Medical care
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Randomized Controlled Trial Comparative Study
Comparability of interview- and self-administration of the Functional Assessment of Cancer Therapy-General (FACT-G) in English- and Spanish-speaking ambulatory cancer patients.
Flexibility is important in choosing methods and modes of questionnaire administration, to accommodate the needs of patients with diverse linguistic, cultural, educational, and functional skills. ⋯ Among both English- and Spanish-speaking ambulatory cancer patients, the FACT-G can be administered by either interview- or self-administration, without concern for significant mode effects on the data. Results may not be generalizable to patients with greater disease severity or those with low literacy.
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Comparative Study
Comparison of resource utilization for Medicaid dementia patients using nursing homes versus home and community based waivers for long-term care.
Medicaid waiver home and community-based long-term care services (HCBS) may provide a partial solution to the escalating costs of long-term care. Persons with dementia can have complex caregiving needs; it is unknown whether their expenditures and resource utilization differ between community-based versus institutional settings. ⋯ The escalation in inpatient use for HCBS waiver recipients suggests that future development of HCBS programs should consider the unique needs of persons with dementia so as to optimize their health outcomes. Despite increasing inpatient use among HCBS recipients, their overall expenditures remained significantly lower than those of nursing home patients.
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There is limited information on patients' knowledge about their cost-sharing requirements and how that influenced their care-seeking behavior. ⋯ Patients have limited knowledge of their office visit copayment amounts, and are changing their care-seeking behavior in response to perceived costs. Moreover, most patients are making these changes without discussing their cost concerns with their physician.
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In the United States, $50,000 per Quality-Adjusted Life-Year (QALY) is a decision rule that is often used to guide interpretation of cost-effectiveness analyses. However, many investigators have questioned the scientific basis of this rule, and it has not been updated. ⋯ It is very unlikely that $50,000 per QALY is consistent with societal preferences in the United States.