Medical care
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Rural health care workforce forecasting has not included adjustments for predictable changes in practice patterns, such as the introduction of practice guidelines. ⋯ The implementation of practice guidelines could result in an increased need for rural health care physicians or other providers. That increase, caused by guideline implementation, should be accounted for in future rural health care workforce predictions.
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To estimate the impact of insurance status on inpatient resource use after adjusting for health upon admission and site of care. ⋯ Inpatient resource use is affected by both the hospital in which care is received and the type of patient admitted. Failure to control for unmeasured differences across hospitals is likely to overstate the impact of insurance substantially.
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Randomized Controlled Trial Clinical Trial
Special issues in assessing care of Medicaid recipients.
The authors describe the process used to develop and test survey items targeted to Medicaid consumers for the Consumer Assessment of Health Plans Study (CAHPS). In addition, the authors highlight the special challenges in locating and surveying Medicaid recipients and provide recommendations for increasing response rates. ⋯ The testing and formatting efforts described in this article, in combination with a formal literacy review, led to the development of a Medicaid questionnaire that measures the important health care experiences of Medicaid consumers in a format that is "respondent-friendly." Our recommendations for surveying Medicaid recipients can benefit any survey of a Medicaid population.
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Even though psychiatric disorders are disproportionately present among the homeless, little is known about the extent to which homeless people receive treatment for those problems or the factors that are associated with receiving treatment. This article examines utilization and predictors of mental health and substance abuse treatment among a community-based probability sample of homeless adults. ⋯ More attention must be directed at how to better deliver appropriate mental health and substance abuse services to homeless adults.
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Concerns about quality of care are increasing as hospitals struggle to lower costs. Hospital report cards are controversial, but little is known about their impact. ⋯ Recent hospital report cards were rated better than pioneering federal efforts. A report based on clinical data was rated better, understood better, and disseminated more often to key staff than one that was based on administrative data. Barriers to constructive use of outcomes data persist, especially at high mortality hospitals.