Research Roundup: Evaluating Hospitalists' Workload; Hispanics And Medicare Part D

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

Health Affairs: Lower Hispanic Participation In Medicare Part D May Reflect Program Barriers
Despite the successes of Medicare’s Part D prescription drug program, an estimated 12.5 percent of Americans ages sixty-five and older do not have prescription drug coverage. It is possible that some who remain without coverage do so for rational economic reasons. ... To investigate the role that race and ethnicity may play in Medicare Part D participation, we analyzed data from the 2011 National Health and Aging Trends Study. We found that Hispanics were 35 percent less likely than non-Hispanic whites to have coverage, after individual predictors of prescription drug demand were controlled for. There was no statistically significant difference in Part D coverage between non-Hispanic blacks and non-Hispanic whites (Brian McGarry, Robert Strawderman and Yue Li, May 2014).

JAMA Internal Medicine: Preventing 30-Day Hospital Readmissions
Study: Randomized trials that assessed the effect of interventions on all-cause or unplanned readmissions within 30 days of discharge in adult patients hospitalized for a medical or surgical cause for more than 24 hours and discharged to home. ... Tested interventions are effective at reducing readmissions, but more effective interventions are complex and support patient capacity for self-care. Interventions tested more recently are less effective (Dr. Aaron Leppin et al., 5/12). 

JAMA Internal Medicine: Effect Of Hospitalist Workload On The Quality And Efficiency Of Care 
We conducted a retrospective cohort study of 20,241 admissions of inpatients cared for by a private hospitalist group at a large academic community hospital system between February 1, 2008, and January 31, 2011. ... The main outcomes were length of stay (LOS), cost, rapid response team activation, in-hospital mortality, patient satisfaction, and 30-day readmission rates. ... The LOS increased as workload increased, particularly at lower hospital occupancy. For hospital occupancies less than 75%, LOS increased from 5.5 to 7.5 days as workload increased. ... Increasing hospitalist workload is associated with clinically meaningful increases in LOS and cost (Dr. Daniel Elliott et al., May 2014).

American Society Of Clinical Oncologists: Low-Dose Computed Tomography Lung Cancer Screening In The Medicare Program
Based on evidence from the National Lung Cancer Screening Trial (NLST), the U.S. Preventive Services Task Force (USPSTF) recently recommended annual low dose computed tomography (LDCT) lung cancer screening in patients age 55-80 with a 30 pack-year smoking history who currently smoke or quit in the past 15 years. Under the terms of the Affordable Care Act, Medicare will cover this screening procedure. ... In the complete and phased implementation scenarios, screening resulted in 141,000 and 101,000 more lung cancers detected (mostly Stage I), 37.5 million and 22.4 million more LDCT scans. ... Our analyses suggest that LDCT screening will increase lung cancer diagnoses, result in a greater proportion of cases diagnosed at an early stage, and substantially increase Medicare expenditure (Joshua Roth et al., 5/14).

Cancer: Lack Of Reduction In Racial Disparities In Cancer-Specific Mortality Over A 20-Year Period
The Surveillance, Epidemiology, and End Results program was used to identify 2,713,474 patients diagnosed between 1988 and 2007 with either lung, breast, prostate, or colorectal cancer (the leading 3 causes of cancer-related mortality among each sex). ... African Americans presented with a more advanced stage of disease and underwent definitive therapy less often than whites. ... The survival gap for African Americans has not closed over time. Race-based differences in outcome persist independent of stage of disease and treatment, suggesting that additional strategies beyond screening and improving access to care, such as further research into tumor biologies disproportionately affecting African Americans, are needed to improve survival for African American patients with cancer (Dr. Ayal Aizer, 5/15).

JAMA Surgery: Transfer Rates And Use of Post–Acute Care After Surgery At Critical Access Vs Non–Critical Access Hospitals
We used data from the Nationwide Inpatient Sample (2005-2009) and American Hospital Association to perform a retrospective cohort study of patients undergoing common inpatient surgical procedures at CAHs or non-CAHs. ... After adjustment for patient and hospital factors, the higher likelihood of transfer by CAHs vs non-CAHs persisted for 3 procedures: hip replacement, colorectal cancer resection and cholecystectomy, but differences in the use of post–acute care did not. ... Hospital transfers occur more often after surgical admissions at CAHs. However, the proportion of patients at CAHs using post–acute care is equal to or lower than that of patients treated in non-CAHs. These results will affect the ongoing debate concerning CAH payment policy and its implications for health care delivery in rural communities (Dr. Adam Gadzinski et al., 5/14)

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

The Hill: Older Enrollees Could Lead To Higher Premiums, Study Says 
Health premiums in four states may spike this fall because of large numbers of older adults who signed up for Obamacare, according to a study from the conservative American Action Forum. The study released Friday found that older adults in Arkansas, Oregon, New Mexico and West Virginia signed up at much higher rates than young people in the health care law’s insurance exchanges. People over the age of 45 accounted for over 50 percent of enrollees despite making up only 30 percent of the population in those states (Al-Faruque, 5/9). 

Detroit Free Press:  People Taking Statins Eat More Calories Than A Decade Ago, Study Says
People who took statins to lower their cholesterol levels ate more calories and fat in 2009-10 than did those who took them a decade earlier, raising the question of whether the drug provides a false sense of dietary security. Researchers who used data from a national health survey found that in 1999-2000, people who took statins ate fewer calories, by an average of 179 a day, and less fat than people who didn’t take them. The differences began to shrink, and by 2005-06, the difference was insignificant (MacVean, 5/11).

Yahoo Health: Cancer Patients Rarely Requested Unnecessary Treatments 
Going to your doctor and demanding a treatment that is unwarranted may lead to unnecessary costs. But a new study of cancer patients suggests that this request is likely a rare occurrence. ... The study included 2,050 encounters between 26 clinicians and their patients, ... Dr. [Keerthi Gogineni Of the Abramson Cancer Center at University of Pennsylvania] and team found that only 8.6 percent of these encounters included a patient request or demand for treatment or testing. ... This research by Dr. Gogineni and team will be presented at the American Society of Clinical Oncology (ASCO)'s annual meeting (Jones, 5/15).

MinnPost:  Risk Of Dying In Hospital Increases On Weekend Regardless Of Admission Day, Study Finds
Vast research has suggested that patients who are admitted to a hospital on the weekend are more likely to die in the hospital than those with similar medical problems who are admitted Monday through Friday. This “weekend effect” has been documented for a variety of medical conditions, including heart attacks, stroke, head trauma and aneurisms. The reasons for the effect are not entirely clear, but the leading theory is that it’s due to reduced hospital staffing and/or access to specialists and certain kinds of treatments (Perry, 5/15).

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from major news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.