Seth's Blog: Folk wisdom and proofiness

Some thoughts to ponder for the New Year.


Seth's Blog: Folk wisdom and proofiness

Variability in the Measurement of Hospital-wide Mortality Rates — NEJM

Health Services Research is still a young science.

Variability in the Measurement of Hospital-wide Mortality Rates — NEJM

Putting the Value Framework to Work | Health Policy and Reform

More on value in healthcare

Putting the Value Framework to Work | Health Policy and Reform

What Is Value in Health Care? | Health Policy and Reform

New NEJM article discussing health care value and outcomes research.


What Is Value in Health Care? | Health Policy and Reform

The Foundation's Community: Community: Health Care Transformation Has Begun: A Forum on Accelerating Improved Quality and Cost

A new online forum, sponsored by the RW Johnson Foundation.

The Foundation's Community: Community: Health Care Transformation Has Begun: A Forum on Accelerating Improved Quality and Cost

Nurses' Scope of Practice — NEJM

Part 2 of nursing practice expansion discussion

Nurses' Scope of Practice — NEJM

Broadening the Scope of Nursing Practice — NEJM

More on the expanding the role of nurses in this week's NEJM

Broadening the Scope of Nursing Practice — NEJM

Dan Ariely » Blog Archive Good Decisions. Bad Outcomes. «

another perspective on pay for performance initiatives, possibly all outcomes research outside of a highly controlled situation (like a clinical trial)

Dan Ariely » Blog Archive Good Decisions. Bad Outcomes. «

What Is Value in Health Care? | Health Policy and Reform

newly published thoughts on health care quality from the nejm

What Is Value in Health Care? | Health Policy and Reform

Government Payment for Health Care — Causes and Consequences | Health Policy and Reform

New NEJM essay on the role of government in paying for health care. Special vocabulary feature!! Learn what monopsony power means.

Government Payment for Health Care — Causes and Consequences | Health Policy and Reform

Arch Intern Med -- Abstract: Testing for the Presence of Positive-Outcome Bias in Peer Review: A Randomized Controlled Trial, November 22, 2010, Emerson et al. 170 (21): 1934

be sure to check this one out, very creative study with sobering results


Arch Intern Med -- Abstract: Testing for the Presence of Positive-Outcome Bias in Peer Review: A Randomized Controlled Trial, November 22, 2010, Emerson et al. 170 (21): 1934

Arch Intern Med -- Abstract: Health Care Use and Decision Making Among Lower-Income Families in High-Deductible Health Plans, November 22, 2010, Kullgren et al. 170 (21): 1918

more on pt cost sharing

Arch Intern Med -- Abstract: Health Care Use and Decision Making Among Lower-Income Families in High-Deductible Health Plans, November 22, 2010, Kullgren et al. 170 (21): 1918

The Healthcare Imperative: Lowering Costs and Improving Outcomes: Brief Summary of a Workshop

New stuff on efficiency and quality of health care. Timely.

jd

The Healthcare Imperative: Lowering Costs and Improving Outcomes: Brief Summary of a Workshop

Why digging up primary sources is important? « Synchronised Minds

Unfortunately, shortcuts have no place in good scholarly work.

jd


Why digging up primary sources is important? « Synchronised Minds

High-Deductible Health Plans and Better Benefit Design — Ann Intern Med

More on patient cost sharing and its impact on health care utilization.

High-Deductible Health Plans and Better Benefit Design — Ann Intern Med

JAMA -- The Cost-Coverage Trade-off: "It's Health Care Costs, Stupid", February 27, 2008, Emanuel 299 (8): 947

A perspective on patient cost sharing.

JAMA -- The Cost-Coverage Trade-off: "It's Health Care Costs, Stupid", February 27, 2008, Emanuel 299 (8): 947

Temporal Trends in Rates of Patient Harm Resulting from Medical Care — NEJM

Update on iatrogenic harms/risk of seeking medical care.

jd

Temporal Trends in Rates of Patient Harm Resulting from Medical Care — NEJM

How Health Insurance Design Affects Access To Care And Costs, By Income, In Eleven Countries -- Schoen et al., 10.1377/hlthaff.2010.0862 -- Health Affairs

a new cross country comparison - shades of TR Reid.


How Health Insurance Design Affects Access To Care And Costs, By Income, In Eleven Countries -- Schoen et al., 10.1377/hlthaff.2010.0862 -- Health Affairs

Complex Systems View of Educational Policy Research | Science/AAAS

I wonder how strong the parallels are between the educational system and the health care system?


Complex Systems View of Educational Policy Research | Science/AAAS

innovations.cms.gov

the new cms innovations center website.

innovations.cms.gov

Here come the healthcare apps - O'Reilly Radar

another new facet of medical care ripe for good health services research!


Here come the healthcare apps - O'Reilly Radar

The Epidemiology of Prescriptions Abandoned at the Pharmacy — Ann Intern Med

A pretty good bit of creative health services research I think.


The Epidemiology of Prescriptions Abandoned at the Pharmacy — Ann Intern Med

Other blogs on quality and P4P — db's Medical Rants

Interesting insights from Dr Centor about quality and primary care practice models. worth a look.


Other blogs on quality and P4P — db's Medical Rants

Aligning Forces for Quality Launches New Quality Improvement Programs - RWJF

New quality initiative underway


Aligning Forces for Quality Launches New Quality Improvement Programs - RWJF

Standing Up for Quality and Affordable Health Care - HealthCare Notes | Newsroom | HealthCare.gov

In case you were wondering what the HHS Secretary does with her time...


Standing Up for Quality and Affordable Health Care - HealthCare Notes | Newsroom | HealthCare.gov

Medical Loss Ratios - RWJF

New policy brief from the robert wood johnson folks

Medical Loss Ratios - RWJF

APHA Annual Meeting Blog: Get empowered all over again: Video of Jenkins, West is up!

I am told these presentations are incredible - worth checking out.

jd

APHA Annual Meeting Blog: Get empowered all over again: Video of Jenkins, West is up!

Pioneering Ideas: Time to Accelerate Innovation: Takeaways from this Year's mHealth Summit

some followup on the mobile health summit conference.

Pioneering Ideas: Time to Accelerate Innovation: Takeaways from this Year's mHealth Summit

The ACP Advocate Blog by Bob Doherty: Mr. Roger's (Medical Home) Neighborhood

It takes a village... Information about the concept of a medical neighborhood proposed by the american college of physicians.



The ACP Advocate Blog by Bob Doherty: Mr. Roger's (Medical Home) Neighborhood

Payment Reform and the Mission of Academic Medical Centers | Health Policy and Reform

more new stuff...

Payment Reform and the Mission of Academic Medical Centers | Health Policy and Reform

Geographic Variation in the Quality of Prescribing | Health Policy and Reform

new quality study.

jd

Geographic Variation in the Quality of Prescribing | Health Policy and Reform

Program Page | 2010 mHealth Summit

Conference happening right now on the future of mobile health!

Note availability of several live webcasts.

Lot's of business for health services research.

jd


Program Page | 2010 mHealth Summit

American College of Physicians

2 new reports regarding aspects of the patient-centered medical home.

jd


American College of Physicians

Cruel Calculus: Why Saving Premature Babies Is Better Business Than Helping Them Thrive -- Lantos 29 (11): 2114 -- Health Affairs

Interesting perspective on our medical care system.

jd

Cruel Calculus: Why Saving Premature Babies Is Better Business Than Helping Them Thrive -- Lantos 29 (11): 2114 -- Health Affairs

How Geisinger's Advanced Medical Home Model Argues The Case For Rapid-Cycle Innovation -- Steele et al. 29 (11): 2047 -- Health Affairs

Newly published article on one of the leaders in implementing medical homes.

jd

How Geisinger's Advanced Medical Home Model Argues The Case For Rapid-Cycle Innovation -- Steele et al. 29 (11): 2047 -- Health Affairs

The operations research approach to health services

Just-published paper with a different perspective on HSR:

 

OR in Healthcare: A European Perspective

Sally Brailsford^a and Jan Vissers^{b, ,}

^a School of Management, University of Southampton. Southampton SO17 1BJ, UK
^b Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738 3000 DR Rotterdam NL, and School of Industrial Engineering, Eindhoven University of Technology, PO Box 513 5600 MB Eindhoven NL

Received 18 October 2009; 

accepted 16 October 2010. 

Available online 26 October 2010.

Abstract

The European Working Group “Operations Research Applied to Health Services” (ORAHS) is one of the domain specific EURO Working Groups organized by EURO - the European Association of Operational Research Societies. In this paper we report on the development of ORAHS as a platform for OR in health, and analyse the papers presented at meetings over the 35 years of its existence. We propose a two-way framework for analysis, where one dimension is the nine stages of the product life cycle: identifying consumer requirements, designing a new service to meet these requirements, forecasting demand for such a service, securing resources for it, allocating these resources, developing programs & plans to use these resources for delivering the service, establishing criteria for service delivery, managing the performance of the service, and finally, evaluating its performance. The other dimension is a three-level classification into broad application areas referring to processes at different levels in healthcare: patients & providers, units & hospitals, and regional & national. We use this framework to carry out a quantitative analysis of all the papers presented during the meetings of ORAHS since its inception in 1975. We then describe developments over this period in applying OR approaches and techniques to health care, and present an overview of the main application areas and challenges.

Keywords: OR in health services; review

New Health Partnerships - RWJF

An experience with patient activation in care of chronic disease


New Health Partnerships - RWJF

The County Health Rankings - RWJF

Another view on the impact of health services assessment as a positive force for change

jd


The County Health Rankings - RWJF

An Ecological Understanding of Evaluation Use - RWJF

Interesting perspective on HSR evaluative work

jd


An Ecological Understanding of Evaluation Use - RWJF

future_nursing_iom.pdf (application/pdf Object)

Followup on medical teams and the recent IOM future of Nursing recommendation.

jd


future_nursing_iom.pdf (application/pdf Object)

P4P – thoughts stimulated by Reinhardt — db's Medical Rants

More on pay for performance.


P4P – thoughts stimulated by Reinhardt — db's Medical Rants

Arch Intern Med -- Improving Primary Care for Older Patients: Challenge for the Aging Century: Comment on "Practice Redesign to Improve Care for Falls and Urinary Incontinence", October 25, 2010, Kao and Landefeld 170 (19): 1772

More on practice redesign

Arch Intern Med -- Improving Primary Care for Older Patients: Challenge for the Aging Century: Comment on "Practice Redesign to Improve Care for Falls and Urinary Incontinence", October 25, 2010, Kao and Landefeld 170 (19): 1772

Arch Intern Med -- Reforming Payment for Health Care Services: Comment on "Physicians' Opinions About Reforming Reimbursement", October 25, 2010, Chernew 170 (19): 1742

More on reimbursement reform

Arch Intern Med -- Reforming Payment for Health Care Services: Comment on "Physicians' Opinions About Reforming Reimbursement", October 25, 2010, Chernew 170 (19): 1742

Arch Intern Med -- Abstract: Practice Redesign to Improve Care for Falls and Urinary Incontinence: Primary Care Intervention for Older Patients, October 25, 2010, Wenger et al. 170 (19): 1765

evaluation of a practice re-design strategy


Arch Intern Med -- Abstract: Practice Redesign to Improve Care for Falls and Urinary Incontinence: Primary Care Intervention for Older Patients, October 25, 2010, Wenger et al. 170 (19): 1765

Arch Intern Med -- Abstract: Physicians' Opinions About Reforming Reimbursement: Results of a National Survey, October 25, 2010, Federman et al. 170 (19): 1735

Nobody said health care reform would be easy.


Arch Intern Med -- Abstract: Physicians' Opinions About Reforming Reimbursement: Results of a National Survey, October 25, 2010, Federman et al. 170 (19): 1735

Arch Intern Med -- Abstract: Physician Wages Across Specialties: Informing the Physician Reimbursement Debate, October 25, 2010, Leigh et al. 170 (19): 1728

Here are the data that Bruce mentioned yesterday documenting the gap in physician pay between primary care and other specialties


Arch Intern Med -- Abstract: Physician Wages Across Specialties: Informing the Physician Reimbursement Debate, October 25, 2010, Leigh et al. 170 (19): 1728

Interview With a Ghost (Writer) « The Scholarly Kitchen

Here is a bone-chilling blog posting.

Happy Halloween!

jd


Interview With a Ghost (Writer) « The Scholarly Kitchen

Argumentation: The Study of Effective Reasoning, 2nd Edition

At long last, here is the Teaching Company course in rhetoric that I mentioned a while back.

jd


Argumentation: The Study of Effective Reasoning, 2nd Edition

Eric Dishman: Take health care off the mainframe | Video on TED.com

A companion to the NEJM article about moving health care into the home. Interesting Rochester connection too!\

jd

Eric Dishman: Take health care off the mainframe | Video on TED.com

Why Health Care Is Going Home — NEJM

the next major restructuring of our health care system?

jd


Why Health Care Is Going Home — NEJM

Seth's Blog: Deliberately uninformed, relentlessly so [a rant]

Thoughtful commentary on the state of our society, part 2


Seth's Blog: Deliberately uninformed, relentlessly so [a rant]

The ACP Advocate Blog by Bob Doherty: The Muddle-Minded Middle

thoughtful analysis of the state of our society - part 1


The ACP Advocate Blog by Bob Doherty: The Muddle-Minded Middle

Complexity Matters » Some Environments Foster Innovation-What Should Your Work Place Look Like?

Remember from the beginning when we talked about the multi-disciplinary nature of health services research? We have also several times touched on the importance of combining methodological perspectives & thinking creatively about health service research. Here is a post that addresses these issues.

jd


Complexity Matters » Some Environments Foster Innovation-What Should Your Work Place Look Like?

Can Open Access Journals Guarantee Sound Methods? « The Scholarly Kitchen

Here is one for our "research career" series - more on the changing nature of scientific communications. Also, link to the scholarly kitchen website, a great way to follow this sort of thing.

jd


Can Open Access Journals Guarantee Sound Methods? « The Scholarly Kitchen

Ernest Madu on world-class health care | Video on TED.com

A perspective on how to create a health care system. Also, a brief introduction to the TED talks. In case you have not seen these before, they are an incredible source of ideas as well as examples of how to give a good presentation. Enjoy!



Ernest Madu on world-class health care | Video on TED.com

Demo: The Archimedes Outcomes Analyzer

A new approach to addressing some of the evaluation issues we have been discussing.


Demo: The Archimedes Outcomes Analyzer

Seth's Blog: Getting smart about the hierarchy of smart

another view on pay for performance from a different perspective.


incidentally, a very interesting blog to follow for new ideas and forward thinking


Seth's Blog: Getting smart about the hierarchy of smart

SocialMediaToolkit_BM.pdf (application/pdf Object)

New toolkit from the cdc about using social media for public health work - no reason why it shouldn't work for HSR work too.

jd

SocialMediaToolkit_BM.pdf (application/pdf Object)

Legislating against Use of Cost-Effectiveness Information | Health Policy and Reform

Nice followup to our discussion today.

jd

Legislating against Use of Cost-Effectiveness Information | Health Policy and Reform

Arch Intern Med -- Abstract: Hospitalists and the Quality of Care in Hospitals, Aug 10/24, 2009, López et al. 169 (15): 1389

2nd article about hospitalists and quality of care

jd


Arch Intern Med -- Abstract: Hospitalists and the Quality of Care in Hospitals, Aug 10/24, 2009, López et al. 169 (15): 1389

Arch Intern Med -- Do Hospitalists Improve Quality?, Aug 10/24, 2009, Centor and Taylor 169 (15): 1351

first of 2 articles discussing effects of hospitalists on the quality of care

jd

Arch Intern Med -- Do Hospitalists Improve Quality?, Aug 10/24, 2009, Centor and Taylor 169 (15): 1351

JAMA -- Abstract: Cancer Screening Among Patients With Advanced Cancer, October 13, 2010, Sima et al. 304 (14): 1584

An unanticipated consequence of screening guidelines. Timely for our session this thursday.

jd



JAMA -- Abstract: Cancer Screening Among Patients With Advanced Cancer, October 13, 2010, Sima et al. 304 (14): 1584

ACP: InternistWeekly - 12 October 2010

A new IOM report regarding the role of nurses in healthcare from the ACP news feed.

Nurses tapped for more training, bigger role in health care

The Institute of Medicine says nurses' roles, responsibilities and education should change significantly to meet the increased demand for care expected from health care reform.
Further, nurses should train alongside other health professionals and assume leadership roles in redesigning care, stated the report. Nurses should undergo residencies, increase their ranks of those with bachelor's degrees from 50% to 80% by 2020, ensure that at least 10% of their baccalaureates enter a master's or doctoral program within five years, and double the number of doctoral candidates.

There are more than 3 million nurses in the U.S., and because of their direct patient contact and the proportion of time the profession spends in direct patient care, "Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States," the report said.
Once nurses are trained, scope of practice limits should be lifted, the report stated, as should insurance and regulatory hurdles, so that the health system can reap the full benefit. Scope of practice barriers are particularly problematic for advanced practice registered nurses (APRNs), the report found.

Studies of advanced practice nurses and the experiences of health care organizations, such as the Veterans Health Administration, Geisinger Health System, and Kaiser Permanente, that have increased the roles and responsibilities of nurses in patient care show that these nurses deliver safe, high-quality primary care.
In one example, the VA had been transforming itself since the 1990s in anticipation of an aging veteran population. The results of the VA’s initiatives using both front-line RNs and APRNs showed that patients received significantly better health care based on various quality-of-care indicators such as mammography, flu and pneumococcal vaccination, cancer screening and other conditions than patients enrolled in Medicare’s fee-for-service program. In some cases, the study showed, between 93% and 98% of VA patients received appropriate care in 2000; the highest score for comparable Medicare patients was 84%. Meanwhile, spending per enrollee rose much more slowly than in Medicare, by 30% from 1999 to 2007 compared with 80% for Medicare over the same period.

The report is the product of a study convened by the Robert Wood Johnson Foundation Initiative on the Future of Nursing, which will organize a national conference at the end of November to discuss implementation.

The conclusions aren't without detractors. The American Medical Association responded, "Nurses are critical to the health care team, but there is no substitute for education and training. Physicians have seven or more years of postgraduate education and more than 10,000 hours of clinical experience; most nurse practitioners have just two-to-three years of postgraduate education and less clinical experience than is obtained in the first year of a three year medical residency. These additional years of physician education and training are vital to optimal patient care, especially in the event of a complication or medical emergency, and patients agree."



ACP: InternistWeekly - 12 October 2010

The ACP Advocate Blog by Bob Doherty: Should Medicare pay less for less effective care?

Nice discussion of how to pay for health care - variation on our pay for performance series.

The ACP Advocate Blog by Bob Doherty: Should Medicare pay less for less effective care?

Health Affairs

This week, Health Affairs came out with an issue largely devoted to comparative effectiveness research - a wonderful followup to our session last week. Here it is:

Health Affairs

Medical Education Innovation Is Needed To Improve Health Care – Health Affairs Blog

This one speaks for itself: If we are to change how medicine is practiced, we need to appropriately change the way we train the practitioners.

Also includes a healthy menu of other blogs that address health care issues.

jd

Medical Education Innovation Is Needed To Improve Health Care – Health Affairs Blog

Implementation Timeline - Kaiser Health Reform

very useful timeline about how the health care reforms are being implemented.

Implementation Timeline - Kaiser Health Reform

Gmail - MDM - DECISIONS study supplement released online

This is timely on the eve of our session on medical decision making.


Gmail - MDM - DECISIONS study supplement released online

Bending The Cost Curve – Health Affairs Blog

Followup to our discussion yesterday about the health care reform goal of reducing health care costs


Bending The Cost Curve – Health Affairs Blog

Arch Intern Med -- Abstract: Unintended Effects of a Computerized Physician Order Entry Nearly Hard-Stop Alert to Prevent a Drug Interaction: A Randomized Controlled Trial, September 27, 2010, Strom et al. 170 (17): 1578

One of the central provisions of the health care reform bill is expanded use of computerized medical records.

This article documents an unintended consequence, suggesting that we must always "trust, but verify" proposed interventions.




Arch Intern Med -- Abstract: Unintended Effects of a Computerized Physician Order Entry Nearly Hard-Stop Alert to Prevent a Drug Interaction: A Randomized Controlled Trial, September 27, 2010, Strom et al. 170 (17): 1578

Peer-Review in a World with Rational Scientists: Toward Selection of the Average | Santa Fe Institute

Here is one for our systems and our "world of research" collections: systems analysis of how well the peer review system works given the factors influencing by reviewers.

Peer-Review in a World with Rational Scientists: Toward Selection of the Average | Santa Fe Institute

Low-Cost Lessons from Grand Junction, Colorado | Health Policy and Reform

A description of the characteristics of the Grand Junction Colorado health system that has made it famous.


Low-Cost Lessons from Grand Junction, Colorado | Health Policy and Reform

JAMA -- Using Science to Improve the Nation's Health System: NIH's Commitment to Comparative Effectiveness Research, June 2, 2010, Lauer and Collins 303 (21): 2182

Perspective on comparative effectiveness research from the NIH


JAMA -- Using Science to Improve the Nation's Health System: NIH's Commitment to Comparative Effectiveness Research, June 2, 2010, Lauer and Collins 303 (21): 2182

JAMA -- Building the Patient-Centered Medical Home in Ontario, June 2, 2010, Glazier and Redelmeier 303 (21): 2186

A report on the Canadian experience with medical homes in Ontario.


JAMA -- Building the Patient-Centered Medical Home in Ontario, June 2, 2010, Glazier and Redelmeier 303 (21): 2186

PLoS Medicine: Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up?

An interesting perspective on the prospects for comparative effectiveness research to make a difference - will it just be contributing to information overload?


PLoS Medicine: Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up?

Competition On Access: A Role For Government In Health Care Markets - Kaiser Health News

Brian suggested this article on the roles government owned, nonprofit, and for profit hospitals play in the healthcare market - thanks Brian!


Competition On Access: A Role For Government In Health Care Markets - Kaiser Health News

Three Degrees of Separation — Ann Intern Med

A major change in US health care over the past 15 years or so has been the rise of the hospitalist movement. My understanding is that hospitalists have been shown to improve some hospital-related metrics but I am not sure how thoroughly their effects have been examined.

This is an interesting article by Howard Beckman of Rochester, one of my former bosses.


Three Degrees of Separation — Ann Intern Med

What motivates health care workers is needed to explain health care costs | KevinMD.com

Another blog post discussing a new pay for performance initiative that is part of the health care reform act & research on motivation that cites Daniel Pink, Ed Deci (from the UR) and several others.

This blog is one of the most widely read medical-care related blogs & a good one to follow to see what folks in the trenches are thinking about (or at least the outspoken ones).


What motivates health care workers is needed to explain health care costs | KevinMD.com

Kung Fu Panda

Possibly a source of inspiration for aspiring (or discouraged) health services researchers.

Here is everything you ever need to know without seeing the movie:

Wikipedia entry: Kung Fu Panda


jd

Are schools complex adaptive systems?

Interesting trio of articles testing the applicability of a complex adaptive systems approach to school-based interventions.

1.    Keshavarz N, Nutbeam D, Rowling L, Khavarpour F. Schools as social complex adaptive systems: A new way to understand the challenges of introducing the health promoting schools concept. Social Science & Medicine. [doi: DOI: 10.1016/j.socscimed.2010.01.034]. 2010;70(10):1467-74.
2.    Keshavarz N, Nutbeam D, Rowling L. Social complex adaptive systems. A response to Haggis. Social Science & Medicine. [doi: DOI: 10.1016/j.socscimed.2010.01.023]. 2010;70(10):1478-9.
3.    Haggis T. Approaching complexity: A commentary on Keshavarz, Nutbeam, Rowling and Khavarpour. Social Science & Medicine. [doi: DOI: 10.1016/j.socscimed.2010.01.022]. 2010;70(10):1475-7.

Using theory to synthesise evidence from behaviour change interventions: The example of audit and feedbac

 Interesting article demonstrating the use of a conceptual framework to help drive research synthesis.


Gardner B, Whittington C, McAteer J, Eccles MP, Michie S. Using theory to synthesise evidence from behaviour change interventions: the example of audit and feedback. Soc Sci Med. 2010 May;70(10):1618-25.



jd

Childhood obesity

Two posts re: current efforts to combat the childhood obesity epidemic.

thanks Viji!

a.       http://www.npr.org/templates/story/story.php?storyId=129856526

b.      http://www.npr.org/templates/story/story.php?storyId=129856530

Reducing Health Care Costs, Improving Care - US News and World Report

This came from today's Kaiser Daily Health Policy Report email. It talks about using methods and practices from other systems, specifically airlines, in health care. I thought this was interesting as it seemed relevant to our recent discussions and the NSF is funding research in this area.

thanks Chelsea!

jd

Reducing Health Care Costs, Improving Care - US News and World Report

The Effect of Financial Incentives on Hospitals That Serve Poor Patients — Ann Intern Med

This article and accompanying editorial from the Annals of Internal Medicine addresses several of our themes:

1. pay for performance
2. disparities
3. health services research methods

A healthy meal of food for thought.

Jha AK, Orav EJ, Epstein AM. The Effect of Financial Incentives on Hospitals That Serve Poor Patients. Annals of Internal Medicine. 2010 September 7, 2010;153(5):299-306.
The Effect of Financial Incentives on Hospitals That Serve Poor Patients — Ann Intern Med

Werner RM. Does Pay-for-Performance Steal From the Poor and Give to the Rich? Annals of Internal Medicine. 2010 September 7, 2010;153(5):340-1.
http://www.annals.org.ezpminer.urmc.rochester.edu/content/153/5/342.extract

jd

Engineering Science And Episode-Based Hospital Payment – Health Affairs Blog

Another proposal of how we can use tools developed in other disciplines to improve health care delivery.

Should we consider this mechanistic or systems?

Are we dealing with a phenomenon in the zone of certainty or the zone of complexity?

cheers

jd



Engineering Science And Episode-Based Hospital Payment – Health Affairs Blog

HEDIS measures — db's Medical Rants

Interesting stories about the effects of current quality of care efforts. In both cases, the quality assurance measure (implemented by an administrator, i.e. "the suit") did not make clinical sense to the doctor and was felt to have a negative impact on their professional autonomy. This could be seen as evidence supporting the complex adaptive system theory of health services and illustrating how a pure mechanistic approach to such as system can be problematic and even counter-productive.

jd

HEDIS measures — db's Medical Rants

Health Policy Briefs

Summary of the current status of the patient-centered medical home, an important current movement in improving primary care health delivery.


Health Policy Briefs

Adopting A Surgical Safety Checklist Could Save Money And Improve The Quality Of Care In U.S. Hospitals -- Semel et al. 29 (9): 1593 -- Health Affairs

this has been a popular topic of late. Seems to be a good illustration of something that falls in the zone of certainty we discussed yesterday.

jd

Adopting A Surgical Safety Checklist Could Save Money And Improve The Quality Of Care In U.S. Hospitals -- Semel et al. 29 (9): 1593 -- Health Affairs

EBSCOhost: Result List: JN "Academy of Management Journal" and DT 20100601

As promised, a systems-related article. This touches on several hsr topics including quality of care, clinical translational science, and the concept of the learning organization that has been promoted for adoption by healthcare institutions.

FAILING TO LEARN? THE EFFECTS OF FAILURE AND SUCCESS ON ORGANIZATIONAL LEARNING IN THE GLOBAL ORBITAL LAUNCH VEHICLE INDUSTRY. By: MADSEN, PETER M.; DESAI, VINIT. Academy of Management Journal, Jun2010, Vol. 53 Issue 3, p451-476, Abstract: It is unclear whether the common finding of improved organizational performance with increasing organizational experience is driven by learning from success, learning from failure, or some combination of the two. We disaggregate these types of experience and address their relative (and interactive) effects on organizational performance in the orbital launch vehicle industry. We find that organizations learn more effectively from failures than successes, that knowledge from failure depreciates more slowly than knowledge from success, and that prior stocks of experience and the magnitude of failure influence how effectively organizations can learn from various forms of experience.

EBSCOhost: Result List: JN "Academy of Management Journal" and DT 20100601

Defining Medical Expenses — An Early Skirmish over Insurance Reforms | Health Policy and Reform

More information about the details of the health reform process. This one is about a new regulation that defines how insurers spend their money.

jd


Defining Medical Expenses — An Early Skirmish over Insurance Reforms | Health Policy and Reform

Health-systems strengthening: current and future activities : The Lancet

Food for thought as we develop our health system for Helenwoodhalia!



Health-systems strengthening: current and future activities : The Lancet


jd

Health Care Reform

Big day for information and thinking about US health care reform today.

First, Brian sent this link to a tricky implementation issue discussed in the NY Times:
http://economix.blogs.nytimes.com/2010/09/03/on-health-care-the-devils-in-the-details/?hp

(Note that the author, Uwe Rheinhart, is who TR Reid worked with when writing his book.)

Second, Dr Pearson mentioned some issues in his talk today about possible amendments to the bill that will be political issues this fall. Remember that this is an election year.


Finally, Viji found a NPR story about a possible shortage of primary care providers in the face of expected increased demand for primary care services as a consequence of health care reform. We will be having a chance to talk more about primary care later in the semester.  Here is the link:
http://www.npr.org/templates/story/story.php?storyId=129532193


Finally, it is worth noting that the Rochester Public Market is a special place and worth checking out. It was just voted #1 in the nation:http://www.mpnnow.com/photos/x863074334/Rochester-Public-Market-is-tops


jd

The Affordable Care Act and the Future of Clinical Medicine: The Opportunities and Challenges — Ann Intern Med

A newly published summary of changes likely to happen in the US health system as reform progresses. Evaluation of the effects of these changes on health care would seem to be a fertile area for health services researchers.



The Affordable Care Act and the Future of Clinical Medicine: The Opportunities and Challenges — Ann Intern Med

Why pay for performance does not work and may impair patient care | KevinMD.com

One of a growing number of blogs and studies that are questioning the value of pay for performance systems - a literature worth knowing about.

This post come from a well respected medical blog, making it a useful source of information to follow the current conversation about medical practice and issues related to health services research.

This post also qualifies as an example of the law of unintended consequences, one of the arguments in favor of systems theory thinking, as I understand it.

Cheers,

jd



Why pay for performance does not work and may impair patient care | KevinMD.com

http://www.hcfo.org/publications/health-reform-and-delivery-system-organization

Summary of information about how health services research is playing a role in the US health care reform process from a Robert Wood Johnson sponsored conference June 2010.



http://www.hcfo.org/publications/health-reform-and-delivery-system-organization

Is it time to reinvent medicine?

Is it time to reinvent medicine?

My friend Bob Centor writes a great blog and frequently touches on issues of interest to health services researchers. This is one such post.

Where's the best evidence for making healthcare decisions? 2010

Check out this SlideShare Presentation from Vancouver.

Where's the best evidence? 2010

View more documents from Dean Giustini.

Arch Intern Med -- Ambulatory Antibiotic Use and Prescription Drug Coverage in Older Adults, Aug 9/23, 2010, Zhang et al. 170 (15): 1308

Interesting possible unforeseen adverse effect of expanding prescription drug coverage.


Arch Intern Med -- Ambulatory Antibiotic Use and Prescription Drug Coverage in Older Adults, Aug 9/23, 2010, Zhang et al. 170 (15): 1308

Measuring The Health Of Nations: Updating An Earlier Analysis -- Nolte and McKee 27 (1): 58 -- Health Affairs

A new article comparing outcomes of national health systems.

Measuring The Health Of Nations: Updating An Earlier Analysis -- Nolte and McKee 27 (1): 58 -- Health Affairs