Patients Who Discharge From Hospital Against Medical Advice Have Double Rate of Readmission

MedicalResearch.com Interview with:

Professor Mamas Mamas (BM BCh, MA, DPhil, MRCP) Professor of Cardiology at Keele University and an Honorary Professor of Cardiology at the University of Manchester

Prof. Mamas

Professor Mamas Mamas (BM BCh, MA, DPhil, MRCP)
Professor of Cardiology at Keele University and an
Honorary Professor of Cardiology at the University of Manchester

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

Response: Discharge against medical advice occurs in 1 to 2% of all medical admissions but little / no data around how frequently this occurs in the context of PCI or the outcomes associated with such a course of action. We undertook this study to understand both how commonly discharge against medical advice occurs, the types of patients it occurs in and outcomes in terms of both readmission rates and causes of readmisison.   Continue reading

Parent Skin Cleansing Prior to Infant Contact in NICU Important to Reduce Staph Infections

MedicalResearch.com Interview with:
“Bart Infant” by Bart Everson is licensed under CC BY 2.0Gwen M. Westerling, BSN, RN, CIC
Infection Preventionist
Helen DeVos Children’s Hospital

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

Response: The setting of this study is a Level III Neonatal Intensive Care Unit (NICU) with 106 beds.

In 2016, an increase in Hospital Acquired Infections (HAI) was noted in the Neonatal Intensive Care Unit (NICU) caused by Staphylococcus aureus (SA) through diligent Infection Prevention Surveillance. When we reviewed the literature we found the SA is a common skin colonizer and can be a problem for neonates with immature skin and immune systems.

Staphylococcus aureus is easily transmitted through direct contact with skin, the contaminated hands of health care workers, the environment and equipment. We also found one study that listed skin to skin care as a risk factor for acquisition of SA. Before we saw the increase in infections some process changes occurred in our NICU that included increased skin to skin care, meaningful touch between neonates and parents, and two person staff care. We hypothesized that the process changes were exposing neonates to increased amounts of Staphylococcus aureus and contributing to the increase in infections.

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What Causes Failures in Personal Protective Equipment Use in Hospitals?

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.

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Physician MOC Status Linked To Better Diabetes Performance Measure

MedicalResearch.com Interview with:
Bradley Gray, PhD
Senior Health Services Researcher
American Board of Internal Medicine

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

Response: This study is part of an ongoing effort to improve and validate ABIM’s MOC process through the use of real data that is ongoing here at ABIM.

MedicalResearch.com: What are the main findings? 

Response: The paper examines the association between MOC status and a set of HEDIS process quality measures for internists twenty years past the time they initially certified. An example of one HEDIS performance measure we looked at was percentage of patients with diabetes that had twice annual HbA1c testing. The key findings of the paper are that physicians who maintained their certification had better scores on 5 of 6 HEDIS performance measures than similar physicians who did not maintain their certification.

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For Your Surgeon, Do You Want Younger Hands or More Experience?

MedicalResearch.com Interview with:
“Untitled” by Marcin Wichary is licensed under CC BY 2.0
Yusuke Tsugawa, MD, MPH, PhD
Assistant professor
Division of General Internal Medicine and Health Services Research
David Geffen School of Medicine at UCL
Los Angeles, CA 

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

Response: We studied whether patients’ mortality rate differ based on age and sex of surgeons who performed surgical procedures. Using a nationally representative data of Medicare beneficiaries aged 65-99 years who underwent one of 20 major non-elective surgeries, we found that patients treated by older surgeons have lower mortality than those cared for by younger surgeons, whereas there was no difference in patient mortality between male and female surgeons. When we studied age and sex together, we found that female surgeons at their 50s had the lowest patient mortality across all groups.

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Racial Disparities in Post-Procedure ED Visits and Hospitalizations

MedicalResearch.com Interview with:

Dr-Hillary-J-Mull

Hillary J. Mull, PhD, MPP
Center for Healthcare Organization and Implementation Research
Veterans Affairs (VA) Boston Healthcare System
Department of Surgery, Boston University School of Medicine
Boston, Massachusetts

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

Response: Little is known about outpatient procedures that can be considered invasive but are not conducted in a surgical operating room. These procedures are largely neglected by quality or patient safety surveillance programs, yet they are increasingly performed as technology improves and the U.S. population gets older.

We assessed the rate of invasive procedures across five specialties, urology, podiatry, cardiology, interventional radiology and gastroenterology in the Veterans Health Administration between fiscal years 2012 and 2015. Our analysis included examining the rates of post procedure emergency department visits and hospitalizations within 14 days and the key patient, procedure or facility characteristics associated with these outcomes. We found varying rates of post procedure ED visits and hospitalizations across the specialties with podiatry accounting for a high volume of invasive outpatient care but the lowest rate of postoperative utilization (1.8%); in contrast, few of the procedures were in interventional radiology, but the postoperative utilization rate was the highest at 4.7%. In a series of logistic regression models predicting post procedure healthcare utilization for each specialty, we observed significantly higher odds of post procedural outcomes for African American patients compared to white patients.

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Medicaid Expansion Improved Access to Cardiac Care Without Diminishing Outcomes

MedicalResearch.com Interview with:

Donald Likosky, Ph.D., M.S. Associate Professor Head of the Section of Health Services Research and Quality Department of Cardiac Surgery. University of Michigan

Dr. Likosky

Donald Likosky, Ph.D., M.S.
Associate Professor
Head of the Section of Health Services Research and Quality
Department of Cardiac Surgery.
University of Michigan

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

Response: Michigan was one of several states to expand Medicaid. Current evaluations of the Michigan Medicaid expansion program have noted increases in primary care services and health risk assessments, but less work has evaluated its role within a specialty service line. There has been concern among some that Medicaid patients, who have traditionally lacked access to preventive services, may be at high risk for poor clinical outcomes if provided increased access to cardiovascular interventions.

Using data from two physician-led quality collaboratives, we evaluated the volume and outcomes of percutaneous coronary interventions and coronary artery bypass grafting 24mos before and 24mos after expansion. We noted large-scale increased access to both percutaneous coronary interventions (44.5% increase) and coronary artery bypass grafting (103.8% increase) among patients with Medicaid insurance. There was a decrease in access for patients with private insurance in both cohorts. Nonetheless, outcomes (clinical and resource utilization) were not adversely impacted by expansion.  Continue reading

Readmissions After Stent Surgery Common and Often Due to Co-Morbid Disease

MedicalResearch.com Interview with:

“Open Stent” by Lenore Edman is licensed under CC BY 2.0

Example of Open Cardiac Stent

Chun Shing Kwok, MBBS, MSc, BSc, MRCP(UK)
Clinical Lecturer in Cardiology and Specialist Registrar in Cardiology
Keele University & Royal Stoke University Hospital Guy Hilton Research 

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

Response: Percutaneous coronary intervention (PCI) is a common revascularization modality in the treatment for coronary heart disease and the mortality rate after this procedure is low. Improved survival after PCI procedures has led to a growing population at risk of readmissions.  Early unplanned readmissions are important because they are a burden to patients, the local health care economy and it also serves as a quality of care indicator.

MedicalResearch.com: What are the main findings?

Response: Our analysis of 833,344 PCI procedures in the United States demonstrates that unplanned readmissions within 30 days of the index PCI are common (9.3%). The mean total hospital cost was higher for patients who were readmitted compared with those not readmitted ($37,524 vs $23,211). The majority of readmissions within 30 days are noncardiac (56%), with female sex, chronic kidney disease, liver failure, atrial fibrillation, increasing comorbidity burden, and discharge location among the strongest predictors of unplanned 30-day readmission. Patients who experienced an unplanned readmission for noncardiac reasons tended to be younger, with more comorbidities, including alcohol misuse, cancer, and dementia, whereas patients who are readmitted for cardiac reasons are more likely to have in-hospital complications at their index PCI event. 

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

Response: Our results suggest that 30-day readmissions in the United States is common and comorbid illnesses and places of discharge are important factors that influence readmissions. There are important financial consequences of such readmissions, and further strategies to reduce the prevalence should be explored. 

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

Response: Future work should explore if optimization of the management of any comorbid condition during a patient’s index admission for PCI and outreach programs to patients discharged to short-term hospitals, other institutions, and care homes may reduce early readmissions. 

Disclosures: Financial support was provided by the North Staffs Heart Committee. This work was conducted as a part of Dr. Kwok’s PhD research, which was supported by Biosensors International. 

Citations: 

Kwok CS, Rao SV, Potts JE, et al. Burden of 30-day readmissions after percutaneous coronary intervention in 833,344 patients in the United States: predictors, causes, and cost insights from the Nationwide Readmission Database. J Am Coll Cardiol Intv. 2018;Epub ahead of print.

Kalra A, Shishehbor MH, Simon DI. Percutaneous coronary intervention readmissions: where are the solutions? J Am Coll Cardiol Intv. 2018;Epub ahead of print.

 

 

 

 

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.

 

Readmissions After LVAD For Heart Failure High, Mostly For Non-Cardiac Causes

MedicalResearch.com Interview with:
Dr. Sahil Agrawal, MBBS MD

Division of Cardiology, St. Luke’s University Health Network, Bethlehem, PA
Dr Lohit Garg MD
Division of Cardiology
Lehigh Valley Health Network, Allentown 

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

Response: Readmissions among advanced heart failure patients are common and contribute significantly to heath care related costs. Rates and causes of readmissions, and their associated costs among patients after durable left ventricular assist device (LVAD) implantation have not been studied in a contemporary multi-institutional setting. We studied the incidence, predictors, causes, and costs of 30-day readmissions after LVAD implantation using Nationwide Readmissions Database (NRD) in our recently published study.

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Physicians Passage of MOC Exam Linked to Fewer State Disciplinary Actions

MedicalResearch.com Interview with:

Dr. Furman S. McDonald MD MPH Lead author of the research and  Senior Vice President for Academic and Medical Affairs American Board of Internal Medicine (ABIM)

Dr. McDonald

Dr. Furman S. McDonald MD MPH
Lead author of the research and
Senior Vice President for Academic and Medical Affairs
American Board of Internal Medicine (ABIM)

MedicalResearch.com: What is the background for this study? Would you briefly explain how the MOC examination works?

Response: To earn Board Certification from the American Board of Internal Medicine (ABIM), doctors take an exam after completing a medical education training program accredited by the Accreditation Council for Graduate Medical Education to demonstrate they have the knowledge to practice in a specialty. Previously, ABIM conducted research that showed that physicians who passed a certification exam were five times less likely to be disciplined by a state licensing board than those who do not become certified.

After becoming board certified, physicians can participate in ABIM’s Maintenance of Certification (MOC) program, which involves periodic assessments and learning activities to support doctors in staying current with medical knowledge through their careers. ABIM has been in conversations across the medical community and many people have expressed interest in whether performance on the MOC exams doctors take is also associated with important outcomes relevant to patients.

For this study, my ABIM colleagues and I studied whether there was any association between Internal Medicine MOC exam performance and disciplinary actions by state licensing boards. We studied MOC exam results and any reported disciplinary actions for nearly 48,000 general internists who initially certified between 1990 and 2003.  Continue reading

Frail Patients More Likely To Be Readmitted After Surgery

MedicalResearch.com Interview with:
Rachel Khadaroo, MD, PhD, FRCSC
Associate Professor of Surgery
Department of Surgery & Division of Critical Care Medicine
University of Alberta

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

Response: The elderly are the fastest growing population in North America. There are very few studies that have examined the impact of frailty and age on outcomes following abdominal surgery. Readmissions are expensive have been considered an important quality indicator for surgical care. This study examined 308 patients 65 years and older who were admitted for emergency abdominal surgery in two hospitals in Alberta and followed them for 6 months for readmission or death. Patients were classified into 3 categories: Well, pre-frail (no apparent disability), and frail. Continue reading

Clinical Pharmacist Intervention Can Reduce ED Visits and Hospital Readmissions

MedicalResearch.com Interview with:
Lene Vestergaard Ravn-Nielsen, MSc(Pharm) Hospital Pharmacy of Funen Clinical Pharmacy Department Odense University Hospital Odense, Denmark
Lene Vestergaard RavnNielsenMSc(Pharm)
Hospital Pharmacy of Funen
Clinical Pharmacy Department
Odense University Hospital
Odense, Denmark

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

Response: Hospital readmissions are common among patients receiving multiple medication, with considerable costs to the patients and society.

MedicalResearch.com: What are the main findings? 

Response: A multifaceted clinical pharmacist intervention can reduce ED visits and hospital readmissions.  Continue reading

Medicaid Expansion Led To Better, More Timely Surgical Care

MedicalResearch.com Interview with:

Andrew Phillip Loehrer MD MPH Fellow in Surgical Oncology Department The University of Texas MD Anderson Cancer Center

Dr. Loehrer

Andrew Phillip Loehrer MD MPH
Fellow in Surgical Oncology Department
The University of Texas MD Anderson Cancer Center

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

Response: A growing number of studies have examined the effects of the Affordable Care Act’s Medicaid expansion.  But none to date have looked at effects on surgical conditions, which are both expensive and potentially life-threatening.  We examined data for nearly 300,000 patients who presented to hospitals with common and serious surgical conditions such as appendicitis and aortic aneurysms.

We found that expansion of Medicaid coverage was linked to increased insurance coverage for these patients, but even more importantly, Medicaid expansion led patients to come to the hospital earlier before complications set in, and they also received better surgical care once they got there.

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Survival From In-Hospital Cardiac Arrest Improves But Still Worse on Nights and Weekends

MedicalResearch.com Interview with:

Uchenna Ofoma, MD, MS Associate, Critical Care Medicine Assistant Professor of Medicine, Temple University Director of Critical Care Fellowship Research Geisinger Medical Center

Dr. Ofoma

Uchenna Ofoma, MD, MS
Associate, Critical Care Medicine
Assistant Professor of Medicine, Temple University
Director of Critical Care Fellowship Research
Geisinger Medical Center

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

Response: Patients who suffer in-hospital cardiac arrest at nights and during weekends (off-hours) are known to have lower rates of survival to hospital discharge, compared to their counterparts who have cardiac arrest during the daytime on weekdays (on-hours). Since overall survival to hospital discharge has improved over the past decade for the approximately 200,000 patients who experience in-hospital cardiac arrest annually, our study sought to determine whether survival differences between off-hours and on-hours arrest has changed over time.

On-hours was categorized as 7:00 a.m. to 10:59 p.m. Monday to Friday. Off-hours was categorized as 11:00 p.m. to 6:59 a.m. Monday to Friday or anytime on weekends. Among 151,071 adult patients in the GWTG-Resuscitation registry who experienced in-hospital cardiac arrest between January 2000 and December 2014, slightly over half (52%) suffered a cardiac arrest during off-hours. We found that survival to hospital discharge improved significantly in both groups over the study period — for on-hours: from 16.0% in 2000 to 25.2% in 2014; for off-hours: 11.9% in 2000 to 21.9% in 2014.

However, despite overall improvement in both groups, survival from in-hospital cardiac arrest at nights during off-hours remained significantly lower compared to on-hours by an absolute 3.8%.

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

Response: Survival to hospital discharge has improved in both groups of patients. This is reassuring and suggests that health care providers and hospital systems must be doing something right. However, the persistent survival disparities between on-hours and off-hours arrests remains concerning. To ensure that improved survival trends are sustained over time, narrowing this gap must be made an area of focus for quality improvement efforts. Data regarding mediator variables, such as physician and nurse staffing patterns and how they changed over the course of the study was not available for this study. 

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

Response: Since timing of in-hospital cardiac arrest appears to impact survival outcomes, future research should aim at identifying factors that may be associated with these described survival discrepancies and care processes that mitigate against them.

Disclosures: The authors received research support from the Geisinger Health System Foundation and the National Institutes of Health. 

Citations:

Journal of the American College of Cardiology
Volume 71, Issue 4, January 2018
DOI: 10.1016/j.jacc.2017.11.043
Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends
Uchenna R. Ofoma, Suresh Basnet, Andrea Berger, H. Lester Kirchner, Saket Girotra, for the American Heart Association Get With the Guidelines – Resuscitation Investigators, Benjamin Abella, Monique L. Anderson, Steven M. Bradley, Paul S. Chan, Dana P. Edelson, Matthew M. Churpek, Romergryko Geocadin, Zachary D. Goldberger, Patricia K. Howard, Michael C. Kurz, Vincent N. Mosesso Jr., Boulos Nassar, Joseph P. Ornato, Mary Ann Peberdy and Sarah M. Perman

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.

 

ACA Pay-For-Performance Programs Not Living Up To Expectations

MedicalResearch.com Interview with:

Dr. Igna Bonfrer PhD Post-Doctoral Research Fellow Harvard T.H. Chan School of Public Health 

Dr. Bonfrer

Dr. Igna Bonfrer PhD
Post-Doctoral Research Fellow
Harvard T.H. Chan School of Public Health  

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

Response: One of the two main elements of the Affordable Care Act, generally known as Obama Care, is the implementation of value based payments through so called “pay-for-performance” initiatives. The aim of pay-for-performance (P4P) is to reward health care providers for high-quality care and to penalize them for low-quality care.

We studied the effects of the P4P program in US hospitals and found that the impact of the program as currently implemented has been limited.

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Penalties for Readmissions Widens Financial Losses At Delta Safety Net Hospitals

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.

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Hospital Onset Clostridium difficile Infections Increased With Electronic Sepsis Alerts

MedicalResearch.com Interview with:

Dr. Robert Hiensch MD Assistant Professor, Medicine, Pulmonary, Critical Care and Sleep Medicine Icahn School of Medicine at Mount Sinai

Dr. Hiensch

Dr. Robert Hiensch MD
Assistant Professor, Medicine, Pulmonary, Critical Care and Sleep Medicine
Icahn School of Medicine at Mount Sinai.

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

Response: New sepsis guidelines that recommend screening and early treatment for sepsis cases appear to have significant positive impacts on patient outcomes. Less research has been published on what potential side effects may result from these guidelines.

Antibiotics are a cornerstone of sepsis treatment and early antibiotic administration is strongly recommended.  We examined whether the introduction of an electronic based sepsis initiative changed antibiotic prescribing patterns at our hospital. Antibiotics, even when appropriate, contribute to hospital onset Clostridium difficile infections (HO CDIs).  While the authors do not dispute the importance of antibiotic administration in sepsis, it is valuable to know whether the sepsis initiative coincided with both increased antibiotic administration and HO CDIs.

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Coordination Program Reduced ER Visits and Readmissions in Medicaid Population

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.

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

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.

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Racial Gap in Survival After In-Hospital Cardiac Arrest Nearly Closed

MedicalResearch.com Interview with:
Dr. Lee Joseph, MD, MS

Postdoctoral fellow at University of Iowa
Division of Cardiovascular Diseases
Department of Internal Medicine
University of Iowa Carver College of Medicine
Iowa City

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

Response: In-hospital cardiac arrest (IHCA) is common and affects more than 200,000 patients every year. Although survival for in-hospital cardiac arrest has improved in recent years, marked racial differences in survival are present. A previous study showed that black patients with in-hospital cardiac arrest have 27% lower chance of surviving an in-hospital cardiac arrest due to a shockable rhythm compared to white patients. Moreover, lower survival in black patients was largely attributable to the fact that black patients were predominantly treated in lower quality hospitals compared to white patients.  In other words, racial disparities in survival are closely intertwined with hospital quality, and this has been borne out in multiple other studies as well

In this study, we were interested in determining whether improvement in in-hospital cardiac arrest survival that has occurred in recent years benefited black and white patients equally or not? In other words, have racial differences in survival decreased as overall survival has improved. If so, what is the mechanism of that improvement? And finally, did hospitals that predominantly treat black patients make the greatest improvement in survival?

To address these questions, we used data from the Get With The Guidelines-Resuscitation, a large national quality improvement registry of in-hospital cardiac arrest that was established by the American Heart Association in the year 2000. Participating hospitals submit rich clinical data on patients who experience in-hospital cardiac arrest. Over the last 17 years, the registry has grown markedly and currently includes information on >200,000 patients from > 500 hospitals. The primary purpose is quality improvement. But it has also become an important resource to conduct research into the epidemiology and outcomes associated with in-hospital cardiac arrest.

Using data from the Get With the Guidelines-Resuscitation, we identified 112,139 patients at 289 hospitals between 2000-2014. Approximately 25% of the patients were of black race and the remainder were white patients. We constructed two-level hierarchical regression models to estimate yearly risk adjusted survival rates in black and white patients and examined how survival differences changed over time both on an absolute and a relative scale.

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Use of IVC Filters Drops After FDA Device Warning

MedicalResearch.com Interview with:

Riyaz Bashir MD, FACC, RVT Professor of Medicine Director, Vascular and Endovascular Medicine Department of Medicine Division of Cardiovascular Diseases Temple University Hospital Philadelphia, PA 19140

Dr. Bashir

Riyaz Bashir MD, FACC, RVT
Professor of Medicine
Director, Vascular and Endovascular Medicine
Department of Medicine
Division of Cardiovascular Diseases
Temple University Hospital
Philadelphia, PA 19140

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

Response: The use of inferior vena cava filters (IVCF) has been increasing in the United States (US) despite uncertainty about the effectiveness of IVCFs in reducing venous thromboembolism (VTE)-associated morbidity and mortality.  Prompted by the report of high prevalence of fracture and embolization of Bard IVCFs, the US Food and Drug Administration (FDA) issued a device safety warning on August 9th 2010.

In this study, we evaluated national trends of IVCF placement in the US between 2005 and 2014 using the National Inpatient Sample database.  The authors found that there was a 29% reduction in filter use following the 2010 FDA advisory, even though the rates of VTE-related hospitalizations remained unchanged.

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20% of Hospitalized Patients Receiving Antibiotics Experience Side Effects

MedicalResearch.com Interview with:

Pranita Tamma, MD Assistant Professor Director, Pediatric Antimicrobial Stewardship Program Assistant Professor of Pediatrics Johns Hopkins Bloomberg School of Public Health

Dr. Pranita D. Tamma
Assistant Professor of Pediatrics
Director, Pediatric Antimicrobial Stewardship Program
The Johns Hopkins University School of Medicine 

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

Response: A study examining the impact of antibiotics prescribed for nearly 1500 adult patients admitted to The Johns Hopkins Hospital found that adverse side effects occurred in a fifth of them, and that nearly a fifth of those side effects occurred in patients who didn’t need antibiotics in the first place.

In the study, the researchers evaluated the electronic medical records of 1488 adults admitted to the general medicine services at The Johns Hopkins Hospital between September 2013 and June 2014. The patients were admitted for reasons ranging from trauma to chronic disease, but all received at least 24 hours of antibiotic treatment.

The researchers followed patients for 30 days after hospital discharge to evaluate for the development of antibiotic-associated adverse events. To determine the likelihood that an adverse reaction was most likely due to antibiotics and to identify how many adverse reactions could be avoided by eliminating unnecessary antibiotic use, two infectious disease clinicians reviewed all of the data.

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Legionnaires’ Disease Is Widespread and Deadly in US Health Care Facilities

MedicalResearch.com Interview with:
Elizabeth A. Soda, MD
Epidemic Intelligence Service
Divison of Bacterial Diseases
National Center of Immunization and Respiratory Diseases
CDC

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

Response: Legionella is a waterborne bacterium responsible for Legionnaires’ disease, an often severe pneumonia. Legionnaires’ disease primarily affects certain groups of individuals such as those ≥50 year of age, current or former smokers, and those with chronic diseases or weakened immune systems. Health care facilities often have large and complex water systems and care for vulnerable populations that are susceptible to developing Legionnaires’ disease. Thus preventing hospitalized patients from developing Legionnaires’ disease is the ultimate goal. This analysis aimed to describe health care-associated Legionnaires’ disease in 2015 from the 21 U.S. jurisdictions that completely reported their health care-associated Legionnaires’ disease cases to the CDC’s Supplemental Legionnaires’ Disease Surveillance System (SLDSS).

Over 2,800 cases of Legionnaires’ disease cases were reported to SLDSS by the 21 jurisdictions, and 553 (20%) were considered health care associated. The analysis showed 16 of the 21 (76%) jurisdictions had at least one case of Legionnaires’ disease definitely related to a stay in a hospital or long-term care facility. In total there were 85 (3%) definite health care-associated Legionnaires’ disease cases (as defined by continuous exposure to a hospital or long-term facility for the entire 10 days before symptom onset) that resulted from 72 different health care facilities.

Additionally, 20 of 21 jurisdictions (95%) reported 468 (17%) possible health care-associated Legionnaires’ disease cases (as defined by any exposure to a health care facility for a portion of the 10 days before symptom onset) that resulted from approximately 415 different health care facilities.

While approximately 9% of Legionnaires’ disease cases overall are fatal, this report showed a case fatality of 25% for definite health care-associated cases.

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Research Oriented Hospitals Found To Be More Efficient

MedicalResearch.com Interview with:
Antonio García-Romero IE University – IE Business School Madrid, SpainAntonio García-Romero
IE University – IE Business School
Madrid, Spain

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

Response: There is an increasing need for new approaches capable of measuring the “real” effects of research on society. People are interested in knowing what benefits are obtained from scientific research. Our aim in this project was to develop a valid methodology capable of measuring the effects from scientific research on some healthcare outcomes such as the average length of stay in a hospital. Our central hypothesis is that the more research is carried out in hospitals, the more efficient the hospitals are regarding the length of stay (LOS).

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Handwashing Effectiveness Not Affected By Water Temperature

MedicalResearch.com Interview with:

Donald Schaffner, PhD Extension Specialist in Food Science and Distinguished Professor Rutgers-New Brunswick

Dr. Schaffner

Donald Schaffner, PhD
Extension Specialist in Food Science and Distinguished Professor
Rutgers-New Brunswick

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

Response: We been interested in handwashing and cross-contamination research for more than 15 years. About 10 years after I started as a faculty member I was approached about doing research in this area. The first paper republished has turned into my most highly cited paper. I think it was mostly a matter of being in the right place at the right time, with the right idea.

This latest bit of research came out of my ongoing participation in the Conference for Food Protection. This is an unusual meeting, and unlike any other scientific conference. It’s a group of industry scientists, government regulators, and academics would get together every two years to help the FDA Center for Food Safety and Applied Nutrition update a document called the Model Food Code. The code has no regulatory standing, but it is used by state health agencies as the basis for state food codes that regulate restaurants, supermarkets, and other food service establishments.

There are several provisions in the code that we wanted to try to impact with our research. The code currently states that hands must be washed in warm water. The plumbing section of the code also states that hand wash sinks must be capable of dispensing water at 100°F. We wanted to explore whether there was any scientific basis statements.

In some recent survey-based research, graduate student that is also the first author on this manuscript surveyed the Internet for the kind of advice was offered on handwashing posters that provide advice on how to wash your hands. He found that the recommendations varied widely including recommendations on how long to wash your hands.

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