[Research article] High value health IT: Policy reforms for better care and lower costs

From the 16 March 2015 Brookings news release

Achieving better health outcomes at a lower cost and succeeding with payment reforms that shift from volume to value is difficult without health information technology (IT). Health IT can engage and support health care providers, patients, and consumers with access to timely and accurate clinical information from electronic health records (EHRs) and other sources. It can also provide access to cost and coverage information that avoids burdensome administrative processes and unexpected costs. Health IT can achieve these benefits through interoperability across information and data exchange platforms – avoiding duplicative parallel systems and additional data entry. Engaged patients and providers, supported by flexible, usable and useful health IT, can make informed shared decisions about testing and treatment which can lead to more timely, efficient, and higher-value health care.

 

Download the issue brief.

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[News release] As diagnosis codes change, data lost in translation – both ways

From the 16 March 2015 UIC news release

Changes in how medical diagnoses are coded under the latest international disease classification system – known as the ICD-10 codes – may complicate financial analysis, research projects and training programs that depend on look-back comparisons of health care data, report researchers at the University of Illinois at Chicago.

The report, a collaboration of researchers at UIC and at the University of Arizona, is online in the Journal of the American Medical Informatics Association (JAMIA).

Codes for diagnoses – used to justify payments, among other things – may not translate from ICD-10 back to ICD-9 in a simple way, says Andrew Boyd, assistant professor of biomedical and health information sciences at UIC and first author of the paper.

Boyd and his colleagues have been looking at issues that could come up as physicians and hospitals change from one system to the other. Previously they found that some ICD-9 codes map well to ICD-10, but many more have highly convoluted mappings, and some don’t map at all. This forward-mapping is needed for continuing payments of ongoing medical conditions.

“Now, we are taking the same methodology and looking backward,” Boyd said. Reverse-mapping from ICD-10 back to ICD-9 will be important for all sorts of retrospective analyses, he said, “because we have 30 years of data that we want. We don’t want to lose all this information.”

Clinical researchers and analysts conducting studies across datasets – and hospital administrators who manage growth and watch trends for strategic planning – will need to pull data under both the new and the old codes. Mapping back from ICD-10- to ICD-9 is just as complex as mapping from ICD-9 to ICD-10.

The researchers created a web portal tool and translation tables designed to provide guidance on ambiguous and complex translations and to reveal where analyses may be challenging or impossible. The tool lists all ICD-9-CM diagnosis codes related to the input of ICD-10-CM codes and classifies their level of complexity, which can be a one-to-one “identity,” or reciprocal (the simplest); class-to-subclass; subclass-to-class; “convoluted”; or “no mapping.”

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[News release] Survey Finds Physicians Want to Learn More About Diet and Cardiovascular Disease Prevention

From the 13 March 2015 Newswise article

Most physicians are aware of the importance of lifestyle factors in preventing cardiovascular disease (CVD) — and believe diet is as important as statin therapy and exercise, according to a new survey from NYU Langone Medical Center.

Researchers found that a majority of doctors would welcome additional training in diet and nutrition so that they can effectively inform patients on the subject. The study will be presented at the American College of Cardiology’s 64th Annual Scientific Session as a poster presentation.

The 28-question online survey, created by a team from the NYU Langone Center for the Prevention of Cardiovascular Disease, was designed to identify gaps in nutritional knowledge and to evaluate physician attitudes and practices concerning diet in the prevention of CVD. The survey was completed by 236 cardiologists and internal medicine physicians and trainees.

Most of the survey respondents (78 percent) were open to additional training and thought it would result in better patient care. Just over half of the physicians said they currently spend three minutes or less educating patients on diet and lifestyle.

Overall the survey respondents did comparatively well, answering about two thirds of the knowledge-based questions correctly. Surprisingly, cardiologists scored no better than internal medicine physicians.

“We found physicians had a decent knowledge of general nutritional principles, but their practical knowledge was somewhat suboptimal,

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[Survey results] 2014 Leapfrog Hospital Survey Results Now Available

From the Leapfrog group

These results are based on surveys submitted by hospitals across the country that have demonstrated a commitment to transparency by participating in the voluntary Leapfrog Hospital Survey. The survey assesses hospitals on three key areas: how patients fare, resources used in caring for patients, and leadership and structures that promote patient safety. This website also includes information on hospitals’ Hospital Safety Scores.

 

[News release] Insuring undocumented residents could help solve multiple U.S. health care challenges

From the 18 March 2015 UCLA news release

UCLA health care policy analysis finds four key problem areas for Latinos under Affordable Care Act

Latinos are the largest ethnic minority group in the United States, and it’s expected that by 2050 they will comprise almost 30 percent of the U.S. population. Yet they are also the most underserved by health care and health insurance providers.

Latinos’ low rates of insurance coverage and poor access to health care strongly suggest a need for better outreach by health care providers and an improvement in insurance coverage. Although the implementation of the Affordable Care Act of 2010 seems to have helped (approximately 25 percent of those eligible for coverage under the ACA are Latino), public health experts expect that, even with the ACA, Latinos will continue to have problems accessing high-quality health care.

Alex Ortega, a professor of public health at the UCLA Fielding School of Public Health, and colleagues conducted an extensive review of published scientific research on Latino health care. Their analysis, published in the March issue of the Annual Review of Public Health, identifies four problem areas related to health care delivery to Latinos under ACA:

• The consequences of not covering undocumented residents.
• The growth of the Latino population in states that are not participating in the ACA’s Medicaid expansion program.
• The heavier demand on public and private health care systems serving newly insured Latinos.
• The need to increase the number of Latino physicians and non-physician health care providers to address language and cultural barriers.

“As the Latino population continues to grow, it should be a national health policy priority to improve their access to care and determine the best way to deliver high-quality care to this population at the local, state and national levels,” Ortega said. “Resolving these four key issues would be an important first step.”

Insurance for the undocumented

Whether and how to provide insurance for undocumented residents is, at best, a complicated decision, said Ortega, who is also the director of the UCLA Center for Population Health and Health Disparities.

For one thing, the ACA explicitly excludes the estimated 12 million undocumented people in the U.S. from benefiting from either the state insurance exchanges established by the ACA or the ACA’s expansion of Medicaid. That rule could create a number of problems for local health care and public health systems.

For example, federal law dictates that anyone can receive treatment at emergency rooms regardless of their citizenship status, so the ACA’s exclusion of undocumented immigrants has discouraged them from using primary care providers and instead driven them to visit emergency departments. This is more costly for users and taxpayers, and it results in higher premiums for those who are insured.

In addition, previous research has shown that undocumented people often delay seeking care for medical problems.

…

As the ACA is implemented and more people become insured for the first time, local community clinics will be critical for delivering primary care to those who remain uninsured.

“These services may become increasingly politically tenuous as undocumented populations account for higher proportions of clinic users over time,” he said. “So it remains unclear how these clinics will continue to provide care for them.”

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[News release] Scientists unknowingly tweak experiments

Scientists in a laboratory of the University of La Rioja. (Photo credit: Wikipedia)

From the 18 March 2015 Australian National University news release

A new study has found some scientists are unknowingly tweaking experiments and analysis methods to increase their chances of getting results that are easily published.

The study conducted by ANU scientists is the most comprehensive investigation into a type of publication bias called p-hacking.

P-hacking happens when researchers either consciously or unconsciously analyse their data multiple times or in multiple ways until they get a desired result. If p-hacking is common, the exaggerated results could lead to misleading conclusions, even when evidence comes from multiple studies.

“We found evidence that p-hacking is happening throughout the life sciences,” said lead author Dr Megan Head from the ANU Research School of Biology.

The study used text mining to extract p-values – a number that indicates how likely it is that a result occurs by chance – from more than 100,000 research papers published around the world, spanning many scientific disciplines, including medicine, biology and psychology.

“Many researchers are not aware that certain methods could make some results seem more important than they are. They are just genuinely excited about finding something new and interesting,” Dr Head said.

“I think that pressure to publish is one factor driving this bias. As scientists we are judged by how many publications we have and the quality of the scientific journals they go in.

“Journals, especially the top journals, are more likely to publish experiments with new, interesting results, creating incentive to produce results on demand.”

Dr Head said the study found a high number of p-values that were only just over the traditional threshold that most scientists call statistically significant.

“This suggests that some scientists adjust their experimental design, datasets or statistical methods until they get a result that crosses the significance threshold,” she said.

“They might look at their results before an experiment is finished, or explore their data with lots of different statistical methods, without realising that this can lead to bias.”

The concern with p-hacking is that it could get in the way of forming accurate scientific conclusions, even when scientists review the evidence by combining results from multiple studies.

For example, if some studies show a particular drug is effective in treating hypertension, but other studies find it is not effective, scientists would analyse all the data to reach an overall conclusion. But if enough results have been p-hacked, the drug would look more effective than it is.

“We looked at the likelihood of this bias occurring in our own specialty, evolutionary biology, and although p-hacking was happening it wasn’t common enough to drastically alter general conclusions that could be made from the research,” she said.

“But greater awareness of p-hacking and its dangers is important because the implications of p-hacking may be different depending on the question you are asking.”

The research is published in PLOS Biology.

From the 2 March 2015 Guttmacher Institute press release

Increasing Publicly Funded Family Planning Services Could Substantially Reduce These Costs

U.S. government expenditures on births, abortions and miscarriages resulting from unintended pregnancies nationwide totaled $21 billion in 2010, according to “Public Costs from Unintended Pregnancies and the Role of Public Insurance Programs in Paying for Pregnancy-Related Care: National and State Estimates for 2010,” by Adam Sonfield and Kathryn Kost. In 19 states, public expenditures related to unintended pregnancies exceeded $400 million in 2010. Texas spent the most ($2.9 billion), followed by California ($1.8 billion), New York ($1.5 billion) and Florida ($1.3 billion); those four states are also the nation’s most populous.

Previous research has demonstrated that investing in publicly funded family planning services enables women to avoid unwanted pregnancies and space wanted ones, which is good not only for women and families, but also for society as a whole. In the absence of the current U.S. publicly funded family planning effort, the public costs of unintended pregnancies in 2010 would have been 75% higher.

Sonfield and Kost report that the total gross savings from averting all unintended pregnancies in 2010 would have been $15.5 billion. This is less than the total public cost of all unintended pregnancies, because even if all women had been able to time their pregnancies as they wanted, some still would have had planned births that were publicly funded. These potential savings do not account for the cost of providing family planning services and other interventions that might be required to prevent the unintended pregnancies.

“Reducing public expenditures related to unintended pregnancies requires substantial new public investments in family planning services,” says Sonfield. “That would mean strengthening existing programs, such as the Title X family planning program, as well as working to ensure that the Affordable Care Act achieves its full potential to bolster Medicaid and other safety-net programs. We know we can prevent unintended pregnancies and the related costs. There are public programs in place that do it already, but as these data show, there is significantly more progress to be made.”

The new research also highlights the central role played by Medicaid and other public insurance programs in providing critical pregnancy-related care—including prenatal care, labor and delivery, postpartum care and infant care—that help keep women and babies healthy. Fifty-one percent of the four million births in the United States in 2010 were publicly funded, including 68% of unplanned births and 38% of planned births.

“These findings demonstrate the continuing importance of Medicaid and other public health insurance programs in preserving maternal and child health, and in supporting pregnancy-related care,” says Adam Sonfield, coauthor of the new report.

For more information:

Unintended Pregnancy Rates at the State Level: Estimates for 2010 and Trends Since 2002

Fact Sheet: Unintended Pregnancy in the United States (national)

State Facts on Unintended Pregnancy

Fact Sheet: Publicly Funded Family Planning Services in the United States (national)

State Facts on Publicly Funded Family Planning Services

State Data Center

[Research article] Learning about health and medicine from Internet data

From the 2 February 2015 Microsoft research summary

urveys show that around 70% of US Internet users consult the Internet when they require medical information. People seek this information using both traditional search engines and via social media. The information created using the search process offers an unprecedented opportunity for applications to monitor and improve the quality of life of people with a variety of medical conditions. In recent years, research in this area has addressed public-health questions such as the effect of media on development of anorexia, developed tools for measuring influenza rates and assessing drug safety, and examined the effects of health information on individual wellbeing. This tutorial will show how Internet data can facilitate medical research, providing an overview of the state-of-the-art in this area. During the tutorial we will discuss the information which can be gleaned from a variety of Internet data sources, including social media, search engines, and specialized medical websites. We will provide an overview of analysis methods used in recent literature, and show how results can be evaluated using publicly-available health information and online experimentation. Finally, we will discuss ethical and privacy issues and possible technological solutions. This tutorial is intended for researchers of user generated content who are interested in applying their knowledge to improve health and medicine.

[Press release] Trust increases with age; benefits well-being

From the 18 March 2015 EurkAlert!
“Though trust can have negative consequences, especially among older adults at risk of falling for scams and fraud, the studies found no evidence that those negative consequences erode the benefits of trust.”

[News release] Medical expansion has led people worldwide to feel less healthy

From the 19 March 2015 Ohio State University news release

In 28 countries, more medicine has unexpected effects

COLUMBUS, Ohio – Across much of the Western world, 25 years of expansion of the medical system has actually led to people feeling less healthy over time, a new study has found.

A researcher at The Ohio State University used several large multinational datasets to examine changes in how people rated their health between 1981 and 2007 and compared that to medical expansion in 28 countries that are members of the Organization for Economic Co-operation and Development.

During that time, the medical industry expanded dramatically in many of those countries, which you might expect would lead to people who felt healthier.

But that’s not what Hui Zheng, assistant professor of sociology at Ohio State, found.

“Access to more medicine and medical care doesn’t really improve our subjective health. For example, in the United States, the percentage of Americans reporting very good health decreased from 39 percent to 28 percent from 1982 to 2006,” Zheng said.

Hui Zheng

In fact, Zheng conducted what is called a “counterfactual analysis” using the data to see what would have happened if the medical industry hadn’t expanded at all in these countries since 1982. In this analysis, other factors that are generally linked to improved health, such as economic development, were left unchanged.

Under this scenario, the analysis predicted that self-rated health would have increased in these 28 countries. For example, the percentage of Americans reporting very good health could have increased by about 10 percent.

“It seems counterintuitive, but that’s what the evidence shows. More medicine doesn’t lead to citizens feeling better about their health – it actually hurts,” Zheng said.

The study appears in the July 2015 issue of the journal Social Science Research.

The OECD is an organization of countries, including the United States and many countries in Europe, that accept the principles of representative democracy and free-market economy. This study included information from OECD Health Data, World Development Indicators, the World Values Survey and theEuropean Values Study.

Zheng measured three kinds of medical expansion. One was medical investment, which includes health care spending per capita and total health employment; medical professionalization and specialization, which includes the number of practicing physicians and specialists; and expanded pharmaceutical industry, which includes pharmaceutical sales per capita.

…

 

Zheng said there are several reasons why medical expansion may actually lead people to feel less healthy. For one, more diseases are discovered or “created,” which increases the risk of being diagnosed with “new” diseases. Three examples, he said, include the rise in diagnoses of attention deficit hyperactivity disorder (ADHD), depression and autism.

In addition, there is more aggressive screening, which turns up more diseases in people. Overdiagnosis can potentially cause harm to perfectly healthy people, he said.

As more medical care becomes more widely available, people may expect better health, perhaps to an unrealistic degree, Zheng said.

“Consumers begin demanding more medical treatment because of the declines in subjective health and the increasing expectations of good health, and medical expansion continues. It is a cycle,” Zheng said.

In a separate but related study published online in Social Science Research, Zheng found that Americans’ confidence in medicine has declined over the last three decades, again at the same time as medical expansion.

“The decline in confidence has occurred at the same rate, regardless of gender, age, income or any other factor,” Zheng said.

[News release] Sandia showcases biology breakthroughs available for licensing

From the 29 March 2015 Sandia news release

LIVERMORE, Calif.—Technologies developed in Sandia National Laboratories’biosciences program could soon find their way into doctors’ offices — devices like wearable microneedles that continuously analyze electrolyte levels and a lab-on-a-disk that can test a drop of blood for 64 different diseases in minutes.

At a recent seminar for potential investors and licensees, part of the Sandia Technology Showcase series, Sandia bioscientists presented eight ready-to-license technologies in three key areas: medical diagnostics, biosurveillance and therapeutics and drug discovery.

….

[News release] Why “hypoallergenic” isn’t a thing (video)

From the 19 March 2015 American Chemistry Association news release

It’s a simple claim made on thousands of personal care products for adults and kids: hypoallergenic. But what does that actually mean? Turns out, it can mean whatever manufacturers want it to mean, and that can leave you feeling itchy. Speaking of Chemistry is back this week with Sophia Cai explaining why “hypoallergenic” isn’t really a thing. Check it out here:

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[News release] New knowledge strengthens risk assessment of chemical cocktails in food

From the THURSDAY 19 MAR 15 Technical University news release By Miriam Meister 

Denmark’s largest research project on chemical cocktail effects infood, spearheaded by the National Food Institute, Technical University of Denmark, has just been completed. It has established that even small doses of chemicals can have significant negative effects if they are present together. A reliable method for calculating the effects of chemical cocktails has been developed in the project. The project has also shown a need for limiting the Danish population’s exposure to certain substances.

The fact that the traditional way of assessing potential harmful effects of chemicals only takes the individual chemicals into account has long been of concern. Especially since this approach does not take into account the effects that can occur in humans when the chemicals are present at the same time in a cocktail. A serious concern is that substances can amplify each other’s effects, so that their combined effect becomes greater than what can be predicted by looking at the individual chemicals.

“Our research shows that indeed, little strokes fell great oaks also when it comes to chemical exposure. Going forward this insight has a profound impact on the way we should assess the risk posed by chemicals weare exposed to through the foods we eat.”

A recently completed, four-year research project on cocktail effects in foods, led by the National Food Institute, has established that when two or more chemicals appear together, they often have an additive effect. This means that cocktail effects can be predicted based on information from single chemicals, but also that small amounts of chemicals when present together can have significant negative effects.

”Our research shows that indeed, little strokes fell great oaks also when it comes to chemical exposure. Going forward this insight has a profound impact on the way we should assess the risk posed by chemicals we are exposed to through the foods we eat,” Professor Anne Marie Vinggaard from the National Food Institute says.

Danes’ exposure to chemicals via foods

In order to assess the risk posed by various chemicals, it is essential to know what the typical human exposure to a particular chemical is. The cocktail project has created an overview of the amount of pesticides and other contaminants that humans are exposed to via foods.

This work has shown that Danes’ intake of pesticides through foods is relatively limited. However, there is a need for reducing exposure to substances such as lead, cadmium, PCBs and dioxins.

The endocrine disrupting effects of chemicals have generally not been adequately studied. However, in cases where knowledge about the effects is available, the results show a need to reduce the intake of endocrine disrupting chemicals from current levels, such as phthalates and fluorinated chemicals.

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Loneliness and Social Isolation as Risk Factors for Mortality A Meta-Analytic Review

From the article, Perspectives on Psychological Science, March 2015  vol. 10 no. 2 227-237

Several lifestyle and environmental factors are risk factors for early mortality, including smoking, sedentary lifestyle, and air pollution. However, in the scientific literature, much less attention has been given to social factors demonstrated to have equivalent or greater influence on mortality risk (Holt-Lunstad, Smith, & Layton, 2010). Being socially connected is not only influential for psychological and emotional well-being but it also has a significant and positive influence on physical well-being (Uchino, 2006) and overall longevity (Holt-Lunstad et al., 2010; House, Landis, & Umberson, 1988; Shor, Roelfs, & Yogev, 2013). A lack of social connections has also been linked to detrimental health outcomes in previous research. Although the broader protective effect of social relationships is known, in this meta-analytic review, we aim to narrow researchers’ understanding of the evidence in support of increased risk associated with social deficits. Specifically, researchers have assumed that the overall effect of social connections reported previously inversely equates with risk associated with social deficits, but it is presently unclear whether the deleterious effects of social deficits outweigh the salubrious effects of social connections. Currently, no meta-analyses focused on social isolation and loneliness exist in which mortality is the outcome. With efforts underway to identify groups at risk and to intervene to reduce that risk, it is important to understand the relative influence of social isolation and loneliness.

Living alone, having few social network ties, and having infrequent social contact are all markers of social isolation. The common thread across these is an objective quantitative approach to establish a dearth of social contact and network size. Whereas social isolation can be an objectively quantifiable variable, loneliness is a subjective emotional state. Loneliness is the perception of social isolation, or the subjective experience of being lonely, and thus involves necessarily subjective measurement. Loneliness has also been described as the dissatisfaction with the discrepancy between desired and actual social relationships (Peplau & Perlman, 1982).

[News release] Public Access to NSF (National Science Foundation) Research

From the [March 2015] news release

The National Science Foundation (NSF or Foundation) has developed a plan outlining a framework for activities to increase public access to scientific publications and digital scientific data resulting from research the foundation funds. The plan, entitled “Today’s Data, Tomorrow’s Discoveries,” is consistent with the objectives set forth in the Office of Science and Technology Policy’s Feb. 22, 2013, memorandum, “Increasing Access to the Results of Federally Funded Research,” and with long-standing policies encouraging data sharing and communication of research results.

As outlined in section 3.1 of the plan, NSF will require that either the version of record or the final accepted manuscript in peer-reviewed scholarly journals and papers in juried conference proceedings or transactions must:

• Be deposited in a public access compliant repository designated by NSF;
• Be available for download, reading and analysis free of charge no later than 12 months after initial publication;
• Possess a minimum set of machine-readable metadata elements in a metadata record to be made available free of charge upon initial publication;
• Be managed to ensure long-term preservation; and
• Be reported in annual and final reports during the period of the award with a persistent identifier that provides links to the full text of the publication as well as other metadata elements.

This NSF requirement will apply to new awards resulting from proposals submitted, or due, on or after the effective date of the Proposal & Award Policies & Procedures Guide (PAPPG) that will be issued in January 2016.

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