Research roundup: Clinics and electronic records; young adults baffled by exchange; Medicare spending slowdown

Jul 14 2014

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

Health Affairs: Adoption And Use Of Electronic Health Records Among Federally Qualified Health Centers Grew Substantially During 2010–12 
We found that in 2012 nine out of ten health centers had adopted a EHR system, and half had adopted EHRs with basic capabilities. Seven in ten health centers reported that their providers were receiving meaningful-use incentive payments from the Centers for Medicare and Medicaid Services (CMS). Only one-third of health centers had EHR systems that could meet CMS's stage 1 meaningful-use core requirements. Health centers that met the stage 1 requirements had more than twice the odds of receiving quality recognition, compared with centers with less than basic EHRs (Jones and Furukawa, 7/8).

Health Affairs: Progress And Challenges: Implementation And Use Of Health Information Technology Among Critical-Access Hospitals
Despite major national investments to support the adoption of health information technology (IT), concerns persist that barriers are inhibiting that adoption and the use of advanced health IT capabilities in rural areas in particular. Using a survey of Medicare-certified critical-access hospitals, we examined electronic health record (EHR) adoption, key EHR functionalities, telehealth, and teleradiology, as well as challenges to EHR adoption. In 2013, 89 percent of critical-access hospitals had implemented a full or partial EHR. Adoption of key EHR capabilities varied (Hufstader Gabriel, Jones, Samy and King, 7/8).

Annals of Internal Medicine: The Experience Of Young Adults On HealthCare.gov: Suggestions For Improvement: A Case Report
We observed 33 highly educated young adults, aged 19 to 30 years, navigating the HealthCare.gov Web site in Philadelphia .... Participants were challenged by poor understanding of health insurance terms that were inadequately explained. Although participants expressed their preferred benefits (for example, preventive care and dental coverage), they had difficulty matching plans with their preferences, partially because they perceived that the amount of information was overwhelming. Young adults qualifying for affordability provisions were confused by discount applications that made more-comprehensive plans (such as silver) cheaper than less comprehensive alternatives (such as catastrophic). ... Using a systematic approach, we identified 6 actionable improvements for HealthCare.gov (Wong et al., 7/8).

Plos One: Premarket Safety And Efficacy Studies For ADHD Medications In Children
We identified all ADHD medications approved by the Food and Drug Administration (FDA) and extracted data on clinical trials performed by the sponsor and used by the FDA to evaluate the drug's clinical efficacy and safety. ... A total of 32 clinical trials were conducted for the approval of 20 ADHD drugs. The median number of participants studied per drug was 75. Eleven drugs (55%) were approved after <100 participants were studied and 14 (70%) after <300 participants. The median trial length prior to approval was 4 weeks, with 5 (38%) drugs approved after participants were studied <4 weeks and 10 (77%) after <6 months. ... Clinical trials conducted for the approval of many ADHD drugs have not been designed to assess rare adverse events or long-term safety and efficacy. ... better assurance is needed that the proper trials are conducted either before or after a new medication is approved (Bourgeois, Kim and Mandl, 7/9).

The Kaiser Family Foundation/Urban Institute: Medicaid Spending Growth In The Great Recession And Its Aftermath, FY 2007-2012
During [the FY 2007 – 2012 period], Medicaid enrollment rose from 42.3 million to 54.1 million and spending on medical services (that is, excluding administrative and other non-service spending) rose from $292.7 billion in FY 2007 to $383.6 billion in FY 2012–an average annual increase of 5.6 percent. ... In 2012, however, spending growth slowed to near record lows. ... Managed care is playing an increasingly dominant role in Medicaid spending. Growing at 14.1 percent on average per year, managed care grew steadily and faster than any other service category .... Medicaid spending on services for families grew much faster than Medicaid spending on services for the aged and individuals with disabilities. ... Medicaid spending per enrollee on medical services grew more slowly than underlying medical care inflation, national health expenditures per capita, and the growth in private health insurance spending per enrollee (Young and Clemans-Cope, 7/3). 

The Kaiser Family Foundation: The Mystery Of The Missing $1,000 Per Person: Can Medicare's Spending Slowdown Continue?
Based on our comparison of CBO's August 2010 and April 2014 baselines, Medicare spending this year will be about $1,000 lower per person than was expected in 2010, soon after passage of the Affordable Care Act (ACA), which included reductions in Medicare payments to plans and providers and introduced delivery system reforms that aimed to improve efficiency and reduce costs. By 2019, Medicare spending per person is projected to be nearly $2,400 lower per person than was expected following passage of the ACA. Medicare spending projections in CBO's August 2010 and subsequent baselines take into account the anticipated effects of the ACA, along with other factors that are expected to affect future Medicare spending. So it seems that the ACA may be having a bigger than expected effect, but something else may be going on here too (Neuman and Cubanski, 7/8).

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

Examiner.com: Too Many Seniors Suffer From Malnutrition
Malnutrition continues to be a serious problem in older adults. Nutrition screenings should be regular part of geriatric health assessment, ... In a special review article published July 3, 2014 in the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)'s Nutrition in Clinical Practice journal, Dr. Rose Ann DiMaria-Ghalili, an Associate Professor of Nursing at Drexel University, examines each component of the [Comprehensive Geriatric Assessment] and outlines how nutrition screenings would fit into each individual domain: physical/medical, mental, functional, and social (Hart, 7/4).

Reuters: Preventative Services Differ Between Primary Care Docs And OB/GYNs
The services women receive during annual preventive care visits may partially depend on what type of doctor they see, suggests a new report. Women who saw primary care doctors for their annual checkup tended to receive a broader range of services, compared to those who saw obstetrician/gynecologists (OB/GYNs), researchers found (Seaman, 7/7).

Reuters: Rural Residents With Disabilities Less Likely To Get Colon Cancer Screening
People with disabilities are less likely to get screened for colon and rectal cancer if they live in rural areas, according to a new study. Researchers said that means rural residents with disabilities may be at higher risk of getting diagnosed with late-stage cancer than their urban counterparts (Storr, 7/7). 

The New York Times: Weekend Dangers At The E.R.
A new study suggests that emergency surgery done on children during the weekend results in more complications and deaths than similar surgery done during the week. The study, published in the July issue of The Journal of Pediatric Surgery, used a large national database to match 112,064 weekend operations on children younger than 18 with 327,393 operations performed on weekdays. ... Only about 1 percent of cases had complications, and less than one-tenth of 1 percent of the children died. But even after controlling for sex, age, race, the type of surgery and other factors, patients having a procedure on the weekend were 40 percent more likely to sustain an accidental puncture or cut, 14 percent more likely to receive a transfusion, and 63 percent more likely to die (Bakalar, 7/7).

Reuters: Adoption Of New Surgical Technology Linked To Complications
Patients may be more likely to have complications when a new surgical device is first being adopted, suggests a new study looking at prostate removal. Based on the results, the process of how new surgical technologies are introduced to the healthcare system should be improved, researchers suggest. There is currently no formal process for introducing new surgical technologies into hospitals after they are approved by the U.S. Food and Drug Administration (Seaman, 7/8).

JAMA News: Gene Researchers Work To Engineer HIV-Resistant Cells
Ever since the evolution of the HIV/AIDS pandemic, researchers have long sought effective strategies to prevent HIV infection or help the body keep the virus in check after infection has occurred. In addition to a decades-long effort to develop an effective vaccine and continuing research to find less toxic drugs, some researchers are focusing on another strategy-;modifying the genes of host cells to make them resistant to infection (Hampton, 7/9).

Baltimore Sun: Study Shows Minimally Invasive Surgery Underused
Minimally invasive surgery leads to fewer infections and other complications than traditional open surgery but not all hospitals are regularly offering such procedures, according to a new study from Johns Hopkins University. The researchers looked at a database of more than seven million hospitals stays at more than 1,000 hospitals and found laparoscopic methods were underused in several specific surgeries -- appendectomies, colectomies and hysterectomies, which studies have shown have better outcomes when they are done using minimally invasive techniques (Cohn, 7/9). 

Reuters: Older Adults And Their Children Move Closer Together After Health Issues
Seniors who have a stroke or heart attack are more likely to end up living closer to their adult children afterward, according to a new study. Adult children often serve as informal caregivers when their parents become disabled after an illness, researchers note. But living far apart can make caregiving more difficult (Lehman, 7/9).

The Pacific Standard: The Ongoing Mental Health Benefits Of Neighborhood Diversity
Hope to have robust mental health well into your senior years? Seeking safety and stability, you might opt to move to a gated community, but new research from England suggests that might be a bad idea. Examining health information on more than 10,000 seniors, plus localized data on home prices, researchers led by Alan Marshall of the University of Manchester found lower levels of depression in older people who live in economically diverse neighborhoods (Jacobs, 7/3).