MedicalResearch.com Interview with:
Dr. John Romley PhD
Schaeffer Center for Health Policy and Economics
Sol Price School of Public Policy, University of Southern California
Los Angeles, CA
MedicalResearch:What is the background for this study? What are the main findings?Dr. Romley: We've known for a long time now that there is tremendous variation in how much Medicare spends across the country, and that these differences are not necessarily related to quality of care. Researchers have devoted great time, energy and intellect to understanding the drivers of Medicare spending. While progress has been made, our understanding remains limited. We also have had less insight into how private health care varies across the country.
We used new information on how much private health plans pay health care providers over and above cost, and found that areas with low private payment levels tended to have substantially higher Medicare spending and utilization.
(more…)
MedicalResearch.com Interview with:
Alexander Janke BS
School of Medicine at Wayne State University
Medical Research: What is the background for this study? What...
MedicalResearch.com Interview with:
Boback Ziaeian MD
Cardiology Fellow, UCLA Division of Cardiology
PhD Candidate, UCLA Fielding School of Public Health
Medical Research: What is the background for this study? What are the main findings?Dr. Ziaeian: Heart failure is projected to increase dramatically over the coming decade due to an aging population improved medical therapies that prolong heart failure survival. Spending for heart failure is projected to increase from $20.9 billion in 2012 to $53.1 billion in 2030. Despite the magnitude of the impact of heart failure on the US population and economy, our understanding of the factors associated with the highest cost heart failure hospitalizations is limited.
Our study provides a descriptive analysis of how certain patient and hospital factors are associated with increased medical costs nationally. The top 20% of heart failure hospitalizations average $28,500 per hospitalization compared to $3,000 for the lowest 20%. Overall, patients with more medical conditions (such as obesity, lung disease, and peripheral vascular disease) have much higher costs associated with hospital care. As expected, sicker patients receiving more invasive procedures such mechanical ventilation or blood transfusions incurred higher costs. Certain hospital characteristics were also associated with higher costs. Hospitals in urban centers were higher cost compared to more rural hospitals. Hospitals in the Northeast and West Coast of the US were higher in cost compared to the Midwest and South. The reasons for this disparity in medical costs requires further research to better understand.
(more…)
MedicalResearch.com Interview with:Todd Lee MD MPH FRCPC
Consultant in Internal Medicine and Infectious Diseases
Assistant Professor of Medicine, McGill University
Director, General Internal Medicine Consultation Service,
Chief of Service, 6 Medical Clinical Teaching Unit,
McGill University Health Centre
Medical Research: What is the background for this study? What are the main findings?Dr. Lee: Antibiotics are often misused and overused in hospitalized patients leading to harms in terms of side effects, infections due to Clostridium dificile, the development of antibiotic resistance, and increased health care costs. Antimicrobial stewardship is a set of processes which are employed to improve antibiotic use. Through various techniques, stewardship seeks to ensure the patient receives the right drug, at the right dose, by the right route, for the right duration of therapy. Sometimes this means that no antibiotics should be given.
In implementing antimicrobial stewardship programs, some of the major challenges larger health care centers face include limitations in the availability of trained human resources to perform stewardship interventions and the costs of purchasing or developing information technology solutions.
Faced with these same challenges, we hypothesized that for one major area of our hospital, our medical clinical teaching units, we could use our existing resources, namely resident and attending physicians, to perform "antimicrobial self-stewardship". This concept tied the CDCs concept of antibiotic "time outs" (periodic reassessments of antibiotics) to a twice weekly audit using a locally developed checklist. These audits were performed by our senior resident physicians in the context of providing their routine clinical care. We also provided local antibiotic guidelines and regular educational sessions once a rotation.
We demonstrated a significant reduction in antibiotic costs as well as improvement in two of the four major classes of antibiotics we targeted as high priority. We estimated we saved between $140 and $640 in antibiotic expenses per hour of clinician time invested.
Anecdotally, trainees felt the process to be highly valuable and believed they better understood the antibiotic use for their patients. (more…)
MedicalResearch.com Interview with:
Dr. Amalavoyal Chari PhD
Department of Economics, University of Sussex
Brighton UK
Medical Research: What is the background for this study? What are the main findings?Dr. Chari: It is well-known that in the United States, informal (unpaid) caregiving by family members and friends is the primary source of long-term care for the elderly population: Recent estimates indicate that nearly 1 in 5 adults in the United States provides care to an elderly relative or friend over the age of 50.
Informal care is not really “free”: Rather, it diverts caregivers’ effort from other productive activities, and the value of these displaced activities is the opportunity cost of informal elder-care. Estimates of this cost have been limited by the lack of nationally representative data with detailed information to allow an assessment of the value that caregivers attach to time and time spent providing care. Our study utilizes new and unique data from the American Time Use Survey (ATUS) to remedy this deficit, and to provide careful, up-to-date estimates of the opportunity costs of informal eldercare in the United States.
We find that informal care is mainly provided by working-age adults, who consequently bear most of the economic burden in terms of opportunity costs. We find that the price tag for informal caregiving of elderly people by friends and relatives in the United States comes to $522 billion a year. Replacing that care with unskilled paid care at minimum wage would cost $221 billion, while replacing it with skilled nursing care would cost $642 billion annually.
(more…)
MedicalResearch.com Interview with: Luís A. Nunes Amaral PhD
HHMI Early Career Scientist
Professor of Chemical & Biological Eng.
Professor of Medicine
Howard Hughes Medical Institute
Northwestern University, Evanston, Illinois
Medical Research: What is the background for this study? What are the main findings?
Dr. Amaral: There is a well known difficulty in promoting the rapid adoption of best practices by physicians. Because of their work load and because of the inability to figure out when some result is a true advance or just hype, doctors tend to stick to what they believe works. Unfortunately, as a 15 year old Institute of Medicine study shows, this lack of adoption of best practices costs society hundreds of thousands of lives a year in the US alone.
The typical process for informing doctors of what best practices are (such as continual medical education and other broadcasting approaches) do not work well. We believe that a weakness of typical approaches is that they have a one talking to the many style, and they are out of a medical practice context. Our hypothesis was that by seeding a few doctors with desired knowledge, one could have spread of the adoption through one-on-one contacts between physicians in the context of treating patients. We found that this approach has the potential to be very effective.(more…)
MedicalResearch.com Interview with: Dr. Christine Marie Veenstra MD
Department of Internal Medicine, Division of Hematology/Oncology Division of Colorectal Surgery
Center for Healthcare Outcomes and Policy Division of General Medicine Cancer Surveillance and Outcomes Research Team
University of Michigan, Ann Arbor
Medical Research: What is the background for this study? Dr. Veenstra: Nearly 50,000 patients are diagnosed with stage III colorectal cancer each year. Chemotherapy is known to increase survival by up to 20% and is the standard recommendation for these patients after surgery. However, use of chemotherapy may be associated with financial strain.
In order to better understand the financial burden and worry associated with colorectal cancer treatment, we surveyed 956 patients being treated for stage III colorectal cancer. We asked patients to answer questions about financial burden such as whether they had used savings, borrowed money, skipped credit card payments, or cut back on spending for food, clothing or recreational activities because of their cancer treatment. We also asked patients how much they worry about financial problems because of their cancer or its treatment.
(more…)
MedicalResearch.com Interview with:
A/Prof Dominique Cadilhac, MPH PhD
Head: Translational Public Health Division
Stroke and Ageing Research Centre (STARC)
Department of Medicine,
School of Clinical Sciences at Monash Health, Monash University
Melbourne, Australia
Medical Research: What are the main findings of the study?Dr. Cadilhac: Our results provide important information for health policy and planning, by providing a better understanding of the long-term costs of ischemic stroke (IS) and intracerebral hemorrhage stroke (ICH).
243 patients who experienced an ischemic stroke– the most common type of stroke, and 43 patients with intracerebral hemorrhage stroke who went on to survive for 10 years or more were interviewed to calculate annual costs as part of the North East Melbourne Stroke Incidence Study. Average annual healthcare costs 10 years after an ischemic stroke were $5,418 (AUD) – broadly similar to costs estimated between 3 and 5 years ($5,545). Whereas previous estimates for annual healthcare costs for intracerebral hemorrhage stroke ten years after stroke onset were $6,101, Professor Cadilhac’s team found the true cost was $9,032 far higher than costs calculated at 3 to 5 years ($6,101) because of a greater need for aged care facilities 10 years on.
The high lifetime costs per stroke for both subtypes for first-ever events emphasize the significant economic implications of stroke (ischemic stroke AUD103,566 [USD 68,769] and intracerebral hemorrhage stroke AUD82,764 [USD54,956]).
The study also provides evidence of the importance of updating cost estimates when population demography patterns change or if new information on incidence rates, or case-fatality rates, are available. We found a much larger number of intracerebral hemorrhage stroke would be expected than from earlier estimates because
a) there are a larger number of people in the age groups 45 to 84 years living in Australia in 2010; and
b) we applied new information on incidence rates from a larger geographical region than what was found from using the original NEMESIS pilot study region. In the online supplement we also provide an estimate of health loss reported as quality adjusted Life years (QALYs) lost to highlight how many years of healthy life is lost from a first-ever stroke event.
(more…)
MedicalResearch.com Interview with Dr. Harald Schmidt, MA, PhD
Assistant Professor, Department of Medical Ethics and Health Policy , Research Associate, Center for Health Incentives and Behavioral Economics, Perelman School of Medicine
University of Pennsylvania Philadelphia, PA 19104-3308
Medical Research: What are the main findings of the study?Dr. Schmidt: We reviewed currently available policies for aligning cost and quality of care. We focused on interventions are similar in their clinical effectiveness, have modest differences in convenience, but pose substantial cost differences to the healthcare system and patients. To control health care costs while ensuring patient convenience and physician burden, reference pricing would be the most desirable policy. But it is currently politically unfeasible. Alternatives therefore need to be explored. We propose the novel concept of Inclusive Shared Savings, in which physicians, the healthcare system, and, crucially, patients, benefit financially in moving more patients to lower cost but guideline concordant and therapeutically equivalent interventions.
(more…)
MedicalResearch.com Interview with: Daniel A. Waxman, MD, PhD
Department of Emergency Medicine
David Geffen School of Medicine
University of California, Los Angeles
RAND Corporation Santa Monica, California
Medical Research: What are the main findings of the study?Dr. Waxman:About 10 years ago, three states (Texas, Georgia, and South Carolina) passed laws which made it much harder for doctors to be sued for malpractice related to emergency room care. The goal of our research was to determine whether the lower risk of being sued translated into less costly care by emergency physicians. To figure this out, we looked at the billing records of nearly 4 million Medicare patients and compared care before and after the laws took effect, and between states that passed reform and neighboring states that didn’t change their laws. We found that these substantial legal protections didn’t cause ER doctors to admit fewer patients to the hospital, to order fewer CT or MRI scans, or to spend less for the overall ER visit.
(more…)
Medical Research’s Interview with:
James A. McKinnell, MD
Los Angeles Biomedical Research Institute
Medical Research: What are the main findings of the study?Dr. McKinnell: Numerous experts and policy makers have called for hospitals to screen patients for methicillin-resistant Staphylococcus aureus (MRSA) infections and isolate anyone testing positive to prevent the spread of these so-called “Superbugs” in healthcare settings. Several states have enacted laws requiring patients be screened for MRSA upon admission.
We conducted two studies, both of which were presented as abstracts at IDWeek, the annual scientific meeting for infectious disease specialists, which found universal MRSA screening and isolation of high-risk patients will help prevent MRSA infections but may be too economically burdensome for an individual hospital to adopt.
Researchers at Los Angeles Biomedical Research Institute, the University of California, Irvine and John Hopkins University examined the cost of a hospital infection prevention strategy that tested all patients for MRSA and then took precautions to avoid contact with potential carriers. We found that using the traditional method of testing for MRSA in the nose, or nares surveillance, and then isolating MRSA carriers prevented nearly three MRSA infections. But it cost the hospital $103,000 per 10,000 hospital admissions. More extensive screening, through the use of other testing methods, which included PCR-based screening, prevented more infections, but increased the cost.
In the second study, we also evaluated the cost of a hospital infection prevention strategy that targeted high-risk patients. Again, we found the costs of the program exceeded the potential savings to the hospital that would be generated by preventing MRSA infections.
We found nares screening and isolation of high-risk patients prevented fewer than one infection (0.6) per 1,000 high-risk admissions to the hospital and created a financial loss of $36,899 for the hospitals. Using more extensive MRSA screening – which included nares, pharynx and inguinal folds screening – prevented slightly more infections (0.8 infections per 1,000 high-risk admissions), according to the study. But our abstract reported an even larger financial loss of $51,478 with the more extensive screening. (more…)
MedicalResearch.com Interview with: Dr. Song Hee Hong PhD
Associate Professor,
Health Outcomes and Policy Research
Dept. Clinical Pharmacy
University of Tennessee Health Science Center
Memphis, TN 38163
Medical Research: What are the main findings of the study?Dr. Hong: Use of GDDP (generic drug discount programs) increased to 23.1% in 2010 from 3.6% of patients receiving any prescription drugs in 2007.
Generic drug discount programs were more valued among the elderly, sicker and uninsured populations.
The lower use of Generic drug discount programs among racial/ethnic minorities observed when the program was deployed no longer existed when the program matured.
(more…)
MedicalResearch.com Interview with: Michael Johansen, MD MS
Assistant Professor
Dept of Family Medicine
Ohio State University
Medical Research: What are the main findings of the study?Dr. Johansen: Between 2007-2011, the United States spent $63.4 billion on high-cost proton pump inhibitors of which $47.1 billion was in excess of using generic omeprazole.
(more…)
MedicalResearch.com Interview with:Steffie Woolhandler MD MPH
Professor School of Public Health and Hunter College, CUNY;
Professor of Medicine
Harvard Medical School Cambridge Hospital
Medical Research: What are the main findings of the study?Dr. Woolhandler: In 2011, U.S. hospitals spent $215 billion on
billing and administration. Meanwhile, other
countries spent far less. None of the other
seven countries we studied spent even half as
much as the U.S., and they all have modern, high
quality hospitals. While we spent nearly
$700 per capita on hospital paperwork, Scotland
and Canada spent less than $200. This means
that if U.S. hospitals ran as efficiently as
Canada’s, the average family of four would save
$2,000 annually on health care.
(more…)
MedicalResearch.com Interview with: Alejandro Arrieta, PhD
Assistant Professor
Department of Health Policy and Management
Florida International University
Medical Research: What are the main findings of the study?Dr. Arrieta: We found that it makes business sense for insurance companies to reimburse patients for the cost of blood pressure monitors that they can use at home. In just the first year, we estimate that insurance companies can produce returns that range from $0.85 to $3.75 per dollar invested in blood pressure monitors provided to their members.
(more…)
MedicalResearch.com Interview with: Jeff Trost, MD
Assistant Professor of Medicine
Johns Hopkins Medicine
Medical Research: What are the main findings of the study?
Dr. Trost: In our study, we reported the use of two relatively simple tactics to significantly reduce the number of unnecessary blood tests to assess symptoms of heart attack and chest pain and to achieve a large decrease in patient charges.
Specifically, we
1) Provided information and education to physicians about proven testing guidelines and
2) Made changes to the computerized provider order entry system at the medical center, part of the Johns Hopkins Health System. The guidelines call for more limited use of blood tests for so-called cardiac biomarkers. A year after implementation, our intervention led to an estimated $1.25 million reduction in laboratory charges.
MedicalResearch.com Interview with: Ms Qi Wu:
Mental Health and Addiction Research Group, Department of Health Sciences
University of York, Heslington
York UK
Medical Research: What are the main findings of the study?Ms Qi Wu: At any time in the UK about one in six adults has a mental health problem, the prevalence of smoking in this group is over 33%, which is around 50% higher than in the general population. It is estimated that 3 million adults with mental disorders were smokers in 2009-10. Meanwhile, people with mental health disorders are also more likely to smoke heavily, this group accounts for as much as 42% of the total national tobacco consumption. In this study, we calculated the avoidable economic burden of smoking in people with mental disorders.
The main finding was that people with mental disorders who smoke cost the UK economy £2.34 billion a year. The total costs are more or less equally divided among losses sustained from premature death, lost productivity, and healthcare costs to treat smoking related diseases such as lung cancer, cardiovascular disease and chronic obstructive pulmonary disease (COPD) in this group. An estimated £719 million (31% of the total cost) was spent on treating diseases caused by smoking. Productivity losses due to smoking-related diseases were about £823 million (35%) for work- related absenteeism and £797 million (34%) was associated with premature mortality.
(more…)
MedicalResearch.com Interview with Hiraku Kumamar, MD, MPH
Department of Epidemiology
Harvard School of Public Health, Boston, MA and
Soko Setoguchi-Iwata, M.D.
Duke Clinical Research Institute
Durham, NC 27715
Medical Research: What are the main findings of the study?Answer: We evaluated the accuracy of discharge diagnosis of stroke in the Medicare claims database by linking it to a nationwide epidemiological study cohort with 30239 participants called REasons for Geographic And Racial Differences in Stroke (REGARDS). We found that among the 282 events captured using a strict claims definition of stroke, 91% were true events. We also found that 12% of the overall strokes had been identified only by Medicare claims, strongly supporting the use of these readily available data for event follow-up in cohort studies.
(more…)
MedicalResearch.com Interview with: M Luca Lorenzoni
OECD Organisation for Economic Co-operation and Development
Health Accounts, Asian Health and Social Policy Outreach
ELS/Health Division
MedicalResearch: What are the main findings of the study?
Answer:
The United States is an outlier in the scenery of OECD as it ranks first for health care expenditure, but last for coverage.
The slowdown in US health care spending during the past decade brought the growth rate closer to that of other high-spending countries -Canada, France, Germany, the Netherlands and Switzerland- at around 1%. Previously in 2002, the US's health expenditure growth was around 7%, much higher than the approximate 3% which was the average for the other countries examined in the study
Higher health-sector prices (e.g., hospital care and prescription drugs) are thought to be the main driver of expenditure differences between the US and other high-spending countries, and recent price dynamics largely explain declines in health expenditure growth.
(more…)
MedicalResearch.com Interview with: Natasha K Brusco
Manager of Physiotherapy Services, Cabrini Health
PhD Candidate, Physiotherapy Department, Faculty of Health Science,
La Trobe University, Bundoora,
Victoria, Australia
MedicalResearch: What are the main findings of the study?Answer: This economic evaluation reports that providing additional Saturday rehabilitation, compared to Monday to Friday rehabilitation alone, is likely to be cost saving per quality adjusted life year gained and for a minimal clinically important difference in functional independence. This builds on previous literature that reports that additional Saturday rehabilitation can improve functional independence and health related quality of life at discharge and may reduce patient length of stay.
(more…)
MedicalResearch.com Interview with: Yuting Zhang, Ph.D.
Associate professor
Graduate School of Public Health Department of Health Policy and Management.
University of Pittsburgh
MedicalResearch: What are the main findings of the study?Dr. Zhang:Since 2006, the government has randomly assigned low-income enrollees to stand-alone Part D plans, based upon the region in which they live. If low-income Medicare Part D enrollees were assigned to the least expensive plan instead of a random plan, the government and beneficiaries could save more than $5 billion in the first year.
(more…)
MedicalResearch Interview with: Ayal A. Aizer, MD, MHS
Harvard Radiation Oncology Program
Boston, MA
MedicalResearch: What are the main findings of the study?
Dr. Aizer: We studied Americans between the ages of 20-40 using the SEER Database (a national cancer registry) and found that patients who had insurance were more likely to present with localized (curable) versus metastatic (generally incurable) cancer. Patients with localized tumors were more likely to receive the appropriate treatment and, most importantly, survived longer than patients without insurance. Our analysis accounted for demographic and socioeconomic differences between patients who were insured versus uninsured. Our results indicate that insurance status is a powerful predictor of outcome among young adults with cancer. The Affordable Care Act, which will likely improve insurance coverage nationally, may yield improved cancer outcomes among Americans.
(more…)
MedicalResearch.com Interview with Katherine Neuhausen, MD, MPH
Director of Delivery System Transformation, Office of Health Innovation
Clinical Assistant Professor, Department of Family Medicine and Population Health
Virginia Commonwealth University
MedicalResearch: What are the main findings of the study?Dr. Neuhausen: Medicaid Disproportionate Share Hospital (DSH) payments keep safety-net hospitals financially viable because these hospitals play such a critical role caring for the uninsured and Medicaid patients, providing trauma care and other vital community services, and training future health providers. The Affordable Care Act (ACA) reduces these DSH payments because the ACA's authors assumed that safety-net hospitals would receive increased revenue from Medicaid expansion and therefore, have less need for DSH payments. However, we found that California’s DSH need will actually increase because of medical cost inflation, low Medicaid payment rates, and the high number of people who will remain uninsured. As a result, the DSH reductions will create funding gaps that must be filled to ensure the financial stability of safety-net hospitals. The financial outlook for California’s safety-net hospitals is still much better under ACA than it would have been without the ACA. In the absence of the ACA, California’s public hospitals would have had an additional $1.5 billion in costs for uncompensated care for the uninsured and would be facing a financial crisis.
(more…)
MedicalResearch.com Interview with:Nileshkumar J. Patel MD
Staten Island University Hospital
Staten Island, NY, 10304 and
Abhishek J. Deshmukh MD
University of Arkansas
Little Rock, AR
MedicalResearch: What are the main findings of the study?Answer: We analyzed data from almost 4 million hospitalizations for atrial fibrillation (AF) from more than 1,200 hospitals across 45 states in last decade, and found that
- Hospitalization rates for atrial fibrillation have increased exponentially among US adults during the past 10 years, particularly in those 65 years or older.
- The most frequent coexisting conditions were hypertension (59.99%), diabetes (21.47%) and chronic pulmonary disease (20.01%).
- In terms of geographic distribution of admissions, the hospitals in the South constitute (38.5%) the highest percentage of atrial fibrillation hospitalizations, followed by Midwest (24.9%), Northeast (22.2%) and West (14.4%).
- Overall in-hospital mortality was 1%. The mortality rate was highest in >80 years age group (1.93%) and patients with concomitant heart failure (8.2%).
- The percentage of patients discharged to nursing facility increased from 8.1% in 2000 to 11.5% in 2010 and need for home health care increased from 6.7% to 13.1%. Approximately one fourth of the patients (25.83%) were discharged to long-term care institution if atrial fibrillation hospitalization was complicated by acute ischemic stroke.
- Mean cost of AF hospitalization increased significantly from $6,410 in 2001 to $8,439 in 2010 (24.04% increase, p <0.001) even after adjusting for inflation. This represents an absolute increment in annual national cost from approximate 2.15 billion dollars in 2001 to 3.46 billion dollars in 2010. The mean cost of care was highest if AF hospitalization was associated with heart failure ($33,161) and valvular disorders ($28,030).
(more…)
MedicalResearch.com Interview with:Vicki Fung, Ph.D.
Assistant Professor
Department of Medicine, Harvard Medical School
Mongan Institute for Health Policy, Massachusetts General Hospital
MedicalResearch: What are the main findings of the study?Dr. Fung: We found that lower income parents of children with asthma were more likely to delay or avoid taking their children to a doctor's office visit or to the emergency room if they had to pay higher out-of-pocket costs for care; they were also more likely to report borrowing money to pay for asthma care.
(more…)
MedicalResearch.com Interview with:David Lassman
Statistician in the National Health Statistics Group, Office of the Actuary
Centers for Medicare and Medicaid Services (CMS)
Baltimore, Maryland.MedicalResearch: What types of health care spending are included in this report? Answer: In the past, the CMS Office of the Actuary provided periodic updates of health care spending by age and more recently by gender. This report, for the first time, provides a time series of spending by age (five categories – 0-18, 19-44, 45-64, 65-84, and 85+) and gender. We also show spending by three major age categories – children (0-18), working age adults (19-64), and the elderly (age 65 and over). We present data for personal health care only which consists of all the medical goods and services used to treat or prevent a specific disease or condition in a specific person. We provide estimates for the even years between 2002 and 2010. These age and gender estimates are controlled to the most recent Historical National Health Expenditure Accounts.
(more…)
MedicalResearch.com Interview with:
Alex Blum, MD MPH FAAP
Chief Medical Officer
Evergreen Health, Baltimore MD 21211
MedicalResearch.com: What are the main findings of the study?Dr. Blum:Accounting for the social risk of patients using a measure of neighborhood socioeconomic status (SES), did not alter the hospital rankings for congestive heart failure (CHF) readmission rates. (more…)
MedicalResearch.com Interview with:Benjamin D. Sommers, MD, PhD
Assistant Professor of Health Policy & Economics
Harvard School of Public Health / Brigham & Women's Hospital
Boston, MA 02115
MedicalResearch.com: What are the main findings of the study?Dr. Sommers: We find that over the first four years since Massachusetts' 2006 comprehensive health reform law, all-cause mortality in the state fell by 2.9%, compared to a similar population of adults living in counties outside Massachusetts that did not expand insurance during this period. We also found that the law reduced the number of adults in Massachusetts without insurance, reduced cost-related barriers to care, increased use of outpatient visits, and led to improvement in self-reported health. Overall, we estimate that the health reform law prevented over 320 deaths per year in the state - or one life saved per 830 adults gaining health insurance. Mortality rates declined primarily due to fewer deaths from causes amenable to health care, such as cancer, infections, and heart disease. We also found that the health benefits were largest for people living in poor counties in the state, areas with higher percentage of uninsured adults before the law was passed, and for minorities.
(more…)
MedicalResearch.com Interview with:Michael H. Hall, MD
North Shore-LIJ Health System
MedicalResearch: What are the key points of your research?
Dr. Hall: Our study was designed to improve care transition from the hospital to home after coronary bypass surgery. The innovative program (Follow Your Heart), implemented at one of our system hospitals, involves sending cardiac surgery nurse practitioners (NPs) who cared for the patients in the hospital to the homes of discharged patients for at least two visits in the first two weeks after discharge. Their goal is to provide continuity of care for patients that they know from the hospital setting and to provide robust medication management, coordinate community services, and be a communications hub for hospital and community providers (primary care, cardiology, and community nurse home visit services). The nurse practitioners interact with community resources to ensure understanding and satisfaction of the patients’ needs prior to hand-off to those resources after two weeks. Our nurse practitioners utilize encrypted smart phones to provide reports to all appropriate providers and can even send pictures of incisions to the surgeon when necessary.
(more…)
MedicalResearch.com Interview with:Juliana C. N. Chan, MBChB MD FHKAM FRCP
Professor Juliana Chan is Professor of Medicine and Therapeutics, Director, Hong Kong Institute of Diabetes and Obesity and International Diabetes Federation Centre of Education at the Chinese University of Hong Kong, Prince of Wales Hospital and Chief Executive Officer of Asia Diabetes Foundation Hong Kong.
MedicalResearch.com: What are the main findings of the study?Dr. Chan: In this 1-year randomized study, we asked the question whether type 2 diabetic patients receiving team-based integrated care augmented by information technology would further improve in their glycemic control if given additional peer support through the telephone. All patients underwent comprehensive risk assessment guided by the web-based JADE portal which generated personalized risk report with attained treatment targets and decision support. After 1 year, all patients improved significantly in all risk factors including A1c with improved treatment adherence, self efficacy and psychological wellbeing. Although the peer support group did not further improve in A1c, short-stay hospitalization rates were substantially reduced by 50% , especially amongst those with emotional distress. These patients accounted for 20% of the intervention group, in whom peer support further reduced psychological distress and treatment non-adherence.
(more…)
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MedicalResearch.com Interview with:
Dr. John Romley PhD
Schaeffer Center for Health Policy and Economics
Sol Price School of Public Policy, University of Southern California
Los Angeles, CA
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Romley: We've known for a long time now that there is tremendous variation in how much Medicare spends across the country, and that these differences are not necessarily related to quality of care. Researchers have devoted great time, energy and intellect to understanding the drivers of Medicare spending. While progress has been made, our understanding remains limited. We also have had less insight into how private health care varies across the country.
We used new information on how much private health plans pay health care providers over and above cost, and found that areas with low private payment levels tended to have substantially higher Medicare spending and utilization.
(more…)
