Featured Post
January 21, 2021
The United States has one of the highest rates of low birthweight (LBW) among OECD countries, with significant disparities by race and ethnicity. We know that maternal “resilience”—protective factors that buffer the health effects of stress and adversity—may be associated with lower LBW rates, but the relationship among maternal resilience, race/ethnicity, and LBW is not clear. Identifying resilience and LBW patterns by race/ethnicity is important to target prevention efforts.
March 17, 2021
Hospitals lost more than $20 billion in revenue when the pandemic led to an unprecedented nationwide shutdown in elective surgical procedures from March to May 2020. In a new Annals of Surgery study, we quantified this impact and analyzed the potential implications of a widespread interruption in elective surgeries for patients, health disparities, and the financial health of hospitals.
March 10, 2021
[Cross-posted with Penn Center for Mental Health]
Screening tools for autism spectrum disorder (ASD) often fail to identify ASD among children from low-income families and racial/ethnic minority groups, particularly when English is not the family’s primary language. A new visually-based tool may reduce these disparities at a pivotal point in children’s development.
In Pediatrics, Zuleyha Cidav, David Mandell, and colleagues found that the Developmental Check-In Tool (DCI) can accurately identify ASD risk among young children from families that have low income or speak English as a second language.
March 8, 2021
The 2016 presidential campaign saw a dramatic rise in anti-immigrant rhetoric. The sudden, high-profile change was associated with a substantial decline in utilization of health care services by undocumented adults and their children, as shown in the above chart. That’s the takeaway message from a new study in JAMA Network Open by former LDI Associate Fellow Joseph Nwadiuko and colleagues.
The authors compared primary care visits, emergency department use, and inpatient discharges from 2014 through 2017 for more than 20,000 patients in the Johns Hopkins Health System (JHHS). From the announcement of Donald Trump’s candidacy in June 2015 through May 2018, there was a 43.3% relative decrease in primary care visits for undocumented children and a 34.5% relative decline in undocumented adult primary care visits. Emergency department use increased for undocumented children, and there was a relative decrease in hospitalizations among undocumented adults.
March 4, 2020
COVID-19 changed every aspect of our lives, from shopping for groceries to visiting doctors. Early public health messages encouraged people who thought they could put off emergency care to avoid the emergency department (ED), to save capacity for an anticipated surge of COVID cases. Our new study confirms earlier findings from the Centers for Disease Control and Prevention (CDC) showing quite how often this occurred. It also gives us new insights into who stayed home and what kind of care they deferred.
March 3, 2021
[Cross-posted from the Health Affairs blog]
This morning, the Vaccines and Related Biological Products Advisory Committee (VRBPAC) will meet to discuss Johnson & Johnson's/Janssen’s EUA request for what would be the third COVID-19 vaccine to be authorized by the U.S. Food and Drug Administration (FDA). Long an obscure but influential part of the FDA approval process for new treatments and vaccines, VRBPAC has received unparalleled attention during the COVID-19 pandemic. It already met an unprecedented three times in a two-month period late 2020, first to discuss COVID-19 vaccine licensure and the emergency use authorization (EUA) process, and then to consider EUA requests for specific COVID-19 vaccine products from Pfizer/BioNTech and Moderna. Composed of a group of nongovernmental scientists, clinicians, and other experts, VRBPAC helps the FDA obtain independent, expert advice on scientific and regulatory matters, including evaluating vaccine safety and efficacy, and critically, makes these deliberations public and transparent.
February 23, 2021
Prescribing harmful combinations of drugs is an all-too-frequent occurrence, particularly in fragmented health care systems where a patient’s care is spread across multiple physicians and organizations. In a new analysis, my colleagues and I report on what happened to harmful prescribing when Finland implemented a new, nationwide e-prescribing system. We show that new information technology can have a substantial impact by improving information flows between different physicians involved in a patient’s care.
February 17, 2021
In the U.S., providers have tried to increase their leverage over insurers through consolidation—including hospital mergers, vertical integration of hospitals and physician practices, and agglomeration of physician practices into larger multi-specialty groups. But even if doctors and hospitals do not merge, they might still improve their position through collective bargaining. A recent economic case study of such collusion in Chile published in the RAND Journal of Economics and written by LDI Senior Fellow Juan Pablo Atal and Jorge Alé-Chilet and shows prices can increase dramatically, with serious consequences for patients.
The authors study the experience of a trade association of gynecologists in Chillán, Chile. For years, gynecologists in Chillán believed private rates were too low. In 2011, 26 out of 29 gynecologists in the city formed the Gynecologists’ Association of Ñuble. The next year, association members simultaneously canceled their contracts with private insurers, set a new minimum fee for office visits, and named a single representative for all future negotiations. The effect on office visit prices, consumer out-of-pocket expenditures, and provider revenue were large and immediate. Prices for office visits rose by 80%, and patient out-of-pocket costs doubled as coinsurance rates also increased. Consequently, provider profits more than quadrupled. In 2013, the government investigated the association for anti-trust offenses and shut it down in 2016. These results have significant implications for the FTC, which is reviewing similar arrangements in the U.S., as well as value-based payment initiatives, which are associated with provider consolidation.
February 16, 2020
[Cross-posted from the Tradeoffs' Research Corner]
COVID-19 has transformed the way we deliver health care in the United States. With declining in-person visits, the use of telemedicine has taken off, spurred in part by regulatory changes that expanded telemedicine reimbursement by Medicare, Medicaid and private insurers.
There are potential upsides to the expanded use of telemedicine. It offers more convenience for patients, increases access to care in areas with physician shortages such as rural America, and, in some cases, lowers no-show rates. And, during the pandemic, it has offered access to health care for many people who otherwise would have delayed or foregone care. But there are also potential downsides, and a recent paper in JAMA Network Open highlights one of them – increasing inequities in health care access.
February 15, 2021
In states that expanded Medicaid after the Affordable Care Act (ACA), safety-net hospitals (SNHs) saw their operating margins improve and levels of uncompensated care decrease. But a new study finds that while SNHs were also able to scale up some safety-net services—such as inpatient psychiatric care—these changes did not translate into measurable improvements in quality.
SNHs provide essential care to patients and are a vital part of many communities. Despite their crucial role, many SNHs perform poorly on quality measures, and often lack the resources to invest in quality improvement initiatives.
In the new JAMA Internal Medicine study, Paula Chatterjee and Rachel Werner compared quality, financial, and operational outcomes between 495 SNHs in expansion states and 316 SNHs in non-expansion states from 2012 to 2018. Since there is no universal definition for SNHs, they considered a hospital to be a safety-net institution if it was in the top 25% of hospitals for uncompensated care provided in 2010 or 2011 (pre-ACA).
February 11, 2021
As the federal government debates the financial stimulus needed to address the economic fallout from the coronavirus pandemic, the last recession offers an important reminder of the long-term health effects of a slow and uneven recovery. As large parts of the U.S.—particularly rural areas—failed to fully recover economically following the Great Recession, they experienced markedly different health fortunes from areas that experienced a robust recovery. If the pandemic exacerbates these economic trends, we may be left with an even greater disparity in the health and well-being of Americans living in different parts of the country.
The decade following the Great Recession saw the average life expectancy of Americans decline for the first time since the Spanish Flu pandemic of 1918. Studies have noted the rise in so-called "deaths of despair," or deaths from substance abuse and suicide, particularly among the middle-aged white population during this period. The decline in deaths from heart disease, one of the major health advancements of the second half of the 20th century, has also slowed down, and may now be rising again.
What is driving these troubling trends? My colleagues and I published a new study in the Journal of the American Medical Association, in which we found that the diverging economic fortunes of different parts of the country in the post-recession period were linked to differing death rates from heart disease and stroke among middle-aged Americans.
February 10, 2021
What kind of care do patients expect after they are discharged from a hospital to a skilled nursing facility (SNF)? And how do those expectations align with care they actually receive from physicians and advanced practitioners? We know surprisingly little about the patient care experience in these post-acute settings, even though 1.5 million people in the U.S. are discharged to them each year.
February 9, 2020
Through a policy known as “scoop and run,” Philadelphia police play an integral and growing role in the emergency medical transport of victims of the city’s gun violence epidemic. Blood loss is the most critical threat to survival after a serious penetrating wound. Rapid transport to a nearby trauma center by police can be life-saving. When we took a closer look at which patients are transported by police, and evaluated the impact of police transport on patients, police, and clinicians, we identified important and actionable trade-offs to police transport as well as opportunities to consider its health equity implications.Through a policy known as “scoop and run,” Philadelphia police play an integral and growing role in the emergency medical transport of victims of the city’s gun violence epidemic. Blood loss is the most critical threat to survival after a serious penetrating wound. Rapid transport to a nearby trauma center by police can be life-saving. When we took a closer look at which patients are transported by police, and evaluated the impact of police transport on patients, police, and clinicians, we identified important and actionable trade-offs to police transport as well as opportunities to consider its health equity implications.