Curbside Consult with Dr. Jayne 4/11/22

I spent some time this week with people who are knee-deep in public health efforts. One of the major topics of conversation was a preprint study that looked at ongoing declines in the US life expectancy. This year’s decline is significantly smaller than what we experienced last year, with us losing about half a year on average in 2021. The overall US life expectancy is now 76.6 years, representing the lowest value in more than two decades. Although the decline is less steep, it causes some less than optimistic thoughts among public health proponents who thought that having a readily available COVID-19 vaccine would help stabilize life expectancy data. Unfortunately, I think many underestimated the resistance to vaccination that we have seen across the country.

A big part of the discussion was the disparity between life expectancy in the US compared to other countries with similar resources, including Austria, Belgium, Denmark, England and Wales, Finland, France, Germany, Israel, Italy, Netherlands, New Zealand, Northern Ireland, Norway, Portugal, Scotland, South Korea, Spain, Sweden, and Switzerland. Researchers felt this was largely tied to lower vaccination rates in the US compared to our peers. Other wealthy nations have seen increases in life expectancy in 2021 to the point where the gap between the US and our peers differs by more than half a decade. In addition to COVID, our numbers are likely impacted by conditions like diabetes, high blood pressure, and obesity that seem to be growing every year.

Another central theme in the conversation was the sheer amount of healthcare spending in the US compared to the outcomes we see. Although there has been a lot of discussion about value-based care over the last several years, we still see plenty of organizations focusing their marketing efforts around procedural subspecialists who can bring fee-for-service cases to their hospitals. Sometimes it feels like patients would much rather spend money for a pill or a scan or a procedure than they would on healthier lifestyle choices. The reality is that public health isn’t sexy and most of the time the general public doesn’t want to hear about it, despite the fact that clean water, waste management, safe housing, and vaccines are all public health measures that have made life better for many people.

The group knows I’m a clinical informaticist and asked me what technologies I thought could be brought to bear to help the life expectancy crisis. There are a lot of solutions out there, but I think we need to focus on a couple of key themes rather than following every shiny object that passes in front of eyes. First, we need to educate our patients. Patient engagement solutions such as chatbots, patient portals, and the like can help deliver patient education so that patients understand their health situation and know what to do to move things in a positive direction. For some patients this may need to be low tech, such as simple phone calls with a health coach or navigator, and those patients shouldn’t be left behind.

Second, we need to help patients track whether the things they’re doing to try to improve their health are making a difference. I’m surprised that readily available home monitoring devices such as smart scales or connected blood pressure cuffs aren’t used more. They don’t necessarily have to have all the bells and whistles, such as sending data to their care team, but need to be able to help patients see a trend and to know if what they’re doing is helping things get better or not. Seeing immediate results can make a huge difference in patient morale as well as readiness for patients to continue an intervention.

Third, we need to make sure that everyone involved in a patient’s care is aware of their health factors. Interoperability is key here to ensure that there’s not only avoidance of duplicative or unnecessary services but to ensure that different members of the care team know all the different conditions a patient has. There are still a number of patients that see multiple subspecialists with minimal coordination, so I think it’s going to be important to continue to invest in infrastructure such as health information exchanges.

Last, we need to continue to spend some of our tech funds on health surveillance, including not only public health analytics to help identify the next pandemic or severe health threat, but also on analytics to monitor the improvement or decline in the overall health of populations and what might be contributing to those changes. With all the computing power available to us, we should be a lot better informed. If we’re going to get health spending in check, we have to measure, manage, and measure again. I do have some favorite vendors in these areas, but I’m interested to see what our readers think and how impressed (or unimpressed) you might be with the solutions your organizations are using.

I spent a good chunk of the weekend helping some young people learn wilderness survival skills in the context of a fictional “zombie apocalypse” that was made more dramatic by the presence of near-freezing temperatures. It was also a team-building exercise, and it was interesting to see how the different groups came up with completely different shelter designs even though everyone started out with two tarps and a ball of twine. Several used the landscape to their advantage for wind and rain protection, and another did some interesting things with old tires that they found dumped in the woods. One less-than-enterprising group tried to just gift wrap a picnic table with their tarps. Although it was probably effective as a survival shelter, it didn’t score well on creativity in the peer voting at the end of the day.

The winning shelter was a simple design. I spotted one of my co-leaders napping in it following the judging, so I hope it earned all the “suitability for sleep” points that it rightfully deserved. Most of the groups spent the night in their shelters with only sleeping bags and I’m sure the excitement of having made it through the night is an accomplishment they won’t soon forget. Certainly none of them were impressed by my zombie antics, so I suspect I’ll just have to go back to being the “boomer” that the youngsters seem to think I am.

Has your company ever done any “extreme” team building? If so, what did you do? If zombies were taking over the world and you had to abandon your living space, do you think you would make it? Leave a comment or email me.

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