The declaration of COVID19 as a pandemic and the United States declaring a national emergency to help contain and enhance treatment access have resulted in a number of changes to ease potential regulatory burdens or barriers in healthcare.
Like so much happening as a result of the pandemic, the changes have the potential to fundamentally change the healthcare industry not just during the time of the emergency declaration.
Of particular note are coordinated announcements from various agencies within the federal Department of Health and Human Services connected to the provision of telehealth services. The advancement and relaxation of regulations are designed to increase access to telehealth services and make it easier to deliver the services.
The scope of telehealth services now available, as explained by the Centers for Medicare and Medicaid Services (CMS), can be broken into three main categories: (i) telehealth visits, (ii) virtual check-ins, and (iii) e-visits.
Telehealth Visits – For purposes of Medicare, a telehealth visit is between a patient and a clinician that uses interactive audio and video. The visits generally cover visits that could otherwise occur in person. As such, the telehealth visit is being structured as a replacement for an office visit for the time being.
The telecommunication platform must provide real-time communication between the patient and the clinician. CMS will also turn a blind eye to the established patient requirement, which essentially means a telehealth visit can occur with both new and established patients.
Additionally, a patient will be permitted to receive telehealth services while in their home, which reinforces the goal of maintaining social distancing.
Virtual Check-Ins – A virtual check-in is meant to be a brief discussion between a clinician and a patient, which can be audio-only. Further, CMS expects that in most instances the patient will be the one to initiate a check-in. The check-in cannot be related to an office visit from the previous 7 days or lead to a full visit within 24 hours after the check-in. Additionally, the patient must verbally agree to the check-in. Lastly, check-in is only billable for an established patient, which follows from the description of the service as being focused on a quick interaction between a patient and their clinician.
E-Visit – An e-visit is similar to a virtual check-in, but must be patient-initiated and is expected to occur through the patient portal. Further, the service can cover up to a 7 day period between the communication initiated by the patient and interactions with the clinician. Before being able to bill for the e-visit, the patient must be established with the clinician and made aware of the fact that reimbursement will be sought for the services.
On top of opening up the scope and ability to provide telehealth based visits, a bigger change is to reimburse the telehealth visits at the same level as in-person visits.
Arguably, one of the primary barriers to telehealth adoption up until this point has been a lack of or lower reimbursement.
The incentivization of patient interactions through telehealth means not only with healthcare organizations potentially be able to somewhat mitigate the financial fallout from telling patients to remain home, but gives a good alternative that could stabilize access.
Stabilizing access is important since reducing non-emergent issues cannot be put off indefinitely.
Along with trying to provide some financial relief to healthcare organizations enabling telehealth, the Office for the Inspector General (OIG) issued a policy statement acknowledging that patients may also be facing financial constraints. In particular, patients may not be able to afford all cost-sharing amounts. Accordingly, the OIG stated it will not pursue fraud-based enforcement actions if cost-sharing amounts are waived or reduced during the emergency period.
Such a statement is necessary because widely waiving or reducing cost-sharing can be viewed as an inducement to patients that in turn encourages the patients to obtain services from that clinician, which in turn allows for more billing to government healthcare programs.
It is a bit convoluted, but the bottom line is that such a chain of events is not generally permissible and is set out as a form of fraud. While the OIG does explicitly, and not unsurprisingly, reserve the right to change this policy statement at any time, a reversal would not be expected in light of the clearly extraordinary circumstances that currently exist.
The last major action to open up access on the telehealth front is a notification from the Office for Civil Rights (OCR) that it will not enforce HIPAA violations for the good faith provision of telehealth services during the course of the emergency. Good faith effort means still using a non-public service, but that can include general use applications, with FaceTime, Google Hangouts, Facebook messenger and Skype specifically called out.
The implication is that none of these services would have been viewed as acceptable under HIPAA in normal times by OCR, which could end up being useful guidance once the emergency ends. The statement that services need to be non-public is contrasted with examples of public-facing services, which are identified to include Facebook Live, Twitch, and TikTok.
At the same time that OCR gives tacit permission to use general services, the last section of its announcement is to implicitly suggest that it would still prefer the use of services that do meet HIPAA standards.
An exemplary list is provided of services that satisfy HIPAA requirements and ensure greater privacy. Some solutions have expressed a willingness to provide free access for at least some period of time during the emergency, which can mitigate concerns about cost. Given those factors, it seems a safer course for all would be to seek the use of a fully private and secure service
.
A question left unasked and unanswered in the statement is what happens when the emergency ends. Once the privacy cat is let out of the bag, it cannot be put back in.
That means patient data hosted or stored in a non-HIPAA compliant platform could end up being used for a number of unexpected or non-desirable purposes. Understanding that it is important essential to ensure a comprehensive ability to provide needed services to patients during this emergency, awareness of longer-term consequences cannot be completely ignored. Especially when immediacy does not need to be sacrificed to those considerations.
AD One final consideration that is left wholly unaddressed by the changes: what about malpractice protection? Not all professional liability policies will automatically cover services provided by telehealth. Physicians, clinicians, and organizations will need to assess coverage unless some sort of liability waiver is also introduced. As always, healthcare has multiple layers of complications and considerations.
The extraordinary nature of these times is completely unavoidable and cannot be stated often enough.
The potential threat to the health of everyone is very real, but doors are being thrown wide open to help mitigate those dangers. Once the current emergency passes, it can only be hoped that the system has been transformed in better ways permanently.
Lifestyle medicine has been proposed as a way to address the root causes of chronic disease and their associated health care costs.This study aimed to…
Cette étude a examiné l'impact de huit facteurs de mode de vie sur la mortalité et l'espérance de vie chez les vétérans américains. Les facteurs de mode de vie comprenaient le tabagisme, l'activité physique, la consommation excessive d'alcool, le sommeil réparateur, la nutrition, la gestion du stress, les liens sociaux et les troubles de l'utilisation des opioïdes. Les résultats ont montré que l'adoption de ces facteurs de mode de vie était associée à une réduction significative du risque de mortalité et à une augmentation de l'espérance de vie.
Cet article examine la relation entre la variabilité de la pression artérielle (VPA) et la rigidité artérielle. La VPA est définie comme les fluctuations de la pression artérielle sur une période donnée, et elle est considérée comme un facteur de risque indépendant pour les événements cardiovasculaires. Les chercheurs ont étudié la relation temporelle entre la vitesse de l'onde de pouls brachiale-cheville (baPWV) et la VPA de la pression artérielle systolique sur plusieurs années. Ils ont constaté que l'augmentation de la rigidité artérielle précède l'augmentation de la VPA, suggérant que la rigidité artérielle pourrait être la cause de la VPA élevée. De plus, ils ont observé que des valeurs élevées de baPWV et de VPA étaient associées à un risque accru de maladies cardiovasculaires. Les auteurs suggèrent que des interventions précoces visant à améliorer la rigidité artérielle pourraient être utiles pour prévenir les événements cardiovasculaires.
Existe-t-il une recette pour vivre plus longtemps ? Dans une enquête fouillée, des chercheurs décryptent les mécanismes du vieillissement et explorent de nouvelles stratégies pour le freiner voire l’inverser.
Aujourd’hui, le vieillissement n'est plus considéré par les chercheurs comme un phénomène irréversible mais comme une maladie que l’on pourrait soigner. Pour y parvenir, les scientifiques explorent différentes pistes dans le but de réduire l’âge biologique qui, contrairement à l’âge chronologique, reflète l’état physiologique ou fonctionnel de l’individu. Administration d'un populaire médicament antidiabétique pour prévenir les pathologies liées à l'âge, destruction des cellules vieillissantes en les ciblant par un traitement pharmacologique, transfusion de sang d’un individu jeune sur un plus âgé, thérapie génique grâce à une reprogrammation rajeunissant les cellules… Autant d’innovations qui séduisent un nombre croissant de milliardaires de la Silicon Valley, toujours à l'affût d'investissements prometteurs. Mais, si ces techniques ne sont pas encore développées à grande échelle, l’activité physique et la pratique du jeûne, deux anti-âge parmi les plus efficaces selon les études, peuvent se pratiquer régulièrement et à moindre coût.
Bien vieillir
Faisant intervenir une dizaine de scientifiques et d’entrepreneurs internationaux, cette nouvelle enquête du prolifique duo de réalisateurs Sylvie Gilman et Thierry de Lestrade (Un monde obèse, Microbiote – Les fabuleux pouvoirs du ventre, Le jeûne, une nouvelle thérapie ?) dévoile l’avancement de recherches aux allures de science-fiction. Visuellement créatif et usant d'analogies pour faciliter la compréhension des mécanismes biologiques, le film éclaire sur un enjeu majeur de santé publique : bien vieillir en bonne santé.
Documentaire de Thierry de Lestrade et Sylvie Gilman (France, 2022, 56mn)
Arterial stiffness measured by pulse wave velocity and pulse wave analysis has been widely studied in different populations in terms of its correlation with cardiovascular events and all-cause mortality. It remains unknown which arterial stiffness index is better for risk stratification in the general population. We included 4129 participants from Gaoyou County, Jiangsu Province, China, with a median follow-up of 11 years. The primary endpoint was cardiovascular mortality, and the secondary endpoint was all-cause mortality. Harrell’s C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) based on the Cox proportional hazards regression model were evaluated to assess predictive discrimination and accuracy. The associations between the 4 indices and cardiovascular mortality remained significant after adjusting for the Framingham Risk Score (FRS) and/or associated risk factors. Considering reclassification based on the newly integrated models (FRS model combined with the 4 indices), NRI for cardiovascular mortality showed that haPWV and baPWV had more significant improvement in reclassification compared with C1 and C2 [NRI with 95% CI: haPWV 0.410 (0.293, 0.523); baPWV 0.447 (0.330, 0.553); C1 0.312 (0.182, 0.454); C2 0.328 (0.159, 0.463); all P < 0.05]. This study showed that pulse wave velocity (haPWV and baPWV) provides better discrimination of long-term risk than arterial elasticity indices (C1 and C2) in the general population.
Cet article compare les indices de rigidité artérielle mesurés par la vitesse de l'onde de pouls et l'analyse de l'onde de pouls pour prédire la mortalité cardiovasculaire et toutes causes confondues dans une population chinoise. Il examine également plusieurs études antérieures sur le sujet de la rigidité artérielle et de la mortalité.
D'après l'article, les principales conclusions de l'étude montrent que la rigidité artérielle mesurée par la vitesse de l'onde de pouls et l'analyse de l'onde de pouls est un prédicteur indépendant de la mortalité cardiovasculaire et de toutes causes confondues dans la population chinoise.
Les implications de cette recherche pour la prévention et le traitement des maladies cardiovasculaires en Chine pourraient inclure une meilleure évaluation de la rigidité artérielle chez les patients pour identifier les risques cardiovasculaires potentiels. Cela pourrait aider à orienter les interventions précoces et les traitements ciblés pour réduire le risque de maladies cardiovasculaires.
Explore each of these interactive settings to delve into these important global data. Published by the Global Burden of CVD Collaboration—an alliance between JACC, the Institute for Health Metrics and Evaluation, and the National Heart, Lung, and Blood Institute. J Am Coll Cardiol. 2022 Dec, 80 (25) 2372–2425.
Total CVD prevalent cases increased from 601 million in 2020 to 621 million in 2021, and the number of CVD deaths has steadily increased from 12.4 million in 1990 to 20.5 million in 2021.
The total number of disability-adjusted life years (DALYs) due to Ischemic Heart Disease (IHD) has risen steadily since 1990, reaching 185 million DALYs, 9.44 million deaths, and 258 million prevalent cases of IHD in 2021.
The total number of DALYs due to stroke has risen steadily since 1990, reaching 159 million DALYs, 7.69 million deaths in the year 2019, and 94.6 million prevalent cases of stroke in 2021.
I am a practicing UK general practitioner and in this article, I take a magnifying glass to quality indicators including access, affordability, healthcare inequalities and population health, staffing and equipment, and patient and provider experience to discuss how we can shape up.
This report from Panda Health predicts that digital health tools used by hospitals to cope with the COVID-19 pandemic will be subject to increased scrutiny and
journée d'étude sur les libertés numériques en temps de covid-19. technologie, données de santé et droit, organisé par l'oppee, université de bordeaux ...
Member States of the World Health Organization have agreed to a global process to draft and negotiate a convention, agreement or other international instrument under the Constitution of the World Health Organization to strengthen pandemic prevention, preparedness and response.
In endothelial dysfunction, the inner lining of blood vessels does not work and can lead to symptoms like chest pain. The condition also contributes to several cardiovascular disorders.
The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.
The recent SARS-CoV-2 pandemic underscored the effectiveness and rapid deployment of digital public health interventions, notably the digital proximity tracing apps, leveraging Bluetooth capabilities to trace and notify users about potential infection exposures.
Digital proximity tracings showcased the promise of digital public health.
As the world pivots from pandemic responses, it becomes imperative to address noncommunicable diseases (NCDs) that account for a vast majority of health care expenses and premature disability-adjusted life years lost.
The narrative of digital transformation in the realm of NCD public health is distinct from infectious diseases.
The power of artificial intelligence (AI) in this digital transformation is noteworthy.
AI can automate repetitive tasks, facilitating health care providers to prioritize personal interactions, especially those that cannot be digitalized like emotional support.
Moreover, AI presents tools for individuals to be proactive in their health management. However, the human touch remains irreplaceable;
AI serves as a companion guiding through the health care landscape.
Digital evolution, while revolutionary, poses its own set of challenges.
Issues of equity and access are at the forefront. Vulnerable populations, whether due to economic constraints, geographical barriers, or digital illiteracy, face the threat of being marginalized further.
This transformation mandates an inclusive strategy, focusing on not amplifying existing health disparities but eliminating them.
Population-level digital interventions in NCD prevention demand societal agreement.
Policies, like smoking bans or sugar taxes, though effective, might affect those not directly benefiting. Hence, all involved parties, from policy makers to the public, should have a balanced perspective on the advantages, risks, and expenses of these digital shifts.
For a successful digital shift in public health, especially concerning NCDs, AI’s potential to enhance efficiency, effectiveness, user experience, and equity—the “quadruple aim”—is undeniable.
However, it is vital that AI-driven initiatives in public health domains remain purposeful, offering improvements without compromising other objectives.
The broader success of digital public health hinges on transparent benchmarks and criteria, ensuring maximum benefits without sidelining minorities or vulnerable groups.
Especially in population-centric decisions, like resource allocation, AI’s ability to avoid bias is paramount.
Therefore, the continuous involvement of stakeholders, including patients and minority groups, remains pivotal in the progression of AI-integrated digital public health.
Most cardiovascular disease cases and deaths can be attributed to a small number of common, modifiable risk factors. While some factors have extensive global effects (eg, hypertension and education), others (eg, household air pollution and poor diet) vary by a country's economic level. Health policies should focus on risk factors that have the greatest effects on averting cardiovascular disease and death globally, with additional emphasis on risk factors of greatest importance in specific groups of countries.
Une étude prospective réalisée dans 21 pays à revenu élevé, intermédiaire et faible a révélé que la plupart des cas de maladies cardiovasculaires et de décès peuvent être attribués à un petit nombre de facteurs de risque modifiables courants. Les facteurs tels que l'hypertension, l'éducation, la pollution de l'air domestique et une mauvaise alimentation ont un impact significatif sur les maladies cardiovasculaires et les décès à l'échelle mondiale. Les politiques de santé devraient se concentrer sur les facteurs de risque qui ont le plus d'effets pour éviter les maladies cardiovasculaires et les décès dans le monde, en mettant l'accent supplémentaire sur les facteurs de risque les plus importants dans des groupes de pays spécifiques.
Les principaux facteurs de risque modifiables associés aux maladies cardiovasculaires et aux décès sont l'hypertension, les facteurs métaboliques tels que le diabète et l'obésité, les comportements comme le tabagisme et la consommation d'alcool, la pollution de l'air domestique et une mauvaise alimentation.
D'après l'étude, environ 70% des cas de maladies cardiovasculaires et de décès sont attribuables à des facteurs de risque modifiables. Les facteurs métaboliques étaient les plus prédominants pour les maladies cardiovasculaires, contribuant à 41,2% de la fraction attribuable à la population (PAF), avec l'hypertension étant le plus important à 22,3% de la PAF. Les facteurs comportementaux ont contribué le plus aux décès, représentant 26,3% de la PAF, bien que le niveau d'éducation soit le plus important à 12,5% de la PAF.
La pollution de l'air domestique était associée à 13,9 % de la fraction attribuable à la population pour les maladies cardiovasculaires, bien que des méthodes statistiques différentes aient été utilisées pour cette analyse.
From Wikipedia, the free encyclopedia You Are What You Eat: A Twin Experiment is a 2024 American vegan documentary series set for streaming on Netflix. It is based on an 8-week study conducted by Stanford University that put 22 sets of genetically identical twins on opposing (but healthy) diets: omnivore and vegan.
From Wikipedia, the free encyclopedia You Are What You Eat: A Twin Experiment is a 2024 American vegan documentary series set for streaming on Netflix. It is based on an 8-week study conducted by Stanford University that put 22 sets of genetically identical twins on opposing (but healthy) diets: omnivore and vegan.
La série documentaire "You Are What You Eat: A Twin Experiment" est basée sur une étude de 8 semaines menée par l'Université Stanford. L'étude a impliqué 22 paires de jumeaux génétiquement identiques, l'un suivant un régime omnivore et l'autre un régime végétalien. La série se concentre sur quatre paires de jumeaux et explore les effets des régimes sur leur santé. Les résultats ont montré que les jumeaux suivant un régime végétalien ont connu des améliorations significatives de leurs taux de cholestérol, d'insuline et de poids corporel. La série met également en vedette des personnalités notables de la communauté végétalienne et explore les avantages d'un régime à base de plantes.
A new study involving over 700,000 U.S. veterans reports that people who adopt eight healthy lifestyle habits by middle age can expect to live substantially longer than those with few or none of these habits.
L'excès de poids est l'un des facteurs de risque de cancer que l'on peut éviter. Pourtant, le nombre de cancers liés à un excès de poids ne cesse d'augmenter, alertent les autorités sanitaires.
EN SAVOIR PLUS / https://www.e-cancer.fr/Presse/Dossiers-et-communiques-de-presse/Panorama-des-cancers-en-France-l-Institut-national-du-cancer-publie-l-edition-2023-rassemblant-les-donnees-les-plus-recentesPour la troisième année consécutive, l’Institut publie le « Panorama des cancers en France ». Document de référence sur les données des cancers, l’édition 2023 regroupe en trois chapitres les chiffres essentiels les plus récents.Le premier chapitre, sur les données épidémiologiques générales, présente notamment les projections d’incidence1 2023 et leur évolution depuis 1990. Le deuxième chapitre se concentre plus particulièrement sur les données des cancers les plus fréquents chez la femme et chez l’homme. Enfin, dans le troisième et dernier chapitre, l’Institut national du cancer revient sur la prévention des cancers -poids des facteurs de risques évitables et participation aux dépistages organisés- ainsi que sur les soins et les actions de recherche initiées pour limiter le poids de la maladie dans le quotidien des Français ; une ambition de la Stratégie décennale de lutte contre les cancers.
Background: The WEAICOR (Wearables to Investigate the Long Term Cardiovascular and Behavioral Impacts of COVID-19) study was a prospective observational study that used continuous monitoring to detect and analyze biometrics. Compliance to wearables was a major challenge when conducting the study and was crucial for the results. Objective: The aim of this study was to evaluate patients’ compliance to wearable wristbands and determinants of compliance in a prospective COVID-19 cohort. Methods: The Biostrap (Biostrap USA LLC) wearable device was used to monitor participants’ biometric data. Compliance was calculated by dividing the total number of days in which transmissions were sent by the total number of days spent in the WEAICOR study. Univariate correlation analyses were performed, with compliance and days spent in the study as dependent variables and age, BMI, sex, symptom severity, and the number of complications or comorbidities as independent variables. Multivariate linear regression was then performed, with days spent in the study as a dependent variable, to assess the power of different parameters in determining the number of days patients spent in the study. Results: A total of 122 patients were included in this study. Patients were on average aged 41.32 years, and 46 (38%) were female. Age was found to correlate with compliance (r=0.23; P=.01). In addition, age (r=0.30; P=.001), BMI (r=0.19; P=.03), and the severity of symptoms (r=0.19; P=.03) were found to correlate with days spent in the WEAICOR study. Per our multivariate analysis, in which days spent in the study was a dependent variable, only increased age was a significant determinant of compliance with wearables (adjusted R2=0.1; β=1.6; P=.01). Conclusions: Compliance is a major obstacle in remote monitoring studies, and the reasons for a lack of compliance are multifactorial. Patient factors such as age, in addition to environmental factors, can affect compliance to wearables.
Author summary Capturing food exposure of school children is a challenging task due to recall bias. In this manuscript, we describe a machine-learning-based data-collection tool that can automatically record school children’s exposure to food items, food advertisements and food outlets in their homes, schools and neighborhoods. Our data-collection tool consists of a wearable camera to capture continuous footage of children’s environments during a typical school day, and a series of machine learning models that can extract food-related images from the recorded footage and classify them into images that contain food items consumed by the child wearing the camera, or consumed by others, images that contain food advertisements, and images that contain food outlets. We report on a user-centered design study that assessed the acceptability of using wearable cameras to capture food exposure among school children in two urban Arab centers, namely Greater Beirut in Lebanon and Greater Tunis in Tunisia. We then describe how we trained our various machine learning models to capture food exposure among school children and categorize such food exposure into a predefined typology. Finally, we also report on the results of deploying our data-collection tool in a real-world case study in Tunisia.
Effectiveness of non-pharmaceutical interventions (NPIs), such as school closures and stay-at-home orders, during the COVID-19 pandemic has been assessed in many studies. Such assessments can inform public health policies and contribute to evidence-based choices of NPIs during subsequent waves or future epidemics. However, methodological issues and no standardised assessment practices have restricted the practical value of the existing evidence. Here, we present and discuss lessons learned from the COVID-19 pandemic and make recommendations for standardising and improving assessment, data collection, and modelling.
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