August 2009

Healthcare Topics and Trends Update

CHRT's monthly online newsletter, providing convenient access to recently-published articles relating to healthcare quality, sustainability and access.

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End of Life

Effects of a Palliative Care Intervention on Clinical Outcomes in Patients With Advanced Cancer: The Project ENABLE II Randomized Controlled Trial

Bakitas, M. et al., JAMA, August 19, 2009 -- Volume 302, No. 7 (Subscription required to view full text)

This study analyzed the data from a randomized control trial of patients with advanced cancer to determine the effect of a nursing-led, palliative care-focused intervention on quality of life and resource use in patients with advanced cancer. The study found that compared to patients receiving usual oncology care, those receiving the palliative care-focused intervention concurrently with oncology care had higher scores for quality of life and mood. While quality of life was higher, patients in the intervention exhibited no improvements in symptoms or reduced resource use (e.g. hospital days, ICU days, or emergency department visits). The evidence base of testing palliative care interventions concurrent with oncology treatment — as recommended by international guidelines and consensus recommendations — is underdeveloped. This study contributes to the increasing evidence that palliative care may improve quality of life and mood at the end of life among patient with advanced cancer, which are high-priority patient-centered goals and two of the main targets of care.

Health Care Costs

Paying the Price: How Health Insurance Premiums Are Eating Up Middle-Class Incomes--State Health Insurance Premium Trends and the Potential of National Reform

Schoen, C., et al., The Commonwealth Fund Data Brief, August 2009

This data brief provides a detailed analysis of federal data regarding rising health insurance premiums across the U.S. The analysis finds that family premiums for employer-sponsored health insurance increased 119 percent between 1999 and 2008, and could increase another 94 percent by 2020 if the current pace of growth continues. The brief also details potential savings from national reforms; for example, if health system reforms were able to slow health care cost increases by 1 to 1.5 percent per year in all states, it would yield from $2,500 to more than $3,700 in premium savings for family coverage by 2020 (compared to projected trends). The brief concludes that rising health care costs and slow growth in real incomes has left individuals and working families spending a greater percentage of their income on health insurance premiums. These data have many policy implications, and the authors advocate for comprehensive national health reform that addresses long-term growth in health care costs.

Radiology

Exposure to Low-Dose Ionizing Radiation from Medical Imaging Procedures

Fazel, R. et al., NEJM Volume 361:849–857 August 27, 2009 Number 9 (Subscription required to view full text)

This three year study of utilization data in five health care markets across the U.S. showed that high/very high doses of radiation from medical imaging procedures occurred in 20.5 per 1,000 enrollees per year. In general, cumulative effective doses of radiation from imaging procedures increased with advancing age and were higher in women than in men. Computed tomographic and nuclear imaging accounted for 75.4 percent of the cumulative effective dose, with 81.8 percent of the total administered in outpatient settings. The study concluded that imaging procedures are an important source of exposure to ionizing radiation in the U.S. and can result in high cumulative effective doses of radiation.

Elements of Danger -- The Case of Medical Imaging

Lauer, M., NEJM Volume 361:841–843 August 27, 2009 Number 9 (Subscription required to view full text)

This article details the harms of unnecessary imaging and direct dangers of irradiation. While the danger is small for isolated imaging events, it is cumulative and causes a small but real increase in the risk of cancer for patients who undergo clusters of tests. The author cautions against investing resources in high numbers of procedures where there is uncertainty; patients also incur costs for procedures of uncertain value. The author recommends that nearly all imaging procedures be studied in well-designed trials in order to show efficacy. He also suggests that physicians talk more explicitly with patients about the risks of radiation exposure and use evidence to judge whether an imaging test will be efficacious for a particular patient in a specific situation.

Safety Net

Community Health Centers Strained by Recession, Face Bigger Caseloads Under Reform

Villegas, A. Kaiser Health News, August 7, 2009.

Federally qualified health centers (FQHCs) have seen caseloads increase significantly with the growing number of uninsured Americans and the economic turmoil of the recent recession. These safety net providers are becoming health care homes to more than just patients without health insurance. Although 39 percent of all health center patients were uninsured in 2007, 35 percent were covered by Medicaid, 16 percent had private insurance, and the remaining were covered by Medicare or other public plans. Based on their history with funding problems in the past, some worry about the long-term sustainability of community health centers and the lack of long-term funding. As the number of patients in these centers rise, it is important to recruit and retain more physicians and medical staff and prepare for continual viability.