Research roundup: Improving colon cancer screening; disparities in heart care; Medicaid expansion's effect on cities

Jun 21 2014

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

Urban Institute and Robert Wood Johnson Foundation: The ACA And America's Cities: Fewer Uninsured And More Federal Dollars
This report estimated the effect of the Affordable Care Act (ACA) on 14 large and diverse cities: Los Angeles, Chicago, Houston, Philadelphia, Phoenix, Indianapolis, Columbus, Charlotte, Detroit, Memphis, Seattle, Denver, Atlanta, and Miami. Among the seven cities in states that have expanded Medicaid, the ACA will likely decrease the number of uninsured by an average of 57 percent. ... Among the seven cities in states not expanding Medicaid, the ACA will likely decrease the number of uninsured by an average of 30 percent. ... If Medicaid eligibility were expanded in these cities, the number of uninsured would fall by an average of 52 percent (Buettgens and Dev, 6/19). 

JAMA Internal Medicine: Comparative Effectiveness Of A Multifaceted Intervention To Improve Adherence To Annual Colorectal Cancer Screening In Community Health Centers
Colorectal cancer (CRC) screening rates are lower among Latinos and people living in poverty. ... However, the ability of [fecal occult blood testing] to reduce CRC mortality depends on high rates of adherence to annual screening. ... our multifaceted intervention [including computerized reminders, standing orders for medical assistants to give patients home fecal immunochemical tests (FIT), and clinician feedback on CRC screening rates] ... greatly increased adherence to annual CRC screening; most screenings were achieved without personal calls. It is possible to improve annual CRC screening for vulnerable populations with relatively low-cost strategies that are facilitated by health information technologies (Baker et al., 6/16).

Circulation: Early Results Of Massachusetts Healthcare Reform On Racial, Ethnic, And Socioeconomic Disparities In Cardiovascular Care
Insured adults receive invasive cardiovascular procedures more frequently than uninsured adults. We examined the impact of healthcare reform in Massachusetts on use of coronary revascularization procedures and in-hospital and 1-year mortality by race/ethnicity, education, and sex. ... Using hospital claims data, we compared differences in coronary revascularization rates (coronary artery bypass grafting or percutaneous coronary intervention) and in-hospital mortality .... Reducing insurance barriers to receipt of coronary revascularization procedures has not yet eliminated preexisting demographic and educational disparities in access to these procedures (Albert et al., 6/17).

Employee Benefit Research Institute: Consumer Engagement Among HSA And HRA Enrollees
HRAs [health reimbursement arrangements] and HSAs [health savings accounts] are very similar, though there are some key differences that may provide different incentives related to using health care services, and thus, different consumer engagement experiences. An HSA is owned by the individual with the high-deductible health plan and is completely portable. There is no annual use-it-or-lose-it rule associated with an HSA .... In contrast, an HRA is an employer-funded health plan that reimburses employees for qualified medical expenses. ... Leftover funds at the end of each year can be carried over for future use (at the employer's discretion) .... Adults with an HSA were more likely than those with an HRA to exhibit a number of cost-conscious behaviors related to use of health care services (Fronstin, 6/19).

The Kaiser Family Foundation: Potential Supreme Court Decision: Who Will Bear The Coverage "Burdens?"
The Supreme Court is expected to issue its decision [in the Hobby Lobby and Conestoga Wood Specialties cases] by the end of June 2014. ... If the Court decides that Hobby Lobby must comply with the [health law] contraceptive coverage requirement, Hobby Lobby will likely choose to stop providing health insurance .... If, however, the Supreme Court exempts Hobby Lobby from the requirement that they include all prescribed FDA approved contraceptives as the ACA requires, some female employees and dependents ... may either have to go without their preferred contraceptive method, pay out of pocket, or seek subsidized services at a government funded clinic. ... it would be easy to envision that other corporations with religious objections to the full range of contraceptives would eliminate coverage (Sobel, Salganicoff and Nisha Kurani, 6/18).

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

AARP Blog: Diabetes, Alzheimer's Top 2 Areas For Drug Research
Diabetes, Alzheimer's, arthritis and heart disease top the list for the most new drugs in development to treat the common chronic diseases of older Americans, according to a new drug- industry report. The report, by the Pharmaceutical Research and Manufacturers of America (PhRMA), an industry trade association, says 435 medicines that primarily target seniors are currently either in clinical trials or under review by the Food and Drug Administration (FDA) (Sagon, 6/16).

Reuters: Needle Biopsies May Be Underused For Breast Cancer Patients
Most women should undergo a needle biopsy for breast cancer diagnosis, but some surgeons opt for a more invasive procedure instead, according to a new study [in the Journal of Clinical Oncology]. The difference may be a matter of surgeon experience, researchers say, so many women could benefit if surgeons were trained and encouraged to opt for the needle method more often (Doyle, 6/15).

Journal of the American Medical Association: Researchers Focus On Recovery In Schizophrenia
The outlook for people diagnosed with schizophrenia, once considered a devastating illness that only worsens over time, has improved in the past several decades. Antipsychotic medications and psychosocial treatments have allowed many with the illness to achieve some degree of recovery, manage residual symptoms, and lead productive lives. Yet additional efforts are needed to consolidate these improvements and help more patients reach these goals. ... These approaches are outlined in a new report, "Schizophrenia: Time to Commit to Policy Change," drafted by [Stephen Marder, MD, professor of psychiatry at the University of California, Los Angeles] and others (Friedrich, 6/18). 

NewsWorks: Study: One In Five Inmates In Pa. Prisons Has Hepatitis C
Nearly one in five inmates entering Pennsylvania prisons has hepatitis C, according to a study published in the June issue of the American Journal of Public health. Since 2003, Pennsylvania has screened everyone entering prison for hepatitis C unless an inmate chooses to opt out of the test. Of the more than 100,000 people who were tested upon entry between 2004 and 2012, about 18 percent tested positive for the virus. "It's an incredibly high rate," said lead author, Sarah Larney, who's a fellow at the National Drug and Alcohol Research Center at the University of New South Wales and a research associate at Brown University (Gordon, 6/16). 

MinnPost: Few Doctors Discuss End-of-life Planning With Heart-Failure Patients, Mayo Study Finds
About 5 million Americans have heart failure, a chronic condition in which the pumping action of the heart slowly weakens. There is no cure. Treatment -; medications and lifestyle changes -; can help people with the condition live longer and lead more active lives, but half of heart-failure patients die within five years of receiving their diagnosis. Yet, despite that prognosis, few doctors discuss end-of-life planning with heart-failure patients and their families, according to a recent study from researchers at the Mayo Clinic in Rochester (Perry, 6/18).

Reuters: Shared Decision Making Still Lacking For Cancer Screening
When it comes to cancer screening, doctors often do not adequately discuss the balance of pros and cons with their patients, a new study suggests. ... Depending on the screening test in question, between 69 and 93 percent of study participants chose to get screened, and most said they would make the same decision again, the authors write in the American Journal of Preventive Medicine (Pittman, 6/19). 

MedPage Today: Racial Disparity In Stroke Grows In South Carolina
In South Carolina, the rate of stroke hospitalization increased in recent years among young and middle-age blacks, but not other groups, resulting in a widening disparity, researchers found. In black individuals younger than 65, the rate per 100,000 rose from 121 in 2001 to 142 in 2010, a relative 17.3% increase, according to Wayne Feng, MD, of the Medical University of South Carolina Stroke Center in Charleston, and colleagues. In contrast, the stroke hospitalization rate declined in both black and white individuals 65 and older and remained stagnant in younger whites, they reported in the July issue of Stroke: Journal of the American Heart Association (Neale, 6/19). 

Modern Healthcare: Black, Hispanic Dialysis Patients Admitted More Often For Infections
Black and Hispanic patients on dialysis for end-stage renal disease had markedly higher rates of infection-related hospitalizations and were less likely to have visited a specialist for pre-treatment care, a new study finds. Infection-related hospitalizations were about 20% higher for blacks of all ages, and about 30% higher for older Hispanics, compared with white patients, said study co-author Dr. Keith Norris of the David Geffen School of Medicine at UCLA (Rice, 6/19).