Research Roundup: Reporting Study Misconduct; Coordinating Mental Health Benefits

JAMA Internal Medicine: Research Misconduct Identified By The US Food And Drug Administration
Every year, the US Food and Drug Administration (FDA) inspects several hundred clinical sites performing biomedical research on human participants and occasionally finds evidence of substantial departures from good clinical practice and research misconduct. However, the FDA has no systematic method of communicating these findings to the scientific community .... Fifty-seven published clinical trials were identified for which an FDA inspection of a trial site had found significant evidence of 1 or more ... problems .... Only 3 of the 78 publications (4%) that resulted from trials in which the FDA found significant violations mentioned the objectionable conditions or practices found during the inspection. No corrections, retractions, expressions of concern, or other comments acknowledging the key issues identified by the inspection were subsequently published. (Seife, 2/9)

Health Affairs: US Hospitals Experienced Substantial Productivity Growth During 2002–11
We studied productivity growth among US hospitals in treating Medicare patients with heart attack, heart failure, and pneumonia during 2002–11. We found that the rates of annual productivity growth were 0.78 percent for heart attack, 0.62 percent for heart failure, and 1.90 percent for pneumonia. However, unadjusted productivity growth appears to have been negative. These findings suggest that productivity growth in US health care could be better than is sometimes believed, and may help alleviate concerns about Medicare payment policy under the Affordable Care Act. (Romley, Goodman and Sood, 2/11)

U.S. Government Accountability Office: HHS Leadership Needed To Coordinate Federal Efforts Related To Serious Mental Illness
Agencies identified 112 federal programs that generally supported individuals with serious mental illness in fiscal year 2013. ... The programs were spread across eight federal agencies .... Interagency coordination for programs supporting individuals with serious mental illness is lacking. HHS is charged with leading the federal government's public health efforts related to mental health, and the Substance Abuse and Mental Health Services Administration is required to promote coordination of programs relating to mental illness .... Of the 30 programs specifically targeting individuals with serious mental illness, 9 programs had a completed program evaluation, 4 programs had an evaluation underway, and 17 programs had no evaluation completed and none planned. (2/5)

The Kaiser Family Foundation/JAMA: Visualizing Health Policy: Premium Changes In The Affordable Care Act’s Insurance Marketplaces 2014-2015
This Visualizing Health Policy infographic illustrates the change in monthly premiums by county, and select cities, from 2014 to 2015 for a 40-year-old person covered by the second-lowest-cost silver “benchmark” plan in the Affordable Care Act’s insurance marketplaces. Premium changes were greatest in Summit County, Colo. (45% decrease) and southeastern Alaska (34% increase), before tax credits. After accounting for tax credits, premiums for a 40-year-old person with an annual income of $30,000 would remain flat in most of the country, as long as the enrollee changed from the 2014 benchmark plan to the plan designated as the benchmark for 2015. (Cox et al., 2/10)

The Urban Institute/Robert Wood Johnson Foundation: Characteristics Of Those Eligible For Cost-Sharing Reductions And Premium Tax Credits Under The Affordable Care Act
Under the ACA, approximately 23.2 million people will be eligible for financial assistance through the nongroup marketplaces in 2016. ... almost 60 percent are eligible for both tax credits to lower the cost of their health insurance premiums and CSRs [cost-sharing reductions] to lower their direct out-of-pocket payments for medical services. Those eligible for both types of assistance are heavily concentrated in the South, almost half are single adults without children, and the majority are White. They differ from those eligible for premium tax credits alone in that they have lower income, tend to be younger, and more frequently report being in fair or poor health. (Blumberg and Wengle, 2/6)

Center on Budget and Policy Priorities: SNAP Costs Declining, Expected To Fall Much Further
SNAP [Supplemental Nutrition Assistance Program] spending, which rose substantially as a share of the economy (gross domestic product or GDP) in the wake of the Great Recession, has begun to decline, as the Congressional Budget Office (CBO) and other experts expected. ... Spending on SNAP (formerly food stamps) fell by 11 percent in 2014 as a share of GDP. ... As the economic recovery continues and fewer low-income people qualify for SNAP, CBO expects SNAP spending to fall further in future years, returning to its 1995 level as a share of GDP by 2020. (Rosenbaum and Keith-Jennings, 2/9)

JAMA: Accuracy Of Smartphone Applications And Wearable Devices For Tracking Physical Activity Data
[N]early two-thirds of adults in the United States own a smartphone and technology advancements have enabled these devices to track health behaviors such as physical activity and provide convenient feedback. ... The objective of this study was to evaluate the accuracy of smartphone applications and wearable devices. ... Across all devices, 552 step count observations were recorded from 14 participants in 56 walking trials. ... We found that many smartphone applications and wearable devices were accurate for tracking step counts. Data from smartphones were only slightly different than observed step counts, but could be higher or lower. Wearable devices differed more and 1 device reported step counts more than 20% lower than observed. (Case et al., 2/10)

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

Los Angeles Times: Cigarette Smoking Is Even More Deadly Than You Think, Study Says
The U.S. surgeon general says about 480,000 Americans die each year as a result of smoking. But a new analysis suggests the true figure may be closer to 575,000. The 21 causes of death that have been officially blamed on smoking accounted for 83% of the actual deaths among smokers who were tracked in a study published in Thursday’s edition of the New England Journal of Medicine. Additional diseases -- including breast cancer, prostate cancer, hypertensive heart disease and renal failure -- were responsible for most of the rest of the observed deaths. (Kaplan, 2/11)

USA Today: Obamacare Subsidies Slash Costs For Low-Income Consumers
Lower-income insurance shoppers can slash their share of healthcare costs to an average of $14 in co-payments when they visit their primary care doctors, and the percentage of costs they have to share for emergency room visits can be as low as 19%, according to a report out today from the Kaiser Family Foundation. As the deadline for Obamacare open enrollment nears on Sunday, the Kaiser report and a federal study out earlier this week on premium tax credits show how little many lower-income consumers would have to pay out of pocket for coverage. (O'Donnell, 2/11)

Los Angeles Times: HPV Vaccine Doesn't Make Teen Girls Engage In Risky Sexual Behavior, Study Shows
Girls who got vaccinated against HPV were more likely than their unvaccinated peers to become infected with a sexually transmitted disease, but the vaccine was definitely not to blame for their risky sexual behavior, according to a new study of more than 200,000 American teens. Even for girls who didn’t get the HPV vaccine, the risk of being diagnosed with a sexually transmitted infection increased with age, the study authors found. By comparing the changes in infection rates for both groups of girls, the researchers were able to isolate the effect of the vaccine – and they found that it was nonexistent. (Kaplan, 2/9)

Reuters: Trauma Surgery May Not Be Riskier At Night
Contrary to suggestions that sleepy surgeons might make more mistakes in the middle of the night, a large study finds no differences in patient deaths after trauma surgeries done at night or during the day. Researchers who looked at U.S. death rates after so-called exploratory laparotomies, which are done in trauma victims to discover the extent of injuries, found similar mortality both day and night. (Rapaport, 2/6)

Medscape: Pediatric ACO Cuts Cost Growth, But Not Quality
Partners for Kids (PFK) in Ohio, the oldest pediatric accountable care organization (ACO) in the United States, increased value for Medicaid children in 34 counties in the state between 2008 and 2013, according to a new analysis. The gains came primarily through cost savings, and quality remained steady. (Frellick, 2/9)

JAMA: As Home Births Increase, Recent Studies Illuminate Controversies And Complexities
Three years ago, the New York Times published an article in its Fashion and Style section, “The Midwife as Status Symbol.” Trendy expectant mothers, it seemed, increasingly opted for midwives to deliver their babies at home or a birthing center rather than choose an obstetrician-attended hospital birth. The recent medical literature, however, indicates that although home births may be considered fashionable, the decision of where to give birth is not to be taken lightly. Births are inherently unpredictable events, and an unexpected complication without a planned, quick route to a hospital can have tragic consequences. (Lewis, 2/10)

Medscape: Impact Of Burnout: Clinicians Speak Out
Professional burnout has serious negative consequences not only for affected clinicians but potentially for patient care and outcomes as well, new research suggests. A mixed-methods survey of 120 clinicians who provide mental health services showed that 58% reported that burnout had a negative impact on either work quality or productivity. Other reported negative effects included decreased empathy, communication, and patient engagement. In addition, those who reported higher levels of depersonalization were significantly more likely to report that burnout affected their interaction with patients. (Brauser, 2/10)

Kaiser Health News: Study: Physicians Report Few Requests By Patients For ‘Unnecessary’ Treatments
Kaiser Health News staff writer Shefali Luthra reports: "Though medically unnecessary tests and procedures are often blamed for the nation’s high health care costs, patients’ requests for such superfluous treatments may not be what triggers them, suggests a study published today in the JAMA Oncology." (Luthra, 2/12)

The New York Times: Few Health System Studies Use Top Method, Report Says
The gold standard of scientific research, routinely used in the development of new drugs, has been neglected in studies meant to improve the American health care system, researchers reported on Thursday in the journal Science. The method, known as random assignment, compares outcomes for people randomly chosen to receive a treatment with the results for those who are left untreated. Economists from the Massachusetts Institute of Technology analyzed hundreds of studies in top academic journals and found that only 18 percent of such research used this rigorous method. (Tavernise, 2/12)