Nearly Half of All US Medical Care is Delivered by Emergency Departments

MedicalResearch.com Interview with:

David Marcozzi, MD, MHS-CL, FACEP Associate Professor  Director of Population Health Department of Emergency Medicine Adjunct Associate Professor Co-Director of the Program in Health Disparities and Population Health Department of Epidemiology and Public Health University of Maryland School of Medicine Assistant Chief Medical Officer for Acute Care University of Maryland Medical Center

Dr. Marcozzi

David Marcozzi, MD, MHS-CL, FACEP
Associate Professor
Director of Population Health
Department of Emergency Medicine
Adjunct Associate Professor
Co-Director of the Program in Health Disparities and Population Health
Department of Epidemiology and Public Health
University of Maryland School of Medicine
Assistant Chief Medical Officer for Acute Care
University of Maryland Medical Center

MedicalResearch.com: What is the background for this study?

Response: Nearly half of all US medical care is delivered by emergency departments, according to a new study by researchers at the University of Maryland School of Medicine (UMSOM). And in recent years, the percentage of care delivered by emergency departments has grown. The study highlights what many experts argue is a major flaw in American health care: the use of emergency care in non-urgent cases, where clinics and doctor’s offices would be more appropriate.

“I was shocked by this result. This really helps us understand health care in this country. This research underscores the fact that emergency departments are critical to our nation’s healthcare delivery system, particularly for Americans who have no access to care.” said David Marcozzi, MD, MHS-CL, FACEP, an associate professor in the UMSOM Department of Emergency Medicine, and co-director of the UMSOM Program in Health Disparities and Population Health. “Patients seek care delivered in emergency departments for many reasons, and we need to face this fact this is a significant segment of healthcare and actually it may be delivering the type of care that individuals want and need—24/7, 365 days.”  Although he now focuses on population health and hospital throughput, Dr. Marcozzi is an emergency room doctor himself, and works one or two days a week in the University of Maryland Medical Center emergency department, treating patients.

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Overdose Deaths Increase Across Urban Status, Sex and Race Lines

MedicalResearch.com Interview with:
“Pills” by Kurtis Garbutt is licensed under CC BY 2.0
Christopher M. Jones, PharmD
Office of the Assistant Secretary for Planning and Evaluation
Office of the Secretary
U.S. Department of Health and Human Services 

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

Response: Drug overdoses are the leading cause of injury death in the United States, resulting in approximately 52,000 deaths in 2015. Although prescription drugs, in particular opioid pain relievers, were primarily responsible for the rapid expansion of this large and growing public health crisis, illicit drugs (heroin, illicit fentanyl, cocaine, and methamphetamines) now are contributing substantially to the problem. Understanding differences in illicit drug use, illicit drug use disorders, and overall drug overdose deaths in metropolitan and nonmetropolitan areas is important for informing public health programs, interventions, and policies.

We found that the prevalence of self-reported past-month use of illicit drugs increased significantly across urban status (large metropolitan, small metropolitan, and nonmetropolitan) between 2003-2005 and 2012-2014. Prevalence was higher for males than females, however, in the large metropolitan group, the percentage increase in prevalence from 2003–2005 to 2012–2014 was greater for females (23.4%) than for males (21.6%). There were notable differences by age. During 2012–2014, respondents aged 18–25 years had the highest prevalence of past-month use of illicit drugs for all urban levels. For respondents in this age group, the prevalence increased slightly from 2003–2005 to 2012–2014 in large metropolitan areas while the prevalence remained stable among small metropolitan area respondents and nonmetropolitan area respondents. Past-month use of illicit drugs declined over the study period for the youngest respondents (aged 12–17 years), with the largest decline among small metropolitan area youth.

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3 Million Americans Carry a Loaded Gun Daily

MedicalResearch.com Interview with:
“Me holding USP gun” by Nghị Trần is licensed under CC BY 2.0
Ali Rowhani-Rahbar, MD, MPH, PhD
Associate Professor, Department of Epidemiology
Adjunct Associate Professor, Department of Pediatrics
University of Washington
Seattle, WA 98195

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

Response: The impact of firearm carrying on public health and public safety is a topic of considerable interest in the US.  Nonetheless, contemporary national data on some of the most fundamental questions about the scope of firearm carrying among adults in the US do not exist. We used data collected through a nationally representative survey designed by investigators at Harvard University and Northeastern University and conducted in 2015 to understand why, how frequently, or in what manner (i.e., concealed or openly) US adults carry loaded handguns on their person. We also examined the prevalence of handgun carrying among this group by the stringency of state laws regulating concealed carry permits.
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“Shall Issue” Gun Law States Associated With Higher Homicide and Firearm Death Rates

MedicalResearch.com Interview with:

Michael Siegel, MD, MPH Professor, Department of Community Health Sciences Boston University School of Public Health Boston, MA 02118

Prof. Siegel

Michael Siegel, MD, MPH
Professor, Department of Community Health Sciences
Boston University School of Public Health
Boston, MA 02118

MedicalResearch.com: What is the background for this study?

Response: A central question in the debate about public policies to reduce firearm violence is whether easier access to concealed handguns increases or decreases the rate of firearm-related homicides. Previous studies on the impact of concealed carry permitting laws have yielded inconsistent results. Most of these studies were conducted more than a decade ago. This study provided a reexamination of this research question with more recent data, up to and including the year 2015.

While all states allow certain persons to carry concealed handguns, there are 3 major variations in permitting policy. In 9 states, law enforcement officials have wide discretion over whether to issue concealed carry permits; these are referred to as “may issue” states because police chiefs can deny a permit if they deem the applicant to be at risk of committing violence, even if there is not a criminal history. In 29 states, there is little or no discretion; these are referred to as “shall-issue” states because permits must be issued if requisite criteria are met. In an additional 12 states, no permit is necessary to carry a concealed handgun.

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Migraines More Frequent With Increased Anxiety and Depression

MedicalResearch.com Interview with:

“Headache.” by Avenue G is licensed under CC BY 2.0

“Headache.” by Avenue G

Fu-Chi Yang, M.D., Ph.D.Assistant Professor
Department of Neurology,
Tri-Service General Hospital
National Defense Medical Center
Taipei, Taiwan

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

Response: Migraineurs are likely to suffer from comorbid depression and anxiety. Furthermore, increased migraine frequency is associated with an increased risk of mood/anxiety disorders. It is not distinguished by grouping frequency of migraine attacks, whether it is associated with severity scores of depression and anxiety. Thus, we evaluated the relationship between severity of depression/anxiety and migraine frequency

We mainly found that the severity of depression (BDI and HADS-depression scores) and anxiety (HADS anxiety score) were related to migraine frequency, after adjusting confounding factors.

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Air Pollution Related Deaths Concentrated Among Minorities and the Poor

MedicalResearch.com Interview with:

“air pollution, beijing” by 大杨 is licensed under CC BY 2.0

Air Pollution, Beijing

Philip J. Landrigan, MD, MSc, FAAP
Dean for Global Health
Professor of Preventive Medicine and Pediatrics
Arnhold Institute for Global Health
Icahn School of Medicine at Mount Sinai 

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

  1.  Pollution is the largest environmental cause of disease and premature death in the world today.  It is responsible for 9 million deaths per year – 16% of all deaths worldwide – three times more deaths than AIDS, malaria and TB combined.  These numbers are growing from year to year as pollution in many parts of the world increase.
  2. Pollution is highly unjust. 92% of all pollution-related deaths occur in low-and middle- income countries, and in the United States and other high-income countries pollution-related disease and death are concentrated among minorities and the poor.  Think Flint.
  3. Pollution is very costly.  Pollution-related diseases cause productivity losses that reduce GDP in low- and middle-income countries by up to 2% per year. Pollution-related disease also results in health-care costs that are responsible for 1.7% of annual health spending in high-income countries like the US and for up to 7% of health spending in heavily polluted and rapidly developing low- and middle-income countries.
  4. Pollution is neglected and its control is seriously underfunded.
  5. The good news is that despite its great magnitude and long-standing neglect, pollution can be controlled, and pollution prevention is highly cost-effective. Pollution is not the inevitable consequence of economic development. High-income and some middle-income countries have enacted legislation and issued regulations mandating clean air and clean water, established chemical safety policies, and curbed their most flagrant forms of pollution. As a result, our air and water are now cleaner, the blood lead concentrations of our children have decreased by more than 90%, our rivers no longer catch fire, our worst hazardous waste sites have been remediated, and many of our cities are less polluted and more livable. Health has improved and people are living longer. High-income countries have achieved this progress while increasing GDP by nearly 250%. The claim that pollution control stifles economic growth, kills jobs and drags down the economy is false and has repeatedly been proven to be untrue. Pollution control is a winnable battle, and the control of pollution will return billions of dollars to the economies of countries around the world as it has already in the United States.

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ACA Medicaid Expansion Linked To Decrease in Uninsured Cancer Patients

MedicalResearch.com Interview with:

Aparna Soni, MA Department of Business Economics and Public Policy Kelley School of Business Indiana University, Bloomington

Aparna Soni

Aparna Soni, MA
Department of Business Economics and Public Policy
Kelley School of Business
Indiana University, Bloomington

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

Response: Cancer is the leading cause of death among the non-elderly population in the United States. Unfortunately, uninsured people are less likely to get screened for cancer, and treatment is often unaffordable for those who are uninsured.

One of the key objectives of the Affordable Care Act (ACA) was to improve outcomes for cancer patients. Our objective in this study was therefore to assess changes under the ACA in insurance coverage among patients newly diagnosed with cancer.

Our main finding is that uninsurance among patients with newly diagnosed cancer fell by one-third in 2014.

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Maryland All-Payer Model Produced Outpatient and ER Medicare Savings

MedicalResearch.com Interview with:
Susan G. Haber, Sc.D.

Director, Health Coverage for Low-Income and Uninsured Populations
RTI International
Waltham, MA

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

Response: In 2014, the state of Maryland and the federal Centers for Medicare and Medicaid Services (CMS) began testing an alternative payment structure for inpatient and outpatient hospital services. Known as the All-Payer Model, the new system limits hospitals’ revenues from Medicare, Medicaid, and private insurers to a global budget for the year. This builds on Maryland’s hospital rate-setting system that had operated since the 1970s, where all payers pay the same rates. CMS wanted to test whether global budgets could help Maryland limit cost growth and reduce avoidable hospital use. The goal of the model is to limit per capita total hospital cost growth for both Medicare and all payers and to generate $330 million in Medicare savings over 5 years.

RTI researchers studied the impact of hospital global budgets on Medicare beneficiary expenditures and utilization, using Medicare claims data to compare changes in Maryland before and after adoption of global budgets with changes in matched comparison areas outside of the state. Our report found Maryland has reduced total Medicare expenditures by approximately $293 million and total hospital expenditures by about $200 million in its first two years of operation. The reduction in overall expenditures indicates that “squeezing the balloon” on hospital expenditures did not simply produce a cost-shift to other health care sectors. Hospital expenditure savings for Medicare were achieved by reducing expenditures for outpatient emergency department and other hospital outpatient department services. Although inpatient admissions declined, there were no savings in Medicare expenditures for inpatient hospital services because the payment per admission increased. Maryland hospitals reduced avoidable utilization, including admissions for ambulatory care sensitive conditions, and readmissions and emergency department visits following hospital discharge. Despite the success in reducing expenditures, interviews with senior leaders at Maryland hospitals and focus group discussions with physicians and nurses suggest that many hospitals had not yet made fundamental changes in how they operate or developed partnerships with community physicians to divert care from the hospital, although there was variation in how hospitals responded.

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High Blood Pressure Is a Risk Factor For Mitral Regurgitation

MedicalResearch.com Interview with:

Professor Kazem Rahimi, FRCP MD DM MSc FES Deputy Director, The George Institute for Global Health UK Associate Professor of Cardiovascular Medicine, University of Oxford Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust

Dr. Rahimi

Professor Kazem Rahimi, FRCP MD DM MSc FES
Deputy Director, The George Institute for Global Health UK
Associate Professor of Cardiovascular Medicine, University of Oxford
Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust 

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

Response: Mitral regurgitation, the most common heart valve disorder in high-income countries, has until now been considered a degenerative disorder, which results from damage over time due to ‘wear and tear’. As a result, the focus of medical practitioners has been on treating the disorder – by repairing or replacing the valve – rather than preventing it. This is partly because there has been a lack of large-scale, longitudinal studies investigating the effect of risk factors on the condition.

We set out to analyse data on 5.5 million patients in the UK over 10 years. Our findings show, for the first time, that elevated blood pressure is an important risk factor for mitral regurgitation. Consistent with prior evidence on blood pressure associations with other cardiovascular disease – such as stroke and heart attacks – we found an association with mitral regurgitation that is continuous across the whole spectrum of blood pressure. More specifically, every 20 mmHg higher baseline systolic blood pressure is associated with a 26% increased risk of mitral regurgitation, with no threshold below or above which this relationship is not true.

The association we found was only partially mediated by conditions that are established causes of secondary mitral regurgitation, which suggests that high blood pressure has a direct and independent effect on valve degeneration.

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Edible Marijuana Preferred By Consumers Due To Lack of Smoke and Convenience

MedicalResearch.com Interview with:

Sheryl Cates RTI International

Sheryl Cates

Sheryl Cates
RTI International
Durham, NC

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

Response: The goal of this research was to provide a better understanding of consumer perceptions of edible marijuana products, including why users prefer edibles relative to other forms of marijuana such as smoking and vaping and concerns regarding the consumption of edibles. This is important as more states legalize the use of recreational marijuana products. With the increasing popularity of edibles, concerns exist that do not exist with other methods of using marijuana, such as smoking or vaping. These concerns include delayed activation time; accidental ingestion, particularly by children and older adults; and dose titration.

The study team conducted eight focus groups (four groups in Denver, Colorado, and four groups in Seattle, Washington) with users of edibles. Most participants preferred edibles to smoking marijuana because there is no smell from smoke and no secondhand smoke. Other reasons participants like edibles included convenience, discreetness, longer-lasting highs, less intense highs, and edibles’ ability to aid in relaxation, reduce anxiety, and alleviate pain more so than smoking marijuana. Concerns and dislikes about edibles included delayed effects, unexpected highs, the unpredictability of the high, and inconsistency of distribution of marijuana in the product. No participants in either location mentioned harmful health effects from consuming edibles as a concern.  Although focus group findings are not generalizable, the findings are useful for helping inform policy makers and regulators as they establish regulations regarding the manufacture, labeling, and sale of edibles.

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