Aaron E. Carroll's Blog, page 10

HSR Call for Abstracts: The Role of Health Services Research in Advances in Cancer Prevention and Control

Cross-posted from the Health Services Research website.

Sponsored by: Department of Public Health Sciences, University of Virginia School of Medicine
Submission deadline for abstracts: Monday 17 June 2024

Health Services Research (HSR) and the Department of Public Health Sciences, University of Virginia School of Medicine are partnering to publish a Special Issue on The Role of Health Services Research in Cancer Prevention and Control. The special issue will be edited by Kevin Schulman, MD, Roger Anderson, PhD, Xin Hu, PhD, and Asal Pilehvari, PhD.

Paradigm shifts in cancer screening such as mammography, colonoscopy, and Pap smears have been pivotal in detecting cancers at earlier and more treatable stages. Treatments including targeted therapies, immunotherapies, and precision medicine have prolonged disease-free intervals, improved overall survival, and enhanced quality of life for survivors. Interventions in the delivery and quality of palliative care and hospice utilization have improved the end-of-life experience. Health services research has contributed significantly to evaluating the effectiveness, accessibility, and implementation strategies of these screening programs, treatments, and interventions, guiding their integration into clinical practice.

Nonetheless, challenges persist in ensuring equitable access to high-quality cancer care for all. Disparities in cancer outcomes based on factors including socioeconomic status, sex, gender identification, race, ethnicity, disability, comoribidities, care delivery system, health policy, and geographical location remain a concern. Addressing these disparities and further improving cancer prevention and control strategies requires a comprehensive application of health services research.

Health services research can contribute to understanding how integrating innovative approaches of technology such as artificial intelligence (AI), predictive analytics, big data analytics, and evidence synthesis methodologies can improve informed decision-making across the cancer care continuum. Health services research can also inform policy innovations that promote access to care, and patient-centered care approaches. All present opportunities to further enhance cancer prevention and control and improve patient outcomes.

This special issue will include empirical studies that illuminate the application of health services research throughout the cancer care continuum, from prevention and early detection to treatment, survivorship, and end-of-life care. Examples of topic areas of interest include but are not limited to:

Evaluation of cancer care quality indicators, cancer care utilization and economic outcomes, and/or organizational structures or designs associated with efficiency and effectiveness of cancer care delivery.Evaluation of the use of cutting-edge technologies, including AI and machine learning:to evaluate and/or quantify cancer care quality, utilization, and outcomes; oras a clinical application to improve personalized treatment decision, cancer care quality and utilization in real-world-applications, such as risk stratification, pattern recognition, or improved diagnostic accuracy.Generation of data-driven recommendations to address the access, cost or quality of cancer care for key stakeholders across the cancer control continuum, from prevention to end-of-life care, including but not limited to insurance companies, professional societies, health care providers, governments, patients and caregivers.

HSR is issuing a call for abstracts to invite paper submissions for this special issue. The deadline for initial submission of abstracts is 17 June 2024.  Abstracts may not exceed 300 words and must be formatted as indicated in the HSR Author Instructions (Section 2.4.2.2, keywords not necessary).

Abstracts will be evaluated by a multidisciplinary review panel. Evaluation criteria include:

Quality, rigor, and originalityRelevance to the special issue themeClarity of writing and presentation.

Authors of abstracts that most closely match the criteria will be invited in August to submit full manuscripts in November 2024.

Invited manuscripts must follow the Author Instructions and undergo the same HSR peer review process as regular issue manuscripts. However, due to the strict timeline for publishing the special issue, the review and revision process will follow an expedited timeline. Authors must be prompt in returning revisions. Invited articles will be published online on acceptance. Some accepted articles might not be selected for the special issue but will be published in a regular issue.

The expected publication date for the special issue is March 2026.

To submit an abstract for consideration, please email it with the corresponding author’s contact information to hsr@aha.org. Include “Special Issue HSR in Cancer” in the email subject line.

Key dates for authors

Submission deadline for abstracts: 17 June 2024

Full manuscript invitation: 1 August 2024

Full manuscript deadline: 1 November 2024

Special issue publication date: March 2026

Questions? Please email Kelly Teagle at hsr@aha.org.

The post HSR Call for Abstracts: The Role of Health Services Research in Advances in Cancer Prevention and Control first appeared on The Incidental Economist.

When Times Get Tough: Regional Economic Conditions and Preventable Hospitalizations Among Older Patients with Diabetes

In times of economic uncertainty and decline, we all take steps to be more frugal. Clipping coupons, spending less on entertainment and dining, or swapping out a favorite brand name good for a generic alternative won’t hurt you. But sometimes the lengths one can go to save money will.

When sick, some forego the doctor’s visit in favor of a cheap(er) over-the-counter remedy. Others ration an expensive prescription like insulin to make the supply last.

Deferring health care comes with a cost though – often to those who are already vulnerable. For younger and healthy adults, putting off an overdue medical appointment might not be all that risky. But for those who are older or who struggle with chronic disease, deferring care raises the risk that an otherwise preventable illness or complication will become serious.

Our health and health care are not immune to economic changes, but there has been limited study as to how shifting economic tides impact quality of care.

Recent Study

In a study published in Medical Care, evaluators from the Partnered Evidence-based Policy Resource Center explored the relationships between regional economic conditions and quality of care by examining the risk of preventable hospitalization or death among older Veterans with diabetes who seek care from Veterans Health Administration (VHA).

The authors followed a cohort of over 468,000 VHA patients aged 65 years and older with a diabetes diagnosis from July 1, 2012 to June 30, 2014. Baseline data were captured for one year prior to diabetes diagnosis, and Veterans in the cohort were followed for at least 24 months.

Using The Agency for Healthcare Research and Quality Prevention Quality Indicators, the researchers identified four outcomes of interest. These included three types of preventable hospitalization associated with diabetes (short-term complications admissions, long-term complications admissions, and uncontrolled diabetes admissions) and death.

The authors identified six market variables that characterized health insurance coverage and affluence at the regional level. Health insurance variables included the percentage of VHA enrollees aged 65 years and older, Medicare Advantage market penetration rate, and percentage of health insurance coverage among males aged 18-64 years. Regional affluence variables included median household income, Housing Pricing Index, and Veteran unemployment rate.

The evaluators employed a 2-stage discrete-time Cox proportional hazards model to assess the relationships between quality of care in VHA primary care services and economic conditions.

Findings

The study found that most regional market variables were associated with preventable hospitalization or death. Higher rates of health insurance coverage were associated with lower utilization of VHA care and a lower risk of preventable hospitalization or death. Similarly, higher median household income and higher Housing Pricing Index were associated with lower risk of preventable hospitalization and death. However, the authors didn’t find any effect from Veteran unemployment rate.

Using survival analyses, the authors predicted that increases in VHA’s primary care staffing levels could reduce the risk of preventable hospitalization or death for the average Veteran with diabetes at the average VHA facility. But any beneficial reduction could be partially offset if the VHA facility was also affected by the economic downturn.

Conclusion

The authors acknowledged several limitations. As a VHA-specific analysis, the findings might not be generalizable to all patients or health systems. As an observational study, there may be unobserved confounding effects impacting the validity of the findings. The evaluators also found it challenging to use administrative data to identify diabetes diagnoses because of differences in how diagnoses were documented and coded in the electronic health record.

The study’s findings support the need for a better understanding of how health systems, especially safety-net providers, can build resilience to withstand challenging economic conditions. The authors suggested that VHA could benefit from being attuned to changes in regional economic conditions and allocating national resources accordingly. They argued that non-VHA safety-net hospitals, especially those reimbursed with value-based payment models, may be unfairly penalized for lower quality of care resulting from worsening economic conditions, ultimately exacerbating quality concerns.

Quality health care may be most important when times get tough – for that reason, health systems should leverage every available tool to ensure that those most affected by economic downturns receive the highest quality of care possible.

The post When Times Get Tough: Regional Economic Conditions and Preventable Hospitalizations Among Older Patients with Diabetes first appeared on The Incidental Economist.

Ten Years Later: The HPV Vaccine is Still Incredible & Lifesaving

We love some good vaccine data, and we were pretty excited to see a new, long-term study published this month on cervical cancer outcomes after the HPV vaccine.

 



The post Ten Years Later: The HPV Vaccine is Still Incredible & Lifesaving first appeared on The Incidental Economist.

Do Oreos Lower Cholesterol? No.

According to a recent study, “Oreo Cookie Treatment” is better at lowering LDL cholesterol (the “bad” cholesterol) than high-intensity therapy with cholesterol-lowering drugs called statins. ARE OREOS A HEALTH FOOD NOW?!

 



The post Do Oreos Lower Cholesterol? No. first appeared on The Incidental Economist.

Legal Sports Betting – Our Next Addiction Crisis?

With the legalization of sports betting, we may be courting our next addiction crisis.

Sports betting is not new but, in 2018, the Supreme Court lifted a longstanding prohibition that significantly limited gambling on sports. Since that decision, legal sports betting has been big business – approximately $220 billion in five years big. It’s no wonder that 38 states have since chosen to legalize it.

Not everyone is thrilled by the pace of expansion, however – gambling disorder affects an estimated two million adults in the United States each year. In many states where sports betting is now legal, the behavioral health impact is a major concern.

The Science of Addiction and Gambling

Conversations about addiction usually focus on the misuse of drugs and alcohol. Other types of addiction, such as gambling disorder, are left out. This narrow view persists despite how similar gambling disorder and substance use disorders are.

The fundamental science of addiction is centered around the release of “feel good” neurotransmitters in the brain in response to a chemical or behavioral trigger. Over time this release is less and less effective, requiring either increased consumption or potency of the trigger to achieve the same effect. Research shows that gambling disorder relies on many of the same mechanisms. Veterans, college students, and those of lower socioeconomic status appear to be more at-risk for becoming addicted to gambling (and other things) than other groups.

In recent years, the evidence base on sports betting in particular has rapidly developed. When compared to gamblers who do not bet on sports, sports betters have been found to gamble more frequently and report higher rates of problem gambling. Sports betting has also been associated with more frequent use of substances and increased consumption of video games and pornography – two forms of media garnering new attention as being highly addictive.

Gambling Disorder and Its Consequences

As is the case with substance use disorders, gambling disorder has a significant impact on the health and well-being of the individual and those around them.

For starters, the negative social consequences of gambling disorder are many. On top of financial losses, individuals often lose or damage their interpersonal relationships. They may have difficulty performing at work or school. Unfortunately, the impacts persist long after the problem behavior has been resolved.

Gambling disorder doesn’t exist in a vacuum either. Often, individuals also struggle with alcohol and/or substance use disorders. Gambling disorder frequently co-occurs with serious psychiatric conditions, including post-traumatic stress, bipolar, major depressive, and personality disorders. Research has also found pronounced and disheartening links between gambling disorder and suicide.

Given what we are learning about gambling disorder and its impacts, we should be concerned by sports betting’s meteoric rise.

What’s Behind the Sports Betting Boom?

The sports betting boom has been made possible by two key factors: the industry’s ability to incentivize play and the institutional backing of the professional sports apparatus.

Sportsbooks, gambling operators that accept bets and pay out winnings in-person or online, deploy a number of tools to incentivize new players. For example, deposit matches match a new player’s first deposit and free bets give a new player an allowance to make bets. These tactics not only lower the financial barrier of entry but also project the illusion that sports betting isn’t that risky. More and more, players are learning firsthand that these promotions aren’t as generous or straightforward as they seem.

Then, there is the gamification of bets. Gamification adds a degree of fun and whimsy designed to entice the casual viewer. For example, each year, Super Bowl prop bets let viewers gamble on everything from the length of the National Anthem to what songs the half-time performer will sing.

The professional sports industry is also responsible for the growth of sports betting. From the four major American professional leagues (NFL, NBA, MLB, and NHL) to the English Premier League, the governing bodies of sport have quite literally co-signed on sports betting through official sponsorships. Teams and venues have even followed suit with their own partnerships.

Sports media broadcasters incorporate sports betting into their content, too. Some of this integration is subtle – a scrolling ticker with the latest betting odds, for example – but, increasingly, broadcasters are more overt and are going so far as to license their own brands to sportsbooks. If that wasn’t enough, sportsbooks themselves are creating podcasts and TV networks.

Conclusion

Most people who bet on a game or two won’t develop a gambling disorder, but public health experts are understandably worried about the entanglement of sports and gambling. Proponents have a simple answer: Gamble responsibly. Leagues, teams, and sportsbooks encourage players to bet responsibly, know their limits, and never chase losses. They argue the onus is on the individual and they might be right. But we should watch out for those who gamble and lose and be ready with help.

The post Legal Sports Betting – Our Next Addiction Crisis? first appeared on The Incidental Economist.

Changes in Cost-Sharing Have Little Impact on VHA Reliance

Most Veterans enrolled in health care coverage through Veterans Health Administration (VHA) have additional coverage through public programs like Traditional Medicare or private payers like Medicare Advantage or employer-sponsored insurance. In recent years, Veteran enrollment in Medicare Advantage in particular has grown significantly. Historically, it has been unclear how Medicare Advantage policy changes affect how dual-enrolled Veterans use VHA services.

The Partnered Evidence-based Policy Resource Center (PEPReC) published a policy brief exploring whether recent changes in Medicare Advantage plan benefit design (in terms of patient cost sharing) led to changes in reliance of VHA services. Read the full brief here.

PEPReC, within the Veterans Health Administration and funded in large part by the Quality Enhancement Research Initiative (QUERI), is a team of health economists, health services and public health researchers, statistical programmers, and policy analysts who engage policymakers to improve Veterans’ lives through evidence-driven innovations using advanced quantitative methods.

The post Changes in Cost-Sharing Have Little Impact on VHA Reliance first appeared on The Incidental Economist.

Gender-Affirming Surgeries Reduce Suicides

Suicide remains a leading cause of death among Veterans, and the risks are disproportionately higher for transgender Veterans. Gender-affirming surgeries are proven to significantly reduce suicide risk. While Veterans Health Administration offers several forms of gender-affirming care, initial surgeries are explicitly excluded.

The Partnered Evidence-based Policy Resource Center (PEPReC) published a policy brief discussing the health impacts of gender-affirming surgery and suggests there is an urgent need to consider adding initial surgical options to the Veteran benefits package. Read the full brief here.

PEPReC, within the Veterans Health Administration and funded in large part by the Quality Enhancement Research Initiative (QUERI), is a team of health economists, health services and public health researchers, statistical programmers, and policy analysts who engage policymakers to improve Veterans’ lives through evidence-driven innovations using advanced quantitative methods.

The post Gender-Affirming Surgeries Reduce Suicides first appeared on The Incidental Economist.

Will Massachusetts’ New Dental Insurance Law Benefit Patients?

In 2022, 70% of Massachusetts voters supported a ballot question to make dental insurance coverage more transparent and more focused on the patient. Now that the law is enacted (as of January 1, 2024), most voters have forgotten what the details of the law are and how it is supposed to help. Will the dental insurance law save patients money at the dentist’s office, or will insurers increase costs to comply with the new legislation? I have a new piece looking at these questions in the Worcester Telegram and Gazette:

The new Massachusetts dental insurance reform law will likely have wide-ranging consequences for dental health care in the commonwealth. While supporters claim it will provide higher-quality care with greater affordability and access for patients, opponents worry it will hike prices for patients and discourage insurers from providing coverage in the state.

Read the whole piece here.

Research for this article was supported by Arnold Ventures.

The post Will Massachusetts’ New Dental Insurance Law Benefit Patients? first appeared on The Incidental Economist.

Fraud, Abuse, and Malfeasance in the American Health System

The Lown Institute’s 2023 Shkreli Awards have arrived!

 



The post Fraud, Abuse, and Malfeasance in the American Health System first appeared on The Incidental Economist.

The Ugly Stain of Ageism on Smart Home Technology

Smart home technology is increasingly being used by older adults who wish to age in place (growing old in their own homes) rather than moving to institutional care. However, smart home technology can pose risks when used in ways that minimize independence, autonomy, and dignity. I wrote about this recently for Public Health Post, a publication of Boston University School of Public Health.

Older adults may not welcome indoor cameras or other devices that surveil, even at the behest of loved ones, because they feel comfortable assuming some risk in their homes and maintaining their independence. In contrast, many older adults do choose to install smart home technology that helps them manage their health care or connect with loved ones. The point is that it should be their choice, based on their needs.

Read the whole piece here.

This piece is the third installment in a short series on smart home technology used to age in place. You can find the first piece summarizing this technology here, and a second piece understanding caregivers’ perspectives in using products here. 

The post The Ugly Stain of Ageism on Smart Home Technology first appeared on The Incidental Economist.