A Framework to Triage Older Adults with Covid-19 to Provide Patient-Centered Care

“[Summary] [..] Our institution developed and implemented a triage framework in the Emergency Department utilizing the Clinical Frailty Scale (CFS) to promote patient-centered care during our Covid-19 surge. A triage clinician assessed 40 patients aged 70 and older from April 7 to May 22, 2020. In addition to recommendations for medication management, fall risk reduction, delirium prevention and advance care planning, the triage clinician directed patients with a CFS of 1-3 to usual care (n=8, 20.0%), a CFS of 4-6 to geriatric co-management (n=6, 15.0%), a CFS of 7-9 to palliative care triage (n=23, 57.5%) and 7.5% (n=3) to both … Read More

Automated Identification of Adults at Risk for In-Hospital Clinical Deterioration

“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

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

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

Assessment of Sales and Marketing of Online Vouchers for Discounted Direct-to-Consumer Medical Imaging Services

“The expansion of the direct-to-consumer (DTC) medical imaging market elicits several safety and ethical concerns. Discounted DTC imaging may lead to unnecessary testing and subsequent incidental findings, false-positive results, radiation exposure, and downstream interventions. Groupon, Inc, a global e-commerce marketplace, has garnered media attention for its vouchers for discounted DTC medical imaging services. In this study, we evaluated the scope, pricing, customer feedback, and claims of medical imaging services offered through Groupon vouchers. We performed a cross-sectional analysis of Groupon offerings in the US on February 6, 2020. On the Groupon home page, in the Imaging and Scans section [..], … Read More

Caring for oldest, sickest patients now a growth business

“[Oak Street, ChenMed, Partners in Primary Care (owned by Humana), Iora Health, Geisinger] contract with Medicare Advantage plans to provide primary care “on steroids” to older patients with multiple chronic illnesses, as one executive put it. Because they typically take full financial risk from the Advantage plans, which pay them fixed monthly fees for each patient, the clinics make money by keeping patients out of the hospital. They do that by providing preventive and behavioral health care along with managing chronic diseases and addressing social needs. Working with a team of clinicians and coordinators, doctors see about a fifth as … Read More

Accelerating Science-Driven Reimbursement For Digital Therapeutics In State Medicaid Programs

“For evidence-based, prescribed digital therapeutics to reach the most vulnerable populations, they need to be reimbursable by Medicaid. [..] One example is WellDoc, an FDA-cleared digital therapeutic that has been shown to improve outcomes for patients with Type 2 Diabetes, leading to cost savings for employers and health plans. Another example is the FDA-cleared digital health platform Propeller Health, an evidence-based platform for asthma and chronic obstructive pulmonary disease (COPD). There are also digital therapeutics earlier in the FDA-clearance pipeline with growing literature demonstrating reproducible clinical effect. One example is Cognoa, an evidence-based FDA breakthrough-designated company that focuses on diagnosis … Read More

Perspectives of VA Primary Care Clinicians Toward Electronic Consultation-Related Workload Burden: A Qualitative Analysis

“Improving our understanding of clinician-level perceptions regarding e-consultation is important for informing program implementation and adoption, and ensuring that e-consults facilitate delivery of high-quality care. Prior evaluations demonstrated that primary care clinicians and specialists believe that e-consults may improve communication between clinicians. Primary care clinicians and specialists across several health care systems have reported that use of e-consultations increases the efficiency of care and reduces appointment burden for patients. [..] In a 2018 study, primary care clinicians working in safety-net clinics described e-consultations as “increased administrative burden, broadened clinical responsibility, and restructuring of specialty care delivery.” A perception among primary … Read More

No-Fault Compensation for Vaccine Injury — The Other Side of Equitable Access to Covid-19 Vaccines

“Wealthy governments that have invested in vaccine candidates have made bilateral agreements with developers that could result in vaccine doses being reserved for the highest-income countries — a phenomenon known as “vaccine nationalism” — potentially leaving people in poor countries vulnerable to Covid-19. The response to vaccine nationalism has been the creation of the COVAX Facility, an international partnership that aims to financially support leading vaccine candidates and ensure access to vaccines for lower-income countries. Seventy-nine higher-income countries are COVAX members. Their governments will help support 92 countries that couldn’t otherwise afford Covid-19 vaccines. [..] Equally important is offering companies … Read More