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A sizeable minority of strokes occur in hospitalized patients. [Researchers sought to] examine stroke care delivery and outcomes for [973 Canadian] patients with in-hospital vs community-onset stroke. ... Patients with in-hospital stroke compared with those with community-onset stroke had significantly longer waiting times from symptom recognition to neuroimaging ... lower use of thrombolysis [clot-busting drugs] ... and longer time from stroke recognition to administration of thrombolysis. ... After adjustment for age, stroke severity, and other factors, mortality rates at 30 days and 1 year after stroke were similar in those with in-hospital stroke and community-onset stroke; however, those with in-hospital stroke had a longer median length of stay following stroke onset ... and were less likely to be discharged home from the hospital. (Saltman et al., 7/14)

One of the principal strategies contained in the Affordable Care Act (ACA) to achieve near-universal health insurance coverage is expansion of eligibility for the Medicaid program. There has been much debate about whether expansion of the Medicaid program should be used to extend health care benefits to the low-income uninsured. This brief summarizes findings of the Oregon Health Insurance Experiment, a randomized controlled study made possible by a unique lottery process used in 2008 to expand Medicaid coverage in the state. The study addresses many of the issues being considered by policy makers, including take-up rates and characteristics of enrollees; use of health services; health outcomes and measures of well-being; enrollee finances and medical debt; as well as indirect societal effects on labor markets, private insurance coverage, and participation in other public programs. (James, 7/16)

People who are eligible for both Medicare and Medicaid, known as “dual eligibles,” disproportionately are members of racial or ethnic minority groups. They face barriers accessing primary care .... Federally qualified health centers provide services known to address barriers to primary care. We analyzed 2008–10 Medicare data for ... dual eligibles residing in Primary Care Service Areas with nearby federally qualified health centers. Among our findings: There were fewer hospitalizations for ambulatory care–sensitive conditions among blacks and Hispanics who used these health centers than among their counterparts who did not use them (16 percent and 13 percent fewer, respectively). Use of the health centers was also associated with 3 percent and 12 percent fewer hospitalizations for ambulatory care–sensitive conditions among nonelderly disabled blacks and Hispanics, respectively. (Wright, Potter and Trivedi, 7/8)

In recent years, Medicare’s role with respect to end-of-life care has come to the forefront as policymakers and the Administration grapple with whether or not physicians and other health professionals should be reimbursed for talking to patients about their options. ... The following 10 FAQs provide information on Medicare’s current role in end-of-life care and advance care planning. In addition to defining relevant terms, and explaining Medicare coverage for end-of-life care, these FAQs also describe policy proposals being considered by the Administration and Congress regarding advance care planning and care for people with serious and terminal illness. (7/9)

Almost all women use contraception at some point in their life and approximately two-thirds of women of reproductive age currently use contraception. Most, but not all, sources of public and private health insurance coverage now pay for contraceptive services and supplies, but the extent of coverage differs by payer. This fact sheet reviews how coverage of contraceptives varies between private insurance and publicly funded programs including Medicaid, Medicare, TRICARE, the Indian Health Service, and Title X funded clinics. (7/10)

[T]he average provider networks for plans offered on the health insurance exchanges created by the Affordable Care Act (ACA) include 34 percent fewer providers than the average commercial plan offered outside the exchange. The new data quantifies anecdotal reports that exchange networks contain fewer providers than traditional commercial plans. ... Avalere examined the largest rating region in the top five states by 2015 exchange effectuated enrollment: Florida, California, Texas, Georgia, and North Carolina. In each of these rating regions, Avalere compared the average number of providers included, for each of the five provider types examined, in exchange networks compared to commercial networks in the same geographic area. (7/15)

The highest estimates of past year mental health service use were for adults reporting two or more races (17.1 percent), white adults (16.6 percent), and American Indian or Alaska Native adults (15.6 percent), followed by black (8.6 percent), Hispanic (7.3 percent), and Asian (4.9 percent) adults. ... Service cost or lack of insurance coverage was the most frequently cited reason for not using mental health services across all racial/ethnic groups. The belief that use of mental health services would not help was the least frequently cited reason for not using mental health services across all racial/ethnic groups. Among all adults and adults with AMI or SMI, white adults were generally the most likely to cite cost or insurance and believing that services would not help as reasons for not using mental health services compared with other racial/ethnic groups. (7/13)

A study of health care workers in a children’s hospital has found that 83 percent had come to work while sick at least once in the past year, even though almost all believed that working while ill can endanger patients. The study, in JAMA Pediatrics, asked 536 hospital workers about how often they came to work sick. It also asked with what ailments they might do so. Almost 80 percent of the 280 doctors said they would work with a cough or runny nose, and 60 percent with congestion and a sore throat. More than 21 percent said they would come to work with a fever, and almost 8 percent said they would work even if they were vomiting. (Bakalar, 7/13)

Two studies published Tuesday lend support to controversial new cholesterol guidelines that could vastly increase the number of Americans advised to take cholesterol-lowering drugs called statins. One study suggests that the new guidelines are better at identifying who is truly at risk of a heart attack and should be given statins than the older guidelines are. The other suggests that treating people based on the new guidelines would be cost-effective, even with the tremendously increased use of statins. (Pollack, 7/14)

Black patients with advanced colon cancer are less likely to receive chemotherapy after surgery to excise tumors than white patients, a U.S. study suggests. The treatment disparity seen in recent years may be tied to the economic downturn following the 2008 financial crisis, said lead study author Caitlin Murphy, an epidemiology researcher at the University of North Carolina at Chapel Hill. (Rapaport, 7/16)

Nine years after it was first approved in June 2006, the HPV vaccine has had a far more sluggish entree into medical practice than other vaccines at a similar point in their history, according to a report in Tuesday's JAMA. (Henig, 7/14)

Would soccer be safer if young players were not allowed to head the ball? According to a new study of heading and concussions in youth soccer, the answer to that question is not the simple yes that many of us might have hoped. ... People’s concerns about soccer heading and concussions have grown so insistent in the past year or so that some doctors, parents and former professional players have begun to call for banning the practice outright among younger boys and girls, up to about age 14, and curtailing it at other levels of play. (Reynolds, 7/15)

Cancer survivors, who are often left infertile by the disease or treatment, may face unexpected hurdles if they later turn to adoption to start a family, a study suggests. Researchers who contacted adoption agencies found that while all prospective parents were asked to provide a medical history, cancer survivors might also be required to submit letters from physicians or show they were disease free for at least five years. (Rapaport, 7/13)

Organized diet and exercise programs can stave off diabetes for those at risk, according to a new recommendation. The Community Preventive Services Task Force, an independent, unpaid group of public health and prevention experts who develop recommendations for community health, commissioned a review of 53 studies describing 66 combined diet and physical activity promotion programs. The studies were done between 1991 and 2015. (Doyle, 7/13)

Researchers at Washington University have found that some multidrug resistant bacteria intentionally get rid of the genes that protect them from antibiotics. That discovery could eventually provide a new way to treat deadly infections. Molecular microbiologist Mario Feldman, who led the study, said that in the past, infections caused by a bacterium known as Asinetobacter baumannii were easily treated with antibiotics. Not anymore. (Lacapra, 7/15)

Avoiding hospital IDs that say “baby boy” or “baby girl” when parents haven’t chosen a first name for their newborn may help reduce medical errors, a study suggests. As a marker of potential mistakes, researchers analyzed how often doctors order tests, procedures or drugs for one newborn baby and then quickly retract it and place the same order for a different newborn. (Rapaport, 7/13)