Research roundup: Patient safety measure results 'disappointing'

Jan 25 2014

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

The New England Journal of Medicine: National Trends In Patient Safety For Four Common Conditions, 2005–2011 
Patient safety poses serious challenges to the health care system in the United States. Since 2001, nationwide efforts have focused on reducing in-hospital adverse events ... We used the Medicare Patient Safety Monitoring System (MPSMS), a large database of information abstracted from medical records of a random sample of hospitalized patients ... from 2005 to 2011, rates of in-hospital adverse events declined significantly among patients with acute myocardial infarction or congestive heart failure but not among patients with pneumonia or conditions requiring surgery. Although this suggests that national efforts focused on patient safety have made some inroads, the lack of reductions across the board is disappointing (Wang et al., 1/22).

Employee Benefits Research Institute: The Cost Of Spousal Health Coverage
In 2011, policyholders spent an average of $5,430 on health care services, compared with $6,609 for spouses. ... this analysis concludes that the cost of spousal health care coverage is higher than that for policyholders, and non-working spouses cost more than working spouses. ... While "first-mover" firms may save money in the short run by eliminating working spouses from their plan, they may in time gain the responsibility for covering employees who were previously covered as a spouse under another plan, now left without that coverage by other employers implementing the same strategy. ... employers with net reductions in covered spouses may experience a worsening in average risk, resulting in higher spending than expected (Fronstin and Roebuck, 1/23).

Annals of Internal Medicine:  Insurance Status and the Transfer of Hospitalized Patients: An Observational Study
There is little objective evidence to support concerns that patients are transferred between hospitals based on insurance status. ... Design: Data analyzed from the 2010 Nationwide Inpatient Sample. ... All patients aged 18 to 64 years discharged alive from U.S. acute care hospitals with 1 of 5 common diagnoses ... In adjusted analyses, uninsured patients were significantly less likely to be transferred than privately insured patients for 4 diagnoses: biliary tract disease, chest pain, septicemia, and skin infections. Women were significantly less likely to be transferred than men for all diagnoses (Hanmer et al., 1/20).

Annals of Asthma, Allergy and Immunology: Depressive Symptoms And The Incidence of Adult-Onset Asthma in African American Women
Of 31,848 participants [in the Black Women's Health Study] followed from 1999 to 2011, 771 reported incident asthma. Depressive symptoms were ascertained on 1999 and 2005 follow-up questionnaires with the Center for Epidemiological Studies–Depression Scale (CES-D). ... A positive association was observed between CES-D score and the incidence of adult-onset asthma. If the hypothesis is confirmed, depression could contribute substantially to the burden of asthma in adults (Coogan et al., 1/21).

JAMA Surgery:  Positive And Negative Volume-Outcome Relationships In The Geriatric Trauma Population
In trauma populations, improvements in outcome are documented in institutions with higher case volumes. However, it is not known whether improved outcomes are attributable to the case volume within specific higher-risk groups, such as the elderly ... This retrospective cohort study using a statewide trauma registry was set in state-designated levels 1 and 2 trauma centers in Pennsylvania. It included 39,431 eligible geriatric trauma patients (aged >65 years). ... Higher rates of in-hospital mortality, major complications, and failure to rescue were associated with lower volumes of geriatric trauma care and paradoxically with higher volumes of trauma care for younger patients (Matsushima et al., 1/22).

The Kaiser Family Foundation: Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors
The Affordable Care Act's risk adjustment, reinsurance, and risk corridors programs are designed to work together to mitigate the potential effects of adverse selection and risk selection. ... Specifically, risk adjustment is designed to mitigate any incentives for plans to attract healthier individuals and compensate those that enroll a disproportionately sick population. Reinsurance compensates plans for their high-cost enrollees, and by the nature of its financing provides a subsidy for individual market premiums generally over a three-year period. And, risk corridors reduce the general uncertainty insurers face in the early years of implementation when the market is opened up to people with pre-existing conditions who were previously excluded (1/22).

The Kaiser Family Foundation: Coverage For Abortion Services And The ACA
The Patient Protection and Affordable Care Act (ACA) makes significant changes to health coverage for women by expanding access to coverage and broadening the health benefits that many will receive. ... This brief summarizes the major coverage provisions of the ACA that are relevant for women of reproductive age, reviews current federal and state policies on Medicaid and insurance coverage of abortion services, and presents national and state estimates on the availability of abortion coverage for women who are newly eligible for Medicaid or private coverage as a result of the ACA (Salganicoff, Beamesderfer and Kurani, 1/21).

Brookings Institution: Can Canadian-Style Healthcare Work In America? Vermont Thinks So.
In general, single payer health care means that all medical bills are paid out of a single government-run pool of money. Under this system, all providers are paid at the same rate, and citizens receive the same health benefits, regardless of their ability to pay. There are a number of proposed benefits to a single payer system. Currently, providers must follow different procedures with each of many insurance companies to get paid, creating an enormous amount of administrative work. ... Additionally, a single payer system provides universal access to health insurance, which eliminates the problem of the uninsured. However, Vermont's innovative proposal still leaves room for further improvement. Specifically, a single payer system alone does not address "fee-for-service" reimbursement for providers, which may encourage overuse and does not recognize quality and value (Sanghavi and Bleiberg, 1/22). 

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

NBC News: Doctors' Dress Code Aims To Halt Nasty Germs
Short sleeves, bare hands and forearms and white coats that are laundered at least once a week -; if not more often -; are the keys to keeping nasty bugs such as Staphylococcus aureus from hitching a ride on a doctor's wrist. Neckties are questionable. Watches and rings have to go. It's not clear what to do about name tags, lanyards, necklaces and cell phones, but when in doubt, it's best to clean the offending items -; or get rid of them. That's according to new guidance on hospital attire released Monday by the Society for Healthcare Epidemiology of America, or SHEA (Aleccia, 1/20).

Reuters: Many Hospitalized Older People Need Decision Help
When the time comes for making critical medical decisions while in the hospital, a new study says older people often rely on family members or other surrogates to make those calls. Researchers found that about half of the older patients they tracked needed help making decisions within two days of being admitted to the hospital (Seaman, 1/21).

CNBC: Employers Face Tax Hit In States With No Medicaid Expansion
The decision by 25 states not to expand Medicaid coverage under Obamacare could cost some employers more than $1.5 billion in new taxes starting next year, a new analysis reveals. That tax hit might come as a shock to many of those businesses unaware of their exposure to the penalty-;which will kick in if their employer-offered health plan is deemed too expensive and workers then buy private, subsidized Obamacare insurance (Mangen, 1/21).

MedPage Today: Few Docs Ready For Stage 2 'Meaningful Use'
Roughly one physician in eight has an electronic health record (EHR) system capable of supporting most requirements for Stage 2 of the "meaningful use" program, a government survey found. Only 13% of office-based physicians reported an intention to participate in the EHR incentive program and had a system meeting 14 of the 17 Stage 2 core objectives, according to a report released this week from the CDC's National Center for Health Statistics (NCHS) (Pittman, 1/17).

MedPage Today: Medical News: Evidence Not A Factor
Three doctors now in training at Harvard and the NIH -- Senthil Selvaraj, MD, Durga S. Borkar, MD, and Vinay Prasad, MD -- looked at what clinical studies the top five U.S. newspapers by circulation covered. They then mapped those against trials that appeared in the top five clinical journals, ranked by impact factor. Their findings? "Newspapers were more likely to cover observational studies and less likely to cover [randomized control trials] than high impact journals. Additionally, when the media does cover observational studies, they select articles of inferior quality. Newspapers preferentially cover medical research with weaker methodology" (Oransky, 1/21).