“because a vast majority of programs that tie payment to cost and quality goals aren’t focused on disadvantaged populations, they create incentives for hospitals to avoid patients from these groups. For example, in the 1990s, the New York State Department of Health began grading surgeons who performed coronary bypass surgery and making their report cards available to the general public. The aim was to make outcomes more transparent and to help surgeons improve. But to this day, the initiative makes it harder for Black patients to get surgery. Why? Because statistically, outcomes are generally worse for Black patients because of … Read More
“Though studies of resilience could fill a library, researchers have identified a shortlist of pillars and processes common to people who have overcome a difficult start in life and are able to cope when life becomes challenging. Among the factors most relevant to personal resilience are four pillars (awareness and self-reflection; personal skills that strengthen one’s identity; control over one’s life and fair treatment by others; and physical and mental health that results from physical activity, proper nutrition and good sleep hygiene) and three processes (living in diverse communities with abundant social support; experiencing safe spaces and leisure activities; and … Read More
Like other industries, healthcare is fascinated with the possibilities of using technology to help increase efficiencies and deliver solutions to populations. Replacing expensive physicians and other healthcare workers with apps and online tools is appealing. Unfortunately, our efforts to use health information technology (health IT) to reduce healthcare waste have not resulted in meaningful savings. Evidence-based medicine tools have not consistently improved diagnostic or treatment decisions. Congress, government agencies and others have tried to push health systems and payers to publish cost and quality information to help patients make more informed decisions with minimal impact. Highlighting data to promote shared … Read More
“evidence is limited as to whether population-level screening programs and accompanied lifestyle interventions for obesity and cardiovascular risk factors reduce mortality or the incidence of cardiovascular diseases. In 2008, Japan introduced a nationwide screening program to identify individuals with high obesity and cardiovascular risks (known as metabolic syndrome) and to provide health guidance to reduce weight and improve cardiovascular risk. All adults aged 40 to 74 years were required by law to participate every year, and approximately 29 million people in Japan received the screening program in 2017. [..] in addition to screening individuals, it provides lifestyle intervention programs for … Read More
“Almost all crashes among young novice drivers (95.6 percent) are a result of driver error.4 Relatively few crashes result from errors associated with intentional risk taking (for example, aggressive driving). Rather, nearly half of all crashes involve errors associated with inadequate skills and experience, primarily recognition errors (for example, poor scanning and distraction, 46.3 percent), decision errors (for example, following too closely, speed management, 40.1 percent), and performance errors (for example, losing control, 8.0 percent). As a consequence, crash rates among novice drivers peak in the months immediately after licensure and then slowly decline over the first two years of … Read More
“The World Health Organization (WHO) updated its evidence-based guideline on chronic HCV infection in July 2018. [..] We discuss implications of the WHO recommendations for clinicians and patients in the United States. The WHO recommends offering treatment to all persons older than 12 years who have chronic HCV infection, and it notes 3 major considerations for this “treat all” strategy: the effectiveness and safety of direct-acting antiviral agents (DAAs), the emergence of pangenotypic drug regimens, and reduction in the cost of treatment. In current treatment regimens, combination therapy with oral DAAs has replaced interferon and ribavirin. The WHO recommends pangenotypic … Read More
“Diabetes self-care activities take place primarily outside of clinical encounters. Intensive clinic-based programs have been reported to be effective in improving self-care behaviors; however, they are often resource intensive, and participant engagement wanes over time. Peer support models that include peers with the same chronic illness and experiential knowledge may help augment patients’ existing social support structures and improve self-care. Models using peers, such as shared medical appointments and community health worker programs, have been shown to improve diabetes clinical outcomes. A more informal, flexible, and potentially inexpensive means of providing peer support is through volunteer peer coaches or mentors. … Read More
“Numerous studies have shown that rehabilitation is associated with improved post-TKA [total knee arthroplasty] outcomes, whether comparing rehabilitation received at different settings or examining different physical therapy (PT) protocols. This typically requires active patient engagement by incorporating weight bearing exercise, active range of motion, and gait training. However, patients’ fear of falling and postsurgical pain accompanying weight bearing and range of motion exercises often limit patient’s ability to fully participate in PT and thus prolong a patient’s recovery. [..] This randomized clinical trial used a Food and Drug Administration–cleared treadmill using patented National Aeronautics and Space Administration technology to unload … Read More
“The US Centers for Disease Control and Prevention has recognised public health programmes that reduced deaths from coronary heart disease and stroke and prevented deaths from smoking as two of the greatest public health achievements of the 20th century, both championed by robust evidence connecting these risks to reductions in healthy life expectancy. [..] To our knowledge, no study links a comprehensive set of modifiable risk factors to health-care spending by condition. [..] To address this research gap, we estimated US health-care spending attributable to 84 modifiable risk factors in 2016, with the latest data available. We included behavioural risks, … Read More
“The advent of commercial mixed-reality (MR) technology, such as the HoloLens (Microsoft Corporation), offers new possibilities for anatomy education. At Case Western Reserve University (CWRU), the state of Ohio’s shelter in place order meant that students did not return from spring break in 2020, requiring an urgent modification to the anatomy curriculum, which has featured MR technology since 2018. [..] This survey study used a modification of the HoloAnatomy Software Suite (CWRU) that allowed headsets to communicate across different Wi-Fi networks and a system to allow instructors and students to digitally point at an object to ask and answer questions. … Read More