Research roundup: Improving hospital processes can improve care; E-mailing the doctor; Medicaid savings with generic drugs

The theme of Health Affairs this month is "Weighing the Impact Of Health Reform."

Health Affairs: Public Reporting On Hospital Process Improvements Is Linked To Better Patient Outcomes - This study analyzed "data from 3,476 acute care, nonfederal U.S. hospitals that publicly reported quality information on the CMS Hospital Compare Web site from 2004 through 2006" and "evaluated the hospitals' performance every six months during the study period, using the ten original measures from Hospital Compare."

"[F]rom 2004 to 2006, hospital process performance improved, particularly among hospitals with low baseline performance. We also found that these improvements were associated with improved outcomes, most notably for acute myocardial infarction," the authors report. "These results do not prove conclusively whether or not public reporting caused an improvement in processes or outcomes. However, they are encouraging, as efforts aimed at improving process performance may improve quality more broadly" (Werner and Bradlow, July 2010).

Health Affairs: Improved Quality At Kaiser Permanente Through E-Mail Between Physicians And Patients - Based on "effectiveness-of-care measures for diabetes and hypertension from February 2005 to December 2008" used for more than 35,000 patients, the authors report: "For patients with diabetes and hypertension, the use of secure patient-physician e-mail was associated with an increased likelihood that patients would meet each of nine [Healthcare Effectiveness Data and Information Set] measures. In addition, when compared to matched controls, the use of e-mail was associated with a 2.0-6.5-percentage-point improvement in HEDIS performance such as glycemic (HbA1c), cholesterol, and blood pressure screening and control" (Zhou, Kanter, Wang and Garrido, July 2010).

Health Affairs: State Generic Substitution Laws Can Lower Drug Outlays Under Medicaid - This study examined how states' generic substitution laws affected "the use of generic simvastatin, a cholesterol-lowering drug, after the patent for the brand-name equivalent, Zocor, expired." Researchers included prescription refill rates for "all statins, generic simvastatin, brand-name Lipitor, and brand-name Zocor between the first quarter of 2006—approximately six months before simvastatin became available—and the third quarter of 2007—the most recent calendar quarter posted on the CMS Web site at the time of these analyses." 

"States that implemented policies requiring patients' consent prior to generic substitution experienced rates of substitution that were 25 percent lower than those of states that did not require patient consent. By eliminating patient consent requirements, state Medicaid programs could expect to save more than $100 million in coverage for three top-selling medications that are nearing patent expiration" (Shrank et al., July 2010).

Health Affairs: Racial And Ethnic Disparities In Dental Care For Publicly Insured Children - Based on data obtained during the 2005 California Health Interview Survey, the authors write: "African American children were 39 percent and Latino children 36 percent more likely to have a longer interval between dental visits compared to white children," even after "controlling for type of dental insurance and other covariates. ... Having any form of dental insurance significantly decreased the odds of having a longer time since the last dental visit, compared to having no dental insurance. However, children with private insurance were more likely than children in Medicaid or CHIP to have had shorter times reported since their last visit." The authors conclude: "These findings raise concerns about Medicaid's ability to address disparities in dental care access and, more broadly, in health care" (Pourat and Finocchio, July 2010).

Commonwealth Fund: Public Hospital Case Study Series - This series examines eight public hospitals that performed among the top 10 percent in process-of-care measures reported by CMS of more than 2,000 public and private hospitals submitting data from July 2007 through June 2008. The case studies include four hospitals in the Memorial Health System in Florida, three in the Carolinas Health System and Norman Regional Hospital in Oklahoma.

"Lessons for public hospital managers are much the same as the lessons gleaned from leaders of private hospitals," writes the author of the introduction to the series. "Leaders at these three institutions made strong commitments of time (their own and that of their leadership teams) to quality improvement. They strived to create a culture in which frontline workers felt personally responsible for the quality of care their patients received. They backed up their commitment with resources to enable data collection as well as performance tracking and reporting" (Silow-Carroll, 7/7).

Commonwealth Fund: Use of Comparative Effectiveness Research In Drug Coverage And Pricing Decisions: A Six-Country Comparison - This issue brief examines the use of CER in decisions in Denmark, England, France, Germany, the Netherlands and Sweden, highlighting how CER is applied to drug coverage, pricing and cost-sharing decisions, as well as potential lessons for the U.S.

"Currently, while there are no blanket prohibitions in the Patient Protection and Affordable Care Act regarding the use of CER by public and private payers, it remains to be seen how such research will be used in the U.S.," writes the author of this brief. "Based on the experience of Europe, the uptake and impact of CER may be limited if it does not have the authority to formally link research with policy and practice. Establishing a more formal link can improve the transparency of coverage decisions in the public domain and ensure that such policies are based on independent, scientific assessment" (Sorenson, 7/2).