Kelli D. Allen, PhD; Eugene Z. Oddone, MD, MHSc; Cynthia J. Coffman, PhD; Amy S. Jeffreys, MStat; Hayden B. Bosworth, PhD; Ranee Chatterjee, MD, MPH; Jennifer McDuffie, PhD; Jennifer L. Strauss; William S. Yancy, Jr., MD, MHS; Santanu K. Datta, PhD MHS; Leonor Corsino, MD, MHS; Rowena J. Dolor, MD, MHS
Gaps in the use of recommended strategies to manage osteoarthritis might be addressed by interventions aimed at health care providers or patients. This randomized trial evaluated the effects on physical function and symptoms of patient- and provider-targeted interventions aimed at increasing the use of recommended management strategies for hip or knee osteoarthritis.
Jessica Weiss, MD, MCR; Michele Freeman, MPH; Allison Low, BA; Rochelle Fu, PhD; Amy Kerfoot, MD; Robin Paynter, MLIS; Makalapua Motu'apuaka, BS; Karli Kondo, PhD; Devan Kansagara, MD, MCR
Although some guidelines recommend a systolic blood pressure target of less than 150 mm Hg for adults aged 60 years or older, results from a recent trial suggest a lower target may be optimal. This systematic review summarizes evidence from 21 trials and 3 observational studies about the benefits and harms of more versus less intensive blood pressure control in older adults.
Amir Qaseem, MD, PhD, MHA; Timothy J. Wilt, MD, MPH; Robert Rich, MD; Linda L. Humphrey, MD, MPH; Jennifer Frost, MD; Mary Ann Forciea, MD; for the Clinical Guidelines Committee of the American College of Physicians and the Commission on Health of the Public and Science of the American Academy of Family Physicians
This jointly developed guideline from the American College of Physicians and the American Academy of Family Physicians provides recommendations about the benefits and harms of higher versus lower blood pressure targets for the treatment of hypertension in adults aged 60 years or older.
Scott H. Podolsky, MD
This article discusses the effect of antibiotics on many aspects of human growth and health, which has garnered intense interest for more than 60 years.
Michael Pignone, MD, MPH; Anthony J. Viera, MD, MPH
The American College of Physicians and American Academy of Family Physicians report an evidence-based guideline for the pharmacologic management of hypertension in adults aged 60 years or older. The editorialists discuss the guidelines and provide advice for implementation of an office-based program to help achieve optimal outcomes for the treatment of hypertension.
Iris Ma, MD
Bram Rochwerg, MD, MSc; Gordon Guyatt, MD, MSc
Mitchell Levine, MD
Michael Yelland, MBBS, PhD
Diego J. Maselli, MD; Jay I. Peters, MD
Warren G. Thompson, MD
Henry S. Sacks, PhD, MD
David Garcia, MD
James Brophy, MD, FRCP, FACC, PhD
Anthony A. Donato, MD, MHPE
Catherine M. Clase, MD
Geno J. Merli, MD; Howard H. Weitz, MD
Annals Consult Guys brings a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations.
Darren B. Taichman, MD, PhD
David H. Wesorick, MD; Vineet Chopra, MD, MSc
Poonam Hosamani, MD; Abraham Verghese, MD
Karsten Juhl Jørgensen, MD, DrMedSci; Peter C. Gøtzsche, MD, MSc; Mette Kalager, MD, PhD; Per-Henrik Zahl, MD, DrMedSci
Effective breast cancer screening should detect early-stage cancer and prevent advanced disease. Using unique data from screening programs launched in Denmark from 1991 to 2007, this study assessed the association of screening with the size of detected tumors and estimated that a substantial proportion of breast tumors detected represent overdiagnosis—screening-detected tumors that would not become clinically relevant during a woman's lifetime.
Aaron Mendelson, BA; Karli Kondo, PhD; Cheryl Damberg, PhD; Allison Low, BA; Makalapua Motu'apuaka, BA; Michele Freeman, MPH; Maya O'Neil, PhD; Rose Relevo, MLIS, MS; Devan Kansagara, MD, MCR
The effectiveness of pay-for-performance programs, which provide financial rewards or penalties to providers or institutions according to performance on measures of quality, is unclear. This review of 69 studies examines whether such programs positively influence processes of care and improve patient outcomes.
In this opinion piece, the author discusses the plans of the incoming Trump administration and Republican-controlled Congress to repeal and replace the Patient Protection and Affordable Care Act and urges U.S. physicians to resist repeal and demand to see a replacement plan first.
Otis W. Brawley, MD
Jørgensen and colleagues compare breast cancer incidence and death rates in areas of Denmark where screening was introduced at various times in the 1990s. They estimate that screen-detected breast tumors have an overdiagnosis rate of 14.7% to 38.6% (excluding ductal carcinoma in situ). The editorialist discusses the need to accept that overdiagnosis exists, urges recognition of the limitations of screening, and asserts that all elements of breast cancer control should be examined to optimize patient care.
Teryl K. Nuckols, MD, MSHS
Mendelson and colleagues examined 69 recent studies that evaluated pay-for-performance initiatives. The editorialist discusses new policies that require the Centers for Medicare & Medicaid Services to assign penalties or rewards to clinicians based on the quality of care they deliver and the insight existing research provides into the anticipated influence of those policies on health outcomes.
Matthew Miller, MD, ScD; Lisa Hepburn, PhD; Deborah Azrael, PhD
Universal background checks for firearm purchases are favored by most Americans and are endorsed by leading medical, legal, and law enforcement organizations; however, no recent data exist on how often they are performed. This nationally representative survey assessed where current gun owners acquired their most recent firearm and how frequently the acquisition involved a background check, and compared results between states with and without legislation regulating private firearm sales.
Matthew J. Crowley, MD, MHS; Clarissa J. Diamantidis, MD, MHS; Jennifer R. McDuffie, PhD; C. Blake Cameron, MD, MBI; John W. Stanifer, MD, MSc; Clare K. Mock, MD; Xianwei Wang, MD; Shuang Tang, PhD; Avishek Nagi, MS; Andrzej S. Kosinski, PhD; John W. Williams, Jr., MD, MHS
This systematic review of 17 observational studies addresses clinical outcomes of metformin use in persons with type 2 diabetes and moderate to severe chronic kidney disease, congestive heart failure, or chronic liver disease with hepatic impairment. These major findings, which support recent labeling changes by the U.S. Food and Drug Administration, have important clinical implications.
Sanjay Basu, MD, PhD; Jeremy B. Sussman, MD, MS; Rod A. Hayward, MD
Two recent treat-to-target trials yielded discordant results about the effects of intensive blood pressure management. The authors conducted a thought experiment to determine whether heterogeneous treatment effects (HTEs) were hidden in these trials and could explain the observed differences. They also examined the ability of the SMART (sequential, multiple assignment, randomized trial) design to detect HTEs.
Amir Qaseem, MD, PhD, MHA; Michael J. Barry, MD; Linda L. Humphrey, MD, MPH; Mary Ann Forciea, MD; for the Clinical Guidelines Committee of the American College of Physicians
This evidence-based guideline from the American College of Physicians addresses oral pharmacologic treatment of type 2 diabetes in adults.
Sanjay Kaul, MD
Basu and coworkers present an innovative approach using microsimulation modeling to explore heterogeneous treatment effects. This approach is used to explain the divergent results observed in 3 large, well-designed, rigorously conducted randomized clinical trials examining blood pressure goals for hypertension treatment. The editorialist discusses how this approach will help to inform comparative effectiveness research and precision medicine.
Philip J. Cook, PhD
Miller and colleagues provide a nationally representative estimate of how frequently firearm sales in the United States occur without background checks. The editorialist, whose study 20 years ago is often cited as showing that 40% of sales lacked background checks, considers why the issue remains so important as well as what has and has not changed.
Judith E. Fradkin, MD; Griffin P. Rodgers, MD
In this issue, the American College of Physicians provides a new guideline on oral pharmacologic therapy of type 2 diabetes mellitus. The editorialists discuss the paucity of data on the key clinical outcomes addressed in the new guideline. They outline the need for new approaches integrating research and care delivery to foster large, simple, and affordable trials to efficiently compare the effect of interventions on clinically meaningful outcomes.
Kasia J. Lipska, MD, MHS
In this issue, Crowley and colleagues report a systematic review of metformin use and its effect on several relevant clinical outcomes, including all-cause mortality and major cardiovascular events, in patients with kidney disease, congestive heart failure, or chronic liver disease. The editorialist discusses the findings of that review. Because metformin is widely used and inexpensive, a better understanding of its effect on outcomes in contemporary practice, as well as among subgroups of patients with commonly occurring comorbid conditions, is imperative.
Jason H. Wasfy, MD, MPhil; Corwin Matthew Zigler, PhD; Christine Choirat, PhD; Yun Wang, PhD; Francesca Dominici, PhD; Robert W. Yeh, MD, MSc
In this pre–post analysis, the authors evaluated whether passage of the Medicare Hospital Readmissions Reduction Program helped to accelerate improvement in 30-day risk-standardized readmission rates after hospitalizations for acute myocardial infarction, congestive heart failure, or pneumonia and whether the lowest-performing hospitals had faster acceleration in improvement after passage of the law than higher-performing hospitals.
Andrew J. Goodwin, MD; Russell A. Higgins, MD; Karen A. Moser, MD; Kristi J. Smock, MD; Wayne L. Chandler, MD; Kandice Kottke-Marchant, MD, PhD; Sarah K. Hartman, MD; Oksana Volod, MD; Alan F. Brown, MD; Vandita P. Johari, MD; Sharon Burr, MBA, MT; Nataliya Polyakov, MT; Dong Chen, MD, PhD
Age-adjusted d-dimer levels have been recommended for evaluating patients with suspected pulmonary embolism. The authors of this commentary caution that clinicians must understand important differences among laboratories in how d-dimer values are reported, as well as the limited knowledge of certain assays' performances as age-adjusted values, to avoid potentially dangerous misinterpretations that might harm patients.
Craig Garthwaite, PhD; Tal Gross, PhD; Matthew Notowidigdo, PhD; John A. Graves, PhD
Health policy analysts did not know how patients might change the way they use emergency departments (EDs) when the Patient Protection and Affordable Care Act (ACA) was introduced in January 2014. The investigators of this study examined the records of adults who went to hospital EDs before and after the ACA took effect. They found changes in the frequency of visits by uninsured and Medicaid-insured patients and changes in travel time to the ED in 17 Medicaid expansion states but not in 19 nonexpansion states.
Märit Halmin, MD; Klaus Rostgaard, MSc; Brian K. Lee, PhD; Agneta Wikman, MD, PhD; Rut Norda, MD, PhD; Kaspar René Nielsen, MD, PhD; Ole B. Pedersen, MD, PhD; Jacob Holmqvist, MD; Henrik Hjalgrim, MD, DrMedSci; Gustaf Edgren, MD, PhD
The possibility of deleterious effects of prolonged storage of red blood cells on patient outcomes has long been a topic of interest. A population-based cohort study in Sweden and Denmark assessed whether an association exists between the length of red blood cell storage and patient mortality at 30 days and 1 year after transfusion.
Jennifer Erickson, RD; Behnam Sadeghirad, PharmD, MPH; Lyubov Lytvyn, MSc; Joanne Slavin, PhD, RD; Bradley C. Johnston, PhD
Several renowned organizations have provided guidelines on dietary sugar intake. This systematic review examines the consistency and quality of 9 such guidelines that offer 12 recommendations about the consumption of foods containing sugars.
Dean Schillinger, MD; Cristin Kearns, DDS, MBA
Erickson and colleagues report a systematic review of the scientific basis of guidelines on sugar intake, providing another occasion for concern about conflicts between public health interests and the interests of the food and beverage industry. The editorialists discuss the shortcomings of the review.
Andrew Cheung, MD; Thérèse A. Stukel, PhD; David A. Alter, MD, PhD; Richard H. Glazier, MD, MPH; Vicki Ling, MSc; Xuesong Wang, MSc; Baiju R. Shah, MD, PhD
Higher patient volume has been shown to be associated with better quality of care and better outcomes for many acute care conditions, but whether such an association exists for the outpatient management of chronic diseases is uncertain. This cohort study, conducted using linked population-based health care administrative data in Ontario, Canada, explored the association between primary care physician volume and quality of diabetes care.
Daniel M. Blumenthal, MD, MBA; Dana P. Goldman, PhD; Anupam B. Jena, MD, PhD
Insurers are increasingly tying reimbursement to patient outcomes to promote accountability for care, but this has largely not been the case for biopharmaceuticals despite their growing use and high costs. In this opinion piece, the authors discuss the potential benefits of outcomes-based pricing as a means of promoting access to novel biopharmaceuticals and ensuring that manufacturers and insurers are compelled to share accountability for clinical outcomes.
Kevin A. Peterson, MD, MPH
Cheung and colleagues used a data set from Ontario, Canada, to evaluate the association between patient volume and process measures among primary care physicians. The editorialist discusses the implications of the study with regard to the relationship between delivery of primary care services and quality.
Joshua M. Thorpe, PhD, MPH; Carolyn T. Thorpe, PhD, MPH; Walid F. Gellad, MD, MPH; Chester B. Good, MD, MPH; Joseph T. Hanlon, PharmD, MS; Maria K. Mor, PhD; John R. Pleis, MS; Loren J. Schleiden, BS; Courtney Harold Van Houtven, PhD
Recent federal policy changes that have expanded veterans' access to care outside the Department of Veterans Affairs (VA) may have unintended consequences on safe and effective prescribing. This study examined the prevalence and effect of dual use of VA and Medicare Part D prescription benefits on prescribing safety among a national cohort of veteran outpatients with dementia.
P. Todd Korthuis, MD, MPH; Dennis McCarty, PhD; Melissa Weimer, DO, MCR; Christina Bougatsos, MPH; Ian Blazina, MPH; Bernadette Zakher, MBBS; Sara Grusing, BS; Beth Devine, PhD, PharmD, MBA; Roger Chou, MD
Greater integration of medication-assisted treatment (MAT) for opioid use disorder (OUD) in U.S. primary care settings would expand access to treatment for this condition. Models for integrating MAT into primary care vary in their structure. This article summarizes findings of a technical report for the Agency for Healthcare Research and Quality describing MAT models of care for OUD, based on a literature review and interviews with key informants in the field. The report describes 12 representative models of care for integrating MAT in primary care settings.
E. Jennifer Edelman, MD, MHS; David A. Fiellin, MD
Korthuis and colleagues review models for delivery of treatment for opioid use disorder through primary care. The editorialists discuss the findings and highlight opportunities for primary care practices to engage in treatment of opioid use disorder in order to address the current health crisis that is fueled by prescription opioids.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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