TUESDAY, May 13 (HealthDay News) -- Giving doctors cash rewards to reduce hospital spending helps control costs without compromising quality or patients' access to care, according to a five-year study that included more than 220,000 patients.

The study compared six cardiac catheterization labs that implemented this type of "gainsharing" program to 123 non-gainsharing labs.

The researchers, from Arizona State University, found that gainsharing reduced hospital costs by 7.4 percent, or $315 per patient. That means that nationwide use of gainsharing could slash hospital costs for coronary stent patients by about $195 million a year, according to the researchers.

Most of the savings from the gainsharing programs in the study were the result of lower prices for coronary stents. The gainsharing programs didn't lead to any changes in patient referral patterns and didn't increase the overall risk of in-lab complications. In fact, the gainsharing programs were associated with significant decreases in three specific types of complications, the researchers said.

"We found no evidence that gainsharing prompted physicians to avoid patients with existing health problems or pick the healthiest patients," study author Jonathon Ketcham, an assistant professor at the university's School of Health Management and Policy, said in prepared statement.

Further research into gainsharing's effects on other health care quality measures and how it influences doctors' decisions would be valuable, he added.

The study is published in the May/June issue of the journal Health Affairs, a themed issue on health-care reform.

Another study in the issue concluded that doctors in Massachusetts don't face a malpractice premium crisis -- even though the state has the fourth-highest median malpractice settlement payments in the country. Nearly all physicians in the state paid lower inflation-adjusted malpractice premiums in 2005 than in 1990. The findings challenge popular perceptions and assumptions behind legislative proposals to cap malpractice damages awards, said the Suffolk University Law School researchers.

In another study that included a survey of more than 800 doctors, researchers found that primary-care physicians in high-spending health-care regions have more frequent patient return visits, are more likely to recommend screening tests of uncertain benefit, and opt for more resource-intensive management strategies than doctors in low-spending health-care regions.

"Current policy efforts to improve the quality of care and address disparities in spending have focused largely on fostering adherence to clinical guidelines," wrote researcher Brenda Sirovich of the Veterans Affairs Medical Center in White River Junction, Vt., and colleagues. "This study suggests that greater attention to clinical judgment -- and to local factors that are likely to influence physician practice -- will be required."

More information

There's more on U.S. health-care costs at the National Coalition on Health Care  .

THURSDAY, May 8 (HealthDay News) -- Serious mental illness costs Americans at least $193 billion a year in lost earnings alone, a new report shows.

The study broadly defines mood and anxiety disorders that greatly limit a person's ability to function for at least 30 days a year, including instances of any condition linked to suicidal behaviors or frequent violent acts, as serious mental illness (SMI).

"Lost earning potential, costs associated with treating coexisting conditions, Social Security payments, homelessness and incarceration are just some of the indirect costs associated with mental illnesses that have been difficult to quantify," Dr. Thomas R. Insel, director of the National Institute of Mental Health, said in a prepared statement. "This study shows us that just one source of these indirect costs is staggeringly high."

Insel's agency funded the study. The results were published in the May issue of The American Journal of Psychiatry.

The researchers analyzed 2002 data collected from a nationally representative study of almost 5,000 Americans, aged 18 to 64, to determine earnings lost in the year prior to the survey. They found that respondents with SMI reported receiving about 40 percent less in earnings than those without serious mental disorders, who earned an average $38,852.

Researchers arrived at the $193.2 billion figure by extrapolating these results to the general population. They figured most of this comes from the lessened amount of income people with SMI were likely to earn, while the rest of the loss comes from the increased odds that their mental state would prevent them from having any earnings at all.

"The results of this study confirm the belief that mental disorders contribute to enormous losses of human productivity," lead researcher Ronald C. Kessler, of Harvard University, said in a prepared statement. "Yet this estimate is probably conservative, because the [survey used] did not assess people in hospitals or prisons, and included very few participants with autism, schizophrenia or other chronic illnesses that are known to greatly affect a person's ability to work. The actual costs are probably higher that what we have estimated."

More information

The U.S. Surgeon General has more about mental illness.

MONDAY, May 5 (HealthDay News) -- New studies in the field of epigenetics -- which looks at how environmental factors can change gene function without altering DNA sequence -- are identifying new molecular targets that may lead to improved drug treatment of depression, scientists report.

Epigenetics plays a major role in depression and the actions of antidepressants.

"The mechanisms that precipitate depression, such as stress, are incompletely understood," Dr. Eric Nestler, of the University of Texas Southwestern Medical School in Dallas, said in a prepared statement. "One mystery of the disease is its long-lasting nature and delayed response to antidepressant treatment. This persistence is thought to be influenced by slowly developing but stable adaptations, which might include epigenetic regulation."

Nestler held a symposium Monday on epigenetics at the American Psychiatric Association annual meeting, in Washington, D.C. A number of scientists outlined their research on epigenetics and depression. The symposium was sponsored by the U.S. National Institute of Mental Health.

Epigenetic changes aren't the same as genetic mutations, which are variations in the sequences of building blocks that make up the DNA in a gene. In epigenetic changes, genes remain stable, but environmental factors such as diet, stress and a mother's care act on the supporting structures of DNA, such as chromatin, molecules that package genes into chromosomes, according to background information in a news release about the symposium.

Certain chemical reactions can unravel the chromatin, which can affect a gene's DNA code and turn a gene on or off. As a result, a gene may produce more or less protein than normal which, in turn, can affect physical and behavioral traits. This change in protein production can be passed on from one cell to another as they multiply and can also be passed from parents to children.

Research conducted by Nestler and colleagues found that chronic social stress can cause chromatin changes in genes in the brain's nucleus accumbens and hippocampus.

"In both brain regions, we have been able to directly relate these chromatin changes to some of the behavioral abnormalities observed," Nestler said.

In animal models of chronic stress, he and his colleagues were able to manipulate these two brain areas in ways that produced antidepressant-like effects.

In other research, a team at the University of Massachusetts Medical School in Worcester are examining changes in methylation, a type of chemical modification of the DNA and of histones, the protein "backbone" of chromatin.

"We found that these chemical modifications in brain chromatin are dynamically regulated from the perinatal period to old age and could be involved in epigenetic control of gene expression, including genes for brain-derived neurotrophic factor and others implicated in mood and anxiety spectrum disorders," Dr. Schahram Akbarian said in a prepared statement.

He said the findings could help in the design of new antidepressant treatments. Preliminary findings from research in mice suggest that chemical modification of epigenetic-related factors could enhance response to widely used antidepressants.

Researchers at McGill University in Montreal found that separating rats from their mothers at an early age altered the methylation state of specific genes in the hippocampus, resulting in long-term behavioral changes.

They found that differences in a mother's care, such as licking and grooming, can change the development of rat pups' hormonal and behavioral response to stress, resulting in lifelong changes in the pups' response to stress and how they process information about stressors.

"This may reveal experience-dependent adaptability in the chemistry of the DNA and chromatin structure," researcher Michael Meaney said in a prepared statement.

More information

The U.S. National Institute of Mental Health has more about depression.

FRIDAY, May 2 (HealthDay News) -- The use of "virtual" interdisciplinary health-care teams linked by phone, fax and e-mail improves the care of adults with chronic health problems, according to a U.S. study.

Patients who received this type of coordinated care -- which includes physicians, pharmacists, dieticians, social workers and other professionals -- required fewer emergency department visits than those who didn't receive it, according to researchers at Rush University Medical Center, in Chicago.

They developed a pilot project called Virtual Integrated Practice (VIP), which links physician practices with teams of other health-care professionals to coordinate care for patients with diabetes.

Over two years, higher risk diabetic patients who received VIP care made fewer trips to the emergency department than similar patients who didn't receive this kind of care. The patients under VIP care also reported better understanding of how to use their medications.

The study also found that physicians who were part of the VIP teams said they were better informed about how their patients were doing between visits than doctors who weren't part of virtual teams.

"The VIP study showed the feasibility of interdisciplinary teams as a practical solution to many of the challenges seen in primary care geriatric practices," principal investigator Dr. Steven K. Rothschild, an associate professor in the departments of family medicine and preventive medicine at Rush, said in a prepared statement.

"For the most physically frail patients, the intervention meant fewer trips to the emergency department. The VIP model also provides a replicable road map for implementing the Medical Home concept in solo and small group practices that care for frail elders," Rothschild said.

The study was slated to be presented Friday at the American Geriatrics Society annual meeting, in Washington, D.C.

While coordinated care can benefit older adults with multiple chronic illnesses, 60 percent of primary-care physician practices in the United States are small and unlikely to have the resources to establish and maintain interdisciplinary health-care teams, according to background information in a news release about the study. Virtual teams may be an option for those small practices.

More information

MedlinePlus has more about coping with chronic illness.