JAMA internal medicine
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JAMA internal medicine · Apr 2017
Randomized Controlled TrialThe Long-term Effect of Acupuncture for Migraine Prophylaxis: A Randomized Clinical Trial.
The long-term prophylactic effects of acupuncture for migraine are uncertain. ⋯ Among patients with migraine without aura, true acupuncture may be associated with long-term reduction in migraine recurrence compared with sham acupuncture or assigned to a waiting list.
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JAMA internal medicine · Apr 2017
Comparative StudyChanges in Postacute Care in the Medicare Shared Savings Program.
Postacute care is thought to be a major source of wasteful spending. The extent to which accountable care organizations (ACOs) can limit postacute care spending has implications for the importance and design of other payment models that include postacute care. ⋯ Participation in the MSSP has been associated with significant reductions in postacute spending without ostensible deterioration in quality of care. Spending reductions were more consistent with clinicians working within hospitals and SNFs to influence care for ACO patients than with hospital-wide initiatives by ACOs or use of preferred SNFs.
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JAMA internal medicine · Apr 2017
The Illness Experience of Undocumented Immigrants With End-stage Renal Disease.
The exclusion of undocumented immigrants from Medicare coverage for hemodialysis based on a diagnosis of end-stage renal disease (ESRD) requires physicians in some states to manage chronic illness in this population using emergent-only hemodialysis. Emergent-only dialysis is expensive and burdensome for patients. ⋯ Undocumented patients with ESRD experience debilitating, potentially life-threatening physical symptoms and psychosocial distress resulting from emergent-only hemodialysis. States excluding undocumented immigrants with ESRD from scheduled dialysis should reconsider their policies.
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JAMA internal medicine · Apr 2017
Evaluation of Evidence of Statistical Support and Corroboration of Subgroup Claims in Randomized Clinical Trials.
Many published randomized clinical trials (RCTs) make claims for subgroup differences. ⋯ A minority of subgroup claims made in the abstracts of RCTs are supported by their own data (ie, a significant interaction effect). For those that have statistical support (P < .05 from an interaction test), most fail to meet other best practices for subgroup tests, including prespecification, stratified randomization, and adjustment for multiple testing. Attempts to corroborate statistically significant subgroup differences are rare; when done, the initially observed subgroup differences are not reproduced.