Study Rationale: The swift progression of the COVID‐19 pandemic appeared to facilitate the increase in telehealth utilization. However, it is clear neither how telehealth was offered by providers nor how it was used by patients during this time of unusual and rapid change within the health industry.Aim: To investigates the telehealth utilization patterns of Medicare beneficiaries during the height of the COVID‐19 pandemic.Methods and Materials: A cross‐sectional study design was used to examine the responses of 9686 Medicare beneficiaries to the Centers for Medicare and Medicaid Services (CMS) Medicare Current Beneficiary Survey, Fall 2020 COVID‐19 Supplement. Multiple logistic regression analyses were conducted to examine the relationship between telehealth offering and beneficiaries' sociodemographic variables.Results: Over half (58%) of primary care providers provided telehealth services, while only 26%–28% of specialists did. Less than 8% of Medicare beneficiaries reported that they were unable to obtain care because of COVID‐19.Conclusions: This research found that changes in Medicare policy, associated with CMS' declaration of telehealth waivers during the Public Health Emergency (PHE), likely increased the proliferation and utilization of telehealth services during the COVID‐19 pandemic, providing important access to care for certain populations. With the impending conclusion of the PHE, policymakers must 1) ascertain which elements of the new telehealth landscape will be retained, 2) modernize the regulatory, accreditation and reimbursement framework to maintain pace with care model innovation and 3) address disparities in access to broadband connectivity with a particular focus on rural and underserved communities.

Background: Physical therapy is an important treatment option for patients with low back pain (LBP). However, whether to refer patients for physical therapy and the timing of initiation remain controversial. Objective: The objective of this study was to evaluate the impact of receiving physical therapy and the timing of physical therapy initiation on downstream health care utilization and costs among patients with acute LBP. Design: The design was a retrospective cohort study. Methods: Patients who had a new onset of LBP between January 1, 2009, and December 31, 2013, in New York State were identified and grouped into different cohorts on the basis of whether they received physical therapy and the timing of physical therapy initiation. The probability of service use and LBP-related health care costs over a 1-year period were analyzed. Results: Among 46,914 patients with acute LBP, 40,246 patients did not receive physical therapy and 6668 patients received physical therapy initiated at different times. After controlling for patient characteristics and adjusting for treatment selection bias, health care utilization and cost measures over the 1-year period were the lowest among patients not receiving physical therapy, followed by patients with immediate physical therapy initiation (within 3 days), with some exceptions. Among patients receiving physical therapy, those receiving physical therapy within 3 days were consistently associated with the lowest health care utilization and cost measures. Limitations: This study was based on commercial insurance claims data from 1 state. Conclusions: When referral for physical therapy is warranted for patients with acute LBP, immediate referral and initiation (within 3 days) may lead to lower health care utilization and LBP-related costs.

Determining how to collect and use patient-reported outcome measures (PROMs) continues to be an area of discussion, and in some cases frustration.1–5 Gaining a greater depth of knowledge concerning a patient’s initial health status as well as improvement after a medical or surgical intervention, would provide a clearer understanding of needed care paths and outcomes of treatments, oftentimes missing from our current healthcare processes.6 7 While PROMs are not a new idea, the ability to electronically collect, report and use the data has become more relevant in recent years. As such, this work focuses on the challenges and lessons learnt from implementing electronic PROMs (ePROMs) within a destination medical centre which provides team-based comprehensive care for patients. Implementations in multiple departments and disease specific areas of care throughout the organisation took place between January 2016 and March 2018. The International Consortium for Health Outcomes Measurement (ICHOM) standard sets were used in each department as the primary survey tool, as scores could easily be calculated and the disease specific questionnaires administered at the point of care demonstrated a good fit for the organisation’s practices.6 8 ICHOM Standard Sets are global, standardised and validated questionnaires that have been combined into a set that captures information for the provider at a level that patients understand. Pre-existing intake assessments were evaluated within each department and service line and subsequently were merged or replaced with the ICHOM sets to create customised comprehensive condition-specific survey sets. In all cases, collection of the survey sets at patient intake provides a baseline for changes to be monitored as well as provides context for patient concerns, needs and areas in which clinicians may need to further inquire. Follow-up data are collected after operations or procedures and changes in patient responses are monitored and assessed. In the …

EXECUTIVE SUMMARY Success factors related to the implementation of change initiatives are well documented and discussed in the management literature, but they are seldom studied in healthcare organizations engaged in multiple strategic change initiatives. The purpose of this study was to identify key success factors related to implementation of change initiatives based on rich qualitative data gathered from health leader interviews at two large health systems implementing multiple change initiatives. In-depth personal interviews with 61 healthcare leaders in the two large systems were conducted and inductive qualitative analysis was employed to identify success factors associated with 13 change initiatives. Results from this analysis were compared to success factors identified in the literature, and generalizations were drawn that add significantly to the management literature, especially to that in the healthcare sector. Ten specific success factors were identified for the implementation of change initiatives. The top three success factors were (1) culture and values, (2) business processes, and (3) people and engagement. Two of the identified success factors are unique to the healthcare sector and not found in the literature on change models: service quality and client satisfaction (ranked fourth of 10) and access to information (ranked ninth). Results demonstrate the importance of human resource functions, alignment of culture and values with change, and business processes that facilitate effective communication and access to information to achieve many change initiatives. The responses also suggest opportunities for leaders of healthcare organizations to more formally recognize the degree to which various change initiatives are dependent on one another.

Purpose: – The purpose of this paper is to examine how two large health systems formulate and implement strategy with a specific focus on differences and similarities in the nature of strategic initiatives across systems. The aim is to gain a better understanding of the role of resource dependency theory (RDT) and resource based view (RBV) in healthcare strategic management.Design/methodology/approach: – A comparative case study design is used to describe, categorize and compare strategic change initiatives within a children's health and a multi-hospital system located in two competitive metropolitan markets. A total of 61 in-person semi-structured interviews with healthcare administrators were conducted during 2009. Summary statistics and qualitative content analysis were employed to examine strategic initiatives.Findings: – The two health systems have as their top initiatives very similar pursuits, thus indicating that both utilize an externally oriented RDT method of strategy formulation. The relevance of the RBV becomes apparent during resource deployment for strategy implementation. The process of healthcare strategic decision-making incorporates RDT and RBV as separate and compatible activities that are sequential.Research limitations/implications: – Results from this comparative case study are based on only two health systems. Further, the RBV perspective only takes managerial resources and time into consideration.Practical implications: – Given that external resources are likely to become more constrained, it is important that hospitals leverage relevant internal resources, in the identification of competitive advantages and effective execution of strategic initiatives.Originality/value: – The author propose a refined healthcare strategic management framework that takes both RDT and RBV into consideration by systematically linking strategy formulation with deployment of resources.