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.

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.

This report compares ten provider survey tools designed to measure the extent to which a practice is a 'patient-centered medical home' (PCMH). These tools are primarily used for recognition purposes (i.e., to qualify for entry into a payment pilot or demonstration), as opposed to for practice self-improvement, research/evaluation, or quality measurement. Our analysis, Our analysis, conducted for the Centers for Medicare and Medicaid Services, compares these ten tools' operational details (e.g., price, whether a site visit is required) and their content emphases (i.e., the different practice capabilities that the tools emphasize). We conclude by discussing issues for payers to consider when selected a PCMH recognition tool.

This policy paper by Kelly Devers analyzes the trend toward quality improvement (QI) efforts in health care, concluding that while QI alone is no magic bullet, it generally has modest, positive effects. The paper, funded by the Robert Wood Johnson Foundation, reviews the evolution of QI initiatives, the current evidence about whether QI interventions work, QI’s promise for the future, and how to help it find success in health care. The paper offers recommendations for enhancing QI, including by providing incentives for providers to prioritize quality; improving education, training, and technical assistance; investing in health IT; and promoting greater collaboration across organizations.

A number of states have used the flexibility of the Medicaid program to develop innovative payment and delivery systems designed to coordinate and improve quality of care. This brief, based on site visits from Nov. 2009 through March 2010, highlights care coordination and related efforts in five states: Alabama, Oklahoma, Oregon, Pennsylvania and Washington State. Such efforts by states to realign the provider payment and delivery systems are key to improving Medicaid and to successfully implementing coverage expansions under the health reform law.

This status report on the patient-centered medical home covers such topics as: What is a medical home? Where did the concept come from? How are medical homes assessed and paid? Do medical homes actually work? How does the health reform law encourage medical homes? The paper, funded by the Robert Wood Johnson Foundation, concludes that the medical home model has the potential to transform health care delivery, but organizations promoting the model should tread carefully because enthusiasm for the approach may not be borne out in evidence of success. Pilots should be completed and evaluated, and the model should be recalibrated before it is broadly expanded.

This Health Affairs article explores the effect of performance-based incentives through interviews of hospital leaders and unit nurses in 25 hospitals in 2008. Interviewees expressed favorable impressions of the impact that incentive policies have on quality and safety, but raised concerns about the policies' effects on the nurse workforce, given current hospital staffing levels, work environment, salaries, and turnover. We recommend that policy makers invest in implementation support, redesign hospital incentives to reward teamwork, and involve nursing leaders in the design of future incentive policies.

This American Journal of Preventive Medicine article presents findings from a cluster randomized controlled trial aimed at determining whether smoking cessation support in practices is enhanced by the use of telephone quitlines. The study found that a systems approach to identifying smokers, advising and assessing readiness to quit, combined with partnership with a quitline, increased delivery of cessation support for primary care patients by 12.5% beyond that accomplished by traditional tobacco-use vital sign screening alone. The increase in cessation was more pronounced with patients aged 35-54 years and with male and more experienced clinicians.

This Health Services Research article describes how administrative and health records (including electronic medical records) can be linked for comparative effectiveness and health services research, using cancer care research to illustrate points. The article notes challenges that may be encountered in the linkage process, and advocates fostering collaboration among institutions, researchers, and public and private components of the health care sector to ensure that data collected for clinical and transactional purposes can benefit the research community and, ultimately, the patient population.

This Medical Care article studies associations between health system type and inpatient mortality from four acute conditions. Using data for 11 states drawn from a variety of sources and a panel study design with fixed effects models, this study finds that centralized health systems are associated with lower mortality from acute myocardial infarction (AMI), congestive heart failure, and pneumonia. Meanwhile, independent hospital systems had better AMI quality outcomes than centralized physician/insurance and moderately-centralized health systems, and there was no difference in stroke mortality among the health system types studied. The study concludes that hospital system type is associated with care quality.

This American Journal of Preventive Medicine article presents findings from a mixed-methods study conducted in 2005 to understand patient perspectives on colorectal cancer screening. Responses to a mailed survey identified fear and the bowel preparation as the most important barriers to screening, while remarks by focus group participants exposed the intricacies of complex barriers -- such as fear, lack of information, time, the role of physicians, and access to care -- as well as barriers that have little documentation in the literature, such as low self-worth, "para-sexual" sensitivities, fatalism, negative past experiences with testing, and skepticism about the financial motivation behind screening recommendations.

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