Category Archives: General

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 »

The Person-Centered Wellness Home: Reflections on a Conversation with Dr. Thelma Mielenz

With the mania of the presidential election in full tilt and the election just days away, it’s hard to have a rational public discussion about health care.  Supporters of the two presidential candidates have drawn a deep and divisive line (or rather a tectonic fissure) in the sand about health care reform.  This is due, in great part, to the bombastic, and ultimately… Read More »

Healthcare Utilization Rates after Oregon’s 2008 Medicaid Expansion: The Long View

Expanding health insurance coverage may improve health care access [PDF] and reduce financial stress [PDF]. Ideally, having health insurance and the resultant access to care should improve health outcomes and well-being, although the evidence is complicated and mixed. One thing is sure: expanded insurance coverage typically leads to more utilization – a concern for policymakers and administrators because… Read More »

APHA16 Preview

In just a few days, thousands of public health practitioners, students, scholars, and activists will descend on Denver, Colorado for APHA 2016. This year, your faithful co-editors will be there, live-tweeting about sessions! So be sure to follow @MedCareBloggers for real-time updates. Here are just a few of the sessions we’re looking forward to this year:… Read More »

Health insurance access and State Innovation Waivers

A small section of the Affordable Care Act (ACA) packs a potentially big punch: State Innovation Waivers allow states to ask the federal government for authority to change parts of the ACA, namely the individual and employer mandates, establishment of state exchanges, and financial help to purchase insurance.  These waivers can be used by states… Read More »

Do financial incentives affect the delivery of mental health care?

Paying for value, rewarding high-value care, pay-for-performance—all are examples of terminology used to describe aligning financial incentives with clinical goals and processes. Essentially, these policies and programs seek to link quality to payment and their influence is growing, extending even to Medicare. While these concepts have been discussed repeatedly by many in healthcare, including the… Read More »

Freezing or boiling? Measuring workplace climate in primary care

Provider burnout and turnover [PDF] is a major challenge for many community health centers. One factor contributing to this problem is workplace climate, or what the experience of working at the health center is like. As anyone in primary care will tell you, at times it can be overwhelming. Thus it was with great interest that… Read More »

Gap in Payment for Medicare Cost Sharing Limits Access to Care for the Poor

Dual eligibility for Medicare and Medicaid is expected to improve access to care for low-income individuals who qualify for both programs, relative to eligibility for either program alone. Medicaid coverage of Medicare deductibles and co-payments can reduce the financial burdens that these cost sharing requirements may pose for low-income Medicare beneficiaries. These dual eligible beneficiaries… Read More »

Cost-Benefit Analysis of Community Health Workers

According to the 2013 Medical Expenditure Panel Survey, hospital inpatient expenses account for a large portion (nearly 30%) of total health care expenses and health care spending is highly concentrated among a relatively small proportion of individuals. The top 1% of spenders accounted for 21.5% of total expenditures while the lower 50% accounted for just… Read More »

How do Medical Errors Affect Healthcare Professionals?

In 1999, the Institute of Medicine released a report called To Err is Human. This report estimated that 44,000 to 98,000 hospitalized patients die each year as a result of preventable medical errors. But how do medical errors affect healthcare workers? A recent article by Van Gerven and colleagues, published ahead of print in Medical Care, addresses that… Read More »

Health care services use after Medicaid-to-dual transition for adults with mental illness

In 2013, there were 10.7 million people enrolled [PDF] in both Medicare and Medicaid. Dual eligibility depends on age, income, and disability. Dually enrolled beneficiaries are also responsible for a large share of program costs overall; 31% of Medicare fee-for-services spending for 18% of beneficiaries [PDF] who are dually enrolled. Given the additional health challenges [PDF] faced by dual eligibles, this… Read More »

Time for a vacation?

As I sat at my desk daydreaming about my family’s upcoming August beach vacation and remembering good times from last year’s beach trip with the kids, I began to feel the anxiety creeping in. I think you know the kind of anxiety I’m talking about: worry about falling behind on work, concern that my lack… Read More »

Quality Measurement in Home Care: Avoiding Unintended Effects

In theory, quality measurement and reporting generally benefits patients and their families, as (PDF link) public data on quality increases transparency and provider accountability. It also may benefit providers as a tool for quality assurance and improvement; however, the evidence does not always provide a clear picture. Unique challenges exist for patients receiving home care… Read More »

Autism and iPads: An Interview with Speech Language Pathologist Lauren Ross

In 2014 the Centers for Disease Control and Prevention reported that one in every 68 children have autism spectrum disorder (ASD). Consequently, there is a lot of discussion regarding potential causes of autism. However, for this post, I wanted to move away from this more commonly discussed topic and focus instead on how assistive technology (specifically iPads) are being… Read More »

Affordable Care Act reduced cost-sharing for long-acting reversible contraceptive methods

Since January 2013, most private insurance plans have been required to cover contraceptive services without patient cost-sharing. While health insurance plans have covered some methods of contraception with low cost-sharing, not all plans or methods have been covered equally. This is particularly the case of long-acting reversible contraceptive (LARC) methods, intrauterine devices (IUDs) and implants,… Read More »

Access to Care for US Latino Children in Traditional and Emerging Latino Communities

About one-quarter of all children born in the United States today are of Latino origin. Over the last twenty years, the under-18 US Latino population has grown rapidly – a result of both immigration and higher fertility rates among Latino adults relative to other groups. The Latino population more than doubled in 9 states between 2000 and… Read More »

Which Bias is Which?

Comparative Effectiveness Research (CER) seeks to compare alternative treatments and ways to deliver healthcare to inform healthcare decisions. It can provide evidence of the harms, benefits, and effectiveness of different treatment options. As the number of studies in CER continues to grow, it is vitally important that the types of bias that exist as a function of the study design be explained. In a Medical Care article published in April, Dr. Sebastien Haneuse lays out definitions and examples of selection bias and confounding bias in CER, with a particular emphasis on distinguishing between the two.

Coverage May Not Solve Disparities in Delayed or Forgone Care Due to Cost

In a new Medical Care article published ahead of print, Cheryl R. Clark, MD, ScD, and colleagues, of Brigham and Women’s Hospital and Harvard, provide pre-ACA implementation estimates of income-based disparities in delayed or forgone care due to cost by race/ethnicity, by state-level Medicaid expansion status. Reforms can be unevenly implemented even if they address the primary causes of… Read More »

Factors associated with better performance on quality indicators for ACOs

Accountable Care Organizations (ACOs) are groups of health care providers, including doctors, hospitals, and other service providers, who provide coordinated care, reducing the need for patients to manage coordination of their own care. These organizations receive incentives from Medicare when they deliver care to patients efficiently. Providers make more money if they keep their patients healthy. Medicare… Read More »

How Primary Care Might Fare Under The Plans of the Two Leading Republican Presidential Contenders

The presidential primaries are in full swing and health care is an issue for both parties. The candidates have left themselves plenty of wiggle room, but there is enough information in the public domain to make some predictions about what the different approaches (and they are different) would mean for the health care system. This… Read More »

Racial and Ethnic Disparities after the ACA: Good News and Bad

The major goal of the Affordable Care Act was to expand health insurance coverage. The Department of Health and Human Services will tell you that the Affordable Care Act is working: more Americans are insured. About 16.4 million people gained insurance in the past five years. What do these numbers mean for racial and ethnic minorities who… Read More »