This Week in JAMA FREE

Medicare beneficiaries comprise the majority of patients receiving hospice care. There is some concern that Medicare's per diem payment structure may create financial incentives to select patients who require less resource-intensive care or who are projected to have longer hospice stays. In an analysis of data from the 2007 National Home and Hospice Care Survey, Wachterman and colleagues compared diagnosis and location of care among patients in for-profit and nonprofit hospices and examined whether length of stay and number of visits per day by hospice providers varied by diagnoses and profit status. Among the authors' findings was that compared with nonprofit hospices, for-profit hospices had higher percentages of patients with diagnoses associated with lower skilled-care needs and higher percentages of patients with longer lengths of stay.

Evidence-based guidelines recommend early use of disease-modifying antirheumatic drugs (DMARDs) among patients with rheumatoid arthritis (RA); however, a number of studies suggest low rates of DMARD receipt. In an analysis of individual-level Healthcare Effectiveness Data and Information Set (HEDIS) data from 93 143 Medicare managed care enrollees who received care for RA between 2005 and 2008, Schmajuk and colleagues examined variations in DMARD receipt. The authors report that 63% of patients received a DMARD during the study period and that receipt varied by demographic factors, socioeconomic status, geographic location, and health plan.

Fatal adverse events (FAEs) have been reported in cancer patients treated with the angiogenesis inhibitor bevacizumab in combination with chemotherapy; however, the association is not consistent across bevacizumab clinical trials. To better understand the overall risk of FAEs associated with bevacizumab, Ranpura and colleagues Article performed a systematic review and meta-analysis of published randomized controlled trials that compared bevacizumab in combination with chemotherapy or biological therapy with chemotherapy or biological therapy alone. The authors found that compared with chemotherapy or biological therapy alone, the addition of bevacizumab was associated with an increased risk of treatment-related mortality. In an editorial, Hayes Article discusses what is known about the benefits and risks of bevacizumab treatment for solid tumors.

Lantos and colleagues discuss the case of a 28-year-old man with chronic granulomatous disease and a history of multiple lengthy hospitalizations who, during a recent several-month hospital stay, developed a new infection and experienced significant deterioration in respiratory status. His attending physician recommended transfer to the intensive care unit. The patient declined transfer because he felt more comfortable with the general medical staff, and he was willing to accept any risks of continued care on the general medical floor. The authors discuss ethical issues that can arise when patients ask clinicians to provide less than optimal care.

“She confided in me that she had expected more from doctors, but she had lived a long life filled with setbacks and would weather this as well.” From “Haiti.”

A new IOM report recommends an increased intake of vitamin D for bone health but also notes the paucity of conclusive evidence that higher levels of the nutrient can help protect against other conditions.

Quality improvement and physician management structure

(ARTICLE AND AUTHOR INTERVIEW)

Mind matters in cancer survival

Hospital readmission as an accountability measure

How would you counsel a 36-year-old woman who is overweight and a current smoker who wishes to donate a kidney to her mother? Go to www.jama.com to read the case and submit your response, which may be selected for online publication. Submission deadline is February 6.

Join Steven J. Jacobsen, MD, PhD, Wednesday, February 16, 2011, from 2 to 3 PM eastern time to discuss herpes zoster in older adults and the risk of subsequent herpes zoster disease. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

For your patients: Information about generalized anxiety disorder.