Research roundup: Patients' experiences at safety-net hospitals

Each week KHN reporter Ankita Rao compiles a selection of recently released health policy studies and briefs.

Archives of Internal Medicine: Patient Experience In Safety-Net Hospitals
Safety-net hospitals, which provide care to low-income patients, perform lower than other hospitals on measures of patient experience, according to this sample of 2,096 hospitals examining patient evaluations about the quality of care they received. About 64 percent of patients rated the hospital a nine or 10 on the 10-point scale compared to 69.5 percent of patients at non-safety-net hospitals. The federal health law will tie part of a hospital's Medicare reimbursements to several measures of quality, including patient satisfaction.  The researchers concluded that the safety net hospitals "have lower performance than non-SNHs on metrics of patient-reported experience, improved somewhat more slowly under public reporting, and are likely to fare poorly under" the health law's "value-based purchasing program" (Chatterjee et al., 9/10/12).  

Health Affairs: Visits To Retail Clinics Grew Fourfold From 2007 to 2009, Although Their Share To Overall Outpatient Visits Remains Low
Researchers found that visits to retail clinics grew from 1.48 million (2000-2006) to 5.97 million (2007-2009). The  increasingly popular clinics in pharmacies, grocery stores and other retail outlets are expanding their services and sometimes partnering with health care systems. The authors write: "Preventive care-;in particular, the influenza vaccine-;was a larger component of care for patients at retail clinics in 2007–09, compared to patients in 2000–06 (47.5 percent versus 21.8 percent). Across all retail clinic visits, 44.4 percent in 2007–09 were on the weekend or during weekday hours when physician offices are typically closed. The rapid growth of retail clinics makes it clear that they are meeting a patient need" (Mehrotra and Lave, 8/12).

Journal of General Internal Medicine: Health-Care Costs At End Of Life Exceed Total Assets For 25 Percent Of Medicare Population
Average out-of-pocket spending for seniors in the last five years of life is $38,688 for individuals and $51,030 for couples in which one spouse dies. Using data from the biennial Health and Retirement Study, researchers found that for 25 percent of "subjects" expenditures exceeded baseline total household assets." Results varied by race or ethnicity; minorities had the lowest mean income and assets, and were in the lowest quartile for spending. The authors conclude that Medicare does not cover "a variety of services particularly valuable for those with chronic diseases or a life limiting illness. ... elderly households face considerable financial risk from out-of-pocket healthcare expenses at the end of life. Disease-related differences in this risk complicate efforts to anticipate or plan for health-related expenditures in the last 5 years of life" (Kelley et al., 9/8/12).

Journal of General Internal Medicine: A Randomized, Controlled Trial of Implementing The Patient-Centered Medical Home Model In Solo and Small Practices
A patient-centered medical home is usually a physician-directed practice that integrates and improve acute and preventive care. Researchers compared two sets of small physicians practices: one set received support, including help in practice redesign, care management and revised payment schedules, the other group of physicians practices did not get support. They conclude: "Irrespective of size, practices can make rapid and sustained transition to a PCMH when provided external supports, including practice redesign, care management and payment reform. Without such supports, change is slow and limited in scope" (Fifield et al., 9/7/12).

Here is a selection of excerpts from news coverage of other recent research:

Medscape: Access to Primary Care Improves Breast Cancer Outcomes
For breast cancer patients, receiving adequate care in the primary care setting could improve outcomes. Specifically, more office visits to a primary care physician was associated with earlier diagnosis and improved outcomes. ... according to a study published in the September/October issue of the Annals of Family Medicine. In addition, breast-cancer-related mortality was 41% lower and overall mortality was 27% lower in these women than in those who had made 1 or no visits (Nelson, 9/11).

Medscape: Hospitals Cut Central-Line Infections 40% With Safety Plan
More than 1000 hospitals in 44 states lowered their rate of central line-associated bloodstream infections (CLABSIs) by 40% over 4 years through a program that features a checklist of precautions such as hand washing and donning sterile apparel, the federal Agency for Healthcare Research and Quality (AHRQ) announced today. AHRQ estimates that the program prevented more than 2000 CLABSIs, saved more than 500 lives, and avoided more than $34 million in healthcare costs (Lowes, 9/10).

Medscape: Extended Office Hours Linked to Lower Health Expenditures
Patients with access to regular healthcare that included extended office hours had less use of and more than 10% lower total expenditures for office visits, prescription medications, emergency department visits, and hospitalizations, according to data from 30,714 patients surveyed for the Medical Expenditure Panel Survey between 2000 and 2008. ... [according to] the Annals of Family Medicine (Brown, 9/10).

MedPage Today: When Drugs Go OTC, Risks Get Fewer Mentions
Ads for prescription drugs that made the leap to over-the-counter (OTC) status were far less likely to warn about potential risks, ... Jeremy Greene, MD, PhD, of Brigham & Women's Hospital in Boston, and colleagues reported in a research letter in the Journal of the American Medical Association (Fiore, 9/11).

MedPage Today: More Heart Docs Working for Hospitals
Although most cardiology practices are still owned by physicians, the percentage owned by hospitals has increased in the past 5 years, a survey by the American College of Cardiology (ACC) showed. In 2007, 73% of practices were owned by physicians and 8% were owned by hospitals, but this year those proportions have shifted to 60% and 24%, respectively, according to findings from the ACC Cardiovascular Practice Census (Neale, 9/11).  

Politico Pro: Report: Risk Pools Won't Work Scaled Up
The health reform law's high-risk insurance pools, one of the first pieces of the law to be enacted, are operating at a loss and prohibitively expensive -; but they also provide needed coverage to a small group of people, according to a new report out Thursday. The Commonwealth Fund report found that the Pre-Existing Condition Insurance Plans are providing a solid "bridge" to extend insurance coverage until the health insurance exchanges and other pieces of the law are set up in 2014. But the report's authors warn that Republican proposals to set up more widespread high-risk pools would not work (Haberkorn, 9/13).