Opiate overdose is now the leading cause of accidental death in the United States, killing more than 50,000 people in 2015. About 20,000 of those deaths were attributed to the use of prescription opiate medications. As a physician, I want to alleviate my patients’ pain, but I have also taken an oath to do my… Read More »
Recently, I sat down to talk with Arlene Ash, PhD about risk adjustment. Dr. Ash is Professor and Chief of the Division of Biostatistics and Health Services Research, Department of Quantitative Health Sciences at the University of Massachusetts Medical School. As a methods expert on risk adjustment in health services research, she has pioneered tools… Read More »
Reproductive rights have been a topic for policy making and legal jurisprudence throughout much of the past century. As the healthcare system of the United States continues to evolve, women’s health and reproductive rights remain central to the debate. A recent policy update by Aishwarya Rajagopalan and Lisa Lines here at The Medical Care Blog discusses… Read More »
The burden of contraception falls primarily on women. In the United States, women need prescriptions for the majority of contraceptive methods, and so are vulnerable to changes in the healthcare system affecting access to care. Recently, President Trump has issued executive orders on religious liberty and related subjects that have paved the way for a rule… Read More »
The functionality and popularity of consumer-grade activity trackers (such as Fitbit) appear to be ever-increasing. If you don’t personally own one, you probably know at least one or two people who do. In an online survey of 1,000 respondents [PDF], conducted in 2016 by PwC, 45% owned a fitness band, with “Health” being the primary… Read More »
Expensive brand-name drugs are prescribed over older, less costly generics whose efficacy and risk profiles aren’t much different. Sometimes the financial issues involved are painfully obvious, such as when a drug company introduces a new, “improved” version of a medication that is merely a longer-acting version of the same chemical entity shortly before the patent expires on the original… 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 »
What’s the first thing you do when you get sick? For many people, a cursory search through various online resources is the initial step in gathering information toward obtaining a diagnosis. The internet places an infinite number of health-related resources at our fingertips, many of which are consumed through social media. Presently, 74% of US… 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 »
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 »
In narrative medicine, the clinician seeks to understand a patient’s story of their illness and their value system. Narrative medicine helps clinicians establish an empathic and therapeutic relationship with a patient, ideally resulting in a person-centered treatment plan. Rita Charon coined that term and approach in 2001 and expanded on it in numerous subsequent publications. Several sessions… Read More »
Smoking cessation is not innovative or trendy or even particularly exciting, but as a primary care doctor, in most cases helping a patient quit smoking is the best thing that I can do to help that patient over their lifetime. Without question. And for that reason, I always make it a priority to talk about it… Read More »
Anytime I see the words “cost saving” in reference to a public health or medical intervention, my first thought is “Yeah, right!” It just doesn’t happen that often. One can spend more money to get better outcomes (or more care provided), or less money for worse outcomes, but rarely less money AND better outcomes. However,… Read More »
I’ll never forget the time Granddaddy tried to eat my hand. At least that’s how it seemed to me at age six. In reality, he’d simply confused my hand with the straw sticking out of the milkshake we’d brought to him at the nursing home. By that point in his early-onset Alzheimer’s disease, the Granddaddy… Read More »
The population of the U.S is progressively becoming older; however, healthy aging is no longer an oxymoron. The availability of preventative medicine and health promotion programs have extended how long people can live healthy lives without chronic disability. Those aged 65 and over are projected to reach 83.7 million by 2050 [PDF]. While modern medicine has become… Read More »
Violence against women and girls is an international concern that cuts across all sectors of society. The United Nations defines violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary… Read More »
Republican Congressional leaders are currently debating how to repeal the Affordable Care Act (ACA) as part of the budget reconciliation process. Much of the debate over the ACA has focused on the individual mandate (and here) and the affordability (here and here) of coverage in the state-based marketplaces. The House version of the legislation, however,… Read More »
One remedy for the looming shortage of physicians in the United States is expanding the caregiver workforce to include nurse practitioners (NPs) and physician assistants (PAs). These health professionals come from fairly disparate backgrounds, yet over the years, increasing numbers of them have practiced side by side with physicians in primary care and specialty settings… Read More »
This post is the third in our 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]. Our third presenter, Kerith Conron, ScD, MPH, is currently the Blachford-Cooper Distinguished Scholar and Research Director at The Williams Institute of UCLA’s School… Read More »
To gauge the effects of medical interventions, we often use meta-analysis to combine the results of randomized control trials (RCTs). RCTs commonly use odds ratios (ORs) to measure the effect of a given intervention on the frequencies of events. Conventional methods of estimating overall ORs suffer from a number of issues. Drs. Chang and Hoaglin describe… Read More »
In an effort to improve the validity and person-centeredness of the nursing home resident assessment tool (the Minimum Data Set, or MDS), the Centers for Medicare and Medicaid Services introduced version 3.0 in October 2010. As a result, many of the measures and items health services researchers had grown accustomed to using in the MDS… Read More »
Ten years ago, Medicare began publicly financing and subsidizing the prescription drug program for seniors known as Part D. Individuals over age 65 with incomes below poverty are dually eligible for both Medicaid and Medicare, and full-benefit dual enrollees are automatically enrolled in a subsidized prescription drug plan with minimal co-payments. Turns out, this policy intervention may have played… Read More »
I once saw a breast cancer so advanced that the tumor had eroded through the woman’s chest wall. This wasn’t in a foreign country with little access to healthcare – it was in the city where I attended medical school: New Haven, Connecticut. The patient worked a full-time job and raised a family, but did… Read More »
In a recent Medical Care article, Guy and colleagues analyzed health insurance expansions among parents from 1999 through 2012 to assess the impacts of four different types of public and private expansions. They primarily examined changes in parents’ health insurance coverage, but they also analyzed whether expanding coverage for parents could “spill over” and raise coverage… Read More »
Let’s be honest, who doesn’t love cat videos? I’m not even a cat person, and I find cat videos to be extremely entertaining. Even if you don’t love cats or cat videos, you have to admit that internet cats have become quite a cultural phenomenon. In 2014, there were about 2 million cat videos on YouTube,… Read More »
High-quality evidence supports the use of medical marijuana for chronic pain, neuropathic pain, and other conditions. Yet, patients who live in some states can’t legally use it — and are threatened with loss of access to their prescribed pain medications if they do. I know this because a close family member of mine has chronic pain.… Read More »
Adequacy of healthcare for transgender patients has recently come to light, particularly with the increased discussion of trans persons in the media. Trans individuals identify their gender differently from their assigned sex at birth. Trans healthcare is an emerging field of research, and this increased focus continues to uncover the lack of knowledge amongst providers… Read More »
Exposure to toxic stress in childhood is associated with adult health inequities. Last fall, the Medical Care Health Equity Committee organized a special panel presentation on the topic at the 2016 APHA Annual Meeting. This post is the second of a series of posts.
The Centers for Medicare and Medicaid Services (CMS) wants to empower consumers to make informed healthcare decisions. CMS also wants providers to improve the quality of care they provide. One step towards accomplishing both of these goals is by public reporting of quality measures (QM). However, with multiple quality measures focusing on different care processes–all of which… Read More »
In the era of value-based care, caregivers and policymakers alike are intensely interested in strategies to reduce 30-day hospital readmissions. Researchers continue to offer up helpful tools in this effort. Recently published online ahead of print in Medical Care, Burke and colleagues make an important contribution with their article The Hospital Score Predicts Potentially Preventable 30-Day Readmissions… Read More »
The year 2016 was a big one for The Medical Care Blog: in February, we moved from our old publisher-hosted location and launched this new domain and design. We’ve published 61 posts here since then – a little more than one a week. We’ve added many new contributors and broadened our audience. Thank you for reading!… Read More »
If you have ever been in a hospital, you are probably familiar with what seems like a continuously revolving door of staff members providing care. With nurses making up the largest occupation in healthcare and the largest segment of hospital staff, continuity of nursing care for hospitalized patients is an important factor in the delivery of quality healthcare.… 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 »
Every year, 340,000 Americans are diagnosed with cancer, and fully 4 in 10 of these diagnoses will be colorectal cancer (CRC). CRC is the second leading cause of cancer death in the United States; however, 60% of CRC deaths could be prevented if everyone 50 years old and older were screened. By instituting patient-centered communication, we… Read More »
The unintended pregnancy rate (reflecting pregnancies that are unwanted or mistimed) for women in the U.S. has hovered at around 50% for the last 35 years. Only recently has that rate dropped to 45%, but the burden continues to fall most heavily on poor, undereducated women, women from racial or ethnic minority backgrounds, and young women. Much talk… Read More »
Access to interpreters improves health care and is generally required by law. Why then, is interpretation access hard to come by in hospitals? From a hospital staff perspective, appropriate policies may be in place, and hospital staff motivated to offer excellent patient care, but all the demands of providing medical care can lead to system breakdown.… 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 »
Being hospitalized with a serious medical condition, surrounded by strange equipment, and listening to medical jargon you’ve never heard before is an intimidating situation for anyone. Compounding the uncertainty and stress of the situation would be not understanding the primary language spoken by your providers, not being able to read your procedure consents, and knowing… Read More »
Posters and banners declaring “Creating the Healthiest Nation: Ensuring the Right to Health” were hung throughout the Colorado Convention Center in downtown Denver last month, celebrating the theme of the American Public Health Association’s (APHA) 144th Annual Meeting and Expo. As a first time attendee, one of approximately 11,600 people, I was a bit overwhelmed;… Read More »
In my medical practice, lacking the tools to communicate meaningfully with other providers who are caring for my patients is a daily frustration. This is only magnified when it comes to caring for my most vulnerable patients who have difficulty communicating for themselves, such as those suffering from substance use disorders (SUDs), so I was… Read More »
After a whirlwind APHA 2016 in Denver, we are back with a quick summary of the meeting and Medical Care Section events. There were about 11,600 conference registrants overall. We were impressed with the great turnout for Medical Care Section events. We had standing room only for the Special Invited Panel Session: The Childhood Roots of Health Inequity, a… 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 »
Expanding health insurance coverage may improve health care access [PDF] and reduce financial stress [PDF]. Ideally, having health insurance and the resultant access to care should improve health outcomes and well-being, although the evidence is complicated and mixed. One thing is sure: expanded insurance coverage typically leads to more utilization – a concern for policymakers and administrators because… Read More »
In just a few days, thousands of public health practitioners, students, scholars, and activists will descend on Denver, Colorado for APHA 2016. This year, your faithful co-editors will be there, live-tweeting about sessions! So be sure to follow @MedCareBloggers for real-time updates. Here are just a few of the sessions we’re looking forward to this year:… Read More »
A small section of the Affordable Care Act (ACA) packs a potentially big punch: State Innovation Waivers allow states to ask the federal government for authority to change parts of the ACA, namely the individual and employer mandates, establishment of state exchanges, and financial help to purchase insurance. These waivers can be used by states… Read More »
Paying for value, rewarding high-value care, pay-for-performance—all are examples of terminology used to describe aligning financial incentives with clinical goals and processes. Essentially, these policies and programs seek to link quality to payment and their influence is growing, extending even to Medicare. While these concepts have been discussed repeatedly by many in healthcare, including the… 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 »
According to the U.S. Department of Health & Human Services, in 2014, more than 240 million prescriptions were written for opioids, which is more than sufficient for each American adult to have one full bottle of opioids. Prescription drugs are second only to marijuana as the most abused category of drug in the United States. A recent article… Read More »