Author Interviews, Diabetes, JAMA / 03.10.2016

MedicalResearch.com Interview with: Dr. Saeid Shahraz Assistant Professor of Medicine Tufts Medical Center MedicalResearch.com: What is the background for this study? Response: American Diabetes Association (ADA) has set up a lower cut point for diagnosing prediabetes ( those with Impaired Fasting  Glucose   100 mg/dL) compared to the World Health Organization's cut point, which is 110 mg/dL. This arbitrariness in cut point definition triples the number of cases labeled as prediabetes. Along with lowering the diagnostic threshold by the ADA, the Centers for Disease Control and Prevention (CDC), the American Medical Association (AMA), and the ADA endorsed and advertised a web-based risk model to define high-risk population for prediabetes. The risk engine asks a few questions ( age, sex, family history of diabetes, history of gestational diabetes and high blood pressure, physical activity and weight) and outputs a score that defines if the person is at risk for prediabetes. We suspected that the risk engine might overestimate the risk. (more…)
Author Interviews, Cost of Health Care, Health Care Systems, JAMA / 14.09.2016

MedicalResearch.com Interview with: Gillian D. Sanders-Schmidler Ph.D. Professor of Medicine Duke Evidence Synthesis Group, Director Duke Evidence-based Practice Center, Director Duke Clinical Research Institute Duke University MedicalResearch.com: What is the background for this study? Response: In 1996, the original panel on cost effectiveness in health and medicine published recommendations for the use of cost effectiveness analysis. During the 20 years since the original panel’s report, the field of cost-effectiveness analysis has advanced in important ways and the need to deliver health care efficiently has only grown. In 2012 the Second Panel on Cost Effectiveness in health and Medicine was formed with a goal of reviewing and updating the recommendations. This paper summarizes those recommendations. This process provided an opportunity for the Panel to reflect on the evolution of cost-effectiveness analysis and to provide guidance for the next generation of practitioners and consumers. (more…)
Author Interviews, Columbia, Cost of Health Care, Health Care Systems / 11.09.2016

MedicalResearch.com Interview with: Peter Muennig, MD, MPH Associate Professor Mailman School of Public Health Columbia University New York, NY 10032 MedicalResearch.com: What is the background for this study? What are the main findings? Response: We looked that the supplemental Earned Income Tax Credit ( EITC ) programs offered by states to determine whether they have health impacts or not. We found that, on average, folks who live in states that offer supplemental EITC showed improvements in health after EITC was implemented. (more…)
AHA Journals, Author Interviews, Heart Disease, Hospital Readmissions, Outcomes & Safety / 09.09.2016

MedicalResearch.com Interview with: Sheila Eckenrode, RN, CPHQ Project Manager Medicare Patient Safety Monitoring System (MPSMS) Qualidigm MedicalResearch.com: What is the background for this study? What are the main findings? Response: We sought to investigate the association at the hospital-level between 21 in-hospital adverse event rates and both mortality and readmission rates for Medicare Fee-For-Service patients with AMI. We used data from the Medicare Patient Safety Monitoring System (MPSMS), the nation's largest randomly selected hospital medical record-abstracted patient safety database, and data from the Centers for Medicare & Medicaid Services, which includes hospital performance on mortality and readmissions for over 4,000 Medicare-certified hospitals, to assess the association between hospital performance on patient safety and hospital performance on 30-day all-cause mortality and readmissions for Medicare fee-for-service patients discharged with AMI. We found that hospital performance on patient safety is associated with hospital performance on mortality and readmission rates for AMI. Hospitals with poorer patient safety performance are likely to have higher 30-day all-cause mortality and readmission rates for these patients. (more…)
Author Interviews, Health Care Systems, JAMA / 09.09.2016

MedicalResearch.com Interview with: Andrew C. Eppstein, MD, FACS Assistant Professor of Clinical Surgery Indiana University School of Medicine Department of Surgery, Division of General Surgery Richard L. Roudebush VA Medical Center Indianapolis, Indiana MedicalResearch.com: What is the background for this study? What are the main findings? Response: A few years ago we encountered long wait times for patients undergoing elective general surgery in our tertiary care VA medical center. Demand had grown and our existing systems were not able to accommodate surgical patients in a timely fashion. By fiscal year (FY) 2012, our wait times averaged 33 days, though patients with malignancies would be moved to the head of the line, pushing more elective cases further back. To address rising demand and worsening wait times, our Surgery Service convened an analysis of our processes using Lean methodology in collaboration with the Systems Redesign Service. Multidisciplinary meetings were held in 2013 to analyze inefficiencies in the current system and ways to address them to create a streamlined, ideal system. The collaborations included surgeons, nurses, ancillary staff, operating room and sterile processing staff, and hospital administration. Projects were rolled out stepwise in mid-2013 under General Surgery, the busiest surgical service at our institution. We noted a sharp decline in patient wait times after initiation of reforms such as improved OR flexibility, scheduling process changes, standardization of work within the department, and improved communication practices. These wait times dropped to 26 days in FY 2013 and further to 12 days in FY 2014, while operating volume and overall outpatient evaluations increased, with decreased no-shows to clinic. Our decreased wait times were sustained through the remainder of the observed period. (more…)
Author Interviews, Cost of Health Care, Weight Research / 02.09.2016

MedicalResearch.com Interview with: John A. Batsis, MD, FACP, AGSF Associate Professor of Medicine and The Dartmouth Institute Geisel School of Medicine at Dartmouth Section of General Internal Medicine - 3M Dartmouth-Hitchcock Medical Center Lebanon, NH MedicalResearch.com: What is the background for this study? Response: In 2011, the Centers for Medicare and Medicaid implemented a regulatory coverage benefit to cover 22 brief, targeted 15-minute counseling visits by clinicians over the course of a 12-month period for Medicare beneficiaries with a body mass index exceeding 30kg/m2. This was an important policy determination in tackling the obesity epidemic in the United States. An emphasis on the importance of counseling, or intensive behavioral therapy, in a primary care setting set the foundation for this benefit. Yet, it was unclear how and if this benefit (which would be free of charge without a copay or deductible for beneficiaries) was being implemented in clinical care. We therefore identified fee-for-service Medicare claims for the years 2012 and 2013 to determine whether the G0477 code (Medicare Obesity benefit code) was billed. We additionally explored the rate of uptake of the Medicare benefit in relation to the prevalence of obesity using the 2012 Behavior Risk Factor Surveillance System data. (more…)
Author Interviews, Education, JAMA / 30.08.2016

MedicalResearch.com Interview with: Daniel J. Morgan M.D., M.S Associate Professor Epidemiology & Public Health University of Maryland School of Medicine MedicalResearch.com: What is the background for this study? Response: Physicians are generally taught if a treatment is indicated, not how well the treatment works. Although this has been part of evidence based medical training, doctors still perform poorly with ability to understand risk and how treatment limits risk (Bayesian reasoning). Many publications focus on relative risk reduction which inflates the perception of an effect over the more accurate absolute risk reduction. (more…)
Author Interviews, Brigham & Women's - Harvard, Electronic Records, JAMA, Outcomes & Safety / 04.08.2016

MedicalResearch.com Interview with: Stephanie Mueller, MD MPH FHM Division of General Medicine Brigham and Women's Hospital Boston, MA 02120 MedicalResearch.com: What is the background for this study?  Response: Failures in communication among healthcare personnel are known threats to patient safety, and occur all too commonly during times of care transition, such as when patient care responsibility is transferred from one provider to another (i.e., handoff). Such failures in communication put patients at risk for adverse outcomes. (more…)
Author Interviews, BMJ / 06.07.2016

MedicalResearch.com Interview with: Professor Tom Bourne Ph.D., FRCOG, FAIUM (hon). Adjunct Professor, Imperial College, London Visiting Professor, KU Leuven, Belgium Consultant Gynaecologist Queen Charlotte's and Chelsea Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous studies had suggested that complaint investigations might be associated with psychiatric morbidity – including depression and suicide. For example in the United States, malpractice litigation has been reported to be associated with burnout, depression and suicidal ideation. We had also witnessed in our daily practice both the burden that complaints investigations have on colleagues, but also that doctors were often practicing defensive medicine to “protect themselves”. Against this background we embarked on a large survey study on doctors in the UK – with almost 8000 physicians replying to the survey. This survey contained questions relating to validated psychological instruments for depression and anxiety, new metrics for defensive practice (hedging and avoidance) as well as single item questions. We published these data in 20151. We found that recent or current complaints were associated with significant levels or anxiety, depression and suicidal ideation, this was irrespective of the complaints procedure – although this was highest when it involved the main UK regulator the general medical council (GMC). Many doctors reported practising defensive medicine due to a fear of complaints – with over 80% reporting hedging and over 40% reporting avoidance. A number of recommendations were made to improve how complaints procedures might work. In the final part of the questionnaire we asked three open questions, how the complaints procedure made the doctor feel, what was the most stressful aspects of the procedure and what could be done to improve things. It is the analysis of this qualitative data that is presented in the current paper. (more…)
Author Interviews, Cost of Health Care, Emergency Care, Health Care Systems / 17.10.2015

MedicalResearch.com Interview with: James Galipeau PhD Ottawa Hospital Research Institute Ottawa, Ontario, Canada  Medical Research: What is the background for this study? Dr. Galipeau: Overcrowding in emergency departments (EDs) is becoming more and more commonplace in Canada. The issue of overcrowding is complex and multidimensional with three distinct but interdependent components: input, throughput (processing), and output. At the processing level, one solution to overcrowding that has emerged is the establishment of observation/short stay units. A short-stay unit is a physical location in a hospital, usually in close proximity to the ED. Patients needing treatments or observation that may take several hours to resolve (e.g., blood transfusions, diagnostic testing, arranging social services) can be accommodated in a short-stay unit without occupying ED beds or needing to be admitted. In theory, ED-based short-stay units can lessen ED overcrowding by influencing outcomes such as ED wait times and hospital costs (if patients are moved from the ED to inpatient care). Although a recent report by the American College of Emergency Physicians recommends pursuing the use of short-stay units to alleviate ED overcrowding, there is a lack of evidence syntheses summarizing their effectiveness, safety, and value for money. Our objective was to conduct a systematic review to evaluate the effectiveness and safety of ED short-stay units compared with care not involving short-stay units. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, PLoS / 14.10.2015

MedicalResearch.com Interview with: James E. Stahl, MD Senior Scientist Assistant Professor of Medicine, Harvard Medical School MGH Institute for Technology Assessment Medical Research: What is the background for this study? What are the main findings? Dr. Stahl: Poor psychological and physical resilience in response to stress drives a great deal of health care utilization. Mind-body interventions can reduce stress and build resiliency. Over the last few decades we have seen substantial evidence that evoking the relaxation response helps the heart, blood pressure, reduces inflammation and creates changes all the way down to the epigenetic level. We have not until now had a broad look at the effect at the health systems level. The rationale for this study is therefore to estimate the effect of mind-body interventions on healthcare utilization. The main findings are that looking at a broad population these tools, and specifically the relaxation response and resiliency training offered at the BHI, results in real world reductions in health care utilization. (more…)
Author Interviews, Baylor College of Medicine Houston, Health Care Systems, Heart Disease, JACC / 14.10.2015

MedicalResearch.com Interview with: Salim S. Virani, M.D., Ph.D Investigator, Health Policy, Quality & Informatics Program, Center for Innovations in Quality, Effectiveness and Safety, Staff Cardiologist, Michael E. DeBakey VA Medical Center Associate Director for Research, Cardiology Fellowship Training Program Associate Professor (tenured), Section of Cardiovascular Research Baylor College of Medicine  Houston Medical Research: What is the background for this study? What are the main findings? Dr. Virani: The increase in Americans securing health care coverage under the Affordable Care Act, in combination with a projected shortage of specialty and non-specialty physicians, has led to a growing pressure on the existing physician workforce in America.  One proposed solution is to increase the scope of practice for advanced practice providers (APPs) (nurse practitioners [NPs] and physician assistants [PAs].  An important aspect of this discussion is whether the quality of care provided by APPs is comparable to that provided by physicians. The study utilized data from the American College of Cardiology’s (ACC) National Cardiovascular Data Registry PINNACLE Registry® to examine whether there were clinically meaningful differences in the quality of coronary artery disease (CAD), heart failure (HF), and atrial fibrillation (AF) care delivered by advanced practice providers  versus physicians in a national sample of cardiology practices. The primary analyses included 883 providers (716 physicians and 167 APPs) in 41 practices who cared for 459,669 patients. The mean number of patients seen by APPs (260.7) was lower compared to that seen by physicians (581.2). Compliance with most CAD, HF, and AF measures was comparable, except for a higher rate of smoking cessation screening and intervention (adjusted rate ratio [RR] 1.14, 95% CI 1.03-1.26) and cardiac rehabilitation referral (RR 1.40, 95% CI 1.16-1.70) among CAD patients receiving care from APPs. Compliance with all eligible CAD measures was low for both (12.1% and 12.2% for APPs and physicians, respectively) with no significant difference. Results were consistent when comparing practices with both physicians and APPs (n = 41) and physician-only practices (n = 49). (more…)
Author Interviews, Dermatology, JAMA, Melanoma / 12.10.2015

Eleni Linos, MD DrPH, MPH Assistant Professor UCSF School of MedicineMedicalResearch.com Interview with: Eleni Linos, MD DrPH, MPH Assistant Professor UCSF School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Linos: Google offers a remarkable service for non-profit organizations-in our case we used AdWords, Google’s keyword-specific advertising service, to disseminate skin cancer prevention messages to people searching for tanning. Our question was simple: can we send a skin cancer prevention message to someone who is searching for information about tanning beds online? From this preliminary data we found that it is possible to use online advertising to reach a large, targeted audience with specific health messages. Or Online advertising for prevention is a brand new concept. It builds on the knowledge of online advertisers and marketers-and uses this knowledge for good. We hope other social media and technology companies will join this effort to provide precise, tailored health messages to those who need them the most. Marketing is a powerful tool when it comes to getting the message out to a larger audience. As we are thinking of using Google Ads for our services, we were recommended to compare Adwords software and tools, as it would make the decision of finding the right software a lot easier. As technology becomes apparent within businesses, it makes sense for us and other companies to use this to their advantage. (more…)
Author Interviews, BMJ, Cost of Health Care, Education, Health Care Systems, University of Pittsburgh / 30.09.2015

Timothy Anderson, M.D. Chief medical resident University of Pittsburgh’s Department of Internal MedicineMedicalResearch.com Interview with: Timothy Anderson, M.D. Chief medical resident Department of Internal Medicine University of Pittsburgh Medical Research: What is the background for this study? What are the main findings? Dr. Anderson: My coauthors and I analyzed the public disclosures of all publicly traded U.S. health care companies listed on the NASDAQ exchange and New York Stock Exchange in January 2014 that specialized in pharmaceuticals, biotechnology, medical equipment and providing health care services.  Of the 442 companies with publicly accessible disclosures on boards of directors, 180 – or 41 percent – had one or more academically affiliated directors in 2013. These individuals included chief executive officers, vice presidents, presidents, provosts, chancellors, medical school deans, professors and trustees from 85 non-profit academic research and health care institutions. These individuals received compensation and stock shares from companies which far exceeds payment for other relationships such as consulting. In some cases compensation approaches or exceeds average professor and physician salaries. (more…)
Author Interviews, Health Care Systems, Outcomes & Safety / 12.09.2015

Megan Colleen McHugh, PhD Research Assistant Professor Center for Healthcare Studies Institute for Public Health and Medicine and Emergency Medicine Northwestern UniversityMedicalResearch.com Interview with: Megan Colleen McHugh, PhD Research Assistant Professor Center for Healthcare Studies Feinberg Institute for Public Health and Medicine and Emergency Medicine Northwestern University   Medical Research: What is the background for this study? What are the main findings? Dr. McHugh: There have been many large efforts to improve the delivery of health care in the U.S., for example, the Robert Wood Johnson Foundation’s Aligning Forces for Quality Program and the Institute for Healthcare Improvement’s 100,000 Lives Campaign.  One of the challenges to understanding whether these programs work is that the intervention “dose” – the quality and quantity of the intervention – often varies across different participating sites. As evaluators of multi-site quality improvement programs, we want to better understand how to measure the dose of a quality improvement intervention at participating sites.  We identified four different approaches to measuring dose.  These approaches resulted in different conclusions about which sites are “low dose” and “high dose” intervention sites. Medical Research: What should clinicians and patients take away from your report? Dr. McHugh: The main audience for this paper is program evaluators.  They should take away the following: 1) Variation in dose scores across intervention sites suggests that dose may be a contributor to the effectiveness of a quality improvement intervention. 2) It is feasible to measure the dose of a quality improvement intervention, but measuring QI dose presents many challenges, including subjective decisions about which approach to measurement to use and the need for extensive data collection. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA / 28.07.2015

Benjamin D. Sommers, MD, PhD Assistant Professor of Health Policy & Economics Harvard T. H. Chan School of Public Health / Brigham & Women's Hospital Boston, MA 02115MedicalResearch.com Interview with: Benjamin D. Sommers, MD, PhD Assistant Professor of Health Policy & Economics Harvard T. H. Chan School of Public Health / Brigham & Women's Hospital Boston, MA 02115 Medical Research: What is the background for this study? What are the main findings? Response: The Affordable Care Act (ACA) expanded insurance options for millions of adults, via an expansion of Medicaid and the new health insurance Marketplaces, which had their first open enrollment period beginning in October 2013.  We used a large national survey to assess the changes in health insurance, access to care, and self-reported health since these expansions began.  What we found is that the beginning of the ACA’s open enrollment period in 2013 was associated with significant improvements in the trends of insurance coverage, access to primary care and medications, affordability of care, and self-reported health.  Among low-income adults in Medicaid expansion states, the ACA was associated with improvements in coverage and access to care, compared to non-expansion states. Gains in coverage and access to medicines were largest among racial and ethnic minorities. (more…)
Author Interviews, Education, Electronic Records, PLoS, UCSF / 17.07.2015

Dr. Courtney Lyles Ph.D. Assistant Professor UCSF School of MedicineMedicalResearch.com Interview with: Dr. Courtney Lyles Ph.D. Assistant Professor UCSF School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Lyles: In our commentary (http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001852), we describe the Meaningful Use program sponsored by the federal government to incentivize healthcare systems to implement electronic health records (EHRs).  This Meaningful Use program also includes financial incentives for healthcare systems who can get substantial proportions of their patient population to access their electronic health records – that is, by logging into an online patient portal website to view medical information like lab results or immunization lists or to perform a healthcare task like requesting a medication refill or messaging their provider.  Because there are billions of dollars at stake in this program for EHR implementation, there is a lot of attention on this issue right now.  Many thought leaders are discussing how we can transform healthcare by digitizing medical information and connecting with patients in their everyday life outside of office or hospital visits.  Portals are key to a lot of changes we might make in healthcare delivery in an attempt to increase convenience and satisfaction for patients.  Perhaps most importantly, these online portal websites are also one of the first health technologies that will be relatively uniformly distributed across healthcare settings, from private doctor’s offices to public clinics/hospitals serving vulnerable patient populations. However, our main message is that we in the medical and healthcare fields should be paying more attention to how patients are able to understand and use the information provided through portal websites.  There is a lot of evidence that patients who have lower education/income, are from racial/ethnic minority groups, or have limited health literacy are significantly less likely to use the existing portal websites.  There is also evidence that portal websites are not extremely usable or accessible, which is an additional barrier for those with communication barriers like lower literacy or limited English proficiency.  Therefore, we don’t want widespread EHR implementation to result in only the most well-resourced individuals gaining the potential benefits of portal access. (more…)
Author Interviews, Cost of Health Care, Primary Care / 15.05.2015

Judith Hibbard, Ph.D. Senior Researcher, Health Policy Research Group University of OregonMedicalResearch.com Interview with: Judith Hibbard, Ph.D. Senior Researcher, Health Policy Research Group University of Oregon MedicalResearch: What is the background for this study? What are the main findings? Dr. Hibbard: Two important trends are happening in health care today: 1) Policies which move away from paying for volume and toward paying for value; and 2) The emphasis on patient engagement and the need for the patient to play a key part in the care process. Because so many quality outcomes are determined to a large extent by patient behaviors, there is an implied assumption that if you pay primary care clinicians (PCPs) more for better quality outcomes, they will also try to engage the patient as a necessary partner in reaching quality targets. That is, there is a tacit assumption that clinicians will naturally engage patients if you incentivize them on the quality metrics. We had an opportunity to examine the soundness of this assumption, when we conducted a study of primary care clinicians whose compensation was based 40% on their performance of quality metrics. The findings show that the vast majority of clinicians did not invest their efforts in patient engagement and activation, when trying to maximize their income under this model. They put their efforts in other areas. However, a year later they were very frustrated that their income was influenced by patient behaviors. This was their greatest frustration with the compensation model, and they indicated that “patient’s unwillingness to change their behavior” as the greatest barrier to achieving their quality goals. (more…)
Author Interviews, Brigham & Women's - Harvard, Electronic Records, JACC, Stroke / 11.05.2015

Dr. Karen E. Joynt, MD MPH Cardiovascular Division Brigham and Women's Hospital and VA Boston Healthcare System Department of Health Policy and Management, Harvard School of Public HealthMedicalResearch.com Interview with: Karen E. Joynt, MD MPH Cardiovascular Division, Brigham and Women's Hospital and VA Boston Healthcare System Department of Health Policy and Management Harvard T.H. Chan School of Public Health MedicalResearch: What is the background for this study?  What are the main findings? Dr. Joynt: While there is a great deal of optimism about the potential of Electronic Health Records (EHRs) to improve health care, there is little national data examining whether hospitals that have implemented EHRs have higher-quality care or better patient outcomes.  We used national data on 626,473 patients with ischemic stroke to compare quality and outcomes between hospitals with versus without EHRs.  We found no difference in quality of care, discharge home (a marker of good functional status), or in-hospital mortality between hospital with versus without EHRs.  We did find that the chances of having a long length of stay were slightly lower in hospitals with EHRs than those without them. (more…)
Author Interviews, Cost of Health Care / 13.02.2015

John Romley Ph.D Economist at the Leonard D. Schaeffer Center for Health Policy and Economics Research Assistant Professor Sol Price School of Public Policy University of Southern California, Los Angeles.MedicalResearch.com Interview with: John Romley Ph.D Economist at the Leonard D. Schaeffer Center for Health Policy and Economics Research Assistant Professor Sol Price School of Public Policy University of Southern California, Los Angeles. MedicalResearch: What is the background for this study? What are the main findings? Dr. Romley: The need for better value in US health care is widely recognized. Existing evidence suggests that improvement in the productivity of American hospitals—that is, the output that hospitals produce from inputs such as labor and capital—has lagged behind that of other industries. However, previous studies have not adequately addressed quality of care or severity of patient illness. Our study, by contrast, adjusts for trends in the severity of patients’ conditions and health outcomes. We studied productivity growth among US hospitals in treating Medicare patients with heart attack, heart failure, and pneumonia during 2002–11. We found that the rates of annual productivity growth were 0.78 percent for heart attack, 0.62 percent for heart failure, and 1.90 percent for pneumonia. (more…)
Author Interviews, Brigham & Women's - Harvard, Diabetes, JAMA / 02.01.2015

Seth A. Berkowitz, MD, MPH Division of General Internal Medicine Massachusetts General Hospital, BostonMedicalResearch.com Interview with: Seth A. Berkowitz, MD, MPH Division of General Internal Medicine Massachusetts General Hospital, Boston Medical Research: What is the background for this study? What are the main findings? Dr. Berkowitz: Prior studies had looked the association between single unmet basic material needs and diabetes control, but hadn't necessarily looked at multiple things people may not be able to afford, which more closely mirrors real-life. Also, prior studies had been done in a 'pre-Affordable Care Act' setting, while, by being in Massachusetts, our study was conducted in a setting of near-universal healthcare coverage that is similar to what the rest of the US is moving towards. We found that difficulties meeting basic material needs, such as difficulties affording food, known as food insecurity, and having financial barriers to taking medications, called cost-related medication underuse, are associated with worse diabetes control and increased use of costly health services in diabetes patients, despite near-universal health insurance coverage (more…)
Author Interviews, Health Care Systems / 23.10.2014

Dr. Steffie Woolhandler MD MPH Professor of Public Health and City University of New York, Lecturer (formerly Professor of Medicine) at Harvard Medical School Primary Care Physician Practicing in the South BronxMedicalResearch.com Interview with: Dr. Steffie Woolhandler MD MPH Professor of Public Health and City University of New York, Lecturer (formerly Professor of Medicine) at Harvard Medical School Primary Care Physician Practicing in the South Bronx Medical Research: What is the background for this study? Dr. Woolhandler: Physicians like myself are extremely frustrated by the administrative burdens of medical practice. Many hours of physicians’ time each week go to administrative work completely unrelated to good patient care, but mandated by private insurers and other payers. Colleagues often tell me that they love seeing patients but are getting burned out by the paperwork. (more…)
Author Interviews, Pulmonary Disease, Race/Ethnic Diversity / 23.10.2014

Nandita Bhan, ScD MSc MA Research Scientist & Adjunct Assistant Professor Public Health Foundation of India (PHFI)MedicalResearch.com Interview with: Nandita Bhan, ScD MSc MA Research Scientist & Adjunct Assistant Professor Public Health Foundation of India (PHFI) Medical Research: What are the main findings of the study? Dr. Bhan: We found that the last decade in the US has seen a rise in racial/ethnic disparities in asthma. Compared to Non-Hispanic White populations, greater rates of asthma were seen among African Americans and lower rates among Hispanic populations. But more importantly, we found that it is not just a question of who you are, but where you live. Results showed heterogeneity by region and place of origin - highlighting that it will be simplistic to assume that asthma rates for Hispanic populations are the same across all states in the US. While data is unable to explore further granularity by ethnicity, our results add to the developing evidence that state policies and politics have impacts on socioeconomic and racial/ethnic inequalities manifesting in health disparities in the US. (more…)
AHA Journals, Author Interviews, Nutrition / 23.10.2014

Mary Ann Honors, Ph.D. Postdoctoral Research Fellow Division of Epidemiology and Community Health University of MinnesotaMedicalResearch.com Interview with: Mary Ann Honors, Ph.D. Postdoctoral Research Fellow Division of Epidemiology and Community Health University of Minnesota Medical Research: What are the main findings of the study? Dr. Honors: The American Heart Association and USDA have made recommendations on what we should and should not eat in order in reduce our cardiovascular disease risk. We wanted to know whether Americans are currently meeting these recommendations, as well as how our diets have changed over time. In particular, we were interested in several specific nutrients, including trans fats, saturated fats, and the omega-3 fatty acids, DHA and EPA. We examined trends in fatty acid intake in participants from the Minnesota Heart Survey. The Minnesota Heart Survey is a an ongoing, cross-sectional study of adults in the Minneapolis-St. Paul metro area that was designed to monitor cardiovascular disease risk factors, including diet. We found that intake of trans fats and saturated fats has declined substantially over the last 30 years. However, intake levels are still above current recommendations. With DHA and EPA, we found that levels of intake were pretty steady over time and below what is recommended. Overall, while we saw some encourage trends, there is still some room for improvement in our diets. (more…)
Author Interviews, Cancer Research, Journal Clinical Oncology, MD Anderson / 21.10.2014

MedicalResearch.com Interview with: Joanna-Grace M. Manzano, MD Assistant Professor Department of General Internal Medicine Maria E. Suarez-Almazor, MD, PhD Barnts Family Distinguished Professor Chief, Section of Rheumatology & Deputy Chair, Dept. of General  Internal Medicine UT MD Anderson Cancer Center Houston, TX Medical Research: What are the main findings of the study? Response: Our study established that unplanned hospitalization among elderly patients with GI cancer are very common – 93 events per 100-person years. Certain characteristics were found to have an increased risk for an unplanned hospitalization in our cohort, namely: older age, black race, advanced disease, higher comorbidity score, residing in poor neighborhoods and dual eligibility for Medicare and Medicaid. Esophageal and gastric cancer had the highest risk for unplanned hospitalization among all GI cancer types. Some of the observed reasons for unplanned hospitalization were potentially preventable and related to the patient’s comorbid illness. (more…)
Author Interviews, Primary Care, Race/Ethnic Diversity / 19.10.2014

Arjumand Siddiqi, Sc.D., Assistant Professor Departments of Epidemiology and Social and Behavioral Sciences Dalla Lana School of Public Health University of Toronto Toronto, Ontario CanadaMedicalResearch.com Interview with: Arjumand Siddiqi, Sc.D., Assistant Professor Departments of Epidemiology and Social and Behavioral Sciences Dalla Lana School of Public Health University of Toronto Toronto, Ontario Canada MedicalResearch: What are the main findings of the study? Dr. Siddiqi: The main finding of the study is that, in a society with universal health insurance (Canada), racial disparities in access to primary care are drastically reduced, with some important exceptions. (more…)
Outcomes & Safety, Surgical Research / 16.10.2014

Terrence Loftus, MD, MBA, FACS Medical Director, Surgical Service & Clinical Resources Banner Health Phoenix, Arizona 85006Medical Research.com Interview with: Terrence Loftus, MD, MBA, FACS Medical Director, Surgical Service & Clinical Resources Banner Health Phoenix, Arizona 85006 Medical Research: What are the main findings of the study? Dr. Loftus: This study demonstrated that a standardized safe surgery program effectively and systematically implemented across a diverse healthcare system resulted in a significant reduction in serious reportable events (SREs), thereby improving the quality of patient care and leading to significant cost avoidance.   For the purposes of the study, SREs were defined as any reported retained surgical item, wrong site, wrong patient or wrong procedure event. Following implementation of the Safe Surgery Program there was a 52% reduction in the SRE rate in the operating rooms and L&D areas in our system. The most dramatic change and greatest area of improvement was in wrong site events which demonstrated a 70% reduction for this type of serious reportable events. This was achieved through a Safe Surgery Program which consisted of three main components.
  • The first component was patient focused procedures. These are steps designed to prevent wrong site, wrong patient or wrong procedure events.
  • The second component was sponge, sharp and instrument count procedures. These are steps designed to prevent retained surgical items.
  • The final component was monthly observational audits that were performed to assess program compliance. (more…)
Accidents & Violence, Author Interviews, JAMA / 16.10.2014

Richard M. Costanzo, PhD. Professor of Physiology and Biophysics and Special Assistant to the Vice President for Research Virginia Commonwealth UniversityMedicalResearch.com Interview with: Richard M. Costanzo, PhD. Professor of Physiology and Biophysics and Special Assistant to the Vice President for Research Virginia Commonwealth University Medical Research: What are the main findings of the study? Dr. Costanzo: In this study we found that individuals with varying degrees olfactory impairment have an increased risk of experiencing a hazardous event.  Those with complete loss (anosmia) were three times more likely to experience an event than those with normal olfactory function.  Factors such as age,sex, and race were found to affect an individual’s risk. (more…)
Author Interviews, CDC, JAMA, Tobacco / 15.10.2014

Dr. Brian Rostron PhD, MPH Center for Tobacco Products US Food and Drug Administration Silver Spring, MarylandMedicalResearch.com Interview with: Dr. Brian Rostron PhD, MPH Center for Tobacco Products US Food and Drug Administration Silver Spring, Maryland Medical Research: What are the main findings of the study? Dr. Rostron: We estimated that Americans in 2009 had had 14 million major medical conditions such as heart attack, stroke, lung cancer, and COPD that were attributable to smoking.  COPD was the leading cause of smoking-attributable morbidity, with over 7.5 million cases of COPD attributable to smoking. (more…)
Accidents & Violence, Author Interviews, Frailty, Lancet / 25.09.2014

MedicalResearch.com Interview with: Dr. MichaelD. Keall PhD Otago University, Wellington, New Zealand Medical Research: What are the main findings of the study? Dr. Keall: We found that home injuries from falls could be reduced by 26% by making some simple modifications to people’s homes, consisting of handrails for steps and stairs, grab rails for bathrooms, outside lighting, edging for outside steps and slip-resistant surfacing for outside surfaces such as decks and porches. (more…)