JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Early Release: 9:00 a.m. ET, Tuesday, March 13, 2007)
JAMA NEWS RELEASES (ACCESS TO CARE THEME ISSUE)
HEART ATTACK PATIENTS WITH FINANCIAL BARRIERS TO HEALTH CARE HAVE POORER RECOVERY, QUALITY OF LIFE AND HIGHER RISK OF REHOSPITALIZATION
UNINSURED OFTEN RECEIVE LESS MEDICAL CARE, TAKE LONGER TO IMPROVE AFTER SUDDEN HEALTH CHANGE
CHILDBIRTH, PREGNANCY COMPLICATIONS ACCOUNT FOR MAJORITY OF EMERGENCY MEDICAID SPENDING FOR UNDOCUMENTED IMMIGRANTS
A NEW FOCUS FOR HEALTH CARE REFORM: REALIGNING COMPETITION AROUND PATIENT VALUE
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
PREGNANCY COMPLICATIONS AND CHILDBIRTH ACCOUNT FOR BULK OF MEDICAID SPENDING ON IMMIGRANTS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
This week's JAMA Report video is on emergency Medicaid spending for immigrants. The report will be fed Tuesday, March 13, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Intelsat America 6 (C-Band), Transponder 09, Downlink Frequency 3880 MHz Vertical, Audio: 6.2/6.8. For more information, call 312/464-JAMA.
Save the Date: JAMA will present new research from its theme issue on Access to Care at a media briefing on Tuesday, March 13, from 9 – 11:15 a.m., at the National Press Club in Washington, D.C. To register, go to www.jamamedia.org, and click on the Events tab, or call 312-464-JAMA.
Please Note: The FOR THE MEDIA Web site now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org.
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Embargoed for Early Release: 9:00 a.m. ET, Tuesday, March 13, 2007
Media Advisory: To contact Harlan M. Krumholz, M.D., S.M., call Karen Peart at 203-432-1326.
HEART ATTACK PATIENTS WITH FINANCIAL BARRIERS TO HEALTH CARE HAVE POORER RECOVERY, QUALITY OF LIFE AND HIGHER RISK OF REHOSPITALIZATION
WASHINGTON, D.C.—About one in five heart attack patients report having financial barriers to health care services, and these patients are more likely to have a lower quality of life and increased rate of rehospitalization, according to a study in the March 14 issue of JAMA, a theme issue on access to care.
Harlan M. Krumholz, M.D., S.M., of the Yale University School of Medicine, New Haven, Conn., presented the results of the study today at a JAMA media briefing on access to care at the National Press Club.
According to background information in the article, more than 16 million Americans avoid health care due to cost or have trouble affording their medications despite having health insurance. Patients who have difficulty affording health care may have an increased risk for poor health outcomes, though few studies have directly investigated this.
Dr. Krumholz and colleagues conducted a study to determine if self-reported financial barriers (as defined by avoidance due to cost) to health care services or medication were associated with worse outcomes for patients recovering from an acute myocardial infarction (AMI; heart attack). Patients were followed for the year after the heart attack to examine the association of their reported financial barriers with a range of outcomes including death, rehospitalization, and health status. The Prospective Registry Evaluating Myocardial Infarction: Event and Recovery (PREMIER) study included 2,498 patients with AMI who were enrolled from January 2003 through June 2004.
Participants were surveyed at the time of their hospitalization concerning their overall health status and were asked whether they avoided health care services in the prior year due to costs and whether they did not take prescribed medication as instructed due to cost.
The researchers found that the prevalence of self-reported financial barriers to health care services or medication was 18.1 percent and 12.9 percent, respectively. Of the individuals who reported financial barriers to health care services or medication, 68.9 percent and 68.5 percent, respectively, were insured.
By 12 months, individuals who reported financial barriers to health care services had a 12.1 percent higher prevalence of angina; a 11.2 percent higher all-cause rehospitalization rate and an 8.0 percent higher cardiac rehospitalization rate. At one year, individuals who reported financial barriers to medication had a 17 percent higher prevalence of angina; a 19.2 percent higher all-cause rehospitalization rate and a 16.4 percent higher cardiac rehospitalization rate. At 1-year follow-up, individuals with financial barriers to health care services or medications were more likely to have a lower quality-of-life score.
“Financial barriers to health care, as defined by self-reported avoidance of health care services or medication due to cost, are a common and potent risk factor for adverse outcomes in the AMI population,” the authors write. “The findings may be helpful to improve risk stratification of patients and to address structural issues in the health care system predisposing certain patients to worse outcomes. This study provides further support for improved needs assessment and discharge planning combined with a mechanism to facilitate implementation of discharge plans.”
(JAMA. 2007;297:1063-1072. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was funded in large part by Cardiovascular Therapeutics, Inc., Palo Alto, Calif.; Cardiovascular Outcomes, Inc., Kansas City, Mo.; and the National Heart, Lung, and Blood Institute. Co-author John A. Spertus, M.D., M.P.H., reported that he has a research grant from Cardiovascular Therapeutics, Inc., and was a consultant for that company. Co-author Susannah M. Bernheim, M.D., M.H.S., was a fellow in the Robert Wood Johnson Clinical Scholars Program during the time the work was conducted. Dr. Krumholz reported that he was a consultant for Cardiovascular Therapeutics, Inc. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Early Release: 9:00 a.m. ET, Tuesday, March 13, 2007
Media Advisory: To contact Jack Hadley, Ph.D., call 202-261-5438.
UNINSURED OFTEN RECEIVE LESS MEDICAL CARE, TAKE LONGER TO IMPROVE AFTER SUDDEN HEALTH CHANGE
WASHINGTON, D.C.—Among individuals who experience a change in health caused by an unintentional injury or new chronic condition, those without insurance are more likely to have difficulty obtaining recommended medical care and more likely to experience larger declines in short-term health, according to a study in the March 14 issue of JAMA, a theme issue on access to care.
Jack Hadley, Ph.D., of the Urban Institute, Washington, D.C., presented the results of the study today at a JAMA media briefing on access to care at the National Press Club.
The large and increasing number of uninsured individuals in the U.S. underscores the importance of knowing the health consequences of being uninsured, according to background information in the article.
Dr. Hadley conducted a study to examine whether uninsured individuals who experienced a health shock caused by either the onset of a chronic condition or an unintentional injury received the same amount of medical care and had similar short-term health outcomes as insured individuals. He analyzed data from Medical Expenditure Panel Surveys (1997-2004), limited to nonelderly individuals whose insurance status was established for two months prior to one or more unintentional injuries (20,783 cases among 15,866 individuals) and onset of one or more chronic conditions (10,485 cases among 7,954 individuals).
Dr. Hadley found that after experiencing a health shock, uninsured individuals were less likely to obtain any medical care: those with an unintentional injury (UI), were 53 percent less likely; those with a new chronic condition (NCC), were 55 percent less likely to obtain any medical care.
Among those who received some care, the uninsured were more likely not to have received any recommended follow-up care: the UI group were 2.6 times more likely, while those with a new chronic condition were 1.7 times more likely.
Results of the research also indicated that uninsured individuals with UIs or a NCC had fewer office-based visits and prescription medicines. Higher proportions of uninsured individuals reported a decrease in health status (classified as much worse) approximately 3.5 months after the health shock. Uninsured individuals with UIs were more likely to report not being fully recovered and no longer receiving treatment. At approximately seven months after the health shock, uninsured individuals with NCCs still reported worse health status.
“The findings for uninsured individuals with a new chronic condition are of particular concern. Because chronic conditions generally require care over an extended period, the finding that the uninsured are more likely to report no longer being treated at the first follow-up interview suggests that their care may have been inadequate. Moreover, their greater dependence on emergency departments for care probably increases the likelihood that their care will be episodic and lack continuity. For individuals who require treatment for chronic conditions, a continuing relationship with a clinician and appropriate medication use may be especially important for improving or maintaining health status,” Dr. Hadley writes.
“The results of this analysis imply that the failure to address the problem of no insurance for U.S. individuals will have adverse health consequences. Moreover, the fact that these consequences apply to uninsured individuals who experienced unintentional injuries or new chronic conditions runs counter to the perception that the uninsured receive care, either through the safety net or their own resources, when they really need it (e.g., when they experience a health shock from an unintentional injury or develop a new chronic condition),” he writes. “If the proportion of individuals without insurance continues to increase, more and more persons may experience preventable deteriorations in their health.”
(JAMA. 2007;297:1073-1084. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The research for this article was supported by contracts from the Kaiser Family Foundation, Washington, D.C. Please see the article for additional information, including author contributions and affiliations, financial disclosures, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Early Release: 9:00 a.m. ET, Tuesday, March 13, 2007
Media Advisory: To contact C. Annette DuBard, M.D., M.P.H., call Becky Oskin at 919-962-8596.
CHILDBIRTH, PREGNANCY COMPLICATIONS ACCOUNT FOR MAJORITY OF EMERGENCY MEDICAID SPENDING FOR UNDOCUMENTED IMMIGRANTS
WASHINGTON, D.C.—A large majority of the Emergency Medicaid expenditures in North Carolina are for childbirth and complications of pregnancy for patients who are undocumented immigrants, although spending for undocumented elderly and disabled patients is increasing at a faster rate, according to a study in the March 14 issue of JAMA, a theme issue on access to care.
C. Annette DuBard, M.D., M.P.H., of the University of North Carolina, Chapel Hill, presented the results of the study today at a JAMA media briefing on access to care at the National Press Club.
A steady increase in the number of foreign-born adults and children living in the United States has fueled debate about the financial burden new immigrants may place on publicly funded health care, but relatively little is known about the health status and health services use of this population, according to background information in the article. Undocumented immigrants constitute an increasing proportion of newly arrived individuals, with numbers now estimated to exceed 10 million, or 29 percent of the total U.S. foreign-born population.
Federal law generally excludes undocumented immigrants, as well as legal immigrants who have been in the United States less than 5 years, from Medicaid eligibility. These individuals can, however, receive Medicaid coverage for emergency medical services (Emergency Medicaid) if they belong to a Medicaid-eligible category, such as children, pregnant women, families with dependent children, elderly or disabled individuals, and if they meet state income and residency requirements.
Dr. DuBard and Mark Wayne Massing, M.D., M.P.H., Ph.D., of the Carolinas Center for Medical Excellence, Cary, N.C., analyzed administrative claims data related to the Emergency Medicaid program in North Carolina from 2001 through 2004 to determine the sociodemographic characteristics of the population served, expenditures including trends over time, and the types of diagnoses by cost and by frequency of hospitalization.
The researchers found that a total of 48,391 individuals received Emergency Medicaid coverage between 2001 and 2004. Among these patients, 99 percent were undocumented, 93 percent were Hispanic, 95 percent were female, and 89 percent were in the 18- to 40-year age group. Emergency Medicaid spending increased by 28 percent during this period. Approximately 82 percent of Emergency Medicaid spending in 2004 was for childbirth and complications of pregnancy, and these accounted for 91 percent of hospitalizations. Injury and poisoning accounted for approximately one-third of the remaining spending. While spending for pregnant women increased by 22 percent during the 4-year period, spending increased by 70 percent for families with dependent children, 82 percent for disabled patients, and 98 percent for elderly patients.
“The trends in use and expenditures under North Carolina’s Emergency Medicaid program described in this study provide important insights into the health care needs of immigrants in new-growth states, and reveal the limited scope of services for which publicly funded reimbursement is applicable under current federal law,” the authors write.
“Medicaid spending for emergency care of recent and undocumented immigrants, although a small proportion of the total Medicaid budget, is increasing rapidly in this new immigrant growth state. Emergency Medicaid is predominantly a program for childbirth coverage, although use and spending are shifting toward non-pregnant adults, particularly those who are elderly and disabled. Increased access to comprehensive contraceptive and prenatal care, injury prevention initiatives, preventive care, and chronic disease management may make better use of the public health care dollar by improving the health status of this population and alleviating demand for costly emergency care.”
(JAMA. 2007;297:1085-1092. Available to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Early Release: 9:00 a.m. ET, Tuesday, March 13, 2007
Media Advisory: To contact Michael E. Porter, Ph.D., M.B.A., call Lyn Pohl at 617-495-6082.
A NEW FOCUS FOR HEALTH CARE REFORM: REALIGNING COMPETITION AROUND PATIENT VALUE
WASHINGTON, D.C.—The health care policy debate is stuck in a place that undermines physicians and the nation’s health. The real problem is not cost, but value, according to an article in the March 14 issue of JAMA, a theme issue on access to care. The only real solution to the national health care problem is to dramatically increase the value of the care delivered for all the money being spent. And that, the authors argue, is an effort that must be market based, medically sound and physician led.
Michael E. Porter, Ph.D., M.B.A., of Harvard University, Cambridge, Mass., and the Harvard Business School, presented the article today at a JAMA media briefing on access to care at the National Press Club.
Dr. Porter and Elizabeth Olmsted Teisberg, Ph.D., M.Engr., M.S., of the University of Virginia, Charlottesville, examined the status of health care today, and propose a strategy for reform.
The authors write that the health sector today has the wrong kind of competition. Each player in the system gains not by increasing value for the patient but by taking value away from someone else. This does not improve health outcomes per dollar spent—in fact, it often does the opposite. Health care competition does not have to be zero sum. The authors make the positive case for realigning competition around patient value, and they call on physicians to lead this change and return the practice of medicine to its appropriate focus: enabling health and effective care.
The authors’ proposal highlights three principles that will put competition on the right track: 1) the goal is value for patients, (2) medical practice should be organized around medical conditions and integrated care cycles, and (3) results—risk-adjusted outcomes and costs for each medical condition—must be measured.
The Goal Is Value for Patients
“Improving value for patients is clearly the only valid goal for ethical reasons. It is also the only goal that aligns the interests of patients, physicians, health insurance plans, employers, and government. If physicians improve value for patients, they will be able to credibly engage Medicare and health plans in new contracting and reimbursement practices that reward such value.”
Organize Around Medical Conditions and Care Cycles
Dramatic improvements in value will require the restructuring of health care delivery, the authors argue. “Organizing care around medical conditions, rather than specialties or procedures, is key to improving value to patients. A medical condition is a set of interrelated patient medical circumstances that are best addressed in an integrated way. This encompasses conditions as physicians usually define them, such as diabetes, congestive heart failure, arthritis, or breast cancer. But this definition differs by including all needed specialties and the prevalent co-morbidities, such as diabetes combined with vascular problems or hypertension.”
“For virtually every condition, the cycle of care begins with screening and prevention and extends all the way through preparation, treatment, recovery, ongoing monitoring, and active disease management in the case of chronic conditions. Multiple specialties, services and even entities are involved in the cycle of care. Value for patients comes from the overall effect of the entire sequence of activities, not from any individual service.” The authors note that physicians are beginning to organize care around medical conditions and are forming institutes, centers, and other types of integrated structures that bring needed specialties and expertise together and encompass the care cycle.
“Better integration of treatment with prevention, rehabilitation, and disease management will reveal obvious ways to improve the overall outcomes and reduce costs. It will also point the way to how to change the broken reimbursement system.”
Measuring Results
“There is simply no way to achieve large and sustained improvements in value for patient without measuring results: the set of risk-adjusted outcomes of care for each medical condition, together with the costs of achieving those outcomes. Processes of care, the focus of much of today’s quality movement, are not results. Good outcome measures are vital feedback indicating what works and what does not. These measures enable professional insight and the development of expertise.”
“Designing risk-adjusted outcomes measures is not easy, but their practicality has been convincingly demonstrated. In some very complex areas of care, such as intensive care, transplant surgery, cardiac surgery, and long-term care for cystic fibrosis, validated measures have been available for many years. Clinicians can and should develop meaningful measures,” they write. “Results information reveals one of the most crucial insights about health care delivery: truly high-quality care is usually less costly. One of the most important reasons to measure results is that the best way to reduce costs is to improve outcomes.”
How Value-Based Care Delivery Could Change Medicine
The authors write that implementing these reforms will create powerful ripple effects throughout the health care system, including more effective collaborations between physicians and care teams, greater patient involvement in their health care, fewer malpractice suits, more supportive health plans and government payers, new means for reimbursement, and higher performance levels by physicians and care teams and an improvement in overall value of patient care.
“Paying for care cycles and rewarding value is ultimately the only feasible way to change a reimbursement system that everyone knows to be broken. When value rules, the nation will finally get better outcomes for every dollar spent on care. Competition on value, then, must become the nation’s health strategy. Improving health and health care value for patients is the only real solution. Value-based competition on results provides a path for reform that recognizes the role of health professionals at the heart of the system. In the economy at large, competition on value underlies the wealth of nations. It can transform the health of nations as well,” the authors conclude.
(JAMA. 2007;297:1103-1111. Available to the media at www.jamamedia.org)
Editor's Note: The George W. Baker Foundation at Harvard Business School and the New England Healthcare Institute provided financial support for the authors’ research during the time that this article was written. The authors receive royalties for their book Redefining Health Care and honoraria for presentations and discussions related to it. They each own stock in a number of companies that are suppliers to the health care sector.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
PREGNANCY COMPLICATIONS AND CHILDBIRTH ACCOUNT FOR BULK OF MEDICAID SPENDING ON IMMIGRANTS
INTRO:
Undocumented immigrants, and legal immigrants who’ve been in the U.S. less than five years, are NOT eligible for Medicaid health coverage. But they can get some Medicaid coverage for health emergencies. So how much money is Medicaid spending on emergency care for these immigrants? Mavis Prall explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Dr. DuBard talking with pregnant patient in exam room
Dr. DuBard in office with colleague
Emergency sign outside hospital
AUDIO:
ANNETTE DUBARD (doo-BARD) IS A FAMILY PHYSICIAN AT A COMMUNITY HEALTH CLINIC IN NORTH CAROLINA, WHERE SHE TREATS A LARGE NUMBER OF LATINO IMMIGRANTS. SHE’S ALSO A RESEARCHER AT UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL. SHE AND A COLLEAGUE STUDIED THE WAY HER STATE SPENDS MEDICAID DOLLARS ON EMERGENCY CARE FOR IMMIGRANTS.
VIDEO:
SOT/FULL
@ :19
Super: Annette DuBard, M.D., M.P.H.
University of North Carolina at Chapel Hill
Runs :16
AUDIO:
“There’s a common public perception that somehow we’re spending a lot of Medicaid money on new or undocumented immigrants, so it is important to keep this in perspective that this accounted for less than one percent of total Medicaid spending in North Carolina.”
VIDEO:
B-ROLL
GFX/JAMA COVER
Emergency department exterior shots
Ambulance driving away
AUDIO:
THE STUDY, PUBLISHED IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, TALLIED EMERGENCY MEDICAID SPENDING IN NORTH CAROLINA FROM 2001 THROUGH 2004. THAT SPENDING DID INCREASE BY ALMOST A THIRD DURING THOSE YEARS, FROM FORTY-ONE MILLION DOLLARS TO FIFTY-THREE MILLION DOLLARS.
VIDEO:
SOT/FULL
Annette DuBard, M.D., M.P.H.
University of North Carolina at Chapel Hill
Runs :16
AUDIO:
“48,000 individuals received emergency care reimbursed under Medicaid in North Carolina during these four years. Nine out of ten were pregnant women receiving care for labor and delivery or for emergency complications of their pregnancies.”
VIDEO:
B-ROLL
Pregnant woman lying on exam table
Dr. DuBard listening to baby’s heartbeat
People sitting wheelchair/with walker
AUDIO:
UNLIKE THIS WOMAN, THE WOMEN IN THE STUDY HAD NO COVERAGE FOR PRENATAL CARE, AND HAD NOWHERE ELSE TO GO BUT THE EMERGENCY ROOM. BUT IT WAS ACTUALLY SPENDING FOR ELDERLY AND DISABLED IMMIGRANTS THAT INCREASED AT A FASTER RATE DURING THE STUDY. THOSE PEOPLE, IF THEY WEREN’T IMMIGRANTS, WOULD HAVE COVERAGE SUCH AS MEDICARE.
VIDEO:
SOT/FULL
Annette DuBard, M.D., M.P.H.
University of North Carolina at Chapel Hill
Runs :15
AUDIO:
“It’s important to recognize that we are not spending as much on this population as people generally think, but we are spending at the wrong end of care and we could stretch the healthcare dollar further by emphasizing preventive care.”
VIDEO:
B-ROLL
Mariela sitting in waiting area
Mom and baby going into clinic
AUDIO:
MARIELA HERNANDEZ CAME HERE FROM MEXICO AS A CHILD AND HAS MANY IMMIGRANT FRIENDS WHO STRUGGLE TO GET HEALTHCARE.
VIDEO:
SOT/FULL
@ 1:42
Super: Mariela Hernandez
Immigrant from Mexico
Runs :03
AUDIO:
“The way to help would be to have the insurance not to be so expensive.”
VIDEO:
B-ROLL
Mariela walking to/at counter in clinic
AUDIO:
SHE SAYS THAT WAY, MORE IMMIGRANTS COULD ACCESS, AND HELP PAY FOR, HEALTHCARE. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
Some states do offer health coverage for legal immigrants within their first five years in the U.S., or for pregnant women and children who are undocumented immigrants. But the authors say other states, or the federal government, need to consider immigrants as they make plans to reform American healthcare. For more information, visit www.jama.com.
