2019 HSC Section 2 - Practice Management

Parent B, LaGrone LN, Albirair MT, et al. Effect of standardized handoff curriculum on improved clinician preparedness in the intensive care unit: a stepped-wedge cluster randomized clinical trial. JAMA Surg . 2018; 153(5):464-470. EBM level 1.........................................130-136 Summary : Transitions in care are a defined source of miscommunication that may result in medical errors. The study reviews the use of a standard handoff technique (iPass). In comparison to a run-up control before use of this tool, residents and faculty showed a reduction in perceived poor handoffs, improved confidence in handoffs, better physician satisfaction in handoffs, and a potential reduction in errors. B. HIPAA-compliant communications between providers Sieck CJ, Hefner JL, Schnierle J, et al. The rules of engagement: perspectives on secure messaging from experienced ambulatory patient portal users. JMIR Med Inform . 2017; 5(3):e13. EBM level 4...........................................................................................................................137-147 Summary : This article explores the views of patients concerning communication via secure patient portals. Prior studies have examined implementation of portals; however, this study explores actual use of the portal. Research shows both patients and physicians could benefit from additional training to maximize the benefit of patient portals. C. Physician employment models Harrill WC, Melon DE, Seshul MJ, et al. Contemporary analysis of practicing otolaryngologists. Laryngoscope . 2018; 128(11):2490-2499. EBM level 4.....................................................148-157 Summary : This study is a cross-sectional survey of practicing otolaryngologists in North Carolina and South Carolina in 2016. It found that most otolaryngologists work within large group practices; solo practices are on the decline, while hospital-based employment is growing among younger physicians outside of academic medicine. Neprash HT, Chernew ME, Hicks AL, et al. Association of financial integration between physicians and hospitals with commercial health care prices. JAMA Intern Med . 2015; 175(12):1932-1939. EBM level 3.........................................................................................158-165 Summary : This article examines how the direct employment of physicians by hospitals impacts healthcare costs. The authors found that physician integration with hospitals results in increased outpatient pricing and costs, while inpatient costs and overall healthcare utilization remain stable. Scott KW, Orav EJ, Cutler DM, Jha AK. Changes in hospital-physician affiliations in U.S. hospitals and their effect on quality of care. Ann Intern Med . 2017; 166(1):1-8. EBM level 3....................................................................................................................................166-174 Summary : This article addresses the impact of direct physician employment by hospitals on overall quality of care; the potential for increased quality is a driving force behind policies aimed at increasing direct physician employment. Hospitals that switched to an employment model were compared to peer-matched controls, and no difference was seen between these groups in any of the quality metrics examined.