Author Interviews, Cost of Health Care, Health Care Systems / 22.10.2019

MedicalResearch.com Interview with: [caption id="attachment_51910" align="alignleft" width="200"]David S Buck, MD, MPH Associate Dean of Community Health Professor, Clinical Sciences University of Houston - College of Medicine Houston, TX 77204 Dr. Buck[/caption] 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.
Author Interviews, Cost of Health Care, Health Care Systems, JAMA / 08.10.2019

MedicalResearch.com Interview with: [caption id="attachment_51752" align="alignleft" width="150"]William Shrank, MD, MSHS Chief Medical Officer Humana Dr. Shrank[/caption] 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. 
Author Interviews, Health Care Systems, Surgical Research / 19.09.2019

MedicalResearch.com Interview with: [caption id="attachment_51389" align="alignleft" width="170"]Gustav Tinghög, PhD Associate Professor Division of Economics                                                                              Department of Management and Engineering, IEI JEDI-lab: JUDGEMENT, EMOTION, DECISION and INTUITION  Linköping University Dr. TINGHÖG[/caption] 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)
Author Interviews, Health Care Systems, JAMA, Primary Care / 18.09.2019

MedicalResearch.com Interview with: [caption id="attachment_51306" align="alignleft" width="200"]Deborah Korenstein, MD FACP General internist and Chief, General Internal Medicine Memorial Sloan Kettering Cancer Center Dr. Korenstein[/caption] Deborah Korenstein, MD FACP General internist and Chief, General Internal Medicine Memorial Sloan Kettering Cancer Center  MedicalResearch.com: What is the background for this study? Response: Executive physicals are 1 to 2-day comprehensive health assessments offering disease screening and preventive testing. Large companies can arrange for these evaluations for senior executives. They are often offered by prestigious academic medical centers, but can also be located in less formal settings like spas. They generally include a set of tests that sometimes vary based on patient characteristics. Any tests that are done in response to from findings from executive physicals are billed to health insurance companies. A single 2008 paper described executive physicals and criticized them for being non-evidence based. Since then, executive physicals have grown in popularity, but their nature and impact have not been described. We set out to describe included services and cost of executive physicals at top academic medical centers.
Author Interviews, Emory, Health Care Systems, JAMA, Kidney Disease, Transplantation / 11.09.2019

 A retraction and replacement have been issued due to a major coding error that resulted in the reporting of incorrect data in this study surrounding the difference in transplant rates between for-profit and non-profit dialysis centers. Please see link below:

Bauchner H, Flanagin A, Fontanarosa PB. Correcting the Scientific Record—Retraction and Replacement of a Report on Dialysis Ownership and Access to Kidney Transplantation. JAMA. 2020;323(15):1455. doi:10.1001/jama.2020.4368

MedicalResearch.com Interview with: [caption id="attachment_51140" align="alignleft" width="122"]Rachel Patzer, PhD, MPH Associate Professor Director, Health Services Research Center Department of Medicine Department of Surgery Emory University School of Medicine Dr. Patzer[/caption] Rachel Patzer, PhD, MPH Associate Professor Director, Health Services Research Center Department of Medicine Department of Surgery Emory University School of Medicine   MedicalResearch.com: What is the background for this study? Response: We know that historically, for-profit dialysis facilities have been shown to have lower rates of kidney transplantation than patients who receive treatment in non-profit dialysis facilities. However, these studies are outdated, and did not examine access to living donor transplantation or include the entirety of the end-stage kidney disease population 
Author Interviews, Cost of Health Care, Health Care Systems / 06.09.2019

MedicalResearch.com Interview with: [caption id="attachment_51181" align="alignleft" width="200"]Vivian Ho, PhD The James A. Baker III Institute Chair in Health Economics Director of the Center for Health and Biosciences Rice's Baker Institute for Public Policy Dr. Vivian Ho[/caption] Vivian Ho, PhD The James A. Baker III Institute Chair in Health Economics Director of the Center for Health and Biosciences Rice's Baker Institute for Public Policy MedicalResearch.com: What is the background for this study? Response: In 2003, approximately 29% of U.S. hospitals employed physicians, a number that rose to 42% by 2012. The share of physician practices owned by hospitals rose from 14% in 2012 to 29% in 2016. Economists refer to these relationships between hospitals and physicians as vertical integration, because they represent hospitals exerting more control over physicians as an essential part of inpatient care. As hospitals gain more control over physicians, they may incentivize delivery of more services but not necessarily higher quality care. When we launched this study, we hypothesized that tighter integration of physicians with hospitals would improve care coordination.
Author Interviews, Global Health, Health Care Systems / 29.08.2019

healthcare health care
At least one half of the world’s 7.7 billion population do not have proper access to crucial health services. Even high-income countries with accessible and affordable healthcare are finding it difficult to meet the needs of their citizens. Meanwhile, in other parts of the world, millions of people spend a significant part of their household budget to be able to access health services -- some are even pushed into poverty as a consequence. Given these facts and statistics, a comprehensive understanding of health insurance can be crucial in encouraging people to seek healthcare services as well as avoid complications from preventable conditions. If you want to know more about the status of healthcare all over the world, here’s a look at the healthcare systems of three top nations. The State of Healthcare In The United States The United States is considered the most powerful country in the world; however, its healthcare system still lags behind other high-income countries. Currently, there is no universal healthcare for U.S. citizens. There are federal-funded programs such as Medicaid that provides health insurance to low-income populations, the elderly and people with disabilities. The Affordable Care Act, which aimed to provide health insurance to all, was enacted in 2010 under the Obama administration. However, this is being challenged by the Trump administration’s American Health Care Act of 2017, which also seeks major reforms to healthcare in the United States. Currently, U.S. citizens who are employed full-time receive private insurance through their employers. While some self-employed individuals and part-time employees opt for private health insurance, many of them have to pay for health services out-of-pocket. In many cases, these expenses are beyond their means. As it stands, healthcare has become one of the hottest issues in the lead-up to the country’s upcoming 2020 elections.
Author Interviews, Health Care Systems, Primary Care, University of Pennsylvania / 11.07.2019

MedicalResearch.com Interview with: [caption id="attachment_50224" align="alignleft" width="200"]Molly Candon PhD Research Assistant Professor of Psychiatry Lecturer, Department of Health Care Management The Wharton School, University of Pennsylvania Co-Instructor, Health Services and Policy Research Methods II, MS in Health Policy Research Program, Perelman School of Medicine, University of Pennsylvania  Dr. Candon[/caption] Molly Candon PhD Research Assistant Professor of Psychiatry Lecturer, Department of Health Care Management The Wharton School, University of Pennsylvania Co-Instructor, Health Services and Policy Research Methods II, MS in Health Policy Research Program, Perelman School of Medicine, University of Pennsylvania  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: A team of researchers (led by Karin Rhodes, MD and Dan Polsky, PhD) conducted a secret shopper study of thousands of primary care practices across 10 states, with trained callers simulating patients with Medicaid and requesting appointments. One of the outcome measures was whether an appointment was scheduled with a physician or Advanced Practitioner. Between 2012 and 2016, the share of appointments scheduled with Advanced Practitioners increased by five percentage points. 
Author Interviews, Cancer Research, Health Care Systems, JAMA, Outcomes & Safety, Surgical Research, Yale / 12.04.2019

MedicalResearch.com Interview with: [caption id="attachment_48489" align="alignleft" width="133"]Daniel J. Boffa, MDAssociate Professor of Thoracic SurgeryYale School of Medicine Dr. Boffa[/caption] Daniel J. Boffa, MD Associate Professor of Thoracic Surgery Yale School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prominent cancer hospitals have been sharing their brands with smaller hospitals in the community.  We conducted a series of nationally representative surveys and found that a significant proportion of the U.S. public assumes that the safety of care is the same at all hospitals that share the same respected brand.  In an effort to determine if safety was in fact the same, we examined complex surgical procedures in the Medicare database. We compared the chance of dying within 90 days of surgery between top-ranked hospitals, and the affiliate hospitals that share their brands.  When taking into account differences in patient age, health, and type of procedure, Medicare patients were 1.4 times more likely to die after surgery at the affiliate hospitals, compared to those having surgery at the top-ranked cancer hospitals.
Author Interviews, BMJ, Health Care Systems, University of Pennsylvania / 11.04.2019

MedicalResearch.com Interview with: [caption id="attachment_48484" align="alignleft" width="148"]Genevieve P. Kanter, PhDAssistant Professor (Research) of Medicine, Medical Ethics and Health PolicyUniversity of Pennsylvania Perelman School of MedicinePhiladelphia, PA  19104-6021 Dr. Kanter[/caption] Genevieve P. Kanter, PhD Assistant Professor (Research) of Medicine Medical Ethics and Health Policy University of Pennsylvania Perelman School of Medicine Philadelphia, PA  MedicalResearch.com: What is the background for this study?   Response: In 2010, the US Congress—concerned about the adverse influence of financial relationships between physicians and drug and device firms, and the lack of transparency surrounding these relationships—enacted the Physician Payments Sunshine Act. This legislation required pharmaceutical and medical device firms to report, for public reporting through the Open Payments program, the payments that these firms make to physicians. We sought to evaluate the effect of Open Payments' public disclosure of industry payments information on US adults' awareness of the issue of industry payments and knowledge of whether their physicians' had received industry payments. 
Author Interviews, End of Life Care, Health Care Systems, JAMA / 08.04.2019

MedicalResearch.com Interview with: [caption id="attachment_48423" align="alignleft" width="143"]Cindy L. Cain, PhDAssistant ProfessorDepartment of SociologyUniversity of Alabama at BirminghamBirmingham, AL 35233  Dr. Cain[/caption] Cindy L. Cain, PhD Assistant Professor Department of Sociology University of Alabama at Birmingham Birmingham, AL 35233   MedicalResearch.com: What is the background for this study? What are the main findings? Response: The End of Life Option Act permits terminally ill Californians to request a prescription for medications that would hasten death, providing they meet all requirements of the law and follow the steps outlined by their health care provider. However, the law also allows health care providers and organizations to opt out of participating. Until now, we did not know how common it was for entire health care organizations to opt out. In this study, we found that 61% of the surveyed hospitals prohibited physician participation in the End of Life Option Act. Thirty-nine percent of hospitals did allow participation in the law; these participating hospitals were less likely to be religiously affiliated and more likely to be nonprofit.
Author Interviews, Health Care Systems, Outcomes & Safety, University of Pennsylvania / 01.04.2019

MedicalResearch.com Interview with: [caption id="attachment_48306" align="alignleft" width="148"]Kira L. Ryskina  MD MSAssistant Professor Of MedicineDivision of General Internal MedicinePerelman School of Medicine, University of Pennsylvania Dr. Ryskina[/caption] Kira L. Ryskina  MD MS Assistant Professor Of Medicine Division of General Internal Medicine Perelman School of Medicine, University of Pennsylvania  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Post-acute care in skilled nursing facilities (SNF or sometimes called subacute rehab) is a very common discharge destination after a hospital stay. Patients discharged to these facilities represent more clinically complex and high-need patients than patients discharged home. We wanted to understand how soon after discharge from the hospital to a skilled nursing facility are patients seen by a physician. We found that first visits by a physician or advanced practitioner (a nurse practitioner or physician assistant) for initial medical assessment occurred within four days of SNF admission in 71.5 percent of the stays. However, there was considerable variation in days to first visit at the regional, facility, and patient levels. One in five initial physician visits occurred more than 4 days after admission to skilled nursing facilities.  In 10.4 percent of stays there was no physician or advanced practitioner visit. Much of the variability in visit timing had to do with SNF characteristics and geography compared to patient clinical or demographic characteristics. Patients who did not receive a physician visit had nearly double the rates of readmissions or deaths compared to patients who were seen. 
Author Interviews, Health Care Systems, JAMA / 24.03.2019

MedicalResearch.com Interview with: [caption id="attachment_48108" align="alignleft" width="160"]Maryam Guiahi, MDAssociate Professor, Ob/GynSchool of MedicineUniversity of Colorado Dr. Guiahi[/caption] Maryam Guiahi, MD Associate Professor, Ob/Gyn School of Medicine University of Colorado  MedicalResearch.com: What is the background for this study? Response: The United States Conference of Catholic Bishops expects providers in Catholic Health Care Facilities to follow the Ethical and Religious Directives for Catholic Health Care Services, which places limits on reproductive and end-of-life care. Prior research has demonstrated that many patients do not anticipate religious health care restrictions, yet often face conflicts in care. We were interested in whether Catholic hospitals disclose their religious affiliation and explain to patients how this affiliation may impact the care they are offered.
Author Interviews, Education, Health Care Systems / 14.03.2019

MedicalResearch.com Interview with: [caption id="attachment_47964" align="alignleft" width="200"]Nicholas A. Rattray, Ph.D.Research Scientist/InvestigatorVA HSR&D Center for Health Information and CommunicationImplementation Core, Precision Monitoring to Transform Care (PRISM) QUERIRichard L. Roudebush Veterans Affairs Medical CenterIndiana University Center for Health Services & Outcomes ResearchRegenstrief Institute, Inc.Indianapolis, Indiana Dr. Rattray[/caption] Nicholas A. Rattray, Ph.D. Research Scientist/Investigator VA HSR&D Center for Health Information and Communication Implementation Core, Precision Monitoring to Transform Care (PRISM) QUERI Richard L. Roudebush Veterans Affairs Medical Center Indiana University Center for Health Services & Outcomes Research Regenstrief Institute, Inc. Indianapolis, Indiana on behalf of study co-authors re: Rattray NA, Flanagan ME, Militello LG, Barach P, Franks Z, Ebright P, Rehman SU, Gordon HS, Frankel RM MedicalResearch.com: What is the background for this study? What are the main findings?  Response: End-of-shift handoffs pose a substantial patient safety risk. The transition of care from one doctor to another has been associated with delays in diagnosis and treatment, duplication of tests or treatment and patient discomfort, inappropriate care, medication errors and longer hospital stays with more laboratory testing. Handoff education varies widely in medical schools and residency training programs. Although there have been efforts to improve transfers of care, they have not shown meaningful improvement. Led for the last decade by Richard Frankel, Ph.D., a senior health scientist at Regenstrief Institute and Indiana University and professor at Indiana University School of Medicine, our team has studied how health practitioners communicate during end-of-shift handoffs. In this current study, funded by VA Health Services and Research Development, we conducted interviews with 35 internal medicine and surgery residents at three VA medical centers about a recent handoff and analyzed the responses. Our team also video-recorded and analyzed more than 150 handoffs. Published in the Journal of General Internal Medicine, this study explains how the person receiving the handoff can affect the interaction. Medical residents said they changed their delivery based on the doctor or resident who was taking over (i.e., training level, preference for fewer details, day or night shift). We found that handoff communication involves a complex combination of socio-technical information where residents balance relational factors against content and risk. It is not a mechanistic process of merely transferring clinical data but rather is based on learned habits of communication that are context-sensitive and variable, what we refer to as “recipient design”. In another paper led by Laura Militello, we focus on how residents cognitively prepare for handoffs. In the paper published in The Joint Commission Journal of Quality and Patient Safety®, researchers detailed the tasks involved in cognitively preparing for handoffs. A third paper, published in BMC Medical Education, reports on the limited training that physicians receive during their residency. Residents said they were only partially prepared for enacting handoffs as interns, and clinical experience and enacting handoffs actually taught them the most.  
Author Interviews, Education, Health Care Systems, Outcomes & Safety, University of Pennsylvania / 07.03.2019

MedicalResearch.com Interview with: [caption id="attachment_47812" align="alignleft" width="179"]Jeffrey H. Silber, MD, PhDDirector, Center for Outcomes ResearchNancy Abramson Wolfson Endowed Chair in Health Services ResearchChildren's Hospital of PhiladelphiaProfessor of Pediatrics, Anesthesiology and Critical CarePerelman School of Medicine, University of PennsylvaniaProfessor of Health Care ManagementWharton School, University of Pennsylvania Dr. Silber[/caption] Jeffrey H. Silber, MD, PhD Director, Center for Outcomes Research Nancy Abramson Wolfson Endowed Chair Health Services Research Children's Hospital of Philadelphia Professor of Pediatrics, Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania Professor of Health Care Management Wharton School, University of Pennsylvania  MedicalResearch.com: What is the background for this study? Response: This was a year-long randomized trial that involved 63 internal medicine residency programs from around the US.  In 2015-2016, about half of the programs were randomized to follow the existing rules about resident duty hours that included restrictions on the lengths of shifts and the rest time required between shifts (the standard arm of the trial) and the other half of the programs didn’t have those shift length or rest period rules (the flexible arm of the trial).  We measured what happened to the patients cared for in those programs (the safety study), and other studies examined how much sleep the residents received, and how alert they were at the end of shifts (the sleep study), and previously we published on the educational outcomes of the interns. To measure the impact on patient outcomes when allowing program directors the ability to use a flexible shift length for their interns, we compared patient outcomes after the flexible regimen went into place to outcomes the year before in the same program. We did the same comparison for the standard arm. Then we compared the difference between these comparisons. Comparing before and after the implementation of the trial within the same program allowed us to be more confident that a particularly strong or weak program, or a program with especially sick or healthy patients, would not throw off the results of the study. The trial was designed to determine, with 95% confidence, if the flexible arm did not do more than 1% worse than the standard arm. If this were true for the flexible arm, we could say the flexible regimen was “non-inferior” to the standard regimen.
Author Interviews, Brigham & Women's - Harvard, Health Care Systems, JAMA, Mental Health Research / 04.03.2019

MedicalResearch.com Interview with: [caption id="attachment_47775" align="alignleft" width="125"]Mark S. Bauer, M.D.Professor of Psychiatry, EmeritusHarvard Medical SchoolCenter for Healthcare Organization and Implementation Research (CHOIR)VA Boston Healthcare System-152MBoston, MA 02130 Dr. Bauer[/caption] Mark S. Bauer, M.D. Professor of Psychiatry, Emeritus Harvard Medical School Center for Healthcare Organization and Implementation Research VA Boston Healthcare System-152M Boston, MA 02130 MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Collaborative Chronic Care Models (CCMs) have extensive evidence for their effectiveness in a wide variety of mental health conditions.  CCMs are frameworks of care that include several or all of the following six elements:  work role redesign for anticipatory, continuous care; self-management support for individuals in treatment; provider decision support; information system support for population-based and measurement-guided care; linkage to community resources; and organization and leadership support. However, evidence for Collaborative Chronic Care Model effectiveness comes almost exclusively from highly structured clinical trials.  Little is known about whether CCMs can be implemented in general clinical practice settings, and the implementation evidence that does exist derives primarily from studies of the CCM used in primary care settings to treat depression. We conducted a randomized, stepped wedge implementation trial using implementation facilitation to establish CCMs in general mental health teams in nine US Department of Veterans Affairs medical centers. We found that establishing Collaborative Chronic Care Models was associated with reduced mental health hospitalization rates and, for individuals with complex clinical presentations, improvements in mental health status.  Additionally, standardized assessment of team clinicians indicated that facilitation improved clinician role clarity and increased focus on team goals.
Author Interviews, Health Care Systems, Opiods / 28.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47704" align="alignleft" width="200"]Cory E. Cronin PhDDepartment of Social and Public HealthOhio University College of Health Sciences and ProfessionsAthens, Ohio Dr. Cronin[/caption] Cory E. Cronin PhD Department of Social and Public Health Ohio University College of Health Sciences and Professions Athens, Ohio MedicalResearch.com: What is the background for this study? What are the main findings?  Response: One of my primary areas of research is exploring how hospitals interact with their local communities. My own background is in health administration and sociology, and I have been working with colleagues in the Heritage College of Osteopathic Medicine here at Ohio University (Berkeley Franz, Dan Skinner and Zelalem Haile) to conduct a series of studies looking at questions related to these hospital-community interactions. This particular question occurred to us because of the timeliness of the opioid epidemic. In analyzing data collected from the American Hospital Association and other sources, we identified that the number of hospitals offering in-patient and out-patient substance use disorder services actually dropped in recent years, in spite of the rising number of overdoses due to opioid use. Other factors seemed to matter more in regard to whether a hospital offered these services or not.
Author Interviews, Health Care Systems, JAMA, Outcomes & Safety, Surgical Research / 22.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47615" align="alignleft" width="200"]Alexis G. Antunez MS University of Michigan Medical School, Ann Arbor Center for Healthcare Outcomes and Policy University of Michigan, Ann Arbor Alexis G. Antunez[/caption] Alexis G. Antunez MS University of Michigan Medical School, Ann Arbor Center for Healthcare Outcomes and Policy University of Michigan, Ann Arbor MedicalResearch.com: What is the background for this study? Response: The American College of Surgeons Commission on Cancer is implementing a National Accreditation Program for Rectal Cancer (NAPRC), aiming to improve and standardize the quality of rectal cancer care in the United States. While this is a commendable goal, previous accreditation programs in other specialties have faced controversy around their uncertain impact on access to care. Furthermore, it is well established that the quality of rectal cancer care is associated with patients’ socioeconomic position. So, the NAPRC could have the unintended consequence of widening disparities and limiting access to high quality rectal cancer care for certain patient populations. 
Author Interviews, Health Care Systems, JAMA, Stroke, University Texas / 11.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47423" align="alignleft" width="139"]Amrou Sarraj, MD, Associate Professor Department of Neurology Dr. Sarraj[/caption] Amrou Sarraj, MD, Associate Professor Department of Neurology McGovern Medical School The University of Texas Health Science Center at Houston. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Secondary analyses of trials showing efficacy and safety of thrombectomy within 6-8 hours of stroke onset showed that patients who were transferred to centers performing thrombectomy from another hospital had worse outcomes than patients who presented directly to the thrombectomy centers. We wanted to assess if the thrombectomy outcomes differ between transferred patients and patients directly coming to the thrombectomy centers when patients are selected with advanced perfusion imaging. We found that thrombectomy outcome rates were similar between patients who presented directly vs transferred from another hospital, including functional independence and safety outcomes. 
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, Health Care Systems, Hospital Acquired, JAMA, Urinary Tract Infections / 06.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47312" align="alignleft" width="184"]Heather Hsu, MD MPH Assistant Professor of Pediatrics Boston University School of Medicine Boston Medical Center Boston, MA 02118 Dr. Hsu[/caption] Heather Hsu, MD MPH Assistant Professor of Pediatrics Boston University School of Medicine Boston Medical Center Boston, MA 02118 MedicalResearch.com: What is the background for this study? What are the main findings?  Response: In October 2013, the Centers for Medicare and Medicaid Services (CMS) implemented value-based incentive programs to financially reward or penalize hospitals based on quality metrics. Two of these programs – Hospital Value Based Purchasing and the Hospital Acquired Condition Reduction Program – began targeting hospitals’ rates of certain healthcare-associated infections deemed to be preventable in October 2015. Previous studies demonstrated minimal impact of these value-based payment programs on other measures of hospital processes, patient experience, and mortality. However, their impact on healthcare-associated infections was unknown. Our goal was to study the association of value-based incentive program implementation with healthcare-associated infection rates, using catheter-associated urinary tract infection in intensive care units (one of the targeted outcomes) as an example. We found no evidence that federal value-based incentive programs had any measurable association with changes in catheter-associated urinary tract infection rates in the critical care units of US hospitals.
Author Interviews, Global Health, Health Care Systems, Lancet, Pediatrics / 29.01.2019

MedicalResearch.com Interview with: "By @plumavioleta "Atardecer en #caracas... #avebolivar # ccs #venezuela." via @PhotoRepost_app" by Pedro Fanega is licensed under CC BY 2.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by/2.0Ms Jenny García, PhD candidate Institut National d’Études Démographiques INED Institut de Démographie de l'université Paris 1 Panthéon Sorbonne IDUP Paris, France Prof Gerardo Correa, MSc Instituto de Investigaciones Económicas y Sociales IIES Universidad Católica Andrés Bello UCAB Caracas, Venezuela Prof Brenda Rousset, PhD Departamento de Estadística, Escuela de Sociología (FaCES) Universidad Central de Venezuela UCV Caracas, Venezuela MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Venezuela, as many countries in Latin America, showed substantial improvements in infant mortality rates during the last 60 years. However, the decreasing pattern might be reversing. Recent socioeconomic and political events have led to a collapse in living standards, along with a breakdown of the health system. At the same time, a strict secrecy policy has ruled public institutions, and since 2013 the Venezuelan government stopped publishing mortality statistics. This study attempts to fill this gap and estimate infant mortality using hospital and census data after 2013. The main finding is that infant mortality rates in Venezuela may have stopped decreasing and started increasing in 2009 – around the time funding for the Venezuelan health system started to be substantially reduced. By 2016, the infant mortality rate was 21.1 deaths per 1000 live births, which is 1.4 times the rate in 2008 (15.0 deaths per 1000 live births), and equivalent to the rate recorded in the late 1990s, meaning 18 years of progress may have been lost. 
Author Interviews, Health Care Systems, JAMA / 21.01.2019

MedicalResearch.com Interview with: [caption id="attachment_47027" align="alignleft" width="160"]David Shulkin, MD Ninth Secretary, U.S. Department of Veterans Affairs Washington, District Of Columbia Shulkin Solutions LLC Gladwyne, Pennsylvania Dr. Shulkin[/caption] David Shulkin, MD Ninth Secretary, U.S. Department of Veterans Affairs Washington, District Of Columbia Shulkin Solutions LLC Gladwyne, Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings?  Response: I came to VA in 2015 as Under Secretary for Health, as a result of the 2014 wait time crisis.  At that time, it was determined that in some locations, veterans had been waiting for care for too long and there were allegations that this had resulted in harm to a number of veterans.  I was in the private sector at the time, but was asked by President Obama to come and help improve the situation. Upon my arrival we created systems to determine which veterans were waiting for urgent healthcare and which ones for routine care.  From here, we established same day services for all veterans waiting for urgent care through primary care and behavioral health access points.  This goal was achieved nationwide at the end of 2016.  When I became Secretary in 2017,  we began publishing our wait time data for all to see, so that veterans had accurate information on which to base their choices on and to provide transparency into where we were improving and where we needed to focus our efforts.  In addition, through programmatic and legislative efforts, we expanded our utilization of private sector options so that veterans with clinical needs would be able to get better access to care. This study was meant to determine whether our efforts from 2014 had resulted in improvements to access and in addition how access to care in the VA compared to access in the private sector.   Despite limitations in the data available from the private sector (since others do not publish their actual wait time data similar to VA) we used a data set that we felt had some applicability for these comparisons. We found that for the most part, VA wait times are often shorter than in the private sector,  and that VA wait times had improved since 2014 while the private sectors access had stayed the same. 
Author Interviews, Health Care Systems / 17.01.2019

MedicalResearch.com Interview with: medicoreachLauren Williams Marketing Manager and  Research Analyst MedicoReach TwitterHandle: https://twitter.com/Lauren7321  MedicalResearch.com: What is the driving force behind the research and market study for estimating the hospitalist number in the US? Response: The existing physician’s database available in the industry comprises details that don’t specify the number of hospitalists in particular. As a result, it is turning out challenging to track and count the hospitalists amidst other specialties. There are a lot of incorrect estimations that are circulating, giving no clear picture. In a vast and growing industry like healthcare, there is no scope for wrong data as it can mislead others. Even the Physician Masterfile that the American Medical Association (AMA) offers do not cover the complete hospitalist population. This is because earlier the hospitalist specialty was not a part of the list of physicians. Hospitalists work as primary care providers specializing in inpatient medicine. They play a significant role, coordinating with specialist physicians and other healthcare professionals. As a caregiver, they provide quality hospital care and boosts efficiency through effective hospital resource allocation. And so, how can we let their presence go overlooked? Our research aimed to bring out their actual numbers before the industry. That is why our research team came up with the research and market study to fetch real facts. 
Author Interviews, Health Care Systems, Ophthalmology / 07.11.2018

MedicalResearch.com Interview with: [caption id="attachment_45754" align="alignleft" width="130"]Nathan Radcliffe, MD Senior Faculty, Ophthalmology Glaucoma and Cataract surgeon Mount Sinai Health System Dr. Radcliffe[/caption] 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, be sure to consult your eye surgeon before increasing any eye treatment to ensure it won't do any further damage to the eye. 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.
Author Interviews, Health Care Systems, Psychological Science / 03.10.2018

MedicalResearch.com Interview with: [caption id="attachment_44977" align="alignleft" width="200"]Professor Mary Dixon-Woods Director, The Healthcare Improvement Studies Institut (THIS Institute) University of Cambridge Prof. Dixon-Woods[/caption] 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. 
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Health Care Systems, JAMA / 26.06.2018

MedicalResearch.com Interview with: [caption id="attachment_42726" align="alignleft" width="140"]A Jay Holmgren Doctoral Student, Health Policy and Management Harvard Business School A Jay Holmgren[/caption] 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.
Author Interviews, Health Care Systems, Infections, JAMA, Outcomes & Safety / 13.06.2018

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.
Author Interviews, CMAJ, Cost of Health Care, Health Care Systems, Hip Fractures, Surgical Research / 12.06.2018

MedicalResearch.com Interview with: [caption id="attachment_42321" align="alignleft" width="108"]Daniel Pincus MD Department of Surgery Institute for Clinical Evaluative Sciences University of Toronto Dr. Pincus[/caption] 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).
Author Interviews, Environmental Risks, Health Care Systems, Surgical Research / 11.12.2017

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.