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: 3:00 p.m. CT, Tuesday, October 24, 2006)
JAMA NEWS RELEASES
MINORITIES, UNINSURED LESS LIKELY TO RECEIVE CARE AT HIGH-VOLUME HOSPITALS
BEHAVIORAL AND EMOTIONAL PROBLEMS COMMON AMONG CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES
FLU VACCINE APPEARS SAFE FOR YOUNG CHILDREN
BLACK PATIENTS HAVE POORER OUTCOMES ON QUALITY OF CARE MEASUREMENTS IN MEDICARE HEALTH PLANS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
HUGE STUDY CONFIRMS FLU VACCINE SAFE IN CHILDREN AGES 6 TO 23 MONTHS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA Report video is on the safety of flu vaccine for young children. The report will be fed Tuesday, October 24, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band), Downlink Freq: 3920 MHz Vertical, Audio: 6.20/6.80. For more information, call 312/464-JAMA.
Save the Date: JAMA will present new research from its theme issue on men’s health at a media briefing on Tuesday, November 14, at the Millennium Broadway Hotel in New York. Program and registration information will be provided in a future email.
Please Note: The FOR THE MEDIA Web site now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, October 24, 2006
Media Advisory: To contact corresponding author Clifford Y. Ko, M.D., M.S., M.S.H.S., call Rachel Champeau at 310-794-0777. To contact editorial author Samuel R. G. Finlayson, M.D., M.P.H., call Jason Aldous at 603-653-1913.
MINORITIES, UNINSURED LESS LIKELY TO RECEIVE CARE AT HIGH-VOLUME HOSPITALS
CHICAGO—Compared to white patients, black, Asian and Hispanic patients and those who are uninsured are less likely to undergo complex surgery at high-volume hospitals, which have been associated with better outcomes, according to a study in the October 25 issue of JAMA.
Efforts to improve the quality of surgical care in the United States have led many organizations to advocate the use of high-volume hospitals for certain procedures, since a number of studies have reported of a direct volume-outcome relationship for certain procedures, with patients at high-volume hospitals consistently having better outcomes. It appears there are important differences in the racial and socioeconomic status of patients who receive care at high- and low-volume hospitals, according to background information in the article. These differences may affect the ability to access or receive care at a high-volume hospital.
Jerome H. Liu, M.D., M.S.H.S., of the David Geffen School of Medicine at the University of California-Los Angeles, and colleagues conducted a study to determine whether the use of high-volume hospitals varies by race/ethnicity or insurance status in a broad population of patients undergoing complex surgical care. The researchers examined patient characteristics and use of high-volume hospitals across 10 hospital-based procedures with known volume-outcome relationships among Californians during a 5-year period (2000-2004), collecting data from California’s Office of Statewide Health Planning and Development patient discharge database.
The procedures included elective abdominal aortic aneurysm repair, coronary artery bypass grafting, carotid endarterectomy, esophageal cancer resection, hip fracture repair, lung cancer resection, cardiac valve replacement, coronary angioplasty, pancreatic cancer resection, and total knee replacement.
According to this database, a total of 719,608 patients received 1 of the 10 operations. The researchers found that “in general, blacks, Asians, Hispanics, patients with Medicaid, and uninsured patients were less likely to go to high-volume hospitals for complex surgical procedures but more likely to go to low-volume hospitals, when compared with whites and patients with Medicare. Furthermore, patients with private insurance were significantly more likely to go to high-volume hospitals for 3 of the surgical procedures.”
For all 10 operations, black patients were significantly less likely to receive care at high-volume hospitals in 6 of the operations, Asians less likely in 5, and Hispanics less likely in 9.
Medicaid patients were significantly less likely than Medicare patients to receive care at high-volume hospitals for 7 of the operations, while uninsured patients were less likely to be treated at high-volume hospitals for 9.
“ … our study demonstrates robust findings in a large (12 percent of the U.S. population), ethnically diverse population that includes all patients undergoing the selected procedures without restrictions based on demographics, insurance, or sampling. While there is significant interest among health care policy experts in improving quality by directing patients to high-volume hospitals, policy development should include explicit efforts to identify the patient and system factors required to reduce current inequities in the receipt of care at such hospitals,” the authors conclude.
(JAMA. 2006;1973-1980. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: DELIVERING QUALITY TO PATIENTS
In an accompanying editorial, Samuel R. G. Finlayson, M.D., M.P.H., of Dartmouth Medical School, Hanover, N.H., comments on the findings of Liu and colleagues.
“In a sense, volume-based referral policies are an ‘end run’ around the issue of quality: they neither require that the essential components of quality be identified (they just measure volume as a proxy for quality), nor do they require that quality is improved at hospitals (they simply direct the patient to specific centers that already meet that standard). The central focus of quality improvement should be the task of delivering quality care to patients, not the other way around.
Granted, there probably is a role for volume-based referral for the few procedures for which the volume-outcome association is particularly strong (e.g., pancreatic surgery). However, an approach that simultaneously sidesteps the task of improving quality and ignores the vast majority of surgical procedures should not be the crown jewel of the surgical quality movement.”
“The question that remains is how patients should be managed in the face of a potential organ donor who is HCV positive. The results of the study by Gasink et al, demonstrating a survival disadvantage among heart transplant recipients who had HCV-positive donors, provide support for the position that transplanting hearts from HCV-positive donors should be avoided if possible. Studies in other organ recipients suggest similar results. Exceptions could be made for critically ill patients who will not survive without a transplant.”
(JAMA. 2006;296:2026-2027. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Financial disclosures – none reported.
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: 3:00 p.m. CT, Tuesday, October 24, 2006
Media Advisory: To contact Stewart L. Einfeld, M.D., email: s.einfeld{at}unsw.edu.au. To contact co-author Andrea M. Piccinin, Ph.D., call 541-737-2078.
BEHAVIORAL AND EMOTIONAL PROBLEMS COMMON AMONG CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL DISABILITIES
CHICAGO—Children and adolescents with developmental disabilities often have emotional and behavioral problems, and these problems can persist as the person grows older, according to a study in the October 25 issue of JAMA.
Intellectual (developmental) disability affects approximately 1 percent to 3 percent of the population in developed countries. Psychopathology (behavioral or mental disorder) with developmental disability is a major cause of failure of community residential placement, reduced occupational opportunity in the post-school period, and leads to major restrictions in participation in recreational and educational programs, according to background information in the article. Despite this, not much attention has been given to the public health issue of psychopathology in developmental disability and little research has examined the course of these problems over time.
Stewart L. Einfeld, M.D., of the University of Sydney, Australia, and colleagues examined the course of psychopathology in a population of 578 children and adolescents with developmental disability. The participants were recruited in 1991 and were ages 5 years to 19.5 years, from 6 rural and urban regions in Australia, and were followed up for 14 years. Data were obtained from 507 participants, with 84 percent of the initial participants being followed up in 2002-2003. The researchers analyzed various measures, including the Developmental Behaviour Checklist (DBC), a measure of psychopathology in young people with developmental disability, completed by parents or other caregivers; and the Total Behaviour Problem Score (TBPS).
The researchers found that the prevalence of participants meeting criteria for major psychopathology or definite psychiatric disorder was 41 percent at the beginning of the study, which decreased to 31 percent in 2002-2003. Overall severity of psychopathology was similar across mild to severe ranges of developmental disability. Psychopathology decreased more in boys than girls over time, and more so in participants with mild developmental disability compared with those with severe or profound developmental disability. Few of the participants (10 percent) with psychopathology received mental health interventions during the study period.
“The overarching finding was one of a small, albeit significant, decline in severity of overall psychopathology over the 14 years in which the young participants with intellectual disability were followed up. Coupled with the absence of any relationship with age in the TBPS, the small size of this decline demonstrates that psychopathology and behavioral disturbance in young people with intellectual disability is a phenomenon that largely persists through to young adulthood,” the authors write.
“The observation that severe psychopathology was already present in a high proportion of the cohort at commencement of the study, and the persistence of these symptoms, suggest the need for effective mental health interventions. This should include support, education, and skills training for their parents who are likely to be stressed by the burden of care. Without effective interventions, these data could lead to the prediction that this sizable and neglected public health problem will also continue to be a burden on families, communities, and governments,” the researchers conclude.
(JAMA. 2006;296:1981-1989. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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: 3:00 p.m. CT, Tuesday, October 24, 2006
Media Advisory: To contact Simon J. Hambidge, M.D., Ph.D., call Jacque Montgomery at 303-344-7410.
FLU VACCINE APPEARS SAFE FOR YOUNG CHILDREN
CHICAGO—Use of the influenza vaccine in children 6 to 23 months is not associated with an increased risk for a medical visit for any serious conditions, according to a study in the October 25 issue of JAMA.
Influenza is a leading vaccine-preventable cause of illness and death in the United States. Children younger than 2 years experience higher rates of illness from influenza than any other age group except individuals older than 65 years, according to background information in the article. Until recently, the trivalent inactivated influenza vaccine was recommended only for adults and children with known chronic medical conditions that could put them at higher risk from influenza infection, such as asthma. But based on the increasing evidence of high rates of illness from influenza infection in young children, the Centers for Disease Control and Prevention recommended use of this vaccine in all children 6 to 23 months old, including healthy children with no chronic medical condition, beginning in the winter season of 2004-2005. By January 31, 2005, 48 percent of all children in this age group in the United States had received trivalent inactivated influenza vaccine. However, its safety in young children has not been adequately studied in large populations.
Simon J. Hambidge, M.D., Ph.D., of Kaiser Permanente Colorado, Denver, and colleagues evaluated the safety of trivalent inactivated influenza vaccine in a large population of children 6 to 23 months old. The researchers analyzed data on significant medically attended events that occurred after vaccination, during “risk windows”, compared with events that occurred in two control periods, one before vaccination and the second after the risk window. These medically attended events, such as acute respiratory tract infection, asthma, cough and pneumonia, were reviewed at eight managed care organizations in the United States that comprise the Vaccine Safety Datalink. The participants received trivalent inactivated influenza vaccine between January 1, 1991, and May 31, 2003 (45,356 children with 69,359 vaccinations).
The researchers found that no conditions were significantly more likely to occur within either the 3-day, the 1- to 42-day, or the 15- to 42-day risk windows compared with both control windows.
“While our findings offer reassurance regarding the safety of the vaccine in the youngest children, large safety studies of influenza vaccine in children in the newly recommended age group of children 3 to 5 years old are needed. Our study, the largest safety study of trivalent inactivated influenza vaccine in children aged 6 to 23 months, adds to prior evidence that influenza vaccine is safe in infants and young children,” the authors conclude.
(JAMA. 2006;296:1990-1997. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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: 3:00 p.m. CT, Tuesday, October 24, 2006
Media Advisory: To contact corresponding author John Z. Ayanian, M.D., M.P.P., call Leah Gourley at 617-432-0442.
BLACK PATIENTS HAVE POORER OUTCOMES ON QUALITY OF CARE MEASUREMENTS IN MEDICARE HEALTH PLANS
CHICAGO—Black patients in Medicare managed care health plans often have poorer outcomes for treatment of conditions such as high blood pressure or high cholesterol, compared to white patients, according to a study in the October 25 issue of JAMA.
Eliminating disparities in health care is a fundamental component of the agenda to improve quality, according to background information in the article. Several performance reporting systems now report publicly on aspects of quality such as surgical outcomes, adherence to evidence-based quality measures, and patients’ assessments of care, but few public reports about the quality of health care organizations have also assessed the equity of care provided by those organizations. Since 1997, all health plans participating in Medicare have reported on the quality of care using Health Plan Employer and Data Information Set (HEDIS) performance measures developed by the National Committee for Quality Assurance. The relationship between overall quality of care and racial disparities in quality has not been well studied.
Amal N. Trivedi, M.D., M.P.H., of Brown University, Providence, R.I., and colleagues conducted a study, using multivariable models, to assess variations among Medicare health plans in overall quality and racial disparity in 4 HEDIS outcome measures. The study sample included 431,573 individual-level observations in 151 Medicare health plans from 2002 to 2004. The researchers analyzed the outcome measures for hemoglobin A1c (a measurement of glucose) for enrollees with diabetes; low-density lipoprotein cholesterol levels for enrollees with diabetes or after a coronary event; and blood pressure levels for enrollees with hypertension.
The average performance on all 4 HEDIS outcome measures was significantly lower for black enrollees than white enrollees, with absolute percentage point differences ranging from 6.8 percent for blood pressure control to 14.4 percent for LDL-C control after a coronary event. For each measure, more than 70 percent of the racial disparity was attributable to within-plan disparity (different outcomes within the same health plan for white and black enrollees) and a much smaller proportion was due to between-plan disparity (disproportionate enrollment of black enrollees in lower-performing plans). Health plans varied substantially in both overall quality and racial disparity on each of the 4 outcome measures.
“The quality of care for Medicare managed care enrollees as assessed by HEDIS outcome measures is less than optimal, variable across health plans, and unequal by race. We observed no consistent relationship between overall performance and racial disparity in these outcome measures. High-quality health plans had racial disparities that were generally comparable in magnitude to low-quality plans, and only 1 plan demonstrated both high quality and low disparity for more than 1 outcome indicator. Furthermore, nationally observed racial disparities in outcomes were largely attributable to different outcomes for black and white enrollees within the same health plan rather than differences in the distribution of black and white enrollees across health plans,” the authors write.
“Effective measurement within health plans is one cornerstone of improving quality and reducing racial disparities in outcomes. Such an approach is especially salient because health plans have both the fiduciary responsibility to enrollees to assure high-quality and equitable care and the management infrastructure to organize efforts to achieve these related goals. For the Medicare program, plan-specific performance reports that include information on equity would capture a dimension of quality not currently assessed by the HEDIS reporting system,” the researchers conclude.
(JAMA. 2006;296:1998-2004. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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
HUGE STUDY CONFIRMS FLU VACCINE SAFE IN CHILDREN AGES 6 TO 23 MONTHS
VIDEO:
B-ROLL
C/u Maegan in stroller
Mom pushing stroller down hall
AUDIO:
MAEGAN WESLEY IS ONE YEAR OLD. HER MOM IS BRINGING HER IN FOR HER FIRST FLU SHOT.
VIDEO:
SOT/FULL
@ :05
Super: Anita Miller Wesley
Maegan’s mom
Runs :09
AUDIO:
“She’s in a daycare setting and exposed to a lot of germs and we lead an active lifestyle and I would never want to expose her to something that she could catch and that I could have prevented with a vaccine.”
VIDEO:
B-ROLL
GFX/JAMA COVER
Maegan and mom entering exam room
AUDIO:
AND A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, CONFIRMS THAT THE VACCINE IS SAFE FOR KIDS MAEGAN’S AGE.
VIDEO:
SOT/FULL
@ :22
Super: Simon Hambidge, M.D., Ph.D.
Denver Health
Runs :11
AUDIO:
“This is really good news for both doctors and parents who want to protect young children from influenza and complications of this nasty illness.”
VIDEO:
B-ROLL
Bite runs through “pediatrician”
Exterior, Denver Health
Dr. Hambidge and colleagues at computer in clinic
Reverse
At “flu vaccine,” close up of nurse’s hand drawing vaccine into syringe
AUDIO:
DR. SIMON HAMBIDGE IS A PEDIATRICIAN AT DENVER HEALTH, AND A RESEARCHER AT KAISER PERMANENTE COLORADO. HE AND COLLEAGUES REVIEWED RECORDS OF MORE THAN 45-THOUSAND CHILDREN, AGES 6 TO 23 MONTHS, WHO GOT THE FLU VACCINE BETWEEN 1991 AND 2003. THE RESEARCHERS CHECKED TO SEE HOW MANY CHILDREN WENT BACK TO THE DOCTOR WITHIN TWO WEEKS AFTER GETTING THE VACCINE.
VIDEO:
SOT/FULL
Simon Hambidge, M.D., Ph.D.
Denver Health
Runs :15
Edit covered with c/u nurse holding vaccine vial
AUDIO:
“Given the size of this study, I think it was surprising we saw so few problems associated with the vaccine.”
“We did find a slight increase for one problem and that was for mild vomiting and diarrhea.”
VIDEO:
B-ROLL
Different baby lying on exam table
Wide of baby on table with mom and nurse standing by
AUDIO:
CONSIDERING THAT THE FLU CAN BE FATAL IN YOUNG CHILDREN, DR. HAMBIDGE SAYS PARENTS SHOULD GET THEIR LITTLE ONES VACCINATED NOW.
VIDEO:
SOT/FULL
Simon Hambidge, M.D., Ph.D.
Denver Health
Runs :15
AUDIO:
“The first time a young child receives flu vaccine it’s necessary to get two flu shots one month apart in order to be fully protected. So it’s really important to get in early before the flu season to the doctor’s office.”
VIDEO:
B-ROLL
Maegan’s mom leaning down to talk to Maegan on exam table
AUDIO:
THAT’S WHAT MAEGAN’S MOM DID. SHE ALREADY BELIEVED THE VACCINE WAS SAFE, BUT SHE’S GLAD TO KNOW ABOUT THIS NEW STUDY.
VIDEO:
SOT/FULL
Anita Miller Wesley
Maegan’s mom
Runs :09
AUDIO:
“I think having additional research saying that the vaccine is safe and that it’s been tested in children and that there aren’t any serious side effects, I think that helps. It makes me as a parent feel more comfortable.”
VIDEO:
B-ROLL
Maegan getting the shot
AUDIO:
AND THOUGH THE SHOT IS NOT COMFORTABLE…
VIDEO:
NAT SOT UP FULL FOR :03
Needle going into Maegan’s leg
AUDIO:
“Maegan crying”
VIDEO:
B-ROLL
Mom picking up, comforting Maegan
AUDIO:
MAEGAN MAY BE SPARED DISCOMFORT WHEN SHE DOESN’T GET THE FLU. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
