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

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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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Whose Patients Have Lower 30-Day Mortality? Younger or Older Doctors?

MedicalResearch.com Interview with:

Yusuke Tsugawa, MD, MPH, PhD</strong> Harvard T. H. Chan School of Public Health Department of Health Policy and Management Cambridge, MA 02138

Dr. Tsugawa

Yusuke Tsugawa, MD, MPH, PhD
Harvard T. H. Chan School of Public Health
Department of Health Policy and Management
Cambridge, MA 02138

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

Response: Although evidence has suggested that older physicians may experience a
decline in medical knowledge and are less likely to adhere to standard care, patients in general had a perception that older doctors are more
experienced and therefore provide superior care.

Using a nationally representative sample of Medicare beneficiaries who were hospitalized
for medical conditions in 2011-2014, we found that patients treated by
younger doctors have lower 30-day mortality compared to those cared
for by older doctors, after adjusting for patient, physician, and
hospital characteristics.

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Hospitals With Rigorous Quality Improvement Programs Penalized In Star Ratings

MedicalResearch.com Interview with:

John Oliver DeLancey, MD, MPH Resident, Department of Urology Research Fellow, Surgical Outcomes and Quality Improvement Center Northwestern University Feinberg School of Medicine

Dr. John Oliver DeLancey

John Oliver DeLancey, MD, MPH
Resident, Department of Urology
Research Fellow, Surgical Outcomes and Quality Improvement Center
Northwestern University Feinberg School of Medicine

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

Response: We initially looked at the star ratings for hospitals that we considered to provide excellent care, and it did not seem that this was reflected in the star ratings. Therefore, we sought to examine which factors were associated with the likelihood of receiving a high or low star rating.

When we examined these associations, we found that academic and community hospitals, who reported nearly all of the measures included, had disproportionally lower star ratings than Critical Access or Specialty hospitals, who reported on average about half of the measures used to generate the star ratings.

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Study Compares Appendectomy Outcomes Between General Surgeons and Surgical Residents

MedicalResearch.com Interview with:
Haggi Mazeh, MD, FACS
Endocrine and General Surgery
Department of Surgery
Hadassah-Hebrew University Medical Center, Mount Scopus
Jerusalem, Israel 91240

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

Response: The level of operating room autonomy given to surgical residents varies greatly between different institutions and different countries. On one hand, providing residents the opportunity to operate alone augments their confidence and their sense of responsibility, possibly accelerating their learning process. On the other hand, it may be argued that the presence of a senior general surgeon in every operation is a safer approach.

Before 2012, a large proportion of appendectomies at our institution were performed by surgical residents alone. After 2012, our institutional policy changed to require the presence of a senior general surgeon in every appendectomy case. This unique situation provided us the opportunity to compare the outcomes of appendectomies performed by residents alone to those performed in the presence of a senior general surgeon.

Our study demonstrated no difference in the complication rates between the two groups of patients. However, surgeries performed in the presence of senior general surgeons were significantly shorter than those performed by residents.

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Risk Factors For Adverse Events After Total Shoulder Replacement

MedicalResearch.com Interview with:

Brad Parsons, MD Associate Professor, Orthopaedics Icahn School of Medicine at Mount Sinai

Dr. Parsons

Brad Parsons, MD
Associate Professor, Orthopaedics
Icahn School of Medicine at Mount Sinai

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

Response: As bundled payment initiatives increase in order to contain health care costs, total shoulder arthroplasty (TSA) is a likely future target.

Understanding modifiable drivers of complications and unplanned readmission as well as identifying when such events occur will be critical for orthopedic surgeons and hospitals to improve outcomes and to make fixed-price payment models feasible for TSA.

Utilizing the American College of Surgeons National Surgical Quality Improvement Program we identified 5801 patients that underwent TSA with a 2.7% readmission rate and 2.5% severe adverse event rate. Patients with 3 or more risk factors were found to have a significantly increased risk of readmission and severe adverse events within the first two weeks postoperatively.

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Physicians, PAs and Nurse Practitioners Provide Similar Amount of Low Value Care

MedicalResearch.com Interview with:

John N. Mafi, MD, MPH Division of General Internal Medicine and Health Services Research Department of Medicine, Ronald Reagan UCLA Medical Center Los Angeles, CA

Dr. John N. Mafi

John N. Mafi, MD, MPH
Division of General Internal Medicine and Health Services Research
Department of Medicine, Ronald Reagan UCLA Medical Center
Los Angeles, CA

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

Response: Our country has a primary care physician shortage. Some have advocated that we expand the scope of practice for nurse practitioners and physician assistants to help alleviate this problem and improve access to primary care. But a 2013 study in the New England Journal of Medicine found that a large number of physicians believed that nurse practitioners provided lower value care when compared with physicians. We decided to put that belief to the test. We studied 29,000 U.S. patients who saw either a nurse practitioner, physician assistant, or physician in the primary care setting for common conditions, and we compared the rate of low-value or unnecessary services—for example, unnecessary antibiotics for the common cold, or MRI for low back pain, or a CT scan for headache. Things that don’t help patients and may harm.

We found no difference in the rates of low value services between nurse practitioners, physician assistants, and physicians. In other words, they did equivalent amounts of inappropriate or bad care.

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Drop in Adverse Drug Events Linked to Meaningful Use of Electronic Records

MedicalResearch.com Interview with:
Michael Furukawa, Ph.D.

Senior Economist
Agency for Healthcare Research and Quality 

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

Response: Despite some progress, patient safety remains a serious concern in U.S. health care delivery, particularly in acute care hospitals. In part to support safety improvement, the Health Information Technology for Economic and Clinical Health (HITECH) Act promoted widespread adoption and use of certified electronic health record technology. To meet Meaningful Use (MU) requirements in the law, hospitals are required to adopt specific capabilities, such as computerized physician order entry, which are expected to reduce errors and promote safer care.

We found that, after the HITECH Act was made law, the occurrence of in-hospital adverse drug events (ADEs) declined significantly from 2010 to 2013, a decline of 19%. Hospital adoption of medication-related MU capabilities was associated with 11% lower odds of ADEs occurring, but the effects did not vary by the number of years of experience with these capabilities. Interoperability capability was associated with 19% lower odds of adverse drug events occurring. Greater exposure to MU capabilities explained about one-fifth of the observed reduction in ADEs.

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Regional Variation in Chemotherapy Prescriptions For Metastatic Prostate Cancer

MedicalResearch.com Interview with:

Megan Elizabeth Veresh Caram MD Clinical Lecturer Internal Medicine, Hematology & Oncology University of Michigan

Dr. Caram

Megan Elizabeth Veresh Caram MD
Clinical Lecturer
Internal Medicine, Hematology & Oncology
University of Michigan

 

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

Response: Abiraterone and enzalutamide are oral medications that were approved by the Food & Drug Administration in 2011 and 2012 to treat men with metastatic castration-resistant prostate cancer. Most men with advanced prostate cancer are over age 65 and thus eligible for Medicare Part D. We conducted a study to better understand the early dissemination of these drugs across the United States using national Medicare Part D and Dartmouth Atlas data.

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Hospital Floors May Be Underappreciated Source Of Hospital Infections

MedicalResearch.com Interview with:

Curtis J. Donskey, MD Geriatric Research, Education, and Clinical Center Cleveland Veterans Affairs Medical Center Cleveland, OH 44106

Dr. Curtis J. Donskey

Curtis J. Donskey, MD
Geriatric Research, Education, and Clinical Center
Cleveland Veterans Affairs Medical Center
Cleveland, OH 44106

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

Response: Many hospitals are making efforts to improve cleaning to reduce the risk for transmission of infection from contaminated environmental surfaces. Most of these efforts focus on surfaces like bed rails that are frequently touched by staff and patients. Despite the fact that floors have consistently been the most heavily contaminated surfaces in hospitals, they have not been a focus of cleaning interventions because they are rarely touched. However, it is plausible that bacteria on floors could picked up by shoes and socks and then transferred onto hands. In a recent study, we found that when a nonpathogenic virus was inoculated onto floors in hospital rooms, it did spread to the hands of patients and to surfaces inside and outside the room. Based on those results, we assessed the frequency of floor contamination in 5 hospitals and examined the potential for transfer of bacteria from the floor to hands.

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Family Input Improves Hospital Safety Surveillance

MedicalResearch.com Interview with:

Alisa Khan, MD, MPH Staff Physician Instructor in Pediatrics Boston Children's Hospital

Dr. Khan

Alisa Khan, MD, MPH
Staff Physician
Instructor in Pediatrics
Boston Children’s Hospital 

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

Response: ​Medical errors are known to be a leading cause of death in the United States. However, the true rate at which errors and adverse events occur in medicine is believed to be even higher than what has been found through the most rigorous patient safety studies.

Families are typically excluded from safety surveillance efforts, both in research and operationally in hospitals. We found that including families in safety reporting at four pediatric hospitals led to significantly higher error/adverse event detection rates, compared to the safety surveillance methodology typically considered most rigorous and highest yield in safety research. In addition, families reported errors/adverse events at similar rates as providers and at several-fold higher rates than the hospital incident reports which typically form the basis of operational hospital safety surveillance.
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Enrollment in Heart Failure Registry Associated With Improved Survival

MedicalResearch.com Interview with:
Lars H. Lund, MD Phd, Assoc. Prof., FESC
Department of Medicine, Karolinska Institutet, and
Department of Cardiology, Karolinska University Hospital
Sweden

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

Response: Registries are accepted for quality reporting but it is actually unknown whether in heart failure they directly improve outcomes.

Here, enrollment in SwedeHF was strongly associated with reduced mortality.

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Estimating Hospital-Related Deaths Due to Medical Error

MedicalResearch.com Interview wth:

Kevin Kavanagh, MD, MS Board Chairman of Health Watch USA

Dr. Kevin Kavanagh

Kevin Kavanagh, MD, MS
Board Chairman of Health Watch USA

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

Response: The genesis of our study was a desire to respond to a keynote speech at a major national patient safety conference which seemed to mitigate the problem of preventable hospital mortality in the United States.

Our main finding is that there is credible evidence indicating that the preventable hospital mortality rate is more than 160,000 per year. When one considers the events which were not captured, and that we did not count diagnostic errors or post-discharge presentation of events, this number can be projected to approximate or exceed 200,000.

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Study Validates Good Quality Care Provided By Foreign-Trained Doctors

MedicalResearch.com Interview with:

Yusuke Tsugawa, MD, MPH, PhD Research Associate at Department of Health Policy and Management Harvard T.H. Chan School of Public Health

Dr. Yusuke Tsugawa

Yusuke Tsugawa, MD, MPH, PhD
Research Associate at Department of Health Policy and Management
Harvard T.H. Chan School of Public Health  

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

Response: Prior evidence has been mixed as to whether or not patient outcomes
differ between U.S. and foreign medical graduates.

However, previous studies used small sample sizes or data from a small number of states.
Therefore, it was largely unknown how international medical graduates
perform compared with US medical graduates.

To answer this question, we analyzed a nationally representative
sample of Medicare beneficiaries admitted to hospitals with a medical
condition in 2011-2014. Our sample included approximately 1.2 million
hospitalizations treated by 40,000 physicians. After adjusting for
severity of illness of patients and hospitals (we compared physicians
within the same hospital), we found that patient treated by
international medical graduates had lower mortality than patients
cared for by US medical graduates (adjusted 30-day mortality rate
11.2% vs 11.6%, p<0.001). We observed no difference in readmissions,
whereas costs of care was slightly higher for international medical
graduates.

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Best Case/Worst Case Framework Helps Surgeons Communicate With Frail Seriously Ill Patients

MedicalResearch.com Interview with:

Margaret L Schwarze, MD, MPP Associate Professor Division of Vascular Surgery University of Wisconsin

Dr. Margaret Schwarze

Margaret L Schwarze, MD, MPP
Associate Professor
Division of Vascular Surgery
University of Wisconsin

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

Response: Surgery can have life-altering consequences for frail older adults, yet many undergo an operation during the last year of life. Surgeons commonly rely on informed consent to disclose risks of discrete complications; however, this information is challenging for patients to interpret with respect to their goals and values.

Our research group developed a communication framework, called Best Case/Worst Case, to change how surgeons communicate with patients facing serious illness.  Surgeons use the framework to describe the best, worst, and most likely scenarios to present a choice between valid treatment alternatives and help patients imagine how they might experience a range of possible treatment outcomes.

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Maternal Mortality and Morbidity Increased on Weekends

MedicalResearch.com Interview with;
Dr. Amirhossein Moaddab
Postdoctoral Research Fellow at Baylor College of Medicine
Houston, Texas

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

Response: Based on data from the Centers for Disease Control and Prevention, the United States maternal mortality ratio is three to four times higher than that of most other developed nations. Previous studies from the demonstrated a possible association between weekend hospital admissions and higher rates of mortality and poor health outcomes.

We investigated differences in maternal and fetal death ratios on weekends compared to weekdays and during different months of the year. In addition we investigated the presence of any medical and obstetrics complications in women who gave birth to a live child and in their offspring by day of delivery.

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