We have seen hospitals filled, high daily death tolls, and exhausted healthcare workers in large cities, like New York and Seattle. How will COVID-19 affect rural America? While initially many rural Americans felt protected by nature of their location, they are now feeling the effects of COVID-19 close to home. Small towns may serve as… Read More: COVID-19 and Rural America »
The current requirements for social distancing affect support groups for people with substance use disorders, but online support groups may provide the perfect solution. This post is the first in a series of planned posts on telehealth for addiction. COVID-19, the disease caused by the novel coronavirus called SARS-CoV2, is putting tremendous strain on all… Read More: Telehealth for Addiction: Online Support Groups »
The COVID-19 pandemic is placing healthcare professionals in the untenable position of rationing personal protective equipment (PPE) and working with suboptimal protection. This post explores which materials may be best suited for crafting homemade masks and considers how to use homemade masks productively. Personal protective equipment is critical when caring for patients with respiratory infection.… Read More: Crafting more effective homemade masks and putting them to work »
The rapid emergence of COVID-19 reminds us of the importance of the public health system. Local health departments (LHDs) play a central role in emergency preparedness and response. Effective epidemic response rests on the performance of the essential public health activities— assessment, policy development, and assurance—by LHDs. Evidence suggests that LHDs can improve population health… Read More: Local health departments and COVID-19 »
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: Healthcare utilization in the SARS-CoV-2 pandemic »
COVID-19, the disease caused by the novel coronavirus, is spreading across the US and around the world. Can providers use telehealth to help identify and manage the novel coronavirus while helping organizations manage capacity and prevent the spread of COVID-19? Read on to find out more. Because of its airborne person-to-person transmission, coronavirus and related… Read More: Using Telehealth to Fight the Novel Coronavirus »
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: The myth of female hysteria and women’s health disparities »
With the current focus on social risk factors (SRFs) affecting health care, it is not surprising that methods for comparing hospital performance might do well to account for such factors in their assessment. If up to 70 percent of health outcomes are driven by factors beyond medical care, and measures used to compare hospitals focus… Read More: Adjusting publicly reported performance measures for social risk factors »
Patients are sometimes referred to as “frequent flyers” when they visit an emergency department multiple times for the same issue. Often this is because discharged patients miss necessary follow-up care. This results in further worsening health, and may contribute to the frequent flying. To address this cycle, patients may be referred to a community health… Read More: Are Community Health Workers Worth It? »
Health care is on everyone’s mind. Here’s what presidential candidates say about healthcare: the 2020 edition. We are two weeks into the 2020 presidential primary season. On the Democratic side, muddled results in Iowa and very close results in New Hampshire have sprung some surprises. Currently at the top of the Democratic field are Pete… Read More: What presidential candidates say about healthcare: 2020 edition »
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: Evidence Synthesis in a Learning Health Care System »
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: Bundled Payment for Maternal Health: An Opportunity to Change Healthcare… »
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: Timing is Everything: Defining the Serious Illness Population for Palliative… »
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: Care experiences among Medicare beneficiaries with cancer: A cross-study overview… »
Over the past eight years, the US health care system has seen the widespread implementation of Accountable Care Organizations (ACOs) as a way to move from volume to value. What are ACOs? ACOs are groups of providers that are collectively accountable for the cost and quality of care for a defined patient population. Examples include… Read More: ACO Implementation: Current evidence and a way forward »
Research shows that decriminalization of drug possession, combined with other harm reduction efforts and treatment services, is an important component of efforts to improve public health and health equity. It was early in medical school when I encountered the first of many patients who had spent years in jail or prison for drug possession. On… Read More: Decriminalization of Drug Possession: Key to the Public’s Health and… »
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: The Changing Telehealth Policy Landscape »
Homelessness is both a public health issue and a deeply troubling sign of policy failures in a rich country such as the US. Yet what are the right ways to respond, both in the moment and on a larger scale? In early November, the American Public Health Association (APHA) gathered for our annual meeting at… Read More: Witnessing and Responding to Homelessness »
Welcome to the final post in our series on patient portals – an attempt to imagine the future. Part 1 of this series summarized the latest data on who is using portals. Part 2 explained some of the barriers to use as well as what factors increase use. Evidence of Increased Patient Engagement and Other… Read More: Patient Portals: Part 3 – The Future of Portals »
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 4 – The National School… »
This year, teachers striking across the country have found common ground on a priority outside of typical debates around salaries or pensions. Educators in three major cities–Los Angeles, Oakland, and Chicago–among others, have been calling for more school counselors, librarians, nurses, psychologists, and social workers to support their students’ development beyond academic benchmarks. These public… Read More: School Health Policy Series: Part 3 – Three Strikes for… »
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 2 – Athletic Trainers in… »
In Part 1 of this series, I summarized the latest data on who is accessing patient portals and for what purposes. In this post, I discuss the facilitators and barriers to patient portal use. General barriers to patient portal use Let’s start by discussing barriers to portal use. Patient portals have generally not been created to… Read More: Patient Portals: Part 2 – What Factors Affect Patient Use? »
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: School Health Policy Series: Part 1 – Everything’s Coming up… »
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: Introducing a Special Series on School Health »
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: APHA 2019 Preview »
Providers’ portal usage rates have been high for some time. While many patients have access to a portal, routine use is less common. In this three-part series, we will explore several questions: Who is using portals? What are the factors that prevent or facilitate the optimal use of portals to engage patients in their care?… Read More: Patient Portals: Part 1 – Who Is Using Portals, and… »
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: What contributes to inappropriate antipsychotic medication use? »
When was the last time you recall seeing your health information recorded on paper? Probably not recently. As stressed in an earlier blog post, electronic health record (EHR) adoption is becoming commonplace for a majority of healthcare providers. Your personal information that was once stored on stagnant paper records is now being captured in dynamic… Read More: How Secure is Your Health Data? »
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: Identifying Team-Based Primary Care is a Major Challenge »
VBID and alternative payment models comprise two approaches to reform with different incentives that influence underlying motives. The underlying principle of Value-Based Insurance Design (VBID) is to align patient out-of-pocket costs, or cost-sharing (deductibles, co-pays, etc.), with clinical value of services. Decreasing cost-sharing for high-value services and increasing cost-sharing for low-value services is the goal of… Read More: Two Approaches to Value in Health Policy Reform »
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: At 5 Years: Great Blog Posts That (Almost) Nobody Read »
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: Using Paolo Freire’s Methods to Teach Inmates About the Social… »
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: Moving from Stigmatization to Healthy Sexuality: The Vital Role of… »
Barbara Starfield was a pediatrician, primary care researcher, and member of the Medical Care section of the American Public Health Association. She passed away suddenly in 2011, and in 2016, the section decided to honor her memory by creating a new award: the Barbara Starfield Medical Care Scholar Award. The purpose of this award is… Read More: Call for Applicants: the Barbara Starfield Scholar Award »
In Part I, we touched on how healthcare stakeholders like clinical researchers, doctors, pharmacists, and other providers can and are implementing blockchain technology to facilitate the collaborative exchange of research and data. In this installment, we discuss the business case for blockchain in healthcare. Policies and implementation regarding exchanging patient medical data among providers vary… Read More: Taking Stock of Blockchain in Healthcare, Part 2 »
Since the American Recovery and Reinvestment Act of 2009 incentivized the adoption and use of electronic health records (EHRs), EHRs have become ubiquitous in the health care industry. Recent federal reports show about 84% adoption in hospitals and about 86% adoption in office-based practices. Patient information that was once captured on paper is now being regularly… Read More: Unlocking the Potential of Our Electronic Health Record Data with… »
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: The ICD-10 transition changed the game more than you think »
Blockchain use is usually associated with the finance industry, but the healthcare industry is actually outpacing finance’s adoption [pdf]. There are so many opportunities for blockchain in healthcare that some cite it as the perfect use case. In this two-part blog post, we will describe the implications of blockchain-based health information technology from the patient,… Read More: Taking Stock of Blockchain in Healthcare, Part I »
Value-based care is all the rage in health care system transformation. Promising in concept, value-based care initiatives aim to reward value over volume, shifting our understanding and practice of delivery and payment reform. These efforts received governmental support in 2015 via the Medicare Access and CHIP Reauthorization Act (MACRA), which launched a myriad of quality… Read More: Getting to the Values of Value-Based Care »
Health and health care disparities are frustratingly persistent. This is widely known, in great part, because of the landmark report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care that then spurred the Agency for Healthcare Research and Quality (AHRQ) to track and report on disparities for 250 measures since the early 2000s. The… Read More: Can Technology Help Reduce Health Disparities? »
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: The State of Abortion in America in 2019 »
Homelessness and housing are issues of public health significance. This month, we published a Special Commentary about homelessness in Medical Care, informed by the 2017 policy statement we co-authored for the American Public Health Association (APHA) about homelessness and how federal, state, and local authorities can use evidence-based solutions to help bring an end to… Read More: Homelessness as a Public Health Issue »
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: Are there geographic barriers to health IT use? »
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: How do you use PROs to improve patient care? »
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: Data-driven “wellness rewards” programs allow covert discrimination »
Hepatitis C treatment has gone through a revolution in the last 5 years. Treatment durations have dropped from 48 to 12 weeks, and success rates have improved dramatically. However, treatment costs have sky-rocketed accordingly, and access to care has become a significant issue, particularly for lower socioeconomic individuals and groups. Eligible veterans should have access… Read More: Veteran Access to Hepatitis C Treatment »
My second child – a daughter – was born 3 days before I was to begin year two of medical school. Already in my 30s, in the first stage of a second career, I decided to push through, and not take any time off. For a year, it worked out, as I had the support… Read More: Can Flexible Training Help Combat Burnout? »
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: Staying Current in Primary Care Research: An Attempt to Take… »
The risk of having a stroke has gone down over the past 25 years among older people in the US, according to new research by Yao and colleagues published this month in Medical Care. The study combined data from several different nationally representative data sources, including Medicare claims and survey data from NHANES and MCBS.… Read More: Stroke risk has declined in the US — for some… »