Research roundup: Too many colonoscopies; N.C. health centers save money; Ankle injuries not necessarily emergencies

Every week, Kaiser Health News reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs.

Archives of Internal Medicine: Overuse Of Screening Colonoscopy In The Medicare Population -- Medical experts traditionally recommend 10 years between normal colonoscopy screenings. However, researchers looking at Medicare data found that in a sample of more than 24,000 average-risk "Medicare patients who had a negative screening colonoscopy finding in 2001 through 2003, 46.2% underwent a repeated examination in fewer than 7 years. In 42.5% of these patients (23.5% of the overall sample), there was no clear indication for the early repeated examination. ... Current Medicare regulations intending to limit reimbursement for screening colonoscopy to every 10 years would not appear to be effective" (Goodwin, et al., 8/8).

Archives of Internal Medicine: Safety-Net Providers After Health Care Reform -- This project examined what effect the Massachusetts 2006 health overhaul had on the state's safety-net hospitals. Before the Massachusetts' law, uninsured adults often turned to community health centers or safety-net hospitals for urgent medical care. The law dramatically reduced the number of uninsured but the number of patients seeking care at the community health centers increased by 31 percent between 2005 and 2009, while the share of center patients who were uninsured fell from 35.5 percent to nearly 20 percent. "Most safety-net patients do not view these facilities as providers of last resort; rather, they prefer the types of care that are offered there" (Ku, et al., 8/8).

KHN summarized news coverage of this study: Study Finds Demand Continues For Safety-Net Care In Massachusetts (8/9)

George Washington University: Bending The Health Care Cost Curve In North Carolina: The Experience Of Community Health Centers -- North Carolina has a "well-developed primary health care system reaching medically underserved communities," the authors note. They explored whether community health centers are more economical than other primary care options. "Our findings indicate that patients served by North Carolina's health centers cost an average of 62 percent less annually across all types of care than do patients with the same health status and demographic characteristics served in other ambulatory care settings. ... These results for North Carolina confirm at the state level the findings of prior national-level studies that show health centers provide significant cost-savings when compared to other primary care practice settings" (Richard, et al., 8/9).

National Bureau Of Economic Research: The Importance Of The Meaning And Measurement Of Affordable In The Affordable Care Act -- This white paper examines the impact the Affordable Care Act (ACA) will have on employees and families with employer-sponsored health insurance (ESI) or those who could get subsidies from health insurance exchanges. By creating stylized models, researchers show that "the ACA could lead to far more lower to moderate income families gaining access to affordable coverage through exchanges or, conversely, to far fewer of these families being covered by ESI, even if no employers drop their health insurance plans as a result of the new law" (Burkhauser, Lyons and Simon, August 2011).

Journal Of Nursing Care Quality: Challenges In Posthospital Care: Nurses As Coaches For Medication Management -- This study examines the effect of two types of medication services offered by nurses to chronically ill patients who have been discharged from the hospital. The first intervention tested was a telephone follow-up and the second was a home visit. The researchers found that 62 percent more medication discrepancies were discovered by the nurses during home visit than detected when they conducted a phone interview (Costa, Poe and Lee, August 2011).

Clinical Orthopedics And Related Research: Incidence Of Patients With Lower Extremity Injuries Presenting To US Emergency Departments By Anatomic Region, Disease Category, And Age -- Noting that a federal health survey found nearly 15 percent of visits to hospital emergency departments were for injuries to the lower leg, ankle and foot, researchers sought to get more detail on those injuries to help with "injury prevention, resource allocation, and training priorities." They determined that in 2009, approximately one third of the injuries reported in the National Electronic Injury Surveillance System were for sprains or strains and the greatest number of those to the ankle. Data and assessment concluded that emergency rooms should consider the "use of telephone triage, scheduled same or next-day urgent care appointments, and other alternatives to the traditional emergency room" to ease the strain on health care resources (Lambers, Ootes and Ring, 7/22).