March, 2014

Improving HPV Vaccination Rates

In the first four years of the introduction of the human papillomavirus (HPV) vaccine, the prevalence of the infection decreased 56% among girls ages 14-19. That makes it all the more important to improve the national HPV vaccination rate; currently only one-third of girls 13-17 have been fully vaccinated. This Issue Brief examines some of the barriers to immunization and summarizes a successful, multipronged clinical intervention to improve vaccination rates.

May/June, 2013

The Case for Baccalaureate-Prepared Nurses

Given that nurses provide the majority of patient care in hospitals, it's no surprise that the quality of nursing care affects patient outcomes. Over the past decade, studies have linked nurse staffing levels, education, job satisfaction, and work environment with better outcomes in hospitals. This Issue Brief adds to that evidence with a study that links changes in nurse education with improvements in surgical patients’ survival. It also discusses how a more educated nurse workforce could fill a range of new roles in primary care, prevention, and care coordination as health reform is implemented.

April, 2013

Three Models of Community-Based Participatory Research

Community-based participatory research (CBPR) is often unfamiliar territory to academic investigators and community organizations alike. We interviewed CBPR investigators at Penn and community leaders to ascertain best practices in CBPR and to compare academic and community perspectives. A number of models of community-academic partnerships emerged, each with its own advantages and disadvantages. The perspectives of the investigators sometimes matched those of the community leaders, but diverged in important ways.

March, 2013

Genomic Variation: What Does It Mean?

New technologies have given us the ability to detect genomic variation at resolutions 50-100 times greater than earlier tests. The good news is that we can now detect variations that help explain developmental delays, autism, or multiple congenital anomalies in up to 20% of children. The bad news is that we can also detect small missing or extra pieces of chromosomes that remain unexplained. This Issue Brief explores the implications of both.

January, 2013

Effects of Conflict-of-Interest Policies in Psychiatry Residency on Antidepressant Prescribing

This study is the first to show how conflict-of-interest policies established by academic medical institutions to insulate their residents from pharmaceutical marketing alters those clinicians' later prescribing patterns. This Issue Brief examines how those conflict-of-interest efforts impacted the prescribing of antidepressants, one of the most heavily promoted drug classes in the past decade.

November/December, 2012

Accountable Care Organizations: Back to the Future?

Public policymakers and private insurers hope Accountable Care Organizations (ACOs) will achieve the triple aim of improving quality of care, improving population health, and reducing costs by coordinating care, managing chronic disease, and aligning financial incentives for hospitals and physicians. The integrated care networks of the 1990s tried some of the same things, and mostly failed. In this Issue Brief, health economists Mark Pauly and Lawton Burns summarize the differences between the two models and analyze of the likely success of ACOs in affecting the costs and quality of health care.

September/October, 2012

Exposure and Vulnerability of California Kindergarteners to Intentionally Unvaccinated Children

Widespread vaccination coverage among children is responsible for reducing or eliminating 14 serious childhood diseases in the United States. Despite this success, some parents remain concerned about the health effects of vaccines, and choose to keep their children unvaccinated. But clusters of unvaccinated children may threaten herd immunity and lead to increasing outbreaks of these preventable diseases. This Issue Brief summarizes a new study that investigates the extent of such clustering, and quantifies the exposure of all California kindergartners to their intentionally unvaccinated schoolmates.

June/August, 2012

On the Way to Health

Information technology (IT) has fundamentally changed the way we work, bank, and communicate. Its impact on health care and health research, however, has been limited by the lack of a comprehensive infrastructure to connect patients, providers, and researchers. As we learn more about how to address the unhealthy behaviors that underlie many chronic conditions, researchers are seeking IT solutions to connect to patients in scalable ways. This Issue Brief describes the development and use of a new web-based IT platform, Way to Health, to deliver and evaluate behavioral interventions to improve health.

June, 2012

Comparing Treatments for Age-Related Macular Degeneration: Safety, Effectiveness and Cost

Since 2005, age-related macular degeneration (AMD) patients have faced a treatment dilemma. Two closely related drugs have produced dramatic improvements in vision but one drug costs 40 times as much as the other. This Issue Brief summarizes a comparative effectiveness research study that provides the most definitive evidence to date about the safety and effectiveness of the two alternatives.

April/May, 2012

Understanding and Addressing the Impact of Autism on the Family

A new study estimates autism costs more than $126 billion each year in the U.S. -- an amount reflecting both the costs of educational and medical services and the costs of not intervening early and effectively enough to prevent lifelong disability. This Issue Brief summarizes the financial impact of childhood autism on families.

March, 2012

'Buddy System' of Peer Mentors May Help Control Diabetes

This report details the results of a study designed to determine if financial incentives or "buddy system" phone support could improve Type 2 diabetes control among a group of outpatient African American veterans at a VA Hospital. The bottom line was that financial incentives had little effect while the buddy system reduced glucose levels by a significant amount.

February, 2012

Designing Health Insurance Exchanges: Key Decisions

A cornerstone of health care reform is the establishment of state-level insurance exchanges where individuals and small businesses can purchase health insurance in an online marketplace. This report reviews the experience of Massachusetts in developing a health insurance exchange and offers policymakers guidance on key features and likely consumer responses.

December, 2011 - January, 2012

How the Newly Insured Use Health Services: a Lesson for the U.S. from Medicare

The Congressional Budget Office estimates that about 32 million previously uninsured people will gain coverage by 2016, when health care reforms are fully implemented. But will these newly insured people use the health care system in the same ways as others? This report summarizes research that investigates how health care use and patterns change among the uninsured and insured once they gain Medicare coverage at age 65.

November, 2011

The Quality of Emergency Medical Services

Although Emergency Medical Services (EMS) is a crucial part of the health care system, there is relatively little research on the quality of those services. EMS agencies often measure their performance using criteria such as response time or total prehospital time. But larger scale studies that cross counties and providers are rare. This Issue Brief summarizes two studies that use comprehensive, longitudinal data from one state to assess the demographic, geographic, and professional factors that affect EMS performance.

October, 2011

Re-engineering Drug Discovery and Development

Despite enormous investments in drug discovery and development, the number of new molecular entities approved each year has hovered around 20-25 for 60 years. Many commentators question the sustainability of the current model of drug development, in which large pharmaceutical companies incur markedly escalating costs to deliver the same number of products to market.

September, 2011

Raising the Profile of Behavioral Economics

The first annual symposium of the Penn-CMU Roybal P30 Center on Behavioral Economics and Health in Philadelphia brought together 50 leading researchers, scholars and health professionals to review the latest developments in the rapidly expanding field of health-related behavioral studies. This eight-page Issue Brief summarizes the findings of the two-day session's eight working groups.

July/August, 2011

When Genetic Screening is Useful but Not Used

When tests for a genetic disorder in one family member are positive, it often makes sense for other at-risk family members to be tested for the same disorder. But that rarely happens, despite the benefits of early detection for various diseases that can be identified by genetic screening. This brief explores a case in which screening of family members would have been useful but was not used.

May/June, 2011

Limitations in Access to Dental and Medical Specialty Care for Publicly Insured Children

Although 42 million children are covered with medical and dental insurance under Medicaid and state-run Children's Health Insurance Programs (CHIP), large numbers encounter great difficulty in actually gaining access to care. Using researchers posing as mothers of young children, these studies sought to make appointments for urgent dental or medical care with dentists and specialty physician practices. The findings define the extent of the problem.

April, 2011

The Pay-Off on Nursing Home Report Cards

Does improving quality through public reporting give nursing homes a competitive advantage in the marketplace, thereby improving their bottom line? This Issue Brief summarizes a series of studies that assess the impact of a decade of public reporting on nursing home quality and on the financial performance of these facilities.

March, 2011

The Changing Geography of Outpatient Procedures

Outpatient surgical visits now account for about two-thirds of all surgical visits in the U.S. and 40% of those surgeries are now performed in ambulatory care centers (ASCs) rather than hospitals. The rapid growth of ASCs raises safety concerns about the risk of complications and adequate access to emergency care.

February, 2011

Evaluating Health Information Technology's Clinical Effects

At the same time computerized physician order entry (COPE) systems promise to improve prescribing patterns and prevent adverse effects, research finds that such electronic records systems can also introduce new errors. Providers and policymakers are discovering that the design of such systems as well as the ways that doctors interact with them can not simply be assumed to "work."

January, 2011

Treating Viral Respiratory Tract Infections with Antibiotics in Hospitals

Despite calls to prescribe antibiotics judiciously, many physicians continue to order antibiotics for inpatients who do not need them. This research looks at antibiotic use in hospitalized adults with a confirmed viral infections, a group that may not benefit from such therapy.

November, 2010

Preventive Surgery and Cancer Mortality in Women With BRCA1/2 Mutations

For more than a decade, researchers have studied whether the removal of breasts, ovaries, and/or fallopean tubes can reduce the cancer and mortality risk in BRCA1/2 mutation carriers. This is a summary of the results of the latest, largest, multinational study on the effects of preventive surgery in these women.

September, 2010

Communities and Health: The Case of Inner-City Violence and Asthma

The health burden of asthma is especially large for resident of low-income, inner-city neighborhoods. Recent work has linked exposure to community violence with worsening asthma symptoms in children. This study tracks adults with moderate to severe asthma and explores the association between exposure to violence and subsequent asthma-related emergency department visits.

June, 2010

The California Nurse Staffing Mandate: Implications for Other States

California is the first state to implement minimum nurse-to-patient staffing requirements in acute care hospitals. It seeks to reduce workloads, improve recruitment and retention of nurses, and improve the quality of patient care. This is the first comprehensive evaluation of that California mandate.

April, 2010

Direct-To-Consumer Advertising of Prescription Drugs

The exploding levels of corporate spending on direct-to-consumer prescription drug ads had sparked increasing controversy. This is a summary of the evidence about the effects of direct-to-consumer advertising, and proposes guidelines for improving the utility of this kind of pharmaceutical industry marketing.

February, 2010, 2009

Foreclosure and Health Status

The cascading effects of the foreclosure crisis on the U.S. economy are all to clear; the effects on individuals' health status are less obvious. This summarizes two studies that examine the health implications of foreclosure and reveal a vulnerable population that may benefit from coordinated health and financial services.

November, 2009

Evaluating Residency Programs by Whether They Produce Good Doctors

Not all physician training programs are alike. Can the quality of that training be judged by the downstream outcomes of patients treated by their graduates? Should patients pick their doctors in part by where they trained? This study looks at one specialty -- OBGYN -- and its graduates.

July, 2009

The Burden of Health Care Costs for Working Families

This study constructs a typical health care budget for working families, calculates the percentage of total compensation devoted to health care over time, and projects how rising health care costs will affect standards of living in the future. Their findings remind us that sustainability depends critically on cost containment.

April, 2009

Time, Distance, and Access to Emergency Care in the United States

As national health care reform advances, increasing attention is being paid to the adequacy of existing resources to meet health care needs. Do we have the right mix of providers and facilities? This is the first national study of population access to emergency care taking into account the locations, people, and transportation systems.

February, 2009

Paying People to Lose Weight and Stop Smoking

Unhealthy behaviors, such as smoking, poor diet, and sedentary lifestyles, account for as much as 40% of premature deaths in the U.S. Financial incentives may provide people with immediate and tangible feedback that helps make is easier for them to do in the short term what is in their long-term best interests.

Issue Briefs synthesize the findings of LDI's Senior Fellows, a consortium of University of Pennsylvania scholars studying medical, economic, social, and ethical issues that influence how health care is organized, financed, managed, and delivered in the United States.