Research Roundup: Medicaid Eligibility; Tracking Discontinued Randomized Trials

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: Medicaid And Marketplace Eligibility Changes Will Occur Often In All States; Policy Options Can Ease Impact
Under the Affordable Care Act (ACA), changes in income and family circumstances are likely to produce frequent transitions in eligibility for Medicaid and health insurance Marketplace coverage for low- and middle-income adults. We provide state-by-state estimates of potential eligibility changes ("churning") if all states expanded Medicaid under health reform, and we identify predictors of rates of churning within states. ... Higher-income states and states that had more generous Medicaid eligibility criteria for nonelderly adults before the ACA experienced more churning, although the differences were small. Even in states with the least churning, we estimated that more than 40 percent of adults likely to enroll in Medicaid or subsidized Marketplace coverage would experience a change in eligibility within twelve months (Sommers et al., 3/10).

The Urban Institute/Kaiser Family Foundation: As The Economy Improves, The Number Of Uninsured Is Falling But Not Because Of A Rebound In Employer Sponsored Insurance
The recession was marked by an increase of almost 6 million uninsured individuals between 2007 and 2010. The losses in coverage were mostly driven by large numbers of individuals losing employer-sponsored insurance, although gains in Medicaid coverage partly offset these losses. ... The main contributor to increasing post-recession coverage rates, even with increased employment, was Medicaid, not employer coverage. Employer coverage rates did stabilize after 2010 after long trends of decline predating the recession, but this change was likely caused by provisions in the Affordable Care Act (ACA) that allowed young adults to continue as dependents on parents’ private plans until age 26. Although full-time work increased and joblessness decreased after the recession, employer coverage rates continue to decline for many (Holahan and McGrath, 3/11).

Journal of the American Medical Association: Prevalence, Characteristics, And Publication Of Discontinued Randomized Trials
Our study found that 25% of initiated RCTs [randomized clinical trials] were discontinued. Although discontinuation was common for RCTs involving patients (28%), it was rare for RCTs involving healthy volunteers (3%). The most commonly reported reason for RCT discontinuation was poor recruitment (10% of included RCTs). We found that trials with investigator sponsorship (vs industry sponsorship) and those with smaller planned sample sizes were at higher risk of discontinuation due to poor recruitment. Of discontinued RCTs, up to 60% remained unpublished. Trial investigators rarely informed RECs about trial discontinuation and publication. ... Greater efforts are needed to make certain that trial discontinuation is reported to RECs and that results of discontinued trials are published (Kasenda et al., 3/11).

JAMA Neurology: Disparities In Access To Deep Brain Stimulation Surgery For Parkinson Disease
[This study examined] deep brain stimulation (DBS) use in Parkinson disease (PD) to determine which factors, among a variety of demographic, clinical, and socioeconomic variables, drive DBS use in the United States. ... Despite the fact that African American patients are more often discharged from hospitals with characteristics predicting DBS use (ie, urban teaching hospitals in areas with a higher than average density of neurologists), these patients received disproportionately fewer DBS procedures compared with their non–African American counterparts. Increased reliance on Medicaid in the African American population may predispose to the DBS use disparity (Chan et al., 3/10).

Journal Of General Internal Medicine: Regardless of Age: Incorporating Principles From Geriatric Medicine To Improve Care Transitions For Patients With Complex Needs
Patients with complex needs can benefit from optimal transitional care, regardless of age. A 50-year-old man with uncontrolled diabetes and limited mobility has similar needs to an 80-year-old woman with cognitive impairment and limited transportation. ... Additionally, lessons learned from transitions from hospitals back to the community can be applied more broadly to other transitions. ... Geriatricians’ holistic approach to patient management, caregiver support, and understanding of the continuum of care (and associated payment systems), facilitates the design, implementation, and evaluation of care delivery systems responsive to the needs of older adults and those with complex needs (Arbaje et al., 2/21).

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

Modern Healthcare: Accountable Care Organizations Face Profit Dilemma
As accountable care organizations proliferate, the ones that succeed will face a new dilemma: how to fairly distribute their share of the money they save. There are now some 360 ACOs participating in the Medicare shared savings program alone, plus many others that are participating in a variety of similar arrangements with private payers. The amount of money any of them will have to divvy up is unclear at this point, but the authors of a new commentary in the Journal of the American Medical Association indicate that the most successful of the first crop of Medicare ACOs will receive a bonus of $5.2 million, which means individual participants will stand to collect several thousand dollars each (Robeznieks, 3/12).

The New York Times: Report Says Medication Use Is Rising For Adults With Attention Disorder
The number of young American adults taking medications for attention deficit hyperactivity disorder nearly doubled from 2008 to 2012, according to a report to be released Wednesday by the nation’s largest prescription drug manager. The drug manager, Express Scripts, which processes prescriptions for 90 million Americans, also found that almost one in 10 adolescent boys were taking medications for the disorder, usually stimulants such as Adderall or Concerta. Some experts said the report provided the clearest evidence to date that the disorder is being diagnosed and treated with medication in children far beyond reasonable rates, and that steeply rising diagnoses among adults might portend similar problems (Schwartz, 3/12). 

Reuters: Nurse Numbers, Education Linked To Patient Death Rate
Both the quality and quantity of nurses on a hospital staff have significant influence on the chances patients will die following even simple surgery, according to a large new study. Researchers found the proportion of staff nurses with a bachelor's degree and the number of patients each nurse had to care for could add up to a difference of 30 percent or more in mortality rates for inpatients (Bond, 3/7).

Propublica: The Perils Of Problematic Prescribing: A Double Dose Of Warnings 
Twice this week, the Centers for Disease Control and Prevention has pointed to the harm caused by aberrant and inappropriate prescribing by physicians. First, the CDC reported Monday that doctors are a primary source of narcotic painkillers for chronic abusers at the highest risk of overdoses (Ornstein, 3/7).

Modern Healthcare: Report Says Surgical-Outcomes Data Unreliable For Comparing Hospitals
The American College of Surgeons claims that by implementing its National Surgical Quality Improvement Program, individual hospitals can prevent 250 to 500 complications, save 12 to 36 lives, and reduce costs by millions of dollars annually. But a new report posted on the JAMA Surgery website concluded that outcomes data in the NSQIP registry were unreliable measures of hospital performance (Robeznieks, 3/12).