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March 31, 2009JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives of 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 CONTENTS
JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT Tuesday, March 31, 2009)
JAMA REPORT (VIDEO SCRIPT)
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED. JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access. SAVE THE DATE: JAMA will present new research from a theme issue on Diabetes at a media briefing on Tuesday, April 14, from 10 a.m. – 12:15 p.m., at the National Press Club in Washington, D.C. To register, go to www.jamamedia.org and click on the Events tab, or call 312-464-JAMA. Program information will be included in a future email. TV Note: This week's JAMA Report video is on the treatment and control of bed bugs. The report will be fed Tuesday, March 31, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 28 (C-Band), Transponder 19, downlink frequency: 4080 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA. Please Note: The FOR THE MEDIA website 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 EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), Tuesday, March 31, 2009
Higher Hospital Safety Rating Not Associated With Lower Risk of In-Hospital Death
CHICAGO—Hospitals that reported higher scores on measures of safe practices did not have a significantly lower rate of in-hospital deaths compared to hospitals that reported lower scores on these measures, according to a study in the April 1 issue of JAMA. The Leapfrog Group is a nonprofit business coalition that provides information regarding hospital safety and quality to its members (large companies that purchase health care) and to consumers. Its primary method of evaluating hospitals is via voluntary participation in the Leapfrog Hospital Survey. Initially, these annual surveys assessed hospitals' adoption of 3 initiatives. In 2004, a fourth initiative was added, the Safe Practices Survey (consisting of hospitals' self-report of structural and process measures). Approximately 1,100 urban hospitals have completed this survey in recent years, with results reported to the public on the Internet. "...to our knowledge it is not yet confirmed that higher scores on the survey correlate with actual outcomes. This issue is pertinent, because survey scores reported on the Internet are ranked by quartiles, which likely suggests to consumers that hospitals in the highest quartile provide safer care than those in lower quartiles," the authors write. Leslie P. Kernisan, M.D., of the University of California, San Francisco, and colleagues examined the relationship between scores reported by urban hospitals on the 2006 Safe Practices Survey and risk of in-hospital death. A Safe Practices Score (SPS) was determined for each hospital as well as 3 alternative scores based on shorter versions of the original survey. Analysis determined the relationship between quartiles of SPS and risk-adjusted inpatient mortality, after adjusting for hospital discharge volume and teaching status. Mortality data were obtained from the Nationwide Inpatient Sample, a database that includes information on inpatient discharge. Of 1,075 hospitals completing the 2006 Safe Practices Survey, 155 (14 percent) were identifiable in the National Inpatient Sample (1,772,064 discharges). Of these discharges, 37,033 resulted in an inpatient death (2.09 percent). The researchers found that quartiles of SPS were not a significant predictor of mortality. From the lowest to highest quartile of SPS, inpatient death rates adjusted for patient and hospital characteristics were 1.97 percent, 2.04 percent, 1.96 percent, and 2.00 percent. Results were similar in the subgroup analyses. None of the 3 alternative survey scores was associated with risk-adjusted inpatient mortality. "In this first study of the relationship between survey scores and hospital outcomes, we studied a national sample of hospitals and found no relationship between quartiles of score and in-hospital mortality, regardless of whether we adjusted for expected mortality risk and certain hospital characteristics," the researchers write.
"It is possible that inviting hospitals to self-report on their patient safety practices and then assigning them to quartiles of score is not an effective way to assess hospital quality and safety. Our findings should not be interpreted, however, as indicating that the safe practices are not important or that they cannot be measured in an informative and valid way. Rather, future work should seek to establish valid methods for assessing adherence to the safe practices. Further research is needed to determine how performance on the Safe Practices Survey or other instruments designed to measure safe practices performance may correlate with other outcomes of interest to patients and policy makers."
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 JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), Tuesday, March 31, 2009
Program That Emphasizes Housing for Homeless Persons with Alcoholism Associated with Reduced Alcohol Use and Health Care Costs
CHICAGO—An intervention that provides housing for homeless persons with severe alcohol problems without requiring abstinence from drinking was associated with reduced health care use and costs and a decrease in the use of alcohol, according to a study in the April 1 issue of JAMA. Chronically homeless people with severe alcohol problems are costly to the public because of their high use of publicly funded health and criminal justice systems resources. Typical interventions such as shelters, abstinence-based housing and treatment programs fail to reverse these patterns for this population, according to background information in the article. The provision of housing reduces hospital visits, admissions and duration of hospital stays among homeless individuals. One type of supportive housing, called Housing First (HF), removes the requirements for sobriety, mandatory attendance to alcohol treatment programs, and other barriers to housing entrance. Mary E. Larimer, Ph.D., of the University of Washington, Seattle, and colleagues evaluated a HF program for chronically homeless individuals with severe alcohol problems, comparing the costs for housed participants with wait-list controls and noting any changes in reported alcohol use. The study included 95 housed participants (with drinking permitted in the residence) and 39 wait-list control participants, who were enrolled between November 2005 and March 2007. The researchers examined the use and cost of services for study participants (such as jail bookings, days incarcerated, shelter and sobering center use, hospital-based medical services, publicly funded alcohol and drug detoxification and treatment, emergency medical services and Medicaid-funded services). In the year prior to the study, housed participants accrued median (midpoint) costs of $4,066 per month per individual, with a total of $8,175,922 in costs accrued by the 95 individuals for the year. After receiving housing, individual median costs per month declined after 6 months ($1,492) and again at 12 months ($958), and total costs for the housed group for the year after enrollment in housing were $4,094,291, a reduction in total costs by more than $4 million. Cost offsets for HF participants at 6 months, in comparison with wait-list controls and accounting for the cost of housing, averaged $2,449 per person per month, with HF participants accruing approximately 53 percent less costs compared with controls over the first 6 months of the study. In addition, there was an approximate 2 percent decrease per month in daily drinking while participants were housed. "...the current study adds to the body of literature in support of HF. Reductions in health care and criminal justice system use and costs and alcohol consumption support expansion and replication of this low-threshold approach. Repeated unsuccessful participation in traditional programs such as abstinence-based or mandated treatment, and high rejection rates of these programs by chronically homeless individuals with alcohol problems, suggests that less conventional approaches such as HF are also needed," the researchers write.
"Findings suggest that permanent, rather than temporary, housing may be necessary to fully realize these cost savings, because benefits continued to accrue the longer these individuals were housed. Findings support strategies to retain these individuals in housing, including offering on-site medical and mental health services, supportive case managers, and minimal rules and regulations pertaining to their housing."
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 JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), Tuesday, March 31, 2009
Control, Treatment of Bed Bugs Challenging
CHICAGO—A review of previously published articles indicates there is little evidence supporting an effective treatment of bites from bed bugs, that these insects do not appear to transmit disease, and control and eradication of bed bugs is challenging, according to an article in the April 1 issue of JAMA. Bed bugs (Cimex lectularius) have been known as a human parasite for thousands of years, but scientific studies of this insect are recent and limited. International travel, immigration, changes in pest control practices and insecticide resistance may have contributed to a recent resurgence of this blood-sucking insect in developed countries. Bed bug infestations have been reported increasingly in homes, apartments, hotel rooms, hospitals, and dormitories in the United States since 1980, according to background information in the article. Hiding places are usually within about 3 to 6 feet of suitable hosts and include seams in mattresses, crevices in box springs, backsides of headboards, spaces under baseboards or loose wallpaper. Health consequences include biting and skin and systemic reactions. The potential for bed bugs to serve as transmitters of disease and optimal methods for bed bug pest control and eradication are unclear. Jerome Goddard, Ph.D., of Mississippi State University, and Richard deShazo, M.D., of the University of Mississippi Medical Center, Jackson, examined the evidence regarding the health and medical effects of bed bugs and control and eradication strategies. The researchers conducted a search for articles on these topics, identified 53 articles that met criteria for inclusion, and summarized the findings. The authors report that although transmission of more than 40 human diseases has been attributed to bed bugs, there is little evidence that they are transporters of communicable disease. A variety of clinical reactions to bed bugs have been reported, including skin and rarely systemic reactions. A review of case reports indicated that the usual response to a bed bug bite appears to be no reaction with a barely visible mark at the location of the bite. The most common reactions for which medical attention is sought are lesions. These usually itch and, if not scraped off, resolve within a week. Some patients experience complex skin reactions. The authors write that the use of any treatment strategy for symptomatic bed bug bites has not been established. Treatments of common and complex skin reactions are usually symptomatic and not evidence based. Treatments that have been used with varying results include antibiotics, antihistamines, topical and oral corticosteroids and epinephrine (adrenaline). The authors add that bed bugs are extremely difficult to eradicate. No evidence-based interventions to eradicate bed bugs or prevent bites were identified. Pesticide control of bed bugs is complicated by insecticide resistance, lack of effective products, and health concerns about spraying mattresses with pesticides.
"Bed bugs are likely to be more problematic in the future due to travel, immigration, and insecticide resistance," the researchers write. "Development of effective repellents and public education about bed bugs are also important goals. Research is needed to elucidate the pathogenesis of clinical reactions to bed bug bites so that optimal therapy may be identified."
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 JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
JAMA REPORTS
VIDEO: Windows Media | Quicktime
BEDBUGS ARE BACK IN FULL FORCE! A NEW STUDY EXAMINES THE CONSEQUENCES OF A BITE FROM THIS MULTIPLYING NOCTURNAL NUISANCE
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