Author Interviews, Cancer Research, Cost of Health Care, ESMO, Melanoma / 08.10.2016

MedicalResearch.com Interview with: [caption id="attachment_28647" align="alignleft" width="200"]Prof. dr Lidija Kandolf Sekulovi Prof. Kandolf[/caption] Prof. dr Lidija Kandolf Sekulovic MD, PhD EADO project access to innovative medicines coordinator Interdisciplinary Melanoma team, Department of Dermatology Medical Faculty, Military Medical Academy Belgrade, Serbia MedicalResearch.com: What made you set out to organize this survey? Response: Before 2011 there were no effective treatment options for metastatic melanoma patients, but that have tremendously changed in the last 5 years. Now we have innovative medicines which are able to prolong overall survival of these patients to more than 18 months, and in some patients, durable responses lasting for up to 10 years are not infrequently reported. However, the access to these medicines is restricted, and patients and physicians are facing more and more difficulties to obtain them. This is especially the case for countries of Eastern and South-Eastern Europe, where majority of patients are still treated with palliative chemotherapy that does not prolong overall survival. We wanted to explore this issue more deeply, to map the access to innovative medicines between 1st May 2015 to 1st May 2016, and particularly the access to first-line treatment recommended by ESMO and EDF/EORTC/EADO guidelines that are based on scientific evidence and which are published in 2015 and 2016.
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Surgical Research / 06.10.2016

MedicalResearch.com Interview with: Diego Lopez Harvard medical student and Dr. Andrew Loehrer MD former surgical resident at MGH senior author: David C. Chang, PhD, MPH, MBA Associate Professor of Surgery Director of Healthcare Research and Policy Development Department of Surgery Massachusetts General Hospital Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: Income inequality in the United States has been increasing in recent decades, and has become an important in this election cycle. Although income inequality is often framed in terms of its effects on politics and the economy, little attention has been paid to its effect on the healthcare system. In our study, we set out to evaluate the way in which counties with differing levels of income inequality made use of the healthcare system while controlling for the overall income (as well as other demographic variables). We found that areas with higher income inequality were associated with higher Medicare expenditures.  And these effects are independent of – meaning they are in addition to – the known effect of poverty on healthcare utilization.
Author Interviews, Cost of Health Care, Ophthalmology, Pharmacology / 06.10.2016

MedicalResearch.com Interview with: [caption id="attachment_28618" align="alignleft" width="166"]Aleksandra Rachitskaya, MD Assistant Professor of Ophthalmology Retina Service, Department of Ophthalmology Cole Eye Institute Cleveland, OH 44195 Dr. Aleksandra Rachitskaya[/caption] Aleksandra Rachitskaya, MD Assistant Professor of Ophthalmology Retina Service, Department of Ophthalmology Cole Eye Institute Cleveland, OH 44195 MedicalResearch.com: What is the background for this study? Response: The Centers for Medicare and Medicaid Services (CMS) Open Payments database lists payment records from drug and device manufacturers to physicians. Anti-vascular endothelial growth factor (anti-VEGF) agents such as ranibizumab (Lucentis®, Genentech, Inc., San Francisco, CA), aflibercept (Eylea™, Regeneron, Tarrytown, NY) and off-label bevacizumab (Avastin®, Genentech, Inc., San Francisco, CA) are used for a variety of indications in ophthalmology. The current study examined the payments made to ophthalmologists related to ranibizumab and aflibercept and correlated those payments to provider usage of these medications. The former was achieved by utilizing Centers for Medicare and Medicaid Services (CMS) Provider Utilization and Payment database.
Author Interviews, Cost of Health Care, Pharmacology / 04.10.2016

MedicalResearch.com Interview with: [caption id="attachment_28545" align="alignleft" width="125"]Kevin Bowen MD MBA Senior Health Outcomes Researcher Prime Therapeutics LLC 1305 Corporate Center Drive Eagan, MN 55121 Dr. Kevin Bowen[/caption] Kevin Bowen MD MBA Senior Health Outcomes Researcher Prime Therapeutics LLC 1305 Corporate Center Drive Eagan, MN 55121 MedicalResearch.com: What is the background for this study? What are the main findings? • Autoimmune specialty drugs now account for about one of every 10 dollars of combined drug expense through the medical and pharmacy benefits in a commercially insured population. • The autoimmune drug class is one of the fastest growing, with this study finding a doubling in autoimmune drug expenditures and a 38 percent increase in utilization, in the most recent four years. • Integrated analysis of medical and pharmacy claims is essential for this category of drugs because more than 25 percent of autoimmune specialty drug use is paid through the medical benefit and medical claims diagnosis coding provides a means of determining what conditions were treated with drugs covered by pharmacy claims.
Author Interviews, Cost of Health Care, Opiods, Pain Research / 26.09.2016

MedicalResearch.com Interview with: [caption id="attachment_28168" align="alignleft" width="200"]Jaren Howard, PharmD, BCPS Associate Director, Medical Affairs Strategic Research Purdue Pharma L.P. Dr. Jared Howard[/caption] Jaren Howard, PharmD, BCPS Associate Director Medical Affairs Strategic Research Purdue Pharma L.P. MedicalResearch.com: What is the background for this study? Response: The existing scientific literature estimating the healthcare burden of opioid misuse disorders often combines all patients within the broad category of “opioid abuse,” defined as opioid abuse, dependence, or overdose/poisoning. Collectively, these three conditions can significantly increase healthcare costs among commercially insured patients. • Real world medical coding practices present challenges to researchers aiming to separately analyze excess costs by diagnosis, though combining these diagnoses may mask some variation in excess costs. • Furthermore, little is known about the specific drivers of excess costs in terms of medical conditions driving excess costs or places of service at the diagnosis-level.
Author Interviews, CDC, Cost of Health Care, Frailty / 23.09.2016

MedicalResearch.com Interview with: [caption id="attachment_28318" align="alignleft" width="144"]Gwen Bergen, PhD Division of Unintentional Injury National Center for Injury Prevention and Control CDC Dr. Gwen Bergen[/caption] Gwen Bergen, PhD Division of Unintentional Injury National Center for Injury Prevention and Control CDC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Older adult falls are the leading cause of injury death and disability for adults aged 65 years and older (older adults). In this study, we analyzed data from the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) survey. Our study found that, in 2014, older Americans reported 29 million falls. Almost a quarter of these or 7 million falls required medical treatment or restricted activity for at least one day. Women reported a higher percentage of falls (30%) compared with men (27%). Whites and American Indian/Alaskan Natives (AI/AN) were more likely to fall compared with Blacks and Asian/Pacific Islanders; and AI/AN were more likely to report a fall injury compared with all other racial/ethnic groups. The percentage of older adults who reported a fall varied by state, ranging from 21% in Hawaii to 34% in Arkansas.
Author Interviews, Cost of Health Care, CT Scanning, Health Care Systems / 23.09.2016

MedicalResearch.com Interview with: Hui Zhang, Ph.D., MBA Virginia Polytechnic Institute and State University Blacksburg MedicalResearch.com: What is the background for this study? What are the main findings? Response: To promote healthcare coordination and contain the rising costs in the US healthcare system, a variety of payment innovations has been developed and field-tested in both public and private sector. Among them, the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs), administered by the Centers for Medicare and Medicaid Services (CMS) has received considerable attention. Our study took a mathematical modeling approach and comprehensively captured and analyzed the effect of this new payment systems on healthcare stakeholder decisions and system-wide outcomes. Our results provided decision-making insights for payers on how to improve MSSP, for ACOs on how to distribute MSSP incentives among their members, and for hospitals on whether to invest in new CT imaging systems.
Author Interviews, Cost of Health Care, Depression, JAMA, Pediatrics / 21.09.2016

MedicalResearch.com Interview with: [caption id="attachment_28010" align="alignleft" width="173"]Laura P. Richardson, MD, MPH Interim Chief | Division of Adolescent Medicine Director | UW Leadership Education in Adolescent Health (LEAH) Program Professor | UW Department of Pediatrics Seattle Children's | University of Washington Dr. Laura Richardson[/caption] Laura P. Richardson, MD, MPH Interim Chief | Division of Adolescent Medicine Director | UW Leadership Education in Adolescent Health (LEAH) Program Professor | UW Department of Pediatrics Seattle Children's | University of Washington MedicalResearch.com: What is the background for this study? Response: Adolescent depression is one of the most common mental health conditions during adolescence. Up to one in five adolescents experience an episode of major depression by age 18. Depressed youth are at greater risk of suicide, dropping out of school and poor long-term health. Treatments, including medications and psychotherapy, have been proven to be effective but most depressed teens don’t receive any treatment. Two years ago, we showed that the Reaching Out to Adolescents in Distress (ROAD) collaborative care model (a.k.a. Reach Out 4 Teens) designed to increase support and the delivery of evidence-based treatments in primary care was effective in treating depression in teens, significantly improving outcomes. We ran a randomized clinical trial at nine of Group Health’s primary care clinics and reported effectiveness results in JAMA. The current paper represents the next step in this work, examining the cost-effectiveness of collaborative care for adolescent depression in our intervention sample of 101 adolescents with depression, ages 13-17 years.
Author Interviews, Cost of Health Care, Opiods, Pain Research / 21.09.2016

MedicalResearch.com Interview with: [caption id="attachment_28168" align="alignleft" width="200"]Jaren Howard, PharmD, BCPS Associate Director, Medical Affairs Strategic Research Purdue Pharma L.P. Dr. Jared Howard[/caption] Jaren Howard, PharmD, BCPS Associate Director, Medical Affairs Strategic Research Purdue Pharma L.P. MedicalResearch.com: What is the background for this study? Response: Opioid abuse, dependence, overdose, and poisoning (referred to collectively for the purposes of this study as “abuse”) represent a costly public health concern to payers. Excess annual costs for a diagnosed opioid abuser range from $10,000-$20,000 per patient. Current literature does not sufficiently address the drivers of excess costs in terms of medical conditions driving costs or places of service.
Author Interviews, Cost of Health Care, OBGYNE, Outcomes & Safety, University Texas / 17.09.2016

MedicalResearch.com Interview with: [caption id="attachment_28034" align="alignleft" width="200"]Fangjian Guo, MD, PhD Assistant Professor BIRCWH Scholar Department of Obstetrics & Gynecology Center for Interdisciplinary Research in Women’s Health The University of Texas Medical Branch Dr. Fangjian Guo[/caption] Fangjian Guo, MD, PhD Assistant Professor BIRCWH Scholar Department of Obstetrics & Gynecology Center for Interdisciplinary Research in Women’s Health The University of Texas Medical Branch MedicalResearch.com: What is the background for this study? What are the main findings? Response: National guidelines consistently recommend against cervical cancer screening among women with a history of a total hysterectomy for a benign condition. These women are unlikely to develop high-grade cervical lesions. The goal of our study was to assess whether these guidelines are being followed. We examined the use of Pap testing among US adult women with a history of total hysterectomy for a benign condition and the roles of health care providers and patients in the initiation of Pap test use. We found that in 2013, 32% of women who have had a hysterectomy received an unnecessary recommendation for cervical cancer screening from a health care provider in the past year; 22.1% of women with hysterectomy received unnecessary Pap testing. Although the majority of Pap tests were performed at a clinician’s recommendation, approximately one fourth were initiated by patients without clinician recommendations. According to standard 2010 US Census population figures, about 4.9 million unnecessary Pap tests are performed annually among women who have had a total hysterectomy for a benign condition. At approximately $30 per test, $150 million in direct medical costs could be saved annually if screening guidelines were followed for these women.
Author Interviews, Cost of Health Care, Health Care Systems, JAMA / 14.09.2016

MedicalResearch.com Interview with: [caption id="attachment_27808" align="alignleft" width="149"]Gillian D. Sanders-Schmidler Ph.D. Professor of Medicine Duke Evidence Synthesis Group, Director Duke Evidence-based Practice Center, Director Duke Clinical Research Institute Duke University Dr. Gillian D. Sanders-Schmidler[/caption] Gillian D. Sanders-Schmidler Ph.D. Professor of Medicine Duke Evidence Synthesis Group, Director Duke Evidence-based Practice Center, Director Duke Clinical Research Institute Duke University MedicalResearch.com: What is the background for this study? Response: In 1996, the original panel on cost effectiveness in health and medicine published recommendations for the use of cost effectiveness analysis. During the 20 years since the original panel’s report, the field of cost-effectiveness analysis has advanced in important ways and the need to deliver health care efficiently has only grown. In 2012 the Second Panel on Cost Effectiveness in health and Medicine was formed with a goal of reviewing and updating the recommendations. This paper summarizes those recommendations. This process provided an opportunity for the Panel to reflect on the evolution of cost-effectiveness analysis and to provide guidance for the next generation of practitioners and consumers.
Author Interviews, Columbia, Cost of Health Care, Health Care Systems / 11.09.2016

MedicalResearch.com Interview with: [caption id="attachment_27824" align="alignleft" width="165"]Peter Muennig, MD, MPH Associate Professor Mailman School of Public Health Columbia University New York, NY 10032 Dr. Peter Muennig[/caption] Peter Muennig, MD, MPH Associate Professor Mailman School of Public Health Columbia University New York, NY 10032 MedicalResearch.com: What is the background for this study? What are the main findings? Response: We looked that the supplemental Earned Income Tax Credit ( EITC ) programs offered by states to determine whether they have health impacts or not. We found that, on average, folks who live in states that offer supplemental EITC showed improvements in health after EITC was implemented.
Author Interviews, Cost of Health Care, Weight Research / 02.09.2016

MedicalResearch.com Interview with: [caption id="attachment_27587" align="alignleft" width="125"]John A. Batsis, MD, FACP, AGSF Associate Professor of Medicine and The Dartmouth Institute Geisel School of Medicine at Dartmouth Section of General Internal Medicine - 3M Dartmouth-Hitchcock Medical Center Lebanon, NH Dr. John Batsis[/caption] John A. Batsis, MD, FACP, AGSF Associate Professor of Medicine and The Dartmouth Institute Geisel School of Medicine at Dartmouth Section of General Internal Medicine - 3M Dartmouth-Hitchcock Medical Center Lebanon, NH MedicalResearch.com: What is the background for this study? Response: In 2011, the Centers for Medicare and Medicaid implemented a regulatory coverage benefit to cover 22 brief, targeted 15-minute counseling visits by clinicians over the course of a 12-month period for Medicare beneficiaries with a body mass index exceeding 30kg/m2. This was an important policy determination in tackling the obesity epidemic in the United States. An emphasis on the importance of counseling, or intensive behavioral therapy, in a primary care setting set the foundation for this benefit. Yet, it was unclear how and if this benefit (which would be free of charge without a copay or deductible for beneficiaries) was being implemented in clinical care. We therefore identified fee-for-service Medicare claims for the years 2012 and 2013 to determine whether the G0477 code (Medicare Obesity benefit code) was billed. We additionally explored the rate of uptake of the Medicare benefit in relation to the prevalence of obesity using the 2012 Behavior Risk Factor Surveillance System data.
Author Interviews, Cost of Health Care, JAMA / 31.08.2016

MedicalResearch.com Interview with: Dr. Rachel O. Reid MD MS Associate Physician Policy Researcher RAND Corporation MedicalResearch.com: What is the background for this study? What are the main findings? Response:  Waste in the US health care system is both common and expensive, estimated to be in the range of $750 billion annually. Contributing to this waste is over-treatment and use of low value services that offer little or no clinical benefit to patients. We studied 1.46 million adults from across the US with commercial insurance and found that spending on 28 low value services totaled $32.8 million in 2013, accounting for 0.5% of their medical spending or $22 per person annually. The most commonly received low-value services included hormone tests for thyroid problems, imaging for low-back pain and imaging for uncomplicated headache. The greatest proportion of spending was for spinal injection for lower-back pain at $12.1 million, imaging for uncomplicated headache at $3.6 million and imaging for nonspecific low-back pain at $3.1 million. Low-value spending was lower among patients who were older, male, black or Asian, lower-income or enrolled on consumer-directed health plans, which have high member cost-sharing.
Accidents & Violence, Author Interviews, CDC, Cost of Health Care, Frailty, Geriatrics / 30.08.2016

MedicalResearch.com Interview with: [caption id="attachment_27484" align="alignleft" width="150"]Elizabeth Burns, MPH Health Scientist, Division of Unintentional Injury Prevention National Center for Injury Prevention and Control CDC Elizabeth Burns MPH[/caption] Elizabeth Burns, MPH Health Scientist, Division of Unintentional Injury Prevention National Center for Injury Prevention and Control CDC MedicalResearch.com: What is the background for this study? Response: Falls are the leading cause of both fatal and non-fatal injuries among Americans aged 65 and older. In 2000, the direct cost of falls were estimated to be $179 million for fatal falls and $19 billion for non-fatal falls. Fall injuries and deaths are expected to rise as more than 10,000 Americans turn 65 each day. Within the next 15 years, the U. S. population of older Americans is anticipated to increase more than 50%, with the total number of older adults rising to 74 million by 2030.
Author Interviews, Compliance, Cost of Health Care / 29.08.2016

MedicalResearch.com Interview with: [caption id="attachment_27444" align="alignleft" width="200"]Elizabeth Geneva Wood, MHPA Department of Health Policy and Administration College of Nursing Washington State University Spokane Ellizabeth Wood[/caption] Elizabeth Geneva Wood, MHPA Department of Health Policy and Administration College of Nursing Washington State University Spokane MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many people don’t fill prescriptions because they can’t afford them, which is risky for their health. The problem of cost-related nonadherence to prescriptions (CRN) was increasing in prevalence over time until several major policy changes in the 2000s that were intended to help prescription affordability and/or access to health insurance. We observed that each of these major policy changes corresponded with a decrease in CRN among the policy’s target population. For seniors, CRN dropped in 2006, when Medicare Part D came into effect. For younger adults (19-25), CRN dropped in 2010, when the Affordable Care Act began allowing them to stay on their parents’ insurance. Cost-related nonadherence rates also dropped for all non-elderly adults (including the younger ones) in 2014 and 2015, when the Medicaid expansion and the introduction of the health insurance marketplaces offered coverage to many previously-uninsured adults.
Author Interviews, Cost of Health Care, Emergency Care, JAMA, Kidney Disease / 22.08.2016

MedicalResearch.com Interview with: [caption id="attachment_27209" align="alignleft" width="122"]Rachel Patzer, PhD, MPH Director of Health Services Research, Emory Transplant Center Assistant Professor Emory University School of Medicine Department of Surgery Division of Transplantation Dr. Rachel Patzer[/caption] Rachel Patzer, PhD, MPH Director of Health Services Research, Emory Transplant Center Assistant Professor Emory University School of Medicine Department of Surgery Division of Transplantation MedicalResearch.com: What is the background for this study? Response: Patients with End Stage Renal Disease (ESRD) make up less than 1% of all Medicare patients, but account for more than 7% of all Medicare expenses. Patients with ESRD have the highest risk of hospitalization of any patient with a chronic disease, and while hospital admissions have decreased over the last several years, emergency department utilization for this patient population has increased by 3% in the last 3 years. The purpose of the study we conducted was to describe the clinical and demographic characteristics associated with emergency department utilization.
Author Interviews, Cost of Health Care, Heart Disease / 19.08.2016

MedicalResearch.com Interview with: [caption id="attachment_27101" align="alignleft" width="198"]Leo F. Buckley, PharmD Virginia Commonwealth University Richmond, Virginia Dr. Leo Buckley[/caption] Leo F. Buckley, PharmD Virginia Commonwealth University Richmond, Virginia MedicalResearch.com: What is the background for this study? Response: As the prevalence and costs of heart failure are expected to increase through the year 2030, significant efforts have been devoted towards devising alternatives to inpatient hospitalization for the management of heart failure decompensations. Since loop diuretics are the mainstay of treatment during the majority of hospitalizations, administration of high doses of loop diuretics in the outpatient setting has increased in popularity. We intended to answer two questions with his study: first, can a patient-specific dosing protocol based on a patient’s usual diuretic dose achieve safe decongestion? and second, does this strategy alter the usual course of heart failure decompensation, which oftentimes culminates in inpatient hospitalization?
Author Interviews, Breast Cancer, Cancer Research, Cost of Health Care, Sloan Kettering, Surgical Research / 18.08.2016

MedicalResearch.com Interview with: [caption id="attachment_27055" align="alignleft" width="275"]Monica Morrow, MD, FACS Chief, Breast Service, Department of Surgery Anne Burnett Windfohr Chair of Clinical Oncology Dr. Monica Morrow[/caption] Monica Morrow, MD, FACS Chief, Breast Service Department of Surgery Anne Burnett Windfohr Chair of Clinical Oncology Memorial Sloan-Kettering Cancer Center MedicalResearch.com: What is the background for this study? Response: DCIS, ductal carcinoma in situ, intraductal cancer or Stage 0 cancer refers to what some people call the earliest form of cancer we can find and others term “precancerous”. This difference in terms is due to the fact that DCIS lacks the ability to spread to other parts of the body, a fundamental characteristic of cancer. The goal of treatment in DCIS is to prevent progression to invasive cancer which has the ability to spread. DCIS accounted for only 2-3 % of breast cancers seen in the pre-screening mammography era, but it comprises 25-30% of the malignancies detected in screening mammography programs. For this reason it is uncommon in women under age 40, and more commonly seen in women over 50 years of age. Approximately 70% of the women in the US diagnosed with DCIS are treated with lumpectomy (removal of the DCIS and a margin of surrounding normal breast tissue), and additional surgeries to obtain clear, or more widely clear, margins are done in approximately 30% of women. For this reason, the Society of Surgical Oncology, the American Society for Therapeutic Radiation Oncology, and the American Society of Clinical Oncology undertook the development of an evidence based guideline to determine the optimal clear margin for women with DCIS treated with lumpectomy and whole breast radiotherapy.
Author Interviews, Cost of Health Care, Heart Disease / 17.08.2016

MedicalResearch.com Interview with: [caption id="attachment_27101" align="alignleft" width="198"]Leo F. Buckley, PharmD Virginia Commonwealth University Richmond, Virginia Dr. Leo Buckley[/caption] Leo F. Buckley, PharmD Virginia Commonwealth University Richmond, Virginia MedicalResearch.com: What is the background for this study? Response: Heart failure hospitalizations have become a significant burden for both patients and the healthcare systems. Significant efforts have been devoted to identifying alternative treatment pathways for acute decompensated heart failure that do not require hospitalization. Our group previously reported our initial experience with ambulatory intravenous diuretic therapy administered serially over several days to weeks in place of inpatient hospitalization. We found that the rate of hospitalization was significantly reduced compared to expected and that the high dose furosemide protocol utilized was safe and well tolerated by patients.
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Education, Heart Disease, JAMA / 16.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26997" align="alignleft" width="225"]Rory Brett Weiner, MD Assistant Professor of Medicine Harvard Medical School Dr. Rory Brett Weiner[/caption] Rory Brett Weiner, MD Assistant Professor of Medicine Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: The increased use of noninvasive cardiac imaging and Medicare spending in the late 1990s and early 2000s has led to several measures to help optimize the use of cardiac imaging. One such effort has been the Appropriate Use Criteria (AUC) put forth by the American College of Cardiology Foundation. The AUC for echocardiography have been useful to characterize practice patterns and more recently been used as a tool to try to improve ordering of echocardiograms. Our research group previously conducted a randomized study of physicians-in-training (cardiovascular medicine fellows) and showed that an AUC based educational and feedback intervention reduced the rate of rarely appropriate transthoracic echocardiograms (TTEs). The current study represents the first randomized controlled trial of an AUC education and feedback intervention attending level cardiologists. In this study, the intervention group (which in addition to education received monthly feedback emails regarding their individual TTE ordering) ordered fewer rarely appropriate TTEs than the control group. The most common reasons for rarely appropriate TTEs in this study were ‘surveillance’ echocardiograms, referring to those in patients with known cardiac disease but no change in their clinical status.
Author Interviews, Brain Cancer - Brain Tumors, Cancer, Cost of Health Care / 12.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26739" align="alignleft" width="180"]Wuyang Yang, M.D., M.S. Research Fellow Department of Neurosurgery Johns Hopkins Hospital Baltimore, MD 21287 Dr. Wuyang Yang[/caption] Wuyang Yang, M.D., M.S. Research Fellow Department of Neurosurgery Johns Hopkins Hospital Baltimore, MD 21287 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The treatment for glioblastoma (GBM) patients involves a combined approach of surgery, radiation therapy and chemotherapy. Despite advancement in the therapeutic approaches for GBM, differing socioeconomic status result in disparities in health-care access, and may superimpose a significant impact on survival of glioblastoma patients. Insurance status is an indirect indicator of overall socioeconomic status of a patient, and has been shown to correlate with survival of patients with malignant tumor in other parts of the body. We conducted the first study to determine a relationship between different types of insurance and survival of GBM patients. In our study of 13,665 cases of GBM patients, we found that non-Medicaid insured patients have a significant survival benefit over uninsured and even Medicaid insured patients. This is the first time a study describes this relationship in glioblastoma patients, and also the first to compare and quantify the likelihood of poor prognosis between different insurance categories. A difference in insurance coverage was also uncovered, and patients with insurance were more likely to be older, female, white, and married. In addition, we found that younger, female, married patients with smaller tumor size survive longer than other patients, which confirmed findings in existing literature.
Author Interviews, Breast Cancer, Cost of Health Care, Johns Hopkins / 11.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26928" align="alignleft" width="170"]Pedram Argani, M.D. Professor of Pathology and Principal consultant of the Breast Pathology Service Johns Hopkins Medicine Dr. Pedram Argani[/caption] Pedram Argani, M.D. Professor of Pathology and Principal consultant of the Breast Pathology Service Johns Hopkins Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Most pathology laboratories, at the request if clinicians, automatically (reflexively) test needle core biopsies containing ductal carcinoma in situ (DCIS) for estrogen receptor (ER) and progesterone receptor (PR). The logic for testing DCIS for these hormone receptors is that, for patients who have pure DCIS that is ER positive after surgical excision, treatment with estrogen blockers like Tamoxifen can decrease the recurrence of DCIS by a small amount, though overall survival (which is excellent) is not impacted. However, there are several factors which suggest that this reflex testing unnecessarily increases costs. • First, the ER/PR results on core needle biopsy do not impact the next step in therapy; namely, surgical excision. • Second, a subset of excisions performed for DCIS diagnosed on core needle biopsy will harbor invasive breast carcinoma, which would than need to be retested for ER/PR. • Third, because ER and PR labeling is often variable in DCIS, negative results for ER/PR in a small core biopsy specimen should logically be repeated in a surgical excision specimen with larger amounts of DICS to be sure that the result is truly negative. • Fourth, many patients with pure DCIS which is ER/PR positive after surgical excision will decline hormone therapy, so any ER/PR testing of their DCIS is unnecessary. • Fifth, PR status in DCIS has no independent value. We reviewed the Johns Hopkins experience with reflex ER/PR testing of DCIS on core needle biopsies over 2 years. We found that reflex core needle biopsy specimen testing unnecessarily increased costs by approximately $140.00 per patient. We found that ER/PR testing in the excision impacted management in only approximately one third of cases, creating an unnecessary increased cost of approximately $440.00 per patient. Extrapolating the increased cost of reflex ER/PR testing of DCIS to the 60,000 new cases of DCIS in the United States each year, reflex core needle biopsy ER/PR testing unnecessarily increased costs by approximately 35 million dollars.
Author Interviews, Cost of Health Care, Emergency Care / 09.08.2016

MedicalResearch.com Interview with: Jessica Moe MD, MA, PGY5 FRCPC Emergency Medicine, University of Alberta MSc (Candidate) Clinical Epidemiology MedicalResearch.com: What is the background for this study? What are the main findings? Response: Frequent visitors are common in many urban emergency departments (ED). They represent high resource-utilizing patients; additionally, existing literature demonstrates that they experience higher mortality and adverse health outcomes than non-frequent ED users. Interventions targeting frequent ED users therefore may potentially prevent adverse outcomes in this high risk patient group. The purpose of this study was to provide an up-to-date review of the existing literature on the effectiveness of interventions for adult frequent ED users. This systematic review summarizes evidence from 31 interventional studies. The majority evaluated case management and care plans; a smaller number of studies examined diversion strategies, printout case notes, and social work visits. Overall, the studies were considered to have moderate to high risk of bias; however, 84% of before-after studies found that ED visits significantly decreased after the intervention. Additionally, studies examining interventions for homelessness consistently found that interventions improved stable housing. Overall, effects on hospital admissions and outpatient visits were unclear. In summary, the available evidence is encouraging and suggests interventions targeted towards frequent ED users may be effective in decreasing ED visit frequency and improving housing stability.
Author Interviews, Cost of Health Care, Outcomes & Safety / 09.08.2016

CareSkore MedicalResearch.com Interview with: CareSkore co-founders: Dr. Puneet Dhillon Grewal MD CareSkore co-founder and Chief Medical Officer Dr. Grewal is an Internal Medicine physician and Cardiologist. She had completed her residency from Rosalind Franklin University of Medical Science, and is currently a Cardiology Fellow at the same institution and Jaspinder Grewal, MBA CareSkore co-founder and Chief Executive Officer, a graduate from the University of Chicago Booth School of Business and a computer engineer. He has 13 years of experience working with large health systems , managing technology and operations. MedicalResearch.com: What is the background for the CareSkore company? What is its mission and objectives? Response: The Affordable Care Act, through penalties and bundled payments, requires hospitals and providers to be accountable for the quality of care they provide. For example, if a patient is readmitted to the hospital within 30-days after discharge, hospital reimbursement is reduced, and in many cases not paid at all. In order to improve the quality of care, hospitals need to understand the clinical risk of patients, so that they can focus efforts on the patient most likely to face adverse events. The three biggest areas of improvement are readmissions, over utilization of services, and hospital acquired conditions (such as pneumonia and surgical site infections).
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA / 08.08.2016

MedicalResearch.com Interview with: [caption id="attachment_24380" align="alignleft" width="123"]Benjamin D. Sommers, MD, PhD Assistant Professor of Health Policy & Economics Harvard T. H. Chan School of Public Health / Brigham & Women's Hospital Boston, MA 02115 Dr. Benjamin D. Sommers[/caption] Benjamin D. Sommers, M.D., Ph.D Assistant Professor of Health Policy & Economics Department of Health Policy & Management Harvard T.H. Chan School of Public Health Assistant Professor of Medicine Division of General Medicine & Primary Care Brigham & Women’s Hospital / Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: More than half of states have expanded Medicaid under the Affordable Care Act, and several states have taken alternative approaches, such as using federal Medicaid funds to purchase private insurance for low-income adults. Our study looks at the effects of these two different approaches - vs. not expanding at all - in three southern states (Kentucky Arkansas, and Texas). What we find is that expanding coverage, whether by Medicaid (Kentucky) or private insurance (Arkansas), leads to significant improvements in access to care, preventive care, quality of care, and self-reported health for low-income adults compared to not expanding (Texas). The benefits of the coverage expansion also took a while to become evident - the first year of expansion (2014) showed some of these changes, but they become much more apparent in the second year (2015).
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, JAMA / 08.08.2016

MedicalResearch.com Interview with: Dong W. Chang, MD, MS Dong W. Chang, MD, is a lead researcher at LA BioMed, one of the nation’s leading independent nonprofit research institutes. His research interests include improving the delivery of care to patients with a focus on identifying new healthcare models for reducing hospital re-admission. He also is the director of Medical-Respiratory ICU at Harbor-UCLA Medical Center in Torrance MedicalResearch.com: What is the background for this study? What are the main findings? Response: With the use of intensive care units (ICUs) on the rise in many hospitals, researchers at LA BioMed and UCLA examined ICU usage. They found patients who were admitted to these units underwent more costly and invasive procedures but didn’t have better mortality rates than hospitalized patients with the same medical conditions who weren’t admitted to the ICU. The study, published in JAMA Internal Medicine, examined records from 156,842 hospitalizations at 94 acute care hospitals for four medical conditions where ICU care is frequently provided but may not be medically necessary:diabetic ketoacidosis, pulmonary embolism, upper gastrointestinal hemorrhage and congestive heart failure. The study found the hospitals that utilize ICUs more frequently were more likely to perform invasive procedures and incur higher costs. But the study found these hospitals had no improvement in mortality among patients in the ICU when compared with other hospitalized patients with these four conditions. Smaller hospitals and teaching hospitals used ICUs at higher rates for patients with the four conditions studied that did larger hospitals. The difference in the average costs ranged from $647 more for upper gastrointestinal hemorrhage care in the ICU to $3,412 more to care for a patient with congestive heart failure in the ICU when compared with hospital care for the same conditions outside the ICU.
Author Interviews, Brigham & Women's - Harvard, Cancer Research, Cost of Health Care / 08.08.2016

MedicalResearch.com Interview with: Sarah C. Markt, ScD, MPH Research Associate Harvard T.H. Chan School of Public Health | Department of Epidemiology Boston, MA 02115 MedicalResearch.com: What is the background for this study? Response: Age is associated with insurance status, with the greatest proportion of uninsured between the ages of 20 to 34 years. For testicular cancer this is important because the median age of diagnosis is 33 years and the majority of the cases are diagnosed between then ages of 20 and 44 years. Previous studies have shown that people with cancer who are uninsured are more likely to present with worse disease, less likely to receive treatment, and are more likely to die of their disease, compared with those who have private insurance. Furthermore, the associations between Medicaid coverage and cancer outcomes have been conflicting.
Author Interviews, Cost of Health Care, Health Care Systems, JAMA, Surgical Research / 28.07.2016

MedicalResearch.com Interview with: [caption id="attachment_26484" align="alignleft" width="160"]Richard Hoehn, MD Resident in General Surgery College of Medicine University of Cincinnati Dr. Richard Hoehn[/caption] Richard Hoehn, MD Resident in General Surgery College of Medicine University of Cincinnati MedicalResearch.com: What is the background for this study? What are the main findings? Response: A recent study from our research group (Hoehn et al, JAMA Surgery, 2015) found that safety-net hospitals perform complex surgery with higher costs compared to other hospitals, and that these higher costs are potentially due to intrinsic differences in hospital performance. In this analysis, we decided to simulate different policy initiatives that attempt to reduce costs at safety-net hospitals. Using a decision analytic model, we analyzed pancreaticoduodenectomy performed at academic hospitals in the US and tried to reduce costs at safety-net hospitals by either 1) reducing their mortality, 2) reducing their patients’ comorbidities and complications, or 3) sending their patients to non-safety-net hospitals for their surgery. While reducing mortality had a negligible impact on cost and reducing comorbidities/complications had a noticeable impact on cost, far and away the most successful way to reduce costs at safety-net hospitals, based on our model, was to send patients away from safety-net hospitals for their pancreaticoduodenectomy.
Author Interviews, Cost of Health Care, JAMA / 25.07.2016

MedicalResearch.com Interview with: [caption id="attachment_26408" align="alignleft" width="152"]James C. Robinson PhD Leonard D. Schaeffer Professor of Health Economics Director, Berkeley Center for Health Technology Division Head, Health Policy and Management University of California School of Public Health Berkeley, CA Dr. James C. Robinson[/caption] James C. Robinson PhD Leonard D. Schaeffer Professor of Health Economics Director, Berkeley Center for Health Technology Division Head, Health Policy and Management University of California School of Public Health Berkeley, CA MedicalResearch.com: What is the background for this study? Response: To moderate the increase in insurance premiums, employers are increasing consumer cost sharing requirements. Under reference pricing, the employer establishes a limit to what it will contribute towards each service or product, typically set at the 60th percentile or other midpoint in the distribution of prices in the market. If the patient selects a facility charging less than or equal to this contribution, he/she receives full coverage, but if a more expensive facility is chosen, the patient must pay the full difference.