Research roundup: Meeting the needs of assisted living residents; Medicaid expansion and community health centers; money follows the person

Nov 25 2013

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

JAMDA: American Infection Prevention And Control Standards In Assisted Living Facilities: Are Residents' Needs Being Met? 
Assisted living facilities (ALFs) provide housing and care to persons unable to live independently, and who often have increasing medical needs. Disease outbreaks illustrate challenges of maintaining adequate resident protections in these facilities. ... Of the 50 states, 84% specify health-based admissions criteria to assisted living facilities; 60% require licensed health care professionals to oversee medical care; ... There is wide variation in how assisted living facilities are regulated in the United States. States may wish to consider regulatory changes that ensure safe health care delivery, and minimize risks of infections, outbreaks of disease, and other forms of harm among assisted living residents (Kossover, Chi, Wise, Tran, Chande and Perz, 11/18).

George Washington University: How Medicaid Expansions And Future Community Health Center Funding Will Shape Capacity To Meet The Nation's Primary Care Needs 
This brief analyzes the effect of federal and state policy decisions on the capacity of community health centers to meet future health care needs. It focuses on two particularly important policy issues: (1) the level of federal grant funding for community health centers and (2) whether states expand Medicaid coverage. ... under the low funding scenario, if Medicaid expansion plans do not change, national health center capacity would decline by one million patients by 2020, falling from 21.1 million in 2012 to 20.1 million in 2020. ... In contrast, under the high federal funding scenario, total health center capacity would rise to 35.6 million patients in 2020 (under current Medicaid expansion patterns), about two-thirds higher than 2012 levels (Ku et al., 11/18).

National Center for Health Statistics: Dementia Special Care Units In Residential Care Communities: United States, 2010
Key findings: In 2010, 17% of residential care communities had dementia special care units. Beds in dementia special care units accounted for 13% of all residential care beds. Residential care communities with dementia special care units were more likely than those without to have more beds, be chain-affiliated, and be purposely built as a residential care community, and less likely to be certified or registered to participate in Medicaid. Residential care communities with dementia special care units were more likely than those without to be located in the Northeast and in a metropolitan statistical area, and less likely to be in the West (Park-Lee, Sengupta and Harris-Kojetin, 11/18).

Urban Institute/Robert Wood Johnson Foundation/Georgetown University: Stabilizing Premiums Under the Affordable Care Act
In addition to the measures prescribed by the federal ACA, states have had an array of options to further protect against and mitigate the effects of both rate shock and adverse selection. Our survey of a cross-section of 11 states found that, while at least a few states were employing most of these strategies, no single strategy was deployed by all the states, and some strategies went unexplored. Further, policy decisions outside of the scope of this paper-;such as robust outreach and enrollment efforts to encourage younger, healthier individuals to obtain coverage, and oversight of insurers marketing plans to healthy young adults outside the exchange-;may further affect the short and long-term stability of rates as the reform is implemented (Blumberg, Rifkin, Corlette and Dash, 11/18).

Mathematica: Money Follows The Person 2012 Annual Evaluation Report
The Money Follows the Person (MFP) demonstration program represents a major federal initiative to give people needing long-term services and supports (LTSS) more choice about where they live and receive care, and to increase the capacity of state long-term care systems to serve people in community settings. ... Calendar year 2012 marked the fifth full year of implementation of the national MFP demonstration. Cumulative MFP enrollment climbed to 30,000 transitions by the end of December 2012, a 50 percent growth over the total number at the same point in 2011. In early 2012, three more states received planning grants bringing the total number of states to have received MFP grants to 47. ... The MFP demonstration appears to be achieving its broad goals of (1) transitioning people successfully, and (2) helping states establish the infrastructure necessary to increase the capacity of long-term care systems to serve people in the community (Irvin et al., October 2013).

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

NPR: How A Vitamin D Test Misdiagnosed African-Americans
By the current blood test for vitamin D, most African-Americans are deficient. That can lead to weak bones. So many doctors prescribe supplement pills to bring their levels up. But the problem is with the test, not the patients, according to a new study. The vast majority of African-Americans have plenty of the form of vitamin D that counts -; the type their cells can readily use. ...  The conclusion from this study is that just because your total levels are low, it doesn't mean we need to replace vitamin D" using supplements, Thadhani says. The study was published Wednesday in the New England Journal of Medicine (Knox, 11/20).

Medscape: Pediatricians' Community Involvement Has Declined
Pediatricians' involvement in community child health activities has declined even though community engagement is an important professional duty, according to an analysis of 2 national mailed surveys of pediatricians (with 881 participants in 2004 and 820 in 2010). Cynthia S. Minkovitz, MD, MPP, a professor in the Department of Population, Family, and Reproductive Health at Johns Hopkins Bloomberg School of Public Health and in the Department of Pediatrics at Johns Hopkins School of Medicine, and the director of the Women's and Children's Health Policy Center in Baltimore, Maryland, and colleagues present their findings in an article published online November 18 in Pediatrics (Brown, 11/18).

HealthDay/Philadelphia Inquirer: Program Helps Heart Patients Stick With Meds After Leaving Hospital
People who are hospitalized for a heart attack or angina are more likely to take their medication properly once they leave the hospital if they receive personal attention from a pharmacist, new research indicates (11/18).

MedPage Today: Racial Flip Seen In Pancreatic Cancer Mortality
Pancreatic cancer mortality has diverged in race-defined directions, increasing in whites and decreasing in blacks for reasons that remain unclear, investigators reported. After 25 years of decline, pancreatic cancer mortality in whites has been on the increase since the mid- to-late 1990s, whereas mortality among blacks has declined steadily since the early 1990s after 20 to 25 years of increases (Bankhead, 11/12).

Time: Why You Might Skip Cancer Screening If You're Older
Cancer rates go up with age, but more experts are suggesting that older people might be better off without regular screening for the disease. That position is supported by the latest data suggesting that while early detection of cancer benefits younger people by giving them a chance to treat tumors and improve their prognosis, the same isn't true for the elderly. They are more likely to die of other conditions like heart disease, and treating small cancers, some of which may be slow growing, that would never become an issue during the patient's lifetime could lead to unneeded physical and mental complications (Sifferlin, 11/20).