Medical care
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: Substantial ethnic differences have been reported in the probability that death will occur in a hospital setting rather than at home, in a hospice, or in a nursing home. To date, no study has investigated the role of both individual characteristics and contextual characteristics, including local health care environments, to explain ethnic differentials in end-of-life care. ⋯ : There are sizeable ethnic differentials in the probability that a death will occur in a hospital in California. These differences are substantially mediated by sociodemographic characteristics of the decedent and local medical care supply. One implication of these findings is that variation exists in the efficiency and quality of end of life care delivered to ethnic minorities.
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The provision of preventive services and continuity of care are important aspects of long-term care (LTC). A proposed quality indicator of such care is the rate of hospitalizations due to ambulatory care sensitive conditions (ACSCs). As the ACSC approach to identifying potentially avoidable hospitalizations (PAH) was developed for younger community-dwelling adults in the United States, we sought to examine its applicability as a quality indicator for older institutionalized residents in Canada. ⋯ Changes to the original list of ACSCs led to more hospitalizations being categorized as potentially avoidable. Significant variation between LTC facilities and over time in our PAH indicator may identify areas for improvement in preventive services and continuity of care for LTC residents.
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Patient-provider communication is essential for high-quality asthma care. The objective of this study was to assess the potential relationship of language barriers with outcomes of inner-city asthmatics. ⋯ Inner-city asthmatics with limited English proficiency have significantly poorer asthma control, higher rates of resource utilization, and a lower quality of life. Further research is necessary to understand the mechanisms underlying this association.
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Individual quality measures have significant limitations for assessing surgical performance. Despite growing interest in composite measures, empirically-based methods for combining multiple domains of surgical quality are not well established. ⋯ Compared with individual surgical quality indicators, empirically derived composite measures are superior in explaining variation in hospital mortality rates and in forecasting future performance. Such measures could be useful for public reporting, value-based purchasing, or benchmarking for quality improvement purposes.
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Editorial Comment
Who you are and where you live: race and the geography of healthcare.