Research roundup: Young women and delays in breast cancer diagnosis

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

JAMA Surgery: Delay In Surgical Treatment And Survival After Breast Cancer Diagnosis In Young Women By Race/Ethnicity –Adolescents and young adults (ages 15-39) make up 5 and 6 percent of all breast cancer cases in the United States and have the lowest five-year survival rates. Using 1997-2006 data from the California Cancer Registry, researchers found "that young women with a delay in surgical treatment (>6 weeks) have shorter survival compared with those who had surgery closer to their diagnosis." The impact on survival rate was greater for African Americans, publicly insured or uninsured individuals, and those with low socioeconomic status. "It is crucial to prevent further physician-related delays before and after the diagnosis of breast cancer is established to maximize the survival of these young women who are in the most productive time of their life," they concluded (Smith, Ziogas, Anton-Culver, 4/24).

American Journal Of Public Health: Change In Health Insurance Coverage In Massachusetts And Other New England States By Perceived Health Status: Potential Impact Of Health Reform – The 2010 federal health law is modeled on Massachusetts' 2006 revamping of its system. Using population-based survey data, the researchers found that coverage increased more in in Massachusetts than in other New England states. "This increase was strong and statistically significant for those most in need of health care such as individuals reporting poor mental health, poor physical health, and more limitations in their activities because of poor physical or mental health," the authors write. People with medical problems "were more likely to purchase insurance than those with better perceived health" after the new law, likely because they had been denied coverage before or it was priced too high based on their conditions. The authors conclude: "This study indicates that if the health care coverage trends observed in the natural experiment in Massachusetts foreshadow what will occur in the United States following full implementation of the ACA, the rate of decrease in health insurance coverage will be slowed and an increase in health insurance coverage is predicted" (Dhingra et al., 4/18).

Health Affairs: Per Capita Caps In Medicaid – Some analysts have suggested that calculating per capita spending and setting an allowable annual rate of growth could slow the growth of federal spending on Medicaid, the federal-state health care program for the poor. Supporters of this proposed change, the author of this brief adds, "describe the approach as a middle ground between the program as it currently operates and other proposals such as block grants, which would more dramatically change the way federal Medicaid funding is calculated.' Others are concerned that a per capita cap approach would shift costs to the states. "Whether a Medicaid per capita cap will emerge as part of negotiations on the federal budget, or entitlement reform efforts, isn't known," the author notes, adding that "several approaches are being discussed" by policymakers looking for ways to cut federal spending (Cassidy, 4/18).

U.S. Department Of Health And Human Services (HHS): National Culturally And Linguistically Appropriate Services (CLAS) Standards In Health And Health Care – In 2000, the HHS Office of Minority Health published its first National CLAS Standards in order to provide a framework aimed at helping all health care organizations in better serving the increasingly diverse communities. Last week, the office released its most updated framework, consisting of 15 measures, that aims to "advance health equity, improve quality, and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services" (4/24). 

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

MedPage Today: Senior-Centered Hospital Care Boosts Outcomes
Older patients, who are making up more of the U.S. population, are at increased vulnerability for adverse events during a hospital stay. As a result, the development of older-patient-centered hospital care practices may help improve patient outcomes, the research teams wrote online in the April 22 issue of JAMA Internal Medicine (Petrochko, 4/22).

Reuters: Aging U.S. To Drive Up Heart-Related Health Costs: Study
The costs linked to heart failure in the United States are expected to more than double within the next two decades as the population ages and treatments help patients with the disease live longer, a study released on Wednesday found. The American Heart Association predicted that the number of Americans with the fatal condition will grow to 8 million in 2030 from about 5 million in 2012 (Heavey, 4/24).

Reuters: Psychiatric Insurance Approval Takes Time In ERs
Doctors spend about 40 minutes getting approvals from insurance companies to get a psychiatric patient from the emergency room to a hospital bed, according to a new study. In some cases, the researchers found the approval process took more than an hour, which the study's senior author said results in patients being kept in ERs longer and doctors taken away from other duties. ... [Dr. J. Wesley Boyd and his colleagues] published their findings in a letter to the Annals of Emergency Medicine (Seaman, 4/23).