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