Addressing Burnout Among Health Care Professionals by Focusing on Process Rather Than Metrics

“First described in 1975 by economist Charles Goodhart, Goodhart’s Law states that “when a measure becomes the target, it ceases to be a good measure.” The famous, and possibly apocryphal, example of Goodhart’s Law is the story of nail factories in the Soviet Union. To boost output, the factory performance was pegged to the number of nails produced, leading to the manufacturing of millions of tiny and useless nails. In response, the performance metric was changed to the nails’ weight. The factories, in turn, adjusted their approach and produced a small number of giant, and equally useless, nails. Hospitals, too, … Read More

Scaling Up Provider-Payer Workflows

Published 2020.9.30 I am involved in several health information technology (health IT) interoperability efforts including the Da Vinci project (a private sector initiative that addresses the needs of the Value Based Care community by leveraging the HL7 [a not-for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services] FHIR platform), Office of the National Coordinator for Health IT Fast Healthcare Interoperability Resources (FHIR) at Scale Taskforce (ONC FAST, a group of “motivated … Read More

Meals As Medicine: Feed The Hungry To Treat The Tuberculosis Pandemic

“Annually, about 10 million people develop TB, and an estimated 1.5 million die from their disease, which makes it the leading infectious killer worldwide, even in the time of COVID-19. [..] Key factors can significantly increase an individual’s risk. In particular, 2.3 million cases of TB were worldwide attributable to undernutrition in 2018: That’s one in five cases. By comparison, 1.2 million cases were attributable to HIV and 0.8 million cases to diabetes—risk factors that receive considerably more attention and funding. Undernutrition blunts the function of the immune system and increases the risk for TB so much so that it … Read More

Effects of Counseling by Peer Human Advisors vs Computers to Increase Walking in Underserved Populations: The COMPASS Randomized Clinical Trial

“Technology-enabled eHealth programs represent potentially cost-efficient and practical means for customized PA [physical activity] guidance to diverse groups. Most people targeted by eHealth, however, are well educated, younger than 50 years, and of non-Hispanic White ancestry, potentially intensifying health disparities. [..] This investigation tested whether a virtual advisor could increase 12-month walking to an extent similar to a comparably structured human advisor program among Latino adults. The human advisor program was delivered by trained peer advisors—a resource-efficient approach that is well accepted by Latino and other diverse groups but may be less convenient and scalable than computer-based programs. [..] Both … Read More

Effects of Time-Restricted Eating on Weight Loss and Other Metabolic Parameters in Women and Men With Overweight and Obesity: The TREAT Randomized Clinical Trial

“Intermittent fasting (IF) has gained attention as a simple weight loss method. Intermittent fasting refers to eating windows separated by defined periods of fasting (>12 hours and up to 48 hours, or more). Most of the reported benefits of IF are either untested or undertested in humans. Time-restricted eating (TRE) is a specific IF protocol involving consistent fasting and eating periods within a 24-hour cycle. [..] We conducted a randomized clinical trial (RCT) designed to determine the effect of TRE on weight and comprehensive metabolic outcomes in overweight and obese patients. We hypothesized that 8-hour TRE prescribed to individuals with … Read More

Excess Mortality by State, updated September 28, 2020

The CDC updated its count of excess deaths by state earlier today. For the weeks between the week ending February 1st through the week ending September 26th, the national excess death rate was 110% (same as last week). Thirteen states, the District of Columbia and New York City are reporting excess death rates higher than the national average (same as last week). Georgia has an excess mortality rate of 110%. California, Georgia and Nevada all had an excess mortality rates of 110%. New York City has the highest excess mortality rate (172% [down three percent]), followed by New Jersey (130% … Read More

Ideas About Resourcing Health Care in the United States: Can Economic Evaluation Achieve Meaningful Use?

“Managing health care spending is critical considering that the U.S. health care economy exceeds $3.5 trillion. Between $760 billion and $935 billion is wasted on low-value care that costs considerably more than its clinical benefits are worth. Giving Equal Weight to Valuation of Health Care Services and Technologies [..] payer reimbursements for health care providers and biomedical manufacturers could not be more different. Medicare and other payers that adhere to Medicare payment structures use prospective payments based on diagnosis-related group for hospital services, and fee schedules based on relative value units for physician services. Payments have created a fundamental divide … Read More

Sophisticated Purchasing of Pharmaceuticals: Learning From Other Countries

“The authors [Emanuel EJ et al. in a JAMA Internal Medicine Special Communication also published today] suggest that the United States should learn from its peers, from other developed nations that have created publicly accountable institutions for health technology assessment and drug price determination and that have reaped a return in the form of prices that are lower and better aligned with clinical value than drug prices in the United States. [..] Payers in the United States (governmental programs, self-insured employers, insurers, pharmacy benefit managers) conduct their own implicit health technology assessments but usually without the transparency or evidence focus … Read More

In The Era Of Hygiene, ‘Clean’ Author Makes The Case For Showering Less

“[physician and health reporter James] Hamblin’s new book, Clean: The New Science of Skin, is a documentary survey of this pre-dawn moment in our understanding of the skin microbiome. [Emily Vaughn] Your book sets out to challenge some cultural norms about hygiene. What types of cleansing do you think are overdue for reexamination, and which are critical? [James Hamblin] There’s a distinction between “hygiene” and “cleansing rituals” that’s especially important in this moment. “Hygiene” is the more scientific or public health term, where you’re really talking about disease avoidance or disease prevention behaviors. Removal of mucus, vomit, blood feces … … Read More