February 2019, Volume XXXII, No 10
University of Minnesota (M Health) has become the first health system in the U.S. to begin offering GammaTile Therapy, a new approach to treating recurrent brain tumors.
GammaTile is an FDA-cleared, surgically targeted radiation therapy that is designed to delay tumor growth for patients with brain tumors. The first patient was treated by University of Minnesota physician Clark Chen, MD, PhD, head of the department of neurosurgery at the Medical School.
Aggressive brain tumors tend to be resistant to current treatments and almost always recur, with outcomes for patients with brain tumors improving little over the past 30 years. GammaTile works differently—it consists of a bioresorbable, conformable 3D-collagen tile embedded with a cesium radiation source. It is placed at the time of surgery so it immediately begins to target residual tumor cells with radiation while limiting the impact on healthy brain tissue.
The treatment offers some advantages over other treatments for patients undergoing surgery for recurrent brain tumors. It doesn’t require any additional trips to the hospital or clinic, unlike current treatments—for example, a course of External Beam Radiation Therapy (EBRT) requires daily treatments for up to six weeks. Additionally, many patients may not be candidates for EBRT at the time of tumor recurrence because the risk of additional EBRT outweighs potential benefits. And those who may be candidates for EBRT typically have to wait four weeks or more for surgical wound healing before beginning treatment, allowing residual, microscopic tumors to grow during the waiting period.
Chen has conducted research that supports the efficacy of radiation treatment immediately after resection. His study, published in the Journal of Neuro-Oncology, showed that patients with glioblastoma, the most common form of primary brain cancer in adults, who received immediate postoperative radiation exhibited improved survival relative to those who did not.
Virtual care software company Zipnosis has released a new report analyzing how health systems are deploying and using virtual care. Results of the 2018 On-Demand Virtual Care Benchmark Survey indicate that there will be a major increase in virtual care use by health systems over the next year, primarily driven by the enhanced efficiency that virtual care offers to providers.
According to Zipnosis, studies have yet to examine how health systems are deploying virtual care, and this study attempts to fill in that gap. The in-depth analysis offers insights into the state of virtual care and looks at everything from adoption to common and future uses.
A recent JAMA study showed that although telemedicine has grown steadily over the past few years, the majority of patients are still opting for in-person visits with their provider. However, the results of Zipnosis’ report show that 96.4 percent of health systems are planning to expand their virtual care services in the next year, with only 3.5 percent stating that they have no firm plans to do so. Among the systems with plans to expand, the most commonly selected options were adding modes of care and expanding use cases and specialties for patient-initiated visits.
The report showed several other key trends. Behavioral health topped the list of areas that respondents would like to see virtual care address (nearly 40 percent), followed by chronic disease detection and management (16 percent). Nearly two-thirds of respondents looking to expand their platforms reported wanting to add real-time chat, video, and asynchronous capabilities to their modes of care.
The majority of respondents (nearly 43 percent) reported the average work time for virtual visits is between one and five minutes, compared to the median visit length of nearly 16 minutes for in-person visits, according to National Institutes of Health data. Most respondents reported using virtual care to treat simple and more common conditions, with more than 50 percent reporting that they use their virtual care solutions to treat upper respiratory infections, urinary tract infections, cough, and pinkeye.
In addition, nearly 42 percent of respondents said their virtual care solution did not integrate with their EMR. While only 21 percent indicated that as a challenge, EMR integration is an area that can help vastly improve the patient experience and should be a key focus moving forward, according to Zipnosis
Research from Mayo Clinic and collaborators has shown that physician burnout appears to be improving, along with indicators for physician well-being, although physicians are still at high risk for burnout.
Researchers from Mayo Clinic, the American Medical Association, and Stanford University collaborated in the national survey of physicians across more than 20 specialties to assess any changes since the previous study that was conducted in 2014, and the original survey that was conducted in 2011. Burnout varies by specialty, but overall, reported levels of burnout and satisfaction with work-life integration improved between 2014 and 2017. However, those numbers only fell to 2011 levels. The researchers say individual and organizational efforts have improved the situation, but more work needs to be done.
More than 30,000 physicians were invited to participate in the electronic survey. Of those, about 17 percent (5,197) responded, and a second attempt to reach those who did not respond gained another 248 participants. Questions mirrored those on previous surveys.
The researchers say the reason for the change may be that physicians adapted to the new work environments over the three-year period. In addition, much progress may be attributed to interventional programs to stem burnout in hospitals and other health care facilities. However, they also note that the indicators may have improved because many distressed physicians have left the profession.
A collaborative study from Hennepin Healthcare and Hennepin County has shown that a large proportion of opioid deaths in Hennepin County in 2015 and 2016 occurred after a jail stay. The researchers, who analyzed death and jail records for the study, say this finding confirms county officials’ suspicions.
The results showed that 71 out of 252 opioid deaths in Hennepin County occurred within one year of release from custody. Nearly 25 percent of those occurred within two weeks of release, and more than half were within 90 days. Among those who died from an overdose after a jail stay, 81 percent were incarcerated for at least 24 hours.
The researchers say the findings point to the need for a shift in how officials in corrections and health and human services offer recovery services.
“Most people with an opioid use disorder will spend time in the criminal justice system,” said Tyler Winkelman, MD, MSc, a physician and researcher at Hennepin Healthcare. “This report shows that correctional facilities can and should play a critical role in the public health response to the opioid epidemic. Expanding treatment options for this population could substantially lower opioid deaths in Hennepin County.”
Currently, Hennepin County social workers connect people with behavioral and chemical health resources for follow-up after being released from jail. However, this new information shows that diagnosing opioid use disorder and beginning medical treatment while in custody could have positive outcomes for people and reduce the number of deaths and the traumatic and expensive overdose-hospitalization-jail cycle that usually precedes them.
Other agencies’ work has shown that this intervention is effective. In Rhode Island, they implemented treatment for opioid use disorders at every jail and prison in the state—one year later, overdose deaths following release from jail decreased by 60 percent and overdose deaths statewide decreased by 12 percent.
Hennepin County is in the process of applying for grant funds available through recent federal legislation, which will be used in combination with county funding, to strengthen current practices. These consist of including substance use disorder screening in jail health intake; creating a system to help people start treatment, or support those who are already using medications like naltrexone, buprenorphine, or methadone to control their disorder; and strengthening connections to community treatment providers.
Other findings from the study time period show that 755 Minnesotans died from causes related to opioids (a 26 percent increase from 2011–2012). Hennepin County residents accounted for 33 percent of those deaths; African American and Native American people were disproportionately represented among those that died from opioid-related causes; and residents of suburban Hennepin County accounted for nearly half the deaths.
Health care spending for Minnesota residents reached $47.1 billion in 2016 and grew at one of the lowest rates in the past decade, according to a report from the Minnesota Department of Health (MDH). However, the report, Minnesota Health Care Spending: 2015 and 2016 Estimates and Ten-Year Projections, also warns that continued growth could double overall spending on health care in the next 10 years.
According to MDH, the slower spending growth in 2016 was driven by reductions in public program spending for beneficiaries of Minnesota Health Care Programs. The reduction resulted from changes in how the Minnesota Department of Human Services negotiated payments to health plans. They note that had public program spending continued its 2015 trend, overall spending would have increased more than 5 percent in 2016, by an additional $1.6 billion. Private health insurance spending increased 6.1 percent and Medicare spending increased 4.9 percent in 2016.
The long-term projections suggest health care spending over the next decade will double, reaching $94.2 billion, meaning Minnesota is on track to spend $1 out of every $6 generated by the state’s economy on health care.