Annals Internal Medicine, Author Interviews, Cost of Health Care, Health Care Systems, University of Pittsburgh / 22.01.2014

Janel Hanmer, MD, PhD University of Pittsburgh Medical Center Montefiore Hospital Pittsburgh, PA 15213MedicalResearch.com Interview with: Janel Hanmer, MD, PhD University of Pittsburgh Medical Center Montefiore Hospital Pittsburgh, PA 15213 MedicalResearch.com: What are the main findings of the study? Dr. Hanmer: We used the National Inpatient Sample - a sample of about 20% of US community hospitals with all discharges from those hospitals - to examine if insurance status is associated with transfer from one hospital to another. We were looking at patients who were already admitted to the hospital, not the patients who presented to the Emergency Department. We selected the five most common general medicine admissions for adults aged 18 to 64. We found that uninsured patients were less likely to be transferred than privately insured patients in four of the five conditions (about 20-40% less likely). We also found that women were less likely than men to be transferred in five of the conditions (about 35 to 40% less likely). (more…)
AHA Journals, Author Interviews, Cost of Health Care, Stroke / 08.01.2014

Dr. James Sheppard MRC Research Fellow Department of Primary Care Health Sciences University of OxfordMedicalResearch.com Interview with Dr. James Sheppard MRC Research Fellow Department of Primary Care Health Sciences University of Oxford MedicalResearch.com: What are the main findings of the study? Dr. Sheppard: The aim of our study was to develop a decision-tree model which estimates the cost-effectiveness and potential implementation costs of a series of interventions which increase thrombolysis rates in acute stroke. The model examined all possible acute stroke patient pathways and was based on real life patient data. We found all proposed interventions to be cost saving whilst increasing patient quality of life after stroke. We estimate that, assuming a "willingness-to-pay"  of USD $30,000 per quality adjusted life year gained, the potential budget available to deliver interventions which improve acute stroke care range from USD $50,000 to USD $144,000. (more…)
Author Interviews, Cost of Health Care, Education, JAMA, University of Pennsylvania / 19.12.2013

Mitesh Patel, MD, MBA RWJF Clinical Scholar, University of Pennsylvania Mitesh Patel, MD, MBA is a Robert Wood Johnson Clinical Scholar the University of Pennsylvania and primary care physician at the Philadelphia VA Medical CenterMedicalResearch.com Interview with: Mitesh Patel, MD, MBA RWJF Clinical Scholar, University of Pennsylvania Mitesh Patel, MD, MBA is a Robert Wood Johnson Clinical Scholar the University of Pennsylvania and primary care physician at the Philadelphia VA Medical Center MedicalResearch.com: What are the main findings of the study? Dr. Patel: We evaluated survey responses from nearly 300 internal medicine residency programs directors to assess whether residency programs were teaching residents the fundamental concepts of practicing high-value, cost-conscious care.  We found that 85% of program directors feel that graduate medical education has a responsibility to help curtail the rising costs of health care.  Despite this, about 6 out of every 7 internal medicine residency programs have not yet adopted a formal curriculum teaching new physicians these important concepts. (more…)
Author Interviews, Cost of Health Care, Infections / 05.12.2013

MedicalResearch.com Interview with: Michael D. April, MD, DPhil San Antonio Uniformed Services Health Education Consortium.Department Harvard Medical School The Medical Practice Evaluation Center MedicalResearch.com: What are the main findings of this study? Dr. April: Using a mathematical model, this study quantified the survival benefits associated with antiretroviral therapy to HIV-infected people in South Africa since 2004.  Our results highlight the astounding benefits of treatment.  In short, antiretroviral therapy has saved 2.8 million years of life in South Africa to date and is projected to save an additional 15.1 million years of life by 2030. (more…)
Author Interviews, Cost of Health Care / 27.11.2013

MedicalResearch.com Interview with: Thomas D. Sequist, MD, MPH, of Atrius Health MedicalResearch.com Interview with: Thomas D. Sequist, MD, MPH, Atrius Health MedicalResearch.com: What are the main findings of the study? Dr. Sequist: Our study, the Impact of Cost Displays on Primary Care Physician Laboratory Test Ordering published in the Journal of General Internal Medicine found that when the costs of certain lab tests were displayed electronically in real time, the rate at which physicians ordered tests decreased. It was conducted among 215 primary care physicians working for Atrius Health, an alliance of six non-profit medical groups and a home health and hospice agency in Massachusetts, where an integrated electronic health record system is used.  Physicians in the intervention group received real-time information on laboratory costs for 27 individual tests when they placed their electronic orders, while the control group did not. What we found was a significant decrease in the ordering rates of both high and low cost range tests by physicians to whom the costs of the tests were displayed electronically in real-time. This included a decrease in ordering rates for four of the 21 lower cost laboratory tests, and one of six higher cost laboratory tests. In addition, physicians were generally very receptive to the intervention. A majority (81 percent) reported that the exercise increased their knowledge regarding costs of care and requesting real-time cost information on an expanded set of health care services. (more…)
Cost of Health Care, Diabetes, Diabetes Care / 26.11.2013

dr_julie_a_schmittdielMedicalResearch.com Interview with: Julie A. Schmittdiel, PhD Kaiser Permanente Division of Research 2000 Broadway Oakland, CA 94612 MedicalResearch.com: What are the main findings of the study? Dr. Schmittdiel: We found that patients with diabetes who used mail order pharmacy were less likely to visit the emergency room than those who did not use mail order pharmacy during a 3 year follow-up period. We also did not see safety concerns associated with mail order pharmacy for most diabetes patients. (more…)
Author Interviews, Cost of Health Care, General Medicine, JAMA, OBGYNE / 26.11.2013

dr_Deanna-KepkaMedicalResearch.com Interview with Deanna Kepka, PhD, MPH   Assistant Professor College of Nursing & Huntsman Cancer Institute University of Utah MedicalResearch.com: What are the main findings of the study? Dr. Kepka: Nearly two-thirds, 64.8% (95% CI: 62.2% - 67.3%) of women reporting a hysterectomy also reported a recent Pap test since their hysterectomy and more than half,  58.4% (95% CI: 55.3% - 61.4%)  of women age 65 years and older without a hysterectomy reported a Pap test in the past three years.  Together, this represents approximately 14 million in the United States. (more…)
Author Interviews, Cost of Health Care, Mental Health Research / 18.11.2013

Dr. Abigail Powers PhD Clinical Psychology Postdoctoral Fellow Emory University School of Medicine MedicalResearch.com: What are the main findings of the study? Dr. Powers: Personality disorders (i.e., problematic personality patterns that cause significant distress and dysfunction in individuals’ lives across many areas of functioning) are associated with many negative health outcomes in young adulthood. The goal of this research study was to determine the relationship between personality pathology and medical resource utilization as individuals age and develop new physical health problems.  Among community-dwelling later middle-aged adults (ages 55-64), we found that personality pathology was related to higher reported medical resource utilization (including doctor visits, hospitalizations, and number of outpatient procedures) independent of health status. Of the 10 DSM-IV personality disorders assessed, narcissistic and antisocial personality disorder features were associated with greater medical resource utilization independent of the presence of physical health problems. Also, among individuals with a greater number of physical health problems, histrionic and dependent personality disorder features were related to greater medical resource utilization, suggesting that important interactions between personality pathology and health conditions may occur in older age and impact resource use. (more…)
Author Interviews, Cost of Health Care, Emergency Care / 06.11.2013

MedicalResearch.com Interview with: Jessica E. Galarraga, MD, MPH Resident Physician Department of Emergency Medicine George Washington University Hospital 2120 L. St. N.W. Suite 475 Washington D.C. Jessica E. Galarraga, MD, MPH Resident Physician Department of Emergency Medicine George Washington University Hospital 2120 L. St. N.W. Suite 475 Washington D.C.   MedicalResearch.com: What are the main findings of the study? Dr. Galarraga: This study examined how emergency department (ED) reimbursements for outpatient visits may be impacted by the insurance coverage expansion of the Patient Protection and Affordable Care Act as newly eligible patients gain coverage either through the Medicaid expansion or through health insurance exchanges. We conducted our analyses using the Medical Expenditure Panel Survey, a nationally representative survey managed by the Agency for Healthcare Research and Quality. We found that ED reimbursements for outpatient encounters by the previously uninsured who gain Medicaid insurance may increase by  17 percent and moving Medicaid-expansion ineligible patients to the private insurance market through insurance exchanges may increase reimbursements as high as 39 percent after the act is implemented. (more…)
Cost of Health Care, Emergency Care, Pediatrics, University of Michigan / 20.10.2013

Adrianne Haggins, MD, MS University of Michigan Health System Department of Emergency Medicine Ann Arbor, MI 48109-5303MedicalResearch.com Interview with: Adrianne Haggins, MD, MS University of Michigan Health System Department of Emergency Medicine Ann Arbor, MI  48109-5303 MedicalResearch.com: What are the main findings of the study? Dr. Haggins: Since the implementation of the Children’s Health Insurance Program (CHIP) in 1997, the last national health care reform that broadly expanded insurance coverage, adolescent use of primary care and specialty care has increased substantially in comparison to no change seen among the comparison group (young adults, who were not covered).  Broadening insurance coverage for adolescents did not result in a decrease in emergency department use, while ED use in the comparison group increased over time.   (more…)
Cost of Health Care / 20.10.2013

MedicalResearch.com Interview with: Gigi Cuckler Economist National Health Statistics Group Office of the Actuary, CMS MedicalResearch.com: What are the main findings of the study? Answer: Below we provide the major findings, but it’s important to note that these estimates incorporate two substantial changes from prior projections.
  • First, the estimates incorporate the June 2012 US Supreme Court ruling that made the Medicaid eligibility expansion under health reform optional for states.
  • Second, unless otherwise stated, the estimates focus on an outlook for spending in which the scheduled Medicare physician payment rate updates under the Sustainable Growth Rate formula do not occur.  The following are highlights from our most recent report:
  • Over the projection period, 2012-22, national health spending is projected to grow at an average rate of 5.8 percent, which is 1.0 percentage point faster than expected average annual growth in the economy over the period.  Consequently, the health share of GDP is projected to increase from 17.9 percent in 2011 to 19.9 percent of the economy by 2022.
  • In the near term of the projection, through 2013, national health spending growth is expected to remain just under 4.0 percent due to the sluggish economic recovery, continued increases in cost-sharing requirements for the privately insured, and low growth for Medicare and Medicaid.
  • However, in 2014, national health spending growth is projected to accelerate to 6.1 percent, reflecting the expanded insurance coverage that will become available through the Affordable Care Act.
  • After 2014 through the remainder of the projection period, national health spending is projected to grow 6.2 percent per year on average, largely as a result of the continued implementation of the coverage expansions under reform, faster projected economic growth, the aging of the population, and the end of the sequester.
  • While projected health spending growth is faster compared to recent experience, it is still slower than the growth experienced over the longer-term history. (more…)
Author Interviews, Cost of Health Care, Heart Disease / 11.10.2013

Ankur Pandya PhD Assistant Professor of Public Health in the Division of Health Policy Department of Public Health at Weill Cornell Medical CollegeMedicalResearch.com Interview with: Ankur Pandya PhD Assistant Professor of Public Health in the Division of Health Policy Department of Public Health at Weill Cornell Medical College MedicalResearch.com: What are the main findings of the study? Dr. Pandya: Our study looked at the impact of some of the future risk factors for cardiovascular disease in the United States.  Using nine National Health and Nutrition Examination Survey waves from 1973 to 2010 we forecasted disease risk and prevalence from 2015 to 2030. We found that despite continued improvements in the disease’s treatment and declining smoking rates, increasing obesity rates, the aging population, and declining mortality from the disease should cause a rise in health care costs, disability, and reductions in the quality of life associated with increased disease prevalence. (more…)
Author Interviews, Cost of Health Care, JAMA, Medicare, Race/Ethnic Diversity, University of Michigan, Weight Research / 25.09.2013

Dr. Lauren Hersch Nicholas Ph.D Research Affiliate, Population Studies Center. Faculty Research Fellow, Survey Research Center University of MichiganMedicalResearch.com Interview Invitation Dr. Lauren Hersch Nicholas Ph.D Research Affiliate, Population Studies Center. Faculty Research Fellow, Survey Research Center University of Michigan MedicalResearch.com: What are the main findings of the study? Dr. Nicholas: We found that a Medicare policy designed to improve the safety of bariatric surgery was associated with 17% decline in the share of Medicare patients from minority groups receiving bariatric surgery. (more…)
CMAJ, Cost of Health Care, Duke, MRI, Orthopedics / 18.09.2013

Matthew P. Lungren, MD Duke University Medical CenterMedicalResearch.com Interview with: Matthew P. Lungren, MD Duke University Medical Center MedicalResearch.com: What are the main findings of the study? Dr. Lungren: In the single center study, knee MRIs are more likely to be normal when the referring doctor has a financial stake in the imaging center or the equipment used; these data suggest that some of these examinations may be unnecessary. (more…)
Author Interviews, Baylor College of Medicine Houston, Blood Pressure - Hypertension, Cost of Health Care, JAMA / 16.09.2013

Laura A. Petersen, MD, MPH MEDVAMC Associate Chief of Staff, Research Director, VA HSR&D Center of Excellence (152) 2002 Holcombe Blvd. Houston TX 77030 Professor of Medicine Chief, Section of Health Services Research Baylor College of Medicine www.houston.hsrd.research.va.govAshley Motter HSR&D Center of Excellence Michael E. DeBakey Veterans Affairs Medical CenterMedicalResearch.com Interview with: Laura A. Petersen, MD, MPH MEDVAMC Associate Chief of Staff, Research Director, VA HSR&D Center of Excellence (152) Houston TX 77030 Professor of Medicine Chief, Section of Health Services Research Baylor College of Medicine HSR&D Center of Excellence Michael E. DeBakey Veterans Affairs Medical Center Houston, Texas 77030 MedicalResearch.com: What are the main findings of the study? Dr. Petersen: VA physicians randomized to the individual incentive group were more likely than controls to improve their treatment of hypertension.  The adjusted changes over the study period in Veterans meeting the combined BP/appropriate response measure were 8.8 percentage points for the individual-level, 3.7 for the practice-level, 5.5 for the combined, and 0.47 for the control groups.  Therefore, a physician in the individual group caring for 1000 patients with hypertension would have about 84 additional patients achieving blood pressure control or appropriate response after 1 year.  The effect of the incentive was not sustained after the washout period. Although performance did not decline to pre-intervention levels, the decline was significant.  None of the incentives resulted in increased incidence of hypotension compared with controls.  While the use of guideline-recommended medications increased significantly over the course of the study in the intervention groups, there was no significant change compared to the control group.  The mean individual incentive earnings over the study represented approximately 1.6% of a physician’s salary, assuming a mean salary of $168,000. (more…)
Author Interviews, Cost of Health Care, PAD / 13.09.2013

MedicalResearch.com Interview with: Nasser Malyar, MD Division of Vascular Medicine Department of Cardiovascular Medicine University Hospital Muenster Albert-Schweitzer-Campus 1, A1 48149 Muenster, Germany MedicalResearch.com: What are the main findings of the study? Dr. Malyar: The main findings of the study were that 1) PAD as a main or co-diagnosis is common among in-hospital treated patients 2) The prevalence of PAD among hospitalized patients is disproportionately increasing, particularly in the subset with critical limb ischemia 3) Despite all efforts and increasingly use of endovascular and surgical revascularization procedures PAD patients still have a poor in-hospital outcome in terms of limb amputation and in-hospital mortality 4) Last but not least the reimbursement costs for in-hospital treatment of patients with PAD are markedly increasing. (more…)
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, JAMA / 11.09.2013

Thanh N. Huynh, MD, MSHS Clinical Instructor UCLA Division of Pulmonary Critical CareMedicalResearch.com Interview with: Thanh N. Huynh, MD, MSHS Clinical Instructor UCLA Division of Pulmonary Critical Care MedicalResearch.com: What are the main findings of the study? Dr. Huynh: Our study shows that it is common for ICU doctors to recognize that futile treatment is provided to patients who cannot benefit from it.  In our study, 11% of ICU patients were perceived as receiving futile treatment.  The outcomes of these 123 patients were uniformly poor, with 85% dying within 6 months.  Advances in critical care medicine has allowed us to save lives, but it has also allowed us provide aggressive life-sustaining treatments that may not benefit all patients.  When aggressive treatment is poorly matched with a patient’s prognosis, doctors will consider such treatment as futile and our study shows that this is not an uncommon occurrence in our health system. (more…)
Author Interviews, Cost of Health Care, JAMA / 04.09.2013

Seth A. Seabury, PhD Department of Emergency Medicine, University of Southern California Los Angeles Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los AngelesMedicalResearch.com Interview with: Seth A. Seabury, PhD Department of Emergency Medicine, University of Southern California, Los Angeles Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles   MedicalResearch.com: What are the main findings of the study? Dr. Seabury: We studied the trends in the earnings of male and female physicians in the US from 1987-2010 using nationally representative data from the Current Population Survey (CPS).  We found that, while the number of female physicians grew significantly, male physicians continue to have significantly higher earnings than female physicians.  The difference in the median earnings of male physicians compared to female physicians actually increased from $33,840 in 1987-1990 to $56,019 in 2006-2010, though the difference across years was not statistically significant.  Our approach controlled for differences in hours worked, so earnings gap was not driven by differences in work hours, though it could be explained by other factors we did not observe in our data (e.g., specialty choice). Looking at other occupations in the US health care industry, the male-female earnings gap was smaller for pharmacists and registered nurses and decreased over time, but was large and increased for physicians assistants.  On the other hand, our numbers indicate that outside of the health care industry, the male-female earnings gap fell by more than 45%.  Even though significant gender inequality persists across the US, female physicians do not appear to have benefited from the relative gains that female workers outside the health care industry have. (more…)
Author Interviews, Case Western, Cleveland Clinic, Cost of Health Care, Pain Research, Surgical Research / 30.08.2013

MedicalResearch.com Interview with: Conor P. Delaney, MD MCh PhD FRCSI FACS FASCRS The Jeffrey L. Ponsky Professor of Surgical Education | Chief, Division of Colorectal Surgery | Vice-Chair, Department of Surgery | Director, CWRU Center for Skills and Simulation | Surgical Director, Digestive Health Institute | University Hospitals Case Medical Center | Case Western Reserve University | 11100 Euclid Avenue Cleveland, OH 44106-5047 MedicalResearch.com: What are the main findings of the study? Answer: Our goal was to see whether the transversus abdominis plane (TAP) block reduced complications and shortened the hospital stay of patients undergoing colorectal operations.  The TAP block is a nerve block injection given at the conclusion of the operation which reduces pain in the operative area.  Results showed that the mean hospital stay dropped to less than 2.5 days after the surgical procedure, significantly lower than the 3.7 days which the University Hospitals Case Medical Center Care pathway had already described for more than 1,000 consecutive patients. In our new study, we employed the TAP block and the Enhanced Recovery Pathway (ERP) on 100 patients.  We found that 27 patients went home the next day and another 35 went home 48 hours after their operations. That is considerably better than the five or six days patients usually stay in the hospital after laparoscopic colorectal procedures, and certainly better than nine days often seen after an open operation.  With a third of patients leaving the day after colorectal resection, we feel these results are significant. (more…)
Author Interviews, Cost of Health Care, Duke / 29.08.2013

S. Yousuf Zafar, MD, MHS Assistant Professor of Medicine Duke Cancer Institute twitter: @yzafarMedicalResearch.com Interview with: S. Yousuf Zafar, MD, MHS Assistant Professor of Medicine Duke Cancer Institute twitter: @yzafar MedicalResearch.com: What are the main findings of the study? Dr. Zafar: We found that cost-related medication non-adherence was prevalent among cancer patients who sought financial assistance. Nearly half of participating cancer patients were non-adherent to medications as a result of cost. Patients  used different cost-coping strategies, for example, trying to find less expensive medications, borrowing money to pay for medications, and otherwise reducing spending. We found that non adherent participants were more likely to be young, unemployed, and without a prescription medication insurance plan. (more…)
Author Interviews, Cost of Health Care, Electronic Records, NYU / 23.08.2013

MedicalResearch.com Interview with: Saul Blecker, MD, MHS Assistant Professor Department of Population Health NYU School of Medicine 227 East 30th St., #648 New York, NY 10016Saul Blecker, MD, MHS Assistant Professor Department of Population Health NYU School of Medicine 227 East 30th St., #648 New York, NY 10016 MedicalResearch.com: What are the main findings of the study? Dr. Blecker: We tracked utilization of the inpatient electronic health record (EHR) as a proxy for hospital intensity of care. EHR utilization was found to have variations over time, particularly when comparing days to nights and weekdays to weekends. (more…)
AHA Journals, Author Interviews, Cost of Health Care, Diabetes / 23.08.2013

MedicalResearch.com Interview with: Xiaohui Zhuo PhD Health economist Division of Diabetes Translation National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention MedicalResearch.com: What are the main findings of the study? First, someone diagnosed with type 2 diabetes may pay an average of about $85,500 treating the disease over his or her lifetime. Lifetime cost is higher for women, and for patients who developed the disease earlier in life. Second, treating diabetic complications account for more than half of lifetime costs, and a majority of which is attributed by damage to large blood vessels, which can lead to coronary heart disease and stroke. (more…)
Author Interviews, Cost of Health Care, Heart Disease, Outcomes & Safety / 20.08.2013

Dr. Finlay McAlister Division of General Internal Medicine Patient Health Outcomes Research and Clinical Effectiveness Unit University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.MedicalResearch.com Interview with: Dr. Finlay McAlister Division of General Internal Medicine Patient Health Outcomes Research and Clinical Effectiveness Unit University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont. MedicalResearch.com: What are the main findings of the study? Answer: Heart Failure carries a high risk of readmission/death in the first 30 days after hospital discharge (approximately 20%) - even in this cohort of patients with first time diagnosis of heart failure who were discharged home to the community.  Patients who do not have an outpatient physician follow-up visit in the first 30 days after discharge have poorer outcomes at 30 days, 3 months, 6 months, and 12 months.  Although outcomes are similar for patients who see an unfamiliar or a familiar physician in that first 30 days, over the longer term follow-up with a familiar physician is associated with better outcomes than follow-up with unfamiliar physician(s). (more…)
Author Interviews, Cost of Health Care, JAMA, Mayo Clinic / 24.07.2013

Jon C. Tilburt, MD, MPH Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota Biomedical Ethics Program, Mayo Clinic Knowledge & Evaluation Research Unit, Mayo Clinic Healthcare Delivery Research Program, Center for the Science of Healthcare Delivery Division of Health Care Policy and Research, Mayo ClinicMedicalResearch.com Interview with: Jon C. Tilburt, MD, MPH Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota Biomedical Ethics Program, Mayo Clinic Knowledge & Evaluation Research Unit, Mayo Clinic Healthcare Delivery Research Program, Center for the Science of Healthcare Delivery Division of Health Care Policy and Research, Mayo Clinic What did you set out to find, what was your objective in this study?
  • We wanted to know physicians perceived roles and responsibilities in addressing health care costs as well as their enthusiasm for proposed strategies to contain health care spending.
Who did you study and what did you look at?
  • Practicing US physicians under age 65, we randomly selected 3900 physicians representing all specialties and mailed them an 8-page survey entitled “Physicians, Health Care Costs, and  Society.” We received 2,556 completed surveys (65% response rate). (more…)
Author Interviews, Cost of Health Care, Heart Disease, JAMA, Radiology, UT Southwestern / 24.07.2013

Susan Matulevicius, MD, MSCS Department of Medicine, The University of Texas Southwestern Medical Center, DallasMedicalResearch.com Interview with: Susan Matulevicius, MD, MSCS Department of Medicine, The University of Texas Southwestern Medical Center, Dallas MedicalResearch.com: What are the main findings of the study? Dr. Matulevicius: In our cohort of 535 transthoracic echocardiograms performed at a single academic medical center, we found that the majority (92%) of echocardiograms were appropriate by the 2011 Appropriate Use Criteria; however, only 1 in 3 echocardiograms lead to an active change in patient care while 1 in 5 resulted in no appreciable change in patient care. (more…)
Author Interviews, Cost of Health Care, Medicare, Outcomes & Safety / 23.07.2013

MedicalResearch.com Interview with: Alai Tan, MD, PhD Assistant Professor, Dept. of Preventive Medicine & Community Health Sr. Biostatistician, Sealy Center on Aging Univerisity of Texas Medical Branch 301 University Blvd., Galveston, TX  77555-0177 MedicalResearch.com: What are the main findings of the study? Dr. Tan: The study developed and validated sex-specific Cox proportional-hazards models with predictors of age and comorbidities to predict patient life expectancy using Medicare claims data. The predictive model was well-calibrated and showed good predictive discrimination for risk of mortality between 5 and 10 years. (more…)
Author Interviews, Cost of Health Care, OBGYNE / 19.07.2013

MedicalResearch.com Interview with: Robert E. Garfield, PhD Department of Perinatology, Division of Obstetrics and Gynecology University Medical Centre Ljubljana, Slovenia Costs of Unnecessary Admissions and Treatments for “Threatened Preterm Labor” MedicalResearch.com :What are the main findings of the study? Dr. Garfield: Unnecessary admissions and treatments for “threatened preterm labor” are still part of everyday clinical practice and contribute to exploding healthcare costs. This happens despite substantial evidence that measuring CL by trans-vaginal ultrasound can help to avoid needless interventions due to the high negative predictive values of this test. (more…)
Author Interviews, Cost of Health Care, JAMA / 10.07.2013

MedicalResearch.com Interview with: Ann M. Sheehy, M.D., M.S. Associate Professor Division Head, Hospital Medicine University of Wisconsin Department of Medicine Ann M. Sheehy, M.D., M.S. Associate Professor Division Head, Hospital Medicine University of Wisconsin Department of Medicine MedicalResearch.com: What are the main findings of the study? Dr. Sheehy: There were three main findings of our study. First, we found that observation in clinical practice is very different from the CMS definition of observation. CMS states that observation should rarely last longer than 48 hours, yet 16.5% of our observation encounters lasted longer than 48 hours. CMS also states that observation care is “well-defined”. We found there were 1141 distinct observation codes for our 4578 observation encounters, indicating that observation care is not well defined. Second, we found that observation care disproportionately affects the general medicine population, as over half of our observation encounters were on the general medicine services. These patients also had longer length of stay, were older, more likely to be female, were more likely to need discharge to a skilled facility, and were more likely to have government insurance as compared to patients on other services. This indicates that observation care adversely affects the adult general medicine population more than other patients on other types of services. Finally, we found that observation cost was greater than reimbursement, resulting in a net negative financial margin. (more…)
Author Interviews, Baylor College of Medicine Houston, Cost of Health Care, Heart Disease, JAMA / 03.07.2013

 MedicalResearch.com Interview with Salim S. Virani, MD, PhD Health Policy and Quality Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center of Excellence, and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas MedicalResearch.com: What are the main findings of the study? Dr. Virani: The main findings of the study are that despite having cholesterol levels at goal (LDL cholesterol <100 mg/dL), about one-third of patients (9200 out of 27947) with coronary heart disease had repeat cholesterol testing in 11 months from their last lipid panel. As expected, no intervention was performed as a response to these lipid panels. Collectively, 12686 additional lipid panels were performed in these patients.  Among 13,114 patients who met the optional treatment target of LDL-C<70 mg/dL, repeat lipid testing was performed in 8,177 (62.3% of those with LDL-C<70) during 11 months of follow-up. Patients with a history of diabetes mellitus (odds ratio [OR], 1.16; 95% CI, 1.10-1.22), a history of hypertension (OR, 1.21; 95%CI, 1.13-1.30), higher illness burden (OR, 1.39; 95%CI, 1.23-1.57), and more frequent primary care visits (OR, 1.32; 95%CI, 1.25-1.39) were more likely to undergo repeat testing, whereas patients receiving care at a teaching facility (OR, 0.74; 95%CI, 0.69-0.80) or from a physician provider (OR, 0.93; 95%CI, 0.88-0.98) and those with a medication possession ratio of 0.8 or higher (OR, 0.75; 95%CI, 0.71-0.80) were less likely to undergo repeat testing. (more…)