Research Roundup: Getting Care Under Medicaid; Diabetes Prevention; Fewer Elective Deliveries
Each week, KHN compiles a selection of recently released health policy studies and briefs.
The New England Journal of Medicine:
Health And Access To Care During The First 2 Years Of The ACA Medicaid Expansions
A total of 29 states and Washington, D.C., expanded Medicaid by September 1, 2015. In year 2 after implementation, uninsurance rates were reduced in expansion states relative to nonexpansion states ... and rates of Medicaid coverage were increased .... Expansions were not associated with significant changes in the likelihood of a doctor visit or overnight hospital stay or health status as reported by the respondent. However, as compared with nonexpansion states, expansion states had a decrease in reports of inability to afford needed follow-up care ... and in reports of worry about paying medical bills ... and an increase in reports of medical care being delayed because of wait times for appointments. (Sarah Miller and Laura R. Wherry, 3/9)
Health Affairs:
Impact Of The YMCA Of The USA Diabetes Prevention Program On Medicare Spending And Utilization
The goal of the [YMCA] program is to help participants lose weight and increase physical activity. We tested whether the program reduced medical spending and utilization .... Using claims data to compute total medical costs for fee-for-service Medicare participants and a matched comparison group of nonparticipants, we found that the overall weighted average savings per member per quarter during the first three years of the intervention period was $278. Total decreases in inpatient admissions and emergency department (ED) visits were significant, with nine fewer inpatient stays and nine fewer ED visits per 1,000 participants per quarter. These results justify continued support of the model. (Alva et al., 3/6)
Health Affairs:
Texas Medicaid Payment Reform: Fewer Early Elective Deliveries And Increased Gestational Age And Birthweight
In 2011 the Texas Medicaid program sought to reduce the rate of early elective deliveries by denying payment to providers for the procedure. We examined the impact of this policy on clinical care practice and perinatal outcomes by comparing the changes in Texas relative to comparison states. We found that early elective delivery rates fell by as much as 14 percent in Texas after this payment policy change, which led to gains of almost five days in gestational age and six ounces in birthweight among births affected by the policy. The impact on early elective delivery was larger in magnitude for minority patients. (Dahlen et al., 3/6)
JAMA Internal Medicine:
Comparison Of Male Vs Female Resident Milestone Evaluations By Faculty During Emergency Medicine Residency Training
How does gender affect the evaluation of emergency medicine residents throughout residency training? ... In this longitudinal, retrospective cohort study of 33 456 direct-observation evaluations from 8 emergency medicine training programs, we found that the rate of milestone attainment was higher for male residents throughout training across all subcompetencies. By graduation, this gap was equivalent to more than 3 months of additional training. (Dayal et al., 3/6)
In news coverage of other recent research:
NPR:
Are Routine Pelvic Exams A Must? Evidence Is Lacking, Task Force Says
An influential advisory panel says there's not enough evidence to determine whether annual pelvic exams should be routine for women who aren't pregnant and have no symptoms of disease. "We basically concluded that we didn't have enough evidence to recommend for or against," says Dr. Kirsten Bibbins-Domingo, an internist and epidemiologist at the University of California, San Francisco who chaired the U.S. Preventive Services Task Force panel asked to evaluate the best evidence on whether the exam is a good screening method. (Patti Neighmond, 3/7)
