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Objective: To investigate the relative progress of safety-net hospitals (SNHs) under Medicare's Comprehensive Care for Joint Replacement (CJR) mandatory bundled payment model over 2016-2020 and to identify the contributors to SNHs' realization of success under the program. Data Sources/Study Setting: Secondary data on all CJR hospitals were collected from the Centers for Medicare and Medicaid Services (CMS) public use files and from the American Hospital Association. Study Design: We addressed whether SNHs can achieve progress in financial performance under CJR by focusing on the relative change in reconciliation payments or the difference between episode spending and target prices. We applied the method of dominance analysis to ordinary least squares regression to determine the relative importance of predictors of change in reconciliation payments over time. Principal Findings: Compared to CJR hospitals overall, SNHs were less successful in meeting episode spending targets. Hospital factors dominated socioeconomic factors in explaining progress among SNHs, but not among non-SNHs. The contribution of nurse staffing was negligible across all CJR hospitals. Conclusions: The formula used by CMS to determine spending targets may not be sufficient to address disparities in SNH financial performance under mandatory bundled payment. KEYWORDS health policy/politics/law/regulation, hospitals, Medicare, social determinants of health, uninsured/safety-net providers What is known on this topic * Hospitals that disproportionately serve Medicare beneficiaries with social risk factors often perform worse under value-based purchasing. * Safety-net hospitals historically have been exposed to greater financial risk than other hospitals. * Safety-net hospitals received lower financial rewards during the first two years of Medicare's mandatory Comprehensive Care for Joint Replacement (CJR) program. What this study adds * Safety-net hospitals were far less successful in spending performance progress over the first five years of CJR. * Under CJR, hospital factors dominated area socioeconomic factors in contributing to spending performance progress in SNHs but not in other hospitals., 1 | INTRODUCTION The Centers for Medicare and Medicaid Services (CMS) is expanding the use of value-based purchasing (VBP) models for Medicare payments to hospitals. A key mechanism is bundled [...]

Researchers say the largest-ever study of general practice in Aotearoa New Zealand sheds new light and creates a powerhouse of data for decision-making. A study into general practice models in [...]

2023 APR 1 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- A new study on antimicrobials and healthcare epidemiology is now available. According [...]

Objective: The need to evaluate decisional capacity among patients in treatment settings as well as subjects in clinical research settings has increasingly gained attention. Decisional capacity is generally conceptualized to include not only an understanding of disclosed information but also an appreciation of its significance, the ability to use the information in reasoning, and the ability to express a clear choice. The authors critically reviewed existing measures of decisional capacity for research and treatment. Method: Electronic medical and legal databases were searched for articles published from 1980 to 2004 describing structured assessments of adults' capacity to consent to clinical treatment or research protocols. The authors identified 23 decisional capacity assessment instruments and evaluated each in terms of format, content, administration features, and psychometric properties. Results: Six instruments focused solely on understanding of disclosed information, and 11 tested for understanding, appreciation, reasoning, and expression of a choice. The instruments varied substantially in format, degree of standardization of disclosures, flexibility of item content, and scoring procedures. Reliability and validity also varied widely. All instruments have limitations, ranging from lack of supporting psychometric data to lack of generalizability across contexts. Conclusions: Of the instruments reviewed, the MacArthur Competence Assessment Tools for Clinical Research and for Treatment have the most empirical support, although other instruments may be equally or better suited to certain situations. Contextual factors are important but understudied. Capacity assessment tools should undergo further empirically based development and refinement as well as testing with a variety of populations.

Abstract Auditory steady-state response (ASSR) audiometry is a commercially available tool that is used to predict behavioral auditory threshold levels. Its particular value stems from the technology's ability to measure [...]

Objective: Passive retrospective cohorts composed of persons who have tested 2 or more times for a sexually transmitted infection (STI) of interest during clinical visits have been used to estimate STI incidence. We hypothesized that the analytic period of a passive cohort might affect the estimate of STI incidence, with shorter periods yielding higher estimates of incidences of infection. Study: We analyzed data collected from women, 12 to 24 years of age, tested for chlamydia 2 or more times at 6 sites in San Francisco between January 1997 and December 2000. Incidence was calculated for 10 different analytic periods. Results: The calculated incidence of chlamydial infection during 1997 was 16.8 (95% confidence interval [CI], 10.9-24.0) per 1000 person-months of follow up. The calculated incidence dropped markedly as the analytic period lengthened, with the incidence estimated to be 9.7 (95% CI, 8.6-10.9) using a study period of 4 years (1997-2000). Estimates of incidence were similar when using the same analytic period, regardless of calendar year, and there was a similar decline in estimated incidence using longer analytic periods. Conclusions: Estimates of STI incidence based on passive cohort data may have limited epidemiologic value because incidence measures may be highly dependent on the analytic period.

Background and Objectives: The effectiveness of condoms in reducing sexually transmitted disease (STD) infection risk has been debated in the face of equivocal epidemiologic evidence. We assessed the potential magnitude of bias in condom effectiveness studies resulting from inaccurate reporting of condom use behavior and misdiagnosis of STD infection status. Goal: The goal of this study was to illustrate the magnitude of bias in condom effectiveness studies in the presence of inaccurate condom use reporting and diagnostic misclassification. Study: We used probabilistic simulations to mimic plausible outcomes for hypothetical prospective and retrospective condom effectiveness studies subject to both inaccurate reporting of the participants' true condom use and diagnostic error. The simulations were conducted by generating a series of binomial (yes, no) random variables corresponding with STD infection status and accurate diagnosis of infection. Results: The simulation results illustrate that failure to address reporting and diagnostic errors can lead to a substantial bias in studies of condom effectiveness. This bias resulted in a roughly 25% to 30% reduction in the probability of detecting a true 2-fold reduction of infection risk resulting from using condoms. Conclusion: Inaccurate reporting of condom use and reliance on imperfect diagnostic tests can substantially bias observable measures of condom effectiveness. The potential for these biases should be addressed in the design and analysis of effectiveness studies.

On the morning of March 13, 2006, eight healthy volunteers forming the first cohort of a planned group escalation study of TeGenero's monoclonal antibody TGN 1412 at a Phase I [...]

A study published in the Journal of Spinal Cord Medicine (JSCM) shows that a treatment that transplants patients' own nasal stem cells to the site of a spinal cord injury [...]

The UK is suffering from an epidemic of poor sexual health. Paul Ward suggests five steps towards a solution. The UK's sexual health is in crisis. Diagnoses of the most [...]

Only a third of patients prescribed antihypertensive and lipid-lowering therapy is still taking both medications after six months, according to a US study. Researchers followed 8,406 patients between 1996 and [...]

NSAID treatment slows down the progression of joint damage in patients with ankylosing spondylitis, according to French research. The study of 215 patients with the condition found that patients who [...]

Lower than average birth weight is associated with an increased risk of dying from CVD, according to a UK study of 37,615 people born between 1911 and 1939. It found [...]

Although multislice CT is now a routine part of the primary survey, many emergency departments have not fully explored an efficient patient management protocol. German researchers have produced encouraging results [...]

Glycaemic control amongst patients with type-2 diabetes may decline in as little as six months after the start of combination therapy, a new study has suggested. Researchers analysed the records [...]

Women's fertility is not as adversely affected by coeliac disease as previously thought, according to researchers from the University of Nottingham. Dr Joe West, specialist registrar in gastroenterology at the [...]

Raised levels of atmospheric pollution are associated with increased heart failure rates in elderly patients, according to a US study. The researchers estimated that a doubling in the average level [...]

Patients with pneumonia who had their procalcitonin level measured stopped taking antibiotics after six days, according to Swiss research. Patients who did not have the hormone level measured stopped at [...]

ECT can reduce the risk of heart attack in severely depressed patients with chronic heart failure, according to US research. The study found that ECT reduced levels of norepine-phrine, which [...]

Elderly patients with hypertension whose BP does not dip at night have higher blood glucose levels than those whose BP does dip, US researchers have found. Fasting glucose levels were [...]

Exposure to gluten in the first three months of life increases the risk of coeliac disease fivefold compared to exposure between four and six months in children genetically predisposed to [...]

SSRIs increase the risk of GI bleeding as much as NSAIDs, according to research presented this week at the Digestive Disease Week conference in Chicago. US researchers compared the records [...]

Asthma is starting to get interesting. After years in which little seemed to change, the past month has seen two new research papers that offer different ways of thinking about [...]

A breath test which measures exhaled nitric oxide (eNO) could replace bronchial provocation tests in the diagnosis of asthma, according to Israeli research. The researchers carried out a prospective study [...]

Acupuncture is no more effective than placebo for treating migraine, according to a team of German and Swiss researchers. The study included 302 patients with migraine, with or without aura. [...]

Chronic infection with H pylori increases the risk of cardiovascular disease in men, according to a Japanese study. The researchers uncovered increased levels of systemic inflammation and endothelial dysfunction in [...]

Low bone mineral density (BMD) is a risk factor for cardiovascular disease, according to a Japanese study presented at the American Heart Association's sixth annual conference on arteriosclerosis, thrombosis and [...]

Children who are waiting for an operation can safely be allowed to drink liquids up to two hours before surgery, according to a review of the literature. Scottish researchers looked [...]

Byline: James Brice The nuclear medicine community is fighting proposed federal budget cuts that would end most Department of Energy support for basic nuclear medical research. The Society of Nuclear [...]

Surgery to treat severe epilepsy in children can improve their development and increase their IQ, a German study has found. The researchers followed the outcome of 50 children aged three [...]

Around one in 10 adults suffers from dysfunctional breathing, according to UK researchers. A group of 307 patients with asthma and 300 patients without asthma used the Nijmegen questionnaire to [...]

Prescribing UK study results further support giving asthma patients the choice of taking inhaled corticosteroids intermittently rather than daily. Patients with mild-to-moderate asthma who did not take daily steroids had [...]

A late diagnosis of lung cancer is usually due to patients being slow to present with symptoms, not by delayed GP referrals, according to UK research. The study included 22 [...]

Vitamin E supplements do not prevent the onset of Alzheimer's disease in people with mild cognitive impairment, a North American study has found. This finding contradicts earlier US research that [...]

Daily text reminders of self-management goals help adolescents with type-1 diabetes on intensive insulin therapy improve glycaemic control, according to a UK study. The researchers assigned 92 patients aged eight-18 [...]

Traumagenomics Using 'glue' for herding cats provides therapeutic insights By ANETTE BREINDL Medical Device Daily Staff Writer Getting large - or, for that matter, small - numbers of academics to [...]

Asthma Steve Ford Mild persistent asthma can be successfully treated with short courses of corticosteroids when needed, rather than daily therapy, say US researchers. They say many patients with asthma [...]