JAMA internal medicine
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JAMA internal medicine · Jun 2019
Association Between Receipt of a Medically Tailored Meal Program and Health Care Use.
Whether interventions to improve food access can reduce health care use is unknown. ⋯ Participation in a medically tailored meals program appears to be associated with fewer hospital and skilled nursing admissions and less overall medical spending.
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JAMA internal medicine · Jun 2019
Randomized Controlled TrialEffect of the Serious Illness Care Program in Outpatient Oncology: A Cluster Randomized Clinical Trial.
High-quality conversations between clinicians and seriously ill patients about values and goals are associated with improved outcomes but occur infrequently. ⋯ The results of this cluster randomized clinical trial were null with respect to the coprimary outcomes of goal-concordant care and peacefulness at the end of life. Methodologic challenges for the primary outcomes, including measure selection and sample size, limit the conclusions that can be drawn from the study. However, the significant reductions in anxiety and depression in the intervention group are clinically meaningful and require further study.
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JAMA internal medicine · Jun 2019
Association of Stratification by Dual Enrollment Status With Financial Penalties in the Hospital Readmissions Reduction Program.
Beginning in fiscal year 2019, Medicare's Hospital Readmissions Reduction Program (HRRP) stratifies hospitals into 5 peer groups based on the proportion of each hospital's patient population that is dually enrolled in Medicare and Medicaid. The effect of this policy change is largely unknown. ⋯ Stratification of the hospitals under the HRRP was associated with a significant shift in penalties for excess readmissions. Policymakers should monitor the association of this change with readmission rates as well as hospital financial performance as the policy is fully implemented.
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JAMA internal medicine · Jun 2019
Comparative Study Observational StudyCardiovascular Outcomes of Calcium-Free vs Calcium-Based Phosphate Binders in Patients 65 Years or Older With End-stage Renal Disease Requiring Hemodialysis.
Guidelines restricting use of calcium-based phosphate binders in all patients with end-stage renal disease owing to their potential contribution to increased cardiovascular risk shifted prescribing from calcium acetate toward the costlier sevelamer carbonate products. ⋯ The results of the study do not suggest increased cardiovascular safety of sevelamer in the routine clinical practice of patients with ESRD compared with calcium acetate; this study's findings suggest that well-designed, long-term, randomized clinical trials are needed.