••Winter 2008/Vol. 12, No. 1

The Dartmouth Atlas Applied to Kaiser Permanente: Analysis of Variation in Care at the End of Life
Matt Stiefel, MPA; Paul Feigenbaum, MD; Elliott S Fisher, MD, MPH

The Dartmouth Atlas method for examination of variation in care at the end of life was replicated by Kaiser Permanente (KP). Although KP inpatient care use rates were 25% to 30% lower and hospice use rates were higher than in the surrounding communities, there was still two- to four-fold variation in inpatient care use across KP geographic areas. Results reinforced emphasis on palliative care for patients with chronic conditions and earlier transitions to hospice.
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Puentes Clinic: An Integrated Model for the Primary Care of Vulnerable Populations
Lawrence Kwan, MD; Cheryl J Ho, MD; Charles Preston, PhD; Viet Le, MD, PhD

This integrated model to address the needs of a medically vulnerable population of homeless and injection-drug users emphasizes open access, outreach, groups, and a team approach to care. Emergency Department and urgent care visit rates decreased, simultaneous with increased primary care visits.
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Myocardial Infarction and Its Association with the Use of Nonselective NSAIDs: A Nested Case-Control and Time-to-Event Analysis
T Craig Cheetham, PharmD, MS; David J Graham, MD, MPH; David Campen, MD; Rita Hui, PharmD, MS; Michele Spence, PhD; Gerald Levy, MD; Stanford Shoor, MD

In a study of 8143 cases and 31,496 matched study control subjects, indomethacin and naproxen were associated with increased odds of adverse cardiovascular outcomes--myocardial infarctions and sudden cardiac death. These events occurred early in therapy.
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Home Hospice Acupuncture: A Preliminary Report of Treatment Delivery and Outcomes
Karen Kaufman, PhD, LAc; Ellen J Salkeld, PhD

The increasing incorporation of complementary and alternative medicine modalities into hospice care prompted a preliminary exploration of the process of offering acupuncture to ameliorate undesirable side effects from needed analgesic and sedative medications. Excellent or good results were noted in the charts of 34% of patients whose chief complaint was pain and in 31%
of patients with anxiety.
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