Lots of great work in this and adjacent areas across disciplines by @vmontori.bsky.social @michaelannica.bsky.social @ishaniganguli.bsky.social @mirandayaver.bsky.social @pamherd.bsky.social @donmoyn.bsky.social just among those I know are on Bluesky!
The conversation around patients’ treatment burden is sometimes framed around reducing the amount of health care - fewer visits, fewer meds. But it may not just be the amount of health care so much as the system that surrounds that care that contributes significantly to the experience of burden.
Increasing numbers of chronic conditions, depression, and sensory, functional, and mobility impairments were all associated with greater perceived burden of health care, suggesting opportunities to improve patient capacity as a means of reducing overall burden.
We found that administrative and financial burden were the most commonly cited sources of burden for older adults - more so than doctors’ visits or medications.
This survey within the Health and Retirement Study focused on patients’ self-reported experience of burden. There was a wide range of treatment burden levels, but almost 90% of older adults reported at least some treatment burden, with 5% reporting levels previously described as “unsustainable”.
Patients' perceived treatment burden is important not only because it reduces quality of life (esp. important in folks with serious illness and/or limited life expectancy), but also because it impacts adherence and potential future health care engagement and outcomes.
🚨 New paper: As a PCP, I often hear from patients that managing their health care feels like a full-time job. To understand this better, we analyzed the first nationally-representative US survey of older adults’ self-reported treatment burden: agsjournals.onlinelibrary.wiley.com/doi/10.1111/...
ICYMI, out in print this week. While we framed this Viewpoint with optimism, it can conversely be said that eroding health survey infrastructure means we’re flying a little more blind each day on priorities like chronic disease, maternal health, and substance use: jamanetwork.com/journals/jam...
NSDUH is one of the only ways we can track trends in substance use in the US. NSDUH is one of the only ways we can track adolescent mental health problems in the US.
We cannot afford to fly blind on these critical issues.
One big thing that AHRQ does is run the Medical Expenditures Panel Survey. This may sound like a trivial thing if you are outside the field. But the Congressional Budget Office relies on this information when modeling health policy changes. That is a huge deal.
Table: Ten key advances in CVD and stroke research funded by the NIH. Advances: Framiningham Heart Study, tPA treatment for ischemic stroke, statin therapy for CVD prevention, CRT for heart failure, RCTs for blood pressure management, improving care of children with heart conditions, developing and evaluating stents for treating coronary artery disease, gene editing for CVD, lifestyle interventions to reduce CVD risk, precision medicine
Many more pieces like this could be written to show the impact of sustained federal investment in US biomedical research. This one has a great table highlighting the role of NIH funding in some of our greatest gains against chronic disease in the past 80 years. www.ahajournals.org/doi/full/10....
1. Today the NIH director issued a new directive slashing overhead rates to 15%.
I want to provide some context on what that means and why it matters.
grants.nih.gov/grants/guide...
We just launched a 16TB archive of every dataset that has been available on data.gov since November. This will be updated day by day as new datasets appear. It can be freely copied, and we're sharing the code behind it to help others make their own archives of data they depend on.
I've caught myself thinking some version of this meme now when I hear folks describing their studies as target trial emulations.
The intensity and seriousness of cancer care has prompted attention to the wide-ranging impact of "time toxicity" of care on patients and caregivers. We would benefit from improved understanding of such burdens and their tradeoffs in other areas as well: jamanetwork.com/journals/jam...
"If someone had asked us in the summer of 2021 what we most needed to facilitate Mom’s healing and well-being, our wish list would have been modest."
So often our health care system fails to live up to its name of providing care: www.healthaffairs.org/doi/full/10....
Want to see if your research has had an impact on public policy?
Enter your info in SagePolicyProfiles to see the citations of your own publications in policy documents.
You get a profile page. Here is mine as an example: policyprofiles.sagepub.com/profile/5920...
I didn't know any of this policy story - worth the read. TL;DR 1980s regulatory changes enabled monopsony behavior by big chains, basically destroying the small local grocer.
For something short, quiet, and contemplative, I enjoyed A Month In the Country (JL Carr), Held (Anne Michaels), and Orbital (Samantha Harvey). For something long, fast-paced, and plot-driven, I second the recommendation for The Bee Sting (Paul Murray)!
As the baby boom generation enters its prime years for long-term care needs, its difficult to come up with a more challenging backdrop than an immigration system about to be cut off at its knees (think: nursing home aides) and states having to fill in funding gaps from Medicaid spending shortfalls.
A lot to think about in this review from a research perspective - what are the essential components of the underlying concept of "decision fatigue"? How do we operationalize that definition? How does this concept apply not only to clinicians, but to patients and caregivers?
#NewLitHighlights #HealthPolicy
Nurse practitioners and physician assistants are now responsible for over a quarter of outpatient visits in traditional Medicare - still a lot of room to understand how to optimize their role in clinical care: www.bmj.com/content/382/...
Reading the replies has been fascinating - it looks like there's a want for expectation-setting from first/senior authors what is needed from middle authors ("we think this is close to ready" vs "we welcome your feedback on x, y, and z specifically"). Not something I'd thought a lot of before!
I assume the draft is close to done and try not to line-edit. Exceptions include if there are critical omissions in the analysis, wording that is ambiguous or could mislead the reviewers, or we're way over word limit - but even then, usually framed as suggestions in comments.
Fiction - The Bee Sting (Paul Murray). Multiple-perspective tragicomic family saga. An object-level summary really doesn't do the book justice - my favorite by far for the year.
Non-Fiction - Endurance (Alfred Lansing). Great writing, an Antarctic adventure that's all the better knowing it's true.
Great advice on making the most of the shifts between clinical and research time as a clinician-investigator, applicable to folks at multiple levels. Wish I'd seen some of these tips before learning them the hard way! (via @BryantShuey)
jamanetwork.com/journals/jam...
If you've got any research (even in the pipeline) that might help better understand the effects of anti-obesity medications on health care and other federal spending, CBO wants to see it:
www.cbo.gov/publication/...
I've turned down requests to review when I don't think I can meet the stated deadlines (usually 2 weeks), but I could work with a longer time frame (like 4 weeks). But there's usually no option to communicate this upfront! As an editor, do you prefer that I just accept the request or decline it?
Not so many people here discussing #FDAPolicy #RxPolicy yet, but this one will be one to follow - for the first time, FDA exercises its FDORA power to expedite withdrawal of drugs initially approved via accelerated approval: www.bloomberg.com/news/article...
#HealthPolicy
