How personnel diversity and affective bonds affect performance-based financing: a moderator analysis of a difference-in-difference estimator.

To spur improvement in health-care service quality and quantity, performance-based financing (PBF) is an increasingly common policy tool, especially in low- and middle-income countries. This study examines how personnel diversity and affective bonds in primary care clinics affect their ability to improve care quality in PBF arrangements. Leveraging data from a large-scale matched PBF intervention in Tajikistan including 208 primary care clinics, we examined how measures of personnel diversity (position and tenure variety) and affective bonds (mutual support and group pride) were associated with changes in the level and variability of clinical knowledge (diagnostic accuracy of 878 clinical vignettes) and care processes (completion of checklist items in 2485 instances of direct observations).

Trade-offs in locational choices for care coordination resources in accountable care organizations.

Background: Care coordination is central to accountable care organizations (ACOs), especially in Medicaid where many patients have complex medical and social needs. Little is known about how to best organize care coordination resources in this context, particularly whether to centralize them. We examined how care coordinators' location, management, and colocation of both (within ACO headquarters, practice sites, or other organizations) relate to care quality and coordination.

Centralization and democratization: Managing crisis communication in health care delivery.

Background: Communication is an essential organizational process for responding to adversity. Managers are often advised to communicate frequently and redundantly during crises. Nonetheless, systematic investigation of how information receivers perceive organizational communication amid crises has remained lacking.

Value-Based Purchasing Design And Effect: A Systematic Review And Analysis.

During the past two decades in the United States, all major payer types-commercial, Medicare, Medicaid, and multipayer coalitions-have introduced value-based purchasing (VBP) contracts to reward providers for improving health care quality while reducing spending. This systematic review qualitatively characterized the financial and nonfinancial features of VBP programs and examined how such features combine to create a level of program intensity that relates to desired quality and spending outcomes. Higher-intensity VBP programs are more frequently associated with desired quality processes, utilization measures, and spending reductions than lower-intensity programs.

Factors affecting collaboration between clinical and community service organizations.

Background: Collaboration between clinical and community-based social service organizations is increasingly seen as vital for preventing and managing chronic diseases but has been challenging to establish and sustain.

Purpose: The aim of this study was to identify organizational barriers and facilitators for clinic-community collaboration.

Methodology/approach: We employed multiple methods to study a national sample of nonprofit community-based organizations that each collaborated with local clinical organizations for diabetes prevention in the United States.

How psychological safety and feeling heard relate to burnout and adaptation amid uncertainty.

Background: Psychological safety-the belief that it is safe to speak up-is vital amid uncertainty, but its relationship to feeling heard is not well understood.

Purpose: The aims of this study were (a) to measure feeling heard and (b) to assess how psychological safety and feeling heard relate to one another as well as to burnout, worsening burnout, and adaptation during uncertainty.

Methodology: We conducted a cross-sectional survey of emergency department staff and clinicians (response rate = 52%; analytic N = 241) in July 2020.

Higher Medicare Expenditures Are Associated With Better Integrated Care as Perceived by Patients.

Background: Integrated care that is continuous, coordinated and patient-centered is vital for Medicare beneficiaries, but its relationship to health care expenditures remains unclear.

Research Objective: This study explores-for the first time-the relationship between integrated care, as measured from the patient's perspective, and health care expenditures.

Methods: Subjects include a sample of continuously eligible fee-for-service Medicare beneficiaries (n=8807) in 2015.

Masked and distanced: a qualitative study of how personal protective equipment and distancing affect teamwork in emergency care.

Background: Newly intensified use of personal protective equipment (PPE) in emergency departments presents teamwork challenges affecting the quality and safety of care at the frontlines.

Objective: We conducted a qualitative study to categorize and describe barriers to teamwork posed by PPE and distancing in the emergency setting.

Methods: We conducted 55 semi-structured interviews between June 2020 and August 2020 with personnel from two emergency departments serving in a variety of roles.

Medical Group Structural Integration May Not Ensure That Care Is Integrated, From The Patient's Perspective.

Structural integration is increasing among medical groups, but whether these changes yield care that is more integrated remains unclear. We explored the relationships between structural integration characteristics of 144 medical groups and perceptions of integrated care among their patients. Patients' perceptions were measured by a validated national survey of 3,067 Medicare beneficiaries with multiple chronic conditions across six domains that reflect knowledge and support of, and communication with, the patient.