Aaron E. Carroll's Blog, page 39

Recent publications from Boston University’s Department of Health Law, Policy and Management: June 2021 Edition

Below are recent publications from me and my colleagues from Boston University’s Department of Health Law, Policy and Management. You can find all posts in this series here.

June 2021 Edition

Annas GJ, Beisel CL, Clement K, Crisanti A, Francis S, Galardini M, Galizi R, Grünewald J, Immobile G, Khalil AS, Müller R, Pattanayak V, Petri K, Paul L, Pinello L, Simoni A, Taxiarchi C, Joung JK. A Code of Ethics for Gene Drive Research. CRISPR J. 2021 Feb; 4(1):19-24. PMID: 33571044.

Annas GJ, Galea S. Addressing public health’s failings during year one of Covid-19. EClinicalMedicine. 2021 Feb; 32:100714. PMID: 33521607.

Bamer AM, McMullen K, Wolf SE, Stewart BT, Kazis L, Rencken CA, Amtmann D. Agreement between proxy- and self-report scores on PROMIS health-related quality of life domains in pediatric burn survivors: a National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System Study. Qual Life Res. 2021 Feb 27. PMID: 33638744.

Bosch NA, Fantasia KL, Modzelewski KL, Alexanian SM, Walkey AJ. Guideline-Concordant Insulin Infusion Initiation Among Critically Ill Patients With Sepsis. Endocr Pract. 2021 Feb 05. PMID: 33549815.

Chen S, Shafer PR, Dusetzina SB, Horný M. Annual Out-Of-Pocket Spending Clusters Within Short Time Intervals: Implications For Health Care Affordability. Health Aff (Millwood). 2021 Feb; 40(2):274-280. PMID: 33523742.

Davoust M, Grim V, Hunter A, Jones DK, Rosenbloom D, Stein MD, Drainoni ML. Examining the implementation of police-assisted referral programs for substance use disorder services in Massachusetts. Int J Drug Policy. 2021 Feb 02; 103142. PMID: 33546937.

Fenton ATHR, Orefice C, Eun TJ, Biancarelli D, Hanchate A, Drainoni ML, Perkins RB. Effect of provider recommendation style on the length of adolescent vaccine discussions. Vaccine. 2021 Feb 5;39(6):1018-1023. PMID: 33446387.

Fix GM, Dryden EM, Boudreau J, Kressin NR, Gifford AL, Bokhour BG. The temporal nature of social context: Insights from the daily lives of patients with HIV. PLoS One. 2021; 16(2):e0246534. PMID: 33571283.

Formica SW, Waye KM, Benintendi AO, Yan S, Bagley SM, Beletsky L, Carroll JJ, Xuan Z, Rosenbloom D, Apsler R, Green TC, Hunter A, Walley AY. Characteristics of post-overdose public health-public safety outreach in Massachusetts. Drug Alcohol Depend. 2021 Feb 01; 219:108499. PMID: 33421800.

Grant GG, Brady KJS, Stoddard FJ, Meyer WJ, Romanowski KS, Chang PH, Painting LE, Fowler LA, Nelson JK, Patel KF, Sheldrick RC, Carter A, Sheridan RL, Slavin MD, Warner P, Palmieri TL, Schneider JC, Kazis LE, Ryan CM. Measuring the impact of burn injury on the parent-reported health outcomes of children 1-to-5 years: Item pool development for the Preschool1-5 Life Impact Burn Recovery Evaluation (LIBRE) Profile. Burns. 2021 Feb 25. PMID: 33832799.

Lederer AM, Hoban MT, Lipson SK, Zhou S, Eisenberg D. More Than Inconvenienced: The Unique Needs of U.S. College Students During the COVID-19 Pandemic. Health Educ Behav. 2021 02; 48(1):14-19. PMID: 33131325.

Linas BP, Savinkina A, Madushani RWMA, Wang J, Eftekhari Yazdi G, Chatterjee A, Walley AY, Morgan JR, Epstein RL, Assoumou SA, Murphy SM, Schackman BR, Chrysanthopoulou SA, White LF, Barocas JA. Projected Estimates of Opioid Mortality After Community-Level Interventions. JAMA Netw Open. 2021 Feb 01; 4(2):e2037259. PMID: 33587136.

Marino M, Ni P, Kazis L, Brandt D, Jette A. Demographic and functional differences among social security disability claimants. Qual Life Res. 2021 Feb 21. PMID: 33611754.

Moitra E, Anderson BJ, Herman DS, Stein MD. Longitudinal examination of coping-motivated marijuana use and problematic outcomes among emerging adults. Addict Behav. 2021 Feb; 113:106691. PMID: 33069107.

Nijhawan AE, Mathews WC, Raifman J, Fleming J, Gebo KA, Moore RD, Berry SA. Hospitalization rates among persons with HIV who gained Medicaid or private insurance after the Affordable Care Act in 2014. J Acquir Immune Defic Syndr. 2021 Feb 11. Online ahead of print. PMID: 33587511.

O’Hanlon CE, Lindvall C, Giannitrapani KF, Garrido M, Ritchie C, Asch S, Gamboa RC, Canning M, Lorenz KA, Walling AM. Expert Stakeholder Prioritization of Process Quality Measures to Achieve Patient- and Family-Centered Palliative and End-of-Life Cancer Care. J Palliat Med. 2021 Feb 19. PMID: 33605800.

O’Neil ME, Klyce DW, Pogoda TK, Cifu DX, Eggleston BE, Cameron DC, Wilde EA, Walker WC, Carlson KF. Associations Among PTSD and Postconcussive Symptoms in the Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium Prospective, Longitudinal Study Cohort. J Head Trauma Rehabil. 2021 Feb 22. PMID: 33656490.

Ryan CM, Stoddard FJ, Kazis LE, Schneider JC. COVID-19 pandemic and the burn survivor community: A call for action. Burns. 2021 Feb; 47(1):250-251. PMID: 33280957.

Siracuse JJ, Woodson J, Ellis RP, Farber A, Roddy SP, Kalesan B, Levin SR, Osborne NH, Srinivasan J. Intermittent Claudication Treatment Patterns in the Commercially Insured Non-Medicare Population. J Vasc Surg. 2021 Feb 03. PMID: 33548437.

Walkey AJ, Bashar SK, Hossain MB, Ding E, Albuquerque D, Winter M, Chon KH, McManus DD. Development and Validation of an Automated Algorithm to Detect Atrial Fibrillation Within Stored Intensive Care Unit Continuous Electrocardiographic Data: Observational Study. JMIR Cardio. 2021 Feb 15; 5(1):e18840. PMID: 33587041.

The post Recent publications from Boston University’s Department of Health Law, Policy and Management: June 2021 Edition first appeared on The Incidental Economist.

Patterns from a Year of Covid Data

Now that we’ve been dealing with Covid-19 for over a year, we have a lot of information to help us understand the kinds of patterns that have emerged. While no one has been left untouched, some communities and groups bore a larger brunt of the impact.

 

@DrTiff_PhD

The post Patterns from a Year of Covid Data first appeared on The Incidental Economist.

Recent publications from Boston University’s Department of Health Law, Policy and Management: May 2021 Edition

Below are recent publications from me and my colleagues from Boston University’s Department of Health Law, Policy and Management. You can find all posts in this series here.

May 2021 Edition

Allen H, Gordon SH, Lee D, Bhanja A, Sommers BD. Comparison of Utilization, Costs, and Quality of Medicaid vs Subsidized Private Health Insurance for Low-Income Adults. JAMA Netw Open. 2021 Jan 04; 4(1):e2032669. PMID: 33399859.

Blok AC, Amante DJ, Hogan TP, Sadasivam RS, Shimada SL, Woods S, Nazi KM, Houston TK. Impact of Patient Access to Online VA Notes on Healthcare Utilization and Clinician Documentation: a Retrospective Cohort Study. J Gen Intern Med. 2021 Jan 14. PMID: 33443693.

Cole MB, Shafer PR, Gordon SH. What the New Biden Administration May Mean for Medicaid. JAMA Health Forum. 2021;2(1):e201497. doi:10.1001/jamahealthforum.2020.1497.

Dor A, Encinosa W, Carey K. Hospital Performance Standards and Medical Pricing: The Impact of Information Disclosure in Cardiac Care. Journal of Economics and Management Strategy. 2020; 29(3):492-515.

Feyman Y, Bor J, Raifman J, Griffith KN. Effectiveness of COVID-19 shelter-in-place orders varied by state. PLoS One. 2020; 15(12):e0245008. PMID: 33382849.

Gershon AS, Lindenauer PK, Wilson KC, Rose L, Walkey AJ, Sadatsafavi M, Anstrom KJ, Au DH, Bender BG, Brookhart MA, Dweik RA, Han MK, Joo MJ, Lavergne V, Mehta AB, Miravitlles M, Mularski RA, Roche N, Oren E, Riekert KA, Schoenberg NC, Stukel TA, Weiss CH, Wunsch H, Africk JJ, Krishnan JA. Informing Healthcare Decisions with Observational Research Assessing Causal Effect. An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med. 2021 01 01; 203(1):14-23. PMID: 33385220.

Gordon SH, Huberfeld NL, Jones DK. What Federalism Means for the US COVID-19 Response. JAMA Health Forum  2020;1(5):e200510. doi:10.1001/jamahealthforum.2020.0510.

Gluck AR, Huberfeld N. “Federalism under the ACA: Implementation, Opposition, Entrenchment.” Eds. Ezekiel J. Emanuel and Abbe R. Gluck. The Trillion Dollar Revolution: How the Affordable Care Act Transformed Politics, Law, and Health Care in America. 2020; pp. 176-191.

Henehan ER, Jernigan DH, Ross CS. Trends in Youth Exposure to Alcohol Advertising on Cable Television, United States, 2013-2018. J Stud Alcohol Drugs. 2021 Jan; 82(1):55-59. PMID: 33573722.

Huberfeld N. Is Medicare for All the Answer? Assessing the Health Reform Gestalt as the ACA Turns 10 (February 3, 2020). Houston Journal of Health Law and Policy, 2020.

Huberfeld, N, Stein M. A straightforward solution to the newly uninsured. The Hill. 2020 Jun 8.

Huberfeld N., Watson S. Medicaid’s Vital Role in Addressing Health and Economic Emergencies. Burris, S., de Guia, S., Gable, L., Levin, D.E., Parmet, WE, Terry, NP (Eds.) Assessing Legal Responses to COVID-19. Boston: Public Health Law Watch. 2020 Jul 31.

Huberfeld N, Shafer P. While the US is reeling from COVID-19, the Trump administration is trying to take away health care. The Conversation. 2020 Aug 25.

Jones DK, Pagel C. Bipartisan Approaches to Tackling Health Care Costs at the State Level. Report of the Milbank Memorial Fund. 2020.

Jones, DK. What is Next in the Health Care Reform Debate After New Hampshire? JAMA Health Forum. 2020;1(2):e200196. doi:10.1001/jamahealthforum.2020.0196.

Kingsdale J. Medicare Advantage for Most. Milbank Q. 2021 Jan 19. PMID: 33463775.

Kressin NR, Battaglia TA, Wormwood JB, Slanetz PJ, Gunn CM. Dense Breast Notification Laws’ Association With Outcomes in the US Population: A Cross-Sectional Study. J Am Coll Radiol. 2020 Dec 24. Online ahead of print. PMID: 3335872.

Loo S, Brochier A, Wexler MG, Long K, Kavanagh PL, Garg A, Drainoni ML. Addressing unmet basic needs for children with sickle cell disease in the United States: clinic and staff perspectives. BMC Health Serv Res. 2021 Jan 12; 21(1):55. PMID: 33435984.

Maschke A, Paasche-Orlow MK, Kressin NR, Schonberg MA, Battaglia TA, Gunn CM. Discussions of Potential Mammography Benefits and Harms among Patients with Limited Health Literacy and Providers: “Oh, There are Harms?” J Health Commun. 2020 Dec 1;25(12):951-961. PMID: 33455518.

Mayo-Smith M, Radwin LE, Abdulkerim H, Mohr DC. Factors Associated With Patient Ratings of Timeliness of Primary Care Appointments. J Patient Exp. 2020 Dec; 7(6):1203-1210. PMID: 33457566.

Raifman J, Bor J, Venkataramani A. Association Between Receipt of Unemployment Insurance and Food Insecurity Among People Who Lost Employment During the COVID-19 Pandemic in the United States. JAMA Netw Open. 2021 01 04; 4(1):e2035884. PMID: 33512519.

Shafer PR, Huberfeld N. Health Care in the Biden Administration’s First 100 Days. JAMA Health Forum. 2020;1(12):e201500. doi:10.1001/jamahealthforum.2020.1500.

Shafer PR, Huberfeld N, Golberstein E. Medicaid Retroactive Eligibility Waivers Will Leave Thousands Responsible For Coronavirus Treatment Costs. Health Affairs Blog. 2020 May 8. DOI: 10.1377/hblog20200506.111318.

Trangenstein PJ, Sadler R, Morrison CN, Jernigan DH. Looking Back and Moving Forward: The Evolution and Potential Opportunities for the Future of Alcohol Outlet Density Measurement. Addict Res Theory. 2021;29(2):117-128. PMID: 33883975.

Tyner CE, Kisala PA, Heinemann AW, Fyffe D, Tate DG, Slavin MD, Jette AM, Tulsky DS. Validation of the Spinal Cord Injury Functional Index for Use in Community-Dwelling Individuals With SCI. Arch Phys Med Rehabil. 2021 Jan 13. PMID: 33453193.

Ulrich MR. A Public Health Law Path for Second Amendment Jurisprudence. Hastings Law Journal. 2020; 71(4):1053-1100.

Ulrich MR. Pedagogy and Policy: A Tribute to Karen Rothenberg’s Contributions to Health Law. Journal of Health Care Law & Policy. 2020; 22(2):205-07.

Vimalananda VG, Meterko M, Qian S, Wormwood JB, Solch Msw A, Fincke BG. Development and psychometric assessment of a survey to measure specialty care coordination as experienced by primary care providers. Health Serv Res. 2020 Oct; 55(5):660-670. PMID: 33460075.

Winer M, Dunlap S, St Pierre C, McInnes DK, Schutt R. Housing and Social Connection: Older Formerly Homeless Veterans Living in Subsidized Housing and Receiving Supportive Services. Clin Gerontol. 2021 Jan 27; 1-10. Online ahead of print. PMID: 33501886.

Yee J, Marchany K, Greenan MA, Walker WC, Pogoda TK. Potential Concussive Event Narratives of Post-9/11 Combat Veterans: Chronic Effects of Neurotrauma Consortium Study. Mil Med. 2021 01 25; 186(Suppl 1):559-566. PMID: 33499440.

Zhao MJY, Prentice JC, Mohr DC, Conlin PR. Association between hemoglobin A1c variability and hypoglycemia-related hospitalizations in veterans with diabetes mellitus. BMJ Open Diabetes Res Care. 2021 Jan; 9(1). PMID: 33431600.

The post Recent publications from Boston University’s Department of Health Law, Policy and Management: May 2021 Edition first appeared on The Incidental Economist.

Cancer Journal: Hard Conversations and Deep Attention

This post is about conversations between friends where one partner has received an end-stage diagnosis. These conversations are hard for both parties.

If you are talking to a friend who is likely to die soon

You may worry that what you say will be inadequate to their situation. Moreover, people in distress sometimes react when you say something that doesn’t work for them. Here are some common examples of comments that are likely to be unhelpful, collected mostly from essays and podcasts. Only a few have been said to me.

“If there is anything I can do for you, just ask.” [A fine thing to say, except when it is obvious to both of us that there is nothing you can do.]“I know what you are going through… and here is what I did.” [You have no idea what I am going through.]“God has a plan for you.” [Well, yes. But have you, like, read the Bible? God’s plan is often a bitter path.]“You are a fighter, and you can beat this disease” [Yeah, I’ve tried, and this is the result, so you’re saying I’m a loser?]

What these examples have in common is that the visiting friend is trying to solve the afflicted friend’s problems. If there is some material task that you can do for the afflicted, do it. But nothing you can say will solve their real problems. And none of us can explain why suffering pervades the world. Your job was just to call or show up, and you have done that. Showing up said more than your words ever could, which is that you value your friend and, literally, that you are there for them.

Instead, focus on listening more than talking. But how do you listen?

The shallow answer is, “the way to be a good listener is to actually listen.” This mirrors the famous quote from Dr. Francis Peabody, “the secret of the care of the patient is in caring for the patient (JAMA 1927; 88:877-882).” I don’t care for these clever responses because they trivialize the tasks. Being a good caregiver or listener is a challenge. Listening to an afflicted person is difficult because it requires you to shift your attention from yourself to your friend.

This shift is hard because you will be profoundly distressed and frightened by what is happening to your friend. Simone Weil wrote, “The sight of an afflicted man frightens away every kind of attention.”*

Simone Weil.

Of course, you want to soothe the distress of your afflicted friend. But focusing on your friend just makes you feel worse, and you begin reacting to your feelings, not theirs. Good listening requires you to be strong and be there for them, not for you.

Luckily, control of attention isn’t just a matter of will. There are specific behaviours you can practice (for example, maintaining eye contact). There’s a lot written on this; I strongly recommend Kate Murphy’s You’re Not Listening.

If you are the person facing an end-stage diagnosis

Few of you are this person right now, but many of you will be someday. These conversations will be difficult for you too, for obvious reasons. You will be sick, in pain, and frightened by death. People will say clumsy, annoying things, and you may not have the resources to respond gracefully.

If people make mistakes in talking to you, be gentle. They did the important thing: they showed up. My view: Nothing that a friend can say to me is wrong.

Just as I urged the visiting friend to attend to and listen to the afflicted person, I suggest that the afflicted person do likewise. Your visiting friend is suffering. Those who love you will suffer your loss long after you have escaped your pain. Listen to them with as much attention as you can muster. If possible, with the deep attention that accepts the reality of what is happening to them and you.

Attending to your friend in this time communicates how much they have meant to you. Deep attention is generous. End-stage cancer is disabling; thanks be to God, I’m not there yet. However, when the time comes that I can’t act, I can still serve by just being there for others.

The point is that you do not need to do things or serve others to give your life meaning. This is because you don’t need to give your life meaning. Your life has meaning, whether you serve or not. The reason to serve others with your kindness and attention is to manifest your gratitude for the love that brought them to be with you.

That said, it is hard to shift your attention to the other person when you are in pain or fearful. The function of pain and fear is to focus your attention on a threat, and your disease is a profound threat. Find a qualified physician to help you with the pain.

Here is something that can help with the fear of dying. In an important sense, that future person who will die isn’t you; he or she is someone else. You are here now, and you are alive, just like everyone else.

How do you focus on the now? You can get there via Jesus (Matthew 6:24, KJV: “Take therefore no thought for the morrow: for the morrow shall take thought for the things of itself.”). Or you can get there by any number of Buddhist paths; my favourite being Zen Master Dogen in the Genjokoan:

To study the Buddha Way is to study the self. To study the self is to forget the self. To forget the self is to be enlightened by the 10,000 things.

Or, if you need a secular path to realize the discontinuity of your present and future selves, and you have a lot of time and energy, try Derek Parfit’s Reasons and Persons. (But don’t say I didn’t warn you.)

And enjoy this moment.

*Weil (1909-1943) was a French philosopher. This post was inspired by Robert Zaretsky’s exceptional new book, The Subversive Simone Weil: A Life in Five Ideas.

@Bill_Gardner

To read the Cancer Posts from the start, please begin here.

The post Cancer Journal: Hard Conversations and Deep Attention first appeared on The Incidental Economist.

New CDC Mask Guidance for Vaccinated People

Lots of people are vaccinated against Covid-19 now and wondering what that means for their daily lives. While many activities are back on the table and things are much better than they were, some precautions are still warranted as we try to decrease cases and increase vaccination numbers. We talk about all that as well as a time, which will come, when we’ll need to start letting our guards down a little to get back to “normal”.

 

@DrTiff_PhD

The post New CDC Mask Guidance for Vaccinated People first appeared on The Incidental Economist.

The Proposed FDA Ban on Menthol Cigarettes

Though likely to face many legal challenges, the FDA recently issued a ban on menthol flavoring in traditional cigarettes and cigars. So why the specific ban on menthol? There are lots of reasons ranging from how it may alter the smoking experience to how it affects certain groups.

 

@DrTiff_PhD

The post The Proposed FDA Ban on Menthol Cigarettes first appeared on The Incidental Economist.

Overdiagnosis and overtreatment – the experts aren’t immune either

Elsa Pearson, MPH, is a senior policy analyst at Boston University School of Public Health. She tweets at @epearsonbusph.

The US health system pushes treatment over prevention. This approach has many flaws, one of the most unfortunate and costly being overdiagnosis and overtreatment.

Overdiagnosis is defined as the “detection of psuedodisease,” or disease that will never cause the patient any issues. Overtreatment is treatment that provides no benefit and may even harm the patient. One survey found that physicians consider more than 20 percent of all care unnecessary, including one in every four tests.

This phenomenon is driven by several factors, including health system consolidation and provider and patient perception. Kendra Allan, a physician assistant, emphasizes the pressure she feels to “do something” when patients come to her with new concerns. As a result, providers fall into the habit of overprescribing and patients come to expect it.

Education is one of the biggest weapons we have against unnecessary care. Providers need to know when to forgo tests and treatments and patients need to know when to say no.

But it’s not that easy in reality. Even the experts fall victim. Here are a few stories. I’ll go first.

Elsa, senior health policy analyst

I have celiac disease, an autoimmune disease, which will make me prone to osteoporosis when I’m older. In my early twenties, my primary care provider ordered a bone density scan to look for osteopenia, the precursor to osteoporosis. With no prior indication of poor bone health, I asked her why. She said we needed a baseline scan before I entered menopause. I declined the scan until the results would have an impact on my treatment plan. We agreed to talk again in twenty years.

Alex, health science specialist

I began to experience double vision. I went to my primary care provider, the emergency department, an optometrist, two ophthalmologists, and two neuro-ophthalmologists. I underwent two MRIs, a CT scan, three eye exams/dilations, rounds of blood work, and finally surgery. The double vision still isn’t resolved. What’s worse, an incidental finding of a benign pituitary tumor turned into more visits with primary care, neurology, and endocrinology, with all the associated testing. I am now triaging which of my appointments are actually important and which I can ignore.

Austin, health economist

About eight years ago, I had a kidney stone, diagnosed with a CT scan. After the CT scan, my urologist suggested I needed an x-ray, too. “Doesn’t a CT scan provide more information than an x-ray?” I asked. He said yes. I asked if my treatment would change at all based on an x-ray’s findings. He said no. I then asked what the x-ray was really for and he couldn’t answer. I declined the extra imaging study and switched doctors.

Aaron, physician and researcher

When I was in medical school, I experienced a bout of extreme abdominal pain and was admitted to the hospital. My care team ordered a swath of tests, most of them unrelated to my original complaint, including multiple CT scans, an echocardiogram, and blood and urine tests, which even led to a cystoscopy. I had a significant reaction to the dye used for one of the CT scans, and I was prescribed antibiotics even though there was no indication I needed them. Ultimately, I left the hospital with diagnoses for heart- and kidney-related issues that had never impacted my health before and likely never will, and for which treatment is unnecessary. I was never told what caused my stomach pain.

While disappointing, it’s oddly comforting that even experts are victims of overdiagnosis and overtreatment. But there are ways you can advocate for yourself next time you’re at the doctor’s office.

Ask questions. Many tests and treatments are complicated. If something is confusing or feels different from your typical treatment plan, ask your provider about it, encourages Kendra Allan, the physician assistant. He or she should be able to explain to you the treatment recommendations and why, as well as any alternatives.

Think it over. Some tests or treatments don’t have to happen right away. If it’s not an emergency, go home and talk it over with someone. Out of the commotion of the clinic, you can weigh the pros and cons and make a measured decision on how to proceed.

Ask for a second opinion. No one provider knows it all. Aaron Carroll, who shared his story above, says you should feel comfortable asking your provider for time to seek a second opinion. This will give you a better idea of what may actually be wrong and what an appropriate treatment plan would look like.

Say no. Some tests and treatments simply aren’t necessary. If something seems excessive or if a suitable alternative exists, feel confident to speak up. Guidelines and recommendations are just that; they may not apply to your situation and there may be a clinically appropriate reason to forgo, modify, or delay care. Allan reasons that if the test won’t change your treatment plan, it shouldn’t happen. Carroll argues providers should be minimalists. “Watchful waiting” is often the most appropriate approach. You should suggest this if your provider can’t justify the proposed work-up.

In American health care, we’ve gotten accustomed to the idea that more is more. But this doesn’t translate to better health outcomes for patients. Reducing overdiagnosis and overtreatment will require a multipronged approach, from provider and patient education to insurance reform. For starters, let’s do what we can as patients and advocate for ourselves.

Research for this piece was supported by the Laura and John Arnold Foundation.

The post Overdiagnosis and overtreatment – the experts aren’t immune either first appeared on The Incidental Economist.

Exploring the Relationship Between Neighborhood Income and Social Distancing during the COVID-19 Pandemic

Izabela Sadej, MSW, is a policy analyst at Boston University School of Public Health. She tweets at @IzzySadej. 

The COVID-19 pandemic has resulted in most communities taking precautionary, sometimes mandatory, measures to reduce the risk of spreading and contracting the virus. Physical distancing, also known as social distancing, has been one of the primary strategies adopted by various states and localities as a prevention tool. This typically includes the closure of schools and businesses and “stay-at-home” orders.  

Since the onset of the pandemic in March 2020, existing systemic health disparities and social inequities have been magnified. Evidence indicates that residents of low-income neighborhoods were less likely to stay–at–home in response to COVID-19 compared to higher-income communities. These communities carry an unequal disease burden with higher confirmed caseloads and mortality rates, alongside financial constraints that impact low-income workers the most, given less of an ability to work-from-home. Many essential businesses are staffed by predominantly low-wage workers forced to choose between risking their income and exposure to COVID-19. This increased inequity, which remains unaddressed by public policy, has led to further research. 

New Research 

A recent study published in Nature Human Behaviour expanded the current evidence base by investigating the relationship between neighborhood income and physical distancing patterns during the COVID-19 pandemic in the United States. The authors hypothesized that: 1) the gap in physical distancing practices would be explained by work demands and not by visits to non-work locations, and; 2) state policies that ordered the closure of non-essential businesses and “stay-at-home” orders would contribute to the gap in physical distancing practices between low- and high-income communities.  

(Academic affiliations of the authors for this study include Boston University School of Public Health Departments of Community Health Sciences; Global Health; Health Law, Policy and Management; and Epidemiology.) 

Methods 

Using longitudinal mobility data derived from smartphones and previous Census data on neighborhood income, the physical distancing practices of low-income neighborhoods were compared to higher-income neighborhoods. This was done by identifying mobility patterns for work-related activities and visits to non-work locations (liquor stores, carryout restaurants, convenience stores, hospitals, parks, places of worship, supermarkets) and comparing patterns two months before and after March 2020. 

A series of analyses were conducted to distinguish the use of smartphone mobility data. This information was collected through SafeGraph, with an average sample size of 19 million smartphone devices used per day throughout the nation, aggregated by U.S. Census Block Groups (BGs). The three main mobility patterns were measured as follows:  

“Staying at home” was determined by a smartphone user’s overnight location for most nights during the previous six weeks, with the device being observed within the home location and nowhere else on a given night.  “Working outside of the home” was observed through similar location tracking metrics as above and observing behavior consistent with full-time, part-time, or delivery work.  “Visits to non-work activities” were observed through counting the number of visits to non-work locations listed above within BG income levels.  

State-level social distancing policies were identified through a public database that tracked media coverage and verified government websites. To assess the impact of these policies on mobility, a differences-in-differences model was used to estimate how much physical distancing changed in each state after the implementation of a stay-at-home (SAH) order, calculated separately for each income quintile. This model allowed researchers to take advantage of the fact that states timed their SAH orders differently, if they implemented them at all. 

Findings  

Lower-income communities were found to increase physical distancing less than higher-income communities. There was no significant evidence that non-work activities contributed to these differences. Instead, differences were caused by lower-income community residents continuing to work outside of the home.  

Physical distancing orders were associated with increased physical distancing activity, though the magnitude of policy effect was modest at every income level compared to overall trends. Residents of all-income levels began physical distancing before the implementation of state orders, with pre-trends steepest at high-income levels. State policies did little to level the disparities in social distancing among income levels.  

The primary limitation of this study is the inability to generalize the findings. Smart phone ownership and usage varies across sociodemographic groups, with the possibility that teens from higher income neighborhoods may have been over-represented in the sample. Additionally, SafeGraph data could have systematically miscounted the number of smartphone users staying at home or going to work due to irregular data collection intervals. Lastly, local jurisdictions and mandates were not considered when measuring the impact of state policies. 

Conclusions  

The results of this study and the impacts of COVID-19 emphasize the importance of incorporating social and economic factors into public health responses. Differences in physical distancing patterns based on income level were noticeable yet state policies did not close this gap. It is crucial for policymakers to consider how existing health disparities within certain communities may be exacerbated by new policies. Many unintended consequences can be anticipated and, thus, mitigated.  

Simultaneously employing other policies alongside physical distancing mandates, such as eviction moratoriums, mandating paid sick leave, and extended unemployment insurance would allow lower-income communities to better protect themselves. A more equitable COVID-19 response would include widespread adoption of these measures, just like the adoption of non-essential business closures and stay-at-home orders.  

The post Exploring the Relationship Between Neighborhood Income and Social Distancing during the COVID-19 Pandemic first appeared on The Incidental Economist.

Substance Use Disorder Treatment Centers: Uncovering Fraud and Advancing Policies to Promote Best Practices

Register and mark your calendar for a webinar on fraud in substance use disorder treatment. (See details below.) The event is part of an Arnold Ventures-funded project that is a collaboration between Boston University School of Public Health and Faegre Drinker. Melissa Garrido is the project’s principle investigator and I am a co-investigator.

Substance Use Disorder Treatment Centers:
Uncovering Fraud and Advancing Policies to Promote Best Practices
Wednesday, June 9, 2021 | 1:00-4:30 p.m. EDT
Registration Link

Agenda
1:00-1:10 WELCOME AND LOGISTICS

1:10-1:30 OVERVIEW: WASTEFUL AND FRAUDULENT SUD TREATMENT

1:30-1:50 THE HUMAN COST SUD OF TREATMENT FRAUD: A REAL STORY

1:50-2:20 PANEL: CURRENT ENFORCEMENT EFFORTS

2:20-2:30 BREAK

2:30-3:30 USING ALGORITHMS TO DETECT WASTE AND FRAUD IN SUD TREATMENT

2:30-3:00 Presentation

3:00-3:30 Reactions and Perspectives

3:30-3:40 BREAK

3:40-4:10 PANEL: EFFORTS TO WEED OUT FRAUDULENT SUD TREATMENT PROVIDERS

4:10-4:30 COMPLEMENTARY PROJECTS AND CLOSING REMARKS

@afrakt

The post Substance Use Disorder Treatment Centers: Uncovering Fraud and Advancing Policies to Promote Best Practices first appeared on The Incidental Economist.

Paid sick leave: just as important as paid family and medical leave

Cecille Joan Avila is a policy analyst at Boston University School of Public Health. She tweets at @cecilleavila.

Almost all countries have paid sick leave except for the United States. While often combined with family and medical leave, the two are distinct. Sick leave is for short-term absences (e.g., illness) whereas family and medical leave is for long-term serious and chronic illnesses, or to take care of a family member or new child.

President Biden’s American Families Plan prioritizes paid family and medical leave. While his address did not explicitly include paid sick leave, his statement does call on Congress to pass the Healthy Families Act, which focuses on it. Both are needed to make the other succeed, and to also address longstanding inequities. Without a federal policy, it’s up to states or individual employers to decide to offer paid sick leave and how much; a move that could make income-based disparities (among others) even worse.

Both paid family and medical leave and paid sick leave are necessary to truly build back better. Without access to both benefits, sick individuals might not even be able to take advantage of long-term paid family and medical leave. While evidence does show that paid family and medical leave benefits maternal health, just prioritizing paid family and medical leave can fuel the narrative that women’s health is valuable only if they are mothers and/or caregivers and not simply as women.

Who has paid sick leave, who doesn’t?

While more individuals gained paid sick leave over the last decade either through local, state, or employer policies, an estimated 32.5 million still do not have access. Who has paid sick leave varies greatly, and depends on factors such as full-time versus part-time, whether an employer is private or public, as well as significant variation among occupations, income levels, and even geography. A 2016 report from the Center for American Progress shows that availability of flexible paid sick days was lowest among Black workers, and access to any paid sick days at all was lowest among Hispanic workers, when compared to their white counterparts.

Considering how race and ethnicity also relates to occupation and income (i.e., wage gaps), paid sick leave would be especially beneficial for those who cannot afford to take even a single unpaid day to deal with health care needs. A national policy should also recognize that not everyone has the luxury of accumulating 30 hours a week at a single job, the current minimum many states set to accrue an hour of paid sick leave. However, more individuals report working multiple jobs to survive financially.

Individual benefits, communal benefits

Numerous studies show relationships between paid sick leave (or the lack of it) and use of preventative services or screenings, which can help reduce rates of heart disease and diabetes and other chronic conditions.

For example, in Connecticut, the first state to implement paid sick leave, rates of Pap smears increased after the law went into effect. In a study conducted among labor workers, a typically lower-income population with lower rates of paid sick leave, paid sick leave was again associated with higher odds of utilizing preventive care services, including going to the dentist.

Conversely, studies show that no paid sick leave can be detrimental. One study showed workers without paid sick leave were less likely to receive preventative health care screenings in the previous 12 months, even knowing they might be at higher risk for high cholesterol, high blood pressure, or high blood sugar. Another found that those without paid sick leave were more likely to skip prescription refills or be unable to afford eyeglasses. Both studies control for household level of income.

Much of the research around paid sick leave focuses on how much it can help more than just the individual, assuming that individuals are well enough to even care for others. A study published in Health Affairs found that those without paid sick leave were more likely to delay medical care, both for themselves and their family members. Yet another study shows that if at least one parent had access to paid sick leave, it increased the likelihood of their children having seen a primary care physician in the last year or receiving a flu vaccination.

Previous pandemics and other countries have shown that granting individuals time to focus on their own health also helps the entire population. It’s time for the United States to catch up.

Complementary policies for long-term good

While the Affordable Care Act helped individuals with health insurance gain access to preventive services with minimal out-of-pocket costs, it didn’t ensure everyone could access those services. Economic stability is a known social determinant of health and paid sick leave could allow more people to take the time needed to access preventative services without foregoing wages. In turn, this could reduce the rates of people using emergency services for issues that could have been avoided if caught earlier through primary care visits, which could help reduce health care costs.

Federally authorized paid sick leave could also help reduce some of the class-based structural inequities that affect an individual’s health. Regardless of how much money a person makes or what jobs they occupy, it would allow for all individuals to feel empowered and able to take care of themselves in the short-term. It could also help them be healthy enough to be around for those who might depend on them in the future.

Research for this piece was supported by the Laura and John Arnold Foundation.

The post Paid sick leave: just as important as paid family and medical leave first appeared on The Incidental Economist.