Research roundup: Mental health parity; nurses' workload; can restaurants reduce portion size?

Apr 7 2014

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

Health Affairs: Mental Health Parity
Historically, health insurance covered mental health care differently than other medical care. Recent laws have begun bringing them into balance. ... Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008. ... the MHPAEA applied to large group health plans, both fully and self-insured, and included a cost exemption. The MHPAEA prohibited differences in treatment limits, cost sharing, and in- and out-of-network coverage. Importantly, the MHPAEA also applied to the treatment of substance use disorders, which the MHPA did not address. ... Importantly, the ACA defined coverage of mental health and substance use treatment as one of the ten essential health benefits (EHBs) (Goodell, 4/3).

Health Affairs: Adults In The Income Range For The Affordable Care Act's Medicaid Expansion Are Healthier Than Pre-ACA Enrollees
The Affordable Care Act (ACA) has dramatically increased the number of low-income nonelderly adults eligible for Medicaid. ... We used simulation methods and data from the Medical Expenditure Panel Survey to compare nondisabled adults enrolled in Medicaid prior to the ACA with two other groups: adults who were eligible for Medicaid but not enrolled in it, and adults who were in the income range for the ACA's Medicaid expansion and thus newly eligible for coverage. Although differences in health across the groups were not large, both the newly eligible and those eligible before the ACA but not enrolled were healthier on several measures than pre-ACA enrollees (Hill et al., 3/27).

Centers for Disease Control and Prevention: Restaurant Owners' Perspectives On A Voluntary Program To Recognize Restaurants For Offering Reduced-Size Portions, Los Angeles County, 2012
[T]he Los Angeles County Department of Public Health conducted semistructured interviews with restaurant owners to better understand contextual factors that may impede or facilitate participation in a voluntary program to recognize restaurants for offering reduced-size portions. ... Interviews were completed with 18 restaurant owners (representing nearly 350 restaurants). ... 1) perceived customer demand is central to menu planning; 2) multiple portion sizes are already being offered for at least some food items; 3) numerous logistical barriers exist for offering reduced-size portions; 4) restaurant owners have concerns about potential revenue losses from offering reduced-size portions; 5) healthful eating is the responsibility of the customer; and 6) a few owners want to be socially responsible industry leaders (Gase, 3/20).

George Washington University/The Robert Wood Johnson Foundation: Ten Years After Keeping Patients Safe: Have Nurses' Work Environments Been Transformed?
A decade has passed since the Institute of Medicine (IOM) published Keeping Patients Safe: Transforming the Work Environment of Nurses. The report revealed that, "the typical work environment of nurses is characterized by many serious threats to patient safety." To counter these threats and reduce health care errors in hospitals and other settings where nurses care for patients, the 2004 report recommended fundamental transformation in the work environment of nurses .... Despite notable achievements in improving health care quality since that time, patients remain at risk of serious harm. ... Despite notable achievements in improving health care quality since that time, patients remain at risk of serious harm (Kurtzman and Fauteux, 3/31).

The Kaiser Family Foundation: Medicaid Beneficiaries Who Need Home And Community-Based Services: Supporting Independent Living And Community Integration
To provide insight into the unique experiences of Medicaid beneficiaries who need HCBS, this report profiles nine seniors and people with disabilities residing in Florida, Georgia, Kansas, Louisiana, North Carolina, and Tennessee. ... Based on a series of telephone interviews conducted in 2013 by the Kaiser Commission on Medicaid and the Uninsured, these profiles illustrate how beneficiaries' finances, employment status, relationships, well-being, independence, and ability to interact with the communities in which they live – in addition to their health care – are affected by their Medicaid coverage and the essential role of HCBS in their daily lives. ... Medicaid is a true safety net as it is often the only available source of these essential services to support community living (Musumeci and Reaves, 3/27).

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

Boston Globe: Benefits Of Mammograms May Have Been Oversold, New Study Finds
Doctors may have oversold the benefits of mammography and underplayed its risks, which has left many women unable to make an informed decision about whether or not to have regular breast cancer screenings beginning at age 40. ... Women in their 40s had just a 15 percent reduction in their breast cancer death risk compared to a 32 percent reduction for older women in their 60s who are far more likely to get breast cancer than younger women, according to the study published Tuesday in the Journal of the American Medical Association (Kotz, 4/1).

Reuters: Most Web-Based Colon-Screening Information Is Lacking: Study
When researchers evaluated a dozen websites meant to inform patients about colon cancer screening, most were written at too high a reading level and lacked important risk and benefit information. This isn't a new problem. Researchers have known for at least 20 years that many materials written for patients, not just those about colonoscopy, are not up to snuff, according to Terry C. Davis [published in Gastrointestinal Endoscopy] (Doyle, 4/1).

Bloomberg: Weight-Loss Surgery Keeps Diabetes At Bay Better Than Medicines
Weight-loss surgery may be a better way to treat diabetes than traditional drug therapy alone, according to a study that found the operation was more likely to keep the chronic condition at bay for at least three years. People who were overweight or mildly obese gained the same benefit from surgery as those who were heavier, a finding that should expand use of the procedure, said Philip Schauer, the lead researcher and director of the Bariatric and Metabolic Institute at the Cleveland Clinic. Most insurance companies limit coverage to those who are morbidly obese or have other medical conditions. ... The study was simultaneously published in the New England Journal of Medicine (Cortez, 3/31).

The Wall Street Journal: Downsides Of Mistaken Penicillin Allergy
Penicillin allergies are the most common and most inaccurate drug allergies reported by hospital patients, resulting in treatments with potentially serious effects, says a study in the Journal of Allergy and Clinical Immunology. The research showed patients with presumed penicillin allergies had longer hospital stays and developed more hospital-acquired infections, compared with those not reporting an allergy. Patients could have better outcomes if hospitals routinely performed penicillin allergy testing during the admission process, the study says. Hospital costs could also be significantly reduced (Lukits, 3/31).

The New York Times: The Device Makers' Shortcut
A few years ago, the Food and Drug Administration announced a stunning recall, saying that electrical wires in some St. Jude Medical heart defibrillators, which were implanted in tens of thousands of people, were defective. ... Now a new paper by Harvard researchers, using records only recently made available by the F.D.A., explains how the faulty leads got onto the market, shedding light on a little-known process used by manufacturers to alter medical devices without putting them through human trials (Rabin, 3/31).

Medscape: One In 3 Patients Fail To Fill Initial Prescriptions‏
Nearly one third of all initial drug prescriptions were not filled within 9 months, with nonadherence highest for expensive drugs and chronic preventive therapies, according to a primary care network cohort study published in the 1 April issue of Annals of Internal Medicine. ... Factors associated with lower odds of nonadherence were increasing patient age, eliminating prescription copayments for low-income groups, and a greater proportion of all physician visits with the prescribing physician (Barclay, 3/31).

Medscape: Hospitalist Workload Linked To Costs, Length Of Stay
Increased hospitalist workload is linked to higher costs and longer length of stay (LOS), according to a study by researchers at the Christiana Care System in Delaware and Northwestern University in Illinois, published online March 31 in JAMA Internal Medicine. ... As one of the fastest growing medical specialties in the United States, hospitalist medicine has been linked to more efficient, less costly, and better-quality care, according to background information in the article. Hospitalists are under pressure, however, to increase productivity in the face of declining revenues and increased demands for care (Hackethal, 3/31).

Modern Healthcare: Academic Medical Centers And Drugmakers Share Directors, Possible Conflicts
Nearly all of the nation's largest pharmaceutical companies have recruited directors from the leadership of academic medical centers, the training ground for future physicians and home to basic science research and clinical trials, according to a new study in the Journal of the American Medical Association. Sixteen of the 17 largest U.S. drug companies reported that at least one of their 2012 directors was also a top executive, department or division leader, dean or governing board member from one of the nation's medical schools, health professions' schools or teaching hospitals and health systems (Evans, 4/1).