John Colbert

May 23, 2019

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

May 23, 2019

Advancing Patient-Centered Care For Individuals With Multiple Chronic Conditions

As part of a series of blog posts from leaders of the Agency for Healthcare Research and Quality (AHRQ), a posting on May 10, 2019 discusses how every day many patients and their caregivers struggle to find care that effectively addresses their needs. Clinicians also are frustrated, experiencing epidemic levels of burnout while working in systems often ill-designed to support them in addressing these fundamental objectives of healthcare delivery. This challenge is particularly pronounced for the nearly one of three American adults, and four of five Medicare beneficiaries, who are living with multiple chronic conditions (MCC). Patients with MCC account for 64% of all clinician visits, 70% of all in-patient hospital stays, 83% of all prescriptions, and 71% of all healthcare spending. Alarmingly, the number of children and adolescents with MCCs is growing as well. Currently, there is a critical mismatch between the way care is delivered (disease-specific) and the needs of patients with MCC, who require whole-person (patient-centered) care. This disconnect too often results in care that is fragmented and of suboptimal quality, leading to poor outcomes and increased costs. Furthermore, practice guidelines that help clinicians make testing and treatment decisions tend to guide the care of each of the patients’ conditions in isolation. One consequence of this narrow scope is that recommended treatments for one condition may interact harmfully with recommended treatments for another one. As a first step towards realizing this vision, AHRQ needs to have a well-conceived and effectively executed research agenda. The Care-and-Learn Model, developed by AHRQ researchers to map the work of the Agency and its research portfolio, will help identify areas of unmet need and prioritize research questions with the most value for advancing the care of individuals with MCC. The blog can be obtained here.

Effects of Early Care And Education On Children’s Health

The journal Health Affairs released a Health Policy Brief as part of an ongoing series on the social determinants of health. In “The Effects of Early Care and Education on Children’s Health,” an overview is provided of the landscape of nonparental early care and education (ECE). The focus primarily is on center-based care, including public and private preschool, child care centers, and Head Start. While the impact of ECE on children’s educational, social-emotional, and behavioral outcomes is well studied, its impact on health has become a subject of significant research interest mainly in the last 10 to 15 years. Challenges in studying the health impacts of ECE are identified and an extended summary of key studies in this area is provided. In short, while such programs are not necessarily designed to improve child health, a growing body of research indicates that they may lead to short- and long-term improvements in health-related outcomes. Additional research needs are discussed and the Brief notes that, moving forward, ECE policy must attend to promoting parental employment and improving children’s outcomes, including health outcomes. The Brief can be obtained here.

Addressing Social Determinants Of Health Through Housing Improvements

Improving the health of individuals and their neighborhoods and communities as a whole is one of the most complex and pressing challenges in health care today. Given the inextricable link between affordable quality housing and good health, housing is one area that hospitals and health systems are starting to focus on more resolutely. A new American Hospital Association (AHA) issue brief describes how hospitals are investing in affordable housing. The brief can be obtained here.

return to may 2019 trends

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

May 23, 2019

Trends Archives

Pregnancy-Related Deaths, United States, 2011-2015

According to a Morbidity and Mortality Weekly Report posted online May 10, 2019 by the CDC, approximately 700 women die annually in the United States from pregnancy-related complications. Among such deaths for which timing was known, 31.3% deaths occurred during pregnancy, 16.9% on the day of delivery, 18.6% on days 1–6 postpartum, 21.4% on days 7–42 postpartum, and 11.7% on days 43–365 postpartum. Leading causes of death varied by timing relative to the end of pregnancy. Approximately three in five pregnancy-related deaths were preventable. Contributing factors can be categorized at the community, health facility, patient, provider, and system levels. The national pregnancy-related mortality ratios (PRMRs) was 17.2 per 100,000 live births. Non-Hispanic black women and American Indian/Alaska Native women had the highest PRMRs (42.8 and 32.5, respectively), 3.3 and 2.5 times as high, respectively, as the PRMR for non-Hispanic white women (13.0).

Severe Joint Pain And Physical Inactivity Among Adults With Arthritis-United States

An estimated 54.4 million (approximately one in four) U.S. adults have doctor-diagnosed arthritis. Severe joint pain and physical inactivity are common among adults with arthritis and are linked to adverse mental and physical health effects and limitations. According to an analysis of 2017 Behavioral Risk Factor Surveillance System (BRFSS) data, the median age-standardized state prevalence of arthritis among adults aged ≥18 years was 22.8% (range = 15.7% [District of Columbia] to 34.6% [West Virginia]) and was generally highest in Appalachia and Lower Mississippi Valley regions. Among adults with arthritis, age-standardized, state-specific prevalences of both severe joint pain (median = 30.3%; range = 20.8% [Colorado] to 45.2% [Mississippi]) and physical inactivity (median = 33.7%; range = 23.2% [Colorado] to 44.4% [Kentucky]) were highest in southeastern states. Maintaining a healthy weight or being physically active can reduce arthritis pain and prevent or delay arthritis-related disability.

HEALTH TECHNOLOGY CORNER

Wireless Sensor System To Monitor Babies In The Neonatal Intensive Care Unit (NICU)

According to an April 30, 2019 report from Deloitte, approximately 300,000 premature babies are delivered each year in the US. Multiple wires and adhesive patches can damage fragile skin and prevent parents from holding and nurturing their babies. A team from the Northwestern University Feinberg School of Medicine has been working for five years to develop a wireless sensor system that uses Bluetooth technology to monitor babies in the neonatal intensive care unit (NICU). The new system appears to be as precise and accurate as traditional monitors. Two lightweight wireless patches are attached to the baby's chest and foot to collect a wide range of data, including temperature, respiratory rate, EKG, oxygen saturation, and blood pressure. The patches are flexible and gentle on a newborn's skin. The wireless device allows for more physical contact between baby and parents. Researchers note that the sensor system could be sent home with a patient, so monitoring can continue beyond the hospital if necessary.

Electric Field-Based Dressing Disrupts Bacterial Biofilm Infection To Restore Healing

Bacterial biofilms are thin, slimy accretions that form on some wounds, including burns or post-surgical infections, as well as after a medical device, such as a catheter, is placed in the body. These bacteria generate their own electricity, using their own electric fields to communicate and form the biofilm, which makes them more hostile and difficult to treat. Researchers at Indiana University School of Medicine have found a way to advance the fight against bacterial infections using electricity. Work has led to the development of a dressing that uses an electric field to disrupt biofilm infection. Findings were published in the April 2019 issue of the journal Annals of Surgery. As an alternative to pharmacological intervention, this effort is the first pre-clinical porcine mechanistic study to recognize the potential of electroceuticals as an effective platform technology to combat wound biofilm infection.

return to may 2019 trends

DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

May 23, 2019

Trends Archives

American Council Education (ACE) President Ted Mitchell sent a letter on May 9, 2019 to members of the House Ways and Means and Senate Finance Committees, urging swift action to correct a mistake made in the Tax Cuts and Jobs Act (TCJA) of 2017 that inadvertently has resulted in harm to many low- and middle-income students who rely on scholarship aid to pay for their college education. The letter notes that the TCJA made changes to the so-called “kiddie tax” that sharply increased the tax levied on the portion of scholarships set aside for expenses, such as room and board that colleges and universities award to students from families of little or modest means. A consequence is that many low- and middle-income students are being taxed at the same rates as wealthy individuals.

Academic, need-based scholarship students are not the only ones who will feel the impact of the amended kiddie tax. College athletes on full scholarships, which include money for housing and other non-tuition expenses, also are affected by kiddie tax changes, many of whom come from economically disadvantaged families. Based on Department of Education data, the increased tax on scholarship/grant aid could exert an effect on nearly 1.4 million students and their families. A related concern is that problems caused by the change to the kiddie tax extend beyond higher education. For example, “Gold Star” Families (immediate family survivors who receive benefits resulting from a fallen service member who died while serving in a time of conflict) also may be affected negatively.

Student Loan Borrower Bill Of Rights Act Of 2019 Re-Introduced

Senators Dick Durbin (D-IL), Elizabeth Warren (D-MA), and Jack Reed (D-RI) on May 8, 2019, re-introduced the Student Loan Borrower Bill of Rights Act of 2019, which would amend the Truth-in-Lending Act, to create consistent disclosure and servicing standards across federal and private student loan programs. Its provisions include:

Requiring various disclosures to borrowers when a loan is sold or transferred,
Standardizing the application of payments and the allocation of payments among multiple loans in a
manner that is most beneficial to a borrower, and
Limiting when borrowers are subject to late fees and other consequences.

Trump Administration Proposes To Reduce Pell Grant Surplus

An effort by the Trump administration that was announced in May 2019 to make a deep reduction in the Pell Grant surplus was criticized by several groups representing colleges, universities, and student aid advocates. A concern is that the proposal, which is in the form of a revised budget request for FY 2020 that would shift $3.9 billion from the Pell surplus to aid in funding a National Aeronautics and Space Administration (NASA) mission to the moon, not only will hurt students, but also make attending college more expensive. Previously, White Office officials sought to take $1.3 billion from left-over Pell funding in 2017. Fiscal year 2018 and 2019 budgets also proposed multibillion-dollar cancellations, but these proposals eventually were withdrawn.

States Pass Laws Aimed At Student Loan Companies

Stimulated to some extent by Democratic gains in state houses around the nation in the November 2018 election, coalitions involving liberal groups, consumer advocacy organizations, and labor unions have launched efforts to regulate student loan companies operating in their respective states. For example, a new law in New York places student loan servicers under the jurisdiction of the state's financial services regulator as a means of protecting student loan borrowers and reducing their financial loan burden by cracking down on unscrupulous lending practices. Both the Trump administration and student loan industry groups oppose these initiatives on the grounds that states don’t have the power to regulate companies collecting federal student loans. Such issues await further resolution in the courts.

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HEALTH REFORM DEVELOPMENTS

John Colbert

May 23, 2019

Trends Archives

A chronic health workforce challenge facing nations throughout the world is a maldistribution of personnel. Approximately 60 million inhabitants of the United States, roughly one of every five individuals, live in rural areas. Significant obstacles face patients and providers in rural communities where rates for the five leading causes of death are higher, poverty is more common, higher rates of uninsurance or underinsurance prevail, greater transportation difficulties exist in going to a hospital or to the offices of health professionals, and residents lack access to high-speed Internet, which limits their access to information. The patient-to-primary care physician ratio in rural areas is only 39.8 physicians per 100,000 individuals, compared to 53.3 physicians per 100,000 in urban areas, to cite just one example of a health professions workforce shortage. A worrisome trend according to the Centers for Medicare & Medicaid Services (CMS) is that since 2010, more than 100 rural hospitals have closed and nearly 40% of rural hospitals currently running are operating with negative margins, limiting the ability of providers to compete based on high value care and leading to fewer choices for beneficiaries.

Similar to other U.S. presidential administrations, the Trump administration has launched initiatives aimed at ensuring improved access to health care services in rural areas. A Rural Health Strategy has been undertaken to increase access to telehealth and other virtual services across the Medicare program. One way of doing so is to pay for virtual check-ins that allow a patient to check in with his or her clinician by telephone or other telecommunication system, along with remote evaluations of recorded videos or images that a patient submits to a clinician to help in making a joint decision whether a trip needs to be made by this individual to be seen in-person. An example of coping with the threat of hospital closures is a proposal to enhance their stability by transforming the way CMS pays certain rural hospitals and facilities in other low wage areas. A related action is a proposed change in the way Medicare factors local labor costs into hospital payments by increasing the wage index of rural and other low wage index hospitals to address payment disparities.

Provision Of Health Coverage For The Uninsured: Medicare For All

The Affordable Care Act of 2010 has been instrumental in reducing the proportion of the U.S. population lacking health insurance coverage. Despite many impressive gains that have been made, an estimated 9.4% of U.S. residents, or 30.4 million individuals, lacked health insurance when surveyed in 2018, according to a report released by the Centers for Disease Control and Prevention (CDC) on May 9 of this year, a rate not significantly different from the survey’s uninsured rate in 2017, but 18.2 million persons fewer than in 2010. The uninsured rate for adults under age 65 was 9.9% in Medicaid expansion states, compared with 18.7% in non-expansion states.

An effort gaining momentum in Congress is a proposal by Democrats called Medicare for All legislation. Generally, this universal health care program would include coverage of primary care, hospital stays, mental health treatment, prescription drugs, along with dental, vision, hearing, and home and community-based long-term care services. Meanwhile, an annual report from the Medicare Board of Trustees that was released last month indicates that the Hospital Insurance (HI) Trust Fund is expected to be depleted in 2026. Also, a report from the RAND Corporation on May 19, 2019 states that the prices paid to hospitals by private health plans averaged 241% of what Medicare would have paid. Since Medicare for All has the prospect of terminating private health plans, an interesting question is what rate will an expanded Medicare program pay and how will these costs be financed?

Predictive Analytics And Social Determinants Of Health (SDoH)

A report from Deloitte on April 30, 2019 discusses how addressing the housing, nutrition, and other social needs of Medicaid members could result in fewer ambulance rides, fewer emergency room visits, and fewer hospitalizations. Predictive analytics could help Medicaid departments and managed care organizations more accurately target these services by using a state’s resources more efficiently and effectively. Officials of SDoH programs also might want to determine how to ensure that spending is aimed at individuals who are most at risk of a decline in health status so that they can leverage the lessons learned from the experience of Medicaid home and community-based service programs.

return to may 2019 trends

BIPARTISAN HEALTH LEGISLATION

John Colbert

May 23, 2019

Trends Archives

Even under ordinary circumstances, it is common for competition between Democrats and Republicans and also between the two legislative chambers to serve as obstacles to passing important bills. Given that a presidential election occurs next year, it can be expected that partisanship will play a role in complicating attempts to pass legislation that would be perceived as accruing to the advantage of one political party over the other party’s fortunes. So, it always is refreshing that at a time of potential conflict, there is evidence that opponents can join forces to advance the common good.

The introduction of H.R. 2781, a bipartisan bill to amend Title VII of the Public Health Service Act to reauthorize certain programs relating to the health professions workforce, and for other purposes, is an example of one such effort. The proposed legislation would increase the authorization for most Title VII programs by 5% over the fiscal year 2019 appropriated levels, 7.2% for Area Health Education Centers (AHECs), and 25% for Geriatric Programs. The legislation also provides flat funding authorization for the Pediatric Loan Repayment program, which has yet to receive an appropriation.

Title VII programs are under the direction of the Health Resources and Services Administration (HRSA). They have been created to enhance the health professions pipeline through a wide variety of education and training programs that play a critical role in addressing major health problems in rural and underserved communities. One aim of H.R. 2781 is to respond to the problem of an emerging shortage of physicians in the United States. It is anticipated that the House Energy and Commerce Committee will conduct a hearing on Title VII reauthorization in June 2019.

Meanwhile, despite partisan differences on important funding legislation for the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS), the House Appropriations Committee on May 8, 2019 approved its FY 2020 spending bill by a party line vote of 30-23. The committee also approved 302(b) allocations for all twelve appropriations subcommittees. Among the various provisions are the following:

The approved legislation provides a program level of $41.084 billion for the National Institutes of Health (NIH), which amounts to a $2 billion or 5.12% increase over the comparable FY 2019 level. The bill provides an across-the-board increase of approximately 5% for all Institutes and Centers to maximize the across-the-board increase for all these entities in order to ensure a significant boost for the best peer-reviewed research across all scientific disciplines.
Other funding allocations include $734.9 million for HRSA’s Title VII health professions and Title VIII nursing workforce development programs, a $93.25 million (14.5%) increase over FY 2019 enacted levels. The amounts include increases for diversity pipeline programs, such as the Health Careers Opportunity Program, which received $20 million in funding for FY 2020, a $5.8 million (41%) increase over FY 2019 levels. Other kinds of programs, such as Children’s Hospital Graduate Medical Education would benefit by an allocation of $350 million, which is a $25 million (7.6%) increase over FY 2019 levels.

return to may 2019 trends

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

May 23, 2019

Trends Archives

By Susan N. Hanrahan, ASAHP President

In my message in the November 2017 issue, I indicated that I will be asking some of you to send a photo and answer a series of “fun” questions to be shared with our membership so that we can continue our collegiality through our newsletter. The 13th of many profiles and the fifth in 2019 is presented as follows:

Name and Title: Ken Johnson, PhD, FASAHP

Place of birth: Blackfoot, Idaho

University: Weber State University

How long have you been in your position? 13 years

What’s the value of a university education? Increased options, increased income

What is the value of ASAHP? Making friends, sharing solutions to problem.

Your philosophy on education in seven words: To help learners learn how to learn.

If I could teach in another field, which one and why? Occupational Psychology – it’s another field that promotes wellness in a variety of ways.

Before I retire I want to: I think I’m good...just increase my retirement fund.

In college, I was known for: Being part of the International Folkdancers as a band member and dancer. What music is playing in my car/office? Classic rock

The last book I read for fun was: Saints

My favorite trip was: Edinburgh, Scotland

If I could travel anywhere it would be: Back to Northern England and Scotland.

Four people I’d take to coffee or have a glass of wine with: I don’t do either of those, but I’d love to visit with some of my ancestors.

The best advice I ever received was: I’ve received too much good advice to just pick one thing.

My hobby is: Woodworking, golfing, fishing

My passion is: My family

My pet peeve is: Bad drivers, I suppose.

A perfect day is: In a peaceful setting with my family

Cats or dogs? Dogs, although we have cats.

E-book or hardback? Hardback

Beach or mountains? I live in and love the mountains. I like to visit the beach.

I wish I could: Travel more.

Only my friends know I: No comment

My favorite saying is . . . on my wall: “Med dig vill jag bli gammal och lite halv blind.” (You’ll have to look it up).

return to may 2019 trends

LANGUAGE TRANSMISSION AND TRANSLATION

John Colbert

May 23, 2019

Trends Archives

Samuel Beckett, a Nobel Laureate in literature from Ireland, produced some of his work in the French language. What may seem odd is that this highly gifted linguist subsequently found it difficult to translate his own material into English, his native language. Apart from variations in vocabulary that distinguish one language from another, even within the same one, communication impediments may arise.

Depending on their level of health literacy, patients can be at a disadvantage in understanding terminology and jargon used by clinicians. Superimposed on differences in understanding spoken and written words is the impact semiotics has on the process of communication in the form of facial gestures, tone of voice, clothing (e.g., white coats worn by health professionals signifying knowledge authority status), and personal appearance (e.g., age, gender, race/ethnicity, body weight, and presence of tattoos and piercings).

Hundreds of millions of interactions occur between clinicians and patients in the U.S. each year, and the quality of the experiences shared by them will help to govern what eventually transpires in the form of beneficial health outcomes. For example, an evaluation of patient–reported outcome measures (PROMs) that appeared on April 15, 2019 in the journal Cancer indicated that more than half of the most commonly used cancer PROMs do not meet plain‐language best practices. This finding may have implications for the quality of care, safety, and experience/satisfaction involving patients characterized by low health literacy.

Access to electronic health records has made it possible for patients to review information written about them. Nevertheless, depending on the branch of health care involved, there is ample room for misinterpretation. Sociolinguistic differences between patients and clinicians can lead to variable misunderstandings of written words that may limit patients’ engagement in their own health care. That outcome should come as no surprise because even within the professional community itself, a veritable Tower of Babel may exist. As an illustration, a radiologist might communicate imaging results to other members of the health care team using terms, such as “probably represents,” which in turn could be interpreted differently by referring clinicians.

Interprofessional education and practice currently is a topic of considerable interest and importance in health care. Data reported on March 22, 2019 in the Journal of Interprofessional Care reveal, however, that there was little consistency in the terminology used by accreditors to describe the learning outcomes that healthcare professions educational programs were expected to embrace. A conclusion reached was that inconsistency in terminology across accreditors found in this study is a clear impediment to healthcare professions educational programs creating a shared mental model for their IPE outcomes. A risk is that until accreditation bodies agree to one such model for all aspects of education, IPE may continue to be perceived by students as an ‘add-on’ to their curricula rather than as an integral part of becoming a health professional.

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PLACING A MAN ON THE MOON AND SOME RELATED MUSINGS

John Colbert

April 22, 2019

Trends Archives

When Neil Armstrong planted his large boots on the surface of the moon in July 1969, one is stimulated to wonder if he could have foreseen that the next thing to soar extraordinarily high would be rhetoric from elected officials in Washington, DC who subsequently would declare to impressive effect that if we can place a man on the moon, then we should be able to cure cancer, eliminate bed bug infestation, and achieve other feats of daring do.

Just as a major national initiative led to reaching the moon, today’s interplanetary dreams include long-duration missions that will take humans to Mars and beyond by public and private entities in the 2020s and 2030s. According to a study described in the April 12, 2019 issue of the journal Science, however, comprehensive studies are needed to assess the impact of long-duration spaceflight on the human body, brain, and overall physiology. To assess the health effects of long-duration spaceflight, one identical twin astronaut was monitored before, during, and after a one-year mission onboard the International Space Station, the time approximately required for a return journey to Mars.

The other twin served as a genetically matched ground control. Largely unknown risks imposed by microgravity and ionizing radiation (IR) exposure during spaceflight currently limit endeavors to visit Mars. Low-risks include changes in the gastrointestinal microbiome and in body mass. Mid-level risks include alterations in collagen regulation and intravascular fluid management. Genomic instability, assessed by chromosomal aberrations, potentially represents a higher risk because it confers a prospect of developing cancer. Structural abnormalities observed in the chromosomes of the traveling twin are typical of IR exposure. Other severe biological effects could relate to microgravity, causing a headward fluid shift and pronounced changes in vascular physiology (e.g., upper body distended arteries and veins). Nonetheless, perhaps there are many valuable lessons that may be learned from space adventures that will accrue to the advantage of earth-bound inhabitants who will benefit in ways involving their health.

return to april 2019 trends

PER SCIENTIAM AD SAPIENTIAM: SOME KEY STEPS IN THE JOURNEY

John Colbert

April 22, 2019

Trends Archives

The accumulation of knowledge may be viewed as a fundamental stepping stone on the road to wisdom. The professional literature is a source of factual information that over time furnishes essential building blocks in the accumulation of knowledge. Some examples are:

James Watson and Francis Crick in an article published in Nature on April 25, 1953 in the brief space of 842 words set in motion a vast panoply of studies that influence achievements to the present day involving the human genome. Their contribution led to sharing a Nobel Prize in 1962. A significant flaw was failing to acknowledge how their understanding of the helical structure of DNA was greatly aided by imagery developed earlier through crystallography by chemist Rosalind Franklin.

Luis Alvarez, a 1968 Nobel Laureate in physics at the University of California, Berkeley, was able to expand his curiosity to the fields of geology and paleontology. His efforts led to an article in the June 6, 1980 issue of Science in which he hypothesized how most life on earth was extinguished when a giant asteroid crashed into the planet at a high speed 65 million years ago (since updated to 66 million).

When John Wakefield indicated in a paper that appeared in the Lancet on February 28, 1998 that MMR vaccine can lead to the onset of autism and other conditions, he inspired a refusal among some parents that exists to the present day to have their children immunized. His assertions were proven false and the manuscript later was retracted in February 2004 by the publisher, but its effects still manage to influence opposition to interventions designed to prevent the occurrence of several infectious diseases.

When viewers stare at the sky, the experience may conjure up thoughts about the possible existence of life on other planets. Sam Levin and co-authors speculated in the February 2019 issue of the International Journal of Astrobiology how evolutionary theory can be used to make predictions about aliens. They even contemplated the possibility someday of discovering a bizarre looking alien called an “Octomite”

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

April 22, 2019

Trends Archives

Hospitals’ Use Of Electronic Health Records Data, 2015-2017

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 helped to advance the adoption and meaningful use of electronic health records (EHRs). Currently, more than 95% of hospitals possess an EHR. With this widespread adoption of the technology, policy is now shifting towards the use of EHR data, which can improve patient care by giving providers access to evidence-based tools that assist with decision making and facilitating clinical practice by automating and streamlining provider workflow. EHR data are used most commonly by hospitals to support quality improvement (82%), monitor patient safety (81%), and measure organization performance (77%). Hospitals with the capability to send, find, receive, or integrate external patient data were twice as likely to use their EHR data compared to hospitals that did not engage in these domains of interoperability. A data brief from The Office of the National Coordinator for Health Information Technology employs data from the American Hospital Association Information Technology Survey to describe trends in the use of EHR data among non-federal acute care hospitals from 2015 to 2017. EHR data are defined as a set of 10 measures that describe hospital processes for leveraging information within their EHR to inform clinical practice. The data brief also presents variation in the use of this data by hospital characteristics and over time. It can be obtained here.

Care Coordination

Care coordination is a methodical approach to care that facilitates better communication between and among individuals, family caregivers, and service providers. There has been significant emphasis in the last several years on care coordination’s role in supporting older adults and in reaching the key aims of health care reform, namely improved patient outcomes, enhanced care experience, reduced costs, reduced provider burnout, and equity in outcomes. A new issue brief provides updates to a 2013 care coordination issue brief developed by Eldercare Workforce Alliance (EWA) and the National Coalition on Care Coordination (N3C). It includes a synthesis of diverse strategies in use and a vision for how services could be improved. Care coordination should be happening wherever and whenever care is provided. Efforts may be staffed within various settings: office-based primary care teams, house call programs, specialty care teams (such as oncology), hospitals (often staffed by discharge planners or transitional care coordinators), skilled nursing facilities, hospice and palliative care programs, aging network organizations, and housing programs. The issue brief can be obtained here.

Strengthening The Connection Between Health Professions Education And Practice

The National Academies of Sciences, Engineering, and Medicine’s Global Forum on Innovation in Health Professional Education with affiliates of the National Center for Interprofessional Practice and Education held a workshop on November 13 and 14, 2018 in Washington, DC entitled Strengthening the Connection between Health Professions Education and Practice. The purpose was to explore methods and methodology for bridging health professions education and practice in ways that improve information flow between learning and application. The workshop also explored various models of training by bringing together multiple health professions across the education-to-practice continuum. Workshop Proceedings can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

April 22, 2019

Trends Archives

Disparities In Prevalence Of Major Cancer Risk Factors And Screening Test Use In The U.S.

According to the April 2019 issue of the journal Cancer Epidemiology, Biomarkers & Prevention, individuals with lower educational attainment have higher prevalence of modifiable cancer risk factors and lower prevalence of screening versus their more educated counterparts. Smoking prevalence is six times higher among males without a high school education than female college graduates. Nearly half of women without a college degree are obese versus about one-third of college graduates. Over 50% of black and Hispanic women are obese compared with 38% of whites and 15% of Asians. Breast, cervical, and colorectal cancer screening utilization is 20% to 30% lower among those with less than high school education compared with college graduates. Screening for breast, cervical, and colorectal cancers also is lower among Hispanics, Asians, and American Indians/Alaska Natives relative to whites and blacks.

Foreign-Body Ingestions Of Young Children Treated In U.S. Emergency Departments: 1995–2015

The number of children in the United States who swallowed coins, toys, and other small objects nearly doubled (91.5% from 9.5 per 10,000 children in 1995 to 18 in 2015), according to an article published on April 10, 2019 in the journal Pediatrics. Some objects can cause serious harm when ingested, and possibly even death. Overall, boys more frequently ingested foreign bodies (52.9%), as did children one year of age (21.3%). Most children were able to be discharged after their suspected ingestion (89.7%). Among the types of objects ingested, coins were the most frequent (61.7%), toys (10.3%), jewelry (7.0%), and batteries (6.8%) followed thereafter. The rates of ingestion of those products also increased significantly over the 21-year period. Across all age groups, the most frequently ingested coin was a penny (65.9%). Button batteries were the most common kind of batteries ingested (85.9%). Small and flat objects, they can damage or even puncture the walls of the esophagus if they become stuck.

HEALTH TECHNOLOGY CORNER

Morning Exercise Is Better Than Evening Exercise Except When It Is Not

Exercise is considered an effective lifestyle intervention for the prevention and mitigation of various diseases. One group of researchers investigated whether the time of day and circadian clock affect exercise performance and related metabolic pathways in mice and humans. They found that exercise performance is better in the evening than in the morning hours, thereby potentially optimizing health benefits. Meanwhile, a different set of investigators observed a more robust metabolic impact of exercise in the morning (beginning of active phase) than at night (beginning of rest phase), resulting in a higher utilization of carbohydrates and ketone bodies, together with the degradation of lipids and amino acids. Both studies were published April 18, 2019 in the journal Cell Metabolism. While the results may not lead to firm conclusions pertaining to humans, they possibly could have implications for any mice that have an opportunity to exercise regularly on treadmills, which relates to how the research was conducted.

Using Voice Analysis To Evaluate And Predict Human Behaviors And Identify Health Risks

An Israeli company called VoiceSense is taking advantage of the plethora of devices that capture human speech, such as mobile phones and digital assistants in homes. Voice-analysis research is capturing individual tones, speed, emphases, and pauses, and applying machine learning to make predictions. Feeding the data to an algorithm, over time it learns to pick up subtle speaking signs that might indicate someone who experiences anxiety. Mental and behavioral health issues often prove to be difficult to monitor effectively. For example, signs and symptoms can creep up on individuals who experience depression before they realize that they might need help. Although using voice to identify anxiety, depression, and specific conditions such as Parkinson’s disease or post-traumatic stress disorder (PTSD) still is in the early stages, researchers aim to produce a sensor that can monitor and alert a patient to such problems in order to facilitate earlier intervention.

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DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

April 22, 2019

Trends Archives

A major objective of the Association of Schools of Allied Health Professions (ASAHP) is to be a leading interprofessional voice for improvements in health and health care. An essential belief is that all health professions programs and schools should provide interprofessional education (IPE) opportunities for students from several health disciplines in order to foster competencies beyond clinical care, including leadership, advocacy, and evidence-based practice. Another significant step in that direction is the upcoming 2019 ASAHP Summit, a project co-sponsored by the ASAHP Interprofessional Subcommittee and the ASAHP Clinical Education Task Force, and co-hosted by Kindred Healthcare and Saint Louis University. In preparation for this event scheduled to occur on May 31, 2019 at Saint Louis University, Association members are being requested to complete a survey regarding some recommendations made by the Clinical Education Task Force. Information derived from the study will enhance Summit activities.

Developments in interprofessional education involving allied health are featured in the Association’s Journal of Allied Health. A new section called “Interprofessional Practice and Education” was created in this publication beginning with the Fall 2017 issue. Eleven IPE articles appeared in the four issues of the journal distributed in 2018. Two more appeared in the Spring 2019 issue and another two are scheduled for the Summer 2019 issue. Also, the recipient of the ASAHP Excellence and Innovation in Interprofessional Education and Collaborative Health Care Award will be announced later this year.

Secretary Devos Testifies At House Hearing On Department Of Education Policies And Priorities

Department of Education Secretary Betsy DeVos testified on April 10, 2019 at a House Education and Labor Committee hearing entitled “Examining the Policies and Priorities of the U.S. Department of Education.” The purpose of the hearing was to consider the Department’s fiscal year 2020 budget request and other Department initiatives. She discussed the Administration’s proposals to create a single income driven repayment (IDR) plan capped at 12.5% and to eliminate the Public Service Loan Forgiveness program. She opined that the current loan program provides an after-the-fact benefit that fails to help students complete their program and does not take into account borrower earnings in their chosen professions. The aim of the Administration’s proposed plan is to support all borrowers pursuing any career through the single IDR plan, which will allow them to make affordable monthly payments based on their income.

Negotiated Rulemaking On Accreditation, Innovation, And Other Topics

The U.S. Department of Education (USDE) released draft consensus language from its negotiated rulemaking on accreditation, innovation, and other topics on April 17, 2019. Negotiated rulemaking is the process used by the USDE to negotiate the terms of a proposed administrative rule or regulatory change. The negotiated rulemaking full committee met four times between mid-January and early April, 2019. Three subcommittees that addressed distance education, faith-based institutions, and TEACH Grants made recommendations to the full committee. Consensus language pertaining to revised regulatory proposals will affect accreditation in some of the following ways:

Require more transparency regarding where regional accreditors operate
Provide more flexibility for innovation for institutions and accreditors
Protect students through enhanced disclosure and teach-out requirements
Simplify and balance the recognition process for both USDE and accrediting organizations
Require arbitration of accreditation decisions prior to going to court
Make it easier for new accreditors to gain recognition

Next, USDE will publish a Notice of Proposed Rulemaking (NPRM) in the Federal Register and provide for a public comment period. For the rule to take effect on July 1, 2020, the final rule must be published in the Federal Register by November of this year.

return to april 2019 trends

HEALTH REFORM DEVELOPMENTS

John Colbert

April 22, 2019

Trends Archives

The Affordable Care Act that became law in 2010 was aimed at expanding the number of individuals with health insurance coverage, reducing health care costs, and increasing the quality of care provided. Although much progress has been made since that year, certain difficulties continue to be unresolved, with a main one being a portion of the U.S. population still lacking adequate coverage.

During the 2016 Presidential campaign, Senator Bernard Sanders (I-VT) ignited great enthusiasm among his followers for his pledge to see to it that a Medicare For All bill would be enacted if he were elected. That notion is as relevant today as it was back then as evidenced by several prominent Democrats who have entered the race for the next presidential election and gone on record in support of his approach.

He introduced an updated version of his proposed legislation (S. 1129) on April 10, 2019. It would replace nearly all forms of private health insurance with a government-managed, single payer version of Medicare that guarantees coverage to all Americans. The universal health care program would include coverage of primary care, hospital stays, mental health treatment, and prescription drugs. This latest iteration also includes coverage for dental, vision, hearing, and home and community-based long- term care services, which resembles the House version of H.R. 1384 that was introduced by Rep. Pramila Jayapal (D-WA) on February 27. Under provisions of the Sanders bill, states would be allowed to provide additional benefits from their own budgets, and the Indian Health Service (IHS) and Veterans Health Administration (VHA) would remain in place. The legislation does not specify how it will be financed.

Provision Of Non-Medical Services For Social Needs That Affect Health

The Trump Administration at the beginning of April 2019 released guidance indicating that beginning in 2020, Medicare Advantage plans, private health plans that contract with Medicare, will be allowed, but not required, to offer chronically ill enrollees non-medical services for social needs that affect health. Plans will be able to select which non-medical services they offer, as long as there is a “reasonable expectation that the services will help people with chronic conditions improve or maintain their health or overall function.” Examples of services include: home-delivered meals, transportation for non-medical needs, pest control, indoor air quality equipment (e.g., an air conditioner for a patient with asthma), and minor home modifications (e.g., permanent ramps, widening of hallways or doorways to accommodate wheelchairs). The new coverage flexibility was made possible by the Creating High Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act (S. 870), which was a component of the Bipartisan Budget Act of 2018 (P.L. 115-123) that the President signed into law in February 2018.

House Reaction To A Lawsuit To Invalidate The Affordable Care Act

In February 2018, attorneys general in 20 states filed a lawsuit claiming that the 2017 Tax Cut law and the Jobs Act’s reduction of the individual responsibility tax penalty to zero, in effect made the Affordable Care Act’s individual mandate unconstitutional. The following December, a federal court judge in Texas entered a judgment that if the suit is upheld, the entire ACA would become invalidated. Democratic attorneys general in 17 states subsequently intervened to defend the entirety of the health reform law. The U.S. House of Representatives in April 2019 joined the fray by passing a measure (H.Res. 271) by a vote of 240-186, condemning the Trump Administration’s support for the lawsuit that would invalidate the ACA. Eight Republicans joined their Democratic colleagues in supporting the resolution, essentially agreeing that a replacement plan must be installed before the law is repealed.

Despite being rebuffed in their efforts in 2017 when Republicans controlled both chambers in Congress, a desire by that party to repeal and replace the ACA has not vanished totally. Its members recognize that a comprehensive replacement plan will have to be designed prior to attempting to launch any repeal effort in the future.

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100th DAY OF THE 116TH CONGRESS

John Colbert

April 22, 2019

Trends Archives

Tuesday, March 16 marked the 100th day of the 116th Congress, a period of considerable activity. Both the House Energy and Commerce Committee and the Ways and Means Committee have marked up bills involving the Affordable Care Act and drug pricing. On the Senate side of Capitol Hill, the Health, Education, Labor, and Pensions Committee has sought information from a wide range of sources regarding how to reduce health care costs for taxpayers, employers, and families after concluding a series of five Senate health committee hearings exploring the same topic.

Congress already has enjoyed a measure of success by having some health care bills signed by President Trump, including: the Medicaid Services Investment and Accountability Act of 2019 (H.R. 1839) and the Medicaid Extenders Act of 2019 (H.R. 259). Progress is being made to enable other pieces of health legislation to advance, such as the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 (H.R. 269) and the Poison Center Network Enhancement Act of 2019 (H.R. 501). Other items requiring attention this session involve legislation to renew expiring programs that involve Community Health Centers and Teaching Health Centers.

A hearty perennial that keeps Congress active is completing work on 12 appropriations bills. House Democrats were forced to cancel a vote on top-line budget numbers because of intra-party disagreement. Some party members supporting H.R. 2021 want to increase defense spending in 2020 by $17 billion for a total of $664 billion and non-defense spending by $34 billion for a total of $631 billion. Other Democrats insist that non-defense spending be raised to the same level as defense spending.

In the health arena, there is little support for the Trump Administration’s FY 2020 budget request involving medical research. Many Republican legislators are inclined to reduce government spending whenever possible, but Subcommittee Chairman Roy Blunt (R-MO) of the Senate Subcommittee for Labor-HHS Appropriations indicated that re-prioritizing funding for the National Institutes of Health (NIH) after a decade of stagnation has been his number one priority. The Administration’s budget request to reduce NIH support by $4.9 billion (a 13% cut) is not a choice he intends to make when the Labor-HHS spending bill is written.

The release of the Mueller Report on April 18 regarding whether President Trump was involved in collusion with Russia or obstruction of justice involving the U.S. presidential election in 2016 has not resulted in producing total calm in political waters that have been roiled for the past two years. A traditional role of Congress is to conduct hearings to examine the performance of federal agencies and to investigate suspected wrongdoings. As of April 2019, it is clear that Democrats in the House of Representatives will use that power to hold hearings on important matters they believe remain insufficiently addressed by the Mueller Report.

Meanwhile, the 2020 election cycle appears to be in full swing even though votes will not be cast for another 19 months. The Democrats lack no shortage of candidates who deem themselves worthy of residing in the big house at 1600 Pennsylvania Avenue, N.W. come January 2021.

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PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

April 22, 2019

Trends Archives

By Susan N. Hanrahan, ASAHP President

In my message in the November 2017 issue, I indicated that I will be asking some of you to send a photo and answer a series of “fun” questions to be shared with our membership so that we can continue our collegiality through our newsletter. The 12th of many profiles and the fourth in 2019 is presented as follows:

Name and Title: Yasmen “Yas” Simonian, PhD, MLS(ASCP)CM, FASAHP Dean and Brady Presidential Distinguished Professor

Place of birth: Tehran, Iran

University: Weber State University

How long have you been in your position? Eleven years

What’s the value of a university education? Opens a world of opportunities. The sky is the limit.

What is the value of ASAHP? Networking, CE, opportunities to present, share ideas, and more.

Your philosophy on education in seven words: Learn lots and then make a decision.

If I could teach in another field, which one and why? History of Medicine, I like the subject.

Before I retire I want to: Leave a legacy that will make a difference for many years to come.

In college, I was known for: Helping others and partying.

What music is playing in my car/office? In the car Greek dancing music and in the office mellow classical.

The last book I read for fun was: Becoming Michelle Obama

My favorite trip was: Greece any day

If I could travel anywhere it would be: Spain, Italy, Greece, Armenia, Serbia, Romania, Middle East

Four people I’d take to coffee or have a glass of wine with: Farogh, Hassan, Helen, mom

The best advice I ever received was: Listen before you talk.

My hobby is: Dancing, cooking, traveling, music.

My passion is: Being with my family and friends.

My pet peeve is: People not putting things back from where they got it from.

A perfect day is: A sunny day on a beach under an umbrella

Cats or dogs? Dog

E-book or hardback? Both

Beach or mountains? Both

I wish I could: Cure cancer

Only my friends know I: Ask me later.

My favorite saying is: You can do it.

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VARIETIES OF PLAGUES BOTH OLD AND NEW

John Colbert

April 22, 2019

Trends Archives

The word plague is versatile, whether used as a noun to describe the assault of a communicable disease on a population or as a verb to convey chronic emotional distress. The first category may best be exemplified by the endemic Black Plague that devasted human life in late Medieval and Renaissance Europe. One historical account in the journal Bulletin of the History of Medicine led to an estimate that the mortality rate from the Black Death and its collateral effects devastated 60% of the entire European population (50 million of its estimated 80 million inhabitants).

Often referred to as the White Plague, during the first half of the 20th century in the U.S., large county tuberculosis (TB) hospitals across the nation housed patients requiring specialized care. A most deadly disease, a provisional total of only 9,029 TB cases were reported in the U.S. in 2018, (an incidence of 2.8 cases per 100,000 persons). The rate among patients born outside this country, however, was more than 14 times higher than that of individuals born here. Risk factors include HIV infection status, a history of homelessness, and residence in a congregate setting.

Until the mid-1950s, polio outbreaks triggered fears of becoming a patient confined for the rest of one’s life in an iron lung. When the Global Polio Eradication Initiative (GPEI) began in 1988, cases of poliomyelitis were reported from 125 countries. Since then, only Afghanistan, Nigeria, and Pakistan have experienced uninterrupted transmission of wild poliovirus (WPV).

Although declared eliminated in the U.S. in 2000, total cases of measles nationwide as of April 11, 2019 already have surpassed those of 2018 and likely soon will eclipse totals for 2017 and 2018 combined, according to the CDC. During the 1940s and early 1950s, the editor of this newsletter in his youth was afflicted with mumps, measles, whooping cough, German measles, chickenpox, and scarlet fever. None of those conditions was considered rare back then, which happily is quite the opposite of the present day, reflecting the current widespread availability of vaccines, effective drugs, and improved standards of living.

Meanwhile, the relative disappearance of some diseases has been replaced by the emergence of other conditions primarily associated with a sense of being plagued by doubts and uncertainties about the purported advantages of modern day life. For example, despite evidence of the positive role that vaccines play in preventing disease, some parents refuse to have their children immunized because of a fear that it causes autism. According to a recent national Pew Research Center study, when Americans peer 30 years into the future, they see a country in decline economically, politically, and on the world stage. Such grim predictions reflect a sour public mood while more extreme forms of hopelessness contribute to suicide continuing to remain among the top 10 causes of mortality in the U.S. since 2008.

Nevertheless, poking through a cloud of despair is a hearty ray of sunshine in the form of knowledge that the health professions remain a sound career choice. An aging population characterized by chronic ailments will require health care services that are not easily transportable to other countries or replaceable by robots.

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GLOBAL SYNDEMIC OF OBESITY, UNDERNUTRITION, AND CLIMATE CHANGE

John Colbert

March 26, 2019

Trends Archives

A syndemic is a portmanteau term, constituting a style of writing often employed by James Joyce in Finnegans Wake and Lewis Carroll in Through The Looking-Glass, to denote a fusion between the words synergy and epidemic. The 23 February-1 March 2019 issue of the British journal The Lancet furnished readers with an opportunity to obtain an enhanced understanding of how obesity, undernutrition, and climate change affect most inhabitants of every nation and region worldwide. A proposition is advanced that the entities do so by co-occurring in time and place; interacting with each other to produce complex sequelae; sharing common underlying societal drivers; and representing three of the gravest threats to human health and survival. One form of purported multifold damage linking the problematic threesome is agriculture's drive towards higher value products, such as processed and animal-source foods that consume great amounts of energy, generate methane and other waste products, and are marketed and consumed heavily in unhealthy quantities.

For example, conceptualizing obesity as a global syndemic might have some utility. Obesity illustrates a pivotal syndemic problem that would appear to require international-level policy interventions to curb the power and influence of multinational corporations, representing Big Sugar and Big Food, which are seen as targeting low-income populations. Viewed within this particular context, advocating in favor of a global syndemic might serve as a constructive political tool to propel positive alliances to take action against multinational corporations. A related perspective is that tearing down silos in the academy and health policy; strengthening government action and community voices; dismantling corporate power to better designate who eats what and where; and promoting improved, more sustainable business models for a healthier future should be syndemic in nature.

return to march 2019 trends

IMPACT OF MARIJUANA LAWS ON HEALTH AND LABOR SUPPLY

John Colbert

March 26, 2019

Trends Archives

As the proportion of the older segment of the population continues to increase both numerically and proportionately, a useful exercise might be to examine how various laws affect them. For example, given the increased popularity of state legislation to legalize the use of marijuana for medical purposes (now legal in 33 states and the District of Columbia) and also for recreational purposes (currently legal in 10 states and DC), use of that substance can be assessed from the standpoint of health and the labor supply for older individuals. A step in that direction is represented by the results of a study reported in the Journal of Policy Analysis and Management on February 6, 2019. Investigators quantified the effects of state medical marijuana laws (MML) on the health and labor supply of adults age 51 and older, focusing on the 55% with one or more medical conditions with symptoms that may respond to medical marijuana.

Three principle findings emerged from the analysis. First, active state MMLs lead to lower pain and better self‐assessed health among older adults, including a 3.4% increase in the probability of reporting very good or excellent health. Second, state MMLs lead to increases in older adult labor supply, with effects concentrated on the intensive margin, with post-MML full-time employment increasing by 5%. Third, the effects of MMLs are largest among older adults with a health condition that would qualify for legal medical marijuana use under current state laws. These findings highlight the role of health policy in supporting work among older adults and the importance of including them in assessments of state medical marijuana laws. Age patterns of disease suggest that the health benefits of MML passage could be concentrated among older adults. The authors contend that if the implementation of an MML, by promoting access to marijuana for medical use, reduces symptoms associated with work‐impeding health conditions, then MMLs could enhance labor supply among the fastest growing segment of the population. This policy effect could facilitate greater retirement savings and also potentially delay the initiation of Social Security benefit claims

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

March 25, 2019

Trends Archives

Emerging Technologies To Support An Aging Population

Emerging technologies that have significant promise to improve quality of life for all Americans, particularly those with physical or cognitive burdens due to aging or disability, are identified in a new report from the White House Task Force on Research and Development for Technology to Support Aging Adults. The report, Emerging Technologies to Support an Aging Population, highlights innovations with the potential to improve quality of life, enhance individual choice, reduce caregiver stress, reduce healthcare costs. Research and development needs also are identified. The report outlines six areas in which technology has the potential to improve the lives of aging adults: key activities of independent living; cognition; communication and social connectivity; personal mobility; transportation; and access to healthcare. The report can be obtained here.

School Success: An Opportunity For Population Health

The National Academies of Sciences, Engineering, and Medicine’s Roundtable on Population Health Improvement hosted a workshop in Oakland, California, at the California Endowment’s Oakland Conference Center on June 14, 2018. The workshop featured presentations that described the relationship between the health and education sectors and shared examples of public health interventions and activities in schools that support school success and are potential opportunities for population health action. The day began with two keynote presentations reflecting on how educational attainment influences health outcomes and how health status affects educational performance. Keynote speakers were followed by Ted Talk style presentations describing school-based public health interventions and the workshop concluded by addressing policies, issues, and opportunities pertaining to shared measurement, legal issues, payment mechanisms, and equity. Steven Woolf from the Center on Society and Health at Virginia Commonwealth University articulated why educational success matters for health. He stated that although the health and education systems work toward similar ends, they have functioned as silos for many years without much communication. Woolf presented an overview of what shapes health through five domains: (1) health systems, (2) individual behaviors, (3) the physical and social environment, (4) public policies and spending, and (5) socioeconomic factors. The public policy and spending domain is of specific importance given that it drives the other domains. Proceedings of the workshop can be obtained here.

CARE Act Implementation: Progress And Promise

The AARP Public Policy Institute published a Spotlight report, The CARE Act Implementation: Progress and Promise. The Caregiver Advise, Record, Enable (CARE) Act became law in 40 states and territories in just four years, while additional states have initiated the legislative process. The swift uptake indicates policy maker recognition of the support family caregivers need to perform the medical/nursing tasks they face at home after a family member or friend is discharged from the hospital. The landmark 2012 AARP and United Hospital Fund report Home Alone: Family Caregivers Providing Complex Chronic Care, funded by The John A. Hartford Foundation, drove the rapid policy adoption of the CARE Act. The report also inspired the creation of the Home Alone AllianceSM, a partnership of public, private, and nonprofit organizations coming together to change the way health care organizations and professionals interface with family caregivers. This Spotlight provides an update on CARE Act implementation, bringing in views from the field. The report can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

March 25, 2019

Trends Archives

Selected Estimates Based On National Health Interview Survey, January To September 2018

Some results for the period January to September 2018 are: (1) the percentage of persons who had a usual place to go for medical care was 87.7%, which was lower than, but not significantly different from, the 2017 estimate of 88.3%; (2) the percentage of the population that failed to obtain needed medical care due to cost at some time during the past 12 months was 4.7%, which was not significantly different from the 2017 estimate of 4.5%; (3) the prevalence of obesity among U.S. adults aged 20 and over was 31.7%, which was not significantly different from the 2017 estimate of 31.3%; (4) the percentage of persons who had excellent or very good health was 66.3%, which was not significantly different from the 2017 estimate of 66.4%; and (5) the percentage of adults aged 65 and over who needed help with personal care from other persons was 7.0%, which was not significantly different from the 2017 estimate of 6.7%.

Electronic Health Behaviors Among U.S. Adults With Chronic Disease

As reported on March 3, 2019 in the Journal of Medical Internet Research, a study explored (1) the differences in technology use; (2) Web-based health information seeking and use behaviors; (3) attitudes toward seeking health information on the Web; and (4) the level of eHealth literacy between adults aged 18 and 64 years with and without chronic disease. About one in three (37.2%) participants reported at least one chronic disease diagnosis. Seventy-five percent of all participants reported having ever searched for health information on the Web. Participants with a chronic disease reported significantly higher instances of visiting and talking to a health care provider based on health information found on the Web (40.0% vs 25.8% and 43.3% vs 27.9%). The uses of health information found on the Web also significantly differed between participants with and without chronic diseases in affecting a decision about how to treat an illness or condition (49.2% vs 35.0%), changing the way they cope with a chronic condition or manage pain.

HEALTH TECHNOLOGY CORNER

Use Of Toilet Seats To Detect Chronic Heart Failure

A paper published on January 18, 2019 in JMIR mHealth and uHealth indicates that a toilet seat–based cardiovascular monitoring system with an integrated electrocardiogram, ballistocardiogram, and photoplethysmogram developed by a Rochester Institute of Technology team is capable of clinical-grade measurements of systolic and diastolic blood pressure, stroke volume, and peripheral blood oxygenation. Toilet seat–based estimates of blood pressure and peripheral blood oxygenation were compared to a hospital-grade vital signs monitor. This system could be positioned uniquely to capture trend data in the home that previously has been unattainable. Demonstration of the clinical benefit of the technology requires additional algorithm development and future clinical trials. With one million new cases of congestive heart failure diagnosed each year, if the FDA eventually approves the product, it could make it easier for hospitals to monitor patients with this condition in the comfort of their own homes.

Medical And Health Data Wearable

OneLife Technologies Corp., a mobile medical software/data collection company, offers the first AT&T LTE-M certified medical wearable. The OnePulse smartwatch goes beyond tracking steps by providing activity trackers, reminders, and alert technologies. Powered by AT&T wireless connectivity, the advanced wearable securely and independently transmits certain critical medical and health data to the cloud, allowing clinicians, patients, and their caregivers to monitor user status and well-being. The AT&T LTE-M connection allows clinicians near real-time access to patient data in a highly secure environment, offering caregivers the ability to intervene when necessary. The OnePulse technology provides data at the wrist for heart rate, location, movement, and sleep. OneLife’s proprietary Bluetooth protocol also has the ability to connect easily to other health and medical devices, e.g., blood pressure cuff, glucometer, and a weight scale.

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Advancing Patient-Centered Care For Individuals With Multiple Chronic Conditions

Effects of Early Care And Education On Children’s Health

Addressing Social Determinants Of Health Through Housing Improvements

More Articles from TRENDS May 2019

LANGUAGE TRANSMISSION AND TRANSLATION

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

BIPARTISAN HEALTH LEGISLATION

HEALTH REFORM DEVELOPMENTS

DEVELOPMENTS IN HIGHER EDUCATION

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

RANDOMIZED CLINICAL TRIALS AND THE WEIGHT OF A SOUL

VALIDATION OF DIGITAL HEALTH SOLUTIONS

Pregnancy-Related Deaths, United States, 2011-2015

Severe Joint Pain And Physical Inactivity Among Adults With Arthritis-United States

HEALTH TECHNOLOGY CORNER

Wireless Sensor System To Monitor Babies In The Neonatal Intensive Care Unit (NICU)

Electric Field-Based Dressing Disrupts Bacterial Biofilm Infection To Restore Healing

More Articles from TRENDS May 2019

LANGUAGE TRANSMISSION AND TRANSLATION

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

BIPARTISAN HEALTH LEGISLATION

HEALTH REFORM DEVELOPMENTS

DEVELOPMENTS IN HIGHER EDUCATION