Research Roundup: Doctors Who Work While Sick; Older, Richer Workers Using Health Savings Accounts

JAMA Pediatrics: Reasons Why Physicians and Advanced Practice Clinicians Work While Sick
When clinicians work with symptoms of infection, they can put patients and colleagues at risk. ... [In a survey] ... in a large children’s hospital in Philadelphia. ... 446 respondents (83.1%) reported working sick at least 1 time in the past year, and 50 (9.3%) reported working while sick at least 5 times. Respondents would work with significant symptoms, including diarrhea (161 [30.0%]), fever (86 [16.0%]), and acute onset of significant respiratory symptoms (299 [55.6%]). ... Reasons deemed important in deciding to work while sick included not wanting to let colleagues down (521 [98.7%]), staffing concerns (505 [94.9%]), not wanting to let patients down (494 [92.5%]), fear of ostracism by colleagues (342 [64.0%]), and concern about continuity of care (337 [63.8%]). (Szymczak et al., 9/8)

JAMA Internal Medicine: Breast Cancer Screening, Incidence, And Mortality Across US Counties
Screening mammography rates vary considerably by location in the United States, providing a natural opportunity to investigate the associations of screening with breast cancer incidence and mortality .... Across US counties, there was a positive correlation between the extent of screening and breast cancer incidence ... but not with breast cancer mortality. ... An absolute increase of 10 percentage points in the extent of screening was accompanied by 16% more breast cancer diagnoses .... the clearest result of mammography screening is the diagnosis of additional small cancers. Furthermore, there is no concomitant decline in the detection of larger cancers, which might explain the absence of any significant difference in the overall rate of death .... Together, these findings suggest widespread overdiagnosis. (Harding et al., 9/8)

Health Affairs: Health Savings Accounts: Growth Concentrated Among High-Income Households And Large Employers
Between 2005 and 2012, the share of employers whose employees had health savings accounts (HSAs) and the share of employees working at these employers grew more than tenfold. High-income and older tax filers both established HSAs and fully funded their HSAs at least four times as often as did low-income and younger filers. (Helmchen et al., 9/8)

Health Affairs: Increased Use Of Prescription Drugs Reduces Medical Costs In Medicaid Populations
We used data on more than 1.5 million Medicaid enrollees to examine the impact of changes in prescription drug use on medical costs. For three distinct groups of enrollees, we estimated the effects of aggregate prescription drug use—and, more specifically, the use of medications to treat eight chronic noncommunicable diseases—on total nondrug, inpatient, outpatient, and other Medicaid spending. We found that a 1 percent increase in overall prescription drug use was associated with decreases in total nondrug Medicaid costs by 0.108 percent for blind or disabled adults, 0.167 percent for other adults, and 0.041 percent for children. Reductions in combined inpatient and outpatient spending from increased drug utilization in Medicaid were similar to an estimate for Medicare by the Congressional Budget Office. (Roebuck et al., 9/8)

Annals of Internal Medicine: The Financial Effect Of Value-Based Purchasing And The Hospital Readmissions Reduction Program On Safety-Net Hospitals In 2014
[Researchers sought to] determine whether safety-net hospitals incur larger financial penalties than other hospitals under VBP [Medicare's value-based purchasing] and HRRP [Hospital Readmissions Reduction Program]. ... Safety-net hospitals were defined as being in the top quartile of the Medicare disproportionate share hospital (DSH) patient percentage and Medicare uncompensated care (UCC) payments per bed. ... Safety-net hospitals in the top quartile ... were more likely to be penalized under VBP than other hospitals (62.9% vs. 51.0% under the DSH definition and 60.3% vs. 51.5% under the UCC per-bed definition). This was also the case under the HRRP (80.8% vs. 69.0% and 81.9% vs. 68.7%, respectively). Safety-net hospitals also had larger payment penalties ($115 900 vs. $66 600 and $150 100 vs. $54 900, respectively). (Gilman et al., 9/8)

JAMA Surgery: Effect Of Delirium And Other Major Complications On Outcomes After Elective Surgery In Older Adults
To evaluate the association of major postoperative complications and delirium, alone and combined, with adverse outcomes after surgery [researchers used a prospective] ... cohort study in 2 large academic medical centers of 566 patients who were 70 years or older without recognized dementia or a history of delirium and underwent elective major orthopedic, vascular, or abdominal surgical procedures .... Forty-seven patients (8.3%) developed major complications and 135 (23.9%) developed delirium. ... major complications only contributed to prolonged LOS [length of stay in the hospital] ...; by contrast, delirium only significantly increased all adverse outcomes, including prolonged LOS ..., institutional discharge ... and 30-day readmission .... The subgroup with complications and delirium had the highest rates of all adverse outcomes. (Gleason et al., 9/9)

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

Reuters: Reference Payment For Colonoscopy Saved California Millions Of Dollars
Two years after offering colonoscopy patients full coverage for their screening if they had it done at lower-priced facilities, the California Public Employees’ Retirement System (CalPERS) saved $7 million, according to a new study. The initiative sought to counter the unpredictable, but generally rising, prices for the procedure at different facilities while also making sure members kept access to colon cancer screening. (Doyle, 9/8)

The New York Times: Lung Screening May Not Push Smokers To Quit
The results of an admittedly small but telling new study suggest that Medicare and other insurers could be spending billions of dollars on screening smokers for lung cancer that would be better spent on helping them quit and keeping others from starting. Although screening is considered “a teachable moment” that could be used to foster smoking cessation, the new study indicated that it more often bolstered smokers’ beliefs that they had dodged a bullet and could safely continue to smoke. (Brody, 9/7)

Reuters: Smoking Worsens Diabetes Complications, But Quitting May Help
People with type 2 diabetes who smoke have significantly higher risks of heart disease, stroke, and death than diabetic non-smokers, a new study shows. They also had higher risks of clogged arteries, heart failure, and reduced blood flow to the limbs. The risks were lower for diabetics who quit smoking, but still moderately higher than risks among never smokers, the researchers write in the journal Circulation. (Kennedy, 9/9)

Medscape: Insurance Expansion Means Boom in Chronic Illness Diagnoses
Insured people are significantly more likely — by 14 percentage points — than similar uninsured people to be diagnosed with diabetes and high cholesterol, a new study indicates. The probability of being diagnosed with high blood pressure was 9 points higher among the insured. Daniel R. Hogan, a technical officer at the World Health Organization in Geneva, Switzerland, and coauthors found that among those already diagnosed, having insurance was linked with significantly healthier levels of blood sugar, total cholesterol, and systolic blood pressure. The results were published in the September issue of Health Affairs. (Frellick, 9/9)

Reuters: Patients Steered To Fewer Pharmacies May Fill More Prescriptions
When patients have drug benefits that encourage them to save money by using certain pharmacies, they may end up filling more prescriptions, a company-funded study suggests. Narrow pharmacy networks that cover prescriptions only at certain retailers and drug benefits that offer consumers lower out-of-pocket fees at a subset of preferred pharmacies have become more common in recent years as a way to limit premium increases and curb drug spending. (Rapaport, 9/8)

Reuters: Less Invasive Heart Valve Surgery Safe For Patients In Their 90s
A modern technique for replacing heart valves without major surgery is safe even for very elderly patients, researchers say. The procedure can yield "excellent short- and mid-term outcomes in a patient population with a lethal disease that without this technology would undoubtedly die,” Dr. Vinod H. Thourani from Emory University, Atlanta, Georgia told Reuters Health by email. (Boggs, 9/8)

Reuters: Shingles Vaccine Not Cost Effective Before Age 60
The shingles vaccine might not be cost-effective for people in their fifties, a new analysis suggests. The Centers for Disease Control and Prevention (CDC) does not recommend the shingles vaccine for that age group, and the authors of the new analysis say their findings support that policy. "Even though the vaccine is effective, it may not be cost effective," lead author Phuc Le of the Cleveland Clinic told Reuters Health. (Seaman, 9/7)

The Associated Press: More Kids Kept Safe From Household Medicines, ER Trend Says
New research suggests parents are doing a better job of keeping household medicines out of the hands of young children. Emergency room visits by children who swallowed medicine while unsupervised have declined substantially, reversing an earlier trend, the study found. By contrast, ER visits for bad reactions from medicines meant for kids and given by parents increased during the same time. (Tanner, 9/7)

Health News Florida: USF Researcher Looks At Cost vs. Quality In Diabetic Healthcare
It’s an age-old question plagues us even as our nation’s healthcare system continues to change: are higher costs in health care for patients always associated with higher quality goods and services? One University of South Florida College of Public Health researcher took on that question – focusing in specifically on a disease that affects millions and millions of Americans: diabetes. (Schreiner, 9/7)

Reuters: Vaginal Mesh Slings For Incontinence Fail In About 3 Percent
About one in 30 women who get a common type of vaginal surgery to address urinary incontinence will need repeat procedures within 10 years to remove or replace mesh slings inserted to prevent leaking urine, a study finds. This risk is considered low, the authors note. Patients fared best when they had slings inserted by surgeons who did the highest volume of these procedures. These patients were 37 percent less likely to need repeat procedures, the study found. (Rapaport, 9/9)