Research Roundup: What Workers Know About Health Care; Screening Harms

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

National Business Group on Health: Employee Perspectives On The Future Of Health Benefits And Health Care Delivery
As health care evolves in response to the Affordable Care Act, employers are trying to determine how they will provide health benefits to employees in the future, while still addressing the immediate challenges of employee health care costs. To assist large employers with this challenge, the National Business Group on Health commissioned Mathew Greenwald and Associates to survey employees [and found that] ... Employees have some knowledge of the ACA and its impact on them but employees need to understand that the ACA brings with it additional costs for employers and that employees will be sharing in these costs. Employees have gained some confidence in the last year when it comes to purchasing health care on their own. This confidence probably arises from the emergence of the public marketplaces. ... Employees do not necessarily understand what is comparative effectiveness research, overuse of care or what Centers of Excellence are (10/22).

The New England Journal of Medicine: Urologists' Use Of Intensity-Modulated Radiation Therapy For Prostate Cancer
Some urology groups have integrated intensity-modulated radiation therapy (IMRT), a radiation treatment with a high reimbursement rate, into their practice. This is permitted by the exception for in-office ancillary services in the federal prohibition against self-referral. ... Using Medicare claims from 2005 through 2010 ...  I compared the use of IMRT in the periods before and during ownership and used a difference-in-differences analysis to evaluate changes in IMRT use according to self-referral status. ... Urologists who acquired ownership of IMRT services increased their use of IMRT substantially more than urologists who did not own such services. Allowing urologists to self-refer for IMRT may contribute to increased use of this expensive therapy (Mitchell, 10/24).

JAMA Internal Medicine: Overdiagnosis And Overtreatment -- Evaluation Of What Physicians Tell Their Patients About Screening Harms
Overdiagnosis is the detection of pseudodisease—screening-detected abnormalities that meet the pathologic definition of cancer but will never progress to cause symptoms. The consequence of overdiagnosis is overtreatment—surgery, chemotherapy, or radiation—that provides the patient no benefits, but only adverse effects. For instance, for every 2000 women attending mammography screening throughout 10 years, 1 less dies of breast cancer. Concurrently, approximately 10 women with pseudodisease receive a diagnosis of breast cancer and are unnecessarily treated. Are patients informed about overdiagnosis by their physicians when discussing cancer screening? How much overdiagnosis would they tolerate when deciding to start or continue screening? (Wegwarth and Gigerenzer, (10/21).

Journal of Hospital Medicine: Do Internal Medicine Interns Practice Etiquette-Based Communication? A Critical Look At The Inpatient Encounter
Trained observers evaluated the use of 5 key communication strategies by internal medicine interns during inpatient clinical encounters: introducing one's self, explaining one's role in the patient's care, touching the patient, asking open-ended questions, and sitting down with the patient. ... A convenience sample of 29 interns was observed on a total of 732 patient encounters. Overall, interns introduced themselves 40% of the time and explained their role 37% of the time. Interns touched patients on 65% of visits, asked open-ended questions on 75% of visits, and sat down with patients during 9% of visits. ... Residents surveyed tended to overestimate their own practice of etiquette-based medicine (Block et al., 10/12).

JAMA Psychiatry: State Parity Laws and Access To Treatment For Substance Use Disorder In The United States 
The passage of the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act incorporated parity for substance use disorder (SUD) treatment into federal legislation. ... The implementation of any SUD parity law increased the treatment rate by 9% in all specialty SUD treatment facilities and by 15% in facilities accepting private insurance. ... the positive association is more pronounced in states with more comprehensive parity laws (Wen, Cummings, Hockenberry, Gaydos and Druss, 10/22).

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

MedPage Today: No Need For Risk Counseling After All HIV Tests
Brief risk counseling at the time of a negative HIV test had no effect on the risk of new sexually transmitted infections (STI), researchers reported. In a randomized trial, about one patient in eight who got a rapid HIV test combined with risk counseling developed a new STI within 6 months, according to Lisa Metsch, PhD, of Columbia University's Mailman School of Public Health in New York City, and colleagues (Smith, 10/22).

Medscape: Editorial Claims Bad Rap For Saturated Fat, Disputes Dietary Dogma
The contention that dietary saturated fats aren't the bad guys that policies and guidelines have portrayed for decades has reemerged in the literature, this time in an "Observations" opinion piece in published in BMJ. "The mantra that saturated fat must be removed to reduce the risk of cardiovascular disease has dominated dietary advice and guidelines for almost four decades," according to the author, Dr Aseem Malhotra (Croydon University Hospital, London, UK). "Yet scientific evidence shows that this advice has, paradoxically, increased our cardiovascular risks" (Stiles, 10/23).

Medscape: Pediatrician Numbers Outpace Family Physicians
Although the number of primary care physicians, including family physicians, internists, and pediatricians, has grown faster than the overall population in the last 3 decades, growth has been uneven for those 3 categories. The growth in general pediatrics has far outpaced that of family medicine and general internal medicine, which have grown only incrementally, according to a policy brief article published in the October 1 issue of American Family Physician (Frellick, 10/23).

Reuters: Obstetricians Change Definition Of On-Time Delivery
For years, babies born after a pregnancy lasting 37 to 42 weeks have been considered to be on time, or "term." But a group of U.S. doctors is now separating deliveries that happen during that span in an effort to improve newborn health. "We have increasingly recognized that newborn outcomes are not uniform between 37 and 42 weeks," Dr. Jeffrey Ecker said. Babies delivered between 37 weeks and 39 weeks of pregnancy will now be considered "early term," according to the American College of Obstetricians and Gynecologists (Seaman, 10/22).

NPR's SHOTS blog: A Toddler Remains HIV-Free, Raising Hope For Babies Worldwide
A 3-year-old girl born in Mississippi with HIV acquired from her mother during pregnancy remains free of detectable virus at least 18 months after she stopped taking antiviral pills. New results on this child, published online by the New England Journal of Medicine, appear to green-light a study in the advanced planning stages in which researchers around the world will try to replicate her successful treatment in other infected newborns (Knox, 10/23).