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Poll of Tennessee parents suggests some misconceptions about antibiotics, related care

lowaryj — Thu, 18 Apr 2024 15:01:28 +0000

Poll of Tennessee parents suggests some misconceptions about antibiotics, related care lowaryj Thu, 04/18/2024 - 10:01 RSS:

The majority of Tennessee parents take their children to their primary care provider or pediatrician when they are sick, but the latest analysis of polling by the Vanderbilt Center for Child Health Policy of parents across the state suggests there are misconceptions about antibiotics, and their use in treating viral infections.

More than 1,000 Tennessee parents across the state were polled in fall 2023 about their perceptions and use of antibiotics to treat viral illnesses in their children. Only 44% of parents agreed that antibiotics were not needed when their child was sick with a viral infection.

Antibiotics are effective treatments for bacterial infections, like strep throat for example, but are ineffective at treating viral infections like the common cold, influenza, respiratory syncytial virus or COVID-19.

About 20% said they would seek a second opinion or ask for an antibiotic at an urgent care visit if their primary care provider said antibiotics were not needed for their child’s viral infection.

"There are tons of germs in the world, but most can be separated into a just few groups. One of those groups is bacteria and another is viruses. Antibiotics, like amoxicillin, are only able to help if the germ that's causing the illness is a bacteria, like in strep throat. However, they don't provide any benefit when treating viruses, like the common cold. It's like using a mousetrap to kill a fly — the fly isn't affected at all by the trap. This is why sometimes kids need antibiotics when they're sick and sometimes they don't,” said Dr. Brittany Lehrer, a third-year pediatric infectious disease fellow at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

One reason care providers are careful about prescribing antibiotics are potential side effects, notably the possibility that new bacteria develop that are more resistant to common and effective antibiotics, like amoxicillin.

“Antibiotics can cause side effects and have downstream impacts on development of antibiotic-resistant bacteria, so they may not work in the future if needed. It’s best to avoid antibiotics unless they’re really needed,” said Dr. Sophie Katz, assistant professor of Pediatric Infectious Diseases at Monroe.

Perceptions about antibiotics differed among the state’s three grand divisions as well, researchers noted. Less than 40% of parents in West Tennessee agreed that antibiotics were not needed for viral infections, and less than half in Middle and East Tennessee agreed.

While most parents said they visit a provider to make sure their child is OK, more than 14% said they visit a provider so their child can return to school faster by either antibiotic treatment or a school note, which researchers said could indicate challenges for many parents face balancing work with child care and possible school absences and learning loss.

“For viral infections like the common cold or pink eye, requiring antibiotic treatment before a child can return to school can drive unnecessary and inappropriate antibiotic use. Schools and child care centers can play an important role in advocating for appropriate antibiotic use,” Katz said.

The annual Vanderbilt Child Health Poll is conducted each fall and covers a range of health and policy issues impacting Tennessee parents and children. The poll is funded in part by a grant from the Boedecker Foundation.

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Poll: Tennessee families with children say they are food insecure

lowaryj — Thu, 21 Mar 2024 15:58:27 +0000

Poll: Tennessee families with children say they are food insecure lowaryj Thu, 03/21/2024 - 10:58 RSS:

Over 40% of Tennessee families with children say they are food insecure; 70% have changed spending on food

by Jake Lowary

This year’s Vanderbilt Child Health Poll shows that over 40% of Tennessee families report they are food insecure ― a similar proportion from last year. Most families (71%) say they have continued to change food spending habits due to high prices.

The annual poll from the Vanderbilt Center for Child Health Policy asked more than 1,000 Tennessee parents a series of questions on food security and the use of food assistance programs. In the poll, food insecurity was evaluated using a standardized questionnaire from the U.S. Department of Agriculture (USDA). According to the USDA, food insecurity occurs when “there is limited or uncertain availability of food or limited or uncertain ability to acquire food in socially acceptable ways.”

This year’s poll also found substantial racial disparities in food insecurity across Tennessee, with 49% of Black families reporting food insecurity compared to 40% of white families. Among families who have changed their food spending habits, 38% of Black parents versus 24% of white parents reported skipping a meal. There are also differences across grand regions of the state, with more food insecure families in West (49%) and East (43%) than in Middle (34%) Tennessee.

“The fact that 2 in 5 Tennessee families continue to struggle with food insecurity tells us that families need additional support to afford enough food. Ensuring that all children can access breakfast and lunch during the school day, which may be the only consistent

Cristin Fritz, MD, MPH

meals for some, would be an important step toward supporting families and ensuring children have the nutrition needed to learn and thrive,” said Cristin Fritz, MD, MPH, assistant professor of Pediatrics at Monroe Carell Jr. Children’s Hospital at Vanderbilt and member of the Center.

Previous polls from the Center have shown that 9 in 10 Tennessee parents support free school meals for all children, a topic that has been considered on a bipartisan basis in both the 2023 and 2024 legislative sessions, though it ultimately failed. Most recently, a bipartisan bill that would provide two meals to school-age children failed in a state House subcommittee on March 12.

“Food insecurity continues to be an enduring challenge for Tennessee children,” said Stephen Patrick, MD, MPH, a neonatologist at Monroe Carell and the William R Long Director of Child Health Policy. “When children are hungry, it hurts their ability to learn, play and grow. During the pandemic, we addressed food insecurity by providing free meals at schools. It was effective ― since these supports went away, we’ve seen food insecurity among Tennessee children rise. This is a solvable problem. No child should go hungry in our state.”

The Vanderbilt Child Health Poll is conducted annually in the fall and explores a variety of issues that impact Tennessee parents and their children. This year the Center asked questions about mental and behavioral health, insurance status, firearm safety and education concerns. The poll is funded in part by a grant from the Boedecker Foundation.

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How a Global Pandemic Became a Lesson in Health Policy

lowaryj — Mon, 18 Mar 2024 19:42:44 +0000

How a Global Pandemic Became a Lesson in Health Policy lowaryj Mon, 03/18/2024 - 14:42 RSS:

(Originally published in June 2023.)

On March 13, 2020, the Department of Health Policy established an ad-hoc committee of researchers, clinicians, and others who shifted their daily focus to advising and informing local, state, and federal leaders on the response to the global pandemic.

A novel coronavirus was sweeping the globe, shutting down businesses, schools, and transforming how health and health care was managed with thousands needing acute care and testing, and policymakers grappling with how to save lives.

Over the next 18 months, this group collected data from various sources to answer questions from policymakers and community leaders. Through a unique partnership with the Tennessee Department of Health, the group was able to track infections and hospitalizations in near real-time to help policymakers understand the trajectory of the pandemic and its effects on the health care system in Tennessee.

As the availability of vaccines became more widespread in the spring and summer of 2021, the group pivoted to not only provide near real-time data on the state of the pandemic in terms of hospitalizations and resource consumption, but also the uptake of vaccination across the state by age group and region.

They also developed resources for the community that included guidance and information about the differences between social distancing and quarantine, and common questions early in the pandemic about the impact on children; this work was translated into multiple languages and distributed by clinicians at the Monroe Carell Jr. Children’s Hospital at Vanderbilt and other community locations around the state.

In addition, these researchers shared their findings on television, on the radio and social media to inform the community about the pandemic.

Over the course of 2020 and 2021, the reports and data analyses the group produced were distributed to VUMC patients in both clinical and community settings, as well as provided directly to local government officials in several large Tennessee cities.

The group was also in regular, direct contact with the COVID Unified Command, a state-level group of leaders managing the state’s response. That group often hand-delivered some of the reports and findings to community leaders around the state.

Mary-Margaret Fill, MD, MPH, is a 2021 graduate of the Department’s MPH program, and the Deputy State Epidemiologist for the Tennessee Dept. of Health. She was closely involved with not only what the state was doing as far as response and disease surveillance, but also with our COVID Advisory Group, which was formed in March 2020 as the pandemic began to sweep the nation. She was often involved in the press briefings held by state officials, and traveled with Gov. Bill Lee and other members of the Unified Command to specific communities in Tennessee. In some cases, those visits also included delivering some of the memos directly to community leaders.

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How Research Informed Major Policy Change

lowaryj — Mon, 18 Mar 2024 18:06:55 +0000

How Research Informed Major Policy Change lowaryj Mon, 03/18/2024 - 13:06 RSS:

(Originally published in March 2023.)

Stacie Dusetzina, PhD, Ingram Professor of Cancer Research and Professor of Health Policy, joined Mark Cuban, billionaire and founder of Cost Plus Drugs Co., and Ruchika Talwar, MD, Urologic Oncology fellow in VUMC’s Department of Urology, for a lecture and discussion on the efforts to reduce prescription drug prices for Americans.

The Department has what is often called its “North Star,” which is having an impact on policy formulation through its research and evidence generation. For nearly 10 years, Stacie Dusetzina, PhD, professor of Health Policy and Ingram Professor of Cancer Research, has focused her research on one core policy issue that has been of interest to lawmakers of all political stripes: the affordability of prescription drugs.

Since this issue arose late in the 2010s, with bipartisan interest in the potential to save millions of Americans on Medicare thousands of dollars annually at the pharmacy counter, Dusetzina has been a central figure in developing evidence and analysis to inform policymakers about the need for reform.

It’s just one example of how the Department faculty have been influential in Medicare and Medicaid reform discussions, and had direct impact on new and existing policy formulation, evaluation, and revision.

In 2022, Dusetzina published attention-grabbing research finding 30% of cancer patients not receiving subsidies don’t initiate prescription drug cancer therapy, likely due to high out-of-pocket costs, and some cancer therapeutics can cost more than $10,000 out of pocket for a single year of treatment, some above $3,000 for the first fill.

A Decade Collecting Evidence

Her focus on Medicare Part D began after reading a piece in The New York Times about rising drug prices and the impact on patients about 10 years before, prior to officially joining the tenure-track faculty in 2018, Dusetzina used her training to start unpacking why drugs cost so much and how that affected patients needing those medications.

After more than 90 peer-reviewed publications, countless conversations with two White House administrations and dozens of policymakers on Capitol Hill, Dusetzina and colleagues were able to reflect on the South Lawn of the White House in the summer of 2022 about how their contributions through research and data informed the provisions in the Inflation Reduction Act that will save older Americans on Medicare tens of thousands of dollars in out-of-pocket costs each year.

“The idea that some of my work made a difference in fixing a program that I really care about and that I knew could be made better – that’s something special,” Dusetzina said. “There are nearly 50 million people in Medicare Part D right now (in 2022). Not all of them need expensive drugs right now, but they will have the financial security of knowing that if they do need them, they will be able to afford them.”

“Stacie is one of our nation’s leading scientists studying drug pricing and access to high-cost medications,” said Nancy Keating, MD, MPH, professor of Health Care Policy and an internist at Harvard University, who has collaborated with Dusetzina several times on Part D research. “The evidence that she has generated related to the role of high out-of-pocket spending on medication nonadherence and medication non-initiation has shed a spotlight on the problems of the Part D benefit and was key to the recent legislation seeking to make prescription drugs more affordable to Medicare beneficiaries.”

The Future of Part D Reform

The legislation was formally signed into law in September 2022 and Dusetzina will continue to analyze the longer-term impacts of the Inflation Reduction Act and new policy options.

“Turns out there are still lots of problems to solve around drug prices and access, even though I think we fixed Part D for the most part,” Dusetzina said. “I’m working on some new projects that focus more broadly on Medicare plan choices and how to make sure people pick the right plans for them and on how to give people better information about drug prices at the time of prescribing.

“I’m also really interested in seeing how these changes will unfold in the Medicare program and how drug companies will respond with their pricing for new drugs. Ultimately, we have to fix prices and coverage if we are going to solve health care affordability. There is going to be a lot to keep me busy.”

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Vanderbilt’s Center for Health Care Modeling Growing Global Health Research

lowaryj — Wed, 13 Mar 2024 17:31:05 +0000

Vanderbilt’s Center for Health Care Modeling Growing Global Health Research

Historical Content

lowaryj Wed, 03/13/2024 - 12:31 RSS:

For years, Professor John Graves, PhD, has been studying health care markets and the policies that influence them. Using statistical models and data from multiple sources, Graves develops models to inform decision-makers and policymakers.

Graves heads a small group of faculty in the Department that aims to answer a simple question asked in dozens of different contexts within health care: Is it worth it? For example, is what we spend on a particular intervention returning the results we want in terms of lives saved or expensive care reduced or averted?

Years of Modeling Expertise Expand Reach

The Vanderbilt Center for Health Economic Modeling was formally established in 2021 to dive deeper and expand its focus beyond health care markets and the Center’s efforts to deliver timely, critical data about the COVID-19 pandemic to state and local leaders.

“Once we got through (COVID-19 modeling for the state) we re-engaged with the original mission, which was to harness within and across department and center expertise in modeling,” Graves said.

Supported by grants from the Centers for Disease Control and Prevention Foundation and Bloomberg Philanthropies in 2022, Graves and a team of colleagues from the Department including Assistant Professor Ashley Leech, PhD, and Assistant Professor Marie Martin, PhD, M.Ed., traveled to Thailand to provide a week-long intensive course to teach modeling methods and improve cost-effectiveness and decision analysis in low- and middle-income countries mostly in Africa and Southeast Asia.

“The initiative tries to go into low and middle income countries and do things like establish better death registries or cancer registries, just trying to bring data to bear and capacity to measure health outcomes and things like that in resource constrained settings,” Graves said.

It’s just one example of what the Center aims to do over the next several years, including partnering with other similar centers on some projects, and expand beyond what’s common among them.

“We have the expertise to branch out into (areas) like workforce modeling, healthcare, workforce antitrust considerations of concentration in markets and what that means for mergers and acquisitions,” Graves said. “We have a bit more of a broad focus, and so we can do more than most modeling centers elsewhere, which I think puts us in a pretty unique place relative to other places.”

Similar courses have been developed and conducted in other venues, including the 2023 Society for Medical Decision Making annual conference in Berlin, and the International Health Economics Association annual congress in Cape Town, South Africa.

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Genomics study led by VUMC researchers recognized as one of 2023’s ‘most significant’

lowaryj — Mon, 26 Feb 2024 19:45:17 +0000

Genomics study led by VUMC researchers recognized as one of 2023’s ‘most significant’ lowaryj Mon, 02/26/2024 - 13:45 RSS:

A May 2023 study from Vanderbilt University Medical Center researchers published in the Annals of Internal Medicine examining the cost-effectiveness of testing for some hereditary cancers and hypocholesterolemia was recognized as one of the 10 “most significant” pieces of genomics research by a working group at the National Institutes of Health.

The study, led by Josh Peterson, MD, MPH, Professor of Biomedical Informatics and Medicine at VUMC, and Greg Guzauskas, PhD, at the University of Washington, examined the cost-effectiveness of testing for hereditary breast, ovarian and other cancers, Lynch syndrome and hypocholesterolemia, and found that testing beyond what is currently recommended could be cost-effective in terms of quality-adjusted life years.

Peterson, who collaborated with Professor of Health Policy John Graves, PhD, said the paper helps fill a few important gaps in the scientific literature.

“First, it estimates cumulative lifetime benefit across a panel of genes that covers three high-evidence scenarios, whereas previous modeling efforts were limited to one scenario, and provides age guidelines for when screening would be most effective if implemented broadly,” Petersons aid.

Additionally, Peterson said the new data can help institutions and policy makers “understand how investment in genomics provides improvement in population health and in what time frame.”

The Centers for Disease Control and Prevention currently list genomic testing for these hereditary conditions as “Tier 1,” meaning they are high priority in genomic testing. Currently, the CDC recommends only testing those who have strong hereditary or family history, though other research has indicated higher prevalence in ethnically diverse populations and there are known effective preventive measures.

The researchers created a model to estimate cost-effectiveness of offering testing regardless of family history, and the study found that testing would be cost-effective if they were below $413 for patients over 30, $290 in 40-year-olds, and $166 in 50-year-olds.

Genomics and precision medicine have grown dramatically in recent years as technological advances and research have highlighted the clinical benefits of genomic testing and precision medicine, similar to cost-effective analyses to help health care leaders and policy makers understand the financial implications of these types of care for health systems and patients.

“The recognition by the Genomic Medicine Working Group (an NIH advisory group) is gratifying and highlights the importance of our collaboration with Health Policy research groups to guide national policy on genetic testing,” said Graves.

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What Florida's planned importation of some drugs means for consumers, Medicare

lowaryj — Thu, 11 Jan 2024 19:20:37 +0000

What Florida's planned importation of some drugs means for consumers, Medicare lowaryj Thu, 01/11/2024 - 13:20 RSS:

In early January 2024, the Food and Drug Administration said it would allow Florida to import some medications from Canada, where they are cheaper than buying in the U.S. It is the first U.S. state to import drugs in bulk, and has raised both acclaim and concern.

Stacie Dusetzina, PhD, Professor of Health Policy, explains with CBS News how this policy can impact Florida taxpayers and who stands to benefit most from the expected lower prices of some certain drugs.

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New federal rule adds transparency to nursing home ownership; VUMC-led research informed rule development

lowaryj — Thu, 16 Nov 2023 21:21:53 +0000

New federal rule adds transparency to nursing home ownership; VUMC-led research informed rule development lowaryj Thu, 11/16/2023 - 15:21 RSS:

A new federal rule published Nov. 15 will require additional transparency and disclosure of ownership and management of nursing homes across the country, and the rule was shaped by research conducted at Vanderbilt University Medical Center.

The rule will help families make more informed decisions about nursing home care, the Centers for Medicare and Medicaid Services said in a news release.

The rule comes at the same time new research led by Professor David Stevenson, PhD, chair of the Department of Health Policy at VUMC, was published finding that private equity firms and real estate investment trusts increased sharply early in the 2013-2022 study period before leveling off as the COVID-19 pandemic became a national public health emergency.

A key focus of the rule is to make the role of private equity firms and real estate investment trusts (REITs) in the sector more transparent. Prior studies have identified quality concerns around these investments, with critics suggesting that these entities may chase short-term profits at the expense of quality care.

The study led by Vanderbilt in collaboration with researchers at Weill Cornell Medical College, sought to further inform policymakers around these issues in advance of issuing the transparency rule. Funded by the Assistant Secretary for Planning and Evaluation (US Department of Health and Human Services), the Vanderbilt-Cornell study is among the first to examine quality of care among PE and REIT invested facilities. Stevenson and colleagues found that registered nurse staffing fell and quality of care deficiencies increased following REIT and PE investment.

“Our study results point to a changing ownership landscape within the nursing home sector over the last decade,” researchers wrote. “The findings contribute to a growing set of studies that assess the influence of these changes on nursing home quality of care, with our findings raising concerns about the impact of PE and REIT investment on nursing home staffing and survey performance.”

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Erves joins Department as director of Community Engaged Research

lowaryj — Wed, 15 Nov 2023 17:29:52 +0000

Erves joins Department as director of Community Engaged Research lowaryj Wed, 11/15/2023 - 11:29 RSS:

Jennifer Cunningham Erves, PhD, MPH, MAEd, MS, CHES, has joined Vanderbilt University Medical Center as associate professor of Health Policy, director of Community Engaged Research, Office of Health Equity, and scholar, Vanderbilt Center for Health Services Research.

Erves is a public health oncology researcher focused on cancer prevention behaviors and lowering cancer disparities. Her current research focuses on improving HPV vaccine uptake among marginalized and underserved populations using behavioral interventions, health communication and implementation science. Her long-standing interests in research include minority health with emphasis on cancer disparities, community engagement, health behavior and qualitative data analysis. She also works with other researchers, state level committees, as well as community-based organizations and members to develop strategies to reduce disparities across diseases.

Erves is a graduate of Tuskegee University, where she received her Bachelor of Science and Master of Science in biology. She received her Master of Arts and Doctor of Philosophy in health education and health promotion from the University of Alabama at Birmingham. Her post-doctoral fellowship was completed for the Meharry Vanderbilt Community Engaged Research Core in Community Engagement. She recently received her Master of Public Health from Vanderbilt University. She is a Certified Health Education Specialist.

Erves comes to VUMC from Meharry Medical College.

“I am delighted to have Dr. Erves leading our community engaged research programs. She brings to this role substantial expertise and innovative strategies that center the needs and priorities of communities often excluded from research,” said Consuelo Wilkins, MD, MSCI, professor of Medicine, Senior Vice President and senior associate dean, Health Equity and Inclusive Excellence.

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New study finds oncologists more likely to provide low-value care after receiving money from pharma industry

lowaryj — Thu, 26 Oct 2023 16:02:08 +0000

New study finds oncologists more likely to provide low-value care after receiving money from pharma industry lowaryj Thu, 10/26/2023 - 11:02 RSS:

A new study published in the medical journal BMJ finds that oncologists who received payments from the pharmaceutical industry were more likely to give patients prescriptions for cancer drugs that are less effective or more expensive.

Authored by Aaron Mitchell, an oncologist and researcher at Memorial Sloan Kettering Cancer Center and Stacie Dusetzina, Ingram professor of Cancer Research and Health Policy at Vanderbilt University Medical Center, the study examined four low-value cancer treatments using a database of payments from drug manufacturers to oncologists. These payments most commonly come in the form of free meals, speaking or consulting fees.

The pharmaceutical industry gives physicians over $2 billion in non-research related payments annually, researchers said. Many previous studies have demonstrated that these payments influence physicians.

“We know from previous research that industry payments can sway doctors between equivalent treatment options, but this study is the first to show these payments can lead to cancer treatments that are not recommended, or even potentially harmful to some patients,” Mitchell said.

The treatments included in the study were:

denosumab for castration-sensitive prostate cancer;
granulocyte colony stimulating factors (GCSF) for patients at low risk for neutropenic fever;
nab-paclitaxel for cancers with no evidence of superiority over paclitaxel, or;
a branded drug in settings where a generic or biosimilar version was available.

For three of the four cancer treatments, the proportion of patients who received the unhelpful or more expensive drug was higher among oncologists who received payments from drug makers in unadjusted analyses, researchers noted.

When adjusted for physician characteristics, two treatments – non-recommended denosumab for prostate cancer, and Abraxane, a more expensive brand-name drug known generically as paclitaxel – were prescribed significantly higher. The other two treatments were not significantly different after adjustment.

In adjusted analyses, industry payments were associated with a 7%% increase in the prescription of denosumab and a 2% increase in the prescription of nab-paclitaxel.

Dusetzina said the findings raise quality-of-care concerns regarding financial relationships between drug makers and physicians.

“Industry payments to physicians clearly influence physician prescribing – and not necessarily for the better. We may need to consider limits on the types and frequency of physician-industry financial interactions as it isn’t clear that these interactions are beneficial for patients. ”

The research was funded by grants from the National Cancer Institute, National Institute of Health Care Management, and Memorial Sloan Kettering Cancer Center.

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New study finds high-deductible health plans associated with more financial barriers to health care for sexual minority adults

lowaryj — Wed, 06 Sep 2023 16:36:10 +0000

New study finds high-deductible health plans associated with more financial barriers to health care for sexual minority adults lowaryj Wed, 09/06/2023 - 11:36 RSS:

A new study published this month in the journal Health Affairs found new evidence that sexual minority (including gay/lesbian and bisexual) adults face more financial barriers to health care than their heterosexual counterparts, regardless of insurance type, and even greater barriers when enrolled in high-deductible health plans.

The study, authored by Health Policy PhD candidate Nathaniel Tran, used a national survey of Americans 18-64 years old enrolled in private health insurance plans to explore the differences in financial barriers to care associated with insurance types.

Among the most noteworthy findings, Tran said, was a clear disparity between adults in high-deductible heath plans versus other private insurance. Compared to their straight counterparts, 8.3% more gay and lesbian plan enrollees reported they had no usual source of health care, and 5% more said they delayed medical care because of cost.

“High-deductible health plans allow patients to have lower premiums upfront in exchange for potentially more out-of-pocket expenses later. Unfortunately, we see people on high-deductible plans delaying or skipping care more often.”

These findings suggest more research is necessary to understand why some people choose high-deductible plans, and better tools to help people select plans that match their health needs.

Sexual minority adults enrolled in high-deductible plans reported significantly more delays in medical care and skipping mental health altogether, compared to heterosexual adults enrolled in high-deductible health plans.

Tran said the findings offer new knowledge and opportunities for insurers and policy makers to consider mechanisms to improve access and affordability for beneficiaries, which could improve uptake of preventive services, meaning overall health expenditures could be lowered over time.

“LGBTQ+ people on average experience poorer mental health than their heterosexual peers. If the way high-deductible health plans are designed makes sexual minority populations skip mental health care more due to cost, then these plans might make the inequality even worse. ”

In June 2022, the President Joe Biden issued an executive order to address equality for LGBTQ+ Americans. In response, the Substance Abuse and Mental Health Services Administration (SAMHSA) compiled a new report on the state of sexual minority population mental health needs and access to care.

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New study brings patient experience evidence to forefront in Medicare Advantage research

lowaryj — Mon, 21 Aug 2023 19:07:38 +0000

New study brings patient experience evidence to forefront in Medicare Advantage research lowaryj Mon, 08/21/2023 - 14:07 RSS:

A new study authored by Department of Health Policy PhD student Emma Achola and faculty in the Department is among the first to use self-reported outcomes to help determine the benefit of post-acute care for Medicare and Medicare Advantage beneficiaries.

To date, most previous research has relied almost entirely on claims data, which does not fully capture the patient experience. In the study, published recently in JAMA Health Forum, the research team used survey data to determine the usage and outcomes of these individuals after certain acute health events.

"he present study adds to the literature by using self-reported outcomes to capture self-perceived functional improvement among Medicare beneficiaries who used postacute care services and examining a broader range of rehabilitative services, such as outpatient clinics," Achola wrote. "Unlike prior studies, we found that MA enrollees who used postacute care services reported less favorable outcomes on some measures than TM beneficiaries."

Read the full study in JAMA Health Forum here.

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Effective medications for opioid use disorder rarely used

lowaryj — Tue, 15 Aug 2023 19:52:53 +0000

Effective medications for opioid use disorder rarely used lowaryj Tue, 08/15/2023 - 14:52 RSS:

Most individuals diagnosed with opioid use disorder are not on recommended medications and even fewer remain in care, according to a research letter published today in JAMA Internal Medicine by lead author Ashley Leech, PhD, assistant professor in the Department of Health Policy at Vanderbilt University Medical Center (VUMC).

In 2021, there were more than 100,000 overdose deaths in the United States, with the highest rates among those ages 25-54.

Just 22% of the 40,000 individuals with opioid use disorder studied by VUMC researchers continuously used buprenorphine for a full year. And among those who discontinued, many were on the medication for just over a month, which is markedly below recommended levels, the authors said.

“Treatment with medications like buprenorphine is safe and highly effective, reducing risk of countless adverse outcomes including overdose death,” said senior author Stephen Patrick, MD, MPH, director Center for Child Health Policy at VUMC. “Nationwide, far too few people with opioid use disorder receive any form of pharmacotherapy and even fewer remain in care.”

Out-of-pocket costs for medication are one factor, according to Leech.

The study’s findings suggest that the higher the cost of a patient’s initial buprenorphine fill, the higher the likelihood of discontinuing the medication even though the study showed that out-of-pocket costs for buprenorphine decreased over time.

Those facing the highest daily costs ($4.28-$25) had a 34% higher risk of discontinuing their treatment compared to those in the lowest cost quartile ($0-$0.71), though some patients had an even higher out-of-pocket cost of up to $98.

“Cost is a barrier to use,” Leech said. “If buprenorphine was added to a federal list of clinically approved, preventive services like the Affordable Care Act’s preventive drug list, which mandates private insurance plans to cover recommended preventive services without patient cost-sharing, patients wouldn’t have to pay for it.”

“If adding buprenorphine to that list were to happen, it could be a huge opportunity to alleviate the lasting effects of the ongoing opioid crisis, including the billions of dollars per year spent on overdose-related hospital costs and other health care expenditures,” she said.

VUMC researchers now plan to do further studies among the most vulnerable patient groups to identify strategies to not only ensure people access treatment but also stay in treatment over time.

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Study Finds Inadequate Use of Recommended Combination Treatment for Miscarriage in the U.S.

lowaryj — Fri, 21 Jul 2023 16:16:05 +0000

Study Finds Inadequate Use of Recommended Combination Treatment for Miscarriage in the U.S. lowaryj Fri, 07/21/2023 - 11:16 RSS:

A new study published in the Journal of the American Medical Association by researchers at Vanderbilt University Medical Center has found that the recommended two-medication regimen, mifepristone plus misoprostol (similar to that used for induced medication abortion) remains significantly underused despite recommendations to do so from medical professionals and major medical societies.

Mifepristone was approved by the Food and Drug Administration in 2000 but remains subject to prescribing restrictions, which has limited its availability.

The use of both mifepristone and misoprostol together to medically manage first trimester miscarriage was recommended by the American College of Obstetricians and Gynecologists in November 2018. ACOG approved the medication combination in light of research demonstrating the use of mifepristone and misoprostol together was safe, more effective and cost-effective compared to using misoprostol alone.

Vanderbilt researchers have found among all states, 0.4% of women treated for miscarriage in 2016 received the two-medication regimen, which increased to only 2.5% in 2020 despite society guidelines.

“Clinicians continue to exclusively prescribe misoprostol alone despite the evidence that combination treatment of mifepristone plus misoprostol is both more effective and cost-effective,” Leech said.

The study used anonymous commercial insurance claims data from January 2016 to November 2020 to compare prescription rates among more than 22,000 women before and after the official recommendation from ACOG. Since some data might not be observed in states with restrictions on abortion care, the study separately looked at rates of medication use for miscarriage both overall and excluding states with abortion care restrictions on fully insured private plans.

In states without restrictions on insurance coverage on abortion care there was minimal variation in the findings, researchers noted. In unrestricted states, just 0.51% of women received both medications in 2016 and 3.08% in 2020.

“The politicization of mifepristone and its prescribing restrictions disincentivizes clinicians from using the most effective regimen to treat patients experiencing miscarriage who desire medical management,” said Elise Boos, MD, assistant professor of Obstetrics and Gynecology at VUMC, and lead author of the study. “Unfortunately, availability issues surrounding mifepristone could potentially worsen due to the growing divide in reproductive health care in the U.S.”

Boos said when women experiencing miscarriages do not receive the most effective regimens for management, they may need additional visits or undesired surgical procedures to remove the pregnancy tissue.

“This increases costs, risks to the patient and undermines their autonomy to choose how their miscarriage is managed. It can be an emotional time for many, and they deserve evidence-based care. Eliminating the politicization of mifepristone will ensure safe miscarriage management.”

The study was funded by grants from the National Institute on Drug Abuse and Vanderbilt University Medical Center.

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Pair of new research papers highlights variation, benefit of opioid treatment programs

lowaryj — Mon, 05 Jun 2023 18:19:08 +0000

Pair of new research papers highlights variation, benefit of opioid treatment programs lowaryj Mon, 06/05/2023 - 13:19 RSS:

Two new research papers published in the journal Medical Care led by Vanderbilt University Medical Center faculty highlight two different areas related to opioid use treatment in women of reproductive age across several U.S. states.

Both studies used similar data and study designs from a randomized field experiment where nearly 4,000 trained callers, either on public health insurance (Medicaid) or private insurance, attempted to seek appointments for treating opioid use disorder across 10 states in the U.S.

“Both studies highlight the challenges women encounter when trying to access treatment for opioid use disorder in different locations within the US,” said Ashley Leech, PhD, assistant professor of Health Policy and one of the lead authors on the papers.

The first study published earlier this month in the journal Medical Care identified variations in the accessibility of opioid use treatment among the 10 U.S. states. Notably, the study highlighted the issue of appointment access contingent on cash payment, irrespective of insurance coverage.

The study found that 40% of insured women were asked to pay in cash to get an appointment for OUD treatment. In 2 states, Florida and Tennessee, women seeking treatment were asked to pay in cash more than 60% of the time, regardless of insurance status or the generosity of their plan’s benefits. In other states, including West Virginia, Washington, and Massachusetts, only a quarter or less of buprenorphine providers requested cash payment.

“State-to-state variation was the most striking pattern in our data, suggesting that women of reproductive age with OUD in certain states face even greater challenges to treatment access than perhaps previously thought,” said Michael Richards, MD, PhD, MPH, professor of Economics at Baylor University and first author of the new study.

In regions with a higher number of providers and assumed competition, 40-50% required cash payment for treatment. Conversely, approximately 30% required cash payment in areas with fewer providers.

“Regardless of insurance type, many individuals with OUD are required to self-finance their treatments as though they are uninsured,” Leech said.

The second study found significant county-level variation in the availability of opioid treatment programs (OTPs). In counties with a higher number of OTPs, reproductive-age women had a greater likelihood of obtaining appointments with any provider for OUD treatment, whether it be a buprenorphine prescriber or an OTP professional.

“Our finding that more opioid treatment programs in a county increased the likelihood that a woman received an OUD treatment appointment may indicate the importance of OUD specialty safety nets at the county level,” said Leech.

OTPs are highly regulated, and specialized stand-alone clinics that can dispense methadone and other FDA-approved medications for OUD.

“In other words, OTPs may be a proxy for a more robust OUD specialty in the county, which may influence one’s comfort in prescribing,” Leech said.

As the nation continues to confront an escalating opioid crisis, implementing policy solutions aimed at expanding access to treatment for OUD across different geographic settings can significantly mitigate overdose and alleviate the negative outcomes commonly associated with OUD, Leech said.

The research was supported by grants from the National Institute on Drug Abuse and the National Institutes for Health.

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Child Health Poll: More Than 1-in-4 Tennessee Parents Worried Their Kids Have Undiagnosed Depression, Anxiety

lowaryj — Wed, 17 May 2023 15:13:27 +0000

Child Health Poll: More Than 1-in-4 Tennessee Parents Worried Their Kids Have Undiagnosed Depression, Anxiety lowaryj Wed, 05/17/2023 - 10:13 RSS:

The latest analysis of the 2023 Tennessee Child Health Poll, released during National Mental Health Awareness Month, has found that roughly 29% of Tennessee parents are concerned their child has undiagnosed anxiety or depression.

The poll, fielded in the fall of 2022 by researchers at the Vanderbilt Center for Child Health Policy, also found more than 30% of parents polled said their child had been diagnosed with attention deficit hyperactivity disorder, anxiety or depression, a 7% increase since the question was first asked in the annual poll in 2019.

“The mental health of kids in Tennessee is suffering, and parents are increasingly concerned,” said Heather Kreth, PsyD, associate professor of Pediatric Psychology and a member of the Center. “The number of children I treat who are suffering from severe depression, anxiety and thoughts of self-harm or suicide has been steadily increasing in recent years. Suicide remains the second leading cause of death for teens and young adults nationwide.”

In total, more than 20% of parents reported concerns their child had undiagnosed anxiety, nearly 14% said they were concerned their child had undiagnosed depression, and more than 11% were concerned their child had undiagnosed ADHD/ADD. In 2019, before the COVID-19 pandemic disrupted the lives of children and families across the state, 14% reported concerns about undiagnosed anxiety, and less than 7% reported concerns about ADHD/ADD.

The findings are the latest to be released from the annual poll that covered a wide range of issues impacting Tennessee parents and kids from online bullying, school firearm violence, food security and insurance status.

Of parents who reported mental health diagnoses for their children, many were diagnosed in the last year. Overall, 38% of diagnoses of depression were made within the last year compared to, 37% for anxiety, and 19% for ADHD.

More than 50% of parents of children who have been diagnosed with a mental health condition reported their children do not receive mental health services. Almost 30% of parents report their children get mental health care from their pediatrician or family doctor, versus a mental health provider.

“We need to equip our pediatricians with resources and brief focused-intervention tools to support patient mental health symptoms,” says Katherine Spencer, Psy.D., a pediatric psychologist who works at Monroe Carell Jr. Children’s Hospital at Vanderbilt. “And beyond that, we have a substantial need to increase treatment capacity for children in the state.”

The Vanderbilt Child Health Poll is conducted annually to gauge parents’ concerns about a wide range of topics. The data are collected from a representative sample of Tennessee parents across each of the three grand divisions of the state. The research was funded in part by a grant from the Boedecker Foundation.

May is National Mental Health Awareness Month. If you or someone you know is experiencing a mental health emergency, please call 988.

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Maternal OUD and NOWS increases risk of postneonatal infant mortality

lowaryj — Mon, 08 May 2023 14:58:17 +0000

Maternal OUD and NOWS increases risk of postneonatal infant mortality lowaryj Mon, 05/08/2023 - 09:58 RSS:

In a new study led by Vanderbilt University Medical Center researchers, infants born to individuals who had opioid use disorder (OUD) during pregnancy or who developed neonatal opioid withdrawal syndrome (NOWS) faced a 54-64% greater risk of postneonatal death than infants without these exposures.

The study, led by Sarah Grossarth, MPH, and Dr. Margaret Adgent, PhD, MSPH, research associate professor in the Department of Health Policy, examined a large cohort of Tennessee Medicaid births, occurring between 2007 and 2018. Using administrative claims and vital records data, they assessed infants born to individuals with OUD documented during pregnancy and infants diagnosed with NOWS. They compared the risk of death among infants with and without these conditions to those that had neither.

“Postneonatal mortality, or infant deaths occurring after 28 days of age, is a rare but horrendous outcome. Our study demonstrated that infants born to individuals with OUD or who were diagnosed with NOWS are at increased risk for this outcome, regardless of whether these conditions were observed separately or in combination, suggesting that comprehensive support for high-risk families should extend beyond pregnancy and delivery, “ said Dr. Adgent, senior author of the study.

The study included more than 390,000 live births over the 11-year period, and reported an incidence rate of 3.47 postneonatal deaths per 1,000 person-years (p-y) among those without observed OUD or NOWS, mostly attributed to ill-defined causes such as sudden unexpected infant death. This rate increased to 8.41 and 8.95 per 1,000 person-years for infants born to individuals with OUD, with and without NOWS diagnosis, respectively. In a small number of infants with NOWS, OUD in the birth parent was not documented. Incidence in this group was also elevated, at 9.25 per 1,000 p-y.

“Our study also highlights that NOWS did not increase the risk for infant mortality above what was observed in OUD-only exposed pregnancies,” Adgent added.

Researchers noted that these data may reflect historical policies around opioid addiction, and that current trends towards expanding supportive care may yield improved outcomes in the future. Additional studies will be useful to understand how maternal use of OUD treatment medications impact these risks.

“Expanding diagnosis, treatment and support for individuals with OUD prenatally and postnatally, as well as their infants, may help prevent devastating outcomes in this vulnerable population,” the study concludes.

The research was funded in part by the U.S. Department of Health and Human Services, the National Institutes of Health. The team of investigators also include Sarah S. Osmundson MD MS, Andrew D. Wiese PhD MPH, Sharon Phillips MSPH, Amelie Pham, MD, Ashley A. Leech, PhD, Stephen W. Patrick MD MPH MS FAAP, Andrew J. Spieker, PhD, and Carlos G. Grijalva MD MPH.

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Study: These quality measures for stroke care improved ‘value’ for patients the most

lowaryj — Tue, 02 May 2023 20:44:19 +0000

Study: These quality measures for stroke care improved ‘value’ for patients the most lowaryj Tue, 05/02/2023 - 15:44 RSS:

Of the 15 process measures endorsed by national health care associations, just five of them contributed to the most improvements in care, a new study from Vanderbilt University Medical Center researchers has found.

The study, a cost-effectiveness analysis published in early May in the Annals of Internal Medicine and led by Assistant Professor of Health Policy Jinyi Zhu, PhD, found that five measures, such as early carotid imaging and intravenous tissue plasminogen activator (tPA), accounted for 92% of the total value of quality improvement among all measures. These five measures effectively enhance health outcomes for patients at a small cost, by signficantly extending their lives or improving their quality of life.

“Cost-effectiveness analysis is a powerful tool to help us systematically weigh the tradeoffs between health benefits and costs,” said Zhu. “By identifying the most valuable measures for improving the quality of acute ischemic stroke care, our study demonstrates the importance of using this approach in health decision-making.”

Zhu and her collaborators at Harvard and Cornell universities found using simulation models that five of the 10 quantifiable quality measures outperformed others in terms of total value, measured in this study by (quality-adjusted) life-years gained and incremental total lifetime cost. The remaining five measures could not be evaluated quantitatively, lacking enough clinical evidence to do so.

The most valuable quality measure in terms of total cost and net health benefit was early carotid imaging, researchers found. Improvement in this measure was found to be highly cost-effective and would benefit a large number of stroke patients. If achieved at 100% implementation, it could produce an estimated net gain of $1.08 billion per year across the large study sample.

The quality measures have been endorsed by the American Stroke Association and American Heart Association to improve quality of care. Setting targets can help clinicians prioritize quality of care efforts, though it was largely unknown which, if any, performed better in terms of value.

“Our study aims to guide clinicians and policy makers in prioritizing which quality measures to focus on when designing initiatives to improve stroke care,” Zhu said. “By targeting the few of the most valuable measures like carotid imaging and use of tPA, we can have a greater impact on patient health outcomes while minimizing the associated costs.”

The study was funded by a grant from the National Institute of Neurological Disorders and Stroke.

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Vanderbilt Child Health Poll: Over 40% of Tennessee Families Are Food Insecure, up From Last Year

lowaryj — Wed, 22 Mar 2023 15:55:30 +0000

Vanderbilt Child Health Poll: Over 40% of Tennessee Families Are Food Insecure, up From Last Year lowaryj Wed, 03/22/2023 - 10:55 RSS:

An increasing number of Tennessee parents are reporting their families are food insecure. Up more than 30% in just one year, 41.2% of Tennessee parents reported low or very low food security compared to 31.3% last year.

The latest release of the poll of more than 1,000 Tennessee parents by the Vanderbilt Center for Child Health Policy asked parents a series of questions focused on food security and changes in food spending due to increases in food prices. Food security was evaluated using a standardized questionnaire from the U.S. Department of Agriculture.

“This significant increase in low food security is alarming for the health of Tennessee children, who rely on adequate nutrition to grow and develop to their full potential,” said Cristin Fritz, MD, MPH, assistant professor of Pediatrics at Monroe Carell Jr. Children’s Hospital at Vanderbilt and member of the Center. “During the pandemic, Congress acted to provide additional supports for families. Now that these supports have ended, families are struggling to afford enough food.”

Previous polls from the Center have shown 9 in 10 Tennessee parents support free school lunch for all children.

Across the three grand divisions of the state, more parents in East (45%) and West Tennessee (44%) reported low or very low food security than parents in Middle Tennessee (38%). There are also notable differences by race. More than half, 51%, of Black parents in Tennessee report low or very low food security compared to 38% of white parents.

Despite the increase in reported low food security and change in food spending habits, over 50% of all parents said they did not receive any type of assistance over the last week or the last 12 months.

“Growing up in a household that experiences food insecurity puts children at a higher risk of developing physical and mental health issues such as obesity, hypertension, diabetes, anxiety and depression,” said Fritz.

This year’s poll also explored food spending habits due to the rising cost of groceries seen nationally in recent months. Over 70% of Tennessee parents report that their family changed their food spending habits due to higher food prices. Of that 70%, 29% of those families who changed their food spending habits said they changed their spending in part by skipping meals.

“Hunger among Tennessee children is a solvable problem,” said Stephen Patrick, MD, MPH, director of the Vanderbilt Center for Child Health Policy. “The rapid increase in food insecurity among Tennessee families with children should be a call to action for all of us. No child should go hungry in our state.”

The poll is conducted annually in the fall and explores a variety of issues that impact Tennessee parents and their children. This year we polled parents on food insecurity and insurance status as well as mental health and firearm safety. The poll is funded in part by a grant from the Boedecker Foundation.

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Cost of covering antiobesity drugs could be billions to Medicare despite, a new analysis finds

lowaryj — Wed, 15 Mar 2023 19:29:48 +0000

Cost of covering antiobesity drugs could be billions to Medicare despite, a new analysis finds lowaryj Wed, 03/15/2023 - 14:29 RSS:

If newer brand-name antiobesity medications were covered by Medicare, they could cost the program between $13.6 to $26.8 billion even with only 10% of people with obesity using them, according to a new analysis published in the New England Journal of Medicine by Vanderbilt University Medical Center researchers in the Department of Health Policy.

The perspective piece led by Khrysta Baig, MSPH, a doctoral student in the Department of Health Policy highlights Medicare’s long-standing prohibition on weight-loss medication coverage, the growing push to expand Medicare coverage for these new drugs, and the financial and health implications for doing so.

The authors estimate a range of possible new costs to Medicare’s Part D program for both older and newer weight-loss drugs. On the lowest end, they estimate new spending could be $67 million if only 1% of beneficiaries with an obesity diagnosis used the generic drug regimen phentermine and topiramate. On the higher end, using the Centers for Disease Control and Prevention’s estimate of obesity in Americans 60 and older, which is roughly 42% of that population or 20 million people, the cost to Medicare Part D would be $26.8 billion if only 10% of those beneficiaries used the branded drug semaglutide (Wegovy).

“Depending on the types of medications used by beneficiaries and their rate of use, it’s likely that Part D premiums would increase to accommodate spending on these products,” the study said.

“Despite newer antiobesity medications being truly exciting innovations, prior analyses in the US have found that semaglutide – priced at $13,618 per year in the US – is not cost-effective when compared to lifestyle modification and older generics. The same can be true for cost-effectiveness in other countries, even where the price of the drug is much lower,” said co-author and Assistant Professor of Health Policy Ashley Leech, PhD.

If 100% of Medicare beneficiaries with obesity used semaglutide, it would cost Medicare and its beneficiaries an estimated $268 billion; nearly double the current annual Part D net spending.

“It’s a purely hypothetical scenario, but it underscores that at current prices, these medications cannot be the only way – or even the main way – we address obesity as a society,” Baig said.

The authors also draw attention to large gaps in what is known about the safety and effectiveness of these medications when taken by older adults. There may be fewer benefits – as higher weight in older adults may not have the same health risks we think of in younger populations – and the side effects may be more detrimental. Which Medicare beneficiaries would be most likely to benefit from these medications is currently unclear since older adults were not well represented in the clinical trials, the authors said.

Regardless of unknowns, Medicare Part D may soon be compelled to cover antiobesity medications if the Treat and Reduce Obesity Act (TROA) is passed by Congress – which has become more likely in recent years. “Given the uncertainty regarding the benefits of these drugs for older adults and the high cost associated with their use, policymakers need to carefully consider tradeoffs of expanding Medicare coverage of these products,” co-author and Ingram Professor of Health Policy Stacie Dusetzina, PhD, said.

The team of investigators also included David D. Kim, PhD, Assistant Professor of Medicine at the University of Chicago.

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