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

英文中文

One cutoff is not enough: Assessing different area deprivation index cutoffs for insurance types on surgical Desirability of Outcome Ranking (DOOR) 一个分界点是不够的：评估不同保险类型的区域剥夺指数分界点对手术结局满意程度排序（DOOR）的影响

IF 2 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2025-06-01 Epub Date: 2025-05-15 DOI: 10.1016/j.hjdsi.2025.100762

Susanne Schmidt , Michael A. Jacobs , Daniel E. Hall , Karyn B. Stitzenberg , Lillian S. Kao , Bradley B. Brimhall , Chen-Pin Wang , Laura S. Manuel , Hoah-Der Su , Jonathan C. Silverstein , Paula K. Shireman

Background

Social Determinants of Health impact health outcomes. Area Deprivation Index (ADI) is used to risk-adjust for neighborhood affluence/deprivation but guidance on choosing deprivation cutoffs is lacking. We hypothesize that different ADI cutoffs are required for different insurance types.

Methods

National Surgical Quality Improvement Program data 2013–2019 merged with electronic health records from three academic healthcare systems. Desirability of Outcome Ranking (DOOR) assessed the association of ADI cutoffs for different insurance types, adjusted for operative stress, frailty, and case status (elective, urgent, emergent). Secondary analyses assessed the association of ADI with case status.

Results

Patients with Private insurance living in areas with ADI>85 had higher/worse DOOR outcomes, which lost significance after adjusting for case status. Medicare cases with ADI>75 exhibited higher/worse DOOR outcomes even after adjusting for case status. ADI was not associated with outcomes in the Medicaid and Uninsured groups. High ADI was associated with increased odds of urgent and emergent cases for the Private and Medicare but not Medicaid or Uninsured groups.

Conclusions

ADI is a useful metric to identify at-risk patients and can be used for risk adjustment. Health systems must understand their population demographics and use their data to determine ADI cutoffs. Patients in deprived neighborhoods have higher odds of urgent and emergent surgeries, despite having Private insurance or Medicare, suggesting that delays/barriers to primary and preventive care may be a major driver of worse outcomes. While insurance coverage is important, healthcare policies supporting reductions in urgent/emergent cases could have the largest impact on improving outcomes.

健康的社会决定因素影响健康结果。区域剥夺指数（ADI）用于社区富裕/剥夺风险调整，但缺乏选择剥夺截止点的指导。我们假设不同的保险类型需要不同的ADI截止值。方法将2013-2019年国家外科质量改进计划数据与来自三个学术医疗保健系统的电子健康记录合并。结果排序的可取性（DOOR）评估了不同保险类型的ADI截止值的相关性，并根据手术压力、虚弱和病例状态（可选、紧急、紧急）进行了调整。二次分析评估了ADI与病例状态的关系。结果居住在ADI>；85地区的私人保险患者的DOOR结果较高/较差，但在调整病例状态后不具有显著性。即使在调整了病例状态后，adi75的医疗保险病例也表现出更高/更差的DOOR结果。在医疗补助和未参保组中，ADI与结果无关。高ADI与私人和医疗保险的紧急和紧急病例的几率增加有关，而与医疗补助或无保险群体无关。结论sadi是识别高危患者的有效指标，可用于风险调整。卫生系统必须了解他们的人口统计数据，并使用他们的数据来确定每日摄入量的下限。贫困社区的患者尽管拥有私人保险或医疗保险，但紧急和紧急手术的几率更高，这表明初级和预防性护理的延误/障碍可能是导致更糟糕结果的主要原因。虽然保险覆盖面很重要，但支持减少紧急/紧急病例的医疗保健政策可能对改善结果产生最大影响。

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引用次数: 0

Looking at military health system surgical procedures through the lens of an episode grouper 通过一集石斑鱼的镜头看军队卫生系统的外科手术程序

IF 2 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2025-06-01 Epub Date: 2025-05-01 DOI: 10.1016/j.hjdsi.2025.100759

Beth A. Hawks , Jennifer Perloff , V.S. Senthil Kumar , Mary Jo Larson , John D. Chapman

Background

With mounting accountability pressure on their publicly funded health system and the demand for a medically ready military force, the military health system (MHS) employs a strategy to optimize care delivery. Research suggests that analysis of episodes of care is a valuable tool for identifying the relative resource use for a given procedure and can direct enhancements in care delivery.

Methods

This proof-of-concept study investigates the feasibility of grouping services for surgical patients into episodes of care. These episodes of care served as a unit of analysis for evaluating resource use within a public healthcare system. Borrowing from a grouping tool developed for the Centers for Medicare and Medicaid Services by Brandeis University, we developed methods to employ it with MHS clinical encounter and claims data. Data included all care paid for by the MHS from FY2009-2015, including care delivered inside and outside of their facilities.

Results

Using this analytic grouping tool, we grouped 49 percent of our administrative data into episodes of care. In these episodes, we see variation in both the care provided directly by the MHS and care provided by the network of private sector providers in rates of sequelae based on the service area for specific surgical procedures.

Conclusions

We offer a novel tool for health systems to evaluate their practice patterns, which can generate valuable strategies for efficiency gains and slowing spending.

Implications

Outside of the traditional population-based metrics to evaluate efficiency, episodes of care are a valuable tool for identifying the mix of services used to produce a given surgical outcome.

背景：由于公共资助的卫生系统面临越来越大的问责压力，以及对医疗就绪的军队的需求，军队卫生系统（MHS）采用了优化医疗服务提供的战略。研究表明，对护理事件的分析是一种有价值的工具，可以确定特定程序的相对资源使用情况，并可以直接提高护理服务。方法：本概念验证研究探讨了将外科病人的服务分组到护理事件中的可行性。这些护理事件作为评估公共医疗保健系统内资源使用的分析单元。借用布兰迪斯大学为医疗保险和医疗补助服务中心开发的分组工具，我们开发了将其用于MHS临床就诊和索赔数据的方法。数据包括MHS从2009-2015财年支付的所有医疗服务，包括在其设施内外提供的医疗服务。结果使用这个分析分组工具，我们将49%的行政数据分组到护理事件中。在这些事件中，我们看到MHS直接提供的护理和私营部门供应商网络提供的护理在基于特定外科手术服务区域的后遗症率方面存在差异。我们为卫生系统提供了一种评估其实践模式的新工具，可以为提高效率和减缓支出制定有价值的战略。除了传统的以人群为基础的评估效率的指标外，护理事件是确定用于产生给定手术结果的服务组合的有价值的工具。

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引用次数: 0

Corrigendum to "Reading the crystal ball: Primary care implications while awaiting outcomes for multi-cancer early detection tests" [Healthcare 11 (2023) 100705]. “解读水晶球：等待多种癌症早期检测结果的初级保健影响”[医疗保健11(2023)100705]的勘误表。

IF 2 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2024-12-11 DOI: 10.1016/j.hjdsi.2024.100755

Grace A Lin, Kathryn A Phillips, A Mark Fendrick

引用次数: 0

The national ambulatory medical care survey (NAMCS) at fifty: Past and future 全国流动医疗护理调查（NAMCS）五十周年：过去与未来。

IF 2 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2024-12-01 Epub Date: 2024-11-11 DOI: 10.1016/j.hjdsi.2024.100754

John D. Goodson , Sara Shahbazi

Introduction

NAMCS, sponsored by the Centers for Disease Control and Prevention, is an annual nationally representative sample survey of visits to non-federal office-based physicians, excluding anesthesiologists, radiologists, and pathologists. NAMCS has collected physician-reported ambulatory care encounter-specific content over five decades. We assessed trends in the use of the data by the health services research community, response rates, and questionnaire changes.

Methods

We extracted all peer-reviewed journal articles using NAMCS data published between 1973 and 2020 and categorized publications into high- and low-impact groups, with high impact considered as the top 25 % of journals. We then examined the annual number of journal publications using NAMCS, data according to the year collected, by impact score groups for 50 years. We compared response rates and the information requested by NAMCS questionnaires from 1973 to the present.

Results

There has been a significant decline in the overall use of NAMCS data by the non-federal health services research community for publication in both high and lower-impact journals. Data used for high impact publications peaked in 1998, at 87, remained high at 58 in 2008 but then sharply declined. Concurrently, there was a substantial decline in NAMCS survey response rates (highest: 80.5 % in 1975 vs. lowest: 28.8 % in 2015). These changes came in the context of increasing questionnaire complexity.

Conclusion

Over the last two decades, annual publication rates citing NAMCS data have declined, coincident with lower response rates and more detailed questionnaires. Nationally representative encounter-specific data verified by the clinician of record will likely have renewed value for those who develop, implement, and assess healthcare policy if response rates improve, and questionnaire review and finalization are streamlined. Though multispecialty data offer unique opportunities for comparisons, sampling a subset of clinicians, such as those providing primary care, would complement national efforts to improve access to continuous comprehensive care.

简介：NAMCS 由美国疾病控制和预防中心发起，每年对非联邦办公室医生（不包括麻醉师、放射科医生和病理学家）的就诊情况进行一次具有全国代表性的抽样调查。五十年来，NAMCS 一直在收集医生报告的非住院医疗就诊特定内容。我们评估了医疗服务研究界使用该数据的趋势、回复率和问卷变化：我们提取了 1973 年至 2020 年间发表的所有使用 NAMCS 数据的同行评审期刊论文，并将出版物分为高影响力组和低影响力组，其中高影响力组为排名前 25% 的期刊。然后，我们使用 NAMCS 数据，根据收集的年份，按 50 年的影响分值组别，检查了每年的期刊论文数量。我们比较了1973年至今的回复率和NAMCS问卷所要求的信息：结果：非联邦卫生服务研究界在高影响力和低影响力期刊上发表的NAMCS数据的总体使用率明显下降。高影响力刊物使用的数据在 1998 年达到顶峰，为 87 篇，2008 年仍高达 58 篇，但随后急剧下降。与此同时，NAMCS 调查的回复率也大幅下降（最高：1975 年为 80.5%，最低：2015 年为 28.8%）。这些变化是在问卷日益复杂的背景下出现的：在过去的二十年中，引用 NAMCS 数据的年度发表率有所下降，这与较低的回复率和更详细的问卷调查相吻合。如果回复率有所提高，问卷审核和定稿工作得以简化，那么由临床记录医生验证的具有全国代表性的特定病例数据对于那些制定、实施和评估医疗保健政策的人来说可能会有新的价值。虽然多专科数据为比较提供了独特的机会，但对临床医生的子集（如提供初级医疗服务的医生）进行抽样调查，将对改善持续全面医疗服务的全国性工作起到补充作用。

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引用次数: 0

Outpatient remdesivir treatment program for hospitalized patients with coronavirus disease-2019: Patient perceptions, process and economic impact 针对冠状病毒病住院患者的雷米替韦门诊治疗项目-2019：患者感知、治疗过程和经济影响

IF 2 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2024-12-01 Epub Date: 2024-08-13 DOI: 10.1016/j.hjdsi.2024.100750

Supavit Chesdachai , Christina G. Rivera , Jordan K. Rosedahl , Lindsey M. Philpot , Ruchita Dholakia , Bijan J. Borah , Evan W. Draper , Richard Arndt , Ravindra Ganesh , Jennifer J. Larsen , Molly J. Destro Borgen , Raymund R. Razonable

Background

Remdesivir is FDA-approved for the treatment of hospitalized patients with severe COVID-19. Many patients improve clinically to allow for hospital dismissal before completing the 5-day course. In a prior work, patients who continued remdesivir in an outpatient setting experienced better 28-day clinical outcomes. Here, we assessed patients' perspectives and the economic impact of this outpatient practice.

Methods

Hospitalized patients who received remdesivir for COVID-19 at Mayo Clinic, Rochester, from 11/6/2020 to 11/5/2021 and were dismissed to continue remdesivir in the outpatient setting were surveyed. The cost of care was compared between those who remained hospitalized versus those who were dismissed.

Results

93 (19.8 %) among 470 eligible patients responded to the electronic survey. Responders were older than non-responders. The majority (70.5 %) had symptoms resolved by the time of the survey. Ten (11.4 %) patients had persistent symptoms attributed to long COVID-19. The majority were satisfied with the quality of care (82.3 %) and overall experience (76.0 %) in the infusion clinic. After adjusting for gender, comorbidity score, and WHO severity scale, the predicted costs for the groups were $16,544 (inpatient) and $9,097 (outpatient) per patient (difference of $7,447; p < .01). An estimate of 1,077 hospital bed-days were made available to other patients as a result of this transition to outpatient.

Conclusion

An outpatient remdesivir program that allowed for early dismissal was perceived favorably by patients. The program resulted in significant cost and resource savings, the latter in terms of the availability of hospital beds for other patients needing critical services.

背景雷米地韦是美国食品及药物管理局批准用于治疗重症 COVID-19 住院患者的药物。许多患者的临床症状有所改善，因此在完成 5 天疗程之前就可以出院。在之前的一项研究中，在门诊继续服用雷米替韦的患者 28 天的临床疗效更好。方法调查了2020年6月11日至2021年5月11日期间在罗切斯特梅奥诊所接受雷米替韦治疗COVID-19，并在门诊继续雷米替韦治疗的住院患者。结果 470 名符合条件的患者中有 93 人（19.8%）回复了电子调查。回复者的年龄大于未回复者。大多数患者（70.5%）在接受调查时症状已经缓解。10名患者（11.4%）的持续症状归因于长期的 COVID-19。大多数患者对输液诊所的护理质量（82.3%）和总体体验（76.0%）表示满意。在对性别、合并症评分和世界卫生组织严重程度量表进行调整后，每名患者的组别预测成本分别为 16,544 美元（住院患者）和 9,097 美元（门诊患者）（差异为 7,447 美元；p <.01）。由于转为门诊治疗，估计有 1,077 个住院日可供其他患者使用。该计划节省了大量成本和资源，后者体现在为其他需要关键服务的患者腾出了医院床位。

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引用次数: 0

Implementation and adaptation of clinical quality improvement opioid measures 阿片类药物临床质量改进措施的实施和调整。

IF 2 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2024-12-01 Epub Date: 2024-10-04 DOI: 10.1016/j.hjdsi.2024.100753

Catherine Hersey , Sarah Shoemaker-Hunt , Michael Parchman , Ellen Childs , John Le , Wesley Sargent

引用次数: 0

Association between patient-reported financial burden and catastrophic health expenditures in cancer survivors 癌症幸存者中患者报告的经济负担与灾难性医疗支出之间的关系

IF 2 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2024-12-01 Epub Date: 2024-09-23 DOI: 10.1016/j.hjdsi.2024.100752

Nishant Uppal , Jordan M. Broekhuis , Jorge L. Gomez-Mayorga , Hao Wei Chen , Natalia Chaves , Benjamin C. James

Purpose

To measure rates of patient-reported financial burden, compare them across cancer types, and determine whether they are predictive of catastrophic health expenditures (CHE).

Methods

We extracted data from the Medical Expenditures Panel Survey from 2011 to 2017 to conduct a retrospective population-based cohort study and multivariable logistic regression to assess the financial burden of cancer across 16 cancer types and compare patient-reported metrics to CHE rates.

Results

Patients with ovarian cancer were most likely to report inability paying bills (34.5 %) and filing for bankruptcy (9.4 %), while patients with thyroid cancer were most likely to incur debt (22.4 %). Patients with kidney cancer had the highest mean debt ($46,915). CHEs were independently predicted by inability to pay medical bills (OR [95 % CI], 1.96 [1.14–3.35]) and bankruptcy filing (OR [95 % CI], 3.90 [1.21–12.60].

Conclusions and implications

We report important variations in the financial burden across cancer types and underscore the importance of assessing how patient-reported measures are related to CHEs. Policy implications. The financial burden of cancer care could explain the lack of improved outcomes with increased national health spending.

方法我们从2011年至2017年的医疗支出小组调查中提取了数据，开展了一项基于人群的回顾性队列研究和多变量逻辑回归，以评估16种癌症类型的癌症经济负担，并将患者报告的指标与灾难性医疗支出（CHE）率进行比较。结果卵巢癌患者最有可能报告无力支付账单（34.5%）和申请破产（9.4%），而甲状腺癌患者最有可能负债（22.4%）。肾癌患者的平均债务最高（46,915 美元）。无法支付医疗账单（OR [95 % CI], 1.96 [1.14-3.35] ）和申请破产（OR [95 % CI], 3.90 [1.21-12.60] ）可独立预测CHEs。对政策的影响。癌症治疗的经济负担可以解释为什么增加国家医疗支出却无法改善治疗效果。

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引用次数: 0

The role of framing in managing EHR portal messages 框架在管理电子病历门户信息中的作用。

IF 2 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2024-09-01 Epub Date: 2024-06-27 DOI: 10.1016/j.hjdsi.2024.100747

Ahmad Anshasi , Eduardo Mulanovich , Joshua M. Liao

引用次数: 0

Enhancing cultural humility in food is medicine services: A mixed-methods investigation of patient food and dietary preferences 增强医疗服务中的文化谦逊：对病人食物和饮食偏好的混合方法调查。

IF 2 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2024-09-01 Epub Date: 2024-08-06 DOI: 10.1016/j.hjdsi.2024.100749

Olivia W. Thomas , Lorrin Liang , Emily Getzoff , Santana Silver , Jessica Peters , Liza Fuentes

Dietary inequities, influenced by sociocultural and economic factors, significantly affect health outcomes, particularly among underserved communities. To address these disparities, the Food is Medicine (FIM) movement strives to enhance access to nutritious food, provide education, and encourage behavioral changes. Boston Medical Center (BMC) ‘s Nourishing Our Community Program (NOCP) exemplifies this mission by offering FIM services such as an on-site food pantry, rooftop farm, and teaching kitchen. However, persistent barriers hinder the effectiveness of programs like NOCP. This quality improvement (QI) project employed mixed methods to refine existing and develop new patient-generated nutrition education materials and resources across various FIM services.

Methods

This QI project included surveys and focus groups conducted electronically and in person between January and May 2023. We analyzed the data using descriptive statistics and qualitative content analysis.

Results

The analysis of results revealed patient preferences and experiences regarding dietary patterns, food choices, and nutrition education. These findings enhanced existing handouts, websites, and group class curricula and forged new partnerships with local community-based organizations.

Conclusion

Our findings underpin the importance of co-designing interventions, dynamic and multimodal resources, and cultural humility in care to meet individual needs.

Implications

This initiative is a model for hospitals aiming to improve educational resources within FIM services and tailor content to the specific needs of diverse patient populations. This project is the first step in programmatic improvement, and continuous refinement is crucial for sustained improvements and advancing health equity at our institution.

受社会文化和经济因素的影响，膳食不平等严重影响了健康状况，尤其是在服务不足的社区。为解决这些不平等问题，"食物即医学"（FIM）运动致力于提高营养食品的可及性、提供教育并鼓励行为改变。波士顿医疗中心（BMC）的 "滋养我们的社区计划"（NOCP）通过提供现场食品储藏室、屋顶农场和教学厨房等 "食物即医学 "服务体现了这一使命。然而，长期存在的障碍阻碍了像 NOCP 这样的计划的有效性。该质量改进（QI）项目采用了混合方法，以完善现有的营养教育材料和资源，并开发新的由患者生成的营养教育材料和资源，适用于各种 FIM 服务：该 QI 项目包括在 2023 年 1 月至 5 月期间通过电子方式和面对面方式进行的调查和焦点小组讨论。我们使用描述性统计和定性内容分析对数据进行了分析：结果分析揭示了患者在饮食模式、食物选择和营养教育方面的偏好和经验。这些发现增强了现有的讲义、网站和小组课程，并与当地社区组织建立了新的合作关系：我们的研究结果强调了共同设计干预措施、动态和多模式资源以及护理中的文化谦逊以满足个人需求的重要性：该项目为医院提供了一个范例，旨在改善FIM服务中的教育资源，并根据不同患者群体的具体需求量身定制教育内容。该项目是计划改进的第一步，不断改进对于持续改进和促进本机构的健康公平至关重要。

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引用次数: 0

Race disparities in emergency department utilization: Analyzing the role of value-based payment among Medicare Advantage beneficiaries 急诊室使用率的种族差异：分析医疗保险优势受益人中基于价值的支付的作用。

IF 2 4区医学 Q3 HEALTH POLICY & SERVICES

Healthcare-The Journal of Delivery Science and Innovation

Pub Date : 2024-09-01 Epub Date: 2024-06-28 DOI: 10.1016/j.hjdsi.2024.100748

Melanie Canterberry, Jeremiah S. Rastegar, Shireen Haq, Gosia Sylwestrzak, Emily Boudreau

引用次数: 0

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