Research Roundup: Hospital Readmissions; Children’s Health; Medicare Overview

The New England Journal of Medicine: Readmissions, Observation, And The Hospital Readmissions Reduction Program
Some policy analysts worry that reductions in readmissions [mandated by the Affordable Care Act] are being achieved by keeping returning patients in observation units .... We analyzed data from 3387 hospitals. From 2007 to 2015, readmission rates for targeted conditions declined from 21.5% to 17.8%, and rates for nontargeted conditions declined from 15.3% to 13.1%. ... Stays in observation units for targeted conditions increased from 2.6% in 2007 to 4.7% in 2015, and rates for nontargeted conditions increased from 2.5% to 4.2%. ... Readmission trends are consistent with hospitals’ responding to incentives to reduce readmissions, including the financial penalties for readmissions under the ACA. We did not find evidence that changes in observation-unit stays accounted for the decrease in readmissions. (Zuckerman et al., 4/20)

Pediatrics: Characteristics Of Rural Children Admitted To Pediatric Hospitals
[Researchers analyzed] 672190 admissions between January 1, 2012, and December 31, 2012, to 41 children’s hospitals .... Rural children accounted for 12% of all admissions ... to the children’s hospitals. Compared with nonrural children, rural children lived farther from the hospital ... and more often resided in low-income ZIP codes (53% vs 24%) and Health Professional Shortage Areas (20% vs 4%) .... Rural children had a higher prevalence of complex chronic conditions (44% vs 37%) ... and medical technology assistance (15% vs 12%) .... In multivariable analysis, rural children experienced higher inpatient costs (mean: $8507 vs $7814) ... and higher odds of 30-day readmission. (Peltz et al., 4/11)

JAMA Internal Medicine: Primary Care Practitioners’ Views On Incorporating Long-Term Prognosis In The Care Of Older Adults
Clinical practice recommendations increasingly advocate that older patients’ life expectancy be considered to inform a number of clinical decisions. ... Twenty-eight primary care practitioners [in a large group practice who were interviewed for the study] ... reported considering life expectancy, often in the range of 5 to 10 years, in several clinical scenarios in the care of older adults .... patient age was found to modulate how prognosis affects the primary care practitioners’ decision making, with significant reluctance among them to cease preventive care that has a long lag time to achieve benefit in younger patients despite limited life expectancy. The participants assessed life expectancy based on clinical experience rather than using validated tools .... Participants often considered prognosis without explicitly discussing it with patients. (Schoenborn et al., 4/11)

The Kaiser Family Foundation: Characteristics Of Remaining Uninsured Men And Potential Strategies To Reach And Enroll Them In Health Coverage
As of the beginning of 2015, there were still over 27 million uninsured nonelderly adults in the U.S. More than half of these uninsured adults were men – or nearly 15 million. An estimated 44% of these men, or nearly 6.5 million, are currently eligible for financial assistance under the ACA. Targeted outreach and enrollment efforts will be key for reaching and enrolling these uninsured men into coverage and achieving continued coverage gains. (Hinton and Artiga, 4/14)

Urban Institute: Uninsurance Among Young Children, 1997–2015: Long-Term Trends And Recent Patterns
This brief uses data from the National Health Interview Survey to explore trends in health insurance coverage for children age 5 and under between 1997 and 2015. Previous studies have shown that children’s health insurance coverage is associated with improved access to care and that early childhood offers a critical opportunity to promote long-term health and development. In this analysis, we find a 75 percent decrease in uninsurance for young children since the creation of the Children’s Health Insurance Program in 1997, though some subgroups of young children continue to have disproportionately high uninsurance rates. We also find that insured young children have greater access to care and service use, and their families struggle with fewer affordability problems than those of young children who are uninsured. (Karpman et al., 4/19)

Urban Institute: Uninsurance Among Children, 1997–2015 : Long-Term Trends And Recent Patterns
Using data from the National Health Interview Survey, this brief examines changes in the share of children age 18 and under without health insurance between 1997 and 2015. We also explore the characteristics and health care experiences of the remaining uninsured children in 2014. We find that the uninsurance rate for children has fallen steadily since the introduction of the Children’s Health Insurance Program in 1997 and that uninsurance continued to drop following implementation of the Affordable Care Act’s key coverage provisions. However, some groups of children are disproportionately likely to be uninsured, and uninsured children face large gaps in health care access, affordability, and service use compared with their insured peers. (Gates et al., 4/19)

The Kaiser Family Foundation: An Overview of Medicare
Medicare plays a key role in providing health and financial security to 55 million older people and younger people with disabilities. ... Many people on Medicare live with health problems including multiple chronic conditions, cognitive impairments, and limitations in their activities of daily living, and many beneficiaries live on modest incomes. In 2011, two-thirds of beneficiaries (66%) had three or more chronic conditions, more than one quarter of all beneficiaries (27%) reported being in fair or poor health, and just over 3 in 10 (31%) had a cognitive or mental impairment. ... Two million beneficiaries (5%) lived in a long-term care facility. In 2014, half of all people on Medicare had incomes below $24,150 per person and savings below $63,350. (4/1)

Cato Institute: Menu Mandates and Obesity: A Futile Effort
One provision of the Patient Protection and Affordable Care Act (ACA) that has been delayed until 2017 is a federal mandate for standard menu items in restaurants and some other venues to contain nutrition labeling. ... Menu mandates have been implemented at the state and local level within the past decade, allowing for a direct examination of the short-run and long-run effects on outcomes such as body mass index (BMI) and obesity. Drawing on nearly 300,000 respondents from the Behavioral Risk Factor Surveillance System (BRFSS) from 30 large cities between 2003 and 2012, we explore the effects of menu mandates. We find that the impact of such labeling requirements on BMI, obesity, and other health-related outcomes is trivial, and, to the extent it exists, it fades out rapidly. (Yelowitz, 4/13)

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

MedPage Today: Study: Carotid Imaging Without Prior Stroke Often Has No Clear Indication
The most common reasons for carotid imaging leading to revascularization in seniors without history of stroke are not adequately addressed in guidelines, a veterans study suggested. ... Only 5.4% of the imaging was done for indications deemed clearly appropriate, while 11.3% of screens were deemed inappropriate, the researchers reported in JAMA Internal Medicine. Thus, "the majority of patients who undergo carotid revascularization for asymptomatic carotid disease received a diagnosis on the basis of results of tests ordered for uncertain or inappropriate reasons," [the researchers] wrote. (Lou, 4/18)

Reuters: Stigma Keeps Some Cancer Patients From Getting Palliative Care
Some cancer patients may turn down care that could ease their pain and improve their quality of life because they think this type of “palliative” treatment amounts to giving up and simply waiting to die, a small Canadian study suggests. (Rapaport, 4/18)

Reuters: 'Nonurgent' Patients Might Still End Up Being Hospitalized
Patients assigned a “nonurgent” status on arrival in the emergency room might still be sick enough to be hospitalized, a new study shows. Patients deemed by triage nurses to be “nonurgent” often receive diagnostic services and procedures, and some are even admitted to critical care units, researchers found. Triage was never intended to completely rule out severe illness, only to give patients an estimate of how long they may have to wait to see a doctor, the researchers note. (Doyle, 4/18)