Research roundup: 20M gain insurance, coverage's effect on surgery choices; opioid use by service members

Jul 4 2014

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

The New England Journal of Medicine: Health Care Coverage Under The Affordable Care Act -; A Progress Report
This report aims to help readers understand recently announced enrollment numbers, as well as other numbers that have received less attention, and assess their importance for the future of the ACA and our health care system. ... Taking all existing coverage expansions together, we estimate that 20 million Americans have gained coverage as of May 1 under the ACA. We do not know yet exactly how many of these people were previously uninsured, but it seems certain that many were. Recent national surveys seem to confirm this presumption. The CBO projects that the law will decrease the number of uninsured people by 12 million this year and by 26 million by 2017. Early polling data from Gallup, RAND, and the Urban Institute indicate that the number of uninsured people may have already declined by 5 million to 9 million and that the proportion of U.S. adults lacking insurance has fallen from 18% in the third quarter of 2013 to 13.4% in May 2014 (David Blumenthal, M.D., M.P.P., and Sara R. Collins, 7/2).

JAMA Surgery: Effect Of Insurance Expansion On Utilization Of Inpatient Surgery 
[This study sought to] estimate the differential effect of insurance expansion on utilization of discretionary vs nondiscretionary inpatient surgery with Massachusetts health care reform . ... We identified a total of 836 311 surgical procedures during the study period. Insurance expansion was associated with a 9.3% increase in the use of discretionary surgery in Massachusetts. Conversely, the rate of nondiscretionary surgery decreased by 4.5%. ... Insurance expansion in Massachusetts led to greater use of discretionary inpatient surgical procedures. Not surprisingly, this effect was greatest for populations at highest risk for being uninsured in Massachusetts before reform. By translating the Massachusetts experience to the national level, we estimated that insurance expansion will result in almost half a million new discretionary surgical procedures (ie, knee and hip replacements, back surgery, inguinal hernia repair, and transurethral resection of the prostate) by 2017. ... for inpatient surgical care, the effect of policies aimed at increasing coverage is not uniform. Instead, patients in need of imperative or nondiscretionary inpatient surgery appear to get this care whether or not they have insurance (Ellimoottil, 7/2).

JAMA Internal Medicine: Chronic Pain And Opioid Use In US Soldiers After Combat Deployment
Opioid medications are prescribed for chronic pain, but recently, rates of opioid use and misuse have ballooned, leading to significant numbers of overdose-related hospitalizations and deaths. The prevalence of chronic pain and opioid use associated with deployment is not well known, despite large numbers of wounded service members. ... Chronic pain was reported by 44.0% [of a sample of 2597 members of an infantry brigade three months after returning from Afghanistan]. Of these, 48.3% reported duration 1 year or longer, 55.6% reported nearly daily or constant frequency, and 51.2% reported severity of moderate to severe; 23.2% reported past-month opioid use, and 57.9% of those reported few or several days use. ... The prevalence of chronic pain (44.0%) and opioid use (15.1%) in this non–treatment-seeking infantry sample were higher than estimates in the general civilian population of 26.0% and 4.0%, respectively. ... These findings suggest a large unmet need for assessment, management, and treatment of chronic pain and related opioid use and misuse in military personnel after combat deployments (Toblin et al., 6/30).

Pew Charitable Trusts: Expanding The Dental Team
More states are looking to midlevel dental providers-;such as dental therapists or dental hygienists who can provide routine preventive and limited restorative care-;to help address critical problems accessing dental care. Pew undertook a series of case studies to enrich the understanding of how such providers perform in practice settings and how they affect practice economics. This report focused on midlevel dental providers employed in three public health programs [in Minnesota, Alaska and California] with the mission of increasing access by the underserved. ... The findings show promise that midlevel providers are an effective and cost-efficient means for addressing the significant unmet need for care (Gehshan et al., 6/30)

Urban Institute/Robert Wood Johnson Foundation/Ford Foundation: Increase In Medicaid Under The ACA Reduces Uninsurance, According To Early Estimates
[S]imple enrollment counts do not fully answer important questions for those tracking how health insurance coverage has been changing under the ACA: How much of the increase in Medicaid coverage is a net gain in insurance coverage rather than a shift to Medicaid from other coverage? Are there differences in the patterns of Medicaid changes across states and among different population subgroups? ... We use the March 2014 [Health Reform Monitoring Survey] to examine recent changes in coverage in Medicaid and other state health insurance programs. ... This early HRMS evidence suggests that significant gains in Medicaid/state coverage occurred following the first Marketplace open enrollment period, especially in the Medicaid-expansion states. Further, the gains in Medicaid/state coverage were a major component of the reduction in uninsurance (Clemans-Cope et al., 6/25).

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

Reuters: Videoconferencing Linked To Reduced Stress For Some Hospitalized Kids 
The ability to videochat with family and friends might help relieve stress among some hospitalized kids, according to a new study. The "virtual visits" seemed to help kids who lived closest to the hospital and were hospitalized for the shortest amount of time, an average of five days. The videochat program has been used at the University of California Davis Children's Hospital in Sacramento for the past several years, said lead author Nikki H. Yang, who works at the hospital (Doyle, 6/30). 

The Wall Street Journal: New Weapon In Fight Against 'Superbugs'
A soil sample from a national park in eastern Canada has produced a compound that appears to reverse antibiotic resistance in dangerous bacteria. Scientists at McMaster University in Ontario discovered that the compound almost instantly turned off a gene in several harmful bacteria that makes them highly resistant to treatment with a class of antibiotics used to fight so-called superbug infections. The compound, called aspergillomarasmine A, or AMA, was extracted from a common fungus found in soil and mold (Lukits, 6/30).

MinnPost:  Working Parents Use ER Visits To Get Doctor's Note For Sick Child, Study Finds
A young doctor who is doing his medical residency in the emergency room of a large, urban hospital recently told me about one of his frustrations regarding patients: Too many of them, he said, sought late-night care in the ER for minor ailments that could have been diagnosed and treated by the patient's own doctor the following day. A study published earlier this week helps explain why one group of patients -; parents of babies and preschoolers -; take their child with a mild illness to the emergency room or to an urgent care clinic rather than to the child's pediatrician. They are in immediate need of a doctor's note that will permit their sick child to return to child care the following day -; or that will permit the parent to stay home with the child (Perry, 6/27).

Los Angeles Times: Vaccines Are Safe And Problems Are 'Extremely Rare,' Study Says
Public health experts have taken a fresh look at the safety records of childhood vaccines and once again pronounced them safe. A systematic review published Tuesday by the journal Pediatrics notes some evidence of "adverse effects" from 11 vaccines. But the authors of the 13-page report emphasize that such problems are "extremely rare" and that the benefits of routine childhood immunizations far outweigh the risks (Kaplan, 7/1).

The New York Times: Common Back and Leg Pain Treatment May Not Help Much, Study Says
A widely used method of treating a common cause of back and leg pain -; steroid injections for spinal stenosis -; may provide little benefit for many patients, according to a new study that experts said should make doctors and patients think twice about the treatment. Hundreds of thousands of injections are given for stenosis each year in the United States, experts say, costing hundreds of millions of dollars (Belluck, 7/2).

news@JAMA:  Only 10% With Chronic Hepatitis C Complete Successful Treatment
Fewer than 10% of US residents with chronic hepatitis C virus (HCV) infection know of their illness, have access to health care, and have been treated successfully with antiviral therapy, according to a new study. The finding comes two years after the Centers for Disease Control and Prevention recommended one-time testing for the baby boom generation born between 1945 and 1965, which accounts for about 75% of all HCV infections in the United States. The study's lead author, Baligh Yehia, MD, MPP, MSHP, of the University of Pennsylvania Perelman School of Medicine in Philadelphia, said the new data provide a baseline of hepatitis C care that health experts can use to monitor the effect and success of screening such a large population (Voelker, 7/2).