Medical Technology

Advances in drugs, devices, and biological products that change the way health care is delivered. LDI Senior Fellows study the adoption and diffusion of medical technologies and assesses their impact on costs and quality of care.

Can Machine Learning Improve Cancer Care?

Oct. 25, 2019

“How long do I have?”

It is the first question many patients ask after a cancer diagnosis. It is also among the hardest to answer. For decades, predicting cancer survival was more art than science. But now, unprecedented computing power and access to digital health information offer a tantalizing opportunity: can machine learning (ML) algorithms succeed where others fail?

Electronic Pill Bottles or Bidirectional Text Messaging to Improve Hypertension Medication Adherence (Way 2 Text): a Randomized Clinical Trial

Shivan J. Mehta, MD, MBA
Aug. 8, 2019

Shivan J. Mehta, Kevin G. Volpp, Andrea B. Troxel, Susan C. Day, Raymond Lim, Noora Marcus, Laurie Norton, Sophia Anderson, David A. Asch

Abstract [from journal]

Background: Poor medication adherence contributes to inadequate control of hypertension. However, the value of adherence monitoring is unknown.

Objective: To evaluate the impact of monitoring adherence with electronic pill bottles or bidirectional text messaging on improving hypertension control.

Design: Three-arm pragmatic randomized controlled trial.

Patients: One hundred forty-nine primary care patients aged 18-75 with hypertension and text messaging capabilities who

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Rise of the Machines in Health Care?

Feb. 22, 2019

Artificial intelligence (AI) is moving fast and breaking things everywhere. It is built into multinational supply chains, web-based services, cars, and, slowly, health care. Although the adoption of AI in health care has been bumpy, it continues unabated. Last year, the U.S.

Does Bad News Travel Faster? On the Determinants of Medical Technology Abandonment

Dec. 20, 2018

Julie Berez, Guy David, David H. Howard, Mark D. Neuman

ABSTRACT [FROM JOURNAL]

This paper studies the abandonment of technology in reaction to information shocks. While the diffusion of new technologies has been widely researched, the factors driving abandonment are not well understood. This is particularly important in the health care sector, where curbing overuse of low-value technologies is a priority. Using the abandonment of pulmonary artery catheters (PACs) as an empirical application, we aim to understand patterns of human behavior when information that a technology is ineffective becomes available. This study focuses on the...

Can We Afford to Cure Cancer?

Oct. 26, 2018

Novel gene and cell therapies hold out the promise of a cure for previously incurable conditions, often at eye-popping prices. Last month, more than 75 health policy and biomedical researchers, federal and state regulators, and clinicians convened at the Cost of a Cure Conference at the University of Pennsylvania to discuss key political, economic, and clinical challenges to the future of gene and cell therapies.

Effect of Continuing Care for People with Cocaine Dependence on Criminal Justice Sentences

Sep. 19, 2018

Alexandra S. Wimberly, Jordan M. Hyatt , James R. McKay

ABSTRACT [FROM JOURNAL]

While continuing care for substance use treatment has been associated with reduced involvement in the criminal justice system, much of this research lacks random assignment to continuing care and so is limited by self‐selection bias. This study sought to determine the impact of adding telephone‐based continuing care to intensive outpatient programs on criminal justice outcomes for people with cocaine dependence. In three continuing care studies, spanning 1998–2008, participants were randomly assigned to an intensive outpatient program or an intensive...

Mandatory Health Care Provider Counseling For Parents Led To A Decline In Vaccine Exemptions In California

Sep. 10, 2018

Malia Jones, Alison M. Buttenheim, Daniel Salmon, and Saad B. Omer

ABSTRACT [FROM JOURNAL] 

Receipt of childhood vaccinations in the US has been declining, and outbreaks of preventable infectious diseases have become more common. In response, in 2014 California implemented a policy change for exemptions from mandatory vaccines for school enrollment. Data on fifteen successive cohorts of kindergarteners enrolled in public and private schools between school years 2001–02 and 2015–16 were analyzed for changes in vaccination trends. The results show an increase in the prevalence and clustering of vaccine exemptions from 2001–02 through 2013–14,...

Comparison of Pharmacy Claims and Electronic Pill Bottles for Measurement of Medication Adherence Among Myocardial Infarction Patients

Aug. 2, 2018

Shivan J. MehtaDavid A. Asch, Andrea B. Troxel, Raymond Lim, Jennifer Lewey, Wenli Wang, Jingsan Zhu, Laurie Norton, Noora Marcus, ...

ABSTRACT [FROM JOURNAL]

Background: Medication adherence after myocardial infarction remains low. Pharmacy claims have typically been used to measure medication adherence, but electronic pill bottles may offer additional information.

Objective: The main objectives of this study were to compare the association of adherence measured by prescription claims and remote monitoring technologies with cardiovascular events.

Research Design: This study was a secondary analysis of a remote monitoring intervention to increase...

How to Pay for Proton Therapy in Cancer Clinical Trials

Jul. 20, 2018

It’s a classic Catch-22: many insurers will not cover expensive proton therapy for some cancers because there’s little proof that it’s more beneficial or less harmful than standard treatment; meanwhile, patients cannot enroll in the clinical trials to test its comparative effectiveness because their insurers won’t cover the therapy. In a commentary in the Journal of Clinical Oncology, LDI Senior Fellow Justin Bekelman and colleagues point out the dilemma and suggest a way forward.

A Randomized Controlled Trial of Opt-in Versus Opt-Out Colorectal Cancer Screening Outreach

Jul. 9, 2018

Shivan J. Mehta, Tanya Khan, Carmen Guerra, Catherine Reitz, Timothy McAuliffe, ...

ABSTRACT [FROM JOURNAL]

Objectives: Colorectal cancer (CRC) screening uptake is suboptimal, despite national efforts to increase screening rates. Behavioral economic approaches such as changing defaults may increase participation. We compare response rates to opt-in or opt-out messaging in mailed fecal immunochemical test (FIT) outreach.

Methods: This is a two-arm randomized controlled trial among 314 patients aged 50–74 years who had at least two primary care visits in the 2...

Complexity of the Relationships of Pain, Posttraumatic Stress, and Depression in Combat-Injured Populations: An Integrative Review to Inform Evidence-Based Practice

Jun. 27, 2018

Nicholas A. Giordano, Christine Bader, Therese S. Richmond, Rosemary C. Polomano 

ABSTRACT [FROM JOURNAL]

Background: Understanding the complex interrelationships between combat injuries, physical health, and mental health symptoms is critical to addressing the healthcare needs of wounded military personnel and veterans. The relationship between injury characteristics, pain, posttraumatic stress disorder (PTSD), and depression among combat-injured military personnel is unique to modern conflicts and understudied in the nursing literature.

Aim: This integrative review synthesizes clinical presentations and relationships...

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