In The News
Do you really need that colonoscopy?
AARP, April 25, 2013
A recent study published in JAMA Internal Medicine suggests that almost a quarter of colonoscopies are either performed too often or given to patients who are too old to benefit. "It looks like some patients are getting screened inappropriately," says UTMB's Kristin Sheffield who led the study. The study didn't fault colonoscopies doctors performed because a patient had a problem or worrisome symptom, such as blood in the stool or abdominal pain. Nor does it address colonoscopies to check patients who previously have had colorectal cancer or precancerous growths.
Colonoscopy may be overused in older adults creating health risk
The Washington Post, March 12, 2013
Older U.S. adults may get too many colonoscopies, costing Medicare an estimated $500 million a year and putting patients at an increased risk of side effects such as bleeding, UTMB researchers found. About one-quarter of colonoscopies in Medicare recipients ages 70 and older may be inappropriate based on screening guidelines, according to analysis of insurance claims data released yesterday in the journal JAMA Internal Medicine. "Inappropriate colonoscopies involve an unnecessary risk with no added benefit for the older patient," said Kristin Sheffield, the study's lead author. "The harms are greater than the expected benefit." The news appears widely throughout the world, appearing in such outlets as The New York Times, MSN, the Fort Worth Star-Telegram, Yahoo! News, Houston Business Journal, Businessweek, U.S. News & World Report, Chicago Tribune and Lifescript.
Why are there so many unneeded preop tests?
OR Manager, March, 2013
Researchers at the University of Texas Medical Branch led by Dr. Taylor S. Riall, a UTMB cancer surgeon, analyze what leads to overuse of preop testing. They're also finding wide geographic variations, similar to those seen for elective surgery. They've learned testing is more prevalent in areas with higher rates of malpractice suits. The findings are leading to discussions about the need for standardized national guidelines.
Minimally invasive breast biopsy lags in Texas
The Oncology Report, Jan. 25, 2013
More than a fifth of women in Texas with image-detected breast abnormalities failed to undergo minimally invasive breast biopsy as recently as 2008, according to a review of statewide Medicare data, even though in 2005 a U.S. consensus panel declared the minimally invasive approach the procedure of choice and that few patients should have excisional biopsy as their initial procedure. "Our studies identify targets for interventions to improve minimally invasive breast biopsy rates, such as the Hispanic disparity and geographic variations in practice pattern," said Dr. Taylor S. Riall, a UTMB cancer surgeon. "Our findings highlight that the strategies for intervention need to vary by geographic region and the underlying etiology of the failure to adopt this cost-effective practice."
Surgeons Forum Discusses Proven Ways of Improving Quality and Reducing Health Care Costs
The Sacramento Bee, September 11, 2012
The American College of Surgeons hosted more than 80 health care leaders at the ACS Surgical Health Care Quality Forum Houston to discuss how programs focused on surgical quality and education can reduce patient complications and readmissions, resulting in lower costs and greater health care value. "When done correctly, outcomes or comparative effectiveness research using population-based data such as ACS NSQIP can play a critical role in the quality improvement process at the local, regional, and national level," said panelist Taylor S. Riall, MD, PhD, FACS, John Sealy Distinguished Chair in Clinical Research, Director, Center for Comparative Effectiveness and Cancer Outcomes, associate professor, department of surgery, and CERCIT investigator.
Pancreatic cancer patients' choices easier with new study
Medical News Today, August 25, 2012
Should patients with pancreatic cancer who know there time is ending soon spend a great amount of that little time undergoing aggressive and difficult treatment that will only add a brief period of additional life? UTMB's Dr. Casey Boyd and colleagues analyzed both hospital and medical care days in pancreatic cancer patients with stage, treatment and survival, which was able to give them a quantitative look at the whole experience of a patient with this disease. She hopes that this paper will help doctors give patients the information they need to make important decisions. The news also appears in Science Daily and Guidry News.
More docs no help for racial colonoscopy gap
MedPage Today, Dec. 17, 2011
Communities that have more physicians available to perform colonoscopies actually have bigger -- not smaller -- disparities in screening rates between minority and white patients, according to a recent study of Texas Medicare claims data. In the study of claims for nearly 975,000 Texas Medicare beneficiaries, colonoscopy use was higher in whites (40.7 percent) than in blacks (35.0 percent) or Hispanics (28.7 percent), reported Dr. Taylor S. Riall and colleagues from UTMB.
Failure to Perform Cholecystectomy for Acute Cholecystitis in Elderly Patients Is Associated with Increased Morbidity, Mortality, and Cost
Taylor S. Riall, MD, PhD, Dong Zhang, PhD, Courtney M.S. Townsend Jr. MD, FACS, Yong-Fang Kuo, Ph.D., and James S. Goodwin, M.D.
Read the article on The Wall Street Journal here.
Surgery: Delaying gallbladder removal for elderly patients resulted in higher hospital readmissions and hastened death, according to a study in the Journal of the American College of Surgeons. Every year, about 1% to 4% of the 20 million Americans with gallstones develop further complications. Researchers analyzed Medicare data for nearly 30,000 patients hospitalized with one of the most common complications, gallbladder inflammation known as acute cholecystitis. Though cholecystectomy -- removal of the gallbladder—is the recommended treatment, only 75% of patients got the surgery during their first hospitalization. Of the remaining patients, 38% returned to the hospital for gallstone-related problems during the following two years, compared to just 4% of the initial cholecystectomy patients. The delayed-cholecystectomy patients were also 56% more likely to die during those two years.
Caveat: Medicare records don't reveal many clinical details, such as how long patients waited to present their acute cholecystitis to the hospital or the specific reasons a doctor gave for delaying surgery.
Growth in the Care of Older Patients by Hospitalists in the United States
Yong-Fang Kuo, Ph.D., Gulshan Sharma, M.D., M.P.H., Jean L. Freeman, Ph.D., and James S. Goodwin, M.D.
This link will take you to the results article.
Background National and population-based information on the increase in patient care by hospitalists in the United States is lacking. Methods Using a 5% sample of Medicare beneficiaries in 1995, 1997, 1999, and the period from 2001 through 2006, we identified 120,226 physicians in general internal medicine who were providing care to older patients in 5800 U.S. hospitals. We defined hospitalists as general internists who derived 90% or more of their Medicare claims for evaluation-and-management services from the care of hospitalized patients. We then calculated the percentage of all inpatient Medicare services provided by hospitalists and identified patient and hospital characteristics associated with the receipt of hospitalist services. Results The percentage of physicians in general internal medicine who were identified as hospitalists increased from 5.9% in 1995 to 19.0% in 2006, and the percentage of all claims for inpatient evaluation-and-management services by general internists that were attributed to hospitalists increased from 9.1% to 37.1% during this same period. Accompanying the increase in care by hospitalists was an increase in the percentage of all hospitalized Medicare patients who were treated by general internists (both hospitalists and traditional, non–hospital-based general internists), from 46.4% in 1995 to 61.0% in 2006. In a multilevel, multivariable analysis controlling for patient and hospital characteristics, the odds of receiving care from a hospitalist increased by 29.2% per year from 1997 through 2006. In 2006, there was marked geographic variation in the rates of care provided by hospitalists, with rates of more than 70% in some hospital-referral regions. Conclusions These analyses of data from Medicare claims showed a substantial increase in the care of hospitalized patients by hospitalist physicians from 1995 to 2006.
New York Times "The New Old Age" Blog, May 25, 2011 NYT blogger Paula Span enumerates the multitude of overtreatments the country's elderly are unnecessarily subjected to -- from pointless mammograms for elderly women with advanced dementia to very low blood sugar level requirements for older diabetics -- and now, as shown in UTMB's Dr. James Goodwin's latest research, the overprescribing of colonoscopies for elderly patients.