Addiction, Author Interviews, JAMA, Opiods / 24.04.2020

MedicalResearch.com Interview with: Tami L. Mark, PhD Senior Director, Behavioral Health Financing and Quality Measurement RTI International  MedicalResearch.com: What is the background for this study? Response: There are effective medications to treat opioid use disorder. Federal and state policymakers have tried to improve access to these medications. However, medications to treat opioid use disorders are still often subject to prior authorization. Studies of other medications finds that prior authorization can reduce access. This study looked at whether removing prior authorization in Medicare Part D plans was associated with increases in the use of medications to treat opioid use disorder.  (more…)
Author Interviews, COVID -19 Coronavirus / 23.04.2020

MedicalResearch.com Interview with: David B. Douglas, M.D., M.P.H. Harvard T.H. Chan School of Public Health MedicalResearch.com: What is the background for this study? Response: Health care workers are facing the major threat of catching COVID-19 through their eyes, yet currently available eye protection is inadequate. Specifically, the use of open-type eye protection allows airborne viruses to float over the top, around the sides or under the bottom of the lenses and contact the eyes. Additionally, eye protection is well known to fog up, which limits usability by making even the most basic tasks challenging. In fact, fogged goggles is a major barrier to use. (more…)
Author Interviews, CDC, NEJM, Pulmonary Disease / 23.04.2020

MedicalResearch.com Interview with: Angela K. Werner, PhD, MPH Environmental Public Health Tracking Program National Center for Environmental Health CDC MedicalResearch.com: What is the background for this study? Response: In August 2019, emergency department (ED) visits related to e-cigarette, or vaping, product-associated lung injury (EVALI) increased sharply, followed by a peak in September. This was followed by a gradual but persistent decline in the number of cases. As of February 18, 2020 (CDC’s latest and final published update), there were a total of 2,807 hospitalized EVALI cases or deaths reported to CDC from all 50 states, the District of Columbia, and two U.S. territories (Puerto Rico and U.S. Virgin Islands). Sixty-eight deaths were confirmed in 29 states and the District of Columbia. Although clinical presentations and outcomes of EVALI patients have been reported, data on patients who died are more limited. This article fills a gap by reporting on a national study assessing detailed demographic, substance use, and clinical characteristics of EVALI patients who have died, and comparing them to the characteristics of EVALI patients who survived. (more…)
Author Interviews, Emergency Care, Heart Disease, JAMA, UT Southwestern / 22.04.2020

MedicalResearch.com Interview with: Rebecca Vigen, MD, MSCS Assistant Professor of Internal Medicine UT Southwestern MedicalResearch.com: What is the background for this study? Response: Emergency department overcrowding is an urgent health priority and chest pain is a common reason for emergency department visits.  We developed a new protocol that uses high sensitivity cardiac troponin testing with a risk assessment tool that guides decisions on discharge and stress testing for patients presenting with chest pain. The protocol allows us to rule out heart attacks more quickly than the protocols utilizing an older troponin assay. (more…)
Author Interviews, Cannabis, JAMA, Pulmonary Disease / 22.04.2020

MedicalResearch.com Interview with: Alex Hollingsworth PhD Assistant Professor O'Neill School of Public and Environmental Affairs Indiana University MedicalResearch.com: What is the background for this study? What are the main findings? Response: I've been working with Coady Wing and Ashley Bradford on a few different studies of the effects of recreational marijuana laws on drug and alcohol use. Soon after EVALI became a major issue, the prevailing theory from the CDC and others was that EVALI was caused by the use of vitamin E acetate in illegal THC vaping products. Our group read about this and we thought about some of the things that often happen in black markets for illegal drugs. For instance, during the alcohol prohibition era, bootleg alcohol producers often made and sold alcohol products that were not that safe to drink. In more recent years, there are cases where black market sellers of illegal drugs like heroin try to increase profit margins by adding other substances, which can be harmful. We thought that maybe something like that could be happening in EVALI. Perhaps people in states where recreational marijuana is legal tended to purchase marijuana products from the legal market and the legal market was not selling any marijuana vaping products that included vitamin E acetate. (more…)
COVID -19 Coronavirus, FDA / 21.04.2020

'The U.S. Food and Drug Administration authorized the first diagnostic test with a home collection option for COVID-19. Specifically, the FDA re-issued the emergency use authorization (EUA) for the Laboratory Corporation of America (LabCorp) COVID-19 RT-PCR Test to permit testing of samples self-collected by patients at home using LabCorp’s Pixel by LabCorp COVID-19 Test home collection kit. “Throughout this pandemic we have been facilitating test development to ensure patients access to accurate diagnostics, which includes supporting the development of reliable and accurate at-home sample collection options,” said FDA Commissioner Stephen M. Hahn, M.D. “The FDA’s around-the-clock work since this outbreak began has resulted in the authorization of more than 50 diagnostic tests and engagement with over 350 test developers. Specifically, for tests that include home sample collection, we worked with LabCorp to ensure the data demonstrated from at-home patient sample collection is as safe and accurate as sample collection at a doctor’s office, hospital or other testing site. With this action, there is now a convenient and reliable option for patient sample collection from the comfort and safety of their home.” (more…)
Author Interviews, COVID -19 Coronavirus / 21.04.2020

MedicalResearch.com Interview with: Dr. med. Manuel Döhla Associate Researcher, AG "One Health" Institute for Hygiene and Public Health Medical Faculty, University of Bonn Bonn, Germany MedicalResearch.com: What is the background for this study? Response: Rapid and reliable testing of suspected cases is an important measure in the fight against the corona pandemic. In PCR diagnostics, 24 hours and sometimes more elapse between testing and notification of the test result. During this period, suspect cases must be isolated pre-emptively so that they do not cause further transmission. This is logistically and personnel-intensive and highly error-prone. The shorter the time between test and result, the more effective containment measures can be. This is why the test we have evaluated, which shows a result within 20 minutes, has aroused our interest. The manufacturer's specifications (sensitivity 70 % in early stage disease (day 4-10), 100 % in late stage disease (day 11-24), specificity 100 %) were promising. (more…)
Author Interviews, Cognitive Issues, Mediterranean Diet, NIH / 21.04.2020

MedicalResearch.com Interview with: Emily Y. Chew, M.D. Director of the Division of Epidemiology and Clinical Applications Deputy Clinical Director at the National Eye Institute (NEI), National Institutes of Health  MedicalResearch.com: What is the background for this study? Response: Dementia is a common disorder that was estimated to have a worldwide prevalence of 44 million in 2016 and is projected to hit 115 million by 2050. Many phase 3 trials of various therapies have failed and we have no treatment currently available for the prevention or reduction of the course of dementia. A slow neurocognitive decline throughout life is part of the normal process of aging. However, there is a subset of individuals who may have accelerated aging and is at high risk of development dementia. If the course of such accelerated decline could be altered in any way, it would be important to evaluate. The role of diet with biologic aging has been studied and diet has been also found to be associated with age-related conditions linked to dementia, including cardiovascular disease and diabetes. We were interested in the cognitive function of our participants who had another neurodegenerative disease, age-related macular degeneration (AMD). We had conducted two randomized controlled clinical trials designed to evaluate the role of oral supplements for the treatment of AMD. We also studied cognitive function in both clinical trials of nearly 8,000 participants who were followed for 10 years. We also evaluated the dietary habits of the participants with food frequency questionnaires (FFQ) at baseline. Cognitive function testing was conducted in the first study, the Age-Related Eye Disease Study (AREDS) near the end of the clinical trial while the AREDS2, the second study, evaluated cognitive function testing at baseline and every 2 years until year 6. AREDS study evaluated cognitive function with in-clinic study visits while AREDS2 was conducted using telephone interviews. Our aim was to determine whether closer adherence to the alternative Mediterranean diet (aMED) was associated with impaired cognitive function these two studies. We were interested in the particular components of the Mediterranean diet that may be important. We also evaluated the interaction of genetics with the diet.    (more…)
Abuse and Neglect, Author Interviews, JAMA, Pediatrics / 21.04.2020

MedicalResearch.com Interview with: Barbara Chaiyachati, MD PhD SafePlace: The Center for Child Protection and Health Division of General Pediatrics The Children’s Hospital of Philadelphia, Center for Pediatric Clinical Effectiveness University of Pennsylvania Philadelphia, Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings? Response: Children in foster care have high rates of medical problems including chronic diseases. There is less known about the differences in mortality for children in foster care. Looking at national data from 2003 to 2016, this study finds that children (ages 1 to 18) in foster care have higher mortality compared to children in the general population and that the difference in mortality has increased over time.   (more…)
Annals Internal Medicine, Author Interviews, COVID -19 Coronavirus / 18.04.2020

MedicalResearch.com Interview with: Nathan Stall, MD, FRCPC Geriatrics and Internal Medicine (Clinical Associate) Sinai Health System and the University Health Network Hospitals PhD Candidate, Clinical Epidemiology & Health Care Research Institute of Health Policy, Management and Evaluation Eliot Phillipson Clinician-Scientist Training Program
Vasily Giannakeas, MPH Epidemiologist/ Dedicated ICES Analyst Women's College Hospital Toronto, Ontario, Canada   MedicalResearch.com: What is the background for this study? Response: As some health care systems approach collapse, a pressing need exists for tools modeling the capacity of acute and critical care systems during the COVID-19 pandemic. We developed an online tool to estimate the maximum number of COVID-19 cases that could be managed per day within the catchment area served by a health care system, given acute and critical care resource availability. The COVID-19 Acute and Intensive Care Resource Tool (CAIC-RT) is open access and available at https://caic-rt.shinyapps.io/CAIC-RT. (more…)
Author Interviews, Colon Cancer, Gastrointestinal Disease, Pancreatic / 17.04.2020

MedicalResearch.com Interview with: Dr Cristina Bosetti PhD Head of the Unit of Cancer Epidemiology Mario Negri Department of Oncology Milan Italy MedicalResearch.com: What is the background for this study? Response: Aspirin has been known since long time to have a beneficial effect in the primary and secondary prevention of cardiovascular diseases. Additional evidence indicates that it has also a favorable role on the risk of various cancers. (more…)
Author Interviews, COVID -19 Coronavirus, Rheumatology / 16.04.2020

MedicalResearch.com Interview with: Ellen M. Gravallese M.D. President, American College of Rheumatology Dr. Gravallese discusses the recent guidance document issued by ACR for the treatment of rheumatic disease patients during the COVID-19 pandemic. MedicalResearch.com: What is the background for this announcement? Are patients with rheumatic disease at greater risk of severe illness or death from the SARS-CoV-2 virus?  Response: This week the ACR issued a guidance document that is the product of the ACR’s Clinical Guidance Task Force, a newly appointed task force that includes experts in infectious disease, as well as experts in biologic and non-biologic rheumatic disease therapies. This clinical guidance document was prepared to assist rheumatology professionals in the care of their patients during this novel pandemic, and to advise as to how to handle rheumatic disease therapies. There is no data to suggest that patients with rheumatic disease are at greater risk of severe illness or death simply because they have a rheumatic disease. Rheumatic disease patients appear to be at risk for poor outcomes if they become infected primarily because of general risk factors such as older age or comorbid medical conditions, such as significant heart or lung disease. A global alliance has been created by the rheumatology community that has developed an international case-reporting registry to collect information pertinent to COVID-19 infection in patients with rheumatic disease. The ACR has played an active role in helping the Alliance get their message out to the rheumatology community, and we continue to support the Alliance with its data dissemination and communication efforts. We hope this registry will provide valuable data to address additional questions about the best way to manage rheumatology patients affected by COVID-19 and we encourage providers to submit their COVID-19-related cases to the Alliance website at www.rheum-covid.org. (more…)
Author Interviews, Neurological Disorders, Parkinson's / 15.04.2020

MedicalResearch.com Interview with: Dr. Viviane Labrie, PhD Dr. Labrie is an associate professor in Van Andel Institute’s Center for Neurodegenerative Science, where she studies Parkinson’s, Alzheimer’s and other neurological diseases. MedicalResearch.com: What is the background for this study? Response: One of the most puzzling and persistent mysteries in neuroscience has been why some people are “right-brained” while others are “left-brained.” The two sides of the brain have different jobs. The left side is analytic and problem-solving, while the right side manages creativity and artistic talents. But despite their differences, the two sides are composed of the same cell types — essentially, brain neurons and their support cells. In this study, we sought to understand how it is possible for these cells to behave completely differently depending on what hemisphere they’re located in.  We also wanted to examine the reasons behind asymmetry in Parkinson’s disease; that is, why Parkinson’s symptoms typically start on one side of the body before the other. This asymmetry in neurodegeneration and symptoms in patients is one of the biggest unsolved puzzles in the Parkinson’s disease field — why do brain cells in one hemisphere begin dying before brain cells in the other hemisphere? (more…)
Author Interviews, Blood Pressure - Hypertension, UT Southwestern / 15.04.2020

MedicalResearch.com Interview with: DaiWai Olson, PhD, RN Professor of Neurology and Neurotheraputics UT Southwestern Medical Center MedicalResearch.com: What is the background for this study? Response: This study resonates across nursing. Kat Siaron is a Neuroscience nurse who had questions about the ‘best’ location for checking blood pressure. Like so many studies this started with a clinical question: “does it make a difference where you check the blood pressure?” She applied for a nursing research fellowship and was one of 6 nurses selected. She spent about 3 months reading articles on blood pressure and looking to see if there are any similar studies. After confirming that this has not been done, she submitted her study for approval from the Institutional Review Board and started data collection. (more…)
Author Interviews, COVID -19 Coronavirus, ENT / 15.04.2020

MedicalResearch.com Interview with: Ahmad R. Sedaghat, MD, PhD, FACS Associate Professor Department of Otolaryngology - Head and Neck Surgery University of Cincinnati College of Medicine Cincinnati, OH, USA   MedicalResearch.com: What is the background for this study? Response: The novel coronavirus, SARS-CoV-2, which causes COVID-19 infects the respiratory tract.  As a rhinologist, I am an expert in diseases of the nose and paranasal sinuses, and as the nose and paranasal sinuses (sinonasal cavities) are a major component of the upper airway, we decided to do a systematic review of the scientific literature on the role of the sinonasal cavities in COVID-19. (more…)
Author Interviews, COVID -19 Coronavirus, Diabetes / 14.04.2020

MedicalResearch.com Interview with: Daniel J. Drucker, M.D. Lunenfeld-Tanenbaum Research Institute Mount Sinai Hospital Toronto  MedicalResearch.com: What is the background for this study? What are the main findings? Response: This review was prompted by shared mechanistic pathways linking actions of molecules such as ACE2 and DPP4, which are important enzymes with cardiometabolic actions, yet also function as coronavirus receptors. The recognition that people with diabetes and obesity are more prone to severe infection also highlights the importance of understanding the biology We highlight the intersection of pathways shared by coronavirus infection, and how these might impact our understanding of diabetes and its therapies. (more…)
Author Interviews, Diabetes, JAMA, Surgical Research / 14.04.2020

MedicalResearch.com Interview with: Katherine Moll Reitz, MD General Surgery Resident University of Pittsburgh MedicalResearch.com: What is the background for this study? Response: Surgical interventions both save lives and improve the quality of those lives each day. However, these same interventions and the recovery thereafter are a major physiologic stressor. Younger, more resilient patients tend to recover faster, with fewer postoperative complications when compared to older, frailer patients undergoing the same surgical treatments. Therefore, investigators at University of Pittsburgh and UPMC have begun focusing on prehabilitation in order to optimize at risk patients preoperatively. Just as an athlete would train for an upcoming event, prehabilitation (including smoking cessation, healthy eating, and physical activity increases) prepares or trains patients for their surgical intervention and can improve their postoperative outcomes. Currently, there is no medication available to aid in this training process, improving patients’ response to the physiologic stress of surgery. Therefore, we are interested in exploring potential safe, well tolerated medical therapies which can optimize patients as pharmacologic prehabilitation. (more…)
Author Interviews, Endocrinology, OBGYNE / 14.04.2020

MedicalResearch.com Interview with: “Open Space Yoga Hawaii” by Open Space Yoga Hawaii is licensed under CC BY 2.0Diana Speelman, Ph.D. Director of Research for the College of Medicine Associate Professor of Biochemistry Reproductive System Course Coordinator L|E|C|O|M Erie, PA 16509 MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by PCOS? Response: Polycystic ovary syndrome (PCOS) is the most common hormone disorder in women of reproductive age.  It is characterized by high androgen levels (e.g., testosterone) in the blood and irregular menstrual cycles.  Despite affecting 5-15% of women, its cause is unknown.  While medications can be used to reduce androgen levels, or help achieve menstrual regularity or stimulate ovulation, these often have undesirable side effects.  Our goal was to investigate the effectiveness of non-pharmacologic approaches, including yoga, on improving the characteristics associated with the disorder.  (more…)
Abuse and Neglect, Author Interviews, COVID -19 Coronavirus / 14.04.2020

MedicalResearch.com Interview with: Dr. Naveen Vankadari PhD Research Fellow Monash University, Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: The recent outbreak of pneumonia-causing COVID-19 pandemic is an urgent global public health issue. It is critical to understand and unravel the key difference of COVID-19 or SARS-CoV-2 with the previous coronavirus (SARS and MERS) infections. Specifically, structural and molecular dynamics which underline the mechanism of viral infection. The study first addresses the structure of COVID-19 spike glycoprotein in both closed (ligand-free) and open (ligand-bound) conformation, which open the arena in understating the viral attachment to the host cell. The study also provides the first and complete sequence alignment of spike glycol protein from COVID19 and SARA-1, showing novel insertions and deletions that highlights the uniqueness of COVID19 and underlies the differential interaction mode. The study also unravels how this new coronavirus camouflages in humans through its unique glycosylation of spike glycoprotein, which makes the most of neutralizing antibodies useless. Furthermore, In addition to known ACE2 receptor in human, the study discovers the human CD26 as another potential receptor of COVID-19 for host adhesion and hijacking.  (more…)
Anesthesiology, Author Interviews, COVID -19 Coronavirus, OBGYNE / 13.04.2020

MedicalResearch.com Interview with: Dr. Alicia Warlick, MD Anesthesiologist at UNC/Rex, American Anesthesiology Raleigh, North Carolina MedicalResearch.com: As a physician working on the frontlines of the COVID-19 battle, how are you addressing expecting mothers’ concerns about the disease and how it might impact their pregnancy? Response: While COVID-19 has disrupted nearly every aspect of healthcare, whether its virtual appointments or delayed surgeries; there are certain things that are inevitable – like childbirth. As this virus continues to take over the country and we learn more about it each day, pregnant women are facing new challenges and fears. For women approaching their due dates, questions about staying healthy, keeping their baby safe and limiting their risk of exposure while in the hospital are all leading to anxiety and stress. And while policies and guidelines are constantly changing, as physicians we need to remind our patients that we are there to alleviate their concerns, address their questions and remind them to not lose sight of the joy the comes with bringing a child into the world. It’s a scary time for everyone, but by working together and supporting one another, we will get through this. (more…)
Accidents & Violence, Author Interviews, JAMA, Ophthalmology, Pediatrics / 13.04.2020

MedicalResearch.com Interview with: Natasha Nayak Kolomeyer, MD Glaucoma Service, Wills Eye Hospital Co-authors: Eric J. Shiuey, MS Sidney Kimmel Medical College, Thomas Jefferson University Anton M. Kolomeyer, MD, PhD Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Philadelphia, Pennsylvania MedicalResearch.com: What is the background for this study? Response: I still remember the 6-year-old boy that was brought in to our emergency room on July 4th with a ruptured globe (severe eye trauma) due to fireworks; he permanently lost vision in that eye despite surgery. This is not a rare occurrence especially around certain holidays. (more…)
Author Interviews, COVID -19 Coronavirus, Heart Disease / 12.04.2020

MedicalResearch.com Interview with: Santiago Garcia, MD FACC Interventional Cardiologist, Minneapolis Heart Institute® Researcher, Minneapolis Heart Institute Foundation® MedicalResearch.com: What is the background for this study?  Response: We analyzed and quantified ST-segment elevation myocardial infarction (STEMI) activations for 9 high-volume (>100 primary percutaneous angioplasties per year) cardiac catheterization laboratories in the US. These centers represent different geographic areas and levels of COVID-19 exposure in the US. The data analyzed was from January 1, 2019 to March 31, 2020. Participating centers included 1-Minneapolis Heart Institute, Minneapolis, MN, 2- Beaumont Hospital Royal Oak, Royal Oak, MI, 3- The Christ Hospital, Cincinnati, OH, 4- Massachusetts General Hospital, Boston, MA, 5- UMass Memorial Medical Center, Worcester, MA, 6- Iowa Heart, Des Moines, IA, 7- Northwell Health Hospital, Manhasset, NY, 8- Prairie Cardiovascular, Springfield, IL, and 9- Swedish Medical Center, Seattle, WA. (more…)
Author Interviews, COVID -19 Coronavirus / 12.04.2020

MedicalResearch.com Interview with: Bart van Straten, Tim Horeman and John van den Dobbelsteen Research team TU Delft, Delft University of Technology, Dpt. of BioMechanical Engineering The Netherlands  MedicalResearch.com: What is the background for this study? Response: The background for this study was the urgent shortages of mouth masks in several hospitals. Franciscus Hospital, Rotterdam, The Netherland requested on 17 March if face masks could be sterilized since they were facing these shortages. The COVID-19 pandemic and its rapid spread has led to imminent shortages of these masks. (more…)
Author Interviews, JAMA, Pediatrics / 10.04.2020

MedicalResearch.com Interview with: Dr Alfredo Tagarro MD PhD Pediatrician - Hospital Universitario Infanta Sofía Clinical Research - Fundación Investigación Hospital Assistant Professor - Universidad Europea de Madrid Madrid MedicalResearch.com: What is the background for this study? Response: Madrid is being hit hard by the disease. Almost all doctors, including pediatricians, are dedicated to attending COVID-19 patients, essencially adults. However, there are some moderate and severe cases among children. In Madrid, clinical pediatricians from 30 hospitals joined their efforts to report and analyze pediatric patients with COVID-19.   (more…)
Author Interviews, COVID -19 Coronavirus, Diabetes / 10.04.2020

MedicalResearch.com Interview with: Gian Paolo Fadini, MD PhD Associate Professor of Endocrinology Department of Medicine, University of Padova Venetian Institute of Molecular Medicine  MedicalResearch.com: What is the background for this study? Response: Since the very beginning of the SARS-CoV-2 pandemic, it was suggested that It has been initially suggested that diabetes mellitus is one of the most common comorbidities in infected people, but its exact prevalence is unclear. However, exact numbers were uncertain. We have addressed this issue in a study published as a letter in the Journal of Endocrinological Investigation. (more…)
Addiction, Annals Internal Medicine, Author Interviews, NIH, Opiods / 10.04.2020

MedicalResearch.com Interview with: Nora D. Volkow, MD Director of the National Institute on Drug Abuse National Institutes of Health Bethesda, MD MedicalResearch.com: What is the background for this study? How does vaping, hookah use, inhaled marijuana, smoking etc impact the risk of coronavirus infection?  Could these activities account for some the risks and infections in younger individuals?   Response: Apart from older age, having underlying cardiopulmonary conditions is a known risk factor for the worst clinical course and outcomes of COVID-19, and many of those conditions are known to be caused or exacerbated by smoking. While evidence continues to emerge about how smoking might interact with COVID-19, it is a reasonable assumption that smoking could contribute to risk even in younger individuals. We still don’t know how vaping—whether of nicotine or marijuana or just flavorings—contributes to the risk of infection or illness severity with the virus that causes COVID-19, but there are a number of reasons to be concerned. We have already seen lung illnesses caused by some vaping products, and evidence suggests vaping may disrupt lung epithelial cell function, which in turn increases viral susceptibility and may put individuals at increased risk of infection with the virus that causes COVID-19 or with more severe disease outcomes. Vaping is a relatively new technology, and as such, there are many unknowns. The rapid increases in vaping by young people over the last few years make this an area of concern, and thus an area where more research is urgently needed. (more…)
Author Interviews, JAMA, Kidney Disease, Medicare / 10.04.2020

MedicalResearch.com Interview with: Lead and Senior coauthors contributing to this interview: Abby Hoffman, BA is a Pre-Doctoral Fellow in Population Health Sciences at Duke University and a PhD Candidate in Health Policy and Management University of North Carolina at Chapel Hill. Virginia Wang, PhD, MSPH is an Associate Professor in the Department of Population Health Sciences, Associate Director of the Center for Health Innovation and Outcomes Research, and Core Faculty in the Margolis Center for Health Policy at Duke University and Investigator at the Durham VA HSR&D Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT).   MedicalResearch.com: What is the background for this study? Response: It is well established that healthcare providers are sensitive to changes in price, though their behavioral response varies. Dialysis facilities are particularly responsive to changes in Medicare reimbursement. Many dialysis patients are eligible for Medicare regardless of age, but dialysis facilities generally receive significantly higher reimbursement from private insurers than from Medicare. In 2011, Medicare implemented a new prospective bundled payment for dialysis that was expected to decrease Medicare payment and reduce overall revenues flowing into facilities. Then the Affordable Care Act (ACA) rules against refusing to insure patients for preexisting conditions and the 2014 ACA Marketplace provided an additional avenue for patients to purchase private insurance. As a result of these policies, dialysis facilities had a strong motivation and opportunity to increase the share of patients with private insurance coverage. We were interested in understanding whether dialysis facilities were shifting their payer mix away from Medicare, possibly in response to these policy changes.  (more…)