This study examines the number and dollar amount of payments to physicians from companies marketing prescription stimulant medications.
PURPOSE: Though researchers have documented that adolescents are vulnerable to coercion focused on reproductive and sexual autonomy, measures to assess this type of coercion for both adolescent females and males have not been validated in a population-based sample.
METHOD: The present study used secondary data collected from high school students across Kentucky (n=16,137 from two independent samples in 2010 and 2014) to 1) determine if five items measuring adolescent reproductive and sexual coercion (ARSC) are appropriate for use among both females and males; and 2) estimate prevalence of identified ARSC factors by sex.
RESULTS: For both male and females, given measurement items, the results supported a two-factor model of ARSC comprised of 1) verbal relationship manipulation and 2) contraceptive interference. Measurement invariance by sex was also supported. Additional findings indicated the high prevalence of ARSC and its associated subscales. Approximately 4 in 10 females and 3 in 10 males reported experiencing ARSC in the previous year, with almost all of those reporting contraceptive interference also reporting verbal relationship manipulation.
CONCLUSIONS: Findings suggest verbal relationship manipulation and contraceptive interference (together forming ARSC) may restrict the autonomous sexual and reproductive decision-making of both female and male adolescents.
This study uses National Health and Nutrition Examination Survey data to evaluate whether patients enrolled in the clinical trials that support the American College of Cardiology/American Heart Association (ACC/AHA) guideline are representative of the US adult population recommended additional pharmacotherapy by the ACC/AHA guideline.
The Physician Payments Sunshine Act requires biomedical companies to report payments made to physicians and teaching hospitals to the Centers for Medicare and Medicaid Services (CMS). Despite significant attention paid to industry payments to physicians, little is known about payments to teaching hospitals, which create the potential for both benefits and institutional conflicts of interest. We examined 2018 CMS Open Payments program data to identify all nonresearch payments made by industry to teaching hospitals and determined that 91 percent of teaching hospitals received industry payments totaling $832 million in 2018. We observed substantial royalty payments, which may reflect the downstream benefits of research partnerships, as well as substantial payments for gifts and education, which raise concerns for institutional conflicts of interest. Hospital predictors of receiving payments included large bed size, major medical school affiliation, and inclusion on the U.S. News & World Report Best Hospitals Honor Roll. Financial payments from industry to teaching hospitals are common and previously underrecognized. Hospitals should strengthen policies to prevent the institutional conflicts of interest that may arise from these payments while promoting beneficial industry collaborations. We also suggest that CMS reporting requirements be broadened to all hospitals to meet the Sunshine Act's goals of encouraging transparency and preventing inappropriate industry influence.
IMPORTANCE: As part of the Choosing Wisely campaign, primary care, surgery, and neurology societies have identified carotid imaging ordered for screening, preoperative evaluation, and syncope as frequently low value.
OBJECTIVE: To determine the changes in overall and indication-specific rates of carotid imaging following Choosing Wisely recommendations.
DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study compared annual rates of carotid imaging before Choosing Wisely recommendations (ie, 2007 to 2012) and after (ie, 2013 to 2016) among adults receiving care in the Veterans Health Administration (VHA) national health system. Data analysis was performed from April 10, 2019, to November 27, 2019.
EXPOSURES: Release of the Choosing Wisely recommendations.
MAIN OUTCOMES AND MEASURES: Annual rates of overall imaging, imaging ordered for stroke workup, imaging ordered for low-value indications (ie, screening owing to carotid bruit, preoperative evaluation, and syncope). Indications were identified using a text lexicon algorithm based on electronic health record review of a stratified random sample of 1000 free-text imaging orders. The subsequent performance of carotid procedures within 6 months after carotid imaging was assessed.
RESULTS: Between 2007 and 2016, 809 071 carotid imaging examinations were identified (mean [SD] age of patients undergoing imaging, 69 [10] years; 776 632 [96%] men), of which 201 467 images (24.9%) were ordered for low-value indications (67 064 [8.2%] for carotid bruit, 25 032 [3.1%] for preoperative evaluation, and 109 400 [13.5%] for syncope), 257 369 (31.8%) for stroke workup, and 350 235 (43.3%) for other indications. Imaging for carotid bruits declined across the study period while there was no significant change in imaging for syncope or preoperative evaluation. Compared with the 6 years before, during the 4 years following Choosing Wisely recommendations, there was no change in the trend for syncope, a small decline in preoperative imaging (post-Choosing Wisely trend, -0.1 [95% CI, -0.1 to <-0.1] images per 10 000 veterans), and a continued but less steep decline in imaging for carotid bruits (post-Choosing Wisely trend, -0.3 [95% CI, -0.3 to -0.2] images per 10 000 veterans). During the study period, 17 689 carotid procedures were identified, of which 3232 (18.3%) were preceded by carotid imaging ordered for low-value indications.
CONCLUSIONS AND RELEVANCE: These findings suggest that Choosing Wisely recommendations were not associated with a meaningful change in low-value carotid imaging in a national integrated health system. To reduce low-value testing and utilization cascades, interventions targeting ordering clinicians are needed to augment the impact of public awareness campaigns.
BACKGROUND/OBJECTIVES: Dementia is associated with higher healthcare expenditures, in large part due to increased hospitalization rates relative to patients without dementia. Data on contemporary trends in the incidence and outcomes of potentially preventable hospitalizations of patients with dementia are lacking.
DESIGN: Retrospective cohort study using the National Inpatient Sample from 2012 to 2016.
SETTING: U.S. acute care hospitals.
PARTICIPANTS: A total of 1,843,632 unique hospitalizations of older adults (aged ≥65 years) with diagnosed dementia.
MEASUREMENTS: Annual trends in the incidence of hospitalizations for all causes and for potentially preventable conditions including acute ambulatory care sensitive conditions (ACSCs), chronic ACSCs, and injuries. In-hospital outcomes including mortality, discharge disposition, and hospital costs.
RESULTS: The survey weighted sample represented an estimated 9.27 million hospitalizations for patients with diagnosed dementia (mean [standard deviation] age = 82.6 [6.7] years; 61.4% female). In total, 3.72 million hospitalizations were for potentially preventable conditions (40.1%), 2.07 million for acute ACSCs, .76 million for chronic ACSCs, and .89 million for injuries. Between 2012 and 2016, the incidence of all-cause hospitalizations declined from 1.87 million to 1.85 million per year (P = .04) while the incidence of potentially preventable hospitalizations increased from .75 million to .87 million per year (P < .001), driven by an increased number of hospitalizations of community-dwelling older adults. Among patients with dementia hospitalized for potentially preventable conditions, inpatient mortality declined from 6.4% to 6.1% (P < .001), inflation-adjusted median costs increased from $7,319 to $7,543 (P < .001), and total annual costs increased from $7.4 to $9.3 billion. Although 86.0% of hospitalized patients were admitted from the community, only 32.7% were discharged to the community.
CONCLUSION: The number of potentially preventable hospitalizations of older adults with dementia is increasing, driven by hospitalizations of community-dwelling older adults. Improved strategies for early detection and goal-directed treatment of potentially preventable conditions in patients with dementia are urgently needed. J Am Geriatr Soc 68:2240-2248, 2020.
