Literature Review

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

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.

To calm and to commend: Veterans’ musical preferences anticipating end of lifeMilitary Medicine; by Beatrice J Krauss; 11/24Listening to music was the most prevalent of the 20 coping mechanisms for stress in this sample of 30 veterans. Musical preferences were stable across age groups. For calming, music at resting heartbeat rhythms was chosen. Music from early adulthood or from the timelessness of the classics was selected most often. Modern music with lyrics has themes of duty, affirmation, gratitude, and relief. The nearly universal soothing effects of lullabies were recognized. For music for honor ceremonies, desires were often independent of the military branch. Patriotic songs, or songs recognizing multiple service branches, or with themes of peace and affirmation were more often chosen than music from a particular service branch.Publisher's note: Anticipating Veteran's Day on Monday.

[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.

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.

Specialized hospice care program honors and supports veterans facing terminal illness NBC 10 News - WSLS, Southwest and Centeral Virginia; by Kelly Marsh; updated 11/7/24 In Southwest Virginia, a quarter of people with a terminal illness is a veteran, a statistic that highlights the unique challenges many former service members face in their final days. In response to this, several specialized hospice programs in the region have been developed to offer care that specifically addresses the needs of veterans as they navigate the end-of-life journey. For many veterans, the experience of facing terminal illness is compounded by the physical and emotional toll of their military service, particularly conditions like Post-Traumatic Stress Disorder (PTSD), depression, and anxiety. ... The We Honor Veterans program, created through a partnership between the National Hospice and Palliative Care Organization and the U.S. Department of Veterans Affairs, encourages hospice centers to offer a heightened level of care for veterans. Across Southwest Virginia, multiple hospice programs have achieved the highest level of recognition—Level 5—demonstrating their commitment to providing veterans with the best possible care. One such program is based in Franklin County. Despite its size, Carilion Hospice in Franklin County has earned a five-star status for its exceptional veteran services ...Editor's note: We thank and recognize all hospice organizations that find meaningful ways to support and honor your veterans. Click here for more information about NHPCO/The Alliance for Care at Home's We Honor Veterans program.

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.

Most heart failure patients miss out on guideline-recommended palliative care Cardiovascular Business; by Dave Fornell; 11/6/24 Over the past decade, the American Heart Association (AHA) and European Society of Cardiology have recommended integrating palliative care into heart failure management. Despite these recommendations, the use of palliative care for heart failure remains low in the United States. Racial and geographic variations in access and use of palliative care are also pronounced, highlighting health disparities. These were the findings of a recent study in the Journal of the American Heart Association. Researchers at Saint Louis University led the study and said only one in eight patients with heart failure in the United States receive palliative care consultations within five years of diagnosis. Their study highlights the alarmingly low uptake of palliative care among adults with heart failure in the U.S., especially compared to patients with cancers that have the same mortality rates. The study also pointed out significant racial and geographic disparities. Black patients were 15% less likely to receive palliative care compared to their white counterparts. They said this disparity is particularly concerning given the higher cardiovascular risk and mortality rates in the Black population.