Research Roundup: Caregivers’ Health; Rehab For Medicaid Kids; Retiree Coverage

The New England Journal of Medicine: One-Year Outcomes In Caregivers Of Critically Ill Patients
Few resources are available to support caregivers of patients who have survived critical illness; consequently, the caregivers’ own health may suffer. We studied caregiver and patient characteristics to determine which characteristics were associated with caregivers’ health outcomes during the first year after patient discharge from an intensive care unit (ICU). ... A large percentage of [the 280] caregivers (67% initially and 43% at 1 year) reported high levels of depressive symptoms. Depressive symptoms decreased at least partially with time in 84% of the caregivers .... Variables that were significantly associated with worse mental health outcomes in caregivers were younger age, greater effect of patient care on other activities, less social support, less sense of control over life, and less personal growth. (Cameron et al., 5/12)

Pediatrics: Outpatient Rehabilitation For Medicaid-Insured Children Hospitalized With Traumatic Brain Injury
[Researchers sought to] describe the prevalence of postdischarge outpatient rehabilitation among Medicaid-insured children hospitalized with a traumatic brain injury (TBI) and to identify factors associated with receipt of services. ... Among 9361 children, only 29% received any type of outpatient rehabilitation therapy during the first year after injury, although 62% sustained a moderate to severe TBI. The proportion of children receiving outpatient therapies declined to 12% in the second and third years. The most important predictor of receipt of outpatient rehabilitation was receipt of inpatient therapies or consultation with a rehabilitation physician during acute care. Compared with children of other racial/ethnic groups, Hispanic children had lower rates of receipt of outpatient speech therapy. (Jimenez et al., 5/6)

JAMA Surgery: Hospital And Payer Costs Associated With Surgical Complications
[N]umerous policy changes aimed at incentivizing high-quality care shift more of this burden [of the cost of surgical complications] to hospitals. ... We performed an observational study merging complication data from the Michigan Surgical Quality Collaborative and internal cost accounting data from the University of Michigan Health System from January 2, 2008, through April 16, 2015. ... The overall complication rate was 14.5% (744 of 5120) for all procedures .... For all studied procedures, mean hospital costs were $19 626 (119%) higher for patients with complications ($36 060) compared with those without complications ($16 434). Mean third-party reimbursement was $18 497 (106%) higher for patients with complications ($35 870) compared with those without complications ($17 373). Consequently, with risk adjustment, overall profit margin decreased from 5.8% for patients without complications to 0.1% for patients with complications. (Healy, 5/11)

Annals of Internal Medicine: Addressing Infection Prevention And Control In The First U.S. Community Hospital To Care For Patients With Ebola Virus Disease: Context For National Recommendations And Future Strategies
Health care personnel (HCP) caring for patients with Ebola virus disease (EVD) are at increased risk for infection with the virus. In 2014, a Texas hospital became the first U.S. community hospital to care for a patient with EVD; 2 nurses were infected while providing care. This article describes infection control measures developed to strengthen the hospital's capacity to safely diagnose and treat patients with EVD. ... The experiences of the authors and others informed national policies for the care of patients with EVD and protection of HCP, including new guidance for [personal protective equipment], a rapid system for deploying CDC staff to assist hospitals (“Ebola Response Team”), and a framework for a tiered approach to hospital preparedness. (Cummings et al., 5/10)

Georgetown University Health Policy Institute/Robert Wood Johnson Foundation: Understanding The Consumer Enrollment Experience In Federally Facilitated Marketplaces
Of the 1,384 calls that [the Assister Help Resource Center] received between November 1, 2015 and January 31, 2016, the majority (546) requested help with the process of determining eligibility for marketplace financial assistance. ... one-on-one assistance is and will continue to be essential for many consumers, a large proportion of whom would not ultimately enroll into coverage without the guidance assisters provide. At the same time, marketplace assisters face a very steep learning curve, and no amount of training can prepare them for all of the different consumer interactions they are likely to have. ... Supporting assisters with policy and technical expertise and monitoring their interactions with consumers are both important marketplace functions. ... officials will need to prioritize areas of the greatest need. (Corlette, Ahn and Ellison, 5/9)

Kaiser Family Foundation: Fading Fast: Fewer Seniors Have Retiree Health Insurance
The Kaiser Family Foundation has been tracking trends in employer-sponsored health coverage, and has documented a significant drop in the share of large employers (200+ workers) offering retiree health coverage, from 66 percent in 1988 to 23 percent in 2015. Firms that continue to offer retiree health benefits have adopted various strategies to limit their liability for these costs, including: hard caps on their financial liability, a shift from a defined benefit to a defined contribution approach, and increases in premiums and cost-sharing requirements paid by retirees and their spouses. In recent years, some employers have elected to offer retiree benefits through contracts with Medicare Advantage plans and private health insurance exchanges. (Neuman and Damico, 5/6)

The Kaiser Family Foundation: ACA Coverage And The Changing Labor Market: Voices From The Field
This brief highlights voices from adult focus group participants with low and moderate incomes with Medicaid or Marketplace coverage following implementation of the ACA. ... Many participants spoke of a changing labor market in which they worked multiple part-time jobs and/or short-term contracts. ... Some had full-time jobs, but received few or no benefits from their employers or were offered health coverage that was unaffordable. ... ACA coverage supported some participants as they transitioned into new careers or were looking for work after being laid off. ... For others, access to health care through Medicaid or the Marketplace supported their ability to work. ... And though Marketplace coverage is not linked to employment, some still found that it was designed for those with traditional jobs and predictable incomes. (Majerol and Tolbert, 5/5)

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

Medscape: 'Weekend Effect' In Hospital Deaths Is Oversimplified
Two new studies published online today in the Lancet call into question previous reports that suggest weekend staffing at hospitals is linked to higher patient mortality. One study looked specifically at acute stroke care and found no weekend effect on mortality, but found quality of care is inconsistent throughout the week. Therefore, the authors say, addressing only weekend care oversimplifies the problem. The second study found no correlation between weekend specialty staffing and patient deaths. (Frellick, 5/10)

Reuters: Calorie Restriction May Have Some Benefit For Non-Obese
Even for people who are a healthy weight or only somewhat overweight, cutting calories for two years may lead to weight loss as well as improved mood and sexual drive, according to a new study. (Doyle, 5/3)

Reuters: Problem Drinking Starts Before Military Deployment
Binge drinking and alcoholism is a big issue in the U.S. Navy and Marine Corps, and the problem may begin even before sailors and marines deploy, a recent study suggests. More than a quarter of sailors and marines who were anonymously surveyed within two weeks before their deployment admitted to binge drinking regularly, and nearly 40 percent reported dangerous drinking. A small but significant number also reported that they had been drugged against their will. (Kennedy, 5/6)

MedPage Today: Distressed Patients Gain Insurance Coverage
In an analysis of data from the National Health Interview Survey (NHIS), the number of uninsured adults ages 18 to 64 fell from 28.1% in 2012 to 19.5% in first 9 months of 2015, Robin Cohen, PhD, and Emily Zammitti, MPH, of the National Center for Health Statistics, reported in a Data Brief. But there was no change in the proportion of adults with serious psychological distress who had a usual place to go for medical care or who had talked to a healthcare provider in the past year, they reported. These figures hovered just under 80% and just under 90%, respectively. (Fiore, 5/4)