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.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT, Tuesday, October 11, 2005)
JAMA NEWS RELEASES
OTHER ILLNESSES PLAY IMPORTANT ROLE IN DIFFERENCE IN BREAST CANCER SURVIVAL RATES BETWEEN BLACKS AND WHITES
TOTAL CHOLESTEROL LEVEL AMONG U.S. ADULTS CONTINUES TO DECLINE
END-STAGE RENAL DISEASE INCIDENCE, PROGNOSIS IMPROVING FOR PATIENTS WITH DIABETES
PHYSICIAN PAY-FOR-PERFORMANCE PROGRAMS MAY PRODUCE LITTLE GAIN IN QUALITY
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
U.S. CHOLESTEROL LEVELS GOING DOWN IN OLDER ADULTS – LEVELS FOR YOUNGER ADULTS STILL TOO HIGH
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA video news release is on cholesterol trends in the U.S. The release will be fed Tuesday, October 11, 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, October 11, 2005
Media Advisory: To contact C. Martin Tammemagi, Ph.D., call Jeffrey Sinibaldi at 905-688-5550, ext. 4687.
OTHER ILLNESSES PLAY IMPORTANT ROLE IN DIFFERENCE IN BREAST CANCER SURVIVAL RATES BETWEEN BLACKS AND WHITES
CHICAGO—Black breast cancer patients have shorter survival than white breast cancer patients largely because of a higher rate of other disorders, such as diabetes and hypertension, according to a study in the October 12 issue of JAMA.
Although breast cancer survival has improved over the last 30 years, disparities in breast cancer survival between blacks and whites have not declined and remain sizeable, according to background information in the article. The 5-year U.S. survival rates in 1995-2000 for black and white breast cancer patients were 75 percent and 89 percent, respectively. Although several causes have been identified, such as advanced cancer stage, lack of access to medical care, inferior treatment, and lower socioeconomic status (SES), not all reasons for this disparity are understood.
C. Martin Tammemagi, Ph.D., of Brock University, St. Catharines, Ontario, Canada and colleagues evaluated data from breast cancer patients to evaluate the associations between adverse comorbidities (co-existing illnesses) and racial survival disparity. A group of patients (n = 906) from the Henry Ford Health System (a large comprehensive health system in Detroit) were followed up for a median of 10 years. Patients included 264 black (29.1 percent) women and 642 white (70.9 percent) women diagnosed as having breast cancer between 1985 and 1990. Detailed comorbidity data (268 comorbidities) and study data were abstracted from various medical records, databases and registries.
A total of 159 blacks (61.9 percent) and 317 whites (50.4 percent) died. Overall, 62.4 percent of deaths were attributed to competing causes. Proportionately more blacks than whites died of breast cancer (64 [24.9 percent] vs. 115 [18.3 percent]) and of competing causes (95 [37.0 percent] vs. 202 [32.1 percent]). Compared with whites, blacks had shorter overall survival (34 percent more likely), breast cancer-specific survival (47 percent more likely to have shorter survival), and competing-causes survival (27 percent more likely to have shorter survival). One or more comorbidities were reported in 221 blacks (86 percent) and 407 whites (65.7 percent). A total of 77 adverse comorbidities were associated with reduced survival. Comorbidity count was associated with all-cause and competing-causes survival but was not associated with recurrence/progression or breast cancer-specific survival. Comparisons of unadjusted and comorbidity-adjusted hazard ratios indicated that comorbidity explained 49.1 percent of all-cause and 76.7 percent of competing-causes survival disparity. Diabetes and hypertension were particularly important in explaining disparity.
"Our findings indicate that control of comorbidity may be an important way of improving the survival of black breast cancer patients and reducing racial disparity. That comorbidity explained more than 40 percent of the survival disparity in patients younger than 70 years indicates that effective management of comorbidity has the potential to lead to a substantial increase in person-years of life gained. Control of just 2 comorbidities, diabetes and hypertension, could have a major beneficial impact," the authors conclude.
(JAMA. 2005;294:1765-1772. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was funded by a grant from the U.S. Department of Defense (U.S. Army Medical Research and Material Command).
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, October 11, 2005
Media Advisory: To contact co-author Clifford L. Johnson, M.S.P.H, call the NCHS Press Office at 301-458-4800.
TOTAL CHOLESTEROL LEVEL AMONG U.S. ADULTS CONTINUES TO DECLINE
CHICAGO—The total cholesterol level among older adults has declined significantly, while there has been little change among younger adults, according to a study in the October 12 issue of JAMA.
Serum total and low-density lipoprotein (LDL) cholesterol contribute significantly to atherosclerosis and its related adverse effects, according to background information in the article. Previous analyses of data from the National Health and Nutrition Examination Surveys (NHANES) showed that mean (average) levels of total cholesterol of U.S. adults had declined from 1960-1962 to 1988-1994, and average levels of LDL cholesterol (available beginning in 1976) had declined between 1976-1980 and 1988-1994.
Margaret D. Carroll, M.S.P.H., of the Centers for Disease Control and Prevention, Hyattsville, Md., and colleagues evaluated trends in lipids between 1960 and 2002 and examined potential contributing factors to the trends observed. The researchers analyzed data from 5 distinct cross-sectional surveys (National Health Examination Survey [NHES] and NHANES) of the U.S. population during 1960-1962, 1971-1974, 1976-1980, 1988-1994, and 1999-2002 that included blood lipid measurements taken from 6,098 to 15,719 adults.
The researchers found: "The age-adjusted [average] total cholesterol level of adults 20 years or older decreased from 206 mg/dL (5.34 mmol/L) in 1988-1994 to 203 mg/dL (5.26 mmol/L) in 1999-2002 and the age-adjusted [average] LDL cholesterol level decreased from 129 mg/dL (3.34 mmol/L) to 123 mg/dL (3.19 mmol/L) during this same period. Significant and substantial declines in [average] total and LDL cholesterol levels were observed in men 60 years or older and women 50 years or older but not in younger adults. In general, [average] high-density lipoprotein (HDL) cholesterol levels did not change during this period. The age-adjusted geometric [average] serum triglyceride level of adults 20 years or older increased from 118 mg/dL (1.33 mmol/L) in 1988-1994 to 123 mg/dL (1.39 mmol/L) in 1999-2002 but was not statistically significant. The age-adjusted percentage of adults 20 years or older with serum total cholesterol level of at least 240 mg/dL (6.22 mmol/L or greater) decreased from 20 percent to 17 percent, thereby achieving one of the Healthy People 2010 objectives."
The authors say that a factor that likely contributed to the decrease in total and LDL cholesterol observed predominantly in the older age groups is the use of cholesterol-lowering medication. Between 1995-1996 and 2001-2002, there was an increase in the number of physician-office visits and hospital visits of men and women aged 45 years or older with statins prescribed. The researchers add that dietary data from NHANES 1999-2002 demonstrated only a small change in the overall intake of saturated fat or cholesterol.
"The continued decrease of total and LDL cholesterol levels in older adults is a positive trend. Clinical trial results suggest that a 1 percent decrease in LDL cholesterol translates into a 1 percent decrease in relative risk for coronary heart disease (CHD)," the authors write. "It appears that the decreases in total and LDL cholesterol may have been influenced more by increased medication use rather than by positive lifestyle changes. Increasing prevalence of obesity among adults may have contributed to a blunting in the decrease in total and LDL cholesterol levels, as reflected in the observed trend toward increased triglyceride levels. However, further research is needed to assess simultaneously the effects of lipid-lowering medications and other lifestyle factors on lipids."
"The National Heart, Lung, and Blood Institute's National Cholesterol Education Program recommends a healthy lifestyle, which includes reducing intake of saturated fat and cholesterol, achieving and maintaining healthy weight, and increasing physical activity for all adults, and regards additional efforts to promote such lifestyle changes to be important for achieving further improvements in the population's lipid levels. Additional analyses of these critical population lifestyle factors and lipid data are important. NHANES continues to monitor lipids and related lifestyle factors of CHD in the U.S. adult population," the authors conclude.
(JAMA. 2005;294:1773-1781. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Co-author Scott M. Grundy, M.D., Ph.D., receives research grants funded by Merck, Abbott, Kos, and GlaxoSmithKline; is a consultant for Pfizer, Abbott, Sanofi Aventis, and AstraZeneca; and receives honoraria from Merck, Abbott, Kos, Bristol-Myers Squibb, and Schering Plough.
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, October 11, 2005
Media Advisory: To contact Patrik Finne, M.D., Ph.D., email: patrik.finne{at}hus.fi.
END-STAGE RENAL DISEASE INCIDENCE, PROGNOSIS IMPROVING FOR PATIENTS WITH DIABETES
CHICAGO—Patients with type 1 diabetes have an improved prognosis with regard to end-stage renal disease over the past four decades, and it appears the incidence of end-stage renal disease is lower than previously estimated, according to a study in the October 12 issue of JAMA.
Diabetic kidney disease is one of the most severe complications of type 1 diabetes, and diabetes is the most important cause of end-stage renal disease (ESRD; severely impaired kidney function, requiring dialysis) in industrialized countries, according to background information in the article. Data on patients' risk of developing ESRD are sparse. Large population-based studies with long-term follow-up have not been performed; therefore, the true incidence and age- and sex-stratified risk estimates of ESRD among patients with type 1 diabetes are not known.
Patrik Finne, M.D., Ph.D., of Helsinki University, Finland, and colleagues estimated the long-term risk of ESRD and death in patients with type 1 diabetes and assessed how age at diagnosis of diabetes, time period of diagnosis, and sex affect these risks. The study included patients younger than 30 years at the time of being diagnosed with type 1 diabetes in Finland in 1965-1999 (n = 20,005), who were identified from the Finnish Diabetes Register. The group was followed from diagnosis of diabetes until development of ESRD (dialysis or kidney transplantation as identified from the Finnish Registry for Kidney Diseases), death, or end of follow-up on December 31, 2001.
The median follow-up time after diagnosis was 16.7 years, with a maximum of 37 years. During the follow-up period, there were 632 cases of ESRD and 1,417 deaths. The researchers found that the cumulative incidence among all type 1 diabetic patients was 2.2 percent at 20 years and 7.8 percent at 30 years after diagnosis. Patients of both sexes diagnosed as having type 1 diabetes before age 5 years had a smaller risk of developing ESRD (3.3 percent after 30 years) than other patients (8.4 percent). The risk of ESRD was lower for patients diagnosed as having type 1 diabetes in later years. The risk did not differ significantly between sexes.
Patients with ESRD had 13.1 times the risk of death compared with other patients with type 1 diabetes when adjusting for age, sex, and time period of diabetes diagnosis. "This emphasizes the severity of ESRD as a complication of diabetes," the authors write. The cumulative death rate was 6.8 percent at 20 years and 15.0 percent at 30 years after diagnosis of type 1 diabetes. The cumulative risk of dying with ESRD was 0.7 percent at 20 years and 3.3 percent at 30 years after diagnosis of type 1 diabetes. The risk of death increased with age at diagnosis. The time period for the diagnosis of diabetes strongly affected survival: patients with diagnosis in 1975-1979 had 48 percent lower risk of dying than those with diagnosis in 1965-1969.
"In conclusion, our data indicate improved prognosis of type 1 diabetes with regard to both ESRD and death," the researchers write. "The overall incidence of ESRD appears to be lower than previously reported."
(JAMA. 2005;294:1782-1787. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Finne was supported with a grant from the Liv och Hälsa 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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Embargoed for Release: 3 p.m. CT, Tuesday, October 11, 2005
Media Advisory: To contact Meredith B. Rosenthal, Ph.D., call Kevin Myron at 617-432-3952.
To contact editorial author R. Adams Dudley, call Janet Basu at 415-502-4608.
PHYSICIAN PAY-FOR-PERFORMANCE PROGRAMS MAY PRODUCE LITTLE GAIN IN QUALITY
CHICAGO—Paying clinicians to reach a common, fixed performance target may produce little gain in overall quality, and may largely reward those with higher performance at baseline, according to a study in the October 12 issue of JAMA.
The number of health plans and purchasers in the United States that have adopted pay-for-performance mechanisms for quality improvement is growing rapidly, according to background information in the article. However, most of these programs are in the early stages of trial, evaluation, and adjustment. Although there is intense interest in and optimism about pay-for-performance programs among many policy makers and payers, there is little published research on pay-for-performance in health care. There have been a few studies demonstrating that pay-for-performance leads to improved quality of care.
Meredith B. Rosenthal, Ph.D., of the Harvard School of Public Health, Boston, and colleagues conducted a study on the impact of a prototypical physician pay-for-performance on quality of care within one of the nation's largest health plans, PacifiCare Health Systems. In 2003, PacifiCare began paying its California medical groups bonuses according to meeting or exceeding 10 clinical and service quality targets. The researchers examined the performance of California medical groups that were subject to pay-for-performance, and a comparison group in the Pacific Northwest (Oregon and Washington). Quality improvement reports were included from October 2001 through April 2004 issued to approximately 300 large physician organizations. There were three process measures of clinical quality: cervical cancer screening, mammography, and hemoglobin A1c testing.
The researchers found that clinical quality scores improved as follows: for cervical cancer screening, 5.3 percent for California vs. 1.7 percent for Pacific Northwest; for mammography, 1.9 percent vs. 0.2 percent; and for hemoglobin A1c testing, 2.1 percent vs. 2.1 percent. Compared with physician groups in the Pacific Northwest, the California network demonstrated greater quality improvement after the pay-for-performance intervention only in cervical cancer screening (a 3.6 percent difference in improvement). For all 3 measures, physician groups with baseline performance at or above the performance threshold for receipt of a bonus improved the least but garnered the largest share of the bonus payments.
"In the first year of its quality incentive program (QIP), the plan paid $3.4 million of a potential bonus pool of $12.9 million. Three quarters of the 172 physician groups eligible at some point during the year for the program received some funds from the bonus pool. We also observed that few groups reached a majority of targets, consistent with the low correlation in performance across clinical areas that has been observed in other studies. Physician groups whose performance was initially lowest improved the most, whereas physician groups that had previously achieved the targeted level of performance improved the least. Unlike quality improvement, which followed an inverse relationship to baseline performance, bonus dollars were garnered in direct proportion to baseline performance. Physician groups whose performance was above the bonus threshold at baseline captured 75 percent of bonus payments on average across the 3 quality domains we examined, despite their limited improvement," the authors write.
"Our findings give rise to a number of speculations about the effects of pay-for-performance. First, groups with baseline performance already above the targeted threshold appeared to understand that they needed only to maintain the status quo to receive the bonus payments. More surprising, perhaps, is that low-performing groups improved as much as they did, given that their short-run chances of receiving a bonus were likely to be low. One possibility is that the groups viewed the QIP as a larger signal of a changing environment in which they would face increasing pressure to improve their care systems and decided to begin moving in that direction. Paying explicitly for quality improvement might alter the incentives for high-performing and low-performing groups, distribute bonus dollars more toward the latter group, and possibly increase the overall impact of pay-for-performance."
The authors add that one possible reason that the QIP failed to yield a greater response is that the financial rewards for quality were too low to motivate substantial departures from the underlying trend in quality improvement. Per enrollee, the maximum annual bonus was a relatively modest $27, or about 5 percent of the professional capitation amount. Moreover, PacifiCare accounts for only about 15 percent of the average group's revenue.
"PacifiCare's QIP, like most current pay-for-performance programs, should be viewed as a first step in the direction of aligning payment incentives with health system quality goals. Realization of the full potential of pay-for-performance to reduce the persistent gap between evidence-based and actual practice will require that payers adapt their incentive strategies as evidence to support best practices accumulates. The principal lesson we derive from this experience is that incentive design matters. The accumulating evidence from the continuing experimentation with pay-for-performance in the market will highlight these initial findings and other potential design lessons," the researchers conclude.
(JAMA. 2005;294:1788-1793. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Financial support for this research was provided by The Commonwealth Fund.
EDITORIAL: PAY-FOR-PERFORMANCE RESEARCH
In an accompanying editorial, R. Adams Dudley, M.D., M.B.A., of the University of California, San Francisco, comments on the study on pay-for-performance and discusses implications for future research in this area.
"While the study by Rosenthal et al is well designed, much more is needed. Pay-for-performance involves a common problem in health services research: despite little evidence, clinicians and policy makers are responding to a major policy trend, while researchers determine how to inform those decision makers. In this context, investigators and research funders need to develop strategies that address 4 fundamental aspects of research: study design, selecting theory-driven hypotheses, reporting research findings in a complete and informative manner, and setting research priorities. Until these issues are clearly addressed, clinicians should be skeptical of any research that purports to describe the impact of pay-for-performance," Dr. Dudley writes.
(JAMA. 2005;294:1821-1823. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was funded by the Agency for Healthcare Research and Quality and the Robert Wood Johnson 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
U.S. CHOLESTEROL LEVELS GOING DOWN IN OLDER ADULTS – LEVELS FOR YOUNGER ADULTS STILL TOO HIGH
AUDIO:
"Well I’ve lost weight, I’ve changed my eating habits and I am on a cholesterol medication, but I don’t know what it is right now."
VIDEO:
B-ROLL
Let her bite run long
Crowd shot
GFX/JAMA Cover
AUDIO:
WHATEVER IT IS, SHE SAYS IT’S WORKING. BUT WHAT ABOUT THE REST OF US? IS OUR CHOLESTEROL UNDER CONTROL? A NEW STUDY ANSWERS THAT QUESTION, IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
@ :21
Super: Clifford Johnson, M.S.P.H.
National Center for Health Statistics
Runs :16
AUDIO:
"Cholesterol levels have continued to decline in the last decade. However, these declines have occurred primarily in the oldest age groups. In the younger adults, there’s been no change in cholesterol levels during the last decade."
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B-ROLL
Clifford Johnson in office discussing data with colleagues
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CLIFFORD JOHNSON AND COLLEAGUES AT THE NATIONAL CENTER FOR HEALTH STATISTICS COMPARED CHOLESTEROL LEVELS IN TENS OF THOUSANDS OF ADULTS OVER THE LAST FORTY YEARS.
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Clifford Johnson, M.S.P.H.
National Center for Health Statistics
Runs :14
AUDIO:
"The average cholesterol for the US adult is now 203, and we’d like that to be below 200, and in fact, we’d like every person’s average cholesterol to be below 200."
VIDEO:
Woman over age 50 walking on sidewalk
Man over age 60 walking on sidewalk
AUDIO:
THE STUDY FOUND THE BIGGEST DROPS IN CHOLESTEROL WERE IN WOMEN OVER AGE FIFTY AND MEN OVER AGE SIXTY.
VIDEO:
SOT/FULL
Clifford Johnson, M.S.P.H.
National Center for Health Statistics
Runs :14
AUDIO:
"These older folks are also likely to be the group who are using cholesterol-lowering medications. Thus, it is not surprising that we saw a significant decrease in cholesterol levels in this particular age group."
VIDEO:
B-ROLL
Street shots of younger, overweight adults
Crowd shot of all sorts of younger adults
AUDIO:
BUT YOUNGER ADULTS, MANY OF WHOM COULD LOWER THEIR CHOLESTEROL BY WATCHING THEIR WEIGHT AND GETTING MORE EXERCISE, DON’T SEEM TO BE DOING SO, SINCE THEIR OBESITY RATES ARE UP, AND THEIR CHOLESTEROL LEVELS AREN’T GOING DOWN. SOME PEOPLE ARE SURPRISED ABOUT THAT.
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NAT SOT UP FULL FOR :04
Young woman on camera
AUDIO:
"I think that it’s been in the news a lot and people are really concerned about their cholesterol."
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B-ROLL
People exercising in health club
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CONCERNED, MAYBE, BUT SEEMS TOO FEW OF US ARE DOING ANYTHING ABOUT IT. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
