Decision Fatigue Among Physicians
|
|
- Ethelbert King
- 5 years ago
- Views:
Transcription
1 Decision Fatigue Among Physicians Han Ye, Junjian Yi, Songfa Zhong 0 / 50
2 Questions Why Barack Obama in gray or blue suit? Why Mark Zuckerberg in gray T-shirt? 1 / 50
3 Questions Why Barack Obama in gray or blue suit? Why Mark Zuckerberg in gray T-shirt? Obama: You ll see I wear only gray or blue suits. I m trying to pare down decisions. I don t want to make decisions about what I m eating or wearing. Because I have too many other decisions to make. Zuckerberg: I really want to clear my life to make it so that I have to make as few decisions as possible about anything except how to best serve this community. 2 / 50
4 Research Questions Whether and how decision fatigue affects physician behavior? What kind of physicians are more vulnerable to decision fatigue? 3 / 50
5 Literature: Decision Fatigue Making too many decisions depletes individuals executive function and mental resources, which may influence their subsequent decisions (Baumeister et al., 1998; Stanovich and West, 2000; Kahneman, 2011; Baumeister and Tierney, 2012). Consumer purchasing for custom-made products (Levav et al., 2010) Judicial parole decisions (Danziger et al., 2011) Voter behavior (Augenblick et al., 2015) Financial analysts forecasts (Hirshleifer et al., 2017) 4 / 50
6 Literature: Physician Behavior Physicians decisions are affected by a variety of factors irrelevant to patient health, which may lead to large variations in procedure use, medical expenditure and patient outcomes. Peer effects among doctors and organizational culture (Lee and Mongan, 2009) Medical liability system (Currie and McLeod, 2008; Frakes, 2013) Physician beliefs about treatment (Cutler et al., 2013) Physicians financial incentives (Clemens and Gottlieb, 2014) Quality of physicians human capital (Currie and McLeod, 2017) 5 / 50
7 Patient Flow Source: The hospital A&E website 6 / 50
8 Patient Flow Data An entire set of ED visits from January 2011 to December 2012 in an acute general hospital of SG (264,115 patient cases). For each patient case, we observe detailed timestamps (e.g. the start and end times of triage, consultation, and task orders) and physician identifiers. With these data, we are able to reconstruct Real-time patient flow volume in the ED Patient s entire path through the ED Physician s shift schedules Sequences of actual patients who are seen by the physician in each shift Potential patients who arrive during a time when the physician s shift is in progress 7 / 50
9 Patient Information Basic demographics: birthdate, gender, address Patient acuity category scale (PACS) Arrival mode: ambulance or walk in Disposition type: discharge home, follow-up in primary care, inpatient admission... 8 / 50
10 Sample Restrictions All patient cases whose attending physician has at least 10 shifts observed is working in a shift with shift length 6-16 hours 242,761 patient cases, with 124 physician identities 9 / 50
11 Dependent Variables Physician decisions 1. physician discharge decision (dummies) outpatient disposition (discharge home or follow-up) discharge home inpatient admission 2. task orders total number of task orders (treatments and diagnostic tests) number of diagnostic tests 3. patient length of stay from the start to the end of patient case consultation Patient outcomes (dummies) 1. death in the ED 2. return visits to the ED within 14 days 10 / 50
12 Independent Variables: Decision Fatigue 1. Number of patients seen by the physician prior to the indexed patient s arrival 2. Hours relative to the shift beginning 11 / 50
13 Table: Summary statistics of outcome variables 12 / 50
14 Table: Summary statistics 13 / 50
15 Graphic Evidence A B Hospital Admission Outpatient Disposition Discharge Home C D Number of Tests Number of Tasks E >20 Length of Stay(mins) F >20 Figure: Physician decisions over the number of previous cases 14 / 50
16 Regression Specifications The baseline regression describing the association between fatigue and physician decisions is as follows: Y ijt = F atigue ijt α + X i β + T t γ + ν j + ɛ ijt (1) Y ijt - decisions for or outcome of patient i, treated by physician j with consultation start time t F atigue ijt - number of cases seen by physician j prior to patient i s arrival X i - patient characteristics including gender, age (in quadratic form), and PACS index T t - time fixed effects: hour of day, day of week and month-year interactions ν j - physician fixed effects standard errors clustered at the physician level 15 / 50
17 OLS Results Table: Fatigue on physician decisions 16 / 50
18 Identification Is the assignment of patients to physicians random? patient side physician side hospital administrators 17 / 50
19 Identification Is the assignment of patients to physicians random? patient side physician side hospital administrators IV: number of hospital ambulance arrivals an important determinant for the physician s workload plausibly exogenous to the underlying health of a given patient isolate the causal effect of workload on physician decision making 17 / 50
20 2SLS Results Table: Fatigue on physician decisions 18 / 50
21 Break within the Shift Mental resources might be replenished by a short rest which increases glucose and leads to a positive mood (Danziger et al., 2011). Restricted sample of visits: the physician is in a shift with an at-least-one-hour break (not in charge of any patient case) break up a shift into two distinct sessions (before and after break) around 10%, 23,733 visits 19 / 50
22 Graphic Evidence A B Hospital Admission Outpatient Disposition Discharged Home C D Number of Tests Number of Tasks E >= >=15 Length of Stay(mins) F >= >=15 Before Break After Break Figure: Physician decisions over the number of previous within-session cases 20 / 50
23 Specification 1 Y ijt = α 1 T otalcase ij + α 2 Session2 ij + α 3m D ijm m (2) +X i β + T t γ + ν j + ɛ ijt T otalcase ij - total number of cases seen by physician j prior to patient i s arrival Session2 - indicator for the after-break session D m - dummies indicating the first three cases in each session D 1-1st case in session 1 D 2-2nd case in session 1 D 3-3rd case in session 1 D 4-1st case in session 2 D 5-2nd case in session 2 D 6-3rd case in session 2 21 / 50
24 Table: Analysis using dummies for the first three decisions in a session 22 / 50
25 Specification 2 Y ijt = α 1 Case ij + α 2 Session2 ij + α 3 Case ij Session2 ij +X i β + T t γ + ν j + ɛ ijt (3) Case - number of previous cases within the current session Session2 - indicator for the after-break session Case Session2 - interaction term between Case and Session2 23 / 50
26 Table: Analysis of linear trend between sessions 24 / 50
27 Robustness 1: Alternative Fatigue Measure Alternative measure of fatigue - cumulative hours elapsed in the physician s shift Y ijt = m α m 1( t t(j, t) = m) + X i β + T t γ + ν j + ɛ ijt (4) t t(j, t): patient s arrival time relative to shift beginning α m : the average effect of m hours work (rounded up to the nearest nonnegative integer) on physician decisions reference category: visits arriving more than six hours after shift beginning 25 / 50
28 Table: Robustness 1 - Alternative fatigue measure 26 / 50
29 Table: Robustness 2 - Number of patients in the ED 27 / 50
30 Table: Robustness 3 - Include both the cumulative minutes and number of previous cases 28 / 50
31 Other Robustness Checks Restrictions on physician working hours - Shift length: 8-12 hours 8-10 hours 29 / 50
32 Heterogeneous Analysis 1 - Nonlinear Fatigue Effects Y ijt = m α m D ijm + X i β + T t γ + ν j + ɛ ijt (5) D ijm - dummy indicator: number of cases seen by physician j before patient i s arrival falls into group m D 1 : number of previous cases is between 0 to 2 D 2 : number of previous cases is between 3 to 5 D 3 : number of previous cases is between 6 to 8 D 4 : number of previous cases is between 9 to 11 D 5 : number of previous cases is between 12 to 14 D 6 : number of previous cases is between 15 to 17 D 7 : number of previous cases is between 18 to 20 reference category: number of previous cases is larger than / 50
33 Nonlinear Fatigue Effects Testcount lnlos Admitted Ordercount Outpatient Discharged #Previous cases Figure: Parameter estimates with 95% CI 31 / 50
34 Heterogeneous Analysis 2 Consider both quantity and composition of cases seen by the physician, before the indexed patient s arrival total number of cases: overall tendency number of severe cases: severe cases are likely to cost much more physician effort in terms of concentration and medical inputs 32 / 50
35 Table: Heterogeneous analysis 2 - number of previous severe cases 33 / 50
36 Will physician decision fatigue increase patient risk? 34 / 50
37 Physician Decision Fatigue and Patient Outcomes Percentage of Death A *** Percentage of Revisiting B *** Below mean Above mean Below mean Above mean Number of previous cases below (Left) versus above (Right) the sample mean (A) Data for PACS1&PACS2 cases. (B)Data for all cases. Figure: Patient outcomes over the number of previous cases 35 / 50
38 Table: Physician decision fatigue on patient outcomes 36 / 50
39 Who Are More Responsive to Fatigue? Physician specific fatigue effects obtained from IV estimations for each physician in our sample Physician characteristics gender, medical credentials, graduation year and school collected from Singapore Medical Council (SMC) 104 out of 124 physicians in our sample 37 / 50
40 Summary Statistics Table: Physician characteristics and fatigue effects 38 / 50
41 A B Discharged Home C >20 Graphs by physician experience Data for patients who were seen by physicians with medical experience (A) less than 10 years; (B) 10 to 17 years; (C) over 17 years. Figure: Proportion of discharge home over the number of previous cases 39 / 50
42 A B Number of Tests C >20 Graphs by physician experience Data for patients who were seen by physicians with medical experience (A) less than 10 years; (B) 10 to 17 years; (C) over 17 years. Figure: Average test orders over the number of previous cases 40 / 50
43 Table: Correlates of fatigue effects and physician characteristics 41 / 50
44 Conclusions Research questions Whether and how decision fatigue affects physician behavior? What kind of physicians are more vulnerable to decision fatigue? 42 / 50
45 Answers to Research Questions Decision fatigue: Physicians show an increased tendency to adopt outpatient disposition especially discharge home reduce task orders shorten patient length of stay increased ED mortality and return visits Physician characteristics influence the magnitudes of fatigue effects medical experience: U-shaped gender: Male 43 / 50
46 Implications To counteract the effects of decision fatigue more breaks; serious cases as earlier cases; more physicians and less choices. 44 / 50
47 Thank you for your comments! 44 / 50
48 Appendix Figures A Outpatient Disposition B C >20 Graphs by physician experience Data for patients who were seen by physicians with medical experience (A) less than 10 years; (B) 10 to 17 years; (C) over 17 years. Figure: Proportion of outpatient disposition over number of previous cases 45 / 50
49 A B Hospital Admission C >20 Graphs by physician experience Data for patients who were seen by physicians with medical experience (A) less than 10 years; (B) 10 to 17 years; (C) over 17 years. Figure: Proportion of hospital admission over the number of previous cases 46 / 50
50 A B Number of Tasks C >20 Graphs by physician experience Data for patients who were seen by physicians with medical experience (A) less than 10 years; (B) 10 to 17 years; (C) over 17 years. Figure: Average task orders over the number of previous cases 47 / 50
51 A Length of Stay(mins) B C >20 Graphs by physician experience Data for patients who were seen by physicians with medical experience (A) less than 10 years; (B) 10 to 17 years; (C) over 17 years. Figure: Average length of stay over the number of previous cases 48 / 50
52 Appendix Tables Table: Robustness - Restrictions on physician working hours shift length 8-12 hours 49 / 50
53 Table: Robustness - Restrictions on physician working hours shift length 8-10 hours 50 / 50
Appendix. We used matched-pair cluster-randomization to assign the. twenty-eight towns to intervention and control. Each cluster,
Yip W, Powell-Jackson T, Chen W, Hu M, Fe E, Hu M, et al. Capitation combined with payfor-performance improves antibiotic prescribing practices in rural China. Health Aff (Millwood). 2014;33(3). Published
More informationProfit Efficiency and Ownership of German Hospitals
Profit Efficiency and Ownership of German Hospitals Annika Herr 1 Hendrik Schmitz 2 Boris Augurzky 3 1 Düsseldorf Institute for Competition Economics (DICE), Heinrich-Heine-Universität Düsseldorf 2 RWI
More informationComparison of New Zealand and Canterbury population level measures
Report prepared for Canterbury District Health Board Comparison of New Zealand and Canterbury population level measures Tom Love 17 March 2013 1BAbout Sapere Research Group Limited Sapere Research Group
More informationFree to Choose? Reform and Demand Response in the British National Health Service
Free to Choose? Reform and Demand Response in the British National Health Service Martin Gaynor Carol Propper Stephan Seiler Carnegie Mellon University, University of Bristol and NBER Imperial College,
More informationMissed Nursing Care: Errors of Omission
Missed Nursing Care: Errors of Omission Beatrice Kalisch, PhD, RN, FAAN Titus Professor of Nursing and Chair University of Michigan Nursing Business and Health Systems Presented at the NDNQI annual meeting
More informationNew Joints: Private providers and rising demand in the English National Health Service
1/30 New Joints: Private providers and rising demand in the English National Health Service Elaine Kelly & George Stoye 3rd April 2017 2/30 Motivation In recent years, many governments have sought to increase
More informationGantt Chart. Critical Path Method 9/23/2013. Some of the common tools that managers use to create operational plan
Some of the common tools that managers use to create operational plan Gantt Chart The Gantt chart is useful for planning and scheduling projects. It allows the manager to assess how long a project should
More informationChasing ambulance productivity
Chasing ambulance productivity Nicholas Bloom (Stanford) David Chan (Stanford) Atul Gupta (Stanford) AEA 2016 VERY PRELIMINARY 0.5 1 0.5 1 0.5 1 The paper aims to investigate the importance of management
More information12/12/2016. The Impact of Shift Length on Mood and Fatigue in Registered Nurses: Are Nurses the Next Grumpy Cat? Program Outcomes: Background
The Impact of Shift Length on Mood and Fatigue in Registered Nurses: Are Nurses the Next Grumpy Cat? Wendy Ungard, DNP, RN, NEA-BC Cincinnati Children s Hospital, Cincinnati, OH Program Outcomes: Review
More informationEmergency admissions to hospital: managing the demand
Report by the Comptroller and Auditor General Department of Health Emergency admissions to hospital: managing the demand HC 739 SESSION 2013-14 31 OCTOBER 2013 4 Key facts Emergency admissions to hospital:
More informationThe Interactive Effect of Medicare Inpatient and Outpatient Reimbursement
The Interactive Effect of Medicare Inpatient and Outpatient Reimbursement JOB MARKET PAPER Andrew Elzinga November 12, 2015 Abstract Hospital care is characterized by inpatient and outpatient departments;
More informationThe Economic Incidence of Federal Student Grant Aid
The Economic Incidence of Federal Student Grant Aid Web Appendices - Not for Publication January 217 Appendix A: RD Estimation with a Multidimensional Treatment This appendix provides a general example
More informationProceedings of the 2016 Winter Simulation Conference T. M. K. Roeder, P. I. Frazier, R. Szechtman, E. Zhou, T. Huschka, and S. E. Chick, eds.
Proceedings of the 2016 Winter Simulation Conference T. M. K. Roeder, P. I. Frazier, R. Szechtman, E. Zhou, T. Huschka, and S. E. Chick, eds. IDENTIFYING THE OPTIMAL CONFIGURATION OF AN EXPRESS CARE AREA
More informationStrengthening Enforcement in Unemployment Insurance. A Natural Experiment
Strengthening Enforcement in Unemployment Insurance. A Natural Experiment Patrick Arni Amelie Schiprowski Preliminary Draft, January 2016 [Please do not distribute without permission.] Abstract Imposing
More informationDifferences in employment histories between employed and unemployed job seekers
8 Differences in employment histories between employed and unemployed job seekers Simonetta Longhi Mark Taylor Institute for Social and Economic Research University of Essex No. 2010-32 21 September 2010
More informationPhysician workload and treatment choice: the case of primary care
Physician workload and treatment choice: the case of primary care Adi Alkalay Clalit Health Services Amnon Lahad School of public health Hebrew University of Jerusalem Alon Eizenberg Department of Economics
More informationHealthcare exceptionalism in a non-market system: hospitals performance, labor supply, and allocation in Denmark
Healthcare exceptionalism in a non-market system: hospitals performance, labor supply, and allocation in Denmark Anne-Line Helsø, Nicola Pierri, and Adelina Wang Copenhagen University, Stanford University
More informationSupplementary Material Economies of Scale and Scope in Hospitals
Supplementary Material Economies of Scale and Scope in Hospitals Michael Freeman Judge Business School, University of Cambridge, Cambridge CB2 1AG, United Kingdom mef35@cam.ac.uk Nicos Savva London Business
More informationReducing emergency admissions
A picture of the National Audit Office logo Report by the Comptroller and Auditor General Department of Health & Social Care NHS England Reducing emergency admissions HC 833 SESSION 2017 2019 2 MARCH 2018
More informationDo Hospitals Respond to Increasing Prices by Supplying Fewer Services?
DISCUSSION PAPER SERIES IZA DP No. 9229 Do Hospitals Respond to Increasing Prices by Supplying Fewer Services? Martin Salm Ansgar Wübker July 2015 Forschungsinstitut zur Zukunft der Arbeit Institute for
More informationChao-Chin Sherina Lee Jui-fen Rachel Lu Chang Gung University, Taiwan. ihea July 11-July 13, 2011
Chao-Chin Sherina Lee Jui-fen Rachel Lu Chang Gung University, Taiwan ihea July 11-July 13, 2011 Motivation Children is the future hope of a country With a declining total fertility rate (TFR) in Taiwan,
More informationImpacts of Trade liberalization on Labor allocation in Vietnam
Trade in the Asian Century: Delivering on the Promise of Economic Prosperity Bangkok, 22-23 September, 2014 Impacts of Trade liberalization on Labor allocation in Vietnam Vu Hoang Dat The Centre for Analysis
More informationHealth service availability and health seeking behaviour in resource poor settings: evidence from Mozambique
Anselmi et al. Health Economics Review (2015) 5:26 DOI 10.1186/s13561-015-0062-6 RESEARCH ARTICLE Health service availability and health seeking behaviour in resource poor settings: evidence from Mozambique
More informationThe Effects of Medicare Home Health Outlier Payment. Policy Changes on Older Adults with Type 1 Diabetes. Hyunjee Kim
The Effects of Medicare Home Health Outlier Payment Policy Changes on Older Adults with Type 1 Diabetes Hyunjee Kim 1 Abstract There have been struggles to find a reimbursement system that achieves a seemingly
More informationPatient Selection Under Incomplete Case Mix Adjustment: Evidence from the Hospital Value-based Purchasing Program
Patient Selection Under Incomplete Case Mix Adjustment: Evidence from the Hospital Value-based Purchasing Program Lizhong Peng October, 2014 Disclaimer: Pennsylvania inpatient data are from the Pennsylvania
More informationSettling for Academia? H-1B Visas and the Career Choices of International Students in the United States
Supplementary material to: Settling for Academia? H-1B Visas and the Career Choices of International Students in the United States Appendix A. Additional Tables Catalina Amuedo-Dorantes and Delia Furtado
More informationPROXIMITY TO DEATH AND PARTICIPATION IN THE LONG- TERM CARE MARKET
HEALTH ECONOMICS Health Econ. 18: 867 883 (2009) Published online 4 September 2008 in Wiley InterScience (www.interscience.wiley.com)..1409 PROXIMITY TO DEATH AND PARTICIPATION IN THE LONG- TERM CARE MARKET
More informationService offshoring and wages: worker-level evidence from Italy
Service offshoring and wages: worker-level evidence from Italy Elisa Borghi Università Carlo Cattaneo - LIUC Rosario Crinò Centro de Estudios Monetarios y Financieros (CEMFI) Final Workshop MIUR-PRIN Project
More informationLong-Term Care Hospitals: A Case Study in Waste *
Long-Term Care Hospitals: A Case Study in Waste * Liran Einav Amy Finkelstein Neale Mahoney August 20, 2018 Abstract There is substantial waste in U.S. healthcare, but little consensus on how to identify
More informationTechnical Notes on the Standardized Hospitalization Ratio (SHR) For the Dialysis Facility Reports
Technical Notes on the Standardized Hospitalization Ratio (SHR) For the Dialysis Facility Reports July 2017 Contents 1 Introduction 2 2 Assignment of Patients to Facilities for the SHR Calculation 3 2.1
More informationTHE ROLE OF HOSPITAL HETEROGENEITY IN MEASURING MARGINAL RETURNS TO MEDICAL CARE: A REPLY TO BARRECA, GULDI, LINDO, AND WADDELL
THE ROLE OF HOSPITAL HETEROGENEITY IN MEASURING MARGINAL RETURNS TO MEDICAL CARE: A REPLY TO BARRECA, GULDI, LINDO, AND WADDELL DOUGLAS ALMOND JOSEPH J. DOYLE, JR. AMANDA E. KOWALSKI HEIDI WILLIAMS In
More informationHealth and Long-Term Care Use Patterns for Ohio s Dual Eligible Population Experiencing Chronic Disability
Health and Long-Term Care Use Patterns for Ohio s Dual Eligible Population Experiencing Chronic Disability Shahla A. Mehdizadeh, Ph.D. 1 Robert A. Applebaum, Ph.D. 2 Gregg Warshaw, M.D. 3 Jane K. Straker,
More informationIs there an impact of Health Information Technology on Delivery and Quality of Patient Care?
Is there an impact of Health Information Technology on Delivery and Quality of Patient Care? Amanda Hessels, PhD, MPH, RN, CIC, CPHQ Nurse Scientist Meridian Health, Ann May Center for Nursing 11.13.2014
More informationINCENTIVE SCHEMES & SERVICE LEVEL AGREEMENTS
MAY 2007 INCENTIVE SCHEMES & SERVICE LEVEL AGREEMENTS Practice Based Commissioning North and South Essex Local Medical Committees CLARIFYING THE RELATIONSHIP BETWEEN PBC GROUPS AND PCTS AIMS The aim of
More informationPatient-mix Coefficients for December 2017 (2Q16 through 1Q17 Discharges) Publicly Reported HCAHPS Results
Patient-mix Coefficients for December 2017 (2Q16 through 1Q17 Discharges) Publicly Reported HCAHPS Results As noted in the HCAHPS Quality Assurance Guidelines, V12.0, prior to public reporting, hospitals
More informationICU Admission Control: An Empirical Study of Capacity Allocation and its Implication on Patient Outcomes
ICU Admission Control: An Empirical Study of Capacity Allocation and its Implication on Patient Outcomes Song-Hee Kim, Carri W. Chan, Marcelo Olivares, and Gabriel Escobar September 7, 2013 Abstract This
More informationFamily Matters? The Importance of Relatives for Frail Elders Mortality and Hospital Readmission
Population Ageing DOI 10.1007/s12062-017-9202-6 Family Matters? The Importance of Relatives for Frail Elders Mortality and Hospital Readmission Tor Helge Holmås 1 & Karin Monstad 1 & Darina Steskal 1 Received:
More informationTracking Functional Outcomes throughout the Continuum of Acute and Postacute Rehabilitative Care
Tracking Functional Outcomes throughout the Continuum of Acute and Postacute Rehabilitative Care Robert D. Rondinelli, MD, PhD Medical Director Rehabilitation Services Unity Point Health, Des Moines Paulette
More informationUsing An APCD to Inform Healthcare Policy, Strategy, and Consumer Choice. Maine s Experience
Using An APCD to Inform Healthcare Policy, Strategy, and Consumer Choice Maine s Experience What I ll Cover Today Maine s History of Using Health Care Data for Policy and System Change Health Data Agency
More informationGender. Age DEMOGRAPHICS POINTS OF DISTINCTION COMISSION FOR ACCREDITATION OF REHABILITATION FACILITIES STATE OF FLORIDA BRAIN AND SPINAL CORD PROGRAM
POINTS OF DISTINCTION 89-bed Acute Adult Inpatient Rehabilitation Unit, All private rooms 4 th largest Rehabilitation provider in the state of Florida Admitted 2157 patients from April 2017 through March
More informationHenry Ford Hospital Inpatient Predictive Model
Henry Ford Hospital Inpatient Predictive Model Mike Meitzner Principal Management Engineer Henry Ford Health System Detroit, Michigan Outline HFHS background CMURC relationship Model Goals Data Cleansing
More informationhow competition can improve management quality and save lives
NHS hospitals in England are rarely closed in constituencies where the governing party has a slender majority. This means that for near random reasons, those parts of the country have more competition
More informationThe Intended and Unintended Consequences of the Hospital Readmission Reduction Program
The Intended and Unintended Consequences of the Hospital Readmission Reduction Program Engy Ziedan University of Illinois at Chicago July 17, 2017 Abstract Pay for performance (P4P) is increasingly being
More informationHealth Economics Series No
Health Economics Series No. 2017-07 Impacts of performance pay for hospitals: The Readmissions Reduction Program Atul Gupta October 2017 Becker Friedman Institute for Research in Economics Contact: 773.702.5599
More informationNBER WORKING PAPER SERIES HOUSEHOLD RESPONSES TO PUBLIC HOME CARE PROGRAMS. Peter C. Coyte Mark Stabile
NBER WORKING PAPER SERIES HOUSEHOLD RESPONSES TO PUBLIC HOME CARE PROGRAMS Peter C. Coyte Mark Stabile Working Paper 8523 http://www.nber.org/papers/w8523 NATIONAL BUREAU OF ECONOMIC RESEARCH 1050 Massachusetts
More informationINDUSTRY STUDIES ASSOCATION WORKING PAPER SERIES
INDUSTRY STUDIES ASSOCATION WORKING PAPER SERIES Proximity and Software Programming: IT Outsourcing and the Local Market By Ashish Arora Software Industry School Heinz School Carnegie Mellon University
More informationHospital Staffing and Inpatient Mortality
Hospital Staffing and Inpatient Mortality Carlos Dobkin * University of California, Berkeley This version: June 21, 2003 Abstract Staff-to-patient ratios are a current policy concern in hospitals nationwide.
More informationFertility Response to the Tax Treatment of Children
Fertility Response to the Tax Treatment of Children Kevin J. Mumford Purdue University Paul Thomas Purdue University April 2016 Abstract This paper uses variation in the child tax subsidy implicit in US
More informationCommunity Performance Report
: Wenatchee Current Year: Q1 217 through Q4 217 Qualis Health Communities for Safer Transitions of Care Performance Report : Wenatchee Includes Data Through: Q4 217 Report Created: May 3, 218 Purpose of
More informationThe Impact of Increased Number of Acute Care Beds to Reduce Emergency Room Wait Times
The Impact of Increased Number of Acute Care Beds to Reduce Emergency Room Wait Times JENNIFER MCKAY Thesis submitted to the Faculty of Graduate and Postdoctoral Studies in partial fulfillment of the requirements
More informationCommon Core Algebra 2 Course Guide
Common Core Algebra 2 Course Guide Unit 1: Algebraic Essentials Review (7 Days) - Lesson 1: Variables, Terms, & Expressions - Lesson 2: Solving Linear Equations - Lesson 3: Common Algebraic Expressions
More informationVersion 1.0 (posted Aug ) Aaron L. Leppin. Background. Introduction
Describing the usefulness and efficacy of discharge interventions: predicting 30 day readmissions through application of the cumulative complexity model (protocol). Version 1.0 (posted Aug 22 2013) Aaron
More informationEmployed and Unemployed Job Seekers and the Business Cycle*
OXFORD BULLETIN OF ECONOMICS AND STATISTICS, 76, 4 (2014) 0305 9049 doi: 10.1111/obes.12029 Employed and Unemployed Job Seekers and the Business Cycle* Simonetta Longhi and Mark Taylor Institute for Social
More informationThank you for joining us today!
Thank you for joining us today! Please dial 1.800.732.6179 now to connect to the audio for this webinar. To show/hide the control panel click the double arrows. 1 Emergency Room Overcrowding A multi-dimensional
More informationAbsenteeism and Nurse Staffing
Abstract number: 025-1798 Absenteeism and Nurse Staffing Wen-Ya Wang, Diwakar Gupta Industrial and Systems Engineering Program University of Minnesota, Minneapolis, MN 55455 wangx665@me.umn.edu, gupta016@me.umn.edu
More informationMeasuring Returns to Hospital Care: Evidence from Ambulance Referral Patterns
Measuring Returns to Hospital Care: Evidence from Ambulance Referral Patterns Joseph Doyle John Graves Jonathan Gruber Samuel Kleiner August 8, 2012 Abstract Endogenous patient sorting across hospitals
More informationCardiovascular Disease Prevention and Control: Interventions Engaging Community Health Workers
Cardiovascular Disease Prevention and Control: Interventions Engaging Community Health Workers Community Preventive Services Task Force Finding and Rationale Statement Ratified March 2015 Table of Contents
More informationCHE Research Paper 151. Spatial Competition and Quality: Evidence from the English Family Doctor Market
Spatial Competition and Quality: Evidence from the English Family Doctor Market Hugh Gravelle, Dan Liu, Carol Propper, Rita Santos CHE Research Paper 151 Spatial competition and quality: Evidence from
More informationHeterogeneous Treatment Effects of Electronic Medical Records on Hospital Efficiency
Heterogeneous Treatment Effects of Electronic Medical Records on Hospital Efficiency Ruirui Sun Graduate Center of City University of New York rsun1@gradcenter.cuny.edu Abstract This paper empirically
More informationClostridium difficile
Understanding Spatial Distribution of Disease: Clostridium difficile Dara Som, MPH and Sherrine Eid, MPH Health Studies Department, Lehigh Valley Hospital, Pennsylvania October 9, 2007 Objectives What
More informationOperator Assignment and Routing Problems in Home Health Care Services
8th IEEE International Conference on Automation Science and Engineering August 20-24, 2012, Seoul, Korea Operator Assignment and Routing Problems in Home Health Care Services Semih Yalçındağ 1, Andrea
More informationT he National Health Service (NHS) introduced the first
265 ORIGINAL ARTICLE The impact of co-located NHS walk-in centres on emergency departments Chris Salisbury, Sandra Hollinghurst, Alan Montgomery, Matthew Cooke, James Munro, Deborah Sharp, Melanie Chalder...
More informationSatisfaction and Experience with Health Care Services: A Survey of Albertans December 2010
Satisfaction and Experience with Health Care Services: A Survey of Albertans 2010 December 2010 Table of Contents 1.0 Executive Summary...1 1.1 Quality of Health Care Services... 2 1.2 Access to Health
More informationGeographic Variation in Medicare Spending. Yvonne Jonk, PhD
in Medicare Spending Yvonne Jonk, PhD Why are we concerned about geographic variation in Medicare spending? Does increased spending imply better health outcomes? How do we justify variation in Medicare
More informationPG snapshot Nursing Special Report. The Role of Workplace Safety and Surveillance Capacity in Driving Nurse and Patient Outcomes
PG snapshot news, views & ideas from the leader in healthcare experience & satisfaction measurement The Press Ganey snapshot is a monthly electronic bulletin freely available to all those involved or interested
More informationAdvancing the Evidence and Innovation Agenda
Advancing the Evidence and Innovation Agenda Jon Baron, Coalition for Evidence-Based Policy Dave Patterson, South Carolina Budget and Control Board, Division of Research Statistics John Laub, University
More informationJamie Tricarico Matese, B.A. Washington, DC December 6, 2017
HOSPITAL READMISSIONS REDUCTION PROGRAM (HRRP) AND HEALTH OUTCOMES: ARE HOSPITAL READMISSIONS ASSOCIATED WITH MORTALITY RATES FOR MEDICARE PNEUMONIA PATIENTS? A Thesis Submitted to the Faculty of the Graduate
More informationThe role of Culture in Long-term Care
(1/24) The role of Culture in Long-term Care Elena Gentili Giuliano Masiero Fabrizio Mazzonna Università della Svizzera Italiana EuHEA Conference 2016 Hamburg, July 15. Introduction (2/24) About this paper
More informationStatistical Analysis Plan
Statistical Analysis Plan CDMP quantitative evaluation 1 Data sources 1.1 The Chronic Disease Management Program Minimum Data Set The analysis will include every participant recorded in the program minimum
More informationPatient-Mix Adjustment Factors for Home Health Care CAHPS Survey Results Publicly Reported on Home Health Compare in July 2017
Patient-Mix Adjustment Factors for Home Health Care CAHPS Survey Results Publicly Reported on Home Health Compare in July 2017 Home Health Care CAHPS (HHCAHPS) Survey results will be refreshed or updated
More informationEvaluation of the inclusive payment system based on the diagnosis procedure combination with respect to cataract operations in Japan
Vol.1, No.2, 93-103 (2009) doi:10.4236/health.2009.12016 Health Evaluation of the inclusive payment system based on the diagnosis procedure combination with respect to cataract operations in Japan ------A
More informationPopulation and Sampling Specifications
Mat erial inside brac ket s ( [ and ] ) is new to t his Specific ati ons Manual versi on. Introduction Population Population and Sampling Specifications Defining the population is the first step to estimate
More informationThe Effects of Cultural Competence on Nurses Burnout
, pp.300-304 http://dx.doi.org/10.14257/astl.2014.47.68 The Effects of Cultural Competence on Nurses Burnout So-Yun, Choi 1, Kyung-Sook, Kim 2 Department of Social Welfare, Namseoul University, Department
More informationScottish Hospital Standardised Mortality Ratio (HSMR)
` 2016 Scottish Hospital Standardised Mortality Ratio (HSMR) Methodology & Specification Document Page 1 of 14 Document Control Version 0.1 Date Issued July 2016 Author(s) Quality Indicators Team Comments
More informationResearch Design: Other Examples. Lynda Burton, ScD Johns Hopkins University
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this
More informationIrene Papanicolas, Alistair McGuire. Using a latent variable approach to measure the quality of English NHS hospitals
Working paper No: 21/2011 May 2011 LSE Health Irene Papanicolas, Alistair McGuire Using a latent variable approach to measure the quality of English NHS hospitals Using a latent variable approach to measure
More informationServices offshoring and wages: Evidence from micro data. by Ingo Geishecker and Holger Görg
Services offshoring and wages: Evidence from micro data by Ingo Geishecker and Holger Görg No. 1434 July 2008 Kiel Institute for the World Economy, Düsternbrooker Weg 120, 24105 Kiel, Germany Kiel Working
More informationTHE MISADVENTURES OF THE RECENTLY-DISCHARGED OLDER ADULT
April 13, 2018 The Misadventures of the Recently-Discharged Older Adult THE MISADVENTURES OF THE RECENTLY-DISCHARGED OLDER ADULT Robert E. Burke MD, MS April 13, 2018 I have no conflicts of interest to
More informationSHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST EXECUTIVE SUMMARY REPORT TO THE TRUST BOARD HELD ON 18 NOVEMBER 2015
SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST EXECUTIVE SUMMARY REPORT TO THE TRUST BOARD HELD ON 18 NOVEMBER 2015 Subject: Supporting TEG Member: Authors: Status 1 Data Quality Baseline Assessment
More informationPatient survey report Survey of adult inpatients 2011 The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
Patient survey report 2011 Survey of adult inpatients 2011 The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust The national survey of adult inpatients in the NHS 2011 was designed, developed
More informationMeasuring Health System Efficiency in Canada
Measuring Health System Efficiency in Canada Multi-phased project Phase I Katerina Gapanenko April 17, 2012 1 The increased cost of health is a great concern 250 200 150 100 50 Health Care spendings in
More informationFUNCTIONAL DISABILITY AND INFORMAL CARE FOR OLDER ADULTS IN MEXICO
FUNCTIONAL DISABILITY AND INFORMAL CARE FOR OLDER ADULTS IN MEXICO Mariana López-Ortega National Institute of Geriatrics, Mexico Flavia C. D. Andrade Dept. of Kinesiology and Community Health, University
More informationEffects of the Ten Percent Cap in Medicare Home Health Care on Treatment Intensity and Patient Discharge Status
Health Services Research Health Research and Educational Trust DOI: 10.1111/1475-6773.12290 RESEARCH ARTICLE Effects of the Ten Percent Cap in Medicare Home Health Care on Treatment Intensity and Patient
More informationQuality Improvement Spillovers: Evidence from the Hospital Readmissions Reduction Program
Quality Improvement Spillovers: Evidence from the Hospital Readmissions Reduction Program Robert J. Batt, Hessam Bavafa, Mohamad Soltani Wisconsin School of Business, University of Wisconsin-Madison, Madison,
More informationCentral East LHIN Strategic Aims
Central East LHIN Strategic Aims Mental Health and Addictions Strategic Aim Update December 16, 2015 Presented By: Dr. Ian Dawe, Jai Mills and Marilee Suter Agenda Background and Overview Aim Metrics Update
More informationMedicare Spending and Rehospitalization for Chronically Ill Medicare Beneficiaries: Home Health Use Compared to Other Post-Acute Care Settings
Medicare Spending and Rehospitalization for Chronically Ill Medicare Beneficiaries: Home Health Use Compared to Other Post-Acute Care Settings Executive Summary The Alliance for Home Health Quality and
More informationInnovation and Diagnosis Related Groups (DRGs)
Innovation and Diagnosis Related Groups (DRGs) Kenneth R. White, PhD, FACHE Professor of Health Administration Department of Health Administration Virginia Commonwealth University Richmond, Virginia 23298
More informationEffect of Appeal Content on Fundraising Success and Donor Behavior
Effect of Appeal Content on Fundraising Success and Donor Behavior Juncai Jiang Virginia Tech. Sriharsha Kamatham University of Texas at Dallas Parneet Pahwa University of Texas at Dallas Nanda Kumar University
More informationDemand and capacity models High complexity model user guidance
Demand and capacity models High complexity model user guidance August 2018 Published by NHS Improvement and NHS England Contents 1. What is the demand and capacity high complexity model?... 2 2. Methodology...
More informationBIG ISSUES IN THE NEXT TEN YEARS OF IMPROVEMENT
BIG ISSUES IN THE NEXT TEN YEARS OF IMPROVEMENT Academy for Health Services Research and Health Policy Annual Meeting Washington, DC: June 24, 2002 Donald M. Berwick, MD, MPP Patient and Community The
More informationDoes the Sector Experience Affect the Wage Gap for Temporary Agency Workers
Does the Sector Experience Affect the Wage Gap for Temporary Agency Workers VERY PRELIMINARY RESULTS Elke Jahn and Dario Pozzoli IAB and IZA; Aarhus University 18-19 March 2010, Increasing Labor Market
More informationEuroHOPE: Hospital performance
EuroHOPE: Hospital performance Unto Häkkinen, Research Professor Centre for Health and Social Economics, CHESS National Institute for Health and Welfare, THL What and how EuroHOPE does? Applies both the
More informationIntroduction and Executive Summary
Introduction and Executive Summary 1. Introduction and Executive Summary. Hospital length of stay (LOS) varies markedly and persistently across geographic areas in the United States. This phenomenon is
More informationAn Empirical Study of the Spillover Effects of Workload on Patient Length of Stay
An Empirical Study of the Spillover Effects of Workload on Patient Length of Stay Jillian Berry Jaeker Anita Tucker Working Paper 13-052 July 17, 2013 Copyright 2012, 2013 by Jillian Berry Jaeker and Anita
More informationStaffing and Scheduling
Staffing and Scheduling 1 One of the most critical issues confronting nurse executives today is nurse staffing. The major goal of staffing and scheduling systems is to identify the need for and provide
More informationSuicide Among Veterans and Other Americans Office of Suicide Prevention
Suicide Among Veterans and Other Americans 21 214 Office of Suicide Prevention 3 August 216 Contents I. Introduction... 3 II. Executive Summary... 4 III. Background... 5 IV. Methodology... 5 V. Results
More informationTree Based Modeling Techniques Applied to Hospital Length of Stay
Rochester Institute of Technology RIT Scholar Works Theses Thesis/Dissertation Collections 8-12-2018 Tree Based Modeling Techniques Applied to Hospital Length of Stay Rupansh Goantiya rxg7520@rit.edu Follow
More informationPatient-mix Coefficients for July 2017 (4Q15 through 3Q16 Discharges) Publicly Reported HCAHPS Results
Patient-mix Coefficients for July 2017 (4Q15 through 3Q16 Discharges) Publicly Reported HCAHPS Results As noted in the HCAHPS Quality Assurance Guidelines, V11.0, prior to public reporting, hospitals HCAHPS
More informationPerformance Measurement of a Pharmacist-Directed Anticoagulation Management Service
Hospital Pharmacy Volume 36, Number 11, pp 1164 1169 2001 Facts and Comparisons PEER-REVIEWED ARTICLE Performance Measurement of a Pharmacist-Directed Anticoagulation Management Service Jon C. Schommer,
More informationLearning Activity: 1. Discuss identified gaps in the body of nurse work environment research.
Learning Activity: LEARNING OBJECTIVES 1. Discuss identified gaps in the body of nurse work environment research. EXPANDED CONTENT OUTLINE I. Nurse Work Environment Research a. Magnet Hospital Concept
More information