News from Annals of Internal Medicine Dec. 2, 2014

Having diabetes or prediabetes in midlife is associated with a greater risk for cognitive decline later in life, according to a study published in Annals of Internal Medicine. Approximately 10 percent of the U.S. population has type 2 diabetes, putting them at risk for several adverse health outcomes, including dementia. Cognitive decline is a precursor to dementia. Hemoglobin A1c (HbA1c) level is a measure of the average circulating glucose level in the blood over the preceding 2 to 3 months and studies have shown an association between HBA1c level and cognitive scores in those with diabetes. Researchers studied 13,351 adults aged 48 to 67 years to determine whether diabetes in midlife is associated with 20-year cognitive decline and to characterize long-term cognitive decline across clinical categories of HbA1c. Diabetes status and cognitive function were established at baseline and cognitive function was assessed periodically during the 20-year follow-up. The researchers found significantly greater cognitive decline among adults with diabetes and prediabetes than those without diabetes at baseline, and those with longer-duration diabetes were found to have greater cognitive decline.

Note: The URL for this story will be live when embargo lifts. For a PDF, please contact Megan Hanks. To interview the lead author, please contact Stephanie Desmon at sdesmon1@jhu.edu or 410-955-7619.

Living in a socioeconomically disadvantaged neighborhood puts patients at high risk for rehospitalization, according to a study published in Annals of Internal Medicine. Socioeconomic disadvantage is characterized by low income, limited education, and substandard living conditions in one's neighborhood or social network. These factors may contribute to rehospitalization but are often overlooked when creating individual care plans post discharge. Researchers sought to determine the relationship between neighborhood socioeconomic disadvantage and 30-day rehospitalization rates. They reviewed health records for a random national sample of Medicare patients (n = 255,744) discharged from the hospital with congestive heart failure, pneumonia, or acute myocardial infarction. Medicare data were linked to 2000 census data to determine the area deprivation index, or ADI (a composite measure of neighborhood socioeconomic disadvantage), for each patient's ZIP+4 residence. They found that patients who lived in socioeconomically disadvantaged neighborhoods in the U.S. had higher rehospitalization rates regardless of which hospital provided the initial treatment. Living in a disadvantaged neighborhood predicted rehospitalization as strongly as the presence of chronic disease. The authors conclude that neighborhood disadvantage should be easy to measure using data routinely collected by the U.S. government and may be useful in targeting patient-and community-based initiatives for lowering rehospitalization rates.

Note: The URL for this story will be live when embargo lifts. For a PDF, please contact Megan Hanks. To interview the lead author, please contact Susan Smith at SSmith5@uwhealth.org or 608-890-5643.

Sharing clinical data with other health care providers through the use of health information exchange (HIE) may reduce emergency room usage and costs, according to a review article published in Annals of Internal Medicine. HIEs were developed to address the fragmentation of patient care across providers by giving physicians a way to share data with other providers who care for the same patients. The U.S. government provides financial incentives to providers that use HIEs but only about 30 percent of hospitals and 10 percent of ambulatory clinics participate. Researchers conducted a systematic review of published evidence to determine if this participation had an effect on clinical care. They found that relatively few of the HIE organizations in the U.S. have been evaluated for their effects on outcomes of care, but low-strength evidence suggests an association between HIE use and reduced utilization and cost in the ER. The researchers suggest further research to specifically evaluate whether use of HIE improves patient outcomes.

Note: The URL for this story will be live when embargo lifts. For a PDF, please contact Megan Hanks. To interview the lead author, please contact Warren Robak at robak@rand.org or 310-451-6913.

Geographic variation in utilization of health care services may not be a reliable indicator of the extent of overuse, according to an article published in Annals of Internal Medicine. Wide variations in medical care use that are not associated with better outcomes and cannot be explained by patient characteristics are often considered proof of waste in the U.S. health care system. To test this assumption, researchers studied health records of older men with lung, colorectal, or prostate cancer to compare average use and geographic variation in use of cancer-related imaging between fee-for service Medicare (n = 34,475) and the department of Veterans Affairs (VA) (n = 6,835) health care system. The researchers found that adjusted annual use of cancer-related imaging was nearly 50 percent lower in the VA cohort compared to the Medicare cohort in the same geographic areas. However, varied by region as much for VA patients as for Medicare patients. These findings demonstrate that geographic variation in use of imaging studies does not necessarily indicate overuse of these studies.

Note: The URL for this story will be live when embargo lifts. For a PDF, please contact Megan Hanks. To interview the lead author, please contact David Cameron at David_Cameron@hms.harvard.edu.

###