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.
November 2, 2020
For patients with cancer, serious illness conversations (SICs)—structured conversations about prognosis, goals, and wishes—can reduce depression and anxiety, improve quality of life, and avoid unnecessary acute care utilization. Early SICs are now endorsed as a metric of high-quality cancer care. However, only 10% of patients with cancer have a documented conversation with their oncologist. What’s preventing these conversations?
October 29, 2020
Only about 1% of children in the U.S. are considered medically complex, but when you work in a busy Children’s Hospital Emergency Department (ED) in a large urban area, the prevalence seems much higher. We see a range of children with complex conditions, such as severe asthma coupled with significant eczema, metabolic disorders, and illnesses requiring a ventilator or other life-sustaining equipment. In our anecdotal experience, these children have a much more difficult time navigating through a complex system when an emergency occurs, and some studies suggest that they are at higher risk of adverse medication events. To understand the experiences of these children and their families when they seek care in an ED, our team interviewed 20 parents and 16 pediatric emergency physicians.
October 27, 2020
A new study in the journal Movement Disorders calculates the considerable health care costs of Parkinson’s disease (PD), a progressive neurodegenerative disorder. Using Medicare fee-for-service claims, LDI Senior Fellows Nabila Dahodwala, Pengxiang Li, Jalpa Doshi, and colleagues quantify this economic burden in one calendar year, and measure the incremental costs of advanced disease. As the above chart shows, these one-year costs vary substantially, from $483 to $48,145 (2018 dollars). After controlling for sociodemographic, clinical, and treatment characteristics, patients with advanced PD group had about $6,000 more in claims costs than those with mild/moderate PD. These data are important for cost-effectiveness studies of PD therapies, and underscore the need to invest in efforts to delay PD disease progression and to improve treatments for advanced PD.
October 22, 2020
About one third of chronic dialysis patients have persistently high blood phosphorus levels, which increases risk for vascular damage, cardiovascular disease, and death. Some patients can control phosphorus levels through a healthy diet, although many also require the use of pills that remove dietary phosphorus in the gut. But what about patients with limited access to healthy food outlets? In a recent study, we found no link between better access to healthy food and lower blood phosphorus level, suggesting that other factors—such as patients’ food literacy, ability to read food labels, and food preferences—may play a larger role in achieving phosphorus control.
October 21, 2020
When the pandemic hit the United States, surgical centers across the country reduced the number of elective and nonemergent procedures they performed. In a recent study in The American Surgeon, Daniel Holena, John Riley, and colleagues document the extent of the decrease in surgical consults and operations performed in the University of Pennsylvania Health System (UPHS) in the 30 days before and after COVID-19 hit in March 2020. Overall, surgical consults decreased by 43%, with a significant reduction in the median daily consult volume from 14 to 8.
October 14, 2020
In the midst of the pandemic, many companies have started marketing diagnostic and serological COVID-19 tests directly to consumers. Such direct-to-consumer (DTC) tests can be initiated by consumers, typically through the company’s website. The sample can be collected at home or in a laboratory, with no or little direct involvement from a health care provider. About a dozen companies have received emergency use authorization (EUA) for diagnostic DTC COVID-19 tests and at least two for serological testing. In our recent article published in the Journal of Law and the Biosciences, we argue that while this type of testing may have a number of benefits, it also raises significant ethical and regulatory concerns, which become particularly urgent due to the scale of the present pandemic.
October 13, 2020
[cross-posted from CHOP PolicyLab]
Over the last decade, there has been considerable focus on programs targeted at reducing the acute health care use of those with the highest health care needs. The logic here is straightforward. If we want to reduce preventable emergency department (ED) visits and hospitalizations, and their associated costs, we should focus on improving care for individuals who use the ED and hospital the most. However, the counter argument is that if we were to direct those resources to lower-risk populations we could see greater health improvements for a larger number of people.
October 7, 2020
Institutional Review Boards (IRBs) — or “Research Ethics Committees” (RECs) outside the United States—are charged with protecting human research subjects. However, the quality of IRB performance is rarely subject to the same scrutiny that the boards themselves apply to research projects. In AJOB Empirical Bioethics, we conducted the first systematic analysis of 10 IRB quality measurement tools. We found widespread variability in their format, length, and content; a common emphasis on IRB structure and process; a general lack of attention to participant outcomes; and a failure to identify clear priorities for assessment.
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.