Author Interviews, Cost of Health Care, JAMA / 28.07.2019

MedicalResearch.com Interview with: blood-tests-lab-tests Renuka S Bindraban, MD and Prabath W. B. Nanayakkara, MD, PhD Section of Acute Medicine Department of Internal Medicine Amsterdam Public Health Research Institute Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, the Netherland MedicalResearch.com: What is the background for this study? Response: It is well known that a significant portion of healthcare activities is considered of low-value. Eliminating such low-value care is often targeted in efforts to both contain rapidly increasing healthcare costs as well as maintain high-quality care. In this context, our study focused on reducing unnecessary laboratory testing. In 2008, our study group performed a multifaceted intervention aimed at reducing unnecessary diagnostic testing at the Internal Medicine department of the Amsterdam University Medical Center, location Vrije Universiteit (VU). In the ‘Reduction of Unnecessary Diagnostics Through Attitude Change of the Caregivers’, we implemented this successful intervention in the Internal Medicine departments of four large teaching hospitals in the Netherlands. The intervention included creating awareness through education and feedback, intensified supervision of residents, and changes in order entry systems. (more…)
Author Interviews, Cost of Health Care, Gastrointestinal Disease, Opiods / 12.03.2019

MedicalResearch.com Interview with: Howard Franklin, MD, MBA Vice President of Medical Affairs and Strategy Salix Pharmaceuticals MedicalResearch.com: What is opioid-induced constipation? Response: Opioid-induced constipation (OIC) is a side effect in as many as 80 percent of chronic pain patients on opioids. OIC is unlikely to improve over time without treatment and can lead to suffering and discomfort. More importantly, the insufficient treatment of OIC can have negative implications for patients, both those on opioid therapy for chronic non-cancer pain as well as advanced illness, and for hospitals. (more…)
Author Interviews, Cost of Health Care, OBGYNE, Yale / 10.07.2015

Xiao Xu, Ph.D. Assistant Professor Department of Obstetrics, Gynecology & Reproductive Sciences Yale School of Medicine MedicalResearch.com Interview with: Xiao Xu, Ph.D. Assistant Professor Department of Obstetrics, Gynecology & Reproductive Sciences Yale School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Xiao Xu: While research has shown hospital variation in costs of care for other conditions, we know little about whether and how hospitals differ in costs of childbirth related care. With nearly 4 million births each year, childbirth is the most common reason for hospital admission in the U.S. Understanding the pattern and causes of variation in resource utilization during childbirth among hospitals can help inform strategies to reduce costs. Our study used data from 463 hospitals across the country and analyzed hospital costs of maternity care for low-risk births. We found that hospital varied widely in average facility costs per maternity stay. (more…)
Author Interviews, Cost of Health Care, Emergency Care, NEJM, UCLA / 16.10.2014

Daniel A. Waxman, MD, PhD Department of Emergency Medicine David Geffen School of Medicine University of California, Los Angeles RAND Corporation Santa Monica, California MedicalResearch.com Interview with: Daniel A. Waxman, MD, PhD Department of Emergency Medicine David Geffen School of Medicine University of California, Los Angeles RAND Corporation Santa Monica, California Medical Research: What are the main findings of the study? Dr. Waxman: About 10 years ago, three states (Texas, Georgia, and South Carolina) passed laws which made it much harder for doctors to be sued for malpractice related to emergency room care. The goal of our research was to determine whether the lower risk of being sued translated into less costly care by emergency physicians. To figure this out, we looked at the billing records of nearly 4 million Medicare patients and compared care before and after the laws took effect, and between states that passed reform and neighboring states that didn’t change their laws. We found that these substantial legal protections didn’t cause ER doctors to admit fewer patients to the hospital, to order fewer CT or MRI scans, or to spend less for the overall ER visit. (more…)
Author Interviews, Cost of Health Care / 08.09.2014

Steffie Woolhandler MD MPH Professor at the School of Public Health and Hunter College, CUNY; Professor of Medicine Harvard Medical School Cambridge Hospital MedicalResearch.com Interview with: Steffie Woolhandler MD MPH Professor School of Public Health and Hunter College, CUNY; Professor of Medicine Harvard Medical School Cambridge Hospital Medical Research: What are the main findings of the study? Dr. Woolhandler: In 2011, U.S. hospitals spent $215 billion on billing and administration. Meanwhile, other countries spent far less. None of the other seven countries we studied spent even half as much as the U.S., and they all have modern, high quality hospitals. While we spent nearly $700 per capita on hospital paperwork, Scotland and Canada spent less than $200. This means that if U.S. hospitals ran as efficiently as Canada’s, the average family of four would save $2,000 annually on health care. (more…)
Author Interviews, General Medicine, Heart Disease, JAMA / 06.08.2014

Maurizio Gasparini, MD MedicalResearch Interview with: Maurizio Gasparini MD Humanitas Research Hospital Rozzano, Italy Medical Research: What are the main findings of the study? Dr. Gasparini: We found that a strategic programming of implantable cardioverter defibrillators which allows the non-sustained arrhythmias to self-terminate is associated with reductions in hospitalizations, length of hospital stay and cost per patient-year and an increase in the time to first hospitalization. These results were mainly driven by reduction in cardiovascular-related events. (more…)
Author Interviews, BMC, Cost of Health Care / 19.06.2014

MedicalResearch.com Interview with: Natasha K Brusco Manager of Physiotherapy Services, Cabrini Health PhD Candidate, Physiotherapy Department, Faculty of Health Science, La Trobe University, Bundoora, Victoria, Australia MedicalResearch: What are the main findings of the study? Answer: This economic evaluation reports that providing additional Saturday rehabilitation, compared to Monday to Friday rehabilitation alone, is likely to be cost saving per quality adjusted life year gained and for a minimal clinically important difference in functional independence. This builds on previous literature that reports that additional Saturday rehabilitation can improve functional independence and health related quality of life at discharge and may reduce patient length of stay. (more…)
Author Interviews, Cost of Health Care, JAMA / 02.04.2014

 Daniel J. Elliott, M.D., MSCE, FACP Associate Chair of Research Department of Medicine and Research Scholar Value Institute, Christiana Care Health System MedicalResearch.com Interview with: Daniel J. Elliott, M.D., MSCE, FACP Associate Chair of Research Department of Medicine and Research Scholar Value Institute, Christiana Care Health System MedicalResearch.com: What are the main findings of the study? Dr. Elliott: The optimal workload for hospitalists has been a question since the earliest days of hospital medicine. However there has been very little empirical evidence to understand the relationship between workload and outcomes. The objective of our study was to determine the association of daily workload for hospitalists on the efficiency, quality, and cost of care. We analyzed data from a single private practice hospitalist group at a community-based health system between February 2008 and January 2011. Our research showed that both length of stay and cost increased for patients as hospitalist workload increased. At the same time, our research showed that workload did not affect patient satisfaction as measured by HCAHPS scores or quality and safety outcomes including admissions, rapid response team activation and mortality. (more…)
Author Interviews, Cost of Health Care, OBGYNE / 19.07.2013

MedicalResearch.com Interview with: Robert E. Garfield, PhD Department of Perinatology, Division of Obstetrics and Gynecology University Medical Centre Ljubljana, Slovenia Costs of Unnecessary Admissions and Treatments for “Threatened Preterm Labor” MedicalResearch.com :What are the main findings of the study? Dr. Garfield: Unnecessary admissions and treatments for “threatened preterm labor” are still part of everyday clinical practice and contribute to exploding healthcare costs. This happens despite substantial evidence that measuring CL by trans-vaginal ultrasound can help to avoid needless interventions due to the high negative predictive values of this test. (more…)
Author Interviews, Cost of Health Care, JAMA / 10.07.2013

MedicalResearch.com Interview with: Ann M. Sheehy, M.D., M.S. Associate Professor Division Head, Hospital Medicine University of Wisconsin Department of Medicine Ann M. Sheehy, M.D., M.S. Associate Professor Division Head, Hospital Medicine University of Wisconsin Department of Medicine MedicalResearch.com: What are the main findings of the study? Dr. Sheehy: There were three main findings of our study. First, we found that observation in clinical practice is very different from the CMS definition of observation. CMS states that observation should rarely last longer than 48 hours, yet 16.5% of our observation encounters lasted longer than 48 hours. CMS also states that observation care is “well-defined”. We found there were 1141 distinct observation codes for our 4578 observation encounters, indicating that observation care is not well defined. Second, we found that observation care disproportionately affects the general medicine population, as over half of our observation encounters were on the general medicine services. These patients also had longer length of stay, were older, more likely to be female, were more likely to need discharge to a skilled facility, and were more likely to have government insurance as compared to patients on other services. This indicates that observation care adversely affects the adult general medicine population more than other patients on other types of services. Finally, we found that observation cost was greater than reimbursement, resulting in a net negative financial margin. (more…)