Research roundup: Kids on Medicaid have trouble seeing a specialist; safety in outpatient facilities; community health center patients linking to electronic health care

Shefali S. Kulkarni compiled this selection of recently released health policy studies and briefs.  

New England Journal Of Medicine: Auditing Access To Specialty Care For Children With Public Insurance -- In this study, researchers posing as parents sought specialty care for children in Cook County, Ill., to examine access opportunities for families on Medicaid. They found a major disparity between children with public insurance versus private insurance -- 66 percent of the callers saying the children were insured by Medicaid were denied an appointment, compared to 11 percent with a private plan. They also found that even when Medicaid patients got an appointment, they were "on average, 22 days later than those obtained for privately insured children." The study suggests that "that increasing the number of providers who accept public insurance will increase access opportunities. Without correcting this dimension, it is unlikely that disparities in access between public and private insurance can be fully eliminated" (Bisgaier and Rhodes, 6/16).

The Journal of the American Medical Association: Paid Malpractice Claims For Adverse Events In Inpatient And Outpatient Settings -- This study looked at a data base showing malpractice claims paid on behalf of doctors to evaluate the "prevalence and seriousness of adverse medical events in the outpatient setting" because much of the emphasis in recent years has been on in-patient care. According to the authors, the "number of paid malpractice claims in each setting is similar and that the average payment amount, although higher in the inpatient setting, was approximately $300 000 in the outpatient setting. ... Furthermore, the outcomes of outpatient events were not trivial—major injury or death accounted for almost two-thirds of paid claims for events in the outpatient setting." They say the results suggest that patient safety efforts should also include out-patient care (Bishop, Ryan and Casolino, 6/15).

Journal Of General Internal Medicine: Use Of An Electronic Patient Portal Among Disadvantaged Populations -- This study looks at the use of electronic patient portals by low-income patients at a federally qualified health center in the New York City area. The use of such portals, which give patients a view of some data from the provider's electronic health records and allows them to send messages to their doctor or request appointments. The study found that 16 percent of the patients at the center received an access code for the portal and of those, 60 percent activated the account. "The odds of repeat portal use, among those with activated accounts, increased with white race, English language, and private insurance or Medicaid compared to no insurance," the authors report. Patients with chronic conditions were also more likely "to become repeat users" (Ancker, Barron, Rockoff, et. al., 6/7).

Robert Wood Johnson Foundation: Does Use Of EHRs Help Improve Quality: Insight From Cleveland -- This brief examines the effect electronic health records (EHRs) have on physicans' adherence to evidence-based care by looking at results from a Cleveland-based health care project to help doctors transition to EHRs and the experience of patients with diabetes. "Recent data show that investments in EHRs are paying off. ... Better Health's report, released January 2011, showed a staggering difference in performance among practices with EHRs as compared to those without: 51 percent of diabetes patients in EHR practices received all the care they needed as compared to only 7 percent in practices with paper records" (6/9).

University of Kansas/Commonwealth Fund: Realizing Health Reform's Potential: Early Implementation Of Pre-Existing Condition Insurance Plans: Providing An Interim Safety Net For The Uninsurable -- This brief looks at the temporary high-risk pools set up by the federal health law to provide coverage to people with medical problems who had trouble getting a health plan before.  The plans have been slower in enrolling members than originally predicted. The authors write, "Structural elements of the program, including affordability of coverage and the requirement to have been uninsured for six months, are probably barriers to enrollment for many who might otherwise benefit. Nevertheless, increased outreach efforts and additional modifications to plans based on enrollment experience will likely result in continued growth in enrollment" (Hall and Moore, 6/14).

Government Accountability Office: Disability Insurance: Preliminary Observations On SSA Efforts To Detect, Prevent And Recover Overpayments -- This report looks at overspending within the Social Security Administration's Disability Insurance program and federal efforts to recover those funds. "Disability Insurance overpayments detected by SSA increased from about $860 million in fiscal year 2001 to about $1.4 billion in fiscal year 2010, though the full extent of overpayments to beneficiaries who have returned to work and are no longer eligible is unknown." The report notes that $839 million in overpayments was recovered in 2010 but the amount owed by beneficiaries in the Disability Insurance Program still grew by $225 million (Bertoni, 6/14).