Research roundup: Questioning money-saving value of kids' preventive dentistry, weight loss

Jun 1 2013

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

Pediatrics: Effectiveness Of Preventive Dental Visits In Reducing Nonpreventive Dental Visits And Expenditures – Although early preventive dental visits are widely recommended for children, it is unclear whether they reduce future dental visits or costs. Using 1998 to 2010 data from Alabama's Children's Health Insurance Program (CHIP) and other state health care programs, researchers found that "children require fewer nonpreventive dental services when they have more preventive visits, indicating that preventive services do improve oral health." But they also note that "more preventive visits did not reduce overall dental or medical (inclusive of dental) expenditures" (Sen et al., 5/27). 

American Public Health Association's Medical Care Journal: The Effect Of Weight Loss On Health, Productivity, And Medical Expenditures Among Overweight Employees – More than 28.5 percent of full-time employees are currently obese in the United States. Another 38 percent are overweight. The authors analyzed data from employees of community colleges and universities and found that significant weight loss of 5 percent or more prevented short-term deterioration in employees' health-related quality of life and reduced absenteeism, and "there is some evidence that employee productivity is increased." But, they add: "We find no evidence of a quick return on investment from reduced medical expenditures, although this may occur over longer periods" (Bilger et al., June 2013).  

Annals Of Emergency Medicine: The Relationship Between Emergency Department Use And Cost-Related Medication Nonadherence Among Medicare Beneficiaries – According to the authors, "despite improved coverage and associated declines in out-of-pocket spending, 11 percent of Medicare beneficiaries continue to report skipping doses, splitting pills, or not filling medications because of cost." They used 2006 and 2007 survey data to evaluate the relationship between beneficiaries' self-reported nonadherence to prescription drugs and emergency department (ED) use. "Our results show that severe cost-related medication nonadherence is associated with a statistically significant increased risk of ED use," the authors report, and conclude: "Specific policies that aim to decrease cost-related medication nonadherence are likely needed for disabled Medicare beneficiaries, who represent a high-risk, high-use population" (Blanchard et al., 5/30). 

JAMA Ophthalmology: Surgical Outcomes And Cost Basis For Resident-Performed Cataract Surgery In An Uninsured Patient Population – Cataract surgeries involve the removal of a clouded lens in the eye. Using medical records of 143 uninsured patients who had such procedures from 2005 to 2011, University of Washington researchers measured the clearness of vision before and after surgery performed by residents. "As in other studies, we found that cataract surgeries remained a cost-effective intervention in patients with modest levels of preoperative visual impairments," the authors report.  "As the nature of surgical training evolves, our study provides evidence of the success and cost-effectiveness of resident-performed cataract surgery in an underserved patient population," they conclude (Moore and Slabaugh, 5/30).

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

Reuters: 'Workplace Wellness' Fails Bottom Line, Waistlines - RAND
According to a report by researchers at the RAND Corp, programs that try to get employees to become healthier and reduce medical costs have only a modest effect. Those findings run contrary to claims by the mostly small firms that sell workplace wellness to companies ranging from corporate titans to mom-and-pop operations. ... The report found, for instance, that people who participate in such programs lose an average of only one pound a year for three years (Begley, 5/24).

Forbes: RAND Corporation (Briefly) Publishes Sobering Report On Workplace Wellness Programs
For a short period of time last Friday, the RAND Corporation's much anticipated final report on Workplace Wellness was available online. At least Reuters managed to snag a copy before RAND withdrew it. RAND's website now says: "This document was posted in error and has been withdrawn pending completion of contractual obligations to the project sponsor" (Munro, 5/28).

The Washington Post: Simple Strategy Works Best To Reduce Infections, Study Finds
Using germ-killing soap to wash the sickest patients every day and applying antibacterial ointment inside their noses turns out to be the most effective way to reduce deadly hospital bloodstream infections, according to a study published Wednesday that has broad implications for practical use. The findings suggest the simple strategy could save lives, researchers said. ... The study [was] published in the New England Journal of Medicine (Sun, 5/29).

The Washington Post: Study: TV And Movie Characters Are Smoking Less But Still Drinking Heavily
The tobacco industry really took a beating in 1998. The Master Settlement Agreement (MSA) they signed with state attorneys general required them to give states $206 billion in compensation for the Medicaid and other costs of treating sick smokers. ... You'd expect to see fewer cigarettes in movies after a deal like that. But the size of the decline may surprise you. A new study in JAMA Pediatrics by Elaina Bergamini, Eugene Demidenko and James Sargent at the Norris Cotton Cancer Center and the Geisel School of Medicine at Dartmouth College finds that the MSA led to an exponential decline in the appearance of tobacco brands in movies. ... But the portrayal of alcohol didn't change much at all (Matthews, 5/29).

Modern Healthcare: Chains Have Best Effect On Acquired Hospitals, Survey Says
Multistate chains do a better job at improving the financial performance of acquired hospitals than local or regional systems, according to a Deloitte analysis. The survey -; which included 77% of hospital deals forged in 2007 and 2008 -; looked at the financial performance of acquired hospitals through 2010. It found that national chains take better advantage of workforce, supply chain and payer synergies, and they're also more effective at increasing volume (Kutscher, 5/30).

Modern Healthcare: Medicare Readmission Rate Falls, But Cause Unclear, Study Says
A new study finds that U.S. hospitals recorded about 70,000 fewer cases than expected of Medicare patients being readmitted for inpatient care last year. That finding is likely to hearten policymakers and health system leaders who have pushed for financial incentives and procedures to improve post-discharge care and coordination as a way to avoid readmissions. But the study does not definitively show the decline in readmission rates was directly caused by those payment and quality reforms (Carlson, 5/30).