JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.

JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT, Tuesday, July 19, 2005)

JAMA NEWS RELEASES

   HOSPITAL 'REPORT CARDS' FOUND NOT EFFECTIVE FOR QUALITY IMPROVEMENT

   CHILDREN BORN WITH EXTREMELY LOW-BIRTH-WEIGHT IN THE 1990S HAVE CONSIDERABLE LONG-TERM HEALTH AND EDUCATIONAL NEEDS

   INSULIN RESISTANCE ASSOCIATED WITH INCREASED RISK FOR CONGESTIVE HEART FAILURE

JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)

   VIDEO: Windows Media | Quicktime

   MAJORITY OF BABIES BORN WEIGHING LESS THAN TWO POUNDS WILL HAVE SPECIAL HEALTH AND EDUCATIONAL NEEDS AT AGE 8

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TV Note: This week's JAMA video news release is on the chronic conditions and special health care needs of children born with extremely low birth weight in the 1990s. The release will be fed Tuesday, July 19, from 9:00 - 9:30 a.m. ET on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band) and from 2:00 - 2:30 p.m. ET on Intelsat America 6, Transponder 11 (C-Band). For more information, call 312/464-JAMA (5262).

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Embargoed for Release: 3 p.m. CT, Tuesday, July 19, 2005
Media Advisory: To contact corresponding author Louise Pilote, M.D., M.P.H., Ph.D., call Ian Popple at 514-843-1560. To contact editorial author Eric David Peterson, M.D., M.P.H., call Richard Merritt at 919-684-4148.

CHICAGO—Hospitals that were given feedback on their performance on certain quality indicators for treating heart attack patients did not show more improvement in those areas than hospitals that were provided with the feedback at a later date, according to a study in the July 20 issue of JAMA.

Acute myocardial infarction (AMI; heart attack) patients often do not receive recommended evidence-based treatments, according to background information in the article. There is increasing interest in implementing quality improvement strategies for AMI care. One quality improvement strategy that has been suggested is feedback on "quality indicators" to hospitals and clinicians treating AMI patients. Quality indicators are defined as a summary of clinical performance over a specified time. It is suggested that "report cards" presenting a summary of quality indicators relevant to care provided by individual hospitals can catalyze quality improvement at these hospitals. Ideally, hospital report cards provide clinicians with an accurate picture of the care they deliver and provide benchmarks for comparison, such as the care delivered at other hospitals or recommended target rates. Hospital report cards are increasingly being implemented in the United States and some parts of Canada as a strategy for quality improvement in many areas of health care, despite lack of strong evidence to support their use.

Christine A. Beck, M.Sc., of McGill University Health Centre, Montreal, and colleagues conducted a study to determine whether hospital report cards produced using linked administrative databases are effective for improving AMI care. The study included patients with AMI who were admitted to 76 acute care hospitals in Quebec that treated at least 30 AMI patients per year between April 1, 1999, and March 31, 2003. The hospitals were randomly assigned to receive rapid (immediate; n = 38 hospitals and 2,533 patients) or delayed (14 months; n = 38 hospitals and 3,142 patients) confidential feedback on quality indicators developed using administrative data. The quality indicators pertained to processes of care and outcomes of patients admitted between 4 and 10 months after randomization. The primary indicator was the proportion of elderly survivors of AMI at each study hospital who filled a prescription for a beta-blocker within 30 days after discharge.

The researchers found that at follow-up, adjusted prescription rates within 30 days after discharge were similar in the early vs. late groups for beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, lipid-lowering drugs and aspirin. In addition, the adjusted death rate was similar in both groups, as were length of in-hospital stay, physician visits after discharge, waiting times for invasive cardiac procedures, and readmissions for cardiac complications.

"In this cluster randomized controlled trial, confidential feedback provided to hospitals in the form of report cards constructed using linked administrative data was not effective in improving quality of AMI care. Our results suggest that even if the United States eventually acquires these types of administrative data through the Medicare program, confidential feedback based on these data are unlikely to be a sufficient strategy for health care quality improvement," the authors write. "More intensive interventions, which could include chart review and continuous and/or public data feedback accompanied by other multimodal interventions, such as team workshops and standard orders, may be effective, but a need remains to study these interventions and their cost-benefit ratios in well-controlled randomized trials."

The researchers speculate that there could be several reasons for the lack of effectiveness of the study intervention, including "that the administrative data were perceived as invalid or irrelevant to practice. It is possible that report cards constructed using chart review data may be more effective than those constructed using administrative data because physicians are less skeptical of their data quality."
(JAMA. 2005;294:309-317. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: For funding/support information, please see the JAMA article.

EDITORIAL: OPTIMIZING THE SCIENCE OF QUALITY IMPROVEMENT

In an accompanying editorial, Eric David Peterson, M.D., M.P.H., of Duke University Medical Center, Durham, N.C., comments on the study in this week's JAMA on quality improvement (QI).

"The report by Beck et al and other similar studies exemplify valuable prototypes for the emerging science of QI. Better means are needed to ensure that medical discoveries are adopted rapidly and completely into community practice. Like the medical discovery process, QI strategies need to be subject to rigorous evaluation to determine what works, at what intensity, and when coupled with what. While the current study intervention was insufficient to motivate change, it does provide important lessons for optimizing the process of translating evidence to practice in the future."
(JAMA. 2005;294:369-371. Available pre-embargo to the media at www.jamamedia.org)

For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.

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Embargoed for Release: 3 p.m. CT, Tuesday, July 19, 2005
Media Advisory: To contact Maureen Hack, M.B., Ch.B., call Janice Guhl at 216-844-1524. To contact editorial co-author Jon E. Tyson, M.D., M.P.H., call Melanie Hillis at 713-500-3030.

CHILDREN BORN WITH EXTREMELY LOW-BIRTH-WEIGHT IN THE 1990S HAVE CONSIDERABLE LONG-TERM HEALTH AND EDUCATIONAL NEEDS

CHICAGO—Children born in the 1990s weighing less than 2.2 lbs. are at significantly increased risk of experiencing chronic health conditions and functional and educational limitations compared to normal-birth-weight children, according to a study in the July 20 issue of JAMA.

Advances in perinatal care in the 1990s resulted in dramatic increases in the survival of extremely low-birth-weight (ELBW, less than 1000 grams [2.2 lbs.]) infants, according to background information in the article. There is little information on how these children function at school age when neurological, cognitive, and health status has to a large extent stabilized. Information on the overall functioning and special health care needs of recent surviving ELBW children is needed to plan for the medical and educational services that they will require at school age.

Maureen Hack, M.B., Ch.B., of Case Western Reserve University, Cleveland, and colleagues conducted a comprehensive examination of health outcomes at age 8 years in a group of ELBW infants born 1992 through 1995. Outcomes included functional limitations and special health care needs together with the more traditional measures of neurological and developmental status. The study included 219 ELBW children and 176 normal-birth-weight (NBW) controls of similar sociodemographic status. The children were examined and parents completed a questionnaire concerning their child.

The researchers found that after adjusting for sociodemographic status and sex, ELBW children had significantly more chronic conditions than NBW controls, including functional limitations (64 percent vs. 20 percent), compensatory dependency needs (48 percent vs. 23 percent), and services above those routinely required by children (65 percent vs. 27 percent). These differences remained significant when the 36 ELBW children with neurosensory impairments were excluded. Specific diagnoses and disabilities for ELBW vs. NBW children included cerebral palsy (14 percent vs. 0 percent), asthma (21 percent vs. 9 percent), vision of less than 20/200 (10 percent vs. 3 percent), low IQ of less than 85 (38 percent vs. 14 percent), limited academic skills (37 percent vs. 15 percent), poor motor skills (47 percent vs. 10 percent), and poor adaptive functioning (69 percent vs. 34 percent).

"In the United States in 2002, there were 22,845 live births with a birth weight of 500 to 999 g [1.1 to 2.2 lbs.], of whom approximately 70 percent survived. Our findings underscore the extraordinary costs of care that will be needed to manage the medical, educational, and other service needs of the large proportion of these ELBW children who develop chronic conditions. Proactive planning for the long-term health and educational care needs of all ELBW survivors is essential to optimally treat and possibly improve outcomes through preventative and early intervention services. The American Academy of Pediatrics has emphasized the importance of providing a medical home for children with special health care needs, coordinating their care, involving family, and assisting in navigation of the complex federal, state, and local systems that provide services required by these children. All of these services are highly relevant for the continuing long-term care of ELBW children who survive as a result of neonatal intensive care," the authors conclude.
(JAMA. 2005;294:318-325. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: This study was supported by grants from the National Institutes of Health (NIH).

EDITORIAL: OUTCOMES FOR EXTREMELY LOW-BIRTH-WEIGHT INFANTS — DISAPPOINTING NEWS

In an accompanying editorial, Jon E. Tyson, M.D., M.P.H., of the University of Texas Health Science Center and Houston Medical School, and Saroj Saigal, M.D., of McMaster University, Hamilton, Ontario, discuss the study by Hack et al.

"The current state-of-the-art in follow-up studies might be enhanced to increase their value and facilitate better outcomes for high-risk infants by considering the following strategies. First, follow-up assessments should be performed and reported for all survivors in the lowest gestational age categories as well as all those in the lowest birth-weight categories. ...Second, emphasis should be placed on performing population-based follow-up studies in the United States, as in other countries. Virtually all such studies have been performed outside the United States. ...Third, to help in addressing ethical dilemmas in the care of marginally viable infants, the mortality and long-term morbidity of these infants should be related to treatment decisions to forgo or withdraw intensive care."

"Fourth, quality of life should be assessed in long-term survivors. Despite systematically higher disability rates among ELBW vs. NBW survivors, Canadian studies have reported minimal difference in their self-assessed quality of life in adolescence and early adulthood. Whether this is true in U.S. populations is an important question. And fifth, the use of follow-up assessments should be expanded in testing interventions used before or after nursery discharge to reduce adverse medical, neurodevelopmental, or functional outcomes."

"Most of these strategies would entail considerably more effort and expense. However, the best possible follow-up studies are crucial to a clear understanding of the outcome of small premature infants, the beneficial or harmful effects of perinatal treatment decisions, and the long-term needs of these children for special medical or educational services," the authors write.
(JAMA. 2005;294:371-373. Available pre-embargo to the media at www.jamamedia.org)

For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.

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Embargoed for Release: 3 p.m. CT, Tuesday, July 19, 2005
Media Advisory: To contact Erik Ingelsson, M.D., email: erik.ingelsson{at}pubcare.uu.se.

INSULIN RESISTANCE ASSOCIATED WITH INCREASED RISK FOR CONGESTIVE HEART FAILURE

CHICAGO—New research indicates development of insulin resistance increases a person's risk for development of congestive heart failure, according to a study in the July 20 issue of JAMA.

Congestive heart failure (CHF) is a major cause of illness and death, according to background information in the article. The death rate for patients with CHF is 4 to 8 times that of the general population. The predominant causes of heart failure are hypertension and coronary heart disease. Other established risk factors for CHF include diabetes and obesity, and both are associated with insulin resistance. More detailed characterizations of the association between diabetes and subsequent CHF are still lacking. In patients with manifest CHF, insulin resistance is associated with more-severe disease and a worse prognosis, but insulin resistance has not been investigated as a predictor of CHF.

Erik Ingelsson, M.D., of Uppsala University, Sweden, and colleagues conducted a study to examine whether insulin resistance is a predictor of CHF and is a link between obesity and CHF. The study, conducted in Uppsala, Sweden, included 1,187 elderly (70 years of age or older) men free from CHF and valvular disease at baseline between 1990 and 1995, with follow-up until the end of 2002. Variables reflecting insulin sensitivity and obesity were analyzed together with established risk factors (prior myocardial infarction, hypertension, diabetes, electrocardiographic left ventricular hypertrophy, smoking, and serum cholesterol level) as predictors of subsequent incidence of CHF.

One-hundred four men developed CHF during a median (middle value) follow-up of 8.9 years. "In this community-based sample of elderly men free of CHF and valvular disease at baseline, insulin resistance predicted CHF incidence independently of diabetes and other established risk factors for CHF," the authors write. "The previously described association between obesity and subsequent CHF may be mediated largely by insulin resistance. Further studies are needed to confirm our findings."
(JAMA.2005;294:334-341. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: This study was supported by Primary Health Care in Uppsala County, Swedish Heart Lung Foundation (Hjärt-Lungfonden), the Ernfors Family Foundation, and Thuréus Foundation.

For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.

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JAMA REPORTS

VIDEO: Windows Media | Quicktime

MAJORITY OF BABIES BORN WEIGHING LESS THAN TWO POUNDS WILL HAVE SPECIAL HEALTH AND EDUCATIONAL NEEDS AT AGE 8

VIDEO:
B-ROLL
Picture of Leigh as a baby

AUDIO:
LEIGH VARGO WAS BORN 15 WEEKS EARLY.

VIDEO:
SOT/FULL
@ :04
Super: Bambi Vargo
Leigh’s mother
Runs :07

AUDIO:
"She weighed one pound, six ounces. She actually weighed less than six sticks of butter, we figured out."

VIDEO:
NAT SOT UP FULL FOR :03
Leigh playing the piano

AUDIO:
Leigh playing piano

VIDEO:
B-ROLL
Leigh playing piano

AUDIO:
THIS IS LEIGH TODAY, TWELVE YEARS LATER. SHE’S BEEN DIAGNOSED WITH A NON-VERBAL LEARNING DISORDER, BUT WITH TUTORING SHE’S DOING VERY WELL.

VIDEO:
SOT/FULL
@ :22
Super: Maureen Hack, M.B., Ch.B.
Case Western Reserve University
Runs :08

AUDIO:
"More and more of these very immature babies are surviving, and it’s very important to know how they function when they get to school age."

VIDEO:
B-ROLL
Dr. Hack and colleagues in hospital nursery
Extremely Low Birth Weight Baby in incubator

AUDIO:
DR. MAUREEN HACK AND HER COLLEAGUES AT CASE WESTERN RESERVE UNIVERSITY TRACKED 219 EXTREMELY LOW BIRTH WEIGHT BABIES THROUGH AGE EIGHT, COMPARING THEM TO A GROUP OF NORMAL BIRTH WEIGHT CHILDREN, STUDYING THEIR HEALTH NEEDS AND FUNCTIONAL LIMITATIONS.

VIDEO:
SOT/FULL
Maureen Hack, M.B., Ch.B.
Case Western Reserve University
Runs :15

AUDIO:
"Emotional problems, learning problems, visual problems, hearing problems, and then the more severe problems such as difficulty in walking, talking, toileting, washing themselves, basic functioning of the child."

VIDEO:
B-ROLL
Extremely Low Birth Weight Baby in incubator
GFX/JAMA COVER

AUDIO:
RATES OF SUCH LIMITATIONS WERE MORE THAN DOUBLE IN EXTREMELY LOW BIRTH WEIGHT CHILDREN, ACCORDING TO THE STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.

VIDEO:
SOT/FULL
Maureen Hack, M.B., Ch.B.
Case Western Reserve University
Runs :11

AUDIO:
"64% of the children had a functional limitation and these ranged from mild to severe, compared to 20% of the normal birth weight children."

VIDEO:
B-ROLL
Babies in incubators

AUDIO:
AND 65 PERCENT OF THE EXTREMELY LOW BIRTH WEIGHT CHILDREN HAD SPECIAL HEALTHCARE NEEDS, COMPARED TO 27 PERCENT OF THE NORMAL BIRTH WEIGHT CHILDREN.

VIDEO:
NAT SOT UP FULL FOR :05
Leigh reading

AUDIO:
"The girls were all different sizes and shapes, and yet the pants fit each of them."

VIDEO:
B-ROLL
Leigh reading

AUDIO:
LEIGH’S SPECIAL NEEDS ARE MINOR, ESPECIALLY COMPARED TO UP TO TEN PERCENT OF EXTREMELY LOW BIRTH WEIGHT CHILDREN, WHO EXPERIENCE CEREBRAL PALSY, BLINDNESS OR DEAFNESS.

VIDEO:
SOT/FULL
Maureen Hack, M.B., Ch.B.
Case Western Reserve University
Runs :11

AUDIO:
"Most of the children are functioning, they go to school, they’re in regular classes, but a lot of them need extra help in the educational system, or from the educational system."

VIDEO:
B-ROLL
Leigh looking at photos with her mom

AUDIO:
LEIGH IS GETTING THAT HELP, AND THRIVING. THIS IS MAVIS PRALL WITH THE JAMA REPORT.