Category Archives: Quality

Racial/Ethnic Concordance and Doctor Communication

By | March 14, 2024

Patient-provider racial/ethnic concordance (i.e., physician and patient identify as the same race/ethnicity) has emerged as one key suggestion for mitigating healthcare disparities. Past research has underlined its benefits, including improved infant mortality and more appropriate prescription regimens. However, the sum of the evidence remains unclear and many facets of the patient-provider relationship have yet to… Read More »

Health Equity in the Time of Hospital Consolidation

By | March 7, 2024

Competition between hospitals in a given market should provide incentives to ensure quality while also lowering costs. Over the past two decades, hospital markets have increasingly consolidated. This consolidation reduces competition and increases the comparative leverage that hospitals and associated health systems have. While there are some theoretical advantages of increased consolidation such as potential… Read More »

Health Plans With Deductibles See Lower Lung Cancer Screening Rates

By | November 22, 2023

The United States Preventive Services Task Force has recommended lung cancer screening for at-risk groups since 2013, and updated again in 2021. This is a simple procedure involving a low dose of radiation used to take a CT image of the chest. If utilized by most eligible Americans, screening could reduce lung cancer mortality by… Read More »

Improving Home and Community-Based Services for People with Dementia

Over the past 25 years, significant strides have been made in shifting services for people with dementia and Alzheimer’s disease to home and community settings. Home and community-based services (HCBS) enable people with various forms of dementia to receive care in a familiar setting while promoting their independence, well-being, and overall quality of life. As… Read More »

Using data-driven quality measurement and analytics to build health equity

By | April 27, 2023

The disproportionate impact of COVID-19 on underserved communities underscored the need for systemic change and renewed efforts to reduce health disparities in people with social risks.  This post describes a partnership between Inovalon and Humana to develop a new health equity composite quality measure to identify disadvantaged populations with the largest care disparities and determine… Read More »

Racial and ethnic segregation in primary care

By | April 20, 2023

Primary care in the US is segregated by racial/ethnic identification. What are the implications? Most people in the US are aware that our neighborhoods are often highly segregated by race and ethnicity. Racism — historical and current, structural and individual — plays a role in neighborhood demographics. The same forces also result in segregated workplaces,… Read More »

Pain: no longer a vital sign?

By | April 7, 2023

Pain was widely under-treated in the 1980s. Two decades ago, pain was recognized as an important problem that needed to be managed by healthcare providers. Today, the opioid crisis has led to under-treatment once again. Professional recognition of pain as a symptom that needs managing was the eventual outcome of several decades of research. Again… Read More »

Healthy Intersections Podcast: February 2023

By | February 10, 2023

This month’s podcast features a round-up of this month’s blog posts and a summary of three articles recently published in the journal Medical Care. Listen here or via your favorite podcast platform! Transcript Hello friends. Welcome to the Healthy Intersections Podcast for February 2023. This podcast is sponsored by the American Public Health Association’s Medical… Read More »

Using CLAS Standards to Advance Equity

To address calls for improving health equity, organizations could consider using CLAS Standards to advance diversity, equity, and inclusion (DEI). In recent years, health organization leaders have prioritized the need to address systemic inequities. A 2021 survey of health care organizations identified health equity as a top priority [pdf]. This focus has grown since the… Read More »

Financial alignment of Medicare and Medicaid may improve access to primary care

By | November 21, 2022

Better care coordination may improve access to primary care for people who are dually eligible for Medicare and Medicaid. Recent evaluations of the Financial Alignment Initiative (FAI)–an initiative incentivizing the financial alignment of Medicare and Medicaid–suggests care coordination could improve access to primary care services for some dually eligible beneficiaries. Care coordination alone, however, may… Read More »

APHA Annual Meeting 2022 Preview

By | November 4, 2022

It’s that time of year again–APHA’s Annual Meeting! This year we’ll be meeting in Boston Nov. 6-9 with a digital event Nov. 14-16. I’m looking forward to seeing colleagues this year and getting to catch up with so many interesting people. Of course, I’m also excited about the excellent Medical Care Section Program. Here’s a… Read More »

October 2022 Healthy Intersections Podcast

By | November 9, 2022

In this month’s podcast, Dr. Samy Anand gives an overview of the Medical Care Blog posts published in September and a preview of the journal articles in the October issue of Medical Care. Then, co-editor of the blog, Dr. Lisa Lines, discusses an article in the October issue in more detail. Below is a transcript… Read More »

Centering measurement on patients and family caregivers while developing two novel quality measures

In healthcare, what gets measured gets done. This is particularly true as the use of value-based purchasing, alternative payment models, and consumer tools to compare quality expand in the U.S. Centering measurement on patients, and focusing on their needs, preferences, and values, ensures that what we measure really matters, not only to patients and their… Read More »

Measuring what matters to patients and their family caregivers: Measure development isn’t just for measure developers

In today’s healthcare system, measurement influences everything from quality improvement to payments. So it matters greatly what gets measured. Measuring what matters to patients and their family caregivers will focus healthcare on their needs, preferences, and values. In a recent measure development effort, we brought lived and professional experience together at every stage. We found… Read More »

Is Something Going Wrong With the Patient Centered Medical Home?

By | January 27, 2022

Like others working at the intersection of public health and medicine, my faith in primary care has long been unshakeable. Increasingly actualized as the Patient-Centered Medical Home (PCMH), primary care has experienced a decade plus of attention thanks to efforts at retooling and rebranding the field. But in the last week, a tiny crack formed… Read More »

Engaging Communities to Improve Systems of Care for Children with Complex Health Needs

Children with complex health needs (CCHN) are a unique pediatric patient population. They have chronic medical and/or behavioral conditions that need ongoing health care. They use a disproportionate share of hospital resources. And they face greater social challenges when compared to other children. In North Carolina (where we work) and across the country, CCHN fail… Read More »

Nursing Home Characteristics and COVID-19 Outcomes: The Evidence is Mixed

By | December 17, 2021

COVID-19 has severely affected nursing homes. As of now, over 139,270 residents and 2,155 nursing home staff have died from COVID-19. This post provides insight on the questions researchers are asking to understand the impact of nursing facility factors on COVID-19. A Perfect Storm The combination of a frail, aging population, close living quarters, and… Read More »

Blood-Based Biomarker Tests Address Unmet Need in Alzheimer’s Disease Care

By | September 1, 2022

The Alzheimer’s Association’s 2021 Alzheimer’s Disease Facts and Figures report [PDF] shares that currently, six million Americans are living with Alzheimer’s disease, a number that has increased 145% since the turn of the century.  Around the world, there are 50 million people living with Alzheimer’s disease or related dementia. Only a quarter of would-be patients… Read More »

Authentic Leadership in Healthcare And Public Health: What Is It And Why Should We Care?

The COVID-19 pandemic has strained healthcare and public health. Many workers in these industries have felt growing frustration with leadership. They face a barrage of medical misinformation, ethical strains, and burnout. Now more than ever, authentic leadership is critical in supporting healthcare workers and advancing public health. This post will describe authentic leadership and examine… Read More »

Patient-Centered Transitional Care

By | August 12, 2021

How is research on patient-centered transitional care going? A supplement on this topic funded by the Patient-Centered Outcomes Research Institute (PCORI) was recently published in Medical Care. Care transitions are “ripe with hazard,” as discussed in an editorial from Amy Berman. As pointed out by Berman, figuring out what works and what doesn’t is critical to… Read More »

Veterans Affairs Community Care

By | July 24, 2021

Until a few years ago Veterans generally had to visit a Veterans Affairs (VA) facility to receive care. Long wait times and long travel times caused problems for Veterans who needed healthcare. In response, the VA MISSION Act (2018) expanded access to community providers and increased benefits for caregivers. A recent supplement in Medical Care explores some… Read More »

Challenges to Adopting COVID-19 Monoclonal Antibody Treatment

By | July 15, 2021

The pandemic has highlighted the challenge health care providers face in translating new scientific findings to actual patient care. The integration of COVID-19 monoclonal antibody treatment is a good example of this challenge. Frustration at a Local Hospital In a year of difficult days, my mom came home from work one evening in March especially… Read More »

Unconscious Bias in Health Care

By | June 30, 2021

The global Covid-19 pandemic came with financial, emotional, and physical health implications for just about everyone worldwide. Along with those burdens, a significant strain was placed on resources, people, and systems. Issues that were lingering just beneath the surface bubbled up, inequities became highlighted, and urgent outcries and demands for swift solutions became harder to… Read More »

Reorienting Care for Undocumented Immigrants

By | April 28, 2021

Barriers to immigration into the United States are a common topic of political debates. Less frequently publicized are the numerous barriers to healthcare that undocumented immigrants (UIs) face even after their arrival. These obstacles can have profoundly negative effects: not just on the individual immigrants’ health, but on their local communities as a whole. Medical… Read More »

CMS Launches Compare Website Replacement: How does it measure up?

This fall, CMS launched two new websites: Care Compare and the Provider Data Catalog (PDC).  Both tools replaced the eight existing Compare tools and data.medicare.gov, which were sunset last year. The data included on Care Compare is intended to help Medicare beneficiaries make informed decisions about their care. While there have been articles and press releases… Read More »

Rural Telehealth in the COVID Era and Beyond

National Rural Health Day provides an opportunity to reflect on the quality of medical care in rural and medically underserved communities. This year has posed additional challenges to fragile healthcare systems and vulnerable populations. Faced with new barriers, rural communities are adapting and innovating through telehealth. COVID-19 caught the entire country off balance, highlighting structural… Read More »

Is Sleep Driving Up Your Medical Costs?

By | October 22, 2020

  Millions are losing sleep due to anxiety, fear, and the difficulty of maintaining a schedule during this pandemic. Research suggests that those who get insufficient sleep may be at risk for health conditions such as obesity and heart disease. Yet, too much sleep may increase the risk of other health conditions such as diabetes and… Read More »

Complementary and integrative health in the VA

By | October 8, 2020

The Veterans Health Administration (VA) has expanded research and education on complementary and integrative health (CIH) programs, focusing on pain, mental health, and chronic illness. CIH programs are a part of “Whole Health,” an approach to support veterans’ health and well-being. A recent Medical Care supplement contains several articles on the effectiveness and implementation of… Read More »

Rebuilding the Foundation of Rural Community Health after COVID-19

COVID-19 has exposed the cracks in the foundation of America’s rural community health system. These cracks include increased risk of facility closures, loss of services, low investment in public health, maldistribution of health professionals, and payment policies ill-suited to low-volume rural providers. As a result, short-term relief to stabilize rural health systems and long-term strategies… Read More »

Potential effects of COVID-19 on health care utilization and quality measures

What are the potential impacts of COVID-19 on health care utilization? How will changes in healthcare use impact quality measures? Researchers are asking many key questions to understand the impacts of COVID-19. It is clear that trends in healthcare use are changing. These changes will likely affect quality measure scores in the future. This is… Read More »

Implementation of HCV Treatment Programs

By | November 8, 2022

Successfully implementing an intervention within a complex service delivery system requires multiple, inter-related adoption strategies.  The Veterans Administration’s (VA) renewed emphasis on Hepatitis C treatment offered a perfect opportunity to study which strategies worked. In this post, I will review those findings. Then, I will discuss the importance of accounting for the complexity of strategy… Read More »

Rural Postpartum Mental Health: the Challenge to Improve

Postpartum depression is common, preventable, and treatable. The Agency for Healthcare Research and Quality (AHRQ) challenge competition, “Cross-Sectional Innovation to Improve Rural Postpartum Mental Health,” identifies what communities are doing to improve access to mental healthcare for rural women. Furthermore, the challenge seeks new solutions to ensure that more women and families receive the help… Read More »

Patient Matching: Fixing An Identity Problem in Our Medical Data

By | May 8, 2020

While working as a nurse, I remember one instance of caring for two patients who were twins. Along with the same birthday and the same last name, they both had very similar first names. The twins were roughly around the same height, the same weight, and also had the same hair color. At first glance… Read More »

Risks of inpatient psychiatry during COVID-19 and beyond

By | May 3, 2020

COVID-19 has revealed many vulnerabilities in our societal structure. One particular vulnerability is the risk inherent in our use of congregate institutions to house and treat people. This includes the risks of inpatient psychiatric facilities. Inadvertently, the pandemic has surfaced critical questions that we should seek to answer even when the virus is under control: What is the right… Read More »

Access to Abortion during COVID-19 and Beyond

By | April 19, 2020

Women do not stop needing access to abortions in a pandemic.  They should not need to place themselves and others at risk of COVID-19 to access one.  But that is exactly what is happening — due in part to new bans, but mostly as a result of years of dwindling access across the country. The current… Read More »

The myth of female hysteria and women’s health disparities

By | March 5, 2020

What role might the myth of “female hysteria” play in women’s health disparities? For thousands of years, women’s health complaints were often diagnosed as “female hysteria” – a catch-all term that basically implied “it’s all in her head.” The condition was sometimes believed to be caused by a wandering uterus and/or sexual frustration. Doctors treated… Read More »

Adjusting publicly reported performance measures for social risk factors

By | March 18, 2020

With the current focus on social risk factors (SRFs) affecting health care, it is not surprising that methods for comparing hospital performance might do well to account for such factors in their assessment. If up to 70 percent of health outcomes are driven by factors beyond medical care, and measures used to compare hospitals focus… Read More »

Are Community Health Workers Worth It?

Patients are sometimes referred to as “frequent flyers” when they visit an emergency department multiple times for the same issue. Often this is because discharged patients miss necessary follow-up care. This results in further worsening health, and may contribute to the frequent flying. To address this cycle, patients may be referred to a community health… Read More »

Care experiences among Medicare beneficiaries with cancer: A cross-study overview of published results to date from SEER-CAHPS

Medicare beneficiaries who have cancer are a growing population with unique care needs. Population-based research examining relationships between cancer patient experiences, health care utilization, and subsequent patient health outcomes is lacking. A recently updated data resource called SEER-CAHPS links cancer registry data with Medicare information and patient surveys. It provides a comprehensive, nationally representative source… Read More »

ACO Implementation: Current evidence and a way forward

Over the past eight years, the US health care system has seen the widespread implementation of Accountable Care Organizations (ACOs) as a way to move from volume to value. What are ACOs? ACOs are groups of providers that are collectively accountable for the cost and quality of care for a defined patient population. Examples include… Read More »

Patient Portals: Part 3 – The Future of Portals

By | December 5, 2019

Welcome to the final post in our series on patient portals – an attempt to imagine the future. Part 1 of this series summarized the latest data on who is using portals. Part 2 explained some of the barriers to use as well as what factors increase use. Evidence of Increased Patient Engagement and Other… Read More »

Patient Portals: Part 2 – What Factors Affect Patient Use?

By | November 22, 2019

In Part 1 of this series, I summarized the latest data on who is accessing patient portals and for what purposes. In this post, I discuss the facilitators and barriers to patient portal use. General barriers to patient portal use Let’s start by discussing barriers to portal use. Patient portals have generally not been created to… Read More »

What contributes to inappropriate antipsychotic medication use?

By | October 18, 2019

Inappropriate antipsychotic medication use among older adults with dementia is associated with increased risk [pdf] of hospitalization and death. In 2017, the rate of potentially inappropriate use was 16%, having fallen from 24% in 2011. While this decline has been substantial, further decreasing the rate is an important goal to protect the health and wellbeing… Read More »

Identifying Team-Based Primary Care is a Major Challenge

By | October 2, 2019

I have written a lot about primary care. I’ve covered its role in reducing ED visits, discussed the benefits of one of its most unique facets (coordination of care), and described the challenges of younger adults moving away from traditional models of primary care. It is hard to overstate just how important this field of medicine… Read More »

At 5 Years: Great Blog Posts That (Almost) Nobody Read

By | September 12, 2019

We announced last week that The Medical Care Blog has reached its 5-year milestone. As part of the editorial team, I’m excited to pause briefly and reflect on some great blog posts about healthcare that I think deserve to have been more widely read. Contributions from our authors have helped us reach more than 80,000… Read More »

Unlocking the Potential of Our Electronic Health Record Data with Artificial Intelligence

By | September 26, 2019

Since the American Recovery and Reinvestment Act of 2009 incentivized the adoption and use of electronic health records (EHRs), EHRs have become ubiquitous in the health care industry.  Recent federal reports show about 84% adoption in hospitals and about 86% adoption in office-based practices. Patient information that was once captured on paper is now being regularly… Read More »

Getting to the Values of Value-Based Care

By | July 11, 2019

Value-based care is all the rage in health care system transformation. Promising in concept, value-based care initiatives aim to reward value over volume, shifting our understanding and practice of delivery and payment reform. These efforts received governmental support in 2015 via the Medicare Access and CHIP Reauthorization Act (MACRA), which launched a myriad of quality… Read More »

Are there geographic barriers to health IT use?

By | June 6, 2019

Health information and communications technologies, such as electronic medical records and telemedicine, have the potential to increase access to healthcare in rural areas. This potential was one of the main drivers of the Health Information Technology for Economic and Clinical Health (HITECH) Act that was passed 10 years ago. HITECH gave the Centers for Medicare… Read More »

Street Medicine—a home for high quality medical care for people experiencing homelessness

“One foot in the grave,” he said. “Is that how you feel?” I asked.  “No, it’s how I live.” Unsheltered for 38 years, he had lived primarily behind a dumpster floating in and out of the medical, social and judicial system. In the month before the new Keck School of Medicine of the University of… Read More »