Research Roundup: Residents’ Test Ordering Habits; Housing And Health; And Government Responsibility

JAMA Internal Medicine: Analysis Of Diagnostic Test Ordering Habits Among Internal Medicine Residents
The Dartmouth Atlas of Health Care sheds light on wide variations in spending for Medicare beneficiaries in the 6 months before their death. That report has led to several efforts to better standardize patient care. High-value care has been defined as the seventh competency, with national efforts to educate physicians and physicians in training about how to deliver higher-quality care, while decreasing the cost of that care. Medical students and residents are particular targets for this effort because of the known “imprinting,” or sustained influence, that the training environment has on practice habits during a physician’s career. Kahneman and colleagues found that professionals express a much greater-than-expected degree of variability in the outcomes of their work, even when given the same data with which to base their conclusions. We are aware of 2 previous studies that showed a large degree of variability in resident patterns of test ordering. One study analyzed outpatient test ordering in 1987, and another, “practice intensity” in 2015. (Geleris, 10/8)

Health Affairs: The Maryland Health Enterprise Zone Initiative Reduced Hospital Cost And Utilization In Underserved Communities
The State of Maryland implemented the Health Enterprise Zone Initiative in 2013 to improve access to health care and health outcomes in underserved communities and reduce health care costs and avoidable hospital admissions and readmissions. In each community the Health Enterprise Zone Initiative was a collaboration between the local health department or hospital and community-based organizations. (Gaskin, 10/1)

Pew Research Center: 60% In US Say Health Care Coverage Is Government’s Responsibility
Six-in-ten Americans say it is the federal government’s responsibility to make sure all Americans have health care coverage, including 31% who support a “single payer” approach to health insurance, according to a new national survey by Pew Research Center. These views are little changed from last year, but the share saying health care coverage is a government responsibility remains significantly higher than it was from 2008 through 2016 (51% said this in 2016, compared with 60% today). (Kiley, 10/3)

Pediatrics: Transition Planning Among US Youth With And Without Special Health Care Needs
With this nationally representative study, we present results on new measures of transition planning among YSHCN as well as youth without special health care needs. The relationship between transition planning and various health system characteristics among YSHCN is also examined. (Lebrun-Harris, 10/1)

Health Affairs: Medicare Beneficiaries Living In Housing With Supportive Services Experienced Lower Hospital Use Than Others
There is strong evidence that housing conditions affect population health, but evidence is limited on the extent to which housing with supportive social services can maintain population health and reduce the use of expensive hospital services. We examined a nonprofit, community-based program in Queens, New York, that supplied affordable housing with supportive social services to elderly Medicare beneficiaries. We evaluated whether this program reduced hospital use, including hospital discharges for ambulatory care–sensitive conditions (ACSCs). (Gusmano, 10/1)

JAMA Internal Medicine: Frequency And Associations Of Prescription Nonsteroidal Anti-Inflammatory Drug Use Among Patients With A Musculoskeletal Disorder And Hypertension, Heart Failure, Or Chronic Kidney Disease
Among a retrospective cohort of more than 2.4 million musculoskeletal-related primary care visits by 814 049 older adult patients with hypertension, heart failure, or chronic kidney disease, 9.3% of visits resulted in prescription NSAID use within the following 7 days. Prescription NSAID use was not associated with increased risk of safety-related outcomes at 37 days. (Bouck, 10/8)

The Henry J. Kaiser Family Foundation: The Implementation Of Work Requirements In Arkansas Has Been Complex And Many Medicaid Enrollees Are Not Aware Of New Rules Or Face Obstacles In Complying
The implementation of Medicaid work requirements in Arkansas has been complex, with many Medicaid enrollees still not aware of program changes despite substantial outreach.  In addition, an online reporting requirement is proving difficult for many enrollees due to limited knowledge of the requirements as well as lack of computer literacy and internet access, according to a new analysis from KFF (the Kaiser Family Foundation). (10/9)