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.

Pharmaceutical Patent Citations and Value

Dec. 7, 2017

Discussions of drug pricing often link high prices with the need to promote innovation in the pharmaceutical industry. New technology can drive improved health outcomes, social welfare, and economic growth, but assigning value to specific innovations is technically difficult.

An Ethical Duty to Protect One’s Own Information Privacy?

Nov. 8, 2017

Anita L. Allen

In the Alabama Law Review, Anita Allen explores if individuals have a moral or ethical obligation to protect their own information privacy. Safeguarding others’ privacy is widely understood to be a responsibility of government, business, and individuals. But is anyone ethically required — not just prudentially advised — to protect his or her own privacy? If so, how might a requirement to protect one’s own privacy influence everyday choices, public policy, or the law?

Allen tests the idea of an ethical mandate to protect one’s own privacy, while identifying the practical and...

Accuracy of Billing Codes Used in the Therapeutic Care of Diabetic Retinopathy

Aug. 1, 2017

Marisa Lau, Jonathan L. Prenner, Alexander J. Brucker, Brian L. VanderBeek

In JAMA Ophthalmology, Marisa Lau and colleagues, including Brian VanderBeek, seek to determine the accuracy of diagnostic, procedural, and therapeutic billing codes used in the treatment of diabetic retinopathy. As insurance billing claim databases represent a growing field of scientific inquiry within ophthalmology, validating the accuracy of billing claim codes is of increasing importance. The authors conducted a retrospective medical record review at three clinical practices, examining each patient’s billing data and medical record, measuring positive and negative predictive...

Video Analysis of Factors Associated With Response Time to Physiologic Monitor Alarms in a Children’s Hospital

Jul. 11, 2017

Christopher P. Bonafide, A. Russell Localio, John H. Holmes, Vinay M. Nadkarni, Shannon Stemler, Matthew MacMurchy, Miriam Zander, Kathryn E. Roberts, Richard Lin, Ron Keren

In JAMA Pediatrics, Christopher Bonafide and colleagues, including John Holmes and Ron Keren, seek to identify factors associated with nurses' response time to physiologic monitor alarms at the bedside. As nurse response time to bed alarms remains slow, the authors examine patient- and nurse-related factors that affect responses to alarms. The authors video recorded 551 hours of care administered by 38 nurses to 100 children. They find several variables that shorten nurses’ response time to alarms. These include if the patient was on complex care service, if family members were...

Treatment seeking as a mechanism of change in a randomized controlled trial of a mobile health intervention to support recovery from alcohol use disorders

Jul. 10, 2017

Joseph E. Glass, James R. McKay, David H. Gustafson, Rachel Kornfield, Paul J. Rathouz, Fiona M. McTavish, Amy K. Atwood, Andrew Isham, Andrew Quanbeck, Dhavan Shah

In Journal of Substance Abuse Treatment, Joseph Glass and colleagues, including James McKay, assessed the efficacy of an Addiction-Comprehensive Health Enhancement Support System (A-CHESS) in increasing the use of services for addiction. This model is an electronic health framework that has been applied to a diverse set of health problems, including pediatric asthma and breast and lung cancer, and was previously adopted to alcohol addiction in a randomized-controlled trial. The authors conducted secondary data analyses of this trial, including 349 adults with alcohol use disorders...

Conflict of Interest for Patient-Advocacy Organizations

Jun. 29, 2017

Matthew S. McCoy, Micahel Carniol, Katherine Chockley, John W. Urwin, Ezekiel J. Emanuel, and Harald Schmidt

In the New England Journal of Medicine, Matthew McCoy and colleagues, including Ezekiel Emanuel, examine conflicts of interest arising from the presence of industry executives on the boards of patient-advocacy organizations. Previous research has raised concern that the presence of industry leaders on the boards of these non-profit organizations may lead to advocacy for questionable reforms that do not always benefit the organizations’ constituents. The authors analyzed tax records, annual reports, and websites of 104 of the largest U.S patient-advocacy organizations to understand...

Clinician-Targeted Mobile Apps in Palliative Care: A Systematic Review

Jun. 21, 2017

Salimah H. Meghani, Meredith A. MacKenzie, Brianna Morgan, Youjeong Kang, Anum Wasim, and Saleem Sayani

 

In Journal of Palliative Medicine, Salimah Meghani and colleagues identify and review available palliative care-related smartphone applications for clinicians. The authors assess growth in development of these apps, and review them for purpose, target audience, and number of downloads. They found that the number of palliative care apps targeting clinicians has increased eight-fold over the past five years. Of the 46 applications identified, nine were designed to assist clinicians with goals of advance care planning, seven provide training materials for palliative care, 17 present...

The “value” of value in gynecologic oncology practice in the United States: Society of Gynecologic Oncology evidence-based review and recommendations

Jun. 20, 2017

David E. Cohn, Emily Ko, Larissa A. Meyer, Jason D. Wright, Sarah M. Temkin, Jonathan Foote, Nathaniel L. Jones, Laura J. Havrilesky

In Gynecologic Oncology, David Cohn and colleagues, including Emily Ko, examine trends in gynecologic oncology health care expenditures, and assess how costs may be affected by new models of health care delivery and payment. The authors conduct a review on behalf of the Society of Gynecologic Oncology, and discuss the financial burden of increasing co-payments for cancer patients. They emphasize the need for gynecologic oncology practitioners to prepare for new models of cancer care delivery, such as Oncology Patient-Centered Medical Homes (OCPHM), as well as newer pay for...

Defining Value in Radiation Oncology: Approaches to Weighing Benefits vs. Costs

Jun. 20, 2017

Andre Konski

In Oncology, Andre Konski considers health care payment models and the transition from fee-for-service to value-based payment as it applies to radiation oncology. Konski examines difficulties in determining value, pointing out that both patients and payers could be considered health care ‘customers’ . He assesses how traditional cost-effective analyses may not be suitable for novel radiation oncology therapies, especially as consumers are increasingly conscious of the costs of treatment plans. He argues that radiation oncologists must consider the cost to patients when designing...

43 Ways to Leave Your Technology

Feb. 14, 2017

We recently convened an expert roundtable to tackle how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable. This got us thinking - while the process by which ineffective practices or technologies are abandoned is neither simple nor automatic, even the language used to describe it is not clear. And language matters. It often reflects an unstated focus on one mechanism or one level of decision-making. Here we review, and potentially clarify, the terminology.

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