Prescription Opioid Use Among Cancer Patients before and after the Onset of COVID-19: Evidence from Real-World Data

Objectives: Opioids play a significant role in the effective management of cancer-related pain. The COVID-19 lock down may have reduced access to opioids and caused a decline in the use of prescription of opioids among cancer survivors. This study compared opioid prescription rates among cancer survivors before and after the onset of COVID-19 pandemic using real-world electronic health records (EHR). Method(s): Cohort analyses of cancer patients using data from EHR database from the TriNetX, a global federated health research network across 76 healthcare organizations. We analyzed changes in prescription opioid use before (March 1, 2018, through March 1, 2019) and after onset of COVID-19 (April 01, 2020, through March 2021) among cancer survivors. The key outcome variable was any opioid prescription within 1 year of cancer diagnosis. One-to-one propensity score matching was used to balance the characteristics (age, sex, race, diagnoses including diabetes, hypertensive diseases, overweight, mood disorders, and visual disturbances) of the two cohorts. Data were analyzed using the TriNetX platform. Result(s): There were 1,502,143 cancer survivors before COVID-19 and 1,412,599 cancer survivors after the onset of COVID-19. The one-to-one propensity-score match yielded 1,382,561 cancer patients, mean age 64 at cancer diagnosis, and 73% were white. Percentage of opioid use among cancer patients declined from 35.6% before the COVID-19 to 35.1% after the onset of the pandemic (OR=0.976, 95% CI 0.971-0.981). Average number of opioid prescriptions within 1 year of cancer diagnosis declined from 5.7 before to 5.3 after the COVID-19 onset (p<0.001). Conclusion(s): Among cancer survivors, a small decline in prescription opioid use was observed after the onset of COVID-19 pandemic. Future studies are needed to distinguish the impact of revised guidelines, opioid prescription policy changes, and COVID-19 lock down on lower rates of prescription opioid use among cancer survivors.Copyright © 2023

Stakeholder Analysis: Medicare Diabetes Prevention Program Awareness and Implementation

Study Design: We conducted a qualitative stakeholder analysis project with suppliers of the MDPP and health care providers. Am J Manag Care. 2023;29(6):In Press _____ Takeaway Points More than 5 years after CMS enacted coverage of the CDC-approved Medicare Diabetes Prevention Program (MDPP) in 2018, little is known about why MDPP uptake is so limited. * Findings of our stakeholder analysis with program suppliers and health care providers reinforced existing evidence on insufficient reimbursement and low awareness of the program. * Newer insights include recommendations about lagged payments, ongoing virtual delivery, and formally diagnosing prediabetes among MDPP participants. * Our findings on barriers and facilitators can inform policy to refine the MDPP and research on the MDPP, particularly within the field of implementation science. _____ Population-level strategies to prevent type 2 diabetes are urgently needed for the more than 24 million older adults with prediabetes in the United States.1 Evidence-based lifestyle interventions can prevent diabetes onset, per evidence from the landmark Diabetes Prevention Program trial.2 Thus, the CDC launched the National Diabetes Prevention Program (NDPP) in 2010.3 Significant reductions in weight and medical spending were observed among Medicare beneficiaries who participated in the NDPP,4 prompting CMS to fully cover the Medicare Diabetes Prevention Program (MDPP) starting in 2018.5 Despite unprecedented Medicare coverage for a disease prevention program, MDPP uptake is limited. Regarding awareness, national guidelines recommend referral to lifestyle intervention for adults aged 40 to 70 years with prediabetes.9 Yet less than 5% of adults eligible for a NDPP reported receiving a referral,10 which may stem from limited awareness among health care providers.11 Thus, we conducted a qualitative stakeholder analysis to learn about regional awareness of, referral to, facilitators of, and barriers to the MDPP. The 8 interviewees included 5 program directors (3 from YMCAs, 1 from a private organization, and 1 from a hospital system) and 3 health care providers (2 family physicians and 1 dietitian).

Self-Sovereign Identity for Consented and Content-Based Access to Medical Records Using Blockchain

Electronic health records (EHRs) and medical data are classified as personal data in every privacy law, meaning that any related service that includes processing such data must come with full security, confidentiality, privacy, and accountability. Solutions for health data management, as in storing it, sharing and processing it, are emerging quickly and were significantly boosted by the COVID-19 pandemic that created a need to move things online. EHRs make a crucial part of digital identity data, and the same digital identity trends - as in self-sovereign identity powered by decentralized ledger technologies like blockchain, are being researched or implemented in contexts managing digital interactions between health facilities, patients, and health professionals. In this paper, we propose a blockchain-based solution enabling secure exchange of EHRs between different parties powered by a self-sovereign identity (SSI) wallet and decentralized identifiers. We also make use of a consortium IPFS network for off-chain storage and attribute-based encryption (ABE) to ensure data confidentiality and integrity. Through our solution, we grant users full control over their medical data and enable them to securely share it in total confidentiality over secure communication channels between user wallets using encryption. We also use DIDs for better user privacy and limit any possible correlations or identification by using pairwise DIDs. Overall, combining this set of technologies guarantees secure exchange of EHRs, secure storage, and management along with by-design features inherited from the technological stack. © 2023 Marie Tcholakian et al.

Q&A

In this interview, Sujay Jadhav, global vice president, study start-up, Oracle Health Sciences, touches on how COVID has affected study start-up and what new perspectives it has forced the industry to have on its own challenges. [...]assessing site ability to leverage telehealth will be a factor in site selection. Andy Studna is an Assistant Editor for Applied Clinical Trials Sujay Jadhav Global Vice President, Study Start-Up, Oracle Health Sciences Problems with startup, more than any other phase of a clinical trial, have the greatest potential to increase timelines and budgets.

Maternal and Neonatal Outcomes After Monoclonal Antibody Use

INTRODUCTION: The study aimed to evaluate whether the administration of monoclonal antibodies (MABs) in mildly symptomatic unvaccinated COVID-19-positive pregnant patients reduced the need for maternal hospitalization and to evaluate whether this medication affected the rate of adverse neonatal outcomes and severe maternal disease. We hypothesized that MAB use would reduce the need for hospitalization. METHODS: This retrospective cohort study was completed by obtaining electronic medical record data of all pregnant patients between August 2020 and January 2022 who met criteria for MAB therapy. The two comparison groups were patients who received outpatient MAB therapy during pregnancy and those who were eligible for therapy but declined. Demographic and hospitalization data were obtained. Exclusion criteria included severe illness upon diagnosis requiring hospitalization, or patients for whom delivery and neonatal data were not available. RESULTS: During the study period, 49 patients qualified for MAB therapy, of which delivery data were available for 39 patients. Twenty patients (51%) elected to receive MAB therapy and 19 (49%) declined. Among those who received MAB therapy, 10 (26% of the population) were vaccinated, and among those who declined, 6 (15% of the population) were vaccinated. The two groups were similar in gestational age at delivery (38 weeks 4 days versus 37 weeks 5 days) and gestational age at diagnosis (19 weeks 0 days versus 22 weeks 6 days). Among patients who did not receive MABs, both absolute and relative maternal hospitalization rate was higher (26.3% versus 5%, 12.8% versus 3%, P >.05). When stratified by vaccination status, those who were vaccinated had a 5% probability of hospitalization regardless of MAB therapy. The probability of hospitalization was highest among unvaccinated women who did not receive MAB therapy (67%) and lowest among unvaccinated women who received MAB therapy (0%). CONCLUSION: Unvaccinated patients who declined MAB therapy had a higher rate of hospitalization, although not statistically significant. These preliminary findings warrant further study with a larger cohort. [ FROM AUTHOR] Copyright of Obstetrics & Gynecology is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Comprehensive Code List Associated with CDC-Defined High-Risk Underlying Medical Conditions Leading to Potential Progression to Severe COVID-19 Outcomes

Objectives: This analysis was conducted to develop a comprehensive list of ICD-10 CM codes for underlying conditions identified by the CDC as being associated with high-risk of developing severe COVID-19 and assessed the consistency of these codes when applied to large US based datasets. Method(s): The comprehensive list of ICD 10-CM codes for CDC-defined high-risk underlying conditions were mapped from CDC references and FDA Sentinel code lists. These codes were subsequently applied to Optum's de-identified Clinformatics Data Mart Database (claims) and the Optum de-identified Electronic Health Record (EHR) database across 3 years (2018, 2019 and 2020) among continuously enrolled subjects >= 12 years of age to determine the performance and consistency in identifying these high-risk underlying conditions annually over these years. Result(s): A total of 10,276 ICD-10 codes were mapped to 21 underlying conditions. Within the claims data, 62.7% of subjects >= 12 years had >= 1 CDC-defined high-risk condition (excluding age) with 26.6% of patients >= 65 years while in the EHR data 38% had >= 1 high-risk underlying condition (excluding age) with 14.4% >= 65 years. These results were similar and consistent in both datasets across all years. Patients aged 12-64 years in the claims data had a higher rate of >=1 high risk underlying condition relative to the EHR data, 49.3% and 34%, respectively. The top 5 conditions among the >= 65 were identical across both databases: hypertension, immunocompromised status, heart conditions, diabetes (type 1 or 2), and overweight/obesity. The top 5 conditions among the 12-64 age group were also similar among the databases and included: immunocompromised status, hypertension, overweight/obesity, smoking (current or former), and mental health conditions. Conclusion(s): These findings present a comprehensive list of codes that can be used by researchers, clinicians and policy makers to identify and characterize patients that may be at high-risk for severe COVID-19 outcomes.Copyright © 2023

Chances and Challenges of Mobile Health in Public Health Dentistry

The future of healthcare delivery keeps evolving and mobile phone technology may have a huge role to play. Mobile health (mHealth) is a facet of Electronic Health (eHealth) that involves the use of mobile phones and other wireless devices in medical practice. The effectiveness of mHealth has been proven in different studies as well as in different aspects of medicine and dentistry. Text messaging has made significant progress in delivering health education for maintaining oral hygiene, especially for orthodontic patients as well as tobacco cessation counseling. Mobile phone applications incorporate various features like gaming, audio, and video messages to engage smokers in several behavioural change strategies. Mobile health technology has made an immense contribution to contact tracing, screening, and tele-consultation during the Novel Coronavirus Disease-19 (COVID-19) pandaemic. Given that mHealth is a low cost, easily accessible, and widely available means of communication, it has the potential to play a significant role in public health dentistry.

Healthcare costs vis-à-vis economic growth in pandemic crisis with technology adoption

COVID-19 pandemic brought up issues with healthcare costs, national economic development and welfare of the society in forefront. Nations across the globe followed different approaches to deal with COVID-19, such as zero tolerance, herd immunity, containment to build treatment capability. National healthcare became a contentious sociopolitical issue involving healthcare costs, technologies and societal health. In the United States even during the COVID-19 pandemic, the government approach was pursuing a sustainable improvement in patient care through adoption of medical and information technologies. The national healthcare policies are framed around technological interventions with the assumption that deployment of technologies could keep healthcare costs under control and at the same time improve health outcomes. However, evidences show that the healthcare costs are in the rise even with impressive progress in technological deployment. This article highlights some of the recent trends in healthcare costs, technological preparedness, medical technology developments in managing COVID-19 pandemic. The US government mandated electronic health record (EHR) systems implementation and assess its impact on healthcare costs and health outcomes. This article emphasizes the need for understanding the interconnectedness of costs, technology and societal health.

Discussion on feasibility of electronic informed consent in drug clinical trials.

With the development of science and technology, electronic information technology has penetrated into many aspects of society now. Electronic informed consent is an effective way to adapt to development clinical trial. China is still at an early stage in this field. Affected by the outbreak of COVID-19 in 2020, the demand for electronic informed consent in clinical trial has become more urgent. Based on my own work experience, the author wants to analyze the problems in the traditional informed consent process and the current situations of electronic informed consent in China and explores the feasibility of electronic informed consent in clinical trials.Copyright © 2021 Drug Evaluation Research. All rights reserved.

Uptake of the Post COVID-19 Condition ICD-10-CM Diagnosis Code By Social Factors

Objectives: Post-COVID conditions (PCC) are increasingly reported in people who had COVID. Certain racial or socioeconomic groups may be at greater risk for PCC and less likely to seek care. We examined the uptake of the new ICD-10-CM diagnosis code for PCC in routine clinical practice in the United States and how it varied by race and payer group. Method(s): Using the Optum de-identified Electronic Health Record (EHR) dataset, we identified patients with an ICD-10-CM code for PCC (U09.9) between October 1, 2021, through March 31, 2022, with 6 months of prior EHR activity. The earliest diagnosis defined the index date. All concurrent diagnoses were measured on the index date. Prior COVID diagnosis was assessed using all available data before the index date. Result(s): There were 23,647 patients: 9.9% were African American, 12.1% had Medicaid, and 2.4% were uninsured. There was an overrepresentation of white patients among those with PCC (78.6% compared with 69.6% of the overall EHR in 2021). More African American (24.1%), Medicaid (23.1%), and uninsured (27.5%) patients were diagnosed in the inpatient setting or emergency department than whites (14.0%) and commercially insured patients (10.0%). Among racial groups, African Americans had the highest percentage of documented prior COVID diagnosis at 63.6%. Of concurrent diagnoses, shortness of breath and acute respiratory failure with hypoxia were higher among African Americans (13.9% and 6.1%, respectively) than whites (11.5% and 4.3%, respectively). The same pattern was seen when comparing Medicaid and uninsured to commercial payors. Conclusion(s): The PCC code was used differently across racial groups and payor types and captures varying manifestations of PCC. The differences in diagnosis locations underscore the importance of using data capturing all care settings when conducting studies using this code. Subgroup analyses are important for future studies using U09.9 due to variability in code application.Copyright © 2023

Building Research Capacity in Primary Care Practices That Serve Predominantly Racial and Ethnic Minority Populations

In this commentary, we report on lessons learned over 2 years (2020-2022) from conducting primary care research through a novel alliance of an ACO consisting of independent practices, a health plan, and several academic researchers, with the support of a private foundation. Am J Manag Care. 2023;29(6):In Press _____ Takeaway Points The process of collaborating on research was mutually beneficial for a network of independent practices and a group of academic researchers. * The process benefited the practices by facilitating more precise thinking about quality improvement, motivating the staff, and enabling readiness for health system change. * The process benefited the researchers by illuminating nuances of clinical and organizational workflow and revealing the practices' in-depth understanding of the communities they serve. * If practices have more federally funded opportunities to consistently participate in research, it could help speed greater adoption of payment reform models to promote health equity at the state and national levels. _____ A 2021 National Academies of Sciences, Engineering, and Medicine report, Implementing High-Quality Primary Care, has called out the persistent "neglect of basic primary care research" in the United States.1 A 2020 study by the RAND Corporation found that primary care research represents only 1% of all federally funded projects (including projects funded by the National Institutes of Health, the Agency for Healthcare Research and Quality [AHRQ], and the Veterans Health Administration).2 However, innovation in primary care is central to advancing health care delivery. Leaders in health care innovation recently called for CMS to test a proposal for primary care payment reform in accountable care organizations (ACOs) composed of independent practices (ie, practices not owned by hospitals).3 By innovating in independent practices, these leaders argued that CMS would provide incentives for those practices to stay independent, thereby potentially decreasing the vertical market consolidation that contributes to rising health care costs.3 Yet these same practices may have less experience with the kind of systematic innovation that leads to generalizable insights, because what little funding is available for primary care research is mostly awarded to large academic medical centers.1 AHRQ's practice-based research networks have not fully addressed this gap, as they have struggled to find infrastructure and maintain funding.1 In this commentary, we report on the lessons we learned over 2 years (2020-2022) from conducting primary care research through a novel alliance of an ACO consisting of independent practices, a health plan, and several academic researchers, with the support of a private foundation. [...]ACPNY found that experience with research facilitates innovation and readiness for health system change (lesson 1C).

Overcoming the Challenges of COVID-19

Agile and inventive pandemic response augurs in future-ready clinical trial management The onset of a global health emergency set innovation engines rolling, with active participation across the clinical research spectrum to find effective solutions. Here are 5 landmark solutions that were woven into the existing clinical trial fabric, with agility and innovation, to strengthen processes and make it relevant to current needs and beyond. 1.Accelerated trials to market lifesaving drugs faster When scientists began the process of developing a vaccine against COVID-19 in early 2020, the fastest vaccine that had been developed till then was the mumps vaccine in 4 years during the early 1960s. Navitas Life Sciences' OneClinical® Analytics platform is an artificial intelligence tool that has been shown to reduce clinical trial monitoring costs by 50% while bringing down cycle time by 30%.3 The near-real-time data insights gained from such tools aid in taking proactive corrective action helps resolve critical clinical trial issues at the onset, allowing intelligent deployment of resources.

COVID-19 vaccines in patients with solid tumor cancers receiving immune checkpoint inhibitors

Background: The interaction between checkpoint inhibitors (CPI) and Sars-COV-2 vaccines has been understudied. One potential complication in pts receiving CPI is immune-mediated adverse events (irAEs) resulting from overactivation of the immune system. It is unknown whether concurrent CPI and Sars-COV-2 vaccine administration increases the risk of irAEs. This retrospective study examined the incidence of severe irAEs in cancer patients receiving CPI therapy at the time of vaccination against Sars CoV-2. Method(s): Following IRB approval, pts with solid tumors who received any approved CPI since FDA authorization of the COVID-19 vaccine in December 2020 were identified via institutional electronic health record. Pts who received one or more doses of an authorized vaccine within 60 days of CPI treatment were included. The primary endpoint was to evaluate the incidence of severe irAE (one or more of the following: grade 3 AE or above, multi-system involvement, need for hospitalization). Secondary endpoints included time between CPI and vaccination, need for immunosuppressive therapy, and rate of discontinuation of CPI due to irAE. Data was analyzed using descriptive statistics. Result(s): 290 pts with bladder, head/neck, liver, skin (melanoma, SCC), renal, and gynecologic cancer were included in analysis. The median age was 67 years (IQR: 59.0-74.0) and 66% pts were male. At the time of vaccination, 201 pts (69.3%) received CPI monotherapy, 53 pts (18.3%) received combination (combo) CPI therapy, and 36 pts (12.4%) received other therapies (chemo, TKIs, etc.) with CPI. The vaccine manufacturer was Pfizer Bio-N-Tech in 162 pts (55.9%), Moderna in 122 pts (42.1%), and Johnson and Johnson in 6 pts (2.1%). The number of vaccinations received was >/= 3 in 214 pts, 2 in 64 pts, and 1 in 11 pts. 30 pts (11.5%) experienced severe irAEs following vaccination. The rate of severe irAEs was 10.3% (30/290) in the total population [6% (12/201) with CPI monotherapy, 19% (10/53) with combo CPI, and 22% (8/36) in the combo CPI-other group]. Severe irAEs occurred after the first vaccine dose in 5 pts (16.7%), second dose in 16 pts (53.3%), and third dose in 9 pts (30%) pts. The median time between CPI treatment and vaccination in pts who experienced irAE was15.5 days (IQR: 10.2-23.0). Hospitalization was required for 19 patients (63.3%). 24 pts (80.0%) required immunosuppressive therapy with a median therapy duration of 98.5 days (IQR 40.2-173.0). 16 pts (53.5%) discontinued CPI therapy following severe irAEs Conclusion(s): In this retrospective study, we observed a 10.3% rate of severe irAE in cancer pts receiving CPI concurrently with COVID-19 vaccines. Further investigation in pts with additional cancer types is warranted to help determine best practice guidelines for COVID-19 vaccination in cancer patients receiving CPI.

Research in brief

The deadly complication Scientists failed to find evidence that COVID-19 causes a "cytokine storm” leading to death in patients with COVID-19 but they did find that secondary bacterial pneumonia that does not resolve was a key driver of death in patients with COVID-19 and may have exceeded death rates from the viral infection itself. The approach grouped similar ICU patient-days into clinical states based on electronic health record data and allowed the scientists to discover how complications such as bacterial pneumonia impacted the course of illness. For more on complications in COVID19 see J Clin Investig 2023;published online April 27. https://doi.org/10.1172/JCI170682 For more on efficacious monoclonal antibodies see Ann Intern Med 2023;published online April 18. https://doi.org/10.7326/M22-3428 For more on targets for herpes virus see Sci Adv 2023;9: eadf3977 For more on an RSV vaccine in pregnancy see N Engl J Med 2023;388: 1451–64 For more on Pillar[5]arene see Nat Commun 2023;14: 2141 For more on doxycycline for STIs see N Engl J Med 2023;388: 1296–306 For more on immunity in tuberculosis see Nat Immunol 2023;24: 753–54

Combining information technology and human research efforts to lessen personnel burden and costs One success story

Objectives: Develop a coding system to extract EHR data and establish research validity to lessen need for manual data extraction Methods: As part of a data collection project for COVID + patients requiring ICU care, we established data elements able to be extracted from the Epic electronic health record (EHR). Collaboration between Information Technology (IT), research and clinical personnel established where data elements were located within the EHR and what data could be extracted with minimal manual assistance and uploaded to a research database. Coding was developed using Structured Query Language (SQL) with best practices (includes indexes, execution plans, optimized range keys, avoiding large reads inside read-write transactions as instructed by the Epic consultant). Accuracy of extracted data was evaluated by manual validation of data against Epic records via random selection of patient data within the cohort. Result(s): From July-December 2022, coding was developed which extracted over 130 fields of data from 3093 COVID patients across 5 INOVA ICU sites (demographic, physiologic, lab, interventions, outcome). Prior efforts at data extraction of these elements from research personnel (ZS) who previously performed this task noted an average of 4 hours/patient to complete coded fields. Coded data was also noted to be more accurate when accessed by the same personnel to manually extracted fields. Assuming 4 hrs/pt, manual extraction would require 12,372 hours, which equates to over 6 full time human research personnel. Data coding required 446 hours. Coded data extraction can be almost immediate once fields requested are established, decreasing personnel costs and effort significantly. Conclusion(s): Reduction in need for manual data collection using automated coding extraction can reduce costs, personnel time and enhance research efforts. Sharing coding mapping to other EPIC sites or use of similar methods may improve timeliness of ongoing data extraction and will be useful to develop earlywarning and patient-centered care algorithms to improve care.

Trends in Second Generation Antipsychotic Prescribing for Adolescents from 2013-2021

Objectives: To examine temporal trends of FDA-approved and off-label second-generation antipsychotic (SGA) prescribing for adolescents over time through the Covid-19 pandemic. Method(s): This is a new-user, retrospective longitudinal panel study using electronic health record data from a large, integrated health care system. Outpatient prescription orders for a new SGA (index date) for adolescents (age 10-17 years) during 2013-2021 were analyzed. Prescription orders were linked to diagnoses at time of encounter to examine prescribing behavior. A one-year lookback period was used for baseline inclusion and exclusion criteria, including one-year "washout" of SGAs and continuous insurance enrollment. FDA-approved use was determined by two outpatient diagnoses (one baseline diagnosis and the prescription order diagnosis) for autism, psychotic disorders, bipolar disorders, or Tourette's;the remaining proportion was considered potentially off-label. We report crude annual prescribing rates per 1,000 youths. Result(s): There were 8,145 unique patients with new SGA prescription orders, of which 5,828 (71.6%) had linked diagnoses available. Calendar year 2013 had the highest prescribing rate prior to Covid-19 onset (2.1 per 1,000) but then declined through 2016 (1.7 per 1,000). Prescribing rates in 2020 (2.0 per 1,000) and 2021 (2.2 per 1,000) were higher than those between 2017-2019. Across all study years, SGA prescriptions were mostly off-label and ordered for aripiprazole, quetiapine, or risperidone. The proportion of off-label indications was highest in 2013 (80.1%) and lowest (69.1%) in 2019. Off-label proportions increased again in 2020 (76.1%) and in 2021 (74.1%). At baseline, patients frequently had other psychotropic prescriptions (e.g., antidepressants 63.3%, stimulants 22.9%, and sedatives/hypnotics 20.7%). Conclusion(s): A general decline in SGA prescribing rates among adolescents was observed from 2013 to 2019, but then increased following Covid-19 onset. Despite known safety risks, off-label use of SGAs remains prominent. Future studies are needed to better understand prescribing outside of pediatric professional society guidelines.Copyright © 2023

Successful Inter-Professional Team (IPT) collaboration in the care of peripartum women with COVID-19 on Extracorporeal Membrane Oxygenation (ECMO)

Objectives: To describe the IPT collaborative approach for peripartum women with COVID-19 on ECMO and report the intervention outcomes. Method(s): A retrospective electronic health record review was performed from January 2020 through January 2022. All peripartum women on ECMO with COVID19 admitted to the cardiothoracic intensive care unit (CTICU) were included. The IPT came together to coordinate peripartum care and delivery. An algorithm was created to outline the roles and workflow in the care of these patients. The outcomes evaluated included delivery method, timing, and location, maternal survival at discharge, maternal ICU length of stay (LOS), and neonatal survival Results: Thirteen Peropartum women were placed on ECMO (5 antepartum and 8 postpartum, ages 27-42). None had been vaccinated against COVID-19. All received femoral vessel cannulation (11 venovenous and 2 venoarterial). Four patients underwent Caesareansection delivery while on ECMO. Maternal survival to hospital discharge was 84.6%. All neonates survived with COVID-19 negative status. Conclusion(s): The collaborative IPT approach with a structured algorithm facilitated survival outcomes. This report adds to the limited literature on peripartum. ECMO and provides insights to consider in planning for the care of these patients.

Economics of a Health System's Direct-to-Consumer Telemedicine for Its Employees

Am J Manag Care. 2023;29(6):In Press _____ Takeaway Points The value of direct-to-consumer (DTC) telemedicine services offered by academic health systems is understudied. * DTC telemedicine services for low-acuity or minor illnesses are increasingly offered as an employee benefit, but any per-episode unit cost advantage may be offset by overuse of care. * DTC telemedicine staffed by an academic health system and offered to its employees resulted in lower per-episode unit costs for care within 7 days and only marginally increased the use of services. * DTC telemedicine staffed by an academic health system and offered directly to employees was cost-saving. _____ Employers in the United States have increasingly been offering a direct-to-consumer (DTC) telemedicine benefit for low-acuity or minor illnesses to their employees.1-3 By 2021, more than 95% of employers with 50 or more employees provided some coverage for DTC telemedicine in their largest health plan;more than 75% felt that offering telemedicine was important and nearly 20% either limited or eliminated cost sharing for telemedicine.4 Despite these trends among general employers, few health systems have directly provided DTC telemedicine to their own employees. [...]because these services are easy to access (often available immediately, around the clock, and without travel), they may induce overuse of care, especially for self-limited conditions such as viral upper respiratory infections for which the alternative to in-person care is no care at all, thus increasing the overall cost of care.5-11 Telemedicine will save money relative to in-person care if any unit price advantages are not overwhelmed by the increased use of care overall, induced by its convenience. Employers provide health insurance coverage for 158 million Americans or nearly 50% of the population. Since the COVID-19 pandemic began, telemedicine has represented a significantly larger portion of all medical claims—consistently more than 5% of all medical claims by mid-202112-15—and the estimated value of the global telemedicine industry is projected to reach a quarter of a trillion dollars by 2024.13 Yet, the future of telemedicine remains undetermined with reimbursement rates in debate,16-18 driven in large part because its economic value is understudied and uncertain. Penn Medicine is self-insured and more than 95% of employees use its only employer-sponsored plan—a preferred provider organization (PPO) plan—rather than insurance obtained individually or through a family member. Since 2017, these PPO-insured employees have been offered Penn Medicine OnDemand,19 a 24/7 DTC telemedicine benefit to employees and their adult (≥ 18 years) dependents.

Q&A

In this interview, Jody Casey, vice president, healthcare partnerships at EUigo Health Research, highlights how the pandemic has put the spotlight on diversity in trials, how EUigo is working with physicians to make studies more accessibie, as well as what is in store for the future of appropriate representation in trials. There needs to be a greater breadth of population and diversity in trials. Because a COVID vaccine is so critically important for all Americans, it's been brought to light the fact that trials are generally lacking in diversity. Casey: A unique aspect of Elligo is that we securely access electronic health record (EHR) data from our physician partners.