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UPMC-Developed Test Increases Odds of Correct Surgery for Thyroid Cancer Patients

PITTSBURGH, July 24, 2014 – The routine use of a molecular testing panel developed at UPMC greatly increases the likelihood of performing the correct initial surgery for patients with thyroid nodules and cancer, report researchers from the University of Pittsburgh Cancer Institute (UPCI), partner with UPMC CancerCenter.

The test, available at the UPMC/UPCI Multidisciplinary Thyroid Center and other diagnostic testing agencies, improved the chances of patients getting the correct initial surgery by 30 percent, according to the study published this month in the Annals of Surgery.

“Before this test, about one in five potential thyroid cancer cases couldn’t be diagnosed without an operation to remove a portion of the thyroid,” said lead author Linwah Yip, M.D., assistant professor of surgery in Pitt’s School of Medicine and UPMC surgical oncologist.  Previously, “if the portion removed during the first surgery came back positive for cancer, a second surgery was needed to remove the rest of the thyroid. The molecular testing panel now bypasses that initial surgery, allowing us to go right to fully removing the cancer with one initial surgery. This reduces risk and stress to the patient, as well as recovery time and costs.”

Cancer in the thyroid, which is located in the “Adam’s apple” area of the neck, is now the fifth most common cancer diagnosed in women.  Thyroid cancer is one of the few cancers that continues to increase in incidence, although the five-year survival rate is 97 percent.

Previously, the most accurate form of testing for thyroid cancer was a fine-needle aspiration biopsy, where a doctor guides a thin needle to the thyroid and removes a small tissue sample for testing. However, in 20 percent of these biopsies, cancer cannot be ruled out. A lobectomy, which is a surgical operation to remove half of the thyroid, is then needed to diagnose or rule-out thyroid cancer. In the case of a postoperative cancer diagnosis, a second surgery is required to remove the rest of the thyroid.

Researchers have identified certain gene mutations that are indicative of an increased likelihood of thyroid cancer, and the molecular testing panel developed at UPMC can be run using the sample collected through the initial, minimally invasive biopsy, rather than a lobectomy. When the panel shows these mutations, a total thyroidectomy is advised.

Dr. Yip and her colleagues followed 671 UPMC patients with suspicious thyroid nodes who received biopsies. Approximately half the biopsy samples were run through the panel, and the other half were not. Patients whose tissue samples were not tested with the panel had a 2.5-fold higher statistically significant likelihood of having an initial lobectomy and then requiring a second operation.

“We’re currently refining the panel by adding tests for more genetic mutations, thereby making it even more accurate,” said co-author Yuri Nikiforov, M.D., Ph.D., professor in the Department of Pathology at Pitt and director of thyroid molecular diagnostics at the UPMC/UPCI Multidisciplinary Thyroid Center. “Thyroid cancer is usually very curable, and we are getting closer to quickly and efficiently identifying and treating all cases of thyroid cancer.”

In 2009, the American Thyroid Association (ATA) revised its guidelines to add that doctors may consider the use of molecular markers when the initial biopsy is inconclusive.

“The ATA is currently revising those guidelines to take into account the latest research, including our findings,” said senior author Sally Carty, M.D., Pitt professor of surgery, co-director of the UPMC/UPCI Multidisciplinary Thyroid Center and recent president of the American Association of Endocrine Surgeons. “The molecular testing panel holds promise for streamlining and eliminating unnecessary surgery not just here but nationwide.”

A previous study led by Dr. Yip showed the panel to be cost-saving when used to help in the diagnosis of thyroid cancer.

Each year, approximately half of the 25,000 patients assessed at UPMC’s Multidisciplinary Thyroid Center are found to have thyroid conditions, and more than 900 thyroid operations are performed by the center’s surgeons. The center aims to provide patients with one-stop evaluation from thyroid experts in a variety of fields, including surgery and endocrinology.

Additional researchers on this study are Laura I. Wharry, M.D., Michaele J. Armstrong, Ph.D., Ari Silbermann, B.S., Kelly L. McCoy, M.D., and Michael T. Stang, M.D., all of the Pitt Department of Surgery; Nobuyuki P. Ohori, M.D., and Marina N. Nikiforov, M.D., all of the Pitt Department of Pathology; Shane O. LeBeau, M.D., Christopher Coyne, M.D., and Steven P. Hodak, M.D., all of the Pitt Department of Endocrinology; Julie E. Bauman, M.D., of the PItt Department of Hematology/Oncology; Jonas T. Johnson, M.D., of the Pitt Department of Otolaryngology; and Mitch E. Tublin, M.D., of the Pitt Department of Radiology.

This study was funded by a grant from UPMC.

Pitt Innovation Challenge Poses New Health Care Questions, Looks for Promising Solutions

PITTSBURGH, July 23, 2014 – In the second competition of its kind, the University of Pittsburgh will award up to $375,000 to teams of creative thinkers who have fresh ideas to solve tough, health-related problems.

As in the previous Pitt Innovation Challenge (PInCh), the University of Pittsburgh Clinical and Translational Science Institute (CTSI), in collaboration with the university’s Office of the Provost and the Innovation Institute, also will provide winning teams with project managers to implement their plans.

The next challenge seeks answers to the question, “From cell to community:  How can we individualize solutions for better health(care)?” Solutions could involve personalizing the medical experience; tailoring treatments for a specific disease using genetic information; leveraging family history or other individually unique data; and developing patient-focused interventions.

“The success of the first PInCh showed that scientists and other community members can come up with creative approaches to tackle difficult problems,” said CTSI director Steven Reis, M.D., who also is associate vice chancellor for clinical research, health sciences, and a professor of medicine at the University of Pittsburgh School of Medicine. “The competition provides a way of making good ideas a reality.”

Since their selection at a public judging event in May, the funded teams from the first PInCh have been making great progress with their projects, Dr. Reis noted. “We’re delighted to support these kinds of efforts and are eager to see the impact they will have on the health of our community.”

The first step in the competition requires submitting a two-minute video by Sept. 15 that introduces the team, defines the health problem that is being tackled and briefly outlines the creative solution. Early round winners will be invited to a final round of judging on Nov. 12 at a public event in which teams will make short presentations to a panel of judges.

“We look at PInCh as a new way to leverage the talent and drive here at the University of Pittsburgh in collaboration with partners outside the university,” said John Maier, M.D., Ph.D., PInCH program director. “We want to ask hard questions that traditional academic efforts have struggled to solve and give anyone who is interested and enthusiastic a chance to come up with better solutions.”

Teams that bring together collaborators from different perspectives, institutions and disciplines are encouraged, but at least one member of the team must be a Pitt faculty member. If needed, PInCh organizers will help community members connect with a member of the faculty. The solution could be a device, a software application, an intervention strategy or any other approach the team identifies.

For more information and to register a team, go to www.pinch.pitt.edu.

Telemedicine Effective in Delivering International Cardiac Care, Children’s Hospital Study Shows

PITTSBURGH, July 22, 2014 – After studying more than 1,000 pediatric consultations offered in Latin America through telemedicine, researchers at Children’s Hospital of Pittsburgh of UPMC found that physicians in those countries were highly satisfied with Children’s service and believed telemedicine had improved patient outcomes.

The study, led by Ricardo A. Muñoz, M.D., FAAP, FCCM, FACC, chief, Cardiac Intensive Care Division, at Children’s, was published online in the July issue of Telemedicine and e-Health.

“Lack of skilled physicians is a widespread problem, particularly those with expertise in patients with complex medical problems, such as congenital heart disease,” said Dr. Muñoz, also medical director, Global Business and Telemedicine, at Children’s. “The use of telemedicine services within pediatric cardiac intensive care units (CICUs) can be used as an assisting technology, allowing more expertise and knowledge to be shared with remote centers in need.”

Although a growing body of evidence suggests that telemedicine is associated with improved patient outcomes, the technology remains a relatively new tool in health care, particularly in pediatric critical care. In surveying the Latin American centers, the Children’s researchers hope to design a common approach for future tele-consultations.

“Little is known about the optimal method of telemedicine service delivery in the international setting,” said Dr. Muñoz. “Ideally, a consistent approach should be used for centers with similar organizations, skill level and patient populations. One size does not fit all.”

The study showcased Children’s unusual multicenter experience in telemedicine at three hospitals in Colombia and one in Mexico from July 2011 to June 2013. Children’s physicians provided 1,040 consultations for 476 patients, with a real-time intervention taking place in 23 percent of those encounters, including echocardiography, adjustment of pacemaker settings and pharmacologic therapy. In 6 percent of the tele-consultations, a different diagnosis was suggested based on the interpretation of cardiac or imaging studies.

The number and type of patients seen by Children’s e-CICU were selected by local physicians at each hospital. Although Children’s physicians in Pittsburgh did not have remote access to the children’s electronic medical records, relevant patient data was provided in a secure database and telemedicine hardware was used for real-time consultations. A CICU physician from Children’s participated in all the encounters, with some being joined by other specialists, including cardiac surgeons and neonatal intensivists.

Based on anonymous surveys of physicians participating at the international centers, 96 percent of respondents reported being satisfied or highly satisfied with the telemedicine service, while 58 percent rated the promptness and time dedicated by the tele-intensivist as very high. Physicians reported that they changed their clinical practice sometimes in relation to the telemedicine encounters, with changes in surgical management noted most frequently.

“We know that telemedicine-assisted pediatric cardiac critical care is technologically and logistically feasible in the international arena,” said Dr. Muñoz. “And now we know that the physicians we assist internationally consider this technology to be useful for patient outcomes and education. With continuing improvements in telemedicine technology and our own practices, we will continue to expand access to the world’s best health care for children around the world.”

Children’s Hospital is leading the way in the development of telemedicine services to meet the needs of young patients regionally and around the world. The state-of-the-art video conferencing technologies provide complex pediatric cardiac care through remote and virtual examinations — whenever and wherever expertise is needed. Experts from Children’s CICUs currently oversee international programs and provide consultations and care management in Cali, Bucaramanga and Medellin, all in Colombia, as well as in Mexico City, Mexico.

For more information on telemedicine services, please visit www.chp.edu/CHP/international+services+telemedicine.

Pitt-led Study Suggests Cystic Fibrosis is Two Diseases, One Doesn’t Affect Lungs

PITTSBURGH, July 17, 2014 – Cystic fibrosis (CF) could be considered two diseases, one that affects multiple organs including the lungs, and one that doesn’t affect the lungs at all, according to a multicenter team led by researchers at the University of Pittsburgh School of Medicine. The research, published online today in PLOS Genetics, showed that nine variants in the gene associated with cystic fibrosis can lead to pancreatitis, sinusitis and male infertility, but leave the lungs unharmed.

People with CF inherit from each parent a severely mutated copy of a gene called CFTR, which makes a protein that forms a channel for the movement of chloride molecules in and out of cells that produce sweat, mucus, tears, semen and digestive enzymes, said co-senior investigator David Whitcomb, M.D., Ph.D., chief of gastroenterology, hepatology and nutrition, Pitt School of Medicine. Without functional CFTR channels, secretions become thick and sticky, causing problems such as the chronic lung congestion associated with CF.

“There are other kinds of mutations of CFTR, but these were deemed to be harmless because they didn’t cause lung problems,” Dr. Whitcomb said. “We examined whether these variants could be related to disorders of the pancreas and other organs that use CFTR channels.”

Co-senior author Min Goo Lee, M.D., Ph.D., of Yonsei University College of Medicine in Seoul, Korea, conducted careful tests of CFTR in pancreatic cell models and determined that a molecular switch inside the cell called WINK1 made CFTR channels secrete bicarbonate rather than chloride molecules.

“Pancreas cells use CFTR to secrete bicarbonate to neutralize gastric acids,” Dr. Whitcomb said. “When that doesn’t happen, the acids cause the inflammation, cyst formation and scarring of severe pancreatitis.”

The research team found nine CFTR gene variants associated with pancreatitis after testing nearly 1,000 patients with the disease and a comparable number of healthy volunteers. They also learned that each variant could impair the WINK1 switch to prevent CFTR from becoming a bicarbonate-secreting channel.

Co-senior author Ivet Bahar, Ph.D., Distinguished Professor and John K. Vries Chair of Computational Biology, Pitt School of Medicine, built a computer model of the CFTR protein’s structure and determined that all the nine variants alter the area that forms the bicarbonate transport channel, thus impairing secretion of the molecule.

“It turns out that CFTR-mediated bicarbonate transport is critical to thin mucus in the sinuses and for proper sperm function,” Dr. Whitcomb said. “When we surveyed pancreatitis patients, there was a subset who said they had problems with chronic sinusitis. Of men over 30 who said they had tried to have children and were infertile, nearly all had one of these nine CFTR mutations.”

He added that identification of the mechanisms that cause the conditions make it possible to develop treatments, as well as to launch trials to determine if medications that are used by CF patients might have some benefit for those who do not have lung disease, but who carry the other mutations.

The team includes researchers from the University of Pittsburgh, the Mayo Clinic, Brigham and Women’s Hospital, and many other institutions that are part of the North American Pancreatitis Study Group.

The study was supported by National Institutes of Health grants DK061451, DK062420, GM086238, DK063922, CA047904 and RR024153; the Ministry for Health & Welfare, Republic of Korea; and Brain Korea 21 Project for Medical Sciences, Seoul.

UPMC Presbyterian Receives Highest National Honor for Organ Donor Enrollment Efforts

PITTSBURGH, July 15, 2014 UPMC Presbyterian was recognized by the U.S. Department of Health and Human Services (HHS) for reaching the gold level of achievement, the highest possible, for conducting activities that promoted enrollment in state organ donor registries. The hospital’s efforts over the past year were part of a national campaign known as the Workplace Partnership for Life Hospital Campaign led by HHS to increase donor enrollments in state registries nationwide.

UPMC conducted awareness and registry campaigns to educate staff, patients, visitors and community members about the critical need for organ, eye and tissue donors. The activities included passing out information in Pittsburgh’s Market Square, a parade of transplant recipients throughout the hospital, the annual UPMC Donate Life flag-raising ceremony and outreach efforts on social media. UPMC earned points for each activity implemented between June 2013 and May 2014.

“As transplant pioneers at UPMC, we recognize the importance of the gift of life and have always encouraged our clinicians, staff and members of the community to make the pledge to be an organ donor. We are grateful for the support of the Pittsburgh region in making our efforts a success,” said John Innocenti, president of UPMC Presbyterian Shadyside.

In all, 1,228 hospitals and transplant centers participated in the HHS campaign. Their combined efforts have added 327,659 donor enrollments to state registries nationwide since 2011, exceeding the HHS goal of 300,000. In Pennsylvania, more than 4.5 million people, or 46 percent of registered drivers, are registered organ donors.

UPMC works closely with the Center for Organ Recovery & Education, one of 58 federally designated not-for-profit organ procurement organizations in the United States, to promote organ donor awareness all year long.

For more than 30 years, UPMC has been providing care to adult and pediatric transplant patients through services at the Thomas E. Starzl Transplantation Institute, the UPMC Department of Cardiothoracic Surgery and the Children’s Hillman Center for Pediatric Transplantation. Today, UPMC has performed more than 17,000 transplants, including heart, lung, intestinal, kidney, liver, pancreas and multiple-organ transplants, along with heart assist device implantation.

UPMC Named to U.S. News & World Report Honor Roll of ‘Best Hospitals’ for 15th Time

UPMC Ranks #1 in Pennsylvania, #1 in Pittsburgh for Clinical Excellence

PITTSBURGH, July 15, 2014 UPMC has once again received national recognition for its clinical expertise, earning 12th position on the annual U.S. News & World Report Honor Roll of America’s “Best Hospitals.” UPMC is the highest-ranked medical center in both Pennsylvania and in Pittsburgh.

“While we’re very proud that UPMC was recognized for the 15th year, it is our patients who are the ultimate winners. Our exceptionally skilled and devoted health care professionals do what they do best every day — provide the finest health care in the state and in the region,” said Leslie C. Davis, president, UPMC Hospital and Community Services Division.

“We are honored to receive this national distinction, which recognizes UPMC’s unique combination of high-quality medical care, a top health insurance plan, and close affiliation with the University of Pittsburgh, one of the best medical schools in the country,” added Steven Shapiro, M.D., executive vice president and chief medical and scientific officer at UPMC. “Furthermore, it emphasizes UPMC’s commitment to our patients and showcases how we are leading the way in the development of new technologies and methods of care.”

Nationally, UPMC is ranked for excellence in 15 of 16 specialty areas, and is among the top 10 hospitals in six specialties: ear, nose and throat; gastroenterology; gynecology; psychiatry; pulmonology; and rheumatology.

U.S. News analyzed 4,743 medical centers in the nation, but only those that achieved high scores in six or more specialties were included in the distinguished Honor Roll group. Scores were based on a variety of factors including hospital volume, patient safety, outcomes and reputation for delivering high-quality care.

Last month, U.S. News named its 2014 Honor Roll of America’s Best Children’s Hospitals, recognizing Children’s Hospital of Pittsburgh of UPMC as 9th in the country.

Pitt Researchers Receive $2.1 Million to Study Prevention of Deadly Lung Injury

PITTSBURGH, July 10, 2014 – University of Pittsburgh researchers have received $2.17 million from the National Heart, Lung, and Blood Institute, part of the National Institutes of Health, to study the prevention and early treatment of acute lung injury. Also known as acute respiratory distress syndrome (ARDS), acute lung injury is a deadly condition that causes the lung to fail in critically ill patients either directly through injury to the lung, such as pneumonia, or indirectly related to another illness.

“Many serious illnesses harm the lung, even when that illness starts elsewhere in the body. A trauma patient may develop ARDS as a result of blood loss or treatments. Severe infection, even outside of the lung, is also a major trigger for ARDS,” said Donald. M. Yealy, M.D., professor and chair of Pitt’s Department of Emergency Medicine. Pitt and UPMC investigators recently published in the New England Journal of Medicine a landmark study that brought new insights into early treatment of sepsis, a deadly form of infection. Dr. Yealy and co-lead investigator Derek C. Angus, M.D., M.P.H., Distinguished Professor and Mitchell P. Fink Chair, Department of Critical Care Medicine at Pitt, are members of the steering committee for the Pennsylvania region of the multi-center Prevention and Early Treatment of Acute Lung injury (PETAL) network.

The network, which includes a unique combination of emergency physicians and critical care specialists, will conduct clinical trials to prevent, treat and improve the outcome of patients with ARDS.

“Once lung injury is embedded, it often causes death or long-term damage. Our goal is to recognize the onset of ARDS and treat it before it can do serious harm to the lung,” Dr. Angus said.

Other collaborating and clinical PETAL centers include Penn State University-Hershey Medical Center, University of Colorado, University of California-San Francisco, Harvard University, Tufts University, University of Washington-Seattle, University of Utah-Intermountain Health Center, Wake Forest University, Vanderbilt University, Mount Sinai Medical Center, University of Michigan, Cleveland Clinic and Ohio State University.

The PETAL network is funded by NIH grant #1U01HL123020-01.

Intervention Through Text Messages Cuts Binge Drinking in Young Adults

PITTSBURGH, July 10, 2014 – Using text messaging to collect drinking data and to offer immediate feedback and support to young adults discharged from emergency rooms reduced the number of drinks they later consumed and the number of binge-drinking episodes, according to a new study by researchers at the University of Pittsburgh School of Medicine.

Lead author Brian Suffoletto, M.D., an assistant professor of emergency medicine at Pitt, and his colleagues designed the first-of-its-kind trial, funded by the Emergency Medicine Foundation (EMF), the grant arm of the American College of Emergency Physicians, to see if mobile phone text messaging—ever-present among college students—could be used to effectively collect drinking data, deliver feedback and change drinking behavior in young adults. The findings will be published in the August 2014 issue of Annals of Emergency Medicine and are now available online.

“Each day in the U.S., more than 50,000 adults ages 18 to 24 visit hospital emergency departments, and up to half have hazardous alcohol-use patterns. More than a third of them report current alcohol abuse or dependence,” said Dr. Suffoletto.” The emergency department provides a unique opportunity to screen young adults for drinking problems and to intervene to reduce future risk.”

In the study, the researchers conducted a randomized trial of a text messaging-based program involving 765 young adults who were discharged from four urban emergency departments in western Pennsylvania.

Participants were randomized to three groups. One received a series of standard, automated text-message queries each week about their drinking plans for the weekend, with a follow-up report on their actual consumption. If they reported anticipating a heavy drinking day (more than five drinks during any 24-hour period for men and more than four for women), participants received a text message expressing concern about those levels and asking if they would be willing to set a goal to reduce drinking for the week. Those who said yes then received messages expressing positive reinforcement and strategies for cutting down. Those who refused to set goals received a text message encouraging them to reflect on the decision (for example, “It’s OK to have mixed feelings about reducing your alcohol use. Consider making a list of all the reasons you might want to change.”). A second group received a text-message query about total alcohol consumption but did not receive a pre-weekend message or feedback. The control group did not receive any text messages.

At three months, participants who were exposed to the text-message intervention had decreased their dinking occasions by 1-2 per month from their baseline of 3-4. Nearly 15 percent of the intervention group reported no drinking occasions at all. The assessment-only group, however, increased drinking over the course of the study, which is inconsistent with prior studies showing a reduction in drinking in patients that undergo assessments, the researchers noted. They speculated that the frequent text messaging might have raised the awareness of alcohol use by the participants and improved the accuracy of their responses.

“There is a lot of talk about mobile health intervention but not a lot of evidence. This is one of the first to test mobile intervention and demonstrate the impact it can have in helping patients make healthy decisions,” said Dr. Suffoletto. “Emergency departments could implement a similar automated program at a minimal cost and possibly save the lives of young adults nationwide.”

Co-authors of the study are Clifton Callaway, M.D., Ph.D., Jeff Kristan, Kevin H. Kim, Ph.D., Peter M. Monti, Ph.D., and Duncan B. Clark, M.D., Ph.D., all of the University of Pittsburgh School of Medicine.

UPMC Receives ‘Innovator Award’ and Named ‘Most Wired’ Hospital for 16 Consecutive Years

PITTSBURGH, July 9, 2014 – For its efforts to improve patient care by changing the way clinicians access and view data from electronic medical records, the UPMC Technology Development Center has received the Innovator Award from Hospitals & Health Networks, the journal of the American Hospital Association (AHA). UPMC was also named one of the “Most Wired” health systems in the country for the 16th consecutive year, the only one in the nation to achieve that distinction.

Additionally, Kane Community Hospital, affiliated with UPMC Hamot in Erie, was recognized with the “Most Wired—Small and Rural” award for the seventh time.

Most Wired hospitals meet rigorous criteria across four operational categories : infrastructure, business and administrative management, clinical quality and safety, and clinical integration. The 2014 results are based on a survey completed by 680 participants, representing 1,900 hospitals, or more than 30 percent of all U.S. hospitals.

As we strive to increase quality, lower costs and enhance value, technology is playing a bigger role in health care than ever before,” said UPMC Chief Information Officer Daniel Drawbaugh. “Through UPMC’s Technology Development Center (TDC), we are determined to lead the way in creating the innovative technologies that are necessary to transform not only UPMC but the entire health care system.”

The Most Wired data show that shared health information allows clinicians and patients to have the information they need to promote health and make the most informed decisions about treatments,” said Rich Umbdenstock, president and chief executive officer of the AHA. “Hospitals, their clinicians and their communities are doing tremendous work to enhance their information technology systems in ways that support care and delivery improvement, and patient engagement goals.”

The TDC won the Innovator Award for its development of “Convergence,” a novel, tablet-based platform that extracts patient data from a variety of clinical information systems and presents them in an easy-to-use, visually compelling way. The platform allows clinicians to seamlessly move between existing legacy information systems and new applications, such as Clinical Pathways, which guide physicians through the most appropriate, evidence-based care. “Now, we can spend more time with patients and less time ‘playing detective’ and piecing together the patient’s story,” said Rasu Shrestha, M.D., vice president of medical information technology.

Over the past five years, UPMC has invested more than $1.5 billion in technology to support clinical excellence and administrative efficiency. UPMC is one of the nation’s earliest and most sophisticated users of electronic medical records (EMRs). More than a dozen UPMC hospitals, as well as UPMC outpatient facilities, are at the highest levels of EMR use, as measured by the Healthcare Information and Management Systems Society (HIMSS) Analytics. UPMC has also committed $100 million to a multi-year effort to create advanced analytics capabilities across the health system.

The July H&HN cover story detailing Most Wired results is available at www.hhnmag.com.

Pitt Study Finds Telephone Treatment of Depression After Cardiac Bypass Surgery Improves Outcomes, Saves Money

PITTSBURGH, July 8, 2014 –Screening for depression and then providing a telephone-delivered, nurse-led “collaborative care” intervention following coronary artery bypass graft (CABG) surgery not only improves health-related quality of life, physical functioning and mood symptoms, but also lowers medical costs and is highly cost-effective compared to doctors’ usual care, according to researchers at the University of Pittsburgh School of Medicine.

This analysis of the National Institutes of Health-funded Bypassing the Blues trial was published online today in General Hospital Psychiatry. While previous research showed this collaborative care model to be effective for treating post-CABG depression, the latest study establishes the “business case” to policy makers and insurers for widespread adoption, said Bruce L. Rollman, M.D., M.P.H., professor of medicine, psychiatry, and clinical and translational science at the University of Pittsburgh School of Medicine and principal investigator of the trial.

“One of the holy grails in mental health services research is to demonstrate that treating a common mental health condition such as depression is not only effective and cost-effective, but is also cost-saving. This is the first trial to demonstrate all three outcomes,” said Dr. Rollman. “We now know that screening for and then providing effective depression treatment to medically complex patients with cardiovascular disease is very likely to pay for itself.” A recent American Heart Association science advisory already recommends routine screening and treatment of depression in patients with cardiac disease, he noted.

Researchers examined Medicare and private medical insurance claims data for 189 trial participants. After incorporating the $460 average cost to deliver the intervention that included nurse and supervising physician time, patients randomly assigned to the intervention had $2,068 lower median claims costs at one year after bypass surgery compared to those who received their doctors’ usual care ($16,126 vs. $18,194). The intervention was also highly cost-effective, producing more quality-adjusted life-years (QALY), a measure analysts use to determine the value of different medical actions, while significantly lowering medical claims costs by $9,889 per additional QALY generated, a first for a collaborative care strategy for treating depression in any patient population.

About 400,000 CABG surgeries are performed annually in the U.S., and studies indicate approximately one in five patients who undergo the procedure experience clinical depression. Extending this $2,068 savings to all depressed post-CABG patients has the potential to save over $165 million in medical claims in the first year following surgery, said Dr. Rollman.

The collaborative care model involves care managers who follow an evidence-based treatment protocol under the supervision of a primary care physician. The team systematically contacts patients to monitor their mood symptoms and recommends appropriate adjustments in treatment. Although team-based collaborative care for depression has yet to be widely adopted, it is increasingly being provided by integrated health care systems through “patient-centered medical homes” supported by payment reforms under the Affordable Care Act.

Collaborators on this study include Julie M. Donohue, Ph.D., Bea Herbeck Belnap, Ph.D., Aiju Men, M.S., Fanyin He, Ph.D., Mark S. Roberts, M.P.P., M.D., and Charles F. Reynolds III, M.D., all of the University of Pittsburgh, and Herbert Schulberg, Ph.D., of Weill Cornell Medical College.

The research was supported by the Fine Foundation and by The National Heart Lung and Blood Institute, part of the National Institutes of Health grant number R01HL70000.

For more information about the Bypassing the Blues trial, visit: www.bypassingtheblues.pitt.edu.

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