Study Estimates COVID-19’s Impact on U.S. Medical Costs, Hospital Use

AHRQ Stats: Traumatic Brain Injury Due to Assault

In 2017, about 25 percent of hospitalizations related to treatment of traumatic brain injuries for children younger than 5 years old were caused by assault. (AHRQ, Healthcare Cost and Utilization Project Statistical Brief #255, Inpatient Stays and Emergency Department Visits Involving Traumatic Brain Injury, 2017.)

Today's Headlines:

• Study Estimates COVID-19’s Impact on U.S. Medical Costs, Hospital Use.
• Medicaid Expansion Leads to More Breast Cancer Treatment.
• Media, Specialty Physicians Among Factors Influencing Uptake of Preventive Services Guidelines.
• Highlights From AHRQ’s Patient Safety Network.
• New Research and Evidence From AHRQ.
• AHRQ in the Professional Literature.

Study Estimates COVID-19’s Impact on U.S. Medical Costs, Hospital Use

The spread of COVID-19 in the United States could result in hundreds of billions of dollars in direct medical costs, according to a study partially funded by AHRQ and published in Health Affairs. Using data from AHRQ’s Healthcare Cost and Utilization Project and other sources, researchers developed computer models to simulate the financial impact that COVID-19 could have on the U.S. healthcare system. The models also quantified the potential magnitude of the use of resources such as ventilators and hospital beds that would be required under various scenarios. Models based on 20 percent of the population developing symptomatic infections generated a median estimate of 11.2 million hospitalizations, 62.3 million hospital bed days, and 1.6 million ventilators used, costing $163.4 billion in direct medical costs. Researchers also estimated that having 80 percent of the population become symptomatically infected could result in a median of 44.6 million hospitalizations, 249.5 million hospital bed days and 6.5 million ventilators used. In that scenario, direct medical costs could reach $654 billion over the course of the pandemic. Access the abstract. 

Medicaid Expansion Leads to More Breast Cancer Treatment

Guideline-recommended hormone treatments for women with breast cancer increased in states that expanded Medicaid, a new AHRQ-funded study has found. In the study, published in Health Services Research, researchers examined Medicaid data from 2011 to 2018. They found that Medicaid-financed hormonal therapy prescriptions increased by 27.2 per 100,000 women compared with states that did not expand Medicaid under the Affordable Care Act (ACA). The ACA expanded Medicaid eligibility, but not every state chose to expand its Medicaid program. Previous studies have not found any change in breast cancer screening rates between expansion and nonexpansion states. This study is the first to demonstrate that Medicaid expansion states experienced increased prescription fills for breast cancer hormonal therapy among women enrolled in Medicaid compared with states that did not expand their Medicaid programs. Access the abstract. 

Media, Specialty Physicians Among Factors Influencing Uptake of Preventive Services Guidelines

Multiple complex factors influence guideline uptake, including the media and the influence of specialty physicians, both of which play a greater role in the uptake of new or updated preventive care guidelines than insurance coverage or other external factors, according to an AHRQ-funded study. In addition, even though primary care clinicians said they are motivated to follow evidence-based guidelines, they expressed concern about negative patient outcomes if guidelines that recommend a reduction in services were followed. Researchers conducted interviews with 15 primary care clinicians and nine practice leaders in five states to better understand the collective impact of factors that influence uptake of preventive guidelines from the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices. Clinicians identified patients’ relationships with them and trust in them as the main factor influencing guideline adoption, and they expressed a large preference for shared decision-making over insisting that new recommendations be followed. Access the abstract of the study published in the Journal of the American Board of Family Medicine. 

Highlights From AHRQ’s Patient Safety Network

AHRQ’s Patient Safety Network (PSNet) highlights journal articles, books and tools related to patient safety. Articles featured this week include:

• COVID-19: Peer support and crisis communication strategies to promote institutional resilience.
• Perioperative COVID-19 defense: an evidence-based approach for optimization of infection control and operating room management.
• Unprecedented solutions for extraordinary times: helping long-term care settings deal with the COVID-19 pandemic.

Review additional new publications in PSNet’s current issue or access recent cases and commentaries in AHRQ’s WebM&M (Morbidity and Mortality Rounds on the Web).

New Research and Evidence From AHRQ

• Technical Brief: Characteristics of Existing Asthma Self-Management Education Packages.
• Diagnosis and Treatment of Clinical Alzheimer’s-Type Dementia: A Systematic Review.
• Draft Systematic Review Open for Comment: Interventions for Dyspnea in Patients With Advanced Cancer.

AHRQ in the Professional Literature

Benefits and harms of prescription drugs and supplements for treatment of clinical Alzheimer-type dementia: a systematic review and meta-analysis. Fink HA, Linskens EJ, Macdonald R, et al. Ann Intern Med 2020 Apr 28. [Epub ahead of print.] Access the abstract on PubMed®.

Accuracy of biomarker testing for neuropathologically defined Alzheimer disease in older adults with dementia: a systematic review. Fink HA, Linskens EJ, Silverman PC, et al. Ann Intern Med 2020 Apr 28. [Epub ahead of print.] Access the abstract on PubMed®.

Brief cognitive tests for distinguishing clinical Alzheimer-type dementia from mild cognitive impairment or normal cognition in older adults with suspected cognitive impairment: a systematic review. Hemmy LS, Linskens EJ, Silverman PC, et al. Ann Intern Med 2020 Apr 28. [Epub ahead of print.] Access the abstract on PubMed®.

Setting a minimum passing standard for the uncertainty communication checklist through patient and physician engagement. Salzman DH, Rising KL, Cameron KA, et al. J Grad Med Educ 2020 Feb;12(1):58-65. Access the abstract on PubMed®.

Effect of acute stroke care regionalization on intravenous alteplase use in two urban counties. Govindarajan P, Shiboski S, Grimes B, et al. Prehosp Emerg Care 2019 Nov 11:1-10. Epub 2019 Oct 11. Access the abstract on PubMed®.

A multifaceted intervention to improve patient knowledge and safe use of opioids: results of the ED EMC2 randomized controlled trial. McCarthy DM, Curtis LM, Courtney DM, et al. Acad Emerg Med 2019 Dec;26(12):1311-25. Epub 2019 Nov 19. Access the abstract on PubMed®.

Factors associated with hospital decisions to purchase robotic surgical systems. Shen C, Gu D, Klein R, et al. MDM Policy Pract 2020 Jan-Jun;5(1). Epub 2020 Feb 2. Access the abstract on PubMed®.

Three quality improvement initiatives and performance of rheumatoid arthritis disease activity measures in electronic health records: results from an interrupted time series study. Gandrup J, Li J, Izadi Z, et al. Arthritis Care Res 2020 Feb;72(2):283-91. Epub 2020 Jan 9. Access the abstract on PubMed®.