AHRQ Study Finds Adverse Selection Potential With Affordable Care Act Coverage

Electronic Newsletter, Issue 419

AHRQ's Electronic Newsletter summarizes Agency research and programmatic activities.

April 8, 2014


AHRQ Stats

From 2000 to 2010, the average cost of an asthma-related hospital stay for children remained stable at about $3,600, while it increased for adults from $5,200 to $6,600. (Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Statistical Brief #169: Trends in Pediatric and Adult Hospital Stays for Asthma, 2000-2010.)

Today's Headlines

  1. AHRQ Study Finds Adverse Selection Potential With Affordable Care Act Coverage.
  2. New AHRQ Study Examines Urinary Catheter Use In Emergency Departments.
  3. EDM Forum Seeks Input on Framework to Assess Data Quality.
  4. Research Suggests Team Training May Improve Care Process and Outcomes.
  5. AHRQ's Web M&M Examines Errors By Previous Providers.
  6. Register Now for AHRQ's MEPS Data Users Workshop May 5–6.
  7. AHRQ in the professional literature.

1. AHRQ Study Finds Adverse Selection Potential With Affordable Care Act Coverage

The Affordable Care Act is designed to ensure that health plans cover both high-risk and low-risk people, but there still may be incentives for plans to dissuade individuals with certain medical conditions from enrolling, according to a new study using AHRQ databases. The study finds the possibility of incentives for adverse selection—the disproportionately high enrollment of high-risk, high-cost people in a health plan—especially for those with costly conditions such as mental health/substance abuse and cancer. The study's authors used AHRQ's Medical Expenditure Panel Survey data and predictive modeling to assess incentives of health plans in the new health insurance marketplaces mandated in the Affordable Care Act. The study abstract, "Assessing Incentives for Service-Level Selection in Private Health Insurance Exchanges," was published online February 17 in Journal of Health Economics. Coauthors included AHRQ's Samuel Zuvekas.

2. New AHRQ Study Examines Urinary Catheter Use In Emergency Departments

A new AHRQ-funded study finds that two-thirds of urinary catheters placed in patients in U.S. emergency departments (ED) were potentially avoidable, as their use was inconsistent with Centers for Disease Control and Prevention guidelines. These findings suggest that reducing inappropriate use of ED-placed catheters may reduce catheter-associated urinary tract infection (CAUTI). The study and abstract appeared online March 13 in Academic Emergency Medicine. The study analyzed National Hospital Ambulatory Medical Care Survey data from 1995 through 2010 on the use of urinary catheters for adult patients in the ED setting. The authors noted that while CAUTI is the most prevalent hospital-acquired infection, little is known about ED use of urinary catheters. The study, "Urinary Catheter Use and Appropriateness in U.S. Emergency Departments, 1995–2010," concluded that EDs should actively engage in prevention efforts that can reduce CAUTI.

3. EDM Forum Seeks Input on Framework to Assess Data Quality

The Electronic Data Methods (EDM) Forum—designed to advance the dialogue on the use of electronic clinical data for comparative effectiveness research, patient-centered outcomes research, quality improvement and support of clinical care—is seeking input to develop a framework for assessing the quality of data in electronic databases. The project is aimed at developing a framework to help clinical investigators, patients and policy makers understand the strengths, weaknesses and limitations of observational data used to generate new clinical knowledge. Participants may access the framework and submit feedback through the EDM Forum Wiki page. Stakeholders are also invited to participate in a brief survey on data quality assessment needs.

4. Research Suggests Team Training May Improve Care Process and Outcomes

A new study funded by AHRQ suggests that team training has a positive impact on health care processes and patient outcomes. "Team-Training in Healthcare: A Narrative Synthesis of the Literature" appeared online February 5 in BMJ Quality & Safety. The number of studies on the effectiveness of team-training programs such as TeamSTEPPS® has increased in the past decade, and recent studies suggest team training may produce significant changes in teamwork behaviors, clinical care practices and patient outcomes. The study found that bundling team-training interventions with effective teamwork implementation strategies may offer the greatest impact on patient outcomes.

5. AHRQ's Web M&M Examines Errors By Previous Providers

The current issue of AHRQ's Web M&M features a Spotlight Case describing a 55-year-old woman on metformin with a history of type 2 diabetes who came to an emergency department after three days of progressive malaise, diffuse abdominal pain, and nausea and vomiting. She had been admitted three times in the previous two months with identical symptoms and each time she was diagnosed with sepsis. In reviewing her medical record at her fourth visit, the admitting team realized the clinical presentation was not consistent with sepsis but with acute lactic acidosis secondary to metformin. The metformin and antibiotics were stopped, and she was treated conservatively and did well. The metformin was added to her allergy list, and she had no further episodes. The Perspective on Safety section of the issue features an interview about infection prevention and patient safety with Alison Holmes, M.D., M.P.H., director of infection prevention and control and a professor at Imperial College London. Infection prevention is also the topic of a commentary by Susan S. Huang, M.D., M.P.H., Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine, School of Medicine.

6. Register Now for AHRQ's MEPS Data Users Workshop May 5–6

AHRQ is hosting a free workshop on the use of the Medical Expenditure Panel Survey (MEPS) May 5–6 in Rockville, Md. The MEPS Data Users Workshop is designed for health services researchers who have a background or interest in using the MEPS Household Component, which includes data from a nationally representative sample of families and individuals in selected communities across the United States. The first day provides a general MEPS overview on survey design, file content and the construction of analytic files. Emphasis is on health care utilization, expenditures and medical conditions. The second day provides hands-on experience in which participants can apply knowledge gained from the previous day's lectures by working with programmers and analysts with MEPS data. Programmers and analysts will be available to offer advice on constructing a MEPS data file. Participants will learn how to identify and pull together variables to build a data file to answer their research questions. To fully benefit from the second day, participants should have some prior knowledge of MEPS. A basic knowledge of SAS software is desirable, but not essential. A laptop computer is provided for participant use. Participants may register for and attend the first day only. Attendance on the first day is required for those who wish to participate on day two.

Registration is now open and registrations will be accepted on a first-come, first-served basis.

7. AHRQ in the Professional Literature

Atlas SJ, Ashburner JM, Chang Y, et al. Population-based breast cancer screening in a primary care network. Am J Manag Care. 2012 Dec;18(12):821-9 Select to access the abstract on PubMed®.

Sarfaty M, Stello B, Johnson M, et al. Colorectal cancer screening in the framework of the medical home model: findings from focus groups and interviews. Am J Med Qual. 2013 Sep-Oct;28(5):422-8. Epub 2013 Jan 18. Select to access the abstract on PubMed®.

Dharmar M, Romano PS, Kuppermann N, et al. Impact of critical care telemedicine consultations on children in rural emergency departments. Crit Care Med 2013 Oct;41(10):2388-95. Select to access the abstract on PubMed®.

Glance LG, Osler TM, Mukamel DB, et al. Trends in racial disparities for injured patients admitted to trauma centers. Health Serv Res 2013 Oct;48(5):1684-703. Select to access the abstract on PubMed®.

Harris AD, Pineles L, Belton B, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013 Oct 16; 310(15):1571-80. Select to access the abstract on PubMed®.

George AJ, Boehme AK, Siegler JE, et al. Hospital-acquired infection underlies poor functional outcome in patients with prolonged length of stay. ISRN Stroke 2013 Aug 14;2013. Select to access the abstract on PubMed®.
Russ AL, Fairbanks RJ, Karsh BT, et al. The science of human factors: separating fact from fiction. BMJ Qual Saf 2013 Oct;22(10):802-8. Select to access the abstract on PubMed®.

Norris SL, Holmer HK, Ogden LA, et al. Conflicts of interest among authors of clinical practice guidelines for glycemic control in type 2 diabetes mellitus. PLoS One 2013 Oct 14;8(10):e75284. Select to access the abstract on PubMed®.


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Page last reviewed April 2014
Internet Citation: AHRQ Study Finds Adverse Selection Potential With Affordable Care Act Coverage: Electronic Newsletter, Issue 419. April 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/419.html