MedStar Health Blog

Thank you to all associates who donated and stepped out to support Team MCRN at the 2017 American Heart Association Greater Washington Heart Walk.

The team raised $1,490 to help Americans build healthier lives, free of cardiovascular diseases and stroke. The Heart Walk is the American Heart Association's premier event for raising funds to save lives from this country's No. 1 and No. 5 killers: heart disease and stroke. To date, the American Heart Association has raised over two million dollars for 2017. Millions of Americans live with heart disease, stroke or a cardiovascular condition. The American Heart Association uses donations to help save and improve their lives through research, education and emergency care.

Team MCRN included associates from MedStar Washington Hospital Center, MedStar Southern Maryland Hospital Center, MedStar Cardiology Associates on 21^st, and the MedStar Health Research Institute, in addition to family and friends of our MedStar Health community.

Angela D. Thomas, DrPH, MPH, MBA, presented at a roundtable discussion at the American Public Health Association 2017 Annual Meeting & Expo. Her research investigated potential differences in reported harmful patient safety events among vulnerable populations in a large healthcare system. Dr. Thomas is the Executive Director of the MedStar Health Services Research Network. 

“Differences in reported harmful patient safety events in vulnerable populations” sought to identify differences reported harmful events in a Patient Safety Event Management System (PSEMS) in relation to the race, ethnicity, insurance, and language of patients included in the electronic medical record.

Previous research has shown that there are disparities in quality of care due to racial and ethnic disparities and that these differences remain after controlling for social factors such as income and education. This research sought to increase our knowledge, as disparities in health outcomes are widely documented but little is known about disparities in patient safety events.

The retrospective analysis focused on MedStar’s ten-hospital system and used race as the key independent variable, which was grouped as black, white or other, excluding patients who were listed as unknown or if race data was missing. Other variables included language (English, Other, Unknown), ethnicity (Hispanic, Non-Hispanic, Unknown) and insurance (Medicare, Medicaid, Commercial, Self-pay, Other). The research compared the proportions of vulnerable populations in the PSEMS cohort to the healthcare system cohort.

The research found that there were no notable differences by ethnicity or language. There was a high rate of reported safety events in those patients who are part of Medicaid and/or Medicare. By race, the research found that there were higher proportions of whites in PSEMS than expected, with lower proportions of “Other” (non-Black) minorities. All results were significant at p<.001. Out of the ten hospitals, three had lower proportions of Black patients in PSEMS than expected, and one hospital had a higher proportion of Black patients in PSEMS.

The research concluded that while white patients typically had higher event reporting, race differences emerge by location. Further research will need to be done to determine if there may be an actual disparity in harmful events for some Black, low income, and elderly patients. In addition, there may also be an underreporting of harmful events for minority patients in some settings.

[Editor’s note: This research was conducted as part of Dr. Thomas’ dissertation and we wish to congratulate her on her recent doctor of public health!]

Congratulations to all MedStar researchers who had articles published in November 2017. The selected articles and link to PubMed provided below represent the body of work completed by MedStar Health investigators, physicians, and associates and published in peer-reviewed journals last month. The list is compiled from PubMed for any author using “MedStar” in the author affiliation. Congratulations to this month’s authors. We look forward to seeing your future research.

View the full list of publications on PubMed.gov here.

 Selected research:

1. Emergency Physician Use of Cognitive Strategies to Manage Interruptions.
   Annals of Emergency Medicine, DOI: 10.1016/j.annemergmed.2017.04.036
   Ratwani RM, Fong A, Puthumana JS, Hettinger AZ
2. Why cardiologists should be on social media - the value of online engagement.
   Expert Review of Cardiovascular Therapy, 2017. DOI: 1080/14779072.2017.1408408
   Alraies MC, Sahni S
3. Cross-sectional evaluation of visuomotor tracking performance following subconcussive head impacts.
   Technology and Health Care, 2017. DOI: 3233/THC-171079
   Brokaw EB, Fine MS, Kindschi KE, Santago Ii AC, Lum PS, Higgins M
4. Warming up to the idea of wet wraps.
   Pediatric Dermatology, 2017. DOI: 1111/pde.13277
   Cooper CA, DeKlotz CMC
5. S2-AI screw placement with the aide of electronic conductivity device monitoring: a retrospective analysis.
   European Spine Journal, 2017. DOI: 10.1007/s00586-017-5242-0
   Sandhu FA, McGowan JE, Felbaum DR, Syed HR, Mueller KB

The research team from the MedStar-Georgetown Surgical Outcomes Research Center (MG-SORC) recently published their findings on mixed effects on pre-ACA Medicaid expansion on access to surgical cancer care at high-quality hospitals.

“Medicaid Expansion and Disparity Reduction in Surgical Cancer Care at High Quality Hospitals” was published in the Journal of the American College of Surgeons. The research was based data from the 2001 New York State Medicaid expansion, which is considered a precursor to the Affordable Care Act. 

David Xiao, a health justice scholar at Georgetown University School of Medicine, is the first author on the study. Xiao's work was sponsored by the MedStar Summer Research Program, under the mentorship of Waddah B. Al-Refaie, MD, FACS. Additional co-authors are Chaoyi Zheng, MS; Manila Jindal, BS; Lynt B. Johnson, MD, MBA, FACS; Thomas DeLeire, PhD; Nawar Shara, PhD.

The research identified 67,685 nonelderly adults from the New York State Inpatient Database, who underwent specific cancer surgeries. High-quality hospitals were defined as high-volume or low-mortality hospitals. Disparity was defined in this research as the model-adjusted difference in the percentage of patients operated at high-quality hospitals by insurance type (Medicaid/uninsured vs. privately insured) or by race (African-American vs. white).

The results found that the disparity in access to high-volume hospitals by insurance type was reduced by 0.97 % points per quarter following the expansion. Medicaid/uninsured beneficiaries had similar access to low-mortality hospitals as the privately insured, showing no significant change was detected around expansion. In contrast, racial disparity increased by 0.87% points per quarter in access to high-volume hospitals and by 0.48% points per quarter in access to low-mortality hospitals following Medicaid expansion.

These findings show that the Medicaid expansion reduced the disparity in access to surgical cancer care at high-volume hospitals by payer. However, it was associated with the increased racial disparity in access to high-quality hospitals.

This research was also presented at the 12^th Annual Academic Surgical Congress and nominated for “Outstanding Medical Student Award”.

This research follows Dr. Al-Refaie’s earlier findings, that New York’s Medicaid expansion improved access to cancer surgery for the previously uninsured, but did not preferentially benefit ethnic and racial minorities who are typically the most vulnerable of America’s poorest populations.

MG-SORC is a coalition of surgeons, other clinicians, and scientists committed to contributing to the scientific mission of Georgetown University Medical Center and MedStar Health by advancing the efficient and effective delivery of surgical care in the United States.

Journal of the American College of Surgeons, 2017. DOI: 10.1016/j.jamcollsurg.2017.09.012  

Cigarettes and other tobacco products contain one of the world’s most addictive substances: nicotine. The Centers for Disease Control and Prevention (CDC) estimates that a little more than 15 percent of adults in the United States currently smoke cigarettes. This is a huge problem because cigarettes also contain more than 70 carcinogens, or cancer-causing substances, including:

• Arsenic
• Formaldehyde, which is used for embalming corpses
• Hydrogen cyanide
• Lead

Besides causing cancer, these substances contribute to other serious health issues, such as coronary artery disease, lung problems like chronic obstructive pulmonary disorder (COPD) and emphysema. In fact, CDC data show that using tobacco products has become the leading contributor to preventable disease and death in the U.S., accounting for more than 480,000 deaths per year. Today, more than 16 million Americans live with a smoking-related disease.

While the emphasis often is put on quitting smoking, other forms of tobacco use also contribute to cancer and other respiratory and systemic diseases. Chewing tobacco, e-cigarettes and hookahs have all been linked with serious health implications.

How chewing tobacco and e-cigarettes harm the body

While some may claim that chewing tobacco or using e-cigarettes (vaping) or hookahs is safer than smoking, these products still are dangerous. The damaging effects of chewing tobacco (also called snuff or snus) reach far beyond the mouth. Not only can it give you cancer of the mouth, but you also swallow some of the juice as you chew. This can cause head and neck cancer and cancers of the stomach, digestive tract and bladder as well.

The safety of electronic cigarettes is uncertain. A 2014 WHO report cautioned about the use of e-cigarettes stating that there is no regulation about their nicotine content and they continue to have some carcinogenic substances. The “juice” in hookahs contains addictive substances. Vaping and hookah products that don’t contain nicotine are dangerous as well because they’re made with a variety of chemicals that are known to be toxic and cancer-causing. The amount of nicotine and other substances in these products can vary widely—they’re not as standardized or regulated like other drugs are in the U.S. Additionally, no studies have compared the long-term effects of vaping or hookah use, so we don’t know just how much damage these products can do to the lungs and other organs over time.

How can I quit using tobacco?

If you or a loved one need help to quit smoking, chewing or vaping, talk to your doctor. Depending on your level of dependency on nicotine and the severity of your withdrawal symptoms, your doctor may recommend a combination of strategies to quit, including:

• Going “cold turkey” (quitting without any additional aids)
• Lifestyle changes, such as avoiding triggers and changing daily routines you associate with tobacco use
• Over-the-counter nicotine-replacement therapy, such as lozenges, patches or gum
• Prescription-strength nicotine replacement or step-down therapy, such as Chantix

One can also participate in local a tobacco cessation program. Many such programs are free and not tied to a specific hospital or medical center.

Remember, no one can make you quit using tobacco. It’s a personal decision, and one that requires commitment. Quitting likely won’t be easy, but the long-term benefits greatly outweigh a few weeks of discomfort. If you have the willingness to quit and a good support system, you will succeed.

Request an appointment with a primary care provider if you’re ready to quit using tobacco.