�鶹Ů��

[O]nly about 2% to 7% of US adult patients with cancer participate in clinical trials. Poor accrual to clinical trials has far-reaching implications in the way it affects the pace of progress, cost of drug development, and generalizability of study findings. ... We found that 45.6%, 50.2%, 52.2%, and 38.4% of patients with metastatic breast, prostate, colorectal, and non–small cell lung cancer, respectively, would need to drive more than 60 minutes 1 way to access a clinical trial site. The Mountain, West North Central, and West South Central regions were generally associated with the longest travel times. ... Our findings suggest that innovative approaches are needed to improve the geographic accessibility of trials for patients with advanced cancer in the United States. (Galsky et al., 12/1)

Discharges to [post-acute care] PAC facilities rose nearly 50% over the 15 years, resulting in 1.2 million more discharges to PAC facilities in 2010 compared with 1996 rates. Concurrently, hospital lengths of stay progressively decreased .... There are several potential explanations for these findings. Medicare’s prospective payment system may have influenced other payers leading to “quicker and sicker” discharges, and penalties for 30-day readmissions ... may have had the unintended consequence of increased discharges to PAC facilities. The rise in hospitalist care and changes in the epidemiology of diseases admitted to the hospital may also be significant contributors. ... Policymakers must consider whether the increase in discharges to PAC facilities represents a positive phenomenon or unintended consequences of payment reform. (Burke, 12/1)

In 2008–2012, most older people with a disability had more than one type of disability, and they were likely to be women, aged 85 and over, with less than high school education, widowed, living alone, or living in or near poverty. There were also differences by race and Hispanic origin; older Blacks and Hispanics with a disability had higher rates of poverty, and older Blacks and Whites with a disability had higher rates of living alone. ... With the first Baby Boomers having entered the 65-and-older ranks in 2011, the United States may experience a rapid expansion in the number of older people with a disability in the next 2 decades. The future of disability among older Americans will be affected by how this country prepares for and manages a complex array of demographic, fiscal, medical, technological, and other developments. (He and Larsen, 12/2)

One-third of consumers in the United States who consulted physician website ratings reported selecting and/or avoiding physicians because of these ratings. However, little is known about the validity of these ratings. Available studies have focused mostly on hospital website ratings or non-US website ratings. We partially address this gap by measuring the association between US physician website ratings and traditional quality measures (QMs) of clinical and patient experience. ... The associations between physician website ratings and clinical QMs were small and statistically insignificant. ... For patient experience QMs, associations were also small but were statistically significant. (Gray et al., 12/1)

A common type of knee surgery may increase the chances of arthritis, a new study suggests. The procedure repairs tears in the meniscus, a piece of cartilage that acts as a shock absorber. ... In their study, the scientists used MRI scans to look at 355 knees with arthritis, and compared them to a similar number of knees without arthritis. ... All 31 knees that were operated on to repair meniscal tears developed arthritis within a year, compared with 59 percent of knees with meniscal damage that did not have surgery. (Preidt, 12/3)

Newly diagnosed diabetics generally don’t take advantage of educational programs that could help them manage their disease, a new study suggests. Diabetes self-management education and training (DMST) programs help patients learn to do all the self-care that is essential for control of their blood sugar, the authors of the study explain. ... When [researchers] looked at claims data from almost 100,000 adults with private insurance who were diagnosed with diabetes in 2009-2012, they found that less than seven percent participated in diabetes self management education training. (Lehman, 12/2)

Health information exchanges (HIEs) may reduce emergency department (ED) use and costs in some cases, but their effects on other outcomes are unknown, new research indicates. Robert Rudin, PhD, from RAND Health in Boston, Massachusetts, and colleagues found modest evidence of ED cost reductions in a systematic review of studies published between January 2003 and May 2014. They published their results in the December 2 issue of the Annals of Internal Medicine. (Frellick, 12/2)

Patients who suffer injuries, infections or mistakes during medical care rarely get an acknowledgment or apology, researchers at the Johns Hopkins University School of Medicine report. The study was based on responses of 236 patients who completed ProPublica's Patient Harm Questionnaire during the one-year period ending in May 2013 and who agreed to share their data. Results of the study, led by professor of surgery Marty Makary and conducted independently from ProPublica, were published online Nov. 13 by the Journal of Patient Safety. (Pierce and Allen, 11/21)

The utilization of medical care varies considerably across the United State .... This variation has often been interpreted to imply that areas of high spending are overusing or misusing services .... But at least when it comes to the use of cancer-related imaging, geographic differences in the allocation of care do not necessarily indicate overuse, according to a new analysis. In fact, say the authors, comparing utilization of cancer-related imaging across regions is not a reliable way of measuring the overuse of these services. The article was published online December 1 in the Annals of Internal Medicine. (Nelson, 12/1)