I am a health economist, trained to make sense of messy data. I generally work amidst a sea of numbers. But I’ve found that seeking out stories in health services research–those of doctors and patients–can help me anchor what’s truly important in research. These stories may also help researchers communicate the value of their work… Read More »
Last month, the Centers for Medicare and Medicaid Services (CMS) Innovation Center announced its newest alternative payment model for primary care, Making Care Primary (MCP). MCP builds upon lessons learned from previous CMS primary care models: the Comprehensive Primary Care Initiative, the Comprehensive Primary Care Plus (CPC+) initiative, the Maryland Primary Care Program, and Primary… Read More »
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 »
It is more important than ever to expand access to a broad range of safe and effective contraceptives that includes long-acting reversible contraception (LARC) methods. We are living in a new era in the US. As of early November, 2022, abortions are banned from the point of conception in 12 states and severely restricted in… Read More »
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 »
In a previous post, we shared highlights from an event about fixing health care featuring Dr. Michael Fine, a family medicine physician, former public health official, and the author of Health Care Revolt. The faculty of the Department of Public Health at California State University Los Angeles led the event as part of a department-wide book read.… Read More »
In this episode of our podcast series, Greg Stevens discusses health care provider burnout with Cooper Couch, a practicing physician assistant at an FQHC in rural Colorado. Next, he recaps the blog posts published in February and previews an article published in the April issue of Medical Care. Authored by Jae Downing, Kendall Lawley and Alex McDowell,… Read More »
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 »
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 »
During its recent mid-year meeting, the American Public Health Association’s Medical Care Section was honored to hear from two physician leaders serving at the heart of the fight against COVID-19. Hailing from opposite ends of the country, Drs. Atul Nakhasi (California) and Ayne Amjad (West Virginia) shared their insight about teamwork in a public health… Read More »
The COVID-19 pandemic caused large reductions in in-person office visits, costing primary care practices billions and exposing many of the risks associated with the fee-for-service (FFS) payment system. Capitation arrangements, in which providers are paid a per-member per-month payment, may offer a more attractive, less risky arrangement in the post-COVID-19 world. Almost all US health… Read More »
The COVID-19 pandemic has brought to light the gross underinvestment in public health, primary care, and the social determinants of health in the United States. Yet, this experience gives us a chance to rethink our health and social service systems, as these are often siloed. We see education, employment, healthcare, housing, and other social services… Read More »
The COVID-19 pandemic and the killing of George Floyd are further stressing the already strained U.S. mental health care system. Primary care doctors train to treat common mental health problems, and they can help alleviate this strain on the system. Mental health issues on the rise In a national survey [pdf] of primary care patients… Read More »
A new study out this month in Medical Care by Yongkang Zhang and colleagues finds that people in struggling neighborhoods have considerably higher spending on potentially preventable health care. While overall health care spending was similar between the most deprived areas and average communities, the finding about spending on potentially preventable health care tells an… Read More »
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 »
A 14-year-old girl came to my primary care clinic with abdominal pain, similar to abdominal pain she’s had intermittently for years. As with all women of reproductive age, I checked a urine pregnancy test, and it was positive. I returned to the patient’s room to talk with her about the result, and her first question… Read More »
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 »
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 »
“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 »
“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 »
Why do we care about unintended pregnancies? Rates of unintended pregnancy “indicate the extent to which women and couples can determine freely whether and when they have children,” as stated by Finer and Zolna. There is some evidence that women and girls who have unintended pregnancies have a higher likelihood of other risk factors, such as… Read More »
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 »
The burden of homelessness on the health of those afflicted continues to be a major global public health concern. Last year, the United States recorded an increase in the number of homeless for the first time since 2010. On any given night in 2017, there were 553,742 people in the U.S. experiencing homelessness. In terms of… Read More »
Patients are increasingly involved in shaping research in health care, especially since the advent of the federal Patient-Centered Outcomes Research Institute (PCORI). PCORI actively promotes the engagement of patients and other stakeholders (clinicians, caregivers, purchasers, etc.) in the research process. As we discussed in an earlier entry on this blog, research terminology alone can be a… Read More »
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 »
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 »
The Affordable Care Act (ACA) had a roller-coaster of a year. It began with threats of almost certain repeal, followed by effort after unsuccessful effort to dismantle it. Then in the last days of 2017, there was the successful repeal of the individual mandate penalty. This was brazen politics, suspenseful and often agonizing. It… Read More »
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 »
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 »
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 »
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 »
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 »
The lack of primary care infrastructure in the U.S. has been blamed for our extremely high health expenditures, as we spend about 2.5 times what other comparable countries spend (OECD Health at a Glance) without better health outcomes. Increasing our primary care workforce is an important part of controlling health care costs while also providing… Read More »
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 »
Last month, I left readers with a bit of cliffhanger: How do we actually improve care coordination? Last time, I suggested there were some great ideas, and now it’s time to delve into three promising strategies: 1) individualize and personalize the electronic medical record (EMR); 2. fix the hospital discharge process; and 3) make it a part of normal practice to measure care coordination. Read on for more about each of these tools…