Last week LDI hosted a day-long conference on Medicare for All & Beyond. Our goal was to participate in one of today’s most pressing conversations in health care—how to expand health insurance to the 28 million people in the United States who are currently uninsured. We welcomed close to 300 people from across the spectrum to participate in this conversation, to consider the critical questions underlying today’s debate, and to look in depth at the challenges we face in expanding insurance coverage in our country. The conference gave us all plenty to mull over.
In Health Affairs, Genevieve Kanter and Peter Groeneveld find that Intensive care unit (ICU) beds are not equally distributed across the United States, and income is a strong predictor of access to an ICU. The implications for COVID-19 are troubling. So far, infection rates have been most severe in low-income communities, which also have higher rates of underlying health conditions that increase the odds of requiring intensive care. Without better coordination and redistribution of ICU resources, the negative consequences of the pandemic are likely to grow, with a growing gap between these resources and the communities that need them.
COVID-19 has placed an immense burden on the US health care system, particularly hospitals serving communities with the highest number of cases. To alleviate financial strain, the U.S. Department of Health and Human Services distributed $12 billion of “high impact” relief funds to 395 hospitals that individually cared for 100 or more COVID-19 patients. Collectively, this group accounted for 71% of all US COVID-related hospitalizations through April 10, 2020. However, despite being located in areas with high COVID-19 case counts, hospitals receiving relief funds may serve communities that differ with respect to different characteristics, including social determinants of health.
The year after giving birth is an important one for mothers and their infants. Care delivered during this period is critical to improving mother and infants’ long-term health and reducing future health risks. However, a recent study shows that all too often, this is a missed opportunity to deliver important preventive care to adult women.
In the study published in Medical Care, Emily Gregory, Alexander Fiks, Scott Lorch, and colleagues examined the health care use of nearly 600,000 mother-infant pairs who were eligible for Medicaid for at least 11 of the 12 months following birth in 12 geographically diverse states. They found that 38% of mothers on Medicaid had no adult preventive visits one year postpartum.
In the United States, hepatitis C virus (HCV) infection affects nearly 4.5 million people, is the leading cause of chronic liver disease, and was the leading cause of infectious disease-related deaths prior to the COVID-19 pandemic. Patients with HCV face significant stigma associated with their diagnosis, but the prevalence and determinants of this stigma have not been examined. In a recent study, my colleagues and I explored demographic, clinical, and behavioral factors associated with patients’ experiences of HCV-related stigma.
COVID-19 has taken a severe toll on socioeconomically disadvantaged populations and racial and ethnic minority groups. It has disrupted traditional health care delivery and strained health systems to the breaking point. The need to address behavioral, economic and social determinants of health– in pursuit of the Triple Aim of better health outcomes, improved patient experience, and reduced per capita cost – has never been so compelling. In a new study published in Health Services Research, we add to the growing evidence base that community health workers (CHWs) can help meet these challenges. We used pooled data from three randomized trials to show that a standardized CHW program reduced hospitalizations and decreased fragmentation of hospital care, effects that persisted three months after the intervention ended.
While COVID-19 has created unprecedented challenges for the U.S. health care system, it has also accelerated innovation, including the use and adoption of telemedicine. However, just as the burden of COVID-19 morbidity and mortality continues to fall on more marginalized populations, so too have the socioeconomic, racial, and gender inequities in access to virtual care. In a recent study in Circulation, Lauren Eberly, Sameed Khatana, Ashwin Nathan, Srinath Adusumalli, and colleagues examine how the use of telemedicine for outpatient cardiology care affected existing inequities in access to care for certain populations, and found that being female and being non-English speaking were independently associated with less telemedicine use.
Skeletal Muscle Relaxers (SMRs) are a common opioid substitute for patients with musculoskeletal conditions, but little is known about their safety and efficacy in treating long-term, chronic pain, particularly for older patients and patients with simultaneous opioid use. In JAMA Network Open, LDI fellows Sean Hennessy and Charles Leonard and colleagues Samantha Soprano and Warren Bilker recently examined national trends in outpatient SMR prescriptions from 2005 to 2016. They found that the number of office visits with an SMR prescription doubled over the last decade, but the steepest increase was among adults over age 65, for whom SMR visits tripled.
The COVID-19 pandemic has claimed over half a million lives worldwide. In the U.S., it is estimated that one in five adults who develops symptomatic COVID-19 will wind up in a hospital, and one in 20 may develop respiratory failure requiring a mechanical ventilator. For these critically ill patients, death rates range from 20-50% and increasingly, we are learning that survivors may face lasting symptoms and functional deficits. Faced with this frightening prognosis, some patients might choose to forgo aggressive medical care. Advance care planning (ACP) and advance directives allow patients to make these preferences known to their families and care teams. In a study published today in JAMA Network Open, we examined changes in demand for ACP before and during the COVID-19 pandemic.
Community benefit spending by our nation’s nonprofit hospitals has always been a hot-button issue. To qualify for nonprofit status, health care systems are required to report annually to the Internal Revenue Service how they direct resources towards the community. And the results, for years, have been underwhelming.
In the midst of the COVID-19 epidemic, many people may not have seen our new JAMA Network Open study published last month, which further illustrates this evolving story. The pandemic also provides us an opportunity to examine the issue of community benefit spending through a new lens.
As the country looks to reopen and epidemiologists anticipate future waves of coronavirus (COVID-19) cases, we must address an equally important “pandemic:” the virus’ far-reaching mental health and trauma-related consequences. Whether balancing activities of essential work with exposure risk, bearing witness to suffering or loss, or feeling anguish or guilt for not “doing more” during this time, our society is facing great adversity with potentially devastating consequences. Evidence-based frameworks exist to guide our individual and collective response and prevent the pandemic’s trauma-related effects. What does a trauma-informed framework tell us about how to respond to this mounting crisis to mitigate the aftershocks from the pandemic?
While effective vaccines to control the current pandemic are likely at least a year away, public health officials believe the time to build confidence in those vaccines is now. A new report from the Sabin-Aspen Vaccine Science & Policy Group presents an in-depth analysis into the root causes of vaccine hesitancy and actionable steps to address it. Author of How Behavior Spreads and an expert in network science, Professor Damon Centola contributed an essay, entitled "The Complex Contagion of Doubt in the Anti-Vaccine Movement," to the report. He recently answered a few questions about the anti-vaccination movement and how to curb it.