Hospitalist Workforce in the US is on a Growing Spree

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.  Continue reading

Marketers Spend At Least Six Times FDA Budget on Promotion of Medical Services

MedicalResearch.com Interview with:
Steven Woloshin, MD, MS Professor Co-director of the Center for Medicine and Media The Dartmouth InstituteSteven Woloshin, MD, MS
Professor
Co-director of the Center for Medicine and Media
The Dartmouth Institute

MedicalResearch.com: What is the background for this study? What are the main findings? What influence does medical marketing have on medical care and drug prices?

Response: There are published studies looking at promotional spending mostly for drugs (DTC and professional).  This paper is unique because it is such a broad look including not just drugs but also marketing of disease (in “awareness campaigns”), health services and laboratory tests.

What is new here is the size and scope of marketing.  For context, $29.9 billion spent on promoting prescription drugs, disease awareness campaigns, health services, and laboratory tests corresponds approximately to $1000 per American.    For context, FDA’s total budget is around $5 billion – and NIH’s total budget is about $30 billion.

This figure is up from $17.7 billion in 1997, with the most rapid increase in DTC promotion of prescription drugs and health services.   Pharmaceutical marketing to professionals (detailing visits and samples) accounted for most spending and remained high despite policies to limit industry influence.

$30 billion is of an underestimate (egg, we did not include monies spent on professional marketing (detailing) of laboratory tests, health services or devices, the value of drug coupons/discounts/rebates, company marketing budgets, lobbying or campaign contributions).

Further it is just the tip of the iceberg – marketing works so promotional spending is an important driver of why medical care is so expensive:  it leads to more – and more expensive – tests and treatments.

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Specialty Drugs and Increase Price of Brand Names Raise Health Care Costs

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Inmaculada Hernandez, PharmD, PhD Assistant Professor of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy

Dr. Hernandez

Inmaculada Hernandez, PharmD, PhD
Assistant Professor of Pharmacy and Therapeutics
University of Pittsburgh School of Pharmacy

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

Response: The objective of our study was to answer a research question of high policy relevance: to what extent are rising drug costs due to inflation in the prices of existing products versus the market entry of new, more expensive drugs.

We found that rising prices of brand-name drugs are largely driven by manufacturers increasing prices of medications that are already in the market rather than to the entry of new products.

In contrast, increases in costs of specialty and generic drugs were driven by the entry of new drugs.

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Heart Attacks and Stroke Cause Blows to Financial Health

MedicalResearch.com Interview with:

Allan Garland, MD,  MA  Professor of Medicine & Community Health Sciences Co-Head, Section of Critical Care Medicine University of Manitoba

Dr. Garland

Allan GarlandMD,  MA 
Professor of Medicine & Community
Health Sciences
Co-Head, Section of Critical Care Medicine
University of Manitoba

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

Response: Heart attacks, strokes and cardiac arrest are common acute health events.  Most studies of serious acute health events look at outcomes such as death and how long is spent in the hospital.  But for working age people, the ability to work and earn income are very important outcomes that have rarely been studied.

We set out to carefully measure, across Canada, how much heart attacks, strokes and cardiac arrests affect the ability of working age people to work and earn.

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Preventing Opioid Relapse: Cost-Effectiveness of Buprenorphine–Naloxone vs Extended-Release Naltrexone

MedicalResearch.com Interview with:

Sean M. Murphy, PhD Associate Professor of Research Director, CHERISH Consultation Service  Weill Cornell Medicine Department of Healthcare Policy & Research New York, NY 10065-8722

Dr. Murphy

Sean M. Murphy, PhD
Associate Professor of Research
Director, CHERISH Consultation Service
Weill Cornell Medicine
Department of Healthcare Policy & Research
New York, NY 10065-8722

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

Response: A recent eight-site US randomized effectiveness trial compared buprenorphine-naloxone to extended-release naltrexone to prevent opioid-use relapse. Participants were recruited from inpatient detoxification or short-term residential treatment programs.

Current treatment protocols require persons initiating extended-release naltrexone, but not buprenorphine-naloxone, be fully detoxified from opioids. Both medications were effective at treating opioid use disorder with regard to time abstinent from opioid use and health-related quality-of-life; however, the higher cost of extended-release naltrexone and additional costs associated with detoxification prior to administering this medication, resulted in buprenorphine-naloxone being the better value to the healthcare sector, among patients who require detoxification before initiating extended-release naltrexone.

The economic value of extended-release naltrexone, compared to buprenorphine-naloxone, became more attractive after accounting for additional costs to society (participant time and travel, criminal activity, workforce productivity), and among persons who were successfully initiated on treatment. 

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

Response: Because the economic value of extended-release naltrexone compared to buprenorphine-naloxone increased among persons who were successfully initiated on treatment, identifying persons who are most likely to achieve superior outcomes on extended-release naltrexone in advance would be a preferred to offering this medication to everyone. 

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

Response: Narrowing the cost gap by identifying the best possible patients for each medication, lowering the cost of extended-release naltrexone, and shortening or eliminating the induction period could improve its relative economic value, thereby increasing its attractiveness to payers and allowing more people to access either alternative according to their clinical needs and preferences.

Thus, I would really like to see additional research on treatment models that could achieve these objectives. I am also eager to see comparative effectiveness and economic evaluations of extended-release naltrexone compared to extended-release buprenorphine products. 

Citation:

Murphy SM, McCollister KE, Leff JA, Yang X, Jeng PJ, Lee JD, et al. Cost-Effectiveness of Buprenorphine–Naloxone Versus Extended-Release Naltrexone to Prevent Opioid Relapse. Ann Intern Med. [Epub ahead of print ] doi: 10.7326/M18-0227

Dec 18, 2018 @ 12:50 am

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.

 

Majority of Patients Withhold Important Information From Their Health Care Providers

MedicalResearch.com Interview with:

Dr. Gurmankin Levy

Dr. Andrea Gurmankin Levy, PhD MBE
Department of Social Sciences
Middlesex Community College, Middletown, Connecticut

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

Response: It is so important for clinicians to get accurate information from their patients so that they can make accurate diagnoses and appropriate recommendations. But we know that people tend to withhold information from others, and that this is especially true when it comes to sensitive information. And in fact, in medicine, there is a long-standing conventional wisdom that clinicians need to adjust patients’ answers (e.g., doubling patients’ report of alcohol consumption) to get a more accurate picture. So we wanted to explore this. How many patients withhold medically-relevant information from their clinicians, and why do they do so?  There have been surprisingly few studies looking at this question in a comprehensive way.

Continue reading

Federal Government Contributions to Public Health and the Environment over the Past 220 Years: 1798-2018

MedicalResearch.com Interview with:

Dr. Gilbert Rochon, III PH.D., MPH Adjunct Professor, Dept. of Global Health Management & Policy Tulane University’s School of Public Health & Tropical Medicine Senior Consultant with MSF Global Solutions, LLC New Orleans

Dr. Rochon

Dr. Gilbert Rochon, III PH.D., MPH
Adjunct Professor, Dept. of Global Health Management & Policy
Tulane University’s School of Public Health & Tropical Medicine
Senior Consultant with MSF Global Solutions, LLC
New Orleans

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

Response: Having observed the frequency with which President Donald Trump characterized changes in regulatory policies and funding levels with respect to public health and the environment as eliminating or curtailing “unnecesssary Obama-era regulations,” I became curious as to the full extent and impact of such deregulation and under-funding of health and environmental safeguards.

In the process, I found it necessary to review federal government contributions to public health and the environment under all previous presidents.  Continue reading

Who is Really Sick? Eyeball Assessment vs Formal Triage

MedicalResearch.com Interview with:

Dr Anne Kristine Servais Iversen, Anne Kristine Servais Iversen Department of Obstetrics and Gynecology Rigshospitalet Copenhagen, Denmark 

Dr. Servais Iversen

Dr Anne Kristine Servais Iversen,
Anne Kristine Servais Iversen
Department of Obstetrics and Gynecology
Rigshospitalet
Copenhagen, Denmark 

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

Response: Systematic triage has been implemented worldwide with different triage scales in use all over the world. Prior to the introduction of formalised triage, patients were prioritised based on clinical assumption.

After the introduction of formalised triage only a few studies have assessed agreement between formal and informal triage. Additionally, the majority of formalised triage scales are supported by limited and often insufficient evidence. This is troublesome since formalised triage forces clinicians to follow an algorithm rather than use their experience and clinical judgement. During my own residency at a Danish Emergency ward I was often contacted by the nurse performing formalised triage telling me that a patient she was assessing scored to be very acute (high triage level), but that she didn’t believe that to be the case. In order for her to prioritise the patient to a lower (less acute) triage level the patient had to be assessed by a doctor.

Very often my colleagues and I would agree with the nurse in that the scoring was to high, and we therefore had to overrule the formalised triage decision. In cases like these you ask yourself whether or not we are using the most effective and best form of triage for initial patient sorting.

Our study found that agreement between formalised triage and a quick clinical assessment in the form of Eyeball triage is poor. It also suggest that eyeball triage better predicts those at highest risk of death within 48-hours and 30 days after assessment.

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High Deductible Plans Hit Chronically Ill Low-Income Patients Hardest

MedicalResearch.com Interview with:

Salam Abdus, PhD Division of Research and Modeling, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality Department of Health and Human Services Rockville, Maryland

Dr. Abdus

Salam Abdus, PhD
Division of Research and Modeling,
Center for Financing, Access, and Cost Trends,
Agency for Healthcare Research and Quality
Department of Health and Human Services
Rockville, Maryland

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


Response:
High deductible health plans are more prevalent than ever.

Previous research showed that adults in low-income families or with chronic conditions are more likely to face high financial burdens when they are enrolled in high-deductible health plans, compared to adults in higher income families or healthier adults.

In this study we examined the financial burden of high-deductible health plans among adults who are both low income and chronically ill. We used AHRQ’s Medical Expenditure Panel Survey Household Component (MEPS-HC) data from 2011 to 2015 to study the prevalence of high out-of-pocket health care spending burden of high deductible health plans among adults enrolled in employer-sponsored insurance. We included family out-of-pocket spending on premiums and health care services.

We found that among adults who had family income below 250% of Federal Poverty Level (FPL), had multiple chronic conditions, and were enrolled in high-deductible health plans, almost half (46.9%) had financial family out-of-pocket health care burden exceeding 20 percent of family disposable income.

Continue reading

Sexual Harassment in Academic Medicine Affects Both Women and Men

MedicalResearch.com Interview with:

Sabine Oertelt-Prigione, MD, MSc Professor (Strategic Chair) of Gender in Primary and Transmural Care Department of Primary and Community Care Radboud University Medical Center

Dr. Oertelt-Prigione

Sabine Oertelt-Prigione, MD, MSc
Professor (Strategic Chair) of Gender in Primary and Transmural Care
Department of Primary and Community Care
Radboud University Medical Center

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

Response: This publication is a part of the WPP (Watch, Protect, Prevent) Study conducted between 2014 and 2017 at Charité – Universitaetsmedizin in Berlin, Germany. The project was designed to achieve three goals: a) acquire information about the prevalence of sexual harassment in academic medicine, b) develop and implement specific preventative measures and c) design and adopt a workplace policy against sexual harassment. The two latter goals have been achieved and this manuscript describes the findings that prompted their adoption.

In our study we carefully dissected the harassment experiences of physicians working in our tertiary referral center. Verbal harassment throughout medical careers appears as a very common phenomenon that almost 70% of women and men experience at some point. Physical harassment is less common. While colleagues appear as the main perpetrators for both sexes, women report more frequently harassment by their superiors. Among the structural factors potentially associated with harassment, we only identified strong hierarchies. 

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

Response: First, we show that although the perpetrator profiles differ, both women and men in our study sample are significantly affected by sexual harassment. Second, our results display a gradient of harassment experiences and their prevalence, i.e. the verbal and non-physical forms are more common than physical forms. We argue that tolerance of non-physical forms of misconduct will increase the risk for physical forms by fostering a belief of impunity. Third, in our sample, strong hierarchies associated with an increased likelihood of experiencing harassment in both females and males.

Overall, this data shows that sexual harassment is not an action perpetrated by a single individual, but has a systemic dimension, which needs to be addressed through cultural change. Only measures targeting communication culture, formal structures and interactions in academic medicine will lead to change. 

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

Response: The investigation of sexual harassment is a complicated matter and should be addressed in detail. In order to design effective prevention measures, we need to know exactly what people have experienced. Hence, a simple question such as “Have you ever experienced sexual harassment?” within a statutory survey will most likely not help much in defining further steps.

The connection between communication patterns, hierarchies and harassment was very apparent in our sample and this area needs further investigation.

Last, the fact that men are also significantly affected emphasizes that this is not a women´s issue but a phenomenon that needs to be addressed to improve the working conditions for all healthcare providers.

Disclosures: Sabine Oertelt-Prigione received funding from the German Ministry of Education and Research, the Charité Foundation, the Hans Boeckler Foundation and the Equal Opportunities Program of the City of Berlin. She has provided expert testimony on the issue of sexual harassment to the German Federal Antidiscrimination Agency and the German Parliament. She is a pro-bono expert advisor for ASTIA.

Citation:

Jenner S, Djermester P, Prügl J, Kurmeyer C, Oertelt-Prigione S. Prevalence of Sexual Harassment in Academic Medicine. JAMA Intern Med. Published online October 03, 2018. doi:10.1001/jamainternmed.2018.4859 

Oct 3, 2018 @ 6:20 pm

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.

 

What Types of Health Care Records Are Breached?

MedicalResearch.com Interview with:

Thomas McCoy, M.D. Assistant Professor of Psychiatry Massachusetts General Hospital Psychiatry Massachusetts General Hospital

Dr. McCoy

Thomas McCoy, M.D.
Assistant Professor of Psychiatry
Massachusetts General Hospital
Psychiatry
Massachusetts General Hospital

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

 Response: Big data has the potential to transform how we care for patients but comes with risks of big breaches. My co-author and I use health records in our research and we wanted to better understand the risks that these data might pose to our patients.

MedicalResearch.com:? What are the main findings? 

Response: The majority of breaches are of health care providers whereas the majority of breached records are from health plans. The three largest breaches account for the over half of records breached.

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

Response: This study doesn’t speak to any particular solution; rather, it speaks to the aspects of the system that are most often breached: In 2017 it was hacking or IT incidents and networked servers. 

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

Response: This study speaks to the aspects of the system that are most often breached: In 2017 it was hacking or IT incidents and networked servers; however, much is left to be learned about the specific mechanisms and consequences of these events.

MedicalResearch.com: Is there anything else you would like to add?

Response: Large healthcare datasets present a means of transformational discovery but also come with real risks of large scale disclosure. 

Disclosures: Dr. McCoy reports unrelated grants from The Stanley Center at The Broad Institute, Brain and Behavior Research Foundation, and Telefonica Alpha. Dr. Perlis reports unrelated grants from the National Human Genome Research Institute, National Institute of Mental Health, and Telefonica Alpha; serves on the scientific advisory board for Perfect Health, Genomind, and Psy Therapeutics; and consults to RID Ventures. Dr. Perlis is an editor of JAMA Network Open.

Citation:

McCoy TH, Perlis RH. Temporal Trends and Characteristics of Reportable Health Data Breaches, 2010-2017. JAMA. 2018;320(12):1282–1284. doi:10.1001/jama.2018.9222

 

Sep 28, 2018 @ 11:22 am

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.

 

Medicare’s Bundled Payment Program–Does it Change Hospital Volume or Case Mix?

MedicalResearch.com Interview with:

Amol Navathe, MD, PhD Assistant Professor, Health Policy and Medicine Perelman School of Medicine Penn Leonard Davis Institute of Health Economics

Dr. Navathe

Amol Navathe, MD, PhD
Assistant Professor, Health Policy and Medicine
Perelman School of Medicine
Penn Leonard Davis Institute of Health Economics

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

Response: Medicare’s voluntary Bundled Payments for Care Improvement (BPCI) initiative for lower extremity joint replacement (LEJR) surgery has been associated with reduced episode spending and stable-to-improved quality. However, BPCI may create unintended effects by prompting participating hospitals to increase the overall volume of episodes covered by Medicare. This could potentially eliminate Medicare-related savings or prompt hospitals to shift case mix to lower-risk patients.

Among the Medicare beneficiaries who underwent LEJR, BPCI participation was not significantly associated with a change in market-level volume (difference-in-differences estimate . In non-BPCI markets, the mean quarterly market volume increased 3.8% from 3.8 episodes per 1000 beneficiaries before BPCI to 3.9 episodes per 1000 beneficiaries after BPCI was launched. In BPCI markets, the mean quarterly market volume increased 4.4% from 3.6 episodes per 1000 beneficiaries before BPCI to 3.8 episodes per 1000 beneficiaries after BPCI was launched.

The adjusted difference-in-differences estimate between the market types was 0.32%. Among 20 demographic, socioeconomic, clinical, and utilization factors, BPCI participation was associated with changes in hospital-level case mix for only one factor, prior skilled nursing facility use in BPCI vs. non-BPCI markets.  Continue reading

What Happens When Pay for Performance Incentives Are Withdrawn?

MedicalResearch.com Interview with:

Prof-Bruce Guthrie Head of Population Health Sciences Division Professor of Primary Care Medicine and Honorary Consultant NHS Fife

Prof. Guthrie

Prof. Bruce Guthrie PhD
Head of Population Health Sciences Division
Professor of Primary Care Medicine and Honorary Consultant NHS Fife 

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

Response: The UK Quality and Outcomes Framework (QOF)) is a primary care pay for performance programme (P4P) implemented in 2004. QOF was and still is the largest healthcare P4P programme in the world, initially having ~150 indicators and accounting for ~20% of practice income. QOF has been reduced in scale and scope over time, with 40 indicators retired in 2014. It was abolished in Scotland in 2016 and is due to be further reformed in England. There is some evidence that P4P (and QOF itself) is associated with modest improvements in quality when introduced, but little evidence about what happens when financial incentives are withdrawn.

Our study examined what happened when incentives were withdrawn in 2014 for 12 indicators where there is good before and after data. There were immediate reductions in documented quality of care, which were similar in size to improvements observed when incentives were introduced. These reductions were small to modest (~10%) for indicators relating to care that is already systematically delivered (eg routine diabetes, hypertension and cardiovascular disease) and large for indicators which has historically been less systematically delivered (eg lifestyle advice).

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Physician Burnout Linked to Increased Patient Safety Risks

MedicalResearch.com Interview with:

Dr Maria Panagioti| Senior Research Fellow Division of Population Health, Health Services Research & Primary Care University of Manchester Manchester

Dr. Panagioti

Dr Maria Panagioti, Senior Research Fellow
Division of Population Health
Health Services Research & Primary Care
University of Manchester
Manchester

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

Response: Several studies have shown that the demanding work environment has alarming consequences on the well-being of physicians. Over 50 percent of physicians experience significant signs of burnout across medical specialities. However, the consequences of burnout on patient care are less well-known.

This is the largest meta-analysis to date which pooled data from 43,000 doctors to examine the relationship between burnout in physicians and patient safety, professionalism and patient satisfaction.

We found that burnout in physicians is associated with two times increased risk for patient safety incidents, reduced professionalism and lower patient satisfaction. Particularly in residents and early career physicians, burnout was associated with almost 4 times increased risk for reduced professionalism.  Continue reading

Low Risk Prostate Cancer Imaging More Common Outside of VA Hospitals

MedicalResearch.com Interview with:

Danil V. Makarov, MD, MHS Department of Urology and Department of Population Health New York University Langone School of Medicine VA New York Harbor Healthcare System, Robert F. Wagner Graduate School of Public Service Cancer Institute, New York University School of Medicine, New York

Dr. Makarov

Danil V. Makarov, MD, MHS
Department of Urology and
Department of Population Health
New York University Langone School of Medicine
VA New York Harbor Healthcare System,
Robert F. Wagner Graduate School of Public Service
Cancer Institute, New York University School of Medicine, New York

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

Response: Reducing prostate cancer staging imaging for men with low-risk disease is an important national priority to improve widespread guideline-concordant practice, as determined by the National Comprehensive Cancer Network guidelines. It appears that prostate cancer imaging rates vary by several factors, including health care setting. Within Veterans Health Administration (VHA), physicians receive no financial incentive to provide more services. Outside VHA, the fee-for-service model used in Medicare may encourage provision of more healthcare services due to direct physician reimbursement.

In our study, we compared these health systems by investigating the association between prostate cancer imaging rates and a VA vs fee-for-service health care setting. We used novel methods to directly compare Veterans, Medicare Recipients, and Veterans that chose to receive care from both the VA at private facilities using Medicare insurance through the Choice Act with regard to rates of guideline-discordant imaging for prostate cancer.

We found that Medicare beneficiaries were significantly more likely to receive guideline-discordant prostate cancer imaging than men treated only in VA.

Moreover, we found that men with low-risk prostate cancer patients in the VA-only group had the lowest likelihood of guideline-discordant imaging, those in the VA and Medicare group had the next highest likelihood of guideline-discordant imaging (in the middle), and those in the Medicare-only group had the highest likelihood of guideline-discordant imaging.  Continue reading

Few Programs Dedicated To Preventing Mistreatment of Medical Trainees

MedicalResearch.com Interview with:
“Doctors with patient, 1999” by Seattle Municipal Archives is licensed under CC BY 2.0Dr. Laura M. Mazer, MD
Goodman Surgical Education Center
Department of Surgery
Stanford University School of Medicine
Stanford, California

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

Response: There are numerous articles that clearly document the high prevalence of mistreatment of medical trainees. We have all seen and experienced the results of an “I’ll do unto you like they did unto me” attitude towards medical education. Our motivation for this study was to go beyond just documenting the problem, and start looking at what people are doing to help fix it.

Unfortunately, we found that there are comparatively few reports of programs dedicated to preventing or decreasing mistreatment of medical trainees. In those studies we did review, the study quality was generally poor. Most of the programs had no guiding conceptual framework, minimal literature review, and outcomes were almost exclusively learner-reported.

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Single-Payer Option Feasible For New York – With $139 Billion in New Taxes

MedicalResearch.com Interview with:

Jodi L. Liu, PhD Associate policy researcher RAND Corporation

Dr. Liu

Jodi L. Liu, PhD
Associate policy researcher
RAND Corporation

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

Response: The New York Health Act (NYHA) would create a state-based single-payer plan called New York Health.

The NYHA has been proposed in the New York State Assembly for many years. New York Health would provide all residents with comprehensive health benefits with no cost sharing and create new taxes to help fund the program.

In this study, we used microsimulation modeling to analyze the impact of the NYHA on outcomes such as health care utilization and costs. We estimate that total health care spending could be similar or slightly lower if administrative costs and provider payment rates are reduced. The program would require substantial new taxes and would shift the types of payments people make for health care.

After the presumed redirection of federal and state health care outlays to New York Health, we estimate that the new taxes revenue needed to finance the program in 2022 would be $139 billion.

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Transitional Care Services from Hospital to Home Underutilized, Can Save Money and Readmissions

MedicalResearch.com Interview with:

Andrew B. Bindman, MD Professor of Medicine PRL- Institute for Health Policy Studies University of California San Francisco

Dr. Bindman


Andrew B. Bindman, MD

Professor of Medicine
PRL- Institute for Health Policy Studies
University of California San Francisco

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


Response:
The purpose of this study was to evaluate the use and impact of a payment code for transitional care management services which was implemented by Medicare in.

The transition of patients from hospitals or skilled nursing facilities back to the community often involves a change in a patient’s health care provider and introduces risks in communication which can contribute to lapses in health care quality and safety. Transitional care management services include contacting the patient within 2 business days after discharge and seeing the patient in the office within 7-14 days. Medicare implemented payment for transitional care management services with the hope that this would increase the delivery of these services believing that they could reduce readmissions, reduce costs and improve health outcomes.

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Lay Health Workers Reduce Costs and Improve Cancer Patients’ Satisfaction

MedicalResearch.com Interview with:

Manali Patel MD MPH Assistant Professor of Medicine, Oncology Stanford Palo Alto Veterans Affairs Health Care System 

Dr. Patel

Manali Patel MD MPH
Assistant Professor of Medicine, Oncology
Stanford
Palo Alto Veterans Affairs Health Care System  

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

Response: In prior work, many patients with advanced stages of cancer report a lack of understanding of their prognosis and receipt of care that differs from their preferences.

These gaps in care delivery along with the unsustainable rise in healthcare spending at the end-of-life and professional healthcare provider shortages led our team to consider new ways to deliver cancer care for patients.  Based on input from focus groups with patients, caregivers, oncology care providers and healthcare payers, we designed a novel model of cancer care to address these gaps in care delivery.  The intervention consisted of a well-trained lay health worker to assist patients with understanding and communicating their goals of care with their oncology providers and caregivers.

We found that patients who received the six-month intervention reported greater satisfaction with the care they received and their decision-making, had higher rates of hospice use, lower acute care use, and 95% lower total healthcare expenditures in the last month of life.  The intervention resulted in nearly $3 million dollars in healthcare savings.

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Waiting Room App Uses Selfies To Show Patients Effects of Sun Damage

MedicalResearch.com Interview with:
Startup Screen Dermatology APPDr. med. Titus Brinker
Head of App-Development // Clinician Scientist
Department of Translational Oncology
National Center for Tumor Diseases (NCT)
Department of Dermatology
University Hospital Heidelberg
Heidelberg

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

Response: ​While everyone in the dermatologic community appears to agree on the importance of UV-protection for skin cancer prevention, busy clinicians often lack time to address it with their patients.

Thus, the aim of this study was to make use of waiting rooms that almost every patient visiting a clinic spends time in and address this topic in this setting by the means of modern technology rather than clinicians time.

We used our free photoaging app “Sunface” which shows the consequences of bad UV protection vs. good UV protection on the users’ own 3D-animated selfie 5 to 25 years in the future and installed it on an iPad. The iPad was then centrally placed into the waiting room of our outpatient clinic on a table and had the Sunface App running permanently. The mirroring of the screen lead to a setting where every patient in the waiting room would see and eventually react to the selfie taken by one individual patient which was altered by the Sunface App.

Thus, the intervention was able to reach a large proportion of patients visiting our clinic: 165 (60.7%) of the 272 patients visiting our waiting room in the seven days the intervention was implemented either tried it themselves (119/72,12%) or watched another patient try the app (46/27,9%) even though our outpatient clinic is well organized and patients have to wait less than 20 minutes on average. Longer waiting times should yield more exposure to the intervention. Of the 119 patients who tried the app, 105 (88.2%) indicated that the intervention motivated them to increase their sun protection (74 of 83 men [89.2%]; 31 of 34 women [91.2%]) and to avoid indoor tanning beds (73 men [87.9%]; 31 women [91.2%]) and that the intervention was perceived as fun (83 men [98.8%]; 34 women [97.1%]).

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Did Billions in US AIDS Prevention Money Save Babies’ Lives in Kenya?

MedicalResearch.com Interview with:

Professor Donna Spiegelman ScD Susan Dwight Bliss Professor of Biostatistics Director, Center for Methods in Implementation and Prevention Science (CMIPS)­­­­­­, Yale School of Public Health Professor, Department of Statistics and Data Science, Yale University Director, Interdisciplinary Methods Core, Center for Interdisciplinary Research on AIDS Yale School of Medicine

Dr. Spiegelman

Professor Donna Spiegelman ScD
Susan Dwight Bliss Professor of Biostatistics
Director, Center for Methods in Implementation and Prevention Science (CMIPS)­­­­­­,
Yale School of Public Health
Professor, Department of Statistics and Data Science, Yale University
Director, Interdisciplinary Methods Core, Center for Interdisciplinary Research on AIDS
Yale School of Medicine

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

Response: HIV infections can be transmitted from mothers to their infants during pregnancy, childbirth, and  breastfeeding.  Without access to a package of health services that includes antiretroviral medicines and counseling on best breastfeeding practices, it is estimated that 25% of children born to HIV-positive mothers become infected with HIV.In low-resource settings, 50% of these children die before their second birthday.

A 32% increase in under-five mortality between 1988 and 2003 prompted the Kenyan government to establish Prevention of Mother to Child Transmission of HIV (PMTCT) programs
in over 10,000 health facilities.
This achievement was supported by U.S.President’s Emergency Fund for AIDS Relief
(PEPFAR), the which contributed over $248 million to PMTCT programs in Kenya between 2004 and 2014.

Although this investments in PMTCT coincided with a remarkable halving of Kenya’s under-five mortality rate, it is unknown whether this improvement can be causally attributed to PEPFAR funding for PMTCT. During the 2000s, child mortality decreased across most of sub-Saharan African countries.  These regional trends, rather than PEPFAR funding, may explain all or part of Kenya’s reduction in over 10,000 in child mortality. To help identify whether PEPFAR’s investments in PMTCT made a causal contribution to this reduction in child mortality, we used statistical methods to assess whether the amount or “dose” of PEPFAR funding provided to different provinces in Kenya was associated with increased HIV testing among pregnant women, which is a critical first step in identifying which women need PMTCT, and reduced infant mortality in Kenya.

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Defensive Medicine is Real and Raises Health Care Costs

MedicalResearch.com Interview with:
Jonathan Gruber PhD
Department of Economics, E52-434
MIT
Cambridge, MA 02139

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

Response: There is a large literature trying to estimate the extent of ‘defensive  medicine’ by looking at what happens when it gets harder to sue and/or  you can win less money. But there have been no studies of what happens if you just get rid of the right to sue.  That’s what we have with active duty patients treated on a military base.

The main finding is that when patients can’t sue they are treated about  5% less intensively.  Much of the effect appears to arise from fewer diagnostic tests.

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Antibiotics Still Overprescribed in Many Outpatient Settings

MedicalResearch.com Interview with:

Dr. Katherine Fleming-Dutra, MD, senior author Deputy Director Office of Antibiotic Stewardship CDC

Dr. Fleming-Dutra

Dr. Katherine Fleming-Dutra MD
Deputy Director
Office of Antibiotic Stewardship
CDC

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

Response: Antibiotics are life-saving medications that treat bacterial infections. Any time antibiotics are used, they can lead to antibiotic resistance and could cause side effects such as rashes and adverse events, such as Clostridium difficile infection, which is a very serious and sometimes even fatal diarrheal disease. This is why it is so important to only use antibiotics when they are needed. When antibiotics aren’t needed, they won’t help you and the side effects could still hurt you.

A previous study* reported at least 30% of antibiotic prescriptions written in doctor’s offices and emergency departments were unnecessary. However, the data from that study did not include urgent care centers or retail health clinics. We conducted the current analysis to examine antibiotic prescribing patterns in urgent care centers, retail health clinics, emergency departments, and medical offices.

*Fleming-Dutra, K., et al. (2016). “Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011.” JAMA: the Journal of the American Medical Association 315(17): 1864-1873. https://jamanetwork.com/journals/jama/fullarticle/2518263

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Vitamin D and Colorectal Cancer Risk – What is the Correlation?

MedicalResearch.com Interview with:

Stephanie J. Weinstein, M.S., Ph.D.  Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH 

Dr. Weinstein

Stephanie J. Weinstein, M.S., Ph.D. 
Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics
National Cancer Institute, NIH  

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

Response: Vitamin D, known for its role in maintaining bone health, is hypothesized to lower colorectal cancer risk via several pathways related to cell growth and regulation. Previous prospective studies have reported inconsistent results for whether higher concentrations of circulating 25-hydroxyvitamin D, the accepted measure of vitamin D status, are linked to lower risk of colorectal cancer. The few randomized clinical trials of vitamin D supplementation and colorectal cancer completed thus far have not shown an effect; but study size, relatively short supplementation duration, and only moderate compliance may have contributed to their null findings.

To address inconsistencies in prior studies on vitamin D, and to investigate associations in population subgroups, we harmonized and analyzed participant-level data from over 5,700 colorectal cancer cases who had blood collected before colorectal cancer diagnosis, and 7,100 matched cancer-free controls. Study participants were drawn from 17 prospective cohorts from the United States, Europe, and Asia and were followed for an average of 5.5 years (range: 1 – 25 years). We used a single, widely accepted assay and laboratory for new vitamin D measurements and calibrated existing vitamin D measurements. In the past, substantial differences between assays made it difficult to integrate vitamin D data from different studies. Our novel calibration approach enabled us to explore risk systematically over the broad range of vitamin D levels seen internationally.  Continue reading

New HIV Vaccine Advances in Phase 2 Studies

MedicalResearch.com Interview with:

Dan Barouch, M.D., Ph.D. Professor of Medicine Harvard Medical School Ragon Institute of MGH, MIT, and Harvard Director, Center for Virology and Vaccine Research Beth Israel Deaconess Medical Center Boston, MA 02215

Dr. Barouch

Dan Barouch, M.D., Ph.D.
Professor of Medicine
Harvard Medical School
Ragon Institute of MGH, MIT, and Harvard
Director, Center for Virology and Vaccine Research
Beth Israel Deaconess Medical Center
Boston, MA 02215

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

Response: This study demonstrates that the mosaic Ad26/Env HIV vaccine candidate induced robust and comparable immune responses in humans and monkeys.

Moreover, the vaccine provided 67% protection against viral challenge in monkeys.   

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