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

英文中文

Addressing rural hospital challenges through integration 通过一体化解决农村医院面临的挑战

IF 2.1 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2026-06-01 Epub Date: 2026-01-07 DOI: 10.1016/j.hjdsi.2025.100776

Adam C. Powell , Ronald C. Whiting

引用次数: 0

Does increasing primary care team panel size affect health care costs: Findings from a VHA pilot program 增加初级保健小组的规模是否会影响医疗保健成本：来自VHA试点项目的调查结果。

IF 2.1 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2026-06-01 Epub Date: 2026-02-28 DOI: 10.1016/j.hjdsi.2026.100778

Edwin S. Wong , Leslie L. Taylor , Jorge Rojas , Alaina M. Mori , Ashok Reddy , Jami J. Falk , Traci Solt , Katherine Laurenzano , Karin M. Nelson

Background

In the Veterans Health Administration (VHA), primary care is delivered through a team-based medical home called the Patient Aligned Care Team (PACT). Increasing team panel size is one approach to addressing staffing challenges in primary care.

Objective

To examine whether alternate staffing models that expand team panel size results in greater medical costs.

Design

Quasi-experimental approach comparing pre-post changes in costs between patients assigned to PACT teams with expanded and standard panel sizes, respectively. We analyzed data from VHA's Corporate Data Warehouse linked to cost data from the Managerial Cost Accounting System. Costs were analyzed using two-part modeling to account for the high proportion of zero-cost observations, and adjusted for patient demographics and comorbidity.

Subjects

VHA patients assigned to the PACT team panels at three geographically diverse medical centers between October and December 2021.

Measures

Total medical costs were measured as expenditures on all health care services delivered in VHA facilities or from contract providers in the community. Secondary analysis separately examined costs of VHA delivered and contract care.

Results

At each medical center, implementation of staffing models that increased panel size did not result in statistically significant changes in total medical costs and costs of care delivered by VHA facilities but was associated with a decrease in costs of contract care at one site.

Conclusions

Increasing PACT team panel size above standard levels in VHA did not increase patient-level costs. These results can help guide health system leaders to determine appropriate panel sizes and support staffing needed to meet the needs of patient populations.

背景：在退伍军人健康管理局（VHA），初级保健是通过一个以团队为基础的医疗之家提供的，称为病人联合护理小组（PACT）。增加小组规模是解决初级保健人员配备挑战的一种方法。目的：探讨扩大小组规模的替代人员配备模式是否会导致更高的医疗费用。设计：准实验方法，比较分别分配到扩大小组和标准小组的PACT小组的患者之间的前后成本变化。我们分析了来自VHA公司数据仓库的数据，这些数据与来自管理成本会计系统的成本数据相关联。使用两部分模型分析成本，以解释高比例的零成本观察，并根据患者人口统计学和合并症进行调整。研究对象：2021年10月至12月在三个地理位置不同的医疗中心分配到PACT小组的VHA患者。测量方法：总医疗费用以VHA设施或社区合同提供者提供的所有卫生保健服务的支出来衡量。二级分析分别检查了VHA交付和合同护理的成本。结果：在每个医疗中心，增加小组规模的人员配置模式的实施并没有导致医疗总成本和VHA设施提供的护理成本的统计显着变化，但与一个地点的合同护理成本下降有关。结论：在VHA中，将PACT小组人数增加到标准水平以上并不会增加患者水平的成本。这些结果有助于指导卫生系统领导人确定适当的小组规模和支持所需的人员配备，以满足患者群体的需求。

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引用次数: 0

Pivoting to serious illness conversations to meet advance care planning quality measures in academic primary care clinics 转向重症对话，以满足学术初级保健诊所的提前护理计划质量措施。

IF 2.1 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2026-06-01 Epub Date: 2026-02-15 DOI: 10.1016/j.hjdsi.2026.100777

Grant M. Smith , Anuradha Phadke , Briththa Seevaratnam , Rebecca Fong , Ana Calugar , Winifred G. Teuteberg , Rachelle E. Bernacki

Purpose

As novel payment models incentivize advance care planning (ACP) in primary care, conversation-focused models of ACP that prioritize serious illness conversations (SICs), which focus on discussing patients’ understanding of their illness and their goals and values, can make meeting quality measures more clinically impactful.

Methods

We implemented the Serious Illness Care Program (SICP), an evidence-based ACP intervention, in academic primary care clinics. SICP supports healthcare systems to increase SICs through clinician training, coaching, and integrating a documentation module within the electronic medical record. Key facilitators of our implementation included adapting SICP training to accommodate primary care providers’ (PCPs) schedules, financial incentives for PCPs to complete SICP training and SICs, support of a physician ACP quality lead role, leadership support, and information technology collaboration.

Results

Throughout the 2023 and 2024 fiscal years, 59 of the 84 faculty PCPs (70%) in our primary care clinics completed SICP training. Of the SICP-trained PCPs, 41 (69%) completed at least one SIC. During the implementation, 340 SICs were documented for 238 unique patients.

Conclusion and implications

While additional work is needed to increase rates of PCPs completing SICs, we found that implementing SICP in academic primary care clinics is feasible when incentives, leadership support, and champions are in place.

目的：随着新型支付模式在初级保健中激励预先护理计划（ACP），优先考虑重病对话（SICs）的ACP以对话为重点的模式，侧重于讨论患者对其疾病及其目标和价值观的理解，可以使会议质量措施更具临床影响力。方法：我们在学术初级保健诊所实施了重症护理计划（SICP），这是一种基于证据的ACP干预。SICP支持医疗保健系统通过临床医生培训、指导和在电子病历中集成文档模块来增加ics。我们实施的主要促进因素包括调整SICP培训以适应初级保健提供者（pcp）的时间表，为pcp完成SICP培训和sic提供财政激励，支持医生ACP质量领导角色，领导支持和信息技术协作。结果：在整个2023和2024财政年度，我们初级保健诊所的84名教员pcp中有59名（70%）完成了SICP培训。在sicp培训的pcp中，41名（69%）完成了至少一项sicp。在实施期间，记录了238例特殊患者的340例sic。结论和意义：虽然需要做更多的工作来提高pcp完成SICP的比率，但我们发现，在激励、领导支持和支持者到位的情况下，在学术初级保健诊所实施SICP是可行的。

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引用次数: 0

Evaluating the integration of a COVID-19 symptom checker into an asthma-focused mHealth application 评估将COVID-19症状检查器集成到以哮喘为重点的移动健康应用程序中。

IF 2.1 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2026-06-01 Epub Date: 2025-12-22 DOI: 10.1016/j.hjdsi.2025.100774

Dinah Foer , Jorge Alberto Sulca Flores , Jessica L. Sousa , Anuj K. Dalal , Savanna Plombon , David W. Bates , Robert S. Rudin

Symptom checkers are tools designed to aid self-triage and used in various contexts including acute disease exposures. However, their utility within mobile health (mHealth) applications, particularly those used for long-term disease management, is unclear. This study evaluates the integration of a COVID-19 symptom checker into an asthma-focused mHealth application. Among users of the application, over 75 % engaged with the symptom checker at least once. Notably, patients prompted by the application with a nudge to use the symptom checker—triggered due to problematic scores on their weekly asthma questionnaires—were significantly more likely to complete it compared to those with non-problematic scores who did not receive the nudge. Qualitative analysis of semi-structured patient interviews explained reasons underlying patient symptom checker use which included reassurance that symptoms were not suggestive of COVID-19. Findings support the integration of symptom checkers into mHealth apps that offer continuous monitoring between clinical visits, especially for patients with chronic conditions vulnerable to acute disease triggers. Symptom checker integration can also facilitate timely dissemination of public health information.

症状检查器是用来帮助自我分类的工具，在各种情况下使用，包括急性疾病暴露。然而，它们在移动健康（mHealth）应用程序中的效用，特别是用于长期疾病管理的应用程序，尚不清楚。本研究评估了将COVID-19症状检查器整合到以哮喘为重点的移动健康应用程序中的情况。在该应用程序的用户中，超过75%的用户至少使用过一次症状检查器。值得注意的是，被提示使用症状检查器的应用程序（由于每周哮喘问卷上的问题分数而触发）的患者，与那些得分没有问题但没有收到提示的患者相比，更有可能完成它。半结构化患者访谈的定性分析解释了使用患者症状检查器的原因，其中包括确保症状不提示COVID-19。研究结果支持将症状检查器集成到移动健康应用程序中，该应用程序在临床就诊之间提供持续监测，特别是对于易受急性疾病诱因影响的慢性病患者。症状检查器集成还可以促进公共卫生信息的及时传播。

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引用次数: 0

An introduction to North Carolina Integrated Care for Kids (NC InCK): A model to support whole-child health 介绍北卡罗莱纳儿童综合护理（NC InCK）：一个支持整个儿童健康的模式

IF 2.1 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2026-06-01 Epub Date: 2025-12-19 DOI: 10.1016/j.hjdsi.2025.100773

Charlene A. Wong , Sarah Allin , Chelsea Swanson , Richard J. Chung , Kristen Dubay , Kori Flower , Josie Hatley , Alicia Reynolds Reddi , Michael J. Steiner , Eleanor Wertman , Rushina Cholera

We describe the design of the North Carolina Integrated Care for Kids (NC InCK) model. NC InCK is one of seven nationwide CMMI-funded pediatric health care delivery models that integrate services to promote whole-child health.

NC InCK was collaboratively designed by health care systems, the state Medicaid agency, Medicaid managed care organizations, child-serving organizations across multiple sectors, and families. The model uses three key approaches to integrate care: 1) a risk stratification algorithm using data across healthcare, education, and social systems to holistically understand needs and identify children who may benefit from additional supports; 2) a family-centered, longitudinal care management model to integrate cross-sector services for children and youth needing clinical and nonclinical support; and 3) an alternative payment model with innovative measures around social needs and school readiness to drive investment in child and family well-being.

Early success designing NC InCK has been driven by cross-sector and multi-level governance from the start of model design, garnering deep trust and alignment around shared goals. NC InCK is a step toward supporting whole-child health via cross-sector service integration and timely identification of children and families experiencing medical and social complexity. Lessons learned from design of this demonstration model can be applied to pediatric health initiatives nationwide.

我们描述了北卡罗莱纳儿童综合护理（NC InCK）模型的设计。NC InCK是七个全国cmmi资助的儿科卫生保健提供模式之一，整合服务以促进全儿健康。NC InCK是由医疗保健系统、州医疗补助机构、医疗补助管理的医疗机构、跨多个部门的儿童服务组织和家庭共同设计的。该模型使用三种关键方法来整合护理：1)使用医疗保健、教育和社会系统的数据进行风险分层算法，以全面了解需求并确定可能受益于额外支持的儿童；2)以家庭为中心的纵向护理管理模式，为需要临床和非临床支持的儿童和青少年提供跨部门服务；3)另一种支付模式，采用围绕社会需求和学校准备情况的创新措施，推动对儿童和家庭福祉的投资。NC InCK的早期成功设计是由跨部门和多层次的治理驱动的，从模型设计开始，围绕共同的目标获得了深刻的信任和一致。NC InCK是通过跨部门服务整合和及时识别经历医疗和社会复杂性的儿童和家庭，向支持整个儿童健康迈出的一步。从该示范模型的设计中吸取的经验教训可应用于全国的儿科卫生倡议。

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引用次数: 0

Reversing health care innovation through technology 通过技术逆转医疗保健创新。

IF 2.1 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2026-06-01 Epub Date: 2026-01-17 DOI: 10.1016/j.hjdsi.2025.100772

Joshua M. Liao , Kavita Bhavan , Brett Moran

引用次数: 0

Knocking down silos and herding apps: Digital health governance at a large health system 打破竖井和放牧应用：大型医疗系统的数字健康治理

IF 2.1 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2026-06-01 Epub Date: 2026-01-10 DOI: 10.1016/j.hjdsi.2025.100775

Brian D'Anza , Tayana Williams , Stacy Porter , Robert Eardley , Jeff Sunshine

引用次数: 0

Finding representation for the unrepresented patient: Creating a volunteer health care agent matching program in Massachusetts 为没有代表的病人寻找代表：在马萨诸塞州创建一个志愿者医疗保健代理匹配项目。

IF 2.1 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2025-12-01 Epub Date: 2025-09-16 DOI: 10.1016/j.hjdsi.2025.100769

David N. Sontag , Amy Hudspeth Cabell , Stephanie H. Chan , Jane Kavanagh , Anna Gosline , Rachel Russo

A foundational principle of health care is patient autonomy – respecting an individual's right to control what happens to their body, including what care they do and do not receive. That right is not lost when an individual loses the ability to speak for themselves or make reasoned decisions. One way to ensure health care decision-making aligns with a patient's wishes is for an individual to appoint a health care agent (HCA) to make decisions on their behalf if they are unable to. However, some people are ‘unrepresented’, meaning they do not have anyone to appoint. Lack of an HCA can result in delays in care, care that does not reflect a patient's wishes, and avoidable costs to the health care system. Strategies to address this have largely focused on courts appointing a guardian after an individual has lost decision-making capacity-a lengthy process that often exacerbates delays and, most importantly, does not result in a decision-maker who knows the individual's priorities and preferences. To address this challenge, four Massachusetts organizations developed a volunteer HCA program matching employees of each organization as HCAs for ‘unrepresented’ individuals receiving care at the other organizations. This model shows promise as an approach to ensure individuals can choose their HCA and personally communicate their priorities and preferences to them. Additionally, training volunteers as HCAs for strangers and learning from their experiences may offer insights into how everyone can be better at these conversations and representing the choices of others - especially with people close to them.

医疗保健的一项基本原则是病人自主——尊重个人控制其身体状况的权利，包括他们接受和不接受何种治疗。当一个人失去为自己说话或做出理性决定的能力时，这种权利并不会丧失。确保医疗保健决策符合患者意愿的一种方法是，如果个人无法做到这一点，可以指定一名医疗保健代理人（HCA）代表他们做出决定。然而，有些人“没有代表”，意思是他们没有人可以任命。缺乏HCA可能导致护理延误，护理不能反映患者的意愿，并给卫生保健系统带来本可避免的费用。解决这一问题的策略主要集中在法院在个人失去决策能力后指定一名监护人——这是一个漫长的过程，往往会加剧延误，最重要的是，不会产生一个了解个人优先事项和偏好的决策者。为了应对这一挑战，马萨诸塞州的四个组织制定了一个志愿者HCA计划，为在其他组织接受治疗的“无代表”个人匹配每个组织的员工作为HCA。这种模式有望确保个人可以选择他们的HCA，并亲自向他们传达他们的优先事项和偏好。此外，培训志愿者作为陌生人的hca，并从他们的经验中学习，可能会让我们了解每个人如何更好地进行这些对话，并代表他人的选择——尤其是与亲近的人。

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Investing in health care AI: Decision-making traps 投资医疗人工智能：决策陷阱。

IF 2.1 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2025-12-01 Epub Date: 2025-10-11 DOI: 10.1016/j.hjdsi.2025.100770

Danielle S. Browne , Chieh-Liang Wu , Joshua M. Liao

引用次数: 0

Relationship between mental health professional shortages and depression and anxiety visits: a cohort study of Federally Qualified Health Centers, 2019–2022 精神卫生专业人员短缺与抑郁和焦虑就诊的关系：2019-2022年联邦合格卫生中心的队列研究

IF 2.1 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2025-12-01 Epub Date: 2025-09-04 DOI: 10.1016/j.hjdsi.2025.100767

Ann Annis , Brenden Smith , Wenjuan Ma , Dawn Goldstein

引用次数: 0

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