Research roundup: The effects of health IT, doctor-owned treatment centers, long-term care issues

Apr 9 2010

Health Affairs: Physician-Ownership Of Ambulatory Surgery Centers Linked To Higher Volume Of Surgeries - The authors analyzed data from Florida, using the Healthcare Cost and Utilization Project's State Ambulatory Surgery Databases, revealing "a significant association between physician-ownership of surgicenters and greater use" of certain outpatient procedures. And, the "data reveal that the acquisition of ownership status coincided with significant increases in a physician's use of carpal tunnel release, cataract excision, colonoscopy, and knee arthroscopy," the authors report.

"If our observed trends do reflect physician-induced demand, then possible remedies include revising current federal law to require public disclosure of investment arrangements or barring surgicenter ownership by small groups of physicians, for whom incentives are greatest," the authors write (Hollingsworth, Ye, Strope, Krein and Hollenbeck, April 2010).

Commonwealth Fund: Health Care Opinion Leaders' Views on Health Reform, Implementation, and Post-Reform Priorities - This data brief summarizes the Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey, which was "conducted online … between February 16, 2010, and March 15, 2010, among 1,336 opinion leaders in health policy and innovators in health care delivery and finance."

Though "[e]ighty-eight percent of opinion leaders believe that health reform will successfully expand access to affordable health insurance to the millions of Americans who currently do not have coverage … respondents were less likely to believe the legislation will improve the affordability of health insurance for those Americans who already have coverage (38%) and begin to control rising health care costs and not add to the federal deficit (35%). ... Differences among respondent categories were particularly sharp, with half of those in academic and research institutions believing the law would improve affordability compared with only 25 percent of those in business, insurance, and other health care industries" (Stremikis, Davis and Nuzum, 4/5).

National Academy For State Health Policy/SCAN Foundation: Long Term Services And Supports And Chronic Care Coordination: Policy Advances Enacted By The Patient Protection And Affordable Care Act - This paper examines "policy changes related to the continuum of care for older people -- specifically long term services and supports (LTSS) and chronic care coordination" in the Patient Protection and Affordability Act (the health reform bill), including information on the Community Living Assistance Services and Supports (CLASS) Act, Medicaid-funded home and community-based services, and several Medicaid and Medicare demonstration projects aimed at improving the coordination of care for seniors (Justice, April 2010). (Note: The SCAN Foundation helps fund KHN's aging coverage.)

The Kaiser Family Foundation's Commission on Medicaid and the Uninsured "has updated a brief comparing the Medicaid and Children's Health Insurance Program provisions in the new health reform law with the pre-reform law governing those programs. The analysis focuses on Medicaid coverage and financing changes; how Medicaid and CHIP will interface with a new health insurance exchange and other Medicaid benefits and access changes" (4/7).

Health Affairs: The Effect Of Health Information Technology On Quality In U.S. Hospitals - This study examines the effects of electronic health records and computerized physician order entry on the quality of care.

The authors write: "Health information technology (IT), such as computerized physician order entry and electronic health records, has potential to improve the quality of health care. But the returns from widespread adoption of such technologies remain uncertain. We measured changes in the quality of care following adoption of electronic health records among a national sample of U.S. hospitals from 2004 to 2007. The use of computerized physician order entry and electronic health records resulted in significant improvements in two quality measures, with larger effects in academic than nonacademic hospitals. We conclude that achieving substantive benefits from national implementation of health IT may be a lengthy process. Policies to improve health IT's efficacy in nonacademic hospitals might be more beneficial than adoption subsidies [from federal stimulus funds]" (McCullough et al., April 2010).

The April issue of Health Affairs features additional studies about health IT, including "mixed results" of the safety performance of computerized physician order entry, lessons learned from hospitals about implementing electronic health records, "meaningful" use of specific health record functions, and estimates of the cost and benefits associated with the VA's health IT system, among others.

Related KHN story: Savings From Computerizing Medical Records Are Hard To Measure (Weaver, 4/7)

Center For Studying Health System Change: Electronic Medical Records and Communication with Patients and Other Clinicians: Are We Talking Less? - This issue brief examines how electronic medical records (EMR) can both enhance and disrupt communication in doctors' offices, as described during interviews with "52 physicians and support staff at 26 small and medium-sized physician practices with commercial ambulatory EMRs in place for at least two years. ... Overcoming EMR-related challenges to interpersonal communication will likely involve continued refinement of their design by vendors and use by clinicians to decrease the potential for distraction during the patient encounter" (O'Malley, Cohen and Grossman, April 2010).

Circulation: Cardiovascular Quality and Outcomes: Socioeconomic Position, Not Race, Is Linked To Death After Cardiac Surgery - This study examines the relationship between socioeconomic position (SEP) and survival following cardiac surgery. The researchers analyzed 23,330 people (15,156 white men, 6,932 white women, 678 black men and 564 black women) who underwent heart bypass, valve or combined bypass and valve procedures, finding "that each drop in socioeconomic position had a corresponding ... decrease in the long-term survival rate," according to an American Health Association description of the study. "Specifically, after adjusting for existing risk factors such as high blood pressure and diabetes, patients in the lowest socioeconomic position had a 19 percent to 26 percent higher chance of dying within five years of surgery compared to their counterparts in the highest socioeconomic position" (Koch et al., 4/6).

Journal of the American Medical Association: Quality Of Care Among Obese Patients - "While it may be true that physicians often harbor negative attitudes toward obesity, such attitudes may not be borne out in lower quality of care," this study found. The authors examined "8 different quality measures relating to diabetes management, adult vaccinations, and cancer screening" from large samples of Medicare and Veterans Hospital patients and found: "To the contrary, being obese or overweight was associated with marginally higher rates of recommended care for several measures"  (Chang, Asch and Werner, 4/7).