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.
An opioid overdose is significantly more than an isolated event. Patients who present to the emergency department (ED) with overdose have a 6 percent risk of dying in the following year. As with other high-risk acute conditions, we expect patients who survive overdose to receive evidence-based treatment after leaving the hospital. Whether the overdose was due to prescription opioids or injection drugs, the first occurrence or recurrent, in people with diagnosed opioid use disorder (OUD) or not - we know that timely follow-up care can save lives. But our recent national study showed that just 16% of privately insured patients obtain that essential care.
To address the global health crisis of COVID-19 and its effects on the practice of oral and maxillofacial surgery (OMS), Penn Dental Medicine held a virtual OMS COVID-19 Response Conference on April 9, 2020. The event, organized by Drs. Anh Le and Neeraj Panchal of Penn OMS, featured leading oral and maxillofacial surgeons and administrators from multiple institutions discussing how COVID-19 has transformed the specialty. We recently published proceedings from the conference in the Journal of Oral and Maxillofacial Surgery.
Some states, mostly in the south and Midwest, have been gingerly moving toward reopening restaurants with sit-down dining. You would be separated from other tables (no more din) and your server will look creepy with a mask, but at least you will be able to get out of your home and have someone else cook and wait on you. There has of course been considerable controversy over whether relaxing government rules to permit this activity is safe, and many states, such as Pennsylvania, are not there yet statewide and will change by county if they do. What is the solution to the problem when some people want to emerge from lockdown even though they might infect others? (reposted from the Philadelphia Inquirer)
As we speak, researchers are studying the efficacy of various state interventions in response to the Covid-19 pandemic. How different would deaths have been in New York if only schools were closed, while the rest of the economy remained open? How different would hospitalizations have been had California not locked down? These questions are inherently causal, as they require a comparison of outcomes across “alternate realities” where everything but the policy intervention remains the same. Given that hopping between parallel universes is impossible (for now), statistical methods – such as matching, regression adjustment, inverse-probability weighting, difference-in-differences, and instrumental variables – rely on important assumptions. For instance, all causal methods rely on ignorability assumptions. Ignorability requires that after adjusting for various observed differences at, say, the state level, some other state that did not lock down is “comparable” to California. This allows us to estimate a counterfactual hospitalization rate that would have occurred in absence of lockdown using data from this comparable state.
Accountable care organizations (ACOs) are the largest experiment in payment reforms, but the incentive structure may lead participating physician groups to select fewer vulnerable patients. In a new study in JAMA Network Open, my colleagues and I tested whether physician groups changed their proportions of black patients and patients with low socioeconomic status after joining the Medicare ACO, and found that – in general – they did not. These results are reassuring, although continued monitoring is needed.
In the wake of apandemic that has decimated many hospitals’ budgets, many industry insiders foresee a spike in mergers and acquisitions, in both the for-profit and nonprofit sector. How should anti-trust regulators weigh the costs and benefits of this consolidation for consumers? A recent study by Guy David and colleagues suggests that profit status should not be a factor in regulatory decisions.
In a new paper in JAMA Network Open, our team looked at the potential effects of Medicaid work requirements on Medicaid participation among those not actually subject to these requirements. We estimate that these “spillover effects” – which thus far have not been part of the conversation on work requirements – could be quite large. How we arrived at this answer is worth a bit of explanation.
Accountable care organizations (ACOs) figure prominently in Medicare’s shift “from volume to value.” Providers in ACOs assume financial accountability for overall quality and costs for a defined patient population, and they earn shared savings for containing spending below a defined benchmark. To date, most ACOs have focused on primary care, outpatient services, and care management for patients with chronic medical conditions, such as diabetes and heart failure. This strategy has yielded some savings, but many ACOs may be missing a critical source of savings: surgical procedures.
The novel coronavirus, true to its name, continues to display properties that are surprising once discovered. The official data from the Centers for Disease Control and Prevention on reported cases and deaths appeared to indicate that it is much more lethal than other viral infections (like the flu). In Pennsylvania we have had about 1,600 deaths out of 40,000 cases, or a death rate of 4% (slightly less than the overall national rate but above that in rural states). However, new research using antibody tests that detect whether the test taker had an infection have consistently shown much higher rates of prevalence than indicated by identified cases.
In a newly-published article in Gastroenterology, my colleagues and I present a dramatic chart showing decreases in cirrhosis hospitalizations attributable to the COVID-19 pandemic. This study is one of the first to quantify nationwide shifts in the way health care is being delivered during the pandemic.
As the current COVID-19 pandemic demonstrates, nurses have a critical role in the coordination, delivery, and evaluation of care. Studies show, however, that nursing care is often “missed,” meaning that it is delayed, partially completed, or not completed at all. In a recent study at Penn Nursing's Center for Health Outcomes and Policy Research, my colleagues Eileen Lake, Douglas Sloane, and I investigated how changes in the hospital work environment and nurse staffing over time affect missed nursing care.
In a new study published in JAMA Oncology, my colleagues and I find that behavioral nudges can promote high-value, evidence-based prescribing of specialty drugs in cancer care. For patients with breast, lung, and prostate cancer with bone metastases, clinicians face a decision between two therapies of comparable effectiveness but dramatically different cost. Guidelines endorse the use of either zoledronate or denosumab, bone-modifying agents that protect against skeletal complications. But zoledronate costs as little as $215 a year while denosumab costs as much as $26,000 a year.