Houston hospitals have been reported to have an excess of unnecessary health care tests and procedures. Photo by Dwight C. Andrews/Greater Houston Convention and Visitors Bureau

Houston boasts of being home to the Texas Medical Center, the world's biggest medical complex. Yet Houston's medical community also holds a distinction that's hardly boast-worthy: It's the worst major metro area in Texas for unnecessary health care tests and procedures.

A study released May 4 by the Lown Institute, a health care think tank, shows hospitals in the Houston area collectively fare worse than their counterparts in Dallas-Fort Worth, San Antonio, and Austin for overuse of tests and procedures that the institute says offer little to no benefit.

To come up with its ranking, the institute looked at Medicare data for more than 1 million tests and procedures performed at over 3,100 U.S. hospitals from 2016 to 2018. Among the overused tests and procedures identified in the study are hysterectomy for benign disease, placement of coronary stents for stable heart disease, and diagnostic tests like head imaging for fainting.

"Overuse in American hospitals is a pervasive problem that needs to be addressed," Dr. Vikas Saini, president of the Lown Institute, says in a news release. "Hospitals want to do better, and these objective measures of performance can help them move forward."

Hospitals in Texas ranked fourth worst among all the states for overuse of hospital tests and procedures, the institute says.

Among hospitals in the Houston area, Houston Methodist Sugar Land Hospital ranked worst for overuse of tests and procedures, preceded by Memorial Hermann Northeast Hospital in Humble, OakBend Medical Center in Richmond, Memorial Hermann Sugar Land Hospital, and St. Luke's Health - The Woodlands Hospital, the study says.

At the other end of the spectrum, Houston's Doctors Hospital Tidwell ranks first among Houston-area hospitals for avoiding overuse of tests and procedures, followed by the University of Texas Medical Branch at Galveston, Memorial Hermann-Texas Medical Center, Harris Health System, and HCA Houston Healthcare Clear Lake in Webster.

Estimates suggest that overuse of tests and procedures contributes $75.7 billion to $101.2 billion to wasted U.S. health care spending each year, according to a study published by the journal JAMA Open Health.

"Although clinicians are responsible for ordering tests and treatments, their practice patterns may be influenced by hospital policies and culture. Hospital-level interventions to reduce overuse exist, but to measure and compare their success, a hospital-level measure is required," the study says.

In 2017, a study appearing in the Journal of Hospital Medicine declared that overuse of medical services contributes to low-quality health care and high health care costs. It's estimated that 42 percent of Medicare patients, 15 percent of Medicaid patients, and 11 percent of traditionally insured patients are subjected to at least one overuse of medical services each year, according to an article published by the Journal of Health Affairs.

"We can leverage the circumstances created by the pandemic to advance our understanding of low-value care with the goal of better measurement, appreciation of its harms, and a deeper understanding of its drivers and determinants, so that interventions can be implemented," authors of the Journal of Health Affairs article wrote. "Low-value care harms patients; there has never been a better time to push toward eliminating hurtful practices."

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Rice University lands $18M to revolutionize lymphatic disease detection

fresh funding

An arm of the U.S. Department of Health and Human Services has awarded $18 million to scientists at Rice University for research that has the potential to revolutionize how lymphatic diseases are detected and help increase survivability.

The lymphatic system is the network of vessels all over the body that help eliminate waste, absorb fat and maintain fluid balance. Diseases in this system are often difficult to detect early due to the small size of the vessels and the invasiveness of biopsy testing. Though survival rates of lymph disease have skyrocketed in the United States over the last five years, it still claims around 200,000 people in the country annually.

Early detection of complex lymphatic anomalies (CLAs) and lymphedema is essential in increasing successful treatment rates. That’s where Rice University’s SynthX Center, directed by Han Xiao and Lei Li, an assistant professor of electrical and computer engineering, comes in.

Aided by researchers from Texas Children’s Hospital, Baylor College of Medicine, the University of Texas at Dallas and the University of Texas Southwestern Medical Center, the center is pioneering two technologies: the Visual Imaging System for Tracing and Analyzing Lymphatics with Photoacoustics (VISTA-LYMPH) and Digital Plasmonic Nanobubble Detection for Protein (DIAMOND-P).

Simply put, VISTA-LYMPH uses photoacoustic tomography (PAT), a combination of light and sound, to more accurately map the tiny vessels of the lymphatic system. The process is more effective than diagnostic tools that use only light or sound, independent of one another. The research award is through the Advanced Research Projects Agency for Health (ARPA-H) Lymphatic Imaging, Genomics and pHenotyping Technologies (LIGHT) program, part of the U.S. HHS, which saw the potential of VISTA-LYMPH in animal tests that produced finely detailed diagnostic maps.

“Thanks to ARPA-H’s award, we will build the most advanced PAT system to image the body’s lymphatic network with unprecedented resolution and speed, enabling earlier and more accurate diagnosis,” Li said in a news release.

Meanwhile, DIAMOND-P could replace the older, less exact immunoassay. It uses laser-heated vapors of plasmonic nanoparticles to detect viruses without having to separate or amplify, and at room temperature, greatly simplifying the process. This is an important part of greater diagnosis because even with VISTA-LYMPH’s greater imaging accuracy, many lymphatic diseases still do not appear. Detecting biological markers is still necessary.

According to Rice, the efforts will help address lymphatic disorders, including Gorham-Stout disease, kaposiform lymphangiomatosis and generalized lymphatic anomaly. They also could help manage conditions associated with lymphatic dysfunction, including cancer metastasis, cardiovascular disease and neurodegeneration.

“By validating VISTA-LYMPH and DIAMOND-P in both preclinical and clinical settings, the team aims to establish a comprehensive diagnostic pipeline for lymphatic diseases and potentially beyond,” Xiao added in the release.

The ARPA-H award funds the project for up to five years.

Houston doctor wins NIH grant to test virtual reality for ICU delirium

Virtual healing

Think of it like a reverse version of The Matrix. A person wakes up in a hospital bed and gets plugged into a virtual reality game world in order to heal.

While it may sound far-fetched, Dr. Hina Faisal, a Houston Methodist critical care specialist in the Department of Surgery, was recently awarded a $242,000 grant from the National Institute of Health to test the effects of VR games on patients coming out of major surgery in the intensive care unit (ICU).

The five-year study will focus on older patients using mental stimulation techniques to reduce incidences of delirium. The award comes courtesy of the National Institute on Aging K76 Paul B. Beeson Emerging Leaders Career Development Award in Aging.

“As the population of older adults continues to grow, the need for effective, scalable interventions to prevent postoperative complications like delirium is more important than ever,” Faisal said in a news release.

ICU delirium is a serious condition that can lead to major complications and even death. Roughly 87 percent of patients who undergo major surgery involving intubation will experience some form of delirium coming out of anesthesia. Causes can range from infection to drug reactions. While many cases are mild, prolonged ICU delirium may prevent a patient from following medical advice or even cause them to hurt themselves.

Using VR games to treat delirium is a rapidly emerging and exciting branch of medicine. Studies show that VR games can help promote mental activity, memory and cognitive function. However, the full benefits are currently unknown as studies have been hampered by small patient populations.

Faisal believes that half of all ICU delirium cases are preventable through VR treatment. Currently, a general lack of knowledge and resources has been holding back the advancement of the treatment.

Hopefully, the work of Faisal in one of the busiest medical cities in the world can alleviate that problem as she spends the next half-decade plugging patients into games to aid in their healing.