John Colbert

November 26, 2018

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

November 26, 2018

Use Of Yoga, Meditation, And Chiropractors Among U.S. Adults: 2012-2017
A report from the National Center for Health Statistics (NCHS) in November 2018 examines changes over time in the percentage of adults who used yoga, meditation, and chiropractors in the past 12 months, as well as variation by sex, age, race, and Hispanic origin. Among adults aged 18 and over, increases were seen from 2012 to 2017 in the use of yoga, meditation, and chiropractors. Yoga was the most commonly used complementary health approach among U.S. adults in 2012 (9.5%) and 2017 (14.3%). In 2017, women were more likely to use yoga, meditation, and chiropractors in the past 12 months compared with men. Non-Hispanic white adults were more likely to use yoga, meditation, and chiropractors compared with Hispanic and non-Hispanic black adults. In 2012, seeing a chiropractor was as popular as yoga, followed by meditation, but in 2017, meditation became the 2nd most-used approach ahead of chiropractic.

Increasing Medication Adherence Could Improve Care And Save Health Care Costs
Non-adherence to medication represents a major problem that limits the effectiveness of treatment and adds to the burden of illness and cost of health care. About half of all patients do not take their medication as prescribed, according to a September 2018 report from the National Council for Behavioral Health’s Medical Director Institute. Estimates indicate that medication non-adherence costs the health care delivery system $100 billion to $300 billion annually due to more frequent use of high-cost services, additional prescriptions to offset non-adherence, and interventions to address relapses. The report discusses medication non-adherence in chronic conditions, mental health, and substance use disorders, and offers some possible solutions. If many of these solutions were to be adopted by 2025, a projection is made that the health system would save $2 billion a year from reduced hospital costs alone. Apart from improving communication between patients and providers, some more high-tech solutions include apps and robots.

HEALTH TECHNOLOGY CORNER

Robotic Arm May Help To Rehabilitate Chronic Stroke Victims’ Communication Deficits
Apropos of the article about silos in Health Silo Disruption and Eradication of this issue of TRENDS, treatment in one domain (motor function) may benefit performance in another untreated domain (communication) in individuals with acquired aphasia, the loss of ability to understand or express speech. Research published in Frontiers in Neurology on October 22, 2018 shows that robotic arm rehabilitation in chronic stroke patients with aphasia may promote speech and language function recovery. The rehabilitation in this study targeted the right arm since study participants each had suffered a left hemisphere stroke leading to a deficit in motor function on their right side. The research team observed small, but consistent improvement on measures assessing speech articulation and overall language processing in aphasia. It is believed some treatment approaches may encourage plasticity and reorganization that can span multiple domains. Although this initial finding should be interpreted cautiously, it remains exciting to consider the possibility that stroke rehabilitation in one domain would improve performance in another domain.

Obesity Provides Unexpected Enhancement Of Anticancer Medications
Obesity is associated with increased mortality and reduced longevity, but counter-intuitive findings occasionally suggest evidence of an obesity paradox. An article published in the journal Nature Medicine on November 16, 2018 indicates that overweight patients sometimes respond better than other patients to powerful drugs that harness the immune system to fight tumors. Called checkpoint inhibitors, the drugs block the activation of PD-1, a protein on the surface of immune sentinels called T cells. The body naturally triggers PD-1 to dampen immune responses, but tumors also can stimulate PD-1 to protect themselves. Lifting this molecular “brake” allows the T cells to attack the cancer cells. PD-1 inhibitors have caused untreatable tumors to vanish for years in patients with melanoma, lung cancer, and some other cancer types. Although there is heightened immune dysfunction and tumor progression, there also is greater anti-tumor efficacy and survival after checkpoint blockade that targets some pathways activated in obesity.

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HEALTH REFORM DEVELOPMENTS

John Colbert

November 26, 2018

Trends Archives

The ability to access high quality health care services is a necessary, but not sufficient means of improving the health status of individuals. Race, ethnicity, health literacy, nutritious dietary patterns, being physically fit, the opportunity to live in safe neighborhoods, and the availability of jobs that provide a satisfactory level of income are among the many key factors that have an impact on health. Government programs, such as Medicare have strict limits defined statutorily that determine the scope of services that can be offered to beneficiaries. As discussed below, a recent speech on November 14, 2018 at the Hatch Foundation for Civility and Solutions in Washington, DC by Alex Azar, Secretary of the Department of Health and Human Services (HHS), provides a possible way of expanding services to include a greater emphasis on addressing social determinants of health.

Also, not only do technology developments play a major role in contributing to a constant rate of growth in the cost of health care, they complement efforts to enhance service quality. Telehealth, artificial intelligence (AI), and machine learning are key items as described below.

Addressing Social Determinants Of Health In The U.S. Through Medicare Advantage
HHS Secretary Alex Azar on November 14 stated that the department he oversees is logically positioned to think of healthcare as broad and interconnected with other needs. "Social determinants would be important to HHS even if all we did was healthcare services, but at HHS, we cover health and human services, all under one roof. In our very name and structure, we are set up to think about all the needs of vulnerable Americans, not just their healthcare needs. But what if we went beyond connections and referrals? What if we provided solutions for the whole person, including addressing housing, nutrition and other social needs? What if we gave organizations more flexibility so they could pay a beneficiary’s rent if they were in unstable housing, or make sure that a diabetic had access to, and could afford, nutritious food?” One of the best ways to do so is through Medicare Advantage, which is Part C of the Medicare program. Beginning next year, plans under Part C will be allowed to pay for a wider array of health-related benefits, such as transportation and home health visits.

Telemedicine Usage Increases In Medicare
A report sent to Congress on November 16, 2018 by the Centers for Medicare & Medicaid Services (CMS) describes an increase in telemedicine usage of about 50% in fee-for-service Medicare from 2014 to 2016. Telehealth is emerging as a tool with the potential to improve access to care, potentially reduce costs, and enhance patient satisfaction. Medicare and other telehealth services are being used currently for a range of services in rural communities, allowing patients to connect directly with health care providers and support these providers with clinical decision-making. Moreover, telestroke services connect neurologists to rural patients and providers to provide remote diagnoses and treatment recommendations. Research indicates that telepsychiatry can reduce disparities in access to psychiatric care. When delivered remotely, psychiatric care increases the chances that individuals living in rural communities will be able to access professionals who are culturally and linguistically competent.

Bioethics Influence On Artificial Intelligence and Machine Learning
According to an essay in the September/October 2018 issue of The Hastings Center Report, artificial intelligence (AI) and machine learning have the potential to revolutionize the delivery of health care. AI systems generate conclusions by applying complex algorithms to enormous data sets by replacing human reasoning with rote‐like analysis. Machine learning “trains” or “teaches” the algorithm so that it can “learn” and eventually perform its given tasks automatically. Empirical research has demonstrated that the latest generation of AI and machine learning applications not only can identity at‐risk patients, but even achieve better diagnostic performance than expert physicians can. An example of why it is important to develop ethical frameworks that can support novel technologies has to do with the possibility that schizophrenia is over diagnosed in black patients. For a decision model to make correct predictions about the diagnosis or prognosis of these individuals seeking mental health care, factors such as their social history, their access to providers or hospitals, and the quality of hospitals available to this patient population play an important role. If a machine learning‐based decision support system continually is exposed to this ailment in black patients without appropriate context, then the algorithm will wrongly “teach” the decision system that schizophrenia is common in these patients.

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ELECTION RESULTS TO PONDER

John Colbert

November 26, 2018

Trends Archives

Elections that occur in the middle of a presidential term may provide useful insights regarding directions in which voters prefer to have some corrective measures implemented. Typically, the party that occupies the White House experiences mid-term losses in both congressional and state contests. The year 2018 was no exception insofar as Democrats in Congress regained having a majority in the House of Representatives. Much of what they may hope to achieve will be tempered to a certain extent, however, by the fact that not only will Republicans maintain control of the Senate for the next two years, they will do so with more members than they had prior to the election.

Health was the number one issue for many individuals casting ballots throughout the U.S. Democrats running for office campaigned on promises to protect key provisions of the Affordable Care Act, such as defending protections for patients with pre-existing conditions and preventing future Republican efforts to repeal the ACA. Members of the G.O.P emphasized the risk of heightened fiscal dangers that will occur if either Medicare for All legislation or any single-payer health insurance variation aimed at making health care available at little or no cost for patients ever is enacted.

One policy area of concern may lend itself to some bipartisan agreement. Key members of the Democratic party and President Trump have expressed interest in curbing pharmaceutical price increases. Generally, Republicans tend to oppose government action to set or influence prices. Yet, it would come as no surprise if House Democrats try to require direct government negotiation of Medicare Part D drug reimbursement policy. Democrats also can be expected to be more aggressive when it comes to investigating drug manufacturers suspected of being responsible for initiating price increases of their products. The pharmaceutical industry may not be alone, however, in attracting greater congressional scrutiny. An example involves what is called “surprise bills” that may arise unexpectedly after patients are discharged from hospitals. This issue also has some potential to attract bipartisan support in search of a remedy.

Marijuana legislation usually generates more attention at the state rather than the federal level, but the topic remains of interest to Democrats on Capitol Hill. Republican Pete Sessions of Texas was defeated earlier this month after serving as Chairman of the important House Rules Committee. While in that position, he was able to block proposals from being considered on the House floor, such as allowing states to develop their own approaches to marijuana regulation. His departure may signal increased efforts in that chamber to advance marijuana policy reform measures.

Apart from what occurs in Washington, DC significant actions will continue to occur at the state level. Michigan will move forward in legalizing adult recreational marijuana use, while a medical marijuana ballot measure was approved in Missouri. Voters in Idaho, Nebraska, and Utah approved ballot referenda to expand their Medicaid program coverage under the Affordable Care Act. Newly elected governors in Kansas, Maine, and Wisconsin can be expected to take action to expand their respective Medicaid programs.

Meanwhile, whatever unfolds in the coming two years will serve as an important prelude to identifying key debatable propositions that will manifest themselves in the next election scheduled for 2020.

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PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

November 26, 2018

Trends Archives

By Susan N. Hanrahan, ASAHP President

I am not sure we had a spring or fall in the Mid-South because we went from winter to summer and now have gone from summer to winter. Climate change has seemed to eliminate two of my favorite seasons. Good grief!

Want to thank everyone who attended our Annual Conference in St Pete. We had some great speakers (plenary, poster and platform), beautiful venue (despite the high humidity during the storm) and good celebrations. Our evaluation feedback supported that. We were also given some ideas for our Charleston conference next year (Oct 16 -18) and planning has already begun.

A couple of things I want to share. We are working to enhance our website so that information on committees and task forces is more robust and that links to our Regional Deans groups are available. Even though the deans groups are not “officially” part of ASAHP, they are an avenue for deans across the US to get together outside of our annual conference to discuss and brainstorm on items of mutual interest.

Our International Task Force has completed some preliminary work in better understanding the need for health workers (predominately rehab) internationally and a desire for education and certification for those individuals. Originally it seemed that a “country by country” approach would be needed but the committee has opted for an ‘economies of scale’ model. We have put together a small group to establish the process for standard setting and to use this conceptual framework to develop a set of standards that defines the expected competencies of a rehab health worker.

Once complete, they can be sent globally for peer review. Individual countries can choose to adopt these standards for certification of their rehab health workers. That will be part one. We are partnering, and have entered into a non-disclosure agreement, with the Commission on Graduates of Foreign Nursing Schools (CGFNS) who knows all about process. Rich Oliver (ASAHP) and Julia Dutka (CGFNS) will be co-chairing the group along with ASAHP members Fevzi Akinci, Duquesne University, Katherine Beissner, SUNY Upstate, and David Henzi, UT San Antonio. This is a substantive first step.

One of our most valued assets in the Association is the Journal of Allied Health. We have formed a task force led by Greg Frazer, University of South Alabama, with members Jon Williamson, UT Southwestern, and Bonnie Van Lunen, Old Dominion University, to look at the journal itself for new opportunities while keeping in the back of their minds, succession planning. Our current Editor, Tom Elwood, has been so vital to our operations for so many years. We rely on him heavily and often forget about doing specific planning around the journal itself. If you have thoughts about the journal, please share those with Greg or myself.

Lastly, the Board has selected Phyllis King, University of Wisconsin, Milwaukee as its President-Elect for 2019. Phyllis most recently led the Leadership Development Program for ASAHP, currently serves on the Board of Directors and has been an active member of ASAHP for many years. I look forward to my continued work with Phyllis. Many more things to share but please know that if you have ideas about the Association or want us to put you to work, let me know at hanrahan@astate.edu. Happy ALL holidays between now and next year!!!

Susan Hanrahan, President

Return to November 2018 trends

HEALTH SILO DISRUPTION AND ERADICATION

John Colbert

November 26, 2018

Trends Archives

A lamentation expressed over the decades is that the health domain is dysfunctional to some degree because of the existence of silos that separate clinical services and the health professionals who provide them. One example will suffice to illustrate the nature of the problem. A patient can be referred to a practitioner in a different profession. That visit will be characterized by having to devote 10-15 minutes filling out a form on paper to register information about current medications in use, recent hospitalization episodes, allergies, and family history of particular diseases. A physical examination and the administration of some laboratory-based tests may follow, but there is no guarantee that any of this critical information subsequently will reach all relevant providers furnishing care for that patient.

A lack of interoperability is a dominant concern. Although efforts are underway to share information, no effective mechanism exists to establish a repository to house clinical data and ensure that it properly can be distributed to health professionals involved in patient care. Thus, it should be evident that efforts are necessary to make improvements that can occur on both an intramural and an extramural basis.

From an Intramural perspective, advances have been made through initiatives in interprofessional education to enable students from different health professions to learn about the unique contributions that personnel from other fields contribute to the betterment of both individual and population health status. Depending on the kind of employment undertaken upon completion of academic preparation, it is inevitable that some jobs will entail a mix of practitioners from a broad spectrum of disciplines. For instance, a neonatal intensive care unit (NICU) may provide care for an infant with a gestational age of 22-24 weeks who weighs only one pound. Cardiology, nursing, respiratory therapy, nutrition, and physical therapy are among the professions involved whose representatives must work together in a seamless manner to provide the most effective team-oriented care required.

The Extramural sphere is a region where health professionals stand to benefit from research and discoveries that emerge from totally different fields. For example, investigators in polymer chemistry and macromolecular science and engineering are studying the use of bio-inspired materials to develop products that mimic the adaptable skin of a sea cucumber for potential use in creating a worm-like robot to deliver a stent or remove plaque by crawling through a blood vessel.

Actuarial science personnel are using predictive analytics to figure out how to employ big data to direct patients to higher quality, lower cost providers. Computer scientists at Sandia National Laboratories are working to improve this nation’s biosurveillance system that alerts authorities to disease outbreaks by mimicking the human immune system. The November 2018 issue of the International Journal of Molecular Sciences discusses how the marine environment creates opportunities for acquiring new substances with anti-cancer activity. Overall, perhaps an unlimited number of resources are in a position to be exploited, but only if health professionals are willing to embrace the challenge of attempting to disrupt and eradicate the artificial boundaries that separate a vast multiplicity of disciplines.

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IDENTIFICATION OF FITNESS TRENDS FOR 2019

John Colbert

October 29, 2018

Trends Archives

While much of the health care domain is characterized by efforts to treat disease, an important portion of it is oriented toward enhancing health promotion and disease prevention. The November 2019 issue of the American College of Sports Medicine’s (ACSM's) Health & Fitness Journal features articles and columns dedicated to several top trends in the 2019 fitness survey, a study in its 13th consecutive year of being conducted. Responses came from more than 2,000 health fitness professionals from around the world and these respondents represented all sectors of the industry: commercial, clinical, community, and corporate. This annual survey is viewed as being useful because it emphasizes the value of appreciating the differences between trends and fads in the fitness industry, helping to make important investment decisions and programming decisions for future growth and development. Despite the inherent difficulty of predicting the future of any industry, the survey helps to track trends that can assist owners, operators, program directors, and health fitness professionals with making important business decisions.

Wearable technology took over the #1 spot for 2019 after dropping to #3 in 2018, which may be the result of manufacturers correcting some monitoring inaccuracies of the past. High Intensity Interval Training (HIIT), the #1 trend in 2014 and 2018, fell to #3 for 2019. Group training made a significant return in 2017 as the #6 trend and has been the #2 trend for the past two years (2018 and 2019). Fitness programs aimed at older adults have regained some popularity after falling out of the top 10 trends in 2017, appearing at #9 in 2018 and becoming #4 for 2019. Bodyweight training first appeared as a fitness trend at #3 in 2013 and has been a top five fitness trend since that time, realizing a peak as the #1 fitness trend in 2015. In 2019, bodyweight training is the #5 fitness trend. A new trend to watch will be the employment of certified fitness professionals, a new potential trend for 2019 (#6) replacing educated, certified, and experienced fitness professionals, which was determined to be too broadly defined for this survey. Other trends to watch are mobile exercise apps, worksite health promotion and workplace well-being programs, outcome measurements, and post-rehabilitation classes.

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GENDER PEER EFFECTS IN DOCTORAL STEM PROGRAMS

John Colbert

October 29, 2018

Trends Archives

The underrepresentation of women in science, technology, engineering, and mathematics (STEM) fields can begin as early as grade school and intensify at each successive career step so that men greatly outnumber women as scientists and engineers at senior levels. This underrepresentation of women in STEM is a topic of great interest in economics and public policy today. Yet, factors affecting persistence in these fields are not well understood and understanding the nature of the situation especially is limited at the graduate education level. A step in the direction of learning more is represented by a paper released by the National Bureau of Economic Research (NBER) last month. It describes an investigation of peer gender composition in the training process of STEM doctoral degrees.

Using year-to-year variation within doctoral programs in the fraction of each cohort that is female, researchers found that women in cohorts with no female peers are less likely to graduate within six years of initial enrollment than men, but an increase in the share of female peers in a cohort increases the probability of on-time graduation for women as compared to their male counterparts. This effect largely is driven by students in typically male programs (less than 38.5% female students in the average cohort) and by dropout behavior in the first year of enrollment. Peer gender composition has a small effect on first term GPA and no effect on the probability of obtaining research funding. The small/null findings for these two channels suggest that the results largely cannot be explained by women learning or competing more successfully in cohorts with more female peers. The findings are consistent, however, with a climate mechanism, through which more female peers create a female friendly environment that encourages women to persist in doctoral programs, despite having no significant effect on learning or financial support. Taken together, the findings indicate that peer gender composition can be a useful proxy for climate and that yearly variations in this measure can provide a useful identification strategy for investigating gender gaps in outcomes.

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

October 29, 2018

Trends Archives

2017 National Healthcare Quality And Disparities Report
For the 15th year in a row, the Agency for Healthcare Research and Quality (AHRQ) has reported on progress and opportunities for improving healthcare quality and reducing healthcare disparities. The 2017 National Healthcare Quality and Disparities Report recently was made available. It tracks more than 300 healthcare process, outcome, and access measures, covering a wide variety of conditions and settings. The report and chartbooks are organized around the concept of access to care, quality of care, disparities in care, and six priority areas, including patient safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. Trends show that about 55% percent of quality measures are improving overall for Blacks, however, most recent data in 2014-2015 show that about 40% of quality measures were worse for Blacks compared with Whites. Trends also show that about 60% of quality measures are improving overall for Hispanics, but in 2014-2015, nearly one-third of quality measures were worse for Hispanics compared with non-Hispanic Whites. The report can be obtained here.

Interoperability Among Health Care Technologies
While health care has made great strides in the proliferation of electronic health records, establishment of regional health information exchanges, and development of data exchange standards and interfaces, interoperability among health care technologies remains quite limited, according to a report from the National Academy of Medicine that recently was made available. Interoperability is the ability to deliver data seamlessly and automatically across time and space from and to multiple devices and organizations. A lack of interoperability results in waste, inefficiency, and clinician burnout, according to the report. The document outlines steps for health systems to establish comprehensive, ongoing procurement strategies with system-wide interoperability by moving away from serial purchases of individual software and hardware with proprietary interfaces toward those that will interoperate with others through a vendor-neutral open platform. The report also contains a technical supplement that details specific approaches. It can be obtained here.

Enhancing High Schools As A Driver Of Individual Mobility And Community Progress
For much of the last century, high schools served as a driver of individual mobility and community progress. Today, however, in too many school districts and communities, high schools are no longer fulfilling that promise. There remain about 1,300 traditional high schools in need of serious improvement and redesign. With an average graduation rate of 49%, these low-graduation-rate high schools are concentrated in 18 states from the inner city to the heartland and sit at the fault lines of race, class, and inequity in America. Yet, clear rays of hope exist. Over the last two decades, the number of low-performing high schools has been cut in half, as high school graduation rates have reached an all-time high. While graduation at the remaining low-performing high schools still is just a 50-50 proposition, these schools make up a small percentage of high schools throughout the country, totaling just 10% of all traditional high schools enrolling 300 or more students. Among its various topics, the Great American High School report includes coverage of progress made and remaining challenges in enabling all students to graduate from high school ready for college or career. The report can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

October 29, 2018

Trends Archives

U.S. Adults Who Should Take Statins For Heart Disease Prevention Fail To Do So
Only 42% of the 26.8 million adults for whom statins are recommended to prevent heart disease actually take the medications, according to an Agency for Healthcare Research and Quality (AHRQ) study. Statin use rates have remained flat in the last decade, despite evidence that they reduce death from heart disease. In 2016, the U.S. Preventive Services Task Force (USPSTF) released new recommendations on statin use to prevent heart disease, the leading cause of death among adults age 40 and older. Using data from AHRQ’s Medical Expenditure Panel Survey to assess the size and characteristics of the population that meets the USPSTF criteria for statin use, researchers found that among adults recommended for statin use, women, Hispanics and individuals living in the South or without health insurance were less likely to receive them. A conclusion reached is that new USPSTF recommendations may result in decreased personal costs and expanded access to statins.

Fast Food Consumption By U.S. Adults
Data from the National Health and Nutrition Examination Survey reveal that during 2013–2016, 36.6% of adults consumed fast food on a given day. The percentage decreased with age: 44.9% aged 20–39, 37.7% aged 40–59, and 24.1% aged 60 and over. A higher percentage of non-Hispanic black adults consumed fast food than non-Hispanic white, non-Hispanic Asian, and Hispanic adults. The percentage of adults who consumed fast food increased with more family income. Among those who consumed fast food, men were more likely than women to eat fast food at lunch, but women were more likely to report eating fast food as a snack. Fast food is a part of the American diet and has been associated with high caloric intake, and poor diet quality. Time, financial resources, price, and availability influence fast food consumption, which was based on 24-hour recall.

HEALTH TECHNOLOGY CORNER

Use Of Biological Swimmers As Cargo Delivery Agents In Blood
Nature presents intriguing biological swimmers with innate energy harvesting abilities from their local environments. Use of natural swimmers as cargo delivery agents presents an alternative strategy to transport therapeutics inside the body to locations otherwise difficult to access by traditional delivery strategies. A manuscript published on September 25, 2018 in the journal Advance Materials describes a biocompatible biohybrid microswimmer powered by a unicellular freshwater green microalga, Chlamydomonas reinhardtii. Nontoxic and biodegradable, it moves by lashing a propeller-like tail. The researchers outfitted individual algal cells with magnetic polymer beads that could hold drugs in small amounts and allowed the researchers to steer the algae by applying a magnetic field to them. In the laboratory, these microswimmers darted through bodily fluids such as blood at more than 100 micrometres per second and successfully deposited payloads onto mammalian cells.

Novel Devices For Studying Acute And Chronic Mechanical Stress In Retinal Pigment Epithelial Cells
Macular degeneration (AMD) is the leading cause of adult blindness in developed countries. Physical changes within the retina are an important factor in its development. As reported in a study published on October 8, 2018 in the journal Lab on a Chip, researchers at Utah State University aimed to mimic changes in cells and find the mechanisms for the initiation and progression of diseases. Their study examines the effects of mechanical stress on elevated protein levels and abnormal development of new blood vessels. They were able to develop new devices to stress human cells in the lab mechanically. One device is designed to mimic slow and continuous stress levels and a second one is used for mimicking high levels of stress. They discovered that mechanical stress results in the expression of vascular endothelial growth factor, a protein that can cause disease initiation and progression. Besides AMD, mechanical stress can occur in other diseases including diabetic retinopathy and even cancer.

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DEVELOPMENTS IN HIGHER EDUCATION

John Colbert

October 29, 2018

Trends Archives

Students and their families view attainment of a baccalaureate degree as an important first step in obtaining a decent paying job upon graduation. Given the fact that the costs of pursuing a college education are beyond the financial reach of many families in the United States today, they especially want their investment to produce favorable outcomes for their offspring in the job market.

Unfortunately, not all academic majors are geared toward producing graduates who will be in high demand by employers seeking workers with that level of formal education. According to a new report from the data analytics firm Burning Glass Technology, some vocationally geared majors, such as fitness studies and criminal justice do not fare as well compared to majors in other areas, such as English and gender studies. All too many students may find jobs after graduation, but in the context of their educational background, they are underemployed.

Health care education programs continue to be an exception. A rapidly growing proportion of the population that is age 65 and older, a group characterized by highly significant numbers of individuals who have one or more chronic conditions, means that the demand for health care services will grow. Shortages of physicians and dentists suggest that there will be increased opportunities for graduates of physician assistant and dental hygiene programs, to cite just two examples, to obtain gainful employment in the health sector following graduation. A challenge will be to ensure that high school graduates are prepared adequately in science and mathematics to thrive academically in health science higher education programs. Just as importantly, it will be essential to attract more students from underrepresented racial and ethnic groups in order to achieve a greater alignment with major demographic changes that the U.S. population is undergoing.

Negotiated Rulemaking For Accreditation And Innovation
The U.S. Department of Education (USDE) announced a negotiated rulemaking on higher education accreditation and innovation, along with three subcommittees to address distance learning and educational innovation, faith-based entities’ participation in Title IV programs and TEACH Grants. A main committee will focus on accreditation while three subcommittees will address these additional issues. The negotiated rulemaking committee will meet three times in 2019: on January 14-16, on February 19-22, and on March 25-28. Each of the three subcommittees also will meet three times, on January 17-18, February 12-13, and March 11-12. The meetings will be held in Washington, DC. Topics to be addressed by the main committee will include:

Requirements for accreditors in their oversight of institutions
Criteria used by the Secretary to recognize accrediting organizations
Simplification of USDE’s recognition of accrediting organizations
Clarification of the responsibilities for each member of the “triad” (accreditors, states and USDE)
Clarification of permissible arrangements between institutions and others providing an education program

Delayed Publication Of New Regulations For Borrower Defense And Gainful Employment
The USDE also announced that final regulations for borrower defense to repayment will not be published by November 1, 2018. The agency received more than 38,000 comments on its proposed borrower defense rules, indicating that additional time is needed to review the comments. Borrower defense regulations focus on the conditions under which students may obtain relief from federal loans. Additionally, final gainful employment regulations also will not be published by November 1, which means that current gainful employment regulations will remain in effect. These regulations address whether or not students who have borrowed federal money complete programs leading to earnings that enable the students to repay the loans. The missed deadlines for publishing new borrower defense and gainful employment regulations mean that the earliest date either could be implemented will be July 2020.

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PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

October 29, 2018

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 6th of many profiles this year is presented as follows:

Name and Title: Patricia A. Prelock, Ph.D., CCC-SLP, BCS-CL, Professor & Dean, College of Nursing and Health Sciences

Place of birth: Youngstown, OH

University: University of Vermont, Burlington, VT

How long have you been in your position? I am in my 10th year as Dean for the College of Nursing and Health Sciences and I have been a Professor in Communication Sciences and Disorders and in Pediatrics in the Larner College of Medicine for 18 years.

What’s the value of a university education? A university education creates opportunities for our next generation of scholars, leaders and health care professionals to create new knowledge, challenge perspectives, think critically, problem solve, and facilitate innovations in teaching, learning and practice.

What is the value of ASAHP? As a very new member of the organization, our college is experiencing the value of the communications (journal and updates), the opportunities for leadership training, and the potential for networking. We are just getting our feet wet in this new circle of connection with shared values and goals.

If I could teach in another field, which one and why? As a true interdisciplinary professional, I love teaching across the disciplines of medicine, social work, PT, nutrition, nursing, OT, education, psychology, integrative health, early childhood and special education. If I had to select one, it would probably be medicine (e.g., pediatrics, psychiatry, neurology) as I think they would gain significant value in understanding the roles and responsibilities of other health related disciplines.

Before I retire I want to: I don’t have any plans to retire as I love what I do, although I may slow down a bit in the next 10 years.

In college, I was known for: My energy and passion for serving with meaning.

What music is playing in my car/office? Typically, you would hear classical or country-western music. The last book I read for fun was: Throwaway Children by Diney Costeloe

My favorite trip was: A Mediterranean cruise with my husband Billy during which we visited London, Italy, Spain, France, and the Rock of Gibraltar. I have enjoyed, however, several recent professional trips to Hong Kong, Japan, and China.

My hobby is: Walking, boating, snowshoeing, magic, traveling.

My passion is: My grandchildren and serving the needs of children with autism spectrum disorders.

Cats or dogs? We have 2 dogs, Riley (1 year old German Shepherd) and Cocoa (9 year old chocolate lab & a therapy dog).

E-book or hardback? I love the feel and ability to leaf through the pages of a hardback book.

Beach or mountains? We live on a sandy beach on Lake Champlain and can see both the Green Mountains of Vermont and the Adirondacks of NY, so I love the beach, the mountains and the trees of Vermont.

Return to TRENDS October 2018

REFLECTIONS ON AN EXPERIMENT IN DEMOCRACY

John Colbert

October 29, 2018

Trends Archives

The founders of this nation envisioned an arrangement in which the executive, legislative, and judicial branches of government would function effectively to meet the needs of the populace in both domestic and foreign matters. That experiment has endured for some 240 years in times both good and bad. Leaders in all three branches either are elected or appointed while the month of October in each even-numbered year results in a federal election that involves one-third of the Senate and all members of the House of Representatives who aspire to remain in office. These officials return home that month to make their individual appeals to the electorate.

Much of what transpires in government that works beneficially tends to occur without attracting much notice. Social Security checks are mailed or deposited into private accounts every month, payments are made to providers by the Centers for Medicare & Medicaid Services, and members of the military serve in posts throughout the world to safeguard the nation’s interests. As of the end of October 2018, the U.S. Census Bureau estimates that the population is nearly 329 million inhabitants. Given that a typical family consisting of only five individuals can engage in heated disputes regarding, what time to have dinner, what to eat, and whether the meal should consist of home-cooked or carry-out comestibles, it comes as no surprise that a national agglomeration in the hundreds of millions will generate vastly different and especially noisy opinions on the essential roles that government should play in their lives.

Key political factions often are described in binary terms, such as Democrat and Republican or liberal and conservative. Stuck in heavy traffic with no idea of what is happening further up the road and well beyond view, a liberal might conclude that if a police officer was at the main intersection that lies in the distance, traffic would be able to flow more smoothly. A conservative sitting in the next vehicle might just as easily believe that there must be a uniformed official at that same intersection. Otherwise, the situation would not be as messed up as it appears to be. The basic difference between these opposing points of view is that one group believes that government must be more involved as a desirable mechanism to solve various problems while the other group sees that same entity as the cause of a great many difficulties.

Yet, although progress may appear to be too slow at times, constructive action does occur. Presidents propose budgets and Congress acts on them in ways that its members see fit. Ultimately, agreements are reached on spending priorities and the chief executive signs appropriation bills into law. Medicare data show that spending for this program was 15 percent of total federal spending in 2016 and is projected to rise to 17.5 percent by 2027 while the Medicaid program helped provide health care to an estimated 73 million individuals in fiscal 2017 at a cost of about $596 billion. Several congressional committees and sub-committees in both chambers provide valuable oversight of executive branch activities pertaining to these two programs. Moreover, public hearings furnish an opportunity for representatives of a wide range of organizations in the private sector to weigh in with their opinions in ways that accrue to the advantage of program beneficiaries.

As was the case with deciding on the legality of the individual mandate created by the Affordable Care Act, the Supreme Court also sometimes will join a fray to arbitrate jurisdictional controversies. Thus, while it is somewhat less than perfect, the nation’s experiment in democracy endures in meaningful ways.

return to trends october 2018

HEALTH REFORM DEVELOPMENTS

John Colbert

October 29, 2018

Trends Archives

REFLECTIONS ON AN EXPERIMENT IN DEMOCRACY of the newsletter refers to the federal election in November 2018 that will determine the composition of both the House and the Senate, beginning in 2019. As in previous contests that have been conducted since 2010, the Patient Protection and Affordable Care Act (ACA) of 2010 has the potential to influence the outcome. Not a single Republican in either chamber voted in favor of the ACA when it became law. Many candidates of that political party also chose to focus on its negative aspects when vying for office in the elections of 2012, 2014, and 2016. From the time of its inception, multiple attempts also have been made in Congress to repeal and replace this legislation.

Upon assuming the majority in both chambers and taking control of the White House after the 2016 election, Republicans appeared to be in a strong position to achieve their objective of eliminating this law. They came close to doing so in 2017, but the ACA remains in effect and many Democrats are using that fact as a basis for attacking Republicans in the upcoming November 2018 election. A key feature of the ACA is that it eliminated the ability of insurance companies to prohibit patients with preexisting conditions either from obtaining coverage or by requiring them to pay exorbitantly priced premiums for such protection. The Democrat’s message in the present election cycle is: Republicans intend to return to the days when insurers possessed such power and Democrats pledge to prevent them from doing so.

Employers’ Reimbursement Arrangements To Provide Health Coverage For Employees
Meanwhile, the Departments of Labor, Health and Human Services, and the Treasury proposed new rules in the October 29, 2018 issue of the Federal Register pertaining to how employers may use health reimbursement arrangements (HRAs) to provide health coverage to employees. The rule would expand the uses of HRAs to include payment of premiums for individual market coverage in some instances. The Departments estimate that the proposed changes would have an impact on coverage for approximately 10.7 million individuals, decrease the number of uninsured by 800,000, and cost the federal government approximately $30 billion in lost tax revenue from 2020-2028. The proposed rule was issued in compliance with an October 2017 Executive Order on “Promoting Healthcare Choice and Competition Across the United States,” suggesting that these changes would help make coverage more affordable for small to mid-sized employers and provide employees with more coverage options. Public Comments can be submitted for 60 days after publication of the rule.

Access To Health Care For Low-Income Adults With & Without Medicaid Expanded Eligibility
Low-income adults in states that expanded Medicaid under the Affordable Care Act were less likely to report having any unmet medical needs compared with those in non-Medicaid expansion states, according to a Government Accountability Office (GAO) report released on October 15, 2018. Among other findings:

About 26 percent of low-income adults in Medicaid expansion states reported having unmet medical needs compared to 40 percent in non-expansion states.
About 9.4 percent of low-income individuals in Medicaid expansion states said that they passed up needed medical care in the past 12 months because they couldn't afford it compared to 20 percent in non-expansion states.
About 82 percent of low-income adults had a usual place of care in Medicaid expansion states compared to 68 percent in non-expansion states.

Health and Workplace Benefits Survey (WBS) Results
The EBRI/Greenwald & Associates Health and Workplace Benefits Survey (WBS) of 1,025 workers in the United States ages 21–64 was conducted in June 2018. Among its main findings: (1) Workers rank health care as the most critical issue in the nation, (2) One-half of workers describe the health care system as poor (22 percent) or fair (28 percent), (3) Confidence about the health care system is mixed and declines looking into the future, and (4) Thirty-four percent of workers say they are confident that they are able to afford health care without financial hardship today, but this percentage decreases to just 30 percent when they consider the next 10 years.

Return to October 2018 trends

MICROBIOME’S OMNIPRESENT UNSEEN GUESTS

John Colbert

October 29, 2018

Trends Archives

Much of health care is delivered at the level of treating acknowledged symptoms, but it is what exists at less visible layers, such as the human microbiome housing several trillion microbial cells, that can be of critical importance. Patients and their caregivers in the clinical setting engage in transactions in which one group arrives with a concatenation of symptoms while the other group is confronted with the task of interpreting these signs correctly in order to develop an effective treatment plan.

An example of the value of comprehending and appreciating layers of increasing complexity is afforded by a painting completed by Salvador Dali in 1956 called Nature Morte Vivante, which in English translates into “Living Still Life.” Influenced by Nobel Laureate physicist Werner Heisenberg’s work in quantum mechanics, the title is a play on words characterized by the basic notion of something being perfectly still, yet continuing to be in motion simultaneously. The seeming paradox is explained by the fact that although an object may not appear to be moving, it is composed of millions of atoms that are in rapid motion.

A closer look at the canvas reveals other features that may not appear to be obvious upon cursory examination. Mathematics did not escape Dali’s attention as evidenced by his employment of the Fibonacci sequence, a generator of spiral images that appear throughout the painting. He associated the spiral with a key element of nature and became even more intrigued by it when he learned of the masterpiece 852-word article, highly unusual for its brevity, by James Watson and Francis Crick that was published in the April 25, 1953 issue of the journal Nature. These researchers suggested a spiral structure (a helix) for the salt of deoxyribose nucleic acid (DNA), one “with novel features of considerable biological interest.”

This helix would revolutionize genetics. Essentially no recognition was given, however, of the work of chemist Rosalind Franklin, whose x-ray diffraction studies in crystallography provided the imagery that inspired Watson and Crick. Assuming that Dali was unaware of her contribution, it is likely that he would have been fascinated to learn about this hidden layer of meaning that subsequently accrued to the enormous advantage of her newly more world famous colleagues.

Allied health clinicians and their patients often interact on the basis of seeking and providing relief from symptoms involving aches, pain, discomfort, and physical immobility. Additional layers that lack such clarity are semiotics (non-language features reflecting patient and caregiver differences based on age, sex, gender, race/ethnicity, and health literacy), genomics, proteomics, metabolomics, and the microbiome. The latter unseen guests continue to attract a significant amount of attention as demonstrated by the following examples of papers in the professional literature: Disruption of maternal gut microbiota during gestation alters offspring microbiota and immunity (Microbiome, July 2018), The gut microbiota and dysbiosis in autism spectrum disorders (Current Neurology and Neuroscience Reports, November 2018), and Researchers link gut bacteria to heart transplant success or failure (Journal of Clinical Investigation Insight, October 4, 2018).

Return to October 2018 trends

SOCIAL SECURITY AND PAYING FOR HEALTH CARE

John Colbert

August 27, 2018

Trends Archives

As guaranteed pension plans continue to disappear in the lives of most workers, many retirees will rely heavily on Social Security monthly payments. Numerically, the ranks of the so-called “Baby Boomer” generation reaching the age of 65 increase by an average 10,000 individuals every day, a growth spurt that will continue over a 19-year period that began on January 1, 2011. The Social Security program assumes great importance in the lives of patients who rely on Medicare to address their health care wants and needs.

Participation in Medicare can entail high out-of-pocket costs for some beneficiaries that relate to the nature of their health problems. Approximately one in five Medicare beneficiaries has serious physical or cognitive limitations that require personal care services and supports. A March 2017 report from the National Center for Health Statistics (NCHS) examines health care access and utilization among adults with multiple chronic conditions (MCC). As the number of these conditions increases, the health care costs for those so diagnosed also will grow. The program is expensive and money is spent unevenly: 10% of enrollees represent 63% of expenditures. The 5% who die each year account for 30% of costs, often involving intensive care that prolongs life with no hope of recovery.

The adequacy of retirement income – from Social Security benefits and other sources – can be reduced quite substantially by personal health care expenditures. As reported in a study published in October 2017 by the Center for Retirement Research at Boston College, data for the period 2002-2014 were used to calculate post-out-of-pocket benefit ratios, defined as the share of either Social Security benefits or total income available for non-medical spending. The results show that average out-of-pocket spending (excluding long-term care) was $4,274 per year in 2014, with approximately two-thirds ($2,965) spent on premiums.

In 2014, the average retiree had only 65.7 percent of Social Security benefits remaining after this spending and only 82.2 percent of total income. Nearly one-fifth (18 percent) of retirees had less than 50 percent of their 2014 Social Security income remaining after out-of-pocket spending, with six percent of retirees falling below 50 percent of total income. A conclusion drawn from this analysis is that with less than two -thirds of Social Security benefits available for non-medical consumption, and limited income outside of Social Security for much of the aged population, many retirees likely feel that making ends meet is difficult. Meanwhile, Medicare spending per beneficiary is expected to resume its decades-long rise by the end of the present decade, which will exert even more pressure on retirees’ budgets.

A shortfall in Social Security financing poses a significant challenge for policymakers. The Medicare program also is on a short financial leash since its trust fund rapidly is running dry. Alternatives for shoring up these two sets of accounts are not pleasant to contemplate because they entail some mixture of either lowering annual benefit levels or imposing higher tax rates. Finding remedies for certain problems can be deferred for only so long. Eventually, Congress will be compelled to tackle them. No option exists in shifting a portion of the burden to the states. Many of them have crises in the form of significantly underfunded pension and health benefit systems for current and future retired public service employees.

return to trends july - august 2018

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

John Colbert

August 27, 2018

Trends Archives

Matching Patients And Their Records
Despite widespread adoption of electronic health records and increasing exchange of health care data, the benefits of interoperability and health information technology have been hampered by the inability to match patients and their records reliably. The Pew Charitable Trusts contracted with the RAND Corporation to investigate "patient-empowered" approaches to record matching — solutions that have some additional, voluntary role for patients beyond simply furnishing demographics to their health care providers — and to select a promising solution for further development and pilot testing. A report recommends adopting a three-stage approach that aims to: improve the quality of identity information; establish new smartphone app functionality to facilitate bidirectional exchange of identity information and health care data between patients and providers; and create advanced functionality to improve value further. The report also suggests that because the solution contains multiple components involving diverse stakeholders, a governance mechanism likely will be needed to provide leadership, track pilot tests, and evaluation, along with convening key parties to build consensus where consensus is needed. The report can be obtained at https://www.rand.org/pubs/research_reports/RR2275.html.

Reasonable Patient Care Under Uncertainty
An article published on August 2, 2018 in the journal Health Economics discusses how limited ability to predict illness and treatment response may affect the welfare achieved in patient care. The discussion covers both decentralized clinical decision-making and care that adheres to clinical practice guidelines. The author explains why predictive ability has been limited, calling attention to questionable methodological practices in the research that supports evidence‐based medicine. Research is summarized on identification whose objective is to yield credible prediction of patient outcomes. Recognizing that uncertainty will continue to afflict medical decision making, basic decision theory is applied to suggest reasonable decision criteria with well‐understood welfare properties. The article can be obtained at https://onlinelibrary.wiley.com/doi/epdf/10.1002/hec.3803.

Patient-Centered Medical Homes And Accountable Care Organizations
Patient-centered medical homes (PCMHs) and accountable care organizations (ACOs) often were considered to be competing models for reforming health care delivery. It increasingly has become apparent, however, that one helps the other, according to the main finding from the new Patient- Centered Primary Care Collaborative (PCPCC) 2018 evidence report, “Advanced Primary Care: A Key Contributor to Successful ACOs,” the first study of its kind to look at how the role of advanced primary care, such as the PCMH, may contribute to the success or failure of ACOs. While these two leading models are transforming health care delivery and payment, little research has been done on how these models interact to promote lower costs and better quality for populations. Using qualitative and quantitative methods, researchers at the Robert Graham Center and IBM Watson Health found that: The attributes of successful ACO’s are necessary to transform the practice of primary care, successful ACO’s are more likely to be built on the basis of high- quality primary care, Medicare ACOs with a higher proportion of PCMH primary care physicians were more likely to generate savings, and Medicare ACOs with a higher proportion of PCMH primary care physicians demonstrated higher quality scores, including on a significant number of process and outcome measures. The report was published with support from the Milbank Memorial Fund for the fifth time. The document can be obtained at https://www.milbank.org/wp-content/uploads/2018/08/advanced_primary_care_report_080118.pdf.

return to trends july - august 2018

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

John Colbert

August 27, 2018

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 6th of many profiles this year is presented as follows:

Name and Title: Barbara Jacobsmeyer, EVP – President, Inpatient Hospitals at Encompass Health

Place of Birth: St. Louis, MO

Industry: Encompass Health, formerly called HealthSouth

How long have you been in your position? 11 years with the company and 1 1⁄2 years in current role

What’s the value of a university education? Well-rounded educational experience

What is the value of ASAHP? Focus on allied health professionals and common challenges and opportunities in the field to work on as a group. Great that it now includes the employer side so we can work together on these opportunities.

Before I retire I want to: Leave a legacy of mentoring other successful women executives. My favorite trip was: Mediterranean cruise

The best advice I ever received was: “People don’t care how much you know until they know how much you care.”

My hobby is: Running and playing golf.

My passion is: Education on heart disease and stroke My pet peeve is: Smacking gum.

A perfect day is: When I wake up.

Cats or dogs? Dogs – 2

E-book or hardback? E-book

Beach or mountains? Beach

I wish I could: Sing.

Only my friends know I: Can’t sing.

My favorite saying is: Hope is not a strategy.

Return to TRENDS July - August 2018

AFFORDABLE CARE ACT DEVELOPMENTS

John Colbert

August 27, 2018

Trends Archives

International comparisons developed by entities such as the Organization for Economic Co-Operation and Development (OECD), which consists of 36 member nations, rank the United States as highest in health care spending, but doing considerably less well in achieving positive health outcomes for patients. Concerns about the cost of health care have resonated for decades on Capitol Hill, with the result that both legislative and regulatory initiatives either of an incremental or a broad sweeping nature (e.g., the Affordable Care Act) have been implemented in an effort to curtail health care spending. Nonetheless, the challenge continues to exist. A factor contributing to the cost dilemma stems from the regulatory environment as discussed below.

Cost And Consequences Of Complying With Hospital Regulatory Requirements
On July 31 of this year, the Senate Committee on Health, Education, Labor & Pensions (HELP) held a hearing to discuss reducing administrative spending in health care. The event was the third in a series of hearings focused on curbing health care costs. Witnesses included the president and CEO of a state hospital and nursing home association, the president and CEO of America’s Health Insurance Plans (AHIP), an economics professor from Harvard University, and an advisor to the American Action Forum. HELP Committee Chairman Lamar Alexander (R-TN) made reference to a 2017 report from the American Hospital Association (AHA), noting that hospitals and health care providers must comply with 629 different regulatory requirements from four federal agencies. Along with these agency require- ments, providers must follow other state and federal regulations. The AHA report indicates that compliance with non-clinical regulatory requirements collectively costs providers almost $39 billion a year. A typical community hospital, for example, must employ 23 full-time workers just to comply with Medicare regulations.

Individual Insurance Performance In 2018
An analysis from the Kaiser Family Foundation shows that despite significant challenges, the individual market remains stable and insurers generally are profitable. Insurer financial results from 2018 – after the Administration’s decision to cease cost-sharing subsidy payments, but before the repeal of the individual mandate penalty in the tax overhaul goes into effect – showed no sign of a market collapse. Premium and claims data support the notion that 2017 premium increases were necessary as a one-time market correction to adjust for a sicker-than-expected risk pool, and premium increases in 2018 were in large part compensating for policy uncertainty and the termination of cost-sharing subsidy payments. Without these policy changes, it is likely that insurers generally would have required only modest premium increases in 2018. Low loss ratios and higher margins indicate that some insurers over- corrected in 2018, raising premiums more than was necessary to cover claims and administrative costs and earn a reasonable profit. Even though repeal of the individual mandate penalty and expansion of loosely regulated insurance options will tend to drive premiums up in 2019, increases will be mitigated by this over-correction, and in some cases, premiums even will decline. Some insurers have exited the market in recent years, but in 2019, some insurers are reentering markets they previously had departed.

Final Rule Issued On Short-Term, Limited-Duration Insurance Coverage
The Departments of Health and Human Services, Labor, and the Treasury on August 1, 2018 issued a final rule to help individuals struggling to afford health coverage find new, more affordable options. The rule allows for the sale and renewal of short-term, limited-duration plans that cover longer periods than the previous maximum period of less than three months. Such coverage now can cover an initial period of less than 12 months, and taking into account any extensions, a maximum duration of no longer than 36 months in total. This action has an objective of helping increase choices for beneficiaries faced with escalating premiums and dwindling options in the individual insurance market. Short-term, limited-duration insurance, which is not obliged to comply with federal market requirements governing individual health insurance coverage, is aimed at benefiting consumers who are involved in a transition between different coverage options, such as an individual who is between jobs or a student taking time off from school, as well as for middle-class families without access to subsidized ACA plans.

return to trends july - august 2018

QUICK STAT (SHORT, TIMELY, AND TOPICAL)

John Colbert

August 27, 2018

Trends Archives

Causes Of Death In The United States
Data from the National Center for Health Statistics are based on information from all death certificates filed in the 50 states and the District of Columbia in 2016. Causes of death classified by the International Classification of Diseases, Tenth Revision are ranked according to the number of deaths assigned to rankable causes. Statistics are based on the underlying cause of death. In 2016, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Accidents (unintentional injuries); Chronic lower respiratory diseases; Cerebrovascular diseases; Alzheimer’s disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome, and nephrosis; and Intentional self-harm (suicide). They accounted for 74% of all deaths occurring in the United States. It is of special interest to reflect on the extent to which these conditions stem from human behavior and lifestyle choices rather than from infections or any other external causative agents.

Application Of A Tool To Identify Undiagnosed Hypertension — United States, 2016
Approximately 11 million U.S. adults with a usual source of health care have undiagnosed hypertension, placing them at increased risk for cardiovascular events. Using data from the National Health and Nutrition Examination Survey (NHANES), CDC developed the Million Hearts Hypertension Prevalence Estimator Tool, which allows health care delivery organizations to predict their patient population’s hypertension prevalence based on demographic and comorbidity characteristics. Organizations can use this tool to compare predicted prevalence with their observed prevalence to identify potential underdiagnosed hypertension. This study applied the tool using medical billing data alone and in combination with clinical data collected among 8.92 million patients from 25 organizations participating in the American Medical Group Association (AMGA) national learning collaborative to calculate and compare predicted and observed adult hypertension prevalence.

HEALTH TECHNOLOGY CORNER

Tumbling Microbots For Future Health Treatments
Microbots are tiny automated machines programmed to perform specific tasks. They are so tiny—as small as a cell—that they can be injected into the body to do tasks, such as clearing out plaque from arteries, performing tissue biopsies, or delivering targeted treatment to tumors. Because of their size and precision, these microbots could provide less-invasive treatments than a typical surgery or deliver medication in a much more targeted way than a pill. According to an article in the July/August 2018 issue of the journal American Scientist, researchers have been working on developing these tiny robots for three decades, but recent advancements in engineering have led to a surge in research. Animal testing has shown positive results. Microbots have been propelled by hydrogen microbubbles in live mice to treat gastric bacterial infections. For application in humans, challenges involve enabling microbots to move through wet areas and traverse through air pockets in the stomach, intestines, and lungs. Early studies show potential for a tumbling motion to make it possible to navigate such difficult terrains.

Using Shark Skin Patterns To Halt The Spread Of Infections
Efforts to combat the spread of infections, especially in health care settings, mostly involve the use of antibacterial cleaning agents and antibiotic drugs. Another possible strategy is the use of coatings that are antibacterial (inactivating bacteria) or antifouling (preventing the build-up of bacteria) on surfaces such as doorknobs. As reported on May 23, 2018 in the journal ACS Applied Material Interfaces, such a coating was developed with a structure inspired by shark skin. Bacterial attachment is reduced by 70% on the micropatterned, photocatalytic coating, compared with smooth films of the same composition. Most of the bacteria that do settle on the coating are inactivated when the coating is exposed to ultraviolet light. Because the coatings are imprinted onto a flexible substrate, it should be possible to use them in practical applications.

return to trends july - august 2018

21ST CENTURY CURES ACT, CANCER MOONSHOT, AND PRECISION MEDICINE

John Colbert

August 27, 2018

Trends Archives

Francis S. Collins, Director of the National Institutes of Health, presented testimony on July 25, 2018 at a hearing of the House Energy and Commerce Committee, Health Subcommittee on implementation of the 21st Century Cures Act. Among specific areas of scientific opportunity supported by the Act, he high- lighted two components of its Innovation Fund: the Cancer Moonshot, and the bold new Precision Medicine Initiative, called All of Us. The Cancer Moonshot initiative aggressively is pursuing an ambitious goal to accelerate advances in cancer prevention, diagnosis, treatment, and care. Such advances include immunotherapy, in which a person's own immune system is taught to recognize and attack cancer cells. After years of research supported by NIH, immunotherapy is leading to dramatic cures of some cancers, such as leukemia, lymphoma, and melanoma. Moreover, each year as many as 135,000 American women who have undergone surgery for the most common form of early stage breast cancer face a difficult decision, whether or not also to undergo chemotherapy to improve their odds. TAILORx, a large NIH-funded clinical trial, shows that about 70% of such women actually do not benefit from chemotherapy and a genomic test of tumor tissue can identify them quite reliably, producing a significant cost savings perhaps up to $1 billion a year.

The centerpiece of the Precision Medicine Initiative, the All of Us Research Program, will enroll one million or more individuals. On May 6 of this year when enrollment was launched in seven sites across the nation, 10,000 participants were reached. As of the Congressional hearing on July 25, more than 86,000 volunteers had signed up to contribute their health data in many ways over several years. Some are enrolled through health provider organizations, of which 10 are part of the NIH enterprise, including community health centers and the Department of Veterans Affairs. Other participants enroll as direct volunteers, who sign up over the Internet. Almost half are from historically underrepresented racial and ethnic groups, which will enhance research into health disparities. With each new person enrolled, every biological sample preserved, every electronic health record collected, every survey filled out, these data will hold increased promise for advancing human health.

return to trends july - august 2018

HEALTH TECHNOLOGY CORNER

More Articles from TRENDS November 2018

HEALTH SILO DISRUPTION AND ERADICATION

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

ELECTION RESULTS TO PONDER

HEALTH REFORM DEVELOPMENTS

DEVELOPMENTS IN HIGHER EDUCATION

AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

CELEBRATING ALLIED HEALTH WEEK AT DES MOINES UNIVERSITY

NAVIGATING THE HEALTH FRONTIER

More Articles from TRENDS November 2018

HEALTH SILO DISRUPTION AND ERADICATION

PRESIDENT’S CORNER—ASAHP MEMBER FOCUS

ELECTION RESULTS TO PONDER

DEVELOPMENTS IN HIGHER EDUCATION