Research roundup: Prevention services for seniors; drug shortages

Sep 15 2014

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

UCLA Center For Health Policy Research: Bringing It To The Community: Successful Programs That Increase The Use Of Clinical Preventive Services By Vulnerable Older Populations 
This policy brief reports the findings of a systematic review conducted by the Community Health Innovations in Prevention for Seniors (CHIPS) project. ... Clinical preventive services such as colorectal cancer screening and pneumococcal immunization can help reduce rates of premature death and disability. Yet, many older adults are not receiving the full set of clinical preventive services that have been proven effective and are considered "high value" in terms of their costs per life saved. Rates are particularly low among racial and ethnic minority older adults compared to national goals. ... Evidence from the CHIPS program review shows that community organizations are able to increase access to and receipt of clinical preventive services by diverse, and often underserved, older adults (Frank, Kietzman, and Wallace, 9/5).

JAMA Internal Medicine: Use Of Medications Of Questionable Benefit In Advanced Dementia
Advanced dementia is characterized by severe cognitive impairment and complete functional dependence. Patients' goals of care should guide the prescribing of medication during such terminal illness. Medications that do not promote the primary goal of care should be minimized. ... Of 5406 nursing home residents with advanced dementia, 2911 (53.9%) received at least 1 medication with questionable benefit. ... The mean ... 90-day expenditure for medications with questionable benefit was $816..., accounting for 35.2% of the total average 90-day medication expenditures for residents with advanced dementia who were prescribed these medications (Tija et al., 9/8).

JAMA Internal Medicine: Quality Of Care For Elderly Patients Hospitalized For Pneumonia In The United States, 2006 to 2010
Nearly every US acute care hospital reports publicly on adherence to recommended processes of care for patients hospitalized with pneumonia. However, it remains uncertain how much performance of these process measures has improved over time .... Annual performance rates for 7 pneumonia processes of care and an all-or-none composite of these measures; and 30-day, all-cause mortality and hospital readmission, adjusted for patient and hospital characteristics [were analyzed.] ... Performance of processes of care for elderly patients hospitalized for pneumonia improved substantially from 2006 to 2010. Adjusted 30-day mortality declined slightly ... primarily owing to improved survival among non-ICU patients (Lee et al., 9/8).

Health Affairs: Drug Shortages
From 2005 to 2010 the number of reported drug shortages almost tripled. These shortages were especially acute with regard to generic sterile injectable drugs that can be critical and life-saving to patients fighting cancer, combatting an infectious disease, or undergoing surgery. ... health care officials and elected leaders have taken steps to mitigate drug shortages .... But recent news coverage of shortages ... has once again brought attention to the issue. ... One of the most cited reasons ... is low reimbursement rates from Medicare Part B that were initiated ... in 2003. It is theorized that these lower payments incentivized both physicians and manufacturers to switch to higher-cost drugs, thereby reducing investment in cheaper generic drugs, leading to "growing market concentration" and eventual drug shortages (Stencel, 9/11).

Journal of the American Medical Association/The Kaiser Family Foundation: Visualizing Health Policy: The Role Of Medicare Advantage
This Visualizing Health Policy [infographic] provides a snapshot of the role of Medicare Advantage plans, an alternative to traditional Medicare, including information about the proportion of Medicare beneficiaries who are enrolled in Medicare Advantage plans, geographic differences in Medicare Advantage penetration, the trend of increasing enrollment in Medicare Advantage plans, and the concentration of enrollment within a small number of firms and affiliates. It also shows the extent that Medicare has been paying more for beneficiaries in Medicare Advantage plans than for those in traditional Medicare, although that payment differential is projected to decline (Jacobson et al., 9/9).

George Washington University/Kaiser Family Foundation: Community Health Centers: A 2012 Profile And Spotlight On Implications Of State Medicaid Expansion Decisions
In 2012, nearly 1,200 federally funded community health centers were providing access to care for a predominantly low-income population in medically underserved areas across the country. As health insurance coverage expands under the Affordable Care Act (ACA) and the demand for primary care increases, the role of health centers is likely to increase, and the ACA's large investment in the health center program provides new resources ... This brief provides a pre-ACA snapshot of health centers that can help in understanding the impact of state decisions about the ACA Medicaid expansion on health centers as health reform unfolds in the coming years (Shin and Paradise et al., 9/5).

Policy, Politics & Nursing Practice: What Does Nurse Turnover Rate Mean And What Is The Rate?
Registered nurse turnover is an important indicator of the nurse job market. ... The RN Work Project is a 10-year panel study of new nurses. Data were collected from the new nurses, rather than from a specific organization. About 17.5% of new nurses leave their first job within 1 year of starting their jobs. Consistent and accurate measurement of turnover is an important step in addressing organizational work environments and policies about the nursing workforce (Kovner, et al., 8/25).

British Medical Journal: Appraisal Of Evidence Base For Introduction Of New Implants In Hip And Knee Replacement: A Systematic Review Of Five Widely Used Device Technologies
The five selected innovations comprised three in total hip replacement (ceramic-on-ceramic bearings, modular femoral necks, and uncemented monoblock cups) and two in total knee replacement (high flexion knee replacement and gender specific knee replacement). ... We did not find convincing high quality evidence supporting the use of five substantial, well known, and already implemented device innovations in orthopaedics. Moreover, existing devices may be safer to use in total hip or knee replacement. Improved regulation and professional society oversight are necessary to prevent patients from being further exposed to these and future innovations introduced without proper evidence of improved clinical efficacy and safety (Nieuwenhuijse et al., 9/9).

The Kaiser Family Foundation: How Does Where You Work Affect Your Contraceptive Coverage?
The Affordable Care Act (ACA) requires most private health insurance plans to provide coverage for a broad range of preventive services including Food and Drug Administration (FDA) approved prescription contraceptives and services for women. Since the implementation of this provision in 2012, some nonprofit and for profit employers with religious objections to contraceptives have brought legal challenges to this rule. For many women today, their contraceptive coverage depends on their employer or when they purchased their individual insurance plan. [An infographic and text on women's questions about coverage.] (9/8). 

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

Medscape: Intensive Interventions Reduce Readmissions Globally
High-intensity interventions, including care coordination by a nurse, a home visit within 3 days of discharge, and coordination between hospitals and primary care, reduced readmission rates between 5% and 13% up to 1 year after discharge for chronically ill patients, according to study findings published in the September issue of Health Affairs. Only high-intensity interventions reduced readmission rates in the short term (30 days or fewer after discharge), whereas standard transitional care procedures targeted toward those at high risk for poor outcomes were effective for both the intermediate term (31 - 180 days after discharge) and long term (181 - 365 days) (Frellick, 9/8).

Reuters: Depression More Common For Cancer Patients, But Rarely Treated
Three new studies by researchers at the Universities of Oxford and Edinburgh in the U.K. reveal that three-quarters of depressed cancer patients are not receiving treatment for depression. The researchers also found that serious depression is more common for cancer patients than for the general population, and varies by type of cancer. They also tested a new treatment program, with mental health care integrated into cancer treatment, which was much more effective at reducing depression and improving quality of life than current treatments, they found (Doyle, 9/5).

The Associated Press: Study: Rise In ER Visits After Medicaid Expansion
Many people newly insured by Medicaid under the federal health care law are seeking treatment in hospital emergency rooms, one of the most expensive medical settings, a study released Monday concludes. The analysis by the Colorado Hospital Association provides a real-time glimpse at how the nation's newest social program is working (Alonso-Zaldivar, 9/8).

Reuters: Most Asthmatic Kids Lack Health Management Plans At School
In Chicago, most kids with asthma or food allergies don't have a health management form on file at school, a new study shows. The problem is typical of other cities, too, experts say – and it puts these children at risk (Doyle, 9/8).

The Associated Press: Study: Screening May Benefit Heavy-Smoking Seniors
Some current or former heavy smokers may benefit from a new lung cancer test even if they're 65 or older -; although they experience more false alarms, suggests an analysis that comes as Medicare is debating whether to pay for the scans (Neergaard, 9/8).

Reuters: Race And Poverty Tied To Thyroid Surgery Outcomes
Minorities and the poor tend to have worse access to the most experienced thyroid surgeons and hospitals than white or more affluent patients, according to a new study. The research doesn't delve into why the differences in access exist, but the results suggest the disparity may lead to poorer outcomes for some groups (Seaman, 9/10).

Denver Post: Medicare Patients Less Likely To Receive Best Treatment For Some Strokes, Study Finds
Medicare patients might face a conscious or unconscious bias that could mean their stroke is more likely to end in death or long-term disability than patients with private insurance, according to a study announced Sept. 10 by the University of Florida. Researchers found that Medicare patients are likely to have access to surgical treatment for a type of stroke, subarachnoid hemorrhage, that affects about 30,000 Americans a year. Subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. It accounts for 5 percent of all strokes, according to the American Heart Association. Surgical intervention can mean the difference between full recovery and disability, even death, the study authors said (Draper, 9/10).

Modern Healthcare: Most Hospitals Overuse Antibiotics, Premier Finds
Hospitals continue to overuse antibiotics despite warnings that pervasive use can lead to drug resistance and cause billions of dollars in excess healthcare costs, according to a retrospective analysis of 505 hospital members of the Premier health alliance (Rice, 9/10).