“We previously described an automated early warning system that identifies patients at high risk for clinical deterioration. Detection is achieved with the use of a predictive model (the Advance Alert Monitor [AAM] program) that identifies such patients. Beginning in November 2013, we conducted a pilot test of this program in 2 hospitals in Kaiser Permanente Northern California (KPNC), an integrated health care delivery system that owns 21 hospitals. The system generates AAM scores that predict the risk of unplanned transfer to the ICU or death in a hospital ward among patients who have “full code” orders (i.e., patients who wish … Read More
All posts by Anupam
“SCD [sickle cell disease] is a life-threatening, inherited blood disorder, affecting more than 100,000 Americans. Painful vaso-occlusive crises, the hallmark of SCD, result in substantial suffering and lead to associated stigma. Without adequate treatment, SCD affects all organs and is associated with decreased quality of life and a shortened life span. Among the dozens of conditions that are screened for in state newborn-screening programs, SCD is the most commonly detected condition, regardless of ethnicity. It is thus important to recognize SCD as a common and important medical condition among Americans, and not “just Black Americans.” [..] Although SCD is a … Read More
Like many of my colleagues in the American healthcare system, I have been alternatively hopeful and skeptical about the potential value from pursuing more value-based care initiatives in relation to our current fee-for-service model. Accountable Care Organizations (ACOs) will probably save no more than five percent of total healthcare costs. Eight years into Blue Cross Blue Shield’s Alternative Quality Contract with two-sided risk in Massachusetts showed savings ranging from 2.3% to 11.9% over three years. Bundled payments for joint procedures may save a few percent (primarily from reduced post-acute care utilization). Some have suggested Centers of Excellence to both validate … Read More
“[Methods] we searched MEDLINE and Embase for articles published between March 1, 2015, and Aug 14, 2020, without any language restrictions. We included randomised controlled trials of cardiovascular outcomes of an LDL cholesterol-lowering drug recommended by the 2018 American College of Cardiology and American Heart Association guidelines, with a median follow-up of at least 2 years and data on older patients (aged ≥75 years). [..] [Findings] Data from six articles were included in the systematic review and meta-analysis, which included 24 trials from the Cholesterol Treatment Trialists’ Collaboration meta-analysis plus five individual trials. Among 244,090 patients from 29 trials, 21,492 … Read More
“To help establish ACOs in more areas of the country, the Centers for Medicare and Medicaid Services (CMS) developed the ACO Investment Model (AIM) to provide participating ACOs with up-front and ongoing monthly payments over 24 months to fund ACO infrastructure investments and staffing. As part of the Medicare Shared Savings Program (SSP), the payments were to be recouped through any shared savings earned by the ACOs that sufficiently decreased costs relative to a financial benchmark, as specified by SSP regulations. Forty-one new SSP ACOs, primarily located in rural and underserved health care markets, joined AIM in 2016. [..] A … Read More
“Skin cancers represent the most common malignant neoplasms in the United States and account for more than $8 billion of health expenditure annually. Because the US population is aging, the incidence of skin cancers is increasing. In addition to topical chemotherapy, procedural treatments for skin cancers include Mohs micrographic surgery (MMS), simple surgical excision, and shave excision as well as destructive modalities including laser surgery, electrosurgery, and cryosurgery. [Results] From 2012 to 2017, MMS services had the highest mean payment ($378.71; range, $41.24-$466.93) and shave excisions had the lowest ($70.99; range, $15.58-$135.24). During this period, payment rates declined for each … Read More
“If public health officials want to get people to wear masks to curb the spread of Covid-19, they might take a lesson what is now a widely accepted aspect of American life: buckling up. [..] Fred Rivara, an injuries expert and professor of pediatrics at the University of Washington, remembers an unsubstantiated claim that any positive effects would be cancelled out by people dying when they couldn’t escape fiery cars. [..] After years of pressure, President Johnson signed legislation in 1966 that required seat belts in all passenger vehicles and created a national traffic safety agency. Rivara credits science for … Read More
This week’s refresh of the excess mortality count from the CDC (last updated November 4). The federal agency identified over 298,000 excess deaths across the country since the start of this year (about 4,000 more than last week’s estimate). The overall excess mortality rate decreased from 11.3% last week to 11.2% this week. Data from CDC’s National Center for Health Statistics, updated November 4, 2020
“In their 2019 book, The Misinformation Age, Cailin O’Connor and James Owen Weatherall explain how false beliefs persist and spread. They emphasise the social character of fake news. The connections between us in groups or networks enable the propagation of misleading evidence as well as true beliefs. Models of communication show the importance of trust in shaping the spread of beliefs. The greater the distrust among those with different views, the greater the risk of permanent polarisation. We are also prey to conformity bias—a desire to agree with others and to trust the judgments of others. Our predilection to conformity … Read More
“We assessed the clinical effectiveness and cost-effectiveness of a brief falls-risk screening questionnaire, sent by mail, followed by an exercise program or a multifactorial intervention targeted to persons at increased risk for falls, as compared with no screening in community-dwelling older people. All participants received advice by mail. [Methods] [..] This was a three-group, pragmatic, cluster-randomized, controlled trial with parallel economic evaluation that included 63 general practices in seven rural and urban regions in England. Drawing from their patient registries, general practices contacted community-dwelling persons 70 years of age or older who were living in their own homes. Residents of … Read More