John Colbert

June 24, 2019

Trends Archives

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

June 24, 2019

Trends Archives

Prescriptions Filled By Americans In 2018

Americans filled 5.8 billion 30-day equivalent prescriptions in 2018 (17.6 prescriptions per person), an increase of 2.7% from the prior year, according to the IQVIA Institute for Human Data Science’s report, Medicine Use and Spending in the U.S. More than two-thirds of prescriptions are for chronic conditions, which increasingly are filled with 90-day prescriptions and are thought to result in better adherence to prescribed regimens. Retail and mail pharmacies dispensed 127 million specialty prescriptions last year, an increase of 15 million since 2014. While specialty drug prescriptions increased more than 5% between 2017 and 2018, these drugs make up just 2.2% of all prescriptions. The report also notes that patient out-of-pocket costs increased in 2018 to an estimated $61 billion, with Medicare patients facing higher annual out-of-pocket costs than patients in commercial plans or those enrolled in Medicaid.

Dental Care Among Adults Aged 65 And Older

Dental care often is an overlooked aspect of overall health care among older adults. In 2017, slightly less than one-third (29.2%) of adults aged 65 and over had dental insurance. National Center for Health Statistics (NCHS) data show that overall, approximately two-thirds of adults aged 65 and over had a dental visit in the past 12 months. Older adults who were poor (42.7%) or near poor (42.8%) were less likely to have had a dental visit compared with non-poor (74.4%) older adults. Non-Hispanic black (11.2%) and Hispanic (12.3%) adults aged 65 and over were more likely to have unmet need for dental care due to cost compared with non-Hispanic white (6.8%) and non-Hispanic Asian (5.9%) older adults. The percentage with dental insurance was higher among those aged 65–74 (34.3%) compared with older age groups and lower among Hispanic adults (17.5%) compared with other race and Hispanic-origin groups.

HEALTH TECHNOLOGY CORNER

3-D Print Flexible Mesh For Knee And Ankle Braces

Limb prosthetics are medical devices that can be digitally designed and customized for individual patients, as a result of 3-D printing. Typically, they are designed to replace or support bones and other rigid parts of the body, and often are printed from solid, relatively inflexible material. According to an article published on June 19, 2019 in the journal Advanced Functional Materials, engineers at the Massachusetts Institute of Technology have designed pliable, 3-D-printed mesh materials with flexibility and toughness they can tune to emulate and support softer tissues such as muscles and tendons. Additive manufacturing (AM) of medical devices such as orthopedic implants and hearing aids is highly attractive because of its potential to match the complex form and mechanics of individual human bodies. Externally worn and implantable tissue‐support devices, such as ankle or knee braces, and hernia repair mesh, offer a new opportunity for AM to mimic tissue‐like mechanics and improve both patient outcomes and comfort.

Using Pig Brains To Understand Human Brain Functions

An article published on May 22, 2019 in the journal Brain Connections by researchers at the University of Georgia’s Regenerative Bioscience Center reports on a study that shows that as a translational, large animal model, pigs demonstrate great potential for mapping connectome-scale functional connectivity in experimental modeling of human brain disorders. The investigators used an imaging method normally reserved for humans to analyze brain activity in live agricultural swine models, discovering that pig brains are even better platforms than previously thought for the study of human neurological conditions such as Alzheimer’s and Parkinson’s diseases. An immediate potential application is in the study and diagnosis of chronic traumatic encephalopathy (CTE), a progressive brain disease caused by a series of blunt trauma usually seen in military veterans and National Football League players. Currently, CTE can be diagnosed only through an autopsy.

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DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

June 24, 2019

Trends Archives

The 1st Session of the 116th Congress began in January 2019 with an expectation among legislators that this year would be the one to resolve issues for a most important piece of legislation know as the Higher Education Act. Last reauthorized in 2008, since 2013 it has been sustained by a series of short-term continuing resolutions (CRs). As of June 2019, some doubt continues to exist regarding whether the task can be completed by the end of this year. Teams consisting of staff members for Senators Lamar Alexander (R-TN), Chairman of the Committee on Health, Education Labor & Pensions (HELP), and Ranking Member Patty Murray (D-WA) have been working to produce a bill that can achieve bipartisan agreement. An inability to meet their self-imposed deadline of having a bipartisan proposal finished by the end of May would appear to render it unlikely that a bill can be brought to the Senate floor any time soon.

This massive piece of legislation consists of many components, any one of which has the potential to create more delay. Examples are: simplifying the federal student aid application, creating a new income-based repayment plan for borrowers, building a new accountability system for colleges based on whether borrowers actually are repaying their loans, expanding competency-based education programs, requiring colleges to use clearer language in letters telling students about the aid they are receiving, Title IX campus sexual assault incidents, and collecting better data on how much students borrow and how much they earn after graduation. Other aspects include allowing incarcerated individuals to access Pell Grants and making grants available for shorter academic programs. Worth noting is that some current issues not easily resolved are accountability as it relates to the for-profit sector and student loan repayments.

Federal Work-Study (FWS) Experiment Launched

U.S. Secretary of Education Secretary Betsy DeVos announced a new Federal Work-Study (FWS) Experiment to provide institutions with increased flexibilities that will enable students to earn work-study benefits while participating in apprenticeships, internships, and work-based learning programs, as well as earn work-study wages while completing required clinical rotations, externships, and student teaching. “For decades, the Federal Work-Study program has allowed students to support themselves while earning a college degree, but for too long, the majority of the work options students have had access to have been irrelevant to their chosen field of study,” she stated. Under the current FWS program, nearly 92% of all funds are spent to support students in on-campus employment, while just over 8% support students working for non-profit organizations. Less than one-tenth of 1%, or just $726,000 of the billion-dollar FWS program, are spent to support students in private-sector employment, where many students are likely to seek permanent employment. The experiment is aimed at eliminating barriers that made engagement with private-sector employers undesirable for many colleges and universities.

Proposed Regulations On Accreditation, Innovation And Other Topics

The U.S. Department of Education (USDE) on June 12, 2019 published proposed regulations on accreditation, innovation, and other topics, reflecting the draft consensus language approved by the negotiated rulemaking committee that met earlier this year and reached consensus on April 3. The proposed regulations would affect several areas involving accreditation, including: increase expectations by USDE concerning student achievement; provide more flexibility for innovation for institutions and accrediting organizations; and increase the time for institutions and programs to come into compliance with accreditation requirements.

Two aspects of interest for institutions belonging to ASAHP are: (1) Establish that the Department recognizes an institution’s legal authorization to operate postsecondary educational programs when it is exempt from State authorization under the State constitution or by State law as a religious institution with a religious mission, and (2) Revise the State authorization requirements for institutions offering distance education or correspondence courses.

A public comment period began on June 12, 2019 and is in effect until July 12, 2019. Comments can be submitted electronically here.

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HEALTH REFORM DEVELOPMENTS

John Colbert

June 24, 2019

Trends Archives

Chronicity is a term frequently employed to describe the kinds of health problems that affect patients aged 65 and older. It also can be applied to health workforce challenges that steadily prove difficult to overcome. Rural sections of the United States represent areas that often suffer the effects of being inadequately served as a result of severe shortages of various kinds of health professionals. Mental health offers a good example of where considerably more effort is needed to address the health care needs of residents of rural areas. Compared to urban locales, for example, suicide rates are higher in rural parts of the nation.

Unfortunately, no single magic bullet is available to remedy the fact that as many as one-half of U.S. counties, predominantly located in rural areas, do not have a single psychiatrist to respond to the needs of residents. As an illustration of a recently proposed legislative remedy, the “VA Mission Telehealth Clarification Act” was introduced in the U.S. House of Representatives on June 12, 2019. It has seven co-sponsors for the purpose of authorizing health professional trainees to provide treatment via telemedicine. Proposals of a broader nature would involve allowing Medicare beneficiaries to access mental health services through telemedicine regardless of where they live and without having to leave home.

A different kind of approach would entail helping mental health professionals pay off their educational debt if they agree to work in an area with a shortage of workers. Inadequate reimbursement levels may be a major disincentive for mental health professionals to live and work in rural areas, especially in sections of the country that are remote. A way of addressing the situation would be to consider using peer support specialists who could work with doctors who treat patients using telemedicine. These individuals are neither physicians nor other kinds of health professionals. Instead, they are characterized by having knowledge derived from their own personal recovery process in combination with some formal training to enable them to support patients confronting similar challenges.

Obtaining More Savings From Accountable Care Organizations

The Medicare Shared Savings Program (MSSP) has produced modest savings for Medicare and been popular among health care providers, with 561 participating accountable care organizations (ACOs) covering nearly a third of the fee-for-service Medicare population in 2018. According to a paper in the June 6, 2019 issue of the New England Journal of Medicine, the savings pace has not proven to be commensurate with Medicare’s fiscal challenges, however, prompting calls for reform. The Centers for Medicare and Medicaid Services (CMS) responded in December 2018, with “Pathways to Success.” Strengthening incentives for ACOs to reduce spending is challenging because the program is voluntary. Some approaches, such as requiring ACOs to bear downside risk for excess spending, may make the program unattractive to some providers, potentially lowering program-wide savings by reducing participation. The involvement of providers with high spending that isn’t explained by patient risk factors is particularly critical to MSSP success, because the care their patients receive (including care from other providers) presents the greatest opportunities for savings. So far, ACOs with high risk-adjusted spending have lowered spending more than ACOs that began with low spending.

Hearty Perennials Of The Affordable Care Act Battles

For several years, supporters of the ACA have attempted to force the Little Sisters of the Poor to provide free-of-charge abortion-inducing contraceptives to their employees under this law. A 2011 HHS mandate requiring employers to provide certain health care, including birth control and emergency contraception, generated a lawsuit by the nuns. They sued in 2013 to be exempt from the rule, but lengthy court battles later, the case still is ongoing. New HHS rules created in 2017 allowed for religious exemptions for employers, including the group run by the Little Sisters of the Poor, but 13 states and the District of Columbia sued to block the rules. Two judges in January temporarily blocked the rules from going into effect, but a hearing presided over by a federal judge in California in June 2019 helps to guarantee that the dispute will continue to be ongoing regardless of any ruling that emerges.

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SPENDING LEGISLATION TAKES SHAPE

John Colbert

June 24, 2019

Trends Archives

The U.S. House of Representatives on a vote of 226-203 on June 19, 2019 approved a four-bill spending package (H.R. 2740). The Minibus included the fiscal year (FY) 2020 Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) appropriations bill, along with spending for Defense; Energy and Water; and State and Foreign Operations. This legislation specifies all the particulars regarding amounts of money to allocate for a wide range of programs. A prime example is the National Institutes of Health, which stand to benefit by an increase of more than two billion dollars in the upcoming fiscal year that begins this October 1, which is a larger increase than what has been provided in three of the previous four fiscal years.

The Agency for Healthcare Research and Quality (AHRQ) has been slated on several occasions for extinction, including in the current Administration’s budget proposal for FY 2020. Based on action by the House, however, the Agency will continue to exist. Its eventual fate will be determined once the Senate takes action by approving its own spending legislation. Members of that chamber have not yet officially established a timeline for consideration of its FY 2020 appropriation levels.

An ongoing concern in Congress is the steady rise in health care costs. A growing overall population in the U.S. and increases in the number of individuals aged 65 and older, many of whom have multiple chronic health problems, provide assurance that unless some constructive action is taken, costs will increase rather than stabilize or decrease any time soon. Apart from providing appropriations for necessary programs in the health and education spheres, Congress plays a valuable role by conducting hearings to obtain information and guidance on steps that can be taken to respond effectively to various social challenges. An example is that the Senate Health, Education, Labor, and Pensions (HELP) Committee on June 18, 2019 held a hearing on the Lower Health Care Costs Act of 2019 (S. 1895) to examine matters involving a benchmark payment rate for providers. At issue is a concern by representatives from the hospital industry that arbitrary, government-dictated reimbursement could result in significant unintended consequences for patients and create a disincentive for insurers to maintain adequate provider networks.

Except for major figures in Congress, such as House Speaker Nancy Pelosi (D-CA), and Senate Majority Leader Mitch McConnell (R-KY), the 535 elected members of the two chambers may be the equivalent of a giant blur to anyone who does not work for a living as a lobbyist. A fascinating group with a wide range of personal experience and ideological beliefs, legislators are confronted with the challenge of doing their best to represent the constituents who sent them to the nation’s capital as well as act effectively on behalf of the interests of the nation as a whole. An unintended consequence of this duality is that meeting the needs of the voters back home may not always correspond exactly with how the nation itself would benefit.

Members of Congress come from all walks of life, including as health professionals. A head count indicates that four Senators are from the following professions (surgery, optometry, gastroenterology, and ophthalmology). In the House, 26 Representatives are from several professions, including a rehabilitation therapist from Pennsylvania, 13 physicians, and five dentists.

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PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

June 24, 2019

Trends Archives

By Susan N. Hanrahan, ASAHP President

In my message in the November 2017 issue, I indicated that I will be asking some of you to send a photo and answer a series of “fun” questions to be shared with our membership so that we can continue our collegiality through our newsletter. The 14th of many profiles and the fifth in 2019 is presented as follows:

Name and Title: Gwendolyn Mahon, Dean and Professor

Place of birth: Tullamore, Ireland

University: Rutgers, The State University of New Jersey

How long have you been in your position? 4 years

What’s the value of a university education? Opens up your mind to other worlds.

What is the value of ASAHP? ASAHP provides the opportunity to network with educators, administrators and clinicians from other schools across the country.

Your philosophy on education in seven words: A lifelong endeavor for growth and improvement

If I could teach in another field, which one and why? Architectural Engineering, I love the idea of developing ways to build structures that fulfill real world needs.

Before I retire I want to: Walk the entire Camino de Santiago.

In college, I was known for: Studying and working hard.

What music is playing in my car/office? Spanish guitar, Folk, Alternative Rock

The last book I read for fun was: Born to Run, Christopher McDougall

My favorite trip was: We go to Acadia National Park in Maine every summer and it is always my favorite trip.

If I could travel anywhere it would be: A 6 month driving trip across America in an RV hitting every national park.

Four people I’d take to coffee or have a glass of wine with: Leo Varadkar (current Taoiseach of Ireland), Barack Obama, Jane Goodall, My Mom

The best advice I ever received was: If you have nothing good to say about someone then best to say nothing at all.

My hobby is: Gardening, walking, cooking

My passion is: My family

My pet peeve is: People saying they are bored.

A perfect day is: A foggy day on the coast of Maine with family

Cats or dogs? Like both but allergic to cats.

E-book or hardback? Hardback

Beach or mountains? Mountains

I wish I could: Spend more time outdoors.

Only my friends know I: Love to decorate my home.

My favorite saying is: If you are not going to do your best then do not do it at all.

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TENTATIVE VS. DEFINING CRITERIA

John Colbert

June 24, 2019

Trends Archives

The June 2019 issue of the journal Astrobiology features an essay on extraterrestrial life that may have some applicability for health matters here on earth. It does so by presenting a contrast between tentative versus defining criteria, by indicating that the function of tentative criteria is not, like that of defining criteria, to provide an estimate (via a decision procedure) of the likelihood that an extraterrestrial phenomenon is the product of life. Instead, it is to identify phenomena that resist classification as living or nonliving as worthy of further investigation for novel life.

The physicist and philosopher of science Thomas Kuhn argued that a recognition that a puzzling empirical phenomenon is anomalous is a driving force behind scientific revolutions. An anomaly is a violation of a paradigm-induced expectation about a domain of natural phenomena. He characterized scientific paradigms broadly as including laws, theories, and other widely accepted scientific beliefs, as well as sanctioned methods and instruments, concerning a domain of phenomena. Paradigms play vital roles in scientific practice, facilitating the construction of hypotheses, design of experiments, and interpretations of results, but they also may hinder the exploration of nature, discouraging certain lines of research and biasing the interpretation of data. Essentially, a paradigm literally may blind researchers to the presence of anomalies. They either are not perceived as puzzling or alternatively, are interpreted as puzzles that eventually will be solved using the resources (concepts, laws, methods, etc.) provided by the paradigm.

Many key initiatives continue to be undertaken in the health sphere with the intention of improving individual and community health status. The Patient Protection and Affordable Care Act of 2010 was the most ambitious and comprehensive effort in that regard in several decades. Some of its provisions represented the best forms of conventional wisdom, but other portions of the law’s components lacked evidence and may have entailed nothing more substantial than a leap of faith that they would produce desired outcomes. A notable example may be the Hospital Readmissions Reduction Program (HRRP), which was designed to reduce costs and prevent deaths by imposing financial penalties on hospitals if their rate of readmissions within 30 days exceeds an arbitrary threshold.

Based on assessments that have appeared recently in prominent journals (e.g., June 13, 2019 issue of New England Journal of Medicine), the HRRP has assumed the coloration of a debatable proposition rather than a proven fact. Key considerations, such as that a HRRP defines only inpatient hospitalizations, not observation stays or emergency department (ED) visits, as readmissions, and social factors involving poverty cloud the picture quite significantly. The Affordable Care Act was a good faith effort to increase access, lower costs, and improve quality. An implicit assumption involving some aspects of the law was that defining criteria rather than tentative criteria existed, which has the potential to blind advocates of some interventions to the actual worth of what is being proposed. Moving forward in health care, rather than define all proposed actions as valid programs, it would be advisable to consider some of them as experiments awaiting proof of effectiveness.

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VALIDATION OF DIGITAL HEALTH SOLUTIONS

John Colbert

May 23, 2019

Trends Archives

According to an article published on May 13, 2019 in the journal npj Digital Medicine, despite the growth in the number and capabilities of digital health solutions, the confidence of patients, clinicians, payers, and representatives from industry and the regulatory sphere in medicine remains quite low. A need exists for objective, transparent, and standards-based evaluation of digital health products that can bring greater clarity to the digital health marketplace. Investment in the digital health sector is enormous, with nearly $6 billion in funding in 2017, compared to $4.4 billion in the previous year. For mobile health applications alone, there exist more than 3,000,000 of them, with another 200 added daily.

Currently, no reliable mechanism exists to identify validated digital health solutions. Payers also cannot easily identify quality in this crowded field. Regulatory guidance and oversight are limited, with enforcement restricted to companies that make claims out of proportion to the evidence or where application failures might lead to risks to patient safety. For example, a recent evaluation of 280 diabetes mobile applications found only five associated with clinically meaningful improvement and none were of high methodological quality. A more standardized, objective, rigorous, and transparent process for validation is warranted. Specifically, the validation domains would be: technical validation (e.g., how accurately does the solution measure what it claims?), clinical validation (e.g., does the solution have any support for improving condition-specific outcomes?), and system validation (e.g., does the solution integrate into patients’ lives, provider workflows, and healthcare systems?).

return to may 2019 trends

RANDOMIZED CLINICAL TRIALS AND THE WEIGHT OF A SOUL

John Colbert

May 23, 2019

Trends Archives

Randomized clinical trials (RCTs) are considered to be the preferred criterion standard in research for assessing the effectiveness of clinical interventions. Yet, a level that lofty has not always prevailed in experimental work. At the turn of the 20th century, a physician from Haverhill, Massachusetts by the name of Duncan MacDougall conducted an experiment that involved weighing six terminally ill patients immediately before and after being pronounced dead. Upon recording a reduction in a single patient’s weight of 21 grams, he believed the loss represented that individual’s departed soul, while excluding data from the other patients. His findings were reported in both a 1907 issue of the Journal of the American Society for Psychical Research and the periodical American Medicine. A reference to the study also was mentioned in the New York Times.

Progress has been made since then as evidenced by the fact that a lot more rigor characterizes clinical investigations conducted today. Nonetheless, as noted in an article that appeared in the May 2019 issue of the journal JAMA Network Open, scientific lapses committed by MacDougall, such as excluding potentially eligible patients, using unreliable measures, and selectively reporting results that are favorable to the investigator’s hypothesis remain distressingly common. A possible explanation is that confirmation bias may lead to accepting data that support a researcher’s preconceptions and to rejecting data that do not.

Another manuscript in the same issue of that journal entails a systematic review of the level and prevalence of spin in published cardiovascular randomized clinical trial reports with statistically nonsignificant primary outcomes. Spin in this instance is defined as the use of specific reporting strategies, from whatever motive, to highlight that the experimental treatment is beneficial, despite a statistically nonsignificant difference for the primary outcome (i.e., inappropriate use of causal language), or to distract the reader from statistically nonsignificant results (i.e., to focus on a statistically significant secondary result). The authors of the review found that RCTs with statistically nonsignificant primary outcomes were published in high-impact cardiovascular journals and that considerable manipulation of language occurred in both the abstracts and full texts of the reports. Their observations have significant implications for the integrity of clinical science, the translation of clinical evidence at the bedside, peer review, and the rate of medical progress. Indeed, manipulation of language to distort findings also may contribute to further public distrust in science.

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

May 23, 2019

Trends Archives

Advancing Patient-Centered Care For Individuals With Multiple Chronic Conditions

As part of a series of blog posts from leaders of the Agency for Healthcare Research and Quality (AHRQ), a posting on May 10, 2019 discusses how every day many patients and their caregivers struggle to find care that effectively addresses their needs. Clinicians also are frustrated, experiencing epidemic levels of burnout while working in systems often ill-designed to support them in addressing these fundamental objectives of healthcare delivery. This challenge is particularly pronounced for the nearly one of three American adults, and four of five Medicare beneficiaries, who are living with multiple chronic conditions (MCC). Patients with MCC account for 64% of all clinician visits, 70% of all in-patient hospital stays, 83% of all prescriptions, and 71% of all healthcare spending. Alarmingly, the number of children and adolescents with MCCs is growing as well. Currently, there is a critical mismatch between the way care is delivered (disease-specific) and the needs of patients with MCC, who require whole-person (patient-centered) care. This disconnect too often results in care that is fragmented and of suboptimal quality, leading to poor outcomes and increased costs. Furthermore, practice guidelines that help clinicians make testing and treatment decisions tend to guide the care of each of the patients’ conditions in isolation. One consequence of this narrow scope is that recommended treatments for one condition may interact harmfully with recommended treatments for another one. As a first step towards realizing this vision, AHRQ needs to have a well-conceived and effectively executed research agenda. The Care-and-Learn Model, developed by AHRQ researchers to map the work of the Agency and its research portfolio, will help identify areas of unmet need and prioritize research questions with the most value for advancing the care of individuals with MCC. The blog can be obtained here.

Effects of Early Care And Education On Children’s Health

The journal Health Affairs released a Health Policy Brief as part of an ongoing series on the social determinants of health. In “The Effects of Early Care and Education on Children’s Health,” an overview is provided of the landscape of nonparental early care and education (ECE). The focus primarily is on center-based care, including public and private preschool, child care centers, and Head Start. While the impact of ECE on children’s educational, social-emotional, and behavioral outcomes is well studied, its impact on health has become a subject of significant research interest mainly in the last 10 to 15 years. Challenges in studying the health impacts of ECE are identified and an extended summary of key studies in this area is provided. In short, while such programs are not necessarily designed to improve child health, a growing body of research indicates that they may lead to short- and long-term improvements in health-related outcomes. Additional research needs are discussed and the Brief notes that, moving forward, ECE policy must attend to promoting parental employment and improving children’s outcomes, including health outcomes. The Brief can be obtained here.

Addressing Social Determinants Of Health Through Housing Improvements

Improving the health of individuals and their neighborhoods and communities as a whole is one of the most complex and pressing challenges in health care today. Given the inextricable link between affordable quality housing and good health, housing is one area that hospitals and health systems are starting to focus on more resolutely. A new American Hospital Association (AHA) issue brief describes how hospitals are investing in affordable housing. The brief can be obtained here.

return to may 2019 trends

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

May 23, 2019

Trends Archives

Pregnancy-Related Deaths, United States, 2011-2015

According to a Morbidity and Mortality Weekly Report posted online May 10, 2019 by the CDC, approximately 700 women die annually in the United States from pregnancy-related complications. Among such deaths for which timing was known, 31.3% deaths occurred during pregnancy, 16.9% on the day of delivery, 18.6% on days 1–6 postpartum, 21.4% on days 7–42 postpartum, and 11.7% on days 43–365 postpartum. Leading causes of death varied by timing relative to the end of pregnancy. Approximately three in five pregnancy-related deaths were preventable. Contributing factors can be categorized at the community, health facility, patient, provider, and system levels. The national pregnancy-related mortality ratios (PRMRs) was 17.2 per 100,000 live births. Non-Hispanic black women and American Indian/Alaska Native women had the highest PRMRs (42.8 and 32.5, respectively), 3.3 and 2.5 times as high, respectively, as the PRMR for non-Hispanic white women (13.0).

Severe Joint Pain And Physical Inactivity Among Adults With Arthritis-United States

An estimated 54.4 million (approximately one in four) U.S. adults have doctor-diagnosed arthritis. Severe joint pain and physical inactivity are common among adults with arthritis and are linked to adverse mental and physical health effects and limitations. According to an analysis of 2017 Behavioral Risk Factor Surveillance System (BRFSS) data, the median age-standardized state prevalence of arthritis among adults aged ≥18 years was 22.8% (range = 15.7% [District of Columbia] to 34.6% [West Virginia]) and was generally highest in Appalachia and Lower Mississippi Valley regions. Among adults with arthritis, age-standardized, state-specific prevalences of both severe joint pain (median = 30.3%; range = 20.8% [Colorado] to 45.2% [Mississippi]) and physical inactivity (median = 33.7%; range = 23.2% [Colorado] to 44.4% [Kentucky]) were highest in southeastern states. Maintaining a healthy weight or being physically active can reduce arthritis pain and prevent or delay arthritis-related disability.

HEALTH TECHNOLOGY CORNER

Wireless Sensor System To Monitor Babies In The Neonatal Intensive Care Unit (NICU)

According to an April 30, 2019 report from Deloitte, approximately 300,000 premature babies are delivered each year in the US. Multiple wires and adhesive patches can damage fragile skin and prevent parents from holding and nurturing their babies. A team from the Northwestern University Feinberg School of Medicine has been working for five years to develop a wireless sensor system that uses Bluetooth technology to monitor babies in the neonatal intensive care unit (NICU). The new system appears to be as precise and accurate as traditional monitors. Two lightweight wireless patches are attached to the baby's chest and foot to collect a wide range of data, including temperature, respiratory rate, EKG, oxygen saturation, and blood pressure. The patches are flexible and gentle on a newborn's skin. The wireless device allows for more physical contact between baby and parents. Researchers note that the sensor system could be sent home with a patient, so monitoring can continue beyond the hospital if necessary.

Electric Field-Based Dressing Disrupts Bacterial Biofilm Infection To Restore Healing

Bacterial biofilms are thin, slimy accretions that form on some wounds, including burns or post-surgical infections, as well as after a medical device, such as a catheter, is placed in the body. These bacteria generate their own electricity, using their own electric fields to communicate and form the biofilm, which makes them more hostile and difficult to treat. Researchers at Indiana University School of Medicine have found a way to advance the fight against bacterial infections using electricity. Work has led to the development of a dressing that uses an electric field to disrupt biofilm infection. Findings were published in the April 2019 issue of the journal Annals of Surgery. As an alternative to pharmacological intervention, this effort is the first pre-clinical porcine mechanistic study to recognize the potential of electroceuticals as an effective platform technology to combat wound biofilm infection.

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DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

May 23, 2019

Trends Archives

American Council Education (ACE) President Ted Mitchell sent a letter on May 9, 2019 to members of the House Ways and Means and Senate Finance Committees, urging swift action to correct a mistake made in the Tax Cuts and Jobs Act (TCJA) of 2017 that inadvertently has resulted in harm to many low- and middle-income students who rely on scholarship aid to pay for their college education. The letter notes that the TCJA made changes to the so-called “kiddie tax” that sharply increased the tax levied on the portion of scholarships set aside for expenses, such as room and board that colleges and universities award to students from families of little or modest means. A consequence is that many low- and middle-income students are being taxed at the same rates as wealthy individuals.

Academic, need-based scholarship students are not the only ones who will feel the impact of the amended kiddie tax. College athletes on full scholarships, which include money for housing and other non-tuition expenses, also are affected by kiddie tax changes, many of whom come from economically disadvantaged families. Based on Department of Education data, the increased tax on scholarship/grant aid could exert an effect on nearly 1.4 million students and their families. A related concern is that problems caused by the change to the kiddie tax extend beyond higher education. For example, “Gold Star” Families (immediate family survivors who receive benefits resulting from a fallen service member who died while serving in a time of conflict) also may be affected negatively.

Student Loan Borrower Bill Of Rights Act Of 2019 Re-Introduced

Senators Dick Durbin (D-IL), Elizabeth Warren (D-MA), and Jack Reed (D-RI) on May 8, 2019, re-introduced the Student Loan Borrower Bill of Rights Act of 2019, which would amend the Truth-in-Lending Act, to create consistent disclosure and servicing standards across federal and private student loan programs. Its provisions include:

Requiring various disclosures to borrowers when a loan is sold or transferred,
Standardizing the application of payments and the allocation of payments among multiple loans in a
manner that is most beneficial to a borrower, and
Limiting when borrowers are subject to late fees and other consequences.

Trump Administration Proposes To Reduce Pell Grant Surplus

An effort by the Trump administration that was announced in May 2019 to make a deep reduction in the Pell Grant surplus was criticized by several groups representing colleges, universities, and student aid advocates. A concern is that the proposal, which is in the form of a revised budget request for FY 2020 that would shift $3.9 billion from the Pell surplus to aid in funding a National Aeronautics and Space Administration (NASA) mission to the moon, not only will hurt students, but also make attending college more expensive. Previously, White Office officials sought to take $1.3 billion from left-over Pell funding in 2017. Fiscal year 2018 and 2019 budgets also proposed multibillion-dollar cancellations, but these proposals eventually were withdrawn.

States Pass Laws Aimed At Student Loan Companies

Stimulated to some extent by Democratic gains in state houses around the nation in the November 2018 election, coalitions involving liberal groups, consumer advocacy organizations, and labor unions have launched efforts to regulate student loan companies operating in their respective states. For example, a new law in New York places student loan servicers under the jurisdiction of the state's financial services regulator as a means of protecting student loan borrowers and reducing their financial loan burden by cracking down on unscrupulous lending practices. Both the Trump administration and student loan industry groups oppose these initiatives on the grounds that states don’t have the power to regulate companies collecting federal student loans. Such issues await further resolution in the courts.

return to may 2019 trends

HEALTH REFORM DEVELOPMENTS

John Colbert

May 23, 2019

Trends Archives

A chronic health workforce challenge facing nations throughout the world is a maldistribution of personnel. Approximately 60 million inhabitants of the United States, roughly one of every five individuals, live in rural areas. Significant obstacles face patients and providers in rural communities where rates for the five leading causes of death are higher, poverty is more common, higher rates of uninsurance or underinsurance prevail, greater transportation difficulties exist in going to a hospital or to the offices of health professionals, and residents lack access to high-speed Internet, which limits their access to information. The patient-to-primary care physician ratio in rural areas is only 39.8 physicians per 100,000 individuals, compared to 53.3 physicians per 100,000 in urban areas, to cite just one example of a health professions workforce shortage. A worrisome trend according to the Centers for Medicare & Medicaid Services (CMS) is that since 2010, more than 100 rural hospitals have closed and nearly 40% of rural hospitals currently running are operating with negative margins, limiting the ability of providers to compete based on high value care and leading to fewer choices for beneficiaries.

Similar to other U.S. presidential administrations, the Trump administration has launched initiatives aimed at ensuring improved access to health care services in rural areas. A Rural Health Strategy has been undertaken to increase access to telehealth and other virtual services across the Medicare program. One way of doing so is to pay for virtual check-ins that allow a patient to check in with his or her clinician by telephone or other telecommunication system, along with remote evaluations of recorded videos or images that a patient submits to a clinician to help in making a joint decision whether a trip needs to be made by this individual to be seen in-person. An example of coping with the threat of hospital closures is a proposal to enhance their stability by transforming the way CMS pays certain rural hospitals and facilities in other low wage areas. A related action is a proposed change in the way Medicare factors local labor costs into hospital payments by increasing the wage index of rural and other low wage index hospitals to address payment disparities.

Provision Of Health Coverage For The Uninsured: Medicare For All

The Affordable Care Act of 2010 has been instrumental in reducing the proportion of the U.S. population lacking health insurance coverage. Despite many impressive gains that have been made, an estimated 9.4% of U.S. residents, or 30.4 million individuals, lacked health insurance when surveyed in 2018, according to a report released by the Centers for Disease Control and Prevention (CDC) on May 9 of this year, a rate not significantly different from the survey’s uninsured rate in 2017, but 18.2 million persons fewer than in 2010. The uninsured rate for adults under age 65 was 9.9% in Medicaid expansion states, compared with 18.7% in non-expansion states.

An effort gaining momentum in Congress is a proposal by Democrats called Medicare for All legislation. Generally, this universal health care program would include coverage of primary care, hospital stays, mental health treatment, prescription drugs, along with dental, vision, hearing, and home and community-based long-term care services. Meanwhile, an annual report from the Medicare Board of Trustees that was released last month indicates that the Hospital Insurance (HI) Trust Fund is expected to be depleted in 2026. Also, a report from the RAND Corporation on May 19, 2019 states that the prices paid to hospitals by private health plans averaged 241% of what Medicare would have paid. Since Medicare for All has the prospect of terminating private health plans, an interesting question is what rate will an expanded Medicare program pay and how will these costs be financed?

Predictive Analytics And Social Determinants Of Health (SDoH)

A report from Deloitte on April 30, 2019 discusses how addressing the housing, nutrition, and other social needs of Medicaid members could result in fewer ambulance rides, fewer emergency room visits, and fewer hospitalizations. Predictive analytics could help Medicaid departments and managed care organizations more accurately target these services by using a state’s resources more efficiently and effectively. Officials of SDoH programs also might want to determine how to ensure that spending is aimed at individuals who are most at risk of a decline in health status so that they can leverage the lessons learned from the experience of Medicaid home and community-based service programs.

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BIPARTISAN HEALTH LEGISLATION

John Colbert

May 23, 2019

Trends Archives

Even under ordinary circumstances, it is common for competition between Democrats and Republicans and also between the two legislative chambers to serve as obstacles to passing important bills. Given that a presidential election occurs next year, it can be expected that partisanship will play a role in complicating attempts to pass legislation that would be perceived as accruing to the advantage of one political party over the other party’s fortunes. So, it always is refreshing that at a time of potential conflict, there is evidence that opponents can join forces to advance the common good.

The introduction of H.R. 2781, a bipartisan bill to amend Title VII of the Public Health Service Act to reauthorize certain programs relating to the health professions workforce, and for other purposes, is an example of one such effort. The proposed legislation would increase the authorization for most Title VII programs by 5% over the fiscal year 2019 appropriated levels, 7.2% for Area Health Education Centers (AHECs), and 25% for Geriatric Programs. The legislation also provides flat funding authorization for the Pediatric Loan Repayment program, which has yet to receive an appropriation.

Title VII programs are under the direction of the Health Resources and Services Administration (HRSA). They have been created to enhance the health professions pipeline through a wide variety of education and training programs that play a critical role in addressing major health problems in rural and underserved communities. One aim of H.R. 2781 is to respond to the problem of an emerging shortage of physicians in the United States. It is anticipated that the House Energy and Commerce Committee will conduct a hearing on Title VII reauthorization in June 2019.

Meanwhile, despite partisan differences on important funding legislation for the Departments of Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS), the House Appropriations Committee on May 8, 2019 approved its FY 2020 spending bill by a party line vote of 30-23. The committee also approved 302(b) allocations for all twelve appropriations subcommittees. Among the various provisions are the following:

The approved legislation provides a program level of $41.084 billion for the National Institutes of Health (NIH), which amounts to a $2 billion or 5.12% increase over the comparable FY 2019 level. The bill provides an across-the-board increase of approximately 5% for all Institutes and Centers to maximize the across-the-board increase for all these entities in order to ensure a significant boost for the best peer-reviewed research across all scientific disciplines.
Other funding allocations include $734.9 million for HRSA’s Title VII health professions and Title VIII nursing workforce development programs, a $93.25 million (14.5%) increase over FY 2019 enacted levels. The amounts include increases for diversity pipeline programs, such as the Health Careers Opportunity Program, which received $20 million in funding for FY 2020, a $5.8 million (41%) increase over FY 2019 levels. Other kinds of programs, such as Children’s Hospital Graduate Medical Education would benefit by an allocation of $350 million, which is a $25 million (7.6%) increase over FY 2019 levels.

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PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

May 23, 2019

Trends Archives

By Susan N. Hanrahan, ASAHP President

In my message in the November 2017 issue, I indicated that I will be asking some of you to send a photo and answer a series of “fun” questions to be shared with our membership so that we can continue our collegiality through our newsletter. The 13th of many profiles and the fifth in 2019 is presented as follows:

Name and Title: Ken Johnson, PhD, FASAHP

Place of birth: Blackfoot, Idaho

University: Weber State University

How long have you been in your position? 13 years

What’s the value of a university education? Increased options, increased income

What is the value of ASAHP? Making friends, sharing solutions to problem.

Your philosophy on education in seven words: To help learners learn how to learn.

If I could teach in another field, which one and why? Occupational Psychology – it’s another field that promotes wellness in a variety of ways.

Before I retire I want to: I think I’m good...just increase my retirement fund.

In college, I was known for: Being part of the International Folkdancers as a band member and dancer. What music is playing in my car/office? Classic rock

The last book I read for fun was: Saints

My favorite trip was: Edinburgh, Scotland

If I could travel anywhere it would be: Back to Northern England and Scotland.

Four people I’d take to coffee or have a glass of wine with: I don’t do either of those, but I’d love to visit with some of my ancestors.

The best advice I ever received was: I’ve received too much good advice to just pick one thing.

My hobby is: Woodworking, golfing, fishing

My passion is: My family

My pet peeve is: Bad drivers, I suppose.

A perfect day is: In a peaceful setting with my family

Cats or dogs? Dogs, although we have cats.

E-book or hardback? Hardback

Beach or mountains? I live in and love the mountains. I like to visit the beach.

I wish I could: Travel more.

Only my friends know I: No comment

My favorite saying is . . . on my wall: “Med dig vill jag bli gammal och lite halv blind.” (You’ll have to look it up).

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LANGUAGE TRANSMISSION AND TRANSLATION

John Colbert

May 23, 2019

Trends Archives

Samuel Beckett, a Nobel Laureate in literature from Ireland, produced some of his work in the French language. What may seem odd is that this highly gifted linguist subsequently found it difficult to translate his own material into English, his native language. Apart from variations in vocabulary that distinguish one language from another, even within the same one, communication impediments may arise.

Depending on their level of health literacy, patients can be at a disadvantage in understanding terminology and jargon used by clinicians. Superimposed on differences in understanding spoken and written words is the impact semiotics has on the process of communication in the form of facial gestures, tone of voice, clothing (e.g., white coats worn by health professionals signifying knowledge authority status), and personal appearance (e.g., age, gender, race/ethnicity, body weight, and presence of tattoos and piercings).

Hundreds of millions of interactions occur between clinicians and patients in the U.S. each year, and the quality of the experiences shared by them will help to govern what eventually transpires in the form of beneficial health outcomes. For example, an evaluation of patient–reported outcome measures (PROMs) that appeared on April 15, 2019 in the journal Cancer indicated that more than half of the most commonly used cancer PROMs do not meet plain‐language best practices. This finding may have implications for the quality of care, safety, and experience/satisfaction involving patients characterized by low health literacy.

Access to electronic health records has made it possible for patients to review information written about them. Nevertheless, depending on the branch of health care involved, there is ample room for misinterpretation. Sociolinguistic differences between patients and clinicians can lead to variable misunderstandings of written words that may limit patients’ engagement in their own health care. That outcome should come as no surprise because even within the professional community itself, a veritable Tower of Babel may exist. As an illustration, a radiologist might communicate imaging results to other members of the health care team using terms, such as “probably represents,” which in turn could be interpreted differently by referring clinicians.

Interprofessional education and practice currently is a topic of considerable interest and importance in health care. Data reported on March 22, 2019 in the Journal of Interprofessional Care reveal, however, that there was little consistency in the terminology used by accreditors to describe the learning outcomes that healthcare professions educational programs were expected to embrace. A conclusion reached was that inconsistency in terminology across accreditors found in this study is a clear impediment to healthcare professions educational programs creating a shared mental model for their IPE outcomes. A risk is that until accreditation bodies agree to one such model for all aspects of education, IPE may continue to be perceived by students as an ‘add-on’ to their curricula rather than as an integral part of becoming a health professional.

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PLACING A MAN ON THE MOON AND SOME RELATED MUSINGS

John Colbert

April 22, 2019

Trends Archives

When Neil Armstrong planted his large boots on the surface of the moon in July 1969, one is stimulated to wonder if he could have foreseen that the next thing to soar extraordinarily high would be rhetoric from elected officials in Washington, DC who subsequently would declare to impressive effect that if we can place a man on the moon, then we should be able to cure cancer, eliminate bed bug infestation, and achieve other feats of daring do.

Just as a major national initiative led to reaching the moon, today’s interplanetary dreams include long-duration missions that will take humans to Mars and beyond by public and private entities in the 2020s and 2030s. According to a study described in the April 12, 2019 issue of the journal Science, however, comprehensive studies are needed to assess the impact of long-duration spaceflight on the human body, brain, and overall physiology. To assess the health effects of long-duration spaceflight, one identical twin astronaut was monitored before, during, and after a one-year mission onboard the International Space Station, the time approximately required for a return journey to Mars.

The other twin served as a genetically matched ground control. Largely unknown risks imposed by microgravity and ionizing radiation (IR) exposure during spaceflight currently limit endeavors to visit Mars. Low-risks include changes in the gastrointestinal microbiome and in body mass. Mid-level risks include alterations in collagen regulation and intravascular fluid management. Genomic instability, assessed by chromosomal aberrations, potentially represents a higher risk because it confers a prospect of developing cancer. Structural abnormalities observed in the chromosomes of the traveling twin are typical of IR exposure. Other severe biological effects could relate to microgravity, causing a headward fluid shift and pronounced changes in vascular physiology (e.g., upper body distended arteries and veins). Nonetheless, perhaps there are many valuable lessons that may be learned from space adventures that will accrue to the advantage of earth-bound inhabitants who will benefit in ways involving their health.

return to april 2019 trends

PER SCIENTIAM AD SAPIENTIAM: SOME KEY STEPS IN THE JOURNEY

John Colbert

April 22, 2019

Trends Archives

The accumulation of knowledge may be viewed as a fundamental stepping stone on the road to wisdom. The professional literature is a source of factual information that over time furnishes essential building blocks in the accumulation of knowledge. Some examples are:

James Watson and Francis Crick in an article published in Nature on April 25, 1953 in the brief space of 842 words set in motion a vast panoply of studies that influence achievements to the present day involving the human genome. Their contribution led to sharing a Nobel Prize in 1962. A significant flaw was failing to acknowledge how their understanding of the helical structure of DNA was greatly aided by imagery developed earlier through crystallography by chemist Rosalind Franklin.

Luis Alvarez, a 1968 Nobel Laureate in physics at the University of California, Berkeley, was able to expand his curiosity to the fields of geology and paleontology. His efforts led to an article in the June 6, 1980 issue of Science in which he hypothesized how most life on earth was extinguished when a giant asteroid crashed into the planet at a high speed 65 million years ago (since updated to 66 million).

When John Wakefield indicated in a paper that appeared in the Lancet on February 28, 1998 that MMR vaccine can lead to the onset of autism and other conditions, he inspired a refusal among some parents that exists to the present day to have their children immunized. His assertions were proven false and the manuscript later was retracted in February 2004 by the publisher, but its effects still manage to influence opposition to interventions designed to prevent the occurrence of several infectious diseases.

When viewers stare at the sky, the experience may conjure up thoughts about the possible existence of life on other planets. Sam Levin and co-authors speculated in the February 2019 issue of the International Journal of Astrobiology how evolutionary theory can be used to make predictions about aliens. They even contemplated the possibility someday of discovering a bizarre looking alien called an “Octomite”

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

April 22, 2019

Trends Archives

Hospitals’ Use Of Electronic Health Records Data, 2015-2017

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 helped to advance the adoption and meaningful use of electronic health records (EHRs). Currently, more than 95% of hospitals possess an EHR. With this widespread adoption of the technology, policy is now shifting towards the use of EHR data, which can improve patient care by giving providers access to evidence-based tools that assist with decision making and facilitating clinical practice by automating and streamlining provider workflow. EHR data are used most commonly by hospitals to support quality improvement (82%), monitor patient safety (81%), and measure organization performance (77%). Hospitals with the capability to send, find, receive, or integrate external patient data were twice as likely to use their EHR data compared to hospitals that did not engage in these domains of interoperability. A data brief from The Office of the National Coordinator for Health Information Technology employs data from the American Hospital Association Information Technology Survey to describe trends in the use of EHR data among non-federal acute care hospitals from 2015 to 2017. EHR data are defined as a set of 10 measures that describe hospital processes for leveraging information within their EHR to inform clinical practice. The data brief also presents variation in the use of this data by hospital characteristics and over time. It can be obtained here.

Care Coordination

Care coordination is a methodical approach to care that facilitates better communication between and among individuals, family caregivers, and service providers. There has been significant emphasis in the last several years on care coordination’s role in supporting older adults and in reaching the key aims of health care reform, namely improved patient outcomes, enhanced care experience, reduced costs, reduced provider burnout, and equity in outcomes. A new issue brief provides updates to a 2013 care coordination issue brief developed by Eldercare Workforce Alliance (EWA) and the National Coalition on Care Coordination (N3C). It includes a synthesis of diverse strategies in use and a vision for how services could be improved. Care coordination should be happening wherever and whenever care is provided. Efforts may be staffed within various settings: office-based primary care teams, house call programs, specialty care teams (such as oncology), hospitals (often staffed by discharge planners or transitional care coordinators), skilled nursing facilities, hospice and palliative care programs, aging network organizations, and housing programs. The issue brief can be obtained here.

Strengthening The Connection Between Health Professions Education And Practice

The National Academies of Sciences, Engineering, and Medicine’s Global Forum on Innovation in Health Professional Education with affiliates of the National Center for Interprofessional Practice and Education held a workshop on November 13 and 14, 2018 in Washington, DC entitled Strengthening the Connection between Health Professions Education and Practice. The purpose was to explore methods and methodology for bridging health professions education and practice in ways that improve information flow between learning and application. The workshop also explored various models of training by bringing together multiple health professions across the education-to-practice continuum. Workshop Proceedings can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

April 22, 2019

Trends Archives

Disparities In Prevalence Of Major Cancer Risk Factors And Screening Test Use In The U.S.

According to the April 2019 issue of the journal Cancer Epidemiology, Biomarkers & Prevention, individuals with lower educational attainment have higher prevalence of modifiable cancer risk factors and lower prevalence of screening versus their more educated counterparts. Smoking prevalence is six times higher among males without a high school education than female college graduates. Nearly half of women without a college degree are obese versus about one-third of college graduates. Over 50% of black and Hispanic women are obese compared with 38% of whites and 15% of Asians. Breast, cervical, and colorectal cancer screening utilization is 20% to 30% lower among those with less than high school education compared with college graduates. Screening for breast, cervical, and colorectal cancers also is lower among Hispanics, Asians, and American Indians/Alaska Natives relative to whites and blacks.

Foreign-Body Ingestions Of Young Children Treated In U.S. Emergency Departments: 1995–2015

The number of children in the United States who swallowed coins, toys, and other small objects nearly doubled (91.5% from 9.5 per 10,000 children in 1995 to 18 in 2015), according to an article published on April 10, 2019 in the journal Pediatrics. Some objects can cause serious harm when ingested, and possibly even death. Overall, boys more frequently ingested foreign bodies (52.9%), as did children one year of age (21.3%). Most children were able to be discharged after their suspected ingestion (89.7%). Among the types of objects ingested, coins were the most frequent (61.7%), toys (10.3%), jewelry (7.0%), and batteries (6.8%) followed thereafter. The rates of ingestion of those products also increased significantly over the 21-year period. Across all age groups, the most frequently ingested coin was a penny (65.9%). Button batteries were the most common kind of batteries ingested (85.9%). Small and flat objects, they can damage or even puncture the walls of the esophagus if they become stuck.

HEALTH TECHNOLOGY CORNER

Morning Exercise Is Better Than Evening Exercise Except When It Is Not

Exercise is considered an effective lifestyle intervention for the prevention and mitigation of various diseases. One group of researchers investigated whether the time of day and circadian clock affect exercise performance and related metabolic pathways in mice and humans. They found that exercise performance is better in the evening than in the morning hours, thereby potentially optimizing health benefits. Meanwhile, a different set of investigators observed a more robust metabolic impact of exercise in the morning (beginning of active phase) than at night (beginning of rest phase), resulting in a higher utilization of carbohydrates and ketone bodies, together with the degradation of lipids and amino acids. Both studies were published April 18, 2019 in the journal Cell Metabolism. While the results may not lead to firm conclusions pertaining to humans, they possibly could have implications for any mice that have an opportunity to exercise regularly on treadmills, which relates to how the research was conducted.

Using Voice Analysis To Evaluate And Predict Human Behaviors And Identify Health Risks

An Israeli company called VoiceSense is taking advantage of the plethora of devices that capture human speech, such as mobile phones and digital assistants in homes. Voice-analysis research is capturing individual tones, speed, emphases, and pauses, and applying machine learning to make predictions. Feeding the data to an algorithm, over time it learns to pick up subtle speaking signs that might indicate someone who experiences anxiety. Mental and behavioral health issues often prove to be difficult to monitor effectively. For example, signs and symptoms can creep up on individuals who experience depression before they realize that they might need help. Although using voice to identify anxiety, depression, and specific conditions such as Parkinson’s disease or post-traumatic stress disorder (PTSD) still is in the early stages, researchers aim to produce a sensor that can monitor and alert a patient to such problems in order to facilitate earlier intervention.

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DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

April 22, 2019

Trends Archives

A major objective of the Association of Schools of Allied Health Professions (ASAHP) is to be a leading interprofessional voice for improvements in health and health care. An essential belief is that all health professions programs and schools should provide interprofessional education (IPE) opportunities for students from several health disciplines in order to foster competencies beyond clinical care, including leadership, advocacy, and evidence-based practice. Another significant step in that direction is the upcoming 2019 ASAHP Summit, a project co-sponsored by the ASAHP Interprofessional Subcommittee and the ASAHP Clinical Education Task Force, and co-hosted by Kindred Healthcare and Saint Louis University. In preparation for this event scheduled to occur on May 31, 2019 at Saint Louis University, Association members are being requested to complete a survey regarding some recommendations made by the Clinical Education Task Force. Information derived from the study will enhance Summit activities.

Developments in interprofessional education involving allied health are featured in the Association’s Journal of Allied Health. A new section called “Interprofessional Practice and Education” was created in this publication beginning with the Fall 2017 issue. Eleven IPE articles appeared in the four issues of the journal distributed in 2018. Two more appeared in the Spring 2019 issue and another two are scheduled for the Summer 2019 issue. Also, the recipient of the ASAHP Excellence and Innovation in Interprofessional Education and Collaborative Health Care Award will be announced later this year.

Secretary Devos Testifies At House Hearing On Department Of Education Policies And Priorities

Department of Education Secretary Betsy DeVos testified on April 10, 2019 at a House Education and Labor Committee hearing entitled “Examining the Policies and Priorities of the U.S. Department of Education.” The purpose of the hearing was to consider the Department’s fiscal year 2020 budget request and other Department initiatives. She discussed the Administration’s proposals to create a single income driven repayment (IDR) plan capped at 12.5% and to eliminate the Public Service Loan Forgiveness program. She opined that the current loan program provides an after-the-fact benefit that fails to help students complete their program and does not take into account borrower earnings in their chosen professions. The aim of the Administration’s proposed plan is to support all borrowers pursuing any career through the single IDR plan, which will allow them to make affordable monthly payments based on their income.

Negotiated Rulemaking On Accreditation, Innovation, And Other Topics

The U.S. Department of Education (USDE) released draft consensus language from its negotiated rulemaking on accreditation, innovation, and other topics on April 17, 2019. Negotiated rulemaking is the process used by the USDE to negotiate the terms of a proposed administrative rule or regulatory change. The negotiated rulemaking full committee met four times between mid-January and early April, 2019. Three subcommittees that addressed distance education, faith-based institutions, and TEACH Grants made recommendations to the full committee. Consensus language pertaining to revised regulatory proposals will affect accreditation in some of the following ways:

Require more transparency regarding where regional accreditors operate
Provide more flexibility for innovation for institutions and accreditors
Protect students through enhanced disclosure and teach-out requirements
Simplify and balance the recognition process for both USDE and accrediting organizations
Require arbitration of accreditation decisions prior to going to court
Make it easier for new accreditors to gain recognition

Next, USDE will publish a Notice of Proposed Rulemaking (NPRM) in the Federal Register and provide for a public comment period. For the rule to take effect on July 1, 2020, the final rule must be published in the Federal Register by November of this year.

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Prescriptions Filled By Americans In 2018

Dental Care Among Adults Aged 65 And Older

HEALTH TECHNOLOGY CORNER

3-D Print Flexible Mesh For Knee And Ankle Braces

Using Pig Brains To Understand Human Brain Functions

More Articles from TRENDS June 2019

TENTATIVE V. DEFINING CRITERIA

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

SPENDING LEGISLATION TAKES SHAPE

HEALTH REFORM DEVELOPMENTS

DEVELOPMENTS IN HIGHER EDUCATION

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

ASAHP SUMMIT ON ACADEMIC PROGRAMS AND CLINICAL PRACTICE

ARTIFICIAL INTELLIGENCE AS A HEALTH MANAGEMENT TOOL

Federal Work-Study (FWS) Experiment Launched

Proposed Regulations On Accreditation, Innovation And Other Topics

More Articles from TRENDS June 2019

TENTATIVE V. DEFINING CRITERIA

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

SPENDING LEGISLATION TAKES SHAPE

HEALTH REFORM DEVELOPMENTS