Data Stream
Failure to Plan Reader Beware
Although engagement in advance care planning has
increased in recent years, uptake is slower among
African-Americans, Latinos, and those with less
education and income, according to an analysis of the
long-term National Health and Aging Trends Study. Newspapers often race to report initial positive results from trials, suggesting certain
lifestyle factors have the power to lower disease risk, but they rarely mention when the
results have been overturned in replication studies, according to a PLOS One study.
Of 156 initial studies that associated disease risk with a lifestyle factor (e.g., smoking)
and were covered by newspapers:
Of 2,105 Medicare beneficiaries (>65 years):
60 %
50 %
52 %
51.3 %
had their results disconfirmed
in subsequent analyses.
had
end-of-life
discussions
had a legal
proxy for
health
decisions
had an
advance
directive
48.7 %
had their results confirmed in
subsequent analyses.
13 % 2 %
Although
of initial studies received
newspaper coverage ...
...
only of subsequent
analyses were covered.
“Journalists preferentially cover initial findings, although they are often contradicted by
meta-analyses, and rarely inform the public when they are disconfirmed,” the authors
concluded.
However, these numbers were substantially lower among
minorities. For instance, among Latino patients:
19 %
had
end-of-life
discussions
20 %
had a legal
proxy for
health
decisions
17 %
had an
advance
directive
Source: Dumas-Mallet E, Smith A, Boraud T, Gonon F. Poor replication validity of biomedical association studies
reported by newspapers. PLOS One. 2017 February 21. [Epub ahead of print]
Catching Vulnerable Treat-and-Release Patients
Among 4,636 patients enrolled in the Center for Disease Control’s Sickle Cell Data Collection program
between 2005 and 2014, 88% had at least one “treat-and-release” visit, during which they sought
treatment for pain crises in emergency departments (EDs) and were discharged without receiving optimal
care for sickle cell disease (SCD).
Patients had an average of 2.1 visits per year, but rates of ED use varied greatly.
3 % had ≥11 visits
For example, in 2005:
“Our worry is that these differences may occur because
clinicians are not proactively engaging older adults and
their loved ones in culturally appropriate discussions about
their end-of-life plans and preferences until too late,” the
authors said.
Source: Harrison KL, Adrion ER, Ritchie CS, et al. Low completion and
disparities in advance care planning activities among older Medicare
beneficiaries. JAMA Intern Med. 2016;176:1872-5.
(high ED use)
9 % had 4-10 visits (medium ED use)
53 % of
patients had no
treat-and-release
ED visits (no ED use)
35 % had 1-3 visits
(low ED use)
“Further study of the segment of the population with highest ED [use] may highlight areas where changes
in health care and health policy could improve and extend the lives of patients with SCD,” the authors noted.
Source: Paulukonis ST, Feuchtbaum LB, Coates TD, et al. Emergency department utilization by Californians with sickle cell disease,
2005–2014. Pediatr Blood Cancer. 2016 December 21. [Epub ahead of print]
10
ASH Clinical News
April 2017