Study Suggests Farm Traffic Vehicle Accidents Could Be Reduced By More Than Half

State policies that increase lighting and reflecting recommendations for farmers can significantly reduce accidents involving tractors and other farm vehicles

Newswise, October 24, 2016 — A new study from the University of Iowa College of Public Health has found that traffic accidents involving farm vehicles in the Midwest would decrease by more than 50 percent if state policies required more lighting and reflection on those vehicles.

The study by the college’s Great Plains Center for Agricultural Health (GPCAH) compared rates of farm equipment–related crashes in nine Midwestern states in the context of the states’ policies on lighting and marking vehicles.

Those states report an average of more than 1,100 farm vehicle-related crashes each year, often causing severe or fatal injuries.

The American Society of Agricultural and Biological Engineers (ASABE) has issued standards on lighting and marking farm vehicles to promote safety among all roadway users.

The standards suggest certain numbers of headlights, taillights, turn signals, and other exterior lighting visible to other drivers, as well as the number and size of reflective markers.

The organization’s standards are not all required by state laws, but many of the nine states in the study have adopted some of them or have their own policies that address the same issues.

The researchers found fewer crashes in states with more stringent lighting and marking policies, in particular those that adhered to ASABE’s standards.

States with greater compliance with ASABE standards had 11 percent fewer farm equipment road crashes than states with lesser compliance. Illinois law and policies were most compliant with the standards, whereas Missouri's were the least.

Using data from 2005 to 2010, researchers estimate the number of accidents annually would be cut 60 percent, from 972 to 385, if states implemented policies that increased compliance with ASABE standards by 25 percent over current policies.

In Iowa, the study estimates crashes would decrease from an annual average of 164 to 65, or by 60 percent

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Marizen Ramirez, UI professor of occupational and environmental health and lead investigator on the study, says most farm vehicle–passenger vehicle collisions occur because most passenger vehicle drivers are not familiar with farm vehicles and cannot correctly gauge the speed at which they are moving. This often leads to vehicles approaching too quickly and attempting to pass in unsafe conditions, which can result in a crash.

She says the likelihood of a crash is greater in October and November, when more farm vehicles are on the road for the harvest and the sun sets earlier.

“We know that farmers spend a lot of time on the roads, especially during planting and harvest,” she says. “Our research shows that lighting and marking—like reflectors, slow-moving vehicle emblems, and taillights—can help farm vehicles stand out on roadways so passenger vehicle operators are more likely to see them. It helps to do all that you can to increase your visibility on the road, especially when farmers may be driving during and after dawn or dusk.”

Program Will Train Mental Health Providers, Improve Health Care in Rural Missouri

August 11, 2016--According to the U.S. Census, 37 percent of Missourians live in rural communities and have limited access to health care, particularly mental health care.

A new graduate education program at the University of Missouri has received nearly $700,000 from the Health Resources and Services Administration (HRSA) in the U.S. Department of Health and Human Services to train psychology doctoral candidates in integrated, primary health care settings, in an effort to improve health care for underserved populations with mental health and physical disorders.

“Placing psychology doctoral candidates within primary health care agencies will enhance the current infrastructure in Missouri’s communities and improve comprehensive care for patients,” said Laura Schopp, professor of health psychology and co-principal investigator for the training program.

“For example, a patient with diabetes may need psychological help to address mental barriers that could be preventing them from changing their behavior. Having psychologists working side-by-side with primary care providers should result in better patient outcomes and savings to the state in Medicaid dollars.”

The funding will support several training partnerships and placements throughout Missouri including:
• Missouri Department of Mental Health and Community Mental Health Centers
• Missouri Division of Vocational Rehabilitation
• Family and Community Medicine Clinics in the MU School of Medicine
• MU Thompson Center for Autism and Neurodevelopmental Disorders
• Harry S Truman VA Medical Center
• Fort Leonard Wood Army Post

“Previous research has indicated the need for a comprehensive approach to health care,” Schopp said. “If we treat the whole person—mind and body—patients will have significantly better health outcomes. This new training program will allow people to help patients that do not have access to the psychological care that they need.”

The HRSA Graduate Psychology Education program at MU is being led by Brick Johnstone, professor of health psychology in the MU School of Health Professions. Along with Schopp, the program is being assisted by Eric Hart, associate clinical professor of health psychology and training director; Renee Stucky, professor at the Comprehensive Pain Management Center in the MU School of Medicine; Nikole Cronk, associate teaching professor of family and community medicine in the MU School of Medicine; and psychologists from the MU department of health psychology.

This project is supported by HRSA of the U.S. Department of Health and Human Services under grant number 1D40HP29827-01-00 for $699,772 over a three-year period. As required by the grant, MU provides some benefits to graduate students who contribute to this work. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 

Sweet Potato Crop Shows Promise as Feed and Fuel

Newswise, August 3, 2016 --As some Florida growers try to find new crops and the demand for biofuel stock increases globally, University of Florida Institute of Food and Agricultural Sciences researchers have found that sweet potato vines, usually thrown out during harvest, can serve well as livestock feed while the roots are an ideal source for biofuel.

This could be a key finding for the agriculture industry in Florida and to biofuel needs worldwide, said post-doctoral researcher Wendy Mussoline.

“The agriculture industry in Florida is looking to find new, viable crops to replace the citrus groves that have been diminished by the greening disease,” Mussoline said.

“Potato farmers are also trying to find new crops that offer both biofuel alternatives as well as food and/or animal feed opportunities. They are conducting field trials on several varieties of sweet potatoes to determine if they are an economically viable crop that they can market.”

According to a newly published study by professor Ann Wilkie and Mussoline, an industrial sweet potato variety (CX-1) may do the trick.

Currently, 99 percent of the ethanol produced in the United States comes from corn or sorghum, the study says. But scientists and business interests are considering highly productive alternatives such as sweet potatoes for biofuel. Although China produces 81 percent of the world’s sweet potatoes, U.S. sweet potato production reached a record high of 3.2 billion pounds in 2014, according to the U.S. Department of Agriculture.

Wilkie and Mussoline, both researchers in the UF/IFAS soil and water sciences department, found that CX-1 is a superior choice as a dual-purpose crop than the so-called “table” varieties – which people would normally eat -- known as Beauregard and Hernandez.

They determined this by putting CX-1, Beauregard and Hernandez, through multiple tests in the field and laboratory in Gainesville.

“The CX-1 roots have higher starch content and thus higher potential for fuel ethanol yields than the table varieties,” Mussoline said.

The study demonstrated CX-1’s value as animal feed and promotes the industrial sweet potato crop as a dual-purpose crop that could be used for both fuel ethanol -- from the starchy roots -- and nutritious animal feed -- from the vines.

“Although this would be a ‘new’ feedstock for biofuels in the U.S., sweet potato is currently used in other countries; for example, China and Brazil, use it as a biofuel feedstock,” Mussoline said.

“The sweet potato is a high-yielding crop suited to tropical and subtropical climates that requires minimal fertilization and irrigation, and the CX-1 industrial cultivar offers superior potential for feed and fuel,” Wilkie said.

The research was sponsored by the Florida Department of Agriculture and Consumer Services Office of Energy.

The new study is published online in the Journal of the Science of Food and Agriculture, http://bit.ly/29RLhpS.

Telephones Can Bring Cancer Genetic Counseling to Rural Women

New follow up study shows cancer genetic counseling delivered by telephone as good as in-person counseling

Newswise, June 24, 2016 — Ever since Angelina Jolie used cancer genetic counseling and testing to learn about her risk for hereditary breast and ovarian cancer, many other women have chosen to do the same.

But for women in rural communities, traveling to meet in person with cancer genetic counselors can be time-consuming and expensive. Now, a new study shows that getting cancer genetic counseling over the phone can be just as good as getting the same counseling in person.

The work, led by Anita Kinney, PhD, RN, at The University of New Mexico Comprehensive Cancer Center, was published in the Journal of Clinical Oncology.

All the women who took part in the study were at increased risk for hereditary breast or ovarian cancer. The researchers divided the women into two groups.

One group traveled to meet in person with a cancer genetic counselor and the other received counseling over the telephone. Both groups of women received teaching materials and letters about their risk in the mail. With the women’s permission, letters about their risk and how to manage it were mailed to their doctors.

One year after their counseling, the study assessed how the women felt: their anxiety and cancer-related distress, and how much control and how informed they felt about their risk and medical recommendations. It also tracked how many women went on to get genetic testing. Both groups benefited similarly from genetic counseling.

“This study provides important evidence that telephone counseling is an effective alternative to in-person counseling,” says Kinney. “It can help to make cancer genetic services more widely accessible, which is an important consideration in rural states like New Mexico. We hope that our study’s results will help increase health insurance coverage of telephone counseling so that more cancer patients and their family members can benefit from potentially lifesaving cancer risk information.”

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About Anita Kinney, PhD, RN
Anita Kinney, PhD, RN, is a Professor in the Division of Epidemiology and Biostatistics, Department of Internal Medicine, and is The Carolyn R. Surface Endowed Chair in Cancer Control and Population Sciences at University of New Mexico School of Medicine. She serves as Associate Director for Cancer Control and Population Sciences at the UNM Cancer Center. She also serves as the lead investigator for Cancer Care Delivery Research at the New Mexico Underserved/Minority site. Trained at the University of Pennsylvania, UT-Houston School of Public Health, the University of North Carolina-Chapel Hill, and the National Cancer Institute, Dr. Kinney is an international and highly acclaimed expert in cancer prevention and public health. Her overarching research goal is to understand variation in cancer risk; determinants of risk and outcomes; and to use this information to develop effective interventions that facilitate access to quality care, promote cancer equity, informed decision-making and positive changes in health behaviors, cancer prevention care delivery and survivorship. With a particular emphasis on breast, ovarian and colorectal cancers, she is making improvements in reducing cancer risk and the way cancer care is delivered in diverse populations.

About the UNM Comprehensive Cancer Center
The University of New Mexico Comprehensive Cancer Center is the Official Cancer Center of New Mexico and the only National Cancer Institute-designated Cancer Center in a 500-mile radius. One of the premier cancer centers nationwide, the UNM CCC has 125 board-certified oncology physicians, forming New Mexico’s largest cancer care team. It treats about 60 percent of adults and virtually all the children in New Mexico diagnosed with cancer — more than 10,000 people— from every county in the state in more than 135,000 clinic visits each year. Through its partnership with the New Mexico Cancer Care Alliance, an “exemplary national model for cancer health care delivery,” the UNM CCC offers access to more than 175 clinical trials to New Mexicans in every part of the state. Annual research funding of more than $72 million supports the UNM CCC’s 129 cancer scientists. Working with partners at Los Alamos and Sandia National Laboratories, Lovelace Respiratory Research Institute, and New Mexico State University, they have developed new diagnostics and drugs for leukemia, breast cancer, ovarian cancer, prostate cancer, liver and pancreatic cancer, brain cancer, and melanoma; garnered 33 new patents and 117 patents pending; and launched 13 new biotechnology companies since 2010. Learn more at cancer.unm.edu.

Study Examines Use of Telemedicine Among Rural Medicare Beneficiaries

Newswise, May 31, 2016 — Although the number of Medicare telemedicine visits increased more than 25 percent a year for the past decade, in 2013, less than 1 percent of rural Medicare beneficiaries received a telemedicine visit, according to a study appearing in  JAMA.

Medicare limits telemedicine reimbursement to select live video encounters with the patient at a clinic or facility in a rural area. Federal legislation has been proposed to expand Medicare telemedicine coverage. 

Ateev Mehrotra, M.D., of Harvard Medical School, Boston, and colleagues examined trends in telemedicine utilization in Medicare from 2004-2013 using claims from a 20 percent random sample of traditional Medicare beneficiaries.

The researchers found that telemedicine visits among rural Medicare beneficiaries increased from 7,015 in 2004 to 107,955 in 2013 (annual visit growth rate, 28 percent); 0.7 percent of rural beneficiaries received a telemedicine visit in 2013. 

Most visits occurred in outpatient clinics; 12.5 percent occurred in a hospital or skilled nursing facility. Mental health conditions were responsible for 79 percent of visits. 

Rural beneficiaries who received a 2013 telemedicine visit were more likely to be younger than 65 years, have entered Medicare due to disability, have more illnesses, and live in a poorer community compared with those who did not receive a telemedicine visit.

“Proposed federal legislation would encourage greater use of telemedicine through expanded reimbursement. In contrast to others, we found that state laws that mandate commercial insurance reimbursement of telemedicine were not associated with faster growth in Medicare telemedicine use. 

Our results emphasize that nonreimbursement factors may be limiting growth of telemedicine including state licensure laws and restrictions that a patient must be hosted at a clinic or facility,” the authors write.

Editor’s Note: This article was supported by an unrestricted gift to Harvard Medical School by Melvin Hall and CHSi Corporation. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Surgery Surprise: Rural Hospitals May Be Safer and Less Expensive for Common Operations

Critical access hospital study suggests local care works well for straightforward surgical cases in uncomplicated patients

Newswise, May 18, 2016— They may be in small towns. They may only have a couple of surgeons. But for common operations, they may be safer and less expensive than their larger cousins, a new study finds.

“They” are critical access hospitals – a special class of hospital that’s the closest option for tens of millions of Americans living in rural areas. And according to new findings published in the Journal of the American Medical Association, having surgery at one of them may be a better bet for most relatively healthy patients than traveling to a suburban or city hospital.

A University of Michigan-led team carried out the analysis of data from 1.6 million hospital stays for four common operations: gallbladder removal, colon surgery, hernia repair and appendectomy.

They compared what happened to patients covered by Medicare who had their operations at 828 critical access hospitals with data from patients treated at more than 3,600 larger hospitals.

The analysis yielded several surprises:

• The risk of dying within 30 days of the operation was the same whether a patient had surgery at a critical access hospital or a larger hospital.
• The risk of suffering a major complication after surgery, such as a heart attack, pneumonia or kidney damage, was lower at critical access hospitals.
• Patients who had their operation at a critical access hospital cost the Medicare system nearly $1,400 less than patients who had the same operation at a larger hospital, after differences in patient risk and pricing were accounted for.
• The patients who had these operations at critical access hospitals were healthier to begin with than patients treated elsewhere, suggesting that critical access hospital surgeons are appropriately selecting surgical patients who can do well in a small rural setting, and triaging more complex patients to larger centers.
• But even after the researchers corrected for differences in pre-operation health, the critical access hospitals still had equal or better outcomes.

Critical eye on critical access

The findings are timely because of a current debate over whether to change the national policies that designate critical access hospitals, and determine how much they get paid for medical and surgical services. Hundreds are these hospitals are in danger of closing, threatening local access to care for millions of Americans.

Currently, the Medicare system essentially subsidizes them by paying them slightly more than the total cost of care, in order to ensure they can stay financially afloat to serve rural areas. Even still, dozens have closed in recent years.

Recent studies of common medical conditions like heart attacks and pneumonia at critical access hospitals have raised questions about how well they care for patients with these conditions. The new study is the first comprehensive look at the surgical care they provide.

“From a surgical standpoint, these hospitals appear to be doing exactly what we would want them to be doing: common operations on appropriately selected patients who are safe to stay locally for their care,” says Andrew Ibrahim, M.D., first author of the new study and a VA/Robert Wood Johnson Clinical Scholar at the U-M Medical School.

Ibrahim and senior author Justin Dimick, M.D., MPH, worked on the study with Tyler Hughes, M.D., one of two surgeons at the critical access McPherson Hospital in McPherson, KS and a director of the American Board of Surgery.

Says Hughes, “The goal of the rural surgeon is best care nearest home. Data to assure that the care in rural centers is both safe and cost effective is critical in the decisions the profession faces in providing care to the 20 percent of the U.S. population living in truly rural environments.

This study gives credence to what rural surgeons long suspected -- that well-done rural surgery is safe and cost effective.” Hughes helped the U-M team understand the triage process that surgeons at critical access hospitals use to decide whether to take a case or refer the patient to a larger center.

Says Dimick, “For many years, surgeons have debated whether we should concentrate surgery in a subset of our larger hospitals. The downside of this approach is that patients have to travel far from home for surgery, especially those living in remote areas.

“While it may make sense to travel to a higher volume hospital for a few of the most complex operations, this study shows that having surgery locally is safe for many of our most common surgical procedures.” Dimick, a professor of surgery, leads the Center for Healthcare Outcomes and Policy at U-M and is a member of the U-M Institute for Healthcare Policy and Innovation. 

Other findings from the study:

• Less than 5 percent of surgery patients at critical access hospitals got transferred to larger hospitals, compared with more than a quarter of patients treated for non-surgical issues and studied by other teams.
• Critical access hospital surgery patients were less likely to use skilled nursing facilities after their operations.
• Complex operations such as esophagus or pancreas removal were performed so rarely at critical access hospitals they were not included in the study.

More about critical access hospitals

Under the original provision established by the Medicare Rural Hospital Flexibility Program, hospitals were eligible for critical access designation if they have less than 25 inpatient beds and are more than 35 miles away from another hospital. By meeting these criteria and undergoing critical access designation, hospitals are paid 101 percent of reasonable costs.

They are also exempt from certain other limits on Medicare payment that non-critical access hospitals are subject to. Physicians who practice at critical-access hospitals are also able to receive 115 percent of the usual payment for traditional Medicare patients.

The new research is based on data from the Medicare Provider Analysis and Review file from 2009 to 2013, after nearly all of the current 1,332 critical access hospitals underwent designation.

In addition to Ibrahim, Hughes and Dimick, the study team included U-M statistician Jyothi Thumma, MPH. The research was funded by Ibrahim’s support from the Robert Wood Johnson Foundation and U.S. Department of Veterans Affairs, and by National Institute on Aging grant AG039434. Reference: JAMA Vol. 315, No. 19, DOI:10.1001/jama.2016.5618

Grassley’s REACH Act would increase access to Emergency Care in Rural Areas

April 13, 2016--The Medicare Payment Advisory Commission (MedPAC), an independent congressional agency that advises Congress on issues affecting the Medicare program, has begun to discuss an issue important to Sen. Chuck Grassley: new methods of “improving efficiency and preserving access to emergency care in rural areas.”  

The commissioners discussed a possible new payment option for critical access hospitals in which the hospitals would shift to outpatient services only with emergency room services.  

Grassley is the sponsor of the Rural Emergency Acute Care Hospital (REACH) Act that would allow such hospitals to shift from offering inpatient care to outpatient care with emergency room services.

 Grassley’s bill is meant to recognize that inpatient beds are hard to fill in many small communities but emergency room care is critical.  Grassley made the following comment on MedPAC’s discussion.

“It’s good news to hear a discussion about hospital needs in rural communities.  MedPAC notes that rural hospitals have closed, and more are in danger of closing, so a discussion of whether to shift away from inpatient beds to outpatient care and emergency services is timely and necessary.  

"I look forward to more discussions among policy experts and the enactment of policies that keep rural hospitals open and serving their communities in a flexible, updated way.”