Testing, as a mainstay of an effective response to COVID-19, requires sufficient supply to meet the demand. However, since the pandemic hit the US, this has not been the case. While governments have focused on procuring and producing additional tests, researchers have focused on finding ways to make the tests we do have more efficient.
As the U.S. enters the tenth month of the COVID-19 pandemic, it is hard to imagine a time when telemedicine was not a mainstay of health care delivery, particularly in the care of vulnerable patients. However, few studies have examined the scale of how outpatient care has changed at the national level, and whether the changes have been sustained beyond the early months of the pandemic. In our recent study in Hepatology Communications, we found that telemedicine use for outpatient hepatology care in the Veterans Health Administration (VHA) not only dramatically increased during the early months, but has continued at similar levels as the pandemic progresses.
How do patients with Alzheimer's disease and related dementias (ADRD) fare in capitated Medicare Advantage (MA) managed care plans, compared to their peers in traditional Medicare (TM)? This question is increasingly important, as nearly one-third of beneficiaries now choose MA, and the human and financial cost of living with ADRD is substantial.
Patients in inpatient psychiatric care are especially vulnerable to physical and psychological harm, but they have largely been excluded from efforts to monitor, understand, and improve quality of care. In 2012, the Centers for Medicare and Medicaid Services (CMS) implemented the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program to ease inpatient psychiatry into the norms and scrutiny that general hospital care has received for a long time. In a recent study in Medical Care, my co-author and I found that the IPFQR Program has positively impacted restraint and seclusion, reducing the duration of each by about 50% from 2012-2017. Our study is the first and only examination of the IPFQR Program on restraint and seclusion use.
Only about 1% of children in the U.S. are considered medically complex, but when you work in a busy Children’s Hospital Emergency Department (ED) in a large urban area, the prevalence seems much higher. We see a range of children with complex conditions, such as severe asthma coupled with significant eczema, metabolic disorders, and illnesses requiring a ventilator or other life-sustaining equipment. In our anecdotal experience, these children have a much more difficult time navigating through a complex system when an emergency occurs, and some studies suggest that they are at higher risk of adverse medication events. To understand the experiences of these children and their families when they seek care in an ED, our team interviewed 20 parents and 16 pediatric emergency physicians.
A new study in the journal Movement Disorders calculates the considerable health care costs of Parkinson’s disease (PD), a progressive neurodegenerative disorder. Using Medicare fee-for-service claims, LDI Senior Fellows Nabila Dahodwala, Pengxiang Li, Jalpa Doshi, and colleagues quantify this economic burden in one calendar year, and measure the incremental costs of advanced disease. As the above chart shows, these one-year costs vary substantially, from $483 to $48,145 (2018 dollars). After controlling for sociodemographic, clinical, and treatment characteristics, patients with advanced PD group had about $6,000 more in claims costs than those with mild/moderate PD. These data are important for cost-effectiveness studies of PD therapies, and underscore the need to invest in efforts to delay PD disease progression and to improve treatments for advanced PD.
About one third of chronic dialysis patients have persistently high blood phosphorus levels, which increases risk for vascular damage, cardiovascular disease, and death. Some patients can control phosphorus levels through a healthy diet, although many also require the use of pills that remove dietary phosphorus in the gut. But what about patients with limited access to healthy food outlets? In a recent study, we found no link between better access to healthy food and lower blood phosphorus level, suggesting that other factors—such as patients’ food literacy, ability to read food labels, and food preferences—may play a larger role in achieving phosphorus control.
When the pandemic hit the United States, surgical centers across the country reduced the number of elective and nonemergent procedures they performed. In a recent study in The American Surgeon, Daniel Holena, John Riley, and colleagues document the extent of the decrease in surgical consults and operations performed in the University of Pennsylvania Health System (UPHS) in the 30 days before and after COVID-19 hit in March 2020. Overall, surgical consults decreased by 43%, with a significant reduction in the median daily consult volume from 14 to 8.
In the midst of the pandemic, many companies have started marketing diagnostic and serological COVID-19 tests directly to consumers. Such direct-to-consumer (DTC) tests can be initiated by consumers, typically through the company’s website. The sample can be collected at home or in a laboratory, with no or little direct involvement from a health care provider. About a dozen companies have received emergency use authorization (EUA) for diagnostic DTC COVID-19 tests and at least two for serological testing. In our recent article published in the Journal of Law and the Biosciences, we argue that while this type of testing may have a number of benefits, it also raises significant ethical and regulatory concerns, which become particularly urgent due to the scale of the present pandemic.
Over the last decade, there has been considerable focus on programs targeted at reducing the acute health care use of those with the highest health care needs. The logic here is straightforward. If we want to reduce preventable emergency department (ED) visits and hospitalizations, and their associated costs, we should focus on improving care for individuals who use the ED and hospital the most. However, the counter argument is that if we were to direct those resources to lower-risk populations we could see greater health improvements for a larger number of people.
Institutional Review Boards (IRBs) — or “Research Ethics Committees” (RECs) outside the United States—are charged with protecting human research subjects. However, the quality of IRB performance is rarely subject to the same scrutiny that the boards themselves apply to research projects. In AJOB Empirical Bioethics, we conducted the first systematic analysis of 10 IRB quality measurement tools. We found widespread variability in their format, length, and content; a common emphasis on IRB structure and process; a general lack of attention to participant outcomes; and a failure to identify clear priorities for assessment.
Patients with cirrhosis have a high risk of post-operative mortality. As the burden of cirrhosis continues to rise in the United States, it is critical to ensure that we are properly assessing this risk for vulnerable patients prior to surgery. There are concerns in the hepatology and surgical communities that existing prediction tools tend to overestimate the risk, resulting in many patients being denied surgeries that might otherwise be safe to perform.
In a recent study in Hepatology, my colleagues and I developed and tested a novel risk prediction tool—the VOCAL-Penn score—to provide more accurate post-operative mortality predictions for patients with cirrhosis. Using national data of nearly 4,000 veterans with cirrhosis who underwent major surgeries, we compared the VOCAL-Penn Score to three existing tools: the model for end-stage liver disease (MELD), Child-Turcotte-Pugh (CTP), and the Mayo risk score.