Health Policy Center Authors
Publications by Kelly J. Devers for Health Policy Center
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More about Kelly J. Devers's areas of expertise can be found on this Urban Institute expert's page.
The Feasibility of Using Electronic Health Data for Research on Small Populations (Research Report)
Kelly J. Devers, Bradford H. Gray, Christal Ramos, Arnav Shah, Fredric Blavin, Timothy Waidmann
This report explores the feasibility of using electronic health record (EHR) and other electronic health data for research on small populations. The first part of the report illustrates the challenges and limitations of using existing federal surveys and federal claims databases for studying small populations. The second part explores the potential of the increasingly available EHR and other existing electronic health data to complement federal data sources, as well as potential next steps to demonstrate and improve the feasibility of using EHRs for research on small populations.
Nine States' Use of Collaboratives to Improve Children's Health Care Quality in Medicaid and CHIP (Article)
Kelly J. Devers, Additional Authors
We examine quality improvement (QI) collaboratives in 9 states participating in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program. In addition to developing patient-centered medical home (PCMH) capability, some states use collaboratives to familiarize practices with CMS's Initial Core Set of Children's Health Care Quality Measures, practice-level quality measurement, and improving QI knowledge and skills. All states supplement the collaboratives with practice facilitation; the majority utilized practice-level parent engagement, but only 4 used workforce augmentation. Overall, practice staff highly valued aspects of the collaboratives and supplemental strategies but also reported a variety of challenges.
Using Qualitative Comparative Analysis (QCA) to Study Patient-Centered Medical Homes (Research Report)
Kelly J. Devers, Nicole Cafarella Lallemand, Rachel A. Burton, Stephen Zuckerman, Additional Authors
This guide provides an in-depth introduction to using qualitative comparative analysis (QCA) – an approach based on set theory and Boolean algebra – in patient-centered medical home evaluations. Specifically, QCA can be used to identify practice-level "conditions" (e.g., practice characteristics, medical home care processes) that are linked to an outcome of interest (e.g., improved care quality, higher patient satisfaction ratings, or reduced health care utilization or expenditures). The guide includes a description of key analytic steps involved in the QCA approach.
How the CHIPRA quality demonstration elevated children on State health policy agendas (Research Brief)
Nicole Cafarella Lallemand, Elizabeth Richardson, Kelly J. Devers, Additional Authors
This Evaluation Highlight is the fourth in a series that presents descriptive and analytic findings from the national evaluation of the CHIPRA Quality Demonstration Grant Program. The CHIPRA quality demonstration grants have provided a unique opportunity not only to advance child health quality in the short term, but also to link child health quality issues to broader Federal and State health reforms. In this Highlight, we give examples of activities in five States—Maine, Maryland, Massachusetts, Vermont, and Oregon—and how they used their CHIPRA quality demonstration grants to elevate children's health care issues on their States' health policy agendas.
Lessons from the Literature on Electronic Health Record Implementation (Research Report)
Fredric Blavin, Christal Ramos, Arnav Shah, Kelly J. Devers
This report summarizes the findings of 75 articles that identify best practices for implementing and optimizing electronic health records (EHRs). The report includes a conceptual framework to structure the analysis and describe lessons learned for organizations that might be facing EHR implementation obstacles. Throughout the EHR implementation process, planning and modifications are continually needed to address technological, professional, and organizational perspectives. These perspectives must be incorporated at each stage to promote implementation and optimization of a system that is technically functional, integrated into the workflow of its users, and is part of a larger strategy to meet organizational goals.
How are CHIPRA Quality Demonstration States working to improve adolescent health care? (Research Brief)
Rachel A. Burton, Ian Hill, Kelly J. Devers
Several CHIPRA Quality Demonstration states are working with participating clinicians to enhance their ability to improve the quality of health care delivered to adolescents. Specifically, North Carolina and Utah are facilitating adolescent-focused quality improvement collaboratives for primary care practices, and Colorado and New Mexico are providing support and coaching to school-based health centers serving adolescents. This Evaluation Highlight describes barriers these states encountered in their efforts to improve care for this population, identifies strategies to address these barriers, and suggests actions state Medicaid agencies could take to enhance adolescent health care.
How are States and Evaluators Measuring Medical Homeness in the CHIPRA Quality Demonstration Grant Program? (Research Report)
Stacey McMorrow, Anna Christensen, Brenda Natzke, Kelly J. Devers, Rebecca Peters
Many Medicaid and CHIP programs and private health plans are pursuing medical home initiatives aimed at improving the quality of health care, but varying conceptual definitions and measurement goals have led to the development of a number of different medical home measurement tools. This Evaluation Highlight, funded by the U.S. Department of Health and Human Services, examines the measurement of "medical homeness" in selected CHIPRA Quality Demonstration projects, describes the development of the Medical Home Index-Revised Short Form (an adaptation of the Medical Home Index survey), and presents preliminary statistics on medical homeness for demonstration practices in six States.
Health Reforms as Examples of Multilevel Interventions in Cancer Care (Research Report)
Kelly J. Devers, Additional Authors
The implementation of the Patient Protection and Affordable Care Act will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer care and research. Successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform.
How are CHIPRA demonstration States approaching practice level quality measurement and what are they learning? (Research Report)
Kelly J. Devers, Additional Authors
This Evaluation Highlight is the first in a series that presents descriptive and analytic findings from the 18-state evaluation of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA)'s Quality Demonstration Grants. In this Highlight, we discuss the early accomplishments, challenges, and lessons learned from the following four States pursuing practice-level quality measurement: Maine, Massachusetts, North Carolina, and Pennsylvania. Our analysis is based on work completed by the States during the first two years of their five-year demonstration projects. These two years included a one-year planning period followed by a year of implementation.
Obtaining Providers' 'Buy-In' And Establishing Effective Means Of Information Exchange Will Be Critical To HITECH's Success (Research Report)
Kelly J. Devers, Robert A. Berenson, Randall R. Bovbjerg, Additional Authors
In a March 2012 article in Health Affairs, a team of authors from the Urban Institute and Mathematica Policy Research finds that achieving ambitious goals for the adoption of electronic health records and the nationwide exchange of electronic health information will require overcoming a number of hurdles. First and foremost, providers and patients have to be persuaded of the value of exchanging information and have to be supportive of steps to make it possible. For example, there are broad concerns about the tradeoffs between sharing information electronically and safeguarding the privacy and security of patients’ health care data. A case in point: existing federal law provides for the use of a single identification number for every US patient, but Congress has blocked the use of federal funds to develop this ID system because of privacy concerns.