Research Roundup: Assessing physician quality; Community health centers' future; Why doctors take gifts; Access to HIV treatment

Archives of Internal Medicine: Associations Between Physician Characteristics And Quality Of Care - Since "most patients do not have access to physician quality measures," they are often encouraged to use public information such as malpractice claims and board certification status to chose a doctor, according to this report that used 2004-2005 insurance claims from about 10,000 Massachusetts physicians for more than 1.13 million adults. According to a RAND description of the study, "researchers evaluated the quality of care the physicians provided for 22 common medical problems such as diabetes and heart disease, by examining the fraction of the time physicians delivered guideline-based care to their patients."

The authors conclude that there were "no statistically significant associations between performance and allopathic vs. osteopathic degree, medical school rankings, disciplinary actions, malpractice claims, or years of experience. ... Few characteristics of individual physicians were associated with higher performance on measures of quality, and observed associations were small in magnitude. Publicly available characteristics of individual physicians are poor proxies for performance on clinical quality measures" (Reid et al., 9/13).

Annals of Internal Medicine: The Effect Of Financial Incentives On Hospitals That Serve Poor Patients - "Despite general support for tying financial incentives to improved quality of care, critics worry that such efforts may have a deleterious effect on providers who care for the underserved," write the authors of this study. They analyzed data from CMS' "largest pay-for-performance program among hospitals," known as the Premier Hospital Quality Incentive Demonstration, to measure the quality of performance in hospitals who treat a majority of poor patients and how such hospitals would be affected by pay-for-performance measures.

The study found that in "both nationally and among pay-for-performance hospitals, hospitals that served poor patients had lower quality performance at baseline." But, the authors report, "[a] high disproportionate-share index was associated with greater improvements in performance for [heart attack] and pneumonia but not for congestive heart failure, and the gains were greater among hospitals that received financial incentives than among the national sample. After 3 years, hospitals that had more poor patients and received financial incentives caught up for all 3 conditions, whereas those with more poor patients among the national sample continued to lag." The authors conclude, "These findings should be reassuring to those who worry that programs that use financial incentives will widen the gaps between hospitals that care for more poor patients and those that do not" (Jha, Orav and Epstein, 9/7).

Kaiser Family Foundation/GWU School of Public Healthand Health Services: Community Health Centers: Opportunities And Challenges Of Health Reform - This issue brief (.pdf) "examines the role that community health centers will play in implementing health reform and providing access to care for millions of Americans who will gain insurance coverage under the new law. It describes the provisions of the new health reform law that affect community health centers, including increased funding designed to expand the number of health centers, health insurance expansions that will significantly reduce the number of health center patients without insurance, and strategies aimed at increasing the primary care workforce. The brief also discusses some of the opportunities and challenges, such as the task of recruiting and retaining qualified health professionals, the need to establish networks and referral arrangements and the renewed focus on prevention and public health" (Rosenbaum, et. al, August 2010).

Commonwealth Fund: All-Payer Claims Databases: State Initiatives To Improve Health Care Transparency - "As health care reform initiatives are enacted across the country, states have an unprecedented opportunity to make lasting, effective policy decisions. But such decisions require information, and health care data are notoriously opaque where they are available at all," write the authors of this report that examines the trend among several states to create "what are known as all-payer claims databases (APCDs). … APCDs combine data from all payers in a state, giving policymakers statewide information on costs, quality, utilization patterns, and both access and barriers to care, as well as numerous other health care measures. And when these data are made publicly available, consumers and purchasers also have the tools they need to compare prices and quality as they make health care decisions." The article explores several state-run initiatives across the country, noting the benefits, issues relating to the development and implementation of such databases, and several proposed future challenges associated with APCD initiatives (Love, Custer and Miller, 9/10).

Institute of Medicine: HIV Screening And Access To Care: Exploring Barriers This report by an IOM committee includes a summary of a recent workshop exploring "the extent to which federal, state, and private health insurance policies prevent more widespread HIV testing." More than 200,000 people in the United States are infected with with HIV/AIDS and do not know it, "making them more likely than those who know they are infected to spread HIV to others. They also cannot benefit from available treatment, lowering their chances for survival. Expanded HIV testing may help diagnose those who do not know they are living with HIV." The report "identifies several barriers to HIV testing and encourages the development of more programs and policies that promote clinician education and training related to HIV testing and reducing HIV stigma and discrimination" (9/16).

In another study, Institutes of Medicine: HIV And Disability: Updating The Social Security Listings - "HIV infection as a disabling condition has evolved in fundamental ways since the [Social Security Administration] listings for HIV infection were last updated in 1993. …. Many patients [now] respond well to treatment, but others, even in the era of potent HIV medications, fail to achieve control of HIV replication or are diagnosed in extremely late disease stages and have rapid progression or disabling complications," according to this report that offers the recommendations of a committee of HIV experts on how to best update the HIV Infection Listings.

Specifically, "the report calls for revisions to the HIV Infection Listings to incorporate assessments of a claimant's work-related functional capacity," according to the summary of this IOM report. "By updating the HIV Infection Listings to better reflect current clinical practice, SSA will be able to more accurately identify those people in need of Social Security disability benefits," the report concludes, according to the summary (9/13).

Journal of the American Medical Association: Effect of Reminders Of Personal Sacrifice And Suggested Rationalizations On Residents' Self-Reported Willingness To Accept Gifts - Doctors "feel comfortable accepting gifts from pharmaceutical and medical device manufacturers that raise ethical concerns about conflicts of interest." Previous studies have looked at how physicians, even those who acknowledge the conflict of interest, have rationalized the practice. "The perception of hardships may contribute to physician acceptance of gifts from the pharmaceutical industry," according to this study of roughly 300 U.S. resident physicians in pediatrics and family medicine, who participated in one of three online surveys "evaluating quality of life and values."

"Reminding physicians of sacrifices made in obtaining their education resulted in gifts being evaluated as more acceptable: 21.7% (13/60) in the control group vs. 47.5% (57/120) in the sacrifice reminders group." The authors write, "Even though few residents reported that their working conditions were bad, reminding them about sacrifices to obtain their medical education significantly increased their readiness to receive gifts. Providing a suggested rationalization that low salaries and education-related debt could potentially justify accepting gifts increased the acceptability of industry-sponsored gifts beyond the effect of simple sacrifice reminders" (Sah and Loewenstein, 9/15).

The study was published in a theme issue of the journal focused on medical education (9/15).