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In This Issue of JAMA Internal Medicine |

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JAMA Intern Med. 2013;173(13):1161-1163. doi:10.1001/jamainternmed.2013.6298.
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Long-acting inhaled β-agonists and anticholinergics, first-line medications for chronic obstructive pulmonary disease (COPD), have both been associated with adverse cardiovascular events. When choosing between the two, patients and physicians would benefit from knowing which has the least cardiovascular risk. Gershon et al conducted a retrospective cohort study of older patients with COPD who were new users of one of these medications to compare their risks of cardiovascular hospitalizations and emergency department visits. They found that new use of long-acting β-agonists and long-acting anticholinergics were associated with similar increased risk of cardiovascular events. A commentary by Woodruff follows.

To investigate whether hospitals with high case survival rates are effective at preventing cardiac arrest, Chen and colleagues examined a large national registry using multivariable hierarchical regression. They found that hospitals with exceptional rates of survival for in-hospital cardiac arrest are also better at preventing cardiac arrests, even after adjusting for patient case-mix. This relationship was partially mediated by measured hospital attributes.

Patient participation in decision making has been hypothesized to decrease excess resource utilization but might increase resource use when health care providers have incentives to decrease use. On the basis of 21 754 admissions at the University of Chicago Medical Center between 2003 and 2011, Tak and colleagues investigated the effect of patient preference for participation in medical decisions on hospital length of stay and costs. While 96.3% of patients preferred to receive information about their conditions and treatment options, only 28.9% of patients preferred to participate in decisions about their care, and compared with patients with a strong desire to delegate decisions to their physician, patients who preferred to participate had a greater length of stay and higher total hospital costs. Patient preference to participate in medical decisions may increase resource use in contexts such as hospital care where health care providers have incentives to decrease use. In a commentary, Lipkin discusses shared decision making.




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