Aiming Higher: Results from a State Scorecard on Health System Performance, 2014

McCarthy, Douglas; How, Sabrina K. H.; Schoen, Cathy; Cantor, Joel C.; Belloff, Dina

doi:10.15868/socialsector.25073

Cited by 34 publications

(34 citation statements)

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“…In addition, there are other factors associated with risk of readmission not included in this study. Hospital characteristics such as variations in length of stay (O'Connor & Fiuzat, 2010), geographic location, teaching status, and volumes of specific procedures/patients treated (Barbieri et al, 2007; Kane, Lin, & Blewett, 2002), acuity levels, and PAC availability may impact readmissions (Jencks, Williams, & Coleman, 2009; McCarthy, How, Schoen, Cantor, & Belloff, 2009; Medicare Payment Advisory Commission, 2003). However, these characteristics 'vere not relevant to our study because it was at one site, but they could affect generalizability elsewhere.…”

Section: Resultsmentioning

confidence: 99%

Impact of Discharge Planning Decision Support on Time to Readmission Among Older Adult Medical Patients

Bowles

Hanlon

Holland

et al. 2014

Professional Case Management

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Purpose of the Study Hospital clinicians are overwhelmed with the volume of patients churning through the health care systems. The study purpose was to determine whether alerting case managers about high-risk patients by supplying decision support results in better discharge plans as evidenced by time to first hospital readmission. Primary Practice Setting Four medical units at one urban, university medical center. Methodology and Sample A quasi-experimental study including a usual care and experimental phase with hospitalized English-speaking patients aged 55 years and older. The intervention included using an evidence-based screening tool, the Discharge Decision Support System (D2S2), that supports Clinicians′ discharge referral decision making by identifying high-risk patients upon admission who need a referral for post-acute care. The usual care phase included collection of the D2S2 information, but not sharing the Information with case managers. The experimental phase Included data collection and then sharing the results with the case managers. The study compared time to readmission between index discharge date and 30 and 60 days in patients in both groups (usual care vs. experimental). Results After sharing the D2S2 results, the percentage of referral or high-risk patients readmitted by 30 and 60 days decreased by 6% and 9%, respectively, representing a 26% relative reduction in readmissions for both periods. Implications for Case Management Practice Supplying decision support to identify high-risk patients recommended for postacute referral is associated with better discharge plans as evidenced by an increase in time to first hospital readmission. The tool supplies standardized information upon admission allowing more . time to work with high-risk admissions.

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Section: Resultsmentioning

confidence: 99%

Impact of Discharge Planning Decision Support on Time to Readmission Among Older Adult Medical Patients

Bowles

Hanlon

Holland

et al. 2014

Professional Case Management

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“…5 US studies show that deaths from most amenable conditions are consistently higher among African Americans than among whites, 39 although the gap varies greatly by state. 40 Therefore, racial differences cannot be attributed solely to lifestyle or biological factors. 39 That conclusion is further supported by research on diabetes outcomes.…”

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confidence: 99%

In Amenable Mortality—Deaths Avoidable Through Health Care—Progress In The US Lags That Of Three European Countries

Nolte

McKee

2012

Health Affairs

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We examined trends and patterns of amenable mortalitydeaths that should not occur in the presence of timely and effective health care-in the United States compared to those in France, Germany, and the United Kingdom between 1999 and 2007. Americans under age sixty-five during this period had elevated rates of amenable mortality compared to their peers in Europe. For Americans over age sixty-five, declines in amenable mortality slowed relative to their peers in Europe. Overall, amenable mortality rates among men from 1999 to 2007 fell by only 18.5 percent in the United States compared to 36.9 percent in the United Kingdom. Among women, the rates fell by 17.5 percent and 31.9 percent, respectively. Although US men and women had the lowest mortality from treatable cancers among the four countries, deaths from circulatory conditions-chiefly cerebrovascular disease and hypertensionwere the main reason amenable death rates remained relatively high in the United States. These findings strengthen the case for reforms that will enable all Americans to receive timely and effective health care.T he United States stands out among other countries for its high expenditure on health care. At $7,960 per capita in 2009, this was roughly double the average in Western European countries.1 Despite this investment, the United States lags behind on a number of indicators of health system performance. 2-4Given the multiple causes of many health outcomes, it remains a challenge to assess the contribution of health care to population health. One approach that has been shown to provide a useful approximation is the concept of amenable mortality.5 It derives from work undertaken in the 1970s in the United States, which proposed a list of conditions in which death should not occur in the presence of timely and effective health care. 6 Deaths from such conditions were to be interpreted as "sentinel" health events and to serve as an index of the quality of care. 5 Examples include diabetes, which should be treated by insulin and other medication; appendicitis, treated by surgery; and acute infections, treated by antibiotics.The key issue is the prevention of death. For example, although the acquisition of tuberculosis is largely driven by socioeconomic conditions, timely treatment is effective in preventing death. So the number of deaths from, for example, diabetes, provides a yardstick of access-or the lack of it-to effective care.Based on this line of reasoning, the concept of amenable mortality has since been applied widely as a way to assess the quality of care in different health systems across countries and over time. [7][8][9][10][11] Recent work using this concept has demonstrated that the United States is increasingly lagging behind other industrialized nations. [12][13][14] This study seeks to better understand some of the reasons behind the comparatively poor per-

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“…The primary provider is notified of the abnormal result of the screening examination (2) and manages subsequent surveillance imaging (3). The primary provider is then notified by the radiologist that the nodule exhibits suspicious features and warrants biopsy (4) and responds by referring the patient back to the radiologist for biopsy (5). The results of the biopsy are sent to the primary physician (6), who refers the patient to oncology and surgical specialists (7), who in turn meet with the radiologist (8) to obtain his or her input about the extent of disease (9).…”

Section: Figurementioning

confidence: 99%

“…If surveillance imaging reveals suspicious behavior of the nodule, a chest biopsy is performed (3). If the biopsy reveals malignancy, the radiologist refers the patient onward for subspecialist care (4). …”

Section: Figurementioning

confidence: 99%

“…Factors identified by the IOM as contributing to the cost-performance nonalignment included prevalence of chronic disease, lifestyle, population health demographics (such as the obesity epidemic), but also inefficient delivery of services (excess administrative costs, unnecessary services, high pricing, deficiency in preventative care, and fraud, amounting to $765 billion) (3). Furthermore, considerable variation in quality of care (as indicated by readmission rates per Medicare beneficiary) has been reported without correlation to regional costs (4, 5). …”

Section: Introductionmentioning

confidence: 99%

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Academic Radiology in the New Health Care Delivery Environment

Qayyum

Kansagra

et al. 2013

Academic Radiology

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Ongoing concerns over the rising cost of health care are driving large-scale changes in the way that health care is practiced and reimbursed in the United States. To effectively implement and thrive within this new health care delivery environment, academic medical institutions will need to modify financial and business models and adapt institutional cultures. In this paper, we review the expected features of the new health care environment from the perspective of academic radiology departments. Our review will include background on Accountable Care Organizations, identify challenges associated with the new managed care model, and outline key strategies—including expanding the use of existing information technology infrastructure, promoting continued medical innovation, balancing academic research with clinical care, and exploring new roles for radiologists in efficient patient management—that will ensure continued success for academic radiology.

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Aiming Higher: Results from a State Scorecard on Health System Performance, 2014

Cited by 34 publications

References 0 publications

Impact of Discharge Planning Decision Support on Time to Readmission Among Older Adult Medical Patients

Impact of Discharge Planning Decision Support on Time to Readmission Among Older Adult Medical Patients

In Amenable Mortality—Deaths Avoidable Through Health Care—Progress In The US Lags That Of Three European Countries

Academic Radiology in the New Health Care Delivery Environment

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