What Do Patients Value About Reading Their Electronic Medical Record Notes?

MedicalResearch.com Interview with:
Macda Gerard
M.D. Candidate | Class of 2021
Wayne State University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: As electronic health records proliferate, patients are increasingly asking for their health information but little is known about how patients use that information or whether they encounter errors in their records. This comes at a time when we’re learning that understanding the patient and family experience, especially what is most valued in exchanges between doctors and patients is important and has many benefits. To learn more, we developed a formal mechanism for patients to provide feedback on what they like about accessing the information in their health records and to inform their clinical team about things like inaccuracies and perceived errors. So that’s the gap we tried to fill.

The patient feedback tool is linked to the visit note in the electronic health record (EHR), and it’s part of a quality improvement initiative aimed at improving safety and learning what motivates patients to engage with their health information on the patient portal. Over the 12-month pilot period, 260 patients and care partners provided feedback using the OpenNotes patient feedback tool. Nearly all respondents found the tool to be valuable and about 70 percent provided additional information regarding what they liked about their notes and the feedback process.

Continue reading

Dementia Care Management Improved Quality of Life For Both Caregivers and Patients With Dementia

MedicalResearch.com Interview with:

Jochen René Thyrian, PhD German Center for Neurodegenerative Diseases (DZNE) Greifswald, Germany     

Dr. Thyrian

Jochen René Thyrian, PhD
German Center for Neurodegenerative Diseases (DZNE)
Greifswald, Germany

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Dementia presents a challenge to the health care systems worldwide. People with dementia (PWD) need comprehensive medical, nursing, psychological and social support to delay the progression of disease and sustain autonomy and social inclusion. Evidence-based interventions alleviate the burden of disease for PwD and their caregivers, as no curative treatment is currently available. Involving caregivers is important because they provide the largest proportion of care for PwD. General physicians in residency have been identified as the first point of contact for PwD and is thus a promising setting for identification, comprehensive needs assessment and initiating dementia-specific treatment and care.

In this study we tested the effectiveness and safety of a model of collaborative care, Dementia Care Management (DCM) on patient-oriented outcomes in n=634 people screened positive for dementia in primary care. DCM is provided by specifically trained nurses, supported by a computerized intervention management system, in close cooperation with the treating physician at the people´s homes. Recommendations for improving treatment and care were based on a comprehensive needs assessment, discussed interprofessionally and their implementation monitored/ adjusted over the course of 6-12 months

Continue reading

Better Coordination Needed Between Hospital Physicians and Home Health Care Providers

MedicalResearch.com Interview with:

Christine D. Jones, MD, MS, Assistant professor Director of Care Transitions, Hospital Medicine Group University of Colorado School of Medicine

Dr. Jones

Christine D. Jones, MD, MS
Assistant professor
Director of Care Transitions, Hospital Medicine Group
University of Colorado School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background for this study is that referrals to home health care at hospital discharge have increased over recent years.  Yet, care coordination including information exchange and communication is often suboptimal between the hospital and home health care and may contribute to medication list discrepancies and even hospital readmissions.

We spoke with focus groups of home health nurses and our main findings were that improvements in key areas could care coordination after hospital discharge.

Specific solutions included:

1) Clearly defining the accountability for home health orders after discharge between hospitalists and primary care providers

2) Changes to insurance requirements that currently only allow physicians to write home health orders so that nurse practitioners and physician assistants can also write home health orders

3) Enhancing access for home health agencies to hospital electronic health records and direct phone lines

4) Encouraging liaisons from home health agencies to meet patients in the hospital to align clinician and patient expectations

5) Direct coordination between home health nurses and clinicians or pharmacists to resolve medication discrepancies

6) Ensuring that detailed information about cognitive and behavioral health is included in information provided to home health from referring hospitals

Continue reading

Men and Women Have Different Post-Op Risks After Joint Replacement

MedicalResearch.com Interview with:

Darwin Chen, MD Assistant Professor, Orthopaedics Icahn School of Medicine at Mount Sinai

Dr. Darwin Chen

Darwin Chen, MD
Assistant Professor, Orthopaedics
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study?

Response: Total hip and knee replacement surgery are among the most commonly performed orthopaedic procedures today. Although success rates are high, complications can occur and some may be preventable. The goal of our research was to assess the impact of gender on complications within the first 30 days after hip and knee replacement.

Continue reading

What Is Best Way To Structure Interdisciplinary Hospital Team Work?

Samuel Pannick, MA, MBBS, MRCP Imperial Patient Safety Translational Research Center, National Institute for Health Research and Imperial College London, London, England West Middlesex University Hospital National Health Service Trust, Middlesex, EnglandMedicalResearch.com Interview with:
Samuel Pannick, MA, MBBS, MRCP
Imperial Patient Safety Translational Research Center, National Institute for Health Research and Imperial College London
West Middlesex University Hospital National Health Service Trust Middlesex, England

Medical Research: What is the background for this study? What are the main findings?

Response: Improving the quality of general medical ward care is a recognized healthcare priority internationally. Ward teams have been encouraged to structure their work more formally, with regular interdisciplinary team meetings and closer daily collaboration with their colleagues. Some early studies suggested that these changes might benefit patients, and help ward teams work more efficiently. However, team interventions on medical wards have been reported with numerous different outcome measures, and prior to this study, it was unclear what their objective benefits were.

We showed that there is little agreement on the objective outcomes that best reflect the quality of interdisciplinary team care on general medical wards. Changes to interdisciplinary care aren’t reflected in the outcome measures that researchers choose most often, like early readmission rates or length of stay. Complications of care – although harder to record – might have more promise as a measure of the quality of inpatient team care in these specific medical areas.

Continue reading

Functional Status Is Important Predictor of Hospital Readmission

Jeffrey C. Schneider, M.D. Medical Director, Trauma, Burn & Orthopedic Program Assistant Professor, Dept. of Physical Medicine and Rehabilitation Harvard Medical School Spaulding Rehabilitation Hospital Boston, MA 02129MedicalResearch.com Interview with:
Jeffrey C. Schneider, M.D.
Medical Director, Trauma, Burn & Orthopedic Program
Assistant Professor, Dept. of Physical Medicine and Rehabilitation
Harvard Medical School
Spaulding Rehabilitation Hospital
Boston, MA 02129

Medical Research: What is the background for this study? What are the main findings?

Response: Hospitalizations account for the largest share of healthcare costs in the U.S., comprising nearly one-third of all healthcare expenditures.  In 2011, readmissions within 30 days of hospital discharge represented more than $41 billion in hospital costs.  Financial penalties for excess 30-day hospital readmissions were instituted by the Centers for Medicare and Medicaid Services in 20124; more than 2,200 hospitals were fined a total of $280 million in reduced Medicare payments in fiscal year 2013.

Most readmission risk prediction models have targeted specific medical diagnoses and have utilized comorbidities and demographic data as the central risk factors for hospital readmission. Yet, large U.S. administrative datasets have demonstrated poor discriminative ability (c-statistics: 0.55-0.65) in predicting readmissions. However, few studies have considered functional status as potential readmission risk factors.

There is increasing evidence that functional status is a good predictor of other health outcomes.  To date, acute care hospital administrative databases do not routinely include functional status measures.  Therefore, inpatient rehabilitation setting is an ideal population in which to examine the impact of functional status on readmission risk, because:

(1) inpatient rehabilitation patients often have complex care transitions after acute care discharge, and represent a significant proportion of total readmissions;

2) inpatient rehabilitation facilities routinely document functional status using a valid instrument—the FIM®; and

(3) a majority of U.S. IRFs participate in one of the only national datasets that contain standardized functional data—the Uniform Data System for Medical Rehabilitation.

Limitations of prior work include small and single-center study designs, narrowly defined patient populations, and defining readmissions beyond the 30-day period.  Overall, there is a lack of literature on the utility of function as a readmission predictor in a large population of medical patients. Moreover, function is a modifiable risk factor with potential to impact readmission outcomes if function-based interventions are instituted early. Therefore, the objective of this study was to compare functional status with medical comorbidities as predictors of acute care readmissions in the medically complex rehabilitation population. We hypothesized that acute care readmission prediction models based on functional status would outperform models based on comorbidities,and that the addition of comorbidity variables to function-based models would not significantly enhance predictive performance.

Continue reading

False Positive Mammograms Can Lead To Psychological Distress Regardless of Whether Diagnostic Procedures Are Required

MedicalResearch.com Interview with:
Bruno M. Heleno MD
The Research Unit for General Practice and Section of General Practice
Department of Public Health
University of Copenhagen

Medical Research: What is the background for this study? What are the main findings?

Dr. Heleno: False positive mammography causes psychological distress. Several observational studies have shown this, and their results have been summarized in systematic reviews. However, it was unclear whether women requiring invasive tests (needle or surgical biopsy) were more distressed than women only requiring non-invasive procedures (clinical examination or imaging). Contrary to previous research, we found that these two groups of women were equally distressed during the 36 months of follow-up in our cohort. The best estimate for the difference for 12 related measures of distress was always close to zero.

Continue reading

Statin Users Have Increased Risk Of Diabetes and Obesity

Ishak Mansi, MD Staff Internist, VA North Texas Health System.   Professor in Department of Medicine & Department of Clinical Sciences, Division of Outcomes and Health services Research, University of Texas Southwestern, Dallas, TXMedicalResearch.com Interview with:
Ishak Mansi, MD
Staff Internist, VA North Texas Health System.
Professor in Department of Medicine &
Department of Clinical Sciences, Division of Outcomes and Health services Research, University of Texas Southwestern, Dallas, TX

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Mansi:  Statin use is associated with increased incidence of diabetes, and possibly increased body weight, and less exercise capacity. Data on the long-term effects of these associations in healthy adults are very limited. Additionally, the effects of these associations on diabetic complications have not been adequately studied.

Dr. Mansi at VA North Texas Health System, Dallas and Professor of Medicine and Clinical Sciences at the University of Texas Southwestern, Dallas, TX and his colleagues found that among generally healthy individuals, statin-users in comparison to non-users had a higher odds of being diagnosed with new onset diabetes, diabetes with complications, and overweight/obesity.

The researchers examined the records of tens of thousands of Tricare beneficiaries, during the period from 10/1/2003 to 3/1/2012. After excluding patients who had at baseline a preexisting cardiovascular diseases or severe chronic diseases that may be life-limiting (including diabetes mellitus), they identified a cohort of 25,970 patients as “healthy cohort”. They, further, matched 3,351 statins-users and 3,351 nonusers on several baseline characteristics to ensure comparability.

There are 3 main important findings for our study:

  1. Statin use was associated with significantly higher risk of new onset diabetes even in a very healthy population. Whereas the risk of diabetes with statins is known, it was thought that this may be due to the overall multiple risks of statin-users (that caused them to receive statins as a therapy).
  2. Statin use was associated with very high risk of diabetes complications in this healthy population: this was never shown before.
  3. Statin use is associated with higher risk of obesity: this also is widely unknown. However, few studies have noted this (one study using patient survey noted this, another study using Mendelian randomization showed it, and post-hoc analysis of a clinical trial showed that statin user gained more weight). Our study, which used a different methodology (retrospective cohort study) add another piece of evidence. Obesity is at endemic level in the US and treatment options are limited.

High-intensity statins was associated with greater risks of all outcomes.

This article is published in the Journal of General Internal Medicine (JGIM). JGIM is the official journal of the Society of General Internal Medicine.

Continue reading

Family Members Can Help Patients Understand Hospital Discharge Instructions

Dennis Tsilimingras, M.D., M.P.H. Assistant Professor, Co-Director of Michigan AHEC (Area Health Education Center), Director of Patient Safety, Department of Family Medicine and Public Health Sciences Wayne State University School of Medicine Detroit, MichiganMedicalResearch.com Interview with:
Dennis Tsilimingras, M.D., M.P.H.
Assistant Professor,
Co-Director of Michigan AHEC (Area Health Education Center),
Director of Patient Safety,
Department of Family Medicine and Public Health Sciences
Wayne State University School of Medicine
Detroit, Michigan

Medical Research: What is the background for this study?

Dr. Tsilimingras: There has been little research to examine post-discharge adverse events (AEs) in rural patients discharged from community hospitals.

Medical Research: What are the main findings?

Dr. Tsilimingras: Over 28 % of 684 patients experienced postdischarge AEs, most of which were either preventable or ameliorable. There was no difference in the incidence of post-discharge AEs in urban versus rural patients, but post-discharge adverse events were associated with hypertension, type 2 diabetes mellitus, and number of secondary discharge diagnoses only in urban patients.

Medical Research: What should clinicians and patients take away from your report?

Dr. Tsilimingras: Post-discharge adverse events were common in both urban and rural patients and many were preventable or ameliorable. Potentially different risk factors for AEs in urban versus rural patients suggests the need for further research into the underlying causes. Patients should be accompanied by family members at the time of discharge to better understand post-discharge instructions.  Patients and family members should not be afraid to ask as many questions as possible regarding follow-up care in their community.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Tsilimingras: Potentially different risk factors for adverse events in urban versus rural patients suggests the need for further research into

the underlying causes. Different interventions may be required in urban versus rural patients to improve patient safety during transitions in care.

Citation:

Post-Discharge Adverse Events Among Urban and Rural Patients of an Urban Community Hospital: A Prospective Cohort Study.

Tsilimingras D1, Schnipper J, Duke A, Agens J, Quintero S, Bellamy G, Janisse J, Helmkamp L, Bates DW.

J Gen Intern Med. 2015 Mar 31. [Epub ahead of print]

 

MedicalResearch.com Interview with: Dennis Tsilimingras, M.D., M.P.H. (2015). Family Members Can Help Patients Understand Hospital Discharge Instructions 

Women With Atrial Fibrillation At Greater Risk Of Stroke Than Men

Gregory YH Lip MD, FRCP (London, Edinburgh, Glasgow), DFM, FACC, FESC Professor of Cardiovascular Medicine, University of Birmingham, UK; Adjunct Professor of Cardiovascular Sciences, Thrombosis Research Unit, Aalborg University, Denmark; Visiting Professor of Haemostasis Thrombosis & Vascular Sciences, Aston University, Birmingham, UK; Visiting Professor of Cardiology, University of Belgrade, Serbia Centre for Cardiovascular Sciences City Hospital Birmingham  England UKMedicalResearch.com Interview with:
Gregory YH Lip MD, FRCP (London, Edinburgh, Glasgow), DFM, FACC, FESC
Professor of Cardiovascular Medicine,
Adjunct Professor of Cardiovascular Sciences,
Thrombosis Research Unit, Aalborg University, Denmark;
Aston Centre for Cardiovascular Sciences City Hospital Birmingham
England UK

Medical Research: What is the background for this study? What are the main findings?

Prof. Lip: Women with atrial fibrillation are at higher risk of stroke than men with atrial fibrillation.

The reasons for this elevated risk remain unclear.

The results from our worldwide study suggest that women are treated no differently to men in terms of anticoagulant therapy for stroke prevention.

Thromboprophylaxis was, however, suboptimal in substantial proportions of men and women, with underuse in those at moderate-to-high risk of stroke and overuse in those at low risk.

Continue reading

Genetic Basis For Acute Lymphoblastic Leukemia Drug Toxicity Identified

MedicalResearch.com Interview with:
Jun J. Yang  Ph.D.

Assistant Member Dept. of Pharm. Sci.
St. Jude Children’s Research Hospital
Memphis, TN 38105

Medical Research: What is the background for this study? What are the main findings?

Dr. Yang: Mercaptopurine is highly effective in acute lymphoblastic leukemia (ALL) and essential for the cure of this aggressive cancer. However, it also has a narrow therapeutic index with common toxicities. Identifying genetic risk factors for mercaptopurine toxicity will help us better understand how this drug works and also potentially enable clinicians to individualize therapy based on patients’ genetic make-up (precision medicine).

In addition to confirming the role of TPMT, we have identified another important genetic risk factor (a genetic variation in a gene called NUDT15) for mercaptopurine intolerance. Patients carrying the variant version of NUDT15 are exquisitely sensitive and required up to 90% reduction of the normal dose of this drug. TPMT variants are more common in individuals of African and European ancestry, whereas NUDT15 variants are important in East Asians and Hispanics.

Continue reading

Novel Intracoronary Imaging Quantifies Lipid in Coronary Artery Vessels

MedicalResearch.com Interview Invitation
Dr.
Eric Boersma
Associate Professor of Clinical Cardiovascular Epidemiology
Thoraxcenter, Erasmus Medical Center and Cardiovascular Research Institute COEUR, Rotterdam, the Netherlands

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Boersma: Near-infrared spectroscopy (NIRS) is a novel intracoronary imaging technique.

The NIRS-derived lipid core burden index (LCBI) quantifies the lipid content within the coronary artery wall.

This study was designed to evaluate the prognostic value of LCBI in patients with coronary artery disease (CAD) undergoing coronary catheterization (CAG).

We learned that patients with high (above the median) LCBI values had 4 times higher risk of coronary events during 1 year follow-up than those with low values.

Continue reading

Adaptive Behaviors To Stress Can Be Transmitted Across Generations

Prof Dr Isabelle Mansuy Lab of Neuroepigenetics University/ETH Zürich Brain Research Institute Zürich, SwitzerlandMedicalResearch Interview with:
Prof Dr Isabelle Mansuy

Lab of Neuroepigenetics University/ETH Zürich
Brain Research Institute Zürich, Switzerland

 

MedicalResearch: What is the background for this study? What are the main findings?

Prof. Mansuy: It is recognised that being exposed to traumatic stress in early life increases the susceptibility to psychiatric and metabolic diseases later in life. This is true for people directly exposed but also for their progeny across generations. It is also known that sometimes, stress exposure in early life can help an individual develop response strategies and be better prepared for later stressful experiences. The mechanisms of such beneficial effects and the question of whether they can be transmitted or not are not known. This study in mice was designed to answer these questions. The main findings are that exposure to traumatic stress of mouse newborns makes the animals and their progeny more efficient in challenging tasks when adult. For instance, they are more able to adapt to rules that change in a complex task to get a water ration when they are thirsty. This suggests more adaptive behaviours in challenging situations that are transmitted across generation. The study identifies the mineralocorticoid receptor, a stress hormone receptor in the brain, as an important molecular mediator of this effect and demonstrates that its expression is altered in the brain by epigenetic mechanisms.

Continue reading

Fenoldopam Does Not Prevent Acute Kidney Injury After Cardiac Surgery

Giovanni Landoni, M.D. Head of Research,Department of Anesthesiology and Intensive Care Associate Professor at Università Vita-Salute San Raffaele, MilanMedicalResearch.com Interview with:
Giovanni Landoni, M.D.
Head of Research,Department of Anesthesiology and Intensive Care
Associate Professor at Università Vita-Salute San Raffaele, Milan

Medical Research: What is the background for this study?

Dr. Landoni: The prevention and treatment of acute kidney injury after cardiac surgery is a major therapeutic goal, but no effective agents have yet been identified. Meta-analyses suggested that fenoldopam might be effective.

Medical Research: What are the main findings?

Dr. Landoni: We found that in cardiac surgery patients with early acute kidney injury (defined as a ≥50% increase of serum creatinine from baseline or oliguria for ≥6 hours), fenoldopam had no impact on the need for renal replacement therapy or 30-day mortality, while increasing the rate of hypotension.

Continue reading

Herpes Zoster Risk Slightly Increased in Patients Taking Biologics

Dr. Norman Putzki, MD PhD Global Program Medical Director Neuroscience Development Franchise Novartis Pharma AG Basel, Switzerland MedicalResearch.com Interview with:
Dr. Norman Putzki, MD PhD
Global Program Medical Director
Neuroscience Development Franchise
Novartis Pharma AG Basel, Switzerland

Medical Research: What is the background for this study? What are the main findings?

Dr. Putzki: Herpes zoster (HZ) infections are increasingly reported in patients taking multiple sclerosis (MS) disease modifying treatments (DMTs). This has been a particular concern ever since more potent MS DMTs have become available.

We have assessed the experience with oral fingolimod, a first in class S1P receptor modulator licensed for multiple sclerosis treatment in 2010, which has today more than 140,000 patient years of exposure in MS clinical trials and the post-marketing setting. Key findings include the fact that Herpes Zoster (HZ) infections occurred at a low rate in clinical trials but were more frequent than with placebo.

In the post-marketing setting, Herpes zoster reporting rates have not increased over time versus clinical trials, and rates have remained stable over time (so there is no risk accumulation).

Our article, which is the result of a consensus meeting with experts in the field of MS and infectious diseases, provides general guidance on risk mitigation; this includes vigilance and appropriate HZ infection management, relevant to physicians when prescribing MS DMTs.

Continue reading