In This Section
In the News: Asthma Insurance and Monitoring, Cancer Survivors' Endocrine Abnormalities
Many research projects aim to keep things on track, from healthcare expenditures to patients’ long-term health. This week’s In the News shares three timely examples, including a study that considered how hospital practice patterns may be influenced by patients’ Medicaid status, an innovative way to monitor asthma patients’ medication usage, and new evidence that demonstrates the importance of lifelong screening of childhood cancer survivors for endocrine abnormalities. Make certain that you know of the research happenings this week at The Children’s Hospital of Philadelphia by reading on for more highlights.
Medicaid Status Has Little Effect on Hospital Practice Patterns for Pediatric Asthma
Researchers at CHOP wanted to know whether the care of Medicaid patients differed from the care of non-Medicaid patients within the same hospital who were admitted for acute asthma. After studying more than 17,000 pairs of pediatric asthma inpatients from 40 U.S. children’s hospitals, they had a reassuring answer: Medicaid and non-Medicaid patients received comparable treatment.
The authors chose asthma because it’s the most prevalent chronic illness among children, and it is a leading cause of hospitalization among U.S. children ages 1 to 15. Unlike many previous studies, the researchers used matched pairs of patients based on age, sex, and asthma severity to ensure that patient populations had similar clinical presentations. The median patient cost was $4,263 for Medicaid patients versus $4,160 for non-Medicaid patients.
The median length of stay was one day for both groups, and intensive care unit (ICU) use was also comparable: 7.1 percent of Medicaid patients used the ICU, as did 6.7 percent of non-Medicaid patients. Although Medicaid payments to providers tend to be lower than private medical insurance reimbursements, these results suggest that within each hospital, Medicaid status has little effect on inpatient costs, ICU use, and length of stay.
“Ongoing monitoring for disparities in treatment is a fundamental responsibility of any insurance system, but must be done with great care,” said study leader Jeffrey Silber, MD, PhD, director of the Center for Outcomes Research at CHOP. “We have demonstrated that multivariate matching is ideally suited to ensure fairness when comparing groups of children, allowing for more meaningful audits, and for potentially actionable results should differential care be observed. For asthma, we are glad to report that we did not find meaningful differences in treatment style between Medicaid and non-Medicaid children hospitalized for asthma inside children’s hospitals.”
Leveraging Technology for Families of High-risk Children With Asthma
On the other side of the asthma care spectrum, researchers from PolicyLab at CHOP studied an innovative way to use electronic reminder systems to improve adherence rates to daily controller medications prescribed to children with asthma. The study focused on 14 black children with a high use of asthma care in West Philadelphia. Previous studies have shown that high-risk minority children have demonstrated adherence rates of only 11 percent to 45 percent.
Chén Kenyon, MD, MSHP, described the current study in a PolicyLab blog. The researchers affixed Bluetooth-enabled electronic inhaler monitoring devices to their rescue and controller medications, provided them with cellular modems that automatically uploaded inhaler use onto an adherence monitoring web platform, and programmed pre-defined medication use alerts. Community health workers contacted families when they underused daily controller medicines or overused rescue medications and then helped them to follow their asthma action plans.
While the families who completed the study reported that they liked the devices and appreciated community health workers’ support, the study team identified several challenges to mainstream adoption of electronic medication monitoring interventions in high-risk populations. Dr. Kenyon pointed out that feasibility concerns, such as recruitment, data transmission failure, and lost devices, should be carefully considered when designing interventions in this setting.
The study results appeared in JMIR Research Protocols, a journal of medical internet research.
Childhood Cancer Survivors Require Lifelong Monitoring for Endocrine Abnormalities Due to Cancer Therapy
According to results from the Childhood Cancer Survivor Study, a multi-institutional cohort that included many CHOP patients, childhood cancer survivors are at increased risk for endocrine system disorders over time. Lead author Sogol Mostoufi-Moab, MD, MSCE, an oncologist and endocrinologist at CHOP, and her co-authors note that these findings support the need for continued risk-based endocrine screening throughout adulthood.
The endocrine system, a group of glands that help control growth, metabolism, puberty, and stress responses, is especially sensitive to chemotherapy and radiation. The study aimed to build evidence on the prevalence and cumulative incidence of endocrine abnormalities in childhood cancer survivors beyond young adulthood.
The investigators analyzed 14,290 survivors who were diagnosed with cancer before age 21 and were treated between 1970 and 1986. Their median age of cancer diagnosis was 6 years, and median age at last follow-up was 32. The study participants completed multi-item surveys that included their age at the onset of endocrine conditions such as underactive or overactive thyroid, thyroid nodule, thyroid cancer, hypopituitarism, osteoporosis, obesity, diabetes mellitus, male gonadal dysfunction, and premature ovarian insufficiency. The researchers compared these self-reported conditions in survivors according to cancer therapy such as head and neck, pelvic, abdominal or total body radiation, and alkylating chemotherapy. For common endocrine disorders such as thyroid abnormalities, obesity, and diabetes mellitus, survivors were compared to 4,031 siblings.
The results, which were published in the Journal of Clinical Oncology, showed that 44 percent of survivors demonstrated at least one endocrinopathy, 16.7 percent at least two, and 6.6 percent three or more. Survivors of Hodgkin lymphoma had the highest frequency of an endocrine abnormality (60 percent) followed by survivors of central nervous system tumors (54 percent).
The study authors concluded that, “Even childhood cancer survivors treated with non-high risk therapies demonstrated an increased risk for certain endocrine outcomes compared with siblings, highlighting the need for long-term surveillance and individualized screening practices in childhood cancer survivors even in the absence of high-risk treatment exposures.”
See more news coverage in this Philly.com article.
In case you missed it, earlier this week on Cornerstone we chatted with Lindsey Albenberg, DO, a pediatric gastroenterologist at CHOP, about the microbes that are on us and in us. “There has been an explosion of studies and of data and literature that try to link the microbiomes of the various body sites to different disease processes,” Dr. Albenberg said.
Last week’s In the News post brought news of tiny bacteria facing a big fight, newborns in families getting help with financial challenges, and tiny DNA molecules having a big impact on medicine.
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