Research Roundup: Family Caregivers; Medicare ACO Enrollment; High-Flow Oxygen Therapy
Each week, KHN compiles a selection of recently released health policy studies and briefs.
Urban Institute:
Distributional Effects Of Alternative Strategies For Financing Long-Term Services And Supports And Assisting Family Caregivers
This study examines how the need for long-term services and supports and their use vary by socioeconomic status and simulates the potential impact of various financing options. Our results show that older people with limited financial resources are more likely to develop serious needs and receive paid help than their counterparts with more financial resources. People with little wealth also tend to need and receive help for a relatively long time. The simulations reveal that the impact of alternative financing options, such as caregiver tax credits, subsidized respite care, and expanded social insurance, varies with income. (Favreault and Johnson, 3/22)
JAMA Internal Medicine:
Medicare Accountable Care Organization Enrollment And Appropriateness Of Cancer Screening
In this population-based analysis, Medicare ACO enrollment resulted in significant improvements in appropriateness of breast and colorectal cancer screening, namely improving screening rates among those likely to benefit and withholding screening from those unlikely to benefit. Conversely, ACO enrollment was associated with significant reductions in prostate cancer screening regardless of age or predicted survival. (Resnick et al, 3/19)
New England Journal of Medicine:
A Randomized Trial Of High-Flow Oxygen Therapy In Infants With Bronchiolitis
High-flow oxygen therapy through a nasal cannula has been increasingly used in infants with bronchiolitis, despite limited high-quality evidence of its efficacy. The efficacy of high-flow oxygen therapy through a nasal cannula in settings other than intensive care units (ICUs) is unclear. (Franklin et al, 3/22)
JAMA Internal Medicine:
Association Of The Centers For Medicare & Medicaid Services’ National Partnership To Improve Dementia Care With The Use Of Antipsychotics And Other Psychotropics In Long-Term Care In The United States From 2009 To 2014
Prescribing of psychotropic medications to patients in long-term care has declined, although the partnership did not accelerate this decrease. However, the use of mood stabilizers, possibly as a substitute for antipsychotics, increased and accelerated after initiation of the partnership in both long-term care residents overall and in those with dementia. Measuring use of antipsychotics alone may be an inadequate proxy for quality of care and may have contributed to a shift in prescribing to alternative medications with a poorer risk-benefit balance. (Maust et al, 3/17)
New England Journal of Medicine:
Helicobacter Pylori Therapy For The Prevention Of Metachronous Gastric Cancer
Patients with early gastric cancers that are limited to gastric mucosa or submucosa usually have an advanced loss of mucosal glandular tissue (glandular atrophy) and are at high risk for subsequent (metachronous) development of new gastric cancer. The long-term effects of treatment to eradicate Helicobacter pylori on histologic improvement and the prevention of metachronous gastric cancer remain unclear. (Choi, 3/22)
New England Journal of Medicine:
Financial Incentives And Vulnerable Populations — Will Alternative Payment Models Help Or Hurt?
First, given the evidence that poverty and functional status, among other factors, strongly influence patient outcomes, [alternative payment models] could include these factors in risk adjustment. Failing to account for them means underestimating the quality of care provided by clinicians serving high-risk populations and overestimating the quality provided by those serving low-risk populations; in many programs, the result is a transfer of money from clinicians caring for high-risk patients to ones caring for low-risk patients. (Maddox, 3/15)
