Literature Review

Any new beginning is forged from the shards of the past, not from the abandonment of the past. ~ Craig D. Lounsbrough

National Alliance for Care at Home, Transcend Strategy Group release hospice report HomeCare, Alexandria, VA and Washington, DC; HomeCare; 1/3/25 The National Alliance for Care at Home (The Alliance) and Transcend Strategy Group, a marketing agency for homecare companies, published the results of their Rural American Hospice Insights report, a new study that explored perceptions of hospice care among rural and small-town communities. The Alliance said the survey, which included 400 participants, aims to provide health equity and break down barriers to accessing hospice and homecare through knowledge sharing, data collection and collaborative discussion.  “Ensuring access to high-quality hospice and homecare in rural communities is critical,” said Steve Landers, CEO of The National Alliance for Care at Home. “These communities deserve care that is tailored to their unique needs, and in an America where more and more health care desserts are arising due to provider closures from inadequate reimbursement, maintaining quality care and continuing to build trust in the care provided is of the utmost importance."

Trends in private equity acquisition of pain management practicesJAMA Network Open; Geronimo Bejarano, MPH; James E. Eubanks, MD, MS; Robert T. Braun, PhD; 12/24Pain has the highest health care spending in the US and is expected to increase with the aging population, which may entice private equity acquisitions of pain management practices. Private equity has increasingly acquired physician practices and acquisitions are associated with higher spending, utilization of more expensive treatments, and increasing patient volume. In this cross-sectional study of private equity acquisitions of pain management practices, we found a rise in acquisitions over the last decade with almost 1 in 10 pain management physicians affiliated with a private equity–owned pain management practice. [The] ... high amount of consolidation within certain states poses concerns for private equity to have enough market power to control care delivery of several procedure-based specialties, including pain management. Policymakers and the Federal Trade Commission have taken notice of the harms of increases in both health care consolidation and private equity acquisitions, and there are ongoing efforts to curb their detrimental effects. 

Accountable Health Communities (AHC) Model: Third evaluation report (2018-2023)CMS press release; 12/27/24The Accountable Health Communities (AHC) Model tested whether connecting beneficiaries to community resources for their health-related social needs (HRSNs) improved health care utilization outcomes and reduced costs. [The five core HRNS's include housing instability, food insecurity, transportation problems, utility difficulties, and interpersonal violence.] Collectively, these findings provide evidence that navigation can transform the delivery of care in ways that address major HRSN barriers to health and promote health equity for underserved populations.

Health systems are struggling to keep up with AI - A national registration system could helpJAMA; Roy Perlis, MD, MSc; Rita Rubin, MA; 12/24This 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. In a Viewpoint published in JAMA this past August, Michael Pencina, PhD, Duke Health’s chief data scientist, argued for a federated registration system for AI and health. Dr Pencina:I strongly believe that every organization needs to know what AI solutions it has implemented. In particular, health systems should keep track of AI algorithms or other AI solutions they’re running in clinical care and clinical operations. Imagine a portal where you record all the AI that you’re running and all the information related to it. Say Duke does it, but another health system does it, and another health system. It becomes national. That opens really interesting opportunities for collaboration, information sharing, and enhancing the ecosystem, as well as transparency for patients, our ultimate stakeholders.

Recommendations to ensure safety of AI in real-world clinical careJAMA; Dean F. Sittig, PhD; Hardeep Singh, MD, MPH; 11/24As HCOs [health care organizations] adapt their clinical and administrative workflows to new AI [artificial intelligence]-driven technologies, unintended adverse consequences will inevitably occur, particularly during transitions. To address these risks, HCOs and AI/EHR [electronic health record] developers must collaborate to ensure that AI systems are robust, reliable, and transparent. HCOs must proactively develop AI safety assurance programs that leverage shared responsibility principles, implement a multifaceted approach to address AI implementation, monitor AI use, and engage clinicians and patients. Monitoring risks is crucial to maintaining system integrity, prioritizing patient safety, and ensuring data security. 

Hospice volunteering isn't for everyone but a rewarding way to give back News Talk 830 WCCO; by Susie Jones; 12/27/24 Volunteering is big part of the holiday season for some, with people wanting to help others even in difficult times. Being a hospice volunteer isn't for everyone.  It can certainly be scary to sit with someone who is dying. "It's not just a job, it's not just a volunteer gig, and I can always, always welcome new volunteers," says Allina Health hospice program administrator Erika Schuld. However, Schuld says it can be very rewarding. "You're in these really intimate, vulnerable settings, and you just form bonds really quickly, and it really is our honor in hospice to walk along with patients and families," explains Schuld. Doctor Glen Varns is the medical director of the program and he says volunteers do not administer medication. Instead they do other things to support families. Editor's note: The CMS standard 42 CFR §418.78(e) requires hospices to use volunteers for at least 5% of patient care hours. This was waived during the COVID-19 pandemic, and then reinstated May 11, 2023 when the Public Health Emergency (PHE) officially expired. CMS's volunteer requirement is unique to hospice care. Ensure that your hospice provides appropriate selection, background checks, required TB tests, job descriptions for different volunteer roles, matching of the volunteer to the best role, training, supervision, and tracking of hours for CMS's requirement. Additionally, your hospice must adhere to applicable state laws and internal HR Policies and Procedures regarding volunteers. Click here for the CMS standard.

Awards and Recognitions: December 2024

Accept your past without regret, handle your present with confidence, and face your future wtihout fear. ~Nicholas Sansbury Smith

Cheers to a new year and another chance for us to get it right. ~Oprah Winfrey

Head and neck cancer mortality in the Appalachian regionJAMA Otolaryngology-Head and Neck Surgery; Todd Burus, MAS; Pamela C. Hull, PhD; Krystle A. Lang Kuhs, PhD, MPH; 12/24In contrast to non-Appalachian US, where HNC [head and neck cancer] mortality rates declined considerably between 1999 and 2020, HNC mortality rates in the Appalachian region have remained stubbornly stable. Moreover, statistically significant increasing rates of HNC mortality in rural Appalachia provide evidence that the lack of rural HNC mortality improvements nationwide are associated with Appalachian disparities. While the exact factors driving these trends are unknown, the Appalachian region has an increased prevalence of multiple risk factors associated with cancer mortality, such as adverse social determinants of health, heightened alcohol and tobacco use, later stage at diagnosis, and limited access to care. Investments in the Appalachian region—such as through the Bipartisan Infrastructure Law or by expanding coverage of the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program among Appalachian states—could help reduce the burden of HNC mortality by improving cancer surveillance and serving the unique needs and experiences of the Appalachian population. These investments could also aid efforts to improve other cancer sites with known disparities in Appalachia, such as lung and colorectal cancers.

Current challenges in neurocritical care: A narrative reviewWorld Neurosurgery; Safa Kaleem, William T. Harris II, Stephanie Oh, Judy H. Ch'ang; 1/25Neurocritical care as a field aims to treat patients who are neurologically critically ill due to a variety of pathologies. As a recently developed subspecialty, the field faces challenges, several of which are outlined in this review ... [including confusion around] brain death testing or the diagnosis of brain death itself ... Given these difficult scenarios encountered in the neuro-ICU, conversations with patients’ decision-makers are often done with the assistance of palliative care services ... the most common reasons for palliative care consultation in the neuro-ICU were discussing prognosis, eliciting patient and family values, understanding medical options, and identifying conflict. Collaboration with hospital chaplains and palliative care services can be helpful, but cultural humility also needs to be a priority for neurocritical care providers to be able to navigate difficult conversations.

Conscience at the end of lifeNursing Reports; Ralph Neil Baergen, James Skidmore; 12/24Caring for patients at the end of life can involve issues that are ethically and legally fraught: withholding or withdrawing artificial nutrition and hydration, pain control that could hasten death, aggressive treatment that is continued when it seems only to be prolonging suffering, patients who request medical assistance in dying, and so forth. Clinicians may find that their deeply held ethical principles conflict with law, institutional policy, or patients' choices. In these situations, they may consider either refusing to participate in procedures that they find morally abhorrent (conscientious refusal) or providing care that they believe to be ethically obligatory despite being contrary to law or policy (conscientious commitment). Healthcare providers who refuse to provide medical services should be expected to explain their reasons, make prompt referrals, and bear some of the resulting costs or burdens.