Research roundup: Conflict of interest in Medicaid drug purchasing; Examining Medigap policies; Electronic medical records and hospital quality

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

JAMA Internal Medicine: Medicaid Drug Selection Committees And Inadequate Management Of Conflicts Of Interest – The authors of this study assert that the decisions about which drugs are selected for state Medicaid reimbursement programs "should be based on available evidence and free of conflicts of interests (COIs)." They add, however, that little is known about how Medicaid drug selection committees identify and manage conflicts of interest. The researchers searched Medicaid websites and contacted staff to identify policies in the 47 states and the District of Columbia that have Medicaid preferred drug lists. "Our findings show the need for a model COI policy for drug selection committees that can be adapted for individual states …," the authors write. "The COI policies were difficult or impossible to find for many states. Only about half of the policies were readily available on state websites, and at least 1 program stated that its policies were not in the public domain." They conclude that the wide variation across the country suggests that the drug selection process is not adequately protected against industry influence (Nguyen and Bero, 2/11).

Kaiser Family Foundation/University Of California At Los Angeles: Medigap: Spotlight On Enrollment, Premiums And Recent Trends –Nearly one in four Medicare beneficiaries have a private supplemental insurance plan to help cover expenses that Medicare doesn't. This report examines enrollment and premium trends for these Medigap plans. The authors find that although Medigap policies must offer a set of standardized benefits, "premiums for identical plans vary greatly both across the country and within states." They also report that "more than half of all Medigap enrollees in 2010 were in plans that cover Medicare's entire Part A and B deductibles" (Huang, Desmond et al, 2/14).

Kaiser Family Foundation: Policy Options To Sustain Medicare For The Future
This report  "presents a compendium of policy ideas that have the potential to produce Medicare savings" and examines "a wide array of options in several areas and lays out the possible implications of these options for Medicare beneficiaries, health care providers, and others, as well as estimates of potential savings, when available." This report is a guide for policymakers as officials debate changes to Medicare and ways to find savings (Neuman and Cubanski, 1/30).

BMC Health Services Research: The Effect Of Electronic Medical Record Adoption On Outcomes In US Hospitals – Researchers in this study examined the relationship between adoption of electronic medical record (EMR) systems at 708 acute-care hospitals in the U.S. and 30-day re-hospitalization of patients, deaths within 30 days of admission, deaths of patients in the hospital and patients' length of stay. They compared the outcomes two years before and after the hospitals adopted electronic medical record systems from 2000 to 2007. "We found that EMR adoption was associated with a small but significant reduction in length of stay and 30-day mortality as well as an increase in 30-day re-hospitalization," the authors write. "The reduced length of stay associated with EMR suggests that EMR might allow faster physician ordering of tests, produces, and medications, speed the process/scheduling of discharge, and reduce delays in the service ordering process." They add, however, that shorter length of stay may increase the 30-day re-hospitalization rate because patients with more severe conditions may return due to being discharged early (Lee, Kuo and Goodwin, 2/1).

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

Medscape: Hospitals Steadily Reducing Most Inpatient Infection Rates
Hospitals throughout the United States have made significant progress in reducing healthcare-associated infections and are on track to meet goals set in 2008 as part of the National Action Plan to Prevent Healthcare-Associated Acquired Infections, according to a report published online February 11 by the Centers for Disease Control and Prevention (CDC). The CDC analysis found that central line–associated bloodstream infections have decreased by 41% (toward a goal of a 50% decrease) and surgical site infections have decreased by 17% (toward a goal of 25%). Rates for both infection sites improved from 2008 to 2010 and continued to improve from 2010 to 2011 (Kelly, 2/12).

MedPage Today: Black Males Not Applying To Med School
Fewer black men are applying to, accepted to, and attending U.S. medical schools despite an increase in the number of overall applicants and uptick in matriculation among other minorities, a report found. Black applicants were the second most populous demographic behind whites in the late 1970s. There were more black applicants than Asians and Hispanics combined. But in 2011, first-time African-American applicants were surpassed by Asians and Hispanics, the Association of American Medical Colleges (AAMC) said (Pittman, 2/10). 

Reuters: U.S.-Wide Salt Reduction Could Prevent Deaths: Study
The United States could prevent up to half a million deaths over the next decade if Americans cut their salt intake to within national guidelines, according to a new study. That finding -- which comes the week New York City announced success toward its goals of cutting salt levels by one-quarter by 2014 -- is based on computer simulations using data from various studies on the effects of extra sodium on blood pressure and heart risks (Pittman, 2/14).