Research roundup: Gearing children's hospitals for future patients; Inappropriate care decreases, but not 'enough'; What patients think about testing

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

JAMA Pediatrics: Inpatient Growth And Resource Use In 28 Children's Hospitals – Researchers in this study examined the use of children's hospitals by relatively healthy children and those "with chronic conditions of varying medical complexity" from 2004 to 2009. They found an increase in the number of individual hospitalizations for both groups. But, the rise was more significant for children with the greatest chronic conditions (conditions affecting two or more body systems or the most complex conditions), a trend that, if continues, "these hospitals may ultimately find themselves structurally and financially stressed to meet the inpatient needs of both types of children," the researchers wrote. "If fewer patients with medical complexity are ultimately diverted to other hospitals, then children's hospitals may predominately care for a patient population that, by nature, is expensive, has a major risk for experiencing suboptimal health outcomes, and tends to draw inadequate reimbursement from payers to cover inpatient care costs" (Berry et al., 12/24).  

JAMA Internal Medicine: Trends In The Overuse Of Ambulatory Health Care Services In The United States – Using 1998, 1999, 2008, and 2009 data from the Centers for Disease Control and Prevention, the authors aimed to determine whether the use and misuse of health care services in the ambulatory setting has decreased. They found an improvement in 6 of 9 "underuse" measures, such as administering aspirin to patients with heart disease or the use of the statins for patients with diabetes.  But only 3 of 13 measures of inappropriate care, which included both overuse and misuse such as prescribing ineffective drugs for urinary tract infections, improved, according to the authors: "We found significant improvement in the delivery of underused care but more limited changes in the reduction of inappropriate care. With the high cost of health care, these results are concerning" (Kale, Bishop, Federman and Keyhani, 12/24).

New England Journal Of Medicine: Ensuring Physicians' Competence – Is Maintenance Of Certification The Answer? – This "Health Policy Report" focuses on physician Maintenance of Certification or MOC, sponsored by the American Board of Medical Specialties. This is one of many initiatives by national accrediting organizations, state medical licensing boards, and the federal government and others "designed to link more closely the goals of learning with the delivery of better care and measures of greater accountability." But it is the most contentious, the authors write: "MOC requires most certified specialists to seek recertification on a periodic basis – typically every 10 years – by successfully completing a four-part assessment designed to test their medical knowledge, clinical competence, and skills in communicating with patients, ... Although the number of specialists engaged in the process grows by about 50,000 diplomates a year, the exercise also draws strong criticism from physicians who assert that MOC is too expensive and the process is too time-consuming" (Iglehart and Baron, 12/27). 

PLOS ONE: 'The Ultimate Decision Is Yours': Exploring Patients' Attitudes About The Overuse Of Medical Interventions – Columbia College of Physicians and Surgeons' researchers conducted focus groups with privately-insured, healthy, middle-aged Americans. "We considered whether attitudes towards testing and screening differ from attitudes toward pharmaceutical use," the authors write. "We also sought to understand how problems of overuse and non-adherence could be related to patients' efforts to take responsibility for their health." While participants were "suspicious of overmedication," they "placed enormous value on testing and screening [but] reacted with hostility to messages recommending fewer procedures." The authors conclude: "Given patients' concerns about overuse of pharmaceuticals, we maintain that they can learn to understand the connections between over-testing and over-treatment, and can actively choose to do less" (Schleifer and Rothman, 12/26). 

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

Reuters: Annual Pap Tests? For Some In U.S., Old Habits Die Hard
An increasing number of younger women in the United States are delaying their first Pap test for cervical cancer until after they reach 21, reflecting new U.S. guidelines, health officials said on Thursday. But 60 percent of U.S. women who have had a total hysterectomy and no longer have a cervix are still getting the tests, a sign that old habits may die hard, experts said. ... two teams at the U.S. Centers for Disease Control and Prevention analyzed Pap test data from 2000 to 2010 to see how well doctors were adjusting to the call for less frequent screening. ... while Pap testing fell among women who had a hysterectomy, dropping to 60 percent in 2010 from 73 percent in 2000, the number still reflects significant overtreatment (Steenhuysen, 1/3). 

MedPage Today: Drug Adherence Linked To Communication
Diabetic patients treated by healthcare professionals who had poor communication skills were less likely to refill their cardiometabolic medications than those whose doctors were good communicators, researchers found. Among a cohort of more than 9,000 patients with diabetes, a 10-point decrease in scores for healthcare provider communication quality increased rates of poor adherence by a significant 0.9%, according to Neda Ratanawongsa, MD, of the University of California San Francisco, and colleagues (Petrochko, 1/2). 

Medscape: Pill Shape, Color Linked To Adherence With Anti-Epileptics
Shape and color differences between branded and generic drugs may be associated with medication discontinuation ... Aaron S. Kesselheim, MD, JD, MPH, from Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts, and colleagues published their findings online December 31, 2012, in the Archives of Internal Medicine. ... "Changes between generic products with different physical characteristics may cause confusion and result in reduced adherence or prescription error," the authors write (Barber, 12/31).