🚨 New paper: As a PCP, I often hear from patients that managing their health care feels like a full-time job. To understand this better, we analyzed the first nationally-representative US survey of older adults’ self-reported treatment burden: agsjournals.onlinelibrary.wiley.com/doi/10.1111/...

ICYMI, out in print this week. While we framed this Viewpoint with optimism, it can conversely be said that eroding health survey infrastructure means we’re flying a little more blind each day on priorities like chronic disease, maternal health, and substance use: jamanetwork.com/journals/jam...

NSDUH is one of the only ways we can track trends in substance use in the US. NSDUH is one of the only ways we can track adolescent mental health problems in the US. We cannot afford to fly blind on these critical issues.

One big thing that AHRQ does is run the Medical Expenditures Panel Survey. This may sound like a trivial thing if you are outside the field. But the Congressional Budget Office relies on this information when modeling health policy changes. That is a huge deal.

Many more pieces like this could be written to show the impact of sustained federal investment in US biomedical research. This one has a great table highlighting the role of NIH funding in some of our greatest gains against chronic disease in the past 80 years. www.ahajournals.org/doi/full/10....

1. Today the NIH director issued a new directive slashing overhead rates to 15%. I want to provide some context on what that means and why it matters. grants.nih.gov/grants/guide...

We just launched a 16TB archive of every dataset that has been available on data.gov since November. This will be updated day by day as new datasets appear. It can be freely copied, and we're sharing the code behind it to help others make their own archives of data they depend on.

The intensity and seriousness of cancer care has prompted attention to the wide-ranging impact of "time toxicity" of care on patients and caregivers. We would benefit from improved understanding of such burdens and their tradeoffs in other areas as well: jamanetwork.com/journals/jam...

"If someone had asked us in the summer of 2021 what we most needed to facilitate Mom’s healing and well-being, our wish list would have been modest." So often our health care system fails to live up to its name of providing care: www.healthaffairs.org/doi/full/10....

Want to see if your research has had an impact on public policy? Enter your info in SagePolicyProfiles to see the citations of your own publications in policy documents. You get a profile page. Here is mine as an example: policyprofiles.sagepub.com/profile/5920...

I didn't know any of this policy story - worth the read. TL;DR 1980s regulatory changes enabled monopsony behavior by big chains, basically destroying the small local grocer.

As the baby boom generation enters its prime years for long-term care needs, its difficult to come up with a more challenging backdrop than an immigration system about to be cut off at its knees (think: nursing home aides) and states having to fill in funding gaps from Medicaid spending shortfalls.

A lot to think about in this review from a research perspective - what are the essential components of the underlying concept of "decision fatigue"? How do we operationalize that definition? How does this concept apply not only to clinicians, but to patients and caregivers?

#NewLitHighlights #HealthPolicy Nurse practitioners and physician assistants are now responsible for over a quarter of outpatient visits in traditional Medicare - still a lot of room to understand how to optimize their role in clinical care: www.bmj.com/content/382/...

Great advice on making the most of the shifts between clinical and research time as a clinician-investigator, applicable to folks at multiple levels. Wish I'd seen some of these tips before learning them the hard way! (via @BryantShuey) jamanetwork.com/journals/jam...

If you've got any research (even in the pipeline) that might help better understand the effects of anti-obesity medications on health care and other federal spending, CBO wants to see it: www.cbo.gov/publication/...

Not so many people here discussing #FDAPolicy #RxPolicy yet, but this one will be one to follow - for the first time, FDA exercises its FDORA power to expedite withdrawal of drugs initially approved via accelerated approval: www.bloomberg.com/news/article... #HealthPolicy

PSA: deck.blue is basically a clone of Tweetdeck for BlueSky—it even lets you curate personal lists, independent of feeds If you haven't used any bsky apps before, you need to create an "app password" (under Settings > Advanced) to log in

This looks like it will be an excellent opportunity to better understand how a wide and diverse range of people contribute to dementia care and its associated outcomes - I'll be looking forward to getting my hands in the data.

#HiSciSky! I'm an #PrimaryCare physician and health services researcher studying prescribing and medication use to improve quality of care for older adults. Interests include #GIM #Geriatrics #Deprescribing #RxEpi #HealthPolicy #RxPolicy. Looking forward to connecting with friends old and new!

Any time you are tempted to dismiss descriptive research as unimportant, keep in mind: a medical diagnosis is a description. "You have lymphoma" seems like an important thing to know, right? Describing our world is important.

Great to see our recent study covered in ⁦@statnews⁩ by @TaraBannow⁩ - we found over 1/3 of both physicians and APCs received industry payments in 2021: https://www.statnews.com/2022/10/31/advanced-practice-clinicians-industry-funding/

We know industry payments to physicians are common, but what about the nurse practitioners, physician assistants, and other APCs critical to patient care? New paper out in @JAMA_current with @TimAndersonMD: https://jamanetwork.com/journals/jama/fullarticle/2798217

"Recommendations for outcome measurement for deprescribing intervention studies" (@DeprescribeUS Measures Working Grp) - lack of standardization in deprescribing measures poses challenges to interpretation, with many opportunities for further development:...

“Moving Deprescribing Upstream” (@michelleskeller @SarahVordenberg @MikeSteinman) - or as I've started to think of it, "the process of deprescribing begins with prescribing": https://link.springer.com/article/10.1007/s11606-022-07537-x

Pair with this new study led by @jeromie_b with a different approach to estimating @CMSGov spending on “dangling” accelerated approval drugs/indications without full approval (~$1-2B in 2019): https://www.acpjournals.org/doi/10.7326/M21-4442

Catching up on new paper from @SkydelJ on @CMSGov spending on drugs approved by @US_FDA Accelerated Approval pathway - huge sum ($60+B/9y) involved, most for drugs with unconfirmed benefit or “confirmed” with surrogate endpoints only:...

Great to see lots of interest in the recent aducanumab saga at policy update with @Aging_MD at #AGS22. For those still here, I’ll be presenting at Sat 5/13 HSR Paper Session on representativeness of trial participants along the pipeline of anti-amyloid mAbs for AD:

Have been thinking a lot recently about this point highlighted by @VouriPharmD - #deprescribing is often framed as a geriatric issue but the framework is applicable in many settings beyond: #AGS22

Obesity care is primary care - appreciate focus on interventions beyond behavioral ones. We have options! And important to remember potential role of obesogenic medications - new study showing high prevalence among people who are overweight/obese:...

Great general principle to keep in mind with #BeersCriteria update at #AGS2022 - discontinuation of a drug is not equivalent to avoiding initiation of a drug. Early exploration in subgroup analysis of ASPREE and ripe for further investigation:...

Proposed #BeersCriteria update on antipsychotics at #AGS2022 spurring a lot of comments/discussion on appropriate conditions for use - recognizing trade-offs and nuances of meeting multiple patient goals including remaining in the community:

Proposed 2022 #BeersCriteria changes presented at #AGS2022 - notably to antiplatelet/anticoagulation recs:

Inspiring @DeprescribeUS #USDeN2022Live keynote by Dr. Barbara Farrell on developing guidelines for the process of #deprescribing:

Great start to @DeprescribeUS #USDeN2022Live meeting! @MikeSteinman highlights gap in research on deprescribing in communities of color - an opportunity for further #pharmacoequity research. @UREssien

Excited to be heading to #SGIM22 - first in-person conference in 3 years! Thanks to @SocietyGIM for sponsoring me as a Young Scholar in GIM. Looking forward to the next few days with my academic home. #ProudtobeGIM

Huge amount of FDA-related legislation up for discussion before @EnergyCommerce, including on clinical trial representation and Accelerated Approval reform - hearing @ 10:30 AM today:...

"Attitudes toward deprescribing among older adults with dementia in the United States" (@matthew_growdon, @MikeSteinman) - adds to our understanding of nuanced attitudes towards polypharmacy and deprescribing in people with dementia:...

"Outcome Measures for Interventions to Reduce Inappropriate Chronic Drugs: A Narrative Review" (@aubert_carole @EveKerrMD) - chronic drug deprescribing studies use wide variety of measures; room to standardize and esp. develop clinically-relevant outcomes:...

"Evaluating the use of prescription sequence symmetry analysis as a pharmacovigilance tool: A scoping review" (@DrEarlIV, @VouriPharmD) - new-to-me neat self-controlled method of identifying/testing prescribing cascades:...

Late to this - @TheWonkologist @peterbachmd examine 30 years of FDA policy through the lens of PDUFA - which allowed industry to gain negotiating power on FDA policy through the FDA budget:...

Great panel @UCStanfordCERSI summit on future of accelerated approval, especially discussion w/r/t generating confirmatory evidence (esp. important in light of recent Aduhelm decision):...

Great to see draft @CMSGov decision to use the CED pathway and cover aducanumab only in the context of an RCT - driving forward the rigorous collection of further data and evidence for efficacy and safety: https://www.statnews.com/2022/01/11/medicare-aduhelm-proposed-decision/

Anyone know of a tool that can quickly map the intersection of citations between 2 (or more) papers (i.e. papers that are cited by both vs only 1 of the inputs)? #AcademicChatter @ArtirKel

Lots of interest recently in FDA decision-making in conditions of uncertainty - new paper examines how FDA justifies some of those decisions - in particular, new drug approvals with borderline efficacy: https://www.acpjournals.org/doi/10.7326/M21-2918 @PerrineJaniaud @oodmanmetrics

How has the @US_FDA used its regulatory levers to encourage evidence development after the approval of new drugs? Glad to be part of project led by @SkydelJ examining all FDA postmarketing requirements and commitments for new drugs from 2009-2018:...

Lest you forget the upcoming @US_FDA decision on aducanumab for Alzheimer disease, @AKesselheim (et al) make their thoughts clear: "Any treatment will appear to be more effective if individuals in whom it works least are removed from the...

I’ve probably seen more conversations on deprescribing modeled this past week on Geriatrics than I have the rest of my residency thus far - so was pleased to see this adding to the evidence base on communication of deprescribing this week:...

In searching for where to get an easy, centralized signup for the COVID vaccine for my parents (and my patients!), I was frustrated by how fragmented the entire process seemed to be. Ineffective investment in public health infrastructure strikes again:...