Following are highlights from Effective Clinical Practice, published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) and the Alliance of Community Health Plans. These highlights do not substitute for the articles as sources of information. For more information or for faxed copies of articles, call 215-351-2655 or e-mail lteer@mail.acponline.org. Articles can also be found at acponline.org/journals/ecp/index.html.
Hip Fracture Outcomes Similar in HMO and Fee-for-Service Rehabilitation Centers A study of older patients with hip fractures compared the outcomes following rehabilitation in fee-for-service and group/staff HMOs. Researchers found no difference in how quickly the patients became ambulatory, resumed daily activities, or returned to community living. Patients in the group/staff model HMO had fewer physician visits and more visits with physical therapists and nurses. The study took place in five group/staff HMOs and six fee-for-service facilities with good reputations for geriatric rehabilitation (“A Comparison of Functional Outcomes after Hip Fracture in Group/Staff HMOs and Fee-for-Service Systems," p. 229).
"Automatic" Prescriptions Help Doctors Follow Cholesterol-Lowering Guidelines Patients on cholesterol-lowering drugs whose physicians allowed a study team to adjust their drug regimens achieved lower cholesterol levels than a control group. Eighteen of 25 patients (72 percent) in the intervention group reached the LDL cholesterol goal of 100 mg/dL or less, meeting National Cholesterol Education Program guidelines, compared to 43 of 101 patients (42.6 percent) in the control group. These preliminary results call for larger studies, the authors say ("The Impact of Automatic Prescriptions on Reducing Low-Density Lipoprotein Cholesterol Levels," p. 240).
A Hard Look at Performance Measures in Medicine An editorialist says healthy skepticism is needed before implementing performance measures. These measures encourage physicians to treat all patients with a disease the same way. Health systems should instead look for ways to target the highest-risk patients ("Are We Overvaluing Performance Measures?" p. 247).