Medical care
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Concern about patient safety has promoted efforts to improve safety climate. A better understanding of how patient safety climate differs among distinct work areas and disciplines in hospitals would facilitate the design and implementation of interventions. ⋯ Differences among and within hospitals suggest that strategies for improving safety climate and patient safety should be tailored for work areas and disciplines.
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In seeking to identify modifiable, system-level factors affecting emergency department (ED) use, we used a statewide Medicaid database to study community variation in ED use and ascertain community characteristics associated with higher use. ⋯ Within this Medicaid population, ED utilization was determined not only by patient characteristics but by community characteristics. Better understanding of system-level factors affecting ED use can enable communities to improve their health care delivery systems-augmenting access to care and reducing reliance on EDs.
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Randomized Controlled Trial
Health coaching via an internet portal for primary care patients with chronic conditions: a randomized controlled trial.
Efforts to enhance patient-physician communication may improve management of underdiagnosed chronic conditions. Patient internet portals offer an efficient venue for coaching patients to discuss chronic conditions with their primary care physicians (PCP). ⋯ Internet portal-based coaching produced some possible benefits in care for chronic conditions but without significantly changing patient outcomes. Limited sample sizes may have contributed to insignificant findings. Further research should explore ways internet portals may improve patient outcomes in primary care. ClinicalTrials.gov registration NCT00130416.
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Black patients are more likely than white patients to prefer and receive more life-sustaining interventions in advanced stages of disease. However, little is known about potential racial differences in use of mechanical ventilation (MV), and the newer modality of noninvasive ventilation (NIV), in treatment of chronic obstructive pulmonary disease (COPD). ⋯ Black patients with COPD exacerbation in VA hospitals are more likely than white patients to receive MV, and this difference is not explained by available clinical or demographic variables. By contrast, black and white patients are equally likely to receive NIV. These findings suggest that unmeasured factors, such as patient preferences or disease severity, may be affecting the use of MV in this setting and therefore warrant further investigation.
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Vertebral compression fractures (VCFs) are the most common type of osteoporotic fracture. Administrative claims data might be useful to identify VCFs, but this approach to case finding has received limited evaluation. ⋯ A simple case finding approach to identify VCFs using administrative claims data can identify prevalent VCFs with high accuracy but misclassified more than half of incident VCFs. A more complex claims algorithm may be used but still will result in some misclassification of incident VCFs.