Medical care
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When patients miss scheduled medical appointments, continuity and effectiveness of healthcare delivery is reduced, appropriate monitoring of health status lapses, and the cost of health services increases. We evaluated the relationship between missed appointments and glycemic control (glycosylated hemoglobin or HbA1c) in a large, managed care population of diabetic patients. ⋯ Patients who underuse care lack recorded information needed to determine level of risk. Frequently missed appointments were associated with poorer glycemic control and suboptimal diabetes self-management practice, are readily ascertained in clinical settings, and therefore could have clinical utility as a risk-stratifying criterion indicating the need for targeted case management.
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Amid a national nurse shortage, there is growing concern that high levels of nurse burnout could adversely affect patient outcomes. ⋯ Improvements in nurses' work environments in hospitals have the potential to simultaneously reduce nurses' high levels of job burnout and risk of turnover and increase patients' satisfaction with their care.
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Utilization of hospice services has been shown to vary by place of residence and patient characteristics. ⋯ The variation in hospice use by several patient characteristics is decreasing over time, a finding consistent with the manner in which new medical technologies diffuse.
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Comparative Study
Characteristics of occasional and frequent emergency department users: do insurance coverage and access to care matter?
The objective of this study was to explore how insurance coverage, access to care, and other individual characteristics are related to the large differences in emergency department (ED) use among the general population. ⋯ The uninsured do not use more ED visits than the insured population as is sometimes argued. Instead, the publicly insured are overrepresented among ED users. Frequent ED users do not appear to use the ED as a substitute for their primary care but, in fact, are a less healthy population who need and use more care overall.
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The objective of this study was to examine the effects of nurse staffing and process of nursing care indicators on assessments of the quality of nursing care. ⋯ Assessments of the quality of nursing are associated with both structural (workload) and process of care indicators (unfinished clinical care and patient safety problems), with the relationship strongest between process of care and quality. Explicating the interrelationship between structure and process of care is key to understanding the influence of both on quality. Studies that assess the causal influence of these features on quality of care and patient outcomes are warranted.