Healthcare systems, whether at an individual hospital-level or encompassing an entire state, are tasked with providing individual care at scale. Designing systems to resolve tensions between cost and quality, efficiency and patient-centered care are at the heart of this health policy challenge. Appropriate care requires identification of which outcomes are most important to patients, and working to design a system that improves access to care and eliminates disparities. Policymakers rely on groups like the Program on Patient-Oriented Policy and Practice (PPOPP) to achieve these important objectives.
PPOPP produces research focused on conceptualizing and implementing policies that encourage the use of best practices in health services settings, incorporate sustainable financing models, and foster a healthcare system that is affordable and accessible to all. A major focus within this work is the evaluation of questions and outcomes that are meaningful and important to patients and caregivers, and crafting policies that are respectful and representative of these individual patient preferences.
As the CSPH’s epicenter for health policy research, PPOPP is home to a multitude of projects, from identifying and disseminating best practices in Medicare Accountable Care Organizations to understanding the use of Advance Care Planning codes among Medicare patients.
Keren Ladin, PhD, MSc
Amanda Reich, PhD, MPH
Avni Gupta, BDS, MPH
Ginger (Zi) Jin, MSc
Katherine Lee, MD
Identifying barriers, facilitators, and outcomes of Advanced Care Planning
Although the use of palliative and hospice care for terminally ill Medicare patients is growing, large numbers of Americans die following intensive, non-curative, burdensome treatments. Available evidence suggests that advanced care planning (ACP) discussions are associated with less aggressive end-of-life (EOL) care, greater concordance between the care patients prefer and the care they receive, and perhaps improved bereavement outcomes for caregivers. Under a new policy from the Centers for Medicare & Medicaid Services (CMS), effective January 1, 2016, clinicians may now bill for having ACP discussions with their patients, providing an unprecedented opportunity to study the use and impact of these discussions on a national basis. This study, which began in September 2017, will use both quantitative and qualitative methods to provide a unique scientific examination of the use of ACP discussions and their impact on the intensity and outcomes of care received by seriously ill patients nearing the end of life.
Improving Patient Safety with Medical Device Identifiers
Until recently, patients, clinicians, payers, and manufacturers lacked a reliable and timely way to get information on the performance of medical devices (such as stents and artificial joints) after they had been surgically implanted. Funded by the Patient-Centered Outcomes Research Institute (PCORI), PPOPP’s UDI2Claims project looks at the feasibility of transmitting Unique Device Identifiers (UDIs) from clinical Electronic Health Record (EHR) systems to insurance claims. We have partnered with Blue Cross Blue Shield of Massachusetts along with working groups representing multiple hospital departments and a wide spectrum of specialties and expertise. Together, we are designing and piloting a system that will reliably capture, analyze, and synthesize data from multiple sources to make the results available to stakeholders as well as researchers. This information will promote transparency for patients, allowing timely warning in case of an implant’s defect or failure, and support evaluations of device effectiveness.