Viewpoints in JAMA


Bringing Diagnosis Into the Quality and Safety Equations


Mark L. Graber, M.D., of RTI International, St. James, N.Y., and colleagues suggest that cases of delayed, missed and incorrect diagnosis are common, with an incidence in the range of 10 percent to 20 percent, and that in a recent survey of more than 6,000 physicians, 96 percent felt that diagnostic errors were preventable. “How is it then that improving diagnosis goes largely unrepresented in the current quality framework?”

In this Viewpoint, the authors discuss the importance of integrating diagnosis into quality and safety measures. “The centuries-old debate over whether diagnosis or treatment is more important cannot ever be answered, but no one debates that the right treatment depends on the correct diagnosis. The time has come for the health care quality and safety communities to give these twin pillars of medical care equal consideration in matters of training, research, and policy.”

(JAMA. 2012;308[12]:1211-1212.


Overcoming the Pricing Power of Hospitals

Bob Kocher, M.D., of Venrock, Palo Alto, Calif., and Ezekiel J. Emanuel, M.D., Ph.D., of the University of Pennsylvania, Philadelphia, describe the effects of aggressive price increases by hospitals, and suggest steps to reduce hospital market power.

“The first step on the transformation pathway is to adopt policies that create the right incentives. The 3 proposed changes of incentivizing physicians, supporting pricing transparency, and reforming local markets (with the exception of prohibiting gag rules) can largely be done without new legislation.”

(JAMA. 2012;308[12]:1213-1214.


Beyond Joint Implant Registries - A Patient-Centered Research Consortium

for Comparative Effectiveness in Total Joint Replacement


Patricia D. Franklin, M.D., M.P.H., M.B.A., of the University of Massachusetts Medical School, Worcester, and colleagues point out that “despite the proven effectiveness of total joint replacement (TJR) surgery in relieving advanced knee and hip arthritis pain, TJR outcomes have come under intense public scrutiny in recent years. The 2010 recall of ASR metal-on-metal hip implants heightened awareness of the importance for implant safety surveillance for this high-cost and high-use procedure and exposed the need for a national systematic patient-centered outcomes monitoring system.”

To address this need, the Agency for Healthcare Research and Quality funded a 4-year $12 million research program, Function and Outcomes Research for Comparative Effectiveness in TJR (FORCE-TJR), which will generate comparative effectiveness research. In this Viewpoint, the authors discuss the objectives and potential usefulness of this program in guiding the decisions of clinicians and patients regarding total joint replacement.

(JAMA. 2012;308[12]:1217-1218.