NEJM Catalyst

📢 Our May 2025 issue is now live! In the issue: ridesharing for veterans, the carbon impact of telehealth, mediating grievances, urgent care at home, intravenous fluid shortage, opioid inaccessibility, a food is medicine initiative, ambient AI scribes, and health literacy. 📖 View the issue: https://nej.md/3E63iPv 🎧 Read or listen to the letter from our editors: Moving Forward with Health Care Innovation Amid Uncertainty https://nej.md/429VpSk 👓 Insights Report: How to Improve Poor Patient Health Literacy https://nej.md/42aGTd5 🚐 In Depth: Paving the Way for Better Health: A Public–Private Collaboration to Break Down Transportation Barriers for Veterans https://nej.md/4cyhmxU 🛌 Case Study: Digitally Enabled Urgent Care at Home: Enhancing Patient Access, Operational Efficiency, and Care Delivery https://nej.md/3G89c39 💬 Case Study: Improving Medicine Using Grievances Collected at a Mediation Center https://nej.md/3G5cp3u 🌳 Case Study: Decarbonizing Health Care: Measuring the Carbon Footprint Impact of a National VA Telehealth Program https://nej.md/4lq8Gxy 💉 Article: Managing the Sudden Critical Shortage of Intravenous Fluids https://nej.md/42r2TPt 💊 Commentary: The Silent Opioid Crisis: Finding a Balance Between Combating Abuse and Increasing Access for Seriously Ill Patients https://nej.md/42siX3y 🍎 Commentary: Laying the Groundwork for the AHA Health Care by Food Initiative https://nej.md/3G1QzxX 📝 Commentary: Ambient Artificial Intelligence Scribes: Learnings after 1 Year and over 2.5 Million Uses https://nej.md/3QV4cRI

Because of their position in the health care delivery system, patients and their families observe malfunctions that quality monitoring tools may miss. Mediation gives the various parties to a conflict the opportunity to express their experiences and grievances in detail and depth, first in interviews and possibly in sessions with others involved in the conflict, in a process that can last from an hour to several months. Grievances offer a unique insight into the patient’s journey through the health care system, which can lead to improvement projects inspired by the patient’s needs and expectations and difficulties encountered throughout the course of care. This article describes how a model was developed in 2012 at Lausanne University Hospital in Lausanne, Switzerland, to leverage the full discovery and informational potential of grievances through a mediation center backed by a rigorously organized computerized monitoring system. Based on a taxonomy of approximately 100 indicators, in which each grievance situation is documented, this computerized system allows the mediators to make effective use of the dissatisfaction by producing statistical data that shed light on the origin and the nature of the grievance. Importantly, the model includes a final stage in which this information is fed back to the various levels of the hospital, from the patient-facing departments to the hospital’s management and leadership staff. With this feedback, the clinical staff or management develop and coconstruct — in some cases with patients — improvement projects to meet patients’ unmet needs. Designed originally to listen and respond to patients, this mediation center has seen the arrival of more and more care professionals who are experiencing challenges with patients. The professionals’ grievances are now collected and inspire projects to improve their working conditions and relationships with patients: https://nej.md/3G5cp3u

Patients worldwide suffer from high-frequency adverse events (AEs). However, the reported rate of severe AEs is significantly below the actual incidence. In particular, patient harm caused by clinical laboratory AEs is generally hidden, indirect, and delayed, and patient safety–oriented quality management models have not been well established. Promoting the recognition of errors, risk control, and safety culture by developing and learning from an AE database could improve patient safety and medical quality. This study aimed to develop a patient safety–oriented quality management model by analyzing the risk priority of adverse events (RPAEs) in an AE database and achieve standardization, risk control, and continuous improvement using procedural safety checklists. The study, launched in January 2008, retrospectively examined a multisource AE database of the emergency laboratory at Taizhou Enze Medical Center between 2008 and 2023. It graded and classified 1,012 AEs from internal and external staff, hospital leaders, patient complaints, and auditors according to severity and content. AE categories in the top 80% of the total risk scores were considered RPAEs, the focus for improvement and quality checks. Among the AEs, 98.62% were reported between 2014 and 2023; 68.67% involved patients and 21.84% caused patient harm. Continuous improvements were implemented using quality management tools, such as information systems, Lean management, and process optimization. Using detailed information, the authors designed a process safety checklist for on-site and immediate assessments and standardization of staff behaviors in key processes to improve patient safety. The authors developed a quality model referred to as the “RPAEs, the root causes, countermeasures, implementation, and safety checklist” model. Moreover, this study presents future directions for quality management in medical laboratories, for China or other countries, such as constructing an indicator system to evaluate the effect of AEs on patient safety: https://nej.md/3Y82GQ6

Innovation defines how health care is delivered, accessed, and experienced by patients. In 2023, University of California, Davis Health implemented an Urgent Care at Home (UCAH) program to bring care directly to patients’ doorsteps, emphasizing both convenience and accessibility. In the first 6 months of implementation, based on assumptions related to a patient-reported survey, the program was credited with diverting as many as 620 patients who may otherwise have presented to the ER. Of the 815 patients visited at home by a mobile care team, 114 (14%) were escalated to the ER for treatment, highlighting the program’s ability to differentiate between cases suitable for home-based care and those requiring higher-acuity interventions. Patients receiving care through the digitally enabled UCAH program had visits lasting approximately 35 minutes, with 38.5% occurring after hours or on weekends. The average patient age was 72 years, and, notably, 256 of 628 survey respondents (41%) reported unsteady gait, highlighting the benefit of at-home care for individuals with impaired mobility. The program demonstrated high levels of patient satisfaction, according to the vendor’s survey of those receiving its mobile urgent care service, with a Net Promoter Score of 89. Over the first 6 months, the program yielded an estimated ROI exceeding 100% of the cost paid to the vendor. Findings suggest that digitally enabled urgent care models can be an effective enhancement to existing care pathways, helping to expand access for patients with mobility limitations, urgent but nonemergent conditions, and barriers to traditional outpatient services. Future research should explore long-term sustainability, health equity impact, and optimal payer alignment to support continued adoption and scaling: https://nej.md/3G89c39

Out now - the May 2025 issue of NEJM Catalyst Innovations in Care Delivery: https://nej.md/3E63iPv

Millions of people in the United States delay or forgo medical care because of transportation challenges, contributing to adverse health outcomes and significant financial losses for health care providers. These barriers disproportionately impact older adults, children, women, persons of color, individuals with disabilities, low-income populations, those with chronic diseases, and veterans. The Veterans Health Administration–Uber Health Connect (VUHC) Initiative is a public–private collaboration designed to provide a rideshare transportation option to help veterans overcome transportation barriers. The pilot launched in January 2022 and was rolled out enterprise-wide in 2024. Between January 1, 2022, and March 31, 2024, the service provided 263,294 rides to 38,399 unique veterans, ensuring continuity of care and timely ED and inpatient discharges. The VUHC Initiative serves as a blueprint that other health care systems can implement to address transportation barriers, increase patient access to care, and improve health equity: https://nej.md/4cyhmxU by Indra Sandal, PhD, MBA, William Patterson, Gregory Goins, Ben Williams, Kristopher "Kit" Teague, Matthew Crowson, MD, Carolyn Clancy, U.S. Department of Veterans Affairs, Uber Health

The concept of health literacy has come into greater focus. Healthy People 2030, the fifth iteration of the United States’ Healthy People initiative, defines health literacy to include both organizational and individual roles. The World Health Organization similarly defines health literacy as “representing the personal knowledge and competencies that accumulate through daily activities, social interactions and across generations. Personal knowledge and competencies are mediated by the organizational structures and availability of resources that enable people to access, understand, appraise, and use information and services….” A January 2025 survey of the NEJM Catalyst Insights Council paints a picture of how changing views on health literacy and technological innovation present both opportunities and obstacles. Acknowledging the importance of health literacy for patient care, members of the NEJM Catalyst Insights Council discuss who is responsible and how to improve health literacy: https://nej.md/42aGTd5 Expert commentary provided by Nico Pronk, HealthPartners

The May 2025 issue of NEJM Catalyst Innovations in Care Delivery highlights programs and interventions at many different health care organizations to address the ills of patients and care delivery as a whole. Read or listen to the letter from the editors: https://nej.md/429VpSk

Crossing the Chasm: How to Expand Adoption of Value-Based Care: https://nej.md/4bHIoCv

Outcomes That Matter to Patients: ICHOM as a Catalyst for Value-Based Care: https://nej.md/4bxrKpb