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A study was conducted to evaluate whether clinicians have negative attitudes toward obesity and they express dissatisfaction in caring for obese persons. Results indicated that there was no evidence that obese patients received inferior care across 8 performance measures; in fact, a slightly higher level of care was recommended in the case of such patients.

A study is conducted to establish the differences in the quality of care provided to Medicare patients between safety-net and non-safety-net hospitals. Findings conclude that hospitals with a higher number of Medicare patients had lower improvement in quality of care.

A cross-sectional study of hospital care is conducted to determine whether quality measured with the process measures used in the US Centers for Medicare & Medicaid Services' (CMS) Hospital Compare are correlated with and are predictive of hospitals' risk-adjusted mortality rates. Results suggest that the CMS's existing set of performance measures are not closely linked to patient outcomes, thus necessitating improved performance measures for better health care.

Health care report cards publicly report information about physician, hospital and health plan quality in order to improve quality. But, public reporting may cause unintended and negative consequences on health care causing physicians to avoid sick patients in order to improve their quality ranking, encouraging physicians to achieve target rates for health care interventions even when it may be inappropriate among some patients, discounting patient preferences and clinical judgment.

The article discusses the current quality improvement interventions in health care prevalent in the United States today. The proposed new model to improve the quality of care, using a collaborative and local approach is highlighted.

Importance: Medicare's Bundled Payments for Care Improvement (BPCI) initiative for lower extremity joint replacement (LEJR) surgery has been associated with a reduction in episode spending and stable-to-improved quality. However, BPCI may create unintended effects by prompting participating hospitals to increase the overall volume of episodes paid for by Medicare, which could potentially eliminate program-related savings or prompt them to shift case mix to lower-risk patients.Objective: To evaluate whether hospital BPCI participation for LEJR was associated with changes in overall volume and case mix.Design, Setting, and Participants: Observational study using Medicare claims data and a difference-in-differences method to compare 131 markets (hospital referral regions) with at least 1 BPCI participant hospital (n = 322) and 175 markets with no participating hospitals (n = 1340), accounting for 580 043 Medicare beneficiaries treated before (January 2011-September 2013) and 462 161 after (October 2013-December 2015) establishing the BPCI initiative. Hospital-level case-mix changes were assessed by comparing 265 participating hospitals with a 1:1 propensity-matched set of nonparticipating hospitals from non-BPCI markets.Exposures: Hospital BPCI participation.Main Outcomes and Measures: Changes in market-level LEJR volume in the before vs after BPCI periods and changes in hospital-level case mix based on demographic, socioeconomic, clinical, and utilization factors.Results: Among the 1 717 243 Medicare beneficiaries who underwent LEJR (mean age, 75 years; 64% women; and 95% nonblack race/ethnicity), BPCI participation was not significantly associated with a change in overall market-level volume. The mean quarterly market volume in non-BPCI markets increased 3.8% from 3.8 episodes per 1000 beneficiaries before BPCI to 3.9 episodes per 1000 beneficiaries after BPCI was launched. For BPCI markets, the mean quarterly market volume increased 4.4% from 3.6 episodes per 1000 beneficiaries before BPCI to 3.8 episodes per 1000 beneficiaries after BPCI was launched. The adjusted difference-in-differences estimate between the market types was 0.32% (95% CI, -0.06% to 0.69%; P = .10). Among 20 demographic, socioeconomic, clinical, and utilization factors, BPCI participation was associated with differential changes in hospital-level case mix for only 1 factor, prior skilled nursing facility use (adjusted difference-in-differences estimate, -0.53%; 95% CI, -0.96% to -0.10%; P = .01) in BPCI vs non-BPCI markets.Conclusions and Relevance: In this observational study of Medicare beneficiaries who underwent LEJR, hospital participation in Bundled Payments for Care Improvement was not associated with changes in market-level lower extremity joint replacement volume and largely was not associated with changes in hospital case mix. These findings may provide reassurance regarding 2 potential unintended effects associated with bundled payments for LEJR. [ABSTRACT FROM AUTHOR]

More and more research is showing the negative effects of passive smoking on health. Passive smoking occurs in non-smokers who are exposed to second-hand smoke. About one-tenth of all smoking-related deaths are due to passive smoking. A 1998 study using ultrasound imaging to measure atherosclerosis in the carotid arteries found that passive smoking increased the thickness of the inner lining of the arteries by 20%. This indicates that passive smoking can increase the progression of atherosclerosis. Other studies have shown that the carotid artery is a good marker of system-wide atherosclerosis.

The article discusses research regarding the prevalence of nursing home specialists in American between 2012 and 2015, and it mentions a strategy for improving medical care which involves the employment of medical professionals who specialize in treating hospitalized patients. Nursing home care costs and quality are addressed, along with U.S. Medicare health insurance fee-for-service billing and the claim that 21 percent of the nursing home clinicians in 2015 were nursing home specialists.

IMPORTANCE Hospital readmissions are common, costly, and potentially preventable. Little is known about the association between available skilled nursing facility (SNF) performance measures and the risk of hospital readmission. OBJECTIVE To measure the association between SNF performance measures and hospital readmissions among Medicare beneficiaries receiving postacute care at SNFs in the United States. DESIGN AND PARTICIPANTS Using national Medicare data on fee-for-service Medicare beneficiaries discharged to a SNF after an acute care hospitalization between September 1, 2009, and August 31,2010, we examined the association between SNF performance on publicly available metrics (SNF staffing intensity, health deficiencies identified through site inspections, and the percentages of SNF patients with delirium, moderate to severe pain, and new or worsening pressure ulcers) and the risk of readmission or death 30 days after discharge to a SNF. Adjusted analyses controlled for patient case mix, SNF facility factors, and the discharging hospital. MAIN OUTCOMES AND MEASURES Readmission to an acute care hospital or death within 30 days of the index hospital discharge. RESULTS Of 1530 824 patients discharged, 357 752 (23.3%; 99% Cl, 23.3%-23.5%) were readmitted or died within 30 days; 72 472 died within 30 days (4.7%; 99% Cl, 4.7%-4.8%), and 321 709 were readmitted (21.0%; 99% Cl, 20.9%-21.1%). The unadjusted risk of readmission or death was lower at SNFs with better staffing ratings and better facility inspection ratings. No. (%) of SNFs 30-d Risk of Readmission or Death, % (99% Cl) Lowest Rating Highest Rating Lowest Rating Highest Rating Unadjusted risk, by staffing Rating 2742 (19.2) 959 (6.7) 25.5 (25.3-25.8) 19.8 (19.5-20.1) Unadjusted risk, by facility inspection rating 2867 (20.1) 1396 (9.8) 24.9 (24.7-25.1) 21.5 (21.2-21.7) Adjusted risk, by facility inspection rating 23.7 (23.7-23.7) 23.0 (23.0-23.1) Adjustment for patient factors, SNF facility factors, and the discharging hospital attenuated these associations; we observed small differences in the adjusted risk of readmission or death according to SNF facility inspection ratings. Other measures did not predict clinically meaningful differences in the adjusted risk of readmission or death. CONCLUSIONS AND RELEVANCE Among fee-for-service Medicare beneficiaries discharged to a SNF after an acute care hospitalization, available performance measures were not consistently associated with differences in the adjusted risk of readmission or death. [ABSTRACT FROM AUTHOR]

IMPORTANCE Interventions to transform primary care practices into medical homes are increasingly common, but their effectiveness in improving quality and containing costs is unclear. OBJECTIVE To measure associations between participation in the Southeastern Pennsylvania Chronic Care Initiative, one of the earliest and largest multipayer medical home pilots conducted in the United States, and changes in the quality, utilization, and costs of care. DESIGN, SETTING, AND PARTICIPANTS Thirty-two volunteering primary care practices participated in the pilot (conducted from June 1, 2008, to May 31, 2011). We surveyed pilot practices to compare their structural capabilities at the pilot's beginning and end. Using claims data from 4 participating health plans, we compared changes (in each year, relative to before the intervention) in the quality, utilization, and costs of care delivered to 64 243 patients who were attributed to pilot practices and 55 959 patients attributed to 29 comparison practices (selected for size, specialty, and location similar to pilot practices) using a difference-in-differences design. EXPOSURES Pilot practices received disease registries and technical assistance and could earn bonus payments for achieving patient-centered medical home recognition by the National Committee for Quality Assurance (NCQA). MAIN OUTCOMES AND MEASURES Practice structural capabilities; performance on 11 quality measures for diabetes, asthma, and preventive care; utilization of hospital, emergency department, and ambulatory care; standardized costs of care. RESULTS Pilot practices successfully achieved NCQA recognition and adopted new structural capabilities such as registries to identify patients overdue for chronic disease services. Pilot participation was associated with statistically significantly greater performance improvement, relative to comparison practices, on 1 of 11 investigated quality measures: nephropathy screening in diabetes (adjusted performance of 82.7% vs 71.7% by year 3, P < .001). Pilot participation was not associated with statistically significant changes in utilization or costs of care. Pilot practices accumulated average bonuses of $92 000 per primary care physician during the 3-year intervention. CONCLUSIONS AND RELEVANCE A multipayer medical home pilot, in which participating practices adopted new structural capabilities and received NCQA certification, was associated with limited improvements in quality and was not associated with reductions in utilization of hospital, emergency department, or ambulatory care services or total costs over 3 years. These findings suggest that medical home interventions may need further refinement. [ABSTRACT FROM AUTHOR]

This study uses MedPAR data to characterize trends in use of skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) after acute care hospitalizations and trends in hospital and SNF/IRF lengths of stay among Medicare beneficiaries. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article related to the characteristics of state health care price websites for improving the utility of health information.

Presents a letter to the editor in reply to readers' comments about publicly reporting quality information and about studies on CABG outcomes.

A response by Rachel M. Werner and Robert A. McNutt to a letter to the editor about their commentary "A new strategy to improve quality: rewarding actions rather than measures," published in the 2009 issue, is presented.

A response by Rachel Werner to a letter to the editor about her article “Comparison of change in quality of care between safety-net and non-safety-net hospitals” in the 2008;299(18):2180-2187 issue is presented.

The article presents a response by Rachel M. Werner and Eric T. Bradlow to letters to the editor about their article "Relationship between Medicare's Hospital Compare performance measures and mortality rates" in a previous issue.