Medical Technology

Advances in drugs, devices, and biological products that change the way health care is delivered. LDI Senior Fellows study the adoption and diffusion of medical technologies and assesses their impact on costs and quality of care.

Generic Medication Prescription Rates After Health System–Wide Redesign of Default Options Within the Electronic Health Record

May. 19, 2016

Mitesh Patel, Susan Day, Scott Halpern, William Hanson, Joseph Martinez, Steven Honeywell Jr, Kevin Volpp

In JAMA Internal Medicine, Mitesh Patel and colleagues, including Scott Halpern and Kevin Volpp, evaluate how changing electronic health record (EHR) defaults affects physician prescribing of generic drugs. For the study, the researchers utilized a systemic change to the University of Pennsylvania Health System’s EHR defaults. As part of this change, an opt-out checkbox labeled “dispense as written” was added to the prescription screen, and if left unchecked the generic-equivalent medication was prescribed. The authors find that generic prescribing rates increased significantly...

Opioids Prescribed After Low-Risk Surgical Procedures in the United States, 2004-2012

Mar. 29, 2016

Hannah Wunsch, Duminda Wijeysundera, Molly Passarella, Mark Neuman

In JAMA, Hannah Wunsch and colleagues, including Mark Neuman, document the rising use of opioids prescribed after low-risk surgical procedures in the US. Using data from commercially insured patients, they tracked opioid use in more than 150,000 adults undergoing one of four low-risk procedures in 2004, 2008 and 2012: carpal tunnel release, laparoscopic cholecystectomy, inguinal hernia repair, or knee arthroscopy. Overall, 80% of all patients filled a prescription for an opioid within 7 days after hospital discharge or after the procedure, and 86.4% of the prescriptions were for...

Biologic therapy adherence, discontinuation, switching, and restarting among patients with psoriasis in the US Medicare population

Mar. 22, 2016

Jalpa Doshi, Junko Takeshita, Lionel Pinto, Penxiang Li, Xinyan Yu, Preethi Rao, Hema N. Viswanathan, Joel M. Gelfand

In the Journal of the American Academy of Dermatology, Jalpa Doshi and colleagues, including Penxiang Li and Preethi Rao, investigate real-world utilization patterns of biologic therapy in Medicare beneficiaries with psoriasis. Studies indicate low adherence to biologics among patients with psoriasis, yet little is known about the adherence level in the Medicare population. Using data from the Medicare Chronic Condition Data Warehouse Part A, B, and D files with 12-month follow-up after index prescription, Doshi and colleagues conducted a retrospective claims analysis on 2707...

Transparency and Negotiated Prices: The Value of Information in Hospital-Supplier Bargaining

Research Brief
Mar. 21, 2016

How does price transparency affect negotiated prices in business-to-business markets? In the first empirical analysis of its kind, LDI Senior Fellows Ashley Swanson and Matthew Grennan estimate how benchmarking information could be useful to hospital buyers in their negotiations with medical technology companies. They explore two mechanisms for possible savings: first, by reducing “asymmetric information” about seller bargaining parameters (that is, not knowing the lowest price a seller would accept); and second, by helping hospitals solve the “agency problem” with their procurement negotiators (that is, allowing hospitals to monitor negotiator performance and restructure financial incentives). Taking coronary stents as their example, the authors look at whether hospitals that join a price benchmarking database, which contains average pricing based on data submitted by member hospitals, can achieve savings in future negotiations with suppliers.

Choosing Wisely in Emergency Medicine: A National Survey of Emergency Medicine Academic Chairs and Division Chiefs

Mar. 14, 2016

Brandon Maughan, Jill Baren, Judy Shea, Raina Merchant

In Academic Emergency Medicine, Brandon Maughan and colleagues, including Judy Shea and Raina Merchant, assess whether leaders of academic emergency medicine departments are aware of the Choosing Wisely campaign, and their attitudes about the campaign. The Choosing Wisely campaign seeks to promote collaboration and communication between patients and physicians regarding the appropriateness of common tests and procedures. For this study, the researchers used a web-based survey of emergency department chairs and division chiefs to examine awareness of the campaign, anticipated...

Optimal Regulation of Medical Devices

Feb. 29, 2016

There’s no shortage of opinions about whether the FDA’s process of approving medical devices is too lax, too strict, or just right.  After all, there’s a lot at stake, both for patients and for the $110 billion market for medical devices in the U.S. But evidence, one way or another, has been sorely lacking.  A study by LDI Senior Fellows Matthew Grennan and Robert Town goes a long way toward filling that gap.

Psoriasis in the US Medicare Population: Prevalence, Treatment, and Factors Associated with Biologic Use

Jan. 29, 2016

Junko Takeshita, Joel Gelfand, Penxiang Li, Lionel Pinto, Xinyan Yu, Preethi Rao, Hema Viswanathan, Jalpa Doshi

In the Journal of Investigative Dermatology, Junko Takeshita and colleagues, including Preethi Rao and Jalpa Doshi, look at factors associated with the use of biologics and other treatments for psoriasis. They  analyzed claims from a nationally representative sample of Medicare beneficiaries with Part D drug coverage. The researchers find that Medicare Part D beneficiaries without a low-income subsidy (LIS) had 70% lower odds of having received biologics than those with LIS. Similarly, the odds of having received biologics were 69% lower among black patients compared with white...

Cost Differences After Initial CT Colonography Versus Optical Colonoscopy in the Elderly

Nov. 19, 2015

Hanna Zafar, Jianing Yang, Katrina Armstrong, Peter Groeneveld

In Academic Radiology, Hanna Zafar and colleagues, including Peter Groeneveld, compare differences in total Medicare costs among asymptomatic elderly patients in the year after initial computed tomographic colonography (CTC) or initial optical colonoscopy (OC). In 2009, the Centers for Medicare and Medicaid Services stopped covering CTC screening among asymptomatic individuals based on the scarcity of data regarding differences in outcomes and costs between patients who received CTC and OC. Zafar and colleagues performed a retrospective cohort study of asymptomatic Medicare...

Diagnostic errors related to acute abdominal pain in the emergency department

Nov. 17, 2015

Laura Medford-Davis, Elizabeth Park, Gil Shlamovitz, James Suliburk, Ashley Meyer, Hardeep Singh

In Emergency Medicine Journal, Laura Medford-Davis and colleagues evaluate possible diagnostic errors and associated process breakdowns for patients who presented to the emergency department (ED) with abdominal pain. The authors conducted a retrospective chart review of adult ED patients at an urban academic hospital, using a computerized algorithm to identify high-risk patients. They considered patients to be high-risk if they presented to the ED with abdominal pain and were discharged, but returned to the ED within 10 days and were then hospitalized.  Diagnostic errors were...

A Comparison of 2 Surgical Site Infection Monitoring Systems

Nov. 5, 2015

Mila Ju, Clifford  Ko, Bruce Hall, Charles Bosk, Karl Bilimoria, Elizabeth Wick

In JAMA Surgery, Mila Jiu and colleagues, including Charles Bosk, compare surgical site infection (SSI) monitoring systems, discrepancies in their implementation, and their relationship to infection rates. The researchers compared the National Health and Safety Network (NHSN), which is required by most states, and the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), which is not. The study looks at how the NHSN or ACS NSQIP was implemented in 16 hospitals. It also observes rates of colon SSIs at these same hospitals. The data were collected...

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