Featured Post
August 25, 2020
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.
October 5, 2020
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.
October 1, 2020
The medical community has learned much about the novel coronavirus in the past seven months. We’ve learned about risk factors for severe illness, treatments that could benefit hospitalized patients, and the effectiveness of masks and social distancing to prevent spread of the infection. Yet many questions remain unanswered. One of those questions is why some patients with Covid-19 worsen several days after initially developing symptoms, in a pattern not characteristic of other viral illnesses.
September 29, 2020
In the Bulletin of the WHO recently, my colleagues Manu Mathur, Harald Schmidt, and I discuss the perception of oral health as a non-essential health care service and its subsequent exclusion from conceptions of Universal Health Coverage (UHC) around the world.
September 24, 2020
Many hospitals have been slow to improve nurse staffing, even as evidence mounts that nursing resources are associated with better outcomes, including lower rates of patient mortality, avoidable complications, and readmissions. One barrier has been the cost of more and better trained nurses: are the benefits worth it? According to a new study by LDI Senior Fellows, the answer is a resounding yes. The study, led by Karen Lasater, PhD, RN, confirmed that hospitals with better nursing resources achieved better outcomes for Medicare patients at no increased cost, even after accounting for additional nursing expenses.
September 24, 2020
In a new article in JAMA Network Open, my colleagues and I evaluated two different peer mentor models for patients with diabetes at the VA. In a randomized clinical trial, having a peer mentor marginally helped patients with high starting A1c values improve their glucose control, but these effects did not persist at 12 months. Using past mentees as mentors was not effective, especially if the past mentee had not improved their glucose control when they were a mentee.
September 23, 2020
The Merit-based Incentive Payment System (MIPS)—Medicare’s largest pay-for-performance program—has stoked controversy since its passage in 2015, with numerous groups calling for its repeal. Because of MIPS’ administrative complexity, the Medicare Payment Advisory Commission (MedPAC) and other stakeholders have speculated that it would not incentivize physicians to improve performance, nor would its scoring distinguish high quality providers or translate to meaningful quality improvement.
New evidence from the first year of the program suggests that these predictions were largely correct. In a recent Health Affairs study, my colleague Jordan Everson and I identify an unexpected issue with the program: providers skipping entire performance categories. Many of these providers nevertheless received positive payment adjustments, while simultaneously forgoing the meaningful quality improvement goals at the heart of MIPS and making its first year metrics unreliable for differentiating provider performance.
September 22, 2020
While this is certainly not the last word on how Medicare Advantage “special needs plans” (SNPs) affect outcomes for patients with end-stage renal disease (ESRD), it may just be the first. The above chart, from a new study in Health Affairs, compares 3-year unadjusted survival rates of patients with ESRD who switched into a Medicare SNP with similar patients who chose to stay within Medicare fee-for-service coverage. The results, after adjustment for clinical and sociodemographic factors, suggest that SNP enrollees had an average hazard ratio of 0.51, meaning that they were about half as likely as the control group to die at some time within three years.
September 17, 2020
[cross-posted from Health Affairs]
Suspected opioid overdose deaths are surging during the COVID-19 pandemic, increasing by more than 40 percent in May and continuing to rise. Medications for opioid use disorder (MOUD)—specifically methadone and buprenorphine—cut mortality in half; however, only a minority of the two million people living with opioid use disorder (OUD) in the US receive MOUD. After the Affordable Care Act was implemented, treatment engagement expanded modestly. Yet, racial, income, and geographic inequities persist. Approximately 40 percent of counties do not have a buprenorphine prescriber, and Black patients are significantly less likely to have access to a buprenorphine provider compared to White patients. The economic, social, psychiatric, and emotional havoc of the COVID-19 pandemic has exacerbated an already worsening opioid crisis and highlighted the need for lower threshold access to evidence-based, life-saving OUD treatment. Moreover, the pandemic has disrupted traditional health care delivery methods, further limiting access to buprenorphine through established care settings.
September 15, 2020
As we approach the sixth month of widespread community transmission of COVID-19 in the United States, our focus must shift beyond acute management of disease to the broader effects of this pandemic on health and wellbeing. In particular, it is important that we understand the consequences of the COVID-19 pandemic on the mental health of children and adolescents. The rate of serious mental health illness in children has been escalating over the past two decades, with teen suicide rates more than doubling over the last ten years. The COVID-19 pandemic has led to significant financial and psychosocial stressors that are likely to increase the burden of mental health needs for youth.
September 14, 2020
In recent years, remarkable achievements in HIV testing and antiretroviral therapies have improved the detection, management, and care of persons living with HIV (PLWH). In the 1980s and 90s, patients with HIV infection faced a devastating prognosis. But now, with proper medications and support, PLWH can enjoy long and fulfilling lives. Thus, when the topic of suicide among PLWH is raised, many physicians are surprised. They often ask me, “wasn’t suicide an issue of a time before we had access to antiretroviral therapies?”
In our recent study in AIDS Care, my colleagues and I found that suicidal thoughts and attempts remain a pressing concern among PLWH, who are significantly more likely to die by suicide compared to the general population. Given that HIV infection can be well-managed with proper care, what accounts for the elevated risk for suicide among PLWH?
September 9, 2020
Colorado’s response to the COVID-19 pandemic has been informed by an evolving partnership between academia and public health practitioners that can serve as a model for other states. As a core member of the COVID-19 Modeling Group—organized as the pandemic reached Colorado—my work is focused on informing hospital and local health department capacity to mitigate and suppress COVID-19. I also lead the development of a public-facing website to track indicators relevant to the pandemic. My engagment began on March 17 when I received an e-mail from the Dean of the Colorado School of Public Health asking: “Do you have the Census data in hand? May want it for modeling the epidemic.” At that point, Colorado had identified 30 cases of COVID-19 and Governor Jared Polis had issued an executive order to suspend all downhill skiing operations. In the weeks to come, the numbers would grow exponentially.
September 2, 2020
On August 3, 2020, The New York Times ran an article entitled “Is Telemedicine Here to Stay?” The article presented various reasons to answer "yes" to that question, and reasons to answer "no." The question, and its answers, offer a powerful and useful example of organizational change generally, as well as change in health care specifically. The uncertainty surrounding telemedicine’s future demonstrates the challenge of sustaining so many organizational changes, not just digital health care, and provides insight into why most organizational change initiatives fail. In this post, I suggest concrete actions that health care provider organizations can take to ensure successful and sustained integration of telemedicine.