Writing
Rethinking Community Benefit Programs-A New Vision for Hospital Investment in Community Health
Chandrashekar, P., Gee, R., Bhatt, J.
Publication: Journal of General Internal Medicine
Date: January 2022
Historically, nonprofit hospitals have tended to provide “community benefits” through charity care—free or discounted care for low-income patients—rather than making investments in social services or community organizations. In this Viewpoint, we argue that community benefit programs can be a powerful tool for hospitals to make community-based investments. This requires (1) policy reforms that incentivize investments in community health, (2) hospital-community partnerships, and (3) a renewed focus on the “investment” in community investment.
Impact of Patient-Physician Language Concordance on Healthcare Utilization
Chandrashekar, P., Zhang, R., Leung, M., Jain, SH.
Publication: Journal of General Internal Medicine
Date: August 2021
Though many hospitals and clinics now provide interpreter services, there is growing evidence that patients should communicate with a language-concordant physician (i.e., a physician fluent in the patient’s native language) for more optimal care. In this study, we show that patient-physician language concordance is associated with greater primary care utilization and lower specialist, inpatient, and ED utilization, suggesting that facilitating language concordance between patients and physicians may lead to lower cost, more appropriate use of healthcare resources.
The Health Care System Is Shortchanging Non-English Speakers
Chandrashekar, P.
Publication: Scientific American
Date: July 2021
The COVID-19 crisis has demonstrated the innumerable ways our health care system falls short in caring for non-English speaking patients. Much of the discussion to date has focused on interpreters, but we need to redesign each part of a non-English-speaking patient’s experience with the health care system—before, during and after an appointment. This involves rethinking how patients access health info in their native language, matching patients with language-concordant clinicians, and turning discharge planning into a conversation that patients can actually participate in. It means supporting patients throughout the healthcare continuum, not just at the point of care.
Stopping the Flood: Reducing Harmful Cascades of Care
Chandrashekar, P., Fendrick, AM., Ganguli, I.
Publication: The American Journal of Managed Care
Date: April 2021
Cascades of care are common and can lead to significant harms for patients, clinicians, and the health care system at large. In this commentary, we argue that there are 2 ways to reduce cascades: decrease the use of unnecessary services that often initiate cascades (ie, close the floodgates) and mitigate cascades once they begin (ie, slow the flow through the floodgates). So far, most efforts to address cascades have focused on identifying, measuring, and educating clinicians on low-value services, with only modest success. We explore potential solutions for both closing the floodgates and slowing a cascade once the floodgates have been opened, including information to assist patients and clinicians in making better decisions, relationships that enable shared decision-making, and policy changes.
Harnessing Trainees to Address Language Barriers During COVID-19
Chandrashekar, P.
Publication: Academic Medicine
Date: March 2021
Around the country, the lack of multilingual COVID-19 materials and interpreters has left non-native English speakers feeling alone, confused, and without proper care. Though long-term measures to address language barriers to health information delivery, such as policy mandates to support those with limited English proficiency and expand language services in hospitals, are critical, there is a compelling need for short-term measures to close these gaps during the COVID-19 crisis. Trainees are well-equipped to serve in this role.
Implementing a Targeted Approach to Social Determinants of Health Interventions
Jain, SH., Chandrashekar, P.
Publication: The American Journal of Managed Care
Date: December 2020
The scale of the coronavirus disease 2019 pandemic and its disproportionate impact on vulnerable populations has spurred unprecedented focus on and investment in social determinants of health (SDOH). Although the greater focus on social determinants is laudable and necessary, there is a tendency for health care organizations to implement SDOH programs at scale without rigorous evidence of effect, rather than targeting interventions to specific patients and assessing their impact. This broad, and sometimes blind, application of SDOH interventions can be costly and wasteful. We argue for rejecting the "more is better" mindset and specifically targeting patients who truly need and would substantially benefit from SDOH interventions.
Addressing Patient Bias and Discrimination Against Clinicians of Diverse Backgrounds
Chandrashekar, P., Jain, SH.
Publication: Academic Medicine
Date: September 2020
The duty to care for all patients is central to the health professions, but what happens when clinicians encounter patients who exhibit biased or discriminatory behaviors? In this paper, we discuss the ethical dilemmas associated with responding to prejudiced patients and then present a framework for clinicians to use when directly facing or witnessing biased behavior from patients. Finally, we describe strategies to address patient bias at the institutional level.
5 Obstacles to Home-Based Health Care, and How to Overcome Them
Chandrashekar, P., Moodley, S., Jain, SH.
Publication: Harvard Business Review
Date: October 2019
One of the most promising opportunities to improve care and lower costs is the move of care delivery to the home. An increasing number of new and established organizations are launching and scaling models to move primary, acute, and palliative care to the home. For frail and vulnerable patients, home-based care can forestall the need for more expensive care in hospitals and other institutional settings. There are tremendous opportunities to improve care through these home-based care models, but there are significant risks and challenges to their broader adoption.
Eliminating Barriers to Virtual Care: Implementing Portable Medical Licensure
Chandrashekar, P., Jain, SH.
Publication: The American Journal of Managed Care
Date: October 2019
Telemedicine offers a promising solution to the growing physician shortage, but state-based medical licensing poses a significant barrier to the widespread adoption of telemedicine services. We thus recommend a mutual recognition scheme whereby states honor each other’s medical licenses. Reforming the United States’ outdated system of state-based medical licensure can help meet patient demand for virtual care services and improve access to care in rural and medically underserved areas.
A Digital Health Preclinical Requirement for Medical Students
Chandrashekar, P.
Publication: Academic Medicine
Date: June 2019
Digital health is gaining momentum within clinical practice but remains poorly understood by many physicians. Though medical schools have a responsibility to prepare students for an increasingly digitized health care system, few integrate digital health training into required curricula. To address these gaps, medical schools should consider creating a digital health preclinical requirement. As the environment of medicine changes, so must the training of future physicians.
Impact of a Student-Run Clinic on Emergency Department Utilization
Thakkar, A., Chandrashekar, P., Blanchfield, B.
Publication: Family Medicine
Date: March 2019
Student-run clinics (SRCs) provide primary care access to low-income patients who would otherwise pursue more expensive care, such as visits to emergency departments (ED). Decreasing inappropriate ED utilization offers an opportunity to create value in the health care system. However, to date, no SRC has rigorously studied this. This study examines whether increased access to ambulatory care through an SRC, the Crimson Care Collaborative (CCC), is associated with decreased ED utilization, providing value to payers and providers, and justifying investment in SRCs. We find that CCC created value to payers and providers by providing a lower-cost source of care and increasing ED capacity for more emergent and appropriate care.
Understanding and Fixing the Growing Divide Between Physicians and Healthcare Administrators
Chandrashekar, P., Jain, SH.
Publication: The Journal of Medical Practice Management
Date: March 2019
Bridging the gap between physicians and healthcare administrators is crucial to reducing physician burnout, improving patient outcomes, and advancing value-based care. To begin solving the seemingly intractable problems facing U.S. healthcare, organizations must mend the fractured physician–administrator relationship. We propose that cultivating mutual understanding can achieve this goal. Strategies to increase physician administrator alignment must center on teaching both groups to walk in each other’s shoes. These strategies require physicians, administrators, and institutions to come together and collaborate toward a common vision.
Improving High-Risk Patient Care through Chronic Disease Prevention and Management
Chandrashekar, P., Jain, SH.
Publication: The Journal of Law, Medicine, and Ethics
Date: September 2018
The value of high-risk pools remains an ongoing debate among policymakers. In this paper, we articulate an alternate vision for managing high-risk patients and reducing the costs of chronic disease. We argue that, rather than separating high-risk patients, the solution to high-risk patient care is implementing clinical models that focus on chronic disease prevention and management, payment models that enable health systems to invest in care management models, and insurance models that incentivize preventative behaviors.
The Case for Product Management Education in Clinical Training
Chandrashekar, P., Thakkar, A.
Publication: New England Journal of Medicine Catalyst
Date: March 2018
The communication gap between physicians and engineers is widely acknowledged, and often leads to the creation of technologies that do not address a true clinical need or fit within clinical workflow, consequently failing to garner the physician support required for widespread adoption. How can physicians learn to speak the language of innovation and claim a role for themselves within the innovation ecosystem? We suggest integrating product management education into the clinical curriculum.
Do mental health mobile apps work: evidence and recommendations for designing high-efficacy mental health mobile apps
Chandrashekar, P.
Publication: mHealth
Date: March 2018
Smartphone-based mental health apps represent a unique opportunity to expand the availability and quality of mental health treatment. In this paper, we present four recommendations for high-efficacy mental health apps, including high patient engagement, simple user interface and experience, transdiagnostic capabilities, and self-monitoring features.
Exploring online communication about cigarette smoking among Twitter users who self-identify as having schizophrenia
Hswen, Y., Naslund, J., Chandrashekar, P., Siegel, R., Brownstein, J., Hawkins, J.
Publication: Psychiatry Research
Date: August 2017
Novel approaches are needed to address elevated tobacco use among people with schizophrenia. This study examined the frequency, timing, and type of communication about tobacco-related content on Twitter among users who self-identify as having schizophrenia compared with healthy users. Users with schizophrenia posted significantly more tweets containing tobacco-related terms compared with control users, suggesting that online communication about tobacco may parallel real world trends of elevated tobacco use observed among people with schizophrenia. Social media could thus inform smoking cessation efforts targeting this at-risk group.