Research roundup: Patients hesitant to focus on costs; Increase in primary care demand is uneven

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

Health Affairs: Focus Groups Highlight That Many Patients Object To Clinicians' Focusing On Costs – One way to contain health care spending is to get patients involved in weighing costs of treatment options with their doctors. Researchers recruited 211 medically insured participants to assess their willingness to consider costs when choosing treatments. The authors found that participants generally "preferred better care, even when the relative benefit it offered was marginal, and even when told that the second-best choice still met the threshold of 'good enough' care from a clinician's perspective. … This study's findings suggest that for cost to be explicitly recognized and discussed factor in clinical decisions, public attitudes about health care costs must first undergo a significant shift" (Sommers et al., 2/2013).

Health Affairs: Seven Million Americans Live In Areas Where Demand For Primary Care May Exceed Supply By More Than 10 Percent –The federal health law's expansion of medical insurance coverage is expected to increase the demand for primary care services but the authors note that the "demand will not be uniform across each state." They identified the small areas expected to face the growing demand for primary care services to predict the number of people who may potentially experience its effects. Based on their analyses, the researchers anticipate that 4 million people are in areas where there will be a 5 percent increase in demand for primary care providers and 7 million people are in areas that can expect a 10 percent rise in demand. The authors conclude: "The results of this study suggest that promoting and refining policies related to the distribution of primary care providers and community health centers may be as important as policies aimed at increasing the overall supply of primary care providers" (Huang and Finegold, 2/20).

JAMA Internal Medicine: Association Of Hospice Patients' Income And Care Level With Place Of Death – Although most Americans say they would like to die at home, studies suggest that this wish isn't always granted. In this study, researchers examined how income levels and the intensity of home health care affected hospice patients' ability to stay in their homes until they died. After analyzing data from a for-profit hospice provider that runs programs in eight states, the researchers found that more than a fifth of hospice enrollees admitted to routine care in a private residence did not die at home but were transferred instead to hospitals, nursing homes and other facilities. "Among those who did not receive continuous care, those with lower median annual household incomes were more likely to transfer from home to another location before death," they report. "However, among those who received any continuous care, rates of transfer from home were similar across income levels." The authors conclude that "hospices may need to provide additional resources to help indigent patients die at home beyond those currently available via routine hospice care" (Barclay, Kuchibhatla, Tulsky, and Johnson, 2/18).

JAMA Surgery: Anticipating The Effects Of Accountable Care Organizations For Inpatient Surgery – According to the study's authors, "previous research about the benefits of integrated delivery systems (IDSs) in ambulatory care suggests that ACOs [accountable care organizations] are likely to improve efficiency." The benefits are less clear for complex hospital-based care which the authors say account for almost half of the country's total Medicare spending. The researchers analyzed nearly two years of Medicare data on patients getting heart bypass, hip replacement colon or back surgery and found few differences in quality or cost among patients treated at hospitals with integrated systems and those that don't have those systems. They said there are several reasons why the improvements seen in outpatient care don't translate to hospitals, including that some of the savings in the out-patient arena come from care of chronic illnesses in which shared information and resources can help lower costs which doesn't apply to hospital surgery units. They conclude: "improvements in the quality and cost-efficiency of hospital-based care may require adjuncts to current ACO programs" (Miller, Ye, Gust, and Birkmeyer, 2/20).

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

Reuters: Adults Cut Back Fast Food, But U.S. Kids Still Eat Too Much Fat: CDC
American adults have made a little progress in recent years in cutting back on calories from fast food, but children are still consuming too much fat, U.S. health researchers say. French fries, pizza and similar items accounted for about 11 percent of U.S. adults' caloric intake from 2007 to 2010, on average, down from about 13 percent between 2003 and 2006, the Centers for Disease Control and Prevention said in one of two reports released on Thursday (Heavey, 2/21).

Reuters: Almost One-Third Of Chemotherapy Used "Off-Label"
About one-third of chemotherapies are used to fight cancers that drug regulators never approved them to treat, says a new study. Chemotherapies - drugs that kill rapidly dividing cells - are approved by the Food and Drug Administration (FDA) to fight specific cancers, but there's nothing stopping doctors from prescribing the drugs "off-label" to treat other types of tumors. Some researchers have questioned whether doctors were prescribing the expensive and toxic drugs outside of their intended use, according to the study's researchers, led by Rena Conti, an assistant professor of health policy and economics at the University of Chicago (Seaman, 2/19).

Medscape: ACA Will Help Spark Boom In Remote Patient Monitoring
The number of Americans remotely monitored at home with devices such as pulse oximeters and peak-flow meters for 5 major chronic illnesses will grow 6-fold by 2017 as healthcare reform pushes hospitals and physicians to stop revolving-door admissions, reports InMedica, a division of IMS Research. In 2012, clinicians reviewed long-distance vital signs on computer screens for some 227,000 patients with congestive heart failure (CHF), chronic obstructive pulmonary disease, diabetes, hypertension, and mental illness, according to the InMedica report released in January. By 2017, that number will jump to almost 1.3 million. The figures include a smattering of patients followed for a grab bag of other conditions such as asthma, coronary artery disease, and hemophilia (Lowes, 2/14). 

MedPage Today: Groups Offer Guidance On Gene Testing In Kids
Decisions involving genetic testing of children must focus on the individual child's best interest, taking into account the implications for family members, according to a policy statement developed jointly by the American Academy of Pediatrics (AAP) and the American College of Medical Genetics and Genomics (ACMG). New recommendations have been needed because of the rapid technological advances in genetics in recent decades and broader interest on the part of the public in screening and testing, explained Lainie F. Ross, MD, PhD, of the University of Chicago, and colleagues from the two groups (Walsh, 2/21). 

MedPage Today: Malpractice: Laser Surgery Lawsuits Surge
Lawsuits relating to injury from laser surgery are on the rise, and physicians have been held liable even if they were not personally operating the device, a retrospective study found. Over a 25-year period, 174 cases of cutaneous injury were reported following procedures such as hair removal and facial rejuvenation, according to H. Ray Jalian, MD, of Harvard Medical School, and colleagues (Walsh, 2/20). 

MedPage Today: Generic Rx Plan Lowers Medicare Psych Costs
Providing generic drug coverage to mentally ill Medicare beneficiaries who hit the drug coverage gap cost less overall than leaving them with no drug coverage, a study found. Healthcare costs were lower by roughly 3% among Medicare beneficiaries with bipolar disorder who had generic-only coverage rather than no drug coverage, and 5% lower for those with schizophrenia and generic-only coverage, according to a study published in the February issue of the American Journal of Managed Care (Pittman, 2/20). 

Medscape: Doula Care Reduces Cesarean Deliveries in Medicaid Patients
Doula support in childbirth is associated with a 40% decrease in cesarean deliveries among Medicaid recipients, according to results from a study published online February 14 in the American Journal of Public Health (Laidman, 2/19).