Research Roundup: Childhood obesity, insurance coverage in cancer trials, hospitals stays and need for nursing homes

Health Affairs this month is devoted to the topic of childhood obesity, with the first study of the group - National, State, And Local Disparities In Childhood Obesity - pointing out that  "new data from the 2007 National Survey of Children's Health show that the percentage of children ages 10-17 who are overweight ... remained stable, while the national prevalence of obesity (BMI in the ninety-fifth percentile and higher) grew significantly, from 14.8 percent in 2003 to 16.4 percent in 2007. This increase in obesity accounted for the entire increase in the combined prevalence of overweight and obesity between 2003 and 2007 (from 30.6 percent to 31.6 percent). An estimated 10.58 million children, or nearly one in three children ages 10-17, were overweight or obese in 2007" (Bethell et al, March 2010).

The Economics Of Childhood Obesity - This paper examines economic policies that may have contributed to the rise in childhood obesity. "The direct costs of childhood obesity include annual prescription drug, emergency room, and outpatient costs of $14.1 billion, plus inpatient costs of $237.6 million"; the annual cost to treat obesity-related illness in adults runs an estimated $147 billion.

Shifts in agricultural policies and food prices are two areas covered: "For example, between 1990 and 2007 the real price of a two-liter bottle of Coca-Cola fell 34.89 percent ... The real price of fruit and vegetables rose 17 percent between 1997 and 2003, an increase that some studies have linked to higher BMI in American children and adolescents." The author concludes: "Incorporating the economic perspective into obesity research and policy can help identify contributors to obesity, calculate the consequences of obesity, and allocate scarce resources to the interventions that offer the greatest benefit per dollar of cost" (Cawley, March 2010).

Journal of the American Medical Directors Association: All-Cause Mortality Rates Of Hip Fractures Treated In the VHA: Do They Differ From Medicare Facilities? - This is an examination of seven years of "post-hip fracture surgery data from 43,165 veterans hospitalized at Medicare paid facilities and 12,539 veterans treated at VA hospitals," according to an Indiana University School of Medicine description of the study. The authors report: "For veterans treated for a [health fractures] in Medicare facilities, the average length of stay was 7 days and 49% were discharged to a nursing home" compared to those treated in the VHA who "had an average length of stay of 14 days and only 35% were discharged to a nursing home," and they conclude: "Our study suggests no difference in [hip fracture]-adjusted mortality rates between the VHA and Medicare facilities" (Lapcevic, French and Campbell, Feb. 2010).

Urban Institute: How Will Comparative Effectiveness Research Affect The Quality Of Health Care? - This issue brief (.pdf) examines the concept of comparative effectiveness research, identifies the current limited use of such information to guide benefits decisions, and the challenges ahead for the expansion of CER. "While investing in [CER] can be a path for improving the quality of health care and increasing the value of health expenditure, we cannot fall into the trap of thinking that just doing the research is enough to change practice, when all evidence suggests that this is far from true," the authors conclude. "Rather, [CER] should be considered a valuable part of a larger effort to foster evidence-based medicine, along with changes in incentives and the organization of health-care delivery that are essential to promote and support high-quality health care" (Docteur and Berenson, 2/15).

Kaiser Family Foundation: Medicaid Financial Eligibility: Primary Pathways For The Elderly And People With Disabilities - This issue brief (.pdf) "details the various eligibility pathways by which individuals with disabilities and the elderly can qualify for Medicaid coverage. The program, which serves as a safety net for many of the nation's poorest and sickest individuals, provides health coverage to nearly 60 million Americans, including 8.5 million with disabilities and 8.8 million low-income frail, elderly and disabled Medicare beneficiaries who rely on Medicaid to fill Medicare's gaps" (2/25). 

Mathematica: Coordinating And Improving Care For Dual Eligibles In Nursing Facilities: Current Obstacles And Pathways To Improvement - This policy brief explores possible avenues to reduce the fragmentation of care for dually eligible Medicare and Medicaid beneficiaries, including shifting the responsibility for long-term nursing facility care from Medicaid to Medicare. The author examines the impact such changes could have on prescription drug use, hospitalizations, home- and community-based services, and state and federal financial and administrative responsibilities while acknowledging: "This would admittedly be a large leap in health care policymaking" (Verdier, March 2010).

Journal of the National Cancer Institute: State Payer Mandates To Cover Care In US Oncology Trials: Do Science And Ethics Matter? - This paper examines state laws regarding insurance coverage for clinical care received by patients who are part of cancer clinical trials in the U.S., including "whether and how such provisions ensure scientific and ethical soundness." The author analyzed three databases that track state coverage mandates for cancer clinical trials, and found that although a "2001 federal law mandates care for Medicare-eligible patients enrolled in clinical trials," 26 states cover "clinical-trial related medical costs for non-Medicare patients, and these offer less protection than the federal law," according to a JNCI description of the study (Taylor, 3/2).