Research roundup: Concerns about ambulance diversions; The health law's impact on nursing homes; Mental health parity

Feb 2 2013

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

Annals Of Emergency Medicine: The Effect Of An Ambulance Diversion Ban On Emergency Department Length Of Stay And Ambulance Turnaround Time – Hospitals across the United States routinely turn away ambulances to relieve overcrowding, but the practice remains controversial. Researchers in this study aimed to identify the impact of Massachusetts' 2009 ambulance diversion ban. The authors found an overall increase of 3.6 percent in patient volume but no evidence suggesting an increase in the length of stay for admitted patients. They also reported a small decrease in ambulance turnaround time. They conclude: "Our findings support the anecdotal reports of the ban's success and are consistent with existing literature that diversion is not an effective means to mitigate ED crowding" (Burke et al., 1/25). 

The Kaiser Commission On Medicaid and the Uninsured/Kaiser Family Foundation: Implementation of Affordable Care Act Provisions to Improve Nursing Home Transparency, Care Quality, and Abuse Prevention – According to the authors, the federal health overhaul is "the first comprehensive legislation" since the Nursing Home Reform Act of 1987 to expand Medicare and Medicaid quality measures for nursing homes and improve government oversight. "The ACA incorporates the Nursing Home Transparency and Improvement Act of 2009, introduced because complex ownership, management, and financing structures were inhibiting regulators' ability to hold providers accountable for compliance with federal requirements. The ACA also incorporates the Elder Justice Act and the Patient Safety and Abuse Prevention Act, which include provisions to protect long-term care recipients from abuse and other crimes," according to a synopsis of the issue paper (Wells and Harrington, 1/30). 

Health Affairs: Federally Facilitated Exchanges
The author writes: "As of the publication date of this brief, 25 states have decided not to establish and run their own exchanges. The result is that the federal government will now have a major role in expanding insurance coverage in the individual and small-business insurance markets in at least half the states. This policy brief explores the issues now arising as the federally facilitated exchanges are being shaped. ... much remains in flux. ... Clearly, HHS will continue to face challenges in planning and implementing federally facilitated exchanges ahead of the October 2013 open enrollment deadline. A separate set of challenges will arise in the creation of partnership exchanges, and there is also the possibility that a federal exchange will evolve, as authorized under the law (Goodell, 1/31).

Center On Budget And Policy Priorities: The Relationship Between SNAP And Work Among Low-Income Households – The Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program, offers financial assistance to millions of eligible low-income individuals and families to lessen the burden of hunger and malnutrition. "The program's success in meeting this core goal has been well documented," the author writes. She adds that "[l]ess well understood is the fact that the program has become quite effective in supporting work and that its performance in this area has improved substantially in recent years," and notes: "Most SNAP participants are either not expected to work or are working.... almost 70 percent (68 percent) of SNAP recipients were not expected to work because they were children, elderly, disabled, or were caring for a disabled family member in their home or for a child under six where another household member was working" (Rosenbaum, 1/29).

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

The Washington Post: Surprise! We Don't Know If Half Our Medical Treatments Work
Clinical Evidence, a project of the British Medical Journal, recently combed through the 3,000 medical treatments that have been studied in controlled, randomized studies. They found, for half of those, we have no idea how well they work (h/t Austin Frakt) ... There are specific bodies dedicated to figuring out whether these 1,500 treatments actually work. That includes the Patient Centered Outcomes Research Institute, or PCORI, which was created by the health-care law to study comparative effectiveness research (Kliff, 1/24).

MedPage Today: Intervention Cut Use of Possibly Unsafe Drugs
Educating physicians on potentially inappropriate medications lowered prescription of such drugs to seniors by nearly a third in 3 years, a proof-of-concept study showed. Exposure to potentially inappropriate medications dropped in those 65 and older from 7.8% at baseline to 5.3% after general practitioners (GPs) in Italy received information on prescribing for older patients (P<0.001), according to the study, published in the December issue of the journal Drugs & Aging (Pittman, 1/24).

Politico Pro: Study: Few Switch Health Plans To Save Money
The majority of people getting coverage from work stuck with their plan -; although many of them had no choice of plans at work. Just one in eight, or 12.8 percent, switched plans in 2010, and of those people, most switched because of a job change or changes in their employer's benefit offerings. Fewer than 3 percent switched in search of lower costs or better care, research released Thursday by the National Institute for Health Care Reform finds. ... But employees have limited options. Only 15 percent of workers had three or more choices while more than half receive just one option from their employer, the study found (McIntyre, 1/31).

MedPage Today: Much Fiction Found In Obesity Reporting
Press reports and scientific writing on dieting, weight gain, and obesity are burdened by false or unproven claims, a literature review found. A search of popular media and scientific literature showed seven myths and six presumptions about obesity were prevalent in text, mostly related to false or unsupported claims about caloric intake or expenditure and dieting, as well as breast feeding, environment, and types of food eaten, according to David Allison, PhD, of the University of Alabama at Birmingham, and colleagues. ... Myths addressed related to weight loss included the idea that small sustained changes in energy intake or expenditure produce longer-term weight changes; that realistic goal setting leading to fewer frustrated attempted weight-losers; that rapid loss of great weight was associated with poorer long-term weight loss compared with gradual weight loss; and that diet readiness was an important element of weight-loss success. The authors also pointed out other myths, including the usefulness of play in physical-education classes in weight loss, breast feeding as protection against obesity, and sexual activity as a 100-to-300-calorie-burning activity (Petrochko, 1/30).