JAMA : the journal of the American Medical Association
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The Agency for Health Care Policy and Research (AHCPR) has recently published guidelines for the management of patients with acute low back pain, which include recommendations for the use of lumbar radiographs, based on the identification of "red flags" for fractures, tumors, or infections. The purpose of this study was to evaluate the potential impact of these guidelines in patients with new episodes of low back pain seen in primary care settings. ⋯ The implementation of the AHCPR guidelines for the initial use of radiographs in patients with low back pain may increase utilization and economic costs. A more restricted and cost-efficient set of guidelines should be proposed.
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Comparative Study
Variations in cataract extraction rates in Medicare prepaid and fee-for-service settings.
To compare rates of cataract extraction in 2 prepaid health settings and in traditional fee-for-service (FFS) settings. ⋯ Because of the potential implications for vision care in the elderly, the significantly different rates of cataract extraction in FFS and prepaid settings warrant further clinical investigation to determine whether there is overuse in FFS vs underuse in prepaid settings. Such investigations must assess the appropriateness of cataract surgery by evaluating its use relative to clinical need.