Research roundup: Long-term care use varies dramatically by state; health spending slowdown explained

Dec 16 2013

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

National Center for Health Statistics/CDC: Long-Term Care Services In The United States: 2013 Overview
In 2012, about 58,500 paid, regulated long-term care services providers served about 8 million people in the United States. Long-term care services were provided by 4,800 adult day services centers, 12,200 home health agencies, 3,700 hospices, 15,700 nursing homes, and 22,200 assisted living and similar residential care communities. Each day in 2012, there were 273,200 participants enrolled in adult day services centers, 1,383,700 residents in nursing homes, and 713,300 residents in residential care communities; in 2011, about 4,742,500 patients received services from home health agencies, and 1,244,500 patients received services from hospices. Provider sectors differed in ownership, and average size and supply varied by region (Harris-Kojetin et al., 12/12).

Journal of Preventive Medicine: Completion Of Advanced Directives Under U.S. Consumers
Current, ongoing national surveys do not include questions about end-of-life (EOL) issues. ... Data were analyzed in 2013 from adults aged 18 years and older who participated in the 2009 or 2010 HealthStyles Survey, a mail panel survey designed to be representative of the U.S. population. ... Of the 7946 respondents, 26.3% had an advance directive. The most frequently reported reason for not having one was lack of awareness. ... These data indicate racial and educational disparities in advance directive completion and highlight the need for education about their role in facilitating EOL decisions (Rao et al., 12/10).

National Bureau of Economic Research: Is This Time Different? The Slowdown In Healthcare Spending
Why have health care costs moderated in the last decade? Some have suggested the Great Recession alone was the cause, but health expenditure growth in the depths of the recession was nearly identical to growth prior to the recession. Nor can the Affordable Care Act (ACA) can take credit, since the slowdown began prior to its implementation. Instead, we identify three primary causes of the slowdown: the rise in high-deductible insurance plans, state-level efforts to control Medicaid costs, and a general slowdown in the diffusion of new technology, particularly in the Medicare population (Chandra, Holmes and Skinner, Dec. 2013).

The Kaiser Family Foundation: A Guide To The Supreme Court's Review Of The Contraceptive Coverage Requirement
Shortly after the Department of Health and Human Services (HHS) announced the new federal rule that required all new private plans to cover prescribed FDA approved contraceptive methods without cost-sharing, a number of corporations sued claiming that this new requirement violates their religious rights. These lawsuits have worked their way through the Federal Courts and, on November 26, 2013, the Supreme Court agreed to hear two cases that involve for-profit corporations. ... While the Court's decision ... will have a direct effect on women's access to contraceptive coverage, it may also have broader ramifications for civil rights protections in the workplace. This policy brief explains the issues raised by the cases pending, answers some key questions about the parties' legal arguments and considers possible effects of the potential decisions (Sobel and Salganicoff, 12/9).

Robert Wood Johnson Foundation: Assuring Better State-Level Nursing Workforce Data Systems 
The question of how to ensure there will be enough nurses to meet the growing demand for health care services created by an aging population, insurance expansion, increase in chronic disease, and new care delivery and financing models can only be addressed through robust and accurate data on the nursing workforce. ... A new set of briefs ... address the reasons states should build data systems, how to do it, and what kinds of data should be included. ... The first brief explains why states need to build better workforce data systems and identifies the types of questions a robust, well developed, longitudinal nursing workforce data system can help address (Fraher et al., 12/12).

Journal of The American Academy of Orthopaedic Surgeons: Platelet-Rich Plasma In Orthopaedic Applications: Evidence-Based Recommendations For Treatment
Autologous platelet-rich plasma (PRP) therapies have seen a dramatic increase in breadth and frequency of use for orthopaedic conditions in the past 5 years. Rich in many growth factors that have important implications in healing, PRP can potentially regenerate tissue via multiple mechanisms. Proposed clinical and surgical applications include spinal fusion, chondropathy, knee osteoarthritis, tendinopathy, acute and chronic soft-tissue injuries, enhancement of healing after ligament reconstruction, and muscle strains. However, for many conditions, there is limited reliable clinical evidence to guide the use of PRP (Welllington et al., Dec. 2013).

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

Washington Examiner: Slow And Sloppy Review Procedures Endanger Patients At Veterans Affairs Hospitals, GAO Finds
Patients at Department of Veterans Affairs hospitals are not being adequately protected from doctors who have histories of providing substandard treatment, according to a new report from the Government Accountability Office. None of the four Veterans Affairs hospitals examined by the GAO complied with all of the requirements for peer review of patient care that results in a bad outcome, which could include patient deaths (Flatten, 12/4).

JAMA: Health Status And Use Of Preventive Services Improved After Enactment Of Massachusetts/ Health Care Reform Law
Implementation of Massachusetts' 2006 health care reform law, the model for the federal Affordable Care Act, was associated with improved health and greater use of preventive services relative to other New England states. The finding appears today in The Milbank Quarterly (Mitka, 12/10).

MedPage Today: Black Kids Don't Fare As Well With Liver Transplants
Bucking a trend in claims of greater equality in transplant outcomes, researchers recently found that young whites had better survival out to 10 years following liver transplant than black children and teens. There was a nearly 25 percentage point difference in survival rates at 10 years between teenage and pediatric white and black liver transplant patients. ... The disparities in graft failure and mortality remained significant after adjustment for socioeconomic, clinical, and demographic characteristics, they wrote online in the journal Liver Transplantation (Petrochko, 12/11).

Kaiser Health News: Capsules: People With Medicare Have Good Access To Doctors, Study Finds
As key congressional committees consider legislation to repeal Medicare's physician payment formula, a new study shows that the program's beneficiaries have generally good access to doctors. The report, prepared by the Kaiser Family Foundation, found that 96 percent of beneficiaries report having access to a doctor's office or clinic, and about 90 percent of beneficiaries say they can schedule timely appointments for routine and specialty care (Carey, 12/10).