniel A Northam Jones, R Sterling Haring, Thomas Merrill, Joel S Weissman
Although there is a widespread belief that ACOs must be patient-centered to be successful, evidence to guide them in achieving that goal has been lacking. This case report examines four ACO innovators in patient-centered care that together represent urban, suburban and rural populations with a broad range of economic, racial, ethnic and geographic diversity. Seven patient-centeredness strategies emerged: transform primary care practices into patient-centered medical homes; move upstream to address social and economic issues; use both high-tech and high-touch to identify and engage high-risk patients; practice a whole-person orientation; optimize patient-reported measures; treat patients like valued customers; and incorporate patient voices into governance and operations...
December 26, 2018: Healthcare
Leah Tuzzio, Eric B Larson, David A Chambers, Gloria D Coronado, Lesley H Curtis, Wendy J Weber, Douglas F Zatzick, Catherine M Meyers
The National Institutes of Health (NIH) Health Care Systems (HCS) Research Collaboratory hosted a workshop to explore challenges and strategies for the dissemination, implementation, and sustainability of findings from pragmatic clinical trials (PCTs) embedded in HCS. PCTs are designed to assess the impact of interventions delivered in usual or real-world conditions and leverage existing infrastructure to answer important clinical questions. The goal of the workshop was to discuss strategies for conducting impactful future PCTs that bridge the gap between evidence, practice, and policy...
December 26, 2018: Healthcare
Helena C Lyson, Sara Ackerman, Courtney Lyles, Dean Schillinger, Pamela Williams, Gato Gourley, Reena Gupta, Margaret Handley, Urmimala Sarkar
BACKGROUND: Team-based care is an innovative approach to primary care in which groups of health care professionals work collaboratively to manage care for groups of patients. Safety-net organizations face specific barriers to implementing health care innovations. More research is needed that documents the dynamics that inform implementation and sustainment of innovative practices in the safety net. METHODS: We conducted qualitative fieldwork, including purposeful observation and semi-structured and informal interviews, to explore the implementation of care teams in safety-net clinics in California...
December 11, 2018: Healthcare
Nakul Raykar, Swagoto Mukhopadhyay, Saurabh Saluja, Sheetal Amte, Siddharth David, Jesudian Gnanaraj, Raman Kataria, Balaram Jadhav, Walt Johnson, John Meara, Nandakumar Menon, Radhakrishna D Prabhu, Devi Shetty, Ravikant Singh, Ravindranath Tongaonkar, Ravindra Vora, Nobhojit Roy
No abstract text is available yet for this article.
December 3, 2018: Healthcare
Nakul Raykar, John Meara, Atul Gawande, Paul Farmer, Nobhojit Roy
No abstract text is available yet for this article.
November 26, 2018: Healthcare
Devin V Williams, Tiffany C Liu, Michael G Zywiel, Miranda K Hoff, Lorrayne Ward, Kevin J Bozic, Karl M Koenig
BACKGROUND: Limited access to specialty care for uninsured and underinsured patients may be exacerbated by traditional fee-for-service approaches to care that incentivize volume and intensity of services over value of care. The purpose of this study was to determine the impact of a value-based integrated practice unit (IPU) on access to musculoskeletal care and surgical outcomes in a safety-net population. METHODS: A new IPU was implemented on 6/1/2016 at an established safety-net clinic providing musculoskeletal care in central Texas to supplement existing musculoskeletal care provided through a fee-for-service model...
October 31, 2018: Healthcare
Sanchay Gupta, Adam L Beckman
No abstract text is available yet for this article.
September 25, 2018: Healthcare
Sanchay Gupta, Adam L Beckman
No abstract text is available yet for this article.
September 11, 2018: Healthcare
Suhas Gondi, Adam L Beckman
No abstract text is available yet for this article.
September 7, 2018: Healthcare
Dori A Cross, Paige Nong, Christy Harris-Lemak, Genna R Cohen, Ariel Linden, Julia Adler-Milstein
BACKGROUND: Improving primary care for patients with chronic illness is critical to advancing healthcare quality and value. Yet, little is known about what strategies are successful in helping primary care practices deliver high-quality care for this population under value-based payment models. METHODS: Double-blind interviews in 14 primary care practices in the state of Michigan, stratified based on whether they did (n = 7) or did not (n = 7) demonstrate improvement in primary care outcomes for patients with at least one reported chronic disease between 2010 and 2013...
September 6, 2018: Healthcare
Kevin G Volpp, Amol Navathe, Emily Oshima Lee, Mark Mugishii, Andrea B Troxel, Kristen Caldarella, Amanda Hodlofski, Susannah Bernheim, Elizabeth Drye, Justin Yoshimoto, Kim Takata, Michael B Stollar, Ezekiel Emanuel
OBJECTIVES: To describe the process of developing a new physician payment system based on value and transitioning away from a fee-for-service payment system STUDY DESIGN: Descriptive. This paper describes a recent initiative involving redesign of primary care provider payment in the State of Hawaii. While there has been extensive discussion about switching payment from volume to value in recent years, much of this change has happened at the organizational level and this initiative focused on changing the incentives for individual providers...
September 2018: Healthcare
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