Research roundup: Helping the homeless transition out of the hospital

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Jun 23 2012

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

Journal of General Internal Medicine: Understanding Transitions In Care from Hospital To Homeless Shelter: A Mixed-Methods, Community-Based Participatory Approach -- Transitioning from a hospital visit can be challenge for many patients, but the homeless face particular difficulties as they move to a shelter, or even back to the streets. Researchers in this study surveyed 98 homeless individuals in New Haven, Conn., as well as interviewed them about their experiences leaving the hospital. More than half said that their providers did not address housing or transportation, and 11 percent reported living on the streets on the night of their discharge. The authors recommend "improved assessment of housing status, communication between hospital and shelter providers, and arrangement of safe transportation" for homeless individuals (Greysen, et al, 6/16).

Urban Institute/Robert Wood Johnson Foundation: Churning Under The ACA And State Policy Options For Mitigation
Concerns have been raised that when the health law's expansion of insurance coverage takes effect in 2014, people will frequently involuntarily transition between eligibility for Medicaid, private insurance subsidies, and other coverage options -- what is referred to as "churning." In this brief, analysts estimate that 29.4 million people under age 65 will see a change in eligibility status from one year to the next. To combat churning, the authors recommend several state-based options, including the integration of Medicaid with plans available on insurance exchanges, as well as the use of premium supports to supplement the Medicaid programs. States can reduce churning by several million people through these strategies, but the authors also conclude "churning will be a fact of life under the ACA" (Buettgens, Nichols and Dorn, 6/14).

The following series of briefs by the Kaiser Family Foundation looks at oral health care coverage and access among three critical populations.

Kaiser Family Foundation: Children And Oral Health: Assessing Needs, Coverage And Access -- The brief describes how income level continues to play a factor in children's oral health, with many families burdened by high out-of-pocket costs even if they have insurance. The authors point out that the health law will increase dental coverage with the expansion of Medicaid. The law also designated pediatric oral health care as an essential benefit required on all health plans (Paradise, 6/19).

Kaiser Family Foundation: Oral Health and Low-Income Nonelderly Adults: A Review Of Coverage And Access -- Oral health is also a major concern among low-income adults, but as this brief notes, adult oral health care is not deemed an essential benefit as it is for children under the health law. States have the option of including oral care on their Medicaid plans, but the authors write that "13 states recently reported that they cut dental benefits in FY 2011 or had plans to do so in FY 2012" (Licata and Paradise, 6/19).

Kaiser Family Foundation: Oral Health And Medicare Beneficiaries: Coverage, Out-of-Pocket Spending, And Unmet Need -- Medicare does not cover routine oral health care, and as this brief describes, many seniors have to turn to other sources, such as Medicare Advantage or Medicaid. The high cost of services deters many elderly from seeking preventive care, and the authors conclude, "Given the significance of risks associated with poor oral health, and the potential costs associated with untreated dental concerns, improving the oral health status of the Medicare population remains a serious issue to be addressed" (Huang, et al, 6/19).

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

Reuters: Surgeons' Pressures May Worsen Shortage: Study
Balancing work and personal responsibilities is a challenge for the majority of U.S. surgeons, and that struggle could lead them to cut back on their office hours or leave their practices altogether, according to a new survey. Of 7,197 surgeons, more than 52 percent said they recently had a work-home conflict. About a quarter said they were likely to reduce their work hours within the next year and about a third said they planned to leave their practice within the next two years (Seaman, 6/20).

Modern Healthcare: Most Calif. Docs' EHRs Wouldn't Meet Meaningful Use: Study
A majority of physicians in California use electronic health records, but only 30% use an EHR system that has the functionality to achieve the CMS' meaningful-use requirements, researchers report in a new study. The study was conducted in 2011 by UCSF and the California Medical Board for the California HealthCare Foundation and the California Department of Health Care Services (Lee, 6/15).

The Associated Press/Boston Globe: With Alzheimer's, Hospital Stays Can Be A Hazard
For people with Alzheimer's disease, a hospital stay may prove catastrophic. … Now a new study highlights the lingering ill effects: Being hospitalized seems to increase the chances of Alzheimer's patients moving into a nursing home -; or even dying -; within the next year, Harvard researchers reported Monday. The risk is higher if those patients experience what's called delirium, a state of extra confusion and agitation, during their stay (Neergaard, 6/18).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.