Research roundup: The costs of obesity; Patients' post-hospital medicine; Women and heart failure

Every week, Kaiser Health News reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs.

Journal of the American Medical Association: Association of ICU or Hospital Admission With Unintentional Discontinuation of Medications for Chronic Diseases -- Researchers examined records of older people admitted to a hospital in Ontario, Canada from 1997-2009 who were already taking medicines for chronic health problems. They measured "failure to renew the prescription within 90 days after hospital discharge," and found that patients "prescribed medications for chronic diseases were at risk for potentially unintentional discontinuation after hospital admission. Admission to the ICU was generally associated with an even higher risk of medication discontinuation."  The authors recommend that hospitals implement better communication strategies, involving the patients and clinicians, and a "system-based method" to improve continuity of medication (Bell et al., 8/24).

Circulation: Heart Failure: Quality Of Care And Outcomes In Women Hospitalized For Heart Failure -- The number of patients with heart failure has increased dramatically during the past decade. This study looks at quality measures such as length of stay and in-hospital mortality to determine if women were receiving the same care for heart failure as male patients. The authors found that women accounted for half of the heart failure admissions, but they were significantly older and sicker than men. They concluded that while women "differ in many clinical characteristics and length of stay," they have "similar clinical presentations, receive similar quality of care for most but not all measures, and experience similar in-hospital mortality" as men (Klein et. al., 8/23).

The Lancet: Health And Economic Burden Of The Projected Obesity Trends In the USA And the UK -- As part of The Lancet's ongoing series on obesity, the authors "used a simulation model to project the probable health and economic consequences in the next two decades from a continued rise in obesity in two ageing populations-;the USA and the UK." They project millions more cases of diabetes, heart disease, stroke, cancer and conclude: "The combined medical costs associated with treatment of these preventable diseases are estimated to increase by $48-;66 billion/year in the USA and by £1·9-;2 billion/year in the UK by 2030" (Wang et al., 8/26).

Commonwealth Fund: Realizing Health Reform's Potential--When Unemployed Means Uninsured: The Toll Of Job Loss On Health Coverage, And How The Affordable Care Act Will Help -- This issue brief examines the impact of the dramatic increase in unemployment during the recent recession: "nearly three-quarters of adults who lost their job-based benefits when they were laid off and remained uninsured said they delayed getting needed health care or filling a prescription because it was too expensive; a similar share reported they had difficulties paying medical bills or were paying off medical debt over time." Although the federal health law will allow workers who lose their jobs to keep health coverage starting in 2014, the brief says efforts are needed now to help those who currently don't have insurance because of the loss of work (Doty et. al., 8/24).

International Journal Of Health Care Finance And Economics: How Do Health Insurance Loading Fees Vary By Group Size? Implications For Health Care Reform -- This paper looks at the how a health insurance loading fee -- "the portion of the premium above the expected amount of medical care expenditures paid by the insurance company" -- varies by the size of the employer. Additionally, it examines what kind of implications the passage of the federal health law can have on the loading fee. The researchers report an, "inverse relationship between employer group size and loading fees. Firms of up to 100 employees face similar loading fees of approximately 34%. Loads decline with firm size and are estimated to be on average 15% for firms with more than 100 employees, but less than 10,000 employees, and 4% for firms with more than 10,000 workers" (Karaca-Mandic, Abraham and Phelps, 8/20).

Journal of the American Medical Association: Automated Identification Of Postoperative Complications Within An Electronic Medical Record Using Natural Language Processing -- Noting that "most automated methods to identify patient safety occurrences rely on administrative data codes," researchers wondered if "free-text searches of electronic medical records could represent an additional surveillance approach." They examined data from 1999 to 2006 of more than 2,000 patients who were undergoing surgery at one of six medical centers operated by the Veterans Health Administration. "Among patients undergoing inpatient surgical procedures at VA medical centers, natural language processing analysis of electronic medical records to identify postoperative complications had higher sensitivity and lower specificity compared with patient safety indicators based on discharge coding," the authors report (Murff et. al., 8/23).