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NEJM—Health Policy and Reform

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https://www.readbyqxmd.com/read/30230965/being-prepared-preexposure-prophylaxis-and-hiv-disparities
#1
Robert H Goldstein, Carl G Streed, Sean R Cahill
If current trends persist, one in six U.S. men who have sex with men will be infected with human immunodeficiency virus (HIV) in their lifetime, according to the Centers for Disease Control and Prevention (CDC). This prediction highlights the long road ahead if we are to end the spread of HIV in..
September 19, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30230961/payment-and-delivery-system-reform-the-next-phase
#2
Hoangmai Pham, Paul B Ginsburg
After nearly a decade of experimentation with value-based payment (VBP), U.S. health care payers, providers, and purchasers are confronting uneven adoption of new care guidelines, modest early results, and still-unacceptable gaps in spending and quality. In determining what comes next, we believe..
September 19, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30221596/effect-of-aspirin-on-disability-free-survival-in-the-healthy-elderly
#3
John J McNeil, Robyn L Woods, Mark R Nelson, Christopher M Reid, Brenda Kirpach, Rory Wolfe, Elsdon Storey, Raj C Shah, Jessica E Lockery, Andrew M Tonkin, Anne B Newman, Jeff D Williamson, Karen L Margolis, Michael E Ernst, Walter P Abhayaratna, Nigel Stocks, Sharyn M Fitzgerald, Suzanne G Orchard, Ruth E Trevaks, Lawrence J Beilin, Geoffrey A Donnan, Peter Gibbs, Colin I Johnston, Joanne Ryan, Barbara Radziszewska, Richard Grimm, Anne M Murray
Background Information on the use of aspirin to increase healthy independent life span in older persons is limited. Whether 5 years of daily low-dose aspirin therapy would extend disability-free life in healthy seniors is unclear. Methods From 2010 through 2014, we enrolled community-dwelling persons in Australia and the United States who were 70 years of age or older (or ≥65 years of age among blacks and Hispanics in the United States) and did not have cardiovascular disease, dementia, or physical disability...
September 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30221595/effect-of-aspirin-on-all-cause-mortality-in-the-healthy-elderly
#4
John J McNeil, Mark R Nelson, Robyn L Woods, Jessica E Lockery, Rory Wolfe, Christopher M Reid, Brenda Kirpach, Raj C Shah, Diane G Ives, Elsdon Storey, Joanne Ryan, Andrew M Tonkin, Anne B Newman, Jeff D Williamson, Karen L Margolis, Michael E Ernst, Walter P Abhayaratna, Nigel Stocks, Sharyn M Fitzgerald, Suzanne G Orchard, Ruth E Trevaks, Lawrence J Beilin, Geoffrey A Donnan, Peter Gibbs, Colin I Johnston, Barbara Radziszewska, Richard Grimm, Anne M Murray
Background In the primary analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial, now published in the Journal, we report that the daily use of aspirin did not provide a benefit with regard to the primary end point of disability-free survival among older adults. A numerically higher rate of the secondary end point of death from any cause was observed with aspirin than with placebo. Methods From 2010 through 2014, we enrolled community-dwelling persons in Australia and the United States who were 70 years of age or older (or ≥65 years of age among blacks and Hispanics in the United States) and did not have cardiovascular disease, dementia, or disability...
September 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30184447/voluntary-euthanasia-implications-for-organ-donation
#5
Ian M Ball, Robert Sibbald, Robert D Truog
In 2015, the Supreme Court of Canada decided to decriminalize medical assistance in dying for patients who are experiencing "grievous and irremediable" suffering. The next year, the Canadian government passed legislation that permits physicians to hasten the death of a patient by means of..
September 6, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30184446/the-violence-of-uncertainty-undermining-immigrant-and-refugee-health
#6
Breanne L Grace, Rajeev Bais, Benjamin J Roth
Hawa rushed her husband Ahmed to the emergency department when she found him unconscious. For months, Ahmed had refused to go to the hospital because he knew Immigration and Customs Enforcement (ICE) officers were nearby. Ahmed is a U.S. citizen, but he fears deportation — he knows refugees who..
September 6, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30184445/quality-of-care-in-the-united-kingdom-after-removal-of-financial-incentives
#7
Mark Minchin, Martin Roland, Judith Richardson, Shaun Rowark, Bruce Guthrie
BACKGROUND: The benefits of pay-for-performance schemes in improving the quality of care remain uncertain. There is little information on the effect of removing incentives from existing pay-for-performance schemes. METHODS: We conducted interrupted time-series analyses of electronic medical record (EMR) data from 2010 to 2017 for 12 quality-of-care indicators in the United Kingdom's Quality and Outcomes Framework for which financial incentives were removed in 2014 and 6 indicators for which incentives were maintained...
September 6, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30184442/-precision-public-health-between-novelty-and-hype
#8
Merlin Chowkwanyun, Ronald Bayer, Sandro Galea
In May 2018, the National Institutes of Health (NIH) began enrollment for a vast medical research cohort. Named "All of Us," it’s meant to include 1 million U.S. volunteers, who will be studied over 10 years at a cost of $1.45 billion. The project promises to "lay the scientific foundation for a..
September 5, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30183495/medicare-spending-after-3-years-of-the-medicare-shared-savings-program
#9
J Michael McWilliams, Laura A Hatfield, Bruce E Landon, Pasha Hamed, Michael E Chernew
Background Health care providers who participate as an accountable care organization (ACO) in the voluntary Medicare Shared Savings Program (MSSP) have incentives to lower spending for Medicare patients while achieving high performance on a set of quality measures. Little is known about the extent to which early savings achieved by ACOs in the program have grown and been replicated by ACOs that entered the program in later years. ACOs that are physician groups have stronger incentives to lower spending than hospital-integrated ACOs...
September 20, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30157399/personalized-hospital-ratings-transparency-for-the-internet-age
#10
Juliet Rumball-Smith, Jill Gurvey, Mark W Friedberg
Each release of new overall hospital ratings is captivating to journalists, hospital leaders, and health care consumers in the United States. These overall ratings, whether published by U.S. News, Consumer Reports, or Hospital Compare, aggregate a wide array of underlying measures into a single..
August 30, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30157390/ending-use-of-oral-poliovirus-vaccine-a-difficult-move-in-the-polio-endgame
#11
Mark A Pallansch
When the world embarked on a mission of global polio eradication with the adoption of a World Health Assembly resolution in 1988, there was only minimal consideration of what would happen after the eradication of wild poliovirus (WPV) had been certified. Poliovirus eradication efforts have targeted..
August 30, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30134130/free-drug-samples-and-the-opioid-crisis
#12
LETTER
Mathias Dewatripont, Michel Goldman
To the Editor: Malpractice on the part of some pharmaceutical companies has been established as a key driver of the opioid crisis. Powerful painkillers are offered under attractive conditions to poorly educated patients who are not aware of the risk of addiction and who eventually die from drug..
August 23, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30110593/heavier-but-healthier-diabetes-and-smoking-cessation
#13
EDITORIAL
Steven A Schroeder
Two opposing trends provide a point and counterpoint for the health of the public. The good news is that the prevalence of smoking among adults in the United States has dropped to a provisional modern low of 13.9% (although this figure means that there are still 37 million smokers), reflecting a..
August 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30110591/smoking-cessation-weight-change-type-2-diabetes-and-mortality
#14
Yang Hu, Geng Zong, Gang Liu, Molin Wang, Bernard Rosner, An Pan, Walter C Willett, JoAnn E Manson, Frank B Hu, Qi Sun
BACKGROUND: Whether weight gain after smoking cessation attenuates the health benefits of quitting is unclear. METHODS: In three cohort studies involving men and women in the United States, we identified those who had reported quitting smoking and we prospectively assessed changes in smoking status and body weight. We estimated risks of type 2 diabetes, death from cardiovascular disease, and death from any cause among those who had reported quitting smoking, according to weight changes after smoking cessation...
August 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30110583/risk-factors-mortality-and-cardiovascular-outcomes-in-patients-with-type-2-diabetes
#15
Aidin Rawshani, Araz Rawshani, Stefan Franzén, Naveed Sattar, Björn Eliasson, Ann-Marie Svensson, Björn Zethelius, Mervete Miftaraj, Darren K McGuire, Annika Rosengren, Soffia Gudbjörnsdottir
BACKGROUND: Patients with diabetes are at higher risk for death and cardiovascular outcomes than the general population. We investigated whether the excess risk of death and cardiovascular events among patients with type 2 diabetes could be reduced or eliminated. METHODS: In a cohort study, we included 271,174 patients with type 2 diabetes who were registered in the Swedish National Diabetes Register and matched them with 1,355,870 controls on the basis of age, sex, and county...
August 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30110581/lessons-from-an-angry-patient
#16
Emmet Hirsch
She bore a scowl and a combative attitude from the moment I walked into the room. In response to my hopeful "How can I help you?" she unleashed a tirade that seemed to pick up where some prior conversation had left off. Though she was new to my practice, she seemed to have already concluded that..
August 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30110580/ibalizumab-in-multidrug-resistant-hiv-accepting-uncertainty
#17
Virginia Sheikh, Jeffrey S Murray, Adam Sherwat
The Food and Drug Administration (FDA) has long recognized that physicians and patients are generally willing to accept greater risks from drugs used to treat life-threatening illnesses than they would from drugs used for less serious illnesses. The agency has therefore exercised broad flexibility..
August 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30089073/a-road-map-for-sustaining-healthy-eating-behavior
#18
Sara N Bleich
Diet-related diseases such as obesity, cardiovascular disease, and type 2 diabetes are among the most common, costly, and preventable health problems in the United States. More than half of Americans (59%) have at least one chronic condition — many of which are related to poor diet — and people..
August 9, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30089071/active-shooter-response-at-a-health-care-facility
#19
Kenji Inaba, Alexander L Eastman, Lenworth M Jacobs, Kenneth L Mattox
On February 8, 1993, Damacio Ybarra Torres, a 40-year-old disgruntled patient, entered the Los Angeles County and University of Southern California (LAC+USC) Medical Center with three concealed firearms. At approximately 12:20 p.m. he opened fire, striking three male physicians. Leaving them..
August 9, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30089064/opioid-prescribing-limits-for-acute-pain-striking-the-right-balance
#20
Margaret Lowenstein, David Grande, M Kit Delgado
U.S. legislators have recently unveiled numerous bills aimed at combating the opioid epidemic through prevention, harm-reduction, and treatment measures. One of them, the Comprehensive Addiction and Recovery Act (CARA) 2.0, was a bipartisan proposal advancing several evidence-based strategies,..
August 9, 2018: New England Journal of Medicine
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