Systems-Level Determinants of Care

One focus of my work on systems-level determinants of care is definitional: developing and operationalizing methods for describing healthcare delivery systems characteristics.  These include several approaches to measuring resource supply-demand, known in emergency department research as “crowding” and “surge”, and in hospital-based research as “occupancy”, as well as using a stakeholder-engagement process to develop a measure of patient-centered medical home (PCMH) characteristics relevant to the practices participating in the Scalable Architecture for Federated Therapeutic Inquiries Network (SAFTINet).

One set of papers focused on defining measures of emergency department crowding.  I have described various approaches to operationalizing crowding measures using data available in an electronic health record, and have validated these against quality of care as well as against provider perception of crowding:

I also explored approaches to defining ED and inpatient capacity at a multicenter network of children’s hospitals during the 2009 influenza H1N1 pandemic.

I also co-authored a framework for describing healthcare delivery systems, a publication requested by the Agency for Healthcare Research and Quality:

I also facilitated a stakeholder-engagement process to develop a measure of patient-centered medical home (PCMH) characteristics relevant to the practices participating in the Scalable Architecture for Federated Therapeutic Inquiries Network (SAFTINet).  This work was described in a manuscript and national presentation, and is the focus of two manuscripts currently in revise-and-resubmit.