Abstract:
Importance:Medicare adopted transitional care management (TCM) payment codes in 2013 to encourage clinicians to furnish TCM services after beneficiaries were discharged to the community from medical facilities. To bill for the 30-day service, a care team member must communicate with the beneficiary or the caregiver within 2 business days after the discharge and the clinician must provide an office visit within 14 days. Objective:To investigate whether the receipt of TCM services was associated with the subsequent health care costs and mortality of the beneficiaries in the month after the service was provided. Design, Setting, and Participants:Retrospective cohort analysis of all Medicare fee-for-service claims for the period of January 1, 2013, through December 31, 2015, for 18 756 707 Medicare fee-for-service beneficiaries with discharges eligible for subsequent TCM services. Discharges from a hospital, an inpatient psychiatric facility, a long-term care hospital, a skilled nursing facility, an inpatient rehabilitation facility, or an outpatient facility for an observational stay were included. Data analysis was performed from July 2016 to March 2018. Exposure:Furnishing of TCM services for the 30 days following an eligible discharge for Medicare beneficiaries as reflected in Medicare fee-for-service claims. Main Outcomes and Measures:Total Medicare (Parts A, B, and D) health care costs and mortality in the 31 to 60 days after discharge, which is 30 days beyond the potential period for which the beneficiary could receive TCM services. Health care costs and mortality were adjusted for beneficiary age, sex, risk score, dual eligibility for Medicare and Medicaid, type of eligible discharge, year of discharge, and whether the eligible discharge to the community included home health care. Results:Of 18 756 707 eligible Medicare beneficiaries during the study period, 43.9% were male and had a mean (SD) age of 72.5 (13.8) years. Transitional care management services were billed following eligible discharges in 3.1% of cases in 2013, 5.5% in 2014, and 7.0% in 2015. The adjusted total Medicare costs ($3358; 95% CI, $3324-$3392 vs $3033; 95% CI, $3001-$3065; P < .001) and mortality (1.6%; 95% CI, 1.6%-1.6% vs 1.0%; 95% CI, 1.0%-1.1%; P < .001) were higher among those beneficiaries who did not receive TCM services compared with those who did receive TCM services in the 31 to 60 days following an eligible discharge. Conclusions and Relevance:Despite the apparent benefits of TCM services for Medicare beneficiaries, the use of this service remains low. An assessment should be made of interventions that can increase the appropriate use of this service.
journal_name
JAMA Intern Medjournal_title
JAMA internal medicineauthors
Bindman AB,Cox DFdoi
10.1001/jamainternmed.2018.2572subject
Has Abstractpub_date
2018-09-01 00:00:00pages
1165-1171issue
9eissn
2168-6106issn
2168-6114pii
2687989journal_volume
178pub_type
社论abstract:Importance:End-of-life care is costly, and decedents often experience overtreatment or low-quality care. Noninvasive ventilation (NIV) may be a palliative approach to avoid invasive mechanical ventilation (IMV) among select patients who are hospitalized at the end of life. Objective:To examine the trends in NIV and IM...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2020.5640
更新日期:2021-01-01 00:00:00
abstract:IMPORTANCE:General medicine rounds by attending physicians provide the foundation for patient care and education in teaching hospitals. However, the detailed activities of these rounds in the current era are not well characterized. OBJECTIVE:To describe the characteristics of attending rounds for internal medicine inp...
journal_title:JAMA internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1001/jamainternmed.2013.6041
更新日期:2013-06-24 00:00:00
abstract:IMPORTANCE:Adherence to long-term therapies in chronic disease is poor. Traditional interventions to improve adherence are complex and not widely effective. Mobile telephone text messaging may be a scalable means to support medication adherence. OBJECTIVES:To conduct a meta-analysis of randomized clinical trials to as...
journal_title:JAMA internal medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1001/jamainternmed.2015.7667
更新日期:2016-03-01 00:00:00
abstract:IMPORTANCE:Cardiac biomarker testing is not routinely indicated in the emergency department (ED) because of low utility and potential downstream harms from false-positive results. However, current rates of testing are unknown. OBJECTIVE:To determine the use of cardiac biomarker testing overall, as well as stratified b...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2014.5830
更新日期:2015-01-01 00:00:00
abstract:IMPORTANCE:Biofeedback with device-guided lowering of breathing frequency could be an alternate nonpharmacologic treatment option for hypertension. Evidence from trials with high methodologic quality is lacking. OBJECTIVE:To evaluate the effects of device-guided lowering of breathing frequency on blood pressure in pat...
journal_title:JAMA internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamainternmed.2013.6883
更新日期:2013-07-22 00:00:00
abstract:Importance:The association between incretin-based drugs, such as dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide 1 (GLP-1) agonists, and acute pancreatitis is controversial. Objective:To determine whether the use of incretin-based drugs, compared with the use of 2 or more other oral antidiabetic dr...
journal_title:JAMA internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1001/jamainternmed.2016.1522
更新日期:2016-10-01 00:00:00
abstract:IMPORTANCE:Controversy exists regarding whether the decision to pursue a do-not-resuscitate (DNR) order should be grounded in an ethic of patient autonomy or in the obligation to act in the patient's best interest (beneficence). OBJECTIVE:To explore how physicians' approaches to DNR decision making at the end of life ...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2015.0295
更新日期:2015-05-01 00:00:00
abstract:IMPORTANCE:Experts debate optimal 25-hydroxyvitamin D (25[OH]D) levels for musculoskeletal health. OBJECTIVE:To compare the effects of placebo, low-dose cholecalciferol, and high-dose cholecalciferol on 1-year changes in total fractional calcium absorption, bone mineral density, Timed Up and Go and five sit-to-stand t...
journal_title:JAMA internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamainternmed.2015.3874
更新日期:2015-10-01 00:00:00
abstract:Importance:Previous studies have shown that medical student mistreatment is common. However, few data exist to date describing how the prevalence of medical student mistreatment varies by student sex, race/ethnicity, and sexual orientation. Objective:To examine the association between mistreatment and medical student ...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2020.0030
更新日期:2020-05-01 00:00:00
abstract:IMPORTANCE:False-positive mammograms, a common occurrence in breast cancer screening programs, represent a potential screening harm that is currently being evaluated by the US Preventive Services Task Force. OBJECTIVE:To measure the effect of false-positive mammograms on quality of life by measuring personal anxiety, ...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2014.981
更新日期:2014-06-01 00:00:00
abstract:IMPORTANCE:Myocardial infarction (MI) is an established risk factor for atrial fibrillation (AF). However, the extent to which AF is a risk factor for MI has not been investigated. OBJECTIVE:To examine the risk of incident MI associated with AF. DESIGN, SETTING, AND PARTICIPANTS:A prospective cohort of 23,928 partici...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2013.11912
更新日期:2014-01-01 00:00:00
abstract:IMPORTANCE:Persons with type 2 diabetes mellitus (T2DM) are at increased risk for decline in cognitive function, reduced brain volume, and increased white matter lesions in the brain. Poor control of blood pressure (BP) and lipid levels are risk factors for T2DM-related cognitive decline, but the effect of intensive tr...
journal_title:JAMA internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamainternmed.2013.13656
更新日期:2014-03-01 00:00:00
abstract:Importance:First-line behavioral and drug therapies for overactive bladder (OAB) symptoms in men are effective but not usually curative. Objective:To determine whether combining behavioral and drug therapies improves outcomes compared with each therapy alone for OAB in men and to compare 3 sequences for implementing c...
journal_title:JAMA internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamainternmed.2019.6398
更新日期:2020-03-01 00:00:00
abstract:IMPORTANCE:Policies and practices that promote advance care planning and advance directive completion implicitly assume that patients' choices for end-of-life (EOL) care are stable over time, even with changes in health status. OBJECTIVE:To systematically evaluate the evidence on the stability of EOL preferences over ...
journal_title:JAMA internal medicine
pub_type: 杂志文章,评审
doi:10.1001/jamainternmed.2014.1183
更新日期:2014-07-01 00:00:00
abstract:IMPORTANCE:Conversational agents are smartphone-based computer programs designed to respond to users in natural language, thereby mimicking conversations between people. Many people use their smartphones to obtain health information. OBJECTIVE:To describe the responses of 4 widely used conversational agents (Siri [App...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2016.0400
更新日期:2016-05-01 00:00:00
abstract:Importance:Chronic kidney disease (CKD) is common in adults with heart failure and is associated with an increased risk of sudden cardiac death. Randomized trials of participants without CKD have demonstrated that implantable cardioverter defibrillators (ICDs) decrease the risk of arrhythmic death in selected patients ...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2017.8462
更新日期:2018-03-01 00:00:00
abstract:IMPORTANCE:National efforts to measure hospital performance in treating cardiac arrest have focused on case survival, with the hope of improving survival after cardiac arrest. However, it is plausible that hospitals with high case-survival rates do a poor job of preventing cardiac arrests in the first place. OBJECTIVE...
journal_title:JAMA internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1001/jamainternmed.2013.1026
更新日期:2013-07-08 00:00:00
abstract:Importance:Home health care workers care for community-dwelling adults and play an important role in supporting patients with confirmed and suspected coronavirus disease 2019 (COVID-19) who remain at home. These workers are mostly middle-aged women and racial/ethnic minorities who typically earn low wages. Despite bein...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2020.3930
更新日期:2020-08-04 00:00:00
abstract:Importance:Postmarket evidence generation for medical devices is important yet limited for prosthetic aortic valve devices in the United Kingdom. Objective:To identify prosthetic aortic valve models that display unexpected patterns of mortality or reintervention using routinely collected national registry data and rec...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2016.6936
更新日期:2017-01-01 00:00:00
abstract:IMPORTANCE:Additional information is needed about the role of dietary sodium on health outcomes in older adults. OBJECTIVE:To examine the association between dietary sodium intake and mortality, incident cardiovascular disease (CVD), and incident heart failure (HF) in older adults. DESIGN, SETTING, AND PARTICIPANTS:W...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2014.6278
更新日期:2015-03-01 00:00:00
abstract::Routine daily laboratory testing of hospitalized patients reflects a wasteful clinical practice that threatens the value of health care. Choosing Wisely initiatives from numerous professional societies have identified repetitive laboratory testing in the face of clinical stability as low value care. Although laborator...
journal_title:JAMA internal medicine
pub_type: 杂志文章,评审
doi:10.1001/jamainternmed.2017.5152
更新日期:2017-12-01 00:00:00
abstract:Importance:Accumulating epidemiologic evidence has suggested favorable associations between plant-based dietary patterns and risk of type 2 diabetes, although there is a lack of a quantitative summary of evidence substantiating this important association. Objective:To quantitatively synthesize available prospective ob...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2019.2195
更新日期:2019-07-22 00:00:00
abstract:IMPORTANCE:Better continuity of care is expected to improve patient outcomes and reduce health care costs, but patterns of use, costs, and clinical complications associated with the current patterns of care continuity have not been quantified. OBJECTIVE:To measure the association between care continuity, costs, and ra...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2014.245
更新日期:2014-05-01 00:00:00
abstract:Importance:Initiatives to reduce sodium in packaged foods have been launched in the United States, yet corresponding changes in the amount of sodium that US households obtain from packaged foods have not been evaluated, to our knowledge. Objective:To assess 15-year changes in the amount of sodium that US households ac...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2017.1407
更新日期:2017-07-01 00:00:00
abstract:Importance:As cervical cancer screening transitions from Papanicolaou cytologic screening to primary human papillomavirus (HPV) testing worldwide, effective triage tests are needed to decide who among the HPV-positive women should receive further diagnostic evaluation to avoid unnecessary colposcopies and biopsies. Ob...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2019.0306
更新日期:2019-07-01 00:00:00
abstract:Importance:The American College of Radiology (ACR) has recognized the importance of minimizing radiation doses used for lung cancer screening (LCS) computed tomography (CT). However, without standard protocols, doses could still be unnecessarily high, reducing screening margin of benefit. Objective:To characterize LCS...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2019.3893
更新日期:2019-09-23 00:00:00
abstract:Importance:Advanced age is associated with lower use of drug treatment to prevent fractures, but concerns about comorbidities and prognosis increase the complexity of managing osteoporosis in this age group. Objective:To determine the association of disease definition, number of comorbidities, and prognosis with 5-yea...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2019.0682
更新日期:2019-06-17 00:00:00
abstract:IMPORTANCE:Transthoracic echocardiography (TTE) accounts for almost half of all cardiac imaging services and is a widely available and versatile tool. Appropriate use criteria (AUC) for echocardiography were developed to improve patient care and health outcomes. Prior studies have shown that most TTEs are appropriate b...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2013.8972
更新日期:2013-09-23 00:00:00
abstract:Importance:Manufacturers of US Food and Drug Administration-approved prescription drugs often apply for additional indications based on randomized clinical trials. Real-world database analyses on a medication's use and outcomes in routine settings of care might help to inform decision making regarding such supplemental...
journal_title:JAMA internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1001/jamainternmed.2017.3919
更新日期:2018-01-01 00:00:00
abstract:Importance:Radiation doses for computed tomography (CT) vary substantially across institutions. Objective:To assess the impact of institutional-level audit and collaborative efforts to share best practices on CT radiation doses across 5 University of California (UC) medical centers. Design, Setting, and Participants:...
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更新日期:2017-06-01 00:00:00