There are some questions in healthcare that can’t be answered with a randomized controlled trial. We can’t randomize babies to inhale secondary tobacco smoke or not to test its health effects. We can’t randomize people to different number of hours sitting the ER before receiving antibiotics after the decision is made...
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I have written about both issues before: freestanding ERs and retail clinics. Two recent studies continue to show how useless they both are in helping create a better more efficient healthcare system. The freestanding ER study  examined the number of these facilities and population characteristics where they locate. They identified 360 freestanding...
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Two recent studies raise doubts about Medicare programs aimed to improve hospital outcomes. One study evaluated voluntary participation in Medicare’s Hospital Readmission Reduction Program, which included 3 “value-based” reforms: meaningful EMR use, bundled care initiatives, and pioneer and shared saving accountable care organization programs. It reported lots of outcomes, and its...
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Hospitalists, doctors who only see patients in the hospital, almost always in a shift work model, are the fastest growing “specialty” in medicine, from nothing about 15 years ago to about 50,000 today. There were some studies that I won’t review much here that showed some benefits from hospitalists compared to...
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