JAMA internal medicine
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JAMA internal medicine · Feb 2017
Comparative StudyComparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians.
In-patient care from a female physician is associated with lower 30 day mortality and readmission rate among elderly patients.
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JAMA internal medicine · Feb 2017
Review Meta AnalysisControlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis.
Burnout is prevalent in physicians and can have a negative influence on performance, career continuation, and patient care. Existing evidence does not allow clear recommendations for the management of burnout in physicians. ⋯ Evidence from this meta-analysis suggests that recent intervention programs for burnout in physicians were associated with small benefits that may be boosted by adoption of organization-directed approaches. This finding provides support for the view that burnout is a problem of the whole health care organization, rather than individuals.
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JAMA internal medicine · Feb 2017
Association of Perioperative Statin Use With Mortality and Morbidity After Major Noncardiac Surgery.
The efficacy of statins in reducing perioperative cardiovascular and other organ system complications in patients undergoing noncardiac surgery remains controversial. Owing to a paucity of randomized clinical trials, analyses of large databases may facilitate informed hypothesis generation and more efficient trial design. ⋯ Early perioperative exposure to a statin was associated with a significant reduction in all-cause perioperative mortality and several cardiovascular and noncardiovascular complications. However, the potential for selection biases in these results must be considered.
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JAMA internal medicine · Feb 2017
Observational StudyCost of Joint Replacement Using Bundled Payment Models.
Medicare launched the mandatory Comprehensive Care for Joint Replacement bundled payment model in 67 urban areas for approximately 800 hospitals following its experience in the voluntary Acute Care Episodes (ACE) and Bundled Payments for Care Improvement (BPCI) demonstration projects. Little information from ACE and BPCI exists to guide hospitals in redesigning care for mandatory joint replacement bundles. ⋯ During a period in which Medicare payments for joint replacement episodes increased by 5%, bundled payment for procedures at BHS was associated with substantial hospital savings and reduced Medicare payments. Decreases in PAC spending occurred only when it was included in the bundle.