Medical care
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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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Cancer screening in individuals with limited life expectancy increases the risk of diagnosis and treatment of cancer that otherwise would not have become clinically apparent. ⋯ Substantial proportions of women with limited life expectancy receive screening mammography. Results presented sound a cautionary note that greater access to primary care and mammographic resources is also associated with higher overuse.
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Previous research has demonstrated that patients undergoing elective surgery on the weekend had an adjusted risk of 30-day mortality that was significantly higher than that of patients operated upon during the week. The generalizability of this association and effect size is unknown. ⋯ Similar to previous studies in distinct health care systems, patients in Ontario undergoing elective surgery on the weekend experienced an increased risk of 30-day postoperative mortality. Mechanisms underlying this effect require further study.
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Most catheter-associated urinary tract infections (CAUTIs) are considered preventable and thus a potential target for health care quality improvement and cost savings. ⋯ Beneficiaries with CAUTI had increased Medicare reimbursement and length of stay compared with those without CAUTI after adjusting for potential confounders.