Literature Review
Increasing Medicaid rates: A critical step to support home-based care
01/19/25 at 03:40 AMIncreasing Medicaid rates: A critical step to support home-based care Association Press, North Salt Lake, UT; by Business Wire; 1/14/25To address the growing challenges facing the healthcare system, the Homecare and Hospice Association of Utah (HHAU) calls for an urgent increase in Medicaid reimbursement rates for Home and Community-Based Services (HCBS) waivers, Private Duty Nursing (PDN), and Home Health. These critical services form the backbone of home-based care, enabling individuals to receive the medical attention and support they need in their homes, while saving tax dollars and alleviating strain on hospitals and long-term care facilities.
Guidelines for evaluating, diagnosing, and disclosing dementia published by Alzheimer’s Association
01/19/25 at 03:35 AMGuidelines for evaluating, diagnosing, and disclosing dementia published by Alzheimer’s Association Practical Neurology; 1/14/25 The Diagnostic Evaluation, Testing, Counseling, and Disclosure Clinical Practice Guideline (DETeCD-ADRD CPG) Workgroup, convened and funded by the Alzheimer’s Association, has developed new recommendations for clinicians to use when evaluating patients with possible Alzheimer disease (AD) or AD and related dementias (ADRD). An executive summary of the recommendations for use in primary care and other practice settings was published in Alzheimer’s & Dementia, along with a companion article summarizing specific guidance for specialists. The Workgroup included representatives from primary, specialty, subspecialty, long-term, and palliative care disciplines as well as the fields of health economics and bioethics. Editor's note: Click for open access to the Alzheimer's Association clinical practice guidelines ..., executive summary of recommendations for primary care.
Physician engagement in addressing health-related social needs and burnout
01/19/25 at 03:30 AMPhysician engagement in addressing health-related social needs and burnoutJAMA Network Open; Masami Tabata-Kelly, MBA, MA; Xiaochu Hu, PhD; Michael J. Dill, MA; Philip M. Alberti, PhD; Karen Bullock, PhD, LICSW, APHSW-C; William Crown, PhD; Malika Fair, MD, MPH; Peter May, PhD; Pilar Ortega, MD; Jennifer Perloff, PhD; 12/24In this cross-sectional study of 5,447 nationally representative physicians in the US, 34.3% regularly dedicated time to addressing HRSNs [health-related social needs]. The study identified variability in physicians’ engagement in addressing HRSNs and found that higher engagement was associated with a greater likelihood of burnout. The findings suggest the need for thorough assessment of the potential unintended consequences of physicians’ engagement in addressing HRSNs on their well-being.
Cancer prevention, screening averted several million more deaths than treatment over 45 years
01/19/25 at 03:25 AMCancer prevention, screening averted several million more deaths than treatment over 45 yearsJAMA; Samantha Anderer; 1/25In the US, cancer prevention and screening have saved more lives from 5 types of cancer combined than treatment advances over the past 45 years, according to a modeling study published in JAMA Oncology. An estimated 5.9 million breast, cervical, colorectal, lung, and prostate cancer deaths were avoided from 1975 to 2020 due to prevention, screening, and treatment efforts, but prevention and screening alone were responsible for averting about 4.8 million—4 out of 5—of those deaths. Still, the authors acknowledged that in all cancer types studied, less than half of total cancer deaths were averted, and they recommended increased investment in prevention and screening strategies.
Introduction: ‘Those who have made death their life’
01/19/25 at 03:20 AMIntroduction: ‘Those who have made death their life’The Daily Yonder - Keep It Rural; by Hannah Clark; 1/15/25 Hannah Clark spent six months riding along with the nurses and certified nursing assistants (CNAs) of Hearth Hospice who provide in-home care to those living in Northwest Georgia and Southeast Tennessee. These hospice workers often drive up to a hundred miles a day to visit a handful of patients scattered across the Appalachian landscape in both rural towns and urban centers. What will follow this introductory essay is her photo reportage in three parts, documenting what she has witnessed accompanying these caregivers. The intimate portraits and vignettes show tender moments at different stages towards the end of one’s life. Their beauty lies in the companionship Clark captured in moments of need and vulnerability. Editor's note: Crucial protocols used for this photographer are worth highlighting. "Before I began working with nurses, I went through a background check, drug screening, and volunteer training. Written permission was given by each household. When patients could not consent due to certain conditions such as Alzheimer’s or Dementia, or patients were non-responsive or actively passing, permission was granted by their power of attorney."
California wildfires and healthcare: Compiled articles
01/19/25 at 03:15 AMCalifornia wildfires and healthcare: Compiled articlesCompiled from various news sources; 1/9/25Click on links below to go to the source articles.
Special Bulletin – CA Wildfires Public Health Emergency
01/19/25 at 03:10 AMSpecial Bulletin – CA Wildfires Public Health EmergencyCommunity Health Accreditation Partner (CHAP); Special Bulletin; 1/14/2025 HHS Declares Public Health Emergency for California to Aid Health Care Response to Wildfires. The declaration follows President Biden’s major disaster declaration and gives the Centers for Medicare & Medicaid Services’ (CMS) health care providers and suppliers greater flexibility in meeting the emergency health needs of Medicare and Medicaid beneficiaries. HHS has waived sanctions and penalties for violations of certain provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule against hospitals in the emergency area. [Click on the title's link to continue reading]
Researchers compared hospital early warning scores for clinical deterioration—Here’s what they learned
01/19/25 at 03:05 AMResearchers compared hospital early warning scores for clinical deterioration—Here’s what they learnedJAMA Network; Roy Perlis, MD, MSc; Jennifer Abbasi; 1/24This conversation is part of a series of interviews in which JAMA Network editors and expert guests explore issues surrounding the rapidly evolving intersection of artificial intelligence (AI) and medicine. Arecent head-to-head study at Yale New Haven Health System compared 6 different early warning scores designed to recognize clinical deterioration in hospitalized patients, including 3 proprietary AI tools. Among the best was the National Early Warning Score (NEWS), a publicly available non-AI tool, while the Epic Deterioration Index “was one of the worst” of the batch, the authors reported in October in JAMA Network Open.
Sunday newsletters
01/19/25 at 03:00 AMSunday newsletters focus on headlines and top read stories of the last week (in order) - enjoy!
Today's Encouragement
01/19/25 at 03:00 AMDo It Anyway by Mother Teresa / Kent M. KeithPeople are often unreasonable, illogical, and self-centered; forgive them anyway.If you do good, people may accuse you of selfish, ulterior motives; do good anyway...
How to help people impacted by the California fires
01/19/25 at 03:00 AMHow to help people impacted by the California firesNBC News - Today Show; by Becca Wood; 1/8/24, updated 1/12/24... As homes burn to the ground and people seek shelter, various charities and organizations are working to provide help on the ground. For those looking for ways to help, NBC News has reviewed and vetted organizations that are aiding in relief efforts. Here is a list of verified charities. Click on the names of each for more information how to help.
Today's Encouragement - You've gotta dance...
01/18/25 at 03:55 AMYou've gotta dance like there's nobody watching, Love like you'll never be hurt, Sing like there's nobody listening, And live like it's heaven on earth. ~ William W. Purkey
Current use and evaluation of artificial intelligence and predictive models in US hospitals
01/18/25 at 03:50 AMCurrent use and evaluation of artificial intelligence and predictive models in US hospitalsHealth Affairs; by Paige Nong, Julia Adler-Milstein, Nate C. Apathy, A. Jay Holmgren, Jordan Everson; 1/25Effective evaluation and governance of predictive models used in health care, particularly those driven by artificial intelligence (AI) and machine learning, are needed to ensure that models are fair, appropriate, valid, effective, and safe, or FAVES. We analyzed data from the 2023 American Hospital Association Annual Survey Information Technology Supplement to identify how AI and predictive models are used and evaluated for accuracy and bias in hospitals. Hospitals use AI and predictive models to predict health trajectories or risks for inpatients, identify high-risk outpatients to inform follow-up care, monitor health, recommend treatments, simplify or automate billing procedures, and facilitate scheduling. We found that 65 percent of US hospitals used predictive models, and 79 percent of those used models from their electronic health record developer.Publisher's note: It would be interesting if hospices collected and reported similar information.
Whom should we regard as responsible for health record inaccuracies that hinder population-based fact finding?
01/18/25 at 03:45 AMWhom should we regard as responsible for health record inaccuracies that hinder population-based fact finding?AMA Journal of Ethics; Kathleen M. Akgün, MD, MS; Shelli L. Feder, PhD, APRN; 1/25EHR [electronic health record] use has revolutionized health information collection and analysis. This growth has led to opportunities to generate important reports about the health of hundreds of millions of people practically in real time. Steadfast commitment to high-quality data collection and reporting is necessary for all parties along the pathway of data generation: from EHR developers, programmers, and vendors to patients, clinicians, and epidemiologists. Pulling back the curtain on how each of these groups generate and interact with EHR data is imperative to assure measurement of accurate population-level health outcomes.
Development and outcomes of a provider-driven, online continuing education program on integrative palliative care: Randomized controlled trial
01/18/25 at 03:40 AMDevelopment and outcomes of a provider-driven, online continuing education program on integrative palliative care: Randomized controlled trialGlobal Advances in Integrative Medicine and Health; William Collinge, PhD, MPH; Leila Kozak, PhD; Scott Mist, PhD, MAcOM; Robert Soltysik, MS; 1/25While conventional medicine excels in emergency and acute care, complementary therapies are increasingly being integrated into efforts for symptom management and quality of life (QoL) in hospital, hospice and nursing home environments. The term “complementary” denotes a cooperative or collaborative relationship between conventional and unconventional modalities, and when such integration takes place, the terms “complementary” and “integrative” are commonly used interchangeably. Hospices have been early adaptors of such therapies with surveys in various states showing between 60-90% of hospices offering these modalities. This provider-driven CE/CME program led to significant positive changes in practitioners’ self-efficacy and implementation of integrative care practices in PC settings. The results indicate that CE/CME can have measurable impacts that benefit providers and may potentially impact patients, families and the culture of care.
Empowering Patient Choice: The Essential Need for a Voluntary Advance Directive Framework in Healthcare
01/18/25 at 03:35 AMPublic healthAlzheimer's and Dementia; Stephanie Frilling; 12/24A Medicare Voluntary Advance Directive Framework (Framework) would enable the creation, storage, and sharing of advance directive documents, ensuring end-of-life care appropriately honors the individual and their care wishes, while supporting healthcare teams and family members in making care decisions for their patients and loved ones. With Medicare enrollment reaching over 65 million beneficiaries in 2023, and Alzheimer's becoming one of the most expensive conditions - CMS policy makers have a growing responsibility to improve care quality at end-of-life.
Preferred and actual location of death in adolescents and young adults with cancer
01/18/25 at 03:30 AMPreferred and actual location of death in adolescents and young adults with cancerJAMA Network Open; by Oreofe O. Odejide, Colin Cernik, Lauren Fisher, Lanfang Xu, Cecile A. Laurent, Nancy Cannizzaro, Julie Munneke, Robert M. Cooper, Joshua R. Lakin, Corey M. Schwartz, Mallory Casperson, Andrea Altschuler, Lori Wiener, Lawrence Kushi, Chun R. Chao, Jennifer W. Mack; 1/14/25In this cohort study of 1929 adolescent and young adult (AYA) decedents, 1226 (63.6%) had a documented discussion about their preferred location of death, with home being most frequently desired. Among these, 224 of 317 (70.7%) who wanted to die at home were able to do so, as were 164 of 172 (95.3%) who preferred a hospital death. The fact that over a quarter of AYA patients with cancer who preferred to die at home were unable to do so suggests a need for effective interventions to improve goal-concordant end-of-life care for AYA patients with cancer.
Advance care planning among diverse U.S. older adults with varied cognition levels
01/18/25 at 03:25 AMAdvance care planning among diverse U.S. older adults with varied cognition levelsAlzheimer's & Dementia; by Zahra Rahemi, Swann Arp Adams; 1/25Older adults from minority groups often experience elevated rates of chronic diseases and cognitive impairment, coupled with lower rates of engagement in advance care planning (ACP) and comfort care as they approach end of life... Our study revealed that individuals facing cognitive impairments exhibited lower rates of engagement in ACP. Notably, among the variables examined, race, ethnicity, rural residence, education, and age emerged as significant predictors of ACP in a national sample of older adults in the U.S. These findings underscore the importance of incorporating these sociodemographic factors into the design of interventional studies aimed at enhancing ACP and mitigating disparities.
Sociodemographic disparities in the use of hospice by U.S. nursing home residents: A systematic review
01/18/25 at 03:20 AMSociodemographic disparities in the use of hospice by U.S. nursing home residents: A systematic reviewAmerican Journal of Hospice and Palliative Medicine; Christine E. DeForge, PhD, RN, CCRN; Hsin S. Ma, MPP, MA; Andrew W. Dick, PhD; Patricia W. Stone, PhD, RN, FAAN, CIC; Gregory N. Orewa, PhD; Lara Dhingra, PhD; Russell Portenoy, MD; Denise D. Quigley, PhD, MA; 1/25 Hospice can improve end-of-life (EOL) outcomes in U.S. nursing homes (NHs). However, only one-third of eligible residents enroll, and substantial variation exists within and across NHs related to resident-, NH-, or community-level factors. Studies adjusting for resident-, NH-, and community-level factors found lower hospice use among male residents, Black/Non-White residents, and residents of rural NHs, with mixed results by payor and ownership. Results were mixed for hospice referral and length-of-stay. These findings suggest complex influences on NH hospice use.
Medicare to Veterans Affairs cost shifting—A challenging conundrum
01/18/25 at 03:15 AMMedicare to Veterans Affairs cost shifting—A challenging conundrumJAMA Health Forum; Kenneth W. Kizer, MD, MPH, DCM; Said Ibrahim, MD, MPH, MBA; 12/24In this issue, Burke et al highlight how costs previously paid by Medicare for VA-Medicare dual eligible enrollees are now being paid by the VA under the VCCP [Veterans Community Care Program]. Today, there is reason to be concerned whether VA health care will be adequately funded because of the rapidly rising VCCP expenditures (driven in part by Medicare to VA cost shifting) and the impact of caring for an additional 740,000 enrollees who have entered the system in the past 2 years. This has created a $12 billion medical care budget shortfall for FY 2024. The substantial budgetary tumult that has resulted from these dynamics is adversely impacting the front lines of care delivery at individual VA facilities, leading to delays in hiring caregivers and impeding access to VA care and timely care delivery, as well as greatly straining the traditional roles of VA staff and clinicians trying to manage the challenging cross-system referral processes. The intertwined issues of Medicare to VA cost shifting and the rising costs of the VCCP present a challenging policy and programmatic conundrum.
Effective solutions for caregivers of older adults: A review of systematic reviews
01/18/25 at 03:10 AMEffective solutions for caregivers of older adults: A review of systematic reviewsJournal of Applied Gerontology; Molly McHugh, Ellen Munsterman, Hannah Cho; 1/25This umbrella review aims to describe caregiver interventions tested across populations of informal caregivers of older adults and to examine the effect of caregiver interventions on depression, burden, and quality of life across intervention types and care-recipient populations. Most commonly, interventions focused on improving outcomes for caregivers of older adults with dementia. Among the included reviews, caregiver depression was most likely to be reduced by caregiver interventions, and cognitive behavioral therapy (CBT) and mindfulness-based interventions (MBI) were most effective. The use of information and communication technologies to deliver caregiver interventions is increasingly common. Standardization of intervention classifications and transparent reports of intervention delivery details will strengthen research in this field.
“I aim to fulfill my promise”: Dementia caregiving from the perspective of spouses and partners
01/18/25 at 03:05 AM“I aim to fulfill my promise”: Dementia caregiving from the perspective of spouses and partnersJournal of Applied Gerontology; Haley M. Shiff, Theresa A. Allison, Madina Halim, Kenneth E. Covinsky, Alexander K. Smith, Deborah E. Barnes, Jennie M. Gubner, Kara Zamora; 1/25In the United States, spouses provide 17% of in-home care for people living with dementia. We found common features underlying the care provided by spouses/partners, including challenges and motivators guided by notions of loyalty and commitment. As cognition and function declined, care partners found the relationship increasingly difficult. They shared the feeling of being stuck as well as the loss of identity and freedom. This finding follows what Westrelin et al. (2024) describe in their study on spousal caregivers of partners living with dementia, in which spouses perceived changes not only in their partner but also in themselves and oscillated between their identity as a caregiver and as a spouse, highlighting the dynamic nature of caregiver identity construction within the context of caring for a partner living with dementia.
[The Netherlands] Family concerns in organ donor conversations: A qualitative embedded multiple-case study
01/18/25 at 03:05 AM[The Netherlands] Family concerns in organ donor conversations: A qualitative embedded multiple-case studyCritical Care; Sanne P C van Oosterhout, Anneke G van der Niet, Wilson F Abdo, Marianne Boenink, Jelle L P van Gurp, Gert Olthuis; 12/24Listening and responding to family concerns in organ and tissue donation is generally considered important, but has never been researched in real time. [This study found that] concerns clustered around six topics: 1) Life-event of a relative's death, 2) Dying well, 3) Tensions and fears about donation, 4) Experiences of time, 5) Procedural clarity, and 6) Involving (non-)present family. When concerns were highly charged with emotion, the clinicians' responses were less frequently attuned to families' needs. The identified concerns and the distinction between clearly and less clearly articulated concerns may prove valuable for clinicians to improve family support. We advise clinicians to engage with a curious, probing attitude to enhance the dialogue around concerns, elaborate on less clearly articulated concerns and identify the informational needs of the family.
Saturday newsletters
01/18/25 at 03:00 AMSaturday newsletters focus on headlines and research - enjoy!
[Canada] Qualitative bereavement experiences and support in community-dwelling older adults: A scoping review
01/18/25 at 03:00 AM[Canada] Qualitative bereavement experiences and support in community-dwelling older adults: A scoping reviewOmega-Journal of Death and Dying; Samantha Teichman, Barbara A. Mitchell, Indira Riadi, Habib Chaudhury, Albert Banerjee, William Odom; 12/24This scoping review examines qualitative studies on bereavement experiences and support mechanisms for community-dwelling older adults. This area of research is especially timely given rapid population aging and the interplay of heightened vulnerability, cumulative losses, shrinking support systems, and the critical need for bereavement support. Such support not only acts as a preventative health measure but can also serve as a catalyst for fostering meaning-making and navigating grief in later life. Through a scoping search and synthesis of relevant qualitative studies ..., the findings reveal four key themes: the impact of grief on wellbeing, grief perceived as an individual issue, challenges in seeking and receiving support, and positive support experiences and transformations. This discussion contributes to developing targeted bereavement support strategies for community-dwelling older adults.