Observed to Expected Excess Mortality for the United States, Updated November 7, 2020

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

Offline: Managing the COVID-19 vaccine infodemic

“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

Screening and Intervention to Prevent Falls and Fractures in Older People

“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

Reimagining Cardiac Rehabilitation in the Era of Coronavirus Disease 2019

“Cardiac rehabilitation integrates patient education, behavior modification, and exercise. The traditional in-person, center-based cardiac rehabilitation model has been shown to reduce all-cause hospital readmissions by 31% and all-cause mortality by 24% over 1 to 3 years. For patients with a recent acute myocardial infarction, coronary revascularization, or acute heart failure exacerbation, cardiac rehabilitation reduces spending on future hospitalizations by approximately $900 per patient over 21 months. Yet uptake has been disappointing. Even before COVID-19, less than a third of eligible patients attended a single session. Supply-and-demand challenges have impeded uptake, and both must be addressed to expand this life-saving therapy. … Read More

Modeling Mitigation Strategies to Reduce Opioid-Related Morbidity and Mortality in the US

“In 2017, approximately 47,600 individuals in the US died from an opioid overdose, and morbidity and mortality from the opioid epidemic continues to accrue. [..] To fully estimate the epidemic’s scope and the impact of interventions to address it, it is essential to consider differences in individuals using prescription opioids vs heroin or illicit fentanyl, the increased risk of second overdose in people who have experienced an initial overdose, and the evolving time-dependent nature of the epidemic. Despite the contributions of prior models of the epidemic, most have not incorporated these elements, nor have they accounted for the more than … Read More

Using DALYs to Investigate Innovations in Care Delivery

On October 27th, the United States Preventive Services Task Force (USPSTF) issued a draft recommendation to extend colorectal cancer screening to individuals 45-49 years of age (Grade B recommendation). Assuming the public comment period does not uncover any surprises, the recommendation will be finalized by the end of the year. The recommendation includes the group’s modeling of benefits and harms with the proposed screening strategy. Compared to our current screening recommendations (screening individuals 50-75 years of age), the new recommendation will add 22-27 additional life-years at a cost of 0.2-2 additional gastrointestinal and cardiovascular complications per 1000 individuals screened. Given … Read More

Effect of an Online Weight Management Program Integrated With Population Health Management on Weight Change: A Randomized Clinical Trial

“Population health management is a team-based approach in which nonclinical staff members identify and reach out (typically outside face-to-face visits) to specific groups of patients with unmet preventive and chronic condition care needs. Population health management has been increasing across primary care and is associated with improved outcomes, but to our knowledge, it has not previously been used for patients with overweight or obesity. The purpose of this trial was to examine whether integrating an online weight management program with population health management support would enhance its effectiveness and lead to greater weight loss at 12 months among primary care … Read More

Getting The Price Right: How Some Countries Control Spending In A Fee-For-Service System

“In most countries with universal health insurance, physicians are paid on a fee-for-service basis, yet prices there are lower than in the US. As Miriam Laugesen and Sherry Glied explain, “Higher fees, rather than higher practice costs, volumes, or tuition expenses, are the main driver of higher US spending.” Among US policy makers, the response has been to focus on market competition, managed care, price transparency, and performance measurement. This response is grounded in the view that fee-for-service private practice and third-party payment saddle the health system with perverse financial incentives. Beginning in the 1970s, managed care emerged as a … Read More

Trends in Industry Payments to Physicians in the United States From 2014 to 2018

“We performed a retrospective, population-based cohort study of US allopathic and osteopathic physicians practicing in 2014 per the National Plan and Provider Enumeration System, excluding other clinicians (eg, nurses, dentists) and physicians activating or deactivating their records between 2014 and 2018. Specialties were grouped by Medicare Data on Provider Practice and Specialty taxonomy classifications: primary care, medical specialty, surgical specialty, obstetrics/gynecology, hospital-based specialty, and psychiatry. [..] Payments were aggregated per physician annually, then categorized by cumulative aggregate value (≤$10,000; $10,001-$25,000; $25,001-$50,000; $50,001-$100,000; $100,001-$500,000; and >$500,000). Values were adjusted to the 2018 Consumer Price Index. [..] Of the 2014 cohort of … Read More

What US Medicine Needs To Do To Finally Embrace Capitation

“In 2012, there were 35,700 hospital-owned physician practices, and in 2018, there were 80,000 hospital-owned physician practices, constituting 128 percent growth. The coronavirus pandemic may actually accelerate these acquisitions due to reduced revenues for independent physician practices. [..] For consolidated health systems that include hospitals and employed physician groups, health care executives face significant pressure on finding appropriate resource allocation to cover fixed and variable costs of inpatient care while also funding alternative sites of care. Striking this balance with a fixed budget is not obvious, and health care executives may need to divest from more expensive hospital-based labor and … Read More