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Highlights

from JAMA - 22 Oct 14



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Indication-Specific Pricing for Cancer Drugs

from JAMA - 22 Oct 14

This Viewpoint addresses the benefits and challenges of adopting indication-specific pricing for cancer drugs.



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Providing Price Displays for Physicians Which Price Is Right?

from JAMA - 22 Oct 14

This Viewpoint discusses ethical issues related to use of price displays for physicians to help contain US health care costs.



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Structuring Payments to Patient-Centered Medical Homes

from JAMA - 22 Oct 14

This Viewpoint discusses the use of structured payments to patient-centered medical homes as a means of optimizing primary care reimbursement.



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The Pioneer Accountable Care Organization Model Improving Quality and Lowering Costs

from JAMA - 22 Oct 14

This Viewpoint discusses the evolution of the Centers for Medicare & Medicaid Services’ Pioneer accountable care organization model.



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What Gets Measured Gets (Micro)managed

from JAMA - 22 Oct 14

When I became an attending physician in 2002, the rules were unwritten but clear: The residents ran the service, and I knew where I stood—in the background. I was to get involved only when necessary, usually meaning if a consultant was being particularly unhelpful, if there was a thorny goals-of-care discussion, or if a patient directly asked for the attending’s opinion. Anything else would result in receiving the worst label you could get as an attending: “micromanager.”



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Who Benefits From Health System Change?

from JAMA - 22 Oct 14

The organization of medical care is changing more rapidly now than at any point in the last century. For decades, health care was a cottage industry: physicians practiced independently or in small groups and had arms-length relationships with hospitals, imaging and laboratory facilities, and other health care entities. Those organizations alternately competed and cooperated as part of an informal local health care system.



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Health Care Price Transparency and Economic Theory

from JAMA - 22 Oct 14

Citizens in most economically developed nations have health insurance coverage that results in only modest cost sharing at the time health care is used. Furthermore, physicians, hospitals, and other clinicians and entities that provide health care within most systems outside the United States are paid on common fee schedules uniformly applied to all clinicians, health care organizations, and insurers. That approach spares the insured the need to seek out lower-priced health care and obviates the



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Association Between Hospital Conversions to For-Profit Status and Clinical and Economic Outcomes

from JAMA - 22 Oct 14

ImportanceAn increasing number of hospitals have converted to for-profit status, prompting concerns that these hospitals will focus on payer mix and profits, avoiding disadvantaged patients and paying less attention to quality of care.ObjectiveTo examine characteristics of US acute care hospitals associated with conversion to for-profit status and changes following conversion.Design, Setting, and ParticipantsRetrospective cohort study conducted among 237 converting hospitals and 631 matched cont



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Physician Practice Competition and Prices Paid by Private Insurers for Office Visits

from JAMA - 22 Oct 14

ImportancePhysician practice consolidation could promote higher-quality care but may also create greater economic market power that could lead to higher prices for physician services.ObjectiveTo assess the relationship between physician competition and prices paid by private preferred provider organizations (PPOs) for 10 types of office visits in 10 prominent specialties.Design and SettingRetrospective study in 1058 US counties in urbanized areas, representing all 50 states, examining the relati



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Total Expenditures per Patient in Hospital-Owned and Physician-Owned Physician Organizations in California

from JAMA - 22 Oct 14

ImportanceHospitals are rapidly acquiring medical groups and physician practices. This consolidation may foster cooperation and thereby reduce expenditures, but also may lead to higher expenditures through greater use of hospital-based ambulatory services and through greater hospital pricing leverage against health insurers.ObjectiveTo determine whether total expenditures per patient were higher in physician organizations (integrated medical groups and independent practice associations) owned by



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Association Between Availability of Health Service Prices and Payments for These Services

from JAMA - 22 Oct 14

ImportanceRecent governmental and private initiatives have sought to reduce health care costs by making health care prices more transparent.ObjectiveTo determine whether the use of an employer-sponsored private price transparency platform was associated with lower claims payments for 3 common medical services.DesignPayments for clinical services provided were compared between patients who searched a pricing website before using the service with patients who had not researched prior to receiving



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Diagnosis and Management of Urinary Tract Infections in the Outpatient Setting A Review

from JAMA - 22 Oct 14

ImportanceUrinary tract infection is among the most common reasons for an outpatient visit and antibiotic use in adult populations. The increasing prevalence of antibacterial resistance among community uropathogens affects the diagnosis and management of this clinical syndrome.ObjectivesTo define the optimal approach for treating acute cystitis in young healthy women and in women with diabetes and men and to define the optimal approach for diagnosing acute cystitis in the outpatient setting.Evid



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Treatment of Generalized War-Related Health Concerns Placing TBI and PTSD in Context

from JAMA - 22 Oct 14

JAMA PsychiatryAssociation Between Traumatic Brain Injury and Risk of Posttraumatic Stress Disorder in Active-Duty MarinesKate A. Yurgil, PhD; Donald A. Barkauskas, PhD; Jennifer J. Vasterling, PhD; Caroline M. Nievergelt, PhD; Gerald E. Larson, PhD; Nicholas J. Schork, PhD; Brett T. Litz, PhD; William P. Nash, MD; Dewleen G. Baker, MD; for the Marine Resiliency Study Team Importance Whether traumatic brain injury (TBI) is a risk factor for posttraumatic stress disorder (PTSD) has been difficul




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Presence of Banned Drugs in Dietary Supplements Following FDA Recalls

from JAMA - 22 Oct 14

The US Food and Drug Administration (FDA) initiates class I drug recalls when products have the reasonable possibility of causing serious adverse health consequences or death. Recently, the FDA has used class I drug recalls in an effort to remove dietary supplements adulterated with pharmaceutical ingredients from US markets. Approximately half of all FDA class I drug recalls since 2004 have involved dietary supplements adulterated with banned pharmaceutical ingredients.



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Insulin vs Sulfonylureas for Second-Line Diabetes Treatment

from JAMA - 22 Oct 14

To the Editor Dr Roumie and colleagues reported that compared with sulfonylureas the addition of insulin to metformin to improve glycemic control was associated with an increased risk of a composite of nonfatal cardiovascular outcomes and all-cause mortality in patients with diabetes mellitus. Although the results presented require verification in carefully designed clinical trials, we have some concerns about the current analyses.



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Insulin vs Sulfonylureas for Second-Line Diabetes Treatment—Reply

from JAMA - 22 Oct 14

In Reply We agree with Drs Tasci and Safer that the risk of metformin and insulin compared with metformin plus sulfonylurea as a second-line diabetes treatment after failure of metformin monotherapy may differ in certain populations. They point to eFigure 3 that shows a statistically significant increased risk in persons aged 65 years or older and no statistically significant increase in younger persons.



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Insulin vs Sulfonylureas for Second-Line Diabetes Treatment

from JAMA - 22 Oct 14

To the Editor In Dr Safford’s Editorial, she discussed our analyses that quantified how sensitive our conclusions were to unmeasured confounding and used as an example the degree of insulin resistance. We would like to provide a clarification to the explanation provided regarding unmeasured confounder imbalance.



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Breast Cancer Screening With Tomosynthesis and Digital Mammography—Reply

from JAMA - 22 Oct 14

In Reply Drs Seidenwurm and Rosenberg correctly point out that the mean recall rate in our study with digital mammography alone (10.7%) was slightly higher than the ACR guidelines of 10% or less. This is not surprising given that prior analyses of performance benchmarks of mammographic interpretation in the United States have consistently acknowledged that recall rates in clinical practice commonly exceed these ACR guidelines.



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Breast Cancer Screening With Tomosynthesis and Digital Mammography

from JAMA - 22 Oct 14

To the Editor Dr Friedewald and colleagues demonstrated improved performance with both lower recall rates and improved invasive cancer detection by adding tomosynthesis to digital mammography. The report also documented the continued large variability of recall rates and cancer detection rates among sites. This variation may be even greater among individual radiologists.



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Insulin vs Sulfonylureas for Second-Line Diabetes Treatment—Reply

from JAMA - 22 Oct 14

In Reply Dr Roumie and colleagues have clarified the interpretation of their analysis of unmeasured confounder imbalance in their study. Because their analysis reported absolute differences, as they point out in their letter, the prevalence of unmeasured confounders would need to be quite high in the insulin-treated group with little or no prevalence in the sulfonylurea-treated group to explain the findings of their study.



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Addressing the Trauma of Hospitalization

from JAMA - 22 Oct 14

To the Editor Drs Detsky and Krumholz highlighted an important problem facing hospitalized patients and their family members and suggested interventions to reduce the potential for traumatization by the experience of being hospitalized for a medical illness or surgical procedure. However, hospitalization is not inherently traumatizing for all patients, and interventions targeting posthospitalization syndrome should also consider premorbid patient characteristics.



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Addressing the Trauma of Hospitalization—Reply

from JAMA - 22 Oct 14

In Reply We agree with Drs Davydow and Katon that there is a need to better integrate mental health concerns into the care of patients who are hospitalized primarily for nonmental health problems.



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Analysis Reveals Large Increase in Hospitalizations in Recent Years Among Older Patients Prescribed Opioids

from JAMA - 22 Oct 14

A government “statistical brief” on opioid-related hospitalizations didn’t get much press coverage when it was posted in August, but at least a few findings merit a closer look.


 

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