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.
December 2, 2020
As the Supreme Court mulls yet another challenge to the constitutionality of the Affordable Care Act (ACA), we have new evidence of the law’s positive impact on young adults, who were allowed to stay on their parents’ insurance until age 26 under the Dependent Coverage Provision (DCP). The ACA helped young adults with cancer maintain continuous coverage, which is key to maintaining access to cancer treatment.
In a recent retrospective cohort study, my colleagues and I found that cancer patients who turned 19 in 2010-2012 (who were eligible to stay on their parents’ insurance) were 15% less likely to lose coverage than those who turned 19 in 2007-2009, before the ACA. We used commercial claims data to identify about 2,800 young adults with a cancer diagnosis between 2000 and 2015, and compared them to their peers prior to the ACA’s implementation. We matched the two groups on cancer type, diagnosis date, and clinical characteristics, and compared time to loss of insurance over 5 years.
December 1, 2020
Women want to have a good birth, in which both they and the baby are healthy and happy at the end. For most women, the optimal birth outcome is a spontaneous vaginal birth (SVB), one without forceps or a vacuum. Some women may be surprised to learn that the hospital where they give birth has a significant effect on the kind of birth they will have. In a new study of nearly 500 hospitals in four states in 2016, Eileen Lake and I find that SVB rates vary widely, even for women at low risk for cesarean section. Let’s take a closer look at these results and what it tells us about hospital deliveries.
November 24, 2020
As the U.S. enters the tenth month of the COVID-19 pandemic, it is hard to imagine a time when telemedicine was not a mainstay of health care delivery, particularly in the care of vulnerable patients. However, few studies have examined the scale of how outpatient care has changed at the national level, and whether the changes have been sustained beyond the early months of the pandemic. In our recent study in Hepatology Communications, we found that telemedicine use for outpatient hepatology care in the Veterans Health Administration (VHA) not only dramatically increased during the early months, but has continued at similar levels as the pandemic progresses.
November 12, 2020
How do patients with Alzheimer's disease and related dementias (ADRD) fare in capitated Medicare Advantage (MA) managed care plans, compared to their peers in traditional Medicare (TM)? This question is increasingly important, as nearly one-third of beneficiaries now choose MA, and the human and financial cost of living with ADRD is substantial.
November 9, 2020
Patients in inpatient psychiatric care are especially vulnerable to physical and psychological harm, but they have largely been excluded from efforts to monitor, understand, and improve quality of care. In 2012, the Centers for Medicare and Medicaid Services (CMS) implemented the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program to ease inpatient psychiatry into the norms and scrutiny that general hospital care has received for a long time. In a recent study in Medical Care, my co-author and I found that the IPFQR Program has positively impacted restraint and seclusion, reducing the duration of each by about 50% from 2012-2017. Our study is the first and only examination of the IPFQR Program on restraint and seclusion use.
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.