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 »

Call for Contributors

The Medical Care Blog is always looking for new contributors! We’re especially interested in people who can commit to writing one blog post per month or every 3 months. We are open to contributors at all stages of career development. Prior blogging experience preferred, but not required. Our posts cover a wide range of topics. Many… Read More »

Seeking Clarity on Opiod Prescribing

According to the National Institutes of Health (NIH), more than 18,000 people died from overdoses of prescription opioids in 2014. This is more than the number of overdose deaths attributed to heroin (10,854) and cocaine (5,415) combined. Opioids are pain relievers that are chemically similar to morphine. Existing clinical guidelines recommend against exceeding a threshold… 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 »

Broadening participation in clinical trials

Diversity in clinical trials is critically important. Each new treatment needs to be tested in a broad, diverse population, because men and women of different ancestries have different responses to both diseases and treatments.  If only certain groups of people participate in clinical trials, it can increase disparities and worsen outcomes for people underrepresented in the clinical trial data. Until… Read More »

Feasibility of MDS 3.0 in Constructing Meaningful End-of-Life Quality Measures

Since the launch of Nursing Home Compare (NHC) in 2002, consumers have had access to information about the quality of care provided by most nursing homes (NHs) throughout the country. The intention is to help consumers distinguish among NHs and motivate informed decision making based on quality. For NHC to be useful, the quality measures… 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 »

All Falls Are Not Equal

All falls are not equal, nor is the financial impact of how Medicare defines fall-related injuries (FRI). In a new Medical Care article published ahead of print, I worked with colleagues at UCLA’s Fielding School of Public Health to explore whether Medicare expenditures associated with fall-related injuries (FRI) depend on how FRIs are identified in… Read More »

Is Care Coordination the Magic Bullet in Primary Care?

Decades of thoughtful research into how we design health care systems has shown that primary care is essential.  We know enough to confidently say that systems responsible for the overall health of patients (like health insurance plans or the Veterans Administration) that choose to skimp on primary care do so at their own peril.  But in a time… Read More »

Multidimensional frailty score as a predictor of postoperative mortality

According to the 2010 U.S. Census, there are 40 million people (13% of the population) older than 65 years of age living in the U.S. This population has increased dramatically during the last two decades. Currently more than half of all surgeries are performed on this group of patients in the U.S. Frailty is typically defined by… 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 »

Pressure ulcers: risk factors and the power of policy

Medical Care has recently published two papers on the topic of pressure ulcers — costly, painful, largely preventable infections associated with poorer quality care. In the first, from researchers at the University of Manitoba, York University, and the University of British Columbia, lead author Malcolm Doupe, PhD and colleagues focus on the risk of developing stage… Read More »

The Impact of Gasoline Costs on the Healthcare Industry

The higher the cost of gasoline, the higher the healthcare costs for the treatment of injuries caused by motorcycle crashes. In an article published ahead of print in Medical Care this week, He Zhu and colleagues discuss the association between gas prices in the United States, hospital costs, and utilization for both motorcycle and non-motorcycle related injuries. Remember… Read More »

Empowering hospice consumers to make informed choices: the role of publicly reported quality information

One of the primary goals of measuring and publicly reporting quality of care is to empower consumers to make informed health care decisions. Numerous national efforts, many initiated as a result of requirements in the Affordable Care Act (ACA) of 2010, are underway to make information about quality of care available to the public. Despite… 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 »

The Health Plans of the Democratic Presidential Candidates and How They May Affect Primary Care

Nearly halfway through the primaries, the Democratic primary contest between Hillary Clinton and Bernie Sanders continues. And perhaps nothing sets these candidates further apart in the progressiveness of their agenda than their approaches to health care. In this post, let’s take a look at the vastly different approaches to health care proposed by candidates Clinton and Sanders, with a particular focus on primary care.

Who Treats Medicaid Patients?

Who treats Medicaid patients? And is the quality of care provided by these individuals the same as you might expect from a clinician who takes only private insurance? An article in the April 2016 issue of Medical Care sought to answer these questions.

Although more than 92% of physicians reported seeing at least one Medicaid patient in 2011, the median proportion of Medicaid patients, for both PCPs and specialists, was less than 6%. This suggests that a small group of providers is responsible for seeing the majority of patients with Medicaid coverage…

As a current medical student, this research struck a nerve, particularly because of the emphasis on IMGs and medical school ranking. … What is more important to me is to understand what I, as a future primary care provider, can do. How do I ensure that people with Medicaid coverage get timely and appropriate referrals to specialty care? How can I expand my provider network to better equip them with the tools they need to ensure their long-term, lasting health?

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 »

Families rate independent and nonprofit nursing homes higher on patient experience

If you had to find a nursing home for a loved one, would you pick an independent, non-profit facility over a facility that was affiliated with a large, for-profit chain? If you said yes, your instincts are good. Independent and non-profit nursing homes are rated higher by patients and their families on the experience of their care. Kai… 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 »

The Use of Clinical Preventive Services under the Affordable Care Act

Increased use of recommended clinical preventive services among adults, such as colorectal and breast cancer screening and influenza vaccination, may save up to 100,000 lives per year and vastly improve life expectancy among the US population. Despite these benefits, recommended preventive services have been underused. In this post, I focus on colorectal cancer screening among adults… Read More »

Measuring Cost-related Medication Burden

As readers of Medical Care are no doubt aware, prescription drug expenditures for Medicare beneficiaries are high – nearly $90 billion in 2012.  There is some evidence that Medicare Part D has reduced financial burdens, at least among some beneficiaries, but recent surveys suggest that around 4.4% of individuals ages 65 and older (including those not on… Read More »

Racial Disparities in Ambulatory Care Sensitive Admissions

Using 2003-2009 Agency for Healthcare Research and Quality (AHRQ) hospital discharge data from 6 geographically and demographically diverse states, Mukamel and colleagues found that African Americans continue to experience poorer quality primary care, especially for chronic conditions.

Welcome to The ^new!^ Medical Care Blog

Welcome! We are so happy you have joined us on our new domain and platform. This move is one that we hope will allow our blog to grow its reach and readership. Our archives remain mostly at the old site. We hope you will share these posts with your colleagues, students, and fellow researchers and practitioners. Comments… Read More »

What might be hindering patient portal usage?

Personally, I find patient portals to be convenient. It’s an easy way to send healthcare-related questions to my provider such as, “does this medication have any side effects?” or, “can you please refill my prescription?”  I perceive the primary benefit as not having to schedule an appointment or wait on hold for 15 minutes to… Read More »

Lost in translation: Medical translators can help overcome language barriers only if…

As our country’s diverse populations grow, the variety in the numbers of spoken languages and dialects is also on the rise. In 2013, approximately 25.1 million individuals were considered Limited English Proficiency (LEP), which is a term that refers to individuals ages 5 and older who report speaking English less than very well as per… Read More »

Smoke-free Public Housing: A Rule Whose Time Has Come

Earlier this month, the Department of Housing and Urban Development (HUD) released a proposed federal rule to implement smoke-free public housing. The proposed rule would affect all living units, common areas, outdoor areas up to 25 feet away from the housing areas, and administrative offices. The change would affect over 700,000 units no later than… Read More »

Breaking the Fee-for-Service Addiction: Don’t Throw the Baby Out with the Bathwater

“Breaking The Fee-For-Service Addiction: Let’s Move To A Comprehensive Primary Care Payment Model,” a recent Health Affairs blog post by Rushika Fernandopulle of Iora Health, argues for replacing FFS payment with risk-adjusted comprehensive payments for primary care. We agree. However, the post portrays sponsors’ continuing to require submission of “dummy claims” as an unproductive addiction… Read More »

Evaluating the ability of patient-centered medical homes to improve clinical outcomes

Support for patient-centered medical homes (PCMH) has been growing in recent years.  A typical PCMH model includes a primary care physician supported by a multidisciplinary team, coordinated care, measurements of quality and safety, and enhanced access to same-day appointments. Preliminary program evaluations have shown that PCMHs can improve access and quality, but to date, there… Read More »

Emergency Department Use in Massachusetts for Low-Income Adults with Subsidized Health Insurance

Emergency department (ED) use has been increasing in the US for several decades, and some estimate that about half of all outpatient ED visits are potentially avoidable (also referred to as primary-care sensitive, or PCS). ED visits are expensive and may signify issues with access to, and quality of, care. Thus, reducing ED use is… Read More »