This Week in JAMA FREE

Reducing hospital readmissions represents an opportunity to improve quality and decrease costs. In an analysis of 2006-2008 national Medicare data for patients hospitalized for acute myocardial infarction, congestive heart failure, or pneumonia, Joynt and colleagues Article examined whether racial disparity exists in hospital readmissions and, if so, whether the disparity is related to where black patients receive care. The authors found that compared with white patients, black patients had higher 30-day readmission rates that were related, in part, to worse outcomes among hospitals that disproportionately care for black patients. In an editorial, Hernandez and Curtis Article discuss the need for equitable and evidence-based strategies to reduce hospital readmissions and racial disparities in health care.

Children with complex chronic health conditions may experience recurrent readmissions to a hospital. In a retrospective analysis of hospitalization data from 317 643 patients who were admitted to 37 tertiary care pediatric hospitals in 2003 and followed up through 2008, Berry and colleagues found that 2.9% of patients experienced 4 or more readmissions—often for the same organ-system problem—within a 365-day period. These patients accounted for 18.8% of all admissions and 23.2% of total inpatient charges during the follow-up period. Factors associated with recurrent readmissions included the presence of a complex chronic condition and the use of assistive medical technology.

Some data suggest that bilirubin has cytoprotective properties, including evidence from animal models that elevated bilirubin levels protect against respiratory injury from environmental stressors. Horsfall and colleagues examined the relationship between normal range serum bilirubin levels and the risk of respiratory disease and all-cause mortality in a longitudinal analysis of data from 504 206 adults. The authors report that moderately higher—but within normal range—bilirubin levels were associated with a reduced risk of lung cancer, chronic obstructive pulmonary disease, and all-cause mortality.

Mr L is a 76-year-old man who has a 2-year history of Alzheimer-type dementia. He lives alone, has a paid daytime caregiver, and is dependent for most instrumental activities of daily living but still signs checks. He has a durable power of attorney for health care but not for financial matters. His daughter is concerned about Mr L's increasing irritability with respect to money and some questionable bank transactions. Widera and colleagues Article discuss the role of the primary clinician when financial incapacity affects older patients with cognitive impairment. Readers may submit comments for online posting at www.jama.com. A commentary by Sabatino Article discusses steps that can be taken in policy and practice to respond to financial capacity issues.

“[W]hen Andrea was moved upstairs, tucked into bed in a new room that was full of light and space and the easier kindness of a staff not overwhelmed by their census, ‘She was so comfortable that she cried.’” From “The Pavilion.”

Studies identifying the important role that oxytocin plays in social interactions have led scientists to investigate whether the hormone might aid in disorders such as autism or schizophrenia.

Sudden acceleration of diabetes quality measures

Me-too drugs: how many is too many?

RCT innovation and leadership

Call for Papers

Authors are invited to submit manuscripts for an upcoming JAMA theme issue.

How would you manage a 27-year-old woman who is in her second trimester of pregnancy, is addicted to heroin, and receives a 1-year jail sentence? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is February 27.

For your patients: Information about deep brain stimulation.