{"title":"Hospital Assets and Private Equity Acquisition.","authors":"Shaun Larkin","doi":"10.1001/jama.2024.23421","DOIUrl":"10.1001/jama.2024.23421","url":null,"abstract":"","PeriodicalId":17196,"journal":{"name":"Journal of the American Medical Association","volume":" ","pages":"257"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Corita R Grudzen, Nina Siman, Allison M Cuthel, Oluwaseun Adeyemi, Rebecca Liddicoat Yamarik, Keith S Goldfeld, Benjamin S Abella, Fernanda Bellolio, Sorayah Bourenane, Abraham A Brody, Lauren Cameron-Comasco, Joshua Chodosh, Julie J Cooper, Ashley L Deutsch, Marie Carmelle Elie, Ahmed Elsayem, Rosemarie Fernandez, Jessica Fleischer-Black, Mauren Gang, Nicholas Genes, Rebecca Goett, Heather Heaton, Jacob Hill, Leora Horwitz, Eric Isaacs, Karen Jubanyik, Sangeeta Lamba, Katharine Lawrence, Michelle Lin, Caitlin Loprinzi-Brauer, Troy Madsen, Joseph Miller, Ada Modrek, Ronny Otero, Kei Ouchi, Christopher Richardson, Lynne D Richardson, Matthew Ryan, Elizabeth Schoenfeld, Matthew Shaw, Ashley Shreves, Lauren T Southerland, Audrey Tan, Julie Uspal, Arvind Venkat, Laura Walker, Ian Wittman, Erin Zimny
<p><strong>Importance: </strong>The emergency department (ED) offers an opportunity to initiate palliative care for older adults with serious, life-limiting illness.</p><p><strong>Objective: </strong>To assess the effect of a multicomponent intervention to initiate palliative care in the ED on hospital admission, subsequent health care use, and survival in older adults with serious, life-limiting illness.</p><p><strong>Design, setting, and participants: </strong>Cluster randomized, stepped-wedge, clinical trial including patients aged 66 years or older who visited 1 of 29 EDs across the US between May 1, 2018, and December 31, 2022, had 12 months of prior Medicare enrollment, and a Gagne comorbidity score greater than 6, representing a risk of short-term mortality greater than 30%. Nursing home patients were excluded.</p><p><strong>Intervention: </strong>A multicomponent intervention (the Primary Palliative Care for Emergency Medicine intervention) included (1) evidence-based multidisciplinary education; (2) simulation-based workshops on serious illness communication; (3) clinical decision support; and (4) audit and feedback for ED clinical staff.</p><p><strong>Main outcome and measures: </strong>The primary outcome was hospital admission. The secondary outcomes included subsequent health care use and survival at 6 months.</p><p><strong>Results: </strong>There were 98 922 initial ED visits during the study period (median age, 77 years [IQR, 71-84 years]; 50% were female; 13% were Black and 78% were White; and the median Gagne comorbidity score was 8 [IQR, 7-10]). The rate of hospital admission was 64.4% during the preintervention period vs 61.3% during the postintervention period (absolute difference, -3.1% [95% CI, -3.7% to -2.5%]; adjusted odds ratio [OR], 1.03 [95% CI, 0.93 to 1.14]). There was no difference in the secondary outcomes before vs after the intervention. The rate of admission to an intensive care unit was 7.8% during the preintervention period vs 6.7% during the postintervention period (adjusted OR, 0.98 [95% CI, 0.83 to 1.15]). The rate of at least 1 revisit to the ED was 34.2% during the preintervention period vs 32.2% during the postintervention period (adjusted OR, 1.00 [95% CI, 0.91 to 1.09]). The rate of hospice use was 17.7% during the preintervention period vs 17.2% during the postintervention period (adjusted OR, 1.04 [95% CI, 0.93 to 1.16]). The rate of home health use was 42.0% during the preintervention period vs 38.1% during the postintervention period (adjusted OR, 1.01 [95% CI, 0.92 to 1.10]). The rate of at least 1 hospital readmission was 41.0% during the preintervention period vs 36.6% during the postintervention period (adjusted OR, 1.01 [95% CI, 0.92 to 1.10]). The rate of death was 28.1% during the preintervention period vs 28.7% during the postintervention period (adjusted OR, 1.07 [95% CI, 0.98 to 1.18]).</p><p><strong>Conclusions and relevance: </strong>This multicomponent intervention to initiate palliativ
{"title":"Palliative Care Initiated in the Emergency Department: A Cluster Randomized Clinical Trial.","authors":"Corita R Grudzen, Nina Siman, Allison M Cuthel, Oluwaseun Adeyemi, Rebecca Liddicoat Yamarik, Keith S Goldfeld, Benjamin S Abella, Fernanda Bellolio, Sorayah Bourenane, Abraham A Brody, Lauren Cameron-Comasco, Joshua Chodosh, Julie J Cooper, Ashley L Deutsch, Marie Carmelle Elie, Ahmed Elsayem, Rosemarie Fernandez, Jessica Fleischer-Black, Mauren Gang, Nicholas Genes, Rebecca Goett, Heather Heaton, Jacob Hill, Leora Horwitz, Eric Isaacs, Karen Jubanyik, Sangeeta Lamba, Katharine Lawrence, Michelle Lin, Caitlin Loprinzi-Brauer, Troy Madsen, Joseph Miller, Ada Modrek, Ronny Otero, Kei Ouchi, Christopher Richardson, Lynne D Richardson, Matthew Ryan, Elizabeth Schoenfeld, Matthew Shaw, Ashley Shreves, Lauren T Southerland, Audrey Tan, Julie Uspal, Arvind Venkat, Laura Walker, Ian Wittman, Erin Zimny","doi":"10.1001/jama.2024.23696","DOIUrl":"10.1001/jama.2024.23696","url":null,"abstract":"<p><strong>Importance: </strong>The emergency department (ED) offers an opportunity to initiate palliative care for older adults with serious, life-limiting illness.</p><p><strong>Objective: </strong>To assess the effect of a multicomponent intervention to initiate palliative care in the ED on hospital admission, subsequent health care use, and survival in older adults with serious, life-limiting illness.</p><p><strong>Design, setting, and participants: </strong>Cluster randomized, stepped-wedge, clinical trial including patients aged 66 years or older who visited 1 of 29 EDs across the US between May 1, 2018, and December 31, 2022, had 12 months of prior Medicare enrollment, and a Gagne comorbidity score greater than 6, representing a risk of short-term mortality greater than 30%. Nursing home patients were excluded.</p><p><strong>Intervention: </strong>A multicomponent intervention (the Primary Palliative Care for Emergency Medicine intervention) included (1) evidence-based multidisciplinary education; (2) simulation-based workshops on serious illness communication; (3) clinical decision support; and (4) audit and feedback for ED clinical staff.</p><p><strong>Main outcome and measures: </strong>The primary outcome was hospital admission. The secondary outcomes included subsequent health care use and survival at 6 months.</p><p><strong>Results: </strong>There were 98 922 initial ED visits during the study period (median age, 77 years [IQR, 71-84 years]; 50% were female; 13% were Black and 78% were White; and the median Gagne comorbidity score was 8 [IQR, 7-10]). The rate of hospital admission was 64.4% during the preintervention period vs 61.3% during the postintervention period (absolute difference, -3.1% [95% CI, -3.7% to -2.5%]; adjusted odds ratio [OR], 1.03 [95% CI, 0.93 to 1.14]). There was no difference in the secondary outcomes before vs after the intervention. The rate of admission to an intensive care unit was 7.8% during the preintervention period vs 6.7% during the postintervention period (adjusted OR, 0.98 [95% CI, 0.83 to 1.15]). The rate of at least 1 revisit to the ED was 34.2% during the preintervention period vs 32.2% during the postintervention period (adjusted OR, 1.00 [95% CI, 0.91 to 1.09]). The rate of hospice use was 17.7% during the preintervention period vs 17.2% during the postintervention period (adjusted OR, 1.04 [95% CI, 0.93 to 1.16]). The rate of home health use was 42.0% during the preintervention period vs 38.1% during the postintervention period (adjusted OR, 1.01 [95% CI, 0.92 to 1.10]). The rate of at least 1 hospital readmission was 41.0% during the preintervention period vs 36.6% during the postintervention period (adjusted OR, 1.01 [95% CI, 0.92 to 1.10]). The rate of death was 28.1% during the preintervention period vs 28.7% during the postintervention period (adjusted OR, 1.07 [95% CI, 0.98 to 1.18]).</p><p><strong>Conclusions and relevance: </strong>This multicomponent intervention to initiate palliativ","PeriodicalId":17196,"journal":{"name":"Journal of the American Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Addressing Health Care's Administrative Cost Crisis.","authors":"Brooke Istvan, Kevin A Schulman, Stefanos Zenios","doi":"10.1001/jama.2024.27670","DOIUrl":"https://doi.org/10.1001/jama.2024.27670","url":null,"abstract":"","PeriodicalId":17196,"journal":{"name":"Journal of the American Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jody D Ciolino, Denise M Scholtens, Lauren B Bonner
{"title":"Factorial Clinical Trial Designs.","authors":"Jody D Ciolino, Denise M Scholtens, Lauren B Bonner","doi":"10.1001/jama.2024.25374","DOIUrl":"https://doi.org/10.1001/jama.2024.25374","url":null,"abstract":"","PeriodicalId":17196,"journal":{"name":"Journal of the American Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cristina Thomas, Herbert Castillo Valladares, Aileen Y Chang
{"title":"Scabies Infestations-Reply.","authors":"Cristina Thomas, Herbert Castillo Valladares, Aileen Y Chang","doi":"10.1001/jama.2024.25288","DOIUrl":"https://doi.org/10.1001/jama.2024.25288","url":null,"abstract":"","PeriodicalId":17196,"journal":{"name":"Journal of the American Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Sometimes Saying Less Is More-Poetry and Effective Patient-Centered Communication.","authors":"Rafael Campo","doi":"10.1001/jama.2024.19498","DOIUrl":"https://doi.org/10.1001/jama.2024.19498","url":null,"abstract":"","PeriodicalId":17196,"journal":{"name":"Journal of the American Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Scabies Infestations.","authors":"Jaimie Oldham, Edel O'Toole, Malvina Cunningham","doi":"10.1001/jama.2024.25291","DOIUrl":"https://doi.org/10.1001/jama.2024.25291","url":null,"abstract":"","PeriodicalId":17196,"journal":{"name":"Journal of the American Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Triple Bypass.","authors":"Wendy Wisner","doi":"10.1001/jama.2024.19072","DOIUrl":"https://doi.org/10.1001/jama.2024.19072","url":null,"abstract":"","PeriodicalId":17196,"journal":{"name":"Journal of the American Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hermioni L Amonoo, Preeti N Malani, Stephen M Schenkel
{"title":"Expanding Palliative Care Access-Bridging Gaps in Diverse Clinical Settings.","authors":"Hermioni L Amonoo, Preeti N Malani, Stephen M Schenkel","doi":"10.1001/jama.2024.24947","DOIUrl":"https://doi.org/10.1001/jama.2024.24947","url":null,"abstract":"","PeriodicalId":17196,"journal":{"name":"Journal of the American Medical Association","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eleni Tsamantioti, Anna Sandström, Charlotte Lindblad Wollmann, Jonathan M Snowden, Neda Razaz
Importance: Women who experience severe maternal morbidity (SMM) might have lasting health issues, and the association of SMM with the probability of future reproductive intentions is unknown.
Objective: To examine the association between SMM in a first birth and the probability of a subsequent birth.
Design, setting, and participants: Retrospective, population-based cohort study conducted among 1 046 974 women in Sweden who had their first birth between 1999 and 2021.
Exposure: Overall SMM and SMM subtypes were identified among all deliveries at 22 weeks of gestation or later (including complications within 42 days of delivery) from the Swedish Medical Birth Register and National Patient Register.
Main outcomes and measures: All women with a recorded first delivery were followed up from 43 days postpartum until the first day of the last menstrual period of the second pregnancy that resulted in a birth (stillbirth or live birth) or until death, emigration, or end of follow-up on December 31, 2021. Multivariable Cox proportional hazards regression was used to estimate associations between SMM and time to subsequent birth with adjusted hazard ratios (aHRs). Sibling analysis was performed to evaluate potential genetic and familial confounding.
Results: A total of 36 790 women (3.5%) experienced an SMM condition in their first birth. Women with any SMM had a lower incidence rate of subsequent birth compared with those without SMM in their first delivery (136.6 vs 182.4 per 1000 person-years), with an aHR of 0.88 (95% CI, 0.87-0.89). The probability of subsequent birth was substantially lower among women with severe uterine rupture (aHR, 0.48; 95% CI, 0.27-0.85), cardiac complications (aHR, 0.49; 95% CI, 0.41-0.58), cerebrovascular accident (aHR, 0.60; 95% CI, 0.50-0.73), and severe mental health conditions (aHR, 0.48; 95% CI, 0.44-0.53) in their first birth. The associations were not influenced by familial confounding as indicated by sibling analyses.
Conclusions and relevance: Our findings suggest that women who experience SMM in their first birth are less likely to have a subsequent birth. Adequate reproductive counseling and enhancing antenatal care are crucial for women with a history of SMM.
{"title":"Association of Severe Maternal Morbidity With Subsequent Birth.","authors":"Eleni Tsamantioti, Anna Sandström, Charlotte Lindblad Wollmann, Jonathan M Snowden, Neda Razaz","doi":"10.1001/jama.2024.20957","DOIUrl":"10.1001/jama.2024.20957","url":null,"abstract":"<p><strong>Importance: </strong>Women who experience severe maternal morbidity (SMM) might have lasting health issues, and the association of SMM with the probability of future reproductive intentions is unknown.</p><p><strong>Objective: </strong>To examine the association between SMM in a first birth and the probability of a subsequent birth.</p><p><strong>Design, setting, and participants: </strong>Retrospective, population-based cohort study conducted among 1 046 974 women in Sweden who had their first birth between 1999 and 2021.</p><p><strong>Exposure: </strong>Overall SMM and SMM subtypes were identified among all deliveries at 22 weeks of gestation or later (including complications within 42 days of delivery) from the Swedish Medical Birth Register and National Patient Register.</p><p><strong>Main outcomes and measures: </strong>All women with a recorded first delivery were followed up from 43 days postpartum until the first day of the last menstrual period of the second pregnancy that resulted in a birth (stillbirth or live birth) or until death, emigration, or end of follow-up on December 31, 2021. Multivariable Cox proportional hazards regression was used to estimate associations between SMM and time to subsequent birth with adjusted hazard ratios (aHRs). Sibling analysis was performed to evaluate potential genetic and familial confounding.</p><p><strong>Results: </strong>A total of 36 790 women (3.5%) experienced an SMM condition in their first birth. Women with any SMM had a lower incidence rate of subsequent birth compared with those without SMM in their first delivery (136.6 vs 182.4 per 1000 person-years), with an aHR of 0.88 (95% CI, 0.87-0.89). The probability of subsequent birth was substantially lower among women with severe uterine rupture (aHR, 0.48; 95% CI, 0.27-0.85), cardiac complications (aHR, 0.49; 95% CI, 0.41-0.58), cerebrovascular accident (aHR, 0.60; 95% CI, 0.50-0.73), and severe mental health conditions (aHR, 0.48; 95% CI, 0.44-0.53) in their first birth. The associations were not influenced by familial confounding as indicated by sibling analyses.</p><p><strong>Conclusions and relevance: </strong>Our findings suggest that women who experience SMM in their first birth are less likely to have a subsequent birth. Adequate reproductive counseling and enhancing antenatal care are crucial for women with a history of SMM.</p>","PeriodicalId":17196,"journal":{"name":"Journal of the American Medical Association","volume":" ","pages":"133-142"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11589858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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