Research roundup: Hospital medication errors; Key Medicaid issues in 2014

Every week, KHN reporter Shefali S. Kulkarni compiles a selection of recently-released health policy studies and briefs.

Government Accountability Office: Use Of Preventive Services Could Be Better Aligned With Clinical Recommendations -- This report looks at Medicare patients' use of eight specific preventive services, which have "the potential to improve health outcomes and lower health care expenditures," according to the authors. Use of cardiovascular and cervical cancer screenings "generally aligned with clinical recommendations, ... but use of other cancer screenings" did not. GAO recommended that Congress "consider requiring beneficiaries to share the cost of a service if the [U.S. Preventive Services] Task Force recommends against use of that particular service for those beneficiaries. The Administrator of CMS should provide coverage for Task Force recommended services" (2/17).

Health Affairs: The Prevention and Public Health Fund -- This brief outlines why the Prevention and Public Health Fund was created as part of the health law, "examines where spending has gone to date; and lays out the debate over preserving, cutting, or eliminating the fund altogether." The author concludes: "It is not clear how the Obama administration will carry out the $250 million cuts in prevention fund spending in fiscal year 2013. Meanwhile, some observers worry that the dollars the fund does provide will simply be used to offset cuts in existing federal health programs, rather than to support new prevention efforts and spending that many believe are needed. Such an outcome could pose special challenges at the state level, where many localities are operating under extremely tight budgets"  (Haberkorn, 2/23).

Journal Of General Internal Medicine: Effects Of Patient- And Medication-Related Factors On Inpatient Medication Reconciliation Errors -- By analyzing a group of more than 400 adults with acute coronary syndromes who were hospitalized, researchers saw that these pre-admission medication list (PAML) errors were most common at hospital admission and discharge. "Errors in preadmission medication histories are associated with older age and number of medications and lead to more discharge reconciliation errors. A recent medication list in the EMR is protective against medication reconciliation errors" (Salanitro et. al., 2/15).

Journal Of The American Medical Association: Association Of Age And Sex With Myocardial Infarction Symptom Presentation And In-Hospital Mortality -- Women are usually older than men when they are hospitalized with a heart attack. This observational study of more than one million patients from 1994-2006 found that "women were more likely than men to present without chest pain and had higher mortality than men, especially among younger age groups, but sex difference in clinical presentation without chest pain and in mortality were attenuated with increasing age" (Canto et. al., 2/23).  

The RAND Institute: The Effect Of The Affordable Care Act On Enrollment And Premiums, With And Without The Individual Mandate -- This analysis uses RAND's "COMPARE microsimulation model" to predict that if the health law's individual mandate begins, as scheduled, in 2014, "91 percent of the nonelderly population," would have health insurance coverage, "compared with 81 percent without any policy change. ... If the ACA is implemented but the mandate is voided, we predict that 87 percent of the population would have insurance coverage" (Eibner and Price, 2/15). 

Kaiser Commission on Medicaid and the Uninsured: Key Issues To Consider For Outreach And Enrollment Efforts Under Health Reform -- "Based on a discussion with federal and state officials and experts, this report identifies key issues to consider with regard to outreach and enrollment under reform," according to the authors. Experts noted that preparing for 2014 "will entail a significant organizational and cultural shift" among state Medicaid eligibility staffs, and add: "Proven Medicaid and CHIP outreach and enrollment strategies will serve as a roadmap for enrolling individuals under reform, but new approaches will also be required" (Stephens and Artiga, 2/21).