The Dartmouth Atlas Applied to Kaiser Permanente: Analysis of Variation in Care at the End of Life
Matt Stiefel, MPA; Paul Feigenbaum, MD; Elliott S Fisher, MD, MPH
The Dartmouth Atlas method for examination of variation in care at the end of life was replicated by Kaiser Permanente (KP). Although KP inpatient care use rates were 25% to 30% lower and hospice use rates were higher than in the surrounding communities, there was still two- to four-fold variation in inpatient care use across KP geographic areas. Results reinforced emphasis on palliative care for patients with chronic conditions and earlier transitions to hospice.
Puentes Clinic: An Integrated Model for the Primary Care of Vulnerable Populations
Lawrence Kwan, MD; Cheryl J Ho, MD; Charles Preston, PhD; Viet Le, MD, PhD
This integrated model to address the needs of a medically vulnerable population of homeless and injection-drug users emphasizes open access, outreach, groups, and a team approach to care. Emergency Department and urgent care visit rates decreased, simultaneous with increased primary care visits.
Myocardial Infarction and Its Association with the Use of Nonselective NSAIDs: A Nested Case-Control and Time-to-Event Analysis
T Craig Cheetham, PharmD, MS; David J Graham, MD, MPH; David Campen, MD; Rita Hui, PharmD, MS; Michele Spence, PhD; Gerald Levy, MD; Stanford Shoor, MD
In a study of 8143 cases and 31,496 matched study control subjects, indomethacin and naproxen were associated with increased odds of adverse cardiovascular outcomes--myocardial infarctions and sudden cardiac death. These events occurred early in therapy.
Home Hospice Acupuncture: A Preliminary Report of Treatment Delivery and Outcomes
Karen Kaufman, PhD, LAc; Ellen J Salkeld, PhD
The increasing incorporation of complementary and alternative medicine modalities into hospice care prompted a preliminary exploration of the process of offering acupuncture to ameliorate undesirable side effects from needed analgesic and sedative medications. Excellent or good results were noted in the charts of 34% of patients whose chief complaint was pain and in 31% of patients with anxiety.
Review Articles
Laparoscopic Colorectal Surgery
James Yoo, MD
The use of minimally invasive techniques in colorectal surgery has lagged behind its application in other surgical fields, even though important new studies have demonstrated the benefits and safety of laparoscopic colorectal surgery, making it now the preferred approach.
Current Status and Treatment of Primary Hyperparathyroidism
Dina M Elaraj, MD; Orlo H Clark, MD
Sporadic rather than familial, 80% to 85% of cases of primary hyperparathyroidism are caused by a solitary parathyroid adenoma. Diagnosis is made by hypercalcemia, elevated parathyroid hormone level, and a normal or high 24-hour urine calcium excretion. Multiple studies have demonstrated symptomatic and metabolic benefits of parathyroidectomy in “asymptomatic” patients.
