Leonard Davis Institute for Health Economics
Since 1967, the Leonard Davis Institute of Health Economics (LDI) has been the leading university institute dedicated to data-driven, policy-focused research that improves our nation’s health and health care. Originally founded to bridge the gap between scholars in business (Wharton) and medicine at the University of Pennsylvania, LDI now connects all of Penn’s schools and the Children’s Hospital of Philadelphia through its more than 240 Senior Fellows. LDI’s research focuses on the key themes of insurance reform, health care delivery, healthy behaviors, and vulnerable populations.
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Publication Expanding Scope of Practice After COVID-19(2021-02-15) Weiner, JanetTo expand access to health care during the COVID-19 pandemic, many states relaxed or waived regulations that define the scope of health professional practice. This experience highlights the need to ensure that all health care professionals practice to the full extent of their capabilities—an issue that predates and will outlast the pandemic. In a virtual conference on November 20, 2020, Penn LDI and Penn Nursing brought together experts in law, economics, nursing, medicine, and dentistry to discuss current gaps in health professional scope of practice, what we have learned from COVID-19, and how to rethink scope of practice to better meet community and public health needs.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, KelseyCan 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 ACA-Mandated Elimination of Cost Sharing for Preventive Screening has had Limited Early Impact(2015-12-21) Polsky, Daniel; Zhu, Jingsan; Mehta, Shivan; Lewis, James; Volpp, Kevin G; Kolstad, Jonathan T; Loewenstein, GeorgeDid the Affordable Care Act’s elimination of cost sharing for preventive services increase rates of colonoscopy and mammography screening? Early results say no.Publication Comparison of the Value of Nursing Work Environments in Hospitals Across Different Levels of Patient Risk(2016-01-20) Silber, Jeffrey H; Rosenbaum, Paul R; McHugh, Matthew D; Ludwig, Justin M; Even-Shoshan, Orit; Smith, Herbert L; Nikman, Bijan A; Fleisher, Lee A; Kelz, Rachel R; Aiken, Linda HHospitals with better nurse working environments provide better value (lower mortality with similar costs) especially for higher-risk surgical patients.Publication Effect of Nudges to Clinicians, Patients, or Both to Increase Statin Prescribing: A Cluster Randomized Clinical Trial(2022-12-06) Tachibana, ChrisNudges — which present information or set choices to achieve desired behavior — increased guideline based statin prescribing over usual care. Clinician nudges alone had a small effect, patient nudges alone had no effect, and combined clinician and patient nudges had the greatest effect, increasing prescribing by 7.2 percentage points. The interventions employed a common electronic health record (EHR) system, making them generalizable and scalable.Publication Duty Hour Reform and the Outcomes of Patients Treated by New Surgeons(2020-12-10) Kelz, Rachel R.; Niknam, Bijan A.; Sellers, Morgan M.; Sharpe, James E.; Rosenbaum, Paul R.; Hill, Alexander S.; Zhou, Hong; Hochman, Lauren L.; Bilimoria, Karl Y.; Itani, Kamal; Romano, Patrick S.; Silber, Jeffrey H.Despite concerns that duty hour reform might adversely affect the performance of new surgeons, this national study found no impact on patient outcomes, including 30-day mortality rates, failure-to-rescue, length of stay, and use of intensive care units. These findings should allay fears that reduced work hours during residency would produce surgeons less prepared for practice than their more experienced colleagues.Publication Chronic Hospital Nurse Understaffing Meets COVID-19(2020-08-18) Lasater, Karen B.; Aiken, Linda H.; Sloane, Douglas M.; French, Rachel; Martin, Brendan; Reneau, Kyrani; Alexander, Maryann; McHugh, Matthew D.A study of hospitals in New York and Illinois at the start of the COVID-19 pandemic found that most did not meet benchmark patient-to-nurse staffing ratios for medical-surgical or intensive care units. New York City hospitals had especially low staffing ratios. Understaffed hospitals were associated with less job satisfaction among nurses, unfavorable grades for patient safety and quality of care, and hesitance by nurses and patients to recommend their hospitals.Publication A National Comparison of Operative Outcomes of New and Experienced Surgeons(2019-10-25) Kelz, Rachel R.; Sellers, Morgan M.; Niknam, Bijan A.; Sharpe, James E.; Rosenbaum, Paul R.; Hill, Alexander S.; Zhou, Hong; Hochman, Lauren L.; Bilimoria, Karl Y.; Itani, Kamal; Romano, Patrick S.; Silber, Jeffrey S.Publication Are There Enough Experienced Physicians to Treat Patients Hospitalized With COVID?(2020-11-16) Ryskina, Kira L.In this national study of 438,895 physicians, 45% provided care to hospitalized patients and 7% provided critical care. At the high estimate of patients requiring hospitalization at the projected peak of the pandemic, 18 states and Washington, DC would have patient to physician ratios greater than 15:1 (a level associated with poor outcomes among hospitalized patients). There was considerable geographic variation in the availability of physicians: 41% of hospital service areas did not have a physician with critical care experience.Publication Affirmative Action Bans and Health Risk Behaviors(2019-07-19) Venkataramani, Atheendar S.; Cook, Erin; O'Brien, Rourke L.; Kawachi, Ichiro; Jena, Anupam B.; Tsai, Alexander C.College affirmative action bans were associated with higher rates of smoking and drinking in underrepresented minority 11th and 12th graders, and these students continued to smoke at higher rates into young adulthood. Policymakers should consider unintended public health consequences of proposals, such as affirmative action bans, that may limit socioeconomic opportunities.