Author Interviews, JAMA, Pediatrics / 06.11.2017

MedicalResearch.com Interview with: [caption id="attachment_37911" align="alignleft" width="100"]Sally H. Adams, PhD, RN Specialist, Division of Adolescent and Young Adult  Medicine Adolescent and Young Adult Health National Resource Center University of California, San Francisco Benioff Children’s Hospital San Francisco, CA 94118 Dr. Adams[/caption] Sally H. Adams, PhD, RN Specialist, Division of Adolescent and Young Adult  Medicine Adolescent and Young Adult Health National Resource Center University of California, San Francisco Benioff Children’s Hospital San Francisco, CA 94118 MedicalResearch.com: What is the background for this study? Response: Major causes of adolescent illness and mortality are preventable. To address this, in the 1990s, professional medical organizations developed healthcare provider guidelines for the delivery of adolescent preventive healthcare. These include the receipt of anticipatory guidance and risk screening services in the effort to promote healthy behaviors and avoid risky behaviors that are intended to be covered within a preventive care visit, but could be addressed in other healthcare visits. The adolescent developmental period is an important time for adolescents to be engaged with the healthcare system. Transitioning from childhood to adulthood, adolescents are becoming increasingly independent - having more responsibility and freedom for decision making in many areas, including healthy choices in behaviors and activities. While families and community settings (schools, churches) play strong roles in this process, the healthcare system also plays an important role.
AHRQ, Author Interviews, Health Care Systems, Opiods / 24.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37708" align="alignleft" width="150"]Anne Elixhauser, Ph.D. Senior Research Scientist Agency for Healthcare Research and Quality Rockville MD 20857 Dr. Elixhauser[/caption] Anne Elixhauser, Ph.D. Senior Research Scientist Agency for Healthcare Research and Quality Rockville MD 20857 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Hospital inpatient data began using ICD-10-CM (I-10) codes on October 1, 2015.  We have been doing analysis using the new codeset to determine to what extent we can follow trends crossing the ICD transition—do the trends look consistent when we switch from I-9 to I-10?  Tracking the opioid epidemic is a high priority so we made this one of our first detailed analyses.  We were surprised to find that hospital stays jumped 14% across the transition, compared to a 5% quarterly increase before the transition (under I-9) and a 3.5% quarterly increase after the transition (under I-10).  The largest increase (63.2%) was for adverse effects in therapeutic use (side effects of legal drugs), whereas stays involving opioid abuse decreased 21% and opioid poisoning (overdose) decreased 12.4%.
Author Interviews, Emergency Care / 20.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37636" align="alignleft" width="200"]David Marcozzi, MD, MHS-CL, FACEP Associate Professor  Director of Population Health Department of Emergency Medicine Adjunct Associate Professor Co-Director of the Program in Health Disparities and Population Health Department of Epidemiology and Public Health University of Maryland School of Medicine Assistant Chief Medical Officer for Acute Care University of Maryland Medical Center Dr. Marcozzi[/caption] David Marcozzi, MD, MHS-CL, FACEP Associate Professor Director of Population Health Department of Emergency Medicine Adjunct Associate Professor Co-Director of the Program in Health Disparities and Population Health Department of Epidemiology and Public Health University of Maryland School of Medicine Assistant Chief Medical Officer for Acute Care University of Maryland Medical Center MedicalResearch.com: What is the background for this study? Response: Nearly half of all US medical care is delivered by emergency departments, according to a new study by researchers at the University of Maryland School of Medicine (UMSOM). And in recent years, the percentage of care delivered by emergency departments has grown. The study highlights what many experts argue is a major flaw in American health care: the use of emergency care in non-urgent cases, where clinics and doctor’s offices would be more appropriate. “I was shocked by this result. This really helps us understand health care in this country. This research underscores the fact that emergency departments are critical to our nation’s healthcare delivery system, particularly for Americans who have no access to care.” said David Marcozzi, MD, MHS-CL, FACEP, an associate professor in the UMSOM Department of Emergency Medicine, and co-director of the UMSOM Program in Health Disparities and Population Health. “Patients seek care delivered in emergency departments for many reasons, and we need to face this fact this is a significant segment of healthcare and actually it may be delivering the type of care that individuals want and need—24/7, 365 days.”  Although he now focuses on population health and hospital throughput, Dr. Marcozzi is an emergency room doctor himself, and works one or two days a week in the University of Maryland Medical Center emergency department, treating patients.
Author Interviews, Cost of Health Care, JAMA, Social Issues / 07.08.2017

MedicalResearch.com Interview with: [caption id="attachment_36342" align="alignleft" width="143"]Dr-arlene-S-Ash.jpg Dr. Ash[/caption] Arlene S. Ash, PhD Department of Quantitative Health Sciences University of Massachusetts Medical School Worcester  MedicalResearch.com: What is the background for this study? What are the main findings? Response: State Medicaid programs (and other health care purchasers) often contract with several managed care organizations, each of which agrees to address all health care needs for some of their beneficiaries. Suppose a Medicaid program has $5000 to spend, on average, for each of its 1 million beneficiaries. How much should they pay health plan “A” for the particular 100,000 beneficiaries it enrolls? If some group, such as those who are homeless, is much more expensive to care for than the payment, plans that try to provide good care for many such people will go broke. We describe the model now used by MassHealth to ensure that plans get more money for enrolling patients with greater medical and social needs. In this medical-social model, about 10% of total dollars is allocated by factors other than the medical-morbidity risk score.
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care / 17.05.2017

MedicalResearch.com Interview with: Eric Roberts, PhD Post-doctoral fellow Department of Health Care Policy Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: Increasing consolidation of health care providers has raised regulatory concerns that less competition will lead to higher health care prices and possibly lower quality care for patients. On the other hand, some industry observers have contended that larger and higher-priced practices are better able invest in systems to support care management, and ultimately, better patient care. In this study, we examined whether larger and higher-priced physician practices provided better and more efficient care to their patients. Higher-priced physician groups were paid an average of 36% more by commercial insurers, and were substantially larger than lower-priced practices located within the same geographic areas. Despite large differences in practices’ prices and size, we found few differences in their patients’ quality and efficiency of care. For example, when we compared patients who received care in high-priced versus low-priced practices, we found no differences in patients’ overall care ratings, physician ratings, access to care, physician communication, and use of preventive services. We also found no differences in patients’ hospital admissions or total spending, suggesting that higher-priced practices were not managing their patients’ care more efficiently than their lower-priced counterparts. We did find that patients in higher-priced practices were more likely to receive recommended vaccinations, review of their medications, and results of medical tests, and that they spent less time in the waiting room for a scheduled doctor’s appointment. However, once practice prices exceeded the average for their geographic area, we observed no further gains in quality on most of these measures.
Author Interviews / 21.03.2017

MedicalResearch.com Interview with: [caption id="attachment_33196" align="alignleft" width="200"]Mitch Rothschild MA, MBA Co-founder of Vitals Mitch Rothschild[/caption] Mitch Rothschild MA, MBA Co-founder of Vitals MedicalResearch.com: What is the background for this study? What are the main findings? Response: There’s so much in the news about health care today. It’s on people’s mind more than ever before due to rising costs and deductibles and, of course, the repeal debate. With that in mind, we wanted to see how the current landscape affects two things: 1) People’s trust in the health system in general; and 2) Their attitude towards the doctor-patient relationship. It shouldn’t be surprising that different generations had different perceptions. But we were amazed by how some generational stereotypes held true when it came to doctor-patient relationships and the health care attitudes. Millennials – Health Care Idealists Being in their 20s and 30s, Millennials are young and in general a healthy bunch. For the most part, they’ve utilized less health care services than other generations. Only 35 percent have a primary care provider, and one in four say they use an alternative care facility, like an urgent care center, when they are sick. Often characterized as optimistic and idealistic, those traits may help explain why they have a high degree of trust in the system and in their doctors. They’re the least likely to question their doctor’s authority or their integrity when it comes to fessing up to medical mistakes. Confident and idealistic, Millennials are often labeled as over-sharers for their habits both on social media and in the real world. But this translates into an open doctor-patient relationship. Millennials are more likely than other generations to say they can tell their doctor “anything.” Perhaps a byproduct of their parents raising them to believe their voice matters, Millennials have an expectation that they can and should engage authority. Yet, that collaborative and open dialogue leads to another positive: They’re the most likely to follow their doctor’s medical advice. Millennials have grown up as digital natives. As such, they’re the most likely to use online reviews to “check up” on a new doctor. Yet, their familiarity with technology leads them to be the least suspicious of pitfalls. More than other generations, Millennials trust health facilities with their personal health information.
Author Interviews, Dermatology, JAMA / 17.03.2017

MedicalResearch.com Interview with: Dr. Alex M. Glazer MD National Society for Cutaneous Medicine New York, New York  MedicalResearch.com: What is the background for this study? What are the main findings? Response: We had previously studied the geographic distribution of dermatologists throughout the United States which revealed that dermatologists are unevenly geographically distributed throughout the country, with many regions having fewer than the 4 providers per 100,000 people needed to adequately care for a population. Because of the influx of PAs and NPs into the healthcare workforce throughout the past decade, we wanted to see how these providers were supplementing dermatologic care. The main finding of our study is that dermatology PAs are helping to supplement dermatologists and together are providing broader, more uniform coverage across the United States
Author Interviews, Electronic Records / 17.03.2017

[caption id="attachment_32974" align="alignleft" width="200"]MedicalResearch.com Interview with: Neil Smiley CEO of Loopback Analytics Neil Smiley[/caption] MedicalResearch.com Interview with: Neil Smiley CEO of Loopback Analytics MedicalResearch.com: What is the background for Loopback Analytics? What are the problems Loopback Analytics is attempting to mitigate? Response: Loopback Analytics (Loopback) is a Software-as-a-Service company that provides event-driven population health management. Founded in 2009, Loopback integrates and manages diverse data sources to support predictive analytics and intervention solutions to address health reform reimbursement challenges with the goal of achieving the Triple Aim – better care, better health and lower costs. Loopback enabled intervention solutions address key challenges associated with value-based care, such as reducing avoidable hospitalizations, high emergency department utilization, medication adherence and optimization of post-acute care networks.
Author Interviews, BMJ, Brigham & Women's - Harvard, Education, Outcomes & Safety / 06.02.2017

MedicalResearch.com Interview with: [caption id="attachment_31685" align="alignleft" width="180"]Yusuke Tsugawa, MD, MPH, PhD Research Associate at Department of Health Policy and Management Harvard T.H. Chan School of Public Health Dr. Yusuke Tsugawa[/caption] Yusuke Tsugawa, MD, MPH, PhD Research Associate at Department of Health Policy and Management Harvard T.H. Chan School of Public Health   MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prior evidence has been mixed as to whether or not patient outcomes differ between U.S. and foreign medical graduates. However, previous studies used small sample sizes or data from a small number of states. Therefore, it was largely unknown how international medical graduates perform compared with US medical graduates. To answer this question, we analyzed a nationally representative sample of Medicare beneficiaries admitted to hospitals with a medical condition in 2011-2014. Our sample included approximately 1.2 million hospitalizations treated by 40,000 physicians. After adjusting for severity of illness of patients and hospitals (we compared physicians within the same hospital), we found that patient treated by international medical graduates had lower mortality than patients cared for by US medical graduates (adjusted 30-day mortality rate 11.2% vs 11.6%, p<0.001). We observed no difference in readmissions, whereas costs of care was slightly higher for international medical graduates.
Author Interviews, Health Care Systems, Johns Hopkins / 01.02.2017

MedicalResearch.com Interview with: Chester G. Chambers, Ph.D. Director, Enterprise Risk Management Program, Johns Hopkins Carey Business School Joint Appointment in Anesthesiology and Critical Care Medicine Maqbool Dada, Ph.D. Joint Appointment in Anesthesiology and Critical Care Medicine John Hopkins Medicine Kayode Ayodele Williams, M.B.A., M.B.B.S., M.D Medical Director : Blaustein Pain Treatment Center Associate Professor of Anesthesiology and Critical Care Medicine John Hopkins Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: The result is based on a retrospective analysis of three specialty clinics in the Johns Hopkins System: a private practice low-volume clinic with one physician and no residents; a medium volume clinic that used one attending physician for each clinic session and included residents; and a high-volume clinic with multiple attending physicians and several residents. Our main finding is that physicians adjust face time based on congestion in the clinic, and seem to do this without always knowing they are doing it. Patients who arrive early and whose service begins before their appointment times, tend to get more face-time then other patients. This is similar to other service systems in which first-line providers speed-up when they see long queues at their stations.This is important because most of the prior research in this setting assumed that this never takes place. We verified that it does happen in multiple settings and the changes in processing rates are statistically significant. This means we need to rethink many earlier conclusions about how clinics run.
Author Interviews, Cost of Health Care, Diabetes, JAMA / 05.01.2017

MedicalResearch.com Interview with: [caption id="attachment_30753" align="alignleft" width="125"]Joseph Dieleman, PhD Institute for Health Metrics and Evaluation | University of Washington Seattle, WA 98121 Dr. Joseph Dieleman[/caption] Joseph Dieleman, PhD Institute for Health Metrics and Evaluation University of Washington Seattle, WA 98121 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The objective of this study was to provide a estimate of total health care spending in the United States for an exhaustive list of health conditions, over an extended period of time – from 1996 to 2013. The study primarily focuses on personal health spending, which includes both individual out-of-pocket costs as well as spending by private and government insurance programs on care provided in inpatient and outpatient facilities, emergency departments, nursing care facilities, dentist offices, and also on pharmaceuticals. There were 155 conditions included in the analysis, and spending was also disaggregated by type of care, and age and sex of the patient. In 2013, we accounted for $2.1 trillion in personal health spending in the U.S. It was discovered that just 20 health conditions made up more than half of all dollars spent on health care in the U.S. in 2013, and spending for each condition varied by age, sex and type of care. Diabetes was the most expensive condition, totaling $101 billion in diagnoses and treatments, growing at an alarmingly rate – a 6.5% increase per year on average. Ischemic heart disease, the number one killer in the U.S., ranked the second most expensive at $88.1 billion, followed by low back and neck pain at $87.6, treatment of hypertension at $83.9 billion, and injury from falls at $76.3. Women aged 85 and older spent the most per person in 2013, at more than $31,000 per person. More than half of this spending (58%) occurred in nursing facilities, while 20% was expended on cardiovascular diseases, 10% on Alzheimer’s disease, and 7% on falls. Men ages 85 and older spent $24,000 per person in 2013, with only 37% on nursing facilities, largely because women live longer and men more often have a partner at home to provide care.
Author Interviews, Cost of Health Care, JACC, UCLA / 28.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30823" align="alignleft" width="200"]Joseph A. Ladapo, MD, PhD David Geffen School of Medicine at UCLA Department of Medicine, Division of General Internal Medicine and Health Services Research Los Angeles, California Dr. Joseph A. Ladapo[/caption] Joseph A. Ladapo, MD, PhD David Geffen School of Medicine at UCLA Department of Medicine, Division of General Internal Medicine and Health Services Research Los Angeles, California MedicalResearch.com: What is the background for this study? What are the main findings? Response: Four million stable patients in the US undergo testing for suspected ischemic heart disease (IHD) annually. There is substantial variation in how these patients are managed by physicians, and both clinical and economic factors have been used to explain this variation. However, it is unknown whether patients’ beliefs and preferences influence management decisions, and we aimed to answer this question. Based on interviews of 351 stable patients at Geisinger Health System newly referred for cardiac stress testing/coronary computed tomographic angiography (CTA) for suspected IHD, we found that patients with an accurate understanding of their initial test result were less likely to undergo follow-up tests/procedures if the initial test was negative and more likely to undergo follow-up tests/procedures if the initial test was positive.
Author Interviews, Hospital Readmissions, JAMA, Yale / 27.12.2016

MedicalResearch.com Interview with: Nihar R. Desai, MD, MPH Assistant Professor of Medicine Section of Cardiovascular Medicine, Yale School of Medicine Center for Outcomes Research and Evaluation Yale New Haven Health System MedicalResearch.com: What is the background for this study? Response: Reducing rates of readmissions after hospitalization has been a major focus for patients, providers, payers, and policymakers because they reflect, at least partially, the quality of care and care transitions, and account for substantial costs. The Hospital Readmission Reduction Program (HRRP) was enacted under Section 3025 of the Patient Protection and Affordable Care Act (ACA) in March 2010 and imposed financial penalties beginning in October 2012 for hospitals with higher than expected readmissions for acute myocardial infarction (AMI), congestive heart failure (HF), and pneumonia among their fee-for-service Medicare beneficiaries. In recent years, readmission rates have fallen nationally, and for both target (AMI, HF, pneumonia) and non-target conditions. We were interested in determining whether the Hospital Readmission Reduction Program (HRRP) associated with different changes in readmission rates for targeted and non-targeted conditions for penalized vs non-penalized hospitals?
Author Interviews, Brigham & Women's - Harvard, Gender Differences, Hospital Readmissions, JAMA / 20.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30658" align="alignleft" width="180"]Yusuke Tsugawa, MD, MPH, PhD Department of Health Policy and Management Harvard T. H. Chan School of Public Health, Department of Medicine Brigham and Women’s Hospital and Harvard Medical School Boston, Massachusetts Dr. Yusuke Tsugawa[/caption] Yusuke Tsugawa, MD, MPH, PhD Department of Health Policy and Management Harvard T. H. Chan School of Public Health, Department of Medicine Brigham and Women’s Hospital and Harvard Medical School Boston, Massachusetts  MedicalResearch.com: What is the background for this study? What are the main findings? Response: We analyzed a 20% sample of Medicare beneficiaries hospitalized with a medical condition in 2011-2014, and found that patients treated by female doctors have lower mortality and readmission rates than those cared for by male doctors.
Author Interviews, Cost of Health Care, Johns Hopkins, Weight Research / 16.12.2016

MedicalResearch.com Interview with: Ruchi Doshi, MPH MD Candidate 2017 | Johns Hopkins University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Current guidelines recommend that physicians collaborate with non-physician health professionals to deliver weight management care. While several studies have looked at barriers physicians face in providing these services, few studies have looked at the barriers that the non-physician health professionals face. Ultimately, we found that one quarter of these health professionals found insurance coverage to be a current challenge to providing weight management care, and that over half of them felt improved coverage would help facilitate weight loss. These findings were consistent regardless of the income level of the patient populations.
Author Interviews, JAMA, Outcomes & Safety / 30.11.2016

MedicalResearch.com Interview with: Jianhui Hu, PhD Center for Health Policy & Health Services Research Henry Ford Health System Detroit, Michigan MedicalResearch.com: What is the background for this study? What are the main findings? Response: In July of 2016, the Center for Medicare and Medicaid services (CMS) released its first-ever hospital Star Rating for consumers to use to compare hospital quality. Since earlier studies have shown that hospitals serving lower-socioeconomic-status (SES) communities have lower scores on measures like readmission rate that are a part of the Star Rating system, we wanted to find out whether a similar relationship might be found between community-level SES and the Star Ratings. Our study used a recently released “stress” ranking of 150 most populated U.S cities and explored possible associations with the hospital Star Ratings. This “stress” ranking was a composite score of 27 individual metrics measuring a number of characteristics of the cities, such as job security, unemployment rate, housing affordability, poverty, mental health, physical activity, health condition, crime rate, etc. Our study found that less-stressed cities had average higher hospital Star Ratings (and more-stressed cities had lower average hospital Star Ratings). Cities such as Detroit and Newark are good examples of those with high “stress” and relatively low hospital Star Ratings, and cities like Madison and Sioux Falls of those with relatively low stress and relatively high hospital Star Ratings. Our correlational analysis indicated that around 20% of the difference in the Star Ratings can be explained by characteristics of the cities in which hospitals were located.
Author Interviews, NEJM, Outcomes & Safety, Surgical Research / 22.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29912" align="alignleft" width="200"]Alan Karthikesalingam MD PhD, NIHR Academic Clinical Lecturer in Vascular Surgery St George's Vascular Institute London, UK Dr. Alan Karthikesalingam[/caption] Alan Karthikesalingam MD PhD, NIHR Academic Clinical Lecturer in Vascular Surgery St George's Vascular Institute London, UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for this study was that the typical diameter at abdominal aortic aneurysm (AAA)  repair, and the population incidence of AAA repair, have been known to vary considerably between different countries. This study aimed to observe whether a discrepancy in the population incidence rate of AAA repair between England and the USA was seen alongside a discrepancy in population rates of AAA-related mortality or AAA rupture in those countries.
Author Interviews, BMJ, Cost of Health Care, Nursing, Outcomes & Safety, University of Pennsylvania / 16.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29710" align="alignleft" width="200"]Dr Linda H Aiken PhD, FAAN, FRCN, RN Claire M. Fagin Leadership Professor in Nursing Professor of Sociology, School of Arts & Sciences Director, Center for Health Outcomes and Policy Research University of Pennsylvania School of Nursing Center for Health Outcomes and Policy Research Philadelphia, PA 19104 Dr Linda H Aiken[/caption] Dr Linda H Aiken PhD, FAAN, FRCN, RN Claire M. Fagin Leadership Professor in Nursing Professor of Sociology, School of Arts & Sciences Director, Center for Health Outcomes and Policy Research University of Pennsylvania School of Nursing Center for Health Outcomes and Policy Research Philadelphia, PA 19104 MedicalResearch.com: What is the background for this study? Response: The idea that adding lower skilled and lower wage caregivers to hospitals instead of increasing the number of professional nurses could save money without adversely affecting care outcomes is intuitively appealing to mangers and policymakers but evidence is lacking on whether this strategy is safe or saves money.
Author Interviews, Cost of Health Care, Emory / 27.10.2016

MedicalResearch.com Interview with: [caption id="attachment_29223" align="alignleft" width="149"]Elizabeth Walker, PhD, MPH, MAT Research Assistant Professor Assistant Director of Evidence-based Learning Department of Behavioral Sciences and Health Education Rollins School of Public Health Emory University Dr. Elizabeth Walker[/caption] Elizabeth Walker, PhD, MPH, MAT Research Assistant Professor Assistant Director of Evidence-based Learning Department of Behavioral Sciences and Health Education Rollins School of Public Health Emory University MedicalResearch.com: What is the background for this study? Response: Previous research has shown that many adults in the United States have one or more chronic health condition; however, not much was known about multimorbidities – having multiple chronic conditions – among people with mental disorders. We used nationally representative data from the National Survey on Drug Use and Health to determine the patterns of co-occurrence of mental illness, substance abuse and/or dependence, and chronic medical conditions. We also examined the association between the cumulative burden of these conditions, as well as living in poverty, and self-rated health.
Author Interviews, Cost of Health Care, Orthopedics / 26.10.2016

MedicalResearch.com Interview with: [caption id="attachment_29160" align="alignleft" width="125"]Kelechi Okoroha, M.D. Orthopaedic Surgery House Officer Henry Ford Health System Dr. Kelechi Okoroha[/caption] Kelechi Okoroha, M.D. Orthopaedic Surgery House Officer Henry Ford Health System MedicalResearch.com: What is the background for this study? What are the main findings? Response: Historically, patient perceptions of surgeon reimbursement have been exaggerated compared with actual reimbursement. Currently there has been an increased focus or reducing health care cost, increasing access to health care and a shift to tie Medicare and insurance reimbursement to quality outcomes. Among these changes was the reduction in reimbursement payments for orthopedic surgeons. When we polled over 200 of our clinic patients, we found that most patients don’t think an orthopedic surgeon is overpaid but they greatly exaggerate how much a surgeon is reimbursed by Medicare for performing knee surgery. When told of the reimbursement payments, patients found them too be low and said they would be willing to pay more out-of-pocket costs. Patients also believe a surgeon should be compensated more for having fellowship training. • Nearly 90 percent of patients say physicians are not overpaid and their salaries should not be cut. • 61 percent of patients say a surgeon’s salary should not be tied to outcomes. • 79 percent of patients say reimbursement to drug and device companies should be reduced.
Author Interviews, Health Care Systems / 25.10.2016

MedicalResearch.com Interview with: [caption id="attachment_29113" align="alignleft" width="85"]Julie M. Kapp, MPH, PhD, FACE Associate Professor 2014 Baldrige Executive Fellow University of Missouri School of Medicine Department of Health Management and Informatics Columbia, MO 65212 Dr. Julie Kapp[/caption] Julie M. Kapp, MPH, PhD, FACE Associate Professor 2014 Baldrige Executive Fellow University of Missouri School of Medicine Department of Health Management and Informatics Columbia, MO 65212 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The United States lags behind its high-income peer countries on a number of critical health outcomes, including life expectancy, and this gap has been widening for the last several decades. The 2010 Patient Protection and Affordable Care Act (ACA) created a number of provisions to try to address this, including an emphasis on a systems-engineering approach to health care services. In addition to the ACA, there is a growing movement toward collective impact among community-based organizations. However, despite this focus, U.S. health and health care activities are often uncoordinated and fragmented. We applied a systems-thinking approach to U.S. population health. We used the Malcolm Baldrige Framework for Performance Excellence as the unifying conceptual systems-thinking approach. In addition to this proposed framework, we make two critical recommendations: 1) the need to drive a strategic outcomes-oriented, rather than action-oriented, approach by creating an evidence-based national reporting dashboard; and 2) improve the operational effectiveness of the workforce.
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA / 24.10.2016

MedicalResearch.com Interview with: [caption id="attachment_29100" align="alignleft" width="137"]Anna D. Sinaiko, PhD, MPP Research Scientist Department of Health Policy & Management Harvard T.H. Chan School of Public Health Boston, MA 02115 Dr. Anna D. Sinaiko[/caption] Anna D. Sinaiko, PhD, MPP Research Scientist Department of Health Policy & Management Harvard T.H. Chan School of Public Health Boston, MA 02115 MedicalResearch.com: What is the background for this study? What are the main findings? Response: One strategy for reducing health care spending in the U.S. is to increase transparency in health care pricing for patients. The idea is that patients can learn about and anticipate the prices they would pay for health care before they receive care, and incorporate that information into their choices about whether and where to receive care. When patients incorporate price information into their decisions, it gives providers an incentive to compete on price and quality. There has been a dramatic increase in the availability of health care price information over the last few years for patients who have commercial health insurance, primarily through web-based tools. In this study, we examined the impact of this information on patient choice of health care facility. We find that a small number of enrollees with commercial health insurance through Aetna, 3% overall, accessed price information through their transparency tool. Among users of the tool, patients who viewed price information for imaging services and for sleep studies before they had the service chose facilities with lower prices, and incurred lower spending (of 12%) for imaging services. We found no effect on patient choices for patients who viewed price information for 6 other health care services (carpal tunnel release, cataract/lens procedures, colonoscopy, echocardiogram, mammograms, and upper gastrointestinal endoscopy).
Author Interviews, Outcomes & Safety, Surgical Research / 18.10.2016

MedicalResearch.com Interview with: Vishal Sarwahi, MD, senior author Associate Surgeon-in-Chief Chief, Spinal Deformity and Pediatric Orthopaedics Billie and George Ross center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery Cohen's Children Medical Center Northwell Hofstra School of Medicine and [caption id="attachment_28960" align="alignleft" width="125"]Stephen F. Wendolowski Research Assistant Pediatric Orthopaedics Cohen Children’s Medical Center New Hyde Park, NY, 11040 Stephen F. Wendolowski[/caption] Stephen F. Wendolowski Research Assistant Pediatric Orthopaedics Cohen Children’s Medical Center New Hyde Park, NY, 11040 MedicalResearch.com: What is LEAN? Response: LEAN is a management principle that supports the concept of continuous improvement through small incremental changes to not only improve efficiency, but also quality. Particularly, we took interest in the 5S’s – Sort, Simplify, Sweep, Standardize, and Self-Discipline. We felt that Sort, Simplify, and Standardize were the most relevant to surgery.
Author Interviews, JAMA, Outcomes & Safety / 17.10.2016

MedicalResearch.com Interview with: [caption id="attachment_28930" align="alignleft" width="180"]David Michael Levine M.D.,M.A. Division of General Internal Medicine and Primary Care Brigham and Women’s Hospital Boston, Massachusetts Dr. David Levine[/caption] David Michael Levine M.D.,M.A. Division of General Internal Medicine and Primary Care Brigham and Women’s Hospital Boston, Massachusetts MedicalResearch.com: What is the background for this study? What are the main findings? Response: About a decade ago, researchers showed that Americans only received half of recommended health care. Since then, national, regional, and local initiatives have attempted to improve quality and patient experience, but there is incomplete information about whether such efforts have been successful. We found that over the past decade the quality of outpatient care has not consistently improved, while patient experience has improved.
Author Interviews, Brigham & Women's - Harvard, JAMA, Technology / 12.10.2016

MedicalResearch.com Interview with: [caption id="attachment_28621" align="alignleft" width="200"]Ateev Mehrotra, M.D. Associate Professor Department of Health Care Policy Harvard Medical School Dr. Ateev Mehrotra[/caption] Ateev Mehrotra, M.D. Associate Professor Department of Health Care Policy Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prior research has highlighted that physicians make diagnostic errors roughly 10 to 15 percent of the time. Over the last two decades, computer-based checklists and other “fail-safe” digital apps have been increasingly used to reduce medication errors or streamline infection-prevention protocols. Lately, experts have wondered whether computers might also help reduce diagnostic errors. In the study, 234 internal medicine physicians were asked to evaluate 45 clinical cases, involving both common and uncommon conditions with varying degrees of severity. For each case, physicians had to identify the most likely diagnosis along with two additional possible diagnoses. Each clinical vignette was solved by at least 20 physicians. The same cases were also evaluated using 19 symptom checkers, websites or apps that use computers that help patients determine potential diagnoses for what is wrong based on their symptoms. The physicians vastly outperformed the symptom-checker apps, listing the correct diagnosis 72 percent of the time, compared with 34 percent of the time for the digital platforms. Eighty-four percent of clinicians listed the correct diagnosis in the top three possibilities, compared with 51 percent for the digital symptom-checkers.
Author Interviews, Cancer Research, Cost of Health Care, JAMA, Pharmacology / 12.10.2016

[caption id="attachment_28580" align="alignleft" width="200"]MedicalResearch.com Interview with: Dr. Sham Mailankody, MBBS Dr. Sham Mailankody[/caption] MedicalResearch.com Interview with: Dr. Sham Mailankody, MBBS Memorial Sloan Kettering Cancer Center MedicalResearch.com: What is the background for this study? Response: The high price of older drugs has been increasingly criticized in part because of recent dramatic price hikes. There are some well known examples like pyrimethamine and more recently EpiPen. Whether and to what degree examples like pyrimethamine represent a common problem or exceptional cases remains unknown. Using Medicare data available for Part B, we sought to analyze the change in average sales price of cancer drugs between January 2010 and January 2015, and whether older drugs were more likely to undergo price increases than newer drugs.
Author Interviews, Cost of Health Care / 12.10.2016

MedicalResearch.com Interview with: [caption id="attachment_28776" align="alignleft" width="125"]Daniel G. Aaron, BS Department of Community Health Sciences Boston University School of Public Health Boston MA 02118 Daniel Aaron[/caption] Daniel G. Aaron, BS Department of Community Health Sciences Boston University School of Public Health Boston MA 02118 MedicalResearch.com: What is the background for this study? Response: The study began with the co-author and me noticing a few sponsorships of health organizations by Coca-Cola and Pepsi. This drove our curiosity to find out how pervasive these sponsorships were and what they meant for public health. MedicalResearch.com: What are the main findings? Response: The main findings are the shear pervasiveness of soda company sponsorships of health organizations, as well as the anti-public health lobbying of the Coca-Cola Company and PepsiCo.
Author Interviews, JAMA, Supplements / 11.10.2016

MedicalResearch.com Interview with: [caption id="attachment_28740" align="alignleft" width="200"]Elizabeth D. Kantor, PhD MPH Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center NY, NY Dr. Elizabeth D. Kantor[/caption] Elizabeth D. Kantor, PhD MPH Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center NY, NY MedicalResearch.com: What is the background for this study? Response: Prior studies show that use of supplements increased between the 1980s and mid-2000s, and despite much research conducted on the health effects of supplements, we know little about recent trends in use. Given this gap, we decided to create an up-to-date, comprehensive resource on the prevalence and trends of supplement use among US adults using nationally representative data from the National Health and Nutrition Examination Survey (NHANES). Data were collected over seven continuous cycles (from 1999-2000 to 2011-2012).
Author Interviews, Outcomes & Safety / 11.10.2016

MedicalResearch.com Interview with: Bala N. Hota, MD Department of Internal Medicine Rush Medical College Chicago, IL MedicalResearch.com: What is the background for this study? Response: There has been a proliferation of online ranking systems that seek to rate the quality of health care systems. Rush University Medical Center (RUMC) has consistently scored highly on patient safety measurement systems. For example, RUMC has received nine consecutive “A” grades for safety from the Leapfrog Group, and was recently ranked “4 stars” in the CMS 2016 star ranking system. In the 2015-2016 US News and World Report Ranking System, however, Rush received a low score for quality, a 1 out of 5 possible points, which was a surprise. To understand these results, the RUMC quality team began a process to validate the data and methods of the US News hospital ranking system. What was found was a surprise – the data backing the ranking system produced by US News had flaws, leading to the low score. Specifically, data were missing from the data set used for the US News analysis, including whether a condition was present on admission in 10% of cases; dates of service were also missing from all cases. The quality team at RUMC then conducted an analysis using national data, and simulated the impact of these data flaws on national rankings.
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