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.
COVID-19 has taken a severe toll on socioeconomically disadvantaged populations and racial and ethnic minority groups. It has disrupted traditional health care delivery and strained health systems to the breaking point. The need to address behavioral, economic and social determinants of health– in pursuit of the Triple Aim of better health outcomes, improved patient experience, and reduced per capita cost – has never been so compelling. In a new study published in Health Services Research, we add to the growing evidence base that community health workers (CHWs) can help meet these challenges. We used pooled data from three randomized trials to show that a standardized CHW program reduced hospitalizations and decreased fragmentation of hospital care, effects that persisted three months after the intervention ended.
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.
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.
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.
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.
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?
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.
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.
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.
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.