The Medicare Care Choices Model was associated with reductions in disparities in the use of hospice care for Medicare beneficiaries with terminal illness.

Objective: To assess the effects of the Medicare Care Choices Model (MCCM) on disparities in hospice use and quality of end-of-life care for Medicare beneficiaries from underserved groups-those from racial and ethnic minority groups, dually eligible for Medicare and Medicaid, or living in rural areas.

Data Sources And Study Setting: Medicare enrollment and claims data from 2013 to 2021 for terminally ill Medicare fee-for-service beneficiaries nationwide.

Study Design: Through MCCM, terminally ill enrolled Medicare beneficiaries received supportive and palliative care services from hospice providers concurrently with curative treatments.

Medicare Care Choices Model Improved End-Of-Life Care, Lowered Medicare Expenditures, And Increased Hospice Use.

The Medicare Care Choices Model (MCCM) tested a new option for eligible Medicare beneficiaries to receive conventional treatment for terminal conditions along with supportive and palliative care from participating hospice providers. Using claims data, we estimated differences in average outcomes from enrollment to death between deceased MCCM enrollees and matched comparison beneficiaries who received usual services covered by original Medicare. Enrollees were 15 percentage points less likely to receive an aggressive life-prolonging treatment at the end of life and spent more than five more days at home.

Effects of Home-Based Primary Care on Hospital Use for High-Need Medicare Patients: an Observational Study.

Background: High-need, high-cost Medicare patients can have difficulties accessing office-based primary care. Home-based primary care (HBPC) can reduce access barriers and allow a clinician to obtain valuable information not obtained during office visit, possibly leading to reductions in hospital use.

Objective: To determine whether HBPC for high-need, high-cost patients reduces hospitalizations and Medicare inpatient expenditures.

Effects of a nursing home telehealth program on spending and utilization for Medicare residents.

Objective: To assess the effects of eLongTermCare (eLTC), a telehealth program implemented by an integrated health system in 45 nursing homes across the Midwest, on the use of acute hospital services and total expenditures for Medicare residents.

Data Sources: Minimum Data Set, Medicare fee-for-service claims, and enrollment data from 2013 to 2018.

Study Design: We used a longitudinal difference-in-differences design to estimate the changes in outcomes for treatment beneficiaries before and after participating in the eLTC program, relative to changes for the matched comparison beneficiaries over the same period.

Public Perceptions of Overlapping Surgery.

Background: Overlapping surgery is highly contentious, both in terms of the safety of the practice and the degree to which patients should be informed. However, no study has surveyed attitudes of the general public toward overlapping surgery and willingness to consent to such a procedure.

Study Design: A survey on overlapping surgery was completed by participants using Amazon Mechanical Turk, an online crowd-sourcing worksite.

The Ethics Liaison Program: building a moral community.

Ethicists often struggle to maintain institution-wide awareness of and commitment to medical ethics. At Beth Israel Deaconess Medical Center (BIDMC), we created the Ethics Liaison Program to address that challenge by making ethics part of the moral culture of the institution. Liaisons represent clinical and non-clinical areas throughout the medical centre.

Hinduism and death with dignity: historic and contemporary case examples.

An estimated 1.2 to 2.3 million Hindus live in the United States.

A Doctor's First, and Last, Responsibility is to Care Comment on "Denial of Treatment to Obese Patients-the Wrong Policy on Personal Responsibility for Health".

The obesity epidemic raises important and complex issues for clinicians and policy-makers, such as what clinical and public health measures will be most effective and most ethically-sound. While Nir Eyal's analysis of these issues is very helpful and while he correctly concludes that "conditioning the very aid that patients need in order to become healthier on success in becoming healthier" is wrong, further discussions of these issues must include unequivocal support for safeguarding the fundamental moral basis of the doctor-patient relationship. Regardless of any patients' failures to demonstrate effective responsibility for their own health, each patient needs and deserves a physician whose caring is never in doubt.

"Apologies" from pathologists: why, when, and how to say "sorry" after committing a medical error.

How pathologists communicate an error is complicated by the absence of a direct physician-patient relationship. Using 2 examples, we elaborate on how other physician colleagues routinely play an intermediary role in our day-to-day transactions and in the communication of a pathologist error to the patient. The concept of a "dual-hybrid" mind-set in the intermediary physician and its role in representing the pathologists' viewpoint adequately is considered.

Transcranial magnetic stimulation: a historical evaluation and future prognosis of therapeutically relevant ethical concerns.

Transcranial Magnetic Stimulation (TMS) is a non-invasive neurostimulatory and neuromodulatory technique increasingly used in clinical and research practices around the world. Historically, the ethical considerations guiding the therapeutic practice of TMS were largely concerned with aspects of subject safety in clinical trials. While safety remains of paramount importance, the recent US Food and Drug Administration approval of the Neuronetics NeuroStar TMS device for the treatment of specific medication-resistant depression has raised a number of additional ethical concerns, including marketing, off-label use and technician certification.

Health professional students in community service: insights from trainees and their mentors.

Objectives: To gain insights from the experiences of student health professionals working with agencies caring for the underserved.

Methods: Five hundred and sixty-six (566) U.S.

Emergency department experiences of acutely symptomatic patients with terminal illness and their family caregivers.

Context: Despite increased focus on improving palliative care in the emergency department (ED), there is little research on how to best address the specific needs of this patient population.

Objectives: To better understand the experiences of acutely symptomatic patients seen in the ED.

Methods: Using in-person semi-structured interviews, we explored the attitudes, experiences, and beliefs of 14 patients and seven family caregivers on the inpatient palliative care consult service, who had been admitted through the ED at two academic medical centers.

Am I doing the right thing? Provider perspectives on improving palliative care in the emergency department.

Study Objective: Although the focus of emergency care is on the diagnosis and treatment of acute illnesses and injuries or the stabilization of patients for ongoing treatment, some patients may benefit from a palliative approach. Little is known about delivering palliative care in the emergency department (ED). We explore the attitudes, experiences, and beliefs of emergency providers about palliative care in the ED, using structured qualitative methods.

Clinical review: influenza pandemic - physicians and their obligations.

An influenza pandemic threatens to be the most lethal public health crisis to confront the world. Physicians will have critical roles in diagnosis, containment and treatment of influenza, and their commitment to treat despite increased personal risks is essential for a successful public health response. The obligations of the medical profession stem from the unique skills of its practitioners, who are able to provide more effective aid than the general public in a medical emergency.

Interdisciplinary education: evaluation of a palliative care training intervention for pre-professionals.

Purpose: Medical education inadequately prepares students for interdisciplinary collaboration, an essential component of palliative care and numerous other areas of clinical practice. This study developed and evaluated an innovative interdisciplinary educational program in palliative care designed to promote interdisciplinary exchange and understanding.

Method: The study used a quasi-experimental longitudinal design.

Medicine and nuclear war: from Hiroshima to mutual assured destruction to abolition 2000.

To determine how physicians might participate in the prevention of nuclear war in the post-Cold War era, we review, from a medical perspective, the history of the nuclear weapons era since Hiroshima and the status of today's nuclear arsenals and dangers. In the 1950s, physicians were active partners in governmental civil defense planning. Since 1962, physicians have stressed prevention of nuclear war as the only effective medical intervention.

Ideals in action: the U.S. Schweitzer Fellows Programs.

The inclusion of formal courses in medical ethics as part of standard undergraduate medical education has not led to widespread confidence in the moral and professional development of young physicians. As important as classes on informed consent and other such topics are, alternative approaches to professional moral development are needed. One example can be found in The U.