Health Insight

Everyday there is new insight into our understanding of Health Determinants and barriers that impact patient outcomes. This page will curate new insight. While health care is likely the most important determinant of health when a patient has an acute condition, studies show it represents only a part of an overall health outcomes:

Health Determinants Insight

Mission (Health Goals) Insight

Insights into the Mission (Health Goals) Determinants that can impact a patient's health outcomes and health status.

Health Goals (Care Goals) Insight

Insights into Health Goals (Care Goals) Determinants that can decisively affect a patient's overall health and well-being.

Care Goals

• Defining the patient’s goals of care (12/11/13)
• Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm (3/1/2012)

End of Life Planning

• End-of-life care, planning fails patients (2/5/15)
• Few doctors discuss end-of-life planning with heart-failure patients, Mayo study finds (6/18/14)
• Dying in America - experts find that improving the quality and availability of medical and social services for patients and their families could enhance quality of life through the end of life (9/17/14)
• Too Many People Die In Hospital Instead Of Home. Here’s Why. (9/22/14)

Strategy (Health Plan) Insight

Insights into the Strategy (Health Plan) Determinants that can impact a patient's health outcomes and health status.

Health Strategy & Care Planning Insight

Insights into Strategy Objectives (Care Plan) Determinants that can decisively affect a patient's overall health and well-being.

• “Triggers of Decline” conceptual model developed to identify at-risk populations of older adults and to develop evidence-based practices to prevent the onset of frailty. (5/10/16)
• Gaps in Understanding about Palliative Care - Reasons for Lack of Policy Support for Family Caregivers (7/2/14)

Care Planning

• Implementing A Care Planning System: How To Fix The Most Pervasive Errors In Health Care (1/2/15)

Decision Aids

• Massachusetts General had over 28,000 orders for 40 patient decision aids over 10 years. (4/2016)
• Proven Best Choices Creates Guides to Offer Patients and Physicians Easy-to-Understand Advice on ‘Best Value’ Options for Breast Cancer Screening and Prostate Cancer Treatments (1/21/16)
• The Ottawa Decision Support Framework is an evidence-based, practical, mid-range theory for guiding patients making health or social decisions (6/22/15)
• Helping Patients Make Better Treatment With Decision Aids (10/2012)

Evidence-Based Practice

• Primary care doctors have trouble finding the evidence they need to guide clinical decisions. A study of Georgia 721 topics from online references for generalists and found only 18% of the recommendations were based on high-quality, patient-oriented evidence. (6/21/17)
• Credibility of Evidence: A Reconsideration of the Logic and Strength of Our Healthcare Decisions (5/22/15)

Medical Advocates

• Medical Advocates Can Help Guide Patients On Difficult Care Choices (1/27/16)

Second Opinions

• Partners expands second-opinion service with Health Advocate partnership. Complete change in the treatment plan was recommended in 90 percent of medical cases remotely reviewed. (4/27/17)
• 88% of second opinions from Mayo physicians result in different or refined diagnosis, study finds (4/4/17)

Shared Decision Making

• Patients with more say in treatment have fewer side effects (7/13/16)
• Inviting Patients To Help Decide Their Own Treatment (3/16/15)
• Shared Decision Making And The Use Of Patient Decision Aids - can lead to patients gaining knowledge, having a more accurate understanding of risks, harms and benefits, feeling less conflicted about decisions and rating themselves as less passive and less often undecided (12/17/14)
• How should doctors and patients look critically at medical decisions? (8/16/13)
• Many medical interventions are 50/50: Who informs the patient? (8/13/2013)

Impacting Realities Insight

Insights into the Impacting Realities Determinants that can impact a patient's health outcomes and health status.

Health Conditions Insight

Insights into Health Conditions Determinants that can decisively affect a patient's overall health and well-being.

Physical Conditions Insight

Insights into Physical Conditions Determinants that can decisively affect a patient's overall health and well-being.

• The number of American kids suffering from asthma and attention deficit hyperactivity disorder (ADHD) is on the increase, with poor children being hit the hardest (5/2/16)
• A lack of progress since 1999 against common illnesses such as heart disease, diabetes, and respiratory disease was largely responsible for higher-than-expected death rates for middle-aged (45–54) white adults in 2014. (1/29/16)
• Don’t judge a person on their chronological age; their biological age might be a lot older than you think, aging study says (7/7/15)

Arthritis

• Arthritis afflicts about 1 in 4 adults in the U.S., CDC report finds. 60% of those with arthritis are between the ages of 18 and 64. (3/7/17)

Asthma

• Nationwide, one in 10 children has asthma. (4/16/14)

Cancer

• Scientists don't agree 66% of cancer is due to bad luck (3/28/17)
• Study: Causes of cancer, 66% from random mutations during cell division (bad luck), about 29% from environment and remaining 5% due to heredity. (3/23/17)
• Death rate from cancer now 25% lower than it was 25 years ago, report says (1/5/17)
• CDC: Brain cancer now killing more children than leukemia (9/16/16)
• Cancer overtakes heart disease as leading cause of death in 22 states (8/25/16)
• Study shows two-thirds of adult cancer incidence across tissues can be explained primarily by “bad luck,” when these random mutations occur in genes, while the remaining third are due to environmental factors and inherited genes. (1/1/15)

Chronic Pain

• Number of Americans in their 60s reporting chronic pain increased from 10% in 1998 to 37% in 2010. (3/16/17)
• Estimated 25.3 million adults (11.2%) had pain every day for the preceding 3 months. Nearly 40 million adults (17.6%) experience severe levels of pain. (8/11/15)
• Chronic pain and the effect on patients’ families (4/17/14)

COPD

• Chronic lower respiratory disease, primarily COPD, is the third leading cause of death in the United States (3/12/15)

Cystic Fibrosis

• Canadians with cystic fibrosis outlive Americans by a decade (3/13/17)

Diabetes

• Diabetes causes 12 percent of deaths in the United States, making it the third-leading cause of death in the country, according to a new study (1/26/17)
• Health Claims On The Rise For Kids’ With Type 2 Diabetes, Obesity-Related Conditions (1/2/17)
• Young people with diabetes were four times more likely to be hospitalized for mental health or substance use treatment in 2014 than were young adults without the disease (7/22/16)
• Childhood diabetes rates are on the rise. The spent $2,173 per capita in out-of-pocket health care costs in 2014. Nearly five times higher than that of kids without the illness. (6/20/16)
• Americans with diabetes reach 21 million (4/15/14)
• About half of all Americans have either diabetes or pre-diabetes. (9/8/15)

Heart Attack Risk

• Depression Among Heart Attack Survivors Can Be Deadly, Yet Is Often Ignored (7/20/17)
• Performing heavy physical activity in a highly emotional state sharply raised the risk of a heart attack. (10/31/16)

High Blood Pressure

• About 70 million American adults (29%) have high blood pressure—that’s 1 of every 3 adults. (6/16/16)

Life Expectancies

• The death rate for Americans between the ages of 25 and 44 rose by 8% between 2010 and 2015 after a century of decline. (6/14/17)
• The mortality rate for white Americans, ages 45 to 54, increased by a half percent each year from 1999 to 2013, attributed to increase in suicide, drugs and alcohol. (3/23/17)

Non-Communicable Disease

• Five non-communicable diseases that kill 16 million people around the world each year, cost the world economy $2.35T annually. 1) Cardiovascular disease, 2) Mental illness, 3) Cancer, 4) Chronic respiratory disease, 5) Diabetes. (2/28/17)

Obesity

• Obesity And Depression Are Entwined, Yet Scientists Don’t Know Why (8/11/2017)
• Being overweight can raise your blood pressure, cholesterol and risk for developing diabetes. It could be bad for your brain, too. (12/30/16)
• Researchers say, is that obesity and its precursor — being overweight — are not one disease but instead, like cancer, are many. (12/12/16)
• Nearly half of America’s overweight people don’t realize they’re overweight (12/1/16)
• Experts Find Additional Evidence Of Obesity-Cancer Link (8/24/16)
• Obesity rates up in US women, stable in men. Obesity was 35 percent among men and 40 percent among women in 2013-14 (6/7/16)
• American obesity rate continues consistent trend upward in 2015 with estimated 30.4% of Americans over 20 years of age obese, more than a 10% increase from 1997 (5/26/16)
• Severe Obesity In Adults Cost State Medicaid Programs Nearly $8 Billion In 2013 (11/2015)

Sepsis

• Sepsis causes more hospital readmissions than COPD, heart failure, heart attack and pneumonia. (1/23/17)

Mental Health Conditions Insight

Insights into Mental Health Conditions Determinants that can decisively affect a patient's overall health and well-being.

Childhood Disorders

• Childhood disruptive behavior disorders increases risk for substance use, violent behaviors, victimization, incarceration, and even premature death. An estimated 50 to 75% of youths who move through the juvenile justice system could be diagnosed with a mental health disorder. (6/1/17)

Depression

• Obesity And Depression Are Entwined, Yet Scientists Don’t Know Why (8/11/2017)
• Depression is the leading cause of illness, disability worldwide according to the World Health Organization (3/31/17)
• The prevalence of major depressive episodes (MDEs) in adolescents (age 12-17) has increased from 13.1% for girls and 4.5% for boys in 2005 to 17.3% for girls and 5.7% for boys in 2014 (11/2016)

Dementia

• Stress And Poverty May Explain High Rates Of Dementia In African-Americans (7/16/17)
• In 1999, the rate of Alzheimer's deaths was 16.5 per 100,000 individuals. By 2014, this rate had increased to 25.4 deaths per 100,000, marking a 54.5% increase. (5/26/17)
• Estimated 5.5 million Americans of all ages are living with Alzheimer’s dementia in 2017. By 2025, Alzheimer’s dementia is estimated to reach 7.1 million. By 2050, the number of people with Alzheimer’s dementia may nearly triple to a projected 13.8 million, barring the development of medical breakthroughs to prevent or cure Alzheimer’s disease. (3/2017)
• Dementia prevalence among US adults 65 years or older declined significantly, from 11.6% in 2000 to 8.8% in 2012. (11/21/16)
• One in 10 Alzheimer’s patients have preventable hospital stays (7/27/16)
• Big Financial Costs Are Part Of Alzheimer's Toll On Families (3/30/16)
• Rates of dementia dropped 44% from the late 1970s to the early 2010s. (2/11/16)
• How dementia drives ER visits, admissions and mortality rates (11/16/15)
• Dementia has a disproportionate impact on family and unpaid caregiving to older adults (10/2015)
• Adults with probable dementia received 171 hours of monthly informal care, versus 89 hours for cognitively impaired adults without dementia and 66 hours for cognitively normal adults 10/2015)

Mental Health Disorders

• Social determinants of health, such as poverty and minority background, severely disadvantage many people with mental disorders. Innovative federal, state, and local programs have combined social services with mental health interventions to try addressing this. (6/2017)
• Patients With Severe Schizophrenia Aren’t Getting The Help They Need (7/25/16)
• An estimated 26% of American adults live with a mental disorder in any given year, and 46% will have a mental disorder in their lifetime. (11/2005)
• 18% of adults in the U.S. have a mental, behavioral or emotional disorder. Most common are specific phobias (8.7%), such as those related to heights, spiders or flying, social phobia (6.8%) and major depression (6.6%) (5/27/16)

Mental Health Impact on Health Care

• Detecting mental health issues can cut workers comp claims costs. Hartford Financial Services Group analyzed its workers comp claim data from 2002 to 2015 and found that 10% of claims featured at least one psychosocial issue, and that those claims account for 60% of claims costs. (3/6/17)
• High-need adults—defined as those with three or more chronic conditions and a functional limitation—who have a diagnosed behavioral health condition among their multiple chronic conditions make greater use of some health care services than their counterparts without a behavioral health condition (11/22/16)
• Patients With High Mental Health Costs Incur Over 30 Percent More Costs Than Other High-Cost Patients (1/2016)
• A large number of 30-day readmissions are not caused by poor-quality care but are instead related to mental health, substance abuse or homelessness. (6/15/16)

Opioid Addiction

• Patients With Mental Disorders Get Half Of All Opioid Prescriptions (6/26/17)
• Between 2005 and 2014, opioid-related emergency department visits nearly doubled and opioid-related inpatient stays increased 64% (6/20/17)
• CDC: Likelihood of chronic opioid use spikes with prescriptions longer than a few days (3/17/17)
• Study: Health Spending Related To Opioid Treatment Rose More Than 1,300 Percent In Four Year Period (9/12/16)
• Insurer rules a hurdle for patients overcoming opioid dependency (8/5/16)
• 3000% increase Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds (8/1/16)
• Prescription opioid overdoses prompted more than 100,000 emergency department (ED) visits in 2010 and cost hospitals more than $2 billion (11/13/14)
• Patient-Centered Research Can Improve Chronic Pain Care and Address Opioid Abuse (5/15/15)

Stress

• Americans reporting at least one symptom of stress over the past month rose from 71% in August 2016 to 80% in January 2017. This includes headache (34%), feeling overwhelmed (33%), feeling nervous or anxious (33%), or feeling depressed or sad (32%). (2/15/17)
• Emotional stress has long been considered a major risk factor for heart disease. A new study suggests that heightened activity in the amygdala (the brain's fear and stress region) is associated with a greater risk of heart disease and stroke. (1/12/17)
• Stress Can Override Benefits Of Healthful Eating (9/27/16)

Substance Use Disorders

• Accidental poisoning increased 13%. 97% percent of accidental poisoning was from drug overdoses and alcohol (12/9/16)
• Nearly 21 million people in the United States have a substance use disorder, comparable with the number of people diagnosed with diabetes and 1.5 times the prevalence of all cancers combined. (11/17/16)
• 4% of all employee drug tests were positive for illicit drugs (i.e., marijuana, heroin,methamphetamines) in 2015, a 10-year peak. (9/15/16)
• Most emergency department 'super-frequent users' have a substance abuse addiction (5/17/14)
• Alcohol dependence or abuse (17 million) was the most commonly reported substance abuse disorder in 2014. 7.1 million reported having an illicit drug use disorder, 4.2 million reported a marijuana use disorder and 1.9 million reported having a pain reliever disorder. (5/27/16)

Suicide

• Suicide rates for teen girls hits 40-year high (8/8/17)
• Study found machine learning is 93% accurate in correctly identifying a suicidal person, and 85% accurate in determining differential diagnosis of mental illness (11/8/16)
• Middle School Suicides Reach An All-Time High (11/4/16)

Treating Mental Health

• Mental Disorders top the list of the most costly conditions in the United States: $201 Billion (5/2016)

Functional Conditions Insight

Insights into Functional Conditions Determinants that can decisively affect a patient's overall health and well-being.

• Health and Retirement Study (HRS) surveys 20,000 people in America about income, work, assets, pension plans, health insurance, disability, physical health and functioning, cognitive functioning, and health care expenditures. (3/2007)

Daily Activities Assistance

• An estimated 6.9% of adults in 2015 over the age of 65 required assistance with personal care. (5/26/16)
• Nearly Half of All Seniors Need Help With Daily Activities, Far More Than We Thought (10/8/14)

Disabilities

• If all five risk factors were eliminated, 53% of disability could be prevented nationally if five risk factors were eliminated. The largest were smoking (17 percent), obesity (16 percent), and hypertension (12 percent). (4/2017)
• Challenges For People With Disabilities Within The Health Care Safety Net. Nearly 57 million Americans had disabilities in 2010. (11/18/14)

Functional Independence

• Patients' functional independence may predict readmissions (5/6/14)

Healthcare Costs

• The average healthcare cost for adults in the United States (2009-2011) was $4,845, for adults with 3 or more chronic conditions and no functional limitations was $7,526, for adults with 3 or more chronic conditions and functional limitation was $21,021 (8/29/16)

Homebound

• An estimated 1.9 million U.S. adults age 65 or older are completely or mostly homebound, while another 5.3 million have functional limitations that make it hard to leave their homes. (7/2015)
• Homebound - Approximately four million adults in the United States are homebound, and many of them cannot access office-based primary care. (1/2015)
• Treating the “Invisible Homebound”: Setting Standards for Health Care Provided at Home (1/30/15)

Impairments

• Arthritis afflicts about 1 in 4 adults in the U.S., CDC report finds. 60% of those with arthritis are between the ages of 18 and 64. 44% of people with arthritis report activity limitations of everyday tasks, such as walking or lifting bags. (3/7/17)
• Adults ages 70 years or older with moderate or more severe hearing impairment have a 54% increased risk of all causes of death (9/25/15)

Limitation in Usual Activities

• About 39.7 million persons (12%) were limited in their usual activities due to one or more chronic health conditions (12/2013)
• About 100 million adults in the United States were affected by chronic pain, including joint pain or arthritis limiting their functional status and adversely impacting their quality of life. The total financial cost of pain to society (health care and productivity estimates) ranges from $560 to $635 billion (2011 Study)

Limitation in Work

• 43% of men in America ages 25 to 54 who are out of the labor force report their health as fair or poor, compared with 12% of employed men and 16% of unemployed men. (3/22/17)
• About 13.8 million adults aged 18–69 (6%) were unable to work due to health problems, and 6.7 million (3%) were limited in the kind or amount of work they could do because of their health (12/2013)

Genomic Insight

Insights into Genomic Profiles Determinants that can decisively affect a patient's overall health and well-being.

• Epigenetics research suggests living things reprogram their genome in response to social factors like stress and lack of food. The biochemical signals passed from mothers to offspring tell the child what kind of world they're going to live in, changing the expression of genes. (7/2016)
• Scientists believe most, if not all, diseases arise from interactions between the genome, the epigenome (controls gene expression), and the environment (broadly defined to include social, behavioral, and physical agents). (5/2011)

Competencies Insight

Insights into Competencies Determinants that can decisively affect a patient's overall health and well-being.

Health Literacy Insight

Insights into Health Literacy Determinants that can decisively affect a patient's overall health and well-being.

• A guide to surviving chronic disease (8/3/16)
• Education - A survey of patients with terminal lung cancer found nearly two-thirds did not understand that radiation treatments intended only to ease their symptoms would not cure their disease. (6/26/13)
• My Knee Guide App Educates and Engages Patients in Total Knee Arthroplasty Care (9/25/14)
• Surgeon entrepreneur develops video replay for specialist appointments to boost patient education (5/28/15)
• 77 Million Adults Have Basic or Below Basic Health Literacy (2003)

Self-Management Competencies Insight

Insights into Self-Management Competencies Determinants that can decisively affect a patient's overall health and well-being.

Education

• Patients need education about their role in care (7/3/14)

Managing Chronic Conditions

• 39% patients admit they’re only somewhat knowledgeable, at best, about how to effectively manage their chronic condition. (7/2017) from West Study.
• Preventing and effectively managing obesity, diabetes, hypertension and cardiovascular disease can reduce onset and duration of dementia and reduce healthcare costs. (4/11/14)

Medication Adherence

• More People Are Making Mistakes With Medicines At Home (7/12/17)
• More than half of heart patients made mistakes taking their medications or misunderstood instructions (7/18/14)
• Only 7% of asthma sufferers were found to use asthma inhalers in the right way (12/20/14)

Physician Office Visits

• How a patient can help their physician diagnose them. 3/19/17)

Functional Competencies Insight

Insights into Functional Competencies Determinants that can decisively affect a patient's overall health and well-being. Literacy

• Health literacy can be a life-or-death matter. 1 out of 3 adult Georgians is functionally illiterate. Without a clear understanding of their health condition, these adults are more likely to skip necessary medical tests and have a harder time with diabetes management or high blood pressure numbers. (10/31/16)

Education Insight

Insights into Education Determinants that can decisively affect a patient's overall health and well-being.

Social Insight

Insights into Social Determinants that can decisively affect a patient's overall health and well-being.

Patient (About & History) Insight

Health Insights into Patient (About & History) Determinants that can decisively affect a patient's overall health and well-being.

• Large Study Finds Association Between Marriage and Cancer Outcomes (9/23/13)

Life Expectancy

• American death rate rises for first time in decade. Rises in death rates from: Alzheimer's disease, heart diseases, suicide and unintentional injuries (auto accidents and drug overdoses) (6/1/16)
• Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century (9/17/15)

Beliefs Insight

Insights into Beliefs Determinants that can decisively affect a patient's overall health and well-being.

• Patients who don't feel they can manage their health or navigate the health care system are more likely to develop a chronic disease over a three-year period than “activated” patients with good self-management skills. Low patient-activation levels are linked to significantly more hospitalizations and emergency department (ED) use. (8/23/16)

Determination Insight

Insights into Determination Determinants that can decisively affect a patient's overall health and well-being.

Resilience Insight

Insights into Resilience Determinants that can decisively affect a patient's overall health and well-being.

Adverse Childhood Events (ACEs)

• Childhood Stress May Prime Pump For Chronic Disease Later (9/29/15)
• How childhood trauma affects health across a lifetime (9/2014)
• Adverse Childhood Events (ACEs) on attributed to higher rates of chronic disease among children (12/2014)

Optimism

• A Brighter Outlook Could Translate To A Longer Life (12/7/16)

Stress

• Psychological resilience plays a role in the molecular impact of traumatic experiences. Promoting resilience may have benefits for physical and mental health (7/12/16)
• Study: Stressful Jobs Make Life Shorter. Researchers found that unhealthy workplaces can affect mortality. (10/29/15)
• How Stress Makes You Sick. Feeling overwhelmed affects everything from digestion to stroke risk. (10/28/15)
• Emotional or physical stress can trigger heart attacks may now have a scientific explanation (6/10/14)

Responsibilities Insight

Insights into Responsibilities Determinants that can decisively affect a patient's overall health and well-being.

• Family caregivers may be sacrificing their own health to help loved ones (2/15/16)
• A caregiving spouse who is between the ages of 66 and 96 and under excessive mental or emotional strain has a 63% greater risk of dying compared to those who are not tasked with caregiving. (1/17/14)
• Quality of life: impact of chronic illness on the partner (11/2001)

Social Well-Being Insight

Insights into Social Well-Being Determinants that can decisively affect a patient's overall health and well-being.

Defining Well-Being

• Most medical research focuses on disease rather than wellness. The diverse and interconnected dimensions of physical, emotional and social well-being. It includes achieving physical vitality, mental alacrity, social satisfaction, a sense of accomplishment, and personal fulfillment. (7/14/15)
• Depression and Anxiety explains the largest variance in life satisfaction. Study shows eliminating Depression and Anxiety would have 4 times the impact of eliminating poverty in improving life satisfaction. (12/12/16)

Competence & Control

• Independence—It’s What Older People Want (11/30/15)

Loneliness

• Why Loneliness Is a Public Health Threat. People with social connections had a 50% lower risk of dying early compared to people who did not have strong social circles. (8/7/17)
• Social Isolation May Worsen Breast Cancer Prospects. Women with fewer social ties — to friends, family, community and religious groups, as well as spouses or romantic partners — were 43% more likely to see their breast cancer return, 64% more likely to die from breast cancer and 69% more likely to die from any cause (12/13/16)
• In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors) 37% felt socially isolated and lacked companionship compared to 15% of other adults. (12/9/12)
• Loneliness a bigger risk factor for death than obesity (9/6/16)
• The profound power of loneliness can depression and other serious health problems (2/3/16)
• How Loneliness Wears on the Body. New research supports the idea that social isolation is detrimental to physical health—and that companionship may improve it. (12/3/15)
• Loneliness May Warp Our Genes, And Our Immune Systems (11/29/15)
• Loneliness increases risk of death by 26%. Social isolation — or lacking social connection — and living alone were found to be even more devastating to a person’s health than feeling lonely, respectively increasing mortality risk by 29% and 32% (3/18/15)
• Social isolation and loneliness are associated with increased mortality (9/12/12)

Love & Connection

• Stressful relationships might be significantly shortening your life, are you better off alone? (5/13/14)

Purpose & Meaning

• People with a sense of purpose and having positive view about aging in late middle age lived about 7 and half years longer than the people who saw aging in a negative light. (5/28/16)

Social Influence

• If a friend is obese, there is a 57% greater chance of becoming obese. (7/25/07)

Social Via Smartphones

• How Smartphones Are Making Kids Unhappy. Today's teens are just not spending as much time with their friends in person, face-to-face, where they can really read each others' emotions and get that social support. (8/7/17)

Support Insight

Insights into Support Determinants that can decisively affect a patient's overall health and well-being.

• A growing number of seniors who find themselves alone just when aging and end-of-life care becomes real. They don’t know how to approach a casual acquaintance to ask for help when they need it most. (11/28/16)
• Population Health Means Asking About Basic Needs: Are Your Providers Ready for That? (11/20/13)
• Lots Of Responsibility For In-Home Care Providers — But No Training Required (1/6/15)

Addressing Social Determinants

• Improving population health will require broader approaches that address social, economic, and environmental factors that influence health. (11/4/15)
• Literature reveals that the vast majority of premature mortality and morbidity is attributable to social, behavioral, and environmental factors. It’s Time To Focus On Social Determinants. (7/21/15)
• Why it’s time to improve the social determinants of health (5/1/15)
• Going Beyond Clinical Walls to address the other 80% of determinants that are often challenging to address in clinical visits. (10/2014)
• Addressing Patients' Social Needs: An Emerging Business Case for Provider Investment (5/29/14)

Caregiver

• More than a million youngsters ages 8–18 are caregivers taking on challenging tasks to help a parent, grandparent, sibling, or other relative. (8/7//17)
• Survey: 70 percent of caregivers say tech plays no role or a minor role in their work (6/27/17)
• New Pennsylvania law requires hospitals to educate caregivers upon patient discharge (4/27/17)
• Study: Many Caregivers Spend $7K Annually Out Of Pocket, which is 20% of their income (11/14/16)
• The number of U.S. workers struggling to care for ill or aging loved ones is growing fast. But the support they need isn't. (11/8/16)
• Elderly Americans’ well-being is at risk unless the U.S. does much more to help millions of family caregivers who sacrifice their own health, finances and personal lives to look out for loved ones (9/14/16)
• In Some States, a New Focus on Family Caregivers. Nearly half of family caregivers administer multiple medications, treat wounds or operate specialized medical equipment. (6/22/16)
• Who Are The 40 Million American Caregivers? Nearly A Quarter Are Millennials (12/3/15)
• 15 things to know about caregivers (11/3/15)
• New council will guide family caregivers to available tools (10/28/15)
• Nearly one-third struggle in their caregiving role and want tools to help them and their family members. 64% feel stressed and overwhelmed; nearly half struggle with balancing personal needs and caregiving. (10/24/15)
• Unpaid caregivers and family members spend more than 100 hours a month, on average, assisting elderly people with dementia (10/16/2015)
• Many Californians unaware of caregiver program for low-income seniors, disabled (7/14/15)
• In 2013, about 40 million family caregivers in the US provided an estimated 37 billion hours of care to an adult with limitations in daily activities. The estimated economic value of their unpaid contributions was approximately $470 billion in 2013. (7/2015)
• An estimated 43.5 million adults in the United States have provided unpaid care to an adult or a child in the 12 months period in 2014 and 2015. (6/2015)
• How Do We Care for the Caregiver (4/23/15)
• Nearly Half of Family Caregivers Spend Over $5,000 Per Year on Caregiving Costs (9/15/14)

Managing Chronic Conditions

• 70 percent of patients with a chronic condition would like more resources or clarity on how to manage their disease, and 91 percent say they need help managing their disease. (7/2017)

Transportation

• The Importance of Nonemergency Medical Transportation for Vulnerable Patients. One patient has to take two bus rides and walk a mile just to get herself and two young children to the doctor. (1/25/17)
• Unreliable or inaccessible transportation has emerged as a significant patient care issue. Legal experts say healthcare systems providing rides to patients raises concerns that they could be violating the Anti-Kickback Statute or providing a beneficiary inducement. (8/31/16)

Socioeconomic Insight

Insights into Socioeconomic Determinants that can decisively affect a patient's overall health and well-being.

Can't Afford Treatments Insight

Insights into Can't Afford Treatments Determinants that can decisively affect a patient's overall health and well-being.

Delay Medical Care

• Half of millennials have delayed medical care because of cost (1/1/16)
• 31% Americans say that they or a family member have put off any sort of medical treatment in the past year because of the cost (11/30/15)

Reduce Medical Care

• Half of ACA exchange customers skimp on healthcare to reduce costs (10/28/16)

Skip Medical Care

• Survey: 1 in 3 older millennials skips medical care because of costs (6/8/17)
• About one-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of cost. (11/16/16)
• Financial Barriers to Care Among Low-Income Children With Asthma (7/2014)* 80 million people (43% of America's working-age adults) didn't go to the doctor or access other medical services last year because of the cost (4/26/13)

Financial Insight

Insights into Financial Determinants that can decisively affect a patient's overall health and well-being.

Annual Healthcare Cost

• Healthcare Costs in 2016 for a Family of Four Will Be $25,826 (5/24/16)
• Annual Healthcare Cost For Family Of Four Now At $24,671 (5/19/15)

Fear of Healthcare Costs

• 53% of Americans believe receiving a large, unaffordable medical bill is as bad as being diagnosed with a serious illness (3/21/17)
• Health Care Worries Top Terrorism, By Far, In Americans’ Minds (2/8/17)
• Healthcare finances a source of fear for 75% of consumers (2/7/17)
• 75% fear health costs could ruin prospects for secure retirement (10/6/14)

Financial Stress

• Financial Stress As A Health Risk Factor Impacts More Americans (4/26/17)
• In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors), 62% of high-need said they experience stress about their ability to afford housing, utilities or nutritious meals compared to 32% of other adults. (12/9/16)
• 85% of employees in survey in 2015 reported at least some level of financial stress. 33% were assessed as having serious debt, such as student debt, medical bills and/or credit card debt. (7/20/16)
• 47% of Americans struggle to pay unexpected $400 bill (6/8/16)
• For Working-Age Cancer Survivors, Medical Debt And Bankruptcy Create Financial Hardships (1/2016)
• Survey shows 52% of employees stressed about their finances. 45% saying that financial matters cause the most stress, nearly as many as stress from job, health, or relationships combined. (2016 Employee Financial Wellness Survey)
• 46% of Americas described paying for care as a hardship rather than affordable (12/19/14)

Health Inequality

• People in households making less than $22,500 a year, 38% reported being in poor or fair health. That's more than three times the rate of health troubles faced by individuals in households making more than $47,700 a year. (6/5/17)
• Having less money is linked to poorer health regardless of personal habits. (7/5/16)
• Life expectancy is higher for the wealthiest. Among American men born in 1940, the wealthiest 10% are expected to live on average 12 years longer than the poorest 10%. (2/12/16)
• Costs deter low-income patients from participating in clinical trials (11/3/15)
• New innovative treatments and technology is often out of the reach of low income patients. (4/5/14)

Medical Bills

• Half of uninsured people face problems with their medical bills (8/23/16)
• 61% of patients confused by medical bills, survey finds (7/14/16)
• CDC: One in five Americans can't pay medical bills (9/30/13)

Prescription Drugs

• Sticker Shock Forces Thousands Of Cancer Patients To Skip Drugs, Skimp On Treatment (3/15/17)
• Faced With Unaffordable Drug Prices, Tens Of Millions Buy Medicine Outside U.S. (12/20/16)

Price Shopping for Medical Services

• Survey found 43% said it was somewhat or very difficult to get information on costs, while another 21% of patients had never tried to get procedure cost information. (1/31/17)
• Less than 7% of total health care spending in 2011 was paid by consumers for “shoppable” services. (3/4/16)

Food Insecurity Insight

Insights into Food Insecurity Determinants that can decisively affect a patient's overall health and well-being.

• Social Determinants of Health Series: Food Insecurity(8/3/17)
• Study of food insecurity in patients with high rates of inpatient hospitalization (“super-utilizers”). Forty adults with ≥3 hospital inpatient admissions within a 12-month period were interviewed. Using USDA definition of food insecurity, 30% were food insecure and 25% were marginally food secure. 40% responded that, in the past 30 days, they worried that their food would run out; 17.5% that they did not eat for a full day. 75% were unable to shop for food on their own and 58% were unable to prepare their own food. (12/1/16)
• 42.2 million Americans lived in food insecure households in 2015 (29.1 million adults and 13.1 million children). (2016)
• Nearly 9 million older adults in the United States experience food insecurity. (12/2015)
• Transitions Into Food Insecurity Associated With Behavioral Problems And Worse Overall Health Among Children (11/2015)
• Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation’s leading health and nutrition issues. (11/2015)
• In Sunlit Paradise, Seniors Go Hungry (5/26/15)
• Food insecurity is an undiagnosed medical problem (3/6/15)
• Exhaustion Of Food Budgets At Month’s End And Hospital Admissions For Hypoglycemia (1/2014)

Health Insurance Insight

Insights into Health Insurance Determinants that can decisively affect a patient's overall health and well-being.

• For sicker Medicare beneficiaries, increased Medicare hospital spending exceeded any savings from reduced drug prescriptions and doctor’s visits (5/8/17)
• Studies Link Cancer Patients' Survival Time To Insurance Status (9/16/16)
• Insurance is paying for more of the cost of treating mental health conditions (68%) but not for Substance Use Disorders (46%) (6/2016)
• New health plans offer discounts and give gift cards to encourage patients to use diabetes care (11/17/15)
• ACA health plans limit access to specialists: 7 findings (10/28/15)
• Study showed total cost for insured members with no chronic conditions was $3,024 a year ($2,204 out-of-pocket) and members with two or more chronic conditions was $11,940 a year ($3,500 out-of-pocket). (9/21/15)
• Why doctors must discuss costly treatment before patients receive bills (10/18/13)

Denied Coverage

• 'Hidden' crisis: Many patients with chronic illnesses find insurance providers deny treatment, new survey says (8/16/17)

Dual Eligible Patients (Qualify for Medicare and Medicaid)

• Low-income people on Medicare who receive assistance from Medicaid tend to have more chronic conditions, as well as cognitive and functional limitations, than others on Medicare: 61% vs. 33% need assistance with one or more activities of daily living, such as eating, bathing, and dressing; more than half, 58% vs. 29% have a mental condition or cognitive impairment; 37% vs. 27% have five or more chronic conditions; 18% vs 6% rate their health status as poor. (6/7/17)

Employer Sponsored Health Insurance

• State-by-State Look at Employer Health Insurance Costs Finds Workers’ Premium Contributions and Deductibles Growing More Slowly But Eating Up Greater Share of Incomes (10/26/16)
• Employer family health plan premiums soar above $18k in 2016 (9/14/16)

High Deductable Health Plans (HDHPs)

• Consumers insured through high-deductible health plans increased from 10 million in 2010 to 75 million in 2016. The average deductible for individuals with employer-based coverage doubled from $735 in 2010 to $1,478 in 2016. Patient payments to providers increased 58% from 2013 to 2016. (6/13/17)
• CDC: Nearly 40% of US adults have high-deductible health plans (6/7/17)
• Patients with chronic illness and high deductibles more likely to delay care, study finds. People with three or more chronic conditions were also nearly three times as likely to delay or avoid care as those without chronic conditions (25% compared to 9%) (11/23/16)
• Given the choice, 34% of employees choose HDHPs (5/3/16)
• Nearly one-quarter of workers are enrolled in an High Deductable Health Plan, up from 4% in 2006. (2/4/16)

Medicaid

• Spike in Late Stage Cancer Diagnosis Related to Medicaid Cut (7/5/17)

Medicare Beneficiaries

• Half of all Medicare beneficiaries had incomes below $26,200 in 2016 (4/21/17)

Patient Out-of-Pocket Cost

• Medicare cancer patients without additional coverage hit with high out-of-pocket costs (11/28/16)
• Patient payment responsibility spiked 13% in 2015 (6/28/16)
• 16 percent of Medicare beneficiaries (8 million) spent 20 percent or more of their income on insurance plus care. (5/10/16)
• The average deductible for people with employer-provided health coverage rose from $303 to $1,077 between 2006 and 2015. (4/12/16)
• Nearly half of workers are covered by an insurance plan with a general annual deductible of at least $1,000 for individual coverage. (2/4/16)
• High out-of-pocket expenses, narrow insurance networks send more patients to ERs (10/26/15)
• Workers with health insurance covered by their employers have an annual deductible amount for single coverage of $1,318. (9/22/15)

Surprise Out-of-Network Bills

• Many Medicare Advantage members burned by out-of-network bills due to changes in network providers (11/28/16)

Uninsured

• Why Do Millions of U.S. Adults Remain Uninsured? 1) The ACA excludes undocumented immigrants; 2) Nineteen states have not expanded Medicaid eligibility; 3) Many people still don’t know about the health insurance marketplaces; 4) Affordability is a concern; 5) Selecting a plan can be difficult: 6) Many aren’t getting the help they need. (10/21/16)
• Federal estimate of uninsured falls to record low 8.6% (9/7/16)
• Who Are the Remaining Uninsured and Why Haven't They Signed Up for Coverage? (8/18/16)
• The percentage uninsured in 2015 was 10.5% (28.4 million) (5/2016)
• Uninsured nonelderly Americans in 2014 was 32 million. 48% of uninsured adults said the main reason they were uninsured was because the cost was too high. Over 5 in 10 of uninsured have family income below 200% of poverty. (10/5/15).

Income & Work Insight

Insights into Income & Work Determinants that can decisively affect a patient's overall health and well-being.

• How working night shifts furthers health disparities (10/25/16)
• Study found that those who work in high-stress jobs with little control are more likely to die sooner than those who have more control over and balance in their work. (10/20/16)
• A large share of American men between the ages of 25 and 54 who aren’t in the labor force may suffer from serious health conditions that are “a barrier to work” and suffer physical pain, sadness, and stress in their daily lives. (10/7/16)
• Job loss due to plant closures affects physical health adversely for individuals in the middle and lower part of the health distribution while those in best physical condition do not seem to be affected. The results similar for mental health. (9/26/16)
• Low-Income Patients Face Hurdles To Care At Public Hospital (8/28/14)
• Low socioeconomic status (SES) is a risk factor for a multitude of medical conditions including cardiovascular disease, respiratory disease, cancer, and mental illness. (3/15/14)
• More than 16 million children in the United States – 22% of all children – live in families with incomes below the federal poverty level

Lack of Sick Leave

• Hassle Of Being A Patient Can Turn Into A Crisis Without Sick Leave. Third of working Americans say their jobs don't offer paid sick days (7/11/16)
• Workers without paid sick leave less likely to take time off for illness or injury compared to those with paid sick leave. 3.0 times more likely to forego medical care for themselves and 1.6 times more likely to forego care for family (3/2016)

Low Income Impact on Outcomes

• Sociodemographic factors are a major driver of adverse health outcomes for patients who qualify for both Medicare and Medicaid (4/2/15)
• Employment status top socioeconomic factor in readmissions (12/11/14)
• Income-Related Disparities Associated With Negative Health Outcomes (8/29/14)
• Data Dive Uncovers Socioeconomics Driving ER Visits, Readmissions (6/6/14)

Work environment

• Social, Psychological, And Physical Aspects Of The Work Environment Could Contribute To Hypertension Prevalence (2/2017)
• Exposure To Harmful Workplace Practices Could Account For Inequality In Life Spans Across Different Demographic Groups (10/2015)

Legal Insight

Insights into Legal Determinants that can decisively affect a patient's overall health and well-being.

Jail Involved

• Early access to primary care for ex-inmates can bring down healthcare costs by keeping them out of the ER (12/5/16)
• The Critical Link Between Health Care And Jails (3/2014)

Environmental Insight

Environmental Determinants that can decisively affect a patient's overall health and well-being.

Access & Logistics Insight

Insights into Access & Logistics Determinants that can decisively affect a patient's overall health and well-being.

• Patients in rural or remote communities with lack of access to a pharmacy may be more likely to end up back in the hospital (8/4/16)
• Late-in-life: To live at home, rural seniors need food, socialization, support (6/23/14)
• Roughly 1.3 million individuals (some 300,000 service members and an additional 1 million dependents) were at risk of living in an area remote from behavioral health care. (2015)
• There is only 1 mental health provider for every 790 individuals. One out of three adults with disability could not see a doctor because of costs. (2015)
• Transportation barriers to health care access are common, and greater for vulnerable populations. (12/2013)

Communication Insight

Insights into Communication Determinants that can decisively affect a patient's overall health and well-being.

Community Insight

Insights into Community Determinants that can decisively affect a patient's overall health and well-being.

• America’s Health Rankings of Behaviors, Community & Environment, Policy, and Clinical Care determinants of health that directly influence health outcomes (2015 Edition)
• Community factors most strongly associated with lower hospital readmission rates include more general practitioners and fewer specialists per capita and the presence of high-quality nursing home care. (4/17/14)
• Time to Act: Investing in the Health of Our Children and Communities (1/13/14)
• Children had a 20-60% higher likelihood of being obese or overweight if living in neighborhoods with unfavorable social conditions such as unsafe surroundings; poor housing; and no access to sidewalks, parks, and recreation centers. (3/2010)

Clean Air

• The surprising link between air pollution and Alzheimer’s disease (1/31/17)
• More Than 9 in 10 People Breathe Bad Air, W.H.O. Study Says (9/28/16)

Clean Water

• 63 million Americans exposed to unsafe drinking water (8/14/17)
• Water testing for lead levels found almost 3,000 areas with poisoning rates far higher than in Flint Michigan. Yet many of these lead hotspots are receiving little attention or funding. (12/19/16)
• Researchers believe as much as $2 billion of healthcare costs each year is tied to the treatment of infections that lurk in water distribution systems. (9/19/16)

Community Related - Life Expectancy

• Widening Disparities In Infant Mortality And Life Expectancy Between Appalachia And The Rest Of The United States, 1990–2013 (8/2017)
• U.S. life expectancy varies by more than 20 years from county to county (5/8/17)
• A person born in Princeton, NJ can expect to live 87 years, his or her neighbor a dozen miles away in Trenton has a life expectancy of 73 years (11/9/16)
• Life Expectancy Study: It's Not Just What You Make, It's Where You Live (4/11/16)

Countries

• When it comes to healthcare, U.S. once again ranks last in quality care compared to other wealthy nations (7/14/17)
• Global study of 700K smartphone users shows link between obesity and activity inequality within country (7/11/17)

Environmental Exposures

• 14 million US kids could be exposed to toxic PCBs at school (10/12/16)

Food Deserts

• Geographic Accessibility Of Food Outlets Not Associated With Body Mass Index Change Among Veterans, 2009–14 (8/2017)
• Some neighborhoods in US, mostly in low-income areas, have been dubbed “food deserts” because they don't have supermarkets or other food retailers that carry affordable and nutritious food. (3/1/2010)

Food Safety

• Lead Detected In 20% Of Baby Food Samples, Surprising Even Researchers (6/15/17)

Low Income Neighborhoods

• One’s neighborhood may drive or influence health disparities, which can be understood as disadvantages in health associated with one’s social, racial, economic, or physical environment, originate in childhood and persist across an individual’s life course. (6/2017)
• A massive study of health and income found that smoking, obesity, and exercise are the most important determinants of longevity. Poor neighborhoods score worse in all of them. (4/12/16)
• People who live in lower-income neighborhoods have a higher rate of diabetic lower-extremity amputations than those in more affluent areas (8/2014)

Noise

• Noise May Raise Blood Pressure Risk based on a study of people who lived near Athens International Airport (6/13/17)
• Noise Disrupts Circadian Rhythms and Causes Other Health Issues (4/25/17)
• Quieting Down Could Save Billions in Heart Disease Costs. It’s estimated that 100 million people in the U.S. are exposed to unhealthy levels of noise, typically from automobile and aircraft traffic (although everything from leaf blowers and lawnmowers to loud music can also contribute). (6/30/15)

Walkable Neighborhoods

• Higher neighborhood walkability was associated with decreased prevalence of overweight and obesity and decreased incidence of diabetes between 2001 and 2012 (5/24/16)

Home Insight

Insights into Home Determinants that can decisively affect a patient's overall health and well-being.

• The most common problems as you age in your home. (8/7/16)
• NYC heat-mortality rates are associated with poverty and poor housing quality. (11/2014)

Aging in Place

• Affordable housing, quality healthcare can let seniors age in place (11/9/16)
• Want a better chance to stay out of a nursing home? Modify your home (11/6/16)
• Many seniors living at home feel imprisoned by their independence (6/19/15)

Environmental Exposures

• Gas Leaks, Mold, and Rats: Millions of Americans Live in Hazardous Homes (7/25/16)
• Controlling environmental allergens can reduce sneezing and nasal congestion that trigger asthma (1/1/14)
• Scientists estimate that lung cancer deaths could be reduced by 2 to 4% by addressing the one in 15 homes the EPA believes has too much radon exposure
• Multi-faceted home ventilation intervention reduces COPD readmissions, study finds (7/15/15)
• At least 4 million households have children living in them that are being exposed to high levels of lead (1/29/16)
• Approximately 40% of the 6.7 million children with diagnosed asthma are believed to be attributable to residential exposures (7/2009)

Homelessness

• Lifetime and 1-year prevalence of homelessness in the US population was found to be 4.2% and 1.5%, respectively (3/18/17)

Home Injuries

• An estimated 4 million emergency department visits and 70,000 hospital admissions were attributed to injuries at home. (6/2009)

Housing Instability

• Housing instability will cost healthcare industry $111B over next decade (8/10/17)

Noise

• Noise Disrupts Circadian Rhythms and Causes Other Health Issues (4/25/17)
• Quieting Down Could Save Billions in Heart Disease Costs. It’s estimated that 100 million people in the U.S. are exposed to unhealthy levels of noise, typically from automobile and aircraft traffic (although everything from leaf blowers and lawnmowers to loud music can also contribute). (6/30/15)

Security Insight

Insights into Security Determinants that can decisively affect a patient's overall health and well-being. Neighborhood Violence

• Injury and violence was ranked as top concerns among Chicago's South and West Side residents, along with diabetes, nutrition, physical activity and weight, substance abuse and tobacco use, according to a health needs survey. (6/23/16)
• Study finds link between neighborhood violence and biological stress in children (11/15/16)

Digital Content & Technology Insight

Insights into Digital Content & Technology Determinants that can decisively affect a patient's overall health and well-being.

Medical Records Insight

Insights into Medical Records Determinants that can decisively affect a patient's overall health and well-being.

• Giving access to doctor notes can stimulate patient engagement (1/6/14)
• Medicare provides medical history on a mobile app (Blue Button) for patients and caregivers to share with doctors

Health Determinants Records Insight

Insights into Health Determinants Records that can decisively affect a patient's overall health and well-being.

Health Interventions Records Insight

Insights into Health Interventions Records Determinants that can decisively affect a patient's overall health and well-being.

Health Outcomes Records Insight

Insights into Health Outcomes Records Determinants that can decisively affect a patient's overall health and well-being.

Technology & Apps Insight

Insights into Technology & Apps Determinants that can decisively affect a patient's overall health and well-being.

• 96% of parents surveyed who said they were using an electronic tracking device for their child with autism claimed it improved their quality of life (5/8/17)
• Mobile Health and Patient Engagement in the Safety Net: A Survey of Community Health Centers and Clinics (5/13/15)

Decision Making and Condition Management

• New apps aim to guide men through treatment, symptom management of prostate cancer (9/10/16)

Devices

• Study finds patients often misuse wrist blood pressure monitors, leading to inaccurate readings (9/7/16)

Digital Health Apps

• Lumosity doesn’t actually improve your cognitive skills (7/11/17)
• Internet, mobile disease interventions seem to work, but long term studies are lacking (9/1/16)
• Study: Health apps near meaningless for low-income patients with chronic conditions (7/20/16)
• Rehab App Aims to Improve Shoulder & Rotator Cuff Repair Rehabilitation (3/21/16)
• Some 43 percent of iOS health apps and 27 percent of Android health apps are useful. (2/22/16)
• 5 digital health tools that could improve COPD management (12/3/15)
• CardioSmart Explorer is a great tool for educating patients with cardiac disease (11/21/14)
• A Vision for Using Digital Health Technologies to Empower Consumers and Transform the U.S. Health Care System (10/1/14)
• A study from Digitas Health found that 90 percent of chronic patients in the US would accept a mobile app prescription as opposed to only 66 percent willing to accept a prescription of medication. (7/1/13)

Digital Health Monitoring

• JAMA study: technology to self-monitor blood glucose levels no better than traditional management of type 2 diabetes (6/16/17)
• Patients are more compliant to smartphone-connected heart monitor devices than traditional event monitors (5/5/16)
• Wristbands, smartwatches, and other wearable devices allow for more real-time monitoring of seizures and other neurologic symptoms—and, possibly, more precise treatment. (8/2015)

Home Automation

• Top Home Tech for Seniors (7/28/14)
• Home automation and in-home care aid gives patients independence without sacrificing their health needs. (3/25/14)

Internet Access

• A growing number of people with chronic conditions also lack internet access (6/9/17)
• Broadband Connectivity Is A Social Determinant Of Health (7/22/16)

Technology Efficacy

• Smart pill bottles didn’t improve medication adherence for heart attack patients, but earlier intervention could help (6/26/17)

Technology Usage

• Survey: 21 percent of Americans have used virtual healthcare, 78 percent are interested (2/9/17)
• Seniors rarely use digital health resources: 5 study findings (8/3/16)
• 41 percent of caregivers use a digital health device (12/18/14)
• Kaiser now has 70% of its 9 million members as active users of its online and mobile offerings, patients are more adherent, satisfied, and loyal (12/10/14)

Impacting People Insight

Insights into the Impacting People Determinants that can impact a patient's health outcomes and health status.

Impacting Activities Insight

Insights into the Impacting Activities Determinants that can impact a patient's health outcomes and health status.

Healthy Lifestyle Insight

• The Population Health Benefits Of A Healthy Lifestyle: Life Expectancy Increased And Onset Of Disability Delayed (8/2017)
• A favorable lifestyle (defined as at least three of the four healthy lifestyle factors) was associated with a substantially lower risk of coronary events than an unfavorable lifestyle (defined as no or only one healthy lifestyle factor). Among participants at high genetic risk, a favorable lifestyle was associated with a 46% lower relative risk of coronary events than an unfavorable lifestyle. (12/15/16)
• Study finds 2.7% of U.S. adults meet criteria for ‘healthy lifestyle’ (4/2016)
• Scientist assert Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Only 5–10% of all cancer cases were attributed to genetic defects, whereas the remaining 90–95% is lifestyle factors including tobacco (25–30%), diet (30–35% - fried foods, red meat), infections (15–20%) the remaining alcohol, sun exposure, environmental pollutants, stress, obesity, and physical inactivity. (7/15/2008)

Physical Activities Insight

• Teenagers are as sedentary as 60-year-olds by age 19 (6/26/17)
• Johns Hopkins: US could save $21B in healthcare costs if kids played outside every day (5/15/17)
• The percent of children aged six to 12 who were physically active three or more times a week had its biggest drop in five years and is now under 25% (5/6/17)
• If all of the children who currently are sedentary started exercising every day in the United States alone, we could expect to save more than $120 billion every year in health care and associated expenses. (5/3/17)
• Modeling The Economic And Health Impact Of Increasing Children’s Physical Activity In The United States (5/2017)
• Researchers found that the weekend warriors who met physical activity guidelines were less likely to die during the nine-year study period, compared with people who didn't get any exercise. A total of at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity over one or two days a week. (1/15/17)
• Pokemon Go Increased U.S. Activity Levels by 144 Billion Steps in Just 30 Days (10/21/16)
• Brain Benefits of Exercise Diminish After Short Rest (9/28/16)
• CDC: More than a quarter of adults over 50 get no exercise outside of daily life activities (9/20/16)
• Study suggests 1 hour of activity per 8 hours of sitting (7/27/16)
• Sitting can be bad, especially if you do it for more than 10 hours a day (7/24/16)
• Moderate exercise is associated with a reduced risk of 13 types of cancer (7/18/16)
• The percentage of adults over 18 who met the 2008 federal physical activity guidelines for aerobic activity increased from 41.4 percent in 2006 to 49.5 percent in 2012. That rate has remained stable through 2015. (5/26/16)
• NIH Common Fund launches physical activity research program to identify biological molecules that change in response to exercise (6/11/15)
• Too much TV tied to premature death (7/1/14)

Nutrition Insight

• Artificial Sweeteners Won't Help You Lose Weight, According to a Sad but Important New Study (7/17/17)
• The frequent consumption of fried potatoes appears to be associated with an increased mortality risk. (6/7/17)
• Pediatricians Advise No Fruit Juice Until Kids Are 1 (5/22/17)
• Red meat increase risk of dying from 8 diseases (5/15/17)
• Diet soda tied to dementia and stroke (4/26/17)
• The number of calories per day that children and adults have been getting from soda and other sugar-sweetened beverages has been dropping for steadily for nearly 20 years, but new data show that since 2009 that number has plateaued. (1/26/17)
• Excess sugar consumption has been linked with Alzheimer's disease (AD) pathology in animal models. (1/24/17)
• Dietary Intake Among US Adults, 1999-2012 Improved. The American Heart Association (AHA) primary diet score (maximum of 50 points) improved from 19.0 to 21.2 (an improvement of 11.6%). (6/21/16)
• More Than Half of What Americans Eat Is 'Ultra-Processed'. And those foods account for 90 percent of U.S. added sugar intake, new research says.(3/10/16)
• Improvements In US Diet Helped Reduce Disease Burden And Lower Premature Deaths, 1999–2012; Overall Diet Remains Poor (11/2015)
• Foods with the largest positive associations with three-year excess weight gain (among children and adolescents) were fat spread (butter or margarine), coated (breaded or battered) poultry, potatoes cooked in oil (French fries, roasted potatoes, and potato chips), coated fish, processed meats, other meats, desserts and sweets, milk, and sugar-sweetened beverages (11/2015)
• Consumption of sugary drinks may lead to an estimated 184,000 adult deaths each year (6/29/15)
• US and UK governments dietary guidelines introduced in 1977 and 1983 to reduce coronary heart disease (CHD) by reducing fat intake didn't have studies to support it. (2/9/15)

Sleep Insight

• Interrupted sleep may lead to Alzheimer’s. Research found significant associations between sleep disordered breathing (SDB) and the accumulation of biomarkers for Alzheimer's disease. (7/18/18)
• Drivers Beware: Crash Rate Spikes With Every Hour Of Lost Sleep (12/6/16)
• In United States, sleep deprivation costs up to $411 billion a year due to lower workforce productivity and higher risk of death (11/30/16)
• Snooze Alert: A Sleep Disorder May Be Harming Your Body And Brain A Sleep Disorder May Be Harming Your Body And Brain. More than 50 million adults in the U.S. have a disorder such as insomnia, restless leg syndrome or sleep apnea. (8/24/15)
• One in 25 American adults takes sleeping pills to help them fall asleep and stay asleep at night (8/29/13)

Adverse Behaviors Insight

Insights into Adverse Behaviors Determinants that can decisively affect a patient's overall health and well-being.

• More than 70 percent of U.S. adults report at least one of the following unhealthy behaviors: smoking, excessive drinking, insufficient sleep, physical inactivity and obesity. (4/5/16)
• Overweight patients with risk factors for heart disease need "intensive behavioral counseling" about diet or exercise, according to USPSTF. (8/25/14)
• 8 Behavior Risks Drive 15 Conditions And 80% Of Healthcare Costs (12/30/13)

Alcohol

• The number of adults who binge drink at least once a week could be as high as 30 million, according to a study published on Wednesday in JAMA Psychiatry. (8/9/17)
• An estimated 32% of Americans had a minimum of one heavy drinking day in the last year. (5/26/16)
• Alcohol dependence or abuse (17 million) was the most commonly reported substance abuse disorder in 2014. (5/27/16)
• Alcohol Consumption - The top 10% of American drinkers consume, on average, 74 alcoholic drinks per week. (9/25/14)

Falls

• Elderly patients treated for falls may be more likely to suffer later adverse events, study finds (7/12/17)
• The national rate of deaths after falls among people 65 and over increased by more than 35 percent between 2005 and 2014. (9/21/16)
• Over 700,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.
• The use of 4 or more medications was associated with increased risk of falling and the risk of recurrent falls (9/27/13)

Risky Behaviors

• Car Accidents Remain a Top Child Killer, and Belts a Reliable Savior (5/29/17)
• Study finds high-risk behaviors often persist after cancer diagnoses. 19.8% of women cancer survivors smoked, compared with 15.8% of women without cancer. No differences existed for fruit and vegetable consumption or body mass index. (9/6/16)

Smoking

• Smoking costs the world economy $1 trillion per year, World Health Organization says (1/10/17)
• New evidence shows there’s no safe amount of smoking. One cigarette a day, or even less than that, still poses significant risks to your health. (12/13/16)
• Centers for Disease Control and Prevention says smoking rates have fallen from 21% of the adult population in 2005 to 15% in 2015 (11/10/16)
• Smoking a pack a day for a year causes 150 mutations in lung cells (11/3/16)
• Cigarettes linked to nearly 30% of cancer deaths: 6 things to know (10/24/16)
• A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. (5/10/16)
• CDC reports smoking rate among adults in the U.S. fell to 15% in 2015, down two percentage points from 2014. (5/24/16)

Substance Use

• How drug use changes the brain — and makes relapse all too common (4/19/17)
• Nearly 21 million people in the United States have a substance use disorder, comparable with the number of people diagnosed with diabetes and 1.5 times the prevalence of all cancers combined. (11/17/16)
• 4% of all employee drug tests were positive for illicit drugs (i.e., marijuana, heroin, methamphetamines) in 2015, a 10-year peak. (9/15/16)
• 3000% increase Opioid Dependence Leads To ‘Tsunami’ Of Medical Services, Study Finds (8/1/16)
• In 2014 7.1 million reported having an illicit drug use disorder, 4.2 million reported a marijuana use disorder and 1.9 million reported having a pain reliever disorder. (5/27/16)
• Prescription opioid overdoses prompted more than 100,000 emergency department (ED) visits in 2010 and cost hospitals more than $2 billion (11/13/14)
• Most emergency department 'super-frequent users' have a substance abuse addiction (5/17/14)

Self-Management Behavior Insight

Insights into Self-Management Behavior Determinants that can decisively affect a patient's overall health and well-being.

Advanced Directives

• 2 out of 3 adults fail to complete an advance directive (7/6/17)
• Being prepared for the final days (4/27/14)
• Lack of advance directives leads to unwanted care (11/2/14)
• Only 20% of Americans have an advanced directive documenting their wishes for end-of-life medical care. (4/16/15)

Medication Adherence

• Many Heart Attack Patients Fail to Stick With Statins (4/19/17)
• More than half of adults and 44% of children drug-tested by a national clinical laboratory last year misused their prescription medications, either taking too much, too little or none of their medications. 45 percent of adults were taking drugs (including illicit drugs) that were not prescribed. (7/25/16)
• 30% of prescriptions are never filled. 69% of nonadherence is due to behavioral issues, such as forgetfulness or procrastination, 16% was due to cost, and 15% say it was medication side effects (7/12/16)
• The U.S. could save $4 billion a year if more seniors with type 2 diabetes followed their doctor’s orders, according to a report by the IMS (7/12/16)
• Study found that only 6.5% of patients (only 46 in study) adhered completely to the discharge medication list after average hospital stay of 4.3 days. The average patient age was 76, prescription medications was 10 and number of chronic diseases was 7. (2/24/13)
• Study: Medication adherence improved with proper prompts (11/17/14)
• When the patient is non-compliant (11/15/12)
• About 40% of patients with schizophrenia are adhering to antipsychotic medications (5/31/15)

Patient Activation Levels

• In 2012, ED costs were 37% lower for those at highest activation level versus the lowest ($1,126 vs. $711). In 2014, the difference was 28% (3/8/16)
• Effect of the Patient Activation Measure (PAM) on Chronic Care: Baseline Findings from a Cluster Randomized Study (5/10/07)
• When Patient Activation Levels Change, Health Outcomes And Costs Change, Too (3/2015)

Prevention

• Study finds 73 percent of sunscreens don’t even work — how to find one that does (5/26/17)

Preventive Screening and Vaccinations

• Percentages of adults who received an influenza vaccination in 2015 was 65.8% for adults aged 65 and over, 46% for ages 50 to 64 and 31.2% for those aged 18 to 49. (5/26/16)
• Percentage of adults over 65 years old vaccinated for pneumonia increased rapidly from 42.4% in 1997 to 53.1% in 2000. In 2015, the percentage rose to 63.5% (5/26/16)

Self Management

• Self management may reduce blood pressure (8/27/14)

Treatment Delays

• 67% of consumers say they have delayed seeking care for a health problem. They delay because: It costs too much (23%), It takes too long to get in to see a doctor or nurse (23%), They thought the problem would go away on its own (36%), They are too busy (13%) (1/2017)

Weight Loss

• American adults either overweight or obese rose from about 53% a generation ago to roughly 66% more recently. 56% of overweight or obese adults reported in 1988 to 1994 they had tried to lose weight in the last year, it has declined to 49% in 2009 to 2014. (3/7/17)

Wellness Programs

• 74 percent of employers use health reward program (12/1/14)
• What Size Reward Drives a Consumer to Take a Desired Health Behavior? (9/9/14)
• Workplace Wellness Produces No Savings (11/25/14)

Care Management Insight

Insights into Care Management Determinants that can decisively affect a patient's overall health and well-being.

Health Mission & Care Goals Insight

Insights into Health Mission & Care Goals Determinants that can decisively affect a patient's overall health and well-being.

Care Goals

• Defining the patient’s goals of care (12/11/13)
• Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm (3/1/2012)

End of Life Planning

• End-of-life care, planning fails patients (2/5/15)
• Few doctors discuss end-of-life planning with heart-failure patients, Mayo study finds (6/18/14)
• Dying in America - experts find that improving the quality and availability of medical and social services for patients and their families could enhance quality of life through the end of life (9/17/14)
• Too Many People Die In Hospital Instead Of Home. Here’s Why. (9/22/14)

Health Strategy & Care Planning Insight

Insights into Health Strategy & Care Planning Determinants that can decisively affect a patient's overall health and well-being.

• “Triggers of Decline” conceptual model developed to identify at-risk populations of older adults and to develop evidence-based practices to prevent the onset of frailty. (5/10/16)
• Gaps in Understanding about Palliative Care - Reasons for Lack of Policy Support for Family Caregivers (7/2/14)

Care Planning

• Implementing A Care Planning System: How To Fix The Most Pervasive Errors In Health Care (1/2/15)

Decision Aids

• Massachusetts General had over 28,000 orders for 40 patient decision aids over 10 years. (4/2016)
• Proven Best Choices Creates Guides to Offer Patients and Physicians Easy-to-Understand Advice on ‘Best Value’ Options for Breast Cancer Screening and Prostate Cancer Treatments (1/21/16)
• The Ottawa Decision Support Framework is an evidence-based, practical, mid-range theory for guiding patients making health or social decisions (6/22/15)
• Helping Patients Make Better Treatment With Decision Aids (10/2012)

Evidence-Based Practice

• Primary care doctors have trouble finding the evidence they need to guide clinical decisions. A study of Georgia 721 topics from online references for generalists and found only 18% of the recommendations were based on high-quality, patient-oriented evidence. (6/21/17)
• Credibility of Evidence: A Reconsideration of the Logic and Strength of Our Healthcare Decisions (5/22/15)

Medical Advocates

• Medical Advocates Can Help Guide Patients On Difficult Care Choices (1/27/16)

Second Opinions

• Partners expands second-opinion service with Health Advocate partnership. Complete change in the treatment plan was recommended in 90 percent of medical cases remotely reviewed. (4/27/17)
• 88% of second opinions from Mayo physicians result in different or refined diagnosis, study finds (4/4/17)

Shared Decision Making

• Patients with more say in treatment have fewer side effects (7/13/16)
• Inviting Patients To Help Decide Their Own Treatment (3/16/15)
• Shared Decision Making And The Use Of Patient Decision Aids - can lead to patients gaining knowledge, having a more accurate understanding of risks, harms and benefits, feeling less conflicted about decisions and rating themselves as less passive and less often undecided (12/17/14)
• How should doctors and patients look critically at medical decisions? (8/16/13)
• Many medical interventions are 50/50: Who informs the patient? (8/13/2013)

Health Disciplines & Resources Insight

Insights into Health Disciplines & Resources Determinants that can decisively affect a patient's overall health and well-being.

• How a Specialist Nurse can Help with Dementia (6/21/14)

Community Health Workers

• Hospitals Eye Community Health Workers To Cultivate Patients’ Successes (4/11/16)
• In L.A., Community Health Workers Are Part Of The Medical Team (10/26/15)
• How Community Health Workers Can Reinvent Health Care Delivery In The US (1/16/15)

Community & Social Services

• How Social Spending Affects Health Outcomes (8/17/16)
• Centers for Disease Control and Prevention (CDC) launches new initiative – Health Impact in 5 Years (HI-5). Promotes list of proven non-clinical, community-wide interventions that improved health within five years and are cost-effective or have cost-saving over the lifetime of the population. (8/11/16)
• Social service shortfalls hinder health, boost medical spending (5/3/16)
• Sharing Knowledge and Data at the Community/System Level To Address Social Determinants (4/2015)
• To Lower The Cost Of Health Care, Low-tech social services also should be considered a key factor in our health care equation. (7/14/15)
• CDC launches Community Health Improvement Navigator (CHI Navigator) website (5/2015) with tools and resources from The Guide to Community Preventive Services, the What Works for Health database (on the University of Wisconsin website), the AHRQ Health Care Innovations Exchange, the Healthy Communities Institute Promising Practices and the New York Academy of Medicine/Trust for America’s Health Compendium of Proven Community-based Prevention Programs.
• Understanding the intersection of health care and social services (11/10/13)

Primary Care Physicians

• Some 28% of U.S. men and 17% of women don’t have a personal doctor or healthcare provider, according to a government survey. (1/12/17)

Team-Based Approach

• To Bring Down Stubbornly High Blood Pressure, It Helps To Have A Team (5/4/17)
• Team-based care can have negative financial impact on primary care in FFS environment (8/10/16)
• The Team Sport of Diagnosis: A Culture Shift Can Reduce Missed Diagnoses (6/15/16)

Care Management - Communications Insight

Insights into Care Management - Communications Determinants that can decisively affect a patient's overall health and well-being.

Communicating Instructions

• Most patients don't understand post-discharge care plans, study finds (1/6/2016)

Difficult Dialog

• The difficulty of asking questions about "adverse childhood experiences" that identifies health risks (3/3/15)
• Many Doctors Who Diagnose Alzheimer's Fail To Tell The Patient (3/24/15)

Digital Communications

• Kaiser Permanente crossed an important threshold last year when 52 percent of its patient interactions were digital. (5/10/17)
• 58% of people in the U.S. with a smartphone shared information with a medical professional using a mobile or wearable device. And 25% used email or text to send a photo of a medical issue to their doctor. (11/15/16)
• Communicating With Your Doctor On Facebook May Be The Future Of Healthcare (6/29/15)
• Pilot project finds mobile engagement with Medicaid patients ‘most cost-effective’ (7/29/14)
• Nearly half of Kaiser Permanente's members use online health management platform (7/25/14)
• Electronic Communication - 71% of vulnerable patient populations want to use electronic communication with health care providers. (2/20/13)

Doctor Patient Discussions

• The language doctors use to talk to diabetes patients makes a difference to success (6/14/17)
• How prudent antibiotic prescribing lowers patient satisfaction (9/13/16)
• Study recommends improving communication with racial minorities and lower-income patients, such as better bedside manner (so patients trust their doctors), communication that is easily understood by everyday people and willingness to discuss how price fits into consumers’ health decisions. (9/2/16)
• Physicians spend twice as much time on EHR, desk work than with patients (9/6/16)
• Doctors and patients want to talk transparently about the costs and value of health care, but it’s easier said than done. (6/15/16)
• Why Do I Only Get 10 Minutes With My Doctor? (9/18/14)
• 15-Minute Visits Take A Toll On The Doctor-Patient Relationship (4/21/14)

Patient Portals

• Just 15% of hospital patients electronically accessed their medical records despite 88% of hospitals offering access. Nearly one-third of patients accessed EHRs offered by physician practices. (3/16/17)

Patient Provided Data

• University of Rochester Medical Center (URMC) collects patient-reported outcomes by using a Patient-Reported Outcomes Measurement Information System (PROMIS), which requires patients to answer five to seven questions on a tablet. (7/6/17)
• Patients Typing Their Own Visit Agendas Into an Electronic Medical Record. Patients and clinicians agreed that the agendas improved patient-clinician communication. (3/2017)

Remote Monitoring

• Study finds readmissions nearly the same for heart failure patients using remote patient monitoring (3/2016)
• Scripps Wired for Health study shows no clinical or economic benefit from digital health monitoring (1/19/16)
• Dr. Patrick Soon-Shiong is working on wearable, real-time monitors to enable doctors to “interrogate” a person’s individual blood cells “all the way down to the atom level” to see how a given drug works or why it fails. (12/11/14)
• Can Fall Monitoring Technology Keep Elders Safe? (4/7/14)
• Brookings Institute analysis, remote monitoring technologies could save the U.S. healthcare system $197 billion between 2010 and 2035. (1/9/14)

Screenings

• Doctors must screen patients for social isolation to address 'loneliness epidemic' (8/8/17)
• Standardized Screening for Health-Related Social Needs in Clinical Settings. The Accountable Health Communities Screening Tool. (5/30/17) See PDF

Text Messaging

• Despite privacy hoops, text messaging offers ‘unprecedented convenience’ (5/11/17)

Care Management - Operational Insight

Insights into Care Management - Operational Determinants that can decisively affect a patient's overall health and well-being.

• Breaking Down Silos Between Health Care And Criminal Justice (3/2014)

Behavioral Health Integration

• Few ACOs Pursue Innovative Models That Integrate Care For Mental Illness And Substance Abuse With Primary Care (10/2014)
• About 10 million—or 4.2%—of adults in the United States suffered from a serious mental illness in 2013 were supported by 112 different federal programs (2/11/15)

Care Transitions

• Only 30% of the 375 surveyed said that the post-acute care their patients received upon discharge was mostly coordinated. And a mere 7% reported they were fully coordinated. (11/131/6)
• Nearly 30% of 30-day readmissions to a children’s hospital may be potentially preventable. (7/2016)
• The difficult transition between the hospital and nursing home (9/5/13)
• One of the most dangerous junctures in medical care: patients leaving the hospital. Nearly a quarter had inadequately reviewed or tracked medications, sometimes even causing fatal events. (5/2/16)
• Nearly 20% of patients experience adverse events within 3 weeks of hospital discharge, nearly three-quarters of which could have been prevented or ameliorated. (7/2016)
• The transition from hospital to home poses significant risks to patients, especially the elderly, and gaps persist in care during this crucial time. (7/11/16)

Coordinated Care

• Patients who visit multiple outpatient providers are at greater risk of having uncoordinated, fragmented care, linked to high rates of hospitalization and emergency department visits as well as lower satisfaction. Among patients with five or more chronic diseases, those with the most fragmented care had 542 tests per 100 patients and those with the least fragmented care had 258 tests per 100 patients. (11/28/16)
• Program of All-Inclusive Care for the Elderly (PACE) cares for frail elders in the community (8/12/16)
• How poor interoperability affects patients. It often requires duplicate testing that is not only costly (e.g., CT scans), but also invasive and not without risk to the patient (e.g., bronchoscopy, biopsies). (12/17/15)
• Four in Ten Older Adults Burdened by Demands of Health Care System (10/14/15)
• International Survey of Older Adults Finds Shortcomings in Access, Coordination, and Patient-Centered Care (11/19/14)
• 5 pieces of the care coordination puzzle (6/11/14)
• Lack of Coordinated Care is a Problem for Older Patients, Survey Says (4/3/14)
• Coordinated care critical for reducing U.S. health spending (10/8/13)

High-Need, High-Cost Patients

• Superusers represent 3% of hospitalized patients in Pennsylvania consumed $1.25 billion in health care costs. (6/21/17)
• Each year, 1 in every 20 Americans racks up just as much in medical bills as another 19 combined. (6/15/17)
• In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors), 62% did not have good access to services that could help them manage their daily living activities. 58% did not have good access to an informed and up-to-date care coordinator. (12/9/16)
• 1.2% of employees are high cost claimants who comprise 31% of total health care spending according to a report on 26 large employers. (9/15/16)
• Caring for High-Need, High-Cost Patients — An Urgent Priority (9/8/16)
• Health care spending for high-need adults exceeded $21,000 per person, nearly three times the average for adults with multiple chronic diseases only ($7,526) and more than four times that of all adults ($4,845). (8/29/16)
• High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care? (8/29/16)
• Report Profiles The 12 Million Sickest Patients; Finds Health Care System Not Meeting Their Needs (8/25/16)
• Top concerns of high-need patients include: Paying for Care, Accessing Care, Insurance Frustrations, Technology Can Be Helpful, Getting Help at Home (6/16/16)
• For Many Patients Who Use Large Amounts Of Health Care Services, The Need Is Intense Yet Temporary. Only 28% of super-utilizers remained on top of the list at the end of a year. (8/2015)
• Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program? (8/7/14)
• 53% of California's healthcare expenditures are spent by just 5% of the population
• The challenge of frequent fliers: 20 ER visits per year is progress (11/11/13)
• Hospital-dependent patient's medical problems cannot be managed outside the hospital. (2/20/14)
• Costliest 1 Percent Of Patients Account For 21 Percent Of U.S. Health Spending (10/7/13)
• Models of Care for High-Need, High-Cost Patients: An Evidence Synthesis (10/29/15)
• Researchers are focusing on high-need, high-cost patients—both because they need the most help and because they have the biggest impact on national health spending. 5 percent of the U.S. population accounts for 50 percent of the nation’s health care costs. (11/11/15)
• Nearly 25% of primary care physicians in the United States report they are not prepared to care for the sickest and frailest patients, and 84% say they are not well prepared to manage patients with serious mental illness (12/7/15)

Palliative Care

• Palliative Care Teams’ Cost-Saving Effect Is Larger For Cancer Patients With Higher Numbers Of Comorbidities (1/2016)
• The Challenge Of Financing Sustainable Community-Based Palliative Care Programs (12/29/14)

Partnering With Community & Social Services

• What Organizations do Hospitals Partner With for Population Health? (12/5/13)
• The Trouble with Home Health Care & Care Coordination (12/28/14)
• Primary Care Physicians In Ten Countries Report Challenges Caring For Patients With Complex Health Needs. Coordinating care and communicating with specialists, hospitals, home care and social service providers. (12/2015)

Health Interventions Insight

Insights into Health Interventions Determinants that can decisively affect a patient's overall health and well-being.

Medical Interventions Insight

Insights into Medical Interventions Determinants that can decisively affect a patient's overall health and well-being.

Access to Medical Care

• High-need adults faced significant barriers accessing needed care in many states. In Alabama, Georgia, Idaho, North Carolina, and South Carolina, for example, 40 percent or more of high-need adults reported not seeing a doctor when needed or not filling a prescription because of cost. (8/7/17)
• In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors), 19% used the ED instead of a physician's office or a clinic, 44% delayed care in the past year because of inhibited access. 22% reported a lack of transportation as a reason for delaying care. 95% have a regular physician or place of care, only 35% said it was somewhat or very easy to get medical care after hours without visiting an ED, compared to 53% of other adults (12/9/16)
• Access to medical care in the evenings and on weekends. 32% of doctors say they see patients in person and only 58% say they provide advice by telephone 24/7. Only 38% of patients say they can obtain medical advice by telephone during off-hours. 2% of patients are able to engage in a video visit with their physicians. (7/7/16)

Behavioral Health Access

• Shortage of Psychiatrists Leads Patients to Costly ER, Hospitalization (5/23/17)
• Suicide rate in America has risen by 24% in the last 15 years associated with a significant reduction in the numbers of psychiatric beds available. (12/28/16)
• Scarcity Of Mental Health Care Means Patients — Especially Kids — Land In ER (10/17/16)
• Suicidal patients often wait hours for hospital beds (9/20/16)
• Number of psychiatric beds in US down 13% from 2010. (8/2/16)
• Population Of US Practicing Psychiatrists Declined, 2003–13, Which May Help Explain Poor Access To Mental Health Care (7/2016)
• The troubling deficiencies in our mental health system (7/4/14)
• 4 Ways to Reach Out for Mental Health Help Anonymously (5/1/14)

Behavioral Health Treatment

• More than half of mentally ill U.S. adults get no treatment (10/19/16)
• Most Americans who screen positive for depression don’t receive treatment — while most who did receive treatment don’t actually have the condition. (8/29/16)
• Over 80% of individuals who had an emergency department visit for self-harm did not receive treatment from a specialty behavioral health provider in the 90 days before their emergency department visit. (8/10/16)
• In fighting an opiod epidemic, medication-assisted treatment is effective but underused (6/2016)
• More than half of people with mental illnesses and 90 percent of people with substance use disorders do not get specialty care services. (2016)
• 80% of people who are dependent on heroin or painkillers are not getting treatment (10/13/15)
• Approximately one in five Americans—including children, teens, college youth, and adults—has a mental health problem. Majority of children with mental health conditions are not identified and lack access to treatment. Barriers include: Stigma, Inadequate screening by primary care providers, Trouble finding treatment, Failure to implement evidence-based therapies, Slow implementation of research findings (10/1/15)

Emergency Room

• 10k patients die each year within 7 days of leaving a hospital ER, study finds. (2/1/17)
• 10 common conditions represent more than 2 million annual visits to NY State hospital ERs at an estimated cost of about $1.3 billion, and 9 out of 10 of them could have been avoided or treated elsewhere (4/6/16).
• Most 2012 Minnesota ED visits were unnecessary. The more than 1 million ED visits may have been prevented (7/23/15)
• ER Revisit Rates Higher Than Previously Thought, Often More Costly Than Initial Visits (6/1/15)

Medications

• 10 most popular prescription drugs for 2017 (7/24/17)
• Study: Prolonged opioid use is the most common postsurgical complication (4/12/17)
• Study of Medicare recipients found about 15% were prescribed an opioid when they were discharged from the hospital; three months later, 42% were still taking the pain medicine. (12/20/16)
• Study found a failure by cardiologists to correctly recognize which of their patients were nonadherent with medications (7/2016)
• 575,000 Americans used at least $50,000 in prescription medicines last year, about 139,000 used at least $100,000 worth of medication (5/13/15)
• ‘America’s other drug problem’: Giving the elderly too many prescriptions. 74-year-old woman with a long history of health problems was in the hospital with pneumonia and difficulty breathing. Her medical records showed she was on 36 medications. (8/15/16)

Observation Stays

• 1 in 5 Medicare patients return to hospital after an observation stay (6/21/17)

Opioid Treatment

• Between 2009 and 2015, the average cost of care per opioid admission increased from $58,500 to $92,400 (8/11/17)
• Addiction treatment hard to find, even as overdose deaths soar (5/24/15)

Physician Visit

• CDC report: 34% of American adults did not see, talk to a physician last year (5/5/16)

Post-Acute Care

• IOM finds regional health spending differences linked to post-hospital care, provider charges (8/5/13)

Readmission to Hospitals

• 28% of patients offered home health care when they’re being discharged from a hospital — mostly older adults — say “no” to those service. (6/15/17)
• Centura Health Shares Strategies for Reducing Readmissions in Bundled Payment Arrangementsfor total hip arthroplasty (THA) and total knee arthroplasty (TKA) (6/9/17)
• 1 in 5 hospital patients discharged with unstable vital signs--a likely cause of deaths, readmissions (8/10/16)
• The government will punish more than half of the nation’s hospitals — a total of 2,597 — having more patients than expected return within a month. (8/2/16)
• One in five elderly patients is back in the hospital within 30 days of leaving (11/2013)

Virtual Visits

• Study shows telehealth increased office visits, had minimal health benefits (8/16/17)
• Survey: More than half of patients prefer telehealth visits to in-person care (7/17/17)
• Rural telehealth use for mental illness sees uptick of 45% yearly (5/2/17)
• Online Psychotherapy Gains Fans And Raises Privacy Concerns (6/30/14)
• 41% of Organizations Are Not Reimbursed for Telehealth Services (11/13/14)

Medical Interventions Outcomes Insight

Insights into Medical Interventions Outcomes Determinants that can decisively affect a patient's overall health and well-being.

Adverse Outcomes

• OIG report: 30% of rehab hospital patients experience harm (7/21/16)
• About one-third of patients over 70 years old and more than half of patients over 85 leave the hospital more disabled than when they arrived (8/9/16)
• Medicare pays for nearly 500,000 hip and knee replacement surgeries each year. Approximately 25,000 patients undergo procedures to remove and replace a previous artificial joint. Medicare program is unable to identify product failures, patient safety problems or performance of medical devices. (6/29/16)
• If Patients Only Knew How Often Treatments Could Harm Them (3/2/15)

Cancer Treatments

• One In Three Women With Breast Cancer Treated Unnecessarily, Study Concludes (1/9/17)
• At a median of 10 years, prostate-cancer–specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. (10/13/16)

Low-Value Care

• 18 'low-value' tests cost Minnesota patients $54.9M, Mayo and state study finds (6/2/17)
• Roughly 93 percent of quality measures and initiatives have focused on underuse. Choosing Wisely focuses on the overuse that impacts quality and safety (12/3/15)
• Medicare spent $8.5 billion on 26 measures of low-value care (7/2014)

Medical Intervention Efficacy

• For every woman in whom mammography detected a breast cancer that was destined to become large and potentially life-threatening, about four are diagnosed with one that would never have threatened their health (10/12/16)

Medical Errors

• Physicians prescribe wrong antibiotic half of the time (10/25/16)
• Medical errors may kill 250,000 a year, but problem not being tracked (5/4/16)
• Medical errors officially the third leading cause of death in U.S., study finds (5/3/16)
• Medication errors or unintended drug side effects occurred in about half of all surgeries done at Boston's Massachusetts General Hospital (10/26/15)
• Study: Medical Error Deaths 4.5 Times More Likely Than IOM Estimate 9/20/13)Medical Decisions'
  

Misdiagnosis

• How 4 types of cognitive bias contribute to physician diagnostic errors — and how to overcome them (6/9/17)
• More than 20% of patients misdiagnosed by primary care providers, Mayo Clinic study finds (4/4/17)
• As many as 1 in 3 adults diagnosed with asthma may not actually have the disease, according to research published in the Journal of the American Medical Association. (1/17/17)
• Institute of Medicine: Most patients will experience a misdiagnosis in their lifetime (9/22/15)
• 1 in 20 patients misdiagnosed each year, survey finds (9/4/14)
• Doctors Wrongly Prescribed Antibiotics in 30% of 2013 Flu Cases, Stays Study (7/17/14)
• 2 Million U.S. Adults Misdiagnosed Every Year (4/17/14)

Physician Preference Sensitive Treatments

• Physician Characteristics Strongly Predict Patient Enrollment In Hospice (6/2015)

Retail Clinics

• Retail clinics reduce unnecessary ER visits by up to 12% (7/17/17)
• While valuable, retail clinics haven’t resulted in lower ER visits (11/14/16)

Surgeries

• A review of 13 studies, involving nearly 1,700 patients, found that arthroscopic surgery for patients with degenerative knee problems did not provide lasting pain relief or improve function. (5/10/17)
• Total knee replacement of patients with knee osteoarthritis had minimal effects on quality of life. If procedure were restricted to more severely affected patients, its effectiveness would rise, with practice becoming economically more attractive than its current use. (3/28/17)
• 400,000 middle-aged and older Americans undergo meniscus surgery. Studies have concluded that meniscus surgery offers no additional benefits regular exercise could not. (8/5/16)
• For 99 percent of people in America, when they go in to have surgery, the outcome of that operation is not measured (5/3/15)
• One-third of knee replacements in the U.S. may be inappropriate (6/30/14)

Un-diagnosed Conditions

• Crowdsourcing is being used to help diagnose those patients who have doctors stumped (8/19/15)
• A survey by HealthMine revealed that 46% of the people who discovered they had a previously undiagnosed chronic condition received the diagnosis through their employer wellness program. (7/11/15)

Unnecessary Care

• Professional Athletes And Back Surgery: A Teachable Moment On Overuse In Health Care? (8/1/17)
• OVERKILL: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it? (5/11/15)
• Choosing Wisely: In addition to wasting valuable resources, the unnecessary use of medical tests, treatments, and procedures can sometimes harm patients (1/20/15)
• Study of 4,215 orders shows $226 spent per patient on unnecessary care (9/16/14)

Virtual Visits

• Telehealth Visits Are 83% Effective, Less Than Half as Costly (12/16/14)
• 12 virtual visit services that connect patients at home to doctors or nurses (6/12/14)
• Telehealth for chronic disease patients improves satisfaction (5/12/14)
• Virtual Visits: Cutting Healthcare Costs (1/2/15)

Non-Medical Interventions Insight

Insights into Non-Medical Interventions Determinants that can decisively affect a patient's overall health and well-being.

Advanced Care Planning

• In 2016, the first year advance-care planning session Medicare paid health care providers for this service, nearly 575,000 Medicare beneficiaries took part in the conversations (8/14/18)

Non-Medical Interventions Outcomes Insight

Insights into Non-Medical Interventions Outcomes Determinants that can decisively affect a patient's overall health and well-being.

Cardiac Rehabilitation

• Cardiac Rehab Improves Health, But Cost And Access Issues Complicate Success (8/31/16)
• Despite research showing that joining a cardiac rehabilitation program can help heart patients heal faster and even live longer; fewer than a third do. (7/18/16)

Employee Wellness Services

• Large firms (at least 200 employees) are more likely to offer Employee Wellness Programs than smaller firms (81% vs. 49%) in an effort to promote employee health and productivity and reduce health related cost (5/19/16)
• Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss In A 2013–15 Study (1/2016)

Fall Prevention

• Hospitals Step Up To Help Seniors Avoid Falls (1/12/16)

Health Coaching

• The underrated value of coaching in healthcare: 4 thoughts from population health expert Dr. William Appelgate (1/25/17)

Legal Counseling

• Kansas hospital offers free legal counsel to low-income patients (8/18/16)

Obesity Counseling

• Few Seniors Benefiting From Medicare Obesity Counseling (2/23/15)
• Seniors’ Obesity-Counseling Benefit Goes Largely Unused (11/20/14)

Opioid Alternative

• How a Colorado health care provider is battling the opioid epidemic with non-pill pain treatments (11/30/16)

Preventitive Care and Screenings

• A study found that only 4% of adults were screened for depression during primary care visits. (2/23/17)
• Why Depression Screenings Should Be Part of Routine Check-Ups (2/16/16)
• US task force recommends physicians screen all adult patients for depression (1/26/16)
• Annual Wellness Visit - It is now more a conversation about wellness and prevention then trying to find evidence of disease as it was in the past (4/1/15)
• Only 10% of Medicaid smokers received cessation medications in 2013. (1/2016)
• Walgreens hopes to screen 3 million on mental health by next year (5/10/16)

Virtual Services

• Smartphone As A Personal Therapist. Could the technology that causes so much of our stress and anxiety also be the cure? (6/30/15)

People Insight

People can decisively affect a patient's overall health and well-being. See People Determinants. These are people that may support and/or influence the overall health.

Family Members & Friends Insight

Insights into Family Members & Friends Determinants that can decisively affect a patient's overall health and well-being.

Care Team & Resources Insight

Insights into Care Team & Resources Determinants that can decisively affect a patient's overall health and well-being.

Other Contributors Insight

Insights into Other Contributors Determinants that can decisively affect a patient's overall health and well-being.