Research Roundup: Surgical Site Infections; Medicare Drug Plans

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

Urban Insitute/RWJF: Physician Network Transparency: How Easy Is It for Consumers to Know What They Are Buying? 

Urban Institute researchers studied nine marketplace websites (California, Colorado, Connecticut, District of Columbia, Massachusetts, Minnesota, Oregon, Rhode Island and Washington) … Most websites studied did not list plan (e.g. HMO) or network (e.g., narrow or tiered) type. Only three of nine websites studied embedded provider directories for each plan on the Marketplace website. The remaining websites diverted consumers to insurance company websites in order to access provider directories. This report shows that states need to make improvements in the clarity, accessibility and functionality of their online insurance marketplaces to make them more consumer-friendly and transparent (Blumberg, Peters, Wengle, and Arnesen, 8/21).

JAMA Surgery: Effect Of Minimally Invasive Surgery On The Risk For Surgical Site Infections

Surgical site infection (SSI) represents the second most common cause of hospital-acquired infection …. We abstracted the data [from the American College of Surgeons National Surgical Quality Improvement Program database] on 30-day SSIs and compared patients undergoing open procedures and MIS [minimally invasive surgery] …. MIS was associated with lower rates of postoperative SSIs in patients undergoing MIS vs open procedures for appendectomy (3.8% vs 7.0%), colectomy (9.3% vs 15.0%), hysterectomy (1.8% vs 3.9%), and radical prostatectomy (1.0% vs 2.4%) (Gandaglia et al., 8/20).

JAMA Internal Medicine: Patients’ Understanding Of Their Hospitalizations And Association With Satisfaction

A total of 177 eligible internal medicine patients who had 2 or more medical conditions, 2 or more medical procedures, and 2 or more days of hospital stay between June 2012 and February 2013 were interviewed on the day of discharge. Patients were … asked to (1) list all their medical diagnoses, (2) identify the indications for their medications from the discharge instruction sheet, and (3) identify the tests and/or procedures they underwent from a list of common tests and procedures provided. … Patients’ shared understanding with their physicians in the domains of diagnosis, medication indications, and tests and/or procedures was suboptimal, yet patients’ perceived understanding and their satisfaction with the quality of communication they received was fairly high (Kebede et al., 8/18).

<a href="http://kff.org/Medicare/report/Medicare-part-d-in-its-ninth-year-the-2014-marketplace-and-key-trends-2006-2014/” target=”_blank”>Kaiser Family Foundation: Medicare Part D In Its Ninth Year: The 2014 Marketplace And Key Trends, 2006-2014

Growth in average monthly Part D premiums has essentially flattened since 2010 after rising about 10 percent annually before then. Rising use of generic drugs, triggered by patent expirations for many popular brand-name drugs, has been a major factor in slowing premium growth—paralleling slower prescription drug spending growth in the broader health system. … In 2014, more than 37 million Medicare beneficiaries are enrolled in Medicare drug plans, an increase of 2 million compared to 2013 and 15 million since 2006. … In 2014, about three-fourths of all plans … use five cost-sharing tiers …. Only 5 percent of PDP enrollees are in plans with the highest star ratings (4 stars or more) (Hoadley, Cubanski et al., 8/18).

The Commonwealth Fund: Arkansas: A Leading Laboratory For Health Care Payment And Delivery System Reform

In crafting their [Medicaid] reform strategies, states can learn from early innovators. This issue brief focuses on one such state: Arkansas. Insights and lessons from the Arkansas Health Care Payment Improvement Initiative (AHCPII) suggest that progress is best gained through an inclusive, deliberative process facilitated by committed leadership, a shared agreement on root problems and opportunities for improvement, and a strategy grounded in the state’s particular health care landscape (Bachrach, du Pont and Lipson, 8/19) 

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

news@JAMA:  Using Antipsychotics For Elderly Patients Boosts Kidney Risks

Older adults treated with atypical antipsychotics are at increased risk of kidney injury, according to a study published today in the Annals of Internal Medicine. The findings add to previous evidence that this class of drugs is risky for older adults. Although atypical antipsychotics are commonly prescribed for older adults to treat agitation and other behavioral symptoms of dementia, the US Food and Drug Administration has not approved the drug for this purpose. In fact, since 2005 the agency has warned that use of these drugs to treat older adults with dementia was associated with a 2-fold increased risk of death (Kuehn, 8/18).

Bloomberg:  Too Many Cancer Screenings Wasted On Those Facing Death

Older patients who aren’t expected to live more than another decade are still being screened too often for cancers, causing more harm than good, a study found. More than half of men 65 and older who had a very high risk of dying in nine years were screened for prostate cancer, a slow-moving disease, according to research today in JAMA Internal Medicine. Almost 38 percent of older women with a similar life expectancy were screened for breast cancer and 31 percent were screened for cervical cancer despite some having undergone a hysterectomy, which means they often had no cervix (Ostrow, 8/18).

USA Today: Hospitalizations, Deaths For Heart Disease Fall

Hospitalizations for heart disease and stroke fell by about one-third over the past decade, according to a new study of nearly 34 million Medicare recipients. The number of Medicare patients hospitalized with heart attacks fell 38% from 1999 to 2011, while the number hospitalized with blood-clot-related strokes fell 34%, according to a study in Circulation. Hospitalizations fell 31% for heart failure, which occurs when the heart is too weak to pump efficiently, and 84% for unstable angina, a sudden chest pain that often leads to heart attacks, partly because some of these cases were reclassified as heart attacks (Szabo, 8/18).

Reuters: Preventable Hospital Deaths After Urological Surgery Rising: Study

As more urological surgeries are performed outside hospitals, deaths from preventable complications among men and women getting inpatient surgery have risen, according to a new study. It’s likely that older, sicker and poorer people make up more of the population having inpatient surgery, not that the surgeries are getting more dangerous, researchers say (Doyle, 8/19).

Reuters: Doctors May Be Missing Chances To Talk To Teens About Smoking

Less than a third of teens say their doctors have spoken to them about tobacco use, according to a new study. “Given that tobacco is still the number one preventable cause of death and disease in the U.S., it is surprising that more clinicians are not intervening with adolescent patients to help them avoid or quit tobacco,” lead author Gillian L. Schauer, of Carter Consulting, Inc., told Reuters Health. … She and her colleagues write in the journal Pediatrics that most current smokers started as teenagers or young adults (Doyle, 8/19).

Los Angeles Times: Simple Measures Made Hospital Patients 70% More Likely To Quit Smoking

A free supply of nicotine replacement medication and a handful of automated phone calls made smokers who wanted to quit much more likely to succeed, according to results of a clinical trial published Tuesday in the Journal of the American Medical Assn. … They estimated that once their 90-day program was set up, it could be maintained at a cost of less than $1,000 per quitter (Kaplan, 8/19).

Reuters:  More Evidence Adult Daycare Eases Stress On Dementia Caregivers

The stress of caring for a family member with dementia may take a toll on health over time, but a new study suggests that even one day off can shift caregivers’ stress levels back toward normal. Based on measurements of the stress hormone cortisol, researchers found that caregivers had healthier stress responses on days when the dementia patient went to adult daycare. Even anticipation of the day off had an effect on cortisol levels (Lehman, 8/19).

MinnPost: Late In Life Care: Stressful, Complicated World Of Surrogate Decision-Makers

Within 48 hours of being hospitalized, almost half of all adults aged 65 or older will need someone else — a trusted relative or friend — to help them make at least one medical decision, and almost one-fourth will need that surrogate to make all of their medical decisions, according to the findings of a study published earlier this year in JAMA Internal Medicine. The most common decision made by surrogates in the study involved life-sustaining care (Perry, 8/20).

Reuters: Researchers Reverse Autism Symptoms In Mice By Paring Extra Synapses

Although many things have gone wrong in the autistic brain, scientists recently have been focusing on one of the most glaring: a surplus of connections, or synapses. Neuroscientists reported Thursday that, at least in lab mice, a drug that restores the healthy “synaptic pruning” that normally occurs during brain development also reverses autistic-like behaviors such as avoiding social interaction (8/21).

Research Roundup: Surgical Site Infections; Medicare Drug Plans