Featured Post
December 2, 2019
A state prescription drug policy first adopted in 1939, and last ended in 2004, appears to have influenced where Purdue Pharma chose to market its opioid drug OxyContin upon launch in 1996. The consequences of that decision reverberate to this day, according to a new NBER paper by LDI Senior Fellow Abby Alpert and colleagues, who estimate that states with the prescription policy had 11.4 fewer overdose deaths per 100,000 people in 2017.
January 21, 2020
Over the last decade, medical cannabis has moved from the fringe to the mainstream—at least in some states. Nearly 900,000 Americans were registered cannabis patients in 2017, which is more than a ten-fold increase since 2009. By the end of 2020, over two-thirds of states and the vast majority of Americans will live in a state with legal access to either medicinal or recreational marijuana. Despite the rapid changes in the legal status and evidence supporting the use of cannabis to treat a range of conditions, physicians and trainees report remain ill-equipped to recognize and advise patients who may benefit from medical cannabis.
[Reposted: Kathleen Noonan. Disappointing Randomized Controlled Trial Results Show A Way Forward On Complex Care In Camden And Beyond , Health Affairs Blog, January 9, 2020. https://www.healthaffairs.org/do/10.1377/hblog20200102.864819/full/: Copyright ©2020 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.]
Two years ago, when I joined the Camden Coalition of Healthcare Providers, I met with a client we’d been serving for nearly 18 months. When we first met Sarah, she was in the early days of recovery from heroin addiction, just starting to self-manage her medical conditions. She was living with her infant in a shelter. Following intensive work with the Camden Coalition and our partners, we were able to support Sarah’s successful transition to stable housing—and along with it, reliable food, peer support, and behavioral health care.
Today, she’s thriving.
January 14, 2020
One benefit of teaching hospitals is obvious: they train the next generation of clinicians. But that training comes at a cost: teaching hospitals tend to have higher-priced clinical care than other hospitals. In the era of value-based care, the question is whether the additional spending produces better patient outcomes, and if so, whether the clinical benefit is worth the cost.
We have some answers in two recent papers (here, and here) by a team of LDI Senior Fellows led by Jeffrey Silber and Lee Fleisher. In general, they find that the value of teaching hospitals is greatest for high-risk surgical and medical patients, where better outcomes justify slightly higher costs. Let’s take a look at what they found.
[reposted from Penn Medicine News]
In November 2019, Rinad Beidas, PhD, an associate professor of Psychiatry and founding director of the Penn Implementation Science Center at the Leonard Davis Institute, tweeted: “Hive mind: I want to curate a library of books for my mentees (who are almost entirely females) on success in personal and professional pursuits with an eye towards academia. Can you help me?”
And help, they could. Within a few days, so many colleagues and collaborators had recommended books that influenced them that Beidas decided to organize the list into a publicly available document open to anyone who would like to contribute. The list currently includes nearly 60 titles of books, each one contributing to mentorship and the advancement of under-represented researchers and faculty, particularly those in the biomedical and health sciences.
But it wasn’t just the number of responses and contributions that came as a surprise. Within hours, several people — some of whom were strangers to Beidas at the time — reached out with ideas that have since turned a simple tweet into a resource that will support women in academia for years to come.
January 6, 2020
In Health Affairs, Amol Navathe and colleagues tell us what happened to quality and cost after three years of Medicare’s bundled payment policy for lower extremity joint replacement. This chart summarizes changes in per-episode costs (quality was unchanged).
January 6, 2020
[cross-posted from The Philadelphia Inquirer]
For decades ever more patients have been arriving at emergency departments (EDs). As concern has mounted, and emergency department crowding – most evident in wait times – has increased, fingers have been pointed. Health systems, politicians and researchers have blamed the decline of primary care, “inappropriate” use of the ED, a fragmented health system, and more recently, social determinants of health.
The solutions offered follow from these diagnoses. Improve primary care access, encourage patients and their doctors to use more primary care, penalize patients who are deemed retrospectively by simple algorithms to have used the ED inappropriately, improve care coordination, and improve social determinants of health by actions like paying for housing or transportation.
In a recent New York Times article, “A Doctor’s Diary: the Overnight Shift in the ER,” a physician describes the tragic cases, frantic pace of work, and long delays of the ED. The article rings true to us: two economists, one an emergency physician and one a fairly frequent user of the ED.
However, the solutions enumerated in the article are unlikely to solve ED overcrowding overall. In an economic framework, they all address only one of the problems – the demand for ED visits.
Jan. 6, 2020
In 2019, Pennylvania established the first voluntary financial incentive program to improve ED treatment and follow-up for patients with opioid use disorder. We evaluated adoption of clinical pathways for care among hospitals in Pennsylvania in a recent publication in JAMA Network Open. Did this incentive work? The short answer – yes.
January 6, 2020
Happy New Year! As we enter the new year (and the new decade) we excited about what we have accomplished and even more excited and hopeful about what lies ahead. We are grateful to the community that we serve, and our position in leading the nation in research to improve the health system. But before we turn the page, we take a look back at what caught our readers’ attention last year. If there’s one theme that ties these articles together, it is about producing, parsing, and promoting evidence where it is needed the most. In 2019, people turned to LDI in record numbers, with more than 550,000 page views on our web site. Our most popular content reflects the depth and breadth of our fellows’ research, and their commitment to addressing the key health care challenges of our day. We can’t wait to see what 2020 brings.
December 19, 2019
It is hardly surprising that there’s a spike in the number of Medicare patients discharged from postacute care in a skilled nursing facility (SNF) the day before their copayment jumps from $0 to more than $150. However, the question remains whether this payment policy – which completely covers the first 20 days of a SNF stay – affects patient outcomes in any way. A recent study by Rachel Werner, Norma Coe, and colleagues now gives us some answers, and heightens concerns that Medicare’s SNF payment policy is having negative, unintended effects on patient outcomes.
December 11, 2019
The impact of childhood exposure to crime and violence is pervasive and longstanding. It might be tempting to assume that the economic losses, spread over a lifetime and across the country, cannot be calculated. But that’s just what LDI Associate Fellow Michal Gilad and co-author Abraham Gutman have done in a new working paper that attempts to calculate the consequences of such childhood exposure. The total? An annual cost to the country of $458 billion—greater than the entire share of the federal budget devoted to children in 2018—or a lifetime cost of $193,413 per child.
December 4, 2019
Americans pay about 14% of prescription drug costs out of pocket. Although there are exceptions in very high deductible plans, most of these payments are relatively modest compared to the incomes of middle-class people. In the New York Times, Aaron Carroll recently repeated the common criticism that such cost sharing is “often preventing people from getting necessary care.” So why do people end up with insurance that encourages them to ignore their doctors’ orders and fail to adhere to prescribed medications? Poor people are covered by Medicaid which has almost no cost sharing, so this is much more likely to be an issue for those who are not poor. Before blaming employers and bureaucrats, however, we should ask ourselves—what would we want?
November 21, 2019
What if someone told you that the nurse who would be your main caregiver throughout your labor routinely missed necessary nursing care activities, like comforting or teaching patients? In a recent study, my colleagues Eileen Lake, Sindhu Srinivas, Kathleen O’Rourke, Jordan Sanders and I found that half of nurses surveyed who worked in labor and delivery in 247 hospitals in four large U.S. states had missed one or more care activities on their last shift. Although labor and delivery nurses are the frontline providers during labor, hospital organizational factors often prevent them from having sufficient time or resources to provide the care that is needed.