Research roundup: Getting a critical care doc at night; Poverty among seniors

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

JAMA Internal Medicine: Firearm Legislation And Firearm-Related Fatalities In The United States – Researchers analyzed 121,084 firearms deaths in the U.S., using 2007 to 2010 data from the Centers for Disease Control and Prevention: "The outcome measures were state-level firearm-related fatalities per 100 000 individuals per year overall, for suicide, and for homicide. In various models, we controlled for age, sex, race/ethnicity, poverty, unemployment, college education, population density, nonfirearm violence–related deaths, and household firearm ownership." They concluded that a "higher number of firearm laws in a state are associated with a lower rate of firearm fatalities in the state, overall and for suicides and homicides individually. As our study could not determine cause-and-effect relationships, further studies are necessary to define the nature of this association" (Fleegler et al., 5/13).

New England Journal Of Medicine: A Randomized Trial Of Nighttime Physician Staffing In An Intensive Care Unit – Previous studies suggest that the use of intensivists, doctors specifically trained in critical-care medicine, improve the outcomes of intensive care unit (ICU) patients. But studies analyzing the impact of nighttime staffing of intensivists in ICUs have shown mixed results. Researchers at the Hospital of the University of Pennsylvania compared nighttime staffing to the use of daytime intensivists who were available for phone-based consultation at night. More than 1,500 patients were included in their analyses. "We found no evidence that this staffing model, as compared with nighttime telephone availability of the daytime intensivist, had a significant effect on length of stay in the ICU or hospital, ICU or in-hospital mortality, readmission to the ICU, or the probability of discharge to home," the authors write. "In an academic medical ICU in the United States, nighttime in-hospital intensivist staffing did not improve patient outcomes" (Kerlin et al., 5/20).

Annals Of Family Medicine: Spreading A Medical Home Redesign: Effects On Emergency Department Use And Hospital Admissions – Patient centered medical homes (PCMH) emphasize long-term relationships between patients and providers as well as other attributes of primary care. This study analyzed how PCMHs in clinics owned by the Washington state insurance and health care system, Group Health Cooperative, affected health care use. The authors found that, one year after the implementation, Group Health patient visits to emergency departments significantly declined and there was a shift from face-to-face doctor/patient visits to greater use of secure messaging and telephone conversations.  "Group Health's experience in spreading its PCMH model shows that achieving PCMH transformation across a diverse set of primary care clinics is possible with a clear change strategy … and sufficient resources and supports," they conclude (Reid et al., May 2013).

Health Care Cost Institute: Health Care Costs From Birth To Death -- Using commercial and Medicare health care data, the author of this report (sponsored by the Society of Actuaries) analyzed cost differences based on age, sex and health status. He reports that costs are generally high in the two years of life and then drop by age 5. They pick up again in the teen years and for women increase during the child-bearing years. Among other key findings: "An aging population is not an overwhelming driver of health care spending. ... Health costs are twice as high for people with cancer or other chronic conditions. Older men are more costly than older women"  (Yamamoto, May 2013). 

Kaiser Family Foundation: A State-By-State Snapshot Of Poverty Among Seniors: Findings From Analysis Of The Supplemental Poverty Measure – The authors write: "During recent deficit reduction discussions, policymakers have put forth a variety of proposals to reduce Federal spending that would affect people on Medicare, including options that would shift costs onto beneficiaries ...  Based on the Census Bureau's supplemental poverty measure, the poverty rate among people ages 65 and older is higher than is reflected in the official poverty measure, and is particularly high among seniors in some states.  ... Under the supplemental poverty measure, which deducts health spending from income, poverty rates could increase if beneficiaries were required to pay higher cost sharing or premiums for Medicare. ... The supplemental measure suggests that a greater share of seniors may already be struggling financially than is conveyed by the official measure" (Levinson et al., 5/20).

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

San Francisco Chronicle: 56% Of Patients Don't Follow Prescription
It might take more than a spoonful of sugar to help the medicine go down for many Americans. In a survey of more than 1,000 adult patients who are on prescription medication for chronic illnesses, 40 percent say they haven't followed doctor's instructions or have skipped taking their meds at least once in the past year. More than a quarter said they've stopped taking medications altogether or never even filled a prescription. It's a problem known as medication nonadherence and is linked to 125,000 deaths in the United States each year (Roethel, 5/21).

Medpage Today: Medical Home Transition Long But Worth It
The path to becoming a patient-centered medical home is long, rough, and varies for each practice, but getting there is essential to providing high-quality, affordable healthcare to all Americans, researchers concluded. The Agency for Healthcare Research and Quality (AHRQ) came to that conclusion in summarizing the results of 14 grants it issued in the summer of 2010 to understand the processes and determinants of transforming primary care practices. ... The results were published Monday in a special supplement of the Annals of Family Medicine (Pittman, 5/20).

Reuters: Health Sites Too Complex, Full Of Cliches: Study
The importance of health literacy hit home for Lisa Gualtieri when a Cambodian refugee diagnosed with cancer asked her to act as a patient advocate. … A new study, published Monday in JAMA Internal Medicine, suggests one potential reason for the family's confusion: Despite good intentions, many experts may be creating educational materials that are too difficult for patients and their families to grasp (Oransky, 5/20).