HIP Model

A practical model for research with learning health systems: Building and implementing effective complex case management

A practical model for research with learning health systems: Building and implementing effective complex case management

For researchers to contribute meaningfully to the creation of learning health systems, practical tools are required to operationalize existing conceptual frameworks. A team of authors including HIP Investigators, Dr. Maureen Smith and Dr. Menggang Yu describe a model currently in use by the University of Wisconsin Health Innovation Program (HIP). The HIP model consolidates and enhances existing learning health system frameworks by defining specific steps needed to create sustainable change based on research conducted within the health system.

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Mother and daughter with staff

Evaluating Integrated Care for Children: A Clarion Call or a Call for Clarity?

Evaluating Integrated Care for Children: A Clarion Call or a Call for Clarity?

“Integrated care” is often used to describe concepts such as coordinated and seamless care instead of the often fragmented and episodic care that patients receive. Integrated care reflects the aspirations of modern health care systems and receives significant academic attention. Authors Dr. Eyal Cohen and HIP Investigator, Dr. Ryan Coller conducted a broad search strategy to identify randomized controlled trials comparing integrated care with usual care.

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Pediatric exam at clinic

Reliability and validity of PROMIS® pediatric family relationships short form in children 8-17 years of age with chronic disease

Reliability and validity of PROMIS® pediatric family relationships short form in children 8-17 years of age with chronic disease

Families play a key role in managing pediatric chronic illness. The PROMIS® pediatric family relationships measure was developed primarily within the general pediatric population. HIP Investigator, Dr. Elizabeth Cox et al. evaluated the Family Relationships short form in the context of pediatric chronic diseases and presented their findings as to whether the Family Relationships measure demonstrates adequate reliability and validity when applied in a clinical population of chronically ill children and their parents.

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Child patient hospitalized

Variation in Hospitalization Rates Following Emergency Department Visits in Children with Medical Complexity

Variation in Hospitalization Rates Following Emergency Department Visits in Children with Medical Complexity

Children with medical complexity (CMC) have lifelong, complex chronic conditions (CCCs) associated with multimorbidity, severe functional limitations, myriad health care needs, and high resource use. Although hospitalizations have been a long-standing measure of a potentially avoidable CMC health service, little is known about the opportunity to influence the hospitalization risk from an ED visit. Therefore, HIP Investigator Dr. Ryan Coller et al. identified factors associated with admission within ED encounters and quantified both the overall ED admission rate for CMC and admission rate variation across children's hospitals.

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Holding hands

Fused comparative intervention scoring for heterogeneity of longitudinal intervention effects

Fused comparative intervention scoring for heterogeneity of longitudinal intervention effects

With the growing cost of health care in the United States, the need to improve efficiency and efficacy has become increasingly urgent. There has been a keen interest in developing interventions to effectively coordinate the typically fragmented care of patients with many comorbidities. Evaluation of such interventions is often challenging given their long-term nature and their differential effectiveness among different patients. Furthermore, care coordination interventions are often highly resource-intensive. Hence there is pressing need to identify which patients would benefit the most from a care coordination program. In this work, Dr. Jared Huling and HIP Investigators Dr. Menggang Yu and Dr. Maureen Smith introduced a subgroup identification procedure for long-term interventions whose effects are expected to change smoothly over time.

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Hospital corridor

The Effects of Discrete Work Shifts on a Nonterminating Service System

The Effects of Discrete Work Shifts on a Nonterminating Service System

Hospital emergency departments (EDs) provide around‐the‐clock medical care, and as such are generally modeled as nonterminating queues. However, from the care provider's point of view, ED care is not a never‐ending process, but rather occurs in discrete work shifts and may require passing unfinished work to the next care provider at the end of the shift. HIP Investigator, Dr. Brian Patterson et al. used data from a large, academic medical center Emergency Department to show that the patients’ rate of service completion varies over the course of the physician shift. Furthermore, patients that have experienced a physician handoff have a higher rate of service completion than nonhanded off patients.

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Research doctor team

Systems consultation for opioid prescribing in primary care: a qualitative study of adaptation

Systems consultation for opioid prescribing in primary care: a qualitative study of adaptation

In order to promote guideline-concordant opioid prescribing practices, a blended implementation strategy called systems consultation was pilot tested in four primary care clinics in one US health system. In this study, HIP Investigator, Dr. Andrew Quanbeck et al. described (1) how systems consultation worked during the pilot test and (2) the modifications necessary to adapt this implementation strategy to primary care.

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Eye doctor

Diabetic Retinopathy Assessment Variability Among Eye Care Providers in an Urban Teleophthalmology Program

Diabetic Retinopathy Assessment Variability Among Eye Care Providers in an Urban Teleophthalmology Program

Teleophthalmology is an evidence-based method for diabetic eye screening. It is unclear whether the type of eye care provider performing teleophthalmology interpretation produces significant variability. While teleophthalmology has become increasingly accepted for diabetic eye screening in primary care settings, the availability of adequately trained, qualified readers may limit its widespread implementation. HIP Investigator, Dr. Yao Liu et al. assessed grading variability between an optometrist, general ophthalmologist, and retinal specialist using images from an urban, diabetic retinopathy teleophthalmology program.

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Meeting with doctors

Does Beneficiary Switching Create Adverse Selection For Hospital-Based ACOs?

Does Beneficiary Switching Create Adverse Selection For Hospital-Based ACOs?

Despite the many uncertainties in the current health care delivery environment, payers and providers continue to demonstrate considerable interest in alternative payment models, including Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs). HIP Investigator, Dr. Maureen Smith et al. believe that there is an alternative explanation for hospital-based ACOs’ seemingly poorer financial performance. Specifically, as Medicare beneficiaries develop new and more complex diseases, the increased utilization they require leads them to facilities that have more specialized care, which may more likely be part of a hospital-based ACO than a physician-led one.

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doctor and nurse with elderly patient

By Default: The Effect of Prepopulated Prescription Quantities on Opioid Prescribing in the Emergency Department

By Default: The Effect of Prepopulated Prescription Quantities on Opioid Prescribing in the Emergency Department

Opioid prescribing patterns have come under increasing scrutiny with the recent rise in opioid prescriptions, opioid misuse and abuse, and opioid-related adverse events. To date, there have been limited studies on the effect of default tablet quantities as part of emergency department (ED) electronic order entry. HIP Investigator, Dr. Brian Patterson et al. evaluated opioid prescribing patterns before and after the removal of a default quantity of 20 tablets from ED electronic order entry.

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