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Tanning industry uses promos, cheap prices to lure adolescents and young adults

Woman laying in tanning bed

It’s well-known that cigarette smoking causes cancer and as a result, prices and advertising are closely regulated to discourage youth from starting.  But another cancer risk, indoor tanning, shown to cause melanoma, lags in regulation.

Researchers at the Colorado School of Public Health have found that the tanning industry uses marketing strategies that appeal to adolescents and young adults, including unlimited tanning packages, discounts, and even offering free tanning when paired with other services like an apartment rental or gym membership.

“This study highlights the fact that a lot of businesses out there are providing this service at a low cost which removes a barrier to adolescents and young adults,” said Nancy Asdigian, lead author of the study and a research associate in the Department of Community and Behavioral Health at the Colorado School of Public Health. “Young people who want to tan do so when they can afford it and don’t when they can’t.  The industry capitalizes on this with the strategies they use to price and promote this risk behavior.”

The study was published this week in the Journal of Public Health Policy.

According to the Global Burden of Disease Study, about 352,000 people worldwide were diagnosed with potentially deadly melanoma in 2015. That includes 81,000 cases in the U.S.

High profile public health and policy efforts along with state age restrictions have helped decrease the prevalence of indoor tanning among youth, but the study said levels remain  `unacceptably high.’

The researchers posed as customers and contacted tanning facilities in Akron, Ohio, Denver, Colorado, Austin, Texas, Boston, Massachusetts, Portland, Oregon and Pittsburgh, Pennsylvania. These cities were selected because they represent a variety of climate and geography as well as a range of stringency of state indoor tanning laws.

Of the 94 tanning places they contacted, 54 were primary tanning salons, and 40 were ‘secondary facilities’ that offered indoor tanning secondary to some other service like hair styling or physical fitness.

The study found that indoor tanning was free at 35 percent of secondary facilities. Nearly all apartments with tanning offered it free compared to 12 percent of gyms. Free tanning was most common in Austin.

Nearly all primary tanning salons offered time-limited price reductions.

“Many provide promos geared toward young adults. They offer packages that incentivize more frequent tanning. The more you use them the cheaper tanning becomes,” Asdigian said. “Everyone wants to get their money’s worth. When you buy a ski pass, you want to ski as much as possible.” In some cases, an individual tanning session could cost as little as $1 if the customer buys an unlimited monthly plan and uses it frequently.

Some countries, including Brazil and Australia, have banned indoor tanning salons altogether. The U.S. imposed a 10% tax on indoor tanning in 2010 and 19 states and the District of Columbia have enacted complete bans on indoor tanning for those under age 18.

But few of these policies have focused on the advertising, promotions or pricing practices of these facilities.

“A next step is to work with policymakers to restrict the use of discounts and deals to lure customers,” said Lori Crane, PhD, MPH, the study’s senior author and professor at the Colorado School of Public Health.

Another strategy would be to eliminate tanning provided in apartment complexes and fitness centers where tanning services are often free and less likely to be licensed and inspected by local regulators.

Asdigian said it’s important to understand the connection between pricing and the use of indoor tanning.

“In this study we described the costs and promotions,” she said. “An important question to answer is how variability in pricing impacts behavior. Establishing that link is an important step.”

The study co-authors include: Yang Lui; Joni A. Mayer; Gery P. Guy and L. Miriam Dickinson.

 

 

 

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Cochrane US Network opens affiliate at CU Anschutz

The Cochrane US Network, made up of some of the country’s leading institutions in the research and practice of evidence-based medicine, announced Tuesday the opening of 11 new affiliates across the country including one at the University of Colorado Anschutz Medical Campus.

These new affiliates will join Cochrane’s 70 other groups around the world to promote evidence-informed decision making in health care by supporting and training systematic review authors and users of Cochrane Reviews, as well as working with clinicians, professional associations, policymakers, patients, health care provider organizations and the media to encourage the dissemination and use of Cochrane evidence.

Robert Dellavalle, MD, PhD, MSPH, professor of dermatology at the CU School of Medicine
Robert Dellavalle, MD, PhD, MSPH, professor of dermatology at the CU School of Medicine

“Cochrane is a leading evidence-based medicine organization, so it’s a very big deal to be a site that is tied to that effort,” said Robert Dellavalle, MD, PhD, MSPH, a professor of dermatology at the University of Colorado School of Medicine, who will lead the CU Anschutz affiliate. “Cochrane is known for having some of the best methodology for doing systematic review of evidence and they are highly cited in the field.”

The Cochrane US Network is made up of the existing Cochrane US West Associate Center based at Oregon Health & Science University; three Cochrane Review Groups producing systematic reviews in neonatal health, fertility regulation and urological conditions; three US satellites of Cochrane Review Groups focusing on eyes and vision, pregnancy and childbirth and musculoskeletal disease; one field specializing in complementary medicine. The 11 new affiliate institutions include:

  • AcademyHealth
  • American College of Physicians
  • Central Michigan University
  • Cornell University
  • Mayo Clinic Evidence-based Practice Center
  • Penn Medicine Center for Evidence-based Practice
  • RTI International – University of North Carolina Evidence-based Practice Center
  • Texas Christian University
  • University of Chicago Medicine
  • University of Colorado Anschutz Medical Campus
  • University of Maryland School of Medicine

Mark Wilson, Cochrane CEO, said: “I am delighted to see such a prestigious and committed group of US institutions and leaders in evidence-informed health care join Cochrane’s global family of collaborators.”

“Many of these researchers and clinicians are leaders in the field, and I am excited by the expertise, innovation and knowledge they will bring to our mission of delivering trusted evidence into health policy and clinical decision-making,” Wilson said. “The US health system is the largest and most sophisticated in the world, yet suffers from huge inequalities in health outcomes and tremendous wastefulness.”

Wilson believes a vibrant Cochrane Network promoting greater use of evidence showing what health interventions work and what don’t can make a real difference.

“I hope that this new – already extensive – network will grow further and welcome many more partners in the years to come,” he said.

These new Cochrane affiliates each have their own specific areas of expertise and focus. Collectively, the Network will focus on producing high quality evidence on priority topics for the US; providing training to systematic review authors and health care practitioners, policymakers and others in the interpretation of Cochrane Reviews. It will also raise the general awareness around Cochrane evidence to make well-informed health and health care decisions.  The new Network will build on the work of the former US Cochrane Center based at Johns Hopkins University.

“The establishment of the US Network is an important development for Cochrane as well as the health care community in the U.S.,” said Marguerite Koster, co-chair of the Cochrane Governing Board. “Coordination and collaboration are core values of the Network because we strongly believe we can add value by working together as a consortium. I very much look forward to the start of the network and to seeing it develop and grow as a platform for anyone interested in evidence-informed health and health care in the US.”

A formal launch of the new ‘Cochrane US Network’ was held today in Washington DC. During the launch meeting Cochrane CEO, Mark Wilson, and Governing Board co-chair, Marguerite Koster, introduced the US Network. Additionally, representatives from the Network will introduce their institutions and planned work, and speak to the value of being part of the Network.

The Cochrane US Network is part of Cochrane, a global independent network of researchers, professionals, patients, careers and people interested in health. Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. Cochrane is a not-for profit organization with over 65,000 members and supporters from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Cochrane’s work is recognized as representing an international gold standard for high quality, trusted information.

 

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New disease discovered by CU Anschutz researchers

A new immunodeficiency disease caused by a novel genetic mutation has been identified by researchers at the University of Colorado Anschutz Medical Campus providing unique insights into cell biology.

The findings were published last week in The Journal of Experimental Medicine.

Elena Hsieh, MD, assistant professor of pediatrics and microbiology, immunology at the CU School of Medicine and CHCO.
Elena Hsieh, MD, assistant professor of pediatrics and microbiology, immunology at the CU School of Medicine and CHCO.

The researchers made the discovery while investigating why an infant was suffering from inflammatory bowel disease along with other conditions including eczema, food allergies, lung disease, and persistent CMV (cytomegalovirus) infection.

“Other than a specialized elemental formula, he was unable to eat any food and his gut inflammation persisted despite numerous therapies,” said the study’s co-author Cullen Dutmer, MD, an assistant professor of pediatrics specializing in allergy and immunology at the University of Colorado School of Medicine and Children’s Hospital Colorado (CHCO).

The young boy’s sister suffered from similar problems, and their collective symptoms were consistent with an immune dysregulation syndrome.  Patients suffering from these syndromes have poorly functioning immune systems which can result in serious, recurrent, or unusual infections, as well as autoimmune/inflammatory complications affecting the gastrointestinal tract, skin, lungs, and circulating blood cells.  This defective (or dysregulated) immune system may also lead to increased risk for cancer.

Cullen Dutmer, MD, an assistant professor of pediatrics specializing in allergy and immunology at the University of Colorado School of Medicine and Children’s Hospital Colorado
Cullen Dutmer, MD, assistant professor of pediatrics specializing in allergy and immunology at the CU School of Medicine and CHCO.

The researchers found that the siblings had the first known human defect in a gene called IL2RB (encoding interleukin-2 receptor beta, IL-2Rb), resulting in decreased numbers of immune cells called regulatory T cells which prevent autoimmunity. At the same time, the children had an accumulation of ‘natural killer’ cells which, if functioning normally, help protect against viral infections and cancer.

“But the mutation meant the natural killer cells were incapable of maturing properly and could not clear CMV, resulting in a persistent and debilitating infection,” said study co-author Elena Hsieh, MD, assistant professor of pediatrics and microbiology, immunology at the CU School of Medicine and CHCO.

“We tracked this disease down to a single gene and that is a fairly rare event,” Hsieh said. “Prior to our findings, there had been no documented cases of a mutation in this particular gene leading to human disease.”

Ross Kedl, PhD, professor of immunology and microbiology at the CU School of Medicine
Ross Kedl, PhD, professor of immunology and microbiology at the CU School of Medicine

Dutmer said it’s likely that others suffer from this condition but it has never been identified.

“Although clearly a rare disease, it has likely been missed in other children,” he said. “Now that it is out there, we know to look for it.”

Study co-author Ross Kedl, PhD, professor of immunology and microbiology at the CU School of Medicine agreed.

“The discovery also means that the defect could be addressed through gene therapy,” Kedl said. “We could feasibly go in, manipulate the gene, and get it back in the right sequence.”

Recent advancements in identifying genetic causes of immunodeficiency diseases have led to innovative treatments.  Gene therapy, a therapeutic approach that corrects specific genetic defects, is emerging as a viable treatment option for some immunodeficiency diseases.

A recent study showcased the use of gene therapy to treat severe combined immune deficiency or SCID caused by mutations in the gene IL2RG (Mamcarz et al., New England Journal of Medicine 2019).

“Identifying the underlying genetic causes of immunodeficiency diseases and other disorders can reveal targets for promising personalized treatment strategies like gene therapy,” Dutmer and Hsieh said. “That would allow for therapeutic interventions that are uniquely tailored to meet the needs of the individual.”

Kedl noted that this discovery illustrates the ‘bench-to-bedside’ research capacities on the CU Anschutz Medical Campus and in its graduate training programs.

One of the first authors of the study, Isabel Fernandez, is an MD/PhD student the CU School of Medicine, pursuing a PhD in Immunology in the Kedl lab. Her co-first author is Ryan Baxter, MS, who is a research assistant in the Hsieh lab.

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Prove it: National telehealth research network greenlighted

The University of Colorado Anschutz Medical Campus is part of a team of researchers that has received a grant of $3.6 million for the SPROUT-CTSA Collaborative Telehealth Research Network.

This five-year grant will support the development of telehealth research efforts, metric development, identification of best practices and the development of collaborative policy and advocacy materials across the country. It builds on work underway as part of the SPROUT (Supporting Pediatric Research on Outcomes and Utilization of Telehealth) collaborative, an established network of institutions and pediatric providers operating within the American Academy of Pediatrics (which is a sub awardee of the grant).

Photo
Christina Olson, MD, assistant professor of pediatrics.

The Medical University of South Carolina (MUSC) is the primary awardee of the grant. Institutions that are part of this collaborative effort include the University of Colorado Anschutz Medical CampusChildren’s Hospital Colorado, University of Pennsylvania – Children’s Hospital of Philadelphia (CHOP) and Mercy Clinic in St. Louis, Missouri.

“At the national level, there is no academic authority currently spearheading multicenter telehealth research studies,” said Christina Olson, MD, assistant professor of pediatrics and site primary investigator at the University of Colorado Anschutz Medical Campus – Children’s Hospital Colorado. “We have piecemeal efforts happening in terms of research, national policy development and payer guidelines. This network will provide tools, resources and guidance to accelerate the development of telehealth studies across the country. We will support champions of telehealth to become champions of research as well.”

“This is a huge step forward in the development of safe and impactful telehealth programs across the country,” said primary investigator for the grant S. David McSwain, MD, MUSC Children’s Health physician and MUSC associate professor of pediatric critical care and chief medical information officer.  “Academic research into the real impact of telehealth services is a critical component of developing and growing programs with the greatest potential to improve our health care system. Many physicians and other health care providers are hesitant about incorporating telehealth into their practices because it’s difficult to separate the theoretical benefits from the real value.”

In 2015, McSwain collaborated with a small group of pediatric physicians across the country to form SPROUT, which has since completed and published the nation’s first broad assessment of pediatric telehealth infrastructure across the country.

“That was a critical starting point,” said John Chuo, MD, associate professor of clinical pediatrics, co-chair of SPROUT and site primary investigator at CHOP. “When we started SPROUT, we realized that we couldn’t conduct studies on pediatric telehealth unless we actually knew which institutions were providing which types of services, and that information wasn’t available anywhere. So we made that our first investigation.”

While much anecdotal or small-scale evidence exists about the benefits of telehealth, including cost reduction, improved quality of care in some patient populations and improved access to care for some rural and underserved populations, barriers to fully demonstrating the gains made via telehealth care delivery persist. For example, there are few best practices in existence for conducting multisite telehealth research involving patient care outcomes, limited access to research trials for rural populations and limitations to care access for special populations such as children or the elderly.

The grant is funded by a Collaborative Innovation Award through the National Center for the Advancing Translational Science (NCATS), a branch of the National Institutes of Health. The program will operate in collaboration with CTSA (Clinical and Translational Science Award) sites across the country to facilitate research development and support current and future telehealth researchers to develop projects and apply for funding. CU’s Colorado Clinical and Translational Sciences Institute (CCTSI) and its partner, Children’s Hospital Colorado are one of these CTSA sites. As opposed to supporting a specific clinical research study, this grant seeks to establish an easily accessible support structure around telehealth research: tools, resources, guidance, collaboration, education and advocacy materials that will be valuable to anyone across the country who wants to study telehealth programs.

“We expect this network to become the preeminent source for evidence-based policy and outcomes data,” said Brooke Yeager McSwain, RRT, health policy consultant for the project and manager of the South Carolina Children’s Telehealth Collaborative. “Our national and state legislators have seen the benefits of telehealth for certain populations and regions. We have to demonstrate to them that this works across the country and has the potential to dramatically impact health care delivery models, particularly in value-based care.”

Alison Curfman, MD, medical director of Pediatrics at Mercy Virtual and a co-investigator of the grant, spends much of her time thinking about better ways to partner with children and their families for overall better health. “We have to ensure that children have access to every type of care that they need at the right time, no matter where they live. The technology is here. The commitment of the early-adopters is here. Our next frontier is proving to other pediatric providers across the health care spectrum that telehealth is about so much more than convenience.”

Guest contributor: Wendy Meyer, Colorado Clinical and Translational Sciences Institute.

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Sexual behavior may influence gut microbiome

A person’s sexual behavior could affect their microbiome and immune system, potentially elevating their risk of HIV infection, according to a new study from researchers at the University of Colorado Anschutz Medical Campus.

The study was published last week in the journal PLOS Pathogens.

Brent Palmer, PhD, associate professor of medicine in the Division of Allergy and Clinical Immunology at the CU School of Medicine
Brent Palmer, PhD, associate professor of medicine in the Division of Allergy and Clinical Immunology at the CU School of Medicine

The microbiome, a community of microbes in the gut, play a major role in driving and shaping the human immune system. But recent studies have shown that men who have sex with men (MSM) have very distinct microbiomes compared with men who have sex with women (MSW), regardless of HIV-infection status.

CU Anschutz researchers wanted to know whether this altered microbiome induces T cell activation associated with HIV transmission risk and increased disease severity.

To study this they took stool samples of 35 healthy men – men who had sex with men and men who had sex with women – and transplanted them into mice. The mice who received the MSM stool samples showed increased evidence of activation of CD4+ T cells, which would put them at a higher risk of HIV if they were human.

They also isolated immune cells from the intestines of HIV negative individuals and exposed them to bacteria from MSM and MSW feces. Human gut derived immune cells exposed to MSM fecal bacteria were more likely to be infected by HIV virus in vitro. This was again linked with increased immune activation by these fecal bacteria.

“These results provide evidence for a direct link between microbiome composition and immune activation in HIV-negative and HIV-positive MSM, and a rationale for investigating the gut microbiome as a risk factor for HIV transmission,” said the study’s senior author Brent Palmer, PhD, associate professor of medicine in the Division of Allergy and Clinical Immunology at the CU School of Medicine.

Exactly why the microbiome of men who have sex with men is so distinct remains unknown. Some have theorized that diet may promote inflammation and thereby activate T cells.

“There is a unique microbiome associated with men who have sex with men that drives immune activation in the gut that may also drive higher levels of HIV infection,” Palmer said. “But we still don’t know exactly why this is.”

Yet understanding this microbiome is important, Palmer said, because it could directly affect the immune system of high-risk men and lead to an increased risk of HIV infection.

The study co-authors include Sam X. Li, PhD, and Catherine Lozupone, PhD, of the University of Colorado Anschutz Medical Campus.

 

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Over half of home health care clinicians say they lack adequate information from hospitals

Home health care clinician

A survey of Colorado home health care clinicians (HHCs) revealed that 60 percent said they had not received enough information to guide patient treatment while 52 percent said patients often had unrealistic expectations of the kind of care they would receive.

The study, conducted by researchers at the University of  Colorado Anschutz Medical Campus, also showed major gaps in communication between hospital and home health care staff, some that could have serious medical consequences.

The study was published today in the Journal of the American Medical Directors Association.

“We have heard of medication errors occurring between hospitals and home health care providers,” said the study’s lead author Christine D. Jones, MD, MS, assistant professor at the University of Colorado School of Medicine.  “As a result, patients can receive the wrong medication or the wrong dose. Some home health providers don’t get accurate information about how long to leave a urinary catheter or intravenous line in.”

Jones and her colleagues surveyed nurses and staff at 56 HHC agencies throughout Colorado. Participants were sent a 48-question survey covering communication between hospitals and HHCs, patient safety, pending tests, medication schedules, clinician contact and other areas.

More than half said hospitals did not adequately prepare patients for home health care upon discharge. They also said patients often expected a level of home care that was simply not available including extended hours, housekeeping and help with transportation.

Dr. Christine Jones, assistant professor of medicine and lead author of the study.
Dr. Christine Jones, assistant professor of medicine and lead author of the study.

Home health care workers with access to electronic health records (EHRs) for referring providers had fewer problems relating to a lack of information about patients, including critical medication data.

They were able to electronically access notes, orders, lab and radiology results and referrals. Some 12 percent of respondents reported positive experiences when accessing the Colorado Regional Health Information Organization (CORHIO, www.corhio.org) about hospital admissions.

Yet many did not have access to such information.

“Although almost all (96 percent) indicated that Internet-based access to a patient’s hospital record would be at least somewhat useful,” Jones said. “Fewer than half reported having access to EHRs for referring hospitals or clinics.”

She said the survey revealed problems getting medication doses right due to conflicting information.

“Notably, additional studies have found extremely high rates of medication discrepancies (94 percent – 100 percent) when referring provider and HHC medications lists are compared,” Jones said.

The study suggested targeted education of hospital staff about what home health clinicians actually provide to patients and caregivers to avoid frustration.

Jones noted that if these issues are arising in Colorado, they could signify a national problem.

“For hospitals and HHC agencies seeking strategies to improve communication, this study can provide targets for improvement,” she said. “Future interventions to improve communication between the hospital and HHC should aim to improve preparation of patients and caregivers to ensure they know what to expect from HHC and to provide access to EHR information for HHC agencies.”

The study’s co-authors include: Jacqueline Jones, PhD, RN, FAAN; Kathryn H. Bowles, PhD, RN, FAAN, FACMI; Linda Flynn, PhD, RN, FAAN; Frederick A. Masoudi, MD, MSPH; Eric A. Coleman, MD, MPH; Cari Levy, MD, PhD and Rebecca S. Boxer, MD, MS.

 

 

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Researchers discover a genetic defect linked to pediatric liver disease

Researchers from the University of  Colorado Anschutz Medical Campus, in collaboration with several other institutions, have discovered a genetic defect linked to Biliary atresia (BA), the most common pediatric cause of end-stage liver disease, and the leading indication for liver transplantation in children.

Their findings were published January in the journal Hepatology.

Ronald Sokol, MD
Ronald Sokol, MD

“We don’t know the cause of Biliary atresia, which interferes with our ability to treat affected children,” said study co-author Ronald Sokol, MD, a pediatric gastroenterologist and hepatologist at Children’s Hospital Colorado and Director of the Colorado Clinical and Translational Sciences Institute (CCTSI) at CU Anschutz.

By identifying a genetic mutation linked to the disease, Sokol, along with researchers from Emory University, University of Utah, Children’s Hospital of Philadelphia, Washington University at St. Louis, and others, may finally determine the cause of this devastating condition. The group used next-generation gene sequencing to discover that a genetic defect of the gene PKD1L1 was linked to BA in a subset of patients.

Some children with BA also have splenic abnormalities and cardiac malformations called biliary atresia splenic malformation syndrome or BASM. Researchers hypothesized that the genetic factors causing an asymmetric position of organs in the body could also cause the development of BA in BASM patients, and that the genes involved could be discovered using whole exome sequencing.

So they sequenced DNA specimens from 67 subjects with BASM, including 58 patient-parent trios. Researchers looked at 2,016 genes – a subset of the full genome – that were associated with proteins that were candidates to cause a disease like BA. The study found five patients who had two copies of mutations in the gene PKD1L1 and three additional patients who had one mutation in the gene.

“The importance of this is that researchers have never identified a gene, when mutated, that causes BA,” Sokol said. “This is the first time it has been found.”

The CCTSI’s Pediatric Clinical and Translational Research Center played a key role in the study. The patients who were participants came from a liver disease research network, which Dr. Sokol chairs, the Childhood Liver Disease Research Network (ChiLDReN). This network has been funded by the NIH for 15 years and includes 14 centers across the nation, Canada and the UK.

The gene that was identified may be the first of other genes to be found to be linked with BASM or BA. Understanding what causes BA is a breakthrough that could lead to new therapeutic approaches that would ultimately avoid liver transplantation.

In the first analysis of the data, researchers looked at more than 2,000 genes. Now that they have the data from the whole exome sequencing, researchers can go back and analyze the other 18,000 genes for other genetic causes of BA.

“What we learn about what causes the disease could translate into new therapeutic targets and strategies,” Sokol said.

Guest contributor: Wendy Meyer, Colorado Clinical and Translational Sciences Institute

 

 

 

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Research initiative uses Big Data to improve patient care

Researchers at the University of Colorado College of Nursing are participating in an initiative to improve health care outcomes and efficiencies by using large clinical and administrative data in a pediatric acute care setting. The project was funded by a grant received from Data Science to Patient Value (D2V) from the CU School of Medicine.

D2V is a multidisciplinary research initiative that funds projects focusing on using technology and Big Data and their applications to health care through collaborations with multiple stakeholders, including providers, patients, health systems, payers and policy makers. Also playing key roles in the initiative are the CU College of Nursing and the Colorado School of Public Health (ColoradoSPH).

Using Big Data

The use of Big Data to improve health-care delivery is being studied by Principal Investigator John Welton, PhD, RN, FAAN, and Co-Investigators Marcelo Coca Perraillon, PhD, an assistant professor in the Department of Health, Systems, Management & Policy in the ColoradoSPH and Peggy Jenkins, PhD, RN, assistant professor in the College of Nursing. Their study focuses on developing a database warehouse called the Nursing Value Research Data Warehouse (NVRDW) that collects data for each nurse caring for each patient during hospitalization.

The PI for the study, Welton, states, “This is the largest database of its kind to date detailing the overall care delivered by individual nurses and provides exciting potential to better understand the factors leading to better hospital outcomes of care.”

‘This is the largest database of its kind to date detailing the overall care delivered by individual nurses.’ – John Welton, PhD, RN, FAAN

The NVRDW is a large “pool” of data collected from various sources within multiple organizations that can be used to improve patient outcomes or transform health-care systems and deliver quality care to patients. Additionally, it can be used by researchers as a resource to create innovative strategies that improve patient outcomes.

One of the products from the D2V study is the creation of a consortium of three schools of nursing including the University of Kansas and University of Minnesota to share expertise to collect Big Data across multiple institutions in the future and leverage the expertise developed from the D2V project to improve the quality of care and optimizing nursing care to lower health care costs.

“There is a distinct purpose for data stored in the warehouse, such as research or reporting to improve patient outcomes or transform health-care systems,” said Jenkins. “Because so much data are collected in health-care settings, it is important to resource teams working to standardize the data so it can be compared and used to inform innovation.”

Providing Quality Care

Playing a huge role in the future of health care, Big Data is becoming more important to measure the quality of care provided to patients. Jenkins believes that nurses are just one of many individual interprofessional providers of patient care who can help in improving the quality of health care.

Big Data’s impact on health care

With technology becoming more present in the delivery of health-care services, more data is being collected than ever before. From tracking vital signs to discover trends, charting patient care histories through electronic health records, or using multiple patients’ health histories to predict health conditions and create treatment plans, Big Data is being used to reduce costs, create innovative treatments and provide effective care in a timely manner.

“Interprofessional collaboration of data scientists, informaticians, nurse scientists, nurse leaders, academia, clinical practice sites, and industry is necessary to construct data warehouses,” she said.

Although not all hospitals and health-care settings have large database warehouses, the multidisciplinary work at the CU Anschutz Medical Campus is a step in the right direction. Problems such as incompatible data systems could make it hard to import data to use to improve quality of care. Patient confidentiality can also become an issue. With large amounts of data such as electronic health records being housed in one database, it can make patients’ information vulnerable to a security breech, so it is important to have clear protocols in place to make the data secure.

Additionally, Big Data can create higher-value care that is more efficient, effective, higher quality and more cost effective, which can improve the care patients receive from providers in all sectors of the health field. This is particularly essential to nursing care, Jenkins notes.

“Using new methods, nurses are viewed as unique providers of patient care, and the value of quality nursing care provided divided by costs can be measured,” she said. “There is much to be learned about nurse characteristics and processes contributing to quality patient outcomes.”

Welton adds, “We are at the start of our journey to better understand the inner workings of health care by examining the care of each provider. We know a lot about physician care, but we are just beginning to collect data at the individual nurse-patient unit of analysis.”

The foundational D2V project has started a national dialogue on how to use this work to collect increasingly larger datasets to complement the many efforts to improve future health-care systems.

Guest contributor: This story was written by freelance contributor Katherine Phillips

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Drug prices not always aligned with value, CU Anschutz researchers say

In many countries, health care reimbursements for drugs are directly related to their value or net health benefits in treating disease.

But a new study by researchers at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences , in collaboration with a group of international clinical and economic experts, shows that’s not the case in the U.S.

Jon Campbell, PhD, of the Skaggs School of Pharmacy and Pharmaceutical Sciences is senior author of the study
Jon Campbell, PhD, associate professor at Skaggs School of Pharmacy and Pharmaceutical Sciences, is lead author of the study.

The study was published Monday in the August issue of the journal Health Affairs.

“In the United Kingdom, for example, cost effectiveness is a driver of decisions to pay for, or decline to pay for, health interventions,” said the study’s lead author Jon Campbell, PhD, associate professor of pharmacy. “They generally do not pay more than £30,000 to £40,000 per quality-adjusted life-year (QALY) for new medical interventions, thus signaling to manufacturers and other innovators what their country is willing to pay for additional health improvements.”

Melanie Whittington, PhD
Melanie Whittington, PhD, research faculty at the Skaggs School of Pharmacy and Pharmaceutical Sciences, is-co-author of the study.

QALY is used to measure one year of perfect health.

In the U.S., there is no formally agreed-upon cost-effectiveness threshold, due mostly to its fragmented health care system.

Using a forecasting model, they calculated the cost-effectiveness for commonly reimbursed cardiovascular drugs by estimating the cost per health outcome achieved. They wanted to see if the U.S. had an observed payment threshold, if even implicitly.

Instead they found a wide spectrum of cost-effectiveness, suggesting that drug prices are not consistently associated with what they produce in terms of health gains. Prices were, in short, not consistently aligned with value.

“When we purchase a medical treatment, we expect to get something in return, such as living a longer life or having fewer symptoms,” said study co-author Melanie Whittington, PhD, research faculty at the CU School of Pharmacy. “The results of our study show the amount insurance providers pay to get one more unit of health, such as one additional year of life in perfect health, varies considerably and can exceed what is considered good value in other parts of the world. This contributes to higher-priced medical treatments.”

She noted that the study used data from 1985-2011 and that in recent years health care leaders have been talking more about value-driven health care.

Campbell said the U.S. pays up to twice as much for branded drugs and health care services compared to other wealthy nations.

The reason, he said, may be due to the difference in price paid with little difference in the quantity of drugs or health services actually used.

“The U.S. gets very little in terms of additional health outcomes for this added price paid,” said Campbell, director of the pharmaceutical outcomes research graduate track at the Center for Pharmaceutical Outcomes Research at CU Anschutz. “In the pharmaceutical space, the U.S. has done a poor job at signaling to manufacturers what we are willing to pay for improvements in health and what improvements in health we care about.”

He and Whittington hope the study will stimulate more debate in this country about what constitutes an acceptable cost per unit of health gained for drugs and how to achieve value-driven health care delivery in the U.S.

“Solutions toward fair drug pricing include the U.S. sending more signals about what we value in health and U.S. decision makers being willing and able to walk away from unfair pricing,” Campbell said.

The study co-authors include Vasily Belozeroff, health economist at Amgen Inc., Thousand Oaks, Calif.; Robert Rubin, distinguished professor of medicine at Georgetown University in Washington D.C.; Paolo Raggi, professor of medicine at the Mazankowski Alberta Heart Institute and the University of Alberta in Edmonton; Andrew Briggs, professor of health economics at the University of Glasgow in Scotland and visiting investigator at Memorial Sloan Kettering Cancer Center, New York, N.Y.

The study can be found here: Prices for common cardiovascular drugs in the U.S. are not consistently aligned with value

 

 

 

 

 

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Study reveals lack of self-awareness among doctors when prescribing opioids

As health providers struggle to curb the epidemic of opioid abuse, researchers at the University of Colorado Anschutz Medical Campus and the University of Massachusetts Medical School have found that 65 percent of emergency department (ED) physicians surveyed underestimated how often they prescribed the highly addictive pain killers to patients.

Those rates dropped after they saw their actual data.

The year-long study, published this month in the journal Academic Emergency Medicine, focused on how doctors perceive themselves relative to their peers when it comes to prescribing opioids. Most felt they were restrained, but the results showed otherwise.

Dr. Sean Michael, assistant professor of emergency medicine and author of the study.
Dr. Sean Michael, assistant professor of emergency medicine and author of the study.

“We surveyed 109 emergency medicine providers at four different hospital EDs,” said study author Sean Michael, MD, MBA, assistant professor of emergency medicine at the University of Colorado School of Medicine. “We asked them to report their perceived opioid prescribing rates compared to their peers. Then we showed them where they actually were on that spectrum.”

Some 65 percent of those surveyed prescribed more opioids that they thought they did. Michael and his team found participants discharged 119,428 patients and wrote 75,203 prescriptions, of which 15,124 (or about 20 percent) were for opioids over the course of the 12-month study.

The researchers then monitored the doctors after they were shown their actual prescription rates.

“Everyone showed an overall decrease in prescribing opioids,” Michael said. “After seeing their real data, the people with inaccurate self-perceptions, on average, had 2.1 fewer opioid prescriptions per 100 patients six months later and 2.2 percent fewer prescriptions per 100 patients at 12 months.”

The study likened the physicians’ initial self-perceptions to the majority of drivers feeling they are above average – a statistical impossibility.

“Thus an intervention to identify and unmask inaccurate self-perception – and correct that perception using a provider’s actual data – appears to have enabled more robust behavior change for a subset of providers who may have otherwise had difficulty internalizing the need to change,” the study said.

The researchers believe the shock many felt upon seeing the reality of their actions versus their perceptions primed them to change their behavior.

Michael pointed out that this problem extends beyond emergency departments. In fact, only about 5-10 percent of all opioid prescriptions are generated by ED physicians.

“Despite making progress on the opioid epidemic, we can’t assume providers are behaving optimally and have all the information they need to do what we are asking of them,” Michael said. “Most believe they are doing the right thing, but we need to directly address this thinking to be sure they are not part of the problem.”

The other authors include Kavita Babu, MD, Christopher Androski Jr., MS, and Martin Reznek, MD, MBA, all from the University of Massachusetts Medical School, Worcester, MA.

 

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