Effects of patients' hospital discharge preferences on uptake of clinical decision support.

The Centers for Medicare and Medicaid Services identified unplanned hospital readmissions as a critical healthcare quality and cost problem. Improvements in hospital discharge decision-making and post-discharge care are needed to address the problem. Utilization of clinical decision support (CDS) can improve discharge decision-making but little is known about the empirical significance of two opposing problems that can occur: (1) negligible uptake of CDS by providers or (2) over-reliance on CDS and underuse of other information.

Patient selection in the presence of regulatory oversight based on healthcare report cards of providers: the case of organ transplantation.

Many healthcare report cards provide information to consumers but do not represent a constraint on the behavior of healthcare providers. This is not the case with the report cards utilized in kidney transplantation. These report cards became more salient and binding, with additional oversight, in 2007 under the Centers for Medicare and Medicaid Services Conditions of Participation.

Can we increase organ donation by reducing the disincentives? An experimental analysis.

Our research utilizes the experimental economics laboratory to investigate the impact that reducing disincentives has on organ donation. The experiment consists of four treatments across different levels of donation related costs, which reflect the disincentives associated with being an organ donor. Our experimental results indicate that sizable increases in the organ donation rate are achievable if we reduce the level of disincentives present.

Incentivizing Cost-Effective Reductions in Hospital Readmission Rates.

The recent regulatory changes enacted by the Centers for Medicare and Medicaid Services (CMS) have identified hospital readmission rates as a critical healthcare quality metric. This research focuses on the utilization of pay-for-performance (P4P) mechanisms to cost effectively reduce hospital readmission rates and meet the regulatory standards set by CMS. Using the experimental economics laboratory we find that both of the P4P mechanisms researched, bonus and bundled payments, cost-effectively meet the performance criteria set forth by CMS.

Higher Quality and Lower Cost from Improving Hospital Discharge Decision Making.

This paper reports research on improving decisions about hospital discharges - decisions that are now made by physicians based on mainly subjective evaluations of patients' discharge status. We report an experiment on uptake of our clinical decision support software (CDSS) which presents physicians with evidence-based discharge criteria that can be effectively utilized at the point of care where the discharge decision is made. One experimental treatment we report prompts physician attentiveness to the CDSS by replacing the default option of universal "opt in" to patient discharge with the alternative default option of "opt out" from the CDSS recommendations to discharge or not to discharge the patient on each day of hospital stay.

Discharge decision-making after complex surgery: Surgeon behaviors compared to predictive modeling to reduce surgical readmissions.

Background: Little is known about how information available at discharge affects decision-making and its effect on readmission. We sought to define the association between information used for discharge and patients' subsequent risk of readmission.

Methods: 2009-2014 patients from a tertiary academic medical center's surgical services were analyzed using a time-to-event model to identify criteria that statistically explained the timing of discharges.

The fishery performance indicators: a management tool for triple bottom line outcomes.

Pursuit of the triple bottom line of economic, community and ecological sustainability has increased the complexity of fishery management; fisheries assessments require new types of data and analysis to guide science-based policy in addition to traditional biological information and modeling. We introduce the Fishery Performance Indicators (FPIs), a broadly applicable and flexible tool for assessing performance in individual fisheries, and for establishing cross-sectional links between enabling conditions, management strategies and triple bottom line outcomes. Conceptually separating measures of performance, the FPIs use 68 individual outcome metrics--coded on a 1 to 5 scale based on expert assessment to facilitate application to data poor fisheries and sectors--that can be partitioned into sector-based or triple-bottom-line sustainability-based interpretative indicators.

Increasing organ donation via changes in the default choice or allocation rule.

This research utilizes a laboratory experiment to evaluate the effectiveness of alternative public policies targeted at increasing the rate of deceased donor organ donation. The experiment includes treatments across different default choices and organ allocation rules inspired by the donor registration systems applied in different countries. Our results indicate that the opt-out with priority rule system generates the largest increase in organ donation relative to an opt-in only program.

Assessing clinical discharge data preferences among practicing surgeons.

Background: It is believed that many postoperative patient readmissions can be curbed via optimization of a patient's discharge from hospital, but little is known about how surgeons make the decision to discharge a patient. This study explored the criteria that surgeons preferentially value in their discharge decision-making process.

Materials And Methods: All surgical faculty and residents at a U.

Transplantation at the nexus of behavioral economics and health care delivery.

The transplant surgeon's decision to accept and utilize an organ typically is made within a constrained time window, explicitly cognizant of numerous health-related risks and under the potential influence of considerable regulatory and institutional pressures. This decision affects the health of two distinct populations, those patients receiving organ transplants and those waiting to receive a transplant; it also influences the physician's life and their institute's productivity. The numerous, at times nonaligned, incentives established by the complex clinical and regulatory environment, have been derived specifically to influence physicians' behaviors, and though well intended, may lead to responses that are nonoptimal when considering the myriad stakeholders being influenced.

Risk factors for 30-day hospital readmission among general surgery patients.

Background: Hospital readmission within 30 days of an index hospitalization is receiving increased scrutiny as a marker of poor-quality patient care. This study identifies factors associated with 30-day readmission after general surgery procedures.

Study Design: Using standard National Surgical Quality Improvement Project protocol, preoperative, intraoperative, and postoperative outcomes were collected on patients undergoing inpatient general surgery procedures at a single academic center between 2009 and 2011.