Literature Review

I cannot do all the good the world needs. But the world needs all the good I can do. ~Jana Stanfield

Sunday newsletters focus on headlines and top read stories of the last week (in order) - enjoy!

Social determinants of health and US health care expenditures by insurerJAMA Network Open; Giridhar Mohan, MPH; Darrell J. Gaskin, PhD, MS; 10/24US health expenditures have been growing at an unsustainable rate, while health inequities and poor outcomes persist. In this cross-sectional study of 14,918 insured adults, individual-level SDOH were significantly associated with US health care expenditures by Medicare, Medicaid, and private insurers. These findings may inform health insurers and policymakers to incorporate SDOH in their decision-making practices to identify and control health care expenditures, advancing health equity.

Current burden of and geographic disparities in liver mortality and access to liver transplantJAMA Network Open; Nicolas S. Rinella, MS; William Charlton, BS; Gautham Reddy, MD; Paige McLean Diaz, MD; Michael R. Charlton, MD; 10/24This study suggests that rates of LRM [liver-related mortality] have increased dramatically since the COVID-19 pandemic and vary several-fold between states. Rates of liver transplant are paradoxically lowest among residents living in states with the highest LRM. These findings highlight apparent geographic disparities in access to liver transplant that allocation policy cannot address.

Financial hardship: A qualitative study exploring perspectives of seriously ill patients and their familyJournal of Pain and Symptom Management; by Danae G. Dotolo, Christina Clare Pytel, Elizabeth L. Nielsen, Jennifer Im, Ruth A. Engelberg, Nita Khandelwal; 11/24Our analysis revealed three themes: 1) Prioritizing Survival and Recovery; 2) Living with Uncertainty—including experiences of prolonged uncertainty, navigating bureaucratic barriers, and long-term worries; and 3) Preferences for Financial Guidance. Our results suggest patients and families prioritize survival over financial hardship initially, and feelings of uncertainty about finances persist. However, patients and family caregivers are reluctant to have their physicians address financial hardship.

“Postponing it any later would not be so great”: A cognitive interview study of how physicians decide to initiate goals of care discussions in the hospitalAmerican Journal of Hospice and Palliative Medicine; by Elizabeth Chuang, Sabrina Gugliuzza, Ammar Ahmad, Michael Aboodi, Michelle Ng Gong, Amber E Barnato; 11/24Participants were hesitant to commit to the present moment as the right time for [goals of care] GOC discussions based on variations in clinical presentation. Clinical decision support systems that include more targeted information about risk of clinical deterioration and likelihood of reversal of the acute condition may prompt physicians to discuss GOC, but more support for managing discomfort with uncertainty is also needed.

Clinician staffing and quality of care in US health centersJAMA Network Open; Q. Wilton Sun, BA; Howard P. Forman, MD, MBA; Logan Stern, DNP, APRN; et alBenjamin J. Oldfield, MD, MHS; 10/24In this cross-sectional study of 791 US health centers, 5 distinct clinician staffing ratio models were identified, and models emphasizing physicians, advanced practice registered nurses, and physician associates were positively associated with distinct sets of individual quality metrics. Clinician staffing may be associated with certain aspects of care quality, underscoring the importance of strategic, tailored staffing to optimize primary care delivery. In this cross-sectional study of health centers, physician FTE [full time equivalent] ratio was associated with higher performance in cancer screening, infant vaccinations, and HIV testing; APRN FTE ratio was associated with higher performance in preventative health assessments; and PA FTE ratio was associated with higher performance in infant vaccination.

[Switzerland] A French-language web-based intervention targeting prolonged grief symptoms in people who are bereaved and separated: Randomized controlled trialJMIR Formative Research; Anik Debrot, Liliane Efinger, Maya Kheyar, Valentino Pomini, Laurent Berthoud; 10/24Losing a loved one, through death or separation, counts among the most stressful life events and is detrimental to health and well-being. About 15% of people show clinically significant difficulties coping with such an event. Web-based interventions (WBIs) are effective for a variety of mental health disorders, including prolonged grief. However, no validated WBI is available in French for treating prolonged grief symptoms.

[UK] Large language models for mental health applications: Systematic reviewZhijun Guo, Alvina Lai, Johan H Thygesen, Joseph Farrington, Thomas Keen, Kezhi Li; 10/24The study identifies several issues: the lack of multilingual datasets annotated by experts, concerns regarding the accuracy and reliability of generated content, challenges in interpretability due to the "black box" nature of LLMs [large language models], and ongoing ethical dilemmas. These ethical concerns include the absence of a clear, benchmarked ethical framework; data privacy issues; and the potential for overreliance on LLMs by both physicians and patients, which could compromise traditional medical practices. As a result, LLMs should not be considered substitutes for professional mental health services. However, the rapid development of LLMs underscores their potential as valuable clinical aids, emphasizing the need for continued research and development in this area.

Why Judy Faulkner believes in 'yin-yang' leadership Becker's Health IT; by Giles Bruce; 11/4/24 Epic founder and CEO Judy Faulkner says effective leadership teams typically consist of people who balance each other out. She pointed to the definition of "yin and yang" as "complementary and at the same time opposing forces that interact to form a dynamic system in which the whole is greater than the assembled parts and the parts are important for cohesion of the whole," she wrote in a Nov. 4 blog post. Ms. Faulkner has often noticed that two people in leadership roles have great success together because they're so different.

The drivers of new C-suite role creation Becker's Hospital Review; by Kelly Gooch and Kristin Kuchno; 11/5/24 In creating new C-suite roles within healthcare, hospitals and health systems have cited reasons as varied as seeing new opportunities for growth or finding gaps in coverage as their motivation. At least 31 new leadership roles have been added to healthcare organizations since February 2024. Among the new roles are chief health equity officer, chief decarbonization officer and chief experience officer. Here is why four organizations added new roles to their executive leadership teams.

West Virginia voters narrowly approve state constitutional ban on physician-assisted suicide WVNews - West Virginia's News; by Steven Adams; 11/7/24 An amendment to West Virginia’s constitution to prohibit physician-assisted suicide — already illegal in the state — managed to squeak through after Tuesday’s election with just enough votes, though the vote was a statistical tie. According to unofficial election results posted by the West Virginia Secretary of State’s Office, Amendment 1 passed, with 335,822 votes (50.5%) for and 329,742 against (49.5%) — a difference of 6,080 votes. The West Virginia Legislature adopted House Joint Resolution 28 during the 2024 regular session earlier this year. The joint resolution placed on the November general election ballot a proposed state constitutional amendment that would ban medically-assisted suicide and/or euthanasia.  

Nurse burnout the root of decreased resident safety, medication errors, study shows McKnights Long-Term Care News; by Zahara Johnson; 11/6/24 A new study has found a direct link between nurse burnout and unfavorable patient and facility outcomes, including medication errors and a degraded safety culture. The meta-analysis of 85 studies and 288,581 nurses, compiling more than 30 years of research, concluded that nurses who suffer from burnout – emotional exhaustion, depersonalization and a low sense of personal accomplishment – have a negative impact on patients.