Research roundup: Does higher Rx drug spending lower Medicare costs?; Price transparency doesn't affect radiological decisions

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

Health Affairs: Regions With Higher Medicare Part D Spending Show Better Drug Adherence, But Not Lower Medicare Costs For Two Diseases – Researchers aimed to find a relationship between geographic variation in Medicare Part D spending and medication-taking behavior among patients with diabetes or heart failure. "If systematic regional differences do exist, then policy makers can use this information to better target interventions designed to improve the quality and efficiency of Medicare service delivery," they write. After analyzing 2006 and 2007 data, they concluded: "We found that beneficiaries residing in areas characterized by higher adjusted drug spending had significantly more 'therapy days'-;days with recommended medications on hand-;than did beneficiaries in lower-spending areas. However, we did not find that this factor translated into short-term savings in Medicare treatment costs for these two diseases (Stuart, Shoemaker, Dai and Davidoff, 1/2013).

Journal of the American College of Radiology: Provider Cost Transparency Alone Has No Impact on Inpatient Imaging Utilization
The researchers write: "Using data from fiscal year 2007, the 10 most frequently ordered imaging tests [at Johns Hopkins Hospital] were identified." From Nov. 2009 to May 2010, they showed the prices of five of the tests and did not show them for the other five to the radiologists ordering the tests. They found that "the mean utilization change was +2.8 ± 4.4% for the active group and −3.0 ± 5.5% for the control group, with no significant difference between the two groups. There was also no significant difference in the correlation between test cost and utilization change ... Provider cost transparency alone does not significantly influence inpatient imaging utilization" (Durand, Feldman, Lewin and Brotman, 1/2).

Journal Of Nursing Care Quality: Early-Career Registered Nurses' Participation In Hospital Quality Improvement Activities – According to the authors, health care leaders and experts agree that engaging registered nurses (RNs) in quality improvement (QI) efforts is essential to improving the nation's health care system. Researchers compared the participation levels in QI activities between early-career registered nurses from 15 states – one cohort licensed to practice 2004-2005 and the other 2007-2008. "We found no statistically significant differences in QI participation between the 2 cohorts, with the exception of their reported use of appropriate strategies to improve hand-washing compliance to reduce nosocomial infection rates," the authors write. "We believe that these findings are significant because they highlight the need to increase mobilization of RNs for QI," they conclude (Djukic, Kovner, Brewer and Bernstein, 1/2013).

JAMA Surgery: Residential Segregation And Lung Cancer Mortality In The United States – "This is the first study, to our knowledge, to examine the specific effect of residential segregation on lung cancer morality using data inclusive of the entire US population," the authors write. After analyzing data from the 2009 Area Resource File and Surveillance, Epidemiology and End Results program, they found that the overall lung cancer death rate between 2003 and 2007 was higher among blacks than for whites and "[b]lacks living in counties with the highest levels of segregation had a 10% higher mortality rate than those residing in counties with the lowest level of segregation." They conclude: "Our data confirm that blacks have been disproportionately affected by segregation and that the greater the segregation, the worse the lung cancer outcomes for this community" (Hayanga, Zeliadt, and Backhus, 1/2013).  

Kaiser Commission on Medicaid and the Uninsured/Kaiser Family Foundation: Faces of the Medicaid Expansion: How Obtaining Medicaid Coverage Impacts Low-Income Adults – The authors write that "the Affordable Care Act (ACA) seeks to fill the longstanding gap in Medicaid coverage for low-income adults by expanding eligibility to a minimum floor of 138% of the federal poverty level (FPL), or $24,344 for a family of 3 in 2012. ... To provide insight into the potential impacts of expanding Medicaid, this report highlights the experiences of adults in California, Connecticut, Minnesota, and the District of Columbia, which all have already expanded Medicaid to adults. Based on focus groups and interviews with previously uninsured adults who recently gained Medicaid coverage in these states, it examines the personal impacts gaining coverage had on individuals' health, finances, employment, and overall well-being" (1/23).