Tag Archives: Healthcare Delivery

Getting postpartum care is unaffordable for many women

By | August 22, 2023

Known as the fourth trimester of care, postpartum care has become unaffordable for many women. The costs of care are increasing, due to rising deductibles, increasing chronic diseases, and a lack of access to Medicaid. While postpartum care technically refers to the 12-week period after delivery, there is a movement to recognize that adequate postpartum… Read More »

Telemedicine and Depression

By | March 23, 2023

 The rapid transition from in-person to care to telemedicine visits at the start of the COVID‑19 pandemic did not adversely affect the quality of care – and even improved some aspects of care – for patients with major depression in a major integrated health system, according to a new report. The study appears as part of… Read More »

December 2022 Healthy Intersections Podcast

By | December 8, 2022

In this month’s podcast, co-editor Jess Williams recaps blog posts from November and talks about some December journal articles. Listen here or wherever you get your podcasts. Transcription Welcome back to Healthy Intersections, the podcast of themedicalcareblog.com. In this month’s episode, I’ll review some of our blog entries from November and give you a preview… Read More »

The Medicaid Outcomes Distributed Research Network MODRN [Podcast]

By | October 10, 2022

The Medicaid Outcomes Distributed Research Network (MODRN) was started by AcademyHealth and is a collaborative research network of state Medicaid agencies and university partners. The goal of the network is to allow analysis and learning about Medicaid by facilitating comparison across states and aggregate data with a shorter lag time than other available sources.  This… Read More »

Diabetes Cure or Diabetes Management?

By | May 26, 2022

Reuter’s announced in January that diabetes deaths in the United States continue to surge well above pre-pandemic levels with over 100,000 Americans dying from diabetes in 2021. Given COVID-19’s relationship to diabetes, we may see this trend continue. Increasing deaths from diabetes is a clear call to action for new solutions. Historically, diabetes has been… Read More »

Whole Person Health: A Path to Health Equity (Part 2)

In our first blog post of this series, we discussed how the current medical approach misses so much of what influences health, and how it perpetuates health inequities in our society. In this post, we go in-depth on the elements of Whole Person Health (WPH) that are necessary components of a just and equitable approach… Read More »

Whole Person Health: A Path to Health Equity (Part 1)

Our current U.S. medical system doesn’t work. It is not able to adequately care for the sickest, most vulnerable, and least resourced people. It often excludes those seen as “other” in our society. To become a just system, we need a new focus on Whole Person Health (WPH). Very briefly, WPH cares for the whole person and… Read More »

Evaluating Community Health Worker Programs

By | February 3, 2022

Evaluating community health worker (CHW) programs can be difficult. Many of the outcomes that we care about, such as patients’ capacity to live healthier lives, can be difficult to measure and take time to manifest. I have been fortunate to be part of a five-year research partnership with the KC Care Health Center that was… 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 »

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 »

Vaccine Points-of-Dispensing Medical Exercise

In military medicine, exercises, such as a mass vaccination points-of-dispensing (POD) scenario, test preparedness capacity, and drill for potential real-world public health emergency scenarios. Exercises are designed to challenge medical teams to work under pressure and problem solve according to conditions presented in the exercise scenario. A benefit of medical exercises in the military is… 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 »

The Complexity of COVID-19 Vaccine Distribution in Rural Areas

During the past year, the COVID-19 pandemic has highlighted health inequality created by social determinants of health (SDoH) in the United States. SDoH include all aspects of the living environment, social support, safety, well-being, and resource availability, directly or indirectly influencing physical health outcomes. Consideration of SDoH is critical for successful comprehensive COVID-19 vaccine rollout.… 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 »

What’s next for virtual care after the pandemic?

By | October 6, 2020

In March, CMS and other Federal agencies announced temporary telehealth policy changes in response to the COVID-19 public health emergency.  These changes promoted continued access to care while allowing for physical distancing.  Virtual care encounters have increased since March.  However, as the public health emergency has continued, there are questions about the future of virtual… Read More »

Maintaining healthcare access during outbreaks

By | October 6, 2020

Preserving access to care is a high priority, even in a pandemic. We need to strengthen the existing coordinated regional treatment network for better preparedness. One consequence of the COVID-19 pandemic has been that people are scared to seek health care because they fear getting infected in clinics and hospitals. Although in many cases it… 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 »

Moving Upstream to Reduce Harm from Fake Opioids

By | July 16, 2020

When a call came in from the county coroner, it was never good news. Every once in a while, her work included a shock big enough to share with the public health team where I served as Medical Director. This was the case that Monday afternoon. Two teenage deaths, likely from opioid overdoses, likely the… 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 »

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 »

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 »

Evidence Synthesis in a Learning Health Care System

By | January 31, 2020

An October 2019 Medical Care supplement describes a learning health care system: the VA Evidence Synthesis Program (ESP). The ESP is dedicated to making high-quality evidence accessible to improve health and healthcare for veterans. The articles in the issue describe the outcomes from integrating research synthesis with qualitative and quantitative data from health systems. These… 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 »

The Changing Telehealth Policy Landscape

Although telehealth has been in use for quite some time, uptake has been low. In particular, an inconsistent policy landscape presents a number of obstacles, such as site restrictions on where telehealth can be delivered, provider restrictions on who can deliver services, and reimbursement restrictions around payment for services. However, some recently developed policies aim… 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 »

APHA 2019 Preview

By | October 31, 2019

Creating the Healthiest Nation: For science. For action. For health. The annual meeting of the American Public Health Association is just around the corner! The meeting starts this weekend, November 2nd, and runs through November 6th in Philadelphia. Special Sessions The Medical Care Section has some fantastic sessions planned for the meeting. In addition to… 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 »

Using Paolo Freire’s Methods to Teach Inmates About the Social Determinants of Health

Mass incarceration is a true epidemic. It is also one fueled by social determinants, including race. Over the past four decades of “war on drugs” and “tough on crime” policies, the US incarceration rate has increased by over 500% [pdf]. There are over 2 million men and women in jails and prisons across the country… 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 »

Staying Current in Primary Care Research: An Attempt to Take Stock

By | April 25, 2019

For months, I’ve been keenly interested in trying to explore where the field of primary care research stands. It’s daunting to pull your head up from your own research, take stock of what your colleagues (both known and unknown) are doing and try to assess where the field is advancing. Doing this every now and… 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 »

Health Care Revolt–Reflections on Democracy and Medicine

By | March 2, 2021

“A book lying idle on the shelf is wasted ammunition.” – Henry Miller, The Books in My Life (1952) The Medical Care Blog is home to many strong opinions.  In the last year, contributors have written provocatively about the political determinants of health, highlighted the per-mile cost of President Trump’s wall in numbers of children who… Read More »

What’s Happening with Medicare for All?

By | January 31, 2019

It’s a new season. The federal government re-opened this week after a record-breaking shut-down.  Democrats gained control of the U.S. House of Representatives, feeling newly emboldened after the dispute about a border wall.  A gaggle of 2020 presidential hopefuls has revealed themselves in recent weeks, lining up to be, arguably, the most liberal class of… Read More »

Can teamwork make the dream work?

By | January 17, 2019

In 2019, mental health and opioid use disorders remain major public health issues. The most recent estimates suggest that 40 million adults experience mental illness in the U.S. and nearly 8 million adults experience both mental and substance use disorders at the same time. Individuals with mental illness also face higher risks of co-occurring chronic health conditions and… Read More »

Swiping left and the evolution of primary care

By | September 25, 2019

A few weeks ago, a headline in the Chicago Tribune grabbed my attention: “Millennials are trading primary care doctors for faster, cheaper alternatives.” This headline fits the rather unfortunate stereotype of millennials as impatient, job-hopping, financially-struggling, digital natives. But if this is true, then millennials are bound to “swipe left” to health care delivered in a… Read More »

WhatsApp Doc? Connecting Specialists to General Practitioners in India

By | July 24, 2018

In India, cardiovascular diseases (CVDs), specifically coronary heart disease and congestive heart failure, are leading causes of disability and death. The large projected population of patients with CVDs in the coming years poses one of the biggest threats to this fast developing nation’s future. The crushing magnitude of the problem is exacerbated in rural areas where… Read More »

The Primary Care Workforce: A Brief Review

As the older population in the US continues to grow, simultaneously increasing the need for healthcare services and providers, patients these days might be more likely to see a physician assistant (PA) or a nurse practitioner (NP), as opposed to an physician (MD); but what’s the difference? Let’s start out with some key facts: how… Read More »

End-of-Life Care and the Opioid Crisis: Potential Implications and Unintended Consequences

Reactions to the opioid crisis are affecting patients in need of hospice and end-of-life care in the United States. Hospice providers have been largely exempt from the increasing regulation of opioid and narcotic prescriptions, as most recent laws and regulations affecting opioid prescribing specifically exempt individuals receiving cancer treatment, palliative care, or those nearing their end-of-life. However,… Read More »

Primary care is the new 911

By | May 3, 2018

The day had finally come to start my first job as an EMT for a 9-1-1, emergency ambulance company. Before my first shift, I believed that most of the emergencies I would respond to were going to be serious and could be a matter of life or death. However, little did I know that many… Read More »

Sometimes the best medicine isn’t a medicine at all

By | March 15, 2018

Ironically, many healthcare providers–doctors, nurses, physician and medical assistants–are not trained in “health” at all but in “medicine” instead. Often, as providers, our instinct is to first reach for a pill bottle or a procedure and forget about lifestyle changes that could be safer and more financially feasible for our patients. As the burden of… Read More »

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 »

How do mental health conditions contribute to preventable hospitalizations?

By | December 18, 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 »

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

By | December 13, 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 »

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 1, 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 »