“Hospital at home (HaH), a care model that provides acute hospital-level care in patients’ homes, has been well characterized. Controlled trials and subsequent meta-analyses have suggested the efficacy of HaH, demonstrating noninferior or even superior mortality, readmission, and length of stay outcomes compared with traditional hospitalization for heterogeneous patient populations. [..] Reasons for low adoption include misaligned or lack of financial incentives and challenges inherent in implementing a complex intervention. For example, even when home hospitalization models have been implemented in the United States in study settings or those with aligned payment incentives, low participation rates have been ubiquitous (ranging … Read More
All posts in Care Delivery Innovation
“Enthusiasm for the potential impact of AI [artificial intelligence] on hospital operations is often based on its impact in other industries. However, non-health care companies invest in AI after having digitized and optimized their operations with a variety of older mathematical methods. In contrast, hospitals may invest in AI while still scheduling patient appointments using fax machines and allocating resources based largely on anecdotal experience. [..] For decades before the advent of modern AI, the operational management of capital, labor, and resources of large manufacturing, retail, airline, and most other large-scale industries were being designed and refined with rigorous methods … Read More
“[Summary] [..] Our institution developed and implemented a triage framework in the Emergency Department utilizing the Clinical Frailty Scale (CFS) to promote patient-centered care during our Covid-19 surge. A triage clinician assessed 40 patients aged 70 and older from April 7 to May 22, 2020. In addition to recommendations for medication management, fall risk reduction, delirium prevention and advance care planning, the triage clinician directed patients with a CFS of 1-3 to usual care (n=8, 20.0%), a CFS of 4-6 to geriatric co-management (n=6, 15.0%), a CFS of 7-9 to palliative care triage (n=23, 57.5%) and 7.5% (n=3) to both … Read More
“We previously described an automated early warning system that identifies patients at high risk for clinical deterioration. Detection is achieved with the use of a predictive model (the Advance Alert Monitor [AAM] program) that identifies such patients. Beginning in November 2013, we conducted a pilot test of this program in 2 hospitals in Kaiser Permanente Northern California (KPNC), an integrated health care delivery system that owns 21 hospitals. The system generates AAM scores that predict the risk of unplanned transfer to the ICU or death in a hospital ward among patients who have “full code” orders (i.e., patients who wish … Read More
“Cardiac rehabilitation integrates patient education, behavior modification, and exercise. The traditional in-person, center-based cardiac rehabilitation model has been shown to reduce all-cause hospital readmissions by 31% and all-cause mortality by 24% over 1 to 3 years. For patients with a recent acute myocardial infarction, coronary revascularization, or acute heart failure exacerbation, cardiac rehabilitation reduces spending on future hospitalizations by approximately $900 per patient over 21 months. Yet uptake has been disappointing. Even before COVID-19, less than a third of eligible patients attended a single session. Supply-and-demand challenges have impeded uptake, and both must be addressed to expand this life-saving therapy. … Read More
On October 27th, the United States Preventive Services Task Force (USPSTF) issued a draft recommendation to extend colorectal cancer screening to individuals 45-49 years of age (Grade B recommendation). Assuming the public comment period does not uncover any surprises, the recommendation will be finalized by the end of the year. The recommendation includes the group’s modeling of benefits and harms with the proposed screening strategy. Compared to our current screening recommendations (screening individuals 50-75 years of age), the new recommendation will add 22-27 additional life-years at a cost of 0.2-2 additional gastrointestinal and cardiovascular complications per 1000 individuals screened. Given … Read More
“Population health management is a team-based approach in which nonclinical staff members identify and reach out (typically outside face-to-face visits) to specific groups of patients with unmet preventive and chronic condition care needs. Population health management has been increasing across primary care and is associated with improved outcomes, but to our knowledge, it has not previously been used for patients with overweight or obesity. The purpose of this trial was to examine whether integrating an online weight management program with population health management support would enhance its effectiveness and lead to greater weight loss at 12 months among primary care … Read More
“The expansion of the direct-to-consumer (DTC) medical imaging market elicits several safety and ethical concerns. Discounted DTC imaging may lead to unnecessary testing and subsequent incidental findings, false-positive results, radiation exposure, and downstream interventions. Groupon, Inc, a global e-commerce marketplace, has garnered media attention for its vouchers for discounted DTC medical imaging services. In this study, we evaluated the scope, pricing, customer feedback, and claims of medical imaging services offered through Groupon vouchers. We performed a cross-sectional analysis of Groupon offerings in the US on February 6, 2020. On the Groupon home page, in the Imaging and Scans section [..], … Read More
“[Oak Street, ChenMed, Partners in Primary Care (owned by Humana), Iora Health, Geisinger] contract with Medicare Advantage plans to provide primary care “on steroids” to older patients with multiple chronic illnesses, as one executive put it. Because they typically take full financial risk from the Advantage plans, which pay them fixed monthly fees for each patient, the clinics make money by keeping patients out of the hospital. They do that by providing preventive and behavioral health care along with managing chronic diseases and addressing social needs. Working with a team of clinicians and coordinators, doctors see about a fifth as … Read More
“For evidence-based, prescribed digital therapeutics to reach the most vulnerable populations, they need to be reimbursable by Medicaid. [..] One example is WellDoc, an FDA-cleared digital therapeutic that has been shown to improve outcomes for patients with Type 2 Diabetes, leading to cost savings for employers and health plans. Another example is the FDA-cleared digital health platform Propeller Health, an evidence-based platform for asthma and chronic obstructive pulmonary disease (COPD). There are also digital therapeutics earlier in the FDA-clearance pipeline with growing literature demonstrating reproducible clinical effect. One example is Cognoa, an evidence-based FDA breakthrough-designated company that focuses on diagnosis … Read More