“In this issue of JAMA Network Open, Hsia et al sought to determine whether efforts to improve access, treatment, and outcomes for patients with ST-elevation myocardial infarction (STEMI) by means of cardiac care regionalization were associated with widened or narrowed disparities between minority and nonminority communities at the zip code level across the state of California. Access was defined as admission to a hospital with percutaneous coronary intervention (PCI) capability; treatment was defined as receiving coronary angiography or PCI (as clinically indicated) the day of admission or at any time during hospitalization; and outcomes were defined as all-cause mortality at … Read More
All posts by Anupam
“[Introduction] The American Heart Association (AHA), American College of Cardiology (ACC), and the US Preventive Services Task Force (USPSTF) all recommend hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) for primary prevention of cardiovascular events in adults aged 40 to 75 years who have an elevated risk (most often defined as ≥7.5% risk of major adverse cardiovascular event [MACE] within 10 years). [..] Although the benefits of statins to decrease cardiovascular events such as myocardial infarction and stroke have been well documented for adults younger than 75 years, when these benefits occur is unclear. In contrast, the burdens of statins appear … Read More
“[Introduction] [..] In one study of a large Accountable Care Organization, PCP relocation, retirement, or death was the dominant factor associated with the reassignment of approximately one-third of Medicare beneficiaries to a new Accountable Care Organization every year. [Methods] This cohort study used Medicare administrative claims data for a 20% random sample of continuously enrolled, fee-for-service beneficiaries. For the main study sample as well as subgroup analyses, we included beneficiaries visiting a PCP for at least 1 evaluation and management visit from January 1, 2008, to December 31, 2017. We then limited the study sample to PCPs who treated 30 … Read More
This week’s refresh of the excess mortality count from the CDC (last updated November 12). The federal agency identified over 304,000 excess deaths across the country since the start of this year (about six thousand more than last week’s estimate). The overall excess mortality rate remained at 11.2% compared to last week. Data from CDC’s National Center for Health Statistics, updated November 12, 2020
“In a recent post, the administrator of the Centers for Medicare and Medicaid Services (CMS) reported that the Medicare Shared Savings Program (MSSP) generated $2.6 billion in gross savings in 2019 and $1.2 billion in net savings after accounting for shared-savings payments to participating accountable care organizations (ACOs). Achieving this level of savings would constitute remarkable progress in a short time. Relative to CMS’s own estimates, total net savings rose by $876 million over 2017 levels. Moreover, compared to savings estimated in prior evaluations based on counterfactual spending instead of benchmarks, the 2019 reported net savings is more than three … Read More
“[Summary] [..] Our institution developed and implemented a triage framework in the Emergency Department utilizing the Clinical Frailty Scale (CFS) to promote patient-centered care during our Covid-19 surge. A triage clinician assessed 40 patients aged 70 and older from April 7 to May 22, 2020. In addition to recommendations for medication management, fall risk reduction, delirium prevention and advance care planning, the triage clinician directed patients with a CFS of 1-3 to usual care (n=8, 20.0%), a CFS of 4-6 to geriatric co-management (n=6, 15.0%), a CFS of 7-9 to palliative care triage (n=23, 57.5%) and 7.5% (n=3) to both … Read More
“We previously described an automated early warning system that identifies patients at high risk for clinical deterioration. Detection is achieved with the use of a predictive model (the Advance Alert Monitor [AAM] program) that identifies such patients. Beginning in November 2013, we conducted a pilot test of this program in 2 hospitals in Kaiser Permanente Northern California (KPNC), an integrated health care delivery system that owns 21 hospitals. The system generates AAM scores that predict the risk of unplanned transfer to the ICU or death in a hospital ward among patients who have “full code” orders (i.e., patients who wish … Read More
“SCD [sickle cell disease] is a life-threatening, inherited blood disorder, affecting more than 100,000 Americans. Painful vaso-occlusive crises, the hallmark of SCD, result in substantial suffering and lead to associated stigma. Without adequate treatment, SCD affects all organs and is associated with decreased quality of life and a shortened life span. Among the dozens of conditions that are screened for in state newborn-screening programs, SCD is the most commonly detected condition, regardless of ethnicity. It is thus important to recognize SCD as a common and important medical condition among Americans, and not “just Black Americans.” [..] Although SCD is a … Read More
Like many of my colleagues in the American healthcare system, I have been alternatively hopeful and skeptical about the potential value from pursuing more value-based care initiatives in relation to our current fee-for-service model. Accountable Care Organizations (ACOs) will probably save no more than five percent of total healthcare costs. Eight years into Blue Cross Blue Shield’s Alternative Quality Contract with two-sided risk in Massachusetts showed savings ranging from 2.3% to 11.9% over three years. Bundled payments for joint procedures may save a few percent (primarily from reduced post-acute care utilization). Some have suggested Centers of Excellence to both validate … Read More
“[Methods] we searched MEDLINE and Embase for articles published between March 1, 2015, and Aug 14, 2020, without any language restrictions. We included randomised controlled trials of cardiovascular outcomes of an LDL cholesterol-lowering drug recommended by the 2018 American College of Cardiology and American Heart Association guidelines, with a median follow-up of at least 2 years and data on older patients (aged ≥75 years). [..] [Findings] Data from six articles were included in the systematic review and meta-analysis, which included 24 trials from the Cholesterol Treatment Trialists’ Collaboration meta-analysis plus five individual trials. Among 244,090 patients from 29 trials, 21,492 … Read More