Research roundup: End-of-life preferences; surviving trauma when older; ACA's big waiver for states

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

JAMA Internal Medicine: Stability Of End-Of-Life Preferences
Policies and practices that promote advance care planning and advance directive completion implicitly assume that patients' choices for end-of-life (EOL) care are stable over time, even with changes in health status. ... We searched for longitudinal studies of patients' preferences for EOL care in PubMed, EMBASE, and using citation review. ... In 17 studies (71%) more than 70% of patients' preferences for EOL care were stable over time. Preference stability was generally greater among inpatients and seriously ill outpatients than among older adults without serious illnesses. Patients with higher education and who had engaged in advance care planning had greater preference stability, and preferences to forgo therapies were generally more stable than preferences to receive therapies (Auriemma et al., 5/26).

JAMA Surgery: Association Between Race And Age In Survival After Trauma
Racial disparities in survival after trauma are well described for patients younger than 65 years. Similar information among older patients is lacking .... Trauma patients were identified from the Nationwide Inpatient Sample (January 1, 2003, through December 30, 2010) .... A total of 1,073,195 patients were included .... Different racial disparities in survival after trauma exist between white and black patients depending on their age group. Although younger white patients have better outcomes after trauma than younger black patients, older black patients have better outcomes than older white patients. Exploration of this paradoxical finding may lead to a better understanding of the mechanisms that cause disparities in trauma outcomes (Hicks et al., 5/28).

Journal of Health Politics, Policy and Law: Wyden's Waiver: State Innovation On Steroids
Section 1332 of Title I of the Affordable Care Act offers to state governments the ability to waive significant portions of the ACA, including requirements related to qualified health plans, health benefit exchanges, cost sharing, and refundable tax credits. It permits state governments to obtain funding that otherwise would have gone to residents and businesses through the ACA and to use those funds to establish, beginning in 2017, an alternative health reform framework within statutory limitations. ... Section 1332 has the potential to instigate a new, varied, and unprecedented array of state health sector innovations from both sides of the political divide over health care reform (John E. McDonough, 5/19).

The Urban Institute/The Robert Wood Johnson Foundation: Who Are The Newly Insured As Of Early March 2014?
Most newly insured adults are in the income groups targeted by the ACA's Medicaid expansion and the Health Insurance Marketplace subsidies. Newly insured adults tend to be younger than adults who had coverage for the full year; however, they are more likely to report fair or poor health than full-year insured adults. Newly insured adults often lack a strong connection to the health care system; many do not have a usual source of care and have not had a routine checkup in the past year (Adele Shartzer, Sharon K. Long, and Stephen Zuckerman, 5/22).

UCLA Center for Health Policy Research: A Little Investment Goes A Long Way: Modest Cost To Expand Preventive And Routine Health Services To All Low-Income Californians
[The] California legislature is considering a proposal (Senate Bill 1005, the Health for All Act) that would expand Medi-Cal coverage to include primary and preventive care, prescription drugs, mental health care, dental care, and other routine health services for all low-income California residents regardless of immigration status. ... This report finds that the proposed Medi-Cal expansion would involve new state spending, but the cost is modest in comparison to the impact on health and coverage, and the policy also produces savings. ... The net increase in state spending is estimated to be equivalent to 2 percent of state Medi-Cal spending .... The new spending would be substantially offset by an increase in state sales tax revenue from managed care organizations, in addition to savings from reduced county spending in providing care to the uninsured (Lucia et al., 5/21).

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

The Dallas Morning News: Cost An Indirect Measure Of Waste, Medicare Researcher Says
A growing body of health care research shows significant waste can be found by looking at the overuse of certain medical services. "Cost is an indirect measure of overuse," said Dr. Aaron Schwartz, a doctoral candidate at Harvard Medical School, who co-authored a recent report on Medicare waste published in The Journal of the American Medical Association (McClure, 5/24).

NPR: When Older People Walk Now, They Stay Independent Later
Millions of older people have trouble walking a quarter of a mile, which puts them at high risk of losing their mobility, being hospitalized or dying. ... researchers got people in their 70s and 80s to walk and do simple exercises in social groups. The people who did that were less likely to become disabled than those who attended classes on successful aging, according to a report published Monday in JAMA (Shute, 5/27).

Reuters: Cancer Center Ads More Emotional Than Informative
Television and magazine advertisements from cancer centers often tug at people's heartstrings, but rarely provide information needed to make a decision about cancer treatment, says a new study. "I think there is a concern in general and among some physicians that advertising may be creating some inappropriate demand for services or providing unrealistic expectations," Dr. Yael Schenker, the study's senior author from the University of Pittsburgh, said. She and her colleagues write in the Annals of Internal Medicine that most cancer centers in the U.S. use ads to tell people about their services, but there has been little research on the content of those messages (Seaman, 5/27).

Reuters: Stressful Relationships May Raise Risk Of Death
Worries, conflicts and demands in relationships with friends, family and neighbors may contribute to an earlier death suggests a new Danish study. "Conflicts, especially, were associated with higher mortality risk regardless of whom was the source of the conflict," the authors write. "Worries and demands were only associated with mortality risk if they were related to partner or children." Men and people without jobs seemed to be the most vulnerable, Rikke Lund, a public health researcher at the University of Copenhagen, and her colleagues found (Jegtvig, 5/26).

Reuters: Most Doctors Wouldn't Want Intensive Care At End Of Life
Most doctors would not want high-intensity treatment near the end of life, according to a new study from Stanford University School of Medicine. In 2013, researchers surveyed nearly 1,100 young doctors who were finishing their training in a variety of medical specialties. Nearly nine in 10 said they would choose a do-not-resuscitate status near the end of life. "We see too much in our practice and training when high-intensity treatments actually hurt patients," says Vyjeyanthi Periyakoil, a geriatrician who led the study (Belisomo, 5/28).

Modern Healthcare: Heroin Followed Rx Painkillers To Small Towns, Study Finds
The face of drug addiction within the U.S. has changed considerably over the past 50 years, according to a new study. Heroin use has spread to the suburbs and rural areas from urban centers, the study found, sparked in large part by the rise in prescription opioid use seen over the last decade.  The study, published online Monday in JAMA Psychiatry, analyzed nearly 2,800 patients ages 18 and over across 48 states between 2010 and 2013 who reported having heroin dependence. Of those, 75% resided in small urban or non-urban areas and nearly 90% who began using heroin over the past decade were white men and women with an average age of 23 (Johnson, 5/28).

NPR: Doctors Say They Would Shun Aggressive Treatment When Near Death
In fact, nearly 9 in 10 young physicians just finishing up their residencies or fellowships wouldn't want to receive life-prolonging CPR or cardiac life support if they were terminally ill and their heart or breathing stopped, a Stanford University School of Medicine survey finds (Hobson, 5/29).