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AHRQ, Author Interviews, Cost of Health Care / 02.06.2017

MedicalResearch.com Interview with: Anita Soni, PhD, MBA Survey Analyst/Statistician Agency for Healthcare Research and Quality MedicalResearch.com: What is the background for this study? Response: This statistical brief uses the data from the Medical Expenditure Panel Survey (MEPS), which collects a broad range of data related to the health care of the U.S. civilian noninstitutionalized population including health insurance coverage, the number and types of health care events and the sources of payment and payment amounts for those events. The survey also gathers information on which medical conditions are associated with the reported health care events. Condition-specific health care expenditure information derived from MEPS data is useful for policy makers in determining where to focus health policies to improve the quality and efficiency of the health care system from the perspective of disease treatment and management. This Statistical Brief presents data regarding medical expenditures for nine conditions for which an estimated 10 percent or more of the U.S. civilian noninstitutionalized population (individuals age 18 and older) received health care in 2013. (more…)
Author Interviews, Blood Pressure - Hypertension, Compliance, Cost of Health Care, University Texas / 31.05.2017

MedicalResearch.com Interview with: Kalyani B. Sonawane, PhD Assistant Professor/ PhD Program Director Department of Health Services Research, Management and Policy College of Public Health and Health Professions University of Florida Gainesville, FL 32610 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Almost one-third of Americans have high blood pressure. Of those patients who are prescribed medication to control their blood pressure, about 30 percent have problems with side effects and nearly 50 percent will not have their blood pressure controlled within the first year of taking medication. In such scenarios, physicians have the option to either add a medication, such as fixed-dose combination, to the patient’s regimen or gradually increase a patient’s dose of their current drug to achieve blood pressure control; and gradually decrease the dose of their current drug or switch to a different drug to resolve side effects. Using healthcare claims data, we compared the economic impact of these alternative treatment modification strategies. (more…)
Author Interviews, Cost of Health Care, HIV, Opiods, PLoS / 31.05.2017

MedicalResearch.com Interview with: Cora Bernard, MS, PhD candidate Pre-doctoral Student in Management Science and Enginnering Affiliate, Center for Health Policy and the Center for Primary Care and Outcomes Research Stanford Health Policy MedicalResearch.com: What is the background for this study? Response: The US opioid epidemic is leading to an increase in the US drug-injecting population, which also increases the risks of HIV transmission. It is critical to public health that the US invests in a coherent and cost-effective suite of HIV prevention programs. In our model-based analysis, we considered programs that have the potential both to prevent HIV and to improve long-term health outcomes for people who inject drugs. Specifically, we evaluated opioid agonist therapy, which reduces the frequency of injection; needle and syringe exchange programs, which reduce the frequency of injecting equipment sharing; enhanced HIV screening and antiretroviral therapy programs, which virally suppress individuals and decrease downstream transmission; and oral HIV pre-exposure prophylaxis (PrEP), which is taken by an uninfected individual and lowers the risk of infection. (more…)
Author Interviews, Cost of Health Care, MRI, Prostate, Prostate Cancer / 21.05.2017

MedicalResearch.com Interview with: Vikas Gulani, MD, PhD Director, MRI, UH Cleveland Medical Center Associate Professor, Radiology, CWRU School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: We wanted to learn if performing MR before prostate biopsy, followed by MR guided strategies for biopsy, are cost effective for the diagnosis of prostate cancer in men who have not previously undergone a biopsy and who have a suspicion of prostate cancer. The most significant findings are as follows: We found that all three MR guided strategies for lesion targeting (cognitive targeting, MR-ultrasound fusion targeting, and in-gantry targeting) are cost effective, as the increase in net health benefits as measured by addition of quality adjusted life years (QALY), outweigh the additional costs according to commonly accepted willingness to pay thresholds in the United States. Cognitive targeting was the most cost effective. In-gantry biopsy added the most health benefit, and this additional benefit was cost-effective as well. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care / 17.05.2017

MedicalResearch.com Interview with: Eric Roberts, PhD Post-doctoral fellow Department of Health Care Policy Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: Increasing consolidation of health care providers has raised regulatory concerns that less competition will lead to higher health care prices and possibly lower quality care for patients. On the other hand, some industry observers have contended that larger and higher-priced practices are better able invest in systems to support care management, and ultimately, better patient care. In this study, we examined whether larger and higher-priced physician practices provided better and more efficient care to their patients. Higher-priced physician groups were paid an average of 36% more by commercial insurers, and were substantially larger than lower-priced practices located within the same geographic areas. Despite large differences in practices’ prices and size, we found few differences in their patients’ quality and efficiency of care. For example, when we compared patients who received care in high-priced versus low-priced practices, we found no differences in patients’ overall care ratings, physician ratings, access to care, physician communication, and use of preventive services. We also found no differences in patients’ hospital admissions or total spending, suggesting that higher-priced practices were not managing their patients’ care more efficiently than their lower-priced counterparts. We did find that patients in higher-priced practices were more likely to receive recommended vaccinations, review of their medications, and results of medical tests, and that they spent less time in the waiting room for a scheduled doctor’s appointment. However, once practice prices exceeded the average for their geographic area, we observed no further gains in quality on most of these measures. (more…)
Author Interviews, Cost of Health Care, Kidney Disease / 13.05.2017

MedicalResearch.com Interview with: Shaum Kabadi HEOR Director at AstraZeneca MedicalResearch.com: What is the background for this study? What are the main findings? Response: More than 20 million adults – roughly 1 in 10 adults – in the US are estimated to have chronic kidney disease (CKD), and this population is expected to grow as the US population ages. Patients with CKD are at high risk for progression to end-stage renal disease (ESRD), a condition requiring dialysis or kidney transplantation to maintain patients’ long-term survival. The cost of treating ESRD patients was over $40 billion in public and private funds in 2009. Prior research shows per-person annual Medicare expenses attributable to CKD were $1,700 for Stage 2, $3,500 for Stage 3, and $12,700 for Stage 4. Additional research is required to understand the economic burden of CKD by stage in a contemporary cohort of commercially insured patients with non-dialysis-dependent (NDD)-CKD. This retrospective cohort study utilized data from the HealthCore Integrated Research Environment, which contained medical and pharmacy administrative claims integrated with laboratory result values from 14 regionally dispersed Anthem health plans in the US. Of 16,030 patients identified with CKD, the mean (SD) estimated glomerular filtration rate (eGFR) (all in mL/min/1.73 m2) in 2014 was 44.3 (±18.7), and the breakdown by eGFR levels was: Stage 1 (≥90) 3%, Stage 2 (60–89) 13%, Stage 3a (45–59) 27%, Stage 3b (30–44) 35%, Stage 4 (15–29) 19%, and Stage 5 (<15) 3%. Mean age across all stages was 67.4 years, and 47% were women. Hospitalization rate (%) and number of outpatient encounters (visits per patient per year) by stage were: Stage 1 (11.6%, 19.8), Stage 2 (14.9%, 22.5), Stage 3a (16.2%, 23.6), Stage 3b (23.7%, 29.5), Stage 4 (30.7%, 36.3), and Stage 5 (30.8%, 61.7) (p-trend). (more…)
AHRQ, Author Interviews, Cost of Health Care / 03.05.2017

MedicalResearch.com Interview with: Salam Abdus, Ph.D. Agency for Healthcare Research and Quality MedicalResearch.com: What is the background for this study? What are the main findings? Response: When the ACA was passed, some people were concerned that access to care for people who already had insurance would decrease because there would be so many newly insured people trying to get care. To answer this question, we reviewed eight measures of access using data from the Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey (MEPS) and the Census Bureaus’ American Community Survey for the period 2008-2014 to study if change in local area insurance rate affected access to care of adults who were continuously insured for two years. Access measures that we looked at include whether they had a usual source of care, were unable to receive necessary medical care, were delayed in receiving necessary medical care, had a physical exam in the past year, had blood pressure checked, had a flu shot, experienced delays getting a doctor appointment, and problems seeing a specialist. We found no consistent evidence of negative impacts on continuously insured adults. We also looked at two subgroups of vulnerable adults: Medicaid beneficiaries and adults living in health professional shortage areas. For both continuously insured subgroups we found no consistent evidence of negative impacts. (more…)
Author Interviews, Breast Cancer, CDC, Cost of Health Care / 03.05.2017

MedicalResearch.com Interview with: Benjamin Allaire MS RTI International Research Triangle Park Durham, NC, 27709 MedicalResearch.com: What is the background for this study? Response: More than 22,000 women younger than 45 years of age were diagnosed with breast cancer in 2013. Although less than 10 percent of all breast cancers are diagnosed among women younger than age 45, the types of breast cancer these younger women face are typically more aggressive, are diagnosed at more advanced stages, and result in poorer survival compared to breast cancer in older women. Younger women may also require more intense treatment, exhibit cancers that are less responsive to treatment, and have distinct and more prevalent side effects from treatment than older women. These side effects can include poorer quality of life, fertility problems, and depression. As a result, breast cancer treatment for younger women is expensive, making them vulnerable to financial hardship. Recent research has shown that 31.8 percent of cancer survivors are likely to have cancer treatment-induced financial troubles, with higher rates among younger cancer patients. These financial difficulties cause some survivors to forego or delay necessary medical treatments. (more…)
Author Interviews, Cost of Health Care / 26.04.2017

MedicalResearch.com Interview with: Benjamin D. Sommers, MD, PhD Associate Professor of Health Policy & Economics Harvard T. H. Chan School of Public Health / Brigham & Women's Hospital Boston, MA 02115 and Kosali Simon PhD School of Public and Environmental Affairs Indiana University Bloomington, IN MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prescription drugs are considered a high value form of medical care, and can be especially difficult for the uninsured to access. The Affordable Care Act’s Medicaid expansion represents an unprecedented expansion of insurance to low-income non-disabled adults, and our study is the first to examine the effects on prescription utilization in detail. (more…)
AHRQ, Author Interviews, Cost of Health Care / 26.04.2017

MedicalResearch.com Interview with: Marie Stagnitti, M.P.A. Agency for Healthcare Research and Quality Medical Expenditure Panel Survey Household Component Project Officer/Senior Survey Statistician MedicalResearch.com: What is the background for this study? Response: The Medical Expenditure Panel Survey (MEPS) – Household Component (HC) which began in 1996 and is administered annually collects data from a sample of families and individuals in selected communities across the United States, and is drawn from a nationally representative subsample of households that participated in the prior year's National Health Interview Survey (conducted by the National Center for Health Statistics). During the household interviews, MEPS collects detailed information for each person in the household on the following: demographic characteristics, health conditions, health status, use of medical services, charges and source of payments, access to care, satisfaction with care, health insurance coverage, income, and employment. The panel design of the survey, which features several rounds of interviews covering two full calendar years, makes it possible to determine how changes in respondents' health status, income, employment, eligibility for public and private insurance coverage, use of services, and payment for care are related. (more…)
Author Interviews, Cost of Health Care, Medicare, Radiology / 25.04.2017

MedicalResearch.com Interview with: David C. Levin, MD Department of Radiology Thomas Jefferson University Hospital Philadelphia, PA 19107. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Radiology had been previously identified as the most rapidly growing of all physician services in the Medicare program during the early years of the 2000-2009 decade. But there have been deep cuts in imaging reimbursement since then. We wanted to determine how these cuts have affected total Medicare payments for imaging. Our main findings were that since 2006, payments to physicians for imaging under the Medicare Physician Fee schedule have dropped by $4 billion per year, or about 33%. (more…)
Author Interviews, Cost of Health Care, JAMA, Primary Care, UCLA / 10.04.2017

MedicalResearch.com Interview with: John N. Mafi, MD, MPH Assistant Professor of Medicine Division of General Internal Medicine and Health Services Research UCLA David Geffen School of Medicine Los Angeles, CA 90024 Affiliated Natural Scientist in Health Policy RAND Corporation 1776 Main St, Santa Monica, CA 90401 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Between 10-30% of healthcare costs are due to low value care, or patient care that provides little to no benefit to patients, and can sometimes cause harm (e.g., radiation exposure from diagnostic imaging tests). In this study, we found that hospital-based primary care practice provide more low value care than community-based primary care practices across the United States. Understanding where and why low value care occurs is going to be essential if we want to get serious about eliminating it. (more…)
Author Interviews, Cost of Health Care, JAMA, Surgical Research, Thyroid / 05.04.2017

MedicalResearch.com Interview with: Benjamin James, MD MS Assistant Professor of Surgery Adjunct Assistant Professor of Otolaryngology Section of Endocrine Surgery IU Division of General Surgery Indiana University Hospital Indianapolis, IN 46202 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over the few decades, there has been a substantial increase in the incidence of thyroid cancer. It is the fastest growing cancer and a recent study in JAMA found that the mortality rate has been rising. In 2006, Massachusetts passed healthcare reform, which expanded Medicaid, created new subsidized insurance programs for those ineligible for Medicaid and extended young adults eligibility on parental plans until the age of 26. The aim of our study was to evaluate the impact this has had on the treatment of thyroid cancer. To address this question, we used the Hospital Cost and Utilization Project State Inpatient Databases for Massachusetts, New Jersey, New York, and Florida, which included a cohort of 56,581 inpatient admissions from 2001 to 2011. We then compared these states before and after the healthcare reform in Massachusetts to evaluate the effect the healthcare reform had on the treatment of thyroid cancer. (more…)
Author Interviews, End of Life Care, Geriatrics, Medicare, Yale / 04.04.2017

MedicalResearch.com Interview with: Shi-Yi Wang MD, PhD. Department of Chronic Disease Epidemiology Yale School of Public Health New Haven, CT MedicalResearch.com: What is the background for this study? What are the main findings? Response: Care at the end of life is often fragmented and poorly coordinated across different health providers. Multiple transitions in care settings can be burdensome to patients and their families as well as costly to society. Despite these concerns about care transitions in the end of life, we lack contemporary data on the number, timing, and overall pattern of healthcare transitions in the last 6 months of life. This study adds to the extant literature by understanding transition trajectories, national variation of the transitions, and factors associated with transitions. We found that more than 80% of Medicare fee-for-service decedents had at least one health care transition and approximately one-third had ≥ 4 transitions in the last 6 months of life. We produced Sankey diagrams to visualize the sequences of healthcare transitions. The most frequent transition pattern involving at least four transitions: home-hospital-home (or skilled nursing facility)-hospital-healthcare setting other than hospital. There was substantial geographic variation in healthcare transitions in the United States. We found that several factors were associated with a significantly increased risk of having multiple transitions, including female gender, blacks, residence in lower income areas, presence of heart disease or kidney disease. (more…)
Author Interviews, Cost of Health Care, JAMA, Macular Degeneration, Ophthalmology, Telemedicine / 02.04.2017

MedicalResearch.com Interview with: John Wittenborn Senior research scientist NORC's Public Health Analytics University of Chicago MedicalResearch.com: What is the background for this study? What are the main findings? Response:The emergence of anti-VEGF treatment for wet-form AMD (choroidal neovascularization) has had a dramatic impact on preserving vision for many Americans. However, community-based studies show that most patients are not diagnosed with wet-form AMD until they have already lost a significant, and largely unrecoverable amount of their vision.  Early detection of wet-form AMD is key to effective treatment and the preservation of vision. The ForeseeHome telemonitoring technology provides patients with a means to check their own eyes on a daily basis to detect the earliest signs of vision loss from wet-form AMD. This is a novel technology that has the potential to improve visual health outcomes for AMD patients.  A prior clinical trial (the AREDS-2 HOME study) demonstrated that this technology can detect wet-form AMD earlier, and with less vision loss than standard care alone. However, that is exactly where that study ended as it reported no cost information nor follow-up. Since the end of this study, the device has been cleared by the FDA and approved for reimbursement by Medicare for certain higher risk patients, but no study has yet considered the long-term implications of adoption of this technology. In our analysis, we use a computer simulation model to essentially estimate what will come next, after patients realize earlier detection of wet-form AMD by utilizing home monitoring. Basically, we follow simulated patients from the time they begin monitoring for the rest of their lives, recording the likely impacts of home monitoring on patients’ long term outcomes including visual status, costs and quality of life. We find that home telemonitoring among the population indicated for reimbursement by Medicare would cost $35,663 per quality adjusted life year (QALY) gained.  Medicare would expect to incur $1,312 in net budgetary costs over 10 years for each patient who initiates monitoring.  However, Medicare patients may expect to achieve lifetime net savings when accounting for the chance of avoided vision loss and its associated costs later in life. (more…)
Author Interviews, BMJ, Cost of Health Care, Orthopedics / 29.03.2017

MedicalResearch.com Interview with: Bart S Ferket, MD, PhD Assistant Professor, Population Health Science and Policy Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: The annual rate of total knee replacement in the US has doubled since 2000, and especially in those aged 45-65 utilization of this procedure has increased. The increase in practice cannot fully be explained by an increase in the prevalence of osteoarthritis and population growth, and has been partly attributed to expansion to people with less severe symptoms. The total number of procedures performed each year now exceeds 640,000. The evidence for the benefit of total knee replacement has been based on studies without a comparison group of no total knee replacement, and so far only one randomized clinical trial has been published. Although the published literature shows large improvements of pain, physical functioning and overall quality of life following the procedure, patients included in these studies generally had severe preoperative symptoms. A number of studies have suggested, however, that up to a third of recipients of total knee replacement show no benefit, and that those with poor physical functioning before surgery may show larger improvements. Therefore, the current US patient population undergoing total knee replacement might show less significant improvement in symptoms on average as compared with a hypothetical scenario in which eligibility is limited to those with more severe symptoms.   (more…)
Author Interviews, Cost of Health Care, Fertility, OBGYNE / 29.03.2017

MedicalResearch.com Interview with: Emily S. Jungheim, MD, MSCI Assistant Professor, Obstetrics and Gynecology Division of Reproductive Endocrinology and Infertility Washington University St. Louis, Missouri MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many women with health insurance lack coverage for fertility treatment so they end up being self-pay for fertility treatments which can be expensive and limit access to care. 15 states have responded with mandates for employers to include fertility coverage in their employee insurance benefits, and 5 of these have comprehensive mandates that include IVF. Illinois is one of these states. Washington University is located on the border between Illinois and Missouri so our fertility center treats a number of women with coverage for fertility treatment and a large number of women who are self-pay for fertility treatment. We suspected that women requiring IVF to conceive were more likely to follow through with treatments if they had coverage so we decided to look at our data. Ultimately we confirmed our suspicions. Women with coverage were more likely to come back for additional cycles of IVF if they didn't conceive. Ultimately this ability to come back for additional treatment cycles led to a higher chance of live birth. (more…)
Author Interviews, Cost of Health Care, Dermatology / 26.03.2017

MedicalResearch.com Interview with: Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Atopic dermatitis (AD) is associated with considerable morbidity and quality of life impairment. AD patients may require hospitalization for acute treatment of serious flares and/or inadequately controlled chronic disease. We examined data from the 2002-2012 National Inpatient Sample, which contains a representative 20% sample of all hospitalizations in the United States. We found that there were substantial numbers of children and adults hospitalized in the United States for AD. Hospitalization rates for atopic dermatitis were highest in the northeast during the winter likely due to cold and dry weather and south during the summer likely due to heat and humidity. Further, hospitalization rates for AD significantly increased in adults between 2002 and 2012. The costs per individual hospitalization were lower in children and adults with AD compared to those without  atopic dermatitis. However, the high prevalence of hospitalization resulted in total inpatient costs of >$8 and >$3 million per-year for adults and children, respectively. (more…)
Abuse and Neglect, Cost of Health Care, Geriatrics / 25.03.2017

MedicalResearch.com Interview with: Sheila Eckenrode RN, CPHQ Quality Improvement Consultant The New England QIN-QIO Qualidigm, Wethersfield, Connecticut MedicalResearch.com: What is the background for this study? Response: Post-acute care has become a focus for improving quality and cost effectiveness of healthcare in the United States. Changes in Medicare payment systems such as bundled payments and the emergence of Affordable Healthcare Organizations will most likely lead to expansion of post-acute care services and decrease in acute care hospitalizations. Approximately 30% of hospitalized Medicare beneficiaries were referred to home health care at discharge in 2012. In 2013, home health agencies served 3.5 million beneficiaries with Medicare paying $18 billion for these services. Home health care has been emphasized under the Improving Medicare Post-Acute Care Transformation Act of 2014 to provide and improve care at individual patient and community levels. In anticipation of increasing utilization of home care services, our study aimed to demonstrate the overall growth in home care availability as well as identify geographical variation and potential gaps in service. (more…)
Accidents & Violence, Author Interviews, Cost of Health Care / 23.03.2017

MedicalResearch.com Interview with: Sarabeth Spitzer MD Candidate | MS2 Stanford University School of Medicine MedicalResearch.com: What is the background for this study? Response: While firearm homicides make headlines, they cause many more injuries than deaths.[1] No one had performed any recent analysis on the costs of hospitalizations for firearm-related injuries. Stanford is a Level One trauma center, and we care for patients injured by firearms. We wanted to know how much it costs the health system to treat these patients. (more…)
Addiction, Author Interviews, Cost of Health Care / 17.03.2017

MedicalResearch.com Interview with: Hefei Wen, PhD Assistant Professor, Department of Health Management & Policy University of Kentucky College of Public Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: Buprenorphine has been proven effective in treating opioid use disorder. However, the high cost of buprenorphine and the limited prescribing capacity may restrict access to this effective medication-assisted treatment (MAT) for opioid use disorder. We found a 70% increase in Medicaid-covered buprenorphine prescriptions and a 50% increase in buprenorphine spending associated with the implementation of Medicaid expansions in 26 states during 2014. Physician prescribing capacity was also associated with increased buprenorphine prescriptions and spending. (more…)
Allergies, Author Interviews, Cost of Health Care, Pediatrics / 17.03.2017

MedicalResearch.com Interview with: Lavanya Diwakar, FRCPath Honorary consultant in immunology Queen Elizabeth Hospital, Birmingham, and Research fellow in health economic University of Birmingham Birmingham UK MedicalResearch.com: What is the background for this study? Response: The rate of anaphylaxis (serious, potentially life threatening manifestation of allergy) has increased in the last decade. There have been some reports from other countries about an increase in the number of adrenaline autoinjectors being prescribed in children, but this has not been systematically examined in the UK. We looked at a database of patient records from over 500 general practices, THIN (the Health Improvement Network), between 2000 and 2012. We found nearly 24,000 children who had been identified as being at risk of anaphylaxis by General Practitioners and prescribed epipens. (more…)
AHRQ, Author Interviews, Cost of Health Care / 15.03.2017

MedicalResearch.com Interview with: Anita Soni, PhD, MBA Survey Analyst/Statistician Agency for Healthcare Research and Quality Rockville, MD MedicalResearch.com: What is the background for this study? Response: This statistical brief uses the data from the Medical Expenditure Panel Survey (MEPS), which is a nationally representative survey of the U.S. civilian noninstitutionalized population that collects data on the demographic characteristics, health conditions, health status, use of medical care services, charges and payments, access to care, satisfaction with care, health insurance coverage, income, and employment of Americans. This brief focuses on adults 18 and older who received some medical care in 2014. Persons who have multiple chronic conditions—those who were treated for two or more conditions considered to be chronic during 2014 -- are compared to those who, while they had medical care, reported use associated with only one or no chronic conditions.  (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA / 13.03.2017

MedicalResearch.com Interview with: Yusuke Tsugawa, research associate Department of Health Policy and Management Harvard T H Chan School of Public Division of General Internal Medicine and Primary Care Brigham and Women’s Hospital, Boston, MA      MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is well known that health spending varies substantially across geographical regions, and yet regions that spend more on health care dot not achieve better health outcomes. These findings has led to many to conclude that at least 20% of U.S. health care spending could be reduced without compromising quality of care. However, while physicians play a critical role in health care decision making, little is known as to how much health care spending varies between physicians, and its implications for patient outcomes. In this study, we found that the variation in spending across physicians is slightly larger than the variation across hospitals. More importantly, higher spending by physicians did not lead to lower patient mortality or readmission rates, within the same hospital. (more…)
Author Interviews, Cost of Health Care, Diabetes / 07.03.2017

MedicalResearch.com Interview with: Maria L. Alva, DPhil Public Health Economics Program RTI International 701 13 Street, NW, Suite 750 Washington, DC 20005  MedicalResearch.com: What is the background for this study? What are the main findings? Response:  Diabetes affects more than 25 percent of Americans over 65. The estimated economic cost of diagnosed diabetes is $245 billion a year. In spite of this we have almost no evidence of the impact of programs geared to stave off the cost of diabetes. The Y-USA received a Health Care Innovation Award of $11.8 million from the Centers for Medicare & Medicaid Services to offer a diabetes prevention program to individuals 65 and over with prediabetes. The goal of the Y-USA model is to get participants to lose 5 percent or more of their body weight and gradually increase their physical activity to 150 minutes per week.  The program lasts a year. The curriculum comprises sixteen weekly core sessions about healthy eating, exercise and motivation followed by eight monthly maintenance sessions. Epidemiological data from other studies have shown that the risk of diabetes increases with increased levels of BMI. There is mounting evidence that it is possible to prevent or delay diabetes through life-style intervention. It is unclear, however, whether weight-loss interventions can yield reductions in medical spending. The objective of our analysis was to establish whether the -USA Diabetes Prevention Program reduces health care spending and utilization among fee-for-service Medicare beneficiaries. (more…)
Author Interviews, Cost of Health Care, Hearing Loss / 07.03.2017

MedicalResearch.com Interview with: Larry Humes, PhD, CCC-A Department of Speech and Hearing Sciences Indiana University Bloomington MedicalResearch.com: What is the background for this study? What are the main findings? Response: About 40% of adults over the age of 60 have significant hearing loss, yet only about 20% of these older Americans seek help and eventually purchase hearing aids.  There have been several national calls for improvements in the accessibility and affordability of hearing health care for adults, especially older adults, including a 2015 report by the President’s Council of Advisors in Science and Technology and a 2016 report by the National Academies of Science, Engineering and Medicine.  One strategy in common to both of these recent reports is to make hearing aids available directly to the consumer via over-the-counter service delivery. This study was a double-blind placebo-controlled randomized clinical trial investigating two different service-delivery approaches, best-practices and over-the-counter, and two different purchase prices for the hearing aids ($600/pair, $3600/pair).  For the most part, purchase price had no influence on outcomes.  Hearing aids delivered via the best-practices service-delivery model were confirmed to be efficacious, but almost identical positive outcomes were obtained via the over-the-counter service-delivery approach. (more…)
Author Interviews, Cost of Health Care / 07.03.2017

MedicalResearch.com Interview with: Genevieve Kanter, PhD Assistant Professor Department of Health Management and Policy Drexel University Dornsife School of Public Health Philadelphia, PA  MedicalResearch.com: What is the background for this study? What are the main findings? Response: We were interested in the exposure of patients to doctors who accept industry payments. Previous research on physician payments has focused on the percentage of doctors who accepted payments, but these estimates can give a partial or misleading picture of the reach of industry payments in relation to the typical patient. No studies had previously taken a population-based approach to estimate the reach of industry payments. We conducted a nationally representative survey of 3542 Americans. We asked respondents about their awareness of industry payments and if they knew whether their own doctor had received an industry payment. We also asked them to identify the doctor they had visited most frequently in the previous 12 months and linked this information to Open Payments, a government website that reports payments made to doctors by prescription drug and device manufacturers. We found that 65%, or almost two-thirds, of patients had seen--in the past 12 months--a physician who had received an industry payment. For some specialties, patient contact with doctors who had industry contact was much higher; 77% of patients who saw an obstetrician/gynecologist visited a doctor who had accepted payments, and 85% of patients who saw an orthopedic surgeon visited a doctor who had accepted payments. At the same time, very few people knew whether their own doctor had received payments; only 5% of respondents reported knowing whether their doctor had received an industry payment. (more…)
Author Interviews, Cost of Health Care / 06.03.2017

MedicalResearch.com Interview with: Dr. LeaAnne DeRigne Associate Professor School of Social Work Florida Atlantic University Boca Raton, FL 33431 MedicalResearch.com: What is the background for this study? What are the main findings? Response: “Compared to 22 similarly developed countries, the United States is the only one that does not mandate employers to provide paid sick leave benefits or include paid sick leave in a universal social insurance plan,” said LeaAnne DeRigne, Ph.D., lead author and an associate professor in the School of Social Work within FAU’s College for Design and Social Inquiry. For the study, DeRigne and collaborators used cross-sectional data from a sample of 13,545 adults aged 18-64 with current paid employment from the 2015 National Health Interview Survey (NHIS). They examined the relationship between having paid sick leave and obtaining eight preventive care services: blood pressure check; cholesterol check; fasting blood sugar check; getting a flu shot; being seen by a medical doctor or health care provider; getting a Pap test (females only); getting a mammogram (females only); and getting tested for colon cancer. The analysis controlled for demographic and other important predictor variables including gender, marital status, education, race/ethnicity, full time work, insurance coverage, health status, limiting health conditions, family income, age, and family size. (more…)
Asthma, Author Interviews, Cost of Health Care, Pediatrics / 04.03.2017

MedicalResearch.com Interview with: Patrick W. Sullivan, Ph.D. Professor Regis University School of Pharmacy Denver, CO 80221 MedicalResearch.com: What is the background for this study? Response: Asthma is one of the most common chronic disorders among children. It affects 7.1 million children in the U.S. Of these, 4.1 million children suffered an asthma attack in 2011. An asthma attack is an acute period of extreme difficulty breathing. It can be life threatening and is always very frightening for children. Because asthma can be dangerous and frightening, it ends up costing a lot because patients need to go the doctor, hospital or take medications to try to control it. Asthma also has a negative effect on the patient’s health and outlook about their health – both mentally and physically. Previous studies have focused on adults with asthma and have found that it is very expensive – it costs $18 billion in the U.S. to manage adults with asthma. Those studies also showed that adults with asthma have lower quality of life. However, there is not a lot of good evidence on the burden of asthma in children. This study was designed to quantify the cost and mental and physical health of children with asthma in the U.S. (more…)