Researchers in China showed that a community health worker intervention to treat high blood pressure substantially reduced hypertension, dementia and death. In just four years, those over 40 who lived in villages that were randomized to get this intervention had statistically significantly lower blood pressure and lower rates of dementia, cognitive impairment without dementia and death compared to residents of villages that received usual care. This research report was published in Nature.
In the study, about 34,000 people had a lower rate of dementia. The rate of cognitive impairment without dementia was also lower, by 15%. The rate of death was lower as well, by 12%. Rates of reported adverse effects were higher in those who lived in the usual care villages. The values reported here were after statistical adjustment to make the populations equivalent. Those in the treated villages on average took three medications, while those in the control villages (usual care) were on 1.2 medications.
Implications for employers:
KFF recently reported that the portion of the population that had heard false claims about the measles, mumps, rubella (MMR) vaccine continues to be high. About six in ten adults (63%) and a similar percentage of parents (61%) say they have heard false claims that MMR causes autism; this hasn’t changed much since 2023. However, about a third of adults (33%) have heard the false claim that the MMR vaccine is more dangerous than a measles infection. This has increased by 15% since 2023. About one in five (20%) have heard the false claim that vitamin A can prevent measles.
Less than 5% of adults think that all the false claims about measles are definitely true, but many are in what the researchers call the “malleable middle” where they express doubt about the truthfulness of these false claims. The researchers report that “large majorities” of the public (83%) and parents (78%) are “very confident” or “somewhat confident” that the MMR vaccine is safe.
Meanwhile, reported measles cases in the current epidemic have topped 900, and there are reported cases in 30 jurisdictions. Almost all the cases are in those who were unimmunized or whose immunization status was unavailable.
Implications for employers:
The Annals of Internal Medicine published an extensive study of almost 5,000 people with diabetes. The study compared the results of two different types of bariatric surgery, gastric sleeve (GS) and Roux en Y gastric bypass (RYGB). The researchers found that both led to similar expenditures over five years after the procedure. The study was done at Kaiser Permanente (Southern California and Pacific Northwest), and all medical costs were converted to Medicare equivalents. This was an observational study, but the groups that had each surgery were similar in age, weight and risk.
The researchers didn’t say how much bariatric surgery cost. The RYGB surgery cost more in the first six months after the surgery, which isn’t surprising because this surgery is more complex. Afterward, both surgeries led to a decrease in costs of almost $2,000 for each six-month period. Most of the savings were from decreased medication costs, from about $2,200 per period to about $1,000 per period. Inpatient and outpatient care costs weren’t statistically significantly different before and after the surgery.
If the cost of bariatric surgery is about $25,000, the “break even” period where a $4,000 savings per year would lead to net cost savings would be over six years. Few medical services result in cost savings even over a half-dozen years, so this data suggests that bariatric surgery is highly cost-effective.
Implications for employers:
Companies are facing pressure to eliminate diversity, equity and inclusion policies in the current political environment. However, a study in JAMA Network Open suggests that diversity, equity and inclusion can improve the employee experience and quality of care in a healthcare setting.
Researchers categorized hospitals in New York and Illinois as “healthcare equality leaders” if they had high scores on the 2022 Healthcare Equality Index, which measures LGBTQ+ inclusiveness. They correlated this with two negative measures, burnout on a standard survey scale and job dissatisfaction, and two positive measures, reported hospital quality and the likelihood to recommend their hospital. About three-quarters of the hospitals were considered healthcare equity leaders. Nurses at these hospitals were 31% less likely to score high on a burnout survey, and 38% less likely to report high job dissatisfaction. Nurses at the hospitals with more inclusiveness were 83% more likely to report high quality of care, and 72% more likely to recommend their hospital compared to nurses working at hospitals with lower inclusivity scores.
This is an observational study, and it doesn’t prove that having more LGBTQ+ inclusive policies leads to higher employee satisfaction and performance. For example, the researchers found that hospitals that the American Nursing Credentialing Council recognized for having better nursing work environments (MAGNET status) also had higher scores. There was considerable overlap between MAGNET status and more inclusive policies. It’s also possible that more profitable hospitals had more resources as well as more inclusive policies, and the increased resources rather than the inclusive policies drove better RN survey scores. Results of surveys of hospital employees may also not correlate with employee results in other industries.
Implications for employers:
Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.
Plan redesign outweighs cost-shifting to reduce the cost of care, WTW survey finds
