Research roundup: Financial impact of reducing surgical complications; Pay for performance to doctors, hospitals yields mixed results

Oct 20 2012

KHN reporter Alvin Tran compiled a selection of recently released health policy studies and briefs.

Health Affairs: The Impact On Hospitals Of Reducing Surgical Complications Suggests Many Will Need Shared Savings Programs With Payers
The authors write: "We found that if a hospital's surgical inpatient volume is not growing, such a program results in negative cash flow. We also found that if a hospital's surgical volume is growing, and if the hospital can sufficiently reduce the average length-of-stay for surgical patients without complications, the cash flow could be positive. We recommend that hospitals with limited growth prospects that are nonetheless contemplating a surgical complication reduction program establish agreements with payers to share in any savings generated by the program" (Krupka, Sandberg and Weeks, 10/17).

Health Affairs/RWJF Health Policy Brief Series: Pay-For-Performance -- The federal health law seeks to use pay-for-performance initiatives to improve the overall quality of care by providing financial incentives to hospitals and health care providers based on optimal performance and efficiency. But the author of this brief on public and private initiatives writes that PFP programs have yielded mixed results, and notes that the "cost of adopting health information technology" and the impact on "poorer and disadvantaged populations" are raising concerns: "Experience to date with pay-for-performance initiatives has raised a number of questions that require more research and experimentation" (James, 10/11).

American Journal Of Public Health: New Jersey's HIV Exposure Law And The HIV-Related Attitudes, Beliefs, And Sexual And Seropositive Status Disclosure Behaviors Of Persons Living With HIV -- While the majority of states have enacted laws to regulate the sexual behavior of people living with HIV, there is still uncertainty as to whether these have been effective. This study surveyed nearly 500 people with HIV to explore the impact of New Jersey's law. Researchers found that just more than half of the participants knew about the state's exposure law, but there was no link between that awareness and sexual abstinence, condom usage with recent partners, or disclosure of participants' positive HIV-status to partners: "Criminalizing nondisclosure of HIV serostatus does not reduce sexual risk behavior. Although the laws do not appear to increase stigma, they are also not likely to reduce HIV transmission" (Galletly et al., 11/2012).

American Journal Of Infection Control: Wide Variation In Adoption Of Screening And Infection Control Interventions For Multidrug-Resistant Organisms: A National Study -- Many of the nation's hospitals have adopted screening and infection control policies for multidrug-resistant organisms (MDROs). In a survey that included 250 hospitals, Columbia University researchers found that these efforts in intensive care units vary widely. For example, only 40 percent of ICUs had a written policy to screen all patients for any MDRO, and only 27 percent had policies requiring periodic screening following admission (Pogorzelska, Stone and Larson, 10/2012).

BMJ Open: Shame! Self-Stigmatization As An Obstacle To Sick Doctors Returning To Work: A Qualitative Study--Doctors hold the responsibility of treating the sick but they, too, can be vulnerable. Researchers did in-depth interviews with 19 doctors from the United Kingdom who had physical or mental health problems or issues pertaining to drug and alcohol abuse and found that many of them had self-stigmatizing views. These negative self-images made it difficult for doctors to return to work. "Doctors must learn to provide themselves and their colleagues with the same level of excellent care that they provide for their patients," the researchers wrote (Henderson et al., 10/15).

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

Medpage Today: Privacy Key Issue In Genome Decoding
Researchers and clinicians need to develop robust yet understandable informed consent procedures to protect patient wishes after their entire DNA is sequenced, a presidential commission said. As the practice of whole genome sequencing is expanded upon and integrated with clinical medicine, Congress, state governments, and federal agencies need to take greater steps to ensure patients' privacy, the Presidential Commission for the Study of Bioethical Issues recommended. ... Sequencing a single human genome will soon cost less than $1,000 but can tell doctors a patient's predisposition for cancer or Alzheimer's disease, or provide information on which treatment options are best for particular illnesses (Pittman, 10/17).

Medscape: Nonclinical Factors Influence CT Use In ED For Dizziness
Nonclinical factors contribute to the likelihood that a person presenting to the emergency department (ED) with acute dizziness will undergo computed tomography (CT) of the head. Investigators report that the probability of a CT examination was affected by whether it was an item on a template checklist in the ED and by insurance status of the patient. CT was also more likely to be used in men. ... The probability of undergoing CT was 44% for patients with any form of insurance vs 34% for uninsured patients  (Keller, 10/18).

Medpage Today: PCI Often Done At Low-Volume Centers
About a quarter of all percutaneous coronary intervention (PCI) in the U.S. is performed at low-volume centers that do 200 or fewer procedures per year, researchers found. And almost half of all PCI in the states -- 49% -- is done at centers that do no more than 400 such procedures annually, Gregory Dehmer, MD, of Scott & White Healthcare in Temple, Texas, and colleagues reported online in the Journal of the American College of Cardiology (Fiore, 10/18).

Medscape: AAP Urges Pediatricians To Inform Parents About Gun Safety
The American Academy of Pediatrics (AAP) today released a policy statement urging pediatricians to counsel parents about the dangers of allowing children and adolescents access to guns. The statement, an update of a position paper first published in 2000 and reaffirmed in 2004, was published online today in Pediatrics and will appear in the November print edition of the journal. The AAP statement also advocates strong legislative and regulatory reform aimed at preventing firearm injuries and deaths in children, including the reinstatement of the assault weapons ban and closing the "gun show loophole" (Boughton, 10/18).