Research roundup: Practice guidelines may not stop defensive medicine; English language ability tied to hospital readmission rates

Apr 27 2012

KHN reporter Christian Torres compiled this selection of recently-released health policy studies and briefs.

Urban Institute/Robert Wood Johnson Foundation: The Value of Clinical Practice Guidelines As Malpractice "Safe Harbors" -- Overspending on health care has frequently been attributed to doctors practicing defensive medicine -- ordering extra tests, for example -- so that they avoid malpractice lawsuits. The authors of this brief write that while some have said clinical guidelines "should give caregivers a liability 'safe harbor,' shielding them from any malpractice claim for failing to provide services not included in the guideline." The brief "suggests that quality-promoting guidelines hold some promise for cutting wasteful defensiveness, but that practical feasibility limits their reach," as does patients' lack of understanding about appropriate care (Bovbjerg and Berenson, 4/25).

Journal of General Internal Medicine: Professional Language Interpretation And Inpatient Length Of Stay And Readmission Rates -- This three-year study at one hospital found that providing a professional interpreter at both admission and discharge correlated with a shorter stay and decreased likelihood of readmission for patients with limited English proficiency. Patients who didn't have an interpreter at either time stayed 1.5 days longer, on average, and were more likely to be readmitted within 30 days than those who did have an interpreter. Those results could help develop "a business case," authors write, for providing interpretation (Lindholm, Hargraves, Ferguson and Reed, 4/18).

The Kaiser Family Foundation/Urban Institute: The Diversity of Dual Eligible Beneficiaries: An Examination of Services and Spending for People Eligible for Both Medicaid and Medicare -- The authors of this brief write: "As a group, dual eligibles are costly-;with per capita Medicare and Medicaid spending over four times Medicare spending for other beneficiaries. However, a small share of dual eligibles account for most of the group's spending, and dual eligibles who are high cost to the Medicare program are generally not the same individuals who are high cost to the Medicaid program." They suggest that "decision-makers should adopt a multi-pronged approach" (Coughlin et al., 4/18).

SCAN Foundation: Bridging Medical Care and Long-Term Services and Supports: Model Successes and Opportunities For Risk Bearing Entities -- Acute medical care is largely separate from long-term care, often leading to poor quality and higher costs. This brief suggests that managed care plans, accountable care organizations and other organizations have an opportunity to bridge the gap, particularly under the health law and its incentives. Several model health systems are described to showcase how coordinated care can "provide a more cost-effective and humane service" (4/24).

Here is a selection of news coverage of other recent research:

Reuters: Wealthy Pick Colonoscopy Over At-Home Cancer Test
Colonoscopy has become an increasingly popular method of screening for colon cancer while the rate of at-home stool testing has dropped off, according to a new study. The findings, published in the journal Cancer, are primarily driven by a trend among people above the poverty line preferring colonoscopy; poor people still choose at-home testing as frequently as they did a decade ago (Grens, 4/23).

Reuters/Chicago Tribune: Prescription Drug Abuse Abetted By Family, Friends: Study
More than 70 percent of people who abuse prescription pain relievers obtain the drugs from friends or relatives, usually with permission and for free, according to a government study to be released on Wednesday. The study, based on data from the National Survey on Drug Use and Health, underscores the public education challenge that law enforcement officials face in persuading legitimate prescription drug users to dispose of their medications properly before they fall into the wrong hands (Morgan, 4/24). 

Medscape: Uneven State Progress in Reducing Central-Line Infections 
Although central line–associated bloodstream infections (CLABSIs) in hospitals fell significantly nationwide in 2010, uneven state-by-state progress points to considerable room for improvement, according to a report released today by the Centers for Disease Control and Prevention (CDC). ... In 2009, HHS set a goal of reducing them by 50% by 2013 compared with the baseline period of January 2006 to December 2008. ... Today's CDC report also goes deeper into the subject of surgical-site infections (SSIs). Last year the CDC revealed that hospitals had lowered SSIs by roughly 10% in 2010 compared with baseline (Lowes, 4/19).

MedPage Today: Healthcare Market Unique
A review of hospital costs for a common medical procedure casts doubt on the theory that the healthcare marketplace is similar to that for other goods and services, researchers found. In a retrospective review of charges for appendectomies, researchers found that in 2009 one California hospital charged $1,529 for the procedure while another hospital in a different county charged $182,955. ... The fact that the cost of an appendectomy can vary by $181,000 depending on which hospital it's performed at makes healthcare a unique good -- namely one whose cost cannot be accurately predicted, Renee Hsia, MD, of University of California San Francisco, and colleagues wrote in a letter published online in the Archives of Internal Medicine (Walker, 4/23).

Modern Healthcare: New Health Programs Need A Managed Approach: Report
The federal government needs a plan for managing the various programs and projects that resulted and will result from recent healthcare legislation, argues a new report from the Commonwealth Fund Commission on a High Performance Health System, which offered its own take on how that plan could look. The 24-page commission report, "Performance Improvement Imperative: Utilizing a Coordinated, Community-Based Approach to Enhance Care and Lower Costs for Chronically Ill Patients," suggests that the plan be first implemented among chronically ill patients with multiple conditions, a segment that represents a large chunk of healthcare spending (Barr, 4/26).

Medscape: Cost-Effectiveness of Lung Cancer Screening Questioned
Optimistic assumptions about the effects of low-dose computed tomography (CT) lung screening on cancer staging have cast doubts about a published actuarial analysis showing that its targeted use will be as cost-effective as mammography, colonoscopy, and Papanicolaou (Pap) smears. Bruce S. Pyenson and colleagues at the New York office of Milliman, an actuarial and consulting firm ... predicted that annual screening for the 18 million high-risk Americans could prevent 130,000 deaths during the first 15 years of its application (Brice, 4/26).