Shortell hrodThe past six months have been a time of extraordinary growth for CHOIR. We are in the process of developing a national survey of hospitals, health systems and physician organizations as part of our AHRQ-funded National Center of Excellence award with colleagues at The Dartmouth Institute and the 17 health system High Value Healthcare Collaborative. We are also beginning work on our five year CDC/NIH award to examine the impact of the State Innovation Model (SIM) Initiative on care and outcomes for diabetes patients in comparison with those states that applied but did not receive an award. Most recently we received a major award from the Commonwealth Fund to examine the characteristics of physician practices most strongly associated with lower costs and better outcomes for high cost/high complex Medicare patients. We will be working with colleagues from New York-Cornell Medical Center and Stanford University in undertaking this research.

The Center’s output of peer-reviewed publications in leading journals continues to grow. We briefly highlight three here. The first, appearing in a recent issue of Medical Care Research and Review, found that practices owned by health systems adopted a greater number of evidence-based care management processes (CMPs) and health information technology functions over time than did physician-owned practices. Practices with a high percentage of Medicaid patients adopted more CMPs if they were system owned or owned by a community health center. In a recent issue of Medical Care, we found that open access scheduling was more likely to be implemented in practices that were system-owned with greater use of team-based care, health information technology capabilities and public reporting of quality of care data.  By contrast, adoption of after-hours care was more strongly associated with Accountable Care Organization participation in addition to public reporting and operating under pay for performance payment models.  Finally, a recent paper appearing in Health Affairs with colleagues from the New York/Cornell Medical Center found significant under-treatment of patients with depression in comparison with patients with diabetes, asthma, and congestive heart failure. Suggestions to increase the capacity of primary care practices to diagnose and treat patients with depression and related mental illness, along with changes in training and the use of inter-disciplinary health care teams are discussed. Further details on these and other recent publications are available in the associated links.

In this spring’s newsletter issue, we also introduce Alexander Pimperl, PhD, a Harkness Fellow we are hosting from Germany and Ross Baker, PhD, a Visiting Scholar from the University of Toronto. Some of our ongoing and emerging work will be presented at the AcademyHealth Meeting in Boston this coming June. We look forward to seeing you there!


Stephen M. Shortell, Ph.D., MPH, MBA, Hector P. Rodriguez, Ph.D., MPH – Directors