Health Care Quality Took a Big Hit During COVID, Medicare Report Finds

Axios | By Maya Goldman
 
Progress on many key health care quality measures was reversed during the first two years of the pandemic, according to a new comprehensive federal review. 
 
Why it matters: The report identified a "significant worsening" of patient safety measures and "persistent" health equity gaps for historically disadvantaged patients as COVID-19 overwhelmed the health care system. 
 
Context: The federal government asks providers to report on a wide set of several hundred measures meant to assess health care quality. 

• Before the pandemic, from 2016 to 2019, providers' performance on more than half of quality metrics improved, the Centers for Medicare and Medicaid Services said. 
• CMS relaxed reporting requirements when the pandemic hit, but the agency said it continued to collect enough data to compare performance with long-term trends. 

Zoom in: Performance on 38% of measures came in worse than expected in 2020, and 47% worse in 2021, CMS said. 

• About half of safety measures came in worse than expected in those two years. 

• In the starkest example, a measure of central line-associated bloodstream infections was 94% worse than expected in 2021.

 
Quality scores decreased more significantly for minority populations on some measures. 

• For instance, osteoporosis management for Black Medicare Advantage enrollees was 22.4 percentage points worse in 2021, while it fell 14.4 percentage points for white enrollees. 

 
The bottom line: CMS said the data and feedback from focus groups show the need to develop measures that "address bias in care delivery and deficits in cultural competency, unmet health-related social needs, access, and health literacy."

Is Stretching Now Underrated? Accumulating Research Says Yes

Medscape | By Lou Schuler

For many, stretching is the fitness equivalent of awkward small talk. It's the opening act, the thing you tolerate because you know it will be over soon. 

Others have challenged the practice, suggesting that stretching isn't necessary at all. Some research has found that a preworkout stretch may even be disadvantageous, weakening muscles and hindering performance.

To put it plainly, no one seems terribly enthusiastic about touching their toes. 

That's why a 2020 study on exercise and mortality was such a head-scratcher. The study found that stretching was uniquely associated with a lower risk for all-cause mortality among American adults. That's after controlling for participation in other types of exercise. 

The finding seemed like a fluke, until a 2023 study found essentially the same thing. 

Among Korean adults, those who did flexibility exercise at least five times a week had a 20% lower risk of dying during the follow-up period than those who didn't stretch at all. That was slightly better than the risk reduction associated with high volumes of aerobic exercise and resistance training. 

How can that be ? It turns out, stretching is linked to several health benefits that you might not expect. 

The Surprising Benefits of Stretching

When we talk about stretching, we usually mean static stretching — getting into and holding a position that challenges a muscle, with the goal of improving range of motion around a joint. 

It doesn't need to be a big challenge. "Research shows you can get increases in flexibility by stretching to the initial point of discomfort," said David Behm, PhD, an exercise scientist at Memorial University of Newfoundland in Canada who's published dozens of studies on stretching over the past quarter-century. 

That brings us to the first benefit…

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Promising New Wearable Could Retrain the Brain After Stroke

Medscape | By Sarah Amandolare

A new and deceptively simple advance in chronic stroke treatment could be a vibrating glove.

Researchers at Stanford University and Georgia Tech have developed a wearable device that straps around the wrist and hand, delivering subtle vibrations (akin to a vibrating cellphone) that may relieve spasticity as well as or better than the standard Botox injections.

"The vibro-tactile stimulation can be used at home, and we're hoping it can be relatively low cost," said senior study author Allison Okamura, PhD, a mechanical engineer at Stanford University, Stanford, California.

For now, the device is available only to clinical trial patients. But the researchers hope to get the glove into — or rather onto — more patients' hands within a few years. A recent grant from the National Science Foundation's Convergence Accelerator program could help pave the way to a commercial product. The team also hopes to expand access in the meantime through larger clinical trials with patients in additional locations.

The work builds on accumulating research exploring vibration and other stimulation therapies as treatments for neurological conditions. Other vibrating gloves have helped reduce involuntary movement for patients with Parkinson's. And the University of Kansas Medical Center, Kansas City, Kansas, will soon trial the Food and Drug Administration-approved vagal nerve stimulator, an implantable device intended to treat motor function in stroke survivors. Okamura noted that devices use "different types of vibration patterns and intensities," depending on the disease state they target.

Spasticity often develops or worsens months after a stroke. By then, patients may have run out of insurance coverage for rehabilitation. And the effectiveness of Botox injections can "wear out over time," Okamura said.

In a clinical trial, patients wore the device for 3 hours a day for 8 weeks, while doing their usual activities. The researchers continued testing their spasticity for 2 more weeks. Symptom relief continued or improved for some patients, even after they stopped using the device. More than half of the participants experienced equal or better results than another group that only received regular Botox injections.

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Communicating Bad News to Patients

Medscape Medical News | By Paolo Spriano

Communicating bad news to patients is one of the most stressful and challenging clinical tasks for any physician, regardless of his or her specialty. Delivering bad news to a patient or their close relative is demanding because the information provided during the dialogue can substantially alter the person's perspective on life. This task is more frequent for physicians caring for oncology patients and can also affect the physician's emotional state.

The manner in which bad news is communicated plays a significant role in the psychological burden on the patient, and various communication techniques and guidelines have been developed to enable physicians to perform this difficult task effectively.

Revealing bad news in person whenever possible, to address the emotional responses of patients or relatives, is part of the prevailing expert recommendations. However, it has been acknowledged that in certain situations, communicating bad news over the phone is more feasible.

Since the beginning of the COVID-19 pandemic, the disclosure of bad news over the phone has become a necessary substitute for in-person visits and an integral part of clinical practice worldwide. It remains to be clarified what the real psychological impact on patients and their closest relatives is when delivering bad news over the phone compared with delivering it in person.

Right and Wrong Ways

The most popular guideline for communicating bad news is SPIKES, a six-phase protocol with a special application for cancer patients. It is used in various countries (eg, the United States, France, and Germany) as a guide for this sensitive practice and for training in communication skills in this context…

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