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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 502 Research Studies Displayed
Atkinson MK, Benneyan JC, Bambury EA
Evaluating a patient safety learning laboratory to create an interdisciplinary ecosystem for health care innovation.
A patient safety learning laboratory (lab) can be a critical element of nurturing interdisciplinary team innovation across multiple projects and organizations. The purpose of this mixed-methods study was to evaluate a patient safety learning lab to examine the role and activities of a learning ecosystem that support interdisciplinary team innovation. The study found that successful learning ecosystems continuously facilitate alignment between interdisciplinary teams' activities, organizational context, and innovation project objectives. The researchers concluded that Interdisciplinary learning ecosystems have the capacity to facilitate health care improvement and innovation through alignment of team activities, project goals, and organizational contexts.
Citation: Atkinson MK, Benneyan JC, Bambury EA . Evaluating a patient safety learning laboratory to create an interdisciplinary ecosystem for health care innovation. Health Care Manage Rev 2022 Jul-Sep;47(3):E50-E61. doi: 10.1097/hmr.0000000000000330..
Keywords: Patient Safety, Innovations and Emerging Issues, Healthcare Delivery
Sherry TB, Damberg CL, DeYoreo M
Is bigger better?: A closer look at small health systems in the United States.
The purpose of this study was to expand existing health systems research by comparing the features, cost, and quality of care in small U.S. health care systems with those of large U.S. health systems. In this retrospective study with a repeated cross-sectional analysis, the researchers evaluated between 468 and 479 large health systems and between 608 and 641 small health systems serving fee-for-service Medicare beneficiaries, yearly between the year of 2013 and 2017. The study found that small systems had a larger share of beneficiaries and practice sites in small towns or rural areas, performance quality was lower in small systems that in large systems, and there was no difference in total cost of care. The study concluded that the quality of care in small systems is lower than large systems, but small systems provide care for rural Medicare populations. The researchers recommended that future research should explore the reasons for why these differences exist in quality.
Citation: Sherry TB, Damberg CL, DeYoreo M . Is bigger better?: A closer look at small health systems in the United States. Med Care 2022 Jul;60(7):504-11. doi: 10.1097/mlr.0000000000001727..
Keywords: Health Systems, Medicaid, Healthcare Delivery
Norton JM, Ip A, Ruggiano N
AHRQ Author: Camara DS, Hsiao CJ, Bierman AS
Assessing progress toward the vision of a comprehensive, shared electronic care plan: scoping review.
People with multiple chronic conditions often receive care from a broad array of clinicians across multiple health care settings, making it difficult to share care plans between those facilities and providers. One method for possibly improving care for those individuals is through the development and use of comprehensive, shared, electronic care (e-care) plans. The purpose of the study was to review existing e-care plans and related initiatives that could be utilized to develop a comprehensive, shared e-care plan, and facilitate the National Institutes of Health and Agency for Healthcare Research and Quality joint initiative’s creation of e-care planning tools for people with multiple chronic conditions. The researchers conducted a review of literature from 2015-2020, as well as interviews of expert informants to identify information missing from the literature search. The study identified 7 different interventions for e-care plans and 3 different projects for health care data standards, all of which included elements which could be utilized to further the goals of developing a comprehensive, shared e-care plan. The study concluded that while none of the existing interventions met all the optimal e-care plan criteria for people with multiple chronic conditions, each plan included the infrastructure necessary to progress toward that goal. The researchers reported that gaps must first be addressed, but that a comprehensive, shared e-care plan can improve care coordination across multiple care settings and clinicians.
Citation: Norton JM, Ip A, Ruggiano N . Assessing progress toward the vision of a comprehensive, shared electronic care plan: scoping review. J Med Internet Res 2022 Jun 10;24(6):e36569. doi: 10.2196/36569..
Keywords: Chronic Conditions, Care Coordination, Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery, Health Information Exchange (HIE)
Zeng W, Jarawan E, Bajnauth D
AHRQ Author: Ding Y
COVID-19 and global mental health service delivery and financing.
The purpose of this AHRQ-authored letter was to characterize the state of global mental health needs, service delivery, and financing as a result of the COVID-19 pandemic. The authors report that the mental health aftermath of the COVID-19 pandemic will likely be extended in duration and will both compound and deepen the social and economic disruptions that were already taking place prior to the pandemic. The authors conclude that the integration of mental health initiatives into both international and national emergency response strategies and public health strategies is important as governments enhance mental health service delivery and financing as a critical component of building more inclusive and resilient postpandemic health systems.
Citation: Zeng W, Jarawan E, Bajnauth D . COVID-19 and global mental health service delivery and financing. Public Health 2022 Jun;207:127-28. doi: 10.1016/j.puhe.2022.04.005..
Keywords: COVID-19, Healthcare Delivery, Behavioral Health
Andino JJ, Zhu Z, Surapaneni M
Interstate telehealth use by Medicare beneficiaries before and after COVID-19 licensure waivers, 2017-20.
This study analyzed trends in interstate telehealth use by Medicaid beneficiaries during 2017-2020, which covers the period both directly before and during the first year of the pandemic. Although the volume of interstate telehealth use increased in 2020, out-of-state telehealth only made up 0.8% of all outpatient visits, and 5% of all telehealth visits overall. For individual states, out-of-state telehealth made up between 0.2-9.3% of all outpatient visits. Most out-of-state telehealth visits were used for established patient care, and a higher percentage of out-of-state telehealth users lived in rural areas compared with beneficiaries who stayed with in-state care (28% versus 23%).
Citation: Andino JJ, Zhu Z, Surapaneni M . Interstate telehealth use by Medicare beneficiaries before and after COVID-19 licensure waivers, 2017-20. Health Aff 2022 Jun;41(6):838-45. doi: 10.1377/hlthaff.2021.01825.
Keywords: Telehealth, COVID-19, Health Information Technology (HIT), Medicare, Healthcare Delivery
Valley TS, Schutz A, Peltan ID
Organization of outpatient care after COVID-19 hospitalization.
The purpose of this study was to describe post-discharge care delivery for patients with postacute sequelae of COVID-19 (PASC) across a large network of US academic and community hospitals. Beginning in July, 2021, the researchers surveyed 47 hospitals which were participating in the National Heart, Lung, and Blood Institute Clinical Trials Network for the Prevention and Early Treatment of Acute Lung Injury (PETAL Network.) Surveys were completed by physicians, hospital administrators, social workers, research staff or other clinicians over an 8-week period, and data from the 2019 American Hospital Association annual survey database were used to describe the hospitals. The study found that 79% (37) of the responding hospitals provided COVID-specific discharge information to patients hospitalized with COVID-19. Only 26% of hospitals provided discharge information that included potential symptoms or impairments of postacute sequelae of COVID-19. Seventy percent (33) had a PASC clinic (a postdischarge outpatient clinic designed specifically for patients with COVID). Hospitals without PASC clinics were more likely to be located in a ZIP code with a higher Medicare population and a median annual income lower than $40,000, and were also more likely to be smaller, for-profit hospitals. The researchers identified several core areas for possible improvements in PASC care, including: examining the impact of PASC clinics on patient outcomes; assessing the extent to which the pathophysiology and management of PASC differ from sequelae of other infections and syndromes; and exploring whether an inability to systematically identify patients for PASC care may result in an inability for some patients to receive needed care. The researchers concluded that PASC clinics may offer opportunities to coordinate care and serve as an opportunity for making iterative gains in knowledge about PASC clinics and related models and processes and their effectiveness in improving longer-term patient-centered outcomes for survivors of COVID-19.
Citation: Valley TS, Schutz A, Peltan ID . Organization of outpatient care after COVID-19 hospitalization. Chest 2022 Jun;161(6):1485-89. doi: 10.1016/j.chest.2022.01.034..
Keywords: COVID-19, Ambulatory Care and Surgery, Hospitalization, Care Coordination, Healthcare Delivery
Usher MC, Tignanelli CJ, Hilliard B
Responding to COVID-19 through interhospital resource coordination: a mixed-methods evaluation
Researchers sought to describe a novel hospital system approach to managing the COVID-19 pandemic, including multihospital coordination capability and transfer of COVID-19 patients to a single, dedicated hospital. They found that, with standardized communication, interhospital transfers were a safe and effective method of cohorting COVID-19 patients, were well-received by health care providers, and had the potential to improve care quality.
AHRQ-funded; HS026379; HS026732.
Citation: Usher MC, Tignanelli CJ, Hilliard B . Responding to COVID-19 through interhospital resource coordination: a mixed-methods evaluation J Patient Saf 2022 Jun 1;18(4):287-94. doi: 10.1097/pts.0000000000000916..
Keywords: COVID-19, Hospitals, Healthcare Delivery, Public Health, Care Coordination, Transitions of Care
Kranz AM, Steiner ED, Mitchell JM
School-based health services in Virginia and the COVID-19 pandemic.
The purpose of this study was to examine how the COVID-19 pandemic may have impacted the provision of school health services and related student needs. In May 2021, all 1178 Virginia public elementary schools received a web-based survey regarding the impact of the pandemic on school-based health services, with 65% of schools responding (N=767). Schools reported providing fewer school-based health services during the pandemic than before, with dental screenings declining the most (51% before vs 15% after). The study also reported that mental health as a top concern for students increased from 15% before the pandemic to 27% during the pandemic. The study concluded that schools reported providing fewer health services to students during pandemic in the 2020-2021 school year and increased concern about students' mental health.
Citation: Kranz AM, Steiner ED, Mitchell JM . School-based health services in Virginia and the COVID-19 pandemic. J Sch Health 2022 May;92(5):436-44. doi: 10.1111/josh.13147..
Keywords: COVID-19, Children/Adolescents, Public Health, Healthcare Delivery, Community-Based Practice
Everson J, Adler-Milstein JR, Hollingsworth JM
Dispersion in the hospital network of shared patients is associated with less efficient care.
The purpose of this study was to examine the level of distribution of patient-sharing networks across U.S. hospitals and its relationship with 3 measures of care delivered by hospitals that were likely to relate to coordination. The researchers utilized data from 2016 Medicare Fee-for-Service claims to measure the volume of patients that hospitals treated in common, and then calculated a measure of dispersion for each hospital. The relationship between network dispersion, Medicare spending per beneficiary, readmission rates, and emergency department (ED) throughput rates were then estimated. The study reported that hospitals with more dispersed networks had greater spending rates but not higher admission rates or slower ED processes. Among hospitals with less resources, more dispersion was associated with higher readmission rates and slower ED processes. The researchers concluded that dispersed interhospital networks create difficulties in coordinating patients who are treated at multiple hospitals, and that the structure of patient-sharing networks may be an overlooked factor that influences the delivery of care in health care organizations.
AHRQ-funded; HS026395, HS024525, HS024728, HS024454.
Citation: Everson J, Adler-Milstein JR, Hollingsworth JM . Dispersion in the hospital network of shared patients is associated with less efficient care. Health Care Manage Rev 2022 Apr-Jun;47(2):88-99. doi: 10.1097/hmr.0000000000000295..
Keywords: Medicare, Hospitals, Care Coordination, Healthcare Delivery
Kenney MK, Chanlongbutra A, Fanflick PL
AHRQ Author: Chanlongbutra A
Systems of care among children and youth with special health care needs with and without adverse childhood events: National Survey of Children's Health 2016-2017.
The purpose of the study was to compare Children and Youth with Special Health Care Needs (CYSHCN) with non-CYSHCN in the likelihood of experiencing Adverse Childhood Events (ACEs), and then document the differences in receiving recommended and needed health care services among CYSHCS with and without ACEs. The researchers studied a sample of 16,304 CYSHCN from the 2016 and 2017 National Survey of Children’s Health (N=71,181). The study found that CYHSCN had a greater likelihood of having each of the measured Adverse Childhood Events, and greater likelihood of experiencing aggregated levels of ACE’s than non-CYSHCN. In addition, an increase in ACEs was related to a decrease in the likelihood of a CYSHCN having a medical home with family-centered and coordinated care. Having one or greater ACEs increased the likelihood of having unmet mental health care needs. The study concluded that the researcher’s findings extend the current understanding of the relationship between CYSHCN and ACEs, and that the need for additional work to establish care systems for this vulnerable population continues.
Citation: Kenney MK, Chanlongbutra A, Fanflick PL . Systems of care among children and youth with special health care needs with and without adverse childhood events: National Survey of Children's Health 2016-2017. Disabil Health J 2022 Apr;15(2):101226. doi: 10.1016/j.dhjo.2021.101226..
Keywords: Children/Adolescents, Disabilities, Healthcare Delivery, Vulnerable Populations
Bergman ZR, Usher M, Olson A
Comparison of outcomes and process of care for patients treated at hospitals dedicated for COVID-19 care vs other hospitals.
The purpose of this study was to analyze the mortality rate and complications associated with treatment at the COVID-19-dedicated hospitals. Findings showed that, in this cohort study, COVID-19-dedicated hospitals in Minnesota had multiple benefits, including providing high-volume repetitive treatment and isolating patients with the infection. This experience suggests improved in-hospital mortality for patients treated at dedicated hospitals.
AHRQ-funded; HS026732; HS026379.
Citation: Bergman ZR, Usher M, Olson A . Comparison of outcomes and process of care for patients treated at hospitals dedicated for COVID-19 care vs other hospitals. JAMA Netw Open 2022 Mar;5(3):e220873. doi: 10.1001/jamanetworkopen.2022.0873..
Keywords: COVID-19, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes, Healthcare Delivery, Hospitals
Brajcich BC, Benson AB, Gantt G
Management of colorectal cancer during the COVID-19 pandemic: recommendations from a statewide multidisciplinary cancer collaborative.
J Surg Oncol 2022 Mar;125(4):560-63. doi: 10.1002/jso.26758.
Citation: Brajcich BC, Benson AB, Gantt G . Management of colorectal cancer during the COVID-19 pandemic: recommendations from a statewide multidisciplinary cancer collaborative. J Surg Oncol 2022 Mar;125(4):560-63. doi: 10.1002/jso.26758..
Keywords: COVID-19, Cancer: Colorectal Cancer, Cancer, Guidelines, Evidence-Based Practice, Healthcare Delivery
Hays RD, Skootsky SA
Patient experience with in-person and telehealth visits before and during the COVID-19 pandemic at a large integrated health system in the United States.
Researchers sought to compare patient experience by visit type and before and during the pandemic. Using CAHPS® data, they found that patient experience with telehealth visits was as positive as or more positive than that with traditional office-based visits. Doctor communication on telehealth visits was viewed as slightly more positive than that of in-office or telephone visits. Telehealth visits were also slightly more positive than in-office visits for care coordination, overall rating of the doctor, and willingness to recommend to family and friends. Office staff were viewed less positively on the telephone than telehealth or in-office visits. Further, patient experience was similar before and during the COVID-19 pandemic.
Citation: Hays RD, Skootsky SA . Patient experience with in-person and telehealth visits before and during the COVID-19 pandemic at a large integrated health system in the United States. J Gen Intern Med 2022 Mar;37(4):847-52. doi: 10.1007/s11606-021-07196-4..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Patient Experience, Healthcare Delivery
Bierman AS, Tong ST, McNellis RJ
AHRQ Author: Bierman AS, Tong ST, McNellis RJ
Realizing the dream: the future of primary care research.
In this article, the authors discussed the primary care research central to successful primary care transformation and to realizing the vision of a high-performing US health system to serve effectively all Americans and their communities while advancing health equity.
Citation: Bierman AS, Tong ST, McNellis RJ . Realizing the dream: the future of primary care research. Ann Fam Med 2022 Mar-Apr;20(2):170-74. doi: 10.1370/afm.2788..
Keywords: Primary Care, Healthcare Delivery, Evidence-Based Practice, Health Systems, Learning Health Systems, Patient-Centered Healthcare
Rikin S, Perez HR, Zhang C
Changes in outpatient opioid prescribing during the COVID-19 pandemic: an interrupted time series analysis.
Changes in health care delivery during the COVID-19 pandemic may have impacted opioid prescribing. This study evaluated the impact of restrictions on in-person care on opioid prescribing in the outpatient setting. The hypothesis was that after restrictions to in-person care were implemented, there would be a reduction in the number of chronic and non-chronic opioid prescriptions.
Citation: Rikin S, Perez HR, Zhang C . Changes in outpatient opioid prescribing during the COVID-19 pandemic: an interrupted time series analysis. J Prim Care Community Health 2022 Jan-Dec;13:21501319221076926. doi: 10.1177/21501319221076926..
Keywords: COVID-19, Opioids, Medication, Practice Patterns, Healthcare Delivery
Durojaiye A, Fackler J, McGeorge N
Examining diurnal differences in multidisciplinary care teams at a pediatric trauma center using electronic health record data: social network analysis.
The purpose of this study was to apply social network analysis to electronic health record (EHR) data to explore diurnal differences in the multidisciplinary teams caring for pediatric trauma patients. The researchers created an event log comprised of clinical activity metadata obtained from the EHR. The resulting event log was separated into 6 unique event logs, with content based on clinical activity shift (day shift or night shift) and location of the activities (divided by emergency department (ED), pediatric intensive care unit (PICU), and floor). For each event log, social networks were constructed and community overlap identified. The researchers utilized a comparison with qualitative care team data to compare and validate daytime and nighttime network structures for each care location. Validation was assessed via member-checking interviews with clinicians and qualitatively derived care team data, obtained through semi-structured interviews. The study found that of the 413 clinical encounters taking place within the 1-year study period, 65.9% began during the day shift and 34.1% began during the night shift. Multiple communities were identified in the ED and on the floor during the night shift, while a single community was identified in the ED and on the floor during the day shift, and in the PICU during the night shift. Qualitative data results indicated that the networks were accurate representations of the composition and interactions of the care teams. The researchers concluded that social network analysis was an effective method for utilization on EHR data at a pediatric trauma center to explore, identify, and describe diurnal differences in multidisciplinary care teams.
Citation: Durojaiye A, Fackler J, McGeorge N . Examining diurnal differences in multidisciplinary care teams at a pediatric trauma center using electronic health record data: social network analysis. J Med Internet Res 2022 Feb 4;24(2):e30351. doi: 10.2196/30351..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Teams, Healthcare Delivery
Adler-Milstein J, Linden A, Bernstein S
Longitudinal participation in delivery and payment reform programs among US primary care organizations.
The purpose of this retrospective, observational study was to assess longitudinal primary care organization participation patterns in large-scale reform programs and to identify organizational characteristics associated with multiprogram participation. Medicare claims were used to identify organizations that delivered primary care services. Findings showed that no program achieved more than 50% participation; 36% of organizations did not participate in any program; 50% participated in one; 13% in two; and 1% in all three. Larger organizations, those with younger providers, those with more primary care providers, and those with larger Medicare patient panels were more likely to participate in more programs.
Citation: Adler-Milstein J, Linden A, Bernstein S . Longitudinal participation in delivery and payment reform programs among US primary care organizations. Health Serv Res 2022 Feb;57(1):47-55. doi: 10.1111/1475-6773.13646..
Keywords: Primary Care, Medicare, Healthcare Delivery
Lai LY, Kaufman SR, Modi PK
Impact of advanced practice provider integration into multispecialty group practices on outcomes following major surgery.
Researchers examined the impact of advanced practice provider (APP) integration into multispecialty group practices on outcomes after major surgery. Using Medicare data, they found that integration of APPs into multispecialty group practices was associated with improved postoperative outcomes after major surgery. They recommended that future research identify the mechanisms by which APPs improve outcomes to inform optimal utilization.
Citation: Lai LY, Kaufman SR, Modi PK . Impact of advanced practice provider integration into multispecialty group practices on outcomes following major surgery. Surg Innov 2022 Feb;29(1):111-17. doi: 10.1177/15533506211013150..
Keywords: Surgery, Healthcare Delivery
Zimmerman S, Carder P, Schwartz L
The imperative to reimagine assisted living.
Assisted living (AL) has existed in the United States for decades, evolving in response to older adults' need for supportive care and distaste for nursing homes and older models of congregate care. AL is state-regulated, provides at least 2 meals a day, around-the-clock supervision, and help with personal care, but is not licensed as a nursing home. This article presents the background regarding those tensions, as well as potential solutions that have been borne out, paving the path to a better future of assisted living.
Citation: Zimmerman S, Carder P, Schwartz L . The imperative to reimagine assisted living. J Am Med Dir Assoc 2022 Feb;23(2):225-34. doi: 10.1016/j.jamda.2021.12.004..
Keywords: Elderly, Long-Term Care, Healthcare Delivery, Workforce, Quality of Care, Quality of Life, Healthcare Costs
Disruptions to the patient-provider relationship and patient utilization and outcomes: evidence from Medicaid managed care.
The patient-provider relationship is considered a cornerstone to delivering high-value healthcare. However, in Medicaid managed care settings, disruptions to this relationship are disproportionately common. In this paper, the researcher evaluated the impact of a primary provider's exit from a Medicaid managed care plan on adult beneficiary healthcare utilization and outcomes.
Citation: Staiger B . Disruptions to the patient-provider relationship and patient utilization and outcomes: evidence from Medicaid managed care. J Health Econ 2022 Jan;81:102574. doi: 10.1016/j.jhealeco.2021.102574..
Keywords: Medicaid, Clinician-Patient Communication, Healthcare Delivery, Chronic Conditions
Manojlovich M, Hofer TP, Krein SL
Advancing patient safety through the clinical application of a framework focused on communication.
The purpose of this review article was to describe a conceptual framework of communication drawn from multiple academic disciplines and to apply it to health care, specifically for examining communication between providers about the clinical care of their patients. Findings showed that poor communication remained a stubborn problem in health care in part because of a narrow theoretical and definitional approach to resolving it. The proposed conceptual framework suggested ways to build relationships and trust, addressed hierarchical differences between communicators, and illuminated the role of technology in communication.
AHRQ-funded; HS022305; HS024760.
Citation: Manojlovich M, Hofer TP, Krein SL . Advancing patient safety through the clinical application of a framework focused on communication. J Patient Saf 2021 Dec 1;17(8):e732-e37. doi: 10.1097/pts.0000000000000547..
Keywords: Patient Safety, Communication, Healthcare Delivery
Lee DJ, Shelton JB, Brendel P
Impact of the COVID-19 pandemic on urological care delivery in the United States.
This study examined changes in urological care delivery in the US due to the COVID-19 pandemic. Real-world data was analyzed from the American Urological Association Quality (AQUA) Registry from 157 outpatient urological practices and 3,165 providers across 58 states and territories, including over 3.2 million unique patients, over 12 million outpatient visits and over 2 million procedures. Primary outcome measured was the number of outpatient visits and procedures performed from January 2019 to February 2021. The largest decline (>50%) was from March to April 2020 across all patient demographic groups and states. Nonurgent outpatient visits decreased more across various nonurgent procedures (49-59%) than for potentially urgent diagnoses (38-52%). Medicare-insured patients had the steepest declines (55%), while those on Medicaid and government insurance had the lowest percentage of care recovery to baseline. African American patients also had slower recoveries back to baseline.
Citation: Lee DJ, Shelton JB, Brendel P . Impact of the COVID-19 pandemic on urological care delivery in the United States. J Urol 2021 Dec;206(6):1469-79. doi: 10.1097/ju.0000000000002145..
Keywords: COVID-19, Healthcare Delivery
Henriksen K, Rodrick D, Grace EN
AHRQ Author: Henriksen K, Rodrick D, Grace EN, Shofer M, Brady, JP
Pursuing patient safety at the intersection of design, systems engineering, and health care delivery research: an ongoing assessment.
This article describes a grant initiative undertaken by AHRQ that brings design, systems engineering, and health care delivery research together to test new ideas that could make health care safer. Based on feedback received from project teams, lessons learned are emerging that find considerable variation among project teams in deploying the methodology and a longer-than-anticipated amount of time in bringing team members from different disciplines together where they learn to communicate and function as a team. Three narratives are generated in terms of what success might look like.
Citation: Henriksen K, Rodrick D, Grace EN . Pursuing patient safety at the intersection of design, systems engineering, and health care delivery research: an ongoing assessment. J Patient Saf 2021 Dec 1;17(8):e1685-e90. doi: 10.1097/pts.0000000000000577..
Keywords: Patient Safety, Healthcare Delivery, Learning Health Systems, Health Systems
Landon SN, Padikkala J, Horwitz LI
Defining value in health care: a scoping review of the literature.
This literature review’s goal was to understand how value has been defined in the context of health care. A literature search was conducted to identify articles eligible for inclusion. A total of 46 out 1750 publications screened met inclusion criteria. Among the 46 included articles, 22 focused on overall value, 19 on low value, and 5 on high value. The authors developed a framework to categorize definitions based on three core domains: components, perspective, and scope.
Citation: Landon SN, Padikkala J, Horwitz LI . Defining value in health care: a scoping review of the literature. Int J Qual Health Care 2021 Nov 12;33(4). doi: 10.1093/intqhc/mzab140..
Keywords: Value, Healthcare Delivery
Baskin AS, Wang T, Miller J
A health systems ethical framework for de-implementation in health care.
De-implementation is the ethical obligation to eliminate health care practices which are unnecessary, lacking in evidence, harmful, and/ or prevent the spending of resources on more beneficial services. The purpose of this study was to apply Krubiner and Hyder’s bioethical framework for health systems activity to the analysis of de-implementation ethics in the broader context of health care systems. The focus was specifically on ethics principles relevant to de-implementation which serve to call for or facilitate low value surgery. The authors identified the 5 health systems principles from Krubiner and Hyder’s 11 most relevant to the topic of de-implementation. These included: evidence and effectiveness, transparency and public engagement, efficiency, responsiveness, and collaboration. The study concluded that a health-systems framework allows for consideration of the factors which impact de-implementation, and gives providers to ability to think about new ways to address barriers to the reduction of low-value care.
Citation: Baskin AS, Wang T, Miller J . A health systems ethical framework for de-implementation in health care. J Surg Res 2021 Nov;267:151-58. doi: 10.1016/j.jss.2021.05.006..
Keywords: Health Systems, Healthcare Delivery