All posts in Care Delivery Innovation

“Improving our understanding of clinician-level perceptions regarding e-consultation is important for informing program implementation and adoption, and ensuring that e-consults facilitate delivery of high-quality care. Prior evaluations demonstrated that primary care clinicians and specialists believe that e-consults may improve communication between clinicians. Primary care clinicians and specialists across several health care systems have reported that use of e-consultations increases the efficiency of care and reduces appointment burden for patients. [..] In a 2018 study, primary care clinicians working in safety-net clinics described e-consultations as “increased administrative burden, broadened clinical responsibility, and restructuring of specialty care delivery.” A perception among primary … Read More

“Wealthy governments that have invested in vaccine candidates have made bilateral agreements with developers that could result in vaccine doses being reserved for the highest-income countries — a phenomenon known as “vaccine nationalism” — potentially leaving people in poor countries vulnerable to Covid-19. The response to vaccine nationalism has been the creation of the COVAX Facility, an international partnership that aims to financially support leading vaccine candidates and ensure access to vaccines for lower-income countries. Seventy-nine higher-income countries are COVAX members. Their governments will help support 92 countries that couldn’t otherwise afford Covid-19 vaccines. [..] Equally important is offering companies … Read More

“The burden of common mental disorders (CMDs), including major depressive and anxiety disorders, is substantial. CMDs contribute to lowered work productivity, family dysfunction, substance misuse, suicide, and reduced life expectancy. The point prevalence of CMDs has been stable since the 1980s, although expenditures on mental health care and drug therapy have increased dramatically. Given failure of increased treatment to lower CMD prevalence, some have called for reconceptualizing the diagnosis of CMDs and investing in new research to improve treatment. [..] We need to consider organizational reforms in treatment delivery for the subset of patients at highest risk of relapse and … Read More

“Over the last 2 years, use of low-dose aspirin for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) has become one of the most debated topics in cardiology. Initial trials conducted between the 1980s and early 2000s suggested a significant benefit in a primary prevention population at high risk. However, with expanded use of statins and declining ASCVD rates in Western countries in the last 2 decades, the benefit of prophylactic aspirin became progressively less certain among individuals without established ASCVD. Three trials published in 2018 found no benefit or modest benefit with aspirin and raised concerns about the potential … Read More

“contingency management, because the rewards are contingent on staying abstinent. A number of clinical trials have found it highly effective in getting people addicted to stimulants like cocaine and methamphetamine to stay in treatment and to stop using the drugs. But outside the research arena and the Department of Veterans Affairs, [..] it is nearly impossible to find programs that offer such treatment — even as overdose deaths involving meth, in particular, have soared. There were more than 16,500 such deaths last year, according to preliminary data, more than twice as many as in 2016. [..] Researchers say that one … Read More

“At HealthPartners, we envisioned a middle ground between curbside and face-to-face consultation in which referring clinicians and patients could access specialty advice in a timely manner that would be documented and billable, but at a rate lower than for a face-to-face visit. We decided to adopt the e-consult model and use it as an option rather than a requirement for all involved: patients, referring clinicians, and specialists. Referring clinicians could decide when ordering: do they want a face-to-face consultation or could the need be met with an e-consult? Patients could see a specialist in person if they preferred but would … Read More

“As health care expenditures continue to increase, with surgery accounting for approximately one-third of all health care spending, there is a need to identify strategies to decrease expenditures without compromising care quality. [..] the purpose of this study was to perform a population-based analysis of complication rates of minor hand procedures performed in different operative settings. In addition, we sought to investigate differences in total cost and OOP [out-of-pocket] spending across different operative settings. [..] We performed a retrospective cohort study using data from the IBM MarketScan Research databases between 2009 and 2017. These databases contain information from more than … Read More

“We believe the U.S. health care system should embrace this moment as an opportunity to shift the locus of preventive care from face-to-face annual exams to a strategy that focuses on population health: clinical registries that readily identify all preventive services for which a patient is due; annual prevention kits for patients that facilitate widespread deployment of home-based testing, shared decision making, and self-scheduling of preventive screening tests and procedures in more convenient and approachable community settings; and robust community-based strategies involving navigators to overcome health disparities in underserved populations. The first step in this strategy is developing a robust, … Read More

“Health care delivery organizations have faced a myriad of important management challenges during the Covid-19 pandemic. Some of the challenges are idiosyncratic to the individual organization; others, however, are broadly faced by almost every health care delivery organization and are likely to be faced in any major disaster. The first key challenge is the lack of adequate capacity to handle the surging patient volume. [..] A second challenge is the need for real-time redesign of care models for patients. Given the highly contagious nature and severity of the infection, it is necessary for physicians, nurses, and other clinicians to discover … Read More