Measuring Performance of the Diagnostic Process

“During the diagnostic process, it is not unusual, or incorrect, for working diagnostic labels to change as new information is acquired and as the patient’s condition evolves both naturally and in response to interventions. The language used to communicate risk of disease and uncertainty about diagnosis is not uniform and may be overly ambiguous (eg, “cannot rule out,” “consider the possibility”). Thus, attempts to standardize and measure diagnostic processes should avoid unrealistic expectations or overzealous judgments to be both accurate and fair in judgment (eg, driving performance not feasible under the conditions at the time, or expecting actions predicated on … Read More

Health Care Spending Effectiveness: Estimates Suggest That Spending Improved US Health From 1996 To 2016

“US data from the period 1996–2016 are now available on health care spending by cause from the Disease Expenditure Project (DEX) and on DALYs [disability-adjusted life-years] by cause from the Global Burden of Disease (GBD) Study 2017. DALYs are the sum of years of life lost due to premature mortality, as well as years lived with disability among people living with a given cause. Intuitively, DALYs are a measure of burden, and therefore the goal of health systems is to avert DALYs. A decrease in DALYs is a measure of health gain referred to as DALYs averted. [..] We estimated … Read More

The Biden Administration Killed America’s Collective Pandemic Approach

“Coronavirus case numbers are in free fall; vaccines and, to a lesser degree, viral infections have built up a wall of immunity that can blunt the virus’s impact overall. Several experts stressed that certain aspects of the CDC’s new guidelines are genuinely improving on the framework the country was using before. “The timing feels right to make some kind of change,” Whitney Robinson, an epidemiologist at Duke University, told me. But protection against SARS-CoV-2 isn’t spread equally. Millions of kids under 5 are still ineligible for shots. Vaccine effectiveness declines faster in older individuals and is patchy to begin with … Read More

How New England caught the COVID deaths much of the country missed

“The USA TODAY Network in New England and the Documenting COVID-19 project partnered to investigate how New England became a positive data anomaly in terms of COVID death reporting accuracy. Across the region, excess deaths during the pandemic are almost completely accounted for by official COVID deaths, according to our analysis of Centers for Disease Control and Prevention mortality data and expected death models developed by demographers at Boston University. In other parts of the country, these COVID deaths were missed or certified incorrectly as other causes. [..] Hospitals are a dominant and central data source to capture the pandemic’s … Read More

Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019

[Introduction] “Rehabilitation might be needed by anyone with a health condition who experiences difficulties in, for example, mobility, vision, or cognition. Therefore, its scope is very broad and people with diverse underlying health conditions or impairments might require rehabilitation at some stage of the course of their disease. There is evidence showing that many rehabilitative interventions are cost-effective. Low-cost rehabilitation interventions requiring minimal resources have been effective in improving functional outcomes in different health conditions in low-income and lower-middle-income countries and can be used in these settings as successful models of care. Rehabilitation can improve functioning outcomes in adults and … Read More

Assessment of Incidence of and Surveillance Burden for Hepatocellular Carcinoma Among Patients With Hepatitis C in the Era of Direct-Acting Antiviral Agents

“[Introduction] Hepatocellular carcinoma (HCC) is the fastest rising cause of cancer-related mortality in the US. The incidence of HCC has increased over the last 2 decades owing to the hepatitis C virus (HCV) epidemic. Most HCC cases are diagnosed in advanced stages, with a median survival less than 1 year. Regular surveillance for HCC may help improve early cancer detection rates when curative treatment can be applied and is recommended in patients with HCV-associated cirrhosis. The availability of direct-acting antiviral agents (DAAs) for HCV treatment has substantially altered the landscape of HCV. Though new DAA regimens can result in a … Read More

Fleecing Patients: Hospitals Charge Patients More Than Four Times the Cost of Care

Summary of findings: U.S. hospitals charge on average $417 for every $100 of their total costs, in statistical terms a 417 percent charge-to-cost ratio. Over the last 20 years, hospital expenditures have grown faster than overall health care expenditures. Hospital expenditures as a percentage of national health expenditures have increased from 30.8 percent in 1999 to 32.7 percent in 2018. In 2018 hospital expenditures alone comprised close to 6 percent of the national GDP. Of the 100 hospitals with the highest charges relative to their costs, for-profit corporations own or operate 95 of them. All of the top 100 hospitals … Read More

Changes in Health Care Use and Outcomes After Turnover in Primary Care

“[Introduction] [..] In one study of a large Accountable Care Organization, PCP relocation, retirement, or death was the dominant factor associated with the reassignment of approximately one-third of Medicare beneficiaries to a new Accountable Care Organization every year. [Methods] This cohort study used Medicare administrative claims data for a 20% random sample of continuously enrolled, fee-for-service beneficiaries. For the main study sample as well as subgroup analyses, we included beneficiaries visiting a PCP for at least 1 evaluation and management visit from January 1, 2008, to December 31, 2017. We then limited the study sample to PCPs who treated 30 … 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

Effective interventions for potentially modifiable risk factors for late-onset dementia: a costs and cost-effectiveness modelling study

“[Abstract methods] we searched PubMed and Web of Science from inception to March 12, 2020, and included interventions that: successfully targeted any of nine prespecified potentially modifiable risk factors (hypertension, diabetes, hearing loss, obesity, physical inactivity, social isolation, depression, cigarette smoking, and less childhood education); had robust evidence that the intervention improved risk or risk behaviour; and are feasible to enact in an adult population. We established when in the life course each intervention would be delivered. We calculated dementia incidence reduction from annual incidence of dementia in people with each risk factor, and population attributable fraction for each risk, … Read More