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This paper describes the qualitative results of the mixed-methods study by Eggleston and her colleagues. For the quantitative results of the study, read the April 2021 paper in the journal BMC Public Health. Also, watch and read our full story and interview with Eggleston.

Objective

People with chronic conditions are known to be vulnerable to the COVID-19 pandemic. This study aims to describe patients’ lived experiences, challenges faced by people with chronic conditions, their coping strategies, and the social and economic impacts of the COVID-19 pandemic.
 

Design, Setting, and participants

We conducted a qualitative study using a syndemic framework to understand the patients’ experiences of chronic disease care, challenges faced during the lockdown, their coping strategies and mitigators during the COVID-19 pandemic in the context of socioecological and biological factors. A diverse sample of 41 participants with chronic conditions (hypertension, diabetes, stroke, and cardiovascular diseases) from four sites (Delhi, Haryana, Vizag, and Chennai) in India participated in semistructured interviews. All interviews were audio-recorded, transcribed, translated, anonymized and coded using MAXQDA software. We used the framework method to qualitatively analyze the COVID-19 pandemic impacts on health, social and economic well-being.
 

Results

Participant experiences during the COVID-19 pandemic were categorized into four themes: challenges faced during the lockdown, experiences of the participants diagnosed with COVID-19, preventive measures taken, and lessons learned during the COVID-19 pandemic. A subgroup of participants faced difficulties in accessing healthcare while a few reported using teleconsultations. Most participants reported the adverse economic impact of the pandemic which led to higher reporting of anxiety and stress. Participants who tested COVID-19 positive reported experiencing discrimination and stigma from neighbors. All participants reported taking essential preventive measures.
 

Conclusion

People with chronic conditions experienced a confluence (reciprocal effect) of COVID-19 pandemic and chronic diseases in the context of difficulty in accessing healthcare, sedentary lifestyle, and increased stress and anxiety. Patients’ lived experiences during the pandemic provide important insights to inform effective transition to a mixed realm of online consultations and ‘distanced’ physical clinic visits.

 

Karen Eggleston 4X4

Karen Eggleston, PhD

Senior Fellow at FSI, Director of the Asia Health Policy Program at Shorenstein Asia-Pacific Research Center
Full Biography
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Publication Type
Journal Articles
Publication Date
Subtitle
A Qualitative Study
Journal Publisher
BMJ Open
Authors
Kavita Singh
Aprajita Kaushik
Leslie Johnson
Suganthi Jaganathan
Prashant Jarhyan
Mohan Deepa
Sandra Kong
Nikhil Srinivasapura Venkateshmurthy
Dimple Kondal
Sailesh Mohan
Ranjit Mohan Anjana
Mohammed K Ali
Nikhil Tandon
K M Venkat Narayan
Viswanathan Mohan
Karen Eggleston
Dorairaj Prabhakaran1
Number
2021;11:e048926
1
CDDRL Postdoctoral Scholar, 2021-22
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I am a political scientist (PhD degree expected in July 2021 from Harvard) working on political parties, social welfare policies and local governance, primarily in the Middle East and North Africa. My dissertation project focuses on secular parties in the region and explores why they could not form a robust electoral alternative to the Islamist parties in the post-uprisings period. In other projects, I explore voters' responses to executive aggrandizement (focusing on Turkey), and social welfare in the context of ethnic and organizational diversity (focusing on Lebanon). Prior to PhD, I worked as an education policy analyst in Turkey, managing several research projects in collaboration with the Ministry of Education, World Bank and UNICEF. I hold a BA degree in Political Science from Boğaziçi, and Master's degrees from the LSE and Brown. 

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Now that a third COVID-19 vaccine has been given emergency-use authorization, Michelle Mello and colleagues ask whether individuals should be able to choose which vaccine they receive.
Journal Publisher
The New England Journal of Medicine
Authors
Daniel B. Kremer
Douglas J. Opel
Efthimios Parasidis
Michelle Mello
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Pascal Geldsetzer, PhD 
Assistant Professor of Medicine in the Division of Primary Care and Population Health

Title:  Regression Discontinuity in Electronic Health Record Data

Abstract: Regression discontinuity in electronic health record (EHR) data combines the main advantage of randomized controlled trials (causal inference without needing to adjust for confounders) with the large size, low cost, and representativeness of observational studies in routinely collected medical data. Regression discontinuity could be an important tool to help clinical medicine move away from a “one size fits all” approach because, along with the increasing size and availability of EHR data, it would allow for a rigorous examination of how treatment effects vary across highly granular patient subgroups. In addition, given the broad range of health outcomes recorded in EHR data, this design could be used to systematically test for a wide range of unexpected beneficial and adverse health effects of different treatments. I will talk about the broad motivation for this research and discuss examples from some of our ongoing work in this area. If there is time, I will also discuss some of my ongoing research on improving healthcare services for chronic conditions in low- and middle-income country settings. 

Zoom Meeting

Register in advance for this meeting:
https://stanford.zoom.us/meeting/register/tJYpcO2ppzooGNdbf8o1OxXNUWd3rukNEb7i 

After registering, you will receive a confirmation email containing information about joining the meeting.

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Alyce S. Adams, PhD 
Professor of Medicine, Stanford's Center for Health Policy & Center for Primary Care and Outcomes Research
Professor of Epidemiology and Population Health in the Stanford School of Medicine 
Associate Director for Health Equity and Community Engagement in the Stanford Cancer Institute 

Title: Health Policy and the Fight for Equitable Healthcare Outcomes: Why Access Isn’t Enough

Abstract: Using evidence from evaluations of natural experiments, Alyce Adams will discuss the intended and unintended consequences of changes in prescription drug policy at the state and federal level of low income and minority individuals with multiple chronic conditions. We will explore the potential for policy effects to have an immediate and dramatic increase in access to clinically essential treatments. However, she will also discuss where such policies can widen, rather than reduce disparities in treatment. We concluded that increasing access (while critical) is not sufficient to address inequities in treatment use and outcomes among high risk populations. Importantly, new strategies are needed to inform the design of policy interventions that promote access, while simultaneously advancing health equity.

Register in advance for this meeting:
https://stanford.zoom.us/meeting/register/tJcsf-6pqDwtH93u_yfFbEkV_XIbJ2gai0FV  

After registering, you will receive a confirmation email containing information about joining the meeting.

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Stanford Medicine Innovation Professor
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PhD, MPP

Alyce Adams is a Professor of Epidemiology and Population Health in the Stanford School of Medicine, as well as Associate Director for Health Equity and Community Engagement in the Stanford Cancer Institute. Focusing on racial and socioeconomic disparities in chronic disease treatment outcomes, Dr. Adams' interdisciplinary research seeks to evaluate the impact of changes in drug coverage policy on access to essential medications, understand the drivers of disparities in treatment adherence among insured populations, and test strategies for maximizing the benefits of treatment outcomes while minimizing harms through informed decision-making. Prior to joining Stanford School of Medicine, Dr. Adams was Associate Director for Health Care Delivery and Policy and a Research Scientist at the Kaiser Permanente Division of Research, as well as a Professor at the Bernard J. Tyson Kaiser Permanente School of Medicine. From 2000 to 2008, she was an Assistant Professor in the Department of Population Medicine (formerly Ambulatory Care and Prevention) at Harvard Medical School and Harvard Pilgrim Health care. She received her PhD in Health Policy and an MPP in Social Policy from Harvard University. She is Vice Chair of the Board of Directors for AcademyHealth and a former recipient of the John M. Eisenberg Excellence in Mentoring Award from Agency for Healthcare Research and Quality and an invited lecturer on racial disparities in health care in the 2014/2015 National Institute of Mental Health Director’s Innovation Speaker Series.

Professor, Epidemiology and Population Health
Professor, Health Policy
Professor, Pediatrics (by courtesy)
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Authors
Noa Ronkin
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News
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Technological progress boosts productivity and has made societies wealthier, but the impact of new digital technologies could be different from anything seen before. Some experts predict a future with robots and other forms of automation increasingly replacing workers, contributing to stagnant income, and worsening inequality. Yet it is difficult to pinpoint the net impact of advanced technologies on labor. There is anecdotal evidence that robotics and automation reduce manufacturing employment and wages, but evidence from the service sector remains scant. Collaborative research by APARC experts is now starting to fill this gap.

The researchers — including Karen Eggleston, APARC deputy director and director of the Asia Health Policy Program (AHPP), Yong Suk Lee, the deputy director of the Korea Program, and University of Tokyo health economist Toshiaki Iizuka, a former AHPP visiting scholar — set out to probe the impact of robots on services provided in nursing homes in Japan. Their study, one of the first investigations of service sector robots, offers an offset to the dystopian predictions of robot job replacement.

Published by the National Bureau of Economic Research, the study suggests that robot adoption has increased employment opportunities for non-regular care workers, helped mitigate the turnover problem that plagues nursing homes, and provided greater flexibility for workers. It is also published in AHPP's working paper series and is part of a broader research project by Eggleston, Lee, and Iizuka, that explores the impact of robots on nursing home care in Japan and the implications of robotic technologies adoption in aging societies.

Since we are currently still in the early phase of robot diffusion in the service sector, researchers and policymakers need to continue to monitor and assess the extent to which robots complement or augment some types of labor while substituting for others.
Eggleston, Lee, and Iizuka

[Subscribe to APARC's newsletters for the latest analysis from our experts.]

Japan has been on the front lines of a demographic crisis, grappling with a declining overall population, increasing proportion of seniors, and aversion to large-scale immigration. It has also been an early adopter of robots to address the shortage of care workers relative to a growing demand for long-term care services. Japan’s experience is especially instructive as more countries face aging populations, helping shed light on how demographics interact with new automation technologies.

In a VoxEU.org article, Eggleston, Lee, and Iizuka describe their study, its findings, and its implications. Examining the relationship between robot adoption and nursing home staffing in Japan, they find that robot-adopting nursing homes had between 3% and 8% more staff than their non-adopting counterparts. The increases in staffing occurred entirely among the non-regular employees. Nursing homes with robots also appeared to have higher management quality and were better able to reduce the burden on care workers. The results suggest “that the wave of technologies that inspires fear in many countries could help remedy the social and economic challenges posed by population aging in others.”

The Financial Times Magazine has recently featured the study by Eggleston, Lee, and Iizuka, calling it “groundbreaking in several ways but perhaps most clearly for setting its sights not on manufacturing but on the services sector, where robots are only just beginning to make their mark.” The great value of the study, the article notes, is that it lays the foundation for an empirical debate “on a subject that will be deluged with human emotion as robots continue their march into the services sector.”

You can also listen to a Financial Times podcast that features the new study (the segment starts at 4:52).

Read More

Male Japanese doctor showing senior patient records on a clipboard
News

Health Signals Increase Preventive Care, Improve Health Outcomes for Individuals at High Risk of Diabetes, Evidence from Japan Shows

Among the general population, however, researchers including Asia Health Policy Program Director Karen Eggleston find no evidence that additional care improves health outcomes.
Health Signals Increase Preventive Care, Improve Health Outcomes for Individuals at High Risk of Diabetes, Evidence from Japan Shows
A man with interacts with 'Emiew,' a humanoid robot.
News

“Co-Bots,” Not Overlords, Are the Future of Human-Robot Labor Relationships

Yong Suk Lee and Karen Eggleston’s ongoing research into the impact of robotics and AI in different industries indicates that integrating tech into labor markets adjusts, but doesn’t replace, the long-term roles of humans and robots.
“Co-Bots,” Not Overlords, Are the Future of Human-Robot Labor Relationships
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Subtitle

In one of the first studies of service sector robotics, APARC scholars examine the impacts of robots on nursing homes in Japan. They find that robot adoption may not be detrimental to labor and may help address the challenges of rapidly aging societies.

0
Stanford Medicine Innovation Professor
alyce_profile_2022.jpg
PhD, MPP

Alyce Adams is a Professor of Epidemiology and Population Health in the Stanford School of Medicine, as well as Associate Director for Health Equity and Community Engagement in the Stanford Cancer Institute. Focusing on racial and socioeconomic disparities in chronic disease treatment outcomes, Dr. Adams' interdisciplinary research seeks to evaluate the impact of changes in drug coverage policy on access to essential medications, understand the drivers of disparities in treatment adherence among insured populations, and test strategies for maximizing the benefits of treatment outcomes while minimizing harms through informed decision-making. Prior to joining Stanford School of Medicine, Dr. Adams was Associate Director for Health Care Delivery and Policy and a Research Scientist at the Kaiser Permanente Division of Research, as well as a Professor at the Bernard J. Tyson Kaiser Permanente School of Medicine. From 2000 to 2008, she was an Assistant Professor in the Department of Population Medicine (formerly Ambulatory Care and Prevention) at Harvard Medical School and Harvard Pilgrim Health care. She received her PhD in Health Policy and an MPP in Social Policy from Harvard University. She is Vice Chair of the Board of Directors for AcademyHealth and a former recipient of the John M. Eisenberg Excellence in Mentoring Award from Agency for Healthcare Research and Quality and an invited lecturer on racial disparities in health care in the 2014/2015 National Institute of Mental Health Director’s Innovation Speaker Series.

Professor, Epidemiology and Population Health
Professor, Health Policy
Professor, Pediatrics (by courtesy)
CV
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Cover of book "The Dragon, the Eagle, and the Private Sector" with an image of a red dragon and a blue eagle.

The governments of China and the United States -- despite profound differences in history, culture, economic structure, and political ideology -- both engage the private sector in the pursuit of public value. This book employs the term collaborative governance to describe relationships where neither the public nor private party is fully in control, arguing that such shared discretion is needed to deliver value to citizens. This concept is exemplified across a wide range of policy arenas, such as constructing high speed rail, hosting the Olympics, building human capital, and managing the healthcare system. This book will help decision-makers apply the principles of collaborative governance to effectively serve the public, and will enable China and the United States to learn from each other's experiences. It will empower public decision-makers to more wisely engage the private sector. The book's overarching conclusion is that transparency is the key to the legitimate growth of collaborative governance.

This book provides a key to understanding how to achieve . . . quality public-private collaboration, done right. Delving deep into two very different societies. . . the authors provide lessons that illuminate and should inform scholars and policymakers alike.
Fareed Zakaria
Journalist and author
This is the rare book that is both analytic and a pleasure to read. It makes a lasting impression. It deserves a very wide readership among all those concerned about the future of the global economy.
Lawrence H. Summers
President Emeritus, Harvard University
Eggleston, Donahue, and Zeckhauser offer an authoritative and intriguing account of why and how collaborative governance. . . has been widely and deeply practiced in two vastly different countries, China and the US.
Yijia Jing
Fudan University
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Subtitle
Public-Private Collaboration in China and the United States
Authors
Karen Eggleston
John D. Donahue
Richard J. Zeckhauser
Book Publisher
Cambridge University Press
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This study investigates the marginal value of information in the context of health signals that people receive after checkups. Although underlying health status is similar for individuals just below and above a clinical threshold, treatments differ according to the checkup signals they receive. For the general population, whereas health warnings about diabetes increase healthcare utilization, health outcomes do not improve. However, among high-risk individuals, outcomes do improve, and improved health is worth its cost. These results indicate that the marginal value of health information depends on setting appropriate thresholds for health warnings and targeting individuals most likely to benefit from follow-up medical care.

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Journal of Public Economics
Authors
Brian Chen
Karen Eggleston
Toshiaki Iizuka
Katsuhiko Nishiyama
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