Can quality of care and outcomes for elderly patients with acute myocardial
infarction be improved? Dr Marciniak and colleagues show that feedback of
quality data from HCFA peer review organizations to hospitals and physicians
in 4 states resulted in improved process of care, reduced length of stay,
and decreased mortality for Medicare patients with myocardial infarction.
See Article and related editorial Article
Practice guidelines often do not change physician behavior. Dr Soumerai
and colleagues assessed whether local opinion leaders could influence pharmacologic
treatment of acute myocardial infarction. While use of aspirin and β-blockers
increased, other practices either remained unchanged or shifted similarly
at both control and test hospitals.
Specialists may provide primary care for their patients, but to what
extent? This study of Washington State Medicare outpatient visits evaluates
the amount and type of primary care specialists provide for their patients.
Based on their quantitative indices of primary care attributes, Dr Rosenblatt
and colleagues found that pulmonologists, rheumatologists, oncologists, general
surgeons, and gynecologists provided substantial amounts of primary care,
but most specialists did not take on a generalist role.
Rotavirus causes considerable morbidity and expense but little mortality,
so use of a vaccine against this pathogen will be influenced by its cost-effectiveness.
Dr Tucker and colleagues provide such an analysis, finding that a universal
3-dose vaccination program would cost the US health care system $107 million
but save society $296 million.
Measuring quality of care in the context of diverse health care organizations
is a critical need. Dr Landon and colleagues suggest that traditional health
plan definitions are inadequate to assess the organizational characteristics
that affect quality of care. They recommend new conceptual models to characterize
aspects of health care organizations that either facilitate or impose barriers
to quality of care and influence physician behavior.
Should restricted salt intake be recommended for the general population?
In a meta-analysis, Dr Graudal and colleagues found that sodium reduction
is not helpful for the general population but is a useful adjunct for individuals
"Unthought of harmonies come forward, or perhaps they have always existed
in some forgotten memory . . ." Jacques Villon, Maternité, c 1948, French.
Men's sexual quality of life is the focus of a report from the Congress
of the European Association of Urology.
Our annual Contempo issue is now a regular series of brief updates that
highlight important advances shaping clinical practice and public health.
This week, Drs Volberding and Deeks review progress and problems in the antiretroviral
treatment of HIV infection.
"Any number of people have asked me how it feels to be retired. Sometimes
I say it feels great, other times I say it's OK, but mostly I say ask me next
year." From "Identity Matters (or Does It?)."
This week's JAMA Patient Page covers the basics about heart attacks.
We invite readers to copy this page, a patient-friendly look at a topic covered
by a study in each week's JOURNAL, and make it available to interested patients.
This Week in JAMA. JAMA. 1998;279(17):1328. doi:10.1001/jama.279.17.1328