Browsing by Author "Petersen, Laura A."

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    An evidence-based, structured, expert approach to selecting essential indicators of primary care quality
    (Public Library of Science, 2022) Hysong, Sylvia J.; Arredondo, Kelley; Hughes, Ashley M.; Lester, Houston F.; Oswald, Frederick L.; Petersen, Laura A.; Woodard, LeChauncy; Post, Edward; DePeralta, Shelly; Murphy, Daniel R.; McKnight, Jason; Nelson, Karin; Haidet, Paul
    Background The purpose of this article is to illustrate the application of an evidence-based, structured performance measurement methodology to identify, prioritize, and (when appropriate) generate new measures of health care quality, using primary care as a case example. Primary health care is central to the health care system and health of the American public; thus, ensuring high quality is essential. Due to its complexity, ensuring high-quality primary care requires measurement frameworks that can assess the quality of the infrastructure, workforce configurations, and processes available. This paper describes the use of the Productivity Measurement and Enhancement System (ProMES) to compile a targeted set of such measures, prioritized according to their contribution and value to primary care. Methods We adapted ProMES to select and rank existing primary care measures according to value to the primary care clinic. Nine subject matter experts (SMEs) consisting of clinicians, hospital leaders and national policymakers participated in facilitated expert elicitation sessions to identify objectives of performance, corresponding measures, and priority rankings. Results The SMEs identified three fundamental objectives: access, patient-health care team partnerships, and technical quality. The SMEs also selected sixteen performance indicators from the 44 pre-vetted, currently existing measures from three different data sources for primary care. One indicator, Team 2-Day Post Discharge Contact Ratio, was selected as an indicator of both team partnerships and technical quality. Indicators were prioritized according to value using the contingency functions developed by the SMEs. Conclusion Our article provides an actionable guide to applying ProMES, which can be adapted to the needs of various industries, including measure selection and modification from existing data sources, and proposing new measures. Future work should address both logistical considerations (e.g., data capture, common data/programming language) and lingering measurement challenges, such as operationalizating measures to be meaningful and interpretable across health care settings.
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    Can Centralization of Cardiac Procedures Yield Large Cost Savings?
    (2007) Ho, Vivian; Petersen, Laura A.; James A. Baker III Institute for Public Policy
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    Can pay for performance improve physician practice?
    (James A. Baker III Institute for Public Policy, 2014) Petersen, Laura A.; James A. Baker III Institute for Public Policy
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    Can the Obama administration's investment in comparative-effectiveness research yield improvements in health care for the average patient?
    (James A. Baker III Institute for Public Policy;Baylor College of Medicine, 2009) Naik, Aanand; Petersen, Laura A.; James A. Baker III Institute for Public Policy
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    Churning the tides of care: when nurse turnover makes waves in patient access to primary care
    (Springer Nature, 2024) Arredondo, Kelley; Hughes, Ashley M.; Lester, Houston F.; Pham, Trang N.D.; Petersen, Laura A.; Woodard, LeChauncy; SoRelle, Richard; Jiang, Cheng (Rebecca); Oswald, Frederick L.; Murphy, Daniel R.; Touchett, Hilary N.; Hamer, Joshua; Hysong, Sylvia J.
    Team-based primary care (PC) enhances the quality of and access to health care. The Veterans Health Administration (VHA) implements team-based care through Patient Aligned Care Teams (PACTs), consisting of four core members: a primary care provider, registered nurse (RN) care manager, licensed vocational nurse, and scheduling clerk. RNs play a central role: they coordinate patient care, manage operational needs, and serve as a patient point of contact. Currently, it is not known how varying levels of RN staffing on primary care teams impact patient outcomes.
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    Could Medicare Part D Reduce Demand for VA Pharmacy Services?
    (2007) Morgan, R.O.; Hasche, J.; Sundaravaradan, R.; Wei, I.I.; Petersen, Laura A.; Davila, J.; Johnson, Michael; Osemene, N.; Byrne, M.; James A. Baker III Institute for Public Policy
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    Do Financial Rewards for Quality Influence Health Care Providers?
    (James A. Baker III Institute for Public Policy;Baylor College of Medicine, 2006) Petersen, Laura A.; Woodard, LeChauncy D.; Urech, Tracy; Daw, Christina; Sookanan, Supicha; James A. Baker III Institute for Public Policy
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    Do Medical Trainee Errors Differ from Those Involving More Experienced Physicians?
    (2007) Singh, Hardeep; Petersen, Laura A.; Thomas, Eric J.; Studdert, David M.; James A. Baker III Institute for Public Policy
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    Estimating cost savings from regionalizing cardiac procedures using hospital discharge data
    (2007) Ho, Vivian; Petersen, Laura A.; James A. Baker III Institute for Public Policy
    Background: We examined whether higher procedure volumes for coronary artery bypass graft (CABG) surgery or percutaneous coronary interventions (PCI) were associated with lower costs per patient, and if so, estimated the financial savings from regionalizing cardiac procedures. Methods: Cost regressions with hospital-specific dummy variables measured within-hospital cost reductions associated with increasing hospital volume. We used the regression estimates to predict the change in total costs that would result from moving patients in low-volume hospitals to higher volume facilities. Results: A 10% increase in PCI procedure volume lowered costs per patient by 0.7%. For the average hospital performing CABG in 2000, a 10% increase in volume was associated with a 2.8% reduction in average costs. Despite these lower costs, the predicted savings from regionalizing all PCI procedures in the sample from lower to high-volume hospitals amounted to only 1.1% of the entire costs of performing PCI procedures for the sample in 2000. Similarly, the cost savings for CABG were estimated to be only 3.5%. Conclusion: Higher volumes were associated with lower costs per procedure. However, the total potential savings from regionalizing cardiac procedures is relatively minor, and may not justify the risks of reducing access to needed services.
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    Impact of team configuration and team stability on primary care quality
    (BioMed Central, 2019) Hysong, Sylvia J.; Amspoker, Amber B.; Hughes, Ashley M.; Woodard, Lechauncy; Oswald, Frederick L.; Petersen, Laura A.; Lester, Houston F.
    Background: The science of effective teams is well documented; far less is known, however, about how specific team configurations may impact primary care team effectiveness. Further, teams experiencing frequent personnel changes (perhaps as a consequence of poor implementation) may have difficulty delivering effective, continuous, well-coordinated care. This study aims to examine the extent to which primary care clinics in the Veterans Health Administration have implemented team configurations consistent with recommendations based on the Patient-Centered Medical Home model and the extent to which adherence to said recommendations, team stability, and role stability impact healthcare quality. Specifically, we expect to find better clinical outcomes in teams that adhere to recommended team configurations, teams whose membership and configuration are more stable over time, and teams whose clinical manager role is more stable over time. Methods/design: We will employ a combination of social network analysis and multilevel modeling to conduct a database review of variables extracted from the Veterans Health Administration’s Team Assignments Report (TAR) (one of the largest, most diverse existing national samples of primary care teams (nteams > 7000)), as well as other employee and clinical data sources. To ensure the examination of appropriate clinical outcomes, we will enlist a team of subject matter experts to select a concise set of clear, prioritized primary care performance metrics. We will accomplish this using the Productivity Measurement and Enhancement System, an evidence-based methodology for developing and implementing performance measurement. Discussion: We are unaware of other studies of healthcare teams that consider team size, composition, and configuration longitudinally or with sample sizes of this magnitude. Results from this study can inform primary care team implementation policy and practice in both private- and public-sector clinics, such that teams are configured optimally, with adequate staffing, and the right mix of roles within the team.