A Breakthrough, Sobering Report on Teens and Young Adults, Digital Health and Social Media Use: Implications for Mental Health

There’s a load of anecdotal data about teens and young adults (TYAs) and their always-on relationship with mobile phones and social networks. There are also hundreds of stories written in both mass media outlets and professional journals on the topic of TYAs and mental health: especially relative to depression and suicidality.

In a breakthrough study, Hopelab and the Well Being Trust have sponsored the first deep-dive into the many dimensions of young people, their relationship with social media, and depression in Digital Health Practices, Social Media Use, and Mental Well-Being Among Teens and Young Adults in the U.S.,

The report was co-written by Victoria Rideout and Susannah Fox, two names Health Populi readers should know. Rideout is the go-to expert on media and health, with a special interest in children and media. Fox is the go-to person on the role of the internet in healthcare, and particularly the opportunity for digital tools to enable peer-to-peer support.

The study is based on a survey of over 1,300 U.S. teens and young adults, ages 14 to 22, polled in February and March 2018.

As I write up my read on the survey results, I will use the acronym “TYAs” alternating with the phrase “young adults,” to refer to the cohort of 14-22 year old’s surveyed in this study.

The top-line findings alone provide an important baseline profile of TYAs’ use of the internet for health never before described. Nearly 9 in 10 young adults have gone online to seek health information. Two-thirds have used a mobile app related to health. And, 61% of TYAs have read or watched someone else’s health story online.

4 in 10 young people have looked for people with similar concerns online — which is the real power of “social” in “social media.”

Nearly two-thirds of young people seek health information about fitness and exercise, one-half for diet and nutrition, 44% on stress, 42% on anxiety, and 39% on depression. Over 1 in 4 TYAs seek information on sexual health — birth control, pregnancy, and sexually transmitted disease.

And one-fourth seek information on sleep disorders and cancer. Table 1 lists the various search themes conducted by TYAs.

What’s fascinating about the top several responses is that they match the health topics most often sought by most U.S. adults, found in other studies.

The most popular mobile health apps young people use deal with fitness (42%), nutrition (26%), sleep (20%), period/menstruation (20%), and meditation/mindfulness (11%), closely followed by stress reduction (9%).

While a majority of both young women and young men look for health information online, use a mobile health app, and have watched or listened to someone else’s health experience online, at the margin, more females do so than males.

There’s another important difference in use of online health resources regarding TYAs who identify as LGBTQ versus straight youth: many more LGBTQ young

adults seek health resources online than straight young adults, for information on depression (76% vs. 32%), anxiety (75% vs. 36%), stress (68% vs. 40%), and sleep disorders (54% compared with 22%). The second yellow bar graph shows these differences.

This segues into critically important findings on young people and mental well-being. While one-half of respondents reported no depressive symptoms, one-quarter of young adults said they had mild depressive symptoms, and 25% reported moderate-to-severe symptoms of depression.

Those young people reporting moderate-to-severe depressive symptoms also go online for health information more than peers who report no depressive symptoms: for any health topic, any mental health topic, or for knowledge about depression, stress or anxiety. Young people with greater depressive symptoms also use health related mobile apps more than TYAs without depressive symptoms, for all health topics polled in the study – for both general health and behavioral health applications.

Finally, young people with symptoms of depression also seek peer-to-peer health advice more frequently than TYAs with no depressive symptoms.

The third bar graph (in green) may be surprising. While social media use has gotten a rap for taking young people to the “dark side,” this study finds that more young people with depressive symptoms tend to find social media important for self-expression and creativity (by a factor of 2:1), feeling inspired by other people (again, by a factor of 2:1), and feeling “less alone,” for 30% of TYAs with depressive symptoms vs. only 7% of those with no signs of depression.

The authors offer recommendations for “the rest of us” to consider in meeting young peoples’ mental well-being challenges vis-a-vis digital tech and social networks:

• How can we develop better, more effective and empathetic digital tech that inspires, resonates, and addresses young peoples’ health concerns and needs?
• How can we further support and encourage young peoples’ peer-to-peer health experiences?
• How can we help young people “curate” and “titrate” the best digital health resources that can support positive relationships with themselves, others, and the health/care system?
• How can we support all young people, regardless of their sexual orientation, in nurturing positive relationships with themselves, their peers, their families, and communities-at-large?

Health Populi’s Hot Points:  We refer to younger people as “digital natives,” having grown up with the online world as, well, just part of the everyday life-flow. It is not surprising, then, that young people use the internet, social networks, and apps for health as they do for all aspects of daily living.

What’s striking, however, is how natural it has become for young people to “hack” their way to wellness when they can, especially in seeking other “people like me,” dealing with stuff I’m dealing with. This is particularly important, the data demonstrates, for young people who may be made to feel like an “other” — those identifying as LGBTQ. We know the data that, shamefully, shows that people who are gay have a higher incidence of suicidality, of depression and anxiety, as well as less access to health care services. The fact that some younger people who identify as LGBTQ have found ways to leverage technology to feel inspired, to feel connected, and to find a safe place for expression is encouraging…and a place to begin to understand how to meet people where they “are.”

Several quotes jumped off the report page to me. I include three here that particularly resonated with me.

‘

 

 

 

 

In the case of teens and young adults, they are massively online, and that’s the reality for health information seeking, partnering, friending, finding a ride, joining a club, applying to college, finding a roommate….and just living.

This report gives us a place to start to wrestle with the demons of mental well-being for young people, knowing that digital tech and social networks will be part of the prescription for helping to make health and healthcare better with, and not just “for,” teens and young adults.

Thanks to Hopelab and the Well Being Trust for sponsoring this important research.

The post A Breakthrough, Sobering Report on Teens and Young Adults, Digital Health and Social Media Use: Implications for Mental Health appeared first on HealthPopuli.com.

A Breakthrough, Sobering Report on Teens and Young Adults, Digital Health and Social Media Use: Implications for Mental Health posted first on http://dentistfortworth.blogspot.com

Mental illness increases the likelihood of being a crime victim

That is the conclusion from Dean et al. (2018) published in JAMA Psychiatry.  Using a Danish registry of individuals born between 1965 and 1998, the measure the likelihood a crime event (any or violet) between 2001 and 2013.  They find that:

In a total cohort of 2 058 063 (48.7% male; 51.3% female), the adjusted IRRs for being subjected to crime associated with any mental disorder were 1.49 (95% CI, 1.46-1.51) for men and 1.64 (95% CI, 1.61-1.66) for women. The IRRs were higher for being subjected to violent crime at 1.76 (95% CI, 1.72-1.80) for men and 2.72 (95% CI, 2.65-2.79) for women.

The analysis does control for an individual’s own likelihood of committing a crime as well as sociodemographic factors.  The authors conclude the following from these results:

Onset of mental illness is associated with increased risk of exposure to crime, and violent crime in particular. Elevated risk is not confined to specific diagnostic groups. Women with mental illness are especially vulnerable to being subjected to crime. Individual’s own offending accounts for some but not all of the increased vulnerability to being subjected to crime.

HT: Incidental economist.

Source:

• Dean, Kimberlie, Thomas M. Laursen, Carsten B. Pedersen, Roger T. Webb, Preben B. Mortensen, and Esben Agerbo. “Risk of being subjected to crime, including violent crime, after onset of mental illness: a Danish national registry study using police data.” JAMA psychiatry (2018).

Mental illness increases the likelihood of being a crime victim posted first on http://dentistfortworth.blogspot.com

How to design a pragmatic trial

How do you design a good clinical trial?  Clearly, the trial design depends on what question you are answering. For instance consider the dichotomy between an explanatory and pragmatic trial:

A pragmatic randomised trial is undertaken in the “real world” and with usual care and is intended to help support a decision on whether to deliver an intervention. An explanatory randomised trial is undertaken in an idealised setting, to give the initiative under evaluation its best chance to demonstrate a beneficial effect. These two approaches represent different attitudes to decision making on the usefulness of interventions.

The quotation above makes if seem like a pragmatic trial is always best.  That is clearly not the case.  Consider the case where there is a brand new technology which requires significant physician training in the real world.  An explanatory trial could implement training as part of the protocol to insure that only trained doctors use it.  A pragmatic trial could include physicians who were and were not trained and thus the treatment may be less successful in the real world. If one believes that in the long-run physicians will be trained to use the intervention, but in the short-run there could be problems, then an explanatory trial may be superior.  If on the other hand, one is skeptical that physicians will actually pay attention to any training offered in the real world, a pragmatic trial may be more attractive.  Again, both trials approaches are useful, but the best approach depends on the research question of interest (among other factors).

One tool to help researchers decide is the PRECIS-2 tool.  The tool was designed by over 80 international trialists, clinicians, and policymakers.

PRECIS-2 has nine domains—eligibility criteria, recruitment, setting, organisation, flexibility (delivery), flexibility (adherence), follow-up, primary outcome, and primary analysis—scored from 1 (very explanatory) to 5 (very pragmatic) to facilitate domain discussion and consensus.

PRECIS-2 is an update of PRECIS.  PRECIS was widely cited but some limitations included that it didn’t use an explicit rating scale and it was not validated, in addition to some domain-specific critiques.   What are the PRECIS-2 domains and how can one use it?  Take a look at the graphic below.

More detail on each domain is after the jump.

1. 1. Eligibility criteria—Who is selected to participate in the trial? A highly pragmatic approach to eligibility criteria would be to include in the trial anyone with the condition of interest who is likely to be a candidate for the intervention if it was being provided in usual care for this condition.  For instance, children, the elderly and those with comorbid conditions would be more likely to be included in a pragmatic trial
   2. Recruitment—How are participants recruited into the trial?  The most extreme pragmatic approach to recruitment would be to do this in usual care so that only the people who attend a clinic with the condition of interest are recruited after they present on their own behalf without any overt recruitment effort. A highly pragmatic approach to trial design would also recruit from more than one clinic as an explicit way of increasing applicability of the trial results. Recruiting through usual appointments at a diverse range of clinics is likely to score at or close to 5 on the PRECIS-2 scale.
   3. Setting—Where is the trial being done? The most extremely pragmatic approach to setting would be to do the trial in an identical setting to which you intend the results to be applied. Such a trial is likely to score at or close to 5 on PRECIS-2. Even settings that seem rather restrictive could still be a highly pragmatic design choice if this setting is the usual care setting where patients are treated for the particular health condition. For example, if a trial was carried out in the most specialist intensive care units in the country and the intention of the trial was to support decision making in these highly specialised units, then the design choice with regard to setting is still pragmatic.
   4. . Organisation—What expertise and resources are needed to deliver the intervention? This domain has been included to encourage trialists to consider the match between how care is organised and delivered in the trial and how the intervention would be made available to patients in usual care…A highly pragmatic design would aim to slot the intervention into the usual organisation of care for the condition of interest, making use of no more than the existing healthcare staff and resources in that setting. A design like this is likely to score at or close to 5 on PRECIS-2.
   5. 5. Flexibility (delivery)—How should the intervention be delivered? The most pragmatic design approach to delivery flexibility would leave the details of how to implement the intervention up to providers, in other words, what happens in usual care. For example, the details of how to perform a surgical procedure could be left entirely to the surgeon, or how to deliver an educational programme is left to the discretion of the educator.
   6. Flexibility (adherence)—What measures are in place to ensure participants adhere to the intervention? A highly pragmatic design approach would allow for full flexibility in how end user recipients engage with the intervention. In usual care, health professionals encourage patients to take medication or follow therapy as best they can, and such encouragement would not count against a pragmatic design; if it also happens in usual care, allowing it in the trial is a pragmatic design decision. A trial with no special measures to enforce engagement or compliance would score at or close to 5 on PRECIS-2. On the other hand, a trial protocol that lays out methods to monitor and ensure patient compliance would score at or close to 1 on PRECIS-2.
   7. Follow-up—How closely are participants followed up? The most pragmatic position with regard to follow-up would be to have no more follow-up of recipients than would be the case in usual care. Indeed, the most extreme position is to have no follow-up contact at all with recipients and to obtain outcome data by other means (such as electronic medical records or other usual data to measure mortality or hospital admissions). As follow-up becomes more intense, the trial becomes more explanatory and the PRECIS-2 score will decrease.
   8. Primary outcome—How relevant is it to participants?
      The choice of primary outcome is a crucial trial design decision, and a pragmatic approach would be to select an outcome that is of obvious importance from the patient’s perspective. Post-trial, an outcome selected using a pragmatic approach would also be relevant to commissioners of care, the people who decide whether to implement the intervention on the basis of its results. For example, an intervention that aims to reduce falls in elderly people living independently in the community should have as its primary outcome the number of falls in the elderly living independently in the community. This outcome has meaning to patients, their relatives and friends, healthcare professionals, and policymakers. Measures of, say, bone density, muscle strength, or functional ability are distant from the key question of whether the intervention prevents elderly people falling in their own homes.
   9. Primary analysis—To what extent are all data included? Most trials are a superiority design so the most pragmatic approach with regard to the analysis would be to make no special allowance in the analysis for non-adherence, practice variability, etc. In other words, the pragmatic approach to the analysis would typically be an intention-to-treat analysis using all available data…Systematic exclusion of data from participants because, say, they were poorly adherent would make a trial more explanatory. Using all data but doing nothing to try and fill gaps caused by missing data would not in itself make trial more pragmatic or explanatory; missing data, especially if there is a lot of it, makes any conclusions more uncertain regardless of the design approach taken.

Source:

• Loudon, Kirsty, Shaun Treweek, Frank Sullivan, Peter Donnan, Kevin E. Thorpe, and Merrick Zwarenstein. “The PRECIS-2 tool: designing trials that are fit for purpose.” bmj350 (2015): h2147.

How to design a pragmatic trial posted first on http://dentistfortworth.blogspot.com

Beyond The Four, Don’t Count Out the ”W’s” for Healthcare Innovation: Walgreens and Walmart

**While Amazon and Google get lots of positive PR and media attention as major healthcare industry disruptors, don’t forget about the two big “W’s,” Walgreens and Walmart, in the healthcare innovator mix.

I recently read The Four in which Scott Galloway explains the dominance of Amazon, Apple, Google and Facebook in consumers’ everyday lives. These four tech-behemoths each have their particular designs on healthcare innovation, or disruption in the eyes of, say, Epic and Cerner working on health IT systems, or GE and IBM if you’ve been pioneers in health data or big-iron information technology.

Healthcare is complicated, President Trump recognized in late February 2017, just a few weeks after the POTUS took his seat in the Oval Office.

The complications of healthcare are, today, the opportunities to develop innovations and novel on-ramps for health care. Most of the healthcare innovation-attention at this moment is going to the Four, and to Big Tech in general. Over many years, I’ve written extensively about the continuing evolution and deepening of Amazon in healthcare, along with Apple, Facebook, and Google efforts.

To complement what we know about the Four, new announcements from Walgreens and Walmart must be mixed into the healthcare innovation mash-up that we’re tracking here at THINK-Health and in this blog.

First, to Walgreens, which has curated a talented digital health staff in the past decade. In the days when the Balance Rewards loyalty program was growing and adding health tracking to the consumer opportunity, Adam Pellegrini launched many creative and impactful digital health programs during his tenure there. He’s now at Fitbit leading efforts there to build clinical evidence and relationships to make healthcare — not just health and wellness — better.

The latest news from Walgreens is their launch of Find Care Now. Think of this program as the pharmacy chain’s expansion of existing programs in telehealth, married to a ZocDoc-style platform that enables the consumer to shop for and schedule an appointment in one digital encounter. This is easy-to-access through the Walgreens mobile app.

The 17 telehealth channel providers in Walgreens Find Care Now network include:

• Advocate Health Care, Chicago
• Baptist Health, Jacksonville, Florida
• Community Health Network, Indianapolis
• DermatologistOnCall, national online dermatology service
• Florida Hospital, Tampa
• Heal, on-demand doctor house calls in California, Washington, D.C. and Northern Virginia
• LabCorp, lab testing and diagnostics
• MDLIVE, national telehealth service
• MedExpress Urgent Care, an Optum company and provider of neighborhood medical care
• NewYork-Presbyterian Hospital in collaboration with Weill Cornell Medicine and Columbia University Irving Medical Center, New York
• Piedmont Healthcare, Atlanta
• Providence St. Joseph Health, including Providence Express Care in Portland, Oregon, and Swedish Express Care in Seattle
• SSM Health, St. Louis
• UHealth – The University of Miami Health System, Miami
• Walgreens Healthcare Clinics
• Walgreens Hearing
• Walgreens Optical.

The second graphic was generated on the Find Care Now portal based on my home ZIP code. Here, Walgreens gives me options of speaking with a doctor by phone or video for $59 via the MDLIVE service, talking with a psychotherapist for $99 via the MDLIVE Behavioral channel, getting a tele-dermatology consult for $59 cash through Dermatologist OnCall, or perhaps visiting a Walgreens healthcare clinic for some primary care starting at $89 for the visit. Note that the second opinion service served up to me is with New York-Presbyterian Hospitals, seemingly based on the location closest to my postal code (compared with, say, SSM Health in St. Louis or Baptist Health in Jacksonville, FL).

Media coverage of this story couches the Find Care Now program in terms of the Amazon’ing of health care. But that diminishes what Walgreens has already built in terms of institutional memory and health/care ethos. The company has over 78,000 healthcare service providers, including pharmacists, pharmacy technicians, nurse practitioners and other health capital. It’s a brand that 8 million consumers interact with every day, online and in any one of over 8,100 bricks-and-mortar stores located within a few miles of most Americans in all 50 U.S. states.

Now, let’s look to Walmart, tied with Amazon for being the place two-thirds of U.S. households shopped at retail in January and February 2018.

Walmart has made several announcements in recent weeks that further build the company’s healthcare infrastructure and prospects. The appointment of Sean Slovenski, as SVP of Health & Wellness is important because Slovenski comes from Humana, Care Innovations (GE and Intel), and Healthways — organizations that have led in healthcare innovation for many years. Humana’s an important touch point here because of Walmart’s intention to buy or closely collaborate with the health plan. Having an internal healthcare leader that already knows the Humana business and culture would help to position Walmart to more effectively merge/closely align Humana into Walmart’s overall environment and business.

Another key announcement was Walmart’s relationship with Microsoft for cloud computing via MSFT’s Azure. This competes with the Amazon Web Service’s cloud business which has a lot of healthcare data in there already across the healthcare ecosystem’s segments. But don’t count out Microsoft, which has a long history serving both legacy healthcare (providers, plans, pharma) and new-new digital health programs and companies around the world. There are deep and serious healthcare chops here from which Walmart can benefit.

Third, Walmart filed a patent with the U.S. Patent and Trademark Office in December 2017 for an wearable device and innovation that marries blockchain technology to electronic health records (EHRs). “There is a need for a method and system for obtaining a medical record stored on the blockchain when the owner of the private key cannot readily provide the private key,” the application states.

The wearable device for storing the encrypted private key and public key for accessing the data, could be a bracelet, necklace or a ring. Two other technologies would be required to “unlock” the chain: an RFID scanner for obtaining the public key, and a biometric scanner to verify some aspect of the consumer’s identity such as a facial feature, fingerprint, or iris of the eye.

These announcements from Walgreens and Walmart, among other organizations looking to improve health care by expanding access and lowering per capita costs, are coming to market more frequently. Stay tuned to Health Populi for ongoing analysis and forecasting of these projects, some motivated by Amazon and protecting existing market access, and some further out-of-the-box and Amazon locker.

Health Populi’s Hot Points:  Ultimately, expanding healthcare access, improving quality and lowering cost per patient are admirable and necessary objectives in meeting the Triple Aim — healthcare’s operational beacon for making healthcare better and more sustainable in the U.S.

Underneath these audacious goals are data, data everywhere. Thus, Microsoft’s work with Walmart, and Amazon’s clouds that collaborate with numerous healthcare stakeholders, is what enables the “how to make healthcare better.” It’s about Big Data, places to store it, and then the ability to access what’s needed to respond to a challenge at-hand.

It’s also about the right data. As I recently wrote about here in Health Populi, not all data is good data nor all of it necessary for solving a specific challenge. That’s why collaboration is so important, and why I’m bullish on a Walmart-Humana collaboration. Walmart has, arguably, the most retail data on the most consumer/health citizens in America in one place. While there is a lot of data available from data brokers like Acxiom, CoreLogic, Experian and Nielsen, among others, that data costs to access it. In my advisory work with organizations that serve this market, I have learned that such costs can be limiting factors in projects that want to address social determinants of health, but can’t afford the high cost of that data that’s so elusive — yet so important for answering real questions about real peoples’ health in real-life.

Walmart and Humana, among other collaborations, can address the challenge of the right data, right place, right time if that’s where such a project will go. Most of our healthcare challenges are lifestyle borne, with health created where we live, work, play, pray and learn. That calls for collaboration and data-sharing — the former, easier to imagine, and the latter very difficult to do based on current business models that are full of friction. Would that these new collaboratives re-imagine frictionless business based on fair play (coined “Citizen AI” in the Accenture 2018 Digital Health Tech Vision), with a relentless commitment to making healthcare better for all people.

The post Beyond The Four, Don’t Count Out the ”W’s” for Healthcare Innovation: Walgreens and Walmart appeared first on HealthPopuli.com.

Beyond The Four, Don’t Count Out the ”W’s” for Healthcare Innovation: Walgreens and Walmart posted first on http://dentistfortworth.blogspot.com

Paperless Dentistry at Dr. Ku’s

How many of you remember going to the dentist’s office and seeing rows and rows of files stuffed into shelves behind the office manager? All the colorful tabs sticking out providing a decorative aspect to the overwhelming amount of paper.  

 

While many offices still rely on paper records for their patients, offices like Dr. Ku’s have transformed into a paperless practice. This change is beneficial for both the dentist and the patient and ensures that care is streamlined for everyone who walks through our door.

Since our decision to be a paperless dental practice can strike some patients as interesting or raise concerns about data safety, we’re outlining why we chose to go this route and how it is beneficial for everyone.  

 

What is e-dentistry? 

 

E-dentistry allows health information to be stored and shared electronically while allowing the provider to give a higher level of care to the patient by enhancing the management of issues and providing better health outcomes.

According to the American Dental Association, dental practices have been much slower to switch to electronic health records than their physician counterparts. Much of this has to do with how practices are structured, since many dental practices have a sole dentist while other physicians’ offices can have dozens of doctors. Due to the size disparity, the cost to change can be too high for dental practices.

However, at Dr. Ku’s office we believed the investment in a paperless practice was important for our patients and their care, and we were willing to use our resources to make it happen.  

 

What are the benefits? 

 

Thanks to the involvement of the American Dental Association, electronic health records are being improved specifically with dentists in mind. Since all practices of medicine are different, it’s important there’s not just a “one size fits all” approach to a paperless dental practice. Here are some of the reasons why we believe they are so beneficial: 

 

• Improved patient safety through better documentation and built-in protocol and reminders that increase the quality of care. Additionally, if a patient needs their records sent to another provider, they can easily be sent electronically instead of having to fax or copy the paper records.  
• E-prescribing allows your dentist to submit a prescription directly to the pharmacy. Patients no longer need to wait around for prescriptions to be filled after dropping off a paper order. This saves the patient time and increases the likelihood of prescription compliance.  
• More efficient billing results in less time for both the office and patient on the phone with their insurance company. Documenting everything digitally helps to ensure billing codes are current and the turnaround for reimbursement from an insurer is prompt.  

 

Are my records secure? 

 

Rest assured, by law there are safeguards that must be in place for any office to operate an electronic health records system. In fact, these records are more secure than paper records left out in the open in the middle of a practice. Electronic records can be opened only by authorized users as opposed to anyone who may want to open up a paper folder.

In addition, paper records had the potential to be tampered with. An electronic system logs whoever accesses certain patient records and notes who makes changes. Therefore, there is always an electronic paper trail detailing any modifications made.

Finally, electronic records are secure in the event of a disaster. Whether it be a natural disaster or an act of theft, it is much more difficult to destroy something if there is no paper copy.  

 

At Dr. Ku’s office we are very pleased with our current system and would be happy to answer any questions you have about it! 

The post Paperless Dentistry at Dr. Ku’s appeared first on Fort Worth Dentist | 7th Street District | H. Peter Ku, D.D.S. PA.

Paperless Dentistry at Dr. Ku’s posted first on http://dentistfortworth.blogspot.com

How much time to sick kids get with doctors in low-income countries?

How long do sick kids in low-income countries get to spent with their physician at a doctor’s visit?  A paper by Kruk et al. (2018) surveys health facilities in Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and Uganda to find out.  The answer is that patient’s do not get much time at all.

The median duration of 15,444 observations was 8 minutes; providers performed 8.4 of a maximum 24 clinical actions per visit. Content of care was minimally greater for severely ill children. Each additional clinical action was associated with 2 percent higher caregiver knowledge.

These surveys are nationally representative with a fairly large sample size and appear reliable.

Source:

• Kruk, Margaret E., Anna D. Gage, Godfrey M. Mbaruku, and Hannah H. Leslie. “Content of Care in 15,000 Sick Child Consultations in Nine Lower‐Income Countries.” Health services research (2018).

How much time to sick kids get with doctors in low-income countries? posted first on http://dentistfortworth.blogspot.com

Most Americans Over 50 Not Buying Groceries Online….Yet

Only 17% of Americans over 50 years of age shopped for groceries online by mid-2018. But older people in the U.S. have underlying demands and needs that could nudge them to do online grocery shopping, unearthed in a survey from AARP Foundation and IFIC, the International Food Industry Council Foundation.

Typically, older Americans who shop online tend to be college-educated, work full-time, and earn higher incomes. Older people with mobility issues also shop more online than folks without such challenges. But even among those older people who shop online for food, they do so less frequently than younger people do.

• Among the motivations inspiring older people in America to grocery-shop online, most consumers cite:
• Not having to travel to the store, among 82%
• Placing an order when they have time, 78%
• Accessing a wide variety of products, 73%
• Taking time to shop, for 73%
• Avoiding the physical burden of carrying groceries, 72%.

Barriers older people cite preventing or slowing their adoption of food shopping online include high delivery or service fees, receiving items in poor condition, wanting to see/touch groceries in person, difficulty in returning a product, and receiving wrong or incomplete orders.

Lower income Americans over 50 face even more challenges when shopping for food in general, a previous AARP/IFIC survey learned in April 2018.

The pearl to learn from in this study was that income status of Americans over 50 is directly associated with peoples’ perceptions of their own health. These consumers are less likely to rate their health as  “excellent,” at a rate of 38% versus 57%, shown in the second bar chart.

Coupled with low health ratings is the fact that only 19% of low-income older adults rated their physical activity level as high, vs. 29% of all adults over 50.

Nonetheless, and encouragingly, low-income older Americans are keen to achieve health outcomes comparable to the rest of the pouplation. Beyond physical health, more lower-income older people cite emotional/mental health, energy, and muscle health/mobility than the overall older population.

The limiting factor for these folks in achieving better health outomes is their lack of undertanding of how their diet and nutrition translates into their own desired health outcomes.

One specific tactic some older people who shop for food online use to “translate” their food buying choices to their health goals is by reading nutrition labels. However, one-half of these older online shoppers say it’s hard to get nutrition facts online compared with gathering them at the store, in person.

IFIC and AARP conducted this online survey among 1,004 U.S. adults 50 years of age and older in June 2018.

Health Populi’s Hot Points:  Grocery stores ranked highest in the 2018 Temkin Experience Ratings. Look carefully at the chart here from Temkin’s latest consumer poll, and see where health plans lie in consumer experience: dead last with TV and internet service providers (THINK: Comcast, Verizon, et al).

The grocery store’s opportunities for marketing health and engaging with health citizens is huge. Oliver Wyman taught me the concept of health care “front doors,” and when I consider the grocer, I think many “doors,” both offline and online. The grocery chain now has a pharmacy onsite, along with an electronic healthcare kiosk like higi which keeps a personal health record of my blood pressure and other metrics when I choose to use it and store my numbers in its data cloud. A grocery chain with a pharmacy has a pharmacist who is a primary care provider and advice-giver right there when I’m shopping. And the grocery store is a destination for food-as-medicine, which the older consumers in the AARP+IFIC study notes want to get better at using food purchase to achieve health goals like healthy hearts, greater energy, deeper sleep, and that Holiest of Grails, losing weight.

This IFIC/AARP survey coupled with the one published in April 2018 points out the differences between older Americans’ ability to gather information about nutrition online that ties with personal health goals. This is a design challenge that can be addressed by thoroughly understanding and empathizing with older people, their health goals, and their behavior with digital technology. One thing is clear: that older people across socioeconomic strata all look to food for health, and want tools to help them engage in health in this way. Watch for Amazon’s collaboration with Xealth to address this opportunity.

The post Most Americans Over 50 Not Buying Groceries Online….Yet appeared first on HealthPopuli.com.

Most Americans Over 50 Not Buying Groceries Online….Yet posted first on http://dentistfortworth.blogspot.com

Two‐Stage Residual Inclusion: An Overview

Often times, researchers want to measure the effect of certain interventions in the real-world. Doing this in practice is often difficult.  For instance, consider measuring health outcomes among individuals who visit doctors compared to those who don’t.  Inevitably, individuals who visit doctors will have worse outcomes.  Why?  Are doctors killing patients?   This is clearly a selection effect whereby patients who visit doctors were sicker to begin with and doctors almost certainly improve patient health.

An alternative approach would be to use randomized controlled trials (RCT).    RCTs are the gold standard able to determine an an intervention’s causal effect, but they do have their limitations: restrictive inclusion criteria, high expense, short-follow-up.

Other approaches–instrumental variables, or two-stage least squares (2SLS)–have been used to identify causal effect in the real world.  These approaches identify an “instrument” which is correlated with the intervention of interest, but is uncorrelated with the outcome of interest except through the intervention.  One problem with these approaches is that they assume a linear relationship between the variables of interest and outcomes.

The use of two-stage residual inclusion

An alternative approach is to use two-stage residual inclusion (2SRI).  A paper by Terza et al. (2018) outline how implement this approach which can incorporate non-linear relationships.  Let us say we want to estimate the following relatinship:

Y = exp(X_eβ_e + X_oβ_o + X_uβ_u) + ε

where Y is the outcome of interest, X_e is the endogenous variable, X_o is the exogenous, observed variable, and X_u is the unobserved confounding factor. The coefficients are the vectors β_. and ε is the residual.

The process for estimate this relationship is straight forward.

First, one can use non-linear least squares to estimate the coefficients α in the estimating equation:
X_e = exp(Wα) + X_u,

where W = [X_o W⁺] which is a vector of the observed exogenous variables and the instrument W⁺. One then can calculate the results as X^{^}_u = X_e – exp(Wα^{^}) where the carrot represents the estimated or fitted values.

In the second stage, one simply substitutes X^{^}_u for the unobserved X_u into the original equation. In short, in the second stage one would estimate:
Y = exp(X_eβ_e + X_oβ_o + X^{^}_uβ_u) + ε

While this approach will give you the unbiased estimates of the true coefficient values, the standard errors will be incorrect as they need to take into account that X^{^}_u was an estimated and not known quantity. To solve this problem, the author presents a number of solutions:

There are three possible approaches to calculation of the corrected standard errors: (1) bootstrapping; (2) the resampling method proposed by Krinsky and Robb (1986, 1990)…and (3) [asymptotically correct standard errors]…derived from standard asymptotic theory.

Note that in the example provided in this post, a non-linear least squares regression was appropriate but in other cases, a maximum likelihood or GLM estimation strategy would be needed.

If you are interested in applying this approach, do reach the whole article as the appendices also contain useful Stata code for implementation purposes.

Source:

• Terza, Joseph V. “Two‐Stage Residual Inclusion Estimation in Health Services Research and Health Economics.” Health services research 53, no. 3 (2018): 1890-1899.

Two‐Stage Residual Inclusion: An Overview posted first on http://dentistfortworth.blogspot.com

Healthcare, and Especially Covering Pre-Existing Conditions, Ranks High for Voters in 2018

President Trump and his administrative have been trying to make the ACA fail, claim most U.S. adults. Thus, the public holds the POTUS and the Republican party responsible for moving the Affordable Care Act forward….or not, according to the July 2018 Kaiser Health Tracking Poll conducted by the Kaiser Family Foundation (KFF).

Health care will be a key issue in the 2018 mid-term elections that will be held in November. Among U.S. voters’ key health care concerns in 2018, one ranks “most” or “very important” for two-thirds of Americans: that is continuing to protect people with pre-existing health conditions.

Other issues of concern include repealing the ACA, Supreme Court overturning Roe v. Wade, passing legislation to reduce the price of prescription drugs, passing laws to stabilize the ACA health insurance marketplaces, passing a national health plan (or “Medicare-for-all”), and continuing women’s access to reproductive health services.

But as the first bar chart illustrates, it’s guaranteeing pre-existing conditions that ranks top with 63% of Americans.

The vast majority of these voters also vote in battleground states (as defined by the Cook Political Report). These states include Alaska, Arizona, Connecticut, Florida, Iowa, Indiana, Maine, Michigan, Minnesota, Missouri, Nevada, North Dakota, Ohio, Tennessee, and West Virginia. These battleground states have either a toss-up gubernatorial election or Senate race, with two having both: Florida and Nevada.

Underneath that 63% of people seeking the protection of pre-existing conditions are 3 in 4 Democrats (74%), 2 in 3 Independents (64%), and 1 in 2 Republicans (49%).

Besides the desire to lower the price of prescription drugs, the issue of ensuring pre-existing conditions are protected is relatively bipartisan across the three party IDs, with 49% of Republicans, virtually one-half, desiring this health policy outcome.

What’s inconsistent with this position is that while half of Republicans embrace the guarantee of pre-existing conditions to be covered by health insurance, 71% of Republicans would desire that the Supreme Court overturn the Affordable Care Act — the centerpiece of which is the protection of pre-existing conditions for all health citizens. [Without a structure in place for health insurance markets in which to base the guarantee of pre-existing condition coverage, looking for that protection as a fragmented policy prescription won’t work.]

Other findings in this July 2018 Health Tracking Poll are that:

• Most Americans do not want to see the Supreme Court overturn Roe v. Wade (including 82% of Democrats, 70% of Independents, and 43% of Republicans)
• Half of the people living in states that did not expand Medicaid would want their Governors to expand Medicaid going forward
• 50% of Americans say that lowering the price of prescription drugs is most or very important for their vote in the mid-term elections.

KFF polled 1,200 U.S. adults 18 and older in July 2018 for this study, carried out in English and Spanish by telephone (via both cell/mobile and landlines).

Health Populi’s Hot Points:  Nearly one in two Americans across all ages has at least one pre-existing condition. The list of said conditions ranges from “A” for acne, acromegaly, AIDS or ARC, Alzheimer’s Disease, Amyotrophic Lateral Sclerosis, Anemia, Anxiety, Arthritis, Asthma, and Asbestosis, among other “A’s”; to “T,” such as Thyroid disease and Tuberculosis. There are dozens more conditions between A and T, but I wanted to give you a general idea that either “you,” or someone you care about, probably has at least one pre-existing condition.

And remember, too, that “P” for “pregnancy” is also a pre-existing condition, covered by the Affordable Care Act provisions.

Give this election year, it’s instructive to look at the third chart, organizing information from the Foundation’s analysis of the U.S. National Health Interview Survey taken across a national sample of U.S. patients. This is a list of the states with the highest levels of pre-existing conditions.

How interesting it is that this list includes so many of the 2018 mid-term election battleground states, such as West Virginia, Tennessee, Missouri, and Indiana. These and other states are also those that did not expand Medicaid. And these states, too, tend to have lower levels of health outcomes and well-being based on metrics I recently covered in this write-up on preventable heart disease in America.

Americans’ individual health and access to health care services is a tri-partisan issue in 2018, and expanding Medicaid is on the minds’ of at least one-half of residents living and trying to get care in States that did not expand Medicaid plans. Health care is local and the 2018 mid-term elections are all about local priorities this year. But health care? That’s local because it’s personal, and that’s national because every U.S. health citizen pays a huge price when every American isn’t covered – especially, for pre-existing conditions.

The post Healthcare, and Especially Covering Pre-Existing Conditions, Ranks High for Voters in 2018 appeared first on HealthPopuli.com.

Healthcare, and Especially Covering Pre-Existing Conditions, Ranks High for Voters in 2018 posted first on http://dentistfortworth.blogspot.com

Mid-week links

• Is statistics taking over journalism?  Regression to the mean in the MLB.
• Use of real-world evidence to measures NSCLC treatment effectiveness.
• Mental healthcare wait times adversely affect patient outcomes.
• Using cancer cells to kill cancer.
• Amazon to fill your Rx as you leave the hospital?
• Health plan won’t pay your ER bill…or will they?
• VBID and SES.
• Post-publication article review equilibrium?

Mid-week links posted first on http://dentistfortworth.blogspot.com

Does health insurance save lives?

According to one study by Martin Anderson presented at the NBER’s Program on Health Economics meeting May 4, the answer is yes.  Dr. Anderson examines the changes in insurance coverage, health care utilization, and mortality after the expansion of Medicare coverage to all patients with end stage renal disease (ESRD).  The study finds that:

…the expansions increased insurance coverage by between 22 and 30 percentage points…and increased physician visits by 18 to 35 percent. These expansions also decreased mortality due to kidney disease in the under 65 population by between 0.5 and 1.0 deaths per 100,000. Lastly, Andersen provides evidence for two mechanisms that affected mortality: an increase in access to and use of treatment, which may be due to changes in insurance coverage, and an increase in entry of dialysis clinics.

Another question was whether this was a cost-effective health insurance expansion.  He finds that the program saved between 2,000 and 14,000 life years per year, yet this health improvement was not sufficient to offset the program’s cost. At the same time, society typically places a high value on health improvements with patients with significant unmet need, and in the 1970s, patients with ESRD certainly had high unmet need.

Does health insurance save lives? posted first on http://dentistfortworth.blogspot.com

What information can pharmaceutical firms share with payers?

The government strictly regulates what information that pharmaceutical firms can share with payers.  There is good reason for this.  We don’t want drug companies making false claims that a drug can treat/cure a disease when there is no evidence to support that claim. Randomized controlled trials are the gold standard of clinical evidence and studies derived from those trials represent robust evidence that should be able to be communicated with payers. But what about the use of real-world evidence?  What about simulation models?  Economic models?  There has been a lot of uncertainty around what information pharmaceutical firms can and cannot share with payers.

A recent Health Affairs blog by Peter Neumann and Harry Weissman (“The FDA’s New Guidance On Payer Communications: Implications For Real-World Data And Value-Based Contracts“) reviews some recent FDA guidance updating the information pharmaceutical firms can share with payers.

For example, in the payer communication guidance, the FDA takes an expansive view of what it means to “relate” to an approved indication, expressing the idea that in their economic analyses drug companies can extrapolate long-term endpoints based on validated surrogate markers and use quality-adjusted life years (QALYs). In the past, questions have arisen about whether such information would mislead payers, given that long-term endpoints and QALYs are seldom studied in randomized clinical trials and included in product labels. The FDA’s guidance on information consistent with labeling should also help in that it indicates drug (and medical device) companies can promote post-marketing studies based on analyses of real-world databases (for example, on patients’ adherence to therapy) and use such data to support value-based contracts.

The article also notes that evidence provided in support of value-based contracts will be exempted from FDA reporting requirements.  In other words, pharmaceutical firms can use health care economic information (HCEI) flexibly in support of advancing value-based contracts.

Why has FDA made this decision?  They believe that payers unlikely to be duped by weak evidence.

“FDA believes that the risk that payers will be misled is relatively low. Payers are a sophisticated audience with established procedures to carefully consider the full range of relevant evidence about new use of products. Payers possess financial resources and motivation to closely scrutinize information from firms. In making decisions on a population basis, payers can draw on a range of expertise in multiple disciplines that allows them to critically evaluate information presented to them by firms, including an evaluation of the limitations and reliability of that information.”

 

What information can pharmaceutical firms share with payers? posted first on http://dentistfortworth.blogspot.com

What’s The Secret To All-Star Back-To-School Shopping?

If you’re anything like us, it feels like summer just started. However, looking at the calendar the dog days of summer will soon be winding down. Before you know it, you’ll be back in the lunch-packing, homework-checking, scurrying-out-the-door-for-the-bus routine. 

 

If you’re even more like us, then you’re starting to look around for deals on school supplies. If you’re going to do it, you want to do it right. The lists of requirements seems to be growing by the year, and prices definitely aren’t getting any cheaper. And whose children need another fresh supply refresh mid-year? We know that’s the case for us. 

 

Spending tons of money in July and August isn’t ideal when you’ll be forced to replenish broken crayons and dried-out glue in January. To ease your way back into the school schedule and to provide relief to your pocketbook, we’ve listed the best advice given to us by the most school supply shoppers in Fort Worth.  

 

1. Get the list early

 

As soon as your list becomes available from the school, get it and start looking for deals. Not everything on your list comes from the Back-to-School section at Target. For items like Kleenex, hand sanitizer or wipes, look out for deals that may not correspond directly with back to school. If you find paper products for a steal, for example—or cheaper options at retailers like Costco—go ahead and stock up. You’re unlikely to find a teacher who would ever turn down Kleenex and Clorox bleach wipes during flu season if you really end up with a surplus. 

 

2. Factor in your kid’s personality 

 

Everyone has their favorite school supplies. Whether it’s the super-expensive mechanical pencil or the box of 100 uniquely colored crayons, kids want what they want. In order to streamline, consider going alone so you won’t have to quibble over the number of Magic Markers. A few weeks into school, many supplies have been integrated together in a classroom, so choosing the biggest pack or coolest extras might not be meaningful anymore. And for older kids school supply shopping can be a great lesson in budgeting. Tell them their budget and guide their selections to ensure everything is checked-off the list. Offer them the option to keep their savings for an added smart-shopper incentive.  

 

3. Be a savvy shopper

 

If you don’t have time to get lost sifting through folders at Wal-Mart or Target, consider using your digital prowess to minimize stress and maximize efficiency. Most large retailers have apps that allow you to fill up your basket and have it waiting for you at the store—or even shipped to your house. Don’t forget about online retailers like Amazon, too.  

 

For added savings, put all the supplies in your cart and let them sit for a few days. Many times you’ll start to see sales or discounts pop up in your email that are meant to incentivize you to purchase. The best part is that you never have to leave the house! 

 

4. Work with your school

 

Many schools will offer PTA fundraisers that take all the hassle out of school supply shopping. Simply write a check and your student’s supply magically (or at least, that is how it feels) shows up on the desk the first day. For families who are traveling much of the summer or are new to the area, this can relieve a significant amount of stress.  

 

Follow these tips to score great deals on school supplies. If you have any strategies or see great deals, share with us on our Facebook page. We would love to help all our patients ease back into the school year! 

The post What’s The Secret To All-Star Back-To-School Shopping? appeared first on Fort Worth Dentist | 7th Street District | H. Peter Ku, D.D.S. PA.

What’s The Secret To All-Star Back-To-School Shopping? posted first on http://dentistfortworth.blogspot.com

Heart Disease in America: Zip Code Determines Cardiovascular Disease-Destiny

If you live in one of nine U.S. states, your chances of having heart disease are greater than living in the 41 others.

This geography-as-destiny for heart conditions is examined in The Burden of Cardiovascular Diseases Among US States, 1990-2016 published in JAMA Cardiology.

Researchers analyzed data on cardiovascular disease mortality, nonfatal health outcomes, and risk factors by age, sex, and year from 1990 to 2016 for the U.S. population. The outcome used to measure health by state was cardiovascular disease disability-adjusted life-years, or DALYs (FYI, “DALYs” are a commonly used metric in health economics research).   Pennsylvania

While overall cardiovascular disease DALYs decreased between 1990 and 2016, nine states’ results increased: Arkansas, Oklahoma, Alabama, Kentucky, Missouri, Indiana, Kansas, Alaska, and Iowa.

Men’s DALY’s for heart disease were twice as great as women’s.

Twelve risk factors were key to CVD DALYs — in particular, dietary risk exposures, high blood pressure, high body mass index (BMI), high total cholesterol, high fasting plasma glucose level, tobacco smoking, and low levels of physical activity.

The study concluded noting that differences in cardiovascular disease are amenable and responsive to behavior change based on the key risk factors.

Health Populi’s Hot Points: We know that geography can be destiny when it comes to understanding peoples’ health status. Look at the Blue Zones project, the Gallup-Healthways Wellbeing Index, the Aetna Healthiest Communities study, et al. Each of these research studies, and others, appreciate the multiple factors that help a person make health. These are the so-called Social Determinants of Health (SDOHs).

”Make health,” indeed, because these factors lie outside of the healthcare system. The JAMA Cardiology study found a deadly dozen risk factors contributing to the rise of cardiovascular disease in nine states. And we know that many of these states have other factors that can negatively influence their health citizens’ health status, like education attainment, lack of Medicaid expansion (for health care services access), and food deserts.

It is encouraging to see new tech efforts emerging to address SDOHs – such as the use of Lyft and Uber to transport patients to healthcare appointments, Amazon extending rime discounts to clients enrolled in Medicaid and SNAP benefits, and good food-as-medicine channeled to folks who need it, such as Geisinger’s Food Pharmacy.

Each of these, in themselves, are good things. But were I Health/care Queen of America, I would rule for a broader, more health-effective, cost-efficient context, embedding health into public policies for a greater and more holistic impact on the public’s health so that, state-by-state, it wouldn’t much matter if I was Alaskan, a Michigander, a New Yorker, or Texan. I’d just be an American Health Citizen.

The post Heart Disease in America: Zip Code Determines Cardiovascular Disease-Destiny appeared first on HealthPopuli.com.

Heart Disease in America: Zip Code Determines Cardiovascular Disease-Destiny posted first on http://dentistfortworth.blogspot.com

Is Trump stabilizing rather than repealing Health Insurance Exchanges?

While that may not be his intention, a study from Robert Wood Johnson has found that few carriers are leaving the market in 2019 and in fact there is likely to be a net increase in the number of health plans offered.

Favorable financial results for participating carriers is clearly the motivating factor, along with a continuation of the silver-loading policy that has created a relatively stable atmosphere for the subsidized part of the market. It’s possible that, at least in some markets, the marketplace population has become less costly to serve over time. It may be that the market is reaching the end of a multi-year “Goldilocks Process,” characterized by initially too many market participants, then too few, now perhaps closer to an amount that is “just right,” although this remains to be seen.

One issue, however, is that for this market to work, government subsidies will likely need to be continued.

 One thing that seems certain is that the focus of most carriers in the marketplace will be on the subsidized customer. The unsubsidized share will continue to be challenging, particularly in light of the elimination of the mandate and the prospect of short term and association health plans.

Nevertheless, Trump may not actually prove to be the end of Obamacare.

Is Trump stabilizing rather than repealing Health Insurance Exchanges? posted first on http://dentistfortworth.blogspot.com

Closing the Digital Health Gap Between Consumers and Physicians

 

Consumers are more bullish demanding virtual and digital health tools from their physicians than doctors are in providing it, based on the research findings in What can health systems do to encourage physicians to embrace virtual care? from Deloitte.

One-third of physicians have concerns about using virtual care services, such as medical errors that may result, access to technology, and data security.

 

 

 

 

 

 

 

One in two U.S. consumers are now tracking health via digital tools, and one-half of these share the data generated by their apps. That sharing is limited by doctors’ ability to accept patient-generated data, where only a handful of doctors have implemented technology for remote monitoring or integrating data from wearable technologies. One-fourth of doctors plan to implement this capability in the next two years.

Aside from the technology challenges, which are not trivial, physicians do concur with consumers about the potential benefits of virtual care to expand access, provide convenience to patients, and enable connections in-between office appointment times.

Deloitte surveyed 624 physicians and 4,530 consumers to gauge each stakeholder group’s perspectives on digital and virtual healthcare technologies, opportunities and concerns.

Health Populi’s Hot Points:  On a recent walk through Manhattan, I happened upon this ad in a bus stop kiosk promoting the wearable fitness tech products sold at Macy’s. “Macy’s?” you ask. Wearable tech is an important category these days in department stores, with discount retailers like Target and Walmart, at electronics outlets like Best Buy and, of course, via Amazon’s wearable tech ma

The smartwatch category, with fitness tracking, is hot in 2018, some “smarter” than others. Tech companies like Apple, Google, Samsung and Withings are competing with fashion watch purveyors like Fossil (which boasts dozens of popular brands like Burberry, DKNY, Armani, Diesel, Tory  Burch, Kate Spade, Callaway Golf, Skagen, Michele and Adidas, among others) and Tag Heuer.

As the Deloitte consumer-vs-physician study shows, there’s a gap between patients who are taking on more DIY healthcare tasks. Clinicians continue to have real concerns about clinical validity (per the AMA’s Dr. James Madara’s comment that so many of these tools and apps can be “digital snake oil.” And worries about medical error rates and privacy are also justifiable reasons for doctors to slow their adoption of (some) digital and virtual care platforms.

But evidence is growing for telehealth and a more remote health monitoring tools, some undergoing scrutiny by the FDA. We have reached a tipping point now that Medicare begins to pay for some virtual care services. Watch this space and don’t blink: virtual care will soon be, simply, “healthcare.”

The post Closing the Digital Health Gap Between Consumers and Physicians appeared first on HealthPopuli.com.

Closing the Digital Health Gap Between Consumers and Physicians posted first on http://dentistfortworth.blogspot.com

Friday Links

• Physicians as debt collectors.
• U.S. health care administrative costs.
• Cross-subsidies.
• A small donation.
• Most feared CEO in health care.

Friday Links posted first on http://dentistfortworth.blogspot.com

The value of rapid, cloud-enabled onsite testing

With co-authors Katalin Bognar, Michelle Brauer, Lauren Zhao, Rick Hockett, Michael O’Neil and Anupam Jena, I am excited to announce that our study “The potential value of rapid, cloud-enabled onsite testing for the diagnosis of rheumatoid arthritis in the United States” was published in the Journal of Medical Economics today.  The full abstract is below.  Do read the whole article.

Aims: Improvements in information technology have granted the recent development of rapid, cloud-enabled, onsite laboratory testing for rheumatoid arthritis (RA). This study aims to quantify the value to payers of such technologies.

Materials and methods: To calculate the value of rapid, cloud-enabled, onsite laboratory testing to diagnose RA relative to traditional, centralized laboratory testing, we created an Excel-based decision tree model that simulated potential cost-savings to payers who cover routine evaluations of RA patients in the United States. First, we created a conceptual framework to identify the value components of rapid, cloud-enabled onsite testing. Second, we measured value associated with patient time savings, savings on visit fees, change in treatment costs, and QALY improvements leveraging existing literature and information from an observational study. Lastly, we combined these value components to estimate the total incremental value accruing to payers per patient-year relative to centralized laboratory testing.

Results: Rapid, cloud-enabled, onsite testing is estimated to save 1 office and 1.81 laboratory visits during the evaluation period for the average patient. Results from an observational study found that rapid, cloud-enabled testing increased the likelihood of completing diagnostic orders from 84.5% to 97%, resulting in an increased probability of early treatment (3.5 percentage points) with disease-modifying anti-rheumatic drugs among patients eligible for treatment. The combined total value was $5,648 per evaluated patient-year. This value is primarily attributed to health benefits of early treatment ($5,048), fewer visit payments ($459), and patient time savings due to fewer office ($216) and laboratory visits ($255).

Limitations and conclusions: Data on the impact of rapid, cloud-enabled, onsite testing on patient health, care delivery, and clinical decision-making is scarce. More robust real-world data would confirm the validity of our model. Rapid, cloud-enabled, onsite testing has the potential to generate significant value to payers.

The value of rapid, cloud-enabled onsite testing posted first on http://dentistfortworth.blogspot.com

If Data Is The New Oil in Healthcare, Will It Be Safe to Drink? The Accenture Digital Health Tech Vision 2018

With the vast majority of patients’ medical records now digitized in electronic health records systems, the opportunities to mine, learn from, and act on the findings are promising for U.S. healthcare.

More data is moving into internet clouds every day, from healthcare encounters with clinicians and inpatient hospital stays to prescribed medicines, retail receipts for over-the-counter remedies, wearable technologies, credit card swipes for products and services, and GPS check-ins.

That’s a treasure trove of digital footprints that can tell a lot about us as patients, either in real-time or via prediction.

But can we nudge stakeholders in health and healthcare to “do no harm?”

This and other important questions will be brainstormed on the webcast hosted by Accenture on Wednesday 18 July 2018 as we discuss the five trends that paint the firm’s Digital Health Tech Vision 2018.

Accenture’s vision this year is built on five pillars:

• Citizen AI
• Extended Reality
• Data Veracity
• Frictionless Business, and
• The Internet of Thinking.

Together, these factors can bolster personalization and improve consumers’ experience in healthcare, but also have the power to invade, disrupt, and encroach on peoples’ physical and intimate lives in unwelcome ways.

The first trend is Citizen AI. Artificial or augmented intelligence, AI, is fast becoming part of the workflow across all industries. AI enables enterprises to take in a lot of data and make sense of it, with the power of better informing decisions. “The more data an AI is given, the better its predictions become,” Accenture notes.

But there’s a data stewardship role that’s crucial when an organization takes in peoples’ personal information: 81% of health executives agree that organizations aren’t prepared to deal with societal and liability issues that AI-based decisions may raise. How to be responsible, equitable, transparent as a good AI citizen? That’s part of “doing no harm” with data in healthcare. And the more good AI behavior will lead to greater adoption and more trust, in a virtuous cycle of data-sharing, data-using, greater productivity, and better health outcomes. That’s why 73% of health executives told Accenture they plan to develop internal ethical standards related to the use of AI to bolster responsible use of patients’ personal health information.

Extended reality here blurs the lines between physical and virtual, immersive environments. For healthcare, these platforms enable virtual and telehealth, as well as education, in new ways that transcend bricks-and-mortar settings, getting care and new forms of it to people where they live, work, and play. 83% of health executives believe that XR will provide a new foundation for interaction, communication and information, Accenture found.

Data veracity speaks to the data “speaking the truth.” The root of the word “veracity” is “ver,” as in the Spanish “verdad,” or the Greek, “In vino veritas.” Veracity here confronts data’s potential to be noisy, biased, or otherwise “abnormal.” One in 4 health care executives say they’ve been the target of AI bad behaviors like falsified location data and bot fraud more than once. Unsurprisingly, then, 3 in 4 health execs aren’t ready to deal with the “impending waves” of corrupted insights as faked data or faulty algorithms touch healthcare databases.

Frictionless business is the vision for streamlining healthcare and lubricating the value-chain for healthcare collaborators. As organizations come together from different parts of the healthcare ecosystem, there’s the potential for the partnerships to become cumbersome and complicated. “Legacy systems weren’t built to support this kind of rapid and robust expansion” we expect to help improve healthcare. What can help make collaborations fit more like LEGO pieces? Micro-services, APIs, blockchain, and other technology building blocks, Accenture recommends.

Finally, the Internet of Thinking rounds out Accenture’s five themes in the 2018 Digital Health Tech Vision. Consider the “Internet of Things” morphing to the “T” of “Thinking” (IoTh). In healthcare, this IoTh envisions embedded intelligent tools “everywhere,” and especially “at the edge.” This concept is important because bandwidth, storage and computational power costs resources, and healthcare is notoriously cost-constrained. But healthcare decisions can be better informed through AI, and AI requires a lot of data to feed the analytics process. Consider “the edge” as a strategic asset will help healthcare organizations engage with greater intelligence, Accenture believes.

Health Populi’s Hot Points:  In this post-Facebook/Cambridge Analytics era, consumers are justifiably wary about sharing personal information. But one touchpoint is more trusted than others for sharing information, and that’s the physician. I covered this important data point in Health Populi earlier this week.

Today I’ll be joined by Dr. Kaveh Safavi, MD, JD, Senior Global Managing Director with Accenture Health (@DrKavehSafavi), Lisa Suennen, Managing Director for GE Ventures (@VentureValkyrie), and Brian Kalis, Accenture’s Managing Director of Digital Health and Innovation (@BKalis), as we consider these trends and how they can help make healthcare better. Our webcast goes live at 11 am Eastern time, from Accenture studios on Wednesday, July 18, 2018. You can register here on this link.

I’ll post the video link here once it’s up online, so if you miss the live event, you can hear us wax lyrically about the 2018 Digital Health Tech Vision addressing data for good in healthcare.

 

The post If Data Is The New Oil in Healthcare, Will It Be Safe to Drink? The Accenture Digital Health Tech Vision 2018 appeared first on HealthPopuli.com.

If Data Is The New Oil in Healthcare, Will It Be Safe to Drink? The Accenture Digital Health Tech Vision 2018 posted first on http://dentistfortworth.blogspot.com