Research Roundup: Antibiotic Resistance; Physician Turnover; Contraceptive Coverage

Health Affairs/Robert Wood Johnson Foundation: Antibiotic Resistance
While there are a number of drugs designed to treat ... infections, resistant strains are emerging at a rate that is currently outpacing the development of effective new drugs. Methicillin-resistant Staphylococcus aureus (MRSA) alone kills more than 19,000 Americans every year--more than emphysema, HIV/AIDS, Parkinson's disease, and homicide combined. ... pharmaceutical companies do not have strong economic incentives to develop new antibiotic drugs. ... This brief provides an overview of antibiotic resistance, including a summary of its current impact, the factors that contribute to its spread, and the policy recommendations put in place by federal and global public health agencies. It also reviews the debate around the regulation of antibiotic use in agriculture and examines new developments in policy and research. (Chin, 5/21)

JAMA Internal Medicine: The Effect Of Primary Care Provider Turnover On Patient Experience Of Care And Ambulatory Quality Of Care
[Researchers sought to] measure the effect of [primary care provider] PCP turnover on patient experiences of care and ambulatory care quality ... [using a] cohort study of a nationwide sample of primary care patients in the Veterans Health Administration (VHA) .... Turnover was associated with a reduced likelihood of having a positive rating of their personal physician of 68.2% vs 74.6% and a reduced likelihood of getting care quickly of 36.5% vs 38.5%. In contrast, PCP turnover was not associated with lower quality of ambulatory care except for a lower likelihood of controlling blood pressure .... In 9 measures of ambulatory care quality, the difference between patients who experienced no PCP turnover and those who had a PCP turnover was less than 1 percentage point. (Reddy, 5/18)

The Kaiser Family Foundation: Round 2 On The Legal Challenges To Contraceptive Coverage: Are Nonprofits “Substantially Burdened” By The “Accommodation?”
The Affordable Care Act (ACA) requires most private health insurance plans to provide coverage for ... Food and Drug Administration (FDA) approved prescription contraceptives and services for women. ... over 200 corporations have filed lawsuits claiming that including coverage for contraceptives or opting for an “accommodation” from the federal government violates their religious beliefs. ... the Supreme Court ruled that “closely held” for-profit corporations may be exempted from the requirement. This ruling, however, only settled part of the legal questions raised by the contraceptive coverage requirement .... The nonprofits are seeking an “exemption,” meaning their workers would not have coverage for some or all contraceptives, rather than an “accommodation,” which entitles their workers to full contraceptive coverage but releases the employer from paying for it. (Sobel and Salganicoff, 5/18)

UCLA Center for Health Policy Research: Ten-Year Trends In The Health Of Young Children In California: 2003 To 2011-2012
This policy brief presents 10-year trends in several key health and wellness indicators for children ages 0-5 in California. ... [It] covers the years 2003 to 2011-2012, a period in which public health efforts for children focused on childhood obesity and improved nutrition, access to low-cost and free dental services, and the expansion of children’s health insurance programs. CHIS data show improvement in health insurance coverage and access to dental services for low-income children over the 10-year period. However, the percentage of children who were overweight for their age remained unchanged among those in households with incomes below 200 percent of the federal poverty level. ( Holtby, Zahnd and Grant. 5/21)

Urban Institute/Robert Wood Johnson Foundation: Most Adults With Medical Debt Had Health Insurance At The Time The Debt Was Incurred
Medical debt continued to be an issue for American families at the end of 2014, with an estimated one in four nonelderly adults reporting medical debt. Further, medical debt is more of a challenge for middle-income adults, who lack the public coverage options available to low-income adults and lack the financial resources of high-income adults. Of some concern, most adults incurred their family medical debt during periods with health insurance coverage. ... [That] suggests that changes in covered services and cost-sharing requirements would cushion the impacts of higher medical bills for low- and middle-income families. Medical debt resulting from uncovered services was reported by 9.3 percent of low-income adults and 12.7 percent of middle-income adults. (Karpman and Long, 5/21)

Urban Institute/Robert Wood Johnson Foundation: 9.4 Million Fewer Families Are Having Problems Paying Medical Bills
The share of adults with problems paying family medical bills in the previous 12 months fell an estimated 4.7 percentage points between September 2013 and March 2015. Overall, an estimated 9.4 million fewer adults had problems paying family medical bills .... we find that nearly three-quarters of the adults who have problems paying family medical bills forgo needed health care because they cannot afford it. Expansions of health insurance coverage under the ACA are likely to reduce but not eliminate problems with the affordability of health care, while ACA policies designed to limit cost sharing may expand access to care that would otherwise be viewed as unaffordable. (Karpman and Long, 5/21)

The Kaiser Family Foundation: Survey of Non-Group Health Insurance Enrollees, Wave 2
The survey, conducted February 18 – April 5, 2015, after the close of the second open enrollment period, includes individuals who purchased ACA-compliant coverage inside or outside of a Marketplace, as well as those who are currently enrolled in “non-ACA compliant” plans. ... Most (59 percent) of those who did shop for a plan this year (including those who purchased a new plan and those who shopped around but decided to renew a previous plan) say they had about the right number of plans to choose from. ... A large majority of those in ACA-compliant plans, including three quarters (74 percent) of those with Marketplace coverage, rate their overall health insurance coverage as excellent or good. More than half also say their plan is an excellent or good value for what they pay for it (Hamel et al., 5/21)

The Heritage Foundation: The New Disease Classification (ICD-10): Doctors And Patients Will Pay
(HHS) has used the ICD system as the foundation for reimbursement since 1983 .... The ICD-9-CM consists of over 14,000 diagnostic codes that are three to five characters in length, and there are an additional 4,000 ICD-9-CM procedural codes that are three to four characters in length. The ICD-10-CM codes are three to seven characters in length and total 68,000 different codes; the ICD-10-PCS codes are seven characters in length and total roughly 87,000 codes. ... The transition to ICD-10 will be costly—and health care providers, especially those in smaller, independent practices, will face financial and administrative burdens .... a more detailed disease classification system is a good thing. It may allow researchers to study disease and injury more easily and, over the long term, may foster better disease management. However, adoption of the new ICD-10 comes with significant costs and trade-offs. (Grimsley and O'Shea, 5/18)

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

HealthDay: More U.S. Kids Getting Mental Health Treatment
The number of U.S. children and teens being treated for mental health issues has risen by about 50 percent in the past 20 years -- with most of those kids having relatively mild symptoms, a new study finds. The research, published in the May 21 issue of the New England Journal of Medicine, comes at a time of growing concern over young people's mental health treatment. (Norton, 5/20)

The New York Times: Severe Mental Illness Found To Drop In Young, Defying Perceptions
The rate of severe mental illness among children and adolescents has dropped substantially in the past generation, researchers reported Wednesday, in an analysis that defies public perceptions of trends in youngsters’ mental health. The new report, published in The New England Journal of Medicine, comes at a time of fierce debate over the rates and treatment of childhood mental disorders. Critics argue that modern psychiatry is over-diagnosing and treating an increasing number of the worried well or merely quirky. (Carey, 5/20)

MedPage Today: Stroke Rounds: CAS Oucomes Vary Widely By Hospital
In-hospital outcomes among patients undergoing carotid artery stenting (CAS) in the United States varied four-fold after adjusting for differences in patient risk factors in an analysis of data from a large, nationwide stenting registry. Significant variation was seen among hospitals performing CAS in both in-hospital stroke and death, with the risk-adjusted variation ranging from 1.2% to 4.7%, researcher Beau M. Hawkins, MD, of the University of Oklahoma Health Sciences Center, Oklahoma City, and colleagues wrote in the journal JACC: Cardiovascular Interventions, published online May 18. (Boyles, 5/19)

Reuters: Doctors May Not Fully Explain Risks Of Common Heart Procedure
Patients mulling whether to get a common procedure to unclog blocked arteries may not get enough information from their doctors to make the best choice, a small study suggests. Researchers analyzed recordings of 59 conversations between cardiologists and patients about a common procedure called percutaneous coronary intervention (PCI), which is done to reopen arteries and restore blood flow to the heart - and found just two discussions covered all the points needed for patients to make an informed decision. (Rapaport, 5/20)

Reuters: U.S. Birth Data Underscores Higher C-Section Risks, CDC Says
U.S. women who give birth by cesarean section are more likely to face medical complications such as unplanned hysterectomies and the need for blood transfusions, according to a large, federal study based on birth certificate data released on Wednesday. Cesarean births also caused more ruptured uteruses and intensive care unit admissions, the Centers for Disease Control and Prevention reported, after reviewing data from 3.5 million births in 41 states and Washington, D.C., in 2013. (Beasley, 5/20)

Reuters: Senior Housing Transitions Can Lead To Stigma And Isolation
In senior housing facilities where residents are required to relocate as heath issues worsen, seniors tend to isolate themselves and may hide health conditions out of fear of relocation, according to a new study. Transitioning from independent living to assisted living to skilled nursing in one place can be disruptive and stressful, as researchers have known for 30 years, the authors write in The Gerontologist. (Doyle, 5/15)

HealthDay: Prostate Cancer Testing Drops Off Following Controversial Guidelines
Fewer American men are receiving prostate cancer screening in the wake of a national panel's conclusion that the test does men more harm than good, a new study finds. What's more, primary care doctors appear to have broadly accepted the U.S. Preventive Services Task Force's (USPSTF) ruling that the harms of prostate screening outweigh the benefits, according to a second study. (Thompson, 5/17)

Medscape: Medical Resident Burnout Reaches Epidemic Levels
Burnout rates among medical residents are reaching epidemic levels, new research suggests. A survey conducted by investigators at the University of North Carolina, Chapel Hill, showed that approximately 70% of residents met criteria for burnout. "We can't continue to ignore this problem of burnout," said Emily Holmes, MD, chief resident, University of North Carolina, Chapel Hill. "Burned out residents become burned out physicians." Dr Holmes presented the results here at the American Psychiatric Association (APA) 2015 Annual Meeting. (Anderson, 5/17)

Reuters: Single Motherhood Tied To Poorer Health Later In Life
Raising a child alone may take a lasting toll, leading to poorer health and more struggles with daily tasks after age 50, according to a new international study. Social safety nets and resources from extended families may blunt this effect in some countries more than others, and researchers found the association with poor health was strongest in the U.S., England, Sweden and Denmark, compared to southern European countries. (Doyle, 5/21)