This Week in JAMA FREE

The Leapfrog Group—a nonprofit coalition that provides information about hospital safety and quality to consumers and to member companies that purchase health care—evaluates hospitals' practices and quality through analyses of hospital-reported survey data. Whether a hospital's resulting Safe Practices Score correlates with its risk-adjusted inpatient mortality rate is not known. To assess this question, Kernisan Article analyzed 2005 hospital discharge data for all 155 urban US hospitals that completed the 2006 Safe Practices Leap survey and were identifiable in the Nationwide Inpatient Sample. The authors found that hospitals' survey scores were not significantly associated with risk-adjusted inpatient mortality. In a Commentary, Werner and McNutt Article discuss limitations of current approaches to improving quality and propose an alternative strategy.

In a study that enrolled persons with severe alcohol problems and a history of chronic homelessness, Larimer and colleagues assessed the effects of a “housing first” program on the use and cost of health care and public services among participants who were not required to achieve sobriety or attend treatment programs for housing entrance. The authors examined hospital-based medical services, jail bookings, days incarcerated, shelter and sobering-center use, and alcohol and drug detoxification and treatment among 95 Housing First recipients compared with use and costs among 39 individuals who were placed on a housing waiting list. The authors found that the Housing First program was associated with decreased costs for health care and public services after 6 months and those benefits increased with longer retention in housing.

Bed bug (Cimex lectularius) infestations are increasing worldwide. Goddard and deShazo systematically reviewed the literature to assess current understanding of the health and medical effects of bed bugs and to identify key issues in pest control and eradication. They found that bed bug bites cause a range of cutaneous and systemic reactions. Clinical trials of empirical treatments are lacking, but there is no evidence that outcomes differ among patients who receive treatment compared with those who do not. The authors found no evidence that bed bugs transmit disease. Challenges to pest control or eradication are described.

Professional medical associations have an important role in defining and advancing health care standards. Many medical associations receive funding from pharmaceutical and device companies, which could create conflicts of interest that threaten the scientific or ethical integrity of association-promulgated patient care standards. Rothman and colleagues identified and analyzed conflicts of interest that may affect the activities, leadership, and membership of professional medical associations. The authors suggest policies that may help reduce or eliminate these conflicts.

“Statistics show that postmenopausal women die at a much higher rate than premenopausal women, so why not go with a winner?” From “The Women's and Children's HMO.”

Growing evidence suggests that Hispanic women are more likely than white or black women to have inherited forms of breast cancer that are aggressive and often affect women at a relatively young age.

Reforming the HIPAA privacy rule

Quality, transparency, and the US government

The art of pimping

Read it again: It's good for you

Join Michael K. Kearney, MD, April 15, from 2 to 3 PM eastern time to discuss self-care of physicians who care for patients at the end of life. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 51-year-old woman with an acute onset of facial pressure, rhinorrhea, and tooth pain? Go to www.jama.com to read the case and submit your response, which may be selected for online publication. Submission deadline is April 29.

For your patients: Information about bed bugs.