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The Roger C. Lipitz Center for Integrated Health Care

Discussion of Memory During Primary Care Visits of Older Adults with Cognitive Impairment and Accompanying Family

Study by Jennifer Aufill, Halima Amjad, Debra Roter, and Jennifer Wolff in International Journal of Geriatric Psychiatry examines factors associated with memory-related discussion in routine primary care visits of older adults. The study finds discussion of memory appears largely driven by the clinician's, but not the family's, ratings of patient cognition and presence of an established diagnosis, suggesting potential benefit of engaging family to improve cognitive impairment detection in primary care. ...Read More

Change Over Time in Caregiving Networks for Older Adults With and Without Dementia

Article by Brenda Spillman, Vicki Freedman, Judith Kasper and Jennifer Wolff provides national estimates of caregiving networks for older adults with and without dementia and examine how these networks develop over time. Most prior research has focused on primary caregivers and rarely on change over time....Read More

Why State Medicaid Programs Should Cover Hearing Aids for Adults

Hearing loss affects approximately 1 in 5 Americans aged 12 years or older. Prevalence is highest among older adults; two-thirds of Americans aged 70 years and older have hearing loss. Hearing loss is associated with numerous negative health and quality-of-life outcomes, including cognitive decline, dementia, falls, depression, social isolation, hospitalizations, readmissions, and higher health care costs. Studies have shown the impact of hearing loss on patient-clinician communication, indicating it likely impedes effective care provision. Although there are many reasons for Medicaid programs to cover hearing aids and related services, the up-front cost of including this benefit can create barriers....Read More

Why State Medicaid Programs Should Cover Hearing Aids for Adults

Hearing loss affects an estimated two thirds of Americans aged 70 years and older, but Medicare currently excludes hearing aids and related services from coverage and many state Medicaid programs do not yet provide coverage of hearing aids for adults. A JAMA Otolaryngology - Head & Neck Surgery viewpoint by Amber Willink, Mary Ann Hernando and Sarah Steege discusses why hearing aids and related services should be covered for all Medicaid enrollees when medically necessary, regardless of age....Read More

Measuring Nonprofit Hospitals' Provision of Charity Care Using IRS and CMS Data

We explore whether nonprofit hospitals report similar amounts of charity care to the Internal Revenue Service (IRS) and Centers for Medicare & Medicaid Services (CMS). We use nonprofit hospitals’ financial reports to the IRS and the CMS Medicare costs report for 2011 and 2012. In 2012, hospitals reported spending 7.6% more in charity care to the IRS than to CMS: 2.54% of revenues ($5.74 million per hospital) to the IRS versus 2.36% ($5.16 million) to CMS. While the averages are close, there are wide discrepancies for individual hospitals. For example, despite efforts for standardization, 80% of hospitals reported charity care to the CMS that was 40% greater in absolute value than what they reported to the IRS, and only 10% of hospitals reported charity care to CMS that was within 20% of what they reported to the IRS. Our findings suggest that individual hospitals routinely report different amounts of charity care to the IRS and CMS, yet we find relatively few hospital or market characteristics that may explain these differences....Read More

Narrative Approach to Goals of Care Discussions: A Novel Curriculum

David Shih Wu, David E. Kern, Sydney Morss Dy, Scott M. Wright


Innovative patient-centered approaches to goals of care (GOC) communication training are needed. Teaching a narrative approach, centered on the patient’s unique story, is conceptually sound but has not been evaluated with respect to objective skills attainment. We developed a curriculum based on a novel, easily-remembered narrative approach to GOC, the 3-Act Model, and piloted it with a cohort of Internal Medicine (IM) interns.

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The Common Attributes of Successful Care Manager Programs for High-Need, High-Cost Persons: A Cross-Case Analysis.

Thurber EGBoyd CLeff BWolff JAnderson G


Many programs use care managers to improve care coordination for high-need, high-cost patient populations. However, little is known about how programs integrate care managers into care delivery or the attributes shared by successful programs. We used a case study approach to examine the common attributes of 10 programs for high-need, high-cost individuals utilizing a longitudinal care manager that had achieved success in reducing cost, improving quality, or increasing patient satisfaction. Through interviews with program leaders and document review, we identified 10 common attributes of successful care manager programs, offering insights for providers aiming to better serve the high-need, high-cost population.

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Model Performance Metrics in Assessing the Value of Adding Intraoperative Data for Death Prediction: Applications to Noncardiac Surgery.

Lei VJKennedy EHLuong TChen XPolsky DEVolpp KGNeuman MDHolmes JHFleisher LANavathe AS


We tested the value of adding data from the operating room to models predicting in-hospital death. We assessed model performance using two metrics, the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC), to illustrate the differences in information they convey in the setting of class imbalance. Data was collected on 74,147 patients who underwent major noncardiac surgery and 112 unique features were extracted from electronic health records. Sets of features were incrementally added to models using logistic regression, naïve Bayes, random forest, and gradient boosted machine methods. AUROC increased as more features were added, but changes were small for some modeling approaches. In contrast, AUPRC, which reflects positive predicted value, exhibited improvements across all models. Using AUPRC highlighted the added value of intraoperative data, not seen consistently with AUROC, and that with class imbalance AUPRC may serve as the more clinically relevant criterion.

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