1. E-cigarettes hampered smoking cessation in study of smokers discharged from the hospital
More research is needed to determine if e-cigarettes help or hurt attempts to quit smoking in a broader patient population
Abstract: http://annals.org/aim/article/doi/10.7326/M17-2048
URLs go live when the embargo lifts
E-cigarette users were less likely than nonusers to abstain from tobacco at 6 months in a study of smokers who planned to quit after being discharged from the hospital. However, patients using e-cigarettes generally used them infrequently and not every day. This pattern of e-cigarette use may not be an effective way to use the products to quit smoking. However, this finding does not rule out a benefit of e-cigs if a smoker switches completely and uses e-cigarettes regularly, in the same way that FDA-approved nicotine replacement products are intended to be used. More research is needed to determine if e-cigarettes help or hurt attempts to quit smoking in the general population. Findings from a secondary analysis of a large randomized controlled trial are published in Annals of Internal Medicine.
While the benefits and harms of e-cigarettes are still under investigation, the general scientific consensus is that cigarette smokers who completely switch to e-cigarettes are likely to reduce their tobacco-related health risks. It is believed that e-cigarettes can also be used to help smokers of conventional cigarettes quit, but their efficacy as a cessation tool is uncertain.
Researchers from Massachusetts General Hospital studied 1,357 recently-hospitalized adult smokers who planned on quitting following discharge to determine whether e-cigarette use was associated with subsequent tobacco abstinence. Participants were asked about their e-cigarette use at 1 and 3 months after hospital discharge. After 6 months, the researchers used surveys and lab tests to determine who had quit smoking regular cigarettes. The researchers found that those who reported using an e-cigarette after discharge were less likely to be abstinent from tobacco at 6 months than smokers who did not use e-cigarettes. In a propensity score analysis, the negative association between e-cigarette use and cessation was large. However, the authors caution that the association must be interpreted in context. E-cigarettes were used intermittently and more often by smokers without easy, free access to evidence-based cessation aids.
Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org or Angela Collom at acollom@acponline.org. To interview with the lead author, Nancy Rigotti, MD, please contact Susan McGreevey at SMCGREEVEY@mgh.harvard.edu.
2. Medicare's condition-specific readmission measures are poor reflectors of hospital quality
Abstract: http://annals.org/aim/article/doi/10.7326/M17-1492
URLs go live when the embargo lifts
Medicare's condition-specific readmission measures may not provide an accurate picture of hospital quality. Researchers found sizable differences in hospital performance when they compared 30-day readmissions after hospitalizations for Medicare publicly reported conditions with those for unreported conditions and readmissions for non-Medicare patients. The findings are published in Annals of Internal Medicine.
Hospital excess readmission ratios (ERRs) for heart failure (HF), myocardial infarction (MI), and pneumonia among Medicare beneficiaries are used to assess hospital quality and determine reimbursement. It is not known whether readmission rates for these conditions reflect broader hospital-wide performance among all conditions and all payers. Likewise, whether the relationship between readmission rates for publicly reported and unreported conditions varies according to hospital characteristics has not been investigated.
Researchers from the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center reviewed data from the Healthcare Cost and Utilization's Nationwide Readmission Database for 2013 and 2014 for 2,101 hospitals to investigate whether 30-day readmission measures for publicly reported conditions (HF, MI, and pneumonia) among Medicare patients reflect hospital performance on readmissions more broadly in an all-payer national sample. They found that hospitals publicly reported ERRs differed widely from their ERRs for unreported conditions and patient groups. These discrepancies translated into substantial disparities in the numbers of hospitals that would be penalized or not penalized if different groups were used. More than half of all hospitals would have a change in penalty status if it were based on the Medicare unreported or non-Medicare groups. For 59 percent of hospitals, the ERR for Medicare reported hospitalizations was more similar to the ERR for the Medicare unreported group than that for the non-Medicare group, suggesting that Medicare publicly reported readmission metrics are poor reflections of how hospitals perform for non-Medicare patients in particular.
According to the researchers, these findings suggest that current public measures of hospital performance for 30-day readmission rates may give an incomplete and, in some cases, inaccurate picture of hospital quality.
Media contacts: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org or Angela Collom at acollom@acponline.org. To interview lead author, Robert W. Yeh, MD, MSc, please contact Lindsey Diaz-McInnis at ldiaz2@bidmc.harvard.edu or 617-667-7372.
3. American College of Physicians issues ethical guidance for individuals participating in volunteer medical trips
Abstract: http://annals.org/aim/article/doi/10.7326/M17-3361
Editorial: http://annals.org/aim/article/doi/10.7326/M18-0556
URLs go live when the embargo lifts
Physicians who participate in short-term global health experiences, such as volunteer medical trips, have ethical obligations to the individuals and communities they serve, the American College of Physicians (ACP) advises in a new position paper published in Annals of Internal Medicine.
ACP's position mostly addresses practicing physicians, but it also applies to other health care professionals and students, and should inform how institutions, organizations, and others structure short-term global health experiences. According to ACP President Jack Ende, MD, MACP, the primary goal of a short-term experience in global health is to improve the health and well-being of the individuals and communities where they occur.
ACP advises that to fulfill the primary ethical obligation of a short-term experience in global health to improve health and well-being, physicians should advocate for sustainable, mutual benefit; a fair and equitable distribution of resources; and partnerships that respect the individuals and communities served. The ethical principle of justice requires partnering with local leaders to ensure that the potential burdens participants can place on local communities abroad are minimized and preparing for limited material resources.
Individuals who participate in short-term global health experiences must be sensitive to and respectful of cultural differences. Pre-departure preparation should incorporate preparation for logistical and ethical aspects of a short-term experience in global health, including the potential for ethical challenges and moral distress.
Media contacts: For an embargoed PDF or an interview with an ACP spokesperson, please contact Steve Majewski, ACP Media Relations Manager, smajewski@acponline.org or 215-351-2514.
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Also new in this issue:
Balancing Innovation and Safety When Integrating Digital Tools Into Healthcare
Andrew D. Auerbach, MD, MPH; Aaron Neinstein, MD, and Raman Khanna, MD
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M17-3108
Genomic Analysis to Avoid Misdiagnosis of Adults with Bilateral Renal Cysts
Ashima Gulati, MD; Kyongtae T. Bae, MD, PhD, MBA; Terry Watnick, MD
Brief Research Report
Abstract: http://annals.org/aim/article/doi/10.7326/M17-0644
Journal
Annals of Internal Medicine