Research Roundup: Do Mandatory Screening Laws Affect Disparities?; Mass. Health Law, 6 Years Later

Each week KHN reporter Christian Torres compiles a selection of recently released health policy studies and briefs.

The Kaiser Family Foundation: Massachusetts Health Care Reform: Six Years Later -- Since Massachusetts passed its own expansive health law, the state's uninsured rate has dropped and access to care has dramatically improved. But as this brief notes, two major issues remain. Massachusetts will have to find ways to contain health care costs -- now under discussion in the state legislature -- as well as align itself with the federal health law. In the process, other states "can draw on some of the state's early successes and challenges" (5/21).

Journal of Health Care for the Poor and Underserved: A Comparison Of Breast And Cervical Cancer Legislation And Screening In Georgia, North Carolina, And South Carolina -- The authors write: "We identified legislation (1989-2005) relating to breast and cervical cancer in Georgia, North Carolina, and South Carolina. ... The laws specifically intended to increase breast and cervical cancer screening were mandates requiring that insurance policies cover such screening; Georgia and North Carolina enacted such laws, but South Carolina did not. However, we were unable to demonstrate an effect of these laws on either screening rates or disparities. This may reinforce the importance of evidence-based health promotion programs to increase screening" (Miles-Richardson, Blumenthal and Alema-Mensah, May 2012).

The Kaiser Family Foundation: How Is The Affordable Care Act Leading To Changes In Medicaid Today? State Adoption Of Five New Options -- The health law is affecting Medicaid, even ahead of the expansion of coverage in 2014. "The options covered in the brief include incentives for states to get an early start on the Medicaid coverage expansion; increased federal funding to upgrade Medicaid eligibility systems; money to improve care for beneficiaries with chronic conditions by providing 'health home' services; special funding for chronic disease prevention; and help in developing service delivery and payment models that integrate care for beneficiaries who are dually eligible for Medicare and Medicaid" (5/18).

Genetics in Medicine: Association Between Health-Service Use And Multiplex Genetic Testing -- With the advent of genetic testing, there are concerns that patients will seek out unnecessary or inappropriate medical care due to their supposed risk for illness. In this study, researchers analyzed electronic health records for healthy individuals ages 25 to 40, some of whom took a test for risk of diabetes and other common conditions. The authors conclude: "Persons offered and completing multiplex genetic susceptibility testing used more physician visits before testing, but testing was not associated with subsequent changes in use. This study supports the supposition that multiplex genetic testing offers can be provided directly to the patients in such a way that use of health services is not inappropriately increased" (Reid et al., 5/17).

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

Reuters: Tired Surgical Residents May Up Error Risk: Study
A small study suggests surgeons in training are still tired enough to raise their risk of making significant errors, despite new guidelines limiting their work hours. Researchers found that orthopedic surgical residents at two Boston-area hospitals were averaging five and a half hours of sleep a night, and so fatigued during waking hours that a quarter of the time their "impairment" was equivalent to being legally drunk. ... Based on the activity recordings, the researchers also determined that -- compared to data on a group of well-rested residents -- the study participants were only functioning at about 70 percent of their mental effectiveness during 27 percent of the time they were awake (Seaman, 5/21). 

MedPage Today: Program Cuts Use Of Restraints In Nursing Homes 
Nursing homes that took part in a multicomponent, guideline-based intervention made less use of physical restraints on their residents, according to German researchers. From baseline to 6 months after starting the program, the prevalence of physical restraint use dropped from 31.5% to 22.6% in the intervention group, compared with virtually no change in a control group (30.6% to 29.1%), Sascha Köpke, PhD, from the University of Hamburg, and colleagues reported in the Journal of the American Medical Association (Pal, 5/22).

MedPage Today: Intensivist Care At Night May Cut Mortality
Having an intensivist work the graveyard shift may save lives, but only in some circumstances, researchers reported. In a retrospective analysis, an intensivist working overnight in some ICUs was associated with a 28% reduction in risk-adjusted in-hospital mortality. ... But the benefit was seen only in ICUs where consultation with an intensivist was optional, Wallace and colleagues reported online in the New England Journal of Medicine and in a presentation at the annual meeting of the American Thoracic Society (Smith, 5/21).

Medscape: Many Teenagers Have at Least 1 CVD Risk Factor
Thirty-seven percent of normal-weight adolescents had at least 1 risk factor for cardiovascular disease (CVD), as did 49% of those who were overweight and 61% of those who were obese, according to a study published online May 21 in Pediatrics. ... Among all the adolescents in the study, the overall prevalence of risk factors was 14% for prehypertension or hypertension, 22% for borderline-high or high low-density lipoprotein (LDL) cholesterol, 6% for low high-density lipoprotein (HDL) cholesterol, and 15% for prediabetes or diabetes (DeVita-Raeburn, 5/21).