Category Archives: Health Care Systems

4-Meds in One Glaucoma Eyedrop May Decrease Preservatives, Lower Cost, Improve Compliance

Posted on by
Reply

MedicalResearch.com Interview with:

Nathan Radcliffe, MD Senior Faculty, Ophthalmology Glaucoma and Cataract surgeon Mount Sinai Health System

Dr. Radcliffe

Nathan Radcliffe, MD
Senior Faculty, Ophthalmology Glaucoma and Cataract surgeon
Mount Sinai Health System

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

Response: Glaucoma is a leading cause of blindness and the mainstay of therapy is to lower the intraocular pressure (IOP) with topical eye drops.

Up to 40% of patients may require more than one eye drop to control the disease, and yet taking more than one eye drop bottle can result in higher costs, more eye irritation, worse therapeutic compliance, and possibly worse outcomes.  Compounded therapies (not FDA approved, but made at the physician’s request by a compounding pharmacy) can be created to contain multiple glaucoma therapies in one bottle.

We sought to determine if a compounded solution containing three or four drops in one bottle could control glaucoma as well as three or four separate bottles (standard of care) in patients requiring three or four eye drop bottles to control glaucoma.

We performed a multi-center, randomized, observer-masked, parallel-group study comparing a compounded therapy containing latanoprost 0.05%, dorzolamide hydrochloride 2%, timolol maleate 0.5%, brimonidine tartrate 0.2% with 0.01% BAK to standard three or four bottle regaimins.  We measured IOP and corneal staining (a sign of preservative toxicity), as well as other safety measures at week one, month one, two and three.

Continue reading →

Sexual Harassment in Academic Medicine Affects Both Women and Men

Posted on by
Reply

MedicalResearch.com Interview with:

Sabine Oertelt-Prigione, MD, MSc Professor (Strategic Chair) of Gender in Primary and Transmural Care Department of Primary and Community Care Radboud University Medical Center

Dr. Oertelt-Prigione

Sabine Oertelt-Prigione, MD, MSc
Professor (Strategic Chair) of Gender in Primary and Transmural Care
Department of Primary and Community Care
Radboud University Medical Center

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

Response: This publication is a part of the WPP (Watch, Protect, Prevent) Study conducted between 2014 and 2017 at Charité – Universitaetsmedizin in Berlin, Germany. The project was designed to achieve three goals: a) acquire information about the prevalence of sexual harassment in academic medicine, b) develop and implement specific preventative measures and c) design and adopt a workplace policy against sexual harassment. The two latter goals have been achieved and this manuscript describes the findings that prompted their adoption.

In our study we carefully dissected the harassment experiences of physicians working in our tertiary referral center. Verbal harassment throughout medical careers appears as a very common phenomenon that almost 70% of women and men experience at some point. Physical harassment is less common. While colleagues appear as the main perpetrators for both sexes, women report more frequently harassment by their superiors. Among the structural factors potentially associated with harassment, we only identified strong hierarchies. 

MedicalResearch.com: What should readers take away from your report?

Response: First, we show that although the perpetrator profiles differ, both women and men in our study sample are significantly affected by sexual harassment. Second, our results display a gradient of harassment experiences and their prevalence, i.e. the verbal and non-physical forms are more common than physical forms. We argue that tolerance of non-physical forms of misconduct will increase the risk for physical forms by fostering a belief of impunity. Third, in our sample, strong hierarchies associated with an increased likelihood of experiencing harassment in both females and males.

Overall, this data shows that sexual harassment is not an action perpetrated by a single individual, but has a systemic dimension, which needs to be addressed through cultural change. Only measures targeting communication culture, formal structures and interactions in academic medicine will lead to change. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: The investigation of sexual harassment is a complicated matter and should be addressed in detail. In order to design effective prevention measures, we need to know exactly what people have experienced. Hence, a simple question such as “Have you ever experienced sexual harassment?” within a statutory survey will most likely not help much in defining further steps.

The connection between communication patterns, hierarchies and harassment was very apparent in our sample and this area needs further investigation.

Last, the fact that men are also significantly affected emphasizes that this is not a women´s issue but a phenomenon that needs to be addressed to improve the working conditions for all healthcare providers.

Disclosures: Sabine Oertelt-Prigione received funding from the German Ministry of Education and Research, the Charité Foundation, the Hans Boeckler Foundation and the Equal Opportunities Program of the City of Berlin. She has provided expert testimony on the issue of sexual harassment to the German Federal Antidiscrimination Agency and the German Parliament. She is a pro-bono expert advisor for ASTIA.

Citation:

Jenner S, Djermester P, Prügl J, Kurmeyer C, Oertelt-Prigione S. Prevalence of Sexual Harassment in Academic Medicine. JAMA Intern Med. Published online October 03, 2018. doi:10.1001/jamainternmed.2018.4859 

Oct 3, 2018 @ 6:20 pm

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Healthcare Employees Can Work in a ‘Culture of Fear’, Where Speaking Up is Discouraged

Posted on by
Reply

MedicalResearch.com Interview with:

Professor Mary Dixon-Woods Director, The Healthcare Improvement Studies Institut (THIS Institute) University of Cambridge

Prof. Dixon-Woods

Professor Mary Dixon-Woods
Director, The Healthcare Improvement Studies Institute
(THIS Institute)
University of Cambridge 

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

Response: The challenges around employee voice are well documented. For various reasons, employees in all industries are often reluctant to raise concerns when they witness disruptive or unsafe behaviour from their colleagues. But it’s crucial that they speak up – especially in healthcare. Patient safety may depend on it.

Our study focused on a large academic medical centre in the US that wanted to improve employee voice. Despite having reporting mechanisms in place, the organisation still had issues with disruptive behaviour from group of powerful senior individuals that went unchallenged and contributed to a culture of fear.

Through confidential interviews with 67 frontline staff and leaders and the organizational actions that followed, we learned it’s important for employees to feel that their concerns will be dealt with authentically. It also helps when healthcare organisations have clear definitions of acceptable and unacceptable behaviour and well-coordinated response mechanisms. Once someone does raise a concern, organizations need good, fair and transparent systems of investigations and be prepared to implement consequences for disruptive behaviour consistently.  Continue reading →

Voluntary Bundled Payment Program For Care After Acute Hospitalization Unable to Achieve Broad Participation

Posted on by
Reply

MedicalResearch.com Interview with:

A Jay Holmgren Doctoral Student, Health Policy and Management Harvard Business School

A Jay Holmgren

A Jay Holmgren
Doctoral Student, Health Policy and Management
Harvard Business School

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

Response: Post-acute care, care that is delivered following an acute care hospitalization, is one of the largest drivers of variation in US health care spending.

To address this, Medicare has created several payment reform systems targeting post-acute care, including a voluntary bundled payment program known as the Model 3 of the Bundled Payment for Care Improvement (BPCI) Initiative for post-acute care providers such as skilled nursing facilities, long-term care hospitals, or inpatient rehabilitation facilities. Participants are given a target price for an episode of care which is then reconciled against actual spending; providers who spend under the target price retain some of the savings, while those who spend more must reimburse Medicare for some of the difference.

Our study sought to evaluate the level of participation in this program and identify what providers were more likely to participate. We found that fewer than 4% of eligible post-acute care providers ever participated in the program, and over 40% of those who did participate dropped out. The providers more likely to remain in the program were skilled nursing facilities that were higher quality, for-profit, and were part of a multi-facility organization.

Continue reading →

What Causes Failures in Personal Protective Equipment Use in Hospitals?

Posted on by
Reply

MedicalResearch.com Interview with:

Sarah L. Krein, PhD, RN Research Career Scientist VA Ann Arbor Healthcare System Ann Arbor, MI 

Sarah L. Krein, PhD, RN
Research Career Scientist
VA Ann Arbor Healthcare System
Ann Arbor, MI

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

Response: We conducted this study to better understand the challenges faced by health care personnel when trying to follow transmission based precaution practices while providing care for hospitalized patients.  We already know from other studies that there are breaches in practice but our team was interested in better understanding why and how those breaches (or failures) occur so we can develop better strategies to ensure the safety of patients and health care personnel.

Continue reading →

2/3 Canadians Do Not Receive Timely Surgery for Hip Fractures

Posted on by
Reply

MedicalResearch.com Interview with:

Daniel Pincus MD Department of Surgery Institute for Clinical Evaluative Sciences University of Toronto

Dr. Pincus

Daniel Pincus MD
Department of Surgery
Institute for Clinical Evaluative Sciences
University of Toronto

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

Response: We chose to look at hip fractures because is the most common reason for urgent surgery complications have be tied to wait times (and in particular wait times greater than 24 hours).

Continue reading →

Anesthesia, Sterility Measures Contribute To Large Carbon Footprint of Health Care Systems

Posted on by
Reply

MedicalResearch.com Interview with:
<a href="https://www.flickr.com/photos/armymedicine/6127836005">“surgery”</a> by <i> <a href="https://www.flickr.com/people/armymedicine/">Army Medicine</a> </i> is licensed under <a href="https://creativecommons.org/licenses/by/2.0"> CC BY 2.0</a>Andrea MacNeill MD MSc FRCSC
Surgical Oncologist & General Surgeon
University of British Columbia
Vancouver General Hospital
BC Cancer Agency

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

Response: Climate change is one of the most pressing public health issues of the present era, responsible for 140,000 deaths annually.  Somewhat paradoxically, the health sector itself has a considerable carbon footprint, as well as other detrimental environmental impacts.  Within the health sector, operating rooms are known to be one of the most resource-intensive areas and have thus been identified as a strategic target for emissions reductions.

Continue reading →

Price Transparency Not Keeping Up With High-Deductible Health Care Plans

Posted on by
Reply

MedicalResearch.com Interview with:
“Health Insurance” by Pictures of Money is licensed under CC BY 2.0Allison Kratka
MD Candidate 2018
Duke University School of Medicine

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

Response: As there are increasing numbers of high-deductible plans and those with high rates of co-insurance, patients are increasingly expected to help contain the cost of their health care by being savvy health care consumers. We set out to determine how easy or hard it is to find healthcare prices online.

Continue reading →

Dr. Barbara McAneny, Value-Based Care Pioneer, First Oncologist Named As Incoming AMA President

Posted on by
Reply

MedicalResearch.com Interview with:

Barbara L. McAneny MD, CEO New Mexico Oncology Hematology Consultants, Ltd. Albuquerque, NM 87109

Dr. McAneny

Barbara L. McAneny MD, CEO
New Mexico Oncology Hematology Consultants, Ltd.
Albuquerque, NM 87109 

MedicalResearch.com:   What is the meant by value-based care?

Response: There are a lot of people using this term to mean a variety of things, confusion is not surprising.  Generally it means a move to pay more for better patient outcomes and less for worse patient outcomes.  Currently in our Fee for Service system, there are a lot of services for which there are no fees. That deficiency keeps physicians from looking at non face-to-face delivery methods or the use of other health professionals to augment the care they give, because we can’t afford to give services that we aren’t paid to give.

Continue reading →

Penalties for Readmissions Widens Financial Losses At Delta Safety Net Hospitals

Posted on by
Reply

MedicalResearch.com Interview with:

Hsueh-Fen Chen, Ph.D. Associate Professor Department of Health Policy and Management College of Public Health University of Arkansas for Medical Sciences Little Rock, AR 72205

Dr. Chen

Hsueh-Fen Chen, Ph.D.
Associate Professor
Department of Health Policy and Management
College of Public Health
University of Arkansas for Medical Sciences
Little Rock, AR 72205

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

Response: The Centers for Medicare and Medicaid Services announced the Hospital Readmissions Reduction Program (HRRP) and Hospital Value-based Purchasing (HVBP) Program in 2011 and implemented the two programs in 2013. These two programs financially motivate hospitals to reduce readmission rates and improve quality of care, efficiency, and patient experience. The Mississippi Delta Region is one of the most impoverished areas in the country, with a high proportion of minorities occupying in the region.  Additionally, these hospitals are  safety-net resources for the poor. It was largely unknown what the financial performance for the hospitals in the Mississippi Delta Region was under the HRRP and HVBP programs.

Dr. Chen and colleagues in the Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences compared the financial performance between Delta hospitals and non-Delta hospitals (namely, other hospitals in the nation) from 2008 through 2014 that were covered before and after the implementation of the HRRP and HVBP programs. The financial performance was measured by using the operating margin (profitability from patient care) and total margin (profitability from patient care and non-patient care)

Before the implementation of the HRRP and HVBP programs, Delta hospitals had weaker financial performance than non-Delta hospitals but their differences were not statistically significant. After the implementation of the HRRP and HVBP programs, the gap in financial performance between Delta and non-Delta hospitals became wider and significant. The unadjusted operating margin for Delta hospitals was about -4.0% in 2011 and continuously fell to -10.4% in 2014, while the unadjusted operating margin for non-Delta hospitals was about 0.1% in 2011 and dropped to -1.5% in 2014. The unadjusted total margin for Delta hospitals significantly fell from 3.6% in 2012 to 1.1% in 2013 and reached 0.2% in 2014, while the unadjusted total margin for non-Delta hospitals remained about 5.3% from 2012 through 2014. After adjusting hospital and community characteristics, the difference in financial performance between Delta and non-Delta remained significant.

Continue reading →

Trends in Opioid-Related Inpatient Stays Shifted After Switch to ICD-10 Coding

Posted on by
Reply

MedicalResearch.com Interview with:

Anne Elixhauser, Ph.D. Senior Research Scientist Agency for Healthcare Research and Quality Rockville MD 20857

Dr. Elixhauser

Anne Elixhauser, Ph.D.
Senior Research Scientist
Agency for Healthcare Research and Quality
Rockville MD 20857

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

Response: Hospital inpatient data began using ICD-10-CM (I-10) codes on October 1, 2015.  We have been doing analysis using the new codeset to determine to what extent we can follow trends crossing the ICD transition—do the trends look consistent when we switch from I-9 to I-10?  Tracking the opioid epidemic is a high priority so we made this one of our first detailed analyses.  We were surprised to find that hospital stays jumped 14% across the transition, compared to a 5% quarterly increase before the transition (under I-9) and a 3.5% quarterly increase after the transition (under I-10).  The largest increase (63.2%) was for adverse effects in therapeutic use (side effects of legal drugs), whereas stays involving opioid abuse decreased 21% and opioid poisoning (overdose) decreased 12.4%.

Continue reading →

Coordination Program Reduced ER Visits and Readmissions in Medicaid Population

Posted on by
Reply

MedicalResearch.com Interview with:

Roberta Capp MD Assistant Professor Director for Care Transitions in the Department of Emergency Medicine University of Colorado School of Medicine Medical Director of Colorado Access Medicaid Aurora Colorado

Dr. Capp

Roberta Capp MD
Assistant Professor
Director for Care Transitions in the Department of Emergency Medicine
University of Colorado School of Medicine
Medical Director of Colorado Access Medicaid
Aurora Colorado

 

 

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

Response: Medicaid clients are at highest risk for utilizing the hospital system due to barriers in accessing outpatient services and social determinants.

We have found that providing care management services improves primary care utilization, which leads to better chronic disease management and reductions in emergency department use and hospital admissions.

Continue reading →

Financial Incentives to Physicians Did Not Increase Hospital Discharge Follow-Up Visits

Posted on by
Reply

MedicalResearch.com Interview with:

Dr. Lauren Lapointe-Shaw, MD Physician at University Health Network Department of Medicine University of Toronto 

Dr. Lapointe-Shaw

Dr. Lauren Lapointe-Shaw, MD
Physician at University Health Network
Department of Medicine
University of Toronto 

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

Response: Readmissions after hospital discharge are common and costly. We would like to reduce these as much as possible. Early physician follow-up post hospital discharge is one possible strategy to reduce readmissions. To this end, incentives to outpatient physicians for early follow-up have been introduced in the U.S. and Canada. We studied the effect of such an incentive, introduced to Ontario, Canada, in 2006.

Continue reading →

Arriving Late To Appointment Can Shorten Your Visit With The Doctor

Posted on by
Reply

MedicalResearch.com Interview with:
Chester G. Chambers, Ph.D.
Director, Enterprise Risk Management Program, Johns Hopkins Carey Business School
Joint Appointment in Anesthesiology and Critical Care Medicine
Maqbool Dada, Ph.D.
Joint Appointment in Anesthesiology and Critical Care Medicine
John Hopkins Medicine
Kayode Ayodele Williams, M.B.A., M.B.B.S., M.D
Medical Director : Blaustein Pain Treatment Center
Associate Professor of Anesthesiology and Critical Care Medicine
John Hopkins Medicine

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

Response: The result is based on a retrospective analysis of three specialty clinics in the Johns Hopkins System: a private practice low-volume clinic with one physician and no residents; a medium volume clinic that used one attending physician for each clinic session and included residents; and a high-volume clinic with multiple attending physicians and several residents.

Our main finding is that physicians adjust face time based on congestion in the clinic, and seem to do this without always knowing they are doing it. Patients who arrive early and whose service begins before their appointment times, tend to get more face-time then other patients. This is similar to other service systems in which first-line providers speed-up when they see long queues at their stations.This is important because most of the prior research in this setting assumed that this never takes place. We verified that it does happen in multiple settings and the changes in processing rates are statistically significant. This means we need to rethink many earlier conclusions about how clinics run.

Continue reading →

Access To Two Different Health Care Systems Can Lead To Dangerous Presciption Combinations

Posted on by
Reply

MedicalResearch.com Interview with:

Dr-Joshua-M-Thorpe.jpg

Dr. Joshua Thorpe

Joshua M. Thorpe, PhD, MPH
From the Center for Health Equity Research and Promotion
Veterans Affairs Pittsburgh Healthcare System
Pittsburgh Pennsylvania, and
Center for Health Services Research in Primary Care
Department of Pharmacy and Therapeutics
University of Pittsburgh School of Pharmacy

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

Response: Care coordination for persons with dementia is challenging for health care systems under the best of circumstances. These coordination challenges are exacerbated in Medicare-eligible veterans who receive care through both Medicare and the Department of Veterans Affairs (VA). Recent Medicare and VA policy changes (e.g., Medicare Part D, Veteran’s Choice Act) expand veterans’ access to providers outside the VA. While access to care may be improved, seeking care across multiple health systems may disrupt care coordination and increase the risk of unsafe prescribing – particularly in veterans with dementia. To see how expanded access to care outside the VA might influence medication safety for veterans with dementia, we studied prescribing safety in Veterans who qualified for prescriptions through the VA as well as through the Medicare Part D drug benefit.

Continue reading →

Framework for a Systems Thinking Approach to US Population Health

Posted on by
Reply

MedicalResearch.com Interview with:

Julie M. Kapp, MPH, PhD, FACE Associate Professor 2014 Baldrige Executive Fellow University of Missouri School of Medicine Department of Health Management and Informatics Columbia, MO 65212

Dr. Julie Kapp

Julie M. Kapp, MPH, PhD, FACE
Associate Professor
2014 Baldrige Executive Fellow
University of Missouri School of Medicine
Department of Health Management and Informatics
Columbia, MO 65212

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

Response: The United States lags behind its high-income peer countries on a number of critical health outcomes, including life expectancy, and this gap has been widening for the last several decades. The 2010 Patient Protection and Affordable Care Act (ACA) created a number of provisions to try to address this, including an emphasis on a systems-engineering approach to health care services. In addition to the ACA, there is a growing movement toward collective impact among community-based organizations. However, despite this focus, U.S. health and health care activities are often uncoordinated and fragmented.

We applied a systems-thinking approach to U.S. population health. We used the Malcolm Baldrige Framework for Performance Excellence as the unifying conceptual systems-thinking approach. In addition to this proposed framework, we make two critical recommendations:

1) the need to drive a strategic outcomes-oriented, rather than action-oriented, approach by creating an evidence-based national reporting dashboard; and

2) improve the operational effectiveness of the workforce.

Continue reading →

What Interventions Can Reduce Epidemic Physician Burnout?

Posted on by
2

MedicalResearch.com Interview with:

Colin P. West, MD, PhD, FACP Divisions of General Internal Medicine and Biomedical Statistics and Informatics Departments of Internal Medicine and Health Sciences Research Mayo Clinic

Dr. Colin West

Colin P. West, MD, PhD, FACP
Divisions of General Internal Medicine and Biomedical Statistics and Informatics
Departments of Internal Medicine and Health Sciences Research
Mayo Clinic

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

Response: Physician burnout has reached epidemic levels, as documented in national studies of both physicians in training and practicing physicians demonstrating burnout rates in excess of 50%. Consequences include negative effects on patient care, professionalism, physicians’ own care and safety, and the viability of health-care systems. We conducted a systematic review and meta-analysis to better understand the quality and outcomes of the literature on approaches to prevent and reduce burnout.

We identified 2617 articles, of which 15 randomized trials including 716 physicians and 37 cohort studies including 2914 physicians met inclusion criteria. Across interventions, overall burnout rates decreased from 54% to 44%, emotional exhaustion score decreased from 23.82 points to 21.17 points, and depersonalization score decreased from 9.05 to 8.41. High emotional exhaustion rates decreased from 38% to 24% and high depersonalization rates decreased from 38% to 34%.

Continue reading →

Medicare Shared Savings Program May Reduce Hospitals’ Propensity To Purchase New CT Machines

Posted on by
Reply

MedicalResearch.com Interview with:
Hui Zhang, Ph.D., MBA
Virginia Polytechnic Institute and State University
Blacksburg

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

Response: To promote healthcare coordination and contain the rising costs in the US healthcare system, a variety of payment innovations has been developed and field-tested in both public and private sector. Among them, the Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs), administered by the Centers for Medicare and Medicaid Services (CMS) has received considerable attention.

Our study took a mathematical modeling approach and comprehensively captured and analyzed the effect of this new payment systems on healthcare stakeholder decisions and system-wide outcomes. Our results provided decision-making insights for payers on how to improve MSSP, for ACOs on how to distribute MSSP incentives among their members, and for hospitals on whether to invest in new CT imaging systems.

Continue reading →

JAMA Study Updates Goals of Cost-Effective Health Care

Posted on by
Reply

MedicalResearch.com Interview with:

Gillian D. Sanders-Schmidler Ph.D. Professor of Medicine Duke Evidence Synthesis Group, Director Duke Evidence-based Practice Center, Director Duke Clinical Research Institute Duke University

Dr. Gillian D. Sanders-Schmidler

Gillian D. Sanders-Schmidler Ph.D.
Professor of Medicine
Duke Evidence Synthesis Group, Director
Duke Evidence-based Practice Center, Director
Duke Clinical Research Institute
Duke University

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

Response: In 1996, the original panel on cost effectiveness in health and medicine published recommendations for the use of cost effectiveness analysis. During the 20 years since the original panel’s report, the field of cost-effectiveness analysis has advanced in important ways and the need to deliver health care efficiently has only grown. In 2012 the Second Panel on Cost Effectiveness in health and Medicine was formed with a goal of reviewing and updating the recommendations.

This paper summarizes those recommendations. This process provided an opportunity for the Panel to reflect on the evolution of cost-effectiveness analysis and to provide guidance for the next generation of practitioners and consumers.

Continue reading →

Earned Income Tax Credits Linked To Improved Health Parameters

Posted on by
Reply

MedicalResearch.com Interview with:

Peter Muennig, MD, MPH Associate Professor Mailman School of Public Health Columbia University New York, NY 10032

Dr. Peter Muennig

Peter Muennig, MD, MPH
Associate Professor
Mailman School of Public Health
Columbia University
New York, NY 10032

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

Response: We looked that the supplemental Earned Income Tax Credit
( EITC ) programs offered by states to determine whether they have health impacts or not.

We found that, on average, folks who live in states that offer supplemental EITC showed improvements in health after EITC was implemented.

Continue reading →

LEAN Methodologies Improved Wait Time In VA Medical Center

Posted on by
Reply

MedicalResearch.com Interview with:

Andrew C. Eppstein, MD, FACS Assistant Professor of Clinical Surgery Indiana University School of Medicine Department of Surgery, Division of General Surgery Richard L. Roudebush VA Medical Center Indianapolis, Indiana

Dr. Andrew Eppstein

Andrew C. Eppstein, MD, FACS
Assistant Professor of Clinical Surgery
Indiana University School of Medicine
Department of Surgery, Division of General Surgery
Richard L. Roudebush VA Medical Center
Indianapolis, Indiana

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

Response: A few years ago we encountered long wait times for patients undergoing elective general surgery in our tertiary care VA medical center. Demand had grown and our existing systems were not able to accommodate surgical patients in a timely fashion. By fiscal year (FY) 2012, our wait times averaged 33 days, though patients with malignancies would be moved to the head of the line, pushing more elective cases further back.

To address rising demand and worsening wait times, our Surgery Service convened an analysis of our processes using Lean methodology in collaboration with the Systems Redesign Service. Multidisciplinary meetings were held in 2013 to analyze inefficiencies in the current system and ways to address them to create a streamlined, ideal system. The collaborations included surgeons, nurses, ancillary staff, operating room and sterile processing staff, and hospital administration. Projects were rolled out stepwise in mid-2013 under General Surgery, the busiest surgical service at our institution.

We noted a sharp decline in patient wait times after initiation of reforms such as improved OR flexibility, scheduling process changes, standardization of work within the department, and improved communication practices. These wait times dropped to 26 days in FY 2013 and further to 12 days in FY 2014, while operating volume and overall outpatient evaluations increased, with decreased no-shows to clinic. Our decreased wait times were sustained through the remainder of the observed period.

Continue reading →

Comparable Diabetes and Heart Disease Care Provided By Physicians and Advanced Care Providers

Posted on by
1

MedicalResearch.com Interview with:
Salim S. Virani, MD, PhD and
Julia Akeroyd MPH
Health Services Research and Development
Michael E. DeBakey Veterans Affairs Medical Center
Houston

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

Response: Given the increase in the number of Americans seeking primary health care due to the Affordable Care Act, combined with current and anticipated physician shortages in the US, there is a growing need to identify other models of primary care delivery to address chronic diseases.

Continue reading →

Safety-Net Hospitals Can Reduce Costs By Shifting Complex Surgery Patients to Other Hospitals

Posted on by
Reply

MedicalResearch.com Interview with:

Richard Hoehn, MD Resident in General Surgery College of Medicine University of Cincinnati

Dr. Richard Hoehn

Richard Hoehn, MD
Resident in General Surgery
College of Medicine
University of Cincinnati

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

Response: A recent study from our research group (Hoehn et al, JAMA Surgery, 2015) found that safety-net hospitals perform complex surgery with higher costs compared to other hospitals, and that these higher costs are potentially due to intrinsic differences in hospital performance.

In this analysis, we decided to simulate different policy initiatives that attempt to reduce costs at safety-net hospitals. Using a decision analytic model, we analyzed pancreaticoduodenectomy performed at academic hospitals in the US and tried to reduce costs at safety-net hospitals by either
1) reducing their mortality,
2) reducing their patients’ comorbidities and complications, or
3) sending their patients to non-safety-net hospitals for their surgery.

While reducing mortality had a negligible impact on cost and reducing comorbidities/complications had a noticeable impact on cost, far and away the most successful way to reduce costs at safety-net hospitals, based on our model, was to send patients away from safety-net hospitals for their pancreaticoduodenectomy.

Continue reading →

Specialized Stroke Care Centers Improve Outcomes

Posted on by
Reply

MedicalResearch.com Interview with:

Kimon Bekelis, MD Chief Resident Department of Neurosurgery Dartmouth-Hitchcock School of Medicine

Dr. Kimon Bekelis

Kimon Bekelis, MD Chief Resident
Department of Neurosurgery
Dartmouth-Hitchcock School of Medicine

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

Response: Physicians often must decide whether to treat acute stroke patients locally, or refer them to a more distant Primary Stroke Center (PSC). There is little evidence on how much the increased risk of prolonged travel time offsets benefits of specialized  Primary Stroke Center care.

Continue reading →

Interventions Involving Patients and Providers Required To Reduce Low-Value Care

Posted on by
Reply

Medicalresearch.com Interview with:

Alex Mainor, JD, MPH Research Project Coordinator The Dartmouth Institute for Health Policy and Clinical Practice Lebanon, NH 03756

Alex Mainor

Alex Mainor, JD, MPH
Research Project Coordinator
The Dartmouth Institute for Health Policy and Clinical Practice
Lebanon, NH 03756

Carrie H. Colla, Alexander J. Mainor, Courtney Hargreaves, Thomas Sequist, Nancy Morden

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

Response: Waste in the healthcare system is an important concern to healthcare providers, patients, policymakers, and taxpayers, and is estimated to account for 30% of all healthcare costs. Low-value care can expose patients to unnecessary costs for little or no medical benefit, or to potential harm from unnecessary tests and procedures. In recent years, the concept of low-value care has gained wider acknowledgement and acceptance as a pressing concern for the healthcare system, and many interventions have been studied to reduce the use of this wasteful care. However, the landscape of these interventions has not been studied in a systematic and comprehensive way.

In this review, we found that interventions to reduce the use of wasteful medical care are often studied and published selectively. Findings suggest that interventions using clinical decision support, clinician education, patient education, and interventions combining elements from each have strong potential to reduce low-value care.

Continue reading →