Research roundup: Hospital infections and costs; Prescription confusion; Medicaid and access to care

Every Friday, Jennifer Evans compiles this selection of recently released health policy studies and analyses.

Archives of Internal Medicine: The Relationship Between Hospital Spending And Mortality In Patients With Sepsis
"Sepsis affects approximately 750,000 patients each year in the United States and is in many ways a model condition for examining the relationship between hospital spending and patient outcomes and for identifying potential opportunities to improve the value of hospital care," write the authors. Based on a nationwide sample, they "observed substantial variation in risk-adjusted cost and mortality rates among hospitals that cared for patients with sepsis, yet found little correlation between overall levels of spending and hospital survival, implying that, on average, additional expenditures at high-cost hospitals do not translate into better short-term clinical outcomes." Additionally, they "identified a subset of institutions that had both significantly lower-than-expected mortality rates and lower-than-expected costs. These findings highlight potential opportunities to improve the value of sepsis care" (Lagu et al., 2/28).

CDC Morbidity and Mortality Report: Vital Signs: Central Line-Associated Blood Stream Infections - United States, 2001, 2008, and 2009
Between 2001 and 2009, the number of estimated Central line-associated blood stream infections (CLABSIs) occurring among patients hospitalized in ICUs in the U.S. dropped from 43,000 to 18,000 - a reduction of 58 percent, according to this report that also looked at estimated CLABSI rate changes in inpatient wards and hemodialysis facilities. "Given the reported mortality from CLABSIs, these reductions represent estimated 3,000-6,000 lives saved and estimated excess health-care costs of $414 million in ICUs in 2009 alone," the report states, but adds: "A substantial number of CLABSIs continue to occur, especially in outpatient hemodialysis centers and inpatient wards." (Srinivasan et al., 3/4).

Archives of Internal Medicine: Helping Patients Simplify And Safely Use Complex Prescription Regimens
"[T]he average adult in the United States fills 9 prescriptions annually, while adults older than 65 years fill on average 20 prescriptions a year. Greater regimen complexity, based on multiple medications and/or multiple daily doses per drug, may lead to poorer adherence, which in turn will lead to worse health outcomes," according to this study that explored how adults, ages 55-74, would organize a hypothetical 7-drug prescription regimen over a 24-hour period. The authors note: "A universal medication schedule was recently proposed for standardizing prescribing practices to 4 daily time intervals, thereby helping patients simplify ... We investigated whether patients consolidate their medications or whether there is evidence of unnecessary regimen complexity ... Instructions for 2 of the drugs were identical, yet 31.0 percent of the participants did not take these medications at the same time."  They conclude: "Standardized instructions proposed with the universal medication schedule and other task-centered strategies could potentially help patients routinely organize and take medication regimens." (Wolf et al., 2/28).

Related, earlier KHN stories: Helping Patients Understand Their Medical Treatment (Boodman, 3/1) and Experts Seek To Simplify Medication Labels That Often Confuse Patients (Andrews, 2/15).

The Urban Institute/The Commonwealth Fund: Successful Factors In Five High-Quality, Low-Cost Health Plans
This report examines the factors contributing to high performance health delivery systems that include "a significant network of independent physicians," as described by senior executives at "five plans in the top-performance tier in terms of quality and cost," according data collected by the National Committee for Quality Assurance. The report offers case studies of each health plan and highlights common themes the executives highlighted as key for high performance: "building a physician-plan partnership, establishing the plan as a resource for physician practices, providing physician quality and cost data on performance, and emphasizing a local area orientation" (Berenson and Coughlin, March 2011).

Kaiser Family Foundation: Insurance Coverage And Access To Care In Primary Care Shortage Areas
"Thirty-three million nonelderly Americans lived in geographically-designated primary care physician shortage areas in the U.S. in 2005-2007," and "[r]oughly a quarter of them were uninsured," write the authors of this brief that explores the growing demands primary care physicians in these regions may face as the health reform law is implemented. "[W]orking-age adults who were uninsured and living in [Health Professional Shortage Areas] were less healthy than the uninsured who were not in HPSAs. … States will need to make many changes in order to implement health care reform, including greatly expanding their Medicaid programs. ... Addressing workforce challenges is essential to successful implementation of reform" (Hoffman, Damico and Garfield, February 2011).

Robert Wood Johnson Foundation: The Target Efficiency of Online Medicaid/CHIP Enrollment: An Evaluation of Wisconsin's ACCESS Internet Portal
"[M]ore than 60 percent of all applications for BadgerCare Plus — a combined Medicaid and Children's Health Insurance Program (CHIP) — now come through ACCESS, the state's online application system for health coverage and other public benefits," according to this brief. "Lowest-income, rural, and non-English-speaking populations [are the] least likely to choose an online method," the authors write. They conclude that "many of the online applicants were ultimately deemed ineligible for health insurance coverage and/or other programs ... If, however, the marginal cost associated with each ineligible applicant raises the overall average costs per enrolled case, system adjustments may be merited" (Leininger, Friedsam, Voskuil and DeLeire, February 2011).

The Urban Institute/Kaiser Commission on Medicaid and the Uninsured: State Budgets Under Federal Health Reform: The Extent and Causes of Variations in Estimated Impacts
This brief examines the potential impact the Patient Protection and Affordable Care Act (ACA) will have on state budgets, based in part on a review of projections made for five states (Florida, Indiana, Kansas, Maryland and Texas) and five national estimates. "This analysis shows that while the ACA imposes a number of new costs on states, states can also expect offsetting savings and new revenues as health reform is implemented," the authors write (Bovbjerg, Ormond and Chen, February 2011).

Robert Wood Johnson Foundation: Health Care Public Perception Index - This report tracks consumers' confidence in health care in 2010, through a monthly survey of 500 households conducted by the Survey Research Center at the University of Michigan.  "New data demonstrate that despite the eventful year in health reform, there were no significant trends in consumers' collective confidence in their health care, although disparities in confidence among different groups continued over the course of 2010. ... Uninsured Americans continued to have low levels of confidence in their care — on average, 47 points lower than those with health insurance," according to a RWJF summary of the findings (February 2011).