Research Roundup: Testing Before Eye Surgery; Health Law Coverage Gains; End-Of-Life Talks

The New England Journal of Medicine: Preoperative Medical Testing In Medicare Patients Undergoing Cataract Surgery
Cataract surgery is the most common elective surgery among Medicare beneficiaries, with 1.7 million procedures performed annually. It is also very safe, with less than a 1% risk of major adverse cardiac events or death. ... since 2002, guidelines from multiple specialty societies have deemed routine preoperative testing unnecessary. ... In this national assessment of variation in routine preoperative testing before cataract surgery, we found that more than half of Medicare beneficiaries undergoing cataract surgery underwent at least one preoperative test, despite strong evidence about the lack of benefit of preoperative testing. This represents a substantial increase in testing over levels during the baseline period and is most likely an unnecessary Medicare expense. (Chen et al., 4/16)

Health Affairs: Millions Of Americans May Be Eligible For Marketplace Coverage Outside Open Enrollment As A Result Of Qualifying Life Events
Federal regulations establish special enrollment periods—times outside of open enrollment periods—during which people may enroll in or change their health insurance plans .... To be eligible, a person must experience a shift in income or another “qualifying life event,” such as a change in marital status or the number of dependents .... We produced an upper-bound estimate that 3.7 million nonelderly adults with coverage through a federal or state Marketplace could have ... become eligible for a special enrollment period because of income shifts. In addition, more than 8.4 million nonelderly adults who did not have Marketplace coverage—three-quarters of whom had no insurance—became eligible for a special enrollment period as a result of other qualifying life events. Many ... may be unaware of their eligibility. (Hartman et al., 4/29)

The Kaiser Family Foundation: Data Note: How Has The Individual Insurance Market Grown Under The Affordable Care Act?
6.7 million people were insured through marketplace plans as of October 15, 2014. However, it has been unclear precisely how many of these Marketplace enrollees were previously uninsured or how many would have purchased individual coverage directly from an insurer in the absence of the ACA. Kaiser Family Foundation analysis of recently-submitted 2014 filings by insurers to state insurance departments (using data compiled by Mark Farrah Associates) shows that 15.5 million people had major medical coverage in the individual insurance market – both inside and outside of the Marketplaces – as of December 31, 2014. Enrollment was up 4.8 million over the end of 2013, a 46% increase. (Levitt, Cox and Claxton, 4/29)

The Urban Institute: Taking Stock: Gains In Health Insurance Coverage Under The ACA As Of March 2015
We examine changes in insurance coverage for nonelderly adults (ages 18 to 64) overall and by state Medicaid expansion status going back to the first quarter of 2013. ... Fifteen million nonelderly adults gained coverage between September 2013 and March 2015 as the uninsurance rate fell from 17.6 percent to 10.1 percent. ... There have been large coverage gains for low- and middle-income adults targeted by key ACA provisions. ... There were gains in coverage for adults in each age, gender, and racial and ethnic group examined, but adults who are young, nonwhite, or Hispanic saw especially large percentage-point gains. (Long et al., 4/16)

The Commonwealth Fund: Latinos Have Made Coverage Gains But Millions Are Still Uninsured
Since the Affordable Care Act’s health insurance marketplaces opened and states began to expand Medicaid eligibility, uninsured rates among Latinos have begun to decline for the first time in decades. ... the Commonwealth Fund Biennial Health Insurance Survey finds Latinos continue to have the highest uninsured rates among major U.S. racial or ethnic groups. ... While about one-quarter of Latino adults who live in states that expanded their Medicaid programs were uninsured by the end of 2014, nearly half remain uninsured in states that, so far, have not expanded their Medicaid program. ... Texas and Florida, neither of which have expanded eligibility for their Medicaid programs, are home to the largest proportion of Latinos who are uninsured. (Doty et al., 4/27)

Institute of Medicine: Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery
Disasters often impact fundamental elements of a community -- physical infrastructure, health and social services, social connections -- that affect the health of its residents. Accordingly, the recovery period ... presents an important opportunity to redesign physical and social environments in a manner that will improve a community's long-term health status .... In response to concerns that health considerations are not adequately incorporated into disaster recovery decision making, the Institute of Medicine assembled an ad hoc committee to develop recommendations and guidance on strategies for mitigating disaster-related health impacts and optimizing the use of recovery resources to pursue more deliberately and thoughtfully the goal of healthier, more resilient and sustainable communities. (Tuckson et al., 4/15)

The Urban Institute/Inquiry: The Journal of Health Care Organization, Provision, and Financing: The Expanding Role Of Managed Care In The Medicaid Program
This research studies county-level Medicaid managed care (MMC) penetration and health care outcomes among nonelderly disabled and nondisabled enrollees. Results for nondisabled adults show that increased penetration is associated with increased probability of an emergency department visit, difficulty seeing a specialist, and unmet need for prescription drugs, and is not associated with reduced expenditures. We find no association between penetration and health care outcomes for disabled adults. This suggests that the primary gains from MMC may be administrative simplicity and budget predictability for states rather than reduced expenditures or improved access for individuals. (Caswell and Long, 4/16)

PLOS ONE: No Easy Talk: A Mixed Methods Study Of Doctor Reported Barriers To Conducting Effective End-Of-Life Conversations With Diverse Patients
Though most patients wish to discuss end-of-life (EOL) issues, doctors are reluctant to conduct end-of-life conversations. Little is known about the barriers doctors face in conducting effective EOL conversations .... [In this study] 99.99% doctors reported barriers with 85.7% finding it very challenging to conduct EOL conversations with all patients and especially so with patients whose ethnicity was different than their own. ... The biggest doctor-reported barriers to effective EOL conversations are (i) language and medical interpretation issues, (ii) patient/family religio-spiritual beliefs about death and dying, (iii) doctors’ ignorance of patients’ cultural beliefs, values and practices, (iv) patient/family's cultural differences in truth handling and decision making, (v) patients’ limited health literacy and (vi) patients’ mistrust of doctors and the health care system. (Periyakoil, Neri and Kraemer, 4/22)

The UCLA Center for Health Policy Research: Health And Health Behaviors Of Japanese Americans In California: A Sign Of Things To Come For Aging Americans?
The Japanese American population is leading the nation in aging. According to the 2010 U.S. Census, the number of adults 65 and older among Japanese Americans (23.6%) was nearly twice the number of adults in that age group in the general population (12.9%). The same trend has also been observed in California. ... Using data from the California Health Interview Survey (2003, 2005, 2007, 2009, and 2011- 2012), this report contributes to the understanding of the health status and health-related characteristics of Japanese Americans. ... This study shows that for a majority of the indicators (9 out of 15), the Japanese American adult population experiences lower risk. As such, their health and health behaviors may be a source of future study for examining healthy aging, not only in California but also in the United States in general. (Meng et al., 4/29)

Institute of Medicine: Vital Signs: Core Metrics For Health And Health Care Progress
Thousands of measures are in use today to assess health and health care in the United States. Although many of these measures provide useful information, their sheer number, as well as their lack of focus, consistency, and organization, limits their overall effectiveness in improving performance of the health system. To achieve better health at a lower cost, all stakeholders -- including health professionals, payers, policy makers, and members of the public -- must be alert to what matters most. ... Vital Signs identifies the need for a standard set of core measures as a tool for improving health in the United States. This book explains the current use of metrics in health and health care and then proposes a streamlined set of 15 standardized measures, with recommendations for their application at every level and across sectors. (Blumenthal et al., 4/28)

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

Reuters: U.S. Data Show That Mammograms Still Often Begin At 40
Despite 2009 recommendations to stop giving women under 50 screening mammograms, the rate of first mammograms occurring at age 40 is on the increase, according to a new study. ... [Dr. Soudabeh Fazeli Dehkordy of the University of Michigan Health System in Ann Arbor and a team of researchers] used data from surveys in the years before and after the ... recommendation – 2007, 2008, 2010 and 2012 -- to look at patterns in women’s use of mammograms by age. Screening rates were lower overall in 2010 and 2012 than in previous years, the authors report in the American Journal of Preventive Medicine, but the proportion of women who began getting screened at age 40 increased, and was highest after the ... recommendations were issued in 2009. (Doyle, 4/24)

NPR: Maybe You Should Rethink That Daily Aspirin
We've all heard that an aspirin a day can keep heart disease at bay. But lots of Americans seem to be taking it as a preventive measure, when many probably shouldn't. In a recent national survey, more than half the adults who were middle age or older reported taking an aspirin regularly to prevent a heart attack or stroke. The Food and Drug Administration only recommends the drug for people who've already experienced such an event, or who are at extremely high risk. (Singh, 4/27)

HealthDay/The Philadelphia Inquirer: ER Practices Key To Helping Those Addicted To Painkillers
A comparison of three treatments for narcotic painkiller addiction found that patients given the medication buprenorphine in the emergency department do better than those given only referrals. Addiction to prescription narcotic painkillers such as Oxycontin or Vicodin is "a huge public health problem," study first author Dr. Gail D'Onofrio, chair of emergency medicine at Yale School of Medicine in New Haven, Conn., said in a university news release. Drug overdoses account for more deaths each day in the United States than car crashes, she and her colleagues noted. (Dallas, 4/28)

HealthDay/The Philadelphia Inquirer: Few Sickle Cell Patients Receiving Beneficial Drug, Study Finds
Few U.S. adults with sickle cell anemia are getting a recommended medication that can help them manage pain, breathing problems and other debilitating symptoms, according to a new study. Using a national database, researchers found that less than one-quarter of sickle cell patients who should have been taking a drug called hydroxyurea actually were. (Norton, 4/28)

Reuters: Young Women Say They Are Happy With IUDs
College women who choose an intrauterine device (IUD) for long-term contraception say it hurts to have the device inserted at first, but they are otherwise very happy with it more than a year later, according to a new U.S. survey. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) have both endorsed IUDs as first-line contraception for young women who have never had children, but many providers, especially in the U.S., still are not comfortable giving IUDs to these women, said lead author Dr. Alexandra M. Hall of the University of Wisconsin in Menomonie. (Doyle, 4/23)

Medscape: Precertification Requirement Delays Discharge After Stroke
Requiring precertification from private insurance companies delays hospital discharge of stroke patients to a nursing facility or rehabilitation, a new study shows. Researchers found that patients who required insurance precertification had an average delay in discharge of 1.5 days compared with 0.8 day for those not requiring such precertification, a statistically significant difference of 0.7 day. (Anderson, 4/28)

HealthDay: Antibiotics Shortages Could Put Patients At Risk From Superbugs
Shortages of antibiotics, including those used to treat drug-resistant infections, may be putting patients at risk for sickness and death, according to a new report. Between 2001 and 2013, there were shortages of 148 antibiotics. And the shortages started getting worse in 2007, researchers found. (Reinberg, 4/23)

Reuters: Patients Hospitalized On Weekends Risk More Falls And Infections
Patients admitted to the hospital on weekends are more likely to get a preventable illness or injury during their stay than people admitted during the week, a large U.S. study finds. Even after adjusting for patient characteristics, including the severity of the condition that brought them to the hospital, weekend admission was still linked with more than a 20 percent increased likelihood of hospital-acquired conditions when compared to weekday admissions, lead author Dr. Frank Attenello, a researcher at the University of Southern California, said by email. (Rapaport, 4/21)

The Chicago Sun-Times: Great Recession Linked To Rise In Depression
The Great Recession saw the number of adults in the United States suffering from major depression rise significantly and remain higher, according to a new Loyola University Stritch School of Medicine study touted as the first to examine the recession’s impact on mental health. Writing in the Journal of Clinical Psychiatry, the researchers said it’s not a stretch to think that the impact of the recession, which officially began in December 2007 and lasted 18 months, on economic security contributed to that. (4/25)

Reuters: Finding LGBT-Competent Doctors May Be Difficult
Finding doctors at U.S. teaching hospitals who consider themselves competent to care for lesbian, gay, bisexual and transgender (LGBT) patients may be difficult, suggests a new study. Few such hospitals reported having ways to identify doctors knowledgeable about LGBT health, and only a few hospitals offered comprehensive LGBT-competency training to their staffs, researchers report in the American Journal of Public Health. (Seaman, 4/21)