Telemedicine Expansion to Rural Areas Limited by Lack of Broadband Infrastructure Interview with:

Coleman Drake, PhDAssistant Professor, Health Policy and ManagementPitt Public HealthUniversity of Pittsburgh Graduate School of Public Health

Dr. Drake

Coleman Drake, PhD
Assistant Professor, Health Policy and Management
Pitt Public Health
University of Pittsburgh Graduate School of Public Health What is the background for this study? What are the main findings?

 Response: Telemedicine is frequently proposed as a solution to improve access to care in rural areas where driving to the nearest physician can take up to several hours. However, there needs to be sufficient broadband infrastructure for patients to actually use telemedicine. We found that broadband infrastructure is often insufficient to support telemedicine in the most rural areas, particularly in areas where there is inadequate access to primary care physicians and psychiatrists. 

Continue reading

Do Hospitals Designated as Centers of Excellence Have Better Outcomes? Interview with:

Sameed Khatana, MDFellow, Cardiovascular Medicine, Perleman School of MedicineAssociate Fellow, Leonard Davis Institute of Health EconomicsUniversity of Pennsylvania

Dr. Khatana

Sameed Khatana, MD
Fellow, Cardiovascular Medicine, Perleman School of Medicine
Associate Fellow, Leonard Davis Institute of Health Economics
University of Pennsylvania What is the background for this study?

Response: There has been a growing use of quality metrics and indices in the US healthcare system. Much attention has been paid to quality measurement programs used by public payors, however, the use of such programs by commercial payors is much less studied. “Centers of excellence” are one type of quality designation program that is growing in use by commercial payors where certain hospitals are determined to be “high quality” for a certain disease state or procedure based on meeting certain criteria. For some people, this is even impacting the choice of providers and hospitals they can use by payors.

We evaluated centers of excellence programs from three large commercial payors, Aetna, Cigna and Blue Cross Blue Shield, targeted at cardiovascular diseases and interventions and examined publicly reported outcomes for all hospitals performing percutaneous coronary interventions (cardiac stenting) in New York State. 

Continue reading

Intercourse Frequency – Who Compromises More in a Relationship? Interview with:
Prof. Leif Edward Ottesen KennairDepartment of PsychologyFaculty of Social and Educational SciencesNorwegian University of Science and TechnologyProf. Leif Edward Ottesen Kennair
Department of Psychology
Faculty of Social and Educational Sciences
Norwegian University of Science and Technology What is the background for this study?  

Response: Previous studies on intercourse frequency mainly focused on individual data, with no possibility to verify the perceived initiative or frequency. Couples data gave us that possibility. Previous studies had also mainly treated relationship quality as one measure. Therefore it was also interesting to distinguish between various aspects of relationship qualities to try to disentangle how these different aspects were related to frequency of intercourse.

In addition we had some ideas about how a measure of sexual personality or sociosexuality—how interested in short-term sex one is—might be relevant for compromise within the relationship?

Continue reading

Neurology Residents Learn to Identify Physician Burnout Through Simulation Interview with:
Dr. Rebecca Stainman
Dr. Arielle Kurzweil MD
Adult Neurology Program Director
New York University School of Medicine
NYU Langone Health What is the background for this study? What are the main findings? 

Response: Physician burnout is prevalent. Neurologists have among the highest burnout rates, ranked third among specialties in a 2011 study, and over half of US Neurologists report at least 1 symptom of burnout in a 2016 survey.  Efforts to address burnout in training programs have mostly been aimed at implementing wellness curricula and offering mental health resources.

Training neurology residents to effectively identify, address, and help impaired colleagues is equally crucial in these efforts, yet there is a paucity of literature on this topic. We used simulation as a means of addressing this topic, via identifying and addressing an impaired colleague through an objective structured clinical examination (OSCE).  Continue reading

Dialysis Unit Profit Primarily From Small Percentage of Privately Insured Patients Interview with:

Chris Childers, MD, PhDDivision of General SurgeryDavid Geffen School of Medicine at UCLA10833 Le Conte Ave., CHS 72-247Los Angeles, CA 90095

Dr. Childers

Chris Childers, MD, PhD
Division of General Surgery
David Geffen School of Medicine at UCLA
Los Angeles, CA 90095 What is the background for this study?

Response: Patients with end-stage renal disease – poorly functioning kidneys – often have to receive dialysis. This typically requires a patient to visit an outpatient clinic several times a week to have their blood filtered by a machine. Over the past few years, two for-profit companies have increased their control over the outpatient dialysis market – DaVita and Fresenius. Combined they control approximately ¾ of the market.  A number of concerns have been raised against these for-profit companies suggesting that the quality of care they deliver may be worse than the care delivered at not-for-profit companies. But, because they control so much of the market and because patients have to receive dialysis so frequently, patients may not have much choice in the clinic they visit.

Medicare covers patients who are 65 years or older and also patients on dialysis regardless of age.  Medicare pays a fixed rate for dialysis which they believe is adequate to cover the clinics’ costs. However, if a patient also has private insurance, the insurer is required to pay for dialysis instead of Medicare. Whereas Medicare rates are fixed by the federal government, private insurers have to negotiate the price they pay, and may pay much more as a result.

Continue reading

Primary Care: Brief Training Encourages Discussions of Prescription Drug Costs Interview with:

Kevin Fiscella, M.D., M.P.H.Dean’s Professor, Family MedicineProfessor, Public Health Sciences and Community HealthUniversity of Rochester  Medical CenterCo-Director, Research DivisionDepartment of Family MedicineRochester, New York 14620

Dr. Fiscella

Kevin Fiscella, M.D., M.P.H.
Dean’s Professor, Family Medicine
Professor, Public Health Sciences and Community Health
University of Rochester  Medical Center
Co-Director, Research Division
Department of Family Medicine
Rochester, New York 14620 What is the background for this study? What are the main findings?

Response: The study was designed to determine whether one hour of training was sufficient to promote conversations between physicians and their patients regarding patient-borne costs of prescriptions.

We found that the training, which promoted a team-based approach involving brief screening and cost-reducing strategies, nearly doubled the number of conversations. What should readers take away from your report? 

Response: Brief education on brief screening and practical strategies to lower prescription costs increases office visits discussion of prescription costs and strategies to reduce them. What recommendations do you have for future research as a result of this work?

Response: Further questions are whether these effects are sustained and/or whether additional interventions are needed to produce larger and more sustained effects.

No disclosures


Ann Intern Med. 2019 May 7;170(9_Supplement):S46-S53. doi: 10.7326/M18-2011.
Addressing Medication Costs During Primary Care Visits: A Before-After Study of Team-Based Training.
Carroll JK1, Farah S2, Fortuna RJ3, Lanigan AM4, Sanders M2, Venci JV5, Fiscella K5.

May 11, 2019 @ 1:44 pm 

The information on 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.


Health Professionals Concerned About Side Effects and Diversion of Medicinal Cannabis Interview with:
Kyle Gardiner B.Pharm(Hons)PhD candidateDiscipline of PharmacyQueensland University of Technology | QUT · Brisbane, Australia
Kyle Gardiner B.Pharm(Hons)

PhD candidate
Discipline of Pharmacy
Queensland University of Technology | QUT ·
Brisbane, Australia What is the background for this study?  

Response: The background to this study was a personal interest in behavioural science. I am often intrigued as to why health professional behave the way they do. Studies exploring health professional behaviour are seldom complete or comprehensive, however.

Medicinal cannabis presents an interesting case point to explore health professional behaviours due to its topical nature. The socio-political discussion surrounding medicinal cannabis is often quite different from the medical discussion, yet for legal and regulated access to be achieved across most jurisdictions, a health professional is required to be involved in that process. Simply, if health professionals are not willing to behave, the delivery of medicinal cannabis does not occur. For purposes of transparency, I neither support or reject the use of medicinal cannabis and this paper has nothing to do improving or reducing access. This paper is about beginning to understand health professional behaviours within the context of medicinal cannabis. Yet, if we hope to change practice in the future, by definition, we need to change behaviour. We cannot change behaviour without first understanding the behaviour in context.

Continue reading

Open Communication Linked to Lower Hospital Mortality Interview with:
Veronica Toffolutti PhD

Postdoctoral researcher working with Professor David Stuckler
Department of Sociology
Bocconi University What is the background for this study? What are the main findings?

Response: Openness has been linked with better patient safety and better understanding of patients’ care goals. In addition, more open environments appear to be linked with positively ranked quality of teamwork, which in turns lead to better health care.

Yet if the expected benefits are to be achieved, it is necessary to show that greater openness actually corresponds to improvements in performance or lower mortality rates. To the best of our knowledge our is the first study to show an association between hospital mortality and openness and more precisely one point increase in the standardized openness score leads to a decrease of 6.48% in the hospital mortality rates. With the term openness we refer to an environment in which communication among patients, staff members and managers is open and transparent.  Continue reading

Cancer Patients May Receive Better Emergency Care at Hospital Where They Receive Cancer Treatments Interview with:

Keerat Grewal, MD, MSc, FRCPC Schwartz/Reisman Emergency Medicine Institute Mount Sinai Hospital Toronto, ON

Dr. Grewal

Keerat Grewal, MD, MSc, FRCPC
Schwartz/Reisman Emergency Medicine Institute
Mount Sinai Hospital
Toronto, ON What is the background for this study? What are the main findings? 

Response: Patients with cancer have complex care requirements and often use the emergency department. The purpose of our study was to determine whether continuity of care, cancer expertise, or both, impact outcomes among cancer patients in the emergency setting. Using administrative data we looked at adult patients with cancer who received chemotherapy or radiation therapy in the 30 days prior to an emergency department visit.  Continue reading

How Did Medicaid Expansion Affect Low Birth Weights and Preterm Births? Interview with:

Clare Brown, PhDHealth Systems and Services ResearchUniversity of Arkansas for Medical Sciences

Dr. Brown

Clare Brown, PhD
Health Systems and Services Research
University of Arkansas for Medical Sciences

J. Mick Tilford, PhD, Professor and ChairDepartment of Health Policy and ManagementFay W. Boozman College of Public HealthUniversity of Arkansas for Medical Science

Dr. Tilford

J. Mick Tilford, PhD,
Professor and Chair

Department of Health Policy and Management
Fay W. Boozman College of Public Health
University of Arkansas for Medical Science What is the background for this study? What are the main findings? 

Response: Prematurity and low birthweight are associated with increased risk of infant mortality as well as increased risk of chronic conditions throughout infancy and into adulthood. Non-Hispanic black infants are twice as likely to be born low birthweight (13.9% vs 7.0%) and 1.5 times as likely to be born prematurely (13.9% vs 9.1%) compared to non-Hispanic white infants.

Under the Affordable Care Act (ACA), states may expand Medicaid to adults with household income levels at or below 138% of the federal poverty level, thus extending coverage to childless adults and improving continuity. Insurance gain may ultimately improve maternal health, increased use and earlier initiation of prenatal care services, and improved access to pregnancy planning resources.

Our study aimed to evaluate whether there were changes in rates of low birthweight and preterm birth outcomes among states that expanded Medicaid versus states that did not expand Medicaid. Continue reading

Medicaid Payments For Breast Cancer Radiation Vary Widely Interview with:

Ankit Agarwal, MD, MBAPGY-3, Radiation Oncology ResidentUNC Health Care

Dr. Agarwal

Ankit Agarwal, MD, MBA
PGY-3, Radiation Oncology Resident
UNC Health Care What is the background for this study? What are the main findings?

Response: Medicaid provides vital health insurance for millions of mostly low income Americans throughout the United States. However, it is well known that patients with Medicaid have worse clinical outcomes than patients with private insurance or Medicare insurance. Part of the reason for this may be due to difficulties with access to care, in part due to the traditionally very low payments in the Medicaid system.

We found that Medicaid payment rates for a standard course of breast cancer radiation treatment can vary over fivefold (ranging from $2,945 to $15,218)  Continue reading

Stroke: Experimental Antiplatelet Antibody Only Attacks Clots, Without Increasing Bleeding Risk Interview with: Interview with:Martine Jandrot-Perrus MD, PhD.Emeritus Research ProfessorInserm University Paris DiderotActicor BiotechHôpital BichatFrance

Dr. Jandrot-Perrus

Martine Jandrot-Perrus MD, PhD.
Emeritus Research Professor
Inserm University Paris Diderot
Acticor Biotech
Hôpital Bichat
France What is the background for this study? What are the main findings?

Response: Blood platelets are key actors in thrombosis a leading cause of global mortality estimated to account for 1 in 4 death worldwide in 2010.

Thrombosis is associated with cardiovascular diseases (myocardial infarction, stroke, lower limb ischemia, venous thromboembolism), and with numerous pathologies such as cancer, infections or inflammatory diseases. Currently available antiplatelet drugs are the cornerstone of therapy for patients with acute coronary syndromes. However, these drugs all carry an inherent risk of bleeding that restricts their use in sensitive populations and when arterial thrombosis occurs in the cerebral territory. At present the only acute treatment option available for ischemic stroke consists in revascularization by thrombolysis, and/or mechanical thrombectomy. But the number of patients eligible to these treatments is low (» 15% of all patients) and the success rate does not exceed 50%. The responsibility of platelets in the failure for thrombolysis / thrombectomy to restore vascular patency is strongly suspected.

There is thus a clear medical need for new antiplatelet drugs with an improved safety profile. We set out to develop ACT017, a novel, first in class, therapeutic antibody to platelet glycoprotein VI with potent and selective antiplatelet effects. The interest of GPVI resides in the fact that it’s a receptor involved in the development of occlusive thrombi but that it is not strictly required for physiological hemostasis.
Continue reading

Diet Rich in Red Meat Linked to Earlier Death Interview with:

Heli Virtanen, PhD StudentUniversity of Eastern Finland

Heli Virtanen

Heli Virtanen, PhD Student
University of Eastern Finland What is the background for this study?

Response: Optimal amount of protein in diet for supporting longevity is unclear. In addition, there have been indications that different protein sources have differential associations with mortality risk.  Thus, we investigated the associations of proteins and protein sources with mortality risk in the Finnish men of the Kuopio Ischaemic Heart Disease Risk Factor Study.

Continue reading

Brain Training Can Strengthen Cognitive Function in Patients With Mild Impairment Interview with:

Dr. Sandra Bond Chapman PhDFounder and Chief Director, Center for BrainHealth,Co-Leader, The BrainHealth ProjectUniversity of Texas, Dallas

Dr. Chapman

Dr. Sandra Bond Chapman PhD
Founder and Chief Director, Center for BrainHealth,
Co-Leader, The BrainHealth Project
University of Texas, Dallas What is the background for this study?

Response: Finding effective treatments to reverse or slow rates of cognitive decline for those at risk for developing dementia is one of the most important and urgent challenges of the 21st century.

Brain stimulation is gaining attention as a viable intervention to increase neuroplasticity when used in isolation or when combined with cognitive training regimens. Given the growing evidence that certain cognitive training protocols, such as SMART, benefit people with Mild Cognitive Impairment (MCI), a population that is vulnerable to Alzheimer’s disease, we were interested in exploring whether we could further increase the gains from cognitive training (i.e., SMART) when the training was preceded by brain stimulation using tDCS.  Continue reading

Changes in Medicare’s Hospital Readmissions Reduction Program Affect Poor and Low Poverty Hospitals Differently Interview with:

Karen Joynt Maddox, MD, MPHAssistant Professor of MedicineWashington University Brown School of Social Work

Dr. Joynt Maddox

Karen Joynt Maddox, MD, MPH
Assistant Professor of Medicine
Washington University Brown School of Social Work What is the background for this study?

Response: Medicare’s Hospital Readmissions Reduction Program has been controversial, in part because until 2019 it did not take social risk into account when judging hospitals’ performance. In the 21st Century Cures Act, Congress required that CMS change the program to judge hospitals only against other hospitals in their “peer group” based on the proportion of their patients who are poor. As a result, starting with fiscal year 2019, the HRRP divides hospitals into five peer groups and then assesses performance and assigns penalties.  Continue reading

Patients’ Trust in Medical Profession Declined After Open Payments Interview with:

Genevieve Kanter, PhD Assistant Professor Department of Health Management and Policy Drexel University Dornsife School of Public Health Philadelphia, PA

Dr. Genevieve Kanter

Genevieve P. Kanter, PhD

Assistant Professor (Research) of Medicine
Medical Ethics and Health Policy
University of Pennsylvania Perelman School of Medicine
Philadelphia, PA  19104-6021 What is the background for this study?


Response: Physicians frequently have financial relationships with pharmaceutical and medical device firms, but only recently has information on these financial ties been made available to the public. The Open Payments program, created by the Physician Payment Sunshine Act, has made this industry payments information available through a public website since 2014.

Because transparent institutions are believed to engender greater public trust, public disclosure of industry payments could increase public trust in the medical profession, which may have been weakened by physicians’ relationships with industry. On the other hand, Open Payments may have decreased public trust because of the focus of media reporting on physicians receiving the largest sums of money.

We sought to investigate how Open Payments and the public disclosure of industry payments affected public trust in physicians and in the medical profession. We compared changes in trust among patients who lived in states where payments information had, by state statute, previously been made available, to changes in trust among patients who lived in states where this information became newly available through Open Payments.

Continue reading

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

Continue reading

Stress from Traumatic Events Linked to Increased Risk of Heart Disease Interview with:

Huan Song Associated Department of Medical Epidemiology and Biostatistics Karolinska Institutet

Huan Song

Huan Song, PhD
Center of Public Health Sciences, Faculty of Medicine,
University of Iceland, Reykjavík, Iceland
Department of Medical Epidemiology and Biostatistics
Karolinska Institutet, Stockholm, Sweden What is the background for this study?  

Response: Cardiovascular disease (CVD) presents a group of diseases that are common and sometimes fatal in general population. The possible role of stress-related disorders in the development of CVD has been reported. However, the main body of the preceding evidence was derived from male samples (veterans or active-duty military personnel) focusing mainly on posttraumatic stress disorder (PTSD) or self-reported PTSD symptoms. Data on the role of stress-related disorders in CVD in women were, until now, limited. Although incomplete control for familial factors and co-occurring psychiatric disorder, as well as the sample size restriction, limit the solid inference on this association, especially for subtypes of CVD.

Continue reading

Verubecestat Failed to Slow Progression of Early Alzheimer’s Disease Interview with:
Michael F. Egan, MDVice President,  NeuroscienceGlobal Clinical DevelopmentMerck Research LaboratoriesNorth Wales, PAMichael F. Egan, MD
Vice President,  Neuroscience
Global Clinical Development
Merck Research Laboratories
North Wales, PA What is the background for this study?  

Response: Alzheimer’s disease (AD) appears to be due to the gradual accumulation of amyloid over many years (the “amyloid hypothesis”). At some point, it is thought that amyloid triggers abnormalities in tau, which then forms deposits within neurons and leads to progressive neurodegeneration.

Amyloid is made up of  a small, sticky peptide, Abeta, which is produced when the enzyme BACE cleaves a large protein called APP.  In our trial, we tested whether a potent BACE inhibitor, verubecestat, could slow disease progression in subjects with early AD (or prodromal AD) by blocking formation of Abeta.  A previous trial in subjects with dementia due to AD failed to find evidence of efficacy.

One possible reason for this failure is that subjects had too much amyloid in their brain already.

Continue reading

Does Vitamin D Supplementation Impact Relapse-Free Survival in GI Cancers? Interview with:
Mitsuyoshi Urashima MD, PhD, MPH
Professor of Molecular Epidemiology
Jikei University School of Medicine
Tokyo, JAPAN What is the background for this study?  

Response: Serum levels of vitamin D, increase in response to exposure to sunlight, a vitamin D-rich diet, or vitamin D supplementation. In 1989, the risk of colon cancer was estimated to be 70% lower in people with serum vitamin D levels ≥ 20 ng/mL, compared with those < 20 ng/mL.

In a cohort study, higher vitamin D levels were associated with lower total cancer incidence and lower total cancer mortality, particularly digestive system cancer mortality. However, because of the studies’ observational nature, whether lower levels of vitamin D is merely a precursor to relapse and death or causally related to shorter survival cannot be determined.

To clarify this, a randomized, double-blind, placebo-controlled trial using vitamin D supplement was performed in patients with digestive tract cancer from esophagus to rectum; this is the first trial designed to evaluate the effect of vitamin D on survival of these patients.  Continue reading

Waivers to Allow PAs and NPs to Prescribe Buprenorphine Vary by State Interview with:

Joanne Spetz, PhDProfessorPhilip R. Lee Institute for Health Policy StudiesSan Francisco, CA 94143-0936

Dr. Spetz

Joanne Spetz, PhD
Philip R. Lee Institute for Health Policy Studies
San Francisco, CA 94143-0936 What is the background for this study? What are the main findings? 

Response: Medication treatment is an important component of treatment for opioid use disorder. Buprenorphine has been the focus of policies designed to increase access to treatment and is the most widely-used medication due to well-established evidence of its efficacy and its accessibility outside licensed narcotics treatment programs. The most common brand name for this medication is Suboxone.

There is a shortage of providers authorized to prescribe it, in part because only physicians were permitted to obtain waivers from the Drug Enforcement Agency to prescribe it outside of licensed narcotics treatment programs until the opioid bill of 2016. That bill granted nurse practitioners (NPs) and physician assistants (PAs) the ability to apply for waivers. However, in states that require NPs and/or PAs to be supervised by or collaborate with a physician, there are additional requirements regarding the training of the physician before the NP or PA can apply for a waiver. This affects nearly half of states for NPs, and all states for PAs.

We found that the average percentage of NPs with waivers was 5.6% in states that do not require physician supervision, but only 2.4% in more restrictive states. Even after adjusting for other factors, we found that the percentage of NPs with waivers was 75% higher when physician oversight is not required. We didn’t find a similar result for PAs, probably because they must have physician oversight in all states.  Continue reading

Majority of Surveyed Hospitals Prohibit Physician Participation in End of Life Option Act Interview with:

Cindy L. Cain, PhDAssistant ProfessorDepartment of SociologyUniversity of Alabama at BirminghamBirmingham, AL 35233 

Dr. Cain

Cindy L. Cain, PhD
Assistant Professor
Department of Sociology
University of Alabama at Birmingham
Birmingham, AL 35233 What is the background for this study? What are the main findings?

Response: The End of Life Option Act permits terminally ill Californians to request a prescription for medications that would hasten death, providing they meet all requirements of the law and follow the steps outlined by their health care provider.

However, the law also allows health care providers and organizations to opt out of participating. Until now, we did not know how common it was for entire health care organizations to opt out.

In this study, we found that 61% of the surveyed hospitals prohibited physician participation in the End of Life Option Act. Thirty-nine percent of hospitals did allow participation in the law; these participating hospitals were less likely to be religiously affiliated and more likely to be nonprofit.

Continue reading

Medication Abortion Rebounded in Texas After FDA Approved Label Change for Mifeprex®

Sarah Baum, MPHinvestigator at the Texas Policy Evaluation ProjectAssociate at Ibis Reproductive Health

Sarah Baum Interview with:
Sarah Baum, MPH

investigator at the Texas Policy Evaluation Project
Associate at Ibis Reproductive Health What is the background for this study?  

Response: Before 2013, use of medication abortion in Texas mirrored national trends, which have steadily increased since the approval of mifepristone–one of the two medications used for medication abortion–in 2000. However, House Bill 2 (HB 2), which was implemented on November 1, 2013, imposed restrictions on medication abortion and required providers to follow the outdated mifepristone label. HB 2 reduced the gestational age limit to 49 days and generally required four visits.

On March 29, 2016, the US Food and Drug Administration (FDA) approved a revised label for Mifeprex® (mifepristone 200 mg) that reflected evidence-based practice, which essentially nullified the medication abortion restrictions in HB 2. The label change brought medication abortion prescribing guidelines in line with evidence-based practice, reducing the number of required in-person visits from four to two and extending the period when patients can take the pill from seven weeks of pregnancy to 10 weeks. Continue reading

Tooth Loss Linked To Greater Risk of Pancreatic Cancer Among African American Women Interview with:

Dr. Julie Palmer

Dr. Palmer

Julie R. Palmer, ScD
Professor, Boston University School of Medicine
Associate Director, Slone Epidemiology Center at Boston University
Boston, MA 02118 What is the background for this study? What are the main findings?

Response: Since 1995, 59,000 African American women from all regions of the U.S. have participated in a Boston University research study of the health of Black women.  Study participants complete mailed or online questionnaires every two years.

Our major goal is to identify modifiable risk factors for cancers and nonmalignant conditions that disproportionately affect African Americans (e.g., pancreatic cancer, early-onset breast cancer, type 2 diabetes, uterine fibroids).  The reasons for the higher incidence of pancreatic cancer in African Americans relative to non-Hispanic White women in the U.S. are unknown.

I was aware that several recent studies in predominantly White populations had observed a higher incidence of pancreatic cancer in those who had reported poor oral health and wondered whether the higher prevalence of poor oral health among African Americans could play a role in their higher incidence of pancreatic cancer.  We had already asked about gum disease, periodontal disease, and adult tooth loss in several rounds of data collection.

After rigorous analysis, we found that women who reported any adult tooth loss had about two times the risk of future development of pancreatic cancer compared with those who had no tooth loss and had never reported periodontal disease.

The estimated risk was even greater for those who had lost five or more teeth. A similar association was observed for reports of periodontal disease, but the association was not statistically significant.

Continue reading

Cataract Surgery: QI Initiative Markedly Reduced Low-Value Preoperative Care Interview with:

John N. Mafi MPH Assistant Professor of Medicine David Geffen School of Medicine University of California, Los Angeles Natural scientist in Health Policy RAND Corporation Santa Monica, California

Dr. Mafi

John N. Mafi, MD, MPH
Division of General Internal Medicine and Health Services Research
Department of Medicine
David Geffen School of Medicine at UCLA
RAND Health, RAND Corporation What is the background for this study? What types of services are low-value in this setting? 

Response: For decades we have known that offering routine preoperative testing for patients undergoing cataract surgery provides limited value, yet low-value preoperative testing persists at very high rates, even at Los Angeles County Department of Health Services, one of the largest safety net health systems in the United States.

Continue reading

Catholic Hospitals Often Not Transparent About Health Care Restrictions In Their Institutions Interview with:

Maryam Guiahi, MDAssociate Professor, Ob/GynSchool of MedicineUniversity of Colorado

Dr. Guiahi

Maryam Guiahi, MD
Associate Professor, Ob/Gyn
School of Medicine
University of Colorado What is the background for this study?

Response: The United States Conference of Catholic Bishops expects providers in Catholic Health Care Facilities to follow the Ethical and Religious Directives for Catholic Health Care Services, which places limits on reproductive and end-of-life care.

Prior research has demonstrated that many patients do not anticipate religious health care restrictions, yet often face conflicts in care. We were interested in whether Catholic hospitals disclose their religious affiliation and explain to patients how this affiliation may impact the care they are offered.

Continue reading

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