Perceptions About the Impact of Global Medical Travel on Poorer Populations in India

There is anecdotal evidence that the increasing focus on global medical travel health services for foreigners in India is likely to exacerbate the different levels of access to health services between India’s wealthy and poor populations. However, surveyed physicians (n=177) at three hospitals in New Delhi indicated positive attitudes to global medical travel, especially in regards to global medical travel’s effects on poorer populations. Overall, these results appear to be the result of respondents’ support of the economic development, new medical technologies, and increased medical training that comes from the health infrastructure investments needed to attract foreign patients

The impact of provider service networks in Florida Medicaid managed care on enrollees’ satisfaction

Two counties in Florida were selected as pilots in 2006 for the Medicaid Demonstration Program. In reform counties, Medicaid enrollees were required to pick a managed care plan; either a Health Maintenance Organization or a Provider Service Network (PSN). PSNs are a form of managed care that provides health care services directly through a provider or network of organizations to a defined population without an intermediary. There are two types of PSNs: Physician-based PSNs and Healthcare system-based PSNs. The objective of this study is to find the differences in enrollees’ satisfaction between two different types of PSNs. To assess the differences in enrollees’ satisfaction between physician-based PSNs and health system-based PSNs over time, this study used difference-in-difference study design with CAHPS data from 2006 to 2008. The study findings showed that, compared to enrollees in physician-based PSNs, health system-based PSN enrollees had higher satisfaction during the post-reform period. However, the trends in satisfaction for enrollees in health system-based PSNs declined at a greater rate relative to the trends for enrollees in physician-based PSNs. Findings from this study may give other states, facing similar decisions to reform their Medicaid managed care system, information to decide whether to adopt a similar plan or to consider other interventions to improve Medicaid beneficiaries’ satisfaction. PSNs are structured similarly to the new accountable care organizations (ACO) models emerging as a result of the Affordable Care Act. Therefore, study findings may be helpful to in improving patient satisfaction with care in ACOs

The Globalization of Health Services: The Impact of Global Medical Travel in India, Brazil and Mexico

Health administration educators in the U.S. have traditionally focused their teaching on domestic healthcare delivery, and this was done for good reason. Healthcare has always been among the most local of all industries: you visit your local doctor and when you need extra care you go to your local hospital. Historically, most actors in the healthcare value chain – employers, insurers, payers, providers, suppliers, and the government – have been local, regional, or at the most removed, national (Starr, 1982). But in fact, many facets of the healthcare value chain have started to globalize, paralleling to some extent the growing globalization of most other industries

Do Physician-based or Hospital-based Provider Service Networks Better Control Medicaid Expenditures?

In a recent demonstration project, Florida Medicaid enrollees were required to pick a managed care plan that was either a Health Maintenance Organization (HMO) or a Provider Service Network (PSN). PSNs are a form of managed care very similar to Accountable Care Organizations (ACOs) that provides health care services directly through a provider or network of organizations to a defined population without a “middle man” such as a third party insurance company and health plan. There are two types of PSNs: Physician-based PSNs and Healthcare system-based PSNs. Physician-based PSNs are created and controlled by physicians groups. Healthcare system-based PSNs are based on safety net hospitals and their outpatient clinics. Health system-based PSNs are integrated delivery systems, which are organizations that combine healthcare providers into one organization and may provide more efficient care with lower cost of care due to economies of scale. The objective of this study was to examine the differences in healthcare expenditures by enrollees in physician-based and health system-based PSNs. Using a difference in difference approach our study found that compared to enrollees in physician-based PSNs, enrollees in health system-based PSNs lowered expenditures to a greater extent over time compared to physician-based PSNs. Findings from this study provide important information to states considering implementing alternative delivery models to control Medicaid costs

Production of α-Bisabolol from metabolically engineered Escherichia coli

α-Bisabolol is a natural-occurring sesquiterpenoid with applications in cosmetics as whitening and soothing agent. It is synthesized from the universal precursors, isopentenyl pyrophosphate (IPP) and dimethylallyl pyrophosphate (DMAPP), which are generated either through the mevalonate (MVA) pathway or the 2C-methyl-D-erythritol-4-phosphate (MEP) pathway. Farnesyl pyrophosphate (FPP) synthase (IspA) then catalyzes the condensation of IPP and DMAPP to the linear FPP, which is rearranged and cyclized to α-bisabolol by bisabolol synthases. Here, we compared the capacity of 5 α-bisabolol synthases from Lippia dulcis, Streptomyces citricolor, Santalum spicatum, Matricaria recutita, and Artemisia annua for α-bisabolol production. MVA pathway and FPP synthase were also overexpressed to supply sufficient FPP for bisabolol synthesis in the recombinant E. coli. Bisabolol synthase from M. recutita (MrBBS) shows the highest activity of bisabolol synthesis, and 75 mg/L/OD600 of bisabolol was produced in a test-tube culture. We further optimized the expression level of IspA and MrBBS by modulation their RBS strength. The 24 bisabolol synthesis operons with different RBSs were assessed for their performance on bisabolol synthesis. By this approach, the best strain is able to produce bisabolol with a capacity of 220mg/L/OD600 in a test tube culture. The consequence of host strain optimization led to an increase in bisabolol production to 300 mg/L/OD600, which presents a 4-fold increase over the initial engineered strain. This work was supported by a grant (NRF-2016R1A2B2010678) from the National Research Foundation, MSIP, Korea

Telehealth: Advances in Alternative Payment Models

Introduction Previous studies indicated that telehealth services may improve hospital performance. However, the extent to which these telehealth provisions would improve hospital total performance score under the hospital value-based purchasing (HVBP) programme is not clear. The aim of this study is to examine the association between telehealth provision and hospital performance. Methods We performed a retrospective analysis of the association between the provision of telehealth services and 2699 hospital’s total performance score (TPS) on the 2018 HVBP programme and its four domains. Multivariate regression models were used to analyse TPS and hospital performance on each domain. Telehealth services offered by a hospital was categorically operationalized as hospitals with no telehealth services, with one to two telehealth services, and with three or more telehealth services. Results Hospitals with one to two telehealth services have TPS (ß coefficient = 1.50; 95% confident intervals (CI): 0.28, 2.73; p \u3c 0.05) and hospitals with three or more telehealth services have higher efficiency and cost reduction (ß = 1.10; 95% CI: 0.32, 1.87; p \u3c 0.01) domain scores. However, the impact of telehealth on clinical care, person and community engagement, and safety domain scores was not significant. Discussion The expansion of hospital telehealth service provision can improve not only the efficiency of care, but also the total performance of the hospital. Since total performance is directly associated with hospital payments from the government, these findings have significant practice and policy implications. In addition, the effect of telehealth on other quality measures such as clinical care and safety needs further investigation

Routine breast milk monitoring using automated molecular assay system reduced postnatal CMV infection in preterm infants

Human cytomegalovirus (CMV) transmitted through breast milk poses fatal risks to preterm infants. However, current molecular assay systems often do not accommodate breast milk samples. In this study, we evaluated the analytical and clinical performance of the measurement procedure of CMV load in breast milk utilizing the Cobas CMV test on the Cobas 6,800 system. This was enabled by incorporating a simple independent sample preparation procedure before the application of samples on the automated assay system. Clinical data from electronic medical records were retrospectively analyzed. Breast milk samples from mothers of preterm infants born before 33 weeks of gestation were screened for CMV using the automated assay system. CMV positivity rates in breast milk and neonatal samples and the CMV transmission rate were calculated. Furthermore, to validate the analytical accuracy of the overall measurement procedure with newly obtained residual breast milk samples, the linearity of the measurement procedure was assessed, and a simplified sample preparation method was validated against a conventional method. The CMV positivity rates in maternal breast milk and neonatal samples were 57.8 and 5.2%, respectively. The CMV transmission rate through breast milk was 7.7%. No significant differences in gestational age or birth weight were found between the CMV-negative and CMV-positive neonates. The linearity of the procedure was observed within a range of 1.87–4.73 log IU/mL. The simplified sample preparation method had an equivalent or even improved CMV detection sensitivity than the conventional method. Incorporating a simple independent sample preparation procedure effectively resolved any potential issues regarding the application of breast milk on the automated assay system. Our approach contributed to reduced vertical transmission of CMV by providing a convenient and reliable method for the monitoring of breast milk CMV positivity for clinicians

Institutional Board Review for Clinical Investigations on Inflammatory Bowel Diseases: A Single-Center Study

Background/AimsThe growing volume and the diversity of clinical research has led to related laws and regulations as well as the Institutional Review Board (IRB) approval process becoming more stringent. To conduct clinical research efficiently and while following regulations, information about the IRB approval process and feedback is important for investigators. This has yet to be studied.MethodsWe included 381 gastrointestinal disease research proposals (79 with inflammatory bowel disease [IBD], and 302 with non-IBD) reviewed by the IRB of Severance Hospital between January 2009 and December 2013. We retrospectively analyzed research characteristics including research risk levels, results of initial reviews, frequencies of continuing review, numbers of IRB comments, frequencies of IRB comments, and durations from submission to approval.ResultsInvestigators' decisions on risk level were higher in the IBD group than in the non-IBD group (P<0.05). Results of initial reviews, frequencies of continuing reviews, the numbers of IRB review comments, and durations from submission to approval were not different between the two groups, but IRB decisions on risk level were higher in the IBD group (P<0.05). In subgroup analysis, the number of IRB comments from initial review on informed consent forms and procedures as well were quest of more information were significantly higher in the IBD group than in the non-IBD group (P<0.001 and 0.01, respectively).ConclusionsIn Korea, rare diseases such as IBD require more information for the IRB process due to their distinct characteristics. IBD researchers should develop research protocols more carefully and make their research as subject-friendly as possible

Lactobacillus reuteri Reduces the Severity of Experimental Autoimmune Encephalomyelitis in Mice by Modulating Gut Microbiota

The gut microbiome plays an important role in immune function and has been implicated in multiple sclerosis (MS). However, how and if the modulation of microbiota can prevent or treat MS remain largely unknown. In this study, we showed that probiotic Lactobacillus reuteri DSM 17938 (L. reuteri) ameliorated the development of murine experimental autoimmune encephalomyelitis (EAE), a widely used animal model of MS, a model which is primarily mediated by TH17 and TH1 cells. We discovered that L. reuteri treatment reduced TH1/TH17 cells and their associated cytokines IFN-γ/IL-17 in EAE mice. We also showed that the loss of diversity of gut microbiota induced by EAE was largely restored by L. reuteri treatment. Taxonomy-based analysis of gut microbiota showed that three “beneficial” genera Bifidobacterium, Prevotella, and Lactobacillus were negatively correlated with EAE clinical severity, whereas the genera Anaeroplasma, Rikenellaceae, and Clostridium were positively correlated with disease severity. Notably, L. reuteri treatment coordinately altered the relative abundance of these EAE-associated taxa. In conclusion, probiotic L. reuteri changed gut microbiota to modulate immune responses in EAE, making it a novel candidate in future studies to modify the severity of MS