Health Management

Teaching Hospitals and the Disconnect Between Technology Adoption and Comparative Effectiveness Research: The Case of the Surgical Robot

Teaching Hospitals and the Disconnect Between Technology Adoption and Comparative Effectiveness Research: The Case of the Surgical Robot
Medical Care Research and Review, forthcoming

Makarov DV, Li H, Lepor H, Gross CP, Blustein J
03/22/2016

Teaching Hospitals and the Disconnect Between Technology Adoption and Comparative Effectiveness Research: The Case of the Surgical Robot

Teaching Hospitals and the Disconnect Between Technology Adoption and Comparative Effectiveness Research: The Case of the Surgical Robot
Medical Care Research and Review 2016, forthcoming

Makarov DV, Li H, Lepor H, Gross CP, Blustein J
03/22/2016

The promise of Mama Kits: Perceptions of in-kind goods as incentives for facility deliveries in Uganda

The promise of Mama Kits: Perceptions of in-kind goods as incentives for facility deliveries in Uganda
Global Public Health, DOI:10.1080/17441692.2016.1149597

Katherine Austin-Evelyn, Emma Sacksa, Lynn Atuyambe, Dana Greeson, Margaret E. Kruk, and Karen A. Grépin
03/07/2016

There is growing interest in the use of incentives to increase the utilisation of maternal health services globally, including the use of in-kind goods. As part of the Saving Mothers, Giving Life (SMGL) programme, pregnant women in three districts in Uganda were incentivised to deliver in a facility by the promise of ‘Mama Kits’ – clean delivery kits augmented with goods for newborns. We collected and analysed qualitative data from 18 focus groups (130 women) who had a recent home (N = 9) or facility delivery (N = 9 groups) to understand their overall perceptions of the SMGL programme, and, in particular, the Mama Kit. There was a high level of awareness of Mama Kits among women who delivered in a health facility and a moderate awareness among women who delivered at home. When available, kits positively affected women's perceptions of facility delivery because they associated availability of kits with affordability of care. When not available, women's perceptions of their actual or expected delivery experience were negatively affected. When well implemented, in-kind goods can be important complements in broader efforts to incentivise facility delivery. Inconsistent implementation and an underestimation of their influence on care-seeking can undermine efforts to reduce maternal mortality and morbidity.

Variation in Payment Rates under Medicare’s Inpatient Prospective Payment System

Variation in Payment Rates under Medicare’s Inpatient Prospective Payment System
HSR [Health Services Research]. Published online: DOI: 10.1111/1475-6773.12490

Krinsky S, Ryan AM, Mijanovich T, Blustein J
02/04/2016

Objective

To measure variation in payment rates under Medicare's Inpatient Prospective Payment System (IPPS) and identify the main payment adjustments that drive variation.

Data Sources/Study Setting

Medicare cost reports for all Medicare-certified hospitals, 1987–2013, and Dartmouth Atlas geographic files.

Study Design

We measure the Medicare payment rate as a hospital's total acute inpatient Medicare Part A payment, divided by the standard IPPS payment for its geographic area. We assess variation using several measures, both within local markets and nationally. We perform a factor decomposition to identify the share of variation attributable to specific adjustments. We also describe the characteristics of hospitals receiving different payment rates and evaluate changes in the magnitude of the main adjustments over time.

Data Collection/Extraction Methods

Data downloaded from the Centers for Medicare and Medicaid Services, the National Bureau of Economic Research, and the Dartmouth Atlas.

Principal Findings

In 2013, Medicare paid for acute inpatient discharges at a rate 31 percent above the IPPS base. For the top 10 percent of discharges, the mean rate was double the IPPS base. Variations were driven by adjustments for medical education and care to low-income populations. The magnitude of variation has increased over time.

Conclusions

Adjustments are a large and growing share of Medicare hospital payments, and they create significant variation in payment rates.

Telephone Smoking Cessation Counseling for Smokers in Mental Health Clinics: a Patient-Randomized Controlled Trial.

Telephone Smoking Cessation Counseling for Smokers in Mental Health Clinics: a Patient-Randomized Controlled Trial.
American Journal of Preventive Medicine. In press.

Rogers E, Smelson D, Gillespie C, Elbel B, Poole S, Hagedorn H, Kalman D, Krebs P, Fang Y, Wang B, Sherman SE.
01/27/2016

A comparative analysis of hospital readmissions in France and the US

A comparative analysis of hospital readmissions in France and the US

Gusmano, MK, Rodwin, VG, Weisz, D, Cottenet, J, and Quantin, C.
10/04/2015

Policymakers in the US and France are struggling to improve coordination among
hospitals and other health care providers. A comparison of hospital readmission rates, and the factors that may explain them, can provide important insights about the French and US health care systems. In addition, it illustrates a methodological approach to comparative research: how an empirical inquiry along a single indicator can reveal broader issues about system-wide differences across health care systems and policy. Using data from three French regions, the article extends a
previous national-level comparison indicating that rates of hospital readmission for the population aged 65+ are lower in France than in the US. In addition, we extend the range of variables available in the national comparison by drawing on neighborhood-level income data available from a previous study of access to primary care among three French regions. Within France, the odds of surgical hospital readmission are significantly lower in private for-profit hospitals compared with public hospitals. Patients who live in lower income neighborhoods are also more likely to be readmitted for medical and surgical conditions than are patients living in higher income neighborhoods, but this income effect is weaker than in the US. The article concludes with a discussion of how these findings reflect broader system-wide differences between the US and French health systems and the ways in which policymakers attempt to coordinate hospitals and community based services.

Performance Standards for Restaurants: A New Approach to Addressing the Obesity Epidemic.

Performance Standards for Restaurants: A New Approach to Addressing the Obesity Epidemic.
Cohen D, Bhatia R, Story MT, Sugarman SD, Economos CD, Whitsel LP, Williams JD, Elbel B, Harris J, Kappagoda M, Champagne CM, Shields K, Lesser LI, Fox T, Becker N. Performance Standards for Restaurants: A New Approach to Addressing the Obesity Epidemic. Santa Monica, CA: RAND Corporation; 2013.

Cohen D, Bhatia R, Story MT, Sugarman SD, Economos CD, Whitsel LP, Williams JD, Elbel B, Harris J, Kappagoda M, Champagne CM, Shields K, Lesser LI, Fox T, Becker N.
09/10/2015

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