Research roundup: Number of nurses linked to NICU infections; Comparing Medicare budget plans

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

JAMA Pediatrics: Nurse Staffing And NICU Infection Rates –Neonatal intensive care units (NICU) – which provide care for infants who are critically ill – are costly and require a significant amount of nursing services. Little is known, however, about the adequacy of nurse staffing at these units. Using data from 2008 and 2009, researchers analyzed the relationship between adherence to national staffing guidelines and hospitals-associated infections among very low birth-weight (VLBW) infants. "Our results document widespread understaffing relative to guidelines: one-third of NICU infants were understaffed… ," the authors write. "In VLBW infants, NICU nurse understaffing relative to guidelines was associated with a sizable increase in infection risk." They conclude that their findings "suggest that the most vulnerable hospitalized patients, unstable newborns require complex critical care, do not received recommended levels of nursing care. Even in some of the nation's best NICUs, nurse staffing does not match guidelines" (Rogowski et al., 3/18).

State Health Access Data/Robert Wood Johnson Foundation: State Estimates Of The Low-Income Uninsured Not Eligible For The ACA Medicaid Expansion – Millions of Americans will gain access to affordable health insurance under the federal health law, but some immigrants are excluded. "Legal permanent residents, in most circumstances, are ineligible for Medicaid benefits for the first five years during which they result legally in the U.S. and unauthorized immigrants are excluded from Medicaid coverage," the authors of the brief state. They provide estimates of the number of uninsured low-income adults in each state that may be excluded from Medicaid expansion because of their immigration status. "Safety-net health care providers are likely to continue to be key providers for this population after health reform, and the need for safety-net care will not be spread evenly across states," the authors conclude (3/14).

The Kaiser Family Foundation: Illinois, Massachusetts, Ohio, and Washington: Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared – The Centers for Medicare & Medicaid Services (CMS) has established demonstration projects with with Illinois, Massachusetts Ohio and Washington to test changes in delivery care systems for people who qualify for both Medicare and Medicaid, often called dual eligibles. These are among the poorest and sickest beneficiaries in the programs and their care is expensive. This policy brief compares the four programs. The author notes, "While the demonstrations offer the potential opportunity to improve care coordination, lower program costs, and achieve outcomes such as the increased use of HCBS instead of institutionalization, at the same time the high care needs of many dual eligible beneficiaries increase their vulnerability when care delivery systems are changed" (Musumeci, 3/18).

The Kaiser Family Foundation: Medicare and the Federal Budget: Comparison of Medicare Provisions In Recent Federal Debt And Deficit Reduction Proposals -- As Congress and the Obama administration have looked for budget savings, the Medicare program has come under scrutiny. According to the author, over the next decade, Medicare spending "is projected to grow slower than private insurance on a per capita basis, and at about the same rate as the economy." This brief features a side-by-side comparison of the key Medicare provisions in four major budget and debt-reduction plans. The brief also includes short descriptions of Medicare proposals in several other deficit-reduction proposals recently put forward by other members of Congress and influential policy groups (Jacobson, 3/15).

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

Medscape: False-Positive Mammogram Is Far From Harmless
A false-positive screening mammogram can cause lasting psychological harm, according to a study from Denmark. Even after 3 years of being declared free of suspected cancer, women who had a false-positive mammography result consistently reported greater negative psychosocial consequences than their peers with normal findings and those with true breast cancer, report John Brodersen, MD, PhD, and Volkert Dirk Siersma, PhD, from the University of Copenhagen (Brooks, 3/19). 

Medscape: Blacks More Likely Than Whites To Undergo Leg Amputation
Black patients have greater odds than white patients of undergoing lower-extremity amputation rather than revascularization for ischemia, according to a hospital database study reported online March 20 in JAMA Surgery. These disparities persisted after correction for a range of confounding parameters and were greater in wealthier neighborhoods and in hospitals with greater resources (Barclay, 3/20).

Reuters: Less-Invasive Surgery Tied To Less Cost, Absenteeism
Minimally-invasive forms of heart surgery and fibroid removal may be less expensive - and cause patients to take fewer days off from work - than standard versions of the same procedures, a new study suggests. Researchers looking at six common surgeries found that if every one of them performed in the U.S. in 2009 had used minimally-invasive techniques, health plans would have saved $2.3 billion and employees would have missed about 20,000 fewer days of work (Pittman, 3/20). 

Medscape: Study Criticizes Policy Penalizing Nonemergency ED Visits
In an effort to control Medicaid costs, some state legislators have wanted to deny or limit payment for emergency department (ED) visits if a later discharge diagnosis indicated the problem was a nonemergency that could have been handled in a physician's office. Good luck making that work, says a new study published in the Journal of the American Medical Association (JAMA). Lead author Maria Raven, MD, MPH, and colleagues write that in ED visits later deemed to be primary care treatable based on the discharge diagnosis, patients presented the same chief complaints given by the vast majority of all ED patients (Lowes, 3/19).