Research roundup: Chronic disease interventions could save states money; Drilling into childhood cancer disparities; National heart emergency care system proposed

May 5 2012

Each week KHN reporter Christian Torres compiles a selection of recently released health policy studies and briefs.

Urban Institute: Potential Savings Through Prevention Of Avoidable Chronic Illness Among CalPERS State Active Members -- California is one of many states in financial crisis, and according to this report, it could save millions of dollars on state employee health benefits by preventing chronic disease. Researchers write that of analyzed the cost burden of chronic diseases among active employees who are part of the California Public Employees' Retirement System (CalPERS) health program and found that of the "$1.6 billion spent
by CalPERS in 2008 on the health care services used by its State Active members, $362 million (22.4%)" was attributable to diabetes, hypertension, heart and kidney disease. They noted that with "well-designed and targeted interventions," the state could reduce disease prevalence by up to 15 percent and save as much as $54 million per year (Waidmann, Ormond and Spillman, 4/30).

Journal of Clinical Oncology: Treatment Outcomes In Black And White Children With Cancer: Results From the SEER Database and St Jude Children's Research Hospital, 1992 Through 2007 -- Cancer treatment outcomes are significantly worse for black children than white children. In this paper, national data were compared with outcomes at St. Jude Children's Research Hospital - which, the authors write, "provides comprehensive treatment to all patients regardless of their ability to pay." Discrepancies persisted nationwide in the most recent time period, but there was no significant difference between black and white children at St. Jude, regardless of cancer type. "The most straightforward explanation is that both groups receive the same effective risk-directed therapy and supportive care" at the children's hospital, researchers write (Pui et al., 4/30).

George Washington University: An Early Assessment Of The Potential Impact Of Texas' "Affiliation" Regulation On Access To Care For Low-income Women – Courts disputed this week whether Texas could exclude Planned Parenthood from the state Women's Health Program. This analysis describes how Planned Parenthood centers "are the main source of family planning, cancer screening, and preventive health care for women in the WHP." An estimated 52,000 low-income women could lose access to services if the centers were excluded, and while community health centers could be an alternative source of care, they "will have to overcome significant provider shortages and funding gaps to substantially expand access" (Shin, Sharac and Rosenbaum, 5/2).

Circulation: Has the Time Come For A National Cardiovascular Emergency Care System? -- Organizing medical care into regional systems with centers of expertise -- for example, hospital trauma centers -- can help improve outcomes and better pool resources. The authors cite a model in Minnesota and propose regionalizing care for cardiovascular emergencies. Such a system "has the potential to improve clinical outcomes; to provide ongoing education for patients, providers, and the community; and to serve as a foundation for cost-effective care through cardiovascular accountable care organizations," they write (Graham et al., 4/24).

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

MedPage Today: More Proof CMS Infection Pay Policy Works
Hospitals have become more focused on preventing infections since the Centers for Medicare and Medicaid Services (CMS) has stopped paying for those it deems preventable, a survey found. Of 317 infection control specialists surveyed, 81% reported increased attention to hospital-acquired infections as a result of the CMS rule, according to Grace Lee, MD, MPH, of Harvard Medical School, and colleagues. Whether that increased attention has led to fewer infections is unclear, the researchers wrote in the American Journal of Infection Control, but, in April 2010, a CDC report documented a 32% decrease in the incidence of bloodstream infections related to central line insertion in hospital patients (Walker, 5/3). 

MedPage Today: Kids Overlooked For Inclusion In Drug Trials
Clinical drug trials have left pediatrics behind, with too few trials and too little industry funding given the disease burden, researchers found. For the 10 highest burden pediatric conditions, children accounted for 60% of patients but only 12% of the clinical trials, (P<0.001), Florence Bourgeois, MD, MPH, of Children's Hospital Boston, and colleagues reported at the Pediatric Academic Societies meeting in Boston. "This may be related in part to trial funding, with pediatric trials relying primarily on government and nonprofit organizations," the group noted (Phend, 4/28).

MedPage Today: Lower MI Death Risk Linked to Five Strategies
Mortality after myocardial infarction can vary considerably between hospitals. In a multivariate analysis, five strategies were significantly associated with lower mortality and, taken together, were associated with "clinically important" differences in the 30-day risk-standardized mortality rates. Specifically: Holding monthly meetings between hospital clinicians and staff who transported patients to the hospital ... Having cardiologists always on site ... Encouraging clinicians to solve problems creatively ... Avoiding cross-training nurses from intensive care units for the cardiac catheterization laboratory  ... Having physician and nurse champions rather than nurse champions alone (Smith, 4/30).

Medscape: Women, Minorities More Likely To Leave Surgery Career Path
Women and minority trainees in general surgery are more likely to fall short of board certification than their peers, according to a study published yesterday in the May issue of the Journal of the American College of Surgeons (JACS). In addition, female trainees who begin in general surgery are more prone than their male counterparts to end up board certified in another specialty, write lead author Dorothy Andriole, MD, and coauthor Donna Jeffe, PhD, both faculty members of the Washington University School of Medicine in St. Louis. ... These trends should worry a surgical specialty aiming for a larger, more diverse, and fully credentialed workforce, write Dr. Andriole and Dr. Jeffe (Lowes, 5/1). 

WBUR's CommonHealth blog: Study: Psych Patients' ER Waits In Boston Area Average 11 Hours
This just in from the American College of Emergency Physicians: a study led by Massachusetts General Hospital that offers some numbers to quantify the worsening problem of psychiatric patients waiting long hours in emergency rooms -; significantly longer hours than other patients. The study included five hospitals in the greater Boston area, two academic medical centers and three community hospitals (Goldberg, 5/2).

Earlier, related KHN story: Emergency Rooms Provide Care Of Last Resort For Mentally Ill (Gold, 4/13/11).