The Commonwealth Fund Connection is a roundup of recent Fund publications, charts, multimedia, and other timely content.
Regions of the United States where discharged hospital patients are readmitted at comparatively high rates are often the same regions where overall hospitalization rates are high, new Commonwealth Fund–supported research finds. The study, published in the New England Journal of Medicine (Dec. 15, 2011), finds that the high use of hospital services in these areas is the factor most closely linked to rehospitalization rates, a strong indication of broad, systemic problems within U.S. health care.
The study, conducted by Arnold Epstein, M.D., Ashish Jha, M.D., and John Orav, Ph.D., examined rehospitalization rates across the country for Medicare patients with congestive heart failure and pneumonia, while also looking at how other variables, such as overall hospitalization rates, differences in patients' coexisting conditions, quality of discharge planning, and the number of hospital beds and physicians, affected readmissions. Of all the potential causes for regional differences in readmission rates, overall hospital admission rates played the biggest role, accounting for 16 percent to 24 percent of the variation in cases of congestive heart failure and 11 percent to 20 percent for pneumonia cases. No other factor accounted for more than 6 percent of the variation.
Recent Commonwealth Fund–supported articles in the peer-reviewed literature examine:
In another article, 2008–09 Harkness Fellow in Health Care Policy and Practice Christopher Millet, Ph.D., M.Sc., M.Phil., and colleagues call for better measures to assess how well patients are protected from the financial consequences of illness (PloS Medicine, Sept. 2011). An article by 1998–99 Harkness Fellow Mary Seddon and colleagues describes a successful effort to reduce central line–associated bloodstream infections in one New Zealand institution (New Zealand Medical Journal, July 29, 2011).
In a recent analysis, Commonwealth Fund senior policy analyst Mark Zezza, Ph.D., and colleagues found similar variations in spending and inpatient admissions by both Blue Cross Blue Shield of Texas, the state’s largest health insurer, and Medicare (American Journal of Managed Care, Dec. 2011).
Enhancements to the WhyNotTheBest.org interactive map enable robust explorations of health system performance at the national, state, county, and regional levels. Using new map overlays, users can zoom in on communities involved in key delivery system reform efforts, such as the Beacon Communities or areas where patient-centered medical homes have taken hold, as well as flag health care providers that have been recognized for delivering high-quality care.
New performance data have also been added to the map, including:
The Association of Health Care Journalists (AHCJ) has named three veteran journalists to the second class of AHCJ Media Fellowships on Health Performance. The fellowship program, supported by The Commonwealth Fund, is intended to give mid-career print, broadcast, and online reporters an opportunity to learn about examples of high-performing health care systems, focus on innovations in care delivery, and explore a system or its significant parts to determine what makes that system effective or ineffective. Fellows are expected to complete significant and unique reporting projects by the end of 2012.
The 2012 fellows will be:
Applications for the 2012–13 Harkness Fellowships remain open to individuals from the Netherlands and Canada. The Commonwealth Fund's Harkness Fellowships in Health Care Policy and Practice provide a unique opportunity for mid-career professionals—academic researchers, government policymakers, clinicians, managers, and journalists—to spend up to 12 months in the United States conducting a policy-oriented research study.
Deadlines for receipt of applications are as follows:
Note that the application process for Australia, Germany, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom is now closed.