Population Health: Proactive Solutions for Healthy Outcomes

Social environments contribute directly to a wide range of health outcomes. The social determinants of health refer to conditions in the environments in which people live, work, play, worship, and age. Traditionally, the public health sector factored the social determinants of health into practice, while the hospital sector focused on individual factors, such as illness and the provision of episodic curative services. However, health care in the US is evolving. These separate views are no longer sufficient, and population health is now considered the solution. Population health addresses the full range of the determinants of health and involves measuring and optimizing the health of groups by embracing the traditional social determinants of health as well as health care delivery. The purpose of this article is to provide an overview of population health, highlight examples of how it is taking shape in Hawai‘i, and discuss how the University of Hawaiʻi at Mānoa School of Nursing and Dental Hygiene (UHM SONDH) is preparing its graduate nursing students for new roles in population health in Hawaiʻi.

The full Spotlight on Nursing column can be viewed at this link.  

How Technology, Medicine And At-Home Devices Can Improve Healthcare Access And Cost

Healthcare is changing. After years of stagnation and inadequate innovations, the call for care that is higher quality and more accessible and that costs less is beginning to be answered. We're starting to see incremental progress toward meaningful healthcare technology and reimagined delivery models. New developments in digital medicine, DIY care and AI are emerging, with the potential to advance the industry in ways that previous attempts have failed.

Despite signs of progress, doctor's office wait times continue to rise. Middle- and low-income patients are in critical need of more affordable primary and specialty care. Across the country, critical access and other rural hospitals are closing at an alarming rate, leaving people in those areas struggling to find the time, transportation and money needed to see a physician. Primary care visits are declining, while our overall population health continues to lag behind most developed countries.

These issues are the impetus for momentum in digital medicine and direct-to-consumer healthcare. Consumers today expect more from all of the services they use, and healthcare is no exception. New, niche providers and technology focused on patient experience are setting a new standard for healthcare delivery. Some solutions—those that offer unprecedented convenience alongside real medical expertise—have the potential to improve outcomes.

The full Forbes article can be viewed at this link.  

Advocacy, Social Determinants Must Be Part of Physician Training

During my medical school training, there was a brief mention of social determinants of health. We did not have dedicated curriculum and we were not taught to screen for societal issues. The American Medical Student Association and AAFP started my education on how societal issues and health policy ultimately affect the health of the public. From these "introductory courses," so to speak, I was inspired to pursue my Master of Public Health degree concurrent with my Doctorate of Osteopathic Medicine.

By being involved in these organizations and obtaining this additional graduate degree, my perspective of how medicine should be practiced and what additional skillsets a physician needs to learn changed. It became increasingly important to me that the next step of my training would include education in population health. So, I sought out a residency program where there was a focus on public health as it relates to physical health and well-being, and where I was given the opportunity to participate in activism on behalf of and alongside the patients I was seeing in office.

Had I not been a part of these medical organizations or trained at a residency program that teaches residents how systems of oppression and social factors of disease impact the lives of patients, I may have been yet another doctor who overlooked the actual cause of this patient's weight loss.

It is crucial that medical education integrate curricula around activism, advocacy and public health if we wish to truly train physicians to be able to take care of communities.

The full AAFP article can be viewed at this link.

Problems Paying Medical Bills, 2018

In the United States, the percentage of all persons who were in families having problems paying medical bills decreased 5.5 percentage points from 19.7% in 2011 to 14.2% in 2018. In this same year, the percentage of persons who were in families having problems paying medical bills varied by sex, age, race and ethnicity, and health insurance status. Among persons of all ages, the percentage who were in families having problems paying medical bills was higher among females, children aged 0–17 years, and non-Hispanic black persons than among males, adults, and other racial and ethnic groups, respectively. Among persons under age 65, the percentage having problems paying medical bills was highest among those who were uninsured, followed by those who were covered with Medicaid and private health insurance. Among adults aged 65 and over, those with Medicare and Medicaid, and Medicare only had similar percentages of having problems paying medical bills; both were higher than those with Medicare Advantage and private coverage.

The full NCHS Data Brief can be downloaded below.

How Algorithmic Empathy Will Improve Health Care

Recently, health care providers have started using artificially intelligent chat bots to guide patients through normal intake processes and other functions normally performed by staff. The bots can ask patients about basic symptoms, verify health insurance, and follow up after visits. They have the great potential to increase access and reduce costs for health care providers. But one of the key challenges to their successful adoption is maintaining patient engagement with these software robots; how do you get patients to talk to software robots about sensitive medical data? It turns out the answer is empathy.

The full Forbes article can be viewed at this link.  

Patients, clinicians and researchers working together to improve cardiovascular health: a qualitative study of barriers and priorities for patient-oriented research

In this study, research priorities were identified by patients and clinician-researchers working together to improve CV health. Future research programme and projects will be developed to address these priorities. A key output of this study is the creation of the patient advisory council that will provide support and will work with clinician-researchers to improve CV health.

The full article can be downloaded below.  

Tele-transitions of care (TTOC): a 12-month, randomized controlled trial evaluating the use of Telehealth to achieve triple aim objectives

Poor transitions of care leads to increased health costs, over-utilization of emergency room departments, increased re-hospitalizations and causes poor patient experiences and outcomes. This study evaluated Telehealth feasibility in improving transitions of care.

This is a 12-month randomized controlled trial, evaluating the use of telehealth (remote patient monitoring and video visits) versus standard transitions of care with the primary outcomes of hospital readmission and emergency department utilization and secondary outcomes of access to care, medication management and adherence and patient engagement. Electronic Medical Record data, Health Information Exchange data and phone survey data was collected. Multi-variable logistic regression models were created to evaluate the effect of Telehealth on hospital readmission, emergency department utilization, medication adherence. Chi-square tests or Fisher’s exact tests were used to compare the percentages of categorical variables between the Telehealth and control groups. T tests or Wilcoxon rank sum tests were used to compared means and medians between the two randomized groups.

The study conducted between June 2017 and 2018, included 102 patients. Compared with the standard of care, Telehealth patients were more likely to have medicine reconciliation (p = 0.013) and were 7 times more likely to adhere to medication than the control group (p = 0.03). Telehealth patients exhibited enthusiasm (p = 0.0001), and confidence that Telehealth could improve their healthcare (p = 0.0001). Telehealth showed no statistical significance on emergency department utilization (p = 0.691) nor for readmissions (p = 0.31). 100% of Telehealth patients found the intervention to be valuable, 98% if given the opportunity, reported they would continue using telehealth to manage their healthcare needs, and 94% reported that the remote patient monitoring technology was useful.

Telehealth can improve transitions of care after hospital discharge improving patient engagement and adherence to medications. Although this study was unable to show the effect of Telehealth on reduced healthcare utilization, more research needs to be done in order to understand the true impact of Telehealth on preventing avoidable hospital readmission and emergency department visits.

The full article can be downloaded below.  

For The First Time Ever, A Drug Developed By AI Will Be Tested In Human Trials

In a world first, a medicine developed by artificial intelligence may be used to treat patients with obsessive-compulsive disorder. The news is remarkable and hints that in the future, AI may help drug development become faster and more efficiently than ever before. 

The first non-man made drug molecule, DSP-1181, has now entered Phase 1 clinical trials, European Pharmaceutical Review reported. The molecule is a long-acting potent serotonin 5-HT1A receptor agonist and was developed using AI that was the product of a partnership between Japan’s Sumitomo Dainippon Pharma and Exscientia in the UK. The compound was developed in a remarkable time, with AI able to complete in 12 months what typically takes five years. 

The full Forbes article can be viewed at this link.  

The value of healthcare data: to nudge, or not?

The processes of datafication, digitization and automation of healthcare and medicine are making new types and data available for analysis, and at greater volume. While the newly available data is often hailed as a solution to various problems in healthcare, there is only little discussion about who the use of such data empowers and who bears the costs. The use of healthcare data for “nudging”–e.g. to get patients to adopt healthier lifestyles–is a case in point: While such interventions are presumed to be cheap and effective, I argue that their value is a priori unclear. Both because of its assumed value-freeness, and because of its focus on individual behaviour, nudging draws attention away from the societal, political and economic factors that shape human practice. I conclude with a call upon policy makers to facilitate the use of healthcare data to build better institutions and to address social determinants of health before they seek to “fix” individual behaviour through nudging.

The full article can be viewed at this link.  

Value-Based Agreements in Healthcare: Willingness versus Ability

Although pharmaceuticals represent 10% of the overall US healthcare expenditure, the US drug spending and drug pricing are often the most scrutinized areas. For example, President Donald Trump’s “American Patients First” blueprint, which was released in May 2018, is intended as a proposal for multiple cost-reducing strategies, alongside extensive media coverage of drug price hikes for certain manufacturers. Pressure to reduce drug costs has only intensified over the past decade, inspiring increased collaboration and experimentation throughout the pharmaceutical industry.

In addition, the Affordable Care Act influenced a shift from volume to value, which has extended to the payment-delivery models used between health insurers (or payers) and pharmaceutical manufacturers. One such delivery strategy involves value-based contracts, which are designed to align drug prices with the way the drug performs outside of clinical trials or in the real-world setting.

The full article can be downloaded below.