Children with complex health needs (CCHN) are a unique pediatric patient population. They have chronic medical and/or behavioral conditions that need ongoing health care. They use a disproportionate share of hospital resources. And they face greater social challenges when compared to other children. In North Carolina (where we work) and across the country, CCHN fail… Read More »
In this episode of our podcast series, Greg Stevens, co-editor, recaps the blog posts we published on The Medical Care Blog in November and previews the January issue of Medical Care. Greg also interviews Dr. Ben King from the University of Houston School of Medicine about their shared interest in health care for people experiencing homeless.… Read More »
To help determine which health policy changes to the Medicare or Medicaid programs are desirable, the CMS Center for Medicare and Medicaid Innovation (CMMI) relies on formal evaluations, performed by outside contractors, of how smaller scale, typically voluntary, demonstrations and other initiatives impact outcomes of interest. However, determining causal impacts often relies on the key… Read More »
More than 150,000 avoidable deaths occur each year due to mental, emotional, and behavioral health problems. This includes nearly 50,000 suicide deaths and 100,000 overdose deaths. People with chronic persistent mental illness suffer a 20-year shorter life expectancy. This country urgently needs to address how we pay for mental health services. Medicaid is a major… Read More »
“You can’t improve what you don’t measure” is a common phrase highlighting the importance and power of data. Indeed, the importance of data was the central theme of the 2021 All In National Meeting. In case you’re unfamiliar, the host of the national meeting is All In: Data for Community Health: a learning network of… Read More »
COVID-19 has severely affected nursing homes. As of now, over 139,270 residents and 2,155 nursing home staff have died from COVID-19. This post provides insight on the questions researchers are asking to understand the impact of nursing facility factors on COVID-19. A Perfect Storm The combination of a frail, aging population, close living quarters, and… Read More »
In our last blog post, we discussed the Biden Administration’s infrastructure package as an example of an upstream policy effort that could promote equity and help address disparities. However, as we pointed out in the first in this series of blogs, stakeholders who interact with community members are best suited to identify social risk factors… Read More »
In this episode of our new podcast series, Jess Williams, co-editor, recaps the blog posts we published on The Medical Care Blog in November and previews the December issue of Medical Care. As a bonus, Lisa Flaherty from the APHA Medical Care Section interviews two of our December contributors: Dr. Sharla Smith, founder of the… 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 »
While some health outcomes improve in the United States, racial and ethnic disparities in pregnancy-related outcomes persist. In the United States, Black women are three times more likely to die from a pregnancy-related complication than white women. In Kansas, Black women are more than three times as likely to die of pregnancy-related complications compared to… Read More »
The pace of progress is never fast enough for those who stand to suffer the biggest losses. Nowhere is this more apparent than in the glaring health inequities impacting Black mothers and babies in Kansas. Among the multitude of injustices Black Kansans face today, the disproportionate rates of death and devastating health complications for Black… Read More »
Medical care is sometimes, though not on this blog, viewed as the gold standard to address inequities. However, access to medical care only accounts for an estimated 10-20% of the modifiable factors that affect population health. The other 80-90% of modifiable factors are often referred to as social determinants of health (SDOH). These are the… Read More »
The Alzheimer’s Association’s 2021 Alzheimer’s Disease Facts and Figures report [PDF] shares that currently, six million Americans are living with Alzheimer’s disease, a number that has increased 145% since the turn of the century. Around the world, there are 50 million people living with Alzheimer’s disease or related dementia. Only a quarter of would-be patients… Read More »
In Los Angeles, the nation’s homelessness epidemic is playing out in broad relief. Criticized for an inability to visibly stem the local crisis, Los Angeles is now responding. Opening villages of tiny homes for people experiencing homelessness is part of a recent package of efforts gaining traction in the city. The situation in Los Angeles… Read More »
Check out our November 2021 Podcast for a recap of recently published blogs and a preview of articles in the November 2021 issue of Medical Care.
During the pandemic, telemedicine demonstrated it’s power. As we begin to make the shift back to in-person clinical care in a post-pandemic world, it’s important to look at the lessons learned during the pandemic. This will help guide us in how to move forward and improve telemedicine delivery. The History The use of telemedicine is… Read More »
The annual meeting of the American Public Health Association starts this weekend! This year the meeting is being held in person in Denver with lots of virtual options as well. I know everyone is excited about getting back together and connecting as a community. I can’t wait to connect with friends and colleagues and meet… Read More »
The COVID-19 pandemic has strained healthcare and public health. Many workers in these industries have felt growing frustration with leadership. They face a barrage of medical misinformation, ethical strains, and burnout. Now more than ever, authentic leadership is critical in supporting healthcare workers and advancing public health. This post will describe authentic leadership and examine… Read More »
COVID-19 has uncovered and multiplied health workforce equity challenges across the US. In the early days of the pandemic, healthcare workers faced incredible personal risk from an unknown, highly contagious, deadly disease. Insufficient personal protective equipment (PPE) and reprimand and dismissal by employers for speaking out worsened this risk. As waves of COVID-19 swept across… Read More »
In March 2020, the Centers for Disease Control and Prevention (CDC) confirmed COVID-19 as a pandemic. More than 18 months later, the nation has yet to return to ‘normal’. Hope for normalcy increased with the rollout of COVID-19 vaccines in the months that followed. Reluctance and resistance to vaccination, however, have made it difficult to… Read More »
Front-line workers are always at risk. It’s in the name. The COVID-19 pandemic has made this reality more salient for everyone. Risks of sickness from COVID-19 include death and morbidity. Front-line workers may also have lost more friends and co-workers than the average person. Healthcare workers have also been subject to violence and see the… Read More »
Homelessness persists in the US, and across the world, despite decades of recognition and longstanding efforts to end the condition. There have been major successes in our understanding of what policies and programs work to prevent and end homelessness. However, the work must and will find new ways to adapt and improve if we are… Read More »
Nonprofit hospitals make up the majority of hospitals in the US. In exchange for their tax-exempt status, the federal government requires these hospitals to provide support in the form of community benefits. Tracking community benefit spending and its impact is important to ensure that such spending aligns with community needs. Community benefit activities can include… 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 »
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 »
It’s hard to turn down a free lunch. It’s perhaps a little harder still if you’re paying for the free lunches of others. Yet, a decade after the passage of the Affordable Care Act (ACA), that’s what is happening in some states. Legislatures opposed to the ACA are refusing federal dollars for Medicaid expansion; dollars that other… Read More »
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 »
Efforts to achieve herd immunity to COVID-19 in the U.S. have stalled out. Currently, just about 68% of all U.S. adults have received at least one dose, despite vaccines being widely available. This is due, in great part, to a “misinformation pandemic” that now threatens public health. With many people still spending considerable time working from… Read More »
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 »
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 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 »
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 »
The Biden Administration’s proposed infrastructure investments are an example of an upstream effort to address disparities related to social determinants of health (SDOH). As mentioned in our previous blog post, SDOH are the conditions or circumstances within which people live, and these differ based on the distribution of power, money, and resources. The systems and… Read More »
Long-term services and supports (LTSS) for older adults and persons with disabilities have become a policy priority. The American Rescue Plan and the proposed American Jobs Act aim to increase LTSS spending through the Medicaid program, particularly for Home- and Community-Based Services (HCBS). These measures would address the need for wider service availability, while presenting… 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 »
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 »
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 »
The United States is currently experiencing multiple, simultaneous epidemics that claim thousands of lives every week. According to the CDC, over 81,000 drug overdose deaths occurred between June 2019 and May 2020. That’s the highest number of overdose deaths ever recorded in a 12-month period. An estimated 93,000 Americans die annually from alcohol-related causes. Many… 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 »
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 »
The Medicare Part D program, which was launched in 2006, is in the middle of its second decade of providing prescription drug coverage to Medicare beneficiaries. The Part D program has improved beneficiaries’ access to prescription drugs but at increasing cost. Federal spending for Part D has more than doubled from $44.3 billion in 2006… Read More »
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 »
What is telehealth? Telehealth involves using technology to facilitate healthcare interactions but has not been used extensively in Medicare in the past. The use of telehealth may be particularly relevant where there are geographic barriers such as a lack of local providers or a public health emergency such as the coronavirus pandemic. There are a… Read More »
The World Health Organization (WHO) defines social determinants of health (SDOH) as the non-medical factors that influence health outcomes. They are the “conditions in which people are born, grow, work, live, and age.” Currently, SDOH is a hot topic as stakeholders try new ways to improve individual and population health, achieve health equity, and reduce… Read More »
COVID-19-related scams are spreading nearly as fast as COVID-19 and threatening the health and safety of our communities. Since January 2020, people across the country have filed over 426,000 COVID-19-related complaints to the Federal Trade Commission (FTC) about fraud, identify theft, and other consumer protection. They have reported losses totaling over $397 million. As trusted… Read More »
A growing trend in health care, accelerated by the COVID-19 pandemic, is the implementation of telemedicine. Telemedicine is the delivery of health-related information and services among patients and providers via telecommunication technologies. An example is the use of video technology by doctors to evaluate, diagnose, or treat a patient instead of having a face-to-face encounter. … Read More »
As we are overcoming the COVID-19 pandemic, the obesity pandemic is worsening. The United States is the most obese country in the world. Is it time to admit defeat in this 30-year battle against obesity? Only 1 in 122 mildly obese people with a primary care physician will achieve a normal weight, according to a… Read More »
Over 30% of Black, Latinx, and Indigenous populations in the US are enrolled in Medicaid programs; more than half of all Medicaid enrollees are people of color. As such, Medicaid policies disproportionately affect populations of color. As more institutions reckon with historical and current injustices due to centuries of racism and racist policies, understanding how… Read More »
In an earlier post, we showed how rural prisons and census methods create distortions in county demographic and health statistics. In this post, we add further evidence and discuss the economic, political, and research implications of these potentially misleading data. National survey methodology may contribute to inaccurate data Census policy coupled with national survey methodology… Read More »