Democracy and Justice

Czajka, Agnes

doi:10.4324/9781315693330

Cited by 2 publications

(4 citation statements)

References 8 publications

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“…Ninety percent of hospitals achieved the target collection rate of 30% or greater, and 9 exceeded 50%, suggesting that further substantive increases are possible with continued process improvements. Based on existing experience with national health surveys in the US, collection rates range between 30% and 50% . Although lower than survey research standards, high-stakes decisions are nonetheless made with these data.…”

Section: Discussionmentioning

confidence: 99%

“…The primary metrics to evaluate implementation were hospital participation (adoption) and the collection rate (reach), calculated as 1 or more PROMs submitted per patient over either the project duration or per quarter by hospital . Because the collection rates of current national programs in the US to evaluate health care delivery using standardized questionnaires range from approximately 30% to 50%, the target collection rate for this unprecedented effort was reasonably set at 30% or greater.…”

Section: Methodsmentioning

confidence: 99%

“…To demonstrate adoption, our primary goal was to accrue more than 30 hospitals in the first 3 years by following the Institute for Healthcare Improvement (IHI) Framework for Spread and the Consolidated Framework for Implementation Research (CFIR) . Consistent with the collection rates of national patient-reported survey-based programs, the target collection rate was set at 30% or greater to demonstrate reach. We report the implementation strategies conducted to increase collection rates, explore hospital factors contributing to increased collection rates, and characterize nonresponse bias.…”

Section: Introductionmentioning

confidence: 99%

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Patient-Reported Outcome Measures Within a National Multispecialty Surgical Quality Improvement Program

Temple,

Pusic,

Liu

et al. 2024

JAMA Surg

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ImportancePatient-reported outcome measures (PROMs) are increasingly recognized for their ability to promote patient-centered care, but concerted health information technology (HIT)–enabled PROM implementations have yet to be achieved for national surgical quality improvement.ObjectiveTo evaluate the feasibility of collecting PROMs within a national surgical quality improvement program.Design, Setting, and ParticipantsThis was a pragmatic implementation cohort study conducted from February 2020 to March 2023. Hospitals in the US participating in the American College of Surgeons National Surgical Quality Improvement Program and their patients were included in this analysis.ExposuresStrategies to increase PROM collection rates were identified using the Institute for Healthcare Improvement (IHI) Framework for Spread and the Consolidated Framework for Implementation Research and operationalized with the IHI Model for Improvement’s Plan-Do-Study-Act (PDSA) cycles.Main Outcomes and MeasuresThe primary goal was to accrue more than 30 hospitals and achieve collection rates of 30% or greater in the first 3 years. Logistic regression was used to identify hospital-level factors associated with achieving collection rates of 30% or greater and to identify patient-level factors associated with response to PROMs.ResultsAt project close, 65 hospitals administered PROMs to 130 365 patients (median [IQR] age, 60.1 [46.2-70.0] years; 77 369 female [59.4%]). Fifteen PDSA cycles were conducted to facilitate implementation, primarily targeting the Consolidated Framework for Implementation Research domains of Inner Setting (ie, HIT platform) and Individuals (ie, patients). The target collection rate was exceeded in quarter 3 (2022). Fifty-eight hospitals (89.2%) achieved collection rates of 30% or greater, and 9 (13.8%) achieved collection rates of 50% or greater. The median (IQR) maximum hospital-level collection rate was 40.7% (34.6%-46.7%). The greatest increases in collection rates occurred when both email and short-message service text messaging were used, communications to patients were personalized with their surgeon’s and hospital’s information, and the number of reminders increased from 2 to 5. No identifiable hospital characteristic was associated with achieving the target collection rate. Patient age and insurance status contributed to nonresponse.Conclusions and RelevanceResults of this cohort study suggest that the large-scale electronic collection of PROMs into a national multispecialty surgical registry was feasible. Findings suggest that HIT platform functionality and earning patient trust were the keys to success; although, iterative opportunities to increase collection rates and address nonresponse remain. Future work to drive continuous surgical quality improvement with PROMs are ongoing.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patient-Reported Outcome Measures Within a National Multispecialty Surgical Quality Improvement Program

Temple,

Pusic,

Liu

et al. 2024

JAMA Surg

View full text Add to dashboard Cite

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“…To the extent that survey-based studies implicitly overlook individuals with severe mental illness, this may help explain the modest to null findings of prior randomized studies of cash benefits . It could also have implications for the use of national surveys in the evaluation of social policy amid a 3-decade decline in response rates …”

Section: Discussionmentioning

confidence: 99%

Effect of Cash Benefits on Health Care Utilization and Health

Agarwal,

Cook,

Liebman

2024

JAMA

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ImportancePoverty is associated with greater barriers to health care and worse health outcomes, but it remains unclear whether income support can improve health.ObjectiveTo examine the effect of cash benefits on health care utilization and health.Design, Setting, and ParticipantsThe City of Chelsea, Massachusetts, a low-income community near Boston, randomly assigned individuals by lottery to receive cash benefits. Participants’ medical records were linked across multiple health systems. Outcomes were assessed during the intervention period from November 24, 2020, to August 31, 2021.InterventionCash benefits via debit card of up to $400 per month for 9 months.Main Outcomes and MeasuresThe primary outcome was emergency department visits. Secondary outcomes included specific types of emergency department visits, outpatient use overall and by specialty, COVID-19 vaccination, and biomarkers such as cholesterol levels.ResultsAmong 2880 individuals who applied for the lottery, mean age was 45.1 years and 77% were female. The 1746 participants randomized to receive the cash benefits had significantly fewer emergency department visits compared with the control group (217.1 vs 317.5 emergency department visits per 1000 persons; adjusted difference, −87.0 per 1000 persons [95% CI, −160.2 to −13.8]). This included reductions in emergency department visits related to behavioral health (−21.6 visits per 1000 persons [95% CI, −40.2 to −3.1]) and substance use (−12.8 visits per 1000 persons [95% CI, −25.0 to −0.6]) as well as those that resulted in a hospitalization (−27.3 visits per 1000 persons [95% CI, −53.6 to −1.1]). The cash benefit had no statistically significant effect on total outpatient visits (424.3 visits per 1000 persons [95% CI, −118.6 to 967.2]), visits to primary care (−90.4 visits per 1000 persons [95% CI, −308.1 to 127.2]), or outpatient behavioral health (83.5 visits per 1000 persons [95% CI, −182.9 to 349.9]). Outpatient visits to other subspecialties were higher in the cash benefit group compared with the control group (303.1 visits per 1000 persons [95% CI, 32.9 to 573.2]), particularly for individuals without a car. The cash benefit had no statistically significant effect on COVID-19 vaccination, blood pressure, body weight, glycated hemoglobin, or cholesterol level.Conclusions and RelevanceIn this randomized study, individuals who received a cash benefit had significantly fewer emergency department visits, including those related to behavioral health and substance use, fewer admissions to the hospital from the emergency department, and increased use of outpatient subspecialty care. Study results suggest that policies that seek to alleviate poverty by providing income support may have important benefits for health and access to care.

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Democracy and Justice

Cited by 2 publications

References 8 publications

Patient-Reported Outcome Measures Within a National Multispecialty Surgical Quality Improvement Program

Patient-Reported Outcome Measures Within a National Multispecialty Surgical Quality Improvement Program

Effect of Cash Benefits on Health Care Utilization and Health

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