Research roundup: Revamping NCI Clinical Trials, reducing malpractice suits, health disparities persist

Apr 17 2010

Institutes of Medicine: A National Cancer Clinical Trials System For The 21st Century: Reinvigorating The NCI Cooperative Group Program - The "system for conducting cancer clinical trials in the United States is approaching a state of crisis," according to this report on inefficiencies and funding issues faced by the NCI's Clinical Trials Cooperative Group Program - which comprises 10 groups, more than 3,100 institutions, 14,000 investigators and more than 25,000 patients in clinical trials each year. The report's recommendations include an appeal for NCI to increase the amount it reimburses clinicians for the costs of managing patients and an appeal for private and public health plans to cover all nonexperimental costs of participation in clinical trials (Nass, Moses and Mendelsohn, 4/15).

KHN summarized news coverage of the IOM study (4/16)

RAND Institute for Civil Justice: Is Better Patient Safety Associated With Less Malpractice Activity? Evidence From California - A reduction in the number of preventable patient injuries in California hospitals between 2001 and 2005 was associated with a decrease in the volume of malpractice claims within California counties, according to this study (.pdf). The study suggests that options that "promote better patient safety may offer a new avenue for reducing malpractice pressure on physicians, at the same time that they improve clinical outcomes."

The authors analyzed "approximately 365,000 adverse safety events, such as post-surgical problems and hospital-acquired infections, and for approximately 27,000 malpractice claims," according to a RAND description of the study. "This result suggests that policy options that improve patient safety may offer a new avenue for reducing malpractice pressure on physicians, at the same time that they improve clinical outcomes" (Greenberg, Haviland, Ashwood and Main, 4/15).

Circulation: Cardiovascular Quality And Outcomes: Variation In Cardiologists' Propensity To Test And Treat. Is It Associated With Regional Variation In Utilization? - This study examines the factors underlying why cardiologists vary in their treatment of patients, especially in the use of high-tech tests and procedures, as self-reported by cardiologists. "More than 27% of respondents reported ordering a cardiac catheterization if a colleague would in the same situation frequently or sometimes, and nearly 24% reported doing so out of fear of malpractice. These 2 factors were significantly associated with the propensity to test and treat, but only fear of malpractice was associated with regional utilization" (Lucas, Sirovich, Gallagher, Siewers and Wennberg, 4/13).

KHN summarized news coverage of the Circulation: Cardiovascular Quality and Outcomes study (4/14).

AHRQ: National Healthcare Quality Report - This annual report (.pdf) to Congress examines the progress and challenges associated with improving the quality of the nation's health care system: "Health care quality needs to be improved, particularly for uninsured individuals, who are less likely to get recommended care. Some areas merit urgent attention, including patient safety and health care-associated infections (HAIs). Quality is improving, but the pace is slow, especially for preventive care and chronic disease management" (Clancy et al., 4/13).

AHRQ: National Healthcare Disparities Report - This annual report (.pdf) to Congress examines health care disparities for different racial, ethnic or income groups, and tracks changes in such gaps over time. The authors report, "Findings from the 2009 NHDR show that disparities in care for cancer, heart failure, and pneumonia exist across populations. Although quality of hospital care for heart failure and pneumonia has improved overall, care for Whites continues to improve at a higher rate than for minority populations. Thus, quality improvement has not necessarily translated to disparities reduction, which is critical for high-quality care" (Clancy et al., 4/13).

KHN summarized news coverage of the AHRQ studies (4/14).

Journal of the American Medical Association: Health Care Insurance, Financial Concerns In Accessing Care, And Delays To Hospital Presentation In Acute Myocardial Infarction - Patients who lack health insurance or report financial worries are more likely to delay seeking emergency care at the onset of symptoms of a heart attack than those patients with insurance and without financial concerns. Authors analyzed records of 3,721 patients, from an acute myocardial infarction (AMI) registry, interviewed patients and report: "A greater proportion (36.6%) of insured patients without financial concerns arrived within 2 hours of symptom onset compared with 33.5% of insured patients with financial concerns and 27.5% of uninsured patients. Conversely, a smaller proportion (39.3%) of insured patients without financial concerns arrived more than 6 hours from symptom onset compared with 44.6% of insured patients with financial concerns and 48.6% of uninsured patients" (Smolderen et al., 4/14).

KHN summarized news coverage of the JAMA study (4/14).

Chronic Illness: The Case For Involving Adult Children Outside Of The Household In The Self-Management Support Of Older Adults With Chronic Illnesses - With survey data from the Health and Retirement Study, (sampling individuals 51 and older with at least one of the following conditions: high blood pressure, diabetes, lung disease, heart problems, cancer, stroke, psychiatric problems or arthritis), the authors found: "Almost 40 percent of chronically ill older adults in the U.S. live alone, and a majority of those who are married have spouses with at least one chronic illness that can affect their ability to provide support,"  according to a University of Michigan description of the study. The study says "as the gap between available health services for disease management and the need among community-dwelling patients continues to grow, adult children—including those living at a distance—represent an important resource for improving self-care support for people with chronic diseases" (Piette et al., 4/13).

Commonwealth Fund: Lessons From A Health Information Technology Demonstration In New York Nursing Homes - This case study examines the New York State Nursing Home Health Information Technology Demonstration Project  and found that the 20 "participating homes successfully replaced paper records with electronic ones, and, after the intensive pre-implementation planning period, it took less than six months on average for facilities to make this transition" The authors attribute the success, in part, to an "innovative union-employer partnership" (Klinger and White, 4/13).

Kaiser Family Foundation: Medicaid And CHIP Health Reform Implementation Timeline - This timeline (.pdf) highlights key dates for the implementation of provisions in the Patient Protection And Affordable Care Act relating to Medicaid and the Children's Health Insurance Program (CHIP) (4/12).

Commonwealth Fund: The Group Employed Model As A Foundation For Health Care Delivery Reform - This issue brief examines the concept of group employed model (GEM) as a method for delivery of low-cost, high-quality care. As the brief explains, GEMs "are typically composed of a large number of salaried primary care and specialty physicians, often aligned with other health care entities, including hospitals." The brief details how lessons learned from GEMs could serve to inform interests in accountable care organizations (Minott et al., 4/9).

Institute of Medicine: Gulf War And Health, Vol. 8: Health Effects Of Serving In The Gulf War Update 2009 -This report "determines that Gulf War service causes post-traumatic stress disorder (PTSD) and that service is associated with multisymptom illness; gastrointestinal disorders such as irritable bowel syndrome; alcohol and other substance abuse; and anxiety disorders and other psychiatric disorders. To ensure that our veterans receive the best possible care, now and in the future, the government should continue to monitor their health and conduct research to identify the best treatments to assist Gulf War veterans still suffering from persistent, unexplained illnesses" (Hauser et al., 4/9).