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This Week in JAMA
JAMA. 2002;287:1221.
Quality Improvement Project for Acute MI Therapy
The Guidelines Applied in Practice (GAP) project, a multifaceted quality improvement initiative, was developed to improve the use of key evidence-based therapies for patients with acute myocardial infarction (MI). The project consisted of customized clinical tools based on national guidelines to facilitate adherence to quality indicators, recruitment of local physician and nurse opinion leaders, and site visits. In this initial evaluation of the project at 10 participating hospitals, Mehta and colleagues (SEE ARTICLE) report that compared with baseline, adherence improved for most quality indicators after implementation of the project, and use of aspirin and  -blockers on admission and aspirin and smoking cessation counseling at discharge increased significantly. Compared with improvements in adherence to quality indicators in a control group of 11 hospitals, only the increase in use of aspirin at discharge was significantly greater in the GAP hospitals at the time of remeasurement. In an editorial, Rich (SEE ARTICLE) describes barriers to translating the results of clinical trials into clinical practice and identifies important elements of quality improvement interventions to overcome these barriers.
Evaluation of an Internet Health Care Rating System
Health care "report cards" that assess and compare the quality of care provided by hospitals, physicians, and managed care plans are publicly available, including on the Internet. Krumholz and colleagues (SEE ARTICLE) compared the hospital ratings for acute myocardial infarction mortality by an Internet health care quality rating company, which are based on Medicare administrative data, with process-based quality of care measures and risk-standardized 30-day mortality based on medical record review. In the aggregate, patients who received care in higher-ranked hospitals were, on average, more likely to receive aspirin and -blockers and had lower risk-standardized mortality rates than patients treated in lower-ranked hospitals. However, the rating system poorly discriminated between any 2 individual hospitals' process of care or mortality rates. In an editorial, Naylor (SEE ARTICLE) discusses priorities for improving public reporting of clinical performance.
Racial Disparities in Quality of Care
Racial disparities in the use of some health care services have been documented in previous studies. To assess whether racial disparities in the quality of care also exist, Schneider and colleagues used the Health Plan Employer Data and Information Set (HEDIS) to compare the rates of 4 measures of quality of care (breast cancer screening, eye examinations for patients with diabetes, -blocker use after myocardial infarction, and follow-up after hospitalization for mental illness) for white patients and black patients in Medicare managed care health plans. Clinical quality of care was significantly lower for black patients than for white patients on all 4 HEDIS measures.
(SEE ARTICLE)
Primary HHV-8 Infection in Immunocompetent Children
Symptomatic primary infection with human herpesvirus 8 (HHV-8), which causes Kaposi sarcoma and lymphoproliferative disorders, has been reported in several adults with severe immunosuppression, but the manifestations of primary HHV-8 infection in immunocompetent persons are not known. In this prospective cohort study of immunocompetent children aged 1 to 4 years evaluated in the pediatric emergency department of a hospital in Alexandria, Egypt, Andreoni and colleagues identified 6 children with primary infection with HHV-8, 5 of whom had a febrile craniocaudal maculopapular rash.
(SEE ARTICLE)
Corticosteroid Therapy for Pulmonary Sarcoidosis
In this meta-analysis of trials of oral or inhaled corticosteroids for the treatment of pulmonary sarcoidosis, Paramothayan and Jones report that in patients with stage 2 and 3 disease, chest radiograph findings were significantly improved after 6 to 24 months of oral corticosteroid treatment compared with control treatment.
(SEE ARTICLE)
A Piece of My Mind
"The computers are down? . . . How am I supposed to know how I'm doing?" From "A Wake-up Call."
(SEE ARTICLE)
Contempo Updates
Management of postoperative nausea and vomiting.
(SEE ARTICLE)
Medical News & Perspectives
Scientists have virtually completed sequencing the genome of Plasmodium falciparum, the parasite responsible for the deadliest form of human malaria, and researchers are already turning up clues in this gold mine of data for vaccine and drug development.
(SEE ARTICLE)
CLINICIAN'S CORNER
Hypertrophic Cardiomyopathy
A review of hypertrophic cardiomyopathy: epidemiology, genetics, clinical manifestations, and treatment strategies.
(SEE ARTICLE)
Call for Papers: Aging in the 21st Century
Original research reports, reviews, and commentaries on aging are invited for JAMA and Archives Journals theme issues scheduled for November 2002.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about sarcoidosis.
(SEE ARTICLE)
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