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.
July 23, 2020
While COVID-19 has created unprecedented challenges for the U.S. health care system, it has also accelerated innovation, including the use and adoption of telemedicine. However, just as the burden of COVID-19 morbidity and mortality continues to fall on more marginalized populations, so too have the socioeconomic, racial, and gender inequities in access to virtual care. In a recent study in Circulation, Lauren Eberly, Sameed Khatana, Ashwin Nathan, Srinath Adusumalli, and colleagues examine how the use of telemedicine for outpatient cardiology care affected existing inequities in access to care for certain populations, and found that being female and being non-English speaking were independently associated with less telemedicine use.
July 21, 2020
Skeletal Muscle Relaxers (SMRs) are a common opioid substitute for patients with musculoskeletal conditions, but little is known about their safety and efficacy in treating long-term, chronic pain, particularly for older patients and patients with simultaneous opioid use. In JAMA Network Open, LDI fellows Sean Hennessy and Charles Leonard and colleagues Samantha Soprano and Warren Bilker recently examined national trends in outpatient SMR prescriptions from 2005 to 2016. They found that the number of office visits with an SMR prescription doubled over the last decade, but the steepest increase was among adults over age 65, for whom SMR visits tripled.
July 20, 2020
The COVID-19 pandemic has claimed over half a million lives worldwide. In the U.S., it is estimated that one in five adults who develops symptomatic COVID-19 will wind up in a hospital, and one in 20 may develop respiratory failure requiring a mechanical ventilator. For these critically ill patients, death rates range from 20-50% and increasingly, we are learning that survivors may face lasting symptoms and functional deficits. Faced with this frightening prognosis, some patients might choose to forgo aggressive medical care. Advance care planning (ACP) and advance directives allow patients to make these preferences known to their families and care teams. In a study published today in JAMA Network Open, we examined changes in demand for ACP before and during the COVID-19 pandemic.
July 8, 2020
[cross-posted from CHOP PolicyLab]
Community benefit spending by our nation’s nonprofit hospitals has always been a hot-button issue. To qualify for nonprofit status, health care systems are required to report annually to the Internal Revenue Service how they direct resources towards the community. And the results, for years, have been underwhelming.
In the midst of the COVID-19 epidemic, many people may not have seen our new JAMA Network Open study published last month, which further illustrates this evolving story. The pandemic also provides us an opportunity to examine the issue of community benefit spending through a new lens.
July 2, 2020
As the country looks to reopen and epidemiologists anticipate future waves of coronavirus (COVID-19) cases, we must address an equally important “pandemic:” the virus’ far-reaching mental health and trauma-related consequences. Whether balancing activities of essential work with exposure risk, bearing witness to suffering or loss, or feeling anguish or guilt for not “doing more” during this time, our society is facing great adversity with potentially devastating consequences. Evidence-based frameworks exist to guide our individual and collective response and prevent the pandemic’s trauma-related effects. What does a trauma-informed framework tell us about how to respond to this mounting crisis to mitigate the aftershocks from the pandemic?
July 1, 2020
[cross-posted from Health Affairs]
In the span of mere weeks, the novel coronavirus (COVID-19) has upended modern life. Schools and businesses across the country have been shuttered, and the global economy faces the worst downturn since the Great Depression. While the pandemic itself is unprecedented, the situation is particularly alarming given the absence of virtually any therapeutics or vaccines that can treat or prevent COVID-19. Pharmaceutical companies large and small have rapidly expanded research efforts over the past weeks, and there are now more than 70 COVID-19 drug and vaccine trials registered with the Food and Drug Administration (FDA).
June 30, 2020
[cross-posted from Annenberg]
While effective vaccines to control the current pandemic are likely at least a year away, public health officials believe the time to build confidence in those vaccines is now. A new report from the Sabin-Aspen Vaccine Science & Policy Group presents an in-depth analysis into the root causes of vaccine hesitancy and actionable steps to address it. Author of How Behavior Spreads and an expert in network science, Professor Damon Centola contributed an essay, entitled "The Complex Contagion of Doubt in the Anti-Vaccine Movement," to the report. He recently answered a few questions about the anti-vaccination movement and how to curb it.
June 29, 2020
In the longest and largest study to date, hospital participation in Medicare’s bundled payments program for four medical conditions was associated with a 1-2% savings over three years, with no change in mortality. The savings were primarily achieved through reduced spending on skilled nursing care and greater spending on home health in the 90 days after hospital admission for acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, or pneumonia.
June 17, 2020
In October 2018, the Centers for Medicare & Medicaid Services (CMS) launched the Bundled Payments for Care Improvement Advanced (BPCI Advanced) program to continue expanding bundled payments nationwide. Participating hospitals and physician group practices are eligible for financial incentives if they meet quality and cost benchmarks for 90-day episodes beginning with either a hospital admission or an outpatient procedure. In a previous post and article, we described the 832 hospitals that began participating in October 2018.
June 12, 2020
[cross-posted from Health Affairs]
Americans are dying at startling rates, not only of COVID-19 but of all its reverberating effects. To save US lives, we will need to solve not one problem but four. First, we need to reduce community spread of the virus; contact tracing has been highlighted as a solution but is unlikely to be effective unless it is coupled with culturally appropriate, trusted support. Second, millions of people are losing their jobs and struggling to pay for necessities such as food, housing, and medication. Third, many people with chronic conditions such as diabetes and asthma have had to forgo routine care that is critical to maintain their health because they have lost employer-sponsored health insurance or because routine appointments have been suspended. And finally, the stress and isolation of the pandemic is affecting Americans’ mental health, and experts worry that suicide deaths will spike.
June 11, 2020
[cross-posted from CHOP PolicyLab]
Each year there are approximately 400,000 children in the child welfare system in the United States. Children in foster care represent a critically vulnerable population. Nothing illustrates this more than findings from our recent JAMA Pediatrics study, through which we found that children in foster care were 42% more likely to die compared to children in the general population and the difference has increased over time.
Which begs the question, why?
May 28, 2020
A new study suggests that hospitals, payers, and patients might learn something useful about the quality of skilled nursing facilities (SNFs) by checking online Yelp reviews. These reviews could provide important information beyond publicly reported ratings to inform decisions about postacute care.