Asch, David A

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Now showing 1 - 10 of 14
  • Publication
    Effect of Financial Incentives to Physicians, Patients, or Both on Lipid Levels: A Randomized Clinical Trial
    (2016-01-15) Asch, David A; Troxel, Andrea B; Stewart, Walter F; Sequist, Thomas D; Jones, James B; Hirsch, AnneMarie G; Hoffer, Karen; Zhu, Jingsan; Wang, Wenli; Hodolfski, Amanda; Frasch, Antoinette B; Weiner, Mark G; Finnerty, Darra D; Volpp, Kevin G; Rosenthal, Meredith B; Gangemi, Kelsey
    Can financial incentives be used to reduce cholesterol levels in high-risk patients? This randomized trial says modest reductions can be achieved only by targeting incentives to both patients and physicians, not to one or the other.
  • Publication
    Evaluating Residency Programs by Whether They Produce Good Doctors
    (2009-11-23) Asch, David A
    Not all physician training programs are alike. Many physicians and non-physicians believe that graduates of some training programs deliver better care, although this intuition has not been tested. Residency programs provide physicians with in-depth specialty training (usually lasting 3-6 years). Can the quality of that training be judged by the downstream outcomes of patients treated by their graduates? Should patients pick their doctors in part by where they trained? This Issue Brief looks at one specialty—obstetrics and gynecology (OB)—and explores whether OB training programs can be distinguished by the quality of care their graduates provide.
  • Publication
    Hospital Performance Measures and Quality of Care
    (2008-04-01) Bradlow, Eric T; Werner, Rachel M; Asch, David A
    Increasingly, quality improvement initiatives emphasize public reporting of hospital performance measures, to encourage providers to improve, to help consumers pick providers, and to determine provider payments. Although these measures are based on compliance with well established processes of care, it is unknown whether quality measured in this way is correlated with, or predictive of, clinical outcomes. This Issue Brief summarizes studies that examine and quantify the relationship between frequently used measures of hospital performance and hospital mortality.
  • Publication
    Successes and Failures of Hospital Ethics Committees: A National Survey of Ethics Committee Chairs
    (2002-01-01) McGee, Glenn E; Caplan, Arthur L.; Spanogle, Joshua P; Asch, David A.; Penny, Dina
    In 1992, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) passed a mandate that all its approved hospitals put in place a means for addressing ethical concerns. Although the particular process the hospital uses to address such concerns—ethics consultant, ethics forum, ethics committee—may vary, the hospital or healthcare ethics committee (HEC) is used most often. In a companion study to that reported here, we found that in 1998 over 90% of U.S. hospitals had ethics committees, compared to just 1% in 1983, and that many have some and a few have sweeping clinical powers in hospitals.
  • Publication
    Comparing VA and Non-VA Health Care: the Case of Post-Stroke Rehabilitation
    (2001-02-21) Stineman, Margaret; Asch, David A
    The Department of Veterans Affairs (VA) runs the largest integrated health system in the country, and provides care to nearly 4 million patients each year. It has been dogged by persistent doubts about its efficiency and quality of care, despite numerous quality improvement programs and an extensive reorganization in 1995. In fact, recent studies have found that health care in the VA compares favorably with non-VA systems, in areas such as preventive care and treatment for acute myocardial infarction. This Issue Brief summarizes a comparison in another area—inpatient rehabilitation for stroke— and highlights the difficulty and complexity of assessing quality across systems of care.
  • Publication
    On the Way to Health
    (2012-08-29) Asch, David A; Volpp, Kevin G
    Information technology (IT) has fundamentally changed the way we work, bank, and communicate. Its impact on health care and health research, however, has been limited by the lack of a comprehensive infrastructure to connect patients, providers, and researchers. As we learn more about how to address the unhealthy behaviors that underlie many chronic conditions, researchers are seeking IT solutions to connect to patients in scalable ways. This Issue Brief describes the development and use of a new web-based IT platform, Way to Health, to deliver and evaluate behavioral interventions to improve health.
  • Publication
    How Physicians React to Cost-Effectiveness Information
    (2003-07-16) Asch, David A; Hershey, John C; Ubel, Peter A
    Since 1998, the growth of health care spending has accelerated to levels not seen since the 1980s. This growth has renewed pressures on physicians to practice “cost-effective” care, since physicians’ decisions account for the vast majority of all health care spending. But little is known about what physicians think about cost containment, and how they incorporate cost-effectiveness information into their practice patterns. This Issue Brief summarizes three related studies that describe primary care physicians’ attitudes toward considering costs in their clinical decisions, and the effects of providing cost-effectiveness information on physicians’ recommendations.
  • Publication
    Colorectal Cancer Screening With Sigmoidoscopy: Primary Care Issues
    (1999-06-09) Lewis, James D; Asch, David A
    Colorectal cancer is the second leading cause of death from cancer in the U.S., behind lung cancer. Numerous medical societies recommend routine screening for colorectal cancer with flexible sigmoidoscopy for people 50 and over. But who will perform the procedure, and who will pay for it? The case of flexible sigmoidoscopy illustrates the economic and practical issues of introducing a screening procedure into primary care practice. This Issue Brief investigates the role of primary care physicians in providing this service as part of routine care, and identifies attitudinal and financial barriers to overcome.
  • Publication
    Behavioral Economics and Health Annual Symposium
    (2011-09-07) Weiner, Janet; Asch, David A
    The application of behavioral economics to health and health care has captured the imagination of policymakers across the political spectrum. The idea is that many people are irrational in predictable ways, and that this both contributes to unhealthy behaviors like smoking and holds one of the keys to changing those behaviors. Because health care costs continue to increase, and a substantial portion of costs are incurred because of unhealthy behaviors, employers and insurers have great interest in using financial incentives to change behaviors. However, it is in the details that complexity and controversies emerge. Who should the targets be, and what outcomes should be rewarded? How should incentives be structured, to maximize their effectiveness and minimize unintended consequences? In what situations should we be intervening to affect decisions by people who may prefer to be obese or to smoke, and in what situations should we accept their preferences? To begin to answer these questions, the Penn-CMU Roybal P30 Center on Behavioral Economics and Health held its first annual Behavioral Economics and Health Symposium on March 24-25, 2011 with support from the Robert Wood Johnson Foundation. The symposium drew more than 50 researchers, scholars, and health professionals from a variety of disciplines, including medicine, public health, economics, law, management, marketing, and psychology. They heard perspectives on behavioral economics from public and private funders, the CEO of the University of Pennsylvania Health System, and the CEO of stickK.com, a start-up company that uses online, voluntary commitment contracts to help people achieve their goals. Participants formed eight working groups to review the current state-of-the-art in a variety of clinical contexts and to consider how behavioral economics could inform a research agenda to improve health. This Issue Brief summarizes the findings of these working groups and the symposium.
  • Publication
    Genetic Testing for Breast and Ovarian Cancer: Implications for Life Insurance
    (2000-03-21) Lemaire, Jean; Asch, David A; Subramanian, Krupa
    As the science of genetic testing progresses, the debate surrounding the uses of genetic information intensifies. In February, President Clinton signed an executive order prohibiting federal agencies from using such information to make hiring, promotion, or placement decisions. Concerns about privacy and discrimination have led many states to propose or enact statutes that prohibit health insurers from using genetic test results in their underwriting decisions. However, few statutes address access to these results by the life insurance industry. This Issue Brief summarizes the current debate on whether life insurers should have access to genetic testing information for breast and ovarian cancer, and provides actuarial insight into the potential effect of such testing on the voluntary term insurance market.