Health Systems and Policy
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. CSPH 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.
Current projects range from identifying and disseminating best practices in Medicare Accountable Care Organizations to understanding the use of Advance Care Planning codes among Medicare patients.
Projects
Hospital Systems Serving Health Disparity Populations (HSSHDPs) deliver needed services to racial and ethnic minorities and other underserved communities. HSSHDPs may experience long-term effects of natural and human-made disasters that affect health outcomes for populations they serve. The COVID-19 pandemic affected every US healthcare system and provided a unique opportunity to study the effects of large-scale and long-term stressors on under-resourced systems serving vulnerable patient populations. Using the disaster management cycle framework (mitigation, preparedness, response, recovery), this project proposes to conduct a mixed-methods study of the long-term effects of COVID-19 on US hospitals across four critical domains (quality, workforce, finances, innovation), focusing on HSSHDPs and health disparity populations they serve. This project will be the first major national investigation of national disaster effects on HSSDHPs. This study will be significant in identifying HSSDHPs most and least affected by the COVID-19 pandemic and will deepen understanding of factors contributing to successes and challenges. The study will identify actionable best practices and challenges to HSSHDP operations before, during, and after the COVID-19 pandemic.
PI(s): Eric Goralnick, MD, MS; Joel Weissman, PhD
Funding Source: NIH NIMHD R01MD016910
Estimates of nonfatal firearm injury drawn from routinely-collected hospital billing data underestimate assaults and overestimate unintentional injuries. This project will describe the extent to which these discrepancies occur at two study sites (one in Massachusetts, the other in Washington State), identify the underlying reasons for biased estimates, and develop approaches that more accurately classify hospital-treated firearm injuries. A one-year extension project will assess the accuracy of intent coding of trauma registry data.
PI(s): Eric Goralnick, MD, MS and Matthew Miller, MD, MSc, MPH (Northeastern)
Contact Person: Rav Yenduri (ryenduri@bwh.harvard.edu)
Funding Source: National Collaborative on Gun Violence Research
The Global Mass Vaccination Site Collaborative (GMVSC) is a joint initiative led by the Sabin Vaccine Institute’s Boost Community and Ariadne Labs, aimed at providing live programming, resources, accessible tools and experts to assist staff as they plan for and begin operationalization of mass vaccination sites in low- and middle-income countries (LMICs).
Funding Source: Bill and Melinda Gates Foundation
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 looked at the feasibility of transmitting Unique Device Identifiers (UDIs) from clinical Electronic Health Record (EHR) systems to insurance claims. We 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 designed and piloted a system to reliably capture, analyze, and synthesize data from multiple sources and made 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.
PI: Joel Weissman
