Medical care
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To describe patterns in physician and hospital utilization among rural and urban populations in China and to determine factors associated with any differences. ⋯ Three national approaches should be considered in reforming the healthcare system in China: universal insurance coverage, higher amounts of insurance coverage, and increasing the population's level of education. In addition, access issues in remote areas and by rural minority Chinese population should be addressed.
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Comparative Study
Comorbidity and outcomes of coronary artery bypass graft surgery at cardiac specialty hospitals versus general hospitals.
Cardiac specialty hospitals assert better patient outcomes and efficiency, whereas general hospitals contend they attract healthier patients. ⋯ Favorable patient selection may occur at cardiac specialty hospitals. Although healthier patients fare comparably across types of hospitals, patients with greater comorbid disease seem to experience worse 30-day postdischarge mortality at specialty hospitals.
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The risk of bankruptcy before and after brain or spinal cord injury: a glimpse of the iceberg's tip.
Injury and illness are often cited as causes of bankruptcy. However, the incidence of bankruptcy after an acute medical event is unknown. ⋯ The risk of bankruptcy postinjury is not negligible. There is an increase in bankruptcy postinjury, most evident in Medicaid patients. Better rehabilitation, workforce reintegration, and disability programs might reduce bankruptcy postinjury.
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Clinically plausible risk-adjustment methods are needed to implement pay-for-performance protocols. Because billing data lacks clinical precision, may be gamed, and chart abstraction is costly, we sought to develop predictive models for mortality that maximally used automated laboratory data and intentionally minimized the use of administrative data (Laboratory Models). We also evaluated the additional value of vital signs and altered mental status (Full Models). ⋯ Mortality can be well predicted using models that maximize reliance on objective pathophysiologic variables whereas minimizing input from billing data. Such models should be less susceptible to the vagaries of billing information and inexpensive to implement.