David A Asch

University of Pennsylvania, Philadelphia, Pennsylvania, United States

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Publications (241)1997.35 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: In October 2013, multiple United States (US) federal health departments and agencies posted on Twitter, "We're sorry, but we will not be tweeting or responding to @replies during the shutdown. We'll be back as soon as possible!" These "last tweets" and the millions of responses they generated revealed social media's role as a forum for sharing and discussing information rapidly. Social media are now among the few dominant communication channels used today. We used social media to characterize the public discourse and sentiment about the shutdown. The 2013 shutdown represented an opportunity to explore the role social media might play in events that could affect health. (Am J Public Health. Published online ahead of print October 16, 2014: e1-e3. doi:10.2105/AJPH.2014.302118).
    American journal of public health. 10/2014;
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    ABSTRACT: Objectives. We sought to explore the feasibility of using a crowdsourcing study to promote awareness about automated external defibrillators (AEDs) and their locations. Methods. The Defibrillator Design Challenge was an online initiative that asked the public to create educational designs that would enhance AED visibility, which took place over 8 weeks, from February 6, 2014, to April 6, 2014. Participants were encouraged to vote for AED designs and share designs on social media for points. Using a mixed-methods study design, we measured participant demographics and motivations, design characteristics, dissemination, and Web site engagement. Results. Over 8 weeks, there were 13 992 unique Web site visitors; 119 submitted designs and 2140 voted. The designs were shared 48 254 times on Facebook and Twitter. Most designers-voters reported that they participated to contribute to an important cause (44%) rather than to win money (0.8%). Design themes included: empowerment, location awareness, objects (e.g., wings, lightning, batteries, lifebuoys), and others. Conclusions. The Defibrillator Design Challenge engaged a broad audience to generate AED designs and foster awareness. This project provides a framework for using design and contest architecture to promote health messages. (Am J Public Health. Published online ahead of print October 16, 2014: e1-e7. doi:10.2105/AJPH.2014.302211).
    American journal of public health. 10/2014;
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    ABSTRACT: Background. Financial incentives and peer networks could be delivered through eHealth technologies to encourage older adults to walk more. Methods. We conducted a 24-week randomized trial in which 92 older adults with a computer and Internet access received a pedometer, daily walking goals, and weekly feedback on goal achievement. Participants were randomized to weekly feedback only (Comparison), entry into a lottery with potential to earn up to $200 each week walking goals were met (Financial Incentive), linkage to four other participants through an online message board (Peer Network), or both interventions (Combined). Main outcomes were the proportion of days walking goals were met during the 16-week intervention and 8-week follow-up. We conducted a content analysis of messages posted by Peer Network and Combined arm participants. Results. During the 16-week intervention, there were no differences in the proportion of days walking goals were met in the Financial Incentive (39.7%; p = .78), Peer Network (24.9%; p = .08), and Combined (36.0%; p = .77) arms compared with the Comparison arm (36.0%). During 8 weeks of follow-up, the proportion of days walking goals were met was lower in the Peer Network arm (18.7%; p = .025) but not in the Financial Incentive (29.3%; p = .50) or Combined (24.8%; p = .37) arms, relative to the Comparison arm (34.5%). Messages posted by participants focused on barriers to walking and provision of social support. Conclusions. Financial incentives and peer networks delivered through eHealth technologies did not result in older adults walking more.
    Health education & behavior : the official publication of the Society for Public Health Education. 10/2014; 41(1 Suppl):43S-50S.
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    ABSTRACT: To characterise defibrillation and cardiac arrest survival outcomes in movies.
    Resuscitation 09/2014; · 4.10 Impact Factor
  • David A Asch, Debra F Weinstein
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    ABSTRACT: On July 29, 2014, the Institute of Medicine (IOM) released its report on the governance and financing of graduate medical education (GME).(1) An important incidental finding of the IOM's study was that the evidence base available to inform future directions for the substance, organization, and financing of GME is quite limited. The limited evidence reflects a systematic lack of research investment in an area of health care that we believe deserves better. Our nation's lack of research in medical education contrasts starkly with the large and essential commitment to biomedical research funded by industry, philanthropic organizations, and the public. No . . .
    New England Journal of Medicine 07/2014; · 54.42 Impact Factor
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    ABSTRACT: Social media has been embraced as a tool for public health promotion.(1-6) However, effective strategies for harnessing the capabilities of social media remain unclear.(7-9) For example, many state and local health departments have adopted Facebook and Twitter accounts, yet public engagement with these accounts varies.(10-12) Several Web-based interventions for smoking cessation have been developed, but few tobacco prevention Web sites allow users to share links via social media.(13,14) While YouTube videos with health messages have amassed millions of views, such as a popular video targeting soft drink consumption, their long-term impact is difficult to evaluate.(15,16) In general, innovative approaches to disseminating health information must be developed to match the behavior and expectations of the public.(17) (Am J Public Health. Published online ahead of print July 17, 2014: e1-e3. doi:10.2105/AJPH.2014.302088).
    American journal of public health. 07/2014;
  • Annals of internal medicine 07/2014; · 13.98 Impact Factor
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    ABSTRACT: The purpose of this study was to describe clinicians' perceptions of interprofessional collaboration in the intensive care unit and identify factors associated with interprofessional collaboration. We performed 64 semi-structured interviews in seven hospitals with ICU nurses, physicians, respiratory therapists, nurse managers, clinical pharmacists, and dieticians. ICU clinicians perceived two distinct types of facilitators to interprofessional collaboration in critical care: cultural and structural. In the critical care setting, cultural and structural facilitators worked independently as well as in concert to create effective interprofessional collaboration. Initiatives aimed at creating and facilitating interprofessional collaboration should focus attention on cultural and structural facilitators to improve patient care and team effectiveness. © 2014 Wiley Periodicals, Inc.
    Research in Nursing & Health 07/2014; · 2.18 Impact Factor
  • Shivan J Mehta, David A Asch
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 05/2014; 12(5):711-4. · 5.64 Impact Factor
  • Shivan J Mehta, David A Asch
    Cleveland Clinic Journal of Medicine 03/2014; 81(3):173-5. · 3.40 Impact Factor
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    ABSTRACT: Home wireless device monitoring could play an important role in improving the health of patients with poorly controlled chronic diseases, but daily engagement rates among these patients may be low. To test the effectiveness of two different magnitudes of financial incentives for improving adherence to remote-monitoring regimens among patients with poorly controlled diabetes. Randomized, controlled trial. (Clinicaltrials.gov Identifier: NCT01282957). Seventy-five patients with a hemoglobin A1c greater than or equal to 7.5 % recruited from a Primary Care Medical Home practice at the University of Pennsylvania Health System. Twelve weeks of daily home-monitoring of blood glucose, blood pressure, and weight (control group; n = 28); a lottery incentive with expected daily value of $2.80 (n = 26) for daily monitoring; and a lottery incentive with expected daily value of $1.40 (n = 21) for daily monitoring. Daily use of three home-monitoring devices during the three-month intervention (primary outcome) and during the three-month follow-up period and change in A1c over the intervention period (secondary outcomes). Incentive arm participants used devices on a higher proportion of days relative to control (81 % low incentive vs. 58 %, P = 0.007; 77 % high incentive vs. 58 %, P = 0.02) during the three-month intervention period. There was no difference in adherence between the two incentive arms (P = 0.58). When incentives were removed, adherence in the high incentive arm declined while remaining relatively high in the low incentive arm. In month 6, the low incentive arm had an adherence rate of 62 % compared to 35 % in the high incentive arm (P = 0.015) and 27 % in the control group (P = 0.002). A daily lottery incentive worth $1.40 per day improved monitoring rates relative to control and had significantly better efficacy once incentives were removed than a higher incentive.
    Journal of General Internal Medicine 02/2014; · 3.28 Impact Factor
  • Shivan J. Mehta, David A. Asch
    Clinical Gastroenterology and Hepatology. 01/2014; 12(5):711–714.
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    ABSTRACT: Purpose To present the principles and rationale of the Proton Priority System (PROPS), a priority points framework that assigns higher scores to patients thought to more likely benefit from proton therapy, and the distribution of PROPS scores by patient characteristics Methods and Materials We performed multivariable logistic regression to evaluate the association between PROPS scores and receipt of proton therapy, adjusted for insurance status, gender, race, geography, and the domains that inform the PROPS score. Results Among 1529 adult patients considered for proton therapy prioritization during our Center's ramp-up phase of treatment availability, PROPS scores varied by age, diagnosis, site, and other PROPS domains. In adjusted analyses, receipt of proton therapy was lower for patients with non-Medicare relative to Medicare health insurance (commercial vs Medicare: adjusted odds ratio [OR] 0.47, 95% confidence interval [CI] 0.34-0.64; managed care vs Medicare: OR 0.40, 95% CI 0.28-0.56; Medicaid vs Medicare: OR 0.24, 95% CI 0.13-0.44). Proton Priority System score and age were not significantly associated with receipt of proton therapy. Conclusions The Proton Priority System is a rationally designed and transparent system for allocation of proton therapy slots based on the best available evidence and expert opinion. Because the actual allocation of treatment slots depends mostly on insurance status, payers may consider incorporating PROPS, or its underlying principles, into proton therapy coverage policies.
    International journal of radiation oncology, biology, physics 01/2014; · 4.59 Impact Factor
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    ABSTRACT: The goal of medical education is the production of a workforce capable of improving the health and health care of patients and populations, but it is hard to use a goal that lofty, that broad, and that distant as a standard against which to judge the success of schools or training programs or particular elements within them. For that reason, the evaluation of medical education often focuses on elements of its structure and process, or on the assessment of competencies that could be considered intermediate outcomes. These measures are more practical because they are easier to collect, and they are valuable when they reflect activities in important positions along the pathway to clinical outcomes. But they are all substitutes for measuring whether educational efforts produce doctors who take good care of patients.The authors argue that the evaluation of medical education can become more closely tethered to the clinical outcomes medical education aims to achieve. They focus on a specific clinical outcome-maternal complications of obstetrical delivery-and show how examining various observable elements of physicians' training and experience helps reveal which of those elements lead to better outcomes. Does it matter where obstetricians trained? Does it matter how much experience they have? Does it matter how good they were to start? Each of these questions reflects a component of the production of a good obstetrician and, most important, defines a good obstetrician as one whose patients in the end do well.
    Academic medicine: journal of the Association of American Medical Colleges 11/2013; · 2.34 Impact Factor
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    ABSTRACT: To use the natural experiment of health insurance reform in Massachusetts to study the impact of increased insurance coverage on ICU utilization and mortality. Population-based cohort study. Massachusetts and four states (New York, Washington, Nebraska, and North Carolina) that did not enact reform. All nonpregnant nonelderly adults (age 18-64 yr) admitted to nonfederal acute care hospitals in one of the five states of interest were eligible, excluding patients who were not residents of a respective state at the time of admission. We used a difference-in-differences approach to compare trends in ICU admissions and outcomes of in-hospital mortality and discharge destination for ICU patients. Healthcare reform in Massachusetts was associated with a decrease in ICU patients without insurance from 9.3% to 5.1%. There were no significant changes in adjusted ICU admission rates, mortality, or discharge destination. In a sensitivity analysis excluding a state that enacted Medicaid reform prior to the study period, our difference-in-differences analysis demonstrated a significant increase in mortality of 0.38% per year (95% CI, 0.12-0.64%) in Massachusetts, attributable to a greater per-year decrease in mortality postreform in comparison states (-0.37%; 95% CI, -0.52% to -0.21%) compared with Massachusetts (0.01%; 95% CI, -0.20% to 0.11%). Massachusetts healthcare reform increased the number of ICU patients with insurance but was not associated with significant changes in ICU use or discharge destination among ICU patients. Reform was also not associated with changed in-hospital mortality for ICU patients; however, this association was dependent on the comparison states chosen in the analysis.
    Critical care medicine 11/2013; · 6.37 Impact Factor
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    ABSTRACT: On October 1, 2013, without a continuing resolution in place to support its budget, the U.S. federal government partially closed. One of many effects of the government shutdown was the defunding of the Children's Hospitals Graduate Medical Education (CHGME) Payment Program. Fifty-five freestanding children's hospitals currently receive CHGME funds. These hospitals train almost 30% of the general pediatricians, 44% of the pediatric medical and surgical subspecialists, and the majority of the pediatric physician-researchers in the United States.(1),(2) Capable of providing highly specialized care for pediatric patients with complex and acute conditions, freestanding children's hospitals are at the apex of . . .
    New England Journal of Medicine 10/2013; · 54.42 Impact Factor
  • David A Asch, Sean Nicholson, Marko Vujicic
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    ABSTRACT: In November 1636, the prices of tulip bulbs in the Dutch market rose rapidly from their normal level to the point where a single bulb might sell for 10 times the annual earnings of a typical worker. Just as quickly, in May 1637, tulip-bulb prices returned to their previous values. The causes of this dramatic rise and fall remain in dispute. The event occurred during the Dutch Golden Age, when stock exchanges, central banking, and many of the fundamental structures that govern contemporary capital markets and the approaches deployed by MBAs today were developed. One modern economic analysis suggests that . . .
    New England Journal of Medicine 10/2013; · 54.42 Impact Factor
  • Alison M Buttenheim, David A Asch
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    ABSTRACT: Herd immunity against vaccine-preventable diseases is a public good because it is both non-excludable (meaning that there is no way to exclude people from using it) and non-rivalrous (meaning that one person's use does not limit or restrict others' use). Like other public goods, such as lighthouses, street lights and national defense, herd immunity is vulnerable to the "free rider" problem. We discuss four conventional responses to the free rider problem (participation mandates, exclusion, incentives, and social norms) and highlight how a public good perspective can inform the design of interventions to increase vaccine acceptance.
    Human vaccines & immunotherapeutics. 10/2013; 9(12).
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    ABSTRACT: Rationale: The aging population may strain intensive care unit (ICU) capacity and adversely affect patient outcomes. Existing fluctuations in demand for ICU care offer an opportunity to explore such relationships. Objectives: To determine whether transient increases in ICU strain influence patient mortality, and identify characteristics of ICUs that are resilient to surges in capacity strain. Methods: Retrospective cohort study of 264,401 patients admitted to 155 U.S. ICUs from 2001-2008. We used logistic regression to examine relationships of measures of ICU strain (census, average acuity, and proportion of new admissions) near the time of ICU admission with mortality. Measurements and Main Results: 36,465 (14%) patients died in the hospital. ICU census on the day of a patient's admission was associated with increased mortality (OR: 1.02 per SD-unit increase (95% CI: 1.00, 1.03)). This effect was greater among ICUs employing closed (OR: 1.07 (95% CI: 1.02, 1.12)) versus open (OR: 1.01 (95% CI: 0.99, 1.03)) physician staffing models (interaction p-value=0.02). The relationship between census and mortality was stronger when the census was comprised of higher acuity patients (interaction p-value<0.01). Averaging strain over the first three days of patients' ICU stays yielded similar results except that the proportion of new admissions was now also associated with mortality (OR: 1.04 for each 10% increase (95% CI: 1.02, 1.06)). Conclusions: Several sources of ICU strain are associated with small but potentially important increases in patient mortality, particularly in ICUs employing closed staffing models. Although closed ICUs may promote favorable outcomes under static conditions, they are susceptible to being overwhelmed by patient influxes.
    American Journal of Respiratory and Critical Care Medicine 08/2013; · 11.04 Impact Factor
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    ABSTRACT: IMPORTANCE As health information technology grows, secondary uses of personal health information offer promise in advancing research, public health, and health care. Public perceptions about sharing personal health data are important for establishing and evaluating ethical and regulatory structures to oversee the use of these data. OBJECTIVE To measure patient preferences about sharing their electronic health information for secondary purposes (other than their own health care). DESIGN, SETTING, AND PARTICIPANTS In this conjoint analysis study, we surveyed 3336 adults (568 Hispanic, 500 non-Hispanic African American, and 2268 non-Hispanic white); participants were randomized to 6 of 18 scenarios describing secondary uses of electronic health information, constructed with 3 attributes: uses (research, quality improvement, or commercial marketing), users (university hospitals, commercial enterprises, or public health departments), and data sensitivity (whether it included genetic information about their own cancer risk). This design enabled participants to reveal their preferences for secondary uses of their personal health information. MAIN OUTCOMES AND MEASURES Participants responded to each conjoint scenario by rating their willingness to share their electronic personal health information on a 1 to 10 scale (1 represents low willingness; 10, high willingness). Conjoint analysis yields importance weights reflecting the contribution of a dimension (use, user, or sensitivity) to willingness to share personal health information. RESULTS The use of data was a more important factor in the conjoint analysis (importance weight, 64.3%) than the user (importance weight, 32.6%) and data sensitivity (importance weight, 3.1%). In unadjusted linear regression models, marketing uses (β = -1.55), quality improvement uses (β = -0.51), drug company users (β = -0.80), and public health department users (β = -0.52) were associated with less willingness to share health information than research uses and university hospital users (all P < .001). Hispanics and African Americans differentiated less than whites between uses. CONCLUSIONS AND RELEVANCE Participants cared most about the specific purpose for using their health information, although differences were smaller among racial and ethnic minorities. The user of the information was of secondary importance, and the sensitivity was not a significant factor. These preferences should be considered in policies governing secondary uses of health information.
    JAMA Internal Medicine 08/2013; · 13.25 Impact Factor

Publication Stats

5k Citations
1,997.35 Total Impact Points

Institutions

  • 1993–2014
    • University of Pennsylvania
      • • Department of Radiation Oncology
      • • Center for Health Equity Research
      • • Department of Medicine
      • • Center for Bioethics
      • • The Wharton School
      • • Division of General Internal Medicine
      Philadelphia, Pennsylvania, United States
  • 2012
    • Dartmouth College
      Hanover, New Hampshire, United States
  • 2007–2012
    • U.S. Department of Veterans Affairs
      • Center for Health Equity Research and Promotion (CHERP)
      Washington, Washington, D.C., United States
  • 1998–2012
    • Carnegie Mellon University
      • • Department of Social and Decision Sciences
      • • Department of Engineering and Public Policy
      Pittsburgh, PA, United States
  • 1991–2012
    • Hospital of the University of Pennsylvania
      • • Department of Biostatistics and Epidemiology
      • • Department of Medicine
      • • Department of Obstetrics and Gynecology
      • • Department of General Internal Medicine
      Philadelphia, Pennsylvania, United States
  • 2011
    • University of Pittsburgh
      • Section of Palliative Care and Medical Ethics
      Pittsburgh, PA, United States
  • 2010
    • Robert Wood Johnson Foundation
      Princeton, New Jersey, United States
  • 2009
    • University of North Texas HSC at Fort Worth
      • Department of Health Management and Policy
      Fort Worth, TX, United States
  • 2001–2009
    • University of Michigan
      • Division of Pulmonary and Critical Care Medicine
      Ann Arbor, MI, United States
  • 2008
    • University of Texas - Pan American
      • Department of Economics & Finance
      Edinburg, Texas, United States
  • 2001–2008
    • The Philadelphia Center
      • Philadelphia Veterans Administration Medical Center
      Philadelphia, Pennsylvania, United States
  • 2006
    • National Institute on Aging
      Baltimore, Maryland, United States
  • 2004
    • University of Toledo
      • Division of General Internal Medicine
      Toledo, OH, United States
  • 2003
    • Johns Hopkins University
      • Division of General Internal Medicine
      Baltimore, MD, United States
  • 2002
    • Treatment Research Institute, Philadelphia PA
      Philadelphia, Pennsylvania, United States
  • 1999
    • University of Toronto
      Toronto, Ontario, Canada
  • 1995–1997
    • Minneapolis Veterans Affairs Hospital
      Minneapolis, Minnesota, United States
    • University of Chicago
      • Section of General Internal Medicine
      Chicago, IL, United States
  • 1996
    • Spokane VA Medical Center
      Spokane, Washington, United States
    • University of Miami
      • Department of Management
      Coral Gables, FL, United States