Category Archives: General

Hitching our Wagon to the Stars: Making the Most of Quality Reporting

The Centers for Medicare and Medicaid Services (CMS) has a set of “Compare” websites – Hospital Compare, Nursing Home Compare, Home Health Compare, etc.; consumers and policymakers can compare physicians, long-term care hospitals, inpatient rehabilitation facilities, hospice care, and dialysis facilities today, and other settings may follow. Together with their associated health care quality measurement… Read More »

What are compassion practices, and can they play a part in improving healthcare?

Working in the healthcare profession can be both physically and emotionally draining for anyone, no matter their role or job title. Over half of physicians in the US [PDF] experience symptoms of burnout, and studies estimate a large percentage of nurses experience emotional exhaustion and have a higher prevalence of depression when compared to other US workers.  Exhaustion… Read More »

Improving the Patient Care Experience among Persons of Varying Race, Ethnicities, and Languages

Improving the overall patient care experience is an essential focus for organizations as healthcare delivery continues to evolve. The US Department of Health & Human Services Agency for Healthcare Research and Quality (AHRQ) notes patient experience as an integral component of healthcare quality, which includes “several aspects of healthcare delivery that patients value highly when… Read More »

Smoking in America: Medicaid, Quitting, and Income

Over the last few decades, cigarette smoking has become a health burden concentrated primarily among low-income individuals in the U.S. In our recently published research study, Medicaid coverage expansions and cigarette smoking cessation among low-income adults, we sought to determine the relationship between recent expansions of Medicaid coverage and smoking cessation for low-income adults. Demographics… Read More »

Addressing addiction at the local level

As the City of Worcester Commissioner of Health and Human Services, I have developed city-wide initiatives and worked on policy change to address three primary health issues prevalent in our community, those being addiction, mental health, and homelessness, which all tend to occur hand in hand. Addiction is the largest public health and public safety… Read More »

Barriers to Care Among American Indians

American Indians (AIs) typically have poorer health outcomes than any other racial or ethnic minority group in the United States. This includes an increased risk for cancer, diabetes, injury related mortality, and infant mortality.  AIs tend to have the highest rates of poverty and low rates of insurance coverage. Much of the AI population uses the Indian… Read More »

The Aging Physician

There are some occupations where employees are mandated to receive age-based skills and cognitive testing. For example, the National Business Aviation Association has a mandatory retirement age of 65 for airline pilots. Additionally, firefighters, employees of the Federal Bureau of Investigation, air traffic controllers, and nuclear material couriers are all subject to age-based regulations. These agencies impose age-based… Read More »

Promoting Primary Prevention of Neonatal Abstinence Syndrome

“Neonatal abstinence syndrome” (NAS) sounds deceptively innocuous, given that it is literally infant drug withdrawal. It is usually caused by prenatal exposure to opiates but can also result from maternal consumption of other substances, like alcohol and antianxiety medications. Common symptoms include excessive high-pitched crying, fever, sweating, irritability, vomiting, diarrhea, rapid breathing, sleep disturbances, and poor… Read More »

What happens to veterans’ health after leaving the military?

Veterans leaving military service face many challenges transitioning back to civilian life. More than a quarter of veterans report struggling with the return to civilian life, according a Pew Research Poll. Some challenges are psychological; a considerable body of research has linked veteran status with mental health concerns. Other challenges, however, can be physical. Civilian… Read More »

What’s the difference between opioid use, misuse, and addiction?

Opioid addiction seems to be in the news every day. But what’s the difference between an opioid user and an opioid addict? First, let’s define our terms. Opioids are drugs derived from the opium poppy, including heroin and morphine. The class also includes synthetic opium-derived prescription painkillers including oxycontin and fentanyl, as well as drugs… Read More »

Preventing Health Care that Almost Nobody Needs

Medicine, alongside achievements in sanitation and public health, remains one of the major achievements of modern society. The reduction (or eradication) of many infectious diseases from the developed world, breakthroughs in anesthesiology and surgery, and advances in the care of chronic diseases (including HIV) are just a few of the multitudes of achievements. But these… Read More »

How Hurricane Irma Tested Emergency Preparedness Policy for Medically Vulnerable Patients

Hurricane Irma was the first major hurricane to hit Florida in over a decade, causing catastrophic damage in many areas. The human impact of the hurricane was also devastating, with reports of more than 50 deaths in the state. Among these deaths were ten residents of a nursing home in Hollywood Hills that lost power… Read More »

Healthcare engagement and follow-up after perceived discrimination in maternity care

As unconscious bias and discrimination comes to the forefront of national conversation, it is fitting to discuss bias in the healthcare system. Though we pledge to treat all patients fairly and to the best of our capacity, regardless of their background, increasing evidence suggests that healthcare providers, too, have bias and exhibit behaviors perceived by… Read More »

Mobile Apps to Improve Medication Adherence

What do you use your cell phone for on a daily basis? Many people would say using social media, texting, and placing phone calls– but have you ever considered your smartphone as a tool to improve medication adherence?  Our phones are an integral part of our lives, and consequently, researchers, clinicians, and patients have all… Read More »

Universal Health Coverage? A Response

In a recent Health Affairs blog post, Universal Health Coverage? Why?, Walter McClure, Alain Enthoven, and Tim McDonald make a convincing case for expanding health insurance coverage in the United States. They argue that universal coverage is a “wise public investment” that “expands the workforce and makes it more productive,” similar to universal public education.… Read More »

Despite ACA mandates for states to streamline renewal, many beneficiaries still need assistance to retain Medicaid coverage

Enrollment in Medicaid has been shown to enhance access to health care for our nation’s most vulnerable citizens. Yet despite these benefits, a substantial number of beneficiaries lose coverage at the time of renewal. An article by Xu Ji and colleagues, published in this month’s issue of Medical Care, demonstrates how critical maintaining continuous Medicaid coverage… Read More »

Getting recommended preventive care: costs aren’t the only barrier

Annual routine check-ups, flu shots, and mammograms are among the basic preventive services for which the Patient Protection and Affordable Care Act of 2010 established a mandate for insurance plans: full coverage, with no out-of-pocket costs. In making it a little easier for some parts of the US population to access basic services, did the… Read More »

The Prevention and Public Health Fund: Investing in Health Equity

The pursuit of health equity – ensuring equal access to opportunities that enable all communities to lead healthy lives – is a critical task for the U.S. The direct and indirect medical costs associated with sickness and premature death resulting from health care inequities are enormous (estimated to be $230 billion and $1.24 trillion, respectively,… Read More »

New methods in risk modeling: does adding EHR data improve predictions?

One of the challenges in delivering efficient medical care is identifying people who are at risk of a negative outcome, so we can focus our efforts on screening and treating those at elevated risk. We do this in individual face-to-face encounters through clinical, diagnostic processes: taking a patient’s history, performing a physical examination, recording signs… Read More »

Cancer care: sometimes less is more

Cancer is a dreaded disease – and in the US, a typical response to a cancer diagnosis is to try every treatment available in hopes that something might work. Understandable! But cancer overtreatment is a serious problem that drives up costs, causes avoidable morbidity and mortality, and reduces the quality of care. What is overtreatment?… Read More »

The Past, Present, and Future of Risk Adjustment: An Interview with Arlene Ash

Recently, I sat down to talk with Arlene Ash, PhD about risk adjustment. Dr. Ash is Professor and Chief of the Division of Biostatistics and Health Services Research, Department of Quantitative Health Sciences at the University of Massachusetts Medical School. As a methods expert on risk adjustment in health services research, she has pioneered tools… Read More »

The Intersection of Religion, Female Empowerment, and Access to Reproductive Healthcare

Reproductive rights have been a topic for policy making and legal jurisprudence throughout much of the past century. As the healthcare system of the United States continues to evolve, women’s health and reproductive rights remain central to the debate. A recent policy update by Aishwarya Rajagopalan and Lisa Lines here at The Medical Care Blog discusses… Read More »

POLICY UPDATE: Contraception Coverage

The burden of contraception falls primarily on women. In the United States, women need prescriptions for the majority of contraceptive methods, and so are vulnerable to changes in the healthcare system affecting access to care. Recently, President Trump has issued executive orders on religious liberty and related subjects that have paved the way for a rule… Read More »

How Accurate is Your Activity Tracker?

The functionality and popularity of consumer-grade activity trackers (such as Fitbit) appear to be ever-increasing.  If you don’t personally own one, you probably know at least one or two people who do.  In an online survey of 1,000 respondents [PDF], conducted in 2016 by PwC, 45% owned a fitness band, with “Health” being the primary… Read More »

Trying to Reduce Unnecessary Emergency Visits? First, Strengthen Our Primary Care System

Emergency departments (EDs) nationwide are busy places. In some locales they are overcrowded. In places like Los Angeles and other dense, urban areas with high poverty, they are over-capacity to such an extent that they can grind to a halt for all but the highest priority cases. In years past, it was not unheard of for… Read More »

The Impact of Social Media in Healthcare

What’s the first thing you do when you get sick? For many people, a cursory search through various online resources is the initial step in gathering information toward obtaining a diagnosis.  The internet places an infinite number of health-related resources at our fingertips, many of which are consumed through social media. Presently, 74% of US… Read More »

Can Claims Data Algorithms Identify the Physician of Record?

Medical claims data are collected for payment purposes. However, these data are often used for other purposes such as studying quality of care, assessing provider performance, and measuring health. These data are a rich resource for health services research, but when they do not include key pieces of information we can find ourselves bending over… Read More »

Patterns of Buprenorphine-Naloxone Treatment for Opioid Use Disorder

Despite a rapid expansion in the use of buprenorphine-naloxone (bup-nx) as a treatment for opioid use disorder, there is little understanding of the patterns of treatment. In a newly published-ahead-of-print Medical Care article, Brendan Saloner and colleagues from Johns Hopkins used an all-payer claims database to investigate what factors predict the duration of treatment, dosage, and continuity of treatment for… Read More »

The Childhood Roots of Health Inequity: Part 4 – Dr. Jennifer Manly

This post is the final one in our 4-part series focusing on presentations that were delivered at a special panel session at APHA16 on the childhood roots of health inequity [part 1, part 2, part 3]. Our fourth presenter, Dr. Jennifer Manly, is Associate Professor of Neuropsychology in Neurology at the Gertrude H. Sergievsky Center and the… Read More »

Cost-Effectiveness of Antihypertensive Medication

Anytime I see the words “cost saving” in reference to a public health or medical intervention, my first thought is “Yeah, right!” It just doesn’t happen that often. One can spend more money to get better outcomes (or more care provided), or less money for worse outcomes, but rarely less money AND better outcomes. However,… Read More »

Avoiding Anticholinergic Drugs May Reduce Alzheimer’s Risk

I’ll never forget the time Granddaddy tried to eat my hand. At least that’s how it seemed to me at age six. In reality, he’d simply confused my hand with the straw sticking out of the milkshake we’d brought to him at the nursing home. By that point in his early-onset Alzheimer’s disease, the Granddaddy… Read More »

Empathy: What We’re Lacking in End of Life Care

The population of the U.S is progressively becoming older; however, healthy aging is no longer an oxymoron.  The availability of preventative medicine and health promotion programs have extended how long people can live healthy lives without chronic disability. Those aged 65 and over are projected to reach 83.7 million by 2050 [PDF].  While modern medicine has become… Read More »

Intimate Partner Violence: The Under-Addressed Pandemic

Violence against women and girls is an international concern that cuts across all sectors of society. The United Nations defines violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary… Read More »

The Political Context of Medicaid Expansion

Republican Congressional leaders are currently debating how to repeal the Affordable Care Act (ACA) as part of the budget reconciliation process. Much of the debate over the ACA has focused on the individual mandate (and here) and the affordability (here and here) of coverage in the state-based marketplaces. The House version of the legislation, however,… Read More »

The childhood roots of health inequity: Part 3 – Dr. Kerith Conron

This post is the third in our series focusing on presentations that were delivered at a special panel session at APHA16 on the childhood roots of health inequity [part 1, part 2]. Our third presenter, Kerith Conron, ScD, MPH, is currently the Blachford-Cooper Distinguished Scholar and Research Director at The Williams Institute of UCLA’s School… Read More »

Correct inference from systematic reviews of RCTs

To gauge the effects of medical interventions, we often use meta-analysis to combine the results of randomized control trials (RCTs). RCTs commonly use odds ratios (ORs) to measure the effect of a given intervention on the frequencies of events. Conventional methods of estimating overall ORs suffer from a number of issues. Drs. Chang and Hoaglin describe… Read More »

Going Outside the Box: Identification of Active Diagnoses in the MDS 3.0

In an effort to improve the validity and person-centeredness of the nursing home resident assessment tool (the Minimum Data Set, or MDS), the Centers for Medicare and Medicaid Services introduced version 3.0 in October 2010. As a result, many of the measures and items health services researchers had grown accustomed to using in the MDS… Read More »

Chronic pain, opioids, and medical marijuana

High-quality evidence supports the use of medical marijuana for chronic pain, neuropathic pain, and other conditions. Yet, patients who live in some states can’t legally use it — and are threatened with loss of access to their prescribed pain medications if they do. I know this because a close family member of mine has chronic pain.… Read More »

Discrimination in Trans Healthcare and the Call for Further Provider Education

Adequacy of healthcare for transgender patients has recently come to light, particularly with the increased discussion of trans persons in the media. Trans individuals identify their gender differently from their assigned sex at birth. Trans healthcare is an emerging field of research, and this increased focus continues to uncover the lack of knowledge amongst providers… Read More »

The HOSPITAL Score – A Prediction Tool for Potentially Preventable (and Therefore Costly) Readmissions

In the era of value-based care, caregivers and policymakers alike are intensely interested in strategies to reduce 30-day hospital readmissions. Researchers continue to offer up helpful tools in this effort. Recently published online ahead of print in Medical Care, Burke and colleagues make an important contribution with their article The Hospital Score Predicts Potentially Preventable 30-Day Readmissions… Read More »

Top posts of 2016

The year 2016 was a big one for The Medical Care Blog: in February, we moved from our old publisher-hosted location and launched this new domain and design. We’ve published 61 posts here since then – a little more than one a week. We’ve added many new contributors and broadened our audience. Thank you for reading!… Read More »

Burnout among physicians and nurses

Private practitioners are busy people between caring for their patients, recording and documenting data, going to meetings, keeping up with new treatment modalities, and running a practice group. They follow a tight schedule, have multiple sources of pressure, and suffer from burnout. Stress occurs when a person is drained of energy, but can recover. In the case of… Read More »

Measuring patient-centered communication in colorectal cancer care

Every year, 340,000 Americans are diagnosed with cancer, and fully 4 in 10 of these diagnoses will be colorectal cancer (CRC). CRC is the second leading cause of cancer death in the United States; however, 60% of CRC deaths could be prevented if everyone 50 years old and older were screened. By instituting patient-centered communication, we… Read More »

Hospital interpretation and payment incentives

Access to interpreters improves health care and is generally required by law. Why then, is interpretation access hard to come by in hospitals? From a hospital staff perspective, appropriate policies may be in place, and hospital staff motivated to offer excellent patient care, but all the demands of providing medical care can lead to system breakdown.… Read More »

The childhood roots of health inequity: Part 1 – Dr. Paula Braveman

Children who grow up in stressful environments, without adequate adult support, are at much greater risk of developing heart disease, cancer, and many other diseases as adults. This is partly because of the coping behaviors that people use to deal with stress, but also because of the cumulative effects of toxic stress. Thus, many of… Read More »

Confusing the Confused: The impact of lacking professional interpretation services

Being hospitalized with a serious medical condition, surrounded by strange equipment, and listening to medical jargon you’ve never heard before is an intimidating situation for anyone. Compounding the uncertainty and stress of the situation would be not understanding the primary language spoken by your providers, not being able to read your procedure consents, and knowing… Read More »

Data sharing between patient-centered medical homes and addiction treatment providers

In my medical practice, lacking the tools to communicate meaningfully with other providers who are caring for my patients is a daily frustration. This is only magnified when it comes to caring for my most vulnerable patients who have difficulty communicating for themselves, such as those suffering from substance use disorders (SUDs), so I was… Read More »