Surgical Outcomes Found to be Better at ‘Brand Name’ than Affiliate Cancer Hospitals

MedicalResearch.com Interview with:

Daniel J. Boffa, MDAssociate Professor of Thoracic SurgeryYale School of Medicine

Dr. Boffa

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.

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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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No Evidence of Worse STEMI Outcomes During Off-Hours

MedicalResearch.com Interview with:
Senthil Selvaraj, MD, MA and Deepak L. Bhatt, MD, MPH
Brigham and Women’s Hospital Heart & Vascular Center and
Harvard Medical School, Boston, MA

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

Response: There has been significant controversy in the effect of off-hours presentation in ST-elevation myocardial infarction (STEMI). Off-hours presentation has been associated with longer treatment time, an independent predictor of worse outcomes in STEMI, though a number of other studies have shown no difference as well. Moreover, little data has been generated from clinical trials, which has the advantage of comprehensive and adjudicated outcomes.

In our analysis of nearly 2,000 STEMI patients from the CHAMPION PHOENIX study (a randomized, controlled trial of cangrelor in percutaneous coronary intervention), we found that off-hours presentation was not associated with worse efficacy or safety outcomes at 48 hours or 30 days. More specifically, outcomes not typically reported in registry data, such as ischemia-driven revascularization and stent thrombosis, were not significantly different between the groups. Interestingly, treatment times were actually faster in the “off-hours” group as well.

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Puerto Rican Medicare Advantage Enrollees Receive Lower Quality Care than Hispanics in States

MedicalResearch.com Interview with:

Maricruz Rivera-Hernandez, PhD Investigator Department of Health Services, Policy & Practice Center for Gerontology and Health Care Research Brown University, Providence, RI

Dr. Rivera Hernandez

Maricruz Rivera-Hernandez, PhD
Investigator
Department of Health Services, Policy & Practice
Center for Gerontology and Health Care Research
Brown University, Providence, RI 

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

Dr. Rivera-Hernandez: Over three-quarters of Medicare-eligible residents in Puerto Rico enroll in Medicare Advantage plans, making them the primary source of health care coverage for the island’s seniors. Puerto Rican Medicare Advantage plans have a long history of receiving lower payments than Medicare Advantage plans located in the United States.

The study’s purpose was to compare the quality of care provided to Medicare Advantage enrollees in Puerto Rico with that delivered to Medicare Advantage enrollees in the 50 states and the District of Columbia.

We found significantly worse quality for Puerto Rican Medicare Advantage enrollees compared to their US counterparts for 15 of the 17 quality indicators. These indicators measured whether patients received the recommended treatment and achieved desired outcomes in diabetes care, cardiovascular disease, and cancer screening and whether they received any inappropriate medications in 2011.

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