Federal Incentives Did Not Reduce Catheter Infections in Hospitals

MedicalResearch.com Interview with:

Heather Hsu, MD MPH Assistant Professor of Pediatrics Boston University School of Medicine Boston Medical Center Boston, MA 02118

Dr. Hsu

Heather Hsu, MD MPH
Assistant Professor of Pediatrics
Boston University School of Medicine
Boston Medical Center
Boston, MA 02118

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: In October 2013, the Centers for Medicare and Medicaid Services (CMS) implemented value-based incentive programs to financially reward or penalize hospitals based on quality metrics. Two of these programs – Hospital Value Based Purchasing and the Hospital Acquired Condition Reduction Program – began targeting hospitals’ rates of certain healthcare-associated infections deemed to be preventable in October 2015.

Previous studies demonstrated minimal impact of these value-based payment programs on other measures of hospital processes, patient experience, and mortality. However, their impact on healthcare-associated infections was unknown.

Our goal was to study the association of value-based incentive program implementation with healthcare-associated infection rates, using catheter-associated urinary tract infection in intensive care units (one of the targeted outcomes) as an example.

We found no evidence that federal value-based incentive programs had any measurable association with changes in catheter-associated urinary tract infection rates in the critical care units of US hospitals.

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Urine Tests Useful in Primary Care Monitoring of Opioid and Cocaine Use

MedicalResearch.com Interview with:

Sarah M. Bagley MD, MSc Assistant Professor of Medicine and Pediatrics Director, CATALYST Clinic Boston University School of Medicine/Boston Medical Center Boston, MA

Dr. Bagley

Sarah M. Bagley MD, MSc
Assistant Professor of Medicine and Pediatrics
Director, CATALYST Clinic
Boston University School of Medicine/Boston Medical Center
Boston, MA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Urine drug testing is a routine part of the management of primary care patients with opioid use disorder treated with medications such as buprenorphine. In addition, most providers also ask patients about recent drug use.

The point of this study was to see the agreement between the urine drug testing and what patients told a nurse and whether that changed the longer a patient was in treatment. We found that truthful disclosure of opioid and cocaine use increased with time in treatment and that urine drug tests are a useful tool to monitor patients. 

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Lower SNAP Participation by Immigrant Mothers With Young Children

MedicalResearch.com Interview with:
Allison Bovell-Ammon, M.Div. Deputy Director of Policy Strategy Children's HealthWatchAllison Bovell-Ammon, M.Div.
Deputy Director of Policy Strategy
Children’s HealthWatch

MedicalResearch.com: What is the background for this study?  

Response: Children’s HealthWatch was founded in 1998 by pediatric providers treating children with failure to thrive in six US cities across the country. They began their research on the health impacts of economic hardships like food insecurity in response to the 1996 welfare reform legislation after witnessing deteriorating health among young children in their clinics as a result of welfare sanctions on families.

Over the years, the scope of the research has expanded to include research on food insecurity, housing instability, energy insecurity, health care hardships, and child care constraints. Through our current network of pediatricians and public health researchers in five US cities (Boston, Baltimore, Little Rock, Minneapolis, and Philadelphia), we seek to improve the health and well-being of children under age 4 and their families by informing policies that address and alleviate economic hardships. Our ongoing data collection in emergency departments and primary care clinics enables us to rapidly respond to emerging public health issues as policies and economic conditions change. While we have produced other papers and analyses specifically addressing health and economic disparities relevant to immigrant families, we were specifically interested in exploring this topic because the clinicians in our group as well as national media began anecdotally reporting that immigrants were forgoing accessing critical public health programs like SNAP out of fear.

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The US Opioid Crisis is Expanding and Worse Among Young People

MedicalResearch.com Interview with:
Joshua Barocas, MD Assistant Professor of Medicine Section of Infectious Diseases Boston Medical Center / Boston University School of Medicine Joshua Barocas, MD

Assistant Professor of Medicine
Section of Infectious Diseases
Boston Medical Center / Boston University School of Medicine 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Massachusetts has been particularly hard hit by the opioid epidemic despite lower opioid prescribing rates, near universal health insurance, and availability of opioid treatment. That said, it is difficult to estimate the population with or at-risk for opioid use disorder. It is generally a highly stigmatized disease and typical methods to estimate of opioid use disorder relay on contact with the healthcare system and/or patient reporting.

We used a unique and powerful methodology coupled with a first-in-the-nation linked database in Massachusetts to obtain both an accurate count of people with opioid use disorder who are known to the healthcare system and estimate the number who are out there but not yet known to the system.

We found that more than 275,000 people – or 4.6 percent of people over the age of 11 in Massachusetts– have opioid use disorder, a figure nearly four times higher than previous estimates based on national data. In 2011 and 2012, the prevalence of opioid use disorder in Massachusetts for those over the age of 11 was 2.72 percent and 2.87 percent, respectively. That increased to 3.87 percent in 2013, and even more, to 4.6 percent in 2015. Those between the ages of 11 and 25 experienced the greatest increase in prevalence of all age groups. The number of “known” persons increased throughout the study period – from 63,989 in 2011 to 75,431 in 2012, and 93,878 in 2013 to 119,160 in 2015.  Continue reading

Adolescents Face Large Addiction-Treatment Gap

MedicalResearch.com Interview with:

Scott E. Hadland, MD, MPH, MS Assistant Professor of Pediatrics Boston Medical Center / Boston University School of Medicine

Dr. Hadland

Scott E. Hadland, MD, MPH, MS
Assistant Professor of Pediatrics
Boston Medical Center / Boston University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: Amidst a worsening overdose epidemic in the United States, adolescents and young adults have not been spared. Although evidence-based medications like buprenorphine, naltrexone, and methadone are recommended for adolescents and young adults, the extent to which youth receive these medications — and whether these medications help retain youth in addiction treatment — isn’t yet known.

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