Research Roundup: Examining The Health Of Future Medicaid Patients; Rural Trauma Care Issues

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

Journal of the AMA (JAMA): Health Status, Risk Factors, And Medical Conditions Among Persons Enrolled In Medicaid Vs. Uninsured Low-Income Adults Potentially Eligible For Medicaid Under The Affordable Care Act – Under the federal health law, states have the option of expanding Medicaid coverage to most-low income populations, potentially adding millions of new enrollees. Researchers analyzed 2007-2010 survey data  from a study population of more than 1,000 people, and found that, compared to adults already enrolled in state Medicaid programs, low-income uninsured adults who stand to gain from Medicaid expansion "will differ significantly from current Medicaid enrollees," the authors write. "The new Medicaid enrollees are likely to have fewer health conditions but more undiagnosed or uncontrolled conditions and are more likely to be male, non-Hispanic white, and better educated. They are also likely to have fewer health risks, … [But] Because many of the uninsured adults have not seen a physician in the past year and do not have a place they usually go for routine health care, they are likely to need care on first enrolling in Medicaid" (Decker, Kostova, Kenney and Long, 6/23).

JAMA Surgery: The Burden Of Unnecessary Interfacility Transfers In A Rural Trauma System – Regional trauma systems are intended to deliver the appropriate level of care to injured patients, according to the study’s authors. But sometimes patients are rapidly and unnecessarily transferred to a level I trauma center, "secondary overtriage."  After reviewing 7,700 patient records from Dartmouth Hitchcock Regional Hospital in New Hampshire from 2007 to 2011, researchers found that 24 percent of injured adults and 49 percent of injured children met their definition of secondary overtriage. “A significant number of injured patients who are transferred to our rural level I trauma center are minimally injured, do not require surgical intervention, and have less than a 48-hour length of stay,” they write, concluding: "Costs for transportation and additional evaluation for such a significant percentage of patients has important resource utilization implications." They recommend methods such as “teleradiology triage by neurosurgeons and orthopedic surgeons and telephone or video conference consultation between pediatric and adult trauma surgeons" (Sorensen et al., 6/19).

JAMA Internal Medicine: Differences In Human Immunodeficiency Virus Care And Treatment Among Subpopulations In The United States – Early diagnosis, antiretroviral therapy, prompt linkage to care and continued access to care reduce the human immunodeficiency virus (HIV) transmission and related illness and death. Noting that disparities in care and treatment for HIV exist and vary among population groups, authors analyzed data about all the people infected with HIV in the U.S., from the CDC's National HIV Surveillance System: "More than 850,000 persons with HIV did not have a suppressed viral load, including 79% of blacks, 74% of Hispanics or Latinos, and 70% of whites,” the authors write. Younger adults, those under the age of 45 years, were less likely than others to be aware of their infection or have a suppressed viral load. “Increasing the percentage of young persons diagnosed and receiving continuous care is critical to addressing HIV in the United States, ... Ensuring that people stay in care and receive treatment will increase the proportion of HIV-infected individuals who achieve and maintain a suppressed viral load,” they conclude (Hall et al., 6/17).

Georgetown Health Policy Institute/Robert Wood Johnson Foundation: Launching The Medicare Part D Program: Lessons For The New Health Insurance Marketplaces – Medicare Part D program provides prescription drug coverage for approximately 35 million people. And, according to the authors of this report, Part D’s establishment in 2003 is similar to the current and ongoing efforts to create health insurance exchanges under the federal health law because it required a massive public outreach campaign and relied in part on private insurance providers. "Past efforts to design and launch a large national health coverage program suggest that the experience will be far from perfect, at least at the outset,” the authors write. “However, the Medicare Part D experience teaches us that, when things went awry, federal and state officials were often able to identify problems and work with stakeholders to develop policy and operational solutions, so that consumers could obtain the promised benefits. Problems were not always addressed as quickly or as thoroughly as critics would have liked, but fixes were usually found. … eight years later, many of the initial difficulties have been forgotten. The public generally views the program as a success" (Hoadley, Corlette, and Monahan, 6/20).

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