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, December 12, 2006)
JAMA NEWS RELEASES
TREATING PROSTATE CANCER IN ELDERLY MEN ASSOCIATED WITH LONGER SURVIVAL, COMPARED TO NON-TREATMENT
HOSPITAL PERFORMANCE MEASURES MAY NOT ACCURATELY REFLECT QUALITY OF CARE OR PREDICT PATIENT OUTCOMES
MORE PEOPLE IN U.S. DEALING WITH FINANCIAL BURDEN OF HEALTH CARE COSTS
FOLIC ACID SUPPLEMENTATION DOES NOT APPEAR TO REDUCE RISK OF CARDIOVASCULAR DISEASES
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
49 MILLION AMERICANS SPEND 10% OR MORE OF FAMILY INCOME ON HEALTHCARE
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TV Note: This week's JAMA Report video is on the changes in financial burdens for health care among the U.S. population. The report will be fed Tuesday, December 12, 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.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 12, 2006
Media Advisory: To contact Yu-Ning Wong, M.D., call Karen Mallet at 215-728-2700. To contact editorial co-author Mark S. Litwin, M.D., M.P.H., call Kim Irwin at 310-206-2805.
TREATING PROSTATE CANCER IN ELDERLY MEN ASSOCIATED WITH LONGER SURVIVAL, COMPARED TO NON-TREATMENT
CHICAGO—New findings from an observational study suggest that elderly men who received treatment for localized prostate cancer survived significantly longer than men who did not receive treatment, according to a study in the December 13 issue of JAMA; however, the investigators emphasize the importance of validating these results in randomized trials.
The widespread adoption of prostate-specific antigen (PSA) screening has led to an increasing proportion of men being diagnosed with early-stage and low– or intermediate–grade prostate cancer. Studies have demonstrated the slow-developing nature of low- and intermediate-grade prostate cancer, making management options (observation, radiation therapy, and radical prostatectomy) controversial, with uncertain outcomes. This is also applies to men older than 65 years, because of a lack of information from randomized trials. When randomized controlled trial data are not available, observational studies can provide insight into important clinical questions, according to background information in the article
Yu-Ning Wong, M.D., of the Fox Chase Cancer Center, Philadelphia, and colleagues evaluated the association of active treatment (radiation or prostatectomy) vs. observation on overall survival in a large sample of elderly men treated for low– or intermediate–risk localized prostate cancer. The researchers used data from the Surveillance, Epidemiology, and End Results (SEER) Medicare database, a population-based cancer registry encompassing approximately 14 percent of the U.S. population.
This study included data on 44,630 men age 65 to 80 years who were diagnosed between 1991-1999 with prostate cancer and who had survived more than a year past diagnosis. Patients were followed up until death or study end (December 31, 2002). Patients were classified as having received treatment (n = 32,022) if they had claims for radical prostatectomy or radiation therapy during the first 6 months after diagnosis. They were classified as having received observation (n = 12,608) if they did not have claims for radical prostatectomy radiation or hormonal therapy. Patients who received only hormonal therapy were excluded.
The researchers found that patients who received treatment had a 31 percent lower risk of death during the 12-years of follow-up. In the observation group, 4,643 patients died (37 percent) and 7,639 patients (23.8 percent) in the treatment group died. Active treatment was associated with a significant improvement in survival in the study overall. A benefit associated with treatment was seen in all subgroups examined, including older men (age 75-80 years at diagnosis), black men, and men with low-risk disease.
“In summary, even though prostate cancer commonly is considered an indolent [slow to develop and painless] disease, this observational study suggests a reduced risk of mortality associated with active treatment for low- and intermediate-risk prostate cancer in the elderly Medicare population examined. Because observational data can never be free of concerns about selection bias and confounding, these results must be validated by rigorous randomized controlled trials of elderly men with localized prostate cancer before the findings can be used to inform treatment decisions,” the authors write.
(JAMA. 2006;296:2683-2693. 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: TREATING OLDER MEN WITH PROSTATE CANCER — SURVIVAL (OR SELECTION) OF THE FITTEST?
In an accompanying editorial, Mark S. Litwin, M.D., M.P.H., and David C. Miller, M.D., M.P.H., of the University of California, Los Angeles, comment on the findings of Wong and colleagues.
“Improvement in the quality of care for men with prostate cancer may best be achieved not by treating more patients but by treating them more discerningly. Clinicians must remain steadfast in their efforts to reduce overtreatment and undertreatment by thoughtfully defining each patient’s unique balance between the natural history of prostate cancer and that individual patient’s life expectancy.”
“The reported association between treatment and improved survival for older men with low- and intermediate-risk prostate cancer will be confirmed or refuted by the results of ongoing randomized controlled trials … Until then, physicians should apply these provocative findings judiciously and continue their concerted efforts to help patients make informed treatment decisions based not only on survival predictions but also on health status, functional concerns, and—most importantly—personal preference,” they write.
(JAMA. 2006;296:2733-2734. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the editorial for additional information, including 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, December 12, 2006
Media Advisory: To contact Rachel M. Werner, M.D., Ph.D., call Judi Cheary at 215-823-5807. To contact commentary author Susan D. Horn, Ph.D., call 801-466-5595, ext. 125.
HOSPITAL PERFORMANCE MEASURES MAY NOT ACCURATELY REFLECT QUALITY OF CARE OR PREDICT PATIENT OUTCOMES
CHICAGO—A comparison of hospitals with high and low Medicare performance measures found little difference in the rate of death for three common conditions at the hospitals, indicating that the measures may not accurately reflect patient outcomes, according to a study in the December 13 issue of JAMA.
In the United States, quality of care delivered in hospitals is often variable. Because it is assumed that measuring quality of care is a key component in improving care, quality measurement has an increasingly prominent role in quality improvement, according to background information in the article. These measures can provide an incentive to improve the quality of the care delivered and to influence consumer choice of hospitals and health care plans. While some research has documented an association between higher adherence to care guidelines and better outcomes of patients who receive that care, to date there has been limited evidence demonstrating that hospitals that perform better on process measures also have better overall quality.
Rachel M. Werner, M.D., Ph.D., of the Philadelphia Veterans Affairs Medical Center, Philadelphia, and Eric T. Bradlow, Ph.D., of the University of Pennsylvania, Philadelphia, conducted a study to determine whether certain quality measures are correlated with and predictive of hospitals’ risk-adjusted death rates. The researchers analyzed data from Hospital Compare, a website of the Centers for Medicare & Medicaid Services (CMS) that reports results of hospital performance measures. This study included data on hospital care between Jan. 1 and Dec. 31, 2004, for heart attack, heart failure, and pneumonia at acute care hospitals included on the Hospital Compare website. Ten process performance measures were compared with hospital risk-adjusted death rates, which were measured using Medicare Part A claims data. A total of 3,657 acute care hospitals were included in the study based on their performance reported in Hospital Compare.
Across all heart attack performance measures, the absolute reduction in risk-adjusted death rates between hospitals performing in the 25th percentile vs. those performing in the 75th percentile was 0.005 for inpatient death, 0.006 for 30-day death, and 0.012 for death at 1-year. For the heart failure performance measures, the absolute death reduction was smaller, ranging from 0.001 for inpatient death to 0.002 for 1-year death. For the pneumonia performance measures, the absolute reduction in death ranged from 0.001 for 30-day death to 0.005 for inpatient death.
“Our study suggests that in the case of hospital performance, the CMS’s current set of performance measures are not tightly linked to patient outcomes. These findings should not undermine current efforts to improve health care quality through performance measurement and reporting. However, attention should be focused on finding measures of health care quality that are more tightly linked to patient outcomes. Only then will performance measurement live up to expectations for improving health care quality,” the authors conclude.
(JAMA. 2006;296:2694-2702. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Werner was supported by a career development award from the Department of Veterans Affairs. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
COMMENTARY: PERFORMANCE MEASURES AND CLINICAL OUTCOMES
In an accompanying commentary, Susan D. Horn, Ph.D., of the Institute for Clinical Outcomes Research, Salt Lake City, discusses the findings concerning hospital performance measures.
Dr. Horn notes, “The results of this study raise questions about the appropriateness of using Hospital Compare performance measures as the basis either for pay-for-performance systems or for consumers to identify better-quality hospitals. If performance measures are not strongly associated with better outcomes, why should clinicians and health care centers be required to collect and submit the data, and why would payers and consumers want to act on them?”
“As the study by Werner and Bradlow illustrates, current simplistic process measures based on randomized controlled trials (RCTs) do not necessarily provide a meaningful basis for consumers to choose one clinician or hospital over another, or for clinicians or hospitals to improve their outcomes. In the real world where multiple clinical variables and patient factors affect outcomes, RCTs and comprehensive observational studies both have a role to play in improving patient care: the effects of RCTs in clinical practice can be examined in observational studies and observational studies can be progenitors [originators] for new RCTs. Patients, physicians, and policymakers will all benefit from efforts to evaluate rigorously and further understand the relationship between performance measures and clinical outcomes.”
(JAMA. 2006;296:2731-2732. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Horn reports that she in an employee, officer, shareholder, and founder of International Severity Information Systems Inc., which provides products and services to facilitate studies on practice-based evidence for clinical improvement.
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, December 12, 2006
Media Advisory: To contact Jessica S. Banthin, Ph.D., call Karen Migdail at 301-427-1855.
MORE PEOPLE IN U.S. DEALING WITH FINANCIAL BURDEN OF HEALTH CARE COSTS
CHICAGO—An estimated 50 million people younger than 65 years in the U.S. live in families that spend more than 10 percent of their family income on health care, an increase of more than 10 million people in the past decade, according to a study in the December 13 issue of JAMA.
Health care costs have been rising faster than the rest of the U.S. economy for many years. Out-of-pocket payments for health care services by patients increased from $162 billion in 1997 to $236 billion in 2004, according to background information in the article. Although health care expenditures are consuming a larger share of the U.S. gross domestic product, it is not clear to what extent health care expenditures are also consuming a larger share of family budgets. This information could help policymakers understand the impact of their policies and inform the debate on where to target additional subsidies.
Jessica S. Banthin, Ph.D., and Didem M. Bernard, Ph.D., of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, Rockville, Md., examined the net impact of various trends in costs and coverage and changes in benefits on the percentage of family income devoted to insurance and medical care expenditures among the nonelderly population. The researchers analyzed data from the Medical Expenditure Panel Surveys of 1996 and 2003, which are nationally representative samples of U.S. individuals younger than 65 years, to calculate 2 measures of financial burden as a function of tax-adjusted family income. Sample sizes were 19,022 persons in 1996 and 28,970 persons in 2003. Total burden included all out-of-pocket expenditures for health care services, including premiums. Health care services burden excluded premiums and, when applied to the insured population, was used to identify the underinsured, which was defined as insured persons with health care service burdens in excess of 10 percent of tax-adjusted family income.
“We found that the prevalence of high financial burdens increased across the population as a whole and among several subgroups between 1996 and 2003,” the authors write. By 2003, there were 48.8 million individuals (19.2 percent of the population) living in families that spent more than 10 percent of family income on medical care, an increase of 11.7 million persons since 1996. Of these individuals, 18.7 million (7.3 percent of the population) lived in families spending more than 20 percent of family income on medical care in 2003.
In 2003, individuals with higher-than-average risk of incurring high total burdens included poor and low-income individuals and those with nongroup coverage, age 55 to 64 years, living in a non-metropolitan statistical area, in fair or poor health, having any type of limitation, or having a chronic medical condition.
“Our measure of health care service burden can be used to identify the underinsured, i.e., insured persons without adequate financial protection from high out-of-pocket costs. By this definition, we estimate that 17.1 million insured persons younger than 65 years were underinsured in 2003, including 9.3 million persons with private employment-related insurance, 1.3 million persons with private nongroup policies, and 6.6 million persons with public coverage,” they write.
(JAMA. 2006;296:2712-2719. Available to the media at www.jamamedia.org)
Editor's Note: This study was supported by the AHRQ, as employer of Drs. Banthin and Bernard. 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, December 12, 2006
Media Advisory: To contact Lydia A. Bazzano, M.D., Ph.D., call Arthur Nead at 504-247-1443.
FOLIC ACID SUPPLEMENTATION DOES NOT APPEAR TO REDUCE RISK OF CARDIOVASCULAR DISEASES
CHICAGO—An analysis of previous studies suggests that for people with a history of vascular disease, folic acid supplementation does not decrease the risk of coronary heart disease or stroke, as has been suggested in some research, according to a review article in the December 13 issue of JAMA.
Cardiovascular disease (CVD) is the leading cause of death in the United States and worldwide, accounting for 30.9 percent of deaths world-wide and 10.3 percent of the global burden of disease. Of all deaths in the United States, 37.3 percent (910,120 or 1 in every 2.7) are due to CVD. It is estimated that approximately 71.3 million persons in the U.S. have 1 or more forms of CVD, according to background information in the article.
Observational epidemiologic studies have indicated that increased folate intake is related to a lower risk of CVD, and randomized controlled trials have documented that dietary supplementation with folic acid reduces blood levels of homocysteine, which has been associated with an increased risk of CVD. Most trials generally have had insufficient statistical power on their own and have provided inconsistent findings, the authors write.
Lydia A. Bazzano, M.D., Ph.D., of Tulane University School of Public Health and Tropical Medicine, New Orleans, and colleagues performed a meta-analysis of randomized clinical trials to determine the relationship between folic acid supplementation and risk of CVD and all-cause death among persons with pre-existing vascular disease. The study included 12 randomized controlled trials (with 16,958 participants) that compared folic acid supplementation with either placebo or usual care for a minimum duration of 6 months and with clinical cardiovascular disease events reported as an end point.
The researchers found that in comparing the folic acid supplementation groups with the controls groups, the total proportion of events were:
- for CVD, 18.3 percent vs. 19.2 percent;
- for CHD, 11.4 percent vs. 10.6 percent;
- for stroke, 4.7 percent vs. 5.8 percent;
- for all-cause death, 12.0 percent vs. 12.3 percent, respectively.
“The findings of this analysis suggest that folic acid supplementation is ineffective in the secondary prevention of CVD among persons with a history of vascular diseases. Therefore, it is important to focus on strategies of proven benefit in the secondary prevention of CVD, including smoking cessation, lipid reduction, treatment of hypertension and diabetes, maintenance of a healthy weight, and physical activity,” the authors conclude.
(JAMA. 2006;296:2720-2726. Available 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
49 MILLION AMERICANS SPEND 10% OR MORE OF FAMILY INCOME ON HEALTHCARE
VIDEO:
NAT SOT UP FULL FOR :07
Woman in subway station
AUDIO:
“We have a very high deductible and therefore we have to pay a lot of our own basic healthcare expenses.”
VIDEO:
B-ROLL
Bite up through “it is.”
GFX/JAMA COVER
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SOUND FAMILIAR? IT IS, ACCORDING TO A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
@ :13
Super: Jessica Banthin, Ph.D.
Agency for Healthcare Research and Quality
Runs : 12
AUDIO:
“Our study documents what many people suspected, that these rising healthcare costs are falling on families and people in ways that take up a lot of the family budget.”
VIDEO:
B-ROLL
Dr. Banthin and colleague looking at data
Exterior of AHRQ
Physician examining female patient
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DR. JESSICA BANTHIN AND COLLEAGUES AT THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY TRACKED NATIONAL MEDICAL EXPENDITURE DATA ON AMERICANS UNDER AGE 65. THEY CONSIDERED PEOPLE TO BE BURDENED BY HEALTHCARE COSTS IF TEN PERCENT OR MORE OF THEIR FAMILY INCOME WENT TO PAYING FOR HEALTHCARE.
VIDEO:
SOT/FULL
Jessica Banthin, Ph.D.
Agency for Healthcare Research and Quality
Runs : 12
AUDIO:
“49 million Americans, one-fifth of Americans under age 65, are burdened by healthcare expenditures that consume 10% or more of family income.”
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B-ROLL
People in long line for prescriptions
FULL SCREEN GRAPHIC
Healthcare Expenditures
1996 (reveal) 2003
Increase of 11.7 million people
1/3 of poor families
1/4 low-income families
1/4 middle-income families
AUDIO:
THE RESEARCHERS TRACKED THE NUMBER OF PEOPLE BURDENED BY HEALTHCARE EXPENDITURES IN 1996 AND 2003, AND FOUND AN INCREASE OF NEARLY TWELVE MILLION PEOPLE BETWEEN THOSE YEARS. THEY FOUND ONE-THIRD OF PEOPLE LIVING IN POOR FAMILIES BURDENED BY HEALTHCARE COSTS, BUT ALSO ONE-QUARTER OF PEOPLE IN LOW AND MIDDLE-INCOME FAMILIES. AND...
VIDEO:
SOT/FULL 1:3:40-:50
Jessica Banthin, Ph.D.
Agency for Healthcare Research and Quality
Runs : 10
AUDIO:
“It doesn’t matter what type of health insurance you have. The risk is the same for people who receive health insurance coverage through their employer.”
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B-ROLL
People walking along city street
Physician examining hospitalized diabetic patient
Cutaway physician
Patient
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THE RISK OF FINANCIAL BURDEN IS HIGHEST FOR PEOPLE WHO ARE SELF-EMPLOYED AND BUY THEIR OWN INSURANCE, OR FOR PEOPLE WITH SERIOUS, CHRONIC ILLNESSES, SUCH AS DIABETES. IN 2003, EIGHTEEN MILLION AMERICANS SPENT MORE THAN TWENTY PERCENT OF FAMILY INCOME ON HEALTHCARE.
VIDEO:
SOT/FULL
Jessica Banthin, Ph.D.
Agency for Healthcare Research and Quality
Runs : 05
AUDIO:
“Our study shows that falling ill in this country can have a serious impact on your family budget.”
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B-ROLL
Dr. Padilla with family in exam room
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AND THIS DOCTOR SAYS FINANCIAL BURDENS KEEP SOME PATIENTS AWAY UNTIL IT MAY BE TOO LATE.
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@: 1:45
Super: Luis Padilla, M.D.
Upper Cardozo Health Center
Runs : 06
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“We find out that they have cancer or some other chronic disease that could have been better managed if they had had earlier screening.”
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B-ROLL
More Dr. Padilla with family in exam room
AUDIO:
HE SAYS THE RESULT COULD BE A PRICE THAT NO ONE WANTS TO PAY. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
