Research roundup: Racial disparities in cancer screening and VA treatment

May 7 2011

Shefali S. Kulkarni compiled this selection of recently released health policy studies and briefs:

Cancer, Epidemiology, Biomarkers And Prevention: Racial And Ethnic Disparities In Colorectal Cancer Screening Persisted Despite Expansion Of Medicare's Screening Reimbursement -- This study looked at the effect in minority groups of expanded reimbursements by Medicare for colorectal cancer screenings. Although the study found an increase in screenings, "racial/ethnic differences in (colorectal cancer) screening persisted over time in this universally insured population, especially for blacks and Hispanics." The authors concluded: "Despite the expansion of Medicare coverage for CRC screening tests, racial/ethnic differences in CRC screening persisted over time in this universally insured population, especially for blacks and Hispanics. Future studies should explore other factors beyond health insurance that may contribute to screening disparities in this and younger populations" (White et al., May 2011).

Health Affairs: Despite Improved Quality Of Care In The Veterans Affairs Health System, Racial Disparity Persists For Important Clinical Outcomes -- This study looks at changes in the Department of Veterans Affairs health care system following a major overhaul between 1995 and 1999 to see if it had affected racial disparities in the quality of care. The study finds that "that the quality of care improved for both white and black VA enrollees from 2000 to 2009." Nonetheless, researchers found that "racial disparities were substantial and persistent" for clinical "intermediate outcome measures assessing control of blood pressure, glucose, and cholesterol. Almost all of the disparity in outcomes in the VA was explained by within-facility disparity, which suggests that VA medical centers need to measure and address racial gaps in care for their patient populations. Moreover, because cardiovascular disease and diabetes are major contributors to racial disparities in life expectancy, the findings of this study and others underscore the urgency of focused efforts to improve intermediate outcomes among African Americans in the VA and other settings" (Trivedi et al., April, 2011)."

Health Affairs: Reducing The Staggering Costs Of Environmental Disease In Children, Estimates At $76.6 Billion In 2008 -- Researchers sought to update a 2002 study that looked at the cost of health care for children affected by environmental factors. "The intent of this analysis was to inform decisions by policy makers to allocate sufficient resources toward prevention of exposures to lead, methylmercury (a form of mercury that has been found to be harmful to the developing brain), certain pesticides, and outdoor air pollutants that are hazardous to children's learning and development." Using a Consumer Price Index and a Medical Care Consumer Price Index from 1997 to 2008, the researchers estimate that in 2008 the costs of health care for these impacted children would be close to $76.6 billion (Trasande and Liu, May 2011).

Journal Of The American College Of Radiology: Strategies For Radiologists In The Era Of Health Care Reform And Accountable Care Organizations: A Report From The ACR Future Trends Committee -- This white paper from the American College of Radiology assesses the implications of Accountable Care Organizations to the field of radiology. The study finds that the roles of radiologists and imaging services is unclear and therefore explores the fundamental concepts of ACOs and how radiologists can navigate the new health care delivery system. "Strategies for successful radiologist participation in ACOs combine the traditional service of providing timely and high-quality image interpretation with a new set of services based on providing additional value and cost-effectiveness to the imaging portfolio of the ACO" (Bibb et al., May 2011).

Journal Of The American Medical Association: Availability Of Comparative Efficacy Data At The Time Of Drug Approval In The United States -- This study examines whether comparative effectiveness information -- which "compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care" -- is available on drugs when they get FDA approval. "A key objective of comparative effectiveness research is to inform evidence-based treatment decisions made by patients and prescribers. Comparative effectiveness information is also crucial for formulary and coverage decisions." The study found that there was public data available for about half of the new drugs approved by the FDA, but did not evaluate "the extent to which available comparative efficacy information is useful for clinical guidance" (Goldberg et al., 5/4).

Commonwealth Fund: Lessons From High-And-Low Performing States For Raising Overall Health System Performance -- This issue brief looks at which factors act as barriers in states with poor health systems and which are benefiting states with high performing health systems. Researchers looked at the highest- and lowest-ranking states and conducted interviews with a variety of groups, including "state health policy centers/institutes, Medicaid agencies, health care commissions and collaboratives," hospitals, insurers, advocacy groups and others. They found that high-performing states are more likely to have a long-time commitment to reform, a collaborative system among the many health stakeholder groups, transparent price and quality information, leadership for improvement and "a congruent set of policies that focus on system improvement." The authors offer suggestions on what low performing states can do to improve (Silow-Carroll and Moody, May 2011).