More than 2 million cases of skin cancer are diagnosed annually in the United States, and melanoma incidence is increasing.

Diagnostic imaging is indicated for patients with low back pain only if they have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition. In other patients, evidence indicates that routine imaging is not associated with clinically meaningful benefits but can lead to harms. Addressing inefficiencies in diagnostic testing could minimize potential harms to patients and have a large effect on use of resources by reducing both direct and downstream costs. In this area, more testing does not equate to better care. Implementing a selective approach to low back imaging, as suggested by the American College of Physicians and American Pain Society guideline on low back pain, would provide better care to patients, improve outcomes, and reduce costs.

Health care costs in the United States are increasing unsustainably, and further efforts to control costs are inevitable and essential. Efforts to control expenditures should focus on the value, in addition to the costs, of health care interventions. Whether an intervention provides high value depends on assessing whether its health benefits justify its costs. High-cost interventions may provide good value because they are highly beneficial; conversely, low-cost interventions may have little or no value if they provide little benefit. Thus, the challenge becomes determining how to slow the rate of increase in costs while preserving high-value, high-quality care. A first step is to decrease or eliminate care that provides no benefit and may even be harmful. A second step is to provide medical interventions that provide good value: medical benefits that are commensurate with their costs. This article discusses 3 key concepts for understanding how to assess the value of health care interventions. First, assessing the benefits, harms, and costs of an intervention is essential to understand whether it provides good value. Second, assessing the cost of an intervention should include not only the cost of the intervention itself but also any downstream costs that occur because the intervention was performed. Third, the incremental cost-effectiveness ratio estimates the additional cost required to obtain additional health benefits and provides a key measure of the value of a health care intervention.

Evidence shows that high Medicare spending is not associated with better health outcomes at a regional level and that high spending in hospitals is not associated with better process quality. The relationship between hospital spending and inpatient mortality is less well understood.

Black patients are commonly believed to have higher stroke mortality. However, several recent studies have reported better survival in black patients with stroke.

Blood culture contamination leads to inappropriate or unnecessary antibiotic use. However, practical guidelines are inconsistent about the routine use of sterile gloving in collection of blood for culture.

Advance directive law may compromise the clinical effectiveness of advance directives.

The reliability and interpretability of results from clinical trials can be substantially reduced by missing data. Frequently used approaches to address these concerns, such as upward adjustments in sample sizes or simplistic methods for handling missing data, including last-observation-carried-forward, complete-case, or worst-case analyses, are usually inadequate. Although rational imputation methods may be useful to treat missingness after it has occurred, these methods depend on untestable assumptions. Thus, the preferred and often only satisfactory approach to addressing missing data is to prevent it. Procedures should be in place to maximize the likelihood that outcome data will be obtained at scheduled times of evaluation for all surviving patients who have not withdrawn consent. To meaningfully reduce missing data, it is important to recognize and address many factors that commonly lead to higher levels of missingness.

Congestive heart failure (CHF) is common and costly, and outcomes remain suboptimal despite pharmacologic and technical advances.

Storytelling is emerging as a powerful tool for health promotion in vulnerable populations. However, these interventions remain largely untested in rigorous studies.

Acute ischemic strokes are associated with poor outcomes and high health care burden. Evidence exists evaluating the use of neurothrombectomy devices in patients receiving currently recommended treatments that may have limited efficacy.

Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for osteoporosis.