Patients are encouraged to choose physicians on the basis of characteristics such as board certification and malpractice history. However, the value of these characteristics as predictors of quality is unclear. This study investigated the relationship between a number of publicly available physician characteristics and performance on a broad range of clinical quality measures for Massachusetts physicians in 23 common specialties. Only 3 characteristics were found to be independently associated with higher performance: female sex, board certification, and graduation from a domestic medical school. However, these associations were small in magnitude, and the authors conclude that publicly available physician characteristics are poor proxies for clinical quality.
There are very few population-based data describing how frequently inferior vena cava (IVC) filters are inserted in patients with acute venous thromboembolism (VTE) the listed indication(s) for IVC filter placement, and whether listed indications met existing guidelines for IVC filter placement. Using data from the ongoing Worcester VTE study, we determined that 203 of 1547 patients (13.1%) with validated acute VTE had an IVC filter placed after diagnosis. Documented indications and “appropriateness” of IVC filter placement was conducted by 3 VTE specialists. There was unanimous agreement by panel members that use of an IVC filter was appropriate in 51% of cases and inappropriate in 26% of cases, with no consensus in the remaining 23%. Given the increasing use of IVC filters, prospective studies are needed to better define the indications for, and efficacy of, IVC filter placement.
Although lifestyle interventions reduce cardiovascular risk, little is known on the long-term effects on quality of life and cost-effectiveness in primary health care. The Björknäs Study randomized 151 middle-aged patients with increased cardiovascular risk to a supervised program with exercise sessions and diet counseling at a local health center or to a control group. After 3 years, the intervention group showed improved quality of life. Costs per gained quality-adjusted life-year were US $1668 to $4813, which shows the intervention to be highly cost effective.
The authors address the perceived but undocumented notion that only approximately one-third of individuals who are homozygous for type 1 Gaucher disease (GD) mutations, particularly Ashkenazi Jewish N370S homozygotes, are symptomatic and come to medical attention. Prenatal carrier screening of over 8000 Ashkenazi Jewish adults revealed a carrier frequency of 1:15 and 9 previously undiagnosed GD homozygotes (1 in 897). Because these homozygotes have never been systematically studied, they evaluated 37 “asymptomatic” type 1 GD individuals who were serendipitously identified by their or other prenatal carrier screening programs in New York City. Clinical, laboratory, and radiologic studies revealed that all patients had disease manifestations ranging from mild to severe, and, in particular, all had bone involvement that progressed with age in many homozygotes, often requiring therapeutic intervention. These findings indicate that homozygosity for the common N370S mutation does not result in a benign or low penetrant disease and emphasizes the importance of early recognition and appropriate management to minimize or prevent future irreversible disease complications.
Little information exists about current perceptions of medical mistakes in ambulatory care within a diverse population. Kistler et al aimed to learn about the perceptions of medical mistakes, what factors were associated with perceived mistakes, and whether the participants changed physicians because of these perceived mistakes. Kistler et al found that a significant minority of primary care patients perceived mistakes in the ambulatory setting. These perceptions had a concrete effect on the physician-patient relationship, often leading patients to seek another health care professional.
Percentages of participants who perceived harm from diagnostic mistakes (n = 218) and treatment mistakes (n = 208).
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2010;170(16):1421. doi:10.1001/archinternmed.2010.276