Research roundup: The financial burden of hospital acquired infections

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

JAMA Internal Medicine: Health Care–Associated Infections
Health care–associated infections (HAIs) account for a large proportion of the harms caused by health care and are associated with high costs. ... [Using a simulation, the researchers found that the] total annual costs for the 5 major infections were $9.8 billion (95% CI, $8.3-$11.5 billion), with surgical site infections contributing the most to overall costs (33.7% of the total), followed by ventilator-associated pneumonia (31.6%), central line–associated bloodstream infections (18.9%), C difficile infections (15.4%), and catheter-associated urinary tract infections (<1%). ... recent analyses indicate that at least 50% are preventable. ... However, despite the availability of solutions, the strong ethical case for improvement, and the intuitive argument that saving lives ought to save money, large-scale progress against HAIs has been slow. ... an important driver of progress is the move by payers to deny reimbursement for health care related to preventable harm (Zimlichman et al, 9/2).

JAMA Internal Medicine: Patient-Centered Medical Home Intervention at an Internal Medicine Resident Safety-Net Clinic
The patient-centered medical home (PCMH) model holds promise for improving primary care delivery, but it has not been adequately tested in teaching settings. ... we developed and implemented an intervention to improve primary care delivery at an internal medicine safety-net clinic with resident physician providers. ... Patients in the intervention clinic reported improved access to care (scheduling appointments and telephone services) and overall care. ... Although the absolute improvements in satisfaction with access to care and overall care were large, the clinical significance is uncertain. ... Our program did not reduce ED or hospital utilization. In fact, there was a small increase in hospitalization rates in the intervention clinic vs the control clinics (Hochman et al., 9/4).

Centers for Disease Control And Prevention (CDC): Raising Awareness Of Sleep As A Healthy Behavior
Sleep is an essential component of health, and its timing, duration, and quality are critical determinants of health. Sleep may play an important role in metabolic regulation, emotion regulation, performance, memory consolidation, brain recuperation processes, and learning. Because of the importance of these functions, sleep should be viewed as being as critical to health as diet and physical activity. However, public health practitioners and other health care providers have not focused major attention on the importance of sleep to health. In this essay, we briefly summarize the scientific literature about hours of sleep needed and why sleep is an important public health issue. We also suggest areas for expanding sleep research and strategies for increasing awareness of the importance of sleep and improving sleep health (Perry, Patil and Presley-Cantrell, August 2013).

The Commonwealth Fund: In States' Hands: How the Decision to Expand Medicaid Will Affect the Most Financially Vulnerable Americans
Between 2010 and 2012, nearly one-third (32%) of U.S. adults ages 19 to 64, or an estimated 55 million people, were either continuously uninsured or spent a period of time uninsured. Data from the 2011 and 2012 Commonwealth Fund Health Insurance Tracking Surveys of U.S. Adults show that people with incomes below 133 percent of the federal poverty level (i.e., the level that will make them eligible for Medicaid in 2014 under the Affordable Care Act) were uninsured at the highest rates. ... In those states that have not yet decided to expand [their Medicaid programs], as many as two of five (42%) adults who were uninsured for any time over the two years would not have access to the new coverage provisions in the law (Rasmussen, Collins, Doty and Garber, 9/5). 

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

Boston Globe: Study Says Many Patients Enter Hospice Care Too Late
Slightly more patients with terminal cancer are getting hospice care during the end of their lives, but they are still entering hospice care too late -; within days of death -; finds a new national analysis of Medicare patients conducted by Dartmouth researchers. And many are still dying in hospitals, often hooked to ventilators in an intensive care unit, despite studies showing that most cancer patients prefer to die at home. ... according to the analysis released Wednesday from the Dartmouth Atlas Project (Kotz, 9/05). 

Reuters: Quicker Heart Treatment Hasn't Lowered Deaths: Study
A good hospital will get heart attack victims into an operating room and get their clogged artery open within 90 minutes. But a new study shows that shortening that time even further does not significantly lower the risk of dying in the hospital. The analysis, which measured the so-called door-to-balloon time now widely used to assess the quality of heart attack care, found that shaving additional minutes off the 90-minute goal produced diminishing returns. ... In fact, patients who could not get a PCI within 90 minutes died at a rate that was roughly double that of patients who received treatment in 90 minutes or less, according to the report published in the New England Journal of Medicine (Emery, 9/4).

NPR's Shots Blog: Facebook Chats Prompt At-Risk Minority Men To Get HIV Tests
To reach young gay Latino and African-American men, researchers at the David Geffen School of Medicine and School of Public health at the UCLA trained men in the same demographic as peer leaders, giving them information on how HIV spreads. That's a time-honored public health technique. They also created a comparison group, with peer leaders trained to share general health information. ...  Over 12 weeks, 44 percent of the men in the group getting information about HIV prevention asked for a kit, compared with 20 percent in the control group. ... The results were published in the Annals of Internal Medicine (Shute, 9/3).