Category Archives: General

The Role of Crowdsourcing in Research

Crowdsourcing is defined as “a sourcing model in which individuals or organizations obtain goods and services, including ideas and finances, from a large, relatively open and often rapidly evolving group of internet users. Crowdsourcing spreads work among participants to achieve a cumulative result.”  Some well-known examples of crowdsourcing include the online encyclopedia Wikipedia, the traffic… Read More »

Why Aren’t We Expanding Medicaid to Address the Opioid Epidemic?

By | February 7, 2018

Now more than ever, we need a sensible, unified, national response to the opioid epidemic; a response that recognizes the gravity of the situation and the reality that opioid use disorder (OUD) is a chronic – and treatable – condition. While there are many preventive measures that could pay dividends down the line, such as… Read More »

Impact of Medication Adherence on Health Services Utilization in Medicaid

By | February 1, 2018

Medication is an essential aspect of tertiary prevention, as it often addresses symptoms, may restore function, and minimizes adverse consequences associated with chronic conditions. Medication adherence is most often studied in the context of Medicare Part D. In a newly published Medical Care article, Drs. Roebuck, Kaestner, and Dougherty, instead measure the associations between medication… Read More »

Abuse-Deterrent Formulations: A Solution to the Problem

By | January 25, 2018

Despite continuous efforts to address the problem, high rates of prescription opioid use and abuse continue to plague our country.  According to the CDC, deaths involving prescription opioids in the United States have quadrupled since 1999, and so have the sales of these prescription drugs.  In 2015, the American Public Health Association published a policy… Read More »

Five principles for developing digital clinic-based, behavior-change health interventions

 In this post, we describe five principles that guided the development of Positive Health Check, a clinic-based digital health intervention for HIV-positive patients, aimed at making it acceptable and feasible in a clinic setting.

Is your activity tracker a medical device?

Activity tracker technology has come a long way.  The first Fitbit released in 2009 only measured movement, sleep, and calories burned.  In contrast, the Fitbit Ionic smartwatch released in 2017 has a much broader range of functions, including heart rate monitoring, personal coaching, and built-in GPS. Consequently, with this change in functionality comes a change in potential uses for… Read More »

Three Reasons Why the Pro-ACA Resistance Should Take Heart

By | December 28, 2017

The Affordable Care Act (ACA) had a roller-coaster of a year.  It began with threats of almost certain repeal, followed by effort after unsuccessful effort to dismantle it. Then in the last days of 2017, there was the successful repeal of the individual mandate and penalty. This was brazen politics, suspenseful and often agonizing.  … Read More »

How do mental health conditions contribute to preventable hospitalizations?

By | December 21, 2017

What role does mental health play in preventable hospitalizations?  In a new article in the January 2018 issue of Medical Care, Dr. Laura Medford-Davis and colleagues report that in Texas, mental illnesses were associated with higher odds of preventable hospitalizations. Using an administrative database of all Texas hospital admissions from 2005-2008, the authors found that 13% of… Read More »

Top posts of 2017

By | December 20, 2017

It’s been a wonderful year for The Medical Care Blog, and we are very proud of the great work of our contributors. Thank you for reading and sharing! Here are our most-read posts of 2017: Avoiding Anticholinergic Drugs May Reduce Alzheimer’s Risk by Barbara Zabielski The Impact of Social Media in Healthcare by Alexa Ortiz and Catherine… Read More »

APHA 2018 Call for Abstracts + Awesome Accepted Abstracts Webinar Materials

By | December 19, 2017

The Call for Abstracts for the 2018 Annual Meeting of the American Public Health Association is live! Abstracts are now being accepted by the Medical Care Section (as well as the other APHA sections, caucuses, and forums), and the deadline is Friday, February 23 March 2, 2018 (*EXTENDED!*). On behalf of the Medical Care Section’s Health… Read More »

Interpersonal Violence, Behavioral Health, and the Need for Improved Healthcare Delivery for Sex Trafficking Victims

By | December 14, 2017

Each year, millions of people around the world are victims of human trafficking. In the US, the National Human Trafficking Hotline, which maintains one of the most extensive data sets, received 13,897 calls in 2017, with 4,460 human trafficking cases reported. Of the 4,460 cases reported, 3,186 cases were of sex trafficking and 689 cases were… Read More »

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

By | December 7, 2017

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

By | November 24, 2017

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

By | November 9, 2017

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

By | November 2, 2017

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

By | October 19, 2017

“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?

By | October 12, 2017

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?

By | September 30, 2017

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

By | September 28, 2017

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

By | September 22, 2017

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

By | September 14, 2017

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

By | August 3, 2017

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

By | July 28, 2017

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 »

Falls and the rise of wearable sensors

By | July 27, 2017

“I’ve fallen, and I can’t get up!” Remember that catchphrase of the late 1980s and early 1990s, based on the television commercial for LifeCall? Well, the Mrs. Fletcher of yesterday would be amazed by the wearable devices of today – they might even be able to prevent her fall in the first place! According to… Read More »

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

By | July 20, 2017

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

By | July 13, 2017

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

By | June 29, 2017

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

By | June 22, 2017

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?

By | June 8, 2017

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

By | May 26, 2017

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

By | May 4, 2017

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

By | April 27, 2017

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

By | April 6, 2017

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

By | April 5, 2017

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

By | March 23, 2017

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

By | March 13, 2017

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

By | March 9, 2017

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

By | March 6, 2017

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 »