Cost Savings Associated With Implementing 4 Total Joint Replacement Electronic Clinical Quality Measures Nationally: 2020-2040.

Background: Digital transformation using widely available electronic data is a key component to improving health outcomes and customer choice and decreasing cost and measurement burden. Despite these benefits, existing information on the potential cost savings from electronic clinical quality measures (eCQMs) is limited.

Methods: We assessed the costs of implementing 4 eCQMs related to total hip and/or total knee arthroplasty into electronic health record systems across healthcare systems in the United States.

Association of Commercial-to-Medicare Relative Prices With Health System Financial Performance.

Importance: Various studies have documented the rise in commercial insurance prices during the past 2 decades; however, estimates on the association of rising costs with health systems' financial health are lacking. This study calculated 2 measures from standardized Audited Financial Statements (AFSs)-operating margins and days of unrestricted cash on hand-to explore the associations.

Objective: To estimate the association between health systems' financial condition and the ratio of commercial to Medicare relative prices.

Testing of a Risk-Standardized Major Bleeding and Venous Thromboembolism Electronic Clinical Quality Measure for Elective Total Hip and/or Knee Arthroplasties.

Brigham and Women's Hospital has received funding from the Centers for Medicare and Medicaid Services to develop a novel electronic clinical quality measure to assess the risk-standardized major bleeding and venous thromboembolism (VTE) rate following elective total hip and/or knee arthroplasty. There are currently no existing measures that evaluate both the bleeding and VTE events following joint arthroplasty (TJA). Our novel composite measure was tested within two academic health systems with 17 clinician groups meeting the inclusion criteria.

Testing of a Risk-Standardized Complication Rate Electronic Clinical Quality Measure (eCQM) for Total Hip and/or Total Knee Arthroplasty.

Supported by the Centers for Medicare & Medicaid Services (CMS), Brigham and Women's Hospital (BWH) has retooled the existing claims-based measures NQF1550 and NQF3493 into an electronic clinical quality measure (eCQM) to assess the risk-standardized complication rate (RSCR) following elective primary total hip (THA) and knee arthroplasty (TKA) at the clinician group level. This novel eCQM includes risk-adjustment for social determinants of health, includes all adult patients from all payers, leverages electronic health records (EHRs) rather than claims-based data, and includes both inpatient and outpatient procedures and complications which offers benefits compared to existing metrics. Following testing in two geographically different healthcare systems, the overall risk-standardized complication rate within 90 days following THA and TKA at the two sites was 3.

Association of a High-Efficiency Particulate Air Filter COVID-19 Testing Booth With Testing Capacity, Cost Per Test Acquired, and Use of Personal Protective Equipment.

This quality improvement study compares COVID-19 testing throughput, personal protective equipment use, and cost per test before vs after the introduction of high-efficiency particulate air–filtered, positive-pressure Hexapod personal protection booths at a hospital in Boston, Massachusetts.

Field Hospital Boston Hope: Defining Culture During Uncertainty.

As hospitals across the world realized their surge capacity would not be enough to care for patients with coronavirus disease-2019 (COVID-19) infection, an urgent need to open field hospitals prevailed. In this article the authors describe the implementation process of opening a Boston field hospital including the development of a culture unique to this crisis and the local community needs. Through first-person accounts, readers will learn (1) about Boston Hope, (2) how leaders managed and collaborated, (3) how the close proximity of the care environment impacted decision-making and management style, and (4) the characteristics of leaders under pressure as observed by the team.

Association of Display of Patient Photographs in the Electronic Health Record With Wrong-Patient Order Entry Errors.

Importance: Wrong-patient order entry (WPOE) errors have a high potential for harm; these errors are particularly frequent wherever workflows are complex and multitasking and interruptions are common, such as in the emergency department (ED). Previous research shows that interruptive solutions, such as electronic patient verification forms or alerts, can reduce these types of errors but may be time-consuming and cause alert fatigue.

Objective: To evaluate whether the use of noninterruptive display of patient photographs in the banner of the electronic health record (EHR) is associated with a decreased rate of WPOE errors.

Using Magnet Model Components at a COVID-19-Positive Field Hospital.

In this column, the authors who were part of a leadership team at 1000-bed field hospitals for patients with COVID-19 provide background and guidance on the development of a nurse staffing and training model.

Association between specialist compensation and Accountable Care Organization performance.

Objective: To determine if Medicare Shared Savings Program Accountable Care Organizations (ACOs) using cost reduction measures in specialist compensation demonstrated better performance.

Data Sources: National, cross-sectional survey data on ACOs (2013-2015) linked to public-use data on ACO performance (2014-2016).

Study Design: We compared characteristics of ACOs that did and did not report use of cost reduction measures in specialist compensation and determined the association between using this approach and ACO savings, outpatient spending, and specialist visit rates.

Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial.

Background: Substitutive hospital-level care in a patient's home may reduce cost, health care use, and readmissions while improving patient experience, although evidence from randomized controlled trials in the United States is lacking.

Objective: To compare outcomes of home hospital versus usual hospital care for patients requiring admission.

Design: Randomized controlled trial.

Impact of a Student-Run Clinic on Emergency Department Utilization.

Background And Objectives: Student-run clinics (SRCs) provide primary care access to low-income patients who would otherwise pursue more expensive care, such as visits to emergency departments (ED). Decreasing inappropriate ED utilization offers an opportunity to create value in the health care system. However, to date, no SRC has rigorously studied this.

Early experiences with the Acute Community Care Program in eastern Massachusetts.

Objectives: Emergency departments (EDs) frequently provide care for nonemergent health conditions outside of usual physician office hours. A nonprofit, fully integrated health insurer/care delivery system that enrolls socioeconomically disadvantaged adults with complex health needs partnered with an ambulance service provider to offer after-hours urgent care by specially trained and equipped paramedics in patients' residences. The Massachusetts Department of Public Health gave this initiative, the Acute Community Care Program (ACCP), a Special Project Waiver.

Hospital Length of Stay With a Proactive Psychiatric Consultation Model in the Medical Intensive Care Unit: A Prospective Cohort Analysis.

Background: Previous studies have demonstrated that proactive psychiatric consultation reduces hospital length of stay (LOS) in the general medical setting; however this model has not been studied in the intensive care unit (ICU).

Objective: To compare outcomes between a conventional consultation model and a proactive psychiatric consultation model.

Methods: Two medical ICUs (MICUs) were randomized to proactive psychiatric consultation vs conventional consultation psychiatric models.

The Cost of Quality: An Academic Health Center's Annual Costs for Its Quality and Patient Safety Infrastructure.

Background: In the United States, regulatory bodies, state licensing boards, hospital accreditation organizations, and medical specialty boards have increased their demands for data, public reporting, and improvement. Survey research suggests that as much as $15 billion is spent on reporting quality measures, but those costs, as well as those associated with improvement, have not been sufficiently characterized. A study was conducted to examine, in detail, the costs incurred by one health care organization-an academic health center (AHC) with employed physicians-in responding to quality and safety requirements.

The Hidden Cost of Regulation: The Administrative Cost of Reporting Serious Reportable Events.

Background: More than half of the 50 states (27) and the District of Columbia require reporting of Serous Reportable Events (SREs). The goal is to hold providers accountable and improve patient safety, but there is little information about the administrative cost of this reporting requirement. This study was conducted to identify costs associated with investigating and reporting SREs.

Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial.

Background: Hospitals are standard of care for acute illness, but hospitals can be unsafe, uncomfortable, and expensive. Providing substitutive hospital-level care in a patient's home potentially reduces cost while maintaining or improving quality, safety, and patient experience, although evidence from randomized controlled trials in the US is lacking.

Objective: Determine if home hospital care reduces cost while maintaining quality, safety, and patient experience.

ED-based care coordination reduces costs for frequent ED users.

Objectives: We evaluated a pilot quality improvement intervention implemented in an urban academic medical center emergency department (ED) to improve care coordination and reduce ED visits and hospitalizations among frequent ED users.

Study Design: Randomized controlled trial.

Methods: We identified the most frequent ED users in both the 30 days prior to the intervention and the 12 months prior to the intervention.

Assessing Interprofessional education in a student-faculty collaborative practice network.

Although interprofessional relationships are ubiquitous in clinical practice, undergraduate medical students have limited opportunities to develop these relationships in the clinical setting. A few student-faculty collaborative practice networks (SFCPNs) have been working to address this issue, but limited data exist examining the nature and extent of these practices. A systematic survey at a Harvard-affiliated SFCPN is utilised to evaluate the quantity and quality of interprofessional interactions, isolate improvements, and identify challenges in undergraduate interprofessional education (IPE).

Exploring the impact of language services on utilization and clinical outcomes for diabetics.

Background: Significant health disparities exist between limited English proficient and English-proficient patients. Little is known about the impact of language services on chronic disease outcomes such as for diabetes.

Methods/principal Findings: To determine whether the amount and type of language services received during primary care visits had an impact on diabetes-related outcomes (hospitalization, emergency room utilization, glycemic control) in limited English proficient patients, a retrospective cohort design was utilized.

Contemporary performance of U.S. teaching and nonteaching hospitals.

Purpose: To compare the performance of U.S. teaching and nonteaching hospitals using a portfolio of contemporary, publicly reported metrics.

A framework to identify the costs of providing language interpretation services.

The availability of language services for patients with limited English proficiency has become a standard of care in the United States. Finding the resources to pay for language programs is challenging for providers, payers, and policymakers. There is no federal payment policy and states are developing policies using different methodologies for determining costs and reimbursement rates.

The Boston Health Care for the Homeless Program: a public health framework.

During the past 25 years, the Boston Health Care for the Homeless Program has evolved into a service model embodying the core functions and essential services of public health. Each year the program provides integrated medical, behavioral, and oral health care, as well as preventive services, to more than 11 000 homeless people. Services are delivered in clinics located in 2 teaching hospitals, 80 shelters and soup kitchens, and an innovative 104-bed medical respite unit.

Saving billions of dollars--and physicians' time--by streamlining billing practices.

The U.S. system of billing third parties for health care services is complex, expensive, and inefficient.

Cost of an informatics-based diabetes management program.

Objectives: The relatively high cost of information technology systems may be a barrier to hospitals thinking of adopting this technology. The experiences of early adopters may facilitate decision making for hospitals less able to risk their limited resources. This study identifies the costs to design, develop, implement, and operate an innovative informatics-based registry and disease management system (POPMAN) to manage type 2 diabetes in a primary care setting.