Opioid-Induced Constipation: Can Your Hospital Afford the Financial Burden?

MedicalResearch.com Interview with:

Howard Franklin, MD, MBAVice President of Medical Affairs and StrategySalix Pharmaceuticals

Dr. Franklin

Howard Franklin, MD, MBA
Vice President of Medical Affairs and Strategy
Salix Pharmaceuticals

MedicalResearch.com: What is opioid-induced constipation?

Response: Opioid-induced constipation (OIC) is a side effect in as many as 80 percent of chronic pain patients on opioids. OIC is unlikely to improve over time without treatment and can lead to suffering and discomfort. More importantly, the insufficient treatment of OIC can have negative implications for patients, both those on opioid therapy for chronic non-cancer pain as well as advanced illness, and for hospitals. 

Continue reading

Collaborative Chronic Care Model Improved Patient Outcomes in Complex Mental Health Patients

MedicalResearch.com Interview with:

Mark S. Bauer, M.D.Professor of Psychiatry, EmeritusHarvard Medical SchoolCenter for Healthcare Organization and Implementation Research (CHOIR)VA Boston Healthcare System-152MBoston, MA 02130

Dr. Bauer

Mark S. Bauer, M.D.
Professor of Psychiatry, Emeritus
Harvard Medical School
Center for Healthcare Organization and Implementation Research
VA Boston Healthcare System-152M
Boston, MA 02130

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

Response: Collaborative Chronic Care Models (CCMs) have extensive evidence for their effectiveness in a wide variety of mental health conditions.  CCMs are frameworks of care that include several or all of the following six elements:  work role redesign for anticipatory, continuous care; self-management support for individuals in treatment; provider decision support; information system support for population-based and measurement-guided care; linkage to community resources; and organization and leadership support.

However, evidence for Collaborative Chronic Care Model effectiveness comes almost exclusively from highly structured clinical trials.  Little is known about whether CCMs can be implemented in general clinical practice settings, and the implementation evidence that does exist derives primarily from studies of the CCM used in primary care settings to treat depression.

We conducted a randomized, stepped wedge implementation trial using implementation facilitation to establish CCMs in general mental health teams in nine US Department of Veterans Affairs medical centers.

We found that establishing Collaborative Chronic Care Models was associated with reduced mental health hospitalization rates and, for individuals with complex clinical presentations, improvements in mental health status.  Additionally, standardized assessment of team clinicians indicated that facilitation improved clinician role clarity and increased focus on team goals.

Continue reading

Low-Value Health Care: Measuring Hospital-Acquired Complications

MedicalResearch.com Interview with:

Mr. Tim Badgery-Parker ELS, BSc(Hons), MBiostatResearch Fellow,Value in Health Care Division,Menzies Centre for Health Policy

Mr. Badgery-Parker

Mr. Tim Badgery-Parker ELS, BSc(Hons), MBiostat
Research Fellow,Value in Health Care Division
Menzies Centre for Health Policy

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

Response: This is part of a large program of work at the Menzies Centre for Health Policy on low-value care in the Australian health system. We have previously published rates of low-value care in public hospitals in Australia’s most populous state, New South Wales, and a report on rates in the Australian private health insurance population is due for publication shortly. We have also done similar analyses for other Australian state health systems.

This particular paper extends the basic measurement work to focus on what we call the ‘cascade’ effects. That is, looking beyond how much low-value care occurs to examine the consequence for patients and the health system of providing these low-value procedures.

Continue reading

Price of Existing Biologics Increased When New Drugs Entered Market

MedicalResearch.com Interview with:

Alvaro San-Juan-Rodriguez

Alvaro San-Juan-Rodriguez

Alvaro San-Juan-Rodriguez, PharmD
Pharmacoeconomics, Outcomes and Pharmacoanalytics Research Fellow
Pharmacy and Therapeutics
School of Pharmacy
University of Pittsburgh

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

Response: Before 2009, etanercept (Enbrel®), infliximab (Remicade®), and adalimumab (Humira®) were the only tumor necrosis factor (TNF) inhibitors approved by the FDA for rheumatoid arthritis. Subsequently, 3 therapies gained FDA approval: subcutaneous golimumab (Simponi®) in April 2009, certolizumab pegol (Cimzia®) in May 2009, and intravenous golimumab (Simponi Aria®) in July 2013. All 6 agents are brand-name drugs.

Our study aimed to evaluate how the prices of existing TNF inhibitors (Enbrel®, Remicade® and Humira®) changed in response to the market entry of new TNF inhibitors.  Continue reading

Stroke: Outcomes of Patients Transferred for Thrombectomy

MedicalResearch.com Interview with:

Amrou Sarraj, MD, Associate Professor Department of Neurology

Dr. Sarraj

Amrou Sarraj, MD, Associate Professor
Department of Neurology
McGovern Medical School
The University of Texas Health Science Center at Houston.

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

Response: Secondary analyses of trials showing efficacy and safety of thrombectomy within 6-8 hours of stroke onset showed that patients who were transferred to centers performing thrombectomy from another hospital had worse outcomes than patients who presented directly to the thrombectomy centers. We wanted to assess if the thrombectomy outcomes differ between transferred patients and patients directly coming to the thrombectomy centers when patients are selected with advanced perfusion imaging.

We found that thrombectomy outcome rates were similar between patients who presented directly vs transferred from another hospital, including functional independence and safety outcomes. 

Continue reading

Federal Incentives Did Not Reduce Catheter Infections in Hospitals

MedicalResearch.com Interview with:

Heather Hsu, MD MPH Assistant Professor of Pediatrics Boston University School of Medicine Boston Medical Center Boston, MA 02118

Dr. Hsu

Heather Hsu, MD MPH
Assistant Professor of Pediatrics
Boston University School of Medicine
Boston Medical Center
Boston, MA 02118

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

Response: In October 2013, the Centers for Medicare and Medicaid Services (CMS) implemented value-based incentive programs to financially reward or penalize hospitals based on quality metrics. Two of these programs – Hospital Value Based Purchasing and the Hospital Acquired Condition Reduction Program – began targeting hospitals’ rates of certain healthcare-associated infections deemed to be preventable in October 2015.

Previous studies demonstrated minimal impact of these value-based payment programs on other measures of hospital processes, patient experience, and mortality. However, their impact on healthcare-associated infections was unknown.

Our goal was to study the association of value-based incentive program implementation with healthcare-associated infection rates, using catheter-associated urinary tract infection in intensive care units (one of the targeted outcomes) as an example.

We found no evidence that federal value-based incentive programs had any measurable association with changes in catheter-associated urinary tract infection rates in the critical care units of US hospitals.

Continue reading

Not All Hospital Readmissions Are Preventable but READI Protocol Can Assist in Some Cases

MedicalResearch.com Interview with:

Marianne Weiss DNSc RN READI study Principal Investigator Professor of Nursing and Wheaton Franciscan Healthcare / Sister Rosalie Klein Professor of Women’s Health Marquette University College of Nursing Milwaukee Wi, 53201-1881

Dr. Weiss

Marianne Weiss DNSc RN
READI study Principal Investigator
Professor of Nursing and
Wheaton Franciscan Healthcare / Sister Rosalie Klein Professor of Women’s Health
Marquette University College of Nursing
Milwaukee Wi, 53201-1881

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

Response: Our team of researchers has been studying the association of patient readiness for discharge and readmission for several years. We have previously documented that patients who had ‘low readiness’ on our Readiness for Hospital Discharge Scale were more likely to be readmitted. In this study we added structured protocols for discharge readiness assessment and nurse actions to usual discharge care practices to determine the optimal protocol configuration to achieve improved post-discharge utilization outcomes.

In our primary analysis that included patients from a broad range of patient diagnoses, we did not find a significant effect on readmission from adding any of the discharge readiness assessment protocols. The patient sample came from Magnet hospitals, known for high quality care, and the average all-cause readmission rates were low (11.3%).

In patients discharged from high-readmission units (>11.3%), one of the protocols was effective in reducing the likelihood of readmission. In this protocol, the nurse obtained the patients self-report of discharge readiness to inform the nurse’s discharge readiness assessment and actions in finalizing preparations for discharge. This patient-informed discharge readiness assessment protocol produced a nearly 2 percentage point reduction in readmissions. Not unexpectedly, in lower readmission settings, we did not see a reduction in readmission; not all readmissions are preventable.

In the last phase of study, we informed nurses of a cut-off score for ‘low readiness’ and added a prescription for nurse action only in cases of ‘low readiness’; this addition to the protocol added burden to the nurses’ daily work and eliminated the beneficial effects, perhaps because it limited the nurse’s attention to only a subset of patients. 

Continue reading

Venezuela: Rapid Rise in Infant Mortality Linked to Health Care System Collapse

MedicalResearch.com Interview with:
"By @plumavioleta "Atardecer en #caracas... #avebolivar # ccs #venezuela." via @PhotoRepost_app" by Pedro Fanega is licensed under CC BY 2.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by/2.0Ms Jenny García, PhD candidate
Institut National d’Études Démographiques INED
Institut de Démographie de l’université Paris 1 Panthéon Sorbonne IDUP
Paris, France

Prof Gerardo Correa, MSc
Instituto de Investigaciones Económicas y Sociales IIES
Universidad Católica Andrés Bello UCAB
Caracas, Venezuela

Prof Brenda Rousset, PhD
Departamento de Estadística, Escuela de Sociología (FaCES)
Universidad Central de Venezuela UCV
Caracas, Venezuela

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

Response: Venezuela, as many countries in Latin America, showed substantial improvements in infant mortality rates during the last 60 years. However, the decreasing pattern might be reversing. Recent socioeconomic and political events have led to a collapse in living standards, along with a breakdown of the health system. At the same time, a strict secrecy policy has ruled public institutions, and since 2013 the Venezuelan government stopped publishing mortality statistics.

This study attempts to fill this gap and estimate infant mortality using hospital and census data after 2013.

The main finding is that infant mortality rates in Venezuela may have stopped decreasing and started increasing in 2009 – around the time funding for the Venezuelan health system started to be substantially reduced. By 2016, the infant mortality rate was 21.1 deaths per 1000 live births, which is 1.4 times the rate in 2008 (15.0 deaths per 1000 live births), and equivalent to the rate recorded in the late 1990s, meaning 18 years of progress may have been lost.  Continue reading

Primary Care Doctor Visit After Discharge Reduced Hospital Readmission Rates

MedicalResearch.com Interview with:
Dr. Dawn Wiest, 7-day pledge after hospital admissionDawn Wiest, PhD
Director, Action Research & Evaluation
Camden Coalition of Healthcare Providers

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

Response: Understanding the role of care transitions after hospitalization in reducing avoidable readmissions, the Camden Coalition launched the 7-Day Pledge in 2014 in partnership with primary care practices in Camden, NJ to address patient and provider barriers to timely post-discharge primary care follow-up. To evaluate whether our program was associated with lower hospital readmissions, we used all-payer hospital claims data from five regional health systems. We compared readmissions for patients who had a primary care follow-up within seven days with similar patients who had a later or no follow-up using propensity score matching.

Continue reading

How Does the Medicaid Rebate Cap Affect Brand-Name Drug Prices?

MedicalResearch.com Interview with:

Sean Dickson, JD MPH Officer, Drug Spending Research Initiative The Pew Charitable Trusts Washington, DC 20004

Sean Dickson, JD MPH

Sean Dickson, JD MPH
Officer, Drug Spending Research Initiative
The Pew Charitable Trusts
Washington, DC 20004

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

Response: Price increases on existing drugs are an ongoing challenge for patients and insurers, including government programs like Medicaid and Medicare. The Medicaid program requires drug manufacturers to provide a rebate that offsets price increases greater than inflation, but that rebate is capped once price increases exceed 433 percent above inflation.

When these rebates are capped, manufacturers may find it more profitable to take very large price increases, raising costs for all payers. The Medicaid program has proposed removing the cap, and this study considers the effects of that proposal.  Continue reading

Female Radiation Oncologists Less Likely to Receive Industry Payments

MedicalResearch.com Interview with:

Dr. Ann Raldow MD MPH Assistant Professor Department of Radiation Oncology David Geffen School of Medicine UCLA

Dr. Raldow

Dr. Ann Raldow MD MPH
Assistant Professor
Department of Radiation Oncology
David Geffen School of Medicine
UCLA 

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

Response: Similar to women in other historically male-dominated fields, female radiation oncologists face unique obstacles in achieving many metrics of career success, including equal salary, research funding, and academic promotion. Our study of industry payments found that female radiation oncologists were less likely than their male colleagues to receive payments from industry and that these payments tended to be of smaller monetary value.

Continue reading

Younger Cancer Survivors Face Greater Financial Burdens

MedicalResearch.com Interview with:

Zhiyuan "Jason" Zheng PhD Director, Economics and Healthcare Delivery Research American Cancer Society, Inc. Atlanta, GA 30303

Dr. Zheng

Zhiyuan “Jason” Zheng PhD
Director, Economics and Healthcare Delivery Research
American Cancer Society, Inc.
Atlanta, GA 30303

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

Response: Historically, the cost of healthcare can be a substantial burden for cancer survivors and their families in the US. Even with health insurance, a cancer diagnosis can impose significant out-of-pocket costs for medical care.  These are partially due to the rising costs of cancer treatments in recent years, moreover, the increasing levels of coinsurance, copayments, and deductibles also shift a significant portion of the burden to cancer patients.

We found that younger cancer survivors, those aged 18-49 years, bear a higher burden than their older counterparts. We also found that two-thirds of cancer survivors enrolled in high-deductible health plans did not have health savings accounts, and they are more vulnerable to financial hardship than those in high-deductible health plans with health savings accounts and those covered by low-deductible plans.

These findings are important to patients because although cancer patents have benefited from newer and more advanced treatments, financial hardship may lead to emotional distress, cause changes in health behaviors, and jeopardize treatment adherence and health outcomes. 

Continue reading

VA Wait Times Now Often Shorter Than in Private Sector

MedicalResearch.com Interview with:

David Shulkin, MD Ninth Secretary, U.S. Department of Veterans Affairs Washington, District Of Columbia Shulkin Solutions LLC Gladwyne, Pennsylvania

Dr. Shulkin

David Shulkin, MD
Ninth Secretary, U.S. Department of Veterans Affairs
Washington, District Of Columbia
Shulkin Solutions LLC
Gladwyne, Pennsylvania

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

Response: I came to VA in 2015 as Under Secretary for Health, as a result of the 2014 wait time crisis.  At that time, it was determined that in some locations, veterans had been waiting for care for too long and there were allegations that this had resulted in harm to a number of veterans.  I was in the private sector at the time, but was asked by President Obama to come and help improve the situation.

Upon my arrival we created systems to determine which veterans were waiting for urgent healthcare and which ones for routine care.  From here, we established same day services for all veterans waiting for urgent care through primary care and behavioral health access points.  This goal was achieved nationwide at the end of 2016.  When I became Secretary in 2017,  we began publishing our wait time data for all to see, so that veterans had accurate information on which to base their choices on and to provide transparency into where we were improving and where we needed to focus our efforts.  In addition, through programmatic and legislative efforts, we expanded our utilization of private sector options so that veterans with clinical needs would be able to get better access to care.

This study was meant to determine whether our efforts from 2014 had resulted in improvements to access and in addition how access to care in the VA compared to access in the private sector.   Despite limitations in the data available from the private sector (since others do not publish their actual wait time data similar to VA) we used a data set that we felt had some applicability for these comparisons.

We found that for the most part, VA wait times are often shorter than in the private sector,  and that VA wait times had improved since 2014 while the private sectors access had stayed the same.  Continue reading

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.

Continue reading

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.

Continue reading

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.

Continue reading

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.

Continue reading

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