Most Patients Go Back To Same Hospital For 30-Day Readmissions

MedicalResearch.com Interview with:
Rachel Mosher Henke, Ph.D.
Truven Health Analytics
Director of Research
Cambridge, MA

Medical Research: What is the background for this study? What are the main findings?

Dr. Henke: We wanted to see what percentage of patients return to the same hospital for their readmission.  Hospitals are increasingly at risk for the cost of readmissions through new initiatives, such as bundled payment programs.  If a patient goes to another hospital for their readmission, the original hospital has little control over the decision to admit and the intensity of care provided.

We found about three quarters of patients do go back to the same hospital for 30-day readmissions, with some variation in rates by condition.  Patients admitted through the emergency department and patients who live in the same county as the hospital were more likely to return to the same hospital for their readmission. Continue reading

Family Members Can Help Patients Understand Hospital Discharge Instructions

Dennis Tsilimingras, M.D., M.P.H. Assistant Professor, Co-Director of Michigan AHEC (Area Health Education Center), Director of Patient Safety, Department of Family Medicine and Public Health Sciences Wayne State University School of Medicine Detroit, MichiganMedicalResearch.com Interview with:
Dennis Tsilimingras, M.D., M.P.H.
Assistant Professor,
Co-Director of Michigan AHEC (Area Health Education Center),
Director of Patient Safety,
Department of Family Medicine and Public Health Sciences
Wayne State University School of Medicine
Detroit, Michigan

Medical Research: What is the background for this study?

Dr. Tsilimingras: There has been little research to examine post-discharge adverse events (AEs) in rural patients discharged from community hospitals.

Medical Research: What are the main findings?

Dr. Tsilimingras: Over 28 % of 684 patients experienced postdischarge AEs, most of which were either preventable or ameliorable. There was no difference in the incidence of post-discharge AEs in urban versus rural patients, but post-discharge adverse events were associated with hypertension, type 2 diabetes mellitus, and number of secondary discharge diagnoses only in urban patients.

Medical Research: What should clinicians and patients take away from your report?

Dr. Tsilimingras: Post-discharge adverse events were common in both urban and rural patients and many were preventable or ameliorable. Potentially different risk factors for AEs in urban versus rural patients suggests the need for further research into the underlying causes. Patients should be accompanied by family members at the time of discharge to better understand post-discharge instructions.  Patients and family members should not be afraid to ask as many questions as possible regarding follow-up care in their community.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Tsilimingras: Potentially different risk factors for adverse events in urban versus rural patients suggests the need for further research into

the underlying causes. Different interventions may be required in urban versus rural patients to improve patient safety during transitions in care.

Citation:

Post-Discharge Adverse Events Among Urban and Rural Patients of an Urban Community Hospital: A Prospective Cohort Study.

Tsilimingras D1, Schnipper J, Duke A, Agens J, Quintero S, Bellamy G, Janisse J, Helmkamp L, Bates DW.

J Gen Intern Med. 2015 Mar 31. [Epub ahead of print]

 

MedicalResearch.com Interview with: Dennis Tsilimingras, M.D., M.P.H. (2015). Family Members Can Help Patients Understand Hospital Discharge Instructions 

CPR Rate High In End Stage Dialysis Patients Despite Poor Outcomes

MedicalResearch.com Interview with:
Susan P. Y. Wong, M.D.
Acting Instructor & Senior Research Fellow
Division of Nephrology
University of Washington

Medical Research: What is the background for this study? What are the main findings?

Dr. Wong: There is a paucity of information on the use of cardiopulmonary resuscitation (CPR) and its outcomes among patients receiving maintenance dialysis. To address this knowledge gap, we performed a retrospective study to define contemporary trends in in-hospital CPR use and its outcomes among a nationally representative sample of 663,734 patients receiving maintenance dialysis between 2000 and 2011. We found that in-hospital CPR use among this cohort of patients was very high—nearly 20 times more common than that found in the general population. The rate of in-hospital CPR use has also been increasing among patients receiving maintenance dialysis despite evidence of poor long-term survival among these patients. Median survival after hospital discharge for members of this cohort was only 5 months, and this has not change substantially in the recent decade.

We also found that a large proportion  of dialysis patients who died in hospital settings had received CPR during their terminal hospitalization. This proportion has also been steadily increasing over time, and in 2011, 1 in 5 dialysis patients who died in hospital had received CPR during their terminal hospitalization.

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HPV Vaccine Still Valuable For Women Who Were Not Fully Vaccinated As Children

Jacqueline Hirth, PhD, MPH Assistant Professor andMedicalResearch.com Interview with:
Jacqueline Hirth, PhD, MPH
Assistant Professor and
Dr. Abbey B. Berenson MD, MMS, PhD Center for Interdisciplinary Research in Women's Health Obstetrics and Gynecology The University of Texas Medical Branch at Galveston TexasDr. Abbey B. Berenson MD, MMS, PhD
Center for Interdisciplinary Research in Women’s Health
Obstetrics and Gynecology
The University of Texas Medical Branch at Galveston Texas

Medical Research: What is the background for this study? What are the main findings?

Response: In this sample of young women, vaccination was effective at reducing prevalence of vaccine-type HPV (6,11,16,18) compared to women who were unvaccinated. We also found a dose response, with young women who received at least 2 doses of the 3 dose vaccine series having a lower rate of vaccine-type HPV compared to those who only received one dose (8.6% compared to 16.9%, respectively).

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Cancer Risk Elevated In Patients With Hepatitis C

Lisa M. Nyberg, MD, MPH Transplant Hepatologist Director, Hepatology Research Kaiser Permanente, Garfield Specialty Center San Diego, CA  92111MedicalResearch.com Interview with:
Lisa M. Nyberg, MD, MPH
Transplant Hepatologist
Director, Hepatology Research
Kaiser Permanente, Garfield Specialty Center
San Diego, CA  92111

Medical Research: What is the background for this study? What are the main findings?

Dr. Nyberg: The overall cancer rates were higher in patients with Hepatitis C (HCV) vs those without HCV. Of note, though, the HCV cohort had higher rates of alcohol abuse, tobacco use, cirrhosis and diabetes mellitus (DM). However, even after stratification for the variables alcohol abuse, tobacco use, body mass index (BMI) and DM; the increased cancer rates remained significant for total cancer sites, liver cancer and NHL.

Note that this study does not establish a cause and effect relationship between Hepatitis C and cancer. A strength of this study is that it is an evaluation of a large patient population (n=35,712 with HCV and 5,297,191 without HCV). Limitations of the study are those inherent in epidemiological studies using large databases. For example, confounders may not be accurately recorded in automated databases (smoking and alcohol abuse may be under-recorded).

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Yogurt Habit May Not Provide Long Term Health Benefits

Esther Lopez-Garcia, PhD Dept. Preventive Medicine and Public Health School of Medicine Universidad Autónoma de Madrid Madrid,SpainMedicalResearch.com Interview with:
Esther Lopez-Garcia, PhD
Dept. Preventive Medicine and Public Health
School of Medicine
Universidad Autónoma de Madrid
Madrid,Spain

Medical Research: What is the background for this study? What are the main findings?

Dr. Lopez-Garcia: Health-related quality of life (HRQL) is a global indicator of perceived health status, which includes physical and mental domains. Assessing the association between individual foods and HRQL is important because both the food industry and the population as a whole are interested in knowing whether general well-being could be improved by consuming specific foods. Several biological mechanisms might support an association between consumption of yogurt and better Health-related quality of life. However, to our knowledge, the effect of yogurt on HRQL has not yet been studied in epidemiological investigations in the general population. Thus, the objective of this article was to examine the prospective association between habitual yogurt consumption and the physical and mental components of HRQL among the general adult population.

In this study, we found no association between yogurt consumption and the physical and mental components of HRQL after 3.5 years of follow-up of a population-based cohort. The results also held for whole-milk and reduced-fat yogurt.

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Polygenic Risk Score Improves Breast Cancer Prediction

Nasim Mavaddat M.B.B.S. MPhil PhD PhD  Centre for Cancer Genetic Epidemiology Department of Public Health and Primary Care University of Cambridge, Cambridge, UKMedicalResearch.com Interview with:
Nasim Mavaddat M.B.B.S. MPhil PhD PhD

Centre for Cancer Genetic Epidemiology
Department of Public Health and Primary Care
University of Cambridge, Cambridge, UK


MedicalResearch:
What is the background for this study?
What are the main findings?

Dr. Mavaddat: Recent large-scale genome wide association analyses have led to the discovery of genetic variation- called single nucleotide polymorphisms (SNPs) associated with breast cancer risk. Individually these variants confer risks that are too small to be useful for risk prediction. But when combined as a single score, called a polygenic risk score (PRS), this score may be used to stratify women according to their risk of developing breast cancer. This stratification could guide strategies for screening and prevention.

Our study was a large international collaboration involving 41 research groups from many different countries and included 33,673 breast cancer patients and 33,381 controls. We found that the genetic variants act more or less independently, and that the more risk variants a woman has the higher her risk of breast cancer. When women were ranked according to their PRS, women with scores in the top 1% had a threefold increased risk of breast cancer. This translates into an absolute risk of breast cancer of 29% by age 80. By contrast, women with the lowest 1% scores had a risk of 3.5%.

The PRS was effective in stratifying women with and without a family history of breast cancer, so that highest risk was for women with a family history and a high PRS. Finally, we showed that the PRS was better at predicting the risk of ER-positive breast cancer (potentially relevant to the application of risk stratification to chemoprevention for example, with tamoxifen, raloxifene or aromatase inhibitors).

There has been much debate as to whether genomic profiles are useful for individual risk prediction, especially in the context of the preventative strategies available at the present time. The estimates provided in this study will help inform these debates.

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Neuropeptide Level May Signal Neuroblastoma Prognosis

MedicalResearch.com Interview with:
Joanna Kitlinska, PhD
Assistant Professor
Georgetown University Medical Center
Department of Biochemistry and Molecular & Cellular Biology
Washington, DC 20057

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Kitlinska: Neuroblastoma is a pediatric malignancy with extremely heterogeneous phenotypes, ranging from spontaneously regressing to aggressive, untreatable tumors. Consequently, treatment strategies vary significantly between patients, depending on the initial risk assessment. Given the severe late effects of anti-cancer treatment administered to infants and children, proper disease stratification is of utmost importance for neuroblastoma patients.

Due to their neuronal origin, neuroblastomas secrete neuropeptide Y (NPY), a small protein normally released from mature nerves. This, in turn, may result in elevated NPY levels in blood of neuroblastoma patients. We have found that serum NPY is particularly high in patients with aggressive, metastatic disease. Consequently, patients with elevated NPY levels have significantly worse survival. This finding is in agreement with our previous data indicating crucial role for NPY in stimulation of neuroblastoma tumor growth.

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Neuroblastoma Risk May Be Increased by Stress During Pregnancy

MedicalResearch.com Interview with:
Joanna Kitlinska, PhD
Assistant Professor
Georgetown University Medical Center
Department of Biochemistry and Molecular & Cellular Biology
Washington, DC 20057

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Kitlinska: Neuroblastoma is a pediatric tumor which arises due to defects in normal fetal neuronal development. Although the disease is associated with genetic changes, there are also clinical and experimental data implicating non-genetic factors in its etiology. We hypothesized that maternal stress during pregnancy can be one such factor, as it leads to fetal hypoxia and elevated cortisol levels – the two factors known to alter normal neuronal development and increase aggressiveness of neuroblastoma. Indeed, using an animal model of neuroblastoma, we have found that offspring of mothers which have been subjected to stress during pregnancy develop tumors twice as frequently as those from intact pregnancies. Moreover, tumors developing in prenatally-stressed mice were spreading more often to distant organs.

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Dashboard Metrics Improve Physician Compliance With Guidelines

MedicalResearch.com Interview with: Henry J. Michtalik MD, MPH, MHS Department of Medicine, Johns Hopkins University Armstrong Institute for Patient Safety and Quality Baltimore, MarylandMedicalResearch.com Interview with:
Henry J. Michtalik MD, MPH, MHS
Department of Medicine, Johns Hopkins University
Armstrong Institute for Patient Safety and Quality
Baltimore, Maryland

Medical Research: What is the background for this study? What are the main findings?

Dr. Michtalik: Current healthcare reform emphasizes providing high-value, evidence-based care.  Compliance with practice guidelines and best-practices remains a challenge in the ever-changing healthcare environment.  Multiple methods are typically used to enhance compliance with these guidelines, including physician education, computerized order entry systems with clinical decision support, provider feedback, and payment incentives.  These strategies are used for many conditions, including heart failure and venous thromboembolism (VTE), blood clots.

The purpose of this study was to examine the impact of an individualized physician dashboard and pay-for-performance program on improving VTE prophylaxis rates amongst hospitalists.  We performed a retrospective analysis of over 3000 inpatient admissions to a hospitalist service.  We examined the impact of a web-based hospitalist dashboard which provided VTE prophylaxis feedback, both alone and in combination with a pay-for performance program which provided a small financial payment for achieving compliance rates greater than 80%.

We found that compliance significantly increased from 86% during baseline to 90% during the dashboard alone phase.  Addition of the pay-for-performance program further increased compliance to 94%.  The fastest improvement occurred during the dashboard only phase.  Annual physician payments ranged from $53 to $1244, with 17 of the 19 payments under $1000.

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