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 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...

Nurse Generated EHR Data Supports Post-Acute Care Referral Decision Making: Development and Validation of a Two-step Algorithm

Jun. 20, 2018

Kathryn H. Bowles, Sarah J. Ratcliffe, Mary D. Naylor, ...

ABSTRACT [FROM JOURNAL]

Objective: Build and validate a clinical decision support (CDS) algorithm for discharge decisions regarding referral for post-acute care (PAC) and to what site of care. 

Materials and Methods: Case studies derived from EHR data were judged by 171 interdisciplinary experts and prediction models were generated. 

Results: A two-step algorithm emerged with area under the curve (AUC) in validation of 91.5% (yes/no refer) and AUC 89.7% (where to refer). 

Discussion: CDS for...

Loss-Framed Financial Incentives and Personalized Goal-Setting to Increase Physical Activity among Ischemic Heart Disease Patients Using Wearable Devices: The ACTIVE REWARD Trial

Jun. 13, 2018

Neel P. Chokshi, Srinath AdusumalliDylan S. Small, Alexander Morris, Jordyn Feingold, ...

ABSTRACT [FROM JOURNAL] 

Background: Regular physical activity reduces the risk of cardiovascular events, but most ischemic heart disease (IHD) patients do not obtain enough.

Methods and Results: ACTIVE REWARD (A Clinical Trial Investigating Effects of a Randomized Evaluation of Wearable Activity Trackers with Financial Rewards) was a 24‐week home‐based, remotely monitored, randomized trial with a 16‐week intervention (8‐week ramp‐up incentive phase and 8

...

Conflict of Interest Among Public Speakers at FDA Advisory Committees

Apr. 23, 2018

Engaging patients, families, and independent experts in policymaking is a laudable goal, but the process of doing so isn’t necessarily straightforward. If efforts to introduce patient and public perspectives also introduce bias, they may do more harm than good. A recent study raises concerns about bias in public engagement, finding that public engagement efforts by the Food and Drug Administration (FDA) may attract speakers with significant conflicts of interest (COI), which are frequently undisclosed.

Three Solutions to Maximize the Clinical Benefit and Affordability of Targeted Cancer Drugs

Apr. 18, 2018

Spending on cancer drugs in the United States has nearly doubled in the past five years and continues to grow, imposing substantial financial burden on patients with cancer. One of the biggest drivers of this growth is targeted cancer drugs – small molecules, monoclonal antibodies, and other therapies for cancer that target specific genomic aberrations. Now, a group led by the Abramson Cancer Center of the University of Pennsylvania has proposed three solutions to maximize the clinical benefit and affordability of targeted cancer drugs.

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