Author Interviews, Cost of Health Care, End of Life Care, JAMA / 01.05.2018 Interview with: R. Sean Morrison, MD Ellen and Howard C. Katz Professor and Chair Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai New York, NY 10029 What is the background for this study? What are the main findings? Response: Palliative care is team based care that is focused on improving quality of life and reducing suffering for persons with serious illness and their families.  It can be provided at any age and in concert with all other appropriate medical treatments.  Palliative care has been shown to improve patient quality of life, patient and family satisfaction, and in diseases like cancer and heart failure, improve survival.  A number of individual studies have shown that palliative care can reduce costs by providing the right care to the right people at the right time. This study pooled data from six existing studies to quantify the magnitude of savings that high quality palliative care provides. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Outcomes & Safety, Sleep Disorders / 28.11.2016 Interview with: Luc Schlangen PhD Principal Scientist at Philips Lighting Research Eindhoven the Netherlands What is the background for this study? What are the main finding Response: Everyone knows that sleep is critical to one’s overall health and well-being. Yet one-third of the general adult population report difficulties sleeping. Ongoing social commitments and work routines make it difficult to make sleep a priority, also in hospitals. People increasingly recognize that the usage of light emitting electronic devices before bedtime is compromising sleep. Consequently, many people started to use these devices in a more sleep-permissive mode during the evening, using algorithms that automatically dim down the intensity and blue content of their tablet and smart phone screens as the evening progresses. Moreover, there is increasing evidence that brighter daytime light conditions help to improve mood and nighttime sleep quality. These observations inspired us to undertake a joint study with the Maastricht University Medical Center. In the study we explored whether a tunable lighting system with extra daytime brightness and lower light intensities and warmer tones of light in the evening and night, can improve sleep and wellbeing in hospital patients. We found that the system was well appreciated and helped hospital patients to fall asleep more rapidly. Moreover, after 5 days in a room with such a dynamic lighting system patients slept longer by almost 30 minutes as compared to a standardly lit room. (more…)
Author Interviews, Hospital Acquired / 09.11.2016 Interview with: Dusty Deringer Vice president of Patient Experience for Crothall Healthcare Compass One Healthcare What are the main findings from your new research? Response: Patients’ perceptions of a hospital’s cleanliness can have a major impact on their overall care and hospital experience. Specifically, the data show correlations between patients’ perceptions of room cleanliness and three important categories: the risk of hospital-acquired infections; a hospital’s score on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and scores on the HCAHPS teamwork indicators. The findings are important because patients are more likely to recommend a hospital they perceive to be clean. Therefore, it makes cleanliness a target for improvement for all hospitals. (more…)
Author Interviews, Cost of Health Care / 31.10.2016 Interview with: Timothy M. Capstack, MD, FACP, SFHM Regional Medical Director, Physicians Inpatient Care Specialists, LLC (MDICS) Hanover MD What is the background for this study? What are the main findings? Response: Hospitalists—medical providers who provide medical care to hospital inpatients—have become a pervasive part of American medical care. Hospitalists with internal medicine training earn, on average, a little over twice as much as do physician assistants (PAs). The researchers studied the hospitalist staffing model of Physicians Inpatient Care Specialists (MDICS) hospitalists at a 384-bed community hospital in Annapolis, Maryland. MDICS used specifically trained and supported PAs working collaboratively with their physicians to see a large proportion of their patients rather than relying mainly or exclusively on physicians, as many groups do. MDICS believed that their model would provide equal quality of care while saving on salary costs. The MDICS expanded-PA model was compared with a conventional group of hospitalists who used mostly physicians to care for their inpatients. 16,964 inpatient hospitalizations were identified for study; 6,612 expanded-PA and 10,352 conventional patients were seen by the groups over the 18 months that were included. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Outcomes & Safety / 10.10.2016 Interview with: Jared Conley, MD, PhD, MPH Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston, MA 02114 What is the background for this study? What are the main findings? Response: As the U.S. healthcare system seeks to improve the health of populations and individual patients, there is increasing interest to better align healthcare needs of patients with the most appropriate setting of care—particularly as it relates to hospital-based care (accounting for 1/3 of total U.S. healthcare costs). Avoiding hospitalization—as long as safety and quality are not compromised—is often preferred by patients and the added benefit of potentially making care more affordable further promotes such care redesign efforts. There is a growing body of research studying alternative management strategies to hospitalization; we sought to comprehensively review and analyze this work. Alternative management strategies reviewed include outpatient management, quick diagnostic units, observation units, and hospital-at-home. (more…)
Author Interviews, BMJ, Outcomes & Safety / 18.09.2015 Interview with: Dr Daniel Boden Emergency Medicine Consultant Derby Hospitals NHS Foundation Trust Medical Research: What is the background for this study? What are the main findings? Dr. Boden: The overall objective was to evaluate whether there is an association between an intervention to reduce medical bed occupancy and both performance on the 4-hour target and hospital mortality. We undertook a before-and-after study in Derby teaching Hospitals NHS Foundation Trust (a large UK District General Hospital) over a 32 month period. A range of interventions were undertaken to reduce medical bed occupancy within the Trust. Performance on the four-hour target and hospital mortality (HSMR, SHMI and Crude Mortality) were compared before, and after, intervention. Daily data on medical bed occupancy and percentage of patients meeting the four-hour target was collected from hospital records. Segmented regression analysis of interrupted time-series method was used to estimate the changes in levels and trends in average medical bed occupancy, monthly performance on the target and monthly mortality measures (HSMR, SHMI and crude mortality) that followed the intervention. Medical Research: What are the main findings? Dr. Boden:
  • Mean medical bed occupancy decreased significantly from 93.7% to 90.2% (p=0.02).
  • The trend change in 95% target performance, when comparing pre- and post-intervention, revealed a significant improvement (p=0.019). The intervention was associated with a mean reduction in all markers of mortality (range 4.5% - 4.8%). SHMI (p=0.02) and Crude Mortality (p=0.018) showed significant trend changes after intervention.
  • Our conclusion is that lowering medical bed occupancy is associated with reduced patient mortality and improved ability of the acute Trust to achieve the 95% four hour target. Whole system transformation is required to create lower average medical bed occupancy.
Author Interviews, Electronic Records, JAMA / 11.03.2015 Interview with: Jonathan Pell, MD Assistant Professor Hospital Medicine University of Colorado DenverJonathan Pell, MD Assistant Professor Hospital Medicine University of Colorado Denver Medical Research: What is the background for this study? Dr. Pell: Back in 2001, the Institute of Medicine's charter document Crossing the Quality Chasm proposed that the health care system needs to do a better job of patient centered care. In order to provide true patient centered care, we must provide patients and their families with the knowledge and tools they need to make autonomous and informed decisions about their healthcare. A patient cannot make informed decisions about their healthcare without having easy access to their own health information. Almost 15 years later, we are still discussing whether or not patients should have immediate electronic access to information in their electronic health record. Studies have shown that giving outpatients direct electronic access to their test results and even doctors notes does not cause patients worry or confusion, and there is no undue burden on care providers explaining this newly accessible information to their patients - if they can deliver thinking of you flowers from Flowercard, there's no reason they can't deliver a simple print-out of relevant information. Despite this, many institutions still have a moratorium on release of patients' test results, and the duration of this moratorium is variable from institution to institution. The technology to deliver this type of information real-time to patients is readily available. We decided to explore the effect of giving hospitalized patients real-time access to their test results and hospital medication list/schedule. (more…)