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This national cohort survey of older adults assesses which health-related concerns they consider to be most salient in the 2024 election. [ABSTRACT FROM AUTHOR]

The article focuses on advancing equity within a medical publishing network, specifically discussing self-reported demographics of editors and editorial board members. Topics discussed include efforts to ensure diverse representation, the standardized schema for demographic reporting, and initiatives for improving equity and inclusion in medical publishing.

Importance: Medicare Advantage health plans covered 37% of beneficiaries in 2018, and coverage increased to 48% in 2022. Whether Medicare Advantage plans provide similar care for patients presenting with specific clinical conditions is unknown.Objective: To compare 30-day mortality and treatment for Medicare Advantage and traditional Medicare patients presenting with acute myocardial infarction (MI) from 2009 to 2018.Design, Setting, and Participants: Retrospective cohort study that included 557 309 participants with ST-segment elevation [acute] MI (STEMI) and 1 670 193 with non-ST-segment elevation [acute] MI (NSTEMI) presenting to US hospitals from 2009-2018 (date of final follow up, December 31, 2019).Exposures: Enrollment in Medicare Advantage vs traditional Medicare.Main Outcomes and Measures: The primary outcome was adjusted 30-day mortality. Secondary outcomes included age- and sex-adjusted rates of procedure use (catheterization, revascularization), postdischarge medication prescriptions and adherence, and measures of health system performance (intensive care unit [ICU] admission and 30-day readmissions).Results: The study included a total of 2 227 502 participants, and the mean age in 2018 ranged from 76.9 years (Medicare Advantage STEMI) to 79.3 years (traditional Medicare NSTEMI), with similar proportions of female patients in Medicare Advantage and traditional Medicare (41.4% vs 41.9% for STEMI in 2018). Enrollment in Medicare Advantage vs traditional Medicare was associated with significantly lower adjusted 30-day mortality rates in 2009 (19.1% vs 20.6% for STEMI; difference, -1.5 percentage points [95% CI, -2.2 to -0.7] and 12.0% vs 12.5% for NSTEMI; difference, -0.5 percentage points [95% CI, -0.9% to -0.1%]). By 2018, mortality had declined in all groups, and there were no longer statically significant differences between Medicare Advantage (17.7%) and traditional Medicare (17.8%) for STEMI (difference, 0.0 percentage points [95% CI, -0.7 to 0.6]) or between Medicare Advantage (10.9%) and traditional Medicare (11.1%) for NSTEMI (difference, -0.2 percentage points [95% CI, -0.4 to 0.1]). By 2018, there was no statistically significant difference in standardized 90-day revascularization rates between Medicare Advantage and traditional Medicare. Rates of guideline-recommended medication prescriptions were significantly higher in Medicare Advantage (91.7%) vs traditional Medicare patients (89.0%) who received a statin prescription (difference, 2.7 percentage points [95% CI, 1.2 to 4.2] for 2018 STEMI). Medicare Advantage patients were significantly less likely to be admitted to an ICU than traditional Medicare patients (for 2018 STEMI, 50.3% vs 51.2%; difference, -0.9 percentage points [95% CI, -1.8 to 0.0]) and significantly more likely to be discharged to home rather than to a postacute facility (for 2018 STEMI, 71.5% vs 70.2%; difference, 1.3 percentage points [95% CI, 0.5 to 2.1]). Adjusted 30-day readmission rates were consistently lower in Medicare Advantage than in traditional Medicare (for 2009 STEMI, 13.8% vs 15.2%; difference, -1.3 percentage points [95% CI, -2.0 to -0.6]; and for 2018 STEMI, 11.2% vs 11.9%; difference, 0.6 percentage points [95% CI, -1.5 to 0.0]).Conclusions and Relevance: Among Medicare beneficiaries with acute MI, enrollment in Medicare Advantage, compared with traditional Medicare, was significantly associated with modestly lower rates of 30-day mortality in 2009, and the difference was no longer statistically significant by 2018. These findings, considered with other outcomes, may provide insight into differences in treatment and outcomes by Medicare insurance type. [ABSTRACT FROM AUTHOR]

An editorial is presented the importance of health as a central policy issue in the 2024 US election and the need for rigorous research to inform health care and public health policies. Topics include various health-related challenges, such as health disparities, immigration policies, LGBTQ rights, firearm regulations, and the impact of the economy on mental health and access to essential needs.

This study evaluates whether patients enrolled in trials of aducanumab, EMERGE and ENGAGE, were representative of patients with dementia enrolled in Medicare by estimating the proportions of Medicare beneficiaries with Alzheimer disease (AD) or mild cognitive impairment (MCI) who would have been excluded from these trials. [ABSTRACT FROM AUTHOR]

This section discusses the commitment made by the editors and staff of the "Journal of the American Medical Association" (JAMA) and the JAMA Network Journals to the improvement of diversity, inclusion, and equity in medical journal publishing. Topics explored include the promotion of public health and truth in science and medicine by JAMA, the controversy involving the 2021 podcast about structural racism in medicine published by the JAMA Network, and the revised editorial priorities of JAMA.

On average, across the 29 comorbidities we assessed, the difference in prevalence between traditional Medicare and Medicare Advantage enrollees was 0.6 percentage points, and this remained stable across the study period despite intensified coding efforts in Medicare Advantage over this period. Comment & Response B In Reply b As noted by Dr Roehm, Medicare Advantage health plans principally are paid via capitation payments that are adjusted for the health status of the enrolled population. A large body of research suggests that this payment system has created strong incentives for Medicare Advantage health plans to improve their coding of diagnoses in order to increase their payments. [Extracted from the article]

The author discusses outlook for the U.S. health care policy under the administration of U.S. President Joe Biden. Topics explored include the expansion of health insurance coverage under the Affordable Care Act (ACA), the affordability and accessibility of health insurance to the American public, and the impact of the coronavirus disease 2019 (COVID-19) pandemic on medical services and health care spending.

Importance: Patients with advanced-stage cancer are receiving increasingly aggressive medical care near death, despite growing concerns that this reflects poor-quality care.Objective: To assess the association of aggressive end-of-life care with bereaved family members' perceptions of the quality of end-of-life care and patients' goal attainment.Design, Setting, and Participants: Interviews with 1146 family members of Medicare patients with advanced-stage lung or colorectal cancer in the Cancer Care Outcomes Research and Surveillance study (a multiregional, prospective, observational study) who died by the end of 2011 (median, 144.5 days after death; interquartile range, 85.0-551.0 days).Exposures: Claims-based quality measures of aggressive end-of-life care (ie, intensive care unit [ICU] admission or repeated hospitalizations or emergency department visits during the last month of life; chemotherapy ≤2 weeks of death; no hospice or ≤3 days of hospice services; and deaths occurring in the hospital).Main Outcomes and Measures: Family member-reported quality rating of "excellent" for end-of-life care. Secondary outcomes included patients' goal attainment (ie, end-of-life care congruent with patients' wishes and location of death occurred in preferred place).Results: Of 1146 patients with cancer (median age, 76.0 years [interquartile range, 65.0-87.0 years]; 55.8% male), bereaved family members reported excellent end-of-life care for 51.3%. Family members reported excellent end-of-life care more often for patients who received hospice care for longer than 3 days (58.8% [352/599]) than those who did not receive hospice care or received 3 or fewer days (43.1% [236/547]) (adjusted difference, 16.5 percentage points [95% CI, 10.7 to 22.4 percentage points]). In contrast, family members of patients admitted to an ICU within 30 days of death reported excellent end-of-life care less often (45.0% [68/151]) than those who were not admitted to an ICU within 30 days of death (52.3% [520/995]) (adjusted difference, -9.4 percentage points [95% CI, -18.2 to -0.6 percentage points]). Similarly, family members of patients who died in the hospital reported excellent end-of-life care less often (42.2% [194/460]) than those who did not die in the hospital (57.4% [394/686]) (adjusted difference, -17.0 percentage points [95% CI, -22.9 to -11.1 percentage points]). Family members of patients who did not receive hospice care or received 3 or fewer days were less likely to report that patients died in their preferred location (40.0% [152/380]) than those who received hospice care for longer than 3 days (72.8% [287/394]) (adjusted difference, -34.4 percentage points [95% CI, -41.7 to -27.0 percentage points]).Conclusions and Relevance: Among family members of older patients with fee-for service Medicare who died of lung or colorectal cancer, earlier hospice enrollment, avoidance of ICU admissions within 30 days of death, and death occurring outside the hospital were associated with perceptions of better end-of-life care. These findings are supportive of advance care planning consistent with the preferences of patients. [ABSTRACT FROM AUTHOR]

The article previews the open-access periodical "JAMA Health Forum," to be launched by the American Medical Association (AMA) in 2021.

The article focuses on an observational study which evaluated adjuvant chemotherapy use and outcomes for older people with stage III colon cancer from well-defined population-based settings and health care systems. The study was conducted in five geographically defined regions in the U.S., including Alabama, Iowa and North Carolina, in five integrated health care deliver systems and 15 Veterans Affairs Hospitals, using 675 patients. The researchers found that older patients received less-toxic and shorter chemotherapy regimens among patients with stage III colon cancer who underwent surgical resection and received adjuvant therapy.

This article presents the results of a study examining what health effects, if any, are given to uninsured near-elderly patients who acquire Medicare coverage for the first time. This study assessed the effect of getting Medicare coverage on the health of the previously uninsured and showed that after the age of 65, the previously uninsured group became healthier. The Medicare coverage was associated with improved health, especially in those with cardiovascular disease or diabetes, and the authors say their findings offer proof that insuring the near-elderly will benefit the U.S. by saving money and improving health.

In this Viewpoint, JAMA Health Forum's editor reviews important policy issues that characterized the first 6 months of the COVID-19 pandemic, including personal protective equipment (PPE) shortages, health inequities among vulnerable populations, requests from patients for medical exemptions from face mask requirements, and the benefits and risks of school reopenings. [ABSTRACT FROM AUTHOR]

The article presents a medical study examining the connection between the quality of medical care and racial differences in Medicare health plans. The study evaluated the quality of care and racial disparities using multilevel multivariable regression models and 4 Health Plan Employer and Data Information Set (HEDIS). The study found that the racial disparities in Medicare health plans varied widely and were only weakly associated with the quality of care. According to the article, plan-specific performance reports of racial inequalities on outcome measures would provide information not covered by HEDIS reports.

Context: Uninsured adults receive less appropriate care and have more adverse health consequences than insured adults. Longitudinal studies would help to more clearly define the effects of health insurance on health care and health. Objective: To assess the differential effects of gaining Medicare coverage on use of basic clinical services and medications by previously insured and uninsured adults. Design and Setting: Household survey data from the nationally representative Health and Retirement Study were used to analyze differences in receipt of basic clinical services by adults in 1996 and 2000, before and after becoming eligible for Medicare at age 65 years. Participants: A total of 2203 adults aged 60 to 64 years in 1996 who were classified as continuously uninsured (n = 167), intermittently uninsured (n = 216), or continuously insured (n = 1820) in 1994 and 1996, prior to Medicare eligibility. Main Outcome Measures: Individuals' reports of receiving cholesterol testing, mammography (in women), prostate examination (in men), and treatment of arthritis and hypertension in the prior 2 years. Results: The difference in cholesterol testing between continuously insured and continuously uninsured adults was significantly reduced after Medicare eligibility (35.4% vs 17.7%; change of -17.7% [95% CI, -29.3% to -6.2%]; P = .003), and the reduction was substantially greater among those with hypertension or diabetes than among other adults (29.2% vs 7.7%; difference of 21.5% [95% CI, 0.2% to 42.9%]; P = .048). Differences in use were similarly reduced after Medicare eligibility for mammography in women (30.3% vs 15.0%; change of -15.3% [95% CI, -29.9% to -0.7%]; P = .04) and prostate examination in men (45.2% vs 20.0%; change of -25.2% [95% CI, -45.4% to -5.1%]; P = .01). Continuously uninsured adults with arthritis reported significantly greater increases in arthritis-related medical visits and limitations of activity than continuously insured adults after Medicare eli... [ABSTRACT FROM AUTHOR]

Presents a study to determine the use of effective cardiovascular drugs among elderly persons with coronary heart disease by type of health insurance. Design; Setting; Results; Conclusion that elderly Medicare beneficiaries with heart disease who lack drug coverage have disproportionately large drug expenditures and low use rates of statins, a class of relatively expensive drugs that improve survival.

Offers letters to the editor in response to previous medical-related articles. Cost-effectiveness of colorectal cancer screening; Drug dependence as a chronic medical illness; Dextromethorphan and ecstasy pills; Other issues.

Compares nationally representative estimates of the unmet health needs of uninsured and insured adults, particularly among persons with major health risks in the United States. Method of random household telephone survey of adults aged 18 to 64; Results; Conclusion that long-term-uninsured adults reported more unmet health needs than insured adults.

Assesses the differences in physical and psychosocial functioning between men and women who have undergone coronary artery bypass surgery. Collection of four key measures of postoperative functioning; Patient surveys; Clinical and sociodemographical characteristics of bypass surgery patients.

Assesses whether rates of coronary revascularization procedures differ between blacks and whites after coronary angiography is performed and assesses the relationship of these rates to hospital characteristics. Frequency of demographic, clinical, and hospital characteristics which could influence procedure use; Sex-specific rates of revascularization for each race.

Context: Efforts to control medical expenses by emphasizing primary care and limiting specialty care may influence how physicians use informal or "curbside" consultation.Objective: To understand physicians' use of and beliefs about informal consultation.Design: Survey mailed in July 1997.Participants: Of a random sample of Massachusetts general internists, pediatricians, cardiologists, orthopedic surgeons (n=300 each), and infectious disease specialists (n=200) surveyed, 1225 were eligible and 705 (58%) responded.Main Outcome Measures: Self-reported use of and beliefs about informal consultation.Results: Generalist physicians requested more informal consultations than specialists (median, 3 vs 1 per week; P<.001) and were asked to provide fewer (2 vs 5 per week; P<.001). In multivariate analyses, physicians in a health maintenance organization, multispecialty group, or single-specialty group requested more informal consultations than those in solo practice (82%, 40%, and 28% more, respectively; all P<.001) and were more often asked to provide them (43%, 63%, and 14% more, respectively; all P<.05). Physicians with at least 30% of their income from capitation requested 38% more and were asked to provide 46% more informal consultations than those with little or no income from capitation (both P<.001). Generalists' overall approval of informal consultation was greater than specialists' (mean 5.9 vs 5.1 on a 7-point Likert scale; P<.001), and approval was strongly associated with beliefs about how informal consultation affects quality of care (P<.001).Conclusions: Use of informal consultation is common, varies by specialty, practice setting, and capitation, and therefore may increase with current trends toward group practice and managed care. Because overall approval of informal consultation is strongly associated with beliefs about how it affects quality of care, this issue should be carefully considered by physicians who participate in informal consultation. [ABSTRACT FROM AUTHOR]

The author comments on a study by Peikes and colleagues which evaluated programs funded by the U.S. Centers for Medicare and Medicaid Services. He describes the financial and clinical results of the study as sobering. He discusses two issues which need to be addressed in Medicare policy on coordination of chronic disease care. In particular, he describes the need for care coordinators to interact in person with patients and to collaborate closely with patients' physicians.

Assesses smokers' perceptions of their risks of heart disease and cancer. Preventable deaths from cigarette smoking; Relative risk of experiencing myocardial infarction; Optimistic bias of smokers.

The article discusses research concerning the changes in insurance coverage among hospitalized patients in Michigan following the state's expansion of its Medicaid program under the U.S. Affordable Care Act (ACA). Topics discussed include the results showing that the proportion of uninsured discharges has decreased, while the proportion with Medicaid has increased and the assertion that expanded insurance coverage under ACA can reduce the burden of uncompensated care for hospitals.

The authors explore practical and political considerations for Medicaid expansion based on the changing landscape of Medicaid. They examine the challenges of giving a role to the states over the implementation of the U.S. Patient Protection and Affordable Care Act of 2010 (ACA). They also analyze the policy implications of the decisions of several states on Medicaid expansion.

Editorial. Comments on the role of class and race in health care in the United States. Relationship between race and class to the quality and outcomes of medical care in the Medicare and Veterans Health Administration programs; Implications of differences in the process of care by race and class.