“[Introduction] Hip and knee replacements are the most common inpatient surgical procedures for Medicare beneficiaries in the US, with substantial cost and variability in care during the hospitalization and through postacute care. Most hospitals are participating in a bundled payment program for hip or knee replacement surgery, such as the comprehensive care for joint replacement model, with the goal of reducing unnecessary postacute care and rehospitalizations. Patients discharged from hospitals to facilities have higher costs and not necessarily improved outcomes, and payment policies have not resulted in substantially reduced rehospitalizations. [..] Behavioral science has revealed that humans have predictable biases … Read More
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“In the USA, virtual care in its current form, like conventional outpatient care, is still episodic and transactional via a fee-for-service model. This transactional nature occurs despite the knowledge that disease, or even wellness, is a continuous state and flare ups do not coincide with periodic, predetermined follow up clinic visits. In the peri-pandemic period, medical professionals must develop an economic model that would encourage the delivery of continuous care. Maybe there is something to learn here from the role of remote monitoring with pacemakers, loop recorders, and defibrillators. In the not-so-distant past, patients with implanted devices were evaluated in-person … Read More
“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
“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
“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
We in health information technology are optimistic that clinicians will update their clinical documentation practices so they use nomenclatures (e.g., Systematized Nomenclature of Medicine Clinical Terms [SNOMED CT], Logical Observation Identifiers Names and Codes [LOINC], RxNorm) in designated fields and then add more details within the free text portions of their electronic medical record documentation. While medical informaticists might expect to use natural language processing to extract more elements out of physician documentation, the American Medical Association (AMA) has worked to reduce documentation requirements starting January 1, 2021.1 Given the amount of time clinicians spend interacting with electronic medical records … Read More
“Neighborhood socioeconomic status (nSES) variables have been reported to improve predictions in some cases but not others. For instance, Molshatzki et al found that nSES variables improved the prediction of long-term mortality after myocardial infarction but Bhavsar et al found that an nSES index did not improve prediction of a variety of health care use measures within a 3-year window. Another study suggests that neighborhood-level indicators are not predictive above and beyond individual-level indicators. Whether these predictors are useful for risk stratification, and, if so, in what contexts remains unclear. [..] We assess the addition of diverse nSES predictors to … Read More
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
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
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