Comparison of Web-Based and Paper Advance Directives: A Pilot Randomized Clinical Trial.

Background: Digital tools to document care preferences in serious illnesses are increasingly common, but their impact is unknown. We developed a web-based advance directive (AD) featuring (1) modular content eliciting detailed care preferences, (2) the ability to electronically transmit ADs to the electronic health record (EHR), and (3) use of nudges to promote document transmission and sharing.

Objective: To compare a web-based, EHR-transmissible AD to a paper AD.

Spending and quality after three years of Medicare's bundled payments for medical conditions: quasi-experimental difference-in-differences study.

Objective: To evaluate whether longer term participation in the bundled payments for care initiative (BPCI) for medical conditions in the United States, which held hospitals financially accountable for all spending during an episode of care from hospital admission to 90 days after discharge, was associated with changes in spending, mortality, or health service use.

Design: Quasi-experimental difference-in-differences analysis.

Setting: US hospitals participating in bundled payments for acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease (COPD), or pneumonia, and propensity score matched to non-participating hospitals.

The Quality of End-of-Life Care among ICU versus Ward Decedents.

Admissions to ICUs are common during terminal hospitalizations, but little is known about how ICU care affects the end-of-life experience for patients dying in hospitals and their families. We measured the association between ICU care during terminal hospitalization and family ratings of end-of-life care for patients who died in 106 Veterans Affairs hospitals from 2010 to 2016. Patients were divided into four categories: no-ICU care, ICU-only care, mixed care (died outside ICU), and mixed care (died in ICU).

Learning Health Systems and the Revised Common Rule.

Quality improvement (QI) is an important function of learning health systems, and public policy should promote QI activities. Use of systematic methodologies in QI has prompted substantial confusion regarding when QI is human subjects research under the Common Rule, and this confusion persists with the revised Rule. Difficulty distinguishing research from QI imposes costs on the quality improvement process.

The States as Laboratories: Regulation of Decisions for Incapacitated Patients.

In the United States, patients who lose the ability to make their own medical decisions are subject to the laws of their respective states. Laws governing advance directives and physician orders for life-sustaining therapies (POLST), and establishing a surrogate in the absence of an advance directive, vary substantially by jurisdiction. This article traces those laws from their origins, describes current practices and challenges with their application to patient care, and considers future avenues for ethics research and legislative reform.

Patients' Perspectives on Approaches to Facilitate Completion of Advance Directives.

Background: Little is understood about the different ways patients complete advance directives (ADs), which is most commonly through lawyers and increasingly using websites.

Objective: To understand patients' perspectives on different approaches to facilitating AD completion, the value of legal regulation of ADs, and the use of a web-based platform to create an AD.

Design: Semi-structured interviews with patients.

The Use of Individual Provider Performance Reports by US Hospitals.

Medicare reimbursement for hospitals is increasingly tied to performance. The use of individual provider performance reports offers the potential to improve clinical outcomes through social comparison, and isolated cases of clinical dashboard uses at specific institutions have been previously reported. However, little is known about overall trends in how hospitals use the electronic health record to track and provide feedback on provider performance.

Legal restrictions and complications of abortion: insights from data on complication rates in the United States.

Although US federal law requires all American states to permit abortion within their borders, states retain authority to impose restrictions.We used hospital discharge data to study the rates of major abortion complications in 23 states from 2001 to 2008 and their relationship to two laws: (i) restrictions on Medicaid – the state insurance programs for the poor – funding, and (ii) mandatory delays before abortion. Of 131 000 000 discharges in the data set, 10 980 involved an abortion complication.

Multislice CT colonography: current status and limitations.

CT colonography (CTC) is a promising method for colorectal screening providing a full structural evaluation of the entire colon and gaining in popularity due to a superior safety profile, a low rate of complications, and high patient acceptance. Multislice CT (MSCT) has further improved the diagnostic potential of CTC by generating high-resolution CT images of the abdomen and pelvis in shorter acquisition times than was previously possible. Over the past year, multiple studies have been published on every aspect of CTC including techniques, image display, image reconstruction, and clinical trial results assessing the feasibility of CTC as a screening tool.