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10 results

  • 11 - Driving Innovation in Health Care

  • Mark Pauly, University of Pennsylvania, Flaura Winston, Mary Naylor, Kevin Volpp, Lawton Robert Burns, University of Pennsylvania, Ralph Muller, David Asch, University of Pennsylvania School of Medicine, Rachel Werner, University of Pennsylvania School of Medicine, Bimal Desai, University of Pennsylvania School of Medicine, Krisda Chaiyachati, University of Pennsylvania School of Medicine, Benjamin Chartock, Wharton School, University of Pennsylvania
  • Book:
    Seemed Like a Good Idea
    Published online:
    14 July 2022
    Print publication:
    28 July 2022, pp 369-397

  • Summary

    The bulk of medical care system management in the United States does not ground decisions in use of available, high quality evidence. The previous chapters in this book demonstrate both that there sometimes is a rich scientific foundation in health care organization, delivery, and financing that could, if applied, lead to better outcomes, and that sometimes there is little or no evidence on effectiveness of interventions. However, we also observed that the bulk of health care management in the United States does not ground decisions in evidence, using it if available and taking uncertainty into account if not – instead “magical thinking” is often used to make choices.1 Ironically, management holds evidence in high esteem for decision-making by clinicians. In this chapter, we explore why management holds itself to a lower standard regarding its organizational, staffing, and planning choices, seeing experience, intuition, and opinions as good-enough evidence for decisions. We explore what needs to happen for this to change.

Seemed Like a Good Idea
  • Alchemy versus Evidence-Based Approaches to Healthcare Management Innovation
  • Mark Pauly, Flaura Winston, Mary Naylor, Kevin Volpp, Lawton Robert Burns, Ralph Muller, David Asch, Rachel Werner, Bimal Desai, Krisda Chaiyachati, Benjamin Chartock
  • Published online:
    14 July 2022
    Print publication:
    28 July 2022
  • Consumers, public officials, and even managers of health care and insurance are unhappy about care quality, access, and costs. This book shows that is because efforts to do something about these problems often rely on hope or conjecture, not rigorous evidence of effectiveness. In this book, experts in the field separate the speculative from the proven with regard to how care is rendered, how patients can be in control, how providers should be paid, and how disparities can be reduced – and they also identify the issues for which evidence is currently missing. It provides an antidote to frustration and a clear-eyed guide for forward progress, helping health care and insurance innovators make better decisions on deciding whether to go ahead now based on current evidence, to seek and wait for additional evidence, or to move on to different ideas. It will be useful to practitioners in hospital systems, medical groups, and insurance organizations and can also be used in executive and MBA teaching.

  • Predictive validity of acute stress disorder in children and adolescents

  • Tim Dalgleish, Richard Meiser-Stedman, Nancy Kassam-Adams, Anke Ehlers, Flaura Winston, Patrick Smith, Bridget Bryant, Richard A. Mayou, William Yule
  • Journal:
    The British Journal of Psychiatry / Volume 192 / Issue 5 / May 2008
    Published online by Cambridge University Press:
    02 January 2018, pp. 392-393
    Print publication:
    May 2008
    • Article
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  • Adult research suggests that the dissociation criterion of acute stress disorder has limited validity in predicting posttraumatic stress disorder (PTSD). We addressed this issue in child and adolescent survivors (n=367) of road accidents. Dissociation accounted for no significant unique variance in later PTSD, over and above other acute stress disorder criteria. Furthermore, thresholds of either three or more re-experiencing symptoms, or six or more re-experiencing/hyperarousal symptoms, were as effective at predicting PTSD as the full acute stress disorder diagnosis.