Care Ecosystem Collaborative Model and Health Care Costs in Medicare Beneficiaries With DementiaGuterman, Elan L.; Kiekhofer, Rachel E.; Wood, Andrew J.; Allen, I. Elaine; Kahn, James G.; Dulaney, Sarah; Merrilees, Jennifer J.; Lee, Kirby; Chiong, Winston; Bonasera, Stephen J.; Braley, Tamara L.; Hunt, Lauren J.; Harrison, Krista L.; Miller, Bruce L.; Possin, Katherine L.
2023 JAMA Internal Medicine
doi: 10.1001/jamainternmed.2023.4764pmid: 37721734
This secondary analysis of a randomized clinical trial assesses collaborative dementia care and total Medicare reimbursement costs compared with usual care.
Testing Whether Cancer Screening Saves LivesWelch, H. Gilbert; Dey, Tanujit
2023 JAMA Internal Medicine
doi: 10.1001/jamainternmed.2023.3781
ImportanceCancer screening is often promoted as a means to save lives. The question of whether cancer screening truly saves lives is becoming increasingly relevant given the growing enthusiasm for multicancer detection blood tests (ie, liquid biopsies). It is possible in randomized clinical trials for screening to reduce deaths due to the targeted cancer without reducing deaths due to all causes. To explore the feasibility of powering studies for cancer-specific vs all-cause mortality, a series of sample size calculations was performed for selected cancers (breast, colorectal, liver, pancreas, and prostate) and for all cancers combined.
ObservationsRandomized clinical trials of screening for an individual cancer typically require 100 000 or more participants to test its effect on cancer-specific mortality. Testing all-cause mortality requires trials of more than a million participants. However, the sample size requirements change markedly when considering a randomized clinical trial of screening for all cancers, as is envisioned when using multicancer detection blood tests. In this setting, the question of whether cancer screening reduces all-cause mortality can be reasonably addressed in a trial of fewer than 100 000 participants.
Conclusions and RelevanceIt is not feasible to test all-cause mortality when screening for an individual cancer. However, it is feasible to test all-cause mortality for multicancer screening because cancer deaths are such a large component of deaths in general. Observational data on the effects of cancer screening are misleading. Multicancer screening would entail tremendous costs and potentially substantial harms. For these reasons, a randomized clinical trial is mandatory not only to learn if multicancer screening saves lives, but also to learn how frequently it causes harm.
Estimated Lifetime Gained With Cancer Screening TestsBretthauer, Michael; Wieszczy, Paulina; Løberg, Magnus; Kaminski, Michal F.; Werner, Tarjei Fiskergård; Helsingen, Lise M.; Mori, Yuichi; Holme, Øyvind; Adami, Hans-Olov; Kalager, Mette
2023 JAMA Internal Medicine
doi: 10.1001/jamainternmed.2023.3798pmid: 37639247
Key PointsQuestionCancer screening tests are promoted to save lives, but how much is life extended due to commonly used cancer screening tests?
FindingsIn this systematic review and meta-analysis of 18 long-term randomized clinical trials involving 2.1 million individuals, colorectal cancer screening with sigmoidoscopy prolonged lifetime by 110 days, while fecal testing and mammography screening did not prolong life. An extension of 37 days was noted for prostate cancer screening with prostate-specific antigen testing and 107 days with lung cancer screening using computed tomography, but estimates are uncertain.
MeaningThe findings of this meta-analysis suggest that colorectal cancer screening with sigmoidoscopy may extend life by approximately 3 months; lifetime gain for other screening tests appears to be unlikely or uncertain.
Racial Disparities in Emergency Department Physical Restraint UseEswaran, Vidya; Molina, Melanie F.; Hwong, Alison R.; Dillon, David G.; Alvarez, Lizbeth; Allen, Isabel E.; Wang, Ralph C.
2023 JAMA Internal Medicine
doi: 10.1001/jamainternmed.2023.4832
Key PointsQuestionDoes use of physical restraints in the emergency department (ED) vary by patient race and ethnicity?
FindingsIn this systematic review and meta-analysis of 10 studies, adult Black patients were significantly more likely to be restrained in emergency departments compared with White patients and compared with all other ED patients.
MeaningEmergency departments should carefully consider, and take steps to address, how racism may affect disparate use of restraints among adult patients.
Association of Gestational Diabetes With Subsequent Long-Term Risk of MortalityWang, Yi-Xin; Mitsunami, Makiko; Manson, JoAnn E.; Gaskins, Audrey J.; Rich-Edwards, Janet W.; Wang, Liang; Zhang, Cuilin; Chavarro, Jorge E.
2023 JAMA Internal Medicine
doi: 10.1001/jamainternmed.2023.4401pmid: 37695588
This cohort study examines the mortality, morbidity, and other outcomes associated with reproductive characteristics and lifestyle factors among female nurses who participated in the Nurses’ Health Study II.