Medical care
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Randomized Controlled Trial Multicenter Study Comparative Study
Use of interactive voice response to improve colorectal cancer screening.
Only 63% of the US population aged 50-75 years is adherent with recommended colorectal cancer (CRC) screening guidelines. Efforts are needed to increase screening for CRC. ⋯ Our analysis provides "real-world" evidence that IVR is effective when delivered by a commercial health plan, and may be a useful tool for increasing adherence to screening guidelines among patients outside an integrated care practice.
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Because of small sample sizes and low event rates, risk-adjusted surgical outcomes often do not meet reliability benchmarks for distinguishing hospital performance. Nonetheless, it is unclear whether these measures may still be useful for predicting future hospital surgical performance. ⋯ Even at very low reliability levels, risk-adjusted outcome measures may distinguish best and worst hospitals' surgical performance. This study suggests that commonly accepted reliability thresholds may be too high, especially in the context of selective referral.
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Severe sepsis is a common and costly problem. Although consistently defined clinically by consensus conference since 1991, there have been several different implementations of the severe sepsis definition using ICD-9-CM codes for research. We conducted a single center, patient-level validation of 1 common implementation of the severe sepsis definition, the so-called "Angus" implementation. ⋯ The Angus implementation of the international consensus conference definition of severe sepsis offers a reasonable but imperfect approach to identifying patients with severe sepsis when compared with a gold standard of structured review of the medical chart by trained hospitalists.
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Emergency departments (EDs) nationwide are key entry points into the health care system, and their use may reflect changes in access and need in their communities. However, no studies to date have empirically and longitudinally studied how changes in a community's level of insurance coverage, a key determinant of access, affect ED utilization. ⋯ As the rate of insurance coverage increased within California counties, overall ED utilization declined only slightly. Thus, expanding insurance coverage may not lead to significant decreases in overall ED use.
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Estimates of the relative contributions of physicians, physician assistants (PAs), and nurse practitioners (NPs) toward rural primary care are needed to inform workforce planning activities aimed at reducing rural primary shortages. ⋯ Although our findings suggest that a greater reliance on PAs and NPs in rural primary settings would have a minor impact on outpatient practice volume, this shift might reduce the availability of services that have more often been traditionally provided by rural primary care physicians beyond the outpatient clinic setting.