Research roundup: Disparities in heart failure improvements; vets face barriers to mental health care

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

Journal Of American Medical Association: National And Regional Trends In Heart Failure
Hospitalization And Mortality Rates For Medicare Beneficiaries, 1998-2008 -- This report examines treatment of more than 55 million Medicare fee-for-service heart failure patients, from 1998 to 2008. The researchers found that heart failure hospitalization declined susbstantially over that time but "occurred unevenly across race-sex categories, especially for black men, who had the lowest rate of decline." They also note,  "The overall 1-year mortality rate declined slightly over the past decade but remains high. Changes in (heart failure) hospitalization and 1-year mortality rates were uneven across states" (Chen, Normand, Wang and Krumholz, 10/19).

Government Accountability Office: VA Mental Health: Number Of Veterans Receiving Care, Barriers Faced, And Efforts To Increase Access -- Recent legislation increased access to mental health services for veterans returning from U.S. combat operations in Afghanistan and Iraq. The researchers found that from 2006 through 2010, 2.1 million veterans received mental health care from the VA. The key barriers "that may hinder veterans from accessing mental health care from VA ... are stigma, lack of understanding or awareness of mental health care, logistical challenges to accessing mental health care, and concerns about VA's care, such as concerns that VA's services are primarily for older veterans. ... VA has implemented several efforts to increase veterans' access to mental health care, including integrating mental health care into primary care" (Draper et al., 10/14).

Government Accountability Office: Long-Term Care Hospitals: CMS Oversight Is Limited And Should Be Strengthened -- "Allegations about quality-of-care problems have raised questions about the oversight of long-term care hospitals (LTCH), which provide care to individuals with multiple acute or chronic conditions. Medicare pays for about 80 percent of LTCH patient care," the authors write. The GAO recommended that "CMS strengthen its oversight of LTCHs by improving available data on quality of care and by improving oversight of LTCH survey activities. HHS concurred with all of the recommendations"  (Kohn et al., 9/15).

Kaiser Family Foundation/Urban Institute: The Uninsured: A Primer -- Key Facts About Americans Without Health Insurance -- This primer "presents basic information about the uninsured-;who they are and why they do not have health coverage-;and provides an understanding of the difference health insurance makes in people's lives." The authors note that 49 million Americans lacked health insurance in 2010. "The access barriers the uninsured face mean they are less likely to receive preventive care, are more likely to be hospitalized for conditions that could have been prevented, and are more likely to die in the hospital than those with insurance. The financial impact can also be severe." The 2010 federal health law "is expected to reduce the uninsured rate by more than half" (Streeter et al., 10/13).

The Commonwealth Fund: Promoting the Integration And Coordination Of Safety-Net Health Care Providers Under Health Reform: Key Issues -- Authors of this brief note that the health law includes provisions to encourage medical homes and write: "While much discussion has focused on how these strategies might be adopted by Medicare and private insurers, little attention has focused on their application among safety-net health care providers. Such providers face particular challenges in coordinating care for their low-income and uninsured patients, and no single approach is likely to meet their diverse needs. Successful efforts will require federal, state, and local financial resources to sustain the safety net" (Ku et. al., 10/13).