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Policy makers are increasingly interested in identifying waste in our health care system. Kale et al performed a comparative analysis using data from the 1999 and 2009 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to examine the performance of outpatient quality measures. They found that of 9 underuse measures, 6 improved, while of 11 overuse indicators, only 2 improved. The limited improvements in the overuse measures may reflect a national quality mission that is hampered by a lack of incentives and performance measures that support the reduction of inappropriate care.
Chatterjee et al performed a systematic literature search of studies comparing blood transfusion with no transfusion or a liberal vs restricted transfusion strategy. Analyses of transfusion in myocardial infarction (MI) revealed increased all-cause mortality with a strategy of transfusion during MI, with a weighted absolute risk increase of 12% and a number needed to harm of 8. A higher risk with transfusion compared with no or restrictive transfusion was noted for subsequent MI rates as well. A strategy of blood transfusion or liberal blood transfusion compared with no or restricted blood transfusion was associated with a higher incidence of all-cause mortality. A practice of routine or liberal blood transfusion in MI should not be encouraged but requires investigation in a large trial with low risk for bias.
In This Issue of JAMA Internal Medicine. JAMA Intern Med. 2013;173(2):89. doi:10.1001/jamainternmed.2013.2686
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