Research Roundup: Coverage And Access; #MeToo Movement In Medicine; And Hospitals
Each week, KHN compiles a selection of recently released health policy studies and briefs.
The Commonwealth Fund:
States’ Progress On Coverage And Access, 2013–2016
Between 2013 and 2016, the uninsured rate for adults ages 19 to 64 declined in all states and the District of Columbia, and fell by at least 5 percentage points in 47 states. Among children, uninsured rates declined by at least 2 percentage points in 33 states. There were reductions of at least 2 percentage points in the share of adults age 18 and older who reported skipping care because of costs in the past year in 36 states and D.C., with greater declines, on average, in Medicaid expansion states. (Hayes et al., 12/14)
New England Journal of Medicine:
Sexual Harassment In Medicine — #MeToo
The news is filled with stories of celebrities who have engaged in egregious sexual misconduct. A recent poll suggested that more than half of U.S. women have experienced “unwanted and inappropriate sexual advances” at some point in their lives. Because I led a study of workplace sexual harassment in medicine, I was not surprised when reporters contacted me for comments on the recent disclosures. When a secretary filling in for my usual assistant relayed one reporter’s request, she told me she presumed the story was about my personal experience of sexual harassment. Disturbed, I leapt to correct her misapprehension: I was being sought out as a scholarly expert, not a victim. Then I wondered why it seemed so urgent to make that distinction. (Jagsi, 12/13)
JAMA Surgery:
Hospital Financial Distress And Immediate Breast Reconstruction After Mastectomy
In this cohort study of 5760 women with ductal carcinoma in situ who underwent mastectomy, women treated at hospitals under high financial distress and medium financial distress were significantly less likely to receive breast reconstruction surgery than women treated at hospitals with low to no financial distress. ...Hospital financial distress (HFD) is a state in which a hospital is at risk of closure because of its financial condition. Hospital financial distress may reduce the services a hospital can offer, particularly unprofitable ones. Few studies have assessed the association of HFD with quality of care. (Richards, Rundle, Wright et al., 12/6)
Annals Of Internal Medicine:
Effectiveness Of Individualized Glycemic Control For Type 2 Diabetes
Health policies and clinical programs that encourage an individualized approach to glycemic control for U.S. adults with type 2 diabetes reduce costs and increase quality of life compared with uniform intensive control. Additional research is needed to confirm the risks and benefits of this strategy. (Laiteerapong et al., 12/12)
New England Journal of Medicine:
A Bivalent Meningococcal B Vaccine In Adolescents And Young Adults
MenB-FHbp elicited bactericidal responses against diverse meningococcal B strains after doses 2 and 3 and was associated with more reactions at the injection site than the hepatitis A virus vaccine and saline. (Ostergaard et al., 12/14)
JAMA Internal Medicine:
Association of Overlapping Surgery With Increased Risk for Complications Following Hip Surgery
Findings: In this population-based cohort study of patients with hip fracture and hip arthritis, there were 960 and 1560 overlapping procedures, respectively. For patients undergoing overlapping procedures, there was an approximately 90% increase in the risk for surgical complications at 1 year, although the association was weaker in elective hip replacements than in hip fractures. Meaning: Overlapping surgery is associated with an increased risk for complications in hip surgery, particularly for nonelective procedures. ... Overlapping surgery, also known as double-booking, refers to a controversial practice in which a single attending surgeon supervises 2 or more operations, in different operating rooms, at the same time. (Ravi et al., 12/4)
JAMA:
Blood Pressure Trajectories In The 20 Years Before Death
There is mixed evidence that blood pressure (BP) stabilizes or decreases in later life. It is also unclear whether BP trajectories reflect advancing age, proximity to end of life, or selective survival of persons free from hypertension. ... In 46 634 participants (51.7% female; mean [SD] age at death, 82.4 [9.0] years), SBPs and DBPs peaked 18 to 14 years before death and then decreased progressively. (Delgado, Bowman and Ble, 12/4)
