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 »
White paper, grey literature, black box warning. The nature of our medical research, presentation, reporting, and publication has defined the values associated with colors. A white paper is defined as an “authoritative” report on a subject. Grey literature is described as being “non-conventional, fugitive, and sometimes ephemeral.” And a “black box” warning alerts physicians and… Read More »
What comes to mind when you hear the word “weathering”? Perhaps you think of erosion, depletion, and wearing down. Or maybe enduring, surviving, and withstanding. All of these associations accurately describe what happens to our bodies in response to chronic stress. This particular type of physiological stress affects the brain and other parts of the… Read More »
Originally published April 6, 2023; updated April 24, 2023 to add audio links. Welcome! April 2023 marks a new milestone for the Healthy Intersections Podcast (HIP), sponsored by the American Public Health Association’s Medical Care Section. I’m taking on the role of the main producer of HIP. We’re also moving to a video AND audio… Read More »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
As a sexual health educator at public high schools in Tennessee, teachers would consistently jump in as I approached the topic of contraception. Required by law, these teachers would “emphatically promote sexual risk avoidance through abstinence.” After this abrupt interruption, I would then proceed to talk about all forms of contraception, including abstinence. Students would… Read More »
Tailoring the primary care medical home model improves the care experience for US Department of Veterans Affairs (VA) patients with homelessness experience, according to a recent study by Dr. Audrey Jones and colleagues in the journal Medical Care. Researchers from the VA’s Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center and Center for Health Equity Research… 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 »
In the new US consumer marketplace, doing good for society is powerful. Choices that people are making about how their food is grown, how companies test household products and reduce their impact on the environment, and how companies make their profits are driving new business models. Farmers are changing their pest and weed-control methods, manufacturers are… Read More »
As unconscious bias and discrimination comes to the forefront of national conversation, it is fitting to discuss bias in the healthcare system. Though we pledge to treat all patients fairly and to the best of our capacity, regardless of their background, increasing evidence suggests that healthcare providers, too, have bias and exhibit behaviors perceived by… Read More »
This post is the final one in our 4-part series focusing on presentations that were delivered at a special panel session at APHA16 on the childhood roots of health inequity [part 1, part 2, part 3]. Our fourth presenter, Dr. Jennifer Manly, is Associate Professor of Neuropsychology in Neurology at the Gertrude H. Sergievsky Center and the… Read More »
Children who grow up in stressful environments, without adequate adult support, are at much greater risk of developing heart disease, cancer, and many other diseases as adults. This is partly because of the coping behaviors that people use to deal with stress, but also because of the cumulative effects of toxic stress. Thus, many of… Read More »
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.
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.
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 »
Ben King is joining our editorial team at The Medical Care Blog! Dr. King (he/him) is currently an Assistant Professor of Population Health at the new Tilman J Fertitta Family College of Medicine at the University of Houston. He has additional appointments in the Department of Behavioral and Social Sciences, with the UH-Humana Integrated Health… Read More »
The way we’re addressing substance use and overdoses in the United States isn’t working. Let’s be perfectly clear: the “war on drugs” isn’t, and never was, really a war on drugs. It’s been a war waged on communities who are Black, Indigenous, and People of Color (BIPOC). The war on drugs started well before President… Read More »
Dear readers, it’s been awhile since we published a “top posts of the year” roundup! In fact, we haven’t published one since 2018. So, as we wrap another eventful year of blogging at the intersection of public health and medicine, our holiday gift to you is here! Oh – and we’re still one of the… Read More »
Patient experience surveys are a cornerstone of public reporting and pay-for-performance initiatives. Some healthcare providers, payers, and other stakeholders have expressed concerns about declining response rates and representativeness of these surveys [pdf], especially for underserved groups. Increasing response rates is an important goal. Several strategies have been proposed to increase response rates, including administering surveys… Read More »
Happy Pride month! In this post, I’d like to share about a research project in progress that is relevant to the LGTBQIA+ community. This post may also be interesting to those of you who care ok about health equity and the social determinants of health (SDoH). I am a member of the queer community myself.… 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 »
Part 1 of this two-part series laid out arguments for and shortcomings of imputing race/ethnicity from the perspective of health equity. In this post, we’ll talk about gaps in the evidence and a few alternatives to imputation, including approaches involving population-level and neighborhood-level data. Imputation is a common solution to deal with “the missing-data problem.”… Read More »
In Part 1 of this two-part series (originally published Aug. 19, 2021), we lay out arguments for and shortcomings of imputing race/ethnicity from the perspective of health equity. In Part 2, we’ll talk about evidence gaps and research needed, as well as a few alternative approaches. The Biden administration is focusing on health equity and… Read More »
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 »
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 »
Randomized control trials are the commonly held gold standard clinical trial design. The randomized controlled trial (RCT) is the gold standard of clinical research. However, researchers are increasingly asking: must they be? Webster-Clark, Jonsson Funk, and Stürmer discussed single-arm trials: administering a drug to an experimental group and using real-world data (RWD) to select an… Read More »
The inequitable distribution of COVID-19’s terrible burden has been well documented. There are notable disparities by race and ethnicity. COVID-19 rates, including incidence and fatality rates, are higher among Black, Indigenous, and other Persons of Color (BIPOC). This is structural racism at its worst, in which BIPOC individuals are disproportionately represented among essential workers and… Read More »
What accounts for large differences in life expectancy from one neighborhood to another? This post explains what our team has discovered so far using an “artificially intelligent” approach to understanding social risk at the local level. Where you live affects how long you live In 2018, when the National Center for Health Statistics released the… Read More »
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 »
With the 2020 US presidential election drawing near, debate about the options for universal coverage will ramp up. At the heart of this debate is the estimated 45% of US adults who are either uninsured or under-insured. They are at risk of experiencing financial hardship or going without needed care in a time when access to… Read More »
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 »
There is a lot of attention being paid to the proportions of severe and fatal cases in discussions of COVID-19. Unless you’ve been living under a rock since January, you know that there are groups who are more likely to get very sick or die during this pandemic. In this post, we explore the evidence… Read More »
The codes of the International Classification of Diseases (ICD) serve as the backbone for billing, payment, and surveillance programs across the entire healthcare system – nationally and globally. Recent research published in Medical Care by Alexander Mainor and colleagues from the Dartmouth Institute for Health Policy & Clinical Practice has shown that the transition of… Read More »
Access to care facilitates better health, and much of the work in Medical Care analyzes policy changes that affect insurance coverage both for the population as a whole and for disadvantaged groups (see examples, here, here, and here). Unfortunately, even as governments and researchers work on existing problems, technology is enabling new barriers. Wellness programs… Read More »
This post is for the measurement methodologists in the house. Although, the study results have a real impact for anyone reading macro-level studies of health care services and economics. Sure, this is a bit of inside baseball, but it involves a fundamentally important issue at the center of healthcare research and policy that relies on… Read More »
Medication non-adherence can be a tricky issue for healthcare providers, patients, and pharmacists to solve. In addition to cost, there are many other factors that influence whether someone takes their medication(s) as prescribed. As discussed in the literature, side effects, confusion about medications, and the general human tendency to forget may all play a role.… Read More »
Bias in claims data with respect to disease status is a problem for health services researchers, because we often rely on administrative claims (billing data) to measure disease status for large cohorts. Misclassification bias may alter the prevalence of given conditions–which is especially problematic for epidemiology and comparative effectiveness research. It may even alter the… Read More »
Delivering the Olga M. Jonasson Lecture at the 101st Annual Clinical Congress of the American College of Surgeons in Chicago, IL in October 2015, Dr. Julie Ann Freischlag noted how difficult it is for women to break down barriers in many fields, especially in academic medicine. But Dr. Freischlag is no ordinary woman. Throughout her career, she… Read More »