Aaron E. Carroll's Blog, page 14

The Mental Impact of Climate Change

We’ve been on a Climate Change and Health kick lately but so far, we’ve focused on the threats that our physical health faces on a warming planet. However, the looming cloud of climate change is tough on our mental health, too, and we should talk about that.

 



The post The Mental Impact of Climate Change first appeared on The Incidental Economist.

HSR Special Issue Call for Abstracts: Medicare and Medicaid at 60

Cross-posted from the HSR website.

Submission deadline for abstracts: Monday, January 22, 2024

Health Services Research (HSR) and the American Institutes for Research® (AIR) are partnering to publish a special issue on Medicare and Medicaid at 60. The issue will be edited by HSR Senior Associate Editor Marisa Elena Domino, PhD, Executive Director, Center for Health Information and Research, and professor, College of Health Solutions, Arizona State University, and Kelly Devers, PhD, Mai Hubbard, PhD, and Guido Cataife, PhD.

The purpose of this special issue is to provide rigorous and timely evidence for policymakers and other stakeholders about pressing issues related to the financing, organization, and delivery of U.S. health care through Medicare and Medicaid programs, using a prism of access, quality, equity, and costs.

The 60th anniversary of Medicare and Medicaid will occur in 2025. Through demonstration programs and other research, a lot has been learned about Medicare and Medicaid, but there is still a lot we still don’t know about access, quality, equity, and cost. Some key challenges in the U.S. health care system in these two major public insurance programs include:

Addressing high and rising health care spending and suboptimal quality outcomes, in a system where almost 1 in 10 people still lack health insurance.Improving overall population health, with a focus on the growing population of people with multiple chronic conditions and the role of health-related social needs in their care.Reducing health disparities and advancing equity across social, economic, demographic, and geographic dimensions.Complexities of multipayer alignment and lessons learned for Medicare and Medicaid through demonstrations and related efforts to optimize value-based payment approaches.

Within this context, this HSR special issue seeks to advance evidence and understanding related to the following broad topics:

Medicare as Change Agent: Past and Future—As the nation’s single largest health care payer, Medicare has significant purchasing power to drive systemwide change, especially related to payment reform and quality and patient safety initiatives. Examples of research questions in this topic area include:

What are the key lessons learned from Medicare’s push for accountable care through alternative payment models—what does and doesn’t work?What can other payers learn from these efforts? How has provider participation been incentivized in alternative payment models?Have Medicare quality and safety improvement efforts moved the needle on quality and safety?What do we know about the potential for Medicare to better address health-related social needs like housing, food, and transportation?What role has Medicare played in advancing more meaningful quality measurement, including patient-reported outcome measures (PROMs) and person-centered measurement?What have we learned from Medicare person/family engagement efforts and are there lessons for other payers?How has Medicare Advantage (MA) growth affected Traditional Medicare and the broader health care system?Are there adequate safeguards to ensure MA provider network adequacy for beneficiaries?How effective are Medicare policies in supporting an adequate health workforce?What is the evidence base that could inform Medicare Prescription Drug Price Negotiations?

Medicaid as Learning Laboratory—Across states, Medicaid programs differ significantly in eligibility, benefits, provider payments, and other dimensions. For example, the end of the public health emergency’s continuous enrollment requirement is playing out differently across states. Additionally, Medicaid pays for about half of all births in the country and is the nation’s largest payer of long-term care, including home- and community-based services to keep people out of nursing homes. Example research questions include:

What are the implications for access, quality, equity, and costs given Medicaid’s differing state policies?How well do alternative payment models work in state Medicaid programs?How effective are Medicaid efforts to decrease maternal and infant mortality and complications?Are there important innovations in state Medicaid programs to reduce costs, improve quality, and increase access?What efforts are working to improve care and reduce costs for beneficiaries dually eligible for Medicare and Medicaid?What are state Medicaid programs doing related to health-related social needs like housing, food, and transportation?What are states doing to engage patients, families, and communities to improve health and wellbeing?What’s the status of state Medicaid efforts to integrate physical and behavioral health care?How have Medicaid mandatory core quality measures impacted provider performance?

The deadline for initial submission of abstracts is Monday, January 22, 2024. Abstracts may not exceed 300 words and must be formatted as indicated in Section 2.4.2.2 of the HSR Author Instructions (keywords not necessary). Studies can be based on quantitative, qualitative, or mixed methods data or can be literature reviews and syntheses.

Abstracts will be evaluated by a multidisciplinary review panel. Evaluation criteria include: (1) quality, rigor, and originality; (2) relevance to the special issue theme; and (3) clarity of writing and presentation. Authors of abstracts that most closely match the criteria will be invited to submit full manuscripts.

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 process may be shorter. 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 2025.

To submit an abstract for consideration, please email it with the corresponding author’s contact information to hsr@aha.org. Include “Medicare and Medicaid at 60” in the email subject line.

Key dates for authors
Submission deadline for abstracts: 22 January 2024
Full manuscript invitation: 5 February 2024
Full manuscript deadline: 1 April 2024
Special issue publication date: March 2025 but accepted articles will be posted earlier, after approval of proofs by authors

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

The post HSR Special Issue Call for Abstracts: Medicare and Medicaid at 60 first appeared on The Incidental Economist.

High Heat, Health, and Hardship

The earth is heating up, and city dwellers are feeling it the most.

Due to the “Urban Heat Island effect,” cities are quite literally hotter than their surroundings. High-heat cities, also called Urban Heat Islands (UHIs), don’t distribute heat evenly. Some areas within cities are even hotter than other areas. These neighborhoods, often low-income and formerly redlined, are under the most heat duress. (That they were redlined means they were systematic denied financial services, particularly mortgage loans, limiting their residents’ ability to build wealth.)

High-heat neighborhoods and their challenges arise due to several factors aside from redlining. One is the way buildings are constructed. For example, the use of heavy building materials like brick absorb heat within the structure rather than reflect it. Another is that there are more roads and other heat-trapping surfaces and less green space or waterfront. This means there are fewer places for people to escape the heat outdoors. Combined with few air-conditioned spaces for the public to use generally, it’s almost impossible to cool off.

High-heat neighborhoods can be 5 to 20 degrees hotter than surrounding neighborhoods. This poses very real threats to our health, both at the individual and community level. Simply put, high temperatures can be deadly. Heatwaves increase mortality rates, with 600 to 1,300 people dying of heat-related illnesses every year in the United States. Living in a high-heat neighborhood only increases that risk.

Exposure to high-heat conditions can lead to a number of health conditions. It becomes hard to sleep and people are at risk of dehydration and heat stroke. Heat also affects mental health. For example, exposure to heat for prolonged periods can make it hard to concentrate and cause mood and behavioral changes.

Residents of high-heat neighborhoods are oftentimes dually impacted. Aside from heat-related consequences, redlined communities can have worse air and water quality, more incomplete plumbing, and more noise pollution. Compounding with the effects of high-heat, all of these factors can cause high-heat neighborhoods to be particularly hazardous for health.

Structural issues aside, there are inequitable financial costs associated with heat as well. Generally, high-heat exposure leads to increased health care costs, impacting women, the elderly, low-income families, and ethnic minorities the most. More specifically, heat-related illness may result in expensive hospital stays, emergency department use, and medical transports. It can also come with a loss of income from missed work and expensive, long-term health complications.

At the community level, heat has consequences as well.

Violent crime is higher in hotter months, and there is a notable increase in suicides and hospital visits. High heat results in more school closures, especially if buildings don’t have air-conditioning. Missed school means a scramble by parents to find childcare, missed meals and worse educational outcomes for kids.

To cope with the high heat, increased use of air conditioning and fans creates stress on local energy grids and increases community energy expenses.

Given the dangers of UHIs, finding solutions is a pressing concern. Two of the most prominent proposed by scholars and climate activists are Green City and White City techniques.

Green City techniques incorporate nature-based solutions into urban planning and design with an aim to absorb heat. These strategies focus on increasing vegetation through initiatives such as urban forestry, green roofs, and green walls. Vegetation provides shade, absorbs heat, and releases moisture, ultimately cooling the environment. Green City techniques also include installing permeable surfaces like porous pavements instead of heat-retaining asphalt and concrete to allow water to soak into the ground and cool the area.

White City techniques look at reengineering roads, structures, and construction materials to make them more reflective of sunlight. When roofs and pavements are coated with special reflective materials, they reduce heat buildup. The goal is to minimize the amount of heat trapped and then radiated into the surrounding area. These strategies improve energy efficiency, reduce cooling costs, and enhance resident comfort.

Much theoretical work has been done to model Green City and White City techniques, helping policymakers make evidence-based planning decisions. Some cities, such as New York City and Boston, have conducted their own heat studies and are starting to implement a combination of these ideas.

The research is clear that heat impacts our health. Even though we need to learn more about the costs and benefits of Green City and White City techniques, they present a path forward. After all, our cities should be places of refuge, not suffering.

Research for this piece was supported by Arnold Ventures.

The post High Heat, Health, and Hardship first appeared on The Incidental Economist.

TIE is on LinkedIn!

TIE is now on LinkedIn! We joined as a way to foster even more discussion around all things health. We also hope LinkedIn will fill the social media presence gap that has been left by changes to Twitter. Here’s the link to our page. Give it a follow!

The post TIE is on LinkedIn! first appeared on The Incidental Economist.

Less is more, but for health care

In American health care, more is usually…more. But that may be changing. Providers and researchers are starting to wonder if they can achieve the same outcomes with less treatment, saving patients from the physical and non-physical side effects of intervention. What they’re finding is promising. I wrote about this for STAT recently:

A few Massachusetts hospitals have had success reducing their C-section rates through policy changes. South Shore Hospital implemented the TeamBirth Project, which focuses on patient education and having a documented birth plan. The hospital saw a 4% reduction in C-sections in the first year. In a pilot study, Boston Medical Center also implemented documented birth plans along with hourly evaluations during active labor. This cut the length of labor in half and reduced the likelihood of C-section from 20% to 8%.

Read the whole piece here.

Research for this article was supported by Arnold Ventures.

The post Less is more, but for health care first appeared on The Incidental Economist.

OCD, from the partner’s perspective

My husband has obsessive compulsive disorder (OCD). A year into marriage, he’s learning what it means to reveal the dark corners of his mind to someone, and I’m learning how OCD impacts me.

I knew Jonathan had OCD before we started dating and I thought about it a lot as we moved towards marriage. What does it mean to partner for life with someone with OCD? What even is OCD?

OCD is an anxiety disorder of obsessive thoughts and compulsive behaviors. The thoughts are recurring fears or anxieties, and the behaviors are rituals meant to quell those anxieties, except that the relief is always short-lived and the cycle starts again.

A familiar example of OCD may be someone who is afraid of germs. Her fear is encountering germs and being unable to get rid of any she does encounter. Her compulsive behaviors are specific rituals that she does to avoid germs, like washing her hands for a specific amount of time.

My husband has what some call “pure OCD,” where his obsessions and compulsions are all in his mind. He doesn’t have any visible compulsive behaviors but, instead, he tries to quell his anxiety through mental rituals. OCD’s anxiety makes him feel like he can untangle the obsessive thoughts if he dedicates enough time to analyzing them. When he’s mentally looping like this, he says it feels like simultaneously pushing the gas and the brake to the floor.

Researchers are still learning, but OCD likely has biological roots. A recent study of a few dozen patients found measurable chemical imbalances related to internal brain communication. The patients had higher than normal levels of glutamate, which promotes communication, and lower than normal levels of GABA, which quells communication.

In other words, their brains were literally overcommunicating. This makes sense because people with OCD often struggle with making decisions and second guessing themselves.

But what’s often left out of the conversation about OCD is how it affects loved ones.

Family members are certainly told what to do – how to help, how not to hinder. For example, family accommodation – when loved ones essentially “endorse” an individual’s OCD – can lead to enablement; family members should not reassure about obsessions or adapt to compulsions. Resources also talk about how to structure the home environment to best serve the individual with OCD.

But family members are not told how to cope. And the emotional burden can be heavy.

One small study found the family burden of OCD comparable to the family burden of schizophrenia. The partners and parents in the study worried about their loved ones and experienced relational tension with them because of OCD.

For me, the hardest part is feeling helpless. The mental looping – oscillating between obsessions and compulsions – simply isn’t logical. Jonathan knows that, too. But OCD plants and waters seeds of doubt, making him think that maybe this time he’ll get answers and long-lasting relief.

This cycle means family decisions can be hard. Conversations can take longer. Jonathan can’t focus. The to-do list stays undone until his mind finally clears late at night.

He finds it frustrating. I do, too.

Despite this, there is little out there to help partners and parents deal with the stress. Advice seems limited to “take time for yourself” and “consider a support group.” (The study on family member burden mentioned above did find that family therapy was helpful at alleviating some of the stress and tension.)

In my experience so far, the best advice for loved ones is actually for the individual with OCD to get help. Standard treatment is focused on psychotherapy – such as cognitive behavioral therapy – and medication. Sometimes it requires both inpatient and outpatient care but, regardless, it is a life-long commitment.

Jonathan went through intensive treatment before we started dating, including everything mentioned above. Over time, his treatment plan slimmed down and now he only takes daily medication. The OCD onslaught that used to be his everyday has been reduced to an occasional really bad day and more common “sticky” days, where his mind feels stuck in first gear.

The bad days do affect our life but we both agree that our marriage is as successful as it is thus far because of his intensive treatment. In other words, we had a good leg up because he did a lot of personal work ahead of time.

The bottom line is that Jonathan’s OCD is not my battle to fight; it’s his. That is true for any loved one. But it’s also true that we’ve been thrown into the game without a playbook and we need to talk more about the disease’s impact on us.

For now, though, the best support for us seems to be treatment for them.

The post OCD, from the partner’s perspective first appeared on The Incidental Economist.

Debunking and Prebunking: How to Fight Misinformation

It’s the final episode of our three-part series on health misinformation, and we want to spend these few minutes with you talking more about the best strategies for countering misinformation and how we can best deal with misinformation when we come face-to-face with it online. Thanks in part to the National Institute for Healthcare Management, that’s the topic of this week’s Healthcare Triage.

 

The post Debunking and Prebunking: How to Fight Misinformation first appeared on The Incidental Economist.

Do dementia villages actually work? We just don’t know

Dementia villages are on the rise, but there’s not a lot we know about them. My piece, recently published in STAT, describes the strengthens and limitations of this care concept and what should be studied prior to further replication.

Read the full article here.

Photo via Adobe Stock Images. Research for this piece was supported by Arnold Ventures.

The post Do dementia villages actually work? We just don’t know first appeared on The Incidental Economist.

Consequences of Blissful Ignorance: Marijuana’s Health Risks

Marijuana use has grown in recent years due to its reputation of being a natural and risk-free drug. My piece, published in the Fall 2023 issue of Behavioral Health News, uses evidence to explain why its not as safe as you think and what you can do to reduce future harm while partaking.

Read the full article here.

Photo via Adobe Stock Images. Research for this piece was supported by Arnold Ventures.

The post Consequences of Blissful Ignorance: Marijuana’s Health Risks first appeared on The Incidental Economist.

How to Talk About Misinformation

In the first part of this three-episode series we touched on the fact that misinformation has been around for a long time, and that it may seem like a recent problem because the internet has forever changed the way we share information. Since the internet and social media are probably here to stay, the best thing we can do about information, and therefore misinformation, is to understand how we receive it, and how best to deliver it.

 



The post How to Talk About Misinformation first appeared on The Incidental Economist.