Author Interviews, Health Care Systems, JAMA, Technology, UCSD / 01.05.2023

MedicalResearch.com Interview with: Zechariah Zhu, B.S. Affiliate Scientist with the Qualcomm Institute at UC San Diego and study co-author First author: John W. Ayers, PhD, MA MedicalResearch.com: What is the background for this study? Response: In today’s day and age (especially after the COVID-19 pandemic), an increasing number of people are turning to virtual options for healthcare. Most notably, there was a 1.6-fold increase in electronic patient messages, which significantly increased the burden on physicians, with a record-high proportion of physicians (62%) reporting burnout symptoms. On the other hand, we also see the rise of AI technologies like ChatGPT—an AI chatbot assistant that has taken the world by storm recently with its ability to provide lengthy response essays to many questions it is asked. Our objective for this study, then, was to evaluate the ability of ChatGPT to provide quality and empathetic responses to patient questions. (more…)
Author Interviews, COVID -19 Coronavirus, Electronic Records, Health Care Systems, Race/Ethnic Diversity / 07.03.2023

MedicalResearch.com Interview with: Dhruv Khullar, M.D., M.P.P. Director of Policy Dissemination Physicians Foundation Center for Physician Practice and Leadership Assistant Professor of Health Policy and Economics Weill Cornell Medicine, NYC   MedicalResearch.com: What is the background for this study? Response: From prior research, we know that there are racial/ethnic differences in the acute impact of COVID-19, including higher rates of hospitalization and death among Black and Hispanic individuals compared to white individuals. Less is known about whether there are differences in the rates or types of long COVID by race and ethnicity. (more…)
Author Interviews, Health Care Systems, Sleep Disorders / 16.02.2023

MedicalResearch.com Interview with: Michael R. Schutz, Ph.D. Professor of Music Cognition/Percussion at McMaster University Founding director of the MAPLE Lab and Core member of the McMaster Institute for Music and the Mind. Prof. Schutz is also a professional musician and directs McMaster’s percussion ensemble.   MedicalResearch.com: What is the background for this study? Response: Hospitals around the world are filled with devices generating aconstant stream of tones conveying information to medical staff.overburdened healthcare professionals, and contributes to burnout inmedical staff.  The Emergency Care Research Institute (ECRI) regularlyincludes problems with auditory alarms in their list of "Top 10 HealthTechnology Hazards" and they  are so problematic an FDA surveyimplicated them in hundreds of patient deaths.While there is currently a lot of interest in how to improve alarmmanagement protocols, this study is different in that it looks atimproving the quality of the alarm sounds themselves.  For historicalreasons many default to simplistic "beeps" which are generallyannoying.  While annoying is useful for critical alarms requiringimmediate action, the vast majority of these messages are merelyintended to update medical staff of changes (i.e. blood pressure isrising) or indicate other situations that do not require immediateaction. Unfortunately, many machines use the same simplistic andannoying "beeps" regardless of whether the messages are urgent ornon-urgent.  This constant flood of annoying beeps negatively affectsboth patients (extending recovery time due to interrupted rest) andstaff (who can develop "alarm fatigue" from the constant cacophony). (more…)
Author Interviews, Health Care Systems, JAMA / 13.02.2023

MedicalResearch.com Interview with: David A. Hyman, JD, MD The Scott K. Ginsburg Professor of Health Law & Policy Georgetown University Law Center Washington, DC MedicalResearch.com: What is the background for this study? Response: Many doctors believe medical malpractice claiming is effectively random — meaning good doctors are equally likely as bad doctors to end up being the target of a malpractice claim.  Past research has studied whether physicians with 2 paid claims are likely to have another claim than doctors with 1 paid claim. We study whether physicians with 1 paid claim are more likely to have another paid claim, compared to physicians with zero paid claims.  We also compare the pattern of observed claims with what we would expect to find if claiming were truly random (by running a simulation). (more…)
Author Interviews, Health Care Systems, JAMA, Sleep Disorders, Yale / 18.01.2023

MedicalResearch.com Interview with: César Caraballo-Cordovez, MD Postdoctoral Associate Yale/YNHH Center for Outcomes Research and Evaluation (CORE) New Haven, CT 06511 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our group has been interested in how patients’ experience during hospitalization impacts their recovery and their health for a while. In 2013, Dr. Harlan Krumholz (senior author of the current study) identified that patients who were recently hospitalized experienced a period of generalized risk for myriad adverse health events, a condition that he named ‘post-hospital syndrome’. One of the possible explanations for this observation is that the stress from being hospitalized negatively impacts patients’ health during their stay in the hospital and after being discharged. The stress in a hospital may come from different sources–including sleep deprivation. Sleep is fundamental for recovery, and there are many challenges for patients to have adequate sleep while being hospitalized. Among the many sources of sleep interruption are early morning blood draws. Blood draws are often performed in the early morning in order to have recent lab tests results available during morning medical rounds. However, this common practice may disrupt patients’ recovery by interrupting their sleep. We were interested in determining to what extent blood draws contribute to early morning sleep disruptions and whether there has been recent progress in reducing them. We used data from Yale New Haven Hospital from 2016 to 2019 and found that nearly 4 in 10 of total daily blood draws were collected between 4:00am and 7:00am–a proportion that was persistently high over the 3 years we studied. Importantly, we found that this occurred across patients with different sociodemographic characteristics, including older individuals who are at highest risk of adverse health events from sleep deprivation. (more…)
Author Interviews, Health Care Systems, JAMA / 12.07.2022

MedicalResearch.com Interview with: Dr. Joanna JiangJoanna Jiang, PhD Agency for Healthcare Research and Quality Rockville, Maryland MedicalResearch.com:  What is the background for this study?  What are the main findings? Response: Over the last decade we have seen two trends occurring to rural hospitals – closures and mergers. A hospital in financial distress could likely face closure. But if the hospital affiliates with a multihospital system, it may have access to resources from the system that help shelter the hospital from closure. That is exactly what we found in this study. System affiliation was associated with a lower risk of closure for financially distressed hospitals. However, among hospitals that were financially stable, system affiliation was associated with a higher risk of closure. This is somewhat puzzling and needs further study to better understand the reason for closure. (more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, Education, Health Care Systems, Sleep Disorders / 20.05.2022

MedicalResearch.com Interview with: Dr Matthew D Weaver M.P.H., Ph.D. Division of Sleep and Circadian Disorders Departments of Medicine and Neurology Brigham and Women's Hospital Boston, Massachusetts MedicalResearch.com:  What is the background for this study?  Response: The name “resident” stems from the historical practice of resident-physicians residing in hospitals as part of their training. Even after that practice abated, it was common for resident physicians to work 36 consecutive hours followed by 12 or fewer hours of rest. In 1989, the state of New York restricted resident physicians to work no more than 24 consecutive hours and no more than 80 hours per week as part of collective intervention to improve patient safety. The Accreditation Council for Graduate Medical Education (ACGME) then followed in 2003 by limiting work hours to an average of 80 per week over a month and no more than 30 consecutive hours of work. Evidence accumulated demonstrating an association between shifts lasting ≥24 hours and adverse resident and patient safety. As a result, the Institute of Medicine convened a review and report on the issue, ultimately concluding that no resident should work more than 16 consecutive hours without sleep. This recommendation, combined with evidence following the 2003 rules, led the ACGME to issue new rules in 2011 that limited first-year resident physicians to work no more than 16 consecutive hours. Our study compares resident-reported patient safety outcomes before and after this 2011 policy change. (more…)
Author Interviews, Health Care Systems / 14.04.2022

MedicalResearch.com Interview with: James H. Baraldi University of Pittsburgh MedicalResearch.com:  What is the background for this study?  Response: Researchers investigating pharmaceuticals and medical devices in randomized controlled trials (RCTs) often receive payments from the manufacturers of these investigational products. In many cases these payments are not dedicated to the express purpose of research, but rather consist of consulting fees and compensation for travel and lodging and food and beverage. As part of the 2010 Affordable Care Act, the US government passed the Physician Payment Sunshine Act to increase transparency of this type of funding. The law required manufacturers reimbursed by Medicare, Medicaid, or the Children’s Health Insurance Program to disclose to the Centers for Medicare and Medicaid Services information regarding investigator payments. This information became freely and publicly available on the Open Payments website with the earliest data from 2013. Not only have the pharmaceutical and medical device manufacturers disclosed the investigators’ payment information, but the investigators themselves have had to do so in accordance with the requirements of the journals in which they publish their findings or in accordance with the requirements of the International Committee of Medical Journal Editors (ICMJE). (more…)
Author Interviews, Duke, Electronic Records, Health Care Systems, JAMA / 20.04.2021

MedicalResearch.com Interview with: Eugenia McPeek Hinz MD MS FAMIA Associate CMIO - DHTS Duke University Health System MedicalResearch.com: What is the background for this study? Response: Clinician burnout rates have hovered around 50% for much of the past decade.  Burnout is a significant concern in healthcare for its effects on care givers and associated downstream adverse implications on patient care for quality and safety. The ubiquitous presence of Electronic Health Records (EHR) along with the increased clerical components and after hours use has been a significant concern for contributing to provider burnout.  (more…)
Author Interviews, Health Care Systems, JAMA / 22.01.2021

MedicalResearch.com Interview with: Sara Machado PhD Fellow at the Department of Health Policy London School of Economics and Political Science MedicalResearch.com: What is the background for this study? Response: Physician distribution is a determinant of health care access, so knowing how physician density patterns evolve over time is important if we are trying to address disparities in access to care. Moreover, the last 10 years have brought about changes in health care coverage, across the US. Recent evidence points to an uneven physician distribution between urban and rural communities. We examined recent trends in physician density by physician category across rural and urban US counties.  MedicalResearch.com: What are the main findings? Response: We have two main findings.
  • First, density of primary care physicians steadily decreased in more than half of rural counties (994 out of 1,976).
  • Second, medical specialist density, which would care for cardiovascular and pulmonary disease, for example, has been largely stagnant in rural counties, at the lowest density levels (less than 10 physicians per 100,000), and increasing in metropolitan counties.
(more…)
Author Interviews, COVID -19 Coronavirus, Health Care Systems, JAMA, Technology / 27.10.2020

MedicalResearch.com Interview with: Shira H. Fischer, MD, PhD RAND Corporation Boston, Massachusetts MedicalResearch.com: What is the background for this study? What are the main findings? Response: Before the COVID-19 outbreak, telehealth was talked about a lot, but it wasn’t widely available and wasn’t used that often. We wanted to know who was using telehealth, what the barriers to use were, and whether people would be willing to do so if it were available to them. We conducted a survey of over 2,500 Americans across the country and asked them about these topics.  (more…)
Author Interviews, COVID -19 Coronavirus, Health Care Systems / 27.10.2020

MedicalResearch.com Interview with: Steve Olin Chief Product Officer Rally Health, Inc., part of the Optum business of UnitedHealth Grou MedicalResearch.com: Can you please elaborate on Rally Health’s mission? Mr. Olin: Our founding mission 10 years ago and still to this day is to put health in the hands of the individual. As a digital health company, we live this mission through our focus in three key areas: 1) Providing digital-first access to care by giving individuals easy-to-use digital tools and support to navigate their health care and take full advantage of their health benefits; 2) Engaging people in their daily health by creating experiences that people enjoy and that inspire them to perform healthy actions, and by giving them access to resources that help them achieve their health goals; 3) Saving people time and money by providing digital tools that help them understand health care costs and guide them to lower-cost, high-quality care options. (more…)
Author Interviews, Health Care Systems, JAMA / 09.09.2020

MedicalResearch.com Interview with: Kenton J. Johnston, PhD Associate Professor Dept of Health Management & Policy Dept of Health & Clinical Outcomes Research Saint Louis University MedicalResearch.com: What is the background for this study? Response: Consolidation of physician practices into larger health systems comprised of hospitals and other group practices has been occurring rapidly in the U.S. market over the past 10 years. During this same period, Medicare has been gradually increasing the use of “pay for performance,” or “value-based payment” programs. 2019 was the first year that nearly all physicians in the U.S. were paid under Medicare’s new mandatory Merit-Based Incentive Payment System (MIPS). We conducted a study to see whether physicians who were affiliated with health systems performed better under the MIPS than those not affiliated with health systems. (more…)
Author Interviews, Health Care Systems, JAMA / 22.07.2020

MedicalResearch.com Interview with: Reshma Jagsi, M.D., D.Phil. Newman Family Professor and Deputy Chair Department of Radiation Oncology Director of the Center for Bioethics and Social Sciences in Medicine University of Michigan  MedicalResearch.com: What is the background for this study? Response: Hospitals and health care institutions often rely on philanthropy for support to be able to pursue their missions to serve the public health. Little is known about public perspectives, which are needed to inform ethical guidelines. (more…)
Author Interviews, Health Care Systems, Heart Disease, JAMA, Medicare / 24.02.2020

MedicalResearch.com Interview with: Rishi K. Wadhera, MD Beth Israel Deaconess Medical Center Harvard Medical Faculty Physicians MedicalResearch.com: What is the background for this study? Response: In recent years, the Centers for Medicare and Medicaid Services has implemented nationally mandated value-based programs to incentivize hospitals to deliver higher quality care. The Hospital Readmissions Reduction Program (HRRP), for example, has financially penalized hospitals over $2.5 billion to date for high 30-day readmission rates. In addition, the Value-Based Purchasing Program (VBP) rewards or penalizes hospitals based on their performance on multiple domains of care.  Both programs have focused on cardiovascular care. The evidence to date, however, suggests that these programs have not improved health outcomes, and there is growing concern that they may disproportionately penalize hospitals that care for sick and poor patients, rather than for poor quality care. (more…)
Author Interviews, Cost of Health Care, Health Care Systems, JAMA / 19.02.2020

MedicalResearch.com Interview with: Jane M. Zhu, MD, MPP, MSHP Assistant Professor of Medicine Division of General Internal Medicine Oregon Health and Sciences University Penn LDI Adjunct Senior Fellow MedicalResearch.com: What is the background for this study? Response: In recent years, private equity firms have been rapidly entering the health care sector, including by purchasing physician medical groups. There’s a lot of interest in this trend but very little empirical research to understand its scope, characteristics, and effects. (more…)
Author Interviews, C. difficile, Health Care Systems, Hospital Acquired, JAMA / 06.02.2020

MedicalResearch.com Interview with: Valerie Vaughn MD, MSc Assistant Professor of Medicine; Hospital Medicine VA Ann Arbor Healthcare System and University of Michigan Medical School @ValerieVaughnMD MedicalResearch.com: What is the background for this study? Response: Health care-associated infection are a major patient safety problem. Fortunately, they can often be prevented through key practices. The Department of Veterans Affairs has been an early adopters of these key strategies through a combination of policies, directives, and initiatives which have aimed to reduce health care-associated infection. No one had previously looked across infections to see whether key infection prevention practices are being used in the VA. (more…)
Author Interviews, Health Care Systems, JAMA / 30.01.2020

MedicalResearch.com Interview with: Coleman Drake, PhD Assistant Professor, Health Policy and Management Pitt Public Health Affiliate faculty member Medicaid Research Center and Center for Pharmaceutical Policy and Prescribing MedicalResearch.com: What is the background for this study? Response: The religious directives of Catholic hospitals prohibit the provision of many forms of contraception. To examine how Catholic hospitals restrict access to reproductive health services, we examined the market share of Catholic hospitals in every county in the continental US. We found that nearly 40% of women of reproductive-aged women live in counties with high or dominant Catholic hospital market share. We also examined whether the networks of Health Insurance Marketplace (i.e., Obamacare) plans direct their enrollees toward or away from Catholic hospitals, and thus reproductive health services.  (more…)
Author Interviews, Health Care Systems, JAMA, Social Issues / 14.01.2020

MedicalResearch.com Interview with: Elizabeth Tung MD MS Section of General Internal Medicine Instructor of Medicine University of Chicago MedicalResearch.com: What is the background for this study? Response: Medicare provides hospital ratings for all Medicare-certified hospitals in the U.S. based on quality metrics, including mortality, patient experience, hospital readmissions, and others. While ratings are important for comparing hospitals, there's been some concern that some of these quality metrics are outside a hospital's control, especially for hospitals taking care of vulnerable or socially complex patient populations. Take "timeliness of care" as a quality metric, for instance--this measure includes emergency room wait times. But in places that are medically underserved and have very few emergency rooms, these wait times will inevitably be much higher. What this means is that hospitals taking care of medically underserved populations end up getting lower quality ratings, even though they're addressing health disparities by filling an access gap. (more…)
Author Interviews, Health Care Systems, JAMA / 30.12.2019

MedicalResearch.com Interview with: Maryam Guiahi MD, MSc Associate Professor of Obstetrics and Gynecology University of Colorado Denver School of Medicine MedicalResearch.com: What is the background for this study? Response: The composition of the U.S health care system is shifting; between 2001 to 2016 the number of Catholic-owned or affiliated health facilities grew by 22% in contrast to the overall number of acute care hospitals that decreased by 6% and the number of other nonprofit religious hospitals that decreased by 38%. This is relevant as Catholic health care systems enforce religious directives that restrict many aspects of reproductive care and certain aspects of end-of-life care.  Yet little is known about the extent to which U.S. patients consider religious affiliation when selecting a health care facility.  (more…)
Author Interviews, Health Care Systems, University of Pittsburgh / 10.12.2019

MedicalResearch.com Interview with: Hayley Drew Germack PhD Assistant Professor of Acute and Tertiary Care University of Pittsburgh School of Nursing MedicalResearch.com: What is the background for this study? Response: The rate of rural hospital closures has been increasing over the last ten years. Rural hospitals close for a number of reasons including poor hospital economic health tied to uncompensated care and community factors, like a local aging population. Rural hospital and unit closures have been tied to decreased access to emergency and specialty care for patients including decreased access to obstetric-gynecological services and increase travel time for appointments. A recent paper also found a 6% increase in mortality in conditions needing emergent attention after rural hospital closures. We examined the impact of hospital closures in rural counties on the counties’ supply of physicians. (more…)
Annals Internal Medicine, Author Interviews, Health Care Systems, Hepatitis - Liver Disease, UC Davis / 04.12.2019

MedicalResearch.com Interview with: Barbara J Turner MD, MSED, MA, MACP Senior Advisor, Gehr Family Center for Health Systems Science Professor of Clinical Medicine Keck School of Medicine, USC  MedicalResearch.com: What is the background for this study? Response: Chronic hepatitis C (HCV) infection affects millions of persons in the United States but especially minorities and persons from low income communities. Current national guidelines recommend testing all baby boomers (born 1945 – 65) for HCV with the aim of ultimately curing those with chronic HCV infection with a short course of highly effective medication.  However implementation of these guidelines faces many hurdles in “safety net” practices serving vulnerable populations. (more…)
Author Interviews, Beth Israel Deaconess, Emergency Care, Health Care Systems, JAMA / 05.11.2019

MedicalResearch.com Interview with: Laura Burke, MD, MPH Department of Emergency Medicine Beth Israel Deaconess Medical Center Boston, MA 02215Laura Burke, MD, MPH Department of Emergency Medicine Beth Israel Deaconess Medical Center Boston, MA 02215  MedicalResearch.com: What is the background for this study? Response: There has been a lot of attention to the growing intensity and costs of emergency care, but relatively little study of how outcomes have changed in recent years for patients using the ED. We examined 30-day mortality rates for traditional Medicare beneficiaries age 65 and older using the emergency department (ED) from 2009-2016 and also examined how their rates of hospitalization have changed over time.   (more…)
Author Interviews, Cost of Health Care, Health Care Systems / 22.10.2019

MedicalResearch.com Interview with: David S Buck, MD, MPH Associate Dean of Community Health Professor, Clinical Sciences University of Houston - College of Medicine Houston, TX 77204  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: High-Needs, High-Cost (HNHC) patients account for 5% of the general population and cost 50% of the healthcare spending. In Harris County, one patient alone costed $439,600 in a year when he visited multiple medical, social and behavioral agencies for care. This was a result of siloed systems working independently of each other leading to inefficient care for the patient. By providing coordinated care, using patient-centered goals and values, we are able to better engage and provide a holistic approach to patient care.  This paper introduces a novel ‘values-based’ intervention mechanism for the HNHC patients, in addition to a coordinated care management approach, through a single record system. The findings indicate an improved daily functioning of the HNHC patients over 4 months, improved relationship between the providers and the patients and moderate well-being scores. (more…)
Author Interviews, Cost of Health Care, Health Care Systems, JAMA / 08.10.2019

MedicalResearch.com Interview with: William Shrank, MD, MSHS Chief Medical Officer Humana  MedicalResearch.com: What is the background for this study? Response: Health care waste is a serious problem in the system and the rising and uncontrolled costs of healthcare remain one of the top political and social issues in the U.S. We thought that sufficient time had passed since the 2012 groundbreaking analysis that was developed by Donald M. Berwick, MD, MPP and Andrew D. Hackbarth, MPhil, that first characterized waste in the US health system.  (more…)
Author Interviews, Health Care Systems, Surgical Research / 19.09.2019

MedicalResearch.com Interview with: Gustav Tinghög, PhD Associate Professor Division of Economics Department of Management and Engineering, IEI JEDI-lab: JUDGEMENT, EMOTION, DECISION and INTUITION Linköping University MedicalResearch.com: What is the background for this study? Response: Previous studies have shown that when we get tired, we make decisions without engaging in cognitively demanding reasoning, and we postpone risky or uncertain choices. Previous studies have explored this idea of “decision fatigue” in relation to parole hearing outcomes, failure of health services workers to wash their hands, and the likelihood of physicians prescribing antibiotics. In our study we wanted to investigate how patient ordering affected decisions scheduled patients for orthpedic surgery (excluding acute cases) (more…)