September 1, 2009

Summaries of the latest clinical research

• Racial disparities in obesity evident between population groups

MMWR 2009;58(27):740-744. [July 17, 2009]

A CDC study shows that 26% of Americans are obese and there are major racial disparities in obesity levels between population groups.

In examining obesity rates by state, blacks have significantly higher obesity rates in 21 states, including Maine. By gender, 39% of black women are obese as are 32% of black men. Hispanics have a 29% obesity rate, with 29% of Hispanic men and 28% of Hispanic women being considered obese.

• Pay-for-performance: Latest research on how it affects quality of care

Med Care. 2009;47(4):378-87. [April, 2009]

N Engl J Med 2009;361:368-378. [July 23, 2009]

Although one study shows it is possible to reliably measure physician performance, English researchers found that pay-for-performance (P4P) ultimately may not affect the care a patient receives.

Researchers from University of California at Irvine, and NCQA, assessed 11 process and outcome quality measures for 210 physicians with a combined total of 7,574 diabetic patients. They found that combining performance on five to nine measures will reliably separate practices into three quality levels: high, average, or low.

However, researchers from the University of Manchester found that after an initial improvement in care, within a few years, P4P has no impact on the quality of care. They evaluated improvement rates for the treatment of diabetes, asthma and heart disease among 42 family practices in the U.K. before and after a P4P scheme was introduced in 2004.

Results showed a steady increase in care during 2005 and 2007 for diabetes and asthma. The plan had no impact on heart disease care, and plateaued for other conditions after 2007.

• Obese patients may be at higher risk for H1N1 virus, according to CDC

MMWR Morb Mortal Wkly Rep. 2009; 58:749-752. [July 17, 2009]

Obesity may be a risk factor for contracting the H1N1 virus, according to a report from the CDC.

In a series of 10 patients, median age 46 years, with the H1N1 virus referred to the surgical intensive care unit (SICU) of University of Michigan Health System, nine were obese, and seven were considered extremely obese. Three of the obese patients died, with time from onset of illness to death ranging from 17 to 30 days.

As of July 8, of the seven surviving patients, one remained in the SICU, one was on advanced mechanical ventilation, and five were in stable condition.