Research roundup: Benefits of hip surgery; preventing surgical infections; assessing ACOs' predecessors

Aug 30 2014

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

Clinical Orthopaedics And Related Research: Surgery For Hip Fracture Yields Societal Benefits That Exceed The Direct Medical Costs
Surgical treatment of hip fractures can achieve better survival and functional outcomes than nonoperative treatment, but less is known about its economic benefits. ... We estimated the effects of surgical treatment for displaced hip fractures through a Markov cohort analysis of patients 65 years and older. ... Estimated average lifetime societal benefits per patient exceeded the direct medical costs of hip fracture surgery by $65,000 to $68,000 for displaced hip fractures. With the exception of the assumption of nursing home use, the sensitivity analyses show that surgery produces positive net societal savings (Gu, Koenig, Mather and Tongue, 8/5).

JAMA Surgery: The Preventive Surgical Site Infection Bundle In Colorectal Surgery
Surgical site infections (SSIs) are associated with increased morbidity, length of hospitalization, readmission rates, and health care costs. They represent a particularly important problem in colorectal surgery, for which SSI rates are disproportionately high, ranging from 15% to 30%. ... To a large degree, the focus [of reducing SSIs] has been on improving adherence to evidence-based practices ... The preventive SSI [systemic, evidence-based measures called] the bundle was associated with a substantial reduction in SSIs after colorectal surgery. The increased costs associated with SSIs support that the bundle represents an effective approach to reduce health care costs (Keenan et al., 8/27).

Medicare and Medicaid Research Review: Financial And Quality Impacts Of The Medicare Physician Group Practice Demonstration
[The health law's Accountable Care Organization program] was built directly on its predecessor, the Medicare Physician Group Practice (PGP) demonstration .... This article presents the results of the comprehensive CMS-funded evaluation of the PGP demonstration ... The overall impact ... was a savings of $171 per assigned beneficiary person year during the demonstration performance period .... This represents a savings of 2.0 percent of assigned beneficiary expenditures. CMS paid performance bonuses to the participating PGPs that averaged $102 per assigned beneficiary person year across the five demonstration years (Pope et al., 8/28).

Medical Care: The Intended And Unintended Consequences Of Quality Improvement Interventions For Small Practices In A Community-based Electronic Health Record Implementation Project
Despite the rapid rise in the implementation of electronic health records (EHR), commensurate improvements in health care quality have not been consistently observed. ... The study included 143 practices that implemented EHRs .... 71 practices were randomized to receive financial incentives and quality feedback and 72 were randomized to feedback alone. ... Technical assistance and financial incentives-;alongside EHR implementation-;can improve quality of care. Financial incentives for quality may not result in similar improvements for incentivized and unincentivized measures (Ryan et al., 8/27).

Infection Control and Hospital Epidemiology/Rand Corp.: The Association Of State Legal Mandates For Data Submission of Central Line–Associated Bloodstream Infections In Neonatal Intensive Care Units With Process And Outcomes Measures
[This cross sectional study was designed] to determine the association between state legal mandates for data submission of central line–associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) with process and outcome measures. ... Among 190 study NICUs, 107 (56.3%) were located in states with mandates, with mandates in place >3 years in 52 (49%). ... Mandates were predictors of ≥95% compliance with all practices (Zachariah et al., 8/22).

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

MedPage Today: Surgery No Help For Mild Knee OA
Arthroscopic surgery for degenerative meniscal tears in patients with mild knee osteoarthritis had no benefit for function or pain, a meta-analysis determined. In randomized trials that included 805 patients, the standardized mean difference for function at 6 months was 0.25, which was converted to a Knee Injury and Osteoarthritis Outcome Score of 5.6. That did not reach the minimally important difference of 10 (Walsh, 8/27).

Fox News: Teens With Depression Benefit From 'Collaborative Care'
For teenagers with depression, finding and sticking with an effective treatment strategy can be an uphill battle. Their families often struggle to find a professional who can treat depression in adolescents, is accepting new patients and is covered by their insurance. ... But an idea called "collaborative care" -; which increases communication between families and doctors -; may help bridge that gap, said [Dr. Laura Richardson, a professor of pediatrics at Seattle Children's Hospital and the University of Washington in Seattle], who co-authored a new study detailing the findings, published today (Aug. 26) in the journal JAMA (Geggel, 8/26).

MinnPost: Study Links Early-To-Midlife Obesity To Increased Risk Of Dementia
People who are obese in their early to midlife adult years have an increased risk of developing dementia, and the risk is especially high for people who are obese in their 30s, according to a study published [last] week. The study also found that people who become obese late in life have a decreased risk of developing dementia, particularly Alzheimer's disease (Perry, 8/22).

Reuters: More Parents Think Their Overweight Child Is 'About Right'
Between 1988 and 2010, the number of parents who could correctly identify their children as overweight or obese went down, according to a new study. ... In the 1988 to 1994 data set, 78 percent of parents of an overweight boy and 61 percent of parents of an overweight girl, identified the child as "about the right weight." That number increased to 83 percent for boys and 78 percent for girls in the 2005 to 2010 period (Doyle, 8/26).

Reuters: Medicaid Payouts For Office Visits May Influence Cancer Screening: Study
In states where Medicaid pays doctors higher fees for office visits, Medicaid beneficiaries are more likely to be screened for breast, cervical or colorectal cancer, according to a new study. "States tend to vary in their reimbursement rates for different types of medical care services; some states may have low reimbursements for certain services and higher reimbursements for others," said lead author Dr. Michael T. Halpern of the Division of Health Services and Social Policy Research at RTI International (Doyle, 8/26).

Medscape: Futile Treatment Delays Care For Others Waiting For ICU Beds
Patients in intensive care units (ICU) receiving futile treatment delayed or prevented ICU treatment for others in need of intensive care, a study published in the September issue of Critical Care Medicine has revealed (Laidman, 8/28).