Author Interviews, Health Care Systems, JAMA / 21.01.2019

MedicalResearch.com Interview with: [caption id="attachment_47027" align="alignleft" width="160"]David Shulkin, MD Ninth Secretary, U.S. Department of Veterans Affairs Washington, District Of Columbia Shulkin Solutions LLC Gladwyne, Pennsylvania Dr. Shulkin[/caption] David Shulkin, MD Ninth Secretary, U.S. Department of Veterans Affairs Washington, District Of Columbia Shulkin Solutions LLC Gladwyne, Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings?  Response: I came to VA in 2015 as Under Secretary for Health, as a result of the 2014 wait time crisis.  At that time, it was determined that in some locations, veterans had been waiting for care for too long and there were allegations that this had resulted in harm to a number of veterans.  I was in the private sector at the time, but was asked by President Obama to come and help improve the situation. Upon my arrival we created systems to determine which veterans were waiting for urgent healthcare and which ones for routine care.  From here, we established same day services for all veterans waiting for urgent care through primary care and behavioral health access points.  This goal was achieved nationwide at the end of 2016.  When I became Secretary in 2017,  we began publishing our wait time data for all to see, so that veterans had accurate information on which to base their choices on and to provide transparency into where we were improving and where we needed to focus our efforts.  In addition, through programmatic and legislative efforts, we expanded our utilization of private sector options so that veterans with clinical needs would be able to get better access to care. This study was meant to determine whether our efforts from 2014 had resulted in improvements to access and in addition how access to care in the VA compared to access in the private sector.   Despite limitations in the data available from the private sector (since others do not publish their actual wait time data similar to VA) we used a data set that we felt had some applicability for these comparisons. We found that for the most part, VA wait times are often shorter than in the private sector,  and that VA wait times had improved since 2014 while the private sectors access had stayed the same. 
Accidents & Violence, Author Interviews, BMJ / 25.08.2017

MedicalResearch.com Interview with: [caption id="attachment_36594" align="alignleft" width="100"]Dr. Vivian Mcalister, M.B., CCFP(C), FRCSC, FRCS(I), FACS Professor - Department of Surgery London Health Sciences Centre University Hospital London, Ontario, Canada Dr. McAlister[/caption] Dr. Vivian Mcalister, M.B., CCFP(C), FRCSC, FRCS(I), FACS Professor - Department of Surgery London Health Sciences Centre University Hospital London, Ontario, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study was performed by medical and nursing officers who were all deployed to the war zone. We were deeply concerned about the type of injuries we were seeing. They were more awful than any we had seen before. We were familiar with reviews of antipersonnel landmine injuries that were reported by Red Cross surgeons in the 1990s. The injuries that we were dealing with were from antipersonnel IEDs more than landmines. We decided to do a formal prospective study for two reasons: first was to carefully describe the pattern of injury so we could develop new medical strategies, if possible, to help victims. The second reason was to catalogue these injuries so we could impartially and scientifically report what we were witnessing.
Aging, Author Interviews, Geriatrics / 10.06.2017

MedicalResearch.com Interview with: [caption id="attachment_35204" align="alignleft" width="100"]Raya Elfadel Kheirbek, MD, MPH Geriatrician and Palliative Care Physician  Washington DC VA Medical Center  Associate Professor of Medicine  George Washington University  School of Medicine and Health Sciences Dr. Raya Elfadel Kheirbek[/caption] Raya Elfadel Kheirbek, MD, MPH Geriatrician and Palliative Care Physician Washington DC VA Medical Center Associate Professor of Medicine George Washington University School of Medicine and Health Sciences MedicalResearch.com: What is the background for this study? What are the main findings? Response: In the past decade, there has been a shift in the concept of successful aging from a focus on life span to health span. We all want to age gracefully “expecting” optimal health, quality of life and independence. Centenarians are living examples to the progress we have made in health care. They are the best example of successful aging since they have escaped, delayed or survived the major age-related diseases and have reached the extreme limit of human life. However, little is known about Veterans Centenarians’ incidence of chronic illness and its impact on survival. Utilizing the VA Corporate Data Warehouse (CDW), I worked with my colleagues’ researchers and identified 3,351 centenarians who were born between 1910 and 1915. The majority were white men who served in World War II and had no service related disability. The study found that 85 % of all the centenarians had no incidence of major chronic conditions between the ages of 80 and 99 years of age. The data demonstrate that Veteran centenarians tend to have a better health profile and their incidence of having one or more chronic illness is lower than in the general population.
Alzheimer's - Dementia, Annals Internal Medicine, Author Interviews, Critical Care - Intensive Care - ICUs, Health Care Systems, University of Pittsburgh / 12.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30462" align="alignleft" width="144"]Dr-Joshua-M-Thorpe.jpg Dr. Joshua Thorpe[/caption] Joshua M. Thorpe, PhD, MPH From the Center for Health Equity Research and Promotion Veterans Affairs Pittsburgh Healthcare System Pittsburgh Pennsylvania, and Center for Health Services Research in Primary Care Department of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy MedicalResearch.com: What is the background for this study? Response: Care coordination for persons with dementia is challenging for health care systems under the best of circumstances. These coordination challenges are exacerbated in Medicare-eligible veterans who receive care through both Medicare and the Department of Veterans Affairs (VA). Recent Medicare and VA policy changes (e.g., Medicare Part D, Veteran’s Choice Act) expand veterans’ access to providers outside the VA. While access to care may be improved, seeking care across multiple health systems may disrupt care coordination and increase the risk of unsafe prescribing - particularly in veterans with dementia. To see how expanded access to care outside the VA might influence medication safety for veterans with dementia, we studied prescribing safety in Veterans who qualified for prescriptions through the VA as well as through the Medicare Part D drug benefit.
Author Interviews, Health Care Systems, JAMA / 09.09.2016

MedicalResearch.com Interview with: [caption id="attachment_27754" align="alignleft" width="146"]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 Dr. Andrew Eppstein[/caption] 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.
Author Interviews, Exercise - Fitness, Kidney Disease / 20.03.2015

Peter Kokkinos, PhD, FAHA, FACSM Veterans Affairs Medical Center Professor, Georgetown University School of Medicine George Washington University School of Medicine and Health Sciences Director, LIVe ProgramMedicalResearch.com Interview with: Peter Kokkinos, PhD, FAHA, FACSM Veterans Affairs Medical Center Professor, Georgetown University School of Medicine George Washington University School of Medicine and Health Sciences Director, LIVe Program Medical Research: What is the background for this study? Dr. Kokkinos: This is a prospective study and part of a larger cohort, the Veterans Exercise Testing Study (VETS) designed to assess the association between aerobic fitness and the risk of developing Chronic Kidney Disease or CKD. Our cohort included 5,812 middle-aged male Veterans from the Washington, DC Veterans Affairs Medical Center. All participants were CKD-Free prior to entering the study. Exercise capacity was assessed by a graded exercise test and peak Metabolic Equivalents or METs were determined. Accordingly, we established the following four age-adjusted fitness categories based on Quartiles of peak METs achieved: Least-fit (≤25%; 4.8±0.90 METs; n=1258); Low-fit (25.1%-50%; 6.5±0.96 METs; n=1614); Moderate-fit (50.1%-75%; 7.7±0.91 METs; n=1958), and High-fit (>75%; 9.5±1.0 METs; n=1436). Multivariable Cox proportional hazard models were used to assess the exercise capacity-CKD association. The models were adjusted for age, BMI, blood pressure, medications, CVD, Risk factors, race, and history of alcoholism. Medical Research: What are the main findings? Dr. Kokkinos: During a median follow-up period of 7.9 years, 1,000 individuals developed CKD. The CKD-fitness association was independent, inverse and graded. The CKD risk was 22% lower for every 1-MET increase in exercise capacity. When considering fitness categories, CKD risk decreased progressively as fitness status increased. Specifically, when compared to the Least-Fit individuals the risk of developing CKD was 13% 45% and 58% lower for individuals in the Low-Fit; Moderate and High-Fit categories, respectively. These findings support that higher aerobic fitness lowers the risk of developing CKD. The average exercise capacity necessary to realize these health benefits was just over 6.5 METs (Low-fit). This level of fitness is achievable by many middle-aged and older individuals by daily exercises such as brisk walking. Moderate intensity exercises are effective in improving aerobic fitness regardless of age or comorbidities. Thus, exercise interventions for individuals at risk for CKD and those with preclinical CKD may be implemented to prevent or at least attenuate the rate of developing CKD.
Heart Disease, JACC / 13.09.2014

Thomas M. Maddox, MD MSc FACC FAHA Cardiology, VA Eastern Colorado Health Care System Associate Director, VA CART Program Associate Professor, Department of Medicine, University of Colorado School of MedicineMedicalResearch.com Interview with: Thomas M. Maddox, MD MSc FACC FAHA Cardiology, VA Eastern Colorado Health Care System Associate Director, VA CART Program Associate Professor, Department of Medicine, University of Colorado School of Medicine Medical Research: What are the main findings of the study? Dr. Maddox: We were curious to know if the VA, as a provider of PCI at centers without on-site CT surgery, was providing better access to its veterans without compromising their safety.  We were pleased to find that there was evidence of better access, with patients reducing their drive time to PCI facilities by, on average, 90 minutes.  In addition, there was no compromised safety.  Rates of both peri-procedural and 1-year adverse outcomes were low and no different between centers with and without on-site CT surgery.