Depression care in the United States: too little for too few

This study used Collaborative Psychiatric Epidemiology Surveys (CPES) data to calculate nationally representative estimates of depression care. Depression severity was assessed with the Quick Inventory of Depressive Symptomatology Self-Report. Primary predictors were major ethnic/racial groups (Mexican American, Puerto Rican, Caribbean black, African American, and non-Latino white) and World Mental Health Composite International Diagnostic Interview criteria for 12-month major depressive episode. The researchers found that few Americans with recent major depression have used depression therapies and guideline-concordant therapies; however, the lowest rates of use were found among Mexican American and African American individuals. Ethnic/racial differences were found despite comparable depression care need. More Americans with recent major depression used psychotherapy over pharmacotherapy, and these differences were most pronounced among Mexican American and African American individuals. This report highlights the importance of disaggregating ethnic/racial groups and depression therapies in understanding and directing efforts to improve depression care in the United States.

Testing, Testing: The health-care bill has no master plan for curbing costs. Is that a bad thing?

In this essay, author Atul Gawande says the cost of health care "...will essentially devour all our future wage increases and economic growth. The cost problem, people have come to realize, threatens not just our prosperity but our solvency." "So what does the reform package do about it? ...Does it institute nationwide structural changes that curb costs and raise quality? It does not. Instead what it offers is ...pilot programs."

Gawande continues to compare U.S. healthcare to the history of how the Agricultural Extension service did research, developed pilots to test the results, persuaded farmers to try the pilots, and sparked the agricultural revolution that benefited the U.S. economy in the first half of the 20th century. He concludes by suggesting that the many pilot programs for health care improvement proposed in the Senate bill could lead to a similar result and transform American health care.

Forecasting the Effects of Obesity and Smoking on U.S. Life Expectancy

Although increases in obesity over the past 30 years have adversely affected the health of the U.S. population, there have also been reductions in smoking. Having a better understanding of the dual effects of these trends on longevity and quality of life will facilitate more efficient targeting of health care resources. In this study, for 2005 through 2020, researchers forecasted life expectancy and quality-adjusted life expectancy for a representative 18-year-old, assuming a continuation of past trends in smoking, and past trends in body-mass index (BMI) . The 2003 Medical Expenditure Panel Survey was used to examine the effects of smoking and BMI on health-related quality of life.  The study found that  the negative effects of increasing BMI overwhelmed the positive effects of declines in smoking in multiple scenarios. In the base case, increases in the remaining life expectancy of a typical 18-year-old are held back by 0.71 years or 0.91 quality-adjusted years between 2005 and 2020. If all U.S. adults became nonsmokers of normal weight by 2020, and  that the life expectancy of an 18-year-old would increase by 3.76 life-years or 5.16 quality-adjusted years. The authors conclude that if past obesity trends continue unchecked, the negative effects on the health of the U.S. population will increasingly outweigh the positive effects gained from declining smoking rates. Failure to address continued increases in obesity could result in an erosion of the pattern of steady gains in health observed since early in the 20th century.

Abdominal CT scans overused: study

More than half of patients who undergo abdominal/pelvic CT scans receive unnecessary imaging tests that put them at risk for radiation-induced cancer, according to recent research from the University of Wisconsin in Madison. The study reviewed 978 CT scans of the abdomen and pelvis that were performed on 500 patients and found that 52.2 percent of the patients' scans weren't necessary. The researchers found that the average excess radiation dose per patient was 11.3 millisieverts, about the equivalent of 113 chest X-rays. This study adds to the body of knowledge regarding radiation overdoses, which have been prominently reported  in the news over the last few months.

Public Reporting of Discharge Planning and Rates of Readmissions

A reduction in hospital readmissions may improve quality and reduce costs. The Centers for Medicare and Medicaid Services has initiated a national effort to measure and publicly report on the conduct of discharge planning.This study examined hospital performance on the basis of two measures of discharge planning: the adequacy of documentation in the chart that discharge instructions were provided to patients with congestive heart failure, and patient-reported experiences with discharge planning. The authors examined the association between performance on these measures and rates of readmission for congestive heart failure and pneumonia. The results indicated a small correlation in performance between the two discharge measures. Although larger hospitals performed better on the chart-based measure, smaller hospitals and those with higher nurse-staffing levels performed better on the patient-reported measure. The researchers found no association between performance on the chart-based measure and readmission rates among patients with congestive heart failure and only a very modest association between performance on the patient-reported measure and readmission rates for congestive heart failure and pneumonia. The authors conclude by suggesting that current efforts to collect and publicly report data on discharge planning are unlikely to yield large reductions in unnecessary readmissions.