Medical care
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Health care utilization among decedents is increasingly used as a measure of health care efficiency, but decedent-based measures may be biased estimates of care received by "dying" patients. ⋯ Hospitals' end-of-life intensity varies in the use of specific life-sustaining treatments that are somewhat emblematic of aggressive end-of-life care. End-of-life intensity is a relatively stable hospital attribute that is robust to multiple measurement approaches.
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Meta Analysis
Modeling the value for money of changing clinical practice change: a stochastic application in diabetes care.
Decision making about resource allocation for guideline implementation to change clinical practice is inevitably undertaken in a context of uncertainty surrounding the cost-effectiveness of both clinical guidelines and implementation strategies. Adopting a total net benefit approach, a model was recently developed to overcome problems with the use of combined ratio statistics when analyzing decision uncertainty. ⋯ The stochastic application in diabetes care demonstrates that the model provides a simple and useful tool for quantifying and exploring the (combined) uncertainty associated with decision making about adopting guidelines and implementation strategies and, therefore, for informing decisions about efficient resource allocation to change clinical practice.
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Comparative Study
Healthcare utilization in community-acquired pneumonia episodes of care: a comparison across the continuum of managed care.
Compare healthcare utilization and total payments for community-acquired pneumonia (CAP) episodes-of-care among 5 health plan designs spanning the continuum of managed care. ⋯ As previously shown among other patient populations and conditions, PPO episodes of CAP are associated with greater total payments due in large part to increased resource utilization among the episodes of lowest severity.
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Despite the availability of effective treatments for posttraumatic stress reactions after serious physical injuries, many sufferers do not use mental health services. Attempts to understand the factors that facilitate mental health service use have often focused on patient-related factors without assessing provider behavior. ⋯ Findings highlight the importance of physician referral in facilitating access to mental health services for trauma injury survivors.
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Pay-for-performance programs typically rate hospitals using a composite summary score in which process measures are weighted by the total number of treatment opportunities. Alternative methods that weight process measures according to how hospitals organize care and the range for possible improvement may be more closely related to patient outcomes. ⋯ In-hospital cardiac care is organized by clinical and administrative processes of care. Pay-for-performance schemes that incentivize hospitals to focus on administrative process measures may be associated with decreased adherence to clinical processes. A pay-for-performance scheme that acknowledges these factors may be associated with improved inpatient mortality.