Healthcare & Research Study #Healthcare #Statsoft #Statistics
by Win Noren
Health care and the costs surrounding it are laden with numbers. Each year we all see our insurance premiums go up, and sometimes even our out-of-pocket costs go up, too (like when the insurance premium goes up and co-pays to access medical care go up). The debate around medical care is contentious and the mis-use of statistics abounds, but that is a topic for a future post.
Recently a peer-reviewed article was published on PLOS Medicine which found a 25% lower relative risk of death through a specific treatment offered in a randomized trial to elderly Americans with at least one chronic illness. Even more amazing is that this treatment had no adverse side effects. And the treatment was cost effective. In fact, in the high-risk subgroup those receiving the treatment had 29% fewer hospitalizations and 20% lower expenditures than those who did not receive the treatment.
So what is this magic bullet and how can I get this treatment for the elderly in my life?
This study was the “Effect of a Community-Base Nursing Intervention on Mortality in Chronically Ill Older Adults: A Randomized Controlled Trial” and, simply put, it was the provision of a nurse who made weekly visits to the elderly patients in their homes. This study came to my attention through a lengthy but very interesting article in the Washington Post published in late April entitled, “If this was a pill, you’d do anything to get it.”
The author of the article is right: the results of this study are quite stunning. The results are exciting in part because it was a randomized trial where the participants were not “cherry picked” but, rather, were randomly assigned to either the treatment group that received the regular in-home nurse visits or to the control group that did not receive the in-home nurse visits. This means that we have a good expectation that these results will hold true for a bigger population instead of the results being a side-effect of putting all the healthiest subjects in the treatment group.
Of course, that IS the big question: Will such a treatment show a similar result in larger populations and in a more diverse population? Since the trial was conducted in a relatively small geographic area (Doylestown, PA), one questions whether the same results would hold true in a group of elderly that are more diverse in ethnicity and economic status.
This study, which was one of 15 conducted as part of a Medicare-funded “demonstration project,” was conducted by Health Quality Partners (HQP). Of the 15 projects only 4 showed improved patient outcomes without increasing costs, and only this study showed improved patient outcomes while decreasing costs. Unfortunately, it appears that Medicare will not be funding this study further. That decision does not seem to make any sense, given the exciting results of the project to date.
At the same time, perhaps there is encouraging news as Aetna has just announced that they are extending their relationship with HQP, as members who enrolled in this program continue “to have fewer hospital admissions and lower medical costs than members with similar conditions who did not participate.” So perhaps other insurance companies and maybe even Medicare will see a reason to join in such an effort.