2012 Potpourri XXIII

The Annals of Family Medicine publishes research on the effect of an interactive preventive health record on following care recommendations.  The study compared users with people who received normal care.  The intervention consisted of a system which connected patients and providers and gave education, recommendations and reminders to patients.  Although only a minority of patients who were invited to do so agreed to use the system, and not even all of those actually did use it, among users the receipt of recommended preventive care rose substantially, so that almost double the number of users compared to non-users were up-to-date with all recommended services.  (Annals Article)

Medicare spending is well-known for variation in per capita variation across states, but there is no correlation with per capita costs for Medicaid recipients in the same state.  But for hospital referral regions within states, there is much more of a correlation.  Research published in Health Affairs suggests that this reflects the importance of more local factors like hospital bed supply, number of specialists and quantity of other health resources at the regional level, but that demographic factors may be more important at the state level.  The authors caution that this means policies aimed at reducing reimbursement in high-spending Medicare states may have unintended consequences for other populations.   (Health Affairs Article)

Research published in the Archives of Internal Medicine examines shared decision-making.  Patients reacted to a hypothetical scenario in regard to three key behaviors:  asking questions, discussing their preferences and voicing disagreement.  Among the study participants, 11.% thought  should make decisions, 19% thought the physician should be responsible and 70% preferred shared decision-making.  While almost all participants could envision asking questions and discussing preferences, only a small number, 14%, would feel comfortable voicing disagreement.    Concerns were being seen as a difficult patient, damaging their relationship with the doctor and interfering with getting care.   (Archives Article)

A study in the Annals of Internal Medicine looked at 30 day readmissions related to heart attacks.  This is another piece of research suggesting that the current use of this as a quality indicator is flawed.  Over 3010 patients hospitalized for a first heart attack  were scrutinized.  Of these 561 had a least one rehospitalization in 30 days.  Over 30% were unrelated to the initial admission, about 43% were related and it was unclear in the rest, even after chart review, which itself should be a matter of concern.  Factors associated with readmissions were comorbid conditions, longer length of stay at the index admission (duh) and complications of angiography and revascularization.    (Annals Article)

Another study in Health Affairs looks at Japan’s system of controlling health spending by using all-payer rate setting.  While Japan has a fee-for-service payment system, an elderly population and other features that might be expected to drive up costs, but in 2008 it spent 8.5% of GDP on health while the US spent 16.4%.  The authors largely attribute this to the rate setting mechanism employed by the government, which prevents cost-shifting and forces providers and suppliers to control costs.  Providers cannot balance bill for more than the fee schedule and their ability to charge for services not covered by the statutory benefit package is also limited.   (Health Affairs Article)