May 6 heralded another grim milestone in the United States: the first COVID-19-related death of an Immigration and Customs Enforcement (ICE) detainee, a 57-year-old man from El Salvador. Despite having high blood pressure and possibly diabetes, he had been denied release on bond by a judge. He continued to be held in Otay Mesa Detention… Read More »
Every night at 8pm, my neighborhood in Los Angeles, like many, cheers for the front-line health care providers who care for our communities. My family joins in the nightly raucous thanks. But a few nights ago, we paused. Where were the cheers for the public health professionals? Medical professionals have been in the spotlight, doing the… Read More »
We are in the midst of two global public health catastrophes: the rapid spread of COVID-19 and the more insidious, chronic effects of climate change. The swift spread of COVID-19 has devastated many countries and their economies. But global changes in environmental conditions have been harming communities for decades. The World Health Organization estimates that… 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 »
For decades, peer-reviewed journals have been a critical pathway for disseminating and advancing scientific knowledge. However, curbing the spread of misinformation requires evidence translation by experts into plain English. The rapidly evolving knowledge base on COVID-19 shines a spotlight on the issue. For example, a recent article in the New England Journal of Medicine offered… Read More »
While working as a nurse, I remember one instance of caring for two patients who were twins. Along with the same birthday and the same last name, they both had very similar first names. The twins were roughly around the same height, the same weight, and also had the same hair color. At first glance… Read More »
COVID-19 has revealed many vulnerabilities in our societal structure. One particular vulnerability is the risk inherent in our use of congregate institutions to house and treat people. This includes the risks of inpatient psychiatric facilities. Inadvertently, the pandemic has surfaced critical questions that we should seek to answer even when the virus is under control: What is the right… Read More »
Who is essential to the basic functioning of society? Who has to work to enable millions of us to stay safe in our homes during the COVID-19 pandemic? At some level, we all want to think that our jobs are “essential,” and in many senses, they are. They allow us to put food on the… Read More »
As of April 17, 2020, the novel coronavirus has infected more than 2.4 million people globally and led to 170,000 deaths. The global response to the COVID-19 pandemic largely emphasizes social distancing and shelter-in-place ordinances. These policies impact everyone, also upending the lives of those not directly affected by the virus COVID-19 pandemic. Like other… Read More »
Women do not stop needing access to abortions in a pandemic. They should not need to place themselves and others at risk of COVID-19 to access one. But that is exactly what is happening — due in part to new bans, but mostly as a result of years of dwindling access across the country. The current… 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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »