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.
February 8, 2021
[Editor’s note: In a recent New England Journal of Medicine article, a team of researchers highlighted misrepresentations of race in U.S. medical school courses, and recommended ways to address the systemic racism that produces and reproduces these inaccuracies. In this post, three of the authors—each at different stages of their career—reflect on what they learned about the pervasiveness of the problem throughout medicine, including in their own processes and research].
February 2, 2021
Policy makers in the United States seem more interested in tying drug prices to those in other countries than nderstanding the regulatory frameworks that produce lower prices. In a recent paper in JAMA Internal Medicine, my colleagues and I outlined what we learned from studying different regulatory frameworks while writing a book, "Which Country has the World’s Best Health Care?"
The six countries we review in our paper—Australia, France, Norway, Germany, Switzerland, and the United Kingdom—have diverse financing, delivery, and reimbursement systems. None of them have the monopolistic pricing and marketing exclusivity found in the U.S. We found no evidence that the regulatory regimes resulted in meaningful delays in access to new drugs. We then identified several specific lessons learned along the path from approval to purchasing. These include uniform national prices, reimbursement tied to objective standards, linking price to therapeutic value, and considering total budget impact.
January 27, 2021
In-hospital cardiac arrests (IHCAs) are catastrophic and often terminal events. Despite improvements in resuscitation efforts, fewer than 25% of patients who experience an IHCA survive to discharge. Survival varies significantly across hospitals and by race. Racial disparities in IHCA survival have been linked, in part, to the quality of care during hospitalization.
Due to direct and frequent contact with patients, nurses constitute around‐the‐clock surveillance systems and can detect changes in patient status and prompt appropriate interventions when conditions deteriorate. In our new study in Medical Care, we examined whether nurse staffing levels affect between-hospital racial differences in IHCA outcomes. We found that survival differences between Black and white patients are associated with medical-surgical nurse staffing levels in the hospital where they receive care.
January 25, 2021
[Cross-posted with Penn Center for Mental Health]
The opioid epidemic is in its fourth and possibly deadliest wave, exacerbated by the COVID-19 pandemic and disproportionately killing people of color. Medications for opioid use disorder (MOUD)—including methadone, buprenorphine, and naltrexone—are effective in combatting the epidemic, but sorely underused. Philadelphia’s Department of Behavioral Health and Intellectual disability Services (DBHIDS) recently enacted a suite of policies to remove logistical, structural, and payment barriers to MOUD in the publicly-funded behavioral health system, but some facilities still do not use these medications.
To better understand MOUD barriers, my colleagues and I interviewed 25 executive directors of publicly-funded treatment organizations in Philadelphia that adopted or did not adopt MOUD, finding that stigma towards medications and ideological beliefs about OUD treatment contribute to non-adoption.
January 19, 2021
The U.S. Department of Health and Human Services (HHS) overturned their longstanding requirement that physicians must receive approval and undergo training to prescribe buprenorphine, the topline treatment for opioid use disorder (OUD). This is an historic shift in policy, and its importance cannot be overstated. Last week, there were fewer than 100,000 waivered providers. Now, over one million active physicians are permitted to prescribe buprenorphine to up to 30 patients at any one time (hospital-based physicians who initiate buprenorphine treatment are not subject to the 30-patient limit).
January 14, 2021
[co-posted with the Penn Center on Mental Health]
Recognizing that community resources for people who use drugs are threatened by this pandemic, an interdisciplinary team of certified recovery specialists, social workers, nurses, and physicians at the University of Pennsylvania created the “Warmline” in the spring of 2020 to field calls from people seeking connection to treatment for opioid use disorder.
January 13, 2021
For patients with gynecologic cancers, treatment by a specialist—a gynecologic oncologist—is crucial for improving chances of survival. However, in 2015, as many as 10% of women in the U.S. lived in a county that was more than 50 miles from the closest gynecologic oncologist. In a new study, my co-authors and I found that since 2015, gynecologic oncologists are working at more clinics and hospitals and covering a greater geographic area, thus providing greater access to specialized gynecologic cancer care. Our findings suggest that rural disparities related to access to gynecologic cancer care may be addressed by having doctors travel to their patients, rather than the other way around.
January 7, 2021
After hospital discharge, about 40% of Medicare beneficiaries receive post-acute care (PAC) services, such as home health care (HHC), skilled nursing, or inpatient rehabilitation. But do they get the right care at the right time? A recent study found that while sicker patients received more intense levels of PAC services, patients with greater chronic illness were more likely to be rehospitalized in the 30 days after discharge. These findings highlight the importance of assessing patient readiness for discharge and strengthening care transitions from the hospital to ensure that patients get the appropriate care at the right time.
December 21, 2020
At its onset, the COVID-19 pandemic severely disrupted medical care, as millions of ‘elective’ procedures were postponed or cancelled. While the volume of many procedures rebounded by the end of July 2020, the disruption caused a massive backlog. A recent article in Health Services Research looks at the impact of the COVID-19 pandemic on one common procedure, mammograms, and answers the question: When might we expect to clear the queue and return to regular operations?
December 16, 2020
An estimated 34 million Americans provide informal care to family members or friends, often at high emotional and physical cost. While informal caregivers make up an essential part of the health care continuum, health care policies and payment models rarely take caregivers into account. With growing policy efforts to shift care out of costly institutions and into home and community-based settings, understanding how the increased responsibility affects informal caregivers will only become more crucial.
December 11, 2020
In a new nationwide study in JAMA Network Open, we describe the current prevalence and geographic distribution of X-waivered obstetrician-gynecologists in 2019 among more than 31,000 who treat patients with Medicaid. We found that only 560 (1.8%) are X-waivered. Those who are X-waivered are more likely to work primarily in outpatient settings and in counties with fewer uninsured patients. Increasing the number of X-waivered obstetrician-gynecologists is critical to reducing the barriers that pregnant patients with OUD face when seeking treatment.
December 9, 2020
As some college and university leaders plan to resume in-person instruction this spring, it is critical to determine the best way to identify COVID-19 cases among students to safely repopulate campuses. However, there is a lack of consensus about the optimal testing strategy to identify the most infections. In a recent study, we evaluated different screening strategies for the fall term and quantified the number of infected students detected with each approach. While each strategy had costs and benefits, strategies incorporating universal laboratory-based molecular testing detected more cases than symptom-based screening alone. Our findings can serve as a guide for college and university leadership as they look to reopen campuses in the new year.