Learning from negative findings

Abstract A recent IJHPR article by Azulay et al. found no association between the patient activation measure (PAM) and adherence to colonoscopy after a positive fecal occult blood test result. This commentary will use that article as a jumping-off point to discuss why studies sometimes get negative results and how one should interpret such results. It will explore why the Azulay study had negative findings and describe what can be learnt from this study, despite the negative findings. It is important to publish studies with negative findings to know which interventions do not have an effect, avoid publication bias, allow robust meta-analyses, and to encourage sub-analyses to generate new hypotheses. To support these goals authors must submit articles with negative findings with sufficient detail to support the above aims and perform sub-analyses to identify additional relationships that merit study. The commentary will discuss the importance of publishing articles in which the hypothesis is not proven and demonstrate how such articles should be written to maximize learning from their negative findings

The effect of clinical interventions on hospital readmissions: a meta-review of published meta-analyses

Abstract Background The economic impact and ease of measurement of all-cause hospital readmission rates (HRR) have led to the current debate as to whether they are reducible, and whether they should be used as a publicly reported quality indicators of medical care. Objective To assess the efficacy of broad clinical interventions in preventing HRR of patients with chronic diseases Method A meta-review of published systematic reviews of randomized controlled trials (RCTs) of clinical interventions that have included HRR among the patients' outcomes of interest. Main findings Meta-analyses of RCTs have consistently found that, in the community, disease management programs significantly reduced HRR in patients with heart failure, coronary heart disease and bronchial asthma, but not in patients with stroke and in unselected patients with chronic disorders. Inhospital interventions, such as discharge planning, pharmacological consultations and multidisciplinary care, and community interventions in patients with chronic obstructive pulmonary diseases had an inconsistent effect on HRR. Main study limitation Despite their economic impact and ease of measurement, HRR are not the most important outcome of patient care, and efforts aimed at their reduction may compromise patients' health by reducing also justified re-admissions. Conclusions The efficacy of inhospital interventions in reducing HRR is in need of further study. In patients with heart diseases and bronchial asthma, HRR may be considered as a publicly reported quality indicator of community care, provided that future research confirms that efforts to reduce HRR do not adversely affect other patients’ outcomes, such as mortality, functional capacity and quality of life. Future research should also focus on the reasons for the higher efficacy of community interventions in patients with heart diseases and bronchial asthma than in those with other chronic diseases.</p

Lessons From Analyzing The Medical Costs Of Civilian Terror Victims: Planning Resources Allocation For A New Era Of Confrontations

Policy Points: Across the globe, the threat from terrorist attacks is rising, which requires a careful assessment of long-term medical support. We found 3 major sources of costs: hospital expenditures, mental health services dedicated to acute stress reactions, and ambulatory follow-up. During the first year, most of the costs were related to hospitalization and support for stress relief. During the second year, ambulatory and rehabilitation costs continued to grow. Public health specialists should consider these major components of costs and their evolution over time to properly advise the medical and social authorities on allocating resources for the medical and nonmedical support of civilian casualties resulting from war or terror. Context: Across the globe, the threat from terrorist attacks is rising, which requires a careful assessment of long-term medical support. Based on an 18-month follow-up of the Israeli civilian population following the 2014 war in Gaza, we describe and analyze the medical costs associated with rocket attacks and review the demography of the victims who filed claims for disability compensation. We then propose practical lessons to help health care authorities prepare for future confrontations. Method: Using the National Insurance Institute of Israel\u27s (NII) database, we conducted descriptive and comparative analyses using statistical tests (Fisher\u27s Exact Test, chi-square test, and students’ t-tests). The costs were updated until March 30, 2016, and are presented in US dollars. We included only civilian expenses in our analysis. Findings: We identified 5,189 victims, 3,236 of whom presented with acute stress reactions during the conflict. Eighteen months after the conflict, the victims’ total medical costs reached $4.4 million. The NII reimbursed$2,541,053 for associated medical costs and $1,921,792 for associated mental health costs. A total of 709 victims filed claims with the NII for further support, including rehabilitation, medical devices, and disability pensions. Conclusion: We found 3 major sources of costs: hospital expenditures, mental health services dedicated to acute stress reactions, and ambulatory follow-up. During the first year, most of the costs were related to hospitalization and support for stress relief. During the second year, ambulatory and rehabilitation costs continued to grow. Public health specialists should consider these major components of costs and their evolution over time to properly advise the medical and social authorities on allocating resources for the medical and nonmedical support of civilian casualties resulting from war or terror