Category Archives: Specialty care

Postpartum Depression is Overlooked and Undertreated

By | October 10, 2023

The postpartum period, recognized as the fourth trimester or the 12 weeks after birth, is often overlooked. In 2021, 52% of all maternal deaths occurred during the postpartum period. And mental health was the top underlying cause, accounting for 23% of all deaths (mostly suicides and overdoses related to substance use disorder). More than 60%… 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 »

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 »

Retrospective: On Reproductive Health Care

By | August 4, 2022

The Medical Care Blog is returning from its summer break this month. We hope you are feeling recharged and ready to dig deep again into health care and public health. We’re beginning with a series of retrospective posts to highlight the work of our contributors on prominent topics. This week, we focus on a collection… Read More »

Social Drivers of Cancer Mortality: Part 2

By | September 1, 2022

Measuring and addressing social drivers of health are important in cancer research. Part 1 of this series, published in March 2022, described three commonly used area-level SDoH indices. None are not able to explain much variation in cancer mortality rates. In this post, I share results from a new model that shows promise. Methods in… Read More »

Social drivers of cancer mortality

By | March 28, 2022

In 1981, Doll and Peto published a well-known paper estimating that roughly 75-80% of cancer mortality was preventable. Forty years later, cancer mortality has declined some overall – but we still see vast disparities. Some of these disparities have gotten worse over time. With the Biden administration’s reignited Cancer Moonshot initiative, combined with a renewed… Read More »

Pandemic Aging in Place Services: A Silver Lining for the Silver Economy

By | March 16, 2022

When COVID-19 forced sudden lockdowns in 2020, Americans realized quickly that the supply of services available at home did not match growing quarantine demands. Both the public and private sectors responded with shifts to delivering contact-free services. That pandemic shift may have long-term benefits for older adults seeking services to support aging in place. Pandemic… Read More »

Lessons From Conducting the Path-4CNC Virtual Convenings

Last week, we detailed the findings of virtual convenings we held in North Carolina to improve care for children with complex health needs (CCHN). Here, we share our takeaways about the process of planning, holding and following-up on the convenings. We also outline the specific steps other leaders, innovators, and advocates can take to engage… 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 »

December 2021 Podcast

By | December 7, 2021

In this episode of our new podcast series, Jess Williams, co-editor, recaps the blog posts we published on The Medical Care Blog in November and previews the December issue of Medical Care. As a bonus, Lisa Flaherty from the APHA Medical Care Section interviews two of our December contributors: Dr. Sharla Smith, founder of the… Read More »

Parent Perspectives on Birth Equity – Birth Equity Series Part 3

In the United States, 700 women die every year from often preventable pregnancy or childbirth complications. An additional 60,000 more experience highly preventable birth injuries. Black women are three times more likely to die from those complications than white women. According to the CDC, the maternal mortality rate in the U.S. is roughly 17.4 maternal… Read More »

Words Matter in Creating Birth Equity – Birth Equity Series Part 2

While some health outcomes improve in the United States, racial and ethnic disparities in pregnancy-related outcomes persist. In the United States, Black women are three times more likely to die from a pregnancy-related complication than white women. In Kansas, Black women are more than three times as likely to die of pregnancy-related complications compared to… Read More »

Defining Birth Equity in Kansas – Birth Equity Series Part 1

The pace of progress is never fast enough for those who stand to suffer the biggest losses. Nowhere is this more apparent than in the glaring health inequities impacting Black mothers and babies in Kansas. Among the multitude of injustices Black Kansans face today, the disproportionate rates of death and devastating health complications for Black… 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 »

The Uncertainty of Black Pregnant Women and COVID-19 Vaccines

In March 2020, the Centers for Disease Control and Prevention (CDC) confirmed COVID-19 as a pandemic. More than 18 months later, the nation has yet to return to ‘normal’. Hope for normalcy increased with the rollout of COVID-19 vaccines in the months that followed. Reluctance and resistance to vaccination, however, have made it difficult to… Read More »

Supporting Front-line Workers with Resiliency Training

By | September 15, 2021

Front-line workers are always at risk. It’s in the name. The COVID-19 pandemic has made this reality more salient for everyone. Risks of sickness from COVID-19 include death and morbidity. Front-line workers may also have lost more friends and co-workers than the average person. Healthcare workers have also been subject to violence and see the… 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 »

Turning From Obstetric Violence to Birth Justice

By | July 7, 2021

The US maternal mortality rate is higher than it was a quarter of a century ago. For every one person that dies, another 65 almost die. We do not adequately care for mothers and mothers-to-be. Not only that, but as providers, we inadvertently (and at times overtly) inflict obstetric violence, through both individual actions and our… Read More »

Broken Trust and Cancer Prevention

The pandemic has familiarized us all with the phrase “medical mistrust,” often framing those who have it as being irrational or uninformed.  Oft ignored is the biomedical community’s long legacy of broken trust.  Addressing cancer-related inequities will require health professionals to make concerted efforts to repair that broken trust. Cancer and Broken Trust People of… Read More »

How to Reduce Medicaid HCBS Disparities Using an Assets Framework

Long-term services and supports (LTSS) for older adults and persons with disabilities have become a policy priority. The American Rescue Plan and the proposed American Jobs Act aim to increase LTSS spending through the Medicaid program, particularly for Home- and Community-Based Services (HCBS). These measures would address the need for wider service availability, while presenting… Read More »

Monitoring EMS data for substance use

The United States is currently experiencing multiple, simultaneous epidemics that claim thousands of lives every week. According to the CDC, over 81,000 drug overdose deaths occurred between June 2019 and May 2020. That’s the highest number of overdose deaths ever recorded in a 12-month period. An estimated 93,000 Americans die annually from alcohol-related causes. Many… Read More »

Teledermatology: Strengths and Weaknesses for Implementation

By | April 8, 2021

A growing trend in health care, accelerated by the COVID-19 pandemic, is the implementation of telemedicine.  Telemedicine is the delivery of health-related information and services among patients and providers via telecommunication technologies.  An example is the use of video technology by doctors to evaluate, diagnose, or treat a patient instead of having a face-to-face encounter. … Read More »

Rewarding ACOs that Manage Complex Patients

By | March 22, 2021

Health insurers often pay health plans to manage the care of their members. Good care can help prevent emergencies, such as avoidable trips to a hospital emergency department (ED). Medically complex patients, such as those with behavioral health problems or substance use disorders, tend to have a lot of ED visits. Social determinants of health… Read More »

Treating the Opioid Crisis: Current Trends and What’s Next, Part 2

Last week, we discussed three noteworthy trends from the past decade in treating the opioid crisis. The first was recognizing medication for opioid use disorder (MOUD) as the standard of care. The second was formalizing an addiction medicine specialty. And the third was expanding the availability of MOUD. This week, we’ll consider three additional trends in… Read More »

Pediatric Payment Models for Child Health Services

By | December 11, 2020

How could alternative pediatric payment models help to address children’s broad health, social, and developmental needs? This post delves into funding and financing challenges and potential solutions. I recently collaborated on a report on alternative payment models for child health with colleagues from the Duke Margolis Center for Health Policy and Mental Health America. The… Read More »

Becoming dementia friendly: Less stigma, more inclusion, better care

By | November 11, 2020

With a growing recognition of the toll that dementia takes on individuals, families, and communities, there is a movement to prepare our society to better meet the needs of people living with dementia. This movement is referred to as becoming “dementia friendly,” and it can reduce stigma, increase inclusiveness, and improve care. A family example… Read More »

There is still much we don’t know about dementia and wandering

By | November 4, 2020

John bowled in a Friday night league for 20 years. It was often the highlight of his week – a chance to spend time with friends, blow off some steam, and enjoy some friendly competition. Now 75 and living with dementia, John has tried more than once to walk to a bowling alley that no… Read More »

Racism in Reproductive Care and Beyond

By | October 29, 2020

As I scrolled through Ms. Jones’ chart, I jotted down her chronic problems: hypertension, depression, and urinary incontinence. She was taking lisinopril and sertraline. She had seen gynecology back in February for surgical management of the incontinence. The chart said she wanted a hysterectomy as “definitive management.”  It seemed the surgery was canceled due to… 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 »

Wildfires: Effects on Health and Care Delivery

By | August 27, 2020

Climate change is a contributory factor to wildfires in California this year that have engulfed 1.4 million acres of land.  Most recently, lightning strikes sparked new fires in Northern California, including the L.N.U. Lightning Complex (currently the third largest fire in California history).  Wildfires contribute to poor health outcomes and disrupt care delivery.  In addition, the… Read More »

Are DRG-based Reimbursements Appropriate for COVID-19?

Current healthcare reimbursements may create incentives for excess use of ventilators to treat COVID-19 patients. Recent research has shown that healthcare providers, including hospitals, have experienced substantial financial losses as a result of the COVID-19 pandemic. Alternative, less-invasive treatments for critically ill COVID-19 patients could potentially improve patient outcomes. But these approaches expose hospitals to… 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 »

Deportation and the Traumatizing of a Generation

By | June 18, 2020

With less than five weeks to go before welcoming a second child, the patient sat in my exam room in tears. By all accounts, this was a routine appointment at the end of a routine pregnancy. Except on this particular day, clutching family photos from their recent baby shower, the patient shared with me that… Read More »

Natural Experiments for Diabetes

Over the past two decades, research has helped identify ways to reduce complications among people with diabetes and laid the foundation for primary prevention. However, prevention and treatments are still unequally applied, and social, economic, and age-related disparities persist. The June 2020 supplement issue of Medical Care argues for and presents the results of natural… Read More »

Is hydroxychloroquine ready for prime time for COVID-19? Not just yet.

By | April 17, 2020

In early April, President Trump, in his daily press briefing, told Americans to take the drug hydroxychloroquine, calling it a “game changer” for people with COVID-19: “I really think they should take it. But it’s their choice. And it’s their doctor’s choice or the doctors in the hospital. But hydroxychloroquine. Try it, if you’d like.”… Read More »

Healthcare utilization in the SARS-CoV-2 pandemic

By | April 22, 2020

This post summarizes what we know right now about the SARS-CoV-2 virus and the disease it causes, COVID-19. The information contained in this post may change as the situation changes, or may become obsolete. We will attempt to update if any of this changes substantively.  News and social media outlets have fallen short of useful… Read More »

Bundled Payment for Maternal Health: An Opportunity to Change Healthcare Financing

By | January 24, 2020

The need for a comprehensive payment approach that supports the entire maternity care experience from prenatal, labor, and delivery, to postnatal care, is critical for both maternal and child health outcomes. Aligning payment to reward better birth outcomes is becoming more widespread. A handful of states are experimenting with bundled payments to advance value-based payment… Read More »

Timing is Everything: Defining the Serious Illness Population for Palliative Care

The current healthcare system is not built for individuals with serious illnesses. These individuals can benefit from palliative care, which focuses on quality of life and symptom relief. Alternative payment models that incorporate palliative care are in development. Yet, the challenges of expanding these models of care are substantial. Betsy recently died after a sixteen-year… 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 »

School Health Policy Series: Part 4 – The National School Lunch Program: Wasteful or Worth It?

By | December 3, 2019

Do you recall the last time you did not have your morning cup of coffee or tea? Without it, you might be moody throughout the day and not get done what you intended. How about the last time you skipped lunch? Were you able to focus on your work with a rumbling stomach? Now imagine… Read More »

School Health Policy Series: Part 2 – Athletic Trainers in Schools: An Unexpected Battleground for Scope of Practice

By | December 2, 2019

It is impossible to bring up a discussion of school sports without mentioning the great bogeyman of sports-related injuries: concussions. The number of concussions has been on the decline in recent years. But a recent estimate suggests that there are still about 4 concussions per 10,000 athletic exposures in high schools. An athletic exposure is… Read More »

School Health Policy Series: Part 1 – Everything’s Coming up ACEs

By | November 14, 2019

This month, the website www.ACEsAware.org is set to launch. It will train healthcare workers to screen for Adverse Childhood Experiences (known as ACEs) in primary care clinics, but is that scope too narrow?  Should school workers be included too? The website is part of the work of Dr. Nadine Burke Harris in her new role… Read More »

Introducing a Special Series on School Health

By | December 2, 2019

This month, The Medical Care Blog is hosting a series of posts about the importance of school health. Following up on our 2016 series on the childhood roots of inequity (read the first in the series here), we are dedicating our Thursdays this month to posts that reflect on the health challenges that confront schools.… 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 »

Medication Overload: The drug epidemic that no one is talking about

The opioid crisis has captured America’s attention, becoming an official “national emergency” and prompting swift action from government agencies, patient advocates, and health care providers. This is as it should be. Over the past decade, opioid overdoses have led to millions of hospitalizations, more than 100,000 deaths, and caused great harm in communities all across… Read More »

How do you use PROs to improve patient care?

By | May 23, 2019

Patients want to be healthy. They want to live longer, function better and have higher wellbeing. How patients feel is best measured by asking them. Few cancer patients these days have not been asked to fill out standardized questionnaires about their symptoms, functioning, and well-being. While these patient-reported outcomes (PROs) are not new to healthcare… Read More »

Finding Happiness As We Age

How happy are you? That’s a tricky question and there’s a lot that can impact your answer.  According to a 2016 article in The Economist, these include factors like your financial status, health, relationships and education.  One factor that might also have a big influence on your answer is your age.  As a society, we… Read More »

How do physicians learn about new medication safety information?

Physicians and other providers are the gatekeepers for prescription medicines; they decide who, under what circumstances, and for how long someone takes one – or several – medicines. But how do physicians stay abreast of the latest research about the safety and efficacy of the medicines they prescribe? We set out to understand how they… Read More »