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Research Briefs

Survey says
Many doctors are skeptical that patients with CDI (an infection by the bacterium Clostridium difficile) would be willing to be treated with fecal microbiota transplantation (FMT). The treatment is both safe and effective, but it has an obvious drawback: the need to infuse a stool sample taken from a healthy donor into the patient. But Geisel researchers, led by several medical students, found in a survey that most people would be willing to consider FMT, despite the method of treatment. "Our data suggest that patients may be more ready and willing to accept FMT as a treatment alternative for CDI than previously assumed," the authors wrote in Clinical Infectious Diseases.

Aligning incentives
From 2005 to 2006, Medicare lowered the reimbursement rate for chemotherapy given in the last 14 days of a patient's life in recognition of the fact that such treatments are often unnecessary. According to research led by Carrie Colla, Ph.D., an assistant professor of TDI, the change in payment led to a decrease in use of chemotherapy in the last two weeks of a patient's life at doctors' offices. By contrast, at hospitals, where the connection between a chemotherapy treatment and a doctor's salary is less direct, the chemotherapy rate remained unchanged. Colla noted in the Journal of Oncology Practice that "these results suggest that payment reform may be used to better align appropriate incentives with better quality of care."

Cleanliness is next to healthiness
Despite evidence that consistent hand hygiene can reduce the rate of health-care-associated infections, hospitals across the country have struggled to get providers to wash their hands consistently. In recent years, DHMC undertook a large-scale effort to improve hand hygiene and reduce health-care-associated infections. Over the course of the project, the compliance rate increased from 41% to 91%. Over the same period, the rate of health-care-associated infections dropped from 4.8 to 3.3 per 1,000 inpatient days. The authors of a study on the effort noted that there is still room for improvement, especially among physicians, but, they added, "our study adds to the evidence that sustained and significant improvement in [hand hygiene] is achievable."

Painful spending increases
A team of Geisel researchers recently examined changes in spending on back treatments and determined which types of treatment are responsible for much of the $90 billion spent every year on lower back pain. From 1999 to 2008, the average expenditure (adjusted for inflation) for a patient with a back problem rose 95%, from $487 to $950, most of which was accounted for by spending on medical specialists. "There are important decisions on the horizon regarding the U.S. health-care system," the authors noted in Spine. "Our findings imply that medical care, specifically specialty care, rather than primary care, chiropractic care, or physical therapy, is responsible for rising ambulatory care costs for spine conditions."

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Geisel School of Medicine at DartmouthDartmouth-Hitchcock Medical CenterWhite River Junction VAMCNorris Cotton Cancer CenterDartmouth College