Research roundup: Patients' unrealistic expectations for chemo; Neighborhood may affect CPR rates; Rate hike reviews working

Oct 29 2012

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

The New England Journal Of Medicine: Patients' Expectations About Effects Of Chemotherapy For Advanced Cancer-- "To make informed decisions about whether to receive chemotherapy, patients with advanced lung or colorectal cancer need a realistic understanding of its likely benefits," the authors write. Researchers conducted comprehensive reviews of records. "Of 1274 patients with stage IV lung or colorectal cancer who were alive at the time of the baseline survey and who discussed chemotherapy with at least one physician, 1193 (93.6%) opted to receive chemotherapy. They concluded: "Overall, 69% of patients with lung cancer and 81% of those with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer" (Weeks et al., 10/25).

The New England Journal Of Medicine: Association Of Neighborhood Characteristics With Bystander-Initiated CPR -- The survival rates of out-of-hospital cardiac arrest vary widely across the country and some researchers believe that this variation can be explained, in part, by neighborhood characteristics. Researchers analyzed over 4,000 cases of out-of-hospital cardiac arrest where a bystander initiated cardiopulmonary resuscitation (CPR): "We found that patients who had an out-of-hospital cardiac arrest in low-income black neighborhoods were less likely to receive bystander-initiated CPR than those in high-income white neighborhoods" (Sasson et al., 10/25).

American Journal Of Public Health: Impact Of Health Insurance Status And A Diagnosis Of Serious Mental Illness On Whether Chronically Homeless Individuals Engage In Primary Care-- This study used data from 750 chronically homeless adults and found that lacking health insurance in the previous year was strongly associated with using a hospital emergency department as a regular source of medical care. "Findings suggest that people who are chronically homeless and have chronic medical illness would be more likely to access care if they had health insurance. Individual states' deciding not to expand Medicaid coverage will likely have a tremendous impact on the health outcomes and health care costs associated with this and other vulnerable populations," the authors concluded (Chwastiak, Tsai, and Rosenheck, 10/18).

The Kaiser Family Foundation: Quantifying The Effects Of Health Insurance Rate Review-;As part of the Affordable Care Act, rate review programs "require insurers in the small group and individual markets to submit proposed rate increase requests [above a certain threshold] to state or federal regulators, who determine if the requests are reasonable. The report finds that one out of every five requests submitted to states in 2011 resulted in a lower rate increase or no increase at all. On average, approved rate increases were 1.4 percentage points lower than insurers initially requested, a reduction of about one-fifth. ... While many states had rate review programs in place before the ACA passed in 2010, early evidence suggests that insurers have made fewer requests to raise rates by 10% or more after the health reform law's rate review provisions went into effect" (Cox et al., 10/24). 

Health Affairs/Robert Wood Johnson Foundation: Nurse Practitioners And Primary Care: Federal And State Laws And Other Policies Limit How These Professionals Can Help Meet The Growing Need For Primary Care -; With millions of people becoming newly insured in 2014 because of the health law, many believe that primary care providers will be in great demand. According to the author of the brief, one proposed solution to address the need for primary care providers is to expand the scope of services nurse practitioners can provide. Some physicians groups, however, oppose this idea.  "This brief examines the policy proposals for allowing nurse practitioners to practice to their full potential and the accompanying debate" (Cassidy, 10/25).

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

CQ HealthBeat: OB-GYNs Recommend Less-Frequent Pap Tests
The American College of Obstetricians and Gynecologists recommended Monday that most women should be screened for cervical cancer every three to five years, rather than the annual screening that's now common. The ACOG recommendation is generally in line with others made earlier this year by the American Cancer Society and the U.S. Preventive Services Task Force. These new guidelines represent a shift in thinking on the part of doctors toward more targeted use of screening. ... The cervical cancers that are found by testing are so slow-growing that annual tests are not needed, physicians and researchers believe (Norman, 10/23).

Medscape: HIV Screening Not Offered By Urban Hospital Residents
More than 9 of 10 eligible patients admitted to a major hospital in New York City were not offered HIV screening even though state law requires that it be offered. A major barrier to screening appears to be the admitting resident physicians. Marelle Yehuda, MD, a third-year internal medicine resident at Lenox Hill Hospital, New York, New York, reported her medical record review and survey results during a poster session here at ID Week 2012. Although a lack of screening is often attributed to patients' attitudes or behavior, "it's our job to offer everyone HIV screening," Dr. Yehuda told Medscape Medical News (Keller, 10/23).

Medpage Today: Splashy Trial Results Often Fade Later On
Studies with very large effect sizes were usually the result of small samples, with effects that diminished after additional trials were performed, researchers found. Among trials with very large effect sizes, 90% of first trials and 98% of subsequent trials had effect sizes that diminished when included in a meta-analysis, according to John Ioannidis, MD, of Stanford University in California, and colleagues. "Typically trials with very large effects have limited evidence," they wrote online in the Journal of the American Medical Association, adding that "[w]hen additional evidence is obtained, most of the very large treatment effects become much smaller and many lose their nominal significance" (Petrochko, 10/23).

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

Modern Healthcare: Generic Drugs Produced Savings In Recession: Study
A leap in generic-drug use kept the number of nonelderly Americans spending high shares of their income on healthcare flat during the recent recession, according to a health researcher. Peter Cunningham, a senior fellow at the Center for Studying Health System Change, authored a study published Wednesday in Health Affairs that found the percentage of Americans younger than 65 spending more than 10% of their income on healthcare stayed at about 19% of the population from 2006 to 2009. That stabilization came after the share of healthcare high-spenders jumped from about 14% over the preceding five years
 (Daly, 10/24).

CQ HealthBeat: OB-GYNs Recommend Less-Frequent Pap Tests
The American College of Obstetricians and Gynecologists recommended Monday that most women should be screened for cervical cancer every three to five years, rather than the annual screening that's now common. The ACOG recommendation is generally in line with others made earlier this year by the American Cancer Society and the U.S. Preventive Services Task Force. These new guidelines represent a shift in thinking on the part of doctors toward more targeted use of screening. ... The cervical cancers that are found by testing are so slow-growing that annual tests are not needed, physicians and researchers believe (Norman, 10/23).

Medscape: HIV Screening Not Offered By Urban Hospital Residents
More than 9 of 10 eligible patients admitted to a major hospital in New York City were not offered HIV screening even though state law requires that it be offered. A major barrier to screening appears to be the admitting resident physicians. ... Although a lack of screening is often attributed to patients' attitudes or behavior, "it's our job to offer everyone HIV screening," Dr. [Marelle Yehuda, a third-year internal medicine resident at Lenox Hill Hospital, New York] told Medscape Medical News (Keller, 10/23).

Medpage Today: Splashy Trial Results Often Fade Later On
Studies with very large effect sizes were usually the result of small samples, with effects that diminished after additional trials were performed, researchers found. Among trials with very large effect sizes, 90% of first trials and 98% of subsequent trials had effect sizes that diminished when included in a meta-analysis, according to John Ioannidis, MD, of Stanford University in California, and colleagues. "Typically trials with very large effects have limited evidence," they wrote online in the Journal of the American Medical Association, adding that "[w]hen additional evidence is obtained, most of the very large treatment effects become much smaller and many lose their nominal significance" (Petrochko, 10/23).