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Michael L. Barnett Profile picture
@ml_barnett
Aug 23, 2020 • 9 tweets • 3 min read • Read on X
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It's been a depressing news week so is another thread of beautiful pictures from Google Earth to make you happy.

#1: Dramatic angles framing a river in Germany

Pics from Chrome extension: chrome.google.com/webstore/detai… Image
#2: An amazing city with respect for its neighbor forest in Ecuador Image
#3: One very scenic cloud in Vietnam Image
#4: Nice view of the Duomo there Image
#5 So many peninsulas in Paraguay Image
#6: The remotest coastline in West Africa? Image
#7: Colorful transitions in Australia Image
#8: Beaucoup de bateaux Image
#9: A very lonely road in Mongolia

Hope you enjoyed. Reply with your favorite pics if you have some.

/fin Image

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More from @ml_barnett

Michael L. Barnett Profile picture
May 10, 2023
New @NEJM out today!!

After a high risk OUD event (OD or detox)
- White patients get buprenorphine 80% more often than Black pts
- This is not due to diffs in methadone or frequency of health care access
- Rates of rx opioids/benzos are HIGHER than bupe

nejm.org/doi/full/10.10… Image
@NEJM Before I dive in, this was a joint effort of @HarvardHPM @HMSHCP @DartmouthInst w/ Nancy Morden, @ermeara @Ateevm @DrLewinson and many others

We focused on disabled Medicare enrollees from 2016-2019 with an OUD "index event" like OD, IV drug related infection or detox/rehab. Image
@NEJM @HarvardHPM @HMSHCP @DartmouthInst @ermeara @Ateevm @DrLewinson We captured a high risk pop with a clear "touchpoint" (h/t @MarcLarochelle) indicating severe OUD. The need for treatment is obvious and shouldn't vary much by race, right?

Nope. White pts got buprenorphine 23.3% of the time compared to 18.7% and 12.7% for Hispanic and Black pts Image
Read 12 tweets
Michael L. Barnett Profile picture
Mar 23, 2023
Excited to share a new paper today with @McGarryBE and @ashdgandhi published today in @NEJM

TL;DR Nursing homes with higher use of COVID-19 tests for staff had 30% fewer resident cases and 26% fewer deaths than low testing facilities. That's a LOT.

/1

nejm.org/doi/full/10.10… Image
@McGarryBE @ashdgandhi @NEJM Why does this matter? In the early pandemic, we had no vaccines, no Paxlovid. Top priority - keeping COVID out of nursing homes by testing staff frequently. But a lot of nursing homes didn't.

We need to understand what this policy failure cost us.

/2

washingtonpost.com/health/2020/09…
@McGarryBE @ashdgandhi @NEJM This is tricky to study because the best predictor of nursing homes testing more is a COVID outbreak.

We got around this by developing a "relative testing rate" for each home, based on how much it tested staff vs. other homes in the same county and week.

/3 Image
Read 13 tweets
Michael L. Barnett Profile picture
Dec 30, 2022
It's that time again - my list of 10 of the most thought-provoking, surprising, and rigorous studies in health care in 2022!

Themes this year:
1) Care delivery changes that work (and don't)
2) Race and health care
3) Natural experiments in the ED
+ a few misc. cool papers Image
Before we dive in - this list is
A) not comprehensive
B) not presented in any particular order
(I’m also focusing on papers written by folks outside my circle of colleagues/collaborators)

First up is a set of 4 studies on changes to care delivery or coverage.
#1: A lot of interventions that "feel" like they should work have not panned out.

A prime example is a very rigorous RCT to improve birth outcomes among Medicaid enrollees in SC published in @JAMA_current led by @maggiemcconnell + Kate Baicker

jamanetwork.com/journals/jama/…
Read 25 tweets
Michael L. Barnett Profile picture
Feb 4, 2022
New work in @JAMA_current today - who has been getting those precious monoclonal antibody infusions for COVID-19 in the US?

It's not pretty ...

Work led by @CarolineLBehr with @kejoynt @ermeara Arnie Epstein and John Orav.

jamanetwork.com/journals/jama/… ImageImageImage
@JAMA_current @CarolineLBehr @kejoynt @ermeara We identified 1.9 million cases of COVID-19 in Medicare claims without hospitalization/death in the first week.

In nearly every case, those at higher risk of dying from COVID-19 were LESS likely to get monoclonal antibodies (mAbs).

jamanetwork.com/journals/jama/…
@JAMA_current @CarolineLBehr @kejoynt @ermeara Overall, 7.2% of Covid cases got mABs.

But the variation by demographic group is extreme.

0 chronic conditions: 23.2%
6+ chronic conditions: 4.7%

No Medicaid: 8.1%
Medicaid eligible: 4.6%

White: 7.4%
Black: 6.2%

No dementia: 7.8%
Dementia: 3.7%
Read 6 tweets
Michael L. Barnett Profile picture
Dec 22, 2021
Here's my list of 12 papers in 2021 at the intersection of health care, medicine, economics and policy that surprised me, made me think, or were just damn clever.

I'm just going to focus on non-COVID-19 papers - we have enough of that other stuff in our feeds.

Off we go!

/1
Before we dive in - this is
A) definitely not comprehensive
B) definitely not in order of awesomeness

I’m also focusing on papers written by folks outside my direct circle of collaborators (w/ a couple of non-Harvard exceptions I can’t resist).

Sorry @AnupamBJena

/2
@AnupamBJena The first set of papers falls under the theme of "obviously broken systems that we could fix and improve health."

Paper 1:
"SNAP Participation and Health Care User in Older Adults" led by Seth Berkowitz @UNC_SOM and @SanjaybMDPhD in @AnnalsofIM

acpjournals.org/doi/10.7326/M2…
Read 30 tweets
Michael L. Barnett Profile picture
Dec 9, 2021
New analysis in @NEJM today with coauthors @McGarryBE @ashdgandhi @DavidCGrabowski

Vaccine mandates continue to be controversial, including in nursing homes. What are the stakes exactly?

The results are sobering, to say the least ...

nejm.org/doi/full/10.10…
@NEJM @McGarryBE @ashdgandhi @DavidCGrabowski From June-Aug 2021, we compared resident and staff infection + mortality rates between 12,000 homes with the lowest staff vaccination rates (~30%) vs. highest (~80%).

In the least vaccinated homes:
+132% COVID cases in residents
+58% staff cases
+195% resident mortality

yikes
@NEJM @McGarryBE @ashdgandhi @DavidCGrabowski Over an 8 week period, if all nursing homes were magically raised to the highest staff vaccination levels nationally (~80%), we would have:

4,775 fewer resident cases
7,501 fewer staff cases
703 fewer resident deaths (nearly 50% of all deaths)
Read 4 tweets

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