Tailoring Telemedicine so Patients, Clinicians and Payers Seek to Broaden Its Adoption

As we stagger through the first (and possibly second) wave of the COVID-19 pandemic in America, there have been proclamations of transforming healthcare delivery with technology alternating with arguments that healthcare will quickly return to normal with in-office encounters and its associated hassles (i.e., co-payments, waiting rooms, exposure to other patients who might be infected). I have been skeptical of telemedicine’s potential to move beyond urgent care for primarily self-limited conditions. I am optimistic that telemedicine (and/or remote patient monitoring) could augment physical offices managing patients with chronic disease, but we as an industry have not generated the evidence to … Read More

Comparison of Safety and Insurance Payments for Minor Hand Procedures Across Operative Settings

“As health care expenditures continue to increase, with surgery accounting for approximately one-third of all health care spending, there is a need to identify strategies to decrease expenditures without compromising care quality. [..] the purpose of this study was to perform a population-based analysis of complication rates of minor hand procedures performed in different operative settings. In addition, we sought to investigate differences in total cost and OOP [out-of-pocket] spending across different operative settings. [..] We performed a retrospective cohort study using data from the IBM MarketScan Research databases between 2009 and 2017. These databases contain information from more than … Read More

Covid-19 and the Mandate to Redefine Preventive Care

“We believe the U.S. health care system should embrace this moment as an opportunity to shift the locus of preventive care from face-to-face annual exams to a strategy that focuses on population health: clinical registries that readily identify all preventive services for which a patient is due; annual prevention kits for patients that facilitate widespread deployment of home-based testing, shared decision making, and self-scheduling of preventive screening tests and procedures in more convenient and approachable community settings; and robust community-based strategies involving navigators to overcome health disparities in underserved populations. The first step in this strategy is developing a robust, … Read More

Health Care Management During Covid-19: Insights from Complexity Science

“Health care delivery organizations have faced a myriad of important management challenges during the Covid-19 pandemic. Some of the challenges are idiosyncratic to the individual organization; others, however, are broadly faced by almost every health care delivery organization and are likely to be faced in any major disaster. The first key challenge is the lack of adequate capacity to handle the surging patient volume. [..] A second challenge is the need for real-time redesign of care models for patients. Given the highly contagious nature and severity of the infection, it is necessary for physicians, nurses, and other clinicians to discover … Read More

Using Health IT to Support the Surgeon General’s Call to Action to Control Hypertension

On October 7th, the US Department of Health & Human Services published the Surgeon General’s Call to Action to Control Hypertension. The report uses a blood pressure threshold of 130/80 mm Hg as its definition of control. The manuscript includes a goal to optimize patient care for hypertension control and sector-specific recommendations to influence hypertension. Healthy lifestyle changes that could influence blood pressure control include: Losing weight Reducing sodium intake (more specifically, following the Dietary Approaches to Stop Hypertension [DASH] diet promoted by the National Heart, Lung and Blood Institute) Increasing physical activity, and Quitting smoking The report suggests referring … Read More

Intensive Smoking Cessation Counseling for Patients With Cancer

“tobacco cessation after cancer diagnosis is often associated with improved quality of life, fewer complications related to cancer treatment, and longer survival. In a 2018 study, the prevalence of cigarette smoking among adult cancer survivors was 11.8%, and many cancer survivors who quit smoking after a diagnosis may resume smoking. Failure to address the unique challenges of cessation contributes to lack of success in initial cancer treatment due to ongoing smoking and has been associated with an estimated incremental cost of nearly $11,000 per year per smoking patient. Tobacco abstinence is the strongest predictor of cancer survival, after cancer type … Read More

Effect of Patient Financial Incentives on Statin Adherence and Lipid Control: A Randomized Clinical Trial

“Initially, eligibility was limited to individuals with diabetes, LDL-C level greater than 130 mg/dL (to convert LDL-C to mmol/L, multiply by 0.0259), and an annual statin medication possession ratio in pharmacy records of less than 80%. We subsequently broadened eligibility criteria to include individuals with a statin prescription who self-reported nonadherence and had either (1) LDL-C level greater than 100 mg/dL and a diagnosis of ASCVD or an American College of Cardiology/American Heart Association Task Force 10-year cardiovascular disease risk score of at least 7.5%, or (2) LDL-C level greater than 190 mg/dL with no other risk factors, or (3) … Read More

Association of the National Health Guidance Intervention for Obesity and Cardiovascular Risks With Health Outcomes Among Japanese Men

“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

A Novel Health-Transportation Partnership Paves The Road For Young Driver Safety Through Virtual Assessment

“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

Effect of Peer Mentors in Diabetes Self-management vs Usual Care on Outcomes in US Veterans With Type 2 Diabetes: A Randomized Clinical Trial

“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