What are the priority Emergency Department (ED) presenting conditions for which ED-based Shared Decision-Making should be most urgently developed?

An article in this week’s Wall Street Journal focused on the development and use of shared decision-making (SDM) tools in the emergency department (ED).  Decision tools can help engage patients in making decisions about their care, including decisions about which tests and treatments to pursue.  In the ED, relevant decisions are (1) decisions involving two similarly reasonable optionsContinue reading “What are the priority Emergency Department (ED) presenting conditions for which ED-based Shared Decision-Making should be most urgently developed?”

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Emergency Department Return Visits as a Quality Metric

A recent JAMA publication lead-authored by Dr. Amber Sabbatini examined the scientific soundness of emergency department (ED) return visits as a measure of the ED’s quality of care. Emergency department return visits have been considered for wider adoption as a quality metric, especially for those patients who are hospitalized during the return ED visit. The “quality”Continue reading “Emergency Department Return Visits as a Quality Metric”

Robots vs. doctors?

Although I agree with the basic premise of this week’s Washington Post article “The Robot Doctor Will See You Now“–namely, that computers can augment medical care–the article misses the art-science balance so central to physician’s practice.  He states: If you’ve ever gone to a doctor with an odd set of symptoms and realized that your doctor has no clue what theyContinue reading “Robots vs. doctors?”

Coffee: to drink or not to drink

According to the U.S. Food and Drug Administration, 90% of people worldwide, and 80% in the US, consume caffeine in some form every day. The average adult has an intake of about 200 milligrams, or roughly one cup of coffee per day. As one of those few non-coffee-drinking adults–probably rarer still among emergency medicine providers–I was intrigued by  today’s New YorkContinue reading “Coffee: to drink or not to drink”

Social determinants of health and pay-for-performance readmissions measures

In an article released by JAMA Pediatrics today, my co-authors and I show that social determinants of health (patient factors such as health insurance, poverty and other sociodemographic measures) are risk factors for readmissions-related penalties for children’s hospitals. Without adjusting pay-for-performance (P4P) measures for social determinants of health (SDH), hospitals may receive penalties partially related to patient SDH factors beyondContinue reading “Social determinants of health and pay-for-performance readmissions measures”

Readmissions revisited

I am reposting  a post by Garret Johnson and Zoe Lyon, both research assistants for Dr. Ashish Jha at the Harvard T.H. Chan School of Public Health (who also has a great post on risk-adjustment for readmissions.  The post eloquently explores an issue I’ve visited in a recent post: the importance of understanding the diverseContinue reading “Readmissions revisited”

How Performance Metrics Fail Healthcare

A recent New York Times article calls attention to the unintended consequences of healthcare performance metrics.  (Disclaimer: I am am favorably disposed to cite any piece that quotes Avedis Donabedian, one of the fore-parents of health quality research methods.)  With widespread use of the electronic health record, gathering data for performance metrics increasingly overshadows clinical care. AContinue reading “How Performance Metrics Fail Healthcare”