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.
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.
August 31, 2020
In our new study in BMJ Open, we show that in 2015-2019 more than 70% of U.S. opioid-naive patients received an opioid prescription after knee arthroscopy. They received an average of 40 tablets, despite recent studies showing most patients end up taking less than 5 tablets. The take-home message? Despite recent attention to opioid stewardship, we find wide variation in opioid prescribing for the most common outpatient procedure and ample opportunity for improvement.
August 27, 2020
Five percent of Medicaid enrollees account for nearly 50% of Medicaid spending, making this high-cost group a promising target for care management programs. But a recent study by LDI fellows Arman Oganisian, David Grande, Nandita Mitra, Krisda Chaiyachati, and colleagues found that an insurer-led care management program for high-cost, high-need Medicaid patients did not reduce total costs of care or utilization in the first 12 months.
August 19, 2020
Black men bear the disproportionate burden of traumatic injury in the United States, and the disparities are especially acute for violent and intentional trauma. While the physical and psychosocial consequences of trauma can last a lifetime, strategies to mitigate trauma-associated psychological distress remain elusive. Recent studies by Therese Richmond and colleagues are filling this knowledge gap.
August 17, 2020
Over the past two decades, opioid overdose mortality nationwide more than doubled from 21,000 deaths in 2000 to 47,000 deaths in 2017. In a new study of Medicaid enrollees, a team of LDI fellows sheds light on the degree to which new or repeated overdoses may be driving this trend—with significant implications for overdose reduction.
In the study, current and former fellows Francesco DeMayo, Mark Neuman, Sean Hennessy, Young Hee Nam, and Penn Medicine's Warren Bilker found that opioid overdoses did not increase among new users of prescription opioids in four states (CA, FL, NY, PA), even as nationwide overdoses increased. Their findings suggest that the growing number of opioid overdoses among Medicaid enrollees may have largely been driven by repeated overdoses.
August 13, 2020
“There are virtually no regulatory structures in the US to protect health privacy in the context of the digital health footprint.”
That’s the blunt conclusion of a new analysis in JAMA Network Open by David Grande, Raina Merchant, David Asch, Carolyn Cannuscio, and colleagues. Based on interviews and surveys with 26 experts in telemedicine, law, data mining, marketing, health policy, computer science, ethics, cybersecurity, and machine learning/artificial intelligence, the authors describe challenges to health privacy inherent in how data scientists develop and commercialize personalized health data—our “digital health footprint.”
August 6, 2020
When the pandemic hit, an urban children’s hospital saw a dramatic decline in the volume of emergency department (ED) visits, as shown in the above chart. Although children are less likely to suffer severe COVID-19 illness, the pandemic nevertheless disrupted previous patterns of emergency care for pediatric patients. That’s the take-home message in a new cross-sectional study in The Journal of Pediatrics by Barbara Chaiyachati and colleagues.
The authors compared the number and type of ED visits for the first 16 weeks of 2020 to the prior three years (2017 through 2019). The number of visits for all four years was similar from the beginning of the year until week 10 of 2020, around the time the first COVID-19 case was locally reported.
August 4, 2020
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.
August 3, 2020
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.
July 30, 2020
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.
July 28, 2020
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.
July 27, 2020
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.