Literature Review

Characteristics of health systems operating Medicare Advantage PlansJAMA Health Forum; Aaron Hedquist, MSc; Eric Yu, MPH; Pasha Hamed, MA; E. John Orav, PhD; Austin Frakt, PhD; Thomas C. Tsai, MD, MPH; 11/24Health care delivery has rapidly transitioned from independent physicians and hospitals to integrated delivery networks. More than three-quarters of inpatient facilities are affiliated with a health system. Nearly 1 in 7 MA [Medicare Advantage] beneficiaries are enrolled in system-operated MA plans, which remain a consistent source of Medicare enrollment. The findings of this study suggest that larger and church-affiliated health systems are associated with a higher likelihood of operating an MA plan. System-operated MA plans were associated with higher quality ratings and patient satisfaction than unaffiliated MA plans.

How hospice CNAs provide comfort in end-of-life care Intelligent Living; by Jennifer Barns; 12/8/24 End-of-life care is one of the most challenging yet meaningful services that healthcare professionals can offer. During such a delicate time, the role of a hospice CNA becomes essential. ... Table of Contents:

Regulators extend some telemedicine flexibilities, gauge telehealth’s ‘new path forward’ in hospice Hospice News; by Holly Vossel; 12/4/24 Regulators recently extended certain temporary telemedicine waivers granted during the pandemic, with some flexibilities now sunsetting in 2025 rather than the end of this year. The U.S. Drug Enforcement Administration (DEA) and the U.S. Department of Health and Human Services (HHS) have announced the extension of telemedicine flexibilities for the prescribing of controlled medications until Dec. 31, 2025. ... The move was made in response to feedback the agencies received from more than 38,000 comments and two days of public listening sessions. The extension allows for more time to consider a “new path forward” for telemedicine, according to the DEA and HHS. “We continue to carefully consider the input received and are working to promulgate a final set of telemedicine regulations,” the agencies stated in an announcement. “With the end of 2024 quickly approaching, DEA, jointly with HHS, has extended current telemedicine flexibilities through December 31, 2025.” The temporary rule, entitled as the Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications, was recently submitted to the Federal Register and will take effect/become effective Jan. 1, 2025.

Two states lead the pack on palliative care access, many lag behind Hospice News; by Jim Parker; 12/10/24 Two states — Massachusetts and Oregon — rise above the rest when it comes to access to palliative care. This is according to the new rankings from the Center to Advance Palliative Care, America’s Readiness to Meet the Needs of People with Serious Illness Scorecard. The scorecard ranks each state’s capacity to deliver high-quality care to people facing serious illness on a five-star scale by evaluating five domains, according to Stacie Sinclair, the associate director for policy and care transformation at the Center to Advance Palliative Care (CAPC). To develop the scorecard, CAPC applied an updated methodology that considers metrics beyond those used in previous reports, which only examined the availability of palliative care in hospitals with 50 beds or more. 

Race and ethnicity, gender, and promotion of physicians in academic medicineJAMA Network Open; Lauren Clark, MS; Elena Shergina, PhD; Nathalia Machado, PhD; Taneisha S. Scheuermann, PhD; Nasrin Sultana, MS; Deepika Polineni, MD; Grace H. Shih, MD; Robert D. Simari, MD; Jo A. Wick, PhD; Kimber P. Richter, PhD, MPH; 11/24Medical school faculty training the next generation of physicians do not resemble the diversity of America. Compared with the US working population, American Indian, Black, and Hispanic people are underrepresented in the physician workforce. These findings indicate that preferential promotion of White men within academic medicine continues to persist in the new millennium, with racially and ethnically diverse women experiencing greater underpromotion. To achieve a workforce that reflects the diversity of the US population, this study suggests that academic medicine needs to transform its culture and practices surrounding faculty appointments and promotions.

The patient portal messaging crisisJAMA Neurology; Carrie K. Grouse, MD; Gregory J. Esper, MD, MBA; 12/24The patient portal has improved patient access to medical records and facilitated direct communication between patients and their health care teams, improving patient satisfaction, enhancing health care utilization, and increasing treatment adherence. Work associated with portal messaging has fallen primarily on physicians, requiring time outside clinical work hours to respond. Appointment access limitations have driven more asynchronous care delivery, resulting in more complex and time-consuming messages. This trend is causing higher levels of physician burnout, and female physicians are disproportionately affected. Burnout associated with excessive after-hours work in EHRs [electronic health records] is now noted among neurologists.

Promoting the resilience of health care information systems—The day hospitals stood stillJAMA Health Forum; Daniel B. Kramer, MD, MPH; Kevin Fu, PhD; 11/24On Friday, July 19, 2024, health care workers woke to emails declaring systemwide information technology (IT) emergencies. Because Crowdstrike had access to the most sensitive core parts of the Windows operating system, the automated process caused an immediate global outage of computer systems using the Crowdstrike Falcon product, which is embedded in many computer systems at health care organizations. Rather than accept this event as inherent to a complex, digitized, and wired health care ecosystem, we urge the US Congress, health care regulators, and the public to insist on proactive preventive methods to avoid future IT catastrophic events rather than simply waiting for the next disruptive crisis requiring an emergent response.

International comparison of underlying disease among recipients of medical assistance in dyingJAMA Internal Medicine; Brandon Heidinger, BSc; Colleen Webber, PhD; Kenneth Chambaere, PhD; Eliana Close, PhD; Luc Deliens, PhD; Bregje Onwuteaka-Philipsen, PhD; Thaddeus Pope, JD, PhD; Agnes van der Heide, MD, PhD; Ben White, DPhil, LLB, (Hons); James Downar, MD, MHSc; 12/24In 2023, 282 million individuals lived in jurisdictions allowing medical assistance in dying (MAID). But regardless of jurisdiction, cancer and amyotrophic lateral sclerosis (ALS) consistently account for up to 80% of MAID cases, despite accounting for fewer than 30% of all deaths. This observation is consistent with the idea that MAID is driven heavily by illness-related factors common to people with those illnesses and inconsistent with the idea that MAID is driven substantially by factors that are external to the individual and that vary by jurisdiction, such as eligibility criteria, culture, social assistance, or palliative care service availability. The overall incidence of MAID increased over time (per 1 calendar year ... )

Advance care planning, end-of-life preferences, and burdensome care-A pragmatic cluster randomized clinical trialJAMA Internal Medicine; Jennifer L. Wolff, PhD; Danny Scerpella, MPH; Erin R. Giovannetti, PhD; David L. Roth, PhD; Valecia Hanna, MS; Naaz Hussain, MD; Jessica L. Colburn, MD; Martha Abshire Saylor, PhD; Cynthia M. Boyd, MD; Valerie Cotter, DrNP; Maura McGuire, MD; Christine Rawlinson, MSN, RN; Danetta H. Sloan, PhD; Thomas M. Richards, MS; Kathryn Walker, PharmD; Kelly M. Smith, PhD; Sydney M. Dy, MD; for the SHARING Choices Investigators; 12/24Advance care planning (ACP) is a communication process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. In this pragmatic cluster randomized clinical trial, the SHARING Choices intervention increased new documentation of end-of-life preferences but also increased potentially burdensome care at end of life. Mixed findings underscore the importance of comprehensive support for those with serious illness and prioritizing patient-relevant outcomes in ACP interventional research. 

Allostatic load, educational attainment, and risk of cancer mortality among US menJAMA Network Open; Cynthia Li, BS, MD; Sydney P. Howard, DrPH, MS; Charles R. Rogers, PhD, MPH, MS, MCHES; Sydney Andrzejak, MS; Keon L. Gilbert, DrPH; Keith J. Watts, PhD, MSW; Malcolm S. Bevel, PhD, MSPH; Myles D. Moody, PhD, MA; Marvin E. Langston, PhD; Judah V. Doty, MS; Adetunji T. Toriola, MD, PhD, MPH; Darwin Conwell, MD, MSc; Justin X. Moore, PhD, MPH; 12/24Social determinants of health, such as income, occupation, and education, can influence cancer disparities in men. Men with limited access to education and income are more likely to have high allostatic load (AL), a measure of cumulative physiologic stress on the body over time. Chronic stress triggers prolonged neuroendocrine responses, resulting in elevated proinflammatory cytokines, catecholamines, and other proteins. This overactivation can lead to physiologic dysregulation and can promote cancer development. The findings indicate that men with lower educational attainment and high AL face up to a 4-fold increased risk of cancer mortality and nearly 70% increased risk of cancer mortality when accounting possible confounders. 

[Germany] Challenges of regional hospice and palliative care networks: A group discussion study with coordinators and network expertsPalliative Medicine; Sven Schwabe, Hanna Aa Röwer, Christoph Buck, Eileen Doctor, Nils Schneider, Franziska A Herbst; 12/24Within hospice and palliative care, professionals from various disciplines collaborate to deliver comprehensive care to terminal patients and their relatives. Regional hospice and palliative care networks face numerous challenges relating to: (1) establishment and development, (2) infrastructure, (3) moderation, (4) public relations and information exchange, (5) education and training and (6) the development of regional care services and practices. Sustainable infrastructure, competent network governance and adequate resources for network members are essential for the success of regional hospice and palliative care networks. To improve networking, funding conditions should be simplified, the involvement of network partners should be improved and network coordinators should receive training in network management.

Our unrealized imperative: Integrating mental health care into hospice and palliative careJournal of Palliative Medicine; Susan Block; 12/24The field of Hospice and Palliative Medicine (HPM) has its roots in the principles, promulgated by Dame Cicely Saunders, that patient and family are the unit of care and that comprehensive integration of physical, psychological, social, and spiritual care is necessary to address suffering in all its dimensions. Although we aspire to provide comprehensive care for our patients, most hospice and palliative care (HPM) physicians lack basic competencies for identifying and managing patients with psychological distress and mental health distress and disorders, a growing segment of our clinical population. I propose strategies to address these challenges focused on enhancing integration between psychiatry/psychology and HPM, changes in fellowship education and faculty development, addressing the stigma against people with mental health diagnoses, and addressing system and cultural challenges that limit our ability to provide the kind of comprehensive, integrative care that our field aspires to.