Healthcare Reform
The implementation of the Affordable Care Act brought about changes to the way hospitals are reimbursed by Medicare and Medicaid. National value-based programs, such as the Hospital Readmissions Reduction Program and the Value-Based Purchasing program, aim to use financial rewards and penalties to incentivize the delivery of higher-value care for certain cardiovascular conditions. However, there is growing concern that these programs have had unintended consequences. Researchers at the Smith Center are using large national datasets to investigate the impact of these policies on hospital performance and patient outcomes.
Healthcare Disparities
Recent work at the Smith Center has focused on characterizing healthcare disparities across multiple dimensions, including race and ethnicity, socioeconomic status, and neighborhood disadvantage. The goal of this work is to examine factors at the individual, community, and healthcare system levels that are driving disparities in care and outcomes in order to provide insight into potential solutions. Smith Center researchers have performed nationwide analyses that characterize disparities over the last two decades for older adults experiencing poverty. Other work has examined healthcare utilization and outcomes among adults experiencing homelessness, particularly those affected by cardiovascular disease. More recent studies have explored how the COVID-19 pandemic has impacted low-income and minority communities. Smith Center researchers have also focused on the intersection of health policy and disparities to understand how public health and policy interventions affect health equity.
Medical Device Data and Regulation
A growing number of implantable cardiac devices now contain remote monitoring systems that connect patients to clinicians and manufacturers. In addition, large registries of patients with implanted devices are being organized to more quickly identify emerging safety issues. Such intensive collection of personal data can enable researchers to better monitor cardiac disease processes and therapies, but also comes with concerns about privacy, cybersecurity and appropriate use. Smith Center researchers seek to define and evaluate the ethical challenges related to modern information sharing and digital connectivity, better understand the expectations that patients and clinicians have for these capabilities, and examine how federal agencies regulate devices on the market.
Public Reporting of Outcomes
Several states have implemented policies in recent years that mandate public reporting of patient outcomes for certain procedures, including percutaneous coronary intervention. While such policies aim to promote transparency and care quality, the Smith Center has done research into some of the unintended impacts of these policies such as practitioner risk avoidance, institutional costs, changes in diagnosis coding, and other implications for patient outcomes.
End of Life Care in Patients with Implantable Cardiac Devices
Cardiac implantable electrical devices (CIEDs) are increasingly common interventions for a wide spectrum of cardiovascular diseases. Caring for patients with life-sustaining devices such as CIEDs at the end of life raises legal and ethical challenges. Researchers at the Smith Center seek to shed light on these issues and improve our understanding of patients’ and clinicians’ experiences with these therapies in older adults, particularly surrounding issues such as device deactivation, generator replacement, and advance directives.