Research roundup: Nurse education and post-surgery mortality; The influence of publicly reported quality-of-care measures

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

Health Affairs: An Increase In The Number Of Nurses With Baccalaureate Degrees Is Linked To Lower Rates Of Postsurgery Mortality – A 2011 report by the Institute of Medicine called for a more highly educated workforce of registered nurses – one that would be well prepared to meet the health care demands of the public. According to the study authors, health care policymakers have little evidence to support the recommendation of increasing the number of nurses with baccalaureate degrees. Using nurse survey and patient discharge data from 1999 and 2006, the researchers examined whether the changes in the number of baccalaureate-level nurses impacted the death rate among surgical patients at acute care hospitals in Pennsylvania. "We found that increases in a hospital's percentage of nurses who held a baccalaureate degree in nursing were significantly associated with improvements over time in rates of surgical patient morality and failure to rescue," the authors write (Kutney-Lee, Sloane and Aiken, March 2013).

Health Affairs: Publicly Reported Quality-Of-Care Measures Influenced Wisconsin Physician Group To Improve Performance – The Wisconsin Collaborative for Healthcare Quality is a voluntary, statewide consortium of physician groups aiming to improve the quality and cost of care in the state. As part of their efforts, the collaborative publicly reports how providers are performing on various quality of care measures. Although publicly reporting providers' performance on health measures is becoming more common, the overall impact of these disclosures on the quality of patient care is still unclear. Using Medicare billings and survey data, researchers compared the performances of members in the collaborative to other doctors in the state of Wisconsin. "The overall performance of the collaborative members in the aggregate improved significantly," the authors found. "All of the physician groups saw some improvement on a majority of the measures." Physician groups indicated that publicly reported data motivated them to act on improving some, though not all, of the quality of care measures (Lamb, Smith, Weeks and Queram, March 2013).

The Kaiser Family Foundation/Georgetown University Center for Children and Families: Premium Assistance In Medicaid And CHIP: An Overview Of Current Options And Implications Of The Affordable Care Act -- Implementation of the Affordable Care Act (ACA) coverage expansions is likely to spark renewed interest in the use of Medicaid or Children's Health Insurance Program public funds to purchase private coverage, and option called premium assistance. To date, Medicaid and CHIP premium assistance programs remain relatively limited largely reflecting limited access to (employer sponsored insurance) among low-income individuals covered by Medicaid and CHIP and challenges to achieving cost effectiveness,"  the author wrote. "However the passage of the ACA with its expansion in Medicaid and the creation of new health insurance exchange marketplaces may spur increased interest among states in premium assistance options." Still she concluded, "Private market trends, including greater employee cost sharing, declining availability of coverage for low-income workers, and higher rates of cost growth in private versus public coverage increase challenges to implementing premium assistance in the group market." This brief provides an overview of premium assistance options and examines how the ACA may impact the use of premium assistance (Alker, 3/12).

Kaiser Family Foundation: Establishing Health Insurance Exchanges: An Overview of State Efforts – According to this issue brief, states have made a number of decisions regarding state-based exchanges in the past two years, including how they'll be structured, governed and contracted with health insurance providers. "Exchanges must allow consumers to apply for and enroll in coverage online, in person, by phone, fax, or mail and provide culturally and linguistically appropriate assistance," the brief states, "To do this, states must provide access to telephone call centers, build a website with information about insurance options and application assistance, and create a Navigator program to improve public awareness and facilitate enrollment." This issue brief provides an overview of states' progress in setting up the state-based health insurance exchanges through which millions of Americans are expected to purchase coverage under The Patient Protection and Affordable Care Act (ACA) beginning in 2014 (3/11).

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

The New York Times' The New Old Age: New Data To Consider In D.N.R. Decisions
Every year in the United States, about 100,000 hospital patients age 65 and older experience what is known in medical parlance as Code Blue. ... Survival from these catastrophic medical events isn't the norm; only 18 to 20 percent of older patients in hospitals who suffer cardiac arrest end up leaving the hospital alive. But that is an improvement from years past, when survival rates were even more abysmal. What has not been clear is what happened to older hospital patients who left the hospital after a cardiac arrest. Now a new study in The New England Journal of Medicine of 6,972 elderly people who survived in-hospital cardiac arrests between 2000 and 2008 gives some answers (Graham, 3/14).

Reuters: Too Many Drug Types Are Compromising Heart Health: Doctors
About 80 million Americans suffer from heart disease, the nation's No. 1 killer, and most are on multiple drugs. Some cardiologists think prescribing has gotten out of hand. The criticism was voiced by a number of leading heart doctors who attended the annual scientific sessions of the American College of Cardiology, held on March 9-11 in San Francisco. They said eliminating certain drugs could potentially improve care without compromising treatment. Evidence is growing that some medications are not effective (Sherman, 3/13).

The New York Times: Widespread Flaws Found In Ovarian Cancer Treatment
Most women with ovarian cancer receive inadequate care and miss out on treatments that could add a year or more to their lives, a new study has found. The results highlight what many experts say is a neglected problem: widespread, persistent flaws in the care of women with this disease, which kills 15,000 a year in the United States. About 22,000 new cases are diagnosed annually, most of them discovered at an advanced stage and needing aggressive treatment. Worldwide, there are about 200,000 new cases a year (Grady, 3/11).

WBUR: Here And Now: Few Ovarian Cancer Patients Receive Best Possible Care (Audio)
A study presented yesterday at a meeting of the Society of Gynecologic Oncology found that only about 37 percent of ovarian cancer patients receive the kind of complex surgery and chemotherapy that can prolong life. The surgery is called "debulking" and involves removing all visible traces of tumor inside the abdomen. Too often, patients rely on general surgeons or OB/GYN (obstetrics and gynecology) doctors at hospitals where too few of the operations are performed, instead of gynecologic oncologists who regularly do the operations (3/12).

The Wall Street Journal: Breast-Cancer Radiation Raises Heart Risk: Study
Women who had radiation therapy for breast cancer are at increased risk of having a heart attack or other major coronary event, according to a large European study published in the New England Journal of Medicine Wednesday. The risk started climbing five years after treatment and continued for at least two decades, and the higher the dose of radiation the women's hearts received, the greater the risk of having a serious heart problem, the study found (Beck, 3/13).  

Medpage Today: Bonus For Work In Shortage Areas Questioned
Questions surrounding the necessity -- and ultimate value -- of a 25-year-old program to increase the number of physicians in shortage areas held the spotlight at a second day of hearings by the Medicare Payment Advisory Commission. Medicare has provided at least a 10% bonus for services provided by all physicians -- not just primary care or specialities deemed to be in short supply -- working in federally designated Health Professional Shortage Areas (HPSA) since 1987, as provided for in the Budget Reconciliation Act of 1987. But the average number of annual visits to a doctor's office or outpatient facility was 10.3 per beneficiary for HPSAs and 10.0 for non-HPSAs, suggesting that the bonuses may not be needed, according to a MedPAC analysis released at a commission meeting on Friday. Also, only about 40 percent of HPSAs are in non-metropolitan areas (Pittman, 3/9).

Medpage Today: MedPAC: Rx Adherence Not Always A Savings
Medicare patients who had better adherence to their medication regimen did not always have lower overall health costs, according to a study of patients with depression or certain cardiac or pulmonary conditions. Instead, the relationship between medication adherence and Medicare spending varied by condition, regimen, and income status, members of the Medicare Payment Advisory Commission (MedPAC) were told here Thursday. Past studies looking at medication adherence and its effects on healthcare costs "may have limited applicability to the Medicare population as those studies generally focus on younger population with less complex medical conditions," the staff members noted in their introductory materials. To explore the issue within the Medicare program, MedPAC staff undertook a study to understand how medication adherence effects Medicare Part A and B spending (Pittman, 3/8).