Featured Post
May 4, 2021
More than any other sector in health care, nursing homes have suffered during the pandemic. Nursing home residents and staff account for 34% of all COVID-19 deaths, though they make up less than 1% of the population. As a result of COVID-19-related concerns, the number of Americans living in nursing home has dropped by more than 10%. The result is an unprecedented financial crisis for the industry, with nursing homes closing their doors, some laying off their employees, and others being unable to safely staff their facilities.
July 29, 2021
COVID-19 has cast a light on the need for high-quality long-term care, and experts are anticipating heightened demand for home health care due to the high rates of COVID-19 infections and deaths in nursing homes. Home health care provides skilled nursing services and other therapies in patients’ homes and therefore relies heavily on nurses. As of 2018, the home health care industry employed more than 250,000 registered and licensed practical nurses nationwide.
July 28, 2021
Telemedicine visits surged during the pandemic as primary care practices sought to reduce the risk of COVID transmission. Telemedicine provides a key lifeline for patients most vulnerable to COVID infection and eliminates transportation as a barrier to primary care. But it also raises access, quality and equity issues for patients who may have difficulty using telemedicine, including older adults. In a recent study in the Journal of the American Geriatrics Society, we find that telemedicine could be beneficial to older adults, but we observed significant disparities that must be addressed to improve care quality and equity.
July 7, 2021
More than one-third of all Americans age 12 and over remain unvaccinated for COVID-19. The latest Kaiser Family Foundation poll indicates that hesitancy and acceptance of these vaccines varies by geographic, sociodemographic, and cultural factors. While we often think about vaccine hesitancy on an individual level, these individuals belong to communities that respond to the COVID-19 vaccine in very different ways. A new Twitter analysis led by LDI Senior Fellow Sharath Chandra Guntuku offers tantalizing clues about differences in how certain communities talk about the pandemic, and may help target public health messages to improve vaccine acceptance.
June 29, 2021
From contact tracing to vaccination status, the pandemic brought with it a wide range of issues around privacy and the sharing of health information, often telegraphed as “HIPAA” concerns. But few people understand the origins of the Health Insurance Portability and Accountability Act, or HIPAA, and how it strikes a delicate and changing balance between protecting private health information and facilitating data sharing. A recent NEJM Perspective piece by Anita L. Allen and accompanying interview with the author provides a clear and informative history of HIPAA and how it has evolved to respond to changes in health information technology.
June 28, 2021
The alarming rise in drug overdoses has been uneven in the U.S., with significant disparities across urban neighborhoods. In a new study, we examine whether the presence of alcohol outlets contributes to neighborhood disparities in drug overdoses, and whether alcohol outlets that sell drug paraphernalia are associated with neighborhood overdose rates.
The study, published in International Journal of Drug Policy, found that each additional off-premise alcohol outlet in a Baltimore City neighborhood was associated with a 16.6% increase in the neighborhood drug overdose rate. Off-premise settings include liquor and package stores and taverns that sell liquor, beer, and wine. In contrast, on-premise alcohol outlets (restaurants, bars, hotels, and entertainment venues) were not significantly associated with the neighborhood overdose rate when off-premise outlets were also present in a neighborhood.
June 16, 2021
Prescription drug monitoring programs (PDMP) have been crucial tools to address unsafe opioid prescribing. Many states have enacted comprehensive mandates that all clinicians consult the PDMP prior to prescribing an opioid for any given patient. Previously, our team has shown that comprehensive mandates work, reducing not only prescriptions but also opioid-related hospitalizations. Yet, we have to consider all the consequences of these policies – both intended and unintended. Specifically, we need to understand whether comprehensive mandates deter clinicians from writing opioid prescriptions for appropriate indications. In a new study published in JAMA (and presented at the 2021 AcademyHealth Annual Research Meeting), we focus on opioid prescribing for two groups of patients with chronic illness that can cause severe pain: sickle cell disease and cancer with bone metastasis.
June 10, 2021
As African immigrants settle in Europe and the United States, they experience rising rates of chronic diseases such as diabetes and hypertension, at levels not seen in their home countries. Self-care is key to managing these chronic illnesses, but this population may face cultural and societal challenges to adherence to recommended health practices. In the Journal of Advanced Nursing, we report on the results of a systematic review, finding that an interplay of cultural and structural factors influences the self-care practices of African immigrants with chronic diseases. While cultural identity is a powerful influence, African immigrants also report systemic barriers to adopting self-care recommendations.
June 2, 2021
[Cross-posted from Health Affairs]
Criminal justice-involved populations are disproportionately affected by HIV. In the US, one in seven people living with HIV leaves a correctional facility each year. Marginalized populations are at increased risk of both HIV infection and incarceration, and this dual risk is amplified among communities of color.
The 2021–2025 HIV National Strategic Plan—released in January 2021 by the Office of Infectious Disease and HIV/AIDS Policy in the Department of Health and Human Services (HHS)—recognizes the overarching impact of the criminal justice system on the HIV epidemic and includes objectives to increase the capacity of correctional settings to diagnose and treat HIV. However, the plan overlooks the role of HIV prevention strategies within correctional settings. Two such evidence-based strategies—medication for opioid use disorder (MOUD) and pre-exposure prophylaxis (PrEP)—are the focus of this blog post.
June 1, 2021
There is broad agreement that there is plenty of wasteful and low-value care in our health care system. But there’s less agreement about how to identify it and even less agreement about what to do about it. Health insurers have taken different approaches to this problem. Some insurers have adopted prior authorization, a managed care tool that requires physicians to obtain insurer approval before performing particular services. The different approaches to prior authorization are made apparent in a new study in JAMA Health Forum by Aaron Schwartz and colleagues, in which they apply the typical coverage rules of a large Medicare Advantage plan to fee-for-service Medicare, which lacks prior authorization. They find that about 25% of all spending on Medicare Part B outpatient services would be subject to prior authorization if the private plan rules applied.
May 27, 2021
[Cross-posted from CHOP PolicyLab]
The parents of a 7-year-old girl call their clinic with concerns about the health of their daughter. A telehealth visit is scheduled. On the day of the appointment, her parents, who speak and read a language other than English, are unable to navigate the patient portal account to join the virtual visit. She subsequently misses the appointment and experiences months with declining health and school performance that could have been avoided with early diagnosis and treatment.
Telemedicine provides incredible opportunities for patient access and engagement that could mitigate limitations often experienced by vulnerable families. However, like we see in the case above, those benefits may not be enjoyed equally by all.
May 26, 2021
The opioid epidemic has had devastating effects in red states and blue states alike, making it a prime target for bipartisan action. But both federal and state policy have been characterized by sharp partisan differences in response to rising rates of opioid-related overdose deaths. In a study recently published in the Journal of General Internal Medicine, we sought to understand how partisanship might affect legislative progress on this seemingly bipartisan issue by analyzing the content of state legislators’ opioid-related social media posts over time.
May 25, 2021
"There are decades when nothing happens, and there are weeks when decades happen...that describes what's happening right now,” said Sen. Tom Daschle, at Penn LDI’s recent conference on health care reform. An unusual mix of optimism and pragmatism pervaded the conference sessions, as participants acknowledged the serious ideological divides that threaten any large-scale reforms. At the same time, they pointed out the possibilities of this political moment as the nation emerges from the pandemic.